Quality assurance for diagnostic imaging equipment

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Quality assurance for diagnostic imaging equipment
NCRP report no.99
RMSC UDONTHANI
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Introduction

• Purpose
• Definition
• Motivation
• Costs and benefits
• implementation
• Content of a QA program

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Implementation

• A successful QA depends on the understanding and
  support of all those involved in the operation of
  the facility

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Content of a QA program

• QA is a management tool that includes policies
  and procedures designed to optimize the
  performance of personnel and equipment
• Identify aspects of facility operation
• Establishing policies
• Encouraging compliance with policies
• Analyzing records of operation at regular
  intervals

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General concepts of quality assurance and quality
control
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Approaches to QA and QC
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Goal

• Accurate and timely diagnosis
• Minimization of radiation exposure
• Minimization of risk
• Minimization of discomfort
• Minimization of cost

community
patient
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Factors in QA and QC

• Human factors
• Members of facility staff
• Must be dedicated to the concept of QA
• Must communicate freely with each other
• Require a commitment to quality
• Continuing dialogue regarding the quality of
  images
• Equipment factors
• Equipment function properly

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General objectives
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Accuracy in diagnosis

• Procedures to assure that radiological
  examinations are appropriate for clinical problem
• Risks, costs or complexity
• Types and availability of equipment

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Minimizing radiation per examination

• Amount of radiation that is adequate but no more
  than enough to produce a diagnostic image
• In both underexposed and overexposed films, a
  subtle fracture or lesion can be missed

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Provisions for comfort of the patient

• Comfort and privacy
• Patient waiting time
• Departmental conditions
• Room temperature
• Comfort of equipment
• Politeness and consideration of personnel

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Communication

• Interpretation of the image to referring
  physician
• Patients film should be accurately identified
• Patients report form should be periodically
  audited
• Official report, either oral or written, must be
  provided speedily

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Cost

• Reduction of cost to patient and department
• Minimum of technical and clerical errors should
  result in a lower cost per examination

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Quality of images
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Definition of image quality

• There are no hard and fast criteria for defining
  proper image quality
• The image quality needed will vary with the type
  of information needed
• An image with less than optimal definition is
  acceptable if it will answer the clinical problem
• Quality is perceived differently by different
  observers

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Disadvantages of poor quality images

• Incorrect diagnosis
• Miss a fracture or a destructive lesion
• Improper or inadequate set of views
• Risk of repeating a hazardous procedure
• Nonradiological risks in angiographic procedure
  reinjection, recatheterization
• Unproductive patient radiation
• The radiation the patient has received has no
  benefit
• Patient inconvenience
• Increasing waiting time or make another visit
• Increased cost
• Patient, department and hospital

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Cost-benefit consideration
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Costs of a quality assurance program

• Personal costs
• Medical physicists or technologists
• Test equipment
• A small fraction of the total capital budget
• Must be available
• Decrease in patient flow from testing
• Testing may decrease the flow of patients, thus
  may involve a cost

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Savings

• A monetary savings can be realized
• Result of a decrease in repeat studies
• A large fraction of repeats
• Result of technologist decision

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Film and chemical savings

• The number of films used in quality control is
  usually smaller than the number used in repeat
  examinations

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Less downtime of equipment

• The amount of downtime due to component failure
  may be decreased by a quality control program
• Preventive maintenance program

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Saving of technologist time

• Repeat examinations cause unnecessary use of
  technologist time

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Improvement in patient flow

• An increase in the number of patients can result
  in an increased return on the capital investment

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Decreased cost of equipment service

• If the source of an image quality problem can be
  identified by facility personnel, the resultant
  service call will be less

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Education and quality assurance
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Facility personnel

• Technologist
• Positioning of the patient and exposure control
• Quality control technologist
• Adequate training in various aspects of quality
  control
• Practicing radiologist
• To maintain quality assurance
• Interaction with medical physicists and
  technologists
• Medical physicist
• Practical aspects of diagnostic radiology

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Quality assurance personnel performance and
keeping of records
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Introduction

• To assure the adequacy of personnel performance
• Influenced by many factors
• Records must be generated
• Periodic review of records
• To assure the proper functioning of equipment
• It will continue to function satisfactorily
• To detect malfunction before it degrade the
  diagnostic image or represent a hazard to patients

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Elements of a personnel quality assurance program

• Identification of personnel activities
• Establishment of policies setting forth the
  method of performing these activities
• Person responsible for specific activities
• The way tasks to be performed
• The way decisions to be made
• The way personnel to relate to patient
• Institution of a system of record keeping
• Evidence of personnel performance
• Establishment of a system for the regular
  periodic review and analysis of such records
• Corrective action if deficiencies are found

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Activities to be monitored

• Patient scheduling
• Patient reception
• Patient preparation
• Patient examination
• Film processing
• Image quality control
• Image interpretation
• Report preparation
• Report distribution
• File room operation

• Duties
• Participation

Flow chart
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Establishing policies to guide personnel
performance

• To provide specific guidance to facility
  personnel
• Policies adopted should be tailored to the
  individual facility
• Policies must be clear and concise

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Developing a record-keeping system to provide an
index of compliance

• Request form
• Room log
• Report of the interpretation of an imaging study
• Incident report
• Patients film jacket
• Other records
• Daily work schedule, arrival/departure log,
  questionnairs of patient or referring physician
  satisfaction

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Room log

• Daily activity of a given examining room
• Name of the patient
• Study performed
• Film exposed
• Reason for retake
• Reason for supplemental view
• Reason for room out of service
• Daily activity of a given dark room

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Analyzing the records

• Method of review and analysis
• Identifying areas of deficiency
• Instituting corrective action
• Establish a schedule and assign staff personnel,
  rotation, to perform review
• Report findings as part of a regular staff meeting

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Analyzing the records

• Periodic review
• imaging interpretation
• facility operation
• Imaging technique
• Report generation
• File room function

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Analyzing the records

• How long dose it take to complete a study
• What fraction of images are repeated
• What equipment problems effect on image quality
  or patient exposure
• How long dose it take to get a report of an
  imaging study dispatched to its destination
• How frequently do reportable incidents occur
• How long does it take the file room staff to
  retrieve the images of a current case

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Quality assurance committee (QAC)

• QAC
• Chief imaging physician
• Medical physicist
• Chief technologist
• Quality control technologist
• To raise the awareness of importance of quality
  assurance
• Meet at regular intervals to discuss problems

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Evaluation of the findings and institution of
corrective action

• Assessing the adequacy of performance
• Comparison with own previous performance
• Evidence of deterioration of performance should
  suggest prompt corrective action
• Each facility need to set its own standards of
  performance
• To assure that corrective action is taken
• The recommendation of previous deliberations be
  reviewed on the next meeting

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Establishment of a quality control program
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Introduction

• Quality control is an integral and most tangible
  aspect of quality assurance
• Acceptance testing
• Establishment of baseline performance
• Diagnosis of changes in equipment performance
• Verification of correction of causes of
  deterioration

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Who dose it

• All members
• Imaging physician
• Medical physicist supervise and consult
• Quality control technologist
• Must be trained
• Must have adequate time
• Carry out the day-to-day measurements
• Maintain quality control log

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Responsibility

• Physicians responsibility
• Quality control function
• Users responsibility
• Equipment is working
• properly
• Safely
• At optimum image quality

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Documentation, recording and correction

• Measurements clearly and readily
• Recording of data control chart
• Evaluation of chart data and measurements
• Setting standards for variation allowed upper
  and lower control limits
• Testing frequency cost and benefit
• Method of interpretation and corrective action
  reporting problems to service personnel
• Repair decisions initiating the repair

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Tools needed for a quality control program

• Size of the facility
• Expertise of individual
• Scope of the testing program

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Beginning a quality control program for equipment

• Determine the type of equipment needed before
  purchase
• Selecting equipment and preparing specifications
• Service costs over the expected life
• Meet the specifications after installation
• Users must be instructed in proper operation and
  trouble shooting techniques

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General methodology of quality control and
diagnostic testing

• Retake analysis
• Factors affecting retake rate
• Method of retake analysis
• The start-up effect
• Measured and actual retake rate
• Factors to record in retake analysis
• Radiograph artifacts

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General methodology of quality control and
diagnostic testing

• Recording equipment downtime and failure
• Log book for each room listing problems, length
  of time for service
• Exposure per image
• Comparison of exposure within the facility
• Test objects for evaluation of equipment
  performance
• Particularly when changing imaging techniques
• Patient-simulating phantoms or test objects

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Procedures, objectives, and policies-performance
optimization
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Management of personnel activities

• Importance of monitoring personnel performance
• Application of recommendations
• Policy statements

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Importance of monitoring personnel performance

• Greatest possible benefit, least possible cost
• Patient irradiation
• Discomfort
• Inconvenience
• expense

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Importance of monitoring personnel performance

• Unproductive patient irradiation
• Improper scheduling
• Preparation of the patient
• Inappropriate or inadequate examinations
• Errors in image exposure, identification or
  processing
• Delays in image interpretation
• Inability to retrieve images when required

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The end
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QUALITY ASSURANCE PROGRAMS FOR DIAGNOSTIC
RADIOLOGY FACILITIES

• (a) Applicability
• (b) Definitions
• (c) Elements

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A quality assurance program should contain

• (1) Responsibility
• (2) Purchase specifications
• (3) Monitoring and maintenance
• (4) Standards for image quality
• (5) Evaluation
• (6) Records
• (7) Manual
• (8) Training
• (9) Committee
• (10) Review