QAQC

“The Ten-Step Monitoring and Evaluation Process.”

• The Joint Commission (TJC) promotes “____________”

• This QA program uses a 10-step process to resolve identified patient care problems.

Quality assurance (QA) and quality control (QC)

Two areas of activity that are designed to ensure the best possible diagnosis at an acceptable patient radiation dose and with minimum cost.

People

Quality Assurance deals with ———-.

Quality Assurance

• A program of ____ monitors proper patient scheduling, reception, and preparation

• Also involves image interpretation.

Quality Control

• More tangible and obvious than QA.

• A program of ________ is designed to ensure that the radiologist is provided with an optimal image produced through good imaging system performance and resulting in minimal patient radiation dose.

instrumentation and equipment

Quality Control deals with ______and ______.

1. Care planning

2. Test ordering

3. Test scheduling

4. Test protocoling

5. Imaging procedure

6. Image interpretation

7. Reporting

8. Report communication

Steps in the diagnostic imaging chain

Care planning

• Patient-physician discussion: entails the explicit enumeration and description of the recommended imaging procedure, its harms and benefits, and its need as a part of the patient’s care plan.

• Discussion by providers on the care team about decisions regarding diagnostic imaging

Test ordering

Requires ordering physician to generate formal request of imaging modality and body part to be performed

Test scheduling

Involves patient/scheduling department communication to plan on a date and time for imaging.

Test protocoling

Radiologist review of appropriateness of test for given indication and contrast safety if indicated

Imaging procedure

Involves actual capture/performance of imaging exam of any given modality

Image interpretation

Radiologist reads ordered images correlating to any clinical features provided or any diagnostic possibilities

Reporting

Involves the actual dictation into written language of image interpretation and enumeration of any findings

Report communication

Relay of relevant information to ordering provider of given imaging test

Quality assurance (QA)

• Involves the assessment and evaluation of patient care

• Overall management program, put in place to ensure that a comprehensive range of quality control activities work effectively.

• As applied to medical radiography is the organized effort of the staff to ensure that the diagnostic images produced are of high quality.

• Its purpose is to provide adequate diagnostic information with the least possible cost and the least possible radiation exposure to the patient and staff.

Quality control (QC)

• Measurement and performance evaluation of imaging equipment.

• The means by which each area of interest is monitored and evaluated.

• A series of distinct technical procedures which ensure the production of a satisfactory product.

• Begins with the imaging systems used to produce the image and continues with the routine evaluation of image-processing facilities.

• Concludes with a dedicated analysis of each image to identify deficiencies and artifacts (along with their causes) and to minimize reexaminations.

• FDA (Food and Drug Administration)

• PNRI (Philippine Nuclear Research Institute)

• CDRRHR (Center for Device Regulation, Radiation Health, and Research)

Regulating Agencies responsible for governing the medical use of radiation:

PNRI (Philippine Nuclear Research Institute)

Regulates the use of radioactive materials such as those used in cobalt 60 radiotherapy facilities and brachytherapy units.

CDRRHR (Center for Device Regulation, Radiation Health, and Research )

• Regulates the use of devices emitting radiation such as x-ray machines and linear accelerators.

• Formerly known as Bureau of Health Devices and Technology

Combined efforts of the whole radiology staff

A QAQC program requires the ______________.

Hospital QAQC committee and a QAQC team

REQUIREMENTS OF A QAQC PROGRAM:

A _________ and ________ must be created to institutionalize the program.

• Chief of the hospital

• Administrative officer

• Chief radiologist

• Chief radiologic technologist

• Chief physicist

• Hospital maintenance engineer

Hospital QAQC committee includes:

Periodic film analysis and Monthly film analysis report

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Do _______ and _______ to the QA/QC committee.

Radiographic technique charts

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Establish additional ___________ when needed, or revise existing technique charts when appropriate.

Darkroom processing charts

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Establish additional ___________ or revise existing ones when necessary.

Periodic quality control test

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Do ____________ of x-ray equipment, accessories, and dark room equipment.

Room logbook

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Keep a ________ which contains all the test data on equipment, accessories and all the changes/repairs done to all equipment/accessories in the room, sample images, procedures for QC tests, etc.

Brochures and technical manuals

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Keep all ______and _________ pertaining to equipment and accessories.

Meet regularly

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• ________ to discuss film analysis report, QC test results, other reports and problems of the x-ray department/section.

Corrective action

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Decide on__________ to be implemented and on other matters related to the program.

Minutes of meetings

RESPONSIBILITY OF THESE GROUPS (HOSPITAL QAQC COMMITTEE) ARE AS FOLLOWS:

• Keep a record of _________.

hospital order; hospital chief

The creation of these groups (QAQC committee) within the hospital should be formalized with the issuance of a ________ signed by the _________.

Acceptance tested

• Each new piece of radiologic equipment, whether it is x-ray producing or image processing, should be ___________ before it is applied clinically.

• Must be done by someone other than the manufacturer’s representative because it is designed to show that the equipment is performing within the manufacturer’s specifications and is producing an acceptable patient radiation dose.

Periodic monitoring

With use, the performance characteristics of all such items of equipment change and may deteriorate. Consequently, _________ of equipment performance is required.

Preventive maintenance

When periodic monitoring shows that equipment is not performing as was intended, maintenance or repair is necessary. _________ usually makes repair unnecessary

1. Acceptance testing,

2. Routine performance monitoring/evaluation, and

3. Maintenance/ Error correction

An acceptable QC program consists of three steps:

Radiographic intensifying screens

are evaluated regularly for cleanliness and screen-film contact.

All lead apparel

Is checked for cracks, tears, and holes.

View boxes or film illuminators

are examined for intensity and cleanliness.