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Licensed Unlicensed Requires Authentication Published by De Gruyter March 11, 2021

Benefits, limitations and controversies on patient-based real-time quality control (PBRTQC) and the evidence behind the practice

Huub H. van Rossum, Andreas Bietenbeck ORCID logo, Mark A. Cervinski, Alex Katayev, Tze Ping Loh and Tony C. Badrick



In recent years, there has been renewed interest in the “old” average of normals concept, now generally referred to as moving average quality control (MA QC) or patient-based real-time quality control (PBRTQC). However, there are some controversies regarding PBRTQC which this review aims to address while also indicating the current status of PBRTQC.


This review gives the background of certain newly described optimization and validation methods. It also indicates how QC plans incorporating PBRTQC can be designed for greater effectiveness and/or (cost) efficiency. Furthermore, it discusses controversies regarding the complexity of obtaining PBRTQC settings, the replacement of iQC, and software functionality requirements. Finally, it presents evidence of the added value and practicability of PBRTQC.


Recent developments in, and availability of, simulation methods to optimize and validate laboratory-specific PBRTQC procedures have enabled medical laboratories to implement PBRTQC in their daily practice. Furthermore, these methods have made it possible to demonstrate the practicability and added value of PBRTQC by means of two prospective “clinical” studies and other investigations. Although internal QC will remain an essential part of any QC plan, applying PBRTQC can now significantly improve its performance and (cost) efficiency.

Corresponding author: Huub H. van Rossum, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CXAmsterdam, The Netherlands; and Huvaros, The Netherlands, Phone: +31 20 5122756, Fax: +31 20 5122799, E-mail:


Not applicable

  1. Research funding: None to declare

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: H.H. van Rossum is owner and director of that markets MA Generator.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.


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Received: 2021-01-18
Accepted: 2021-02-26
Published Online: 2021-03-11
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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