RT 219 overview

RT 219 overview by yjv

Quality Assurance

Designed to monitor, evaluate, and enhance patient care and workflow efficiency.

It focuses on people, operational processes, patient satisfaction, and clinical outcomes

Quality Control

a specialized subset of QA, focuses on physical performance of imaging hardware, instrumentation, and software

It focuses on technical calibration, equipment operation and physical output

NAM

National Academy of Medicine

Quality Care

providing patients with appropriate service in a technically competent manner, with clear communication, shared decision-making, and cultural sensitivity - NAM

1. Expected Quality

2. Perceived Quality

3. Actual Quality

THREE TIERS OF QUALITY

Expected Quality

What the patient anticipates before the exam and influenced by word of mouth, marketing, and previous experiences.

Perceived Quality

The patient’s subjective evaluation during and after the exam.

Actual Quality

The objective, statistical measurement of the service or product

1. Clinical Indication and Requisition

2. Patient Arrival and Preparation

3. Positioning and Acquisition

4. Image Processing and PACS Archiving

5. Interpretations and Reporting

The Diagnostic Procedure Chain

Anatomical Positioning

Precise alignment of patient anatomy, Central Ray (CR), and Image Receptor (IR).

Exposure Parameter Selection

Choosing optimal kVp, mAs, SID, and grid ratios to minimize exposure dose.

Radiation Protection

Applying lead shielding when appropriate and collimating tightly to the clinical area of interest.

Motion Control

Providing clear respiration instructions and immobilizing when necessary.

Florence Nightingale, 1860

carried out one of the earliest known methods of evaluating the quality of clinical healthcare.

Ernest Codman, MD, 1910

proposed the “end result system of hospital standardization,” a hospital system that would track patients to determine whether the treatment given was effective

Frederick Winslow Taylor

Father of Scientific Management

1. Replace rule-of-thumb work methods with methods based on a scientific study of the tasks.

2. Scientifically select, train, and develop each employee

3. Provide “detailed instruction and supervision of each worker in the performance of that worker’s discrete task.”

4. Divide work nearly equally between managers and workers

Four principles of Taylor’s scientific management

W. Edwards Deming and Joseph Juran, 1980’s

The concept of quality improvement began to gradually replace the concept of scientific management

1992

The Accreditation Manual for Hospitals, published by TJC, standardized performance improvement concepts inspired by the work of Deming and Juran.

1990s, National Academy of Sciences Institute of Medicine

In _____, The __________ began researching how healthcare is delivered in the United States.

March 2016, National Academy of Sciences-Health and Medicine Division

published two key reports:

• To Err is Human (1999)

• Crossing the Quality Chasm (2001)

To Err is Human (1999)

which recognized that there was a need to know more about the healthcare delivery system and its quality.

Crossing the Quality Chasm (2001)

it concluded that the US healthcare delivery system was dysfunctional, with great variety in performance, fragmented and poorly organized, confusing, and complex

1. Radiation Control for Health and Safety Act (Public Law 90-602)

2. Bureau of Radiological Health (BRH)

3. Consumer-Patient Radiation Health and Safety Act (Public Law 112-90)

4. Consumer Assurance of Radiologic Excellence (CARE) Act

5. Medicare Improvements for Patients and Providers Act of 2008

Governmental Action:

Radiation Control for Health and Safety Act (Public Law 90-602)

This law required the US Department of Health, Education, and Welfare to develop and administer standards that would reduce human exposure to radiation from electronic products.

Bureau of Radiological Health (BRH)

They are given the responsibility for implementing Public Law 90-602.

Consumer-Patient Radiation Health and Safety Act (Public Law 112-90)

This addressed issues such as unnecessary repeat examinations, QA techniques, referral criteria, radiation exposure, and unnecessary mass screening programs.

Consumer Assurance of Radiologic Excellence (CARE) Act

was retitled the Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Bill because many of the imaging disciplines included in the CARE legislation are not directly related to radiology.

Medicare Improvements for Patients and Providers Act of 2008

It mandates that any nonhospital institution performing advanced diagnostic services had to be accredited as of January 1, 2012, to receive federal funding.

• Exposure Factor Adaptation

• Algorithm Selection

• Artifact Differentiation

• Radiation Dose Minimization

Importance of Accurate Patient Clinical Information

1. Equipment quality control

2. Administrative responsibilities

3. Risk management

4. Regulatory and standards compliance

5. Radiation safety program

Components of a Quality Management Program in Diagnostic Imaging

Equipment quality control

it involves evaluation of equipment performance to ensure proper image quality, as well as patient and operator safety.

Administrative responsibilities

It involves the establishment of various processes to accomplish the specific departmental tasks that are required, such as departmental procedure manuals for performing diagnostic examinations or procedures for scheduling and routing of patients.

Risk management

The ability to identify potential risks to patients, employees, and visitors at the healthcare institution and establish processes that would minimize these risks is extremely important to healthcare organizations.

Regulatory and standards compliance

Diagnostic imaging departments must be in compliance with state, federal, and local regulatory agencies, as well as accrediting bodies to continue to be in business.

Radiation safety program

This is to ensure that patient exposure is kept as low as reasonably achievable (ALARA) and that department personnel, medical staff, and members of the general public are protected from overexposure to ionizing radiation

1. Continuous Data Collection

2. Statistical Analysis

3. Root Cause and Corrective Action

4. Verification and Re-Evaluation

The Quality Assurance Process Cycle

Continuous Data Collection

Systematic gathering of performance data (e.g., daily tube output, reject-repeat analysis logs, monitor luminance).

Statistical Analysis

Evaluating collected metrics against baseline standards, regulatory thresholds, or control charts to detect variance.

Root Cause Analysis and Corrective Action

Investigating deviations (e.g., faulty AEC sensor vs. positioning error) and executing corrective steps (e.g., engineering service, staff retraining)

Verification and Re-Evaluation

Performing post-intervention testing to confirm equipment stability before returning the system to active clinical use.

1. Threshold of Acceptability

2. Communication Network

3. Patient Comfort

4. Personnel Performance

5. Record-Keeping System

6. Corrective Action

Administrative Responsibilities

Threshold of Acceptability

includes levels of accuracy, sensitivity, and specificity of diagnosis.

Communication Network

Proper communication among all members of a diagnostic imaging department is essential for a successful quality management program

Patient Comfort

Patient comfort, convenience, and privacy should be provided within reasonable limits in diagnostic imaging departments.

Personnel Performance

Policies should be developed to ensure that diagnostic personnel are performing their duties within accepted professional standards for areas such as proper equipment operation, critical thinking, and interaction with patients and other personnel.

Record-Keeping System

is necessary to document that quality management and quality control procedures are being implemented and that they are in compliance with accepted norms

Corrective Action

If equipment or personnel are not performing to accepted standards, corrective action must be taken and documented. A flowchart is a useful tool in demonstrating corrective actions for possible problems.

Flowchart

is a useful tool in demonstrating corrective actions for possible problems.

1. Administrative and Personnel

2. Policy and Procedure Manual

3. Acceptance Testing

4. Routine QC Testing

5. Repeat/Reject Analysis

6. Record Keeping and Auditing

Key Requirements of QA and QC Programs

Administrative and Personnel

Clearly defined organization structure designating a Radiation Safety Officer (RSO), licensed Medical Physicist, and primary QC Technologist.

Policy and Procedure Manual

Written operational documentation covering radiation safety protocols, emergency actions, exposure guidelines, and step-bystep QC testing procedures.

Acceptance Testing

Comprehensive baseline physical evaluation performed by a medical physicist on brandnew or majorly repaired equipment before initial clinical use.

Routine QC Testing

Scheduled noninvasive evaluations divided into Level I (daily/weekly technologist tests), Level II (monthly/quarterly advanced checks), and Level III (annual complex physicist testing).

Reject/ Repeat Analysis

Systematic categorization of discarded images to identify recurring trends (e.g., positioning errors vs. equipment hardware failure) and maintain overall repeat rates below target thresholds (typically 5%).

Record Keeping and Auditing

Maintenance of testing logs, service records, and calibration certificates for regulatory inspections and accreditation audits