680 likes | 1.27k Views
Introduction. PurposeDefinitionMotivationCosts and benefitsimplementationContent of a QA program. ????? (Definition). ??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
E N D
1. Quality assurance for diagnostic imaging equipment
2. Introduction Purpose
Definition
Motivation
Costs and benefits
implementation
Content of a QA program
3. ????? (Definition) ?????????????????????????????????????????????????????????
?????????????????????????????????????????????
???????????????????????????????????????????
??????????????????????????????????????????? ????????????????????????????????????????????????????
4. Implementation A successful QA depends on the understanding and support of all those involved in the operation of the facility
5. Content of a QA program QA is a management tool that includes policies and procedures designed to optimize the performance of personnel and equipment
Identify aspects of facility operation
Establishing policies
Encouraging compliance with policies
Analyzing records of operation at regular intervals
7. General concepts of quality assurance and quality control
8. Approaches to QA and QC
9. Goal Accurate and timely diagnosis
Minimization of radiation exposure
Minimization of risk
Minimization of discomfort
Minimization of cost
10. Factors in QA and QC Human factors
Members of facility staff
Must be dedicated to the concept of QA
Must communicate freely with each other
Require a commitment to quality
Continuing dialogue regarding the quality of images
Equipment factors
Equipment function properly
11. General objectives
12. Accuracy in diagnosis Procedures to assure that radiological examinations are appropriate for clinical problem
Risks, costs or complexity
Types and availability of equipment
13. Minimizing radiation per examination Amount of radiation that is adequate but no more than enough to produce a diagnostic image
In both underexposed and overexposed films, a subtle fracture or lesion can be missed
14. Provisions for comfort of the patient Comfort and privacy
Patient waiting time
Departmental conditions
Room temperature
Comfort of equipment
Politeness and consideration of personnel
15. Communication Interpretation of the image to referring physician
Patient’s film should be accurately identified
Patient’s report form should be periodically audited
Official report, either oral or written, must be provided speedily
16. Cost Reduction of cost to patient and department
Minimum of technical and clerical errors should result in a lower cost per examination
17. Quality of images
18. Definition of image quality There are no hard and fast criteria for defining proper image quality
The image quality needed will vary with the type of information needed
An image with less than optimal definition is acceptable if it will answer the clinical problem
Quality is perceived differently by different observers
19. Disadvantages of poor quality images Incorrect diagnosis
Miss a fracture or a destructive lesion
Improper or inadequate set of views
Risk of repeating a hazardous procedure
Nonradiological risks in angiographic procedure: reinjection, recatheterization
Unproductive patient radiation
The radiation the patient has received has no benefit
Patient inconvenience
Increasing waiting time or make another visit
Increased cost
Patient, department and hospital
20. Cost-benefit consideration
21. Costs of a quality assurance program Personal costs
Medical physicists or technologists
Test equipment
A small fraction of the total capital budget
Must be available
Decrease in patient flow from testing
Testing may decrease the flow of patients, thus may involve a cost
22. Savings A monetary savings can be realized
Result of a decrease in repeat studies
A large fraction of repeats
Result of technologist decision
23. Film and chemical savings The number of films used in quality control is usually smaller than the number used in repeat examinations
24. Less downtime of equipment The amount of downtime due to component failure may be decreased by a quality control program
Preventive maintenance program
25. Saving of technologist time Repeat examinations cause unnecessary use of technologist time
26. Improvement in patient flow An increase in the number of patients can result in an increased return on the capital investment
27. Decreased cost of equipment service If the source of an image quality problem can be identified by facility personnel, the resultant service call will be less
28. Education and quality assurance
29. Facility personnel Technologist
Positioning of the patient and exposure control
Quality control technologist
Adequate training in various aspects of quality control
Practicing radiologist
To maintain quality assurance
Interaction with medical physicists and technologists
Medical physicist
Practical aspects of diagnostic radiology
31. Quality assurance – personnel performance and keeping of records
32. Introduction To assure the adequacy of personnel performance
Influenced by many factors
Records must be generated
Periodic review of records
To assure the proper functioning of equipment
It will continue to function satisfactorily
To detect malfunction before it degrade the diagnostic image or represent a hazard to patients
33. Elements of a personnel quality assurance program Identification of personnel activities
Establishment of policies setting forth the method of performing these activities
Person responsible for specific activities
The way tasks to be performed
The way decisions to be made
The way personnel to relate to patient
Institution of a system of record keeping
Evidence of personnel performance
Establishment of a system for the regular periodic review and analysis of such records
Corrective action if deficiencies are found
34. Activities to be monitored Patient scheduling
Patient reception
Patient preparation
Patient examination
Film processing
Image quality control
Image interpretation
Report preparation
Report distribution
File room operation
35. Establishing policies to guide personnel performance To provide specific guidance to facility personnel
Policies adopted should be tailored to the individual facility
Policies must be clear and concise
36. Developing a record-keeping system to provide an index of compliance Request form
Room log
Report of the interpretation of an imaging study
Incident report
Patient’s film jacket
Other records
Daily work schedule, arrival/departure log, questionnairs of patient or referring physician satisfaction
37. Room log Daily activity of a given examining room
Name of the patient
Study performed
Film exposed
Reason for retake
Reason for supplemental view
Reason for room out of service
Daily activity of a given dark room
38. Analyzing the records Method of review and analysis
Identifying areas of deficiency
Instituting corrective action
Establish a schedule and assign staff personnel, rotation, to perform review
Report findings as part of a regular staff meeting
39. Analyzing the records Periodic review
imaging interpretation
facility operation
Imaging technique
Report generation
File room function
40. Analyzing the records How long dose it take to complete a study
What fraction of images are repeated
What equipment problems effect on image quality or patient exposure
How long dose it take to get a report of an imaging study dispatched to its destination
How frequently do reportable incidents occur
How long does it take the file room staff to retrieve the images of a current case
41. Quality assurance committee (QAC) QAC
Chief imaging physician
Medical physicist
Chief technologist
Quality control technologist
To raise the awareness of importance of quality assurance
Meet at regular intervals to discuss problems
42. Evaluation of the findings and institution of corrective action Assessing the adequacy of performance
Comparison with own previous performance
Evidence of deterioration of performance should suggest prompt corrective action
Each facility need to set its own standards of performance
To assure that corrective action is taken
The recommendation of previous deliberations be reviewed on the next meeting
44. Establishment of a quality control program
45. Introduction Quality control is an integral and most tangible aspect of quality assurance
Acceptance testing
Establishment of baseline performance
Diagnosis of changes in equipment performance
Verification of correction of causes of deterioration
46. Who dose it All members
Imaging physician
Medical physicist : supervise and consult
Quality control technologist
Must be trained
Must have adequate time
Carry out the day-to-day measurements
Maintain quality control log
47. Responsibility Physician’s responsibility
Quality control function
User’s responsibility
Equipment is working
properly
Safely
At optimum image quality
48. Documentation, recording and correction Measurements : clearly and readily
Recording of data : control chart
Evaluation of chart data and measurements
Setting standards for variation allowed : upper and lower control limits
Testing frequency : cost and benefit
Method of interpretation and corrective action : reporting problems to service personnel
Repair decisions : initiating the repair
49. Tools needed for a quality control program Size of the facility
Expertise of individual
Scope of the testing program
50. Beginning a quality control program for equipment Determine the type of equipment needed before purchase
Selecting equipment and preparing specifications
Service costs over the expected life
Meet the specifications : after installation
Users must be instructed in proper operation and trouble shooting techniques
51. General methodology of quality control and diagnostic testing Retake analysis
Factors affecting retake rate
Method of retake analysis
The start-up effect
Measured and actual retake rate
Factors to record in retake analysis
Radiograph artifacts
52. General methodology of quality control and diagnostic testing Recording equipment downtime and failure
Log book for each room : listing problems, length of time for service
Exposure per image
Comparison of exposure within the facility
Test objects for evaluation of equipment performance
Particularly when changing imaging techniques
Patient-simulating phantoms or test objects
54. Procedures, objectives, and policies-performance optimization
55. Management of personnel activities Importance of monitoring personnel performance
Application of recommendations
Policy statements
56. Importance of monitoring personnel performance Greatest possible benefit, least possible cost
Patient irradiation
Discomfort
Inconvenience
expense
57. Importance of monitoring personnel performance Unproductive patient irradiation
Improper scheduling
Preparation of the patient
Inappropriate or inadequate examinations
Errors in image exposure, identification or processing
Delays in image interpretation
Inability to retrieve images when required
58. The end
63. QUALITY ASSURANCE PROGRAMS FOR DIAGNOSTIC RADIOLOGY FACILITIES (a) Applicability
(b) Definitions
(c) Elements
64. A quality assurance program should contain (1) Responsibility
(2) Purchase specifications
(3) Monitoring and maintenance
(4) Standards for image quality
(5) Evaluation
(6) Records
(7) Manual
(8) Training
(9) Committee
(10) Review