The DOI matches its Crossref record.
Combined Shewhart-Cusum control chart for improved quality control in clinical chemistry
Abstract
We describe the adaptation of the decision limit cumulative sum method (cusum) to internal quality control in clinical chemistry. With the decision limit method, the cusum is interpreted against a numerical limit, rather than by use of a V-mask. The method can be readily implemented in computerized quality-control systems or manually on controls charts. We emphasize the manual application here and demonstrate how the technique can be implemented on existing Shewhart or Levey-Jennings control charts. This permits both cusum and Shewhart control rules to be used simultaneously on a single control chart and also minimizes the data calculations necessary for the cusum method. Computer simulation studies are used to determine the performance characteristics of several different cusum rules, alone and in combination with a Shewhart rule. These studies indicate that improvements in existing quality-control systems should be possible by addition of this simple cusum method and by use of a combined Shewhart-cusum control chart. This should be particularly advantageous when introducing the cusum method in laboratories with manual quality-control systems.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Error approaches, including frequentist statistics, are widely used for quality control in laboratory medicine.20,22,73,74”
From Uncertainty in Measurement and Total Error (2017) · cites this paper as [73]
Citations
Cited by
Sorted by citations
Items 101–138 of 138
Laboratory data quality control: A new cost-effective approach
Aydos, M., Nalbant, A., & Vural, Y. (2018) · Measurement and Control · doi:10.1177/0020294018775133 · Cited by 1
Cai, H., Mukherjee, A., Yang, W., et al. (2024) · Communication in Statistics- Theory and Methods · doi:10.1080/03610926.2024.2434941 · Cited by 1
“To improve the detection efficiency of these two control charts, Westgard et al. (1977) used a combined Shewhart-CUSUM control chart to improve the detection ability of systematic errors.”
A Framework for Comprehensive Electronic QA in Radiation Therapy
Kildea, J., Evans, M., & Parker, W. (2010) · International Conference on Machine Learning and Applications · doi:10.1109/icmla.2010.157 · Cited by 1
“We present here the rationale and the framework for development of our system.”
BackgroundQuality Control In Laboratories of Medical Biology (LBM): the Statistical Process Control (SPC)
Lhajjam, H., Elmrabet, H., Azzouzi, H., et al. (2018) · International Colloquium on Logistics and Supply Chain Management (LOGISTIQUA) · doi:10.1109/logistiqua.2018.8428261 · Cited by 1
“Capability Index Cp Process Capability Index Cp is the ratio of the tolerance range to the overall dispersion of the manufacturing process [15].”
BackgroundInfluentialMacdonald, R., & Mieke, S. (2010) · digital Encyclopedia of Applied Physics · doi:10.1002/3527600434.eap704 · Cited by 1
Quality Control in Laboratory Medicine
Strike, P. W. (2005) · Encyclopedia of Biostatistics · doi:10.1002/0470011815.b2a06016 · Cited by 1
Maternal serum α-fetoprotein screening: Further consideration of low-volume testing
STRICKLAND, D. M., Butzin, C. A., & Wians, F. H. (1991) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(91)90502-i · Cited by 1
A Quality Control System and Its Application to Clinical Chemistry
Schoen, I., Graham, G. A., & Custer, E. M. (1986) · Clinics in Laboratory Medicine · doi:10.1016/s0272-2712(18)30774-1 · Cited by 1
Quality Assurance and Control for Accurate Measurement of Food Toxins
Richards, A. (2017) · doi:10.1002/9781118992685.ch21 · Cited by 1
Detecting Rewards Deterioration in Episodic Reinforcement Learning
Greenberg, I., & Mannor, S. (2020) · arXiv · doi:10.48550/arxiv.2010.11660 · Cited by 5
Statistical Quality Control in Clinical Laboratories
Dechert, J. D. (2000) · Encyclopedia of Analytical Chemistry · doi:10.1002/9780470027318.a0543
Hoffman, J. I. E. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-802387-7.00031-7
Maternal serum α‐fetoprotein screening: Further consideration of low‐volume testing
Strickland, D., Butzin, C. A., & Wians, F. H. (1992) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(92)90511-g
Aplicação para monitorização do ANPTE em laboratórios clínicos
Coelho, J. M. M. (2011) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT)
Alternatives to Shewhart Charts
Ryan, T. P. (2011) · Wiley series in probability and statistics · doi:10.1002/9781118058114.ch8
Leçons de Base de Contrôle de Qualité
Cooper, W. (2007)
McGrath, D. A. (2009) · ThinkTech (Texas Tech University)
GLR Control Charts for Monitoring Correlated Binary Processes
Wang, N. (2013) · VTechWorks (Virginia Tech)
Computer-Assisted Quality Control: Considerations for Program Design
Tv, D. (1986) · Clinics in Laboratory Medicine · doi:10.1016/s0272-2712(18)30781-9
Automation in the Clinical Chemistry Laboratory. II. Classification and Examples
Garber, C. C., & Carey, R. N. (1982) · Elsevier eBooks · doi:10.1016/b978-0-12-469001-1.50012-x
Oğuzman, H., Buğdaycı, G., Cinpolat, Y., et al. (2016) · Abant Medical Journal · doi:10.5505/abantmedj.2016.32767
“Kontrol sonuçlarında 2 SD sınırları içerisinde yer alan değerler CVA hesaplamaları için kullanıldı (5).”
Yadav, S. K., Kalra, R., Jahan, A., et al. (2020) · Annals of Pathology and Laboratory Medicine · doi:10.21276/apalm.2715
Profile control chart based on maximum entropyPreprint
Mortezanejad, A. F., Borzadaran, G. R. M., & Gildeh, B. S. (2020) · arXiv (Cornell University)
Hawkins, D. M., & Olwell, D. H. (1998) · Springer eBooks · doi:10.1007/978-1-4612-1686-5_11
(1987) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365518709168162
Serial Measurements: Time Series, Control Charts, Cusums
Hoffman, J. I. E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-817084-7.00031-0
(1996) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.1996.34.12.983
(1981) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.3109/003655181090975999
Tewabe, H., Mitiku, A., & Yenesew, A. (2024) · Practical Laboratory Medicine · doi:10.1016/j.plabm.2024.e00377
“Internal quality control (IQC) involves incorporating control materials, which represent the test materials in terms of matrix composition, physical preparation, and analyte concentration range, into the analytical sequence [3,4,13 – 16].”
MethodAmeliorating the diagnostic power of combined shewhart-memory-type control chart strategies for mean
Rehman, A. U., Shabbir, J., Munir, T., et al. (2024) · Journal of Statistical Computation and Simulation · doi:10.1080/00949655.2024.2346136
“Although the scheme was first introduced by Westgard et al. [4], Lucas [3] showed numerically the superiority of the scheme, in terms of run length performance, to the classical CUSUM.”
Novel of statistical quality control development and econometric applications
Areepong, Y., & Sukparungsee, S. (2024) · Asian Journal of Economics and Banking · doi:10.1108/ajeb-12-2023-0139
May 16, 1924–2024: Celebrating the Centenary of Shewhart’s Quality Control Chart
Morais, M. C. (2025) · Springer eBooks · doi:10.1007/978-3-032-02975-1_1
Modified MEWMA Control Chart for Gumbel Bivariate Exponential-Distributed Data Monitoring
Liu, J. Y., Xie, F., & Zhai, G. (2026) · Chinese Control and Decision Conference (CCDC) · doi:10.1109/ccdc69976.2026.11560795
Antzoulakos, D. L., Fountoukidis, K. G., & Rakitzis, A. C. (2026) · Quality and Reliability Engineering International · doi:10.1002/qre.70397
Metadata
- Authors
- Westgard, J. O., Groth, T., Aronsson, T., & de Verdier, C. H.
- ORCID
- Westgard, J O
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 1977-10-01
- Volume
- 23
- Issue
- 10
- Pages
- 1881-1887
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- OpenAlex
- W2136487613
- Cited by
- 138
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 9 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 3 · 2015: 6 · 2014: 2 · 2013: 5 · 2012: 6
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Advanced Statistical Process Monitoring
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Physical Sciences › Engineering › Control and Systems Engineering › Fault Detection and Control Systems
- Keywords
- Shewhart control charts, CUSUM control chart, internal quality control, Levey-Jennings charts
- MeSH terms
- Chemistry, Clinical, Computers, Decision Making, Models, Theoretical, Probability, Quality Control
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
