Ensuring Quality in PACS

wtf topic 10

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

The ultimate focus in health care is

to improve patient care & provide a high-quality service so that patients will want to return

TJC

The Joint Commission

JCAHO

Joint Commission on the Accreditation of Healthcare Organizations

TJC Requirement Importance

Voluntary but necessary to obtain Medicaid Certification, hold certain licenses, obtain reimbursements from insurance companies, & receive malpractice insurance

Rather than quality, TJC

Currently uses terms Continuous Quality Improvement or Total Quality Management

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 focus

Focused around people & service

Most QA activities will

produce quantitative data that can be analyzed

QA data use

Can be used to monitor the processes & determine whether the process is working as it should & whether the standard of quality has been met

Quality Control

Defined as a comprehensive set of activities designed to monitor & maintain systems that produce a product

QC measures instituted to ensure radiologic procedures are

1. performed safely

2. appropriate for the patient

3. performed efficiently

4. produce a high-quality image

QC measures legal requirement

Required by law to maintain the license for the room or department

QC data management

The data from the various activities are kept by a designated individual within the department

QC/QA relationship

Most QC activities are part of a QA program, & the data are used to improve the quality of the processes & the department

3 MAJOR CATEGORIES OF QC TESTS

1. Acceptance Testing

2. Routine Maintenance

3. Error Maintenance

ACCEPTANCE TESTING

1. Performed before newly installed or majorly repaired equipment can be accepted by the department
   

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

3. Used to determine whether the equipment is performing within the vendors specifications & as promised

Routine Maintenance

1. Performed to ensure that the equipment is performing as expected

2. Can catch problems before they become radiographically apparent

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

Error Testing

1. When errors occur in equipment performance, corrective action must occur

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

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

CQI

• Continuous Quality Improvement

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

CQI Belief

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

The CQI does not

replace QA/QC programs

QA/QC Program Focus

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

CQI Detailed Focus

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

CONCEPT OF CQI involvement

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

• 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 ASSURANCE (redefinition)

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 (redefinition)

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

PACS EQUIPMENT QUALITY CONTROL implementation

When beginning a QC program, care must be taken to document all surrounding variables so that each quality measure can be repeated without harm to the process

DOCUMENTATION importance

very important in any QC activity & all paperwork must be kept up to date to make a valid performance measure

Documentation difficulty

The most difficult part of the process & the easiest part to not complete

Documentation necessity

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

QC ACTIVITIES to be monitored in a PACS environment

DPND

1. Display quality for both monitor & film

2. Processing speed

3. Network transfer speed

4. Data integrity (Data from archive)

Vendor Input

Many vendors have suggestions for what should be monitored for their systems

Vendor Timetable

It is very important that vendor’s list & timetable for these various activities be followed

If any QC activity results in an unacceptable result

The appropriate personnel should be notified & actions should be taken to remedy the situation

ACR Technical Standard for Digital Image Data Management requirement

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

QC program design goal

Should be designed to maximize the quality & accessibility of diagnostic information

ACR testing suggestion

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

SMPTE

Society of Motion Pictures & Television Engineers test pattern

AAPM TG18-QC

A test pattern developed by the American Association of Physicists in Medicine (AAPM) Task Group 18 (TG18) is also becoming more widely accepted for use in these QC tests

AAPM TG18-QC test pattern

American Association of Physicists in Medicine

AAPM suggested testing frequency

Suggests that the testing be performed on acceptance & annually by a trained physicist & the daily & monthly/quarterly tests can be performed by a trained QC technologist or a physicist.

If any of the following tests fails or produces out-of-range readings

corrective action & continued monitoring should be done

Technologist protocol

Should follow the radiology department’s policy on equipment maintenance procedures

Physicist consultation

It may be necessary to contact a radiation physicist to follow up on the findings

MONITOR QUALITY weakness

Monitor is often the weakest link in the digital imaging chain

Monitor effect

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

Monitor cost-effectiveness

It is not cost-effective to provide the highest-quality monitor for all viewing situations

Radiologist Workstation monitors

• 2K-3K monitors for digital projection images

• 1K-2K cross-sectional images

• Up to 4K for mammography

AAPM QC recommendations document title

“Assessment for Display Performance for Medical Imaging Systems”

Monitor Testing Personnel & Frequency

Testing should be completed both by physicists & by technologists/users on a daily & monthly/quarterly basis on all monitors used to view images

Daily Monitor QC steps

1. Turn on the monitor, allow it ample time to warm up.

2. Make sure that the monitor is dust free on the

viewing surface & near the airflow areas.

3. Retrieve a QC monitor test pattern (SMPTE or AAPM

TG18-QC)

4. General image quality & appearance

5. Geometric distortion

6. Luminance, reflection, noise & glare (luminance

meter or photometer)

7. Resolution

PHOTOMETER

A device used to measure luminescence of areas on the monitor

Photometer use

Evaluate the results in comparison to previous measurements

Printer Image Quality QC

1. Wet Laser Imager

2. Dry Laser Imager

(wa ko kasabot ani bruh)

Daily/Weekly quality control

Speed Concern in Radiology

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

1. Workstation Processing Speed

2. Image Transfer Speed

Weekly/Monthly quality control

Data Quality Control areas

1. Data Integrity

2. Compression Recall

Data Integrity QC check

• 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 purpose

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

Compression Protocol Establishment

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

PACS Continuous Quality Improvement specific areas

1. Recognition of Nondiagnostic Images

2. System Up-Time

3. System Training

Recognition of Nondiagnostic Images activity

Documentation of nondiagnostic image being forwarded to the PACS

Poor-quality Image Cause 1

EQUIPMENT MALFUNCTION

EQUIPMENT MALFUNCTION

QC test & appropriate service protocol should be used

Poor-quality Image Cause 2

OPERATOR ERROR

OPERATOR ERROR

Additional training or counselling

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 importance

An important activity that must never stop

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)