M10

Radiology

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

JCAHO

Continuous Quality Improvement or Total Quality Management

Rather than quality, TJC currently uses terms

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.

QA activities

are focused around people & service.

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.

QC measures

are instituted to ensure that radiologic procedures are: ✓ performed safely ✓ appropriate for the patient ✓ performed efficiently ✓ produce a high-quality image

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.

designated individual

The data from the various activities are kept by a _____ within the 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.

ACCEPTANCE TESTING

Testing may be performed by a designated technologist, a radiation physicist, or by service personnel employed by the hospital.

ACCEPTANCE TESTING

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.

ROUTINE MAINTENANCE

Can catch problems before they become radiographically apparent.

ROUTINE MAINTENANCE

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.

ERROR TESTING

Errors will be detected by poor equipment performance or poor quality outcomes.

ERROR TESTING

These corrections will generally be made by service personnel employed by the vendor.

Continuous Quality Improvement

Focus more on the process rather than on the people or the service.

Belief

If the process is good, health care workers will follow it, & service will be good.

QA/QC

The CQI does not replace ___ programs.

QA/QC programs

focus on maintaining a certain level of quality, not necessarily improving to a higher quality.

CQI

focuses on improvingthe process or system within which the people function as team members rather than focusing on an individual’s work

CONCEPT OF CQI

All levels of people within the organization must be involved in the process of improvement.

CONCEPT OF CQI

It is important that everyone participate because if one spoke is not involved, the wheel will fall off, & the quality cart cannot move forward.

QUALITY CONTROL

Comprehensive set of activities designed to monitor & maintain systems that produce a product.

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.

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.

DOCUMENTATION

Without the _____ to back up the findings, it will be difficult to prove the need for repair or update of a system.

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:

ACR Technical Standard for Digital Image Data Management

“Any facility using a digital image data management system must have documented policies & procedures for monitoring & evaluating the effective management, safety & proper performance of acquisition, digitization, compression, transmission, display, archiving & retrieval functions of the system. The QC program should be designed to maximize the quality & accessibility of diagnostic information”

ACR

Also suggests that all the quality tests be carried out with a Society of Motion Pictures & Television Engineers (SMPTE) test pattern to ensure continuity of measurements.

Society of Motion Pictures & Television Engineers

SMPTE

American Association of Physicists in Medicine

AAPM

Task Group 18

TG18

American Association of Physicists in Medicine (AAPM) Task Group 18 (TG18)

is also becoming more widely accepted for use in these QC tests.

acceptance and annually

The AAPM suggests that the testing be performed on ___ ___ by a trained physicist

corrective action & continued monitoring

If any of the following tests fails or produces out-of-range readings, _____ should be done.

technologist

should follow the radiology department’s policy on equipment maintenance procedures.

radiation physicist

It may be necessary to contact a _____ to follow up on the findings.

Monitor

is often the weakest link in the digital imaging chain.

MONITOR QUALITY

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.

2K-3K

for digital projection images

1K-2K

cross-sectional images

Up to 4K

for mammography

PHOTOMETER

A device used to measure luminescence of areas on the monitor

Wet Laser Imager Dry Laser Imager

Printer Image Quality (2 types):

speed

Always a concern in the radiology department, whether it is the __ at which patients are brought back for their X-rays or the __ at which the radiologists gets a final report signed.

Workstation Processing Speed Image Transfer Speed

Speed (2types):

Data Integrity Compression Recall

Data Quality Control (2 types):

Data Integrity

Technologist should check on a daily basis to make sure all images sent to the PACS arrived on the PACS

Compression Recall

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

Compression Recall

Radiologist/Radiation physicists established the compression protocol, and they determine the level of compression that will be acceptable for the institution.

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.

System Up-Time

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)