Unit 9 Exam - Quality Management

After what act did the US Fed. Government initiate radiologic and imaging sciences quality management regulations?

Radiation Control and Safety Act of 1968

Continuous Quality Improvement (CQI)

Continually improves quality by focusing on improving the system or process in which individual workers function rather than on the individuals themselves

Who should be actively involved in continuous quality improvement (CQI)?

Every employee

Standards for Quality

A high standard of safe and effective imaging practices; specifies requirements for a quality management system and demonstrates the ability to consistently provide products/services that meet customer and regulatory associations

Who set forth the standards for quality?

FDA

Communication

Must occur between the entire imaging department and also inter-departmentally

Elements of a Quality Management Program

• Standards for Quality

• Communication

• Quality Manual

• Responsibility & Administration

• Test Equipment, Procedures & Training

• Record Keeping

• Evaluation

• Continuing Education

Quality Manual

Assures the integrity of QMS is maintained and focused on meeting the intended outcomes; describes the structure and interaction

When should the quality manual be reviewed?

Anually

Responsibility and Administration

Professionals who can participate in QM; staff technologist, physicists, supervisory technologists, QC technologists and staff service engineers

Test Equipment, Procedures and Training

QC monitoring, preventive maintenance and corrective maintenance; specific for each procedure and must be trained to perform test accurately

Record Keeping

Data must be recorded after each performance tests and kept on file

Test Review

Review the test was performed accurately; analyze the data obtained

How many levels of evaluation is there?

2

First Level of Evaluation

Results from the monitoring procedures - used to evaluate performance of equipment; analysis of trends and data to determine corrective action

Second Level of Evaluation

Evaluating the effectiveness of their program; study of retake rate and causes of repeats, examination of equipment repair and replacement costs, occurence and reasons for complaints by radiologists

Continuing Education

Keeps the entire department updated to equipment specifications; should include orientation and periodic updates

Quality Assurance Program

Organized effort by the staff operating a facility to ensure the diagnostic images produced are of a sufficiently high quality

Objectives of a QA Program

• Maintain optimal quality of images

• Reduce unnecessary exposure

• Be cost effective

Components of a QA Program

• Quality Control Tests

• Administrative procedures

• Preventative maintenance procedures

• Training

Quality Control Tests

Refers specifically to the calibration and monitoring of equipment along with discussion of the continuing value of repeat analysis

Variables that Frequency of QC Test Depend On

• Inherent variability of the process or equipment

• Age, reliability and frequency of use of the equipment

• Criticality of the element in the image chain

Administrative Procedure

Designed to verify that the QC testing is effective; test performed regularly and correctly, results evaluated promptly and accurately and necessary action taken

Preventive Maintenance Procedure

Performed on a regularly scheduled basis with the goal of preventing breakdowns due to eqipment failing without warning signs detectable by monitoring

Training

Must provide appropriate training for all personnel with QA responsibilites to ensure the level of competence is there to perform QC testing correctly and consistently

Quality Assurance Committee

• Medical physicists

• Radiologist

• Biomedical engineer

• Radiographer

• Information technology technician

Medical Physicist

Advise the facility on radiation protection of the patient, staff and members of the public; conduct tests to ensure the safety and proper performance of imaging equipment used

Who develops and implements a radiation protection program?

Medical physicist

Biomedical Engineer

Corrective and preventative maintenance & fault reporting

Image Quality Control

• Exposure indicator accuracy

• Image integrity

Exposure Indicator Accuracy

Exposure to the image receptor and helps in evaluating image quality and determining whether the image meets standards

Image Integrity

Verification that images are saved to PACS; performed at the end of every procedure

Who is the first at line of defense in preventing, recognizing and reporting QC issues?

Technologists

The quantitative acceptance for CR erasure is an EI values of _________ in the re-exposed image.

0-80

At a minimum, when should CR facilities erase all CR cassettes?

Weekly

Reject Analysis

Repeat exposures are identified (reason, # and tech responsible); allows for solutions to be found to minimize repeats

Causal Reject Analysis

% of repeats from a specific cause

Total Reject Analysis

All repeats no matter what the cause

Repeat rates for radiographic procedures should not exceed ____________?

4-6%

What is the main reason for repeat imaging?

Positioning

What ASRT Practice Standard relate to quality control?

9

Equipment Calibration

Checking of the equipment’s accuracy based on the manufacturer’s recommendations

Uniformity Corrections

Evening out the overall signal or brightness across the entire area of the imaging field

PAPP states use the ROI to check brightness at various points throughout the image should be within _______ of each other.

10%

Spatial resolution test tools are used to indicate ____________.

LP/mm

DoseWatch

Automatically collect and analyze patient radiation and iodine exposure across multi-facility, multi-modality and multi-vendor imaging environments

Benefits of Quality Management

• Patient safety

• Reduced radiation exposure

• Efficacy of patient care

• Departmental efficiency

• Consistent image quality

• Cost-effectiveness

Protective Filtration

Used to remove low-energy x-rays from the beam that cannot penetrate the body

What is the only true measure of actual x-ray beam penetration?

HVL

What material is used for HVL testing?

Aluminum

According to the FDA, the x-axis value should be _________ than the minimum required HVL.

Greater

If HVL falls below the minimum requirement it indicates:

• Calibration of kVp is off

• Insufficient filtration in the beam

When is a kVp accuracy test done?

Annually

For a kVp accuracy test, the acceptable range is _______ kVp of the set kVp.

+/- 5

Exposure Linearity Test

Alignment of a particular mA station relative to other stations in its output of radiation

When should an exposure linearity test be done?

Annually

Each time the mA is doubled the mR/mAs should double within _____ %?

+/- 10

If kVp or mAs are not in range after testing, what must be done?

Calibration

Exposure Reproducibility Test

Ability to repeat the same technique setting and obtain the same results in exposure

Exposures for an exposure reproducibility test should be within _________?

+/- 5%

When should exposure reproducibility test be done?

Annually

What is the acceptable range of a timer accuracy test?

+/- 5% (unless time is > 10 ms)

When is a timer accuracy test done?

Annually

What is the acceptable range of a beam alignment perpendicularity test?

Within 1 degree (5 mm) of vertical alignment

When should a beam alignment perpendicularity test be done?

Semi-annually

When should a collimator accuracy test be done?

Semi-annually

Collimator accuracy test must be within ____% of the SID.

2

How is the collimator accuracy test done?

9 penny test

AEC exposure must be repeatable within an accuracy range of __________.

+/- 10%

When should an AEC exposure test be done?

Annually

When should QC of protective apparel be done?

Annually

T/F: You can keep defective protective apparel.

False

When should exposure rate test for fluoro be done?

Semi-annually

Standard fluoro air kerma rate is _______________?

> 88 mGy/min

High level fluoro air kerma is __________________?

> 176 mGy/min

Who sets forth the air kerma levels for standard and high level fluoro?

FDA

Mobile Fluoro SSD

12 in (30 cm)

Stationary Fluoro SSD

15 in (32 cm)

ABC or AERC Test Acceptable Range

10 - 40µR/s

When should an exposure reproducibility test in fluoro be done?

Semi-annually

What is the exposure reproducibility guideline in fluoro?

+/- 5%

Beam Alignment Test

When should visual/audible monitor testing be done?

Quarterly

T/F: Some quality control begins with the last step instead of the first step.

True