VS205 quality assurance.

Radiology Quality Assurance

Goals of the Quality Assurance Program

  • To ensure the provision of high-quality diagnostic x-rays that are:

    • Dependable: Consistently producing accurate and reliable images.

    • Safe: Minimizing risks to both patients and employees.

  • Resulting in better patient care, leading to:

    • Improved medical outcomes.

    • Increased profit for the clinic through repeat clients.

  • Lowering risk to employees and patients by adhering to ALARA (As Low As Reasonably Achievable) principles.

ABVMA Regulations

  • The Alberta Veterinary Medical Association (ABVMA) oversees the Radiation Protection Act in Alberta.

  • Policies related to this act are examined during PIPS (Practice Inspection and Professional Standards) inspections.

  • It is the responsibility of the practice owner to ensure that:

    1. A Radiation Protection Program is in place.

    2. A Quality Assurance Program is implemented to uphold standards.

Components of the Quality Assurance Program

  • This program involves a systematic set of activities that ensure quality control measures are effectively performed:

    • Each radiograph is analyzed regularly and systematically.

    • Inspections are conducted on a daily, weekly, and monthly basis to maintain standards.

Responsibilities and Inspections

  1. X-ray Machines:

    • Must be inspected and certified by a specialist prior to usage and every five years thereafter.

    • A current certificate must always be displayed.

  2. Training for Radiographers:

    • Continuous education on new information and safety protocols is required.

    • All personnel must be well-trained in safe procedures, equipment handling, and protocols.

  3. Quality Control:

    • Regular checks (daily, weekly, monthly, yearly) of equipment and procedures are essential.

Quality Control Measures

  • X-ray Log Maintenance:

    • Essential to fill out the X-ray log completely for every taken x-ray. This log assists in tracking: a) Total number of x-rays taken monthly/yearly. b) Total number of patients x-rayed. c) X-ray usage trends by cassette. d) Overall rejection rates and patterns in machine performance.

  • Month-to-month analyses are crucial in evaluating and improving processes.

Repeat and Reject Analysis

  • Regular analysis of log data is required to:

    • Assess monthly repeat images (CR and DR) that didn't meet diagnostic standards.

    • Identify recurring issues to minimize similar occurrences in the future.

    • Daily tracking of metrics and forms provided by ABVMA enhances accountability.

  • The goal is to maintain a repeat rate around 5%, with thorough examination for causes if rates exceed expectations.

Physical Measurement Standards

  1. FFD (Focus-to-Film Distance) Measurements:

    • Compare the FFD reading from the x-ray tube with measurements taken using an external tape measure.

  2. X-ray Tube Perpendicularity Check:

    • Use a carpenter's level to ensure the tube is correctly aligned in both front and side views.

    • Verify angulation accuracy with a square for angled tubes.

  3. Calibration:

    • Qualified personnel should ensure that equipment settings (mAs, kVp, and Voltage) match output readings.

    • Connection to external calibrators should verify accuracy.

Collimation and Light Field Tests

  1. Light Field/Collimator Maintenance:

    • Regular cleaning of the collimator's plastic cover to prevent any artifacts in images.

    • Brightness checks and bulb replacements as necessary.

    • Ensure that the size set by collimator knobs corresponds accurately to readings taken with a tape measure.

  2. Beam Alignment Test:

    • Using pennies to check if the x-ray field aligns with the light field of collimation, adjustments must be made if discrepancies are noted.

Inspection of Digital Plates and Cassettes

  • Pixel Activation Testing:

    • Conduct tests to detect any pixel damage using a paper clip method showing non-functional pixels.

  • Cleaning Protocol:

    • Cassettes should be cleaned with a damp cloth, using mild detergents only to prevent artifacts.

  • Log Review:

    • Detailed examination of x-ray log data to identify usage numbers and any trends.

Equipment Maintenance for Digital Plates

  • Plate Handling:

    • Conduct quick erasure of digital plates weekly and slow erasure every three months to prevent image retention.

Protective Gear Assessment

  • X-ray Protective Gear:

    • Regularly assess for damage (e.g., cracks or holes), which may be indicated by black dots or lines on the gear.

    • Damaged equipment must be replaced for safety compliance.

Quality Control Reporting

  • Documentation:

    • All results and inspections must be recorded and compiled by the QC officer, noting that while critical, this process can be time-consuming.

Review Questions

  • Q #1: Why is a Quality Assurance Program important?

  • Q #2: What is the light field alignment test and its significance?

  • Q #3: How can we identify if our safety gear is no longer acceptable for use?

  • Q #4: Why is it essential for personnel to stay updated with current information?