Ensuring Quality in PACS

Quality Aspect

Radiology has both a people-centered

& a product-centered quality.

Quality

Has always been a part of health care, whether as a

service or product.

improve patient care & provide a high-quality service

The ultimate focus in health care is to ... so that patients

will want to return.

Joint Commission on the Accreditation of Healthcare Organizations

Old name of The Joint Commissionn

The Joint Commission

"Voluntary but necessary to obtain Medicaid

Certification, hold certain licenses, obtain

reimbursements from insurance companies, &

receive malpractice insurance."

Continuous Quality Improvement or Total Quality Management

Rather than quality, TJC currently uses

terms ... or ...

Quality Assurance

A plan for the

systematic observation

& assessment of the

different aspects of a

project, service, or

facility to make certain

that standards of

quality are being met

quantitative data

Most QA activities will produce ... that can be

analyzed.

Quality control

Defined as a

comprehensive set

of activities

designed to monitor

& maintain systems

that produce a

product.

✓ performed safely

✓ appropriate for the patient

✓ performed efficiently

✓ produce a high-quality image

QC measures are instituted to ensure

that radiologic procedures are:

license

QC measures are required by law to

maintain the ... for the room or

department.

Acceptance Testing, Routine Maintenance, Error Maintenance

3 major categories of QC tests

Acceptance Testing

• Performed before newly

installed or majorly repaired

equipment can be accepted by

the department.

• Testing may be performed by a

designated technologist, a

radiation physicist, or by

service personnel employed by

the hospital.

• Used to determine whether the

equipment is performing within

the vendors specifications & as

promised.

Routine Maintenance

• Performed to ensure that

the equipment is performing

as expected.

• Can catch problems before

they become

radiographically apparent.

• Testing may be performed

by a designated

technologist, a radiation

physicist, or by service

personnel employed by the

vendor.

Error Testing

• When errors occur in

equipment performance,

corrective action must occur.

• Errors will be detected by poor

equipment performance or

poor quality outcomes.

• These corrections will

generally be made by service

personnel employed by the

vendor.

Continuous quality improvement

CQI

Continuous Quality Improvement (CQI)

Focus more on the process rather than on the

people or the service.

If the process is good, health care workers

will follow it, & service will be good.

Belief of CQI

QA/QC

The ... programs focus on

maintaining a certain level of quality,

not necessarily improving to

a higher quality.

CQI

focuses on improving

the process or system

within which the

people function as

team members rather

than focusing on an

individual's work

Quality Assurance

Systemic observation &

assessment of the different

aspects of a project, service

or facility to make certain

that standards of quality are

being met

Quality Control

Comprehensive set of

activities designed to

monitor & maintain systems

that produce

a product.

Documentation

very important in any QC activity & all paperwork must be

kept up to date to make a valid performance measure

Documentation

is the most

difficult part of

the process &

the easiest part

to not

complete.

1. Display quality for both monitor & film

2. Processing speed

3. Network transfer speed

4. Data integrity (Data from archive)

QC ACTIVITIES

to be monitored in a PACS environment

includes:

Society of Motion Pictures & Television Engineers (SMPTE)

ACR

Also suggests that all the quality tests be

carried out with a ... test pattern to ensure continuity of

measurements.

Monitor

Is often the weakest link in the digital imaging chain

Monitor

has a direct effect on the quality of the

image that is presented to the radiologist for

reading or to the referring physician for review.

Photometer

- device used to measure the luminescence of areas on the monitor

- Evaluate the results in

comparison to previous

measurements

Daily/Weekly quality control

Printer Image Quality:

- Wet laser Imager

- Dry laser Imager

Weekly/Monthly quality control

Speed:

- Workstation Processing Speed

- Image Transfer Speed

Wet Laser Imager, Dry Laser Imager

Printer Image Quality: (2)

Workstation Processing Speed, Image Transfer Speed

Speed: (2)

Data Integrity, Compression Recall

Data Quality Control: (2)

Data Integrity

Technologist should check on a

daily basis to make sure all

images sent to the PACS arrived

on the PACS

• Daily/Weekly/Monthly

Compression Recall

• Used to reduce the size of the image files to increase the speed of the network transfer of images.

Recognition of Nondiagnostic Images,

System Up-time,

System Training

PACS, Continuous Quality Improvement:

Recognition of Nondiagnostic Images

Documentation of nondiagnostic image being

forwarded to the PACS

Equipment Malfunction,

Operator error

Poor-quality Image Causes:

System up-time

• Monitor how often the system is down.

• A log should be kept to note any time the

system is down, the reason, how long, what had

to be done to fix the problem, & who fixed the

problem.

System Training

• An important activity that must never stop.

• The vendor applications training is supposed to train

several super users (people who are trained on all

aspects of the system & are prepared to train others)