Chapter 12: Ensuring Quality In PACS

The Joint Commission (TJC)

Which organization accredits most healthcare facilities, helping them obtain Medicaid certification, maintain required licenses, qualify for insurance reimbursements, and secure malpractice insurance coverage?

Quality Assurance (QA)

What is a plan for the systematic observation and assessment of the different aspects of a project, service, or facility to ensure that certain standards of quality are being met?

People and services

What are quality assurance activities focused around?

Quantitive data

What do most QA activities produce that can be analyzed?

monitor / working / standard

Quantitive data can be used to _____________ the processes and determine whether the process is ____________ as it should and whether the ______________ of qaulity has been met

Quality Control (QC)

What is a comprehensive set of activities designed to monitor and maintain systems that produce a product?

safely / appropriate / efficiently / high-quality image

In a radiology department, QC activities are performed to ensure that:

⦁ The procedure was performed _____________

⦁ The procedure was ______________ for the patient

⦁ The procedure was performed _______________

⦁ The procedure produced a ________-__________ _________ to

be read

To maintain the license for the room or department

Why are quality control activities required by the law?

Designated individual within the department

Who keeps data from the various QC activities performed within the department?

A QA program

What are most QC activities a part of?

Acceptance testing, routine maintenance, error maintenance

What are the three major categories of QC tests that are used at various times?

Acceptance Testing

Which QC test checks if equipment meets the vendor's performance specifications and is done before new installations or after major repairs are accepted by the department?

A designated technologist, a radiation physicist, or service personnel employed by the hospital

Who are the three individuals who can perform acceptance testing?

Routine Maintenance

Which QC test is performed to ensure that the equipment is working as expected and catches problems before they become radiographically apparent?

a designated technologist, a radiation physicist, or service personnel employed by the vendor

Who is responsible for the routine maintenance of equipment in the department?

Error Maintenance

Which QC test detects errors that occur in equipment performance that must be corrected?

By poor equipment performance or poor quality outcomes

How are errors in the equipment detected?

Service personnel employed by the vendor

Who does the error maintenance and correct errors in the equipment?

Technologist

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

Documentation

What is very important to any QC activity that must be kept up to date to make a valid performance measure, and is the most difficult part of the QC process, and the easiest part to not complete?

repair / update

Documentation is neccessary to prove need for ________ or _________ of the system

A society of motion pictures and television engineers or SMPTE test pattern

What tool does the American College of Radiology (ACR) suggest that QC tests be carried out with to ensure the continuity of measurements?

American Association of Physicists in Medicine (AAPM)

Who developed the test pattern task group 18 that is being widely accepted for use in QC activities?

SMPTE

Which QC test pattern is often used for the luminance patches?

AAPM TG18-QC

Which QC test pattern is used mostly for general QC and geometric distortion?

At least monthly

How often does the American College of Radiology (ACR) suggest that QC tasks with test patterns be performed?

Performed on acceptance and annually by a trained physicist

Since the AAPM has a more rigorous schedule, how often should testing be performed and by whom?

Daily, monthly, and quarterly

How often can QC testing be performed by a trained QC technologist or physicist?

Corrective action and continued monitoring should be done

If any QC testing fails or produces out-of-range readings, what actions should take place?

Department policy

What should the technologist follow when it comes to equipment maintenance procedures?

The radiation physicist

Who may be necessary to contact for follow-ups on findings after QC testing is performed?

The monitor

What is the weakest link in the digital imaging chain, because it is used so much?

2k,3k / 1k,2k / 4k

Highest quality medical grade ___ or ____ for digital projection images, ____ to ____ for cross-sectional, an up to _____ for mammography

Both physicists and technologists/users

According to the American Association of Physicists in Medicine (AAPM), what individuals should complete the outline testing for display monitors?

A trained technologist

According to the American Association of Physicists in Medicine (AAPM), what individual does the outline testing of display monitors on a daily and monthly basis?

A medical physicist

According to the American Association of Physicists in Medicine (AAPM), what individual does the outline testing of display monitors upon acceptance and annually?

- on / warm

- dust / viewing / airflow

- SMPTE / TG18-QC

Daily Monitor QC:

- Turn ____ the monitor and allow it ample time to _______ up

- Make sure that the monitor is _______ free on the __________ surface and near the ____________ areas

- Retrieve a QC monitor test pattern (________ or AAPM ________)

- image / appearance

- distortion

- reflection / noise / glare

- Resolution

Check for the following during the daily monitor QC:

- General _________ quality and ____________

- Geometric _____________

- Luminance, __________, ___________, ____________

- _____________

General image quality and appearance

What is being looked for during the daily monitor QC when the overall appearance of the test pattern is evaluated, along with verifying that the vertical and horizontal bars of the test pattern appear continuous?

Geometric Distortion

During the daily monitor QC, what is being looked for when you are ensuring that the border and lines of the test pattern are clear and straight and the test pattern appears to be centered in the active area of the display?

Photometer

What is a device used to measure the luminescence of an area on a monitor?

Resolution

During the daily monitor QC, what is being looked for when you evaluate the CX patterns at the center and corners of the test pattern and verify that all letters/numbers appear?

Angular Response

What may be assessed visually using the TG18-CT test pattern?

Performed based on the same list as the daily monitor QC

How is the monthly and quarterly monitor QC performed?

Maintenance, QC test, and display quality assurance

What are the three ARRT content specifications?

171

ACR standards specify that gray-scale monitors used for interpreting images should provide a minimum of ____cd luminance

Workstation Processing Speed

What refers to the time it takes for a workstation to complete a task, such as opening a study, loading each image, and performing image processing?

Image transfer speed

What should be monitored from the modality to PACS and from the archive to a workstation?

Followed weekly

After acceptance of the system, how often should the image transfer speed be followed to establish a pattern?

Followed monthly

If no changes are seen in the image transfer speed, how often does the procedure need to be followed?

Weekly until a pattern is established again

Anytime the software or equipment is updated, how often should the image transfer speed procedure be done?

Data Integrity

What measures whether all images completed at the modality make it to the PACS?

Compression Recall

What is used to reduce the size of the image files and increase the speed of the network transfer of the images?

- No compression

- Lossless compression (2:1 compression ratio)

- Lossy compression (variable compression ratio)

What are the different compression ratios?

The radiologist and radiation physicist

Who needs to establish compression protocols to determine the level of compression that will be acceptable for the institution?

Recognition of Nondiagnostic Images

What process is primarily carried out by a radiologist, in which a poor-quality image is sent to PACS, is noted along with the technologist's name, and the information is shared with the lead technologist or PACS administrator for follow-up?

System-up time

What procedure involves monitoring how often the system is down and keeping a log that records the reason for the downtime, its duration, how the issue was resolved, and who fixed the problem?

System training

What is an activity that must never stop and is the process of educating users on how to effectively operate and navigate a specific computer system or software, including understanding its functions, workflows, and procedures to ensure accurate and efficient use in daily operations?

For 1 to 2 weeks

During system training, how long are vendor applications personnel usually on site for during the initial installation?

Super users and the PACS administrator

Who needs to set up an ongoing training program?

radiologist / technologist / ancillary

The training program set up by the super users and PACS administrators needs to have several levels of skills training from the ___________ to the ________ to the ____________ personnel

new employee / software

Training should happen each time a ____ ______________ is hired and each time a new version of the _____________ is installed

PACS training

What should be added to the annual skill training requirements?

PACS administrator

Who is the person trained to oversee PACS?

Super User

Who are the people trained on all aspects of the system and are prepared to train others?