10. Ensuring Quality in PACS Flashcards
Radiology has both _______ quality
people-centered & product-centered
Has always been a part of health care, whether as a
service or product
Quality
The ultimate focus in health care is to ___________ so that patients will want to return
improve patient
care & provide a high-quality service
JCAHO
Joint Commission on the Accreditation
of Healthcare Organizations
Voluntary but necessary to obtain Medicaid
Certification, hold certain licenses, obtain
reimbursements from insurance companies, &
receive malpractice insurance
Joint Commission on the Accreditation
of Healthcare Organizations (JCAHO)
Rather than quality, TJC (The Joint Commission) currently uses terms
Continuous Quality Improvement or
Total Quality Management
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
Quality Assurance
QA (Quality Assurance) activities are focused around
people & service
Most QA activities will produce _______ that can be analyzed
quantitative data
These data can be used to
monitor the processes &
determine whether the process is working as it should & whether the standard of quality
has been met
quantitative data (Quality Assurance)
Defined as a comprehensive set of activities
designed to monitor & maintain systems
that produce a product
Quality Control
QC measures are instituted to ensure
that radiologic procedures are:
✓ performed safely
✓ appropriate for the patient
✓ performed efficiently
✓ produce a high-quality image
QC measures are required by law to maintain the _____ for the room or department
license
The data from the various activities are kept by a
________ within the department
designated individual
Most QC activities are part of a _____, & the data
are used to improve the quality of the processes& the department
QA program
3 MAJOR CATEGORIES OF QC TESTS
- Acceptance Testing
- Routine Maintenance
- Error Maintenance
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
Acceptance Testing
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
Routine Maintenance
When errors occur in equipment performance, corrective action must occur
These corrections will generally be made by service personnel employed by the vendor.
Error Testing
Errors will be detected by poor equipment performance or poor quality outcomes
Error Testing
CQI
Continuous Quality Improvement
Focus more on the process rather than on the people
or the service
Continuous Quality Improvement (CQI)
Belief is: If the process is good, health care workers
will follow it, & service will be good
Continuous Quality Improvement (CQI)
The ____ does not replace QA/QC programs
Continuous Quality Improvement (CQI)
The QA/QC programs focus on ______ a certain level of quality, not necessarily improving to
a higher quality
maintaining
focuses on improving the process or system within which the people function as team members rather than focusing on an individual’s work
Continuous Quality Improvement (CQI)
All levels of people within the organization must be involved in
the process of improvement
CONCEPT OF CQI (Continuous Quality 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
CONCEPT OF CQI (Continuous Quality Improvement)
Systemic observation & assessment of the different aspects of a project, service or facility to make certain that standards of quality are being met
Quality Assurance
Comprehensive set of activities designed to monitor & maintain systems that produce a product
Quality Control
When beginning a QC program, care must be taken to ______ all surrounding variables so that each quality measure can be repeated without harm to the process
document
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
Documentation
QC ACTIVITIES
to be monitored in a PACS environment
includes:
- Display quality for both monitor & film
- Processing speed
- Network transfer speed
- Data integrity (Data from archive)
Many vendors have suggestions for what
should be monitored for their systems
QC ACTIVITIES
It is very important that vendor’s list &
timetable for these various activities be
followed
QC ACTIVITIES
If any QC activity results in an ________
result, the appropriate personnel should be
notified & actions should be taken to remedy
the situation
unacceptable
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 Technical Standard for Digital Image
Data Management
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
ACR (American College of Radiology)
SMPTE
Society of Motion Pictures & Television Engineers
AAPM
American Association of Physicists in Medicine
TG18
Task Group 18
A test pattern developed by the ________ is also becoming more widely accepted for
use in these QC tests
American Association of Physicists in Medicine (AAPM) Task Group 18 (TG18)
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
American Association of Physicists in Medicine (AAPM)
If any of the following tests fails or produces out-of-range readings, ______ should be done
corrective action & continued monitoring
The ______ should follow the radiology department’s policy on equipment
maintenance procedures
technologist
It may be necessary to contact a _______ to follow up on the findings
radiation physicist
is often the weakest link in the digital imaging chain
Monitor
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
It is not ______ to provide the highest-quality monitor for all viewing
situations
cost-effective
Radiologist Workstation Monitor:
2K-3K monitors for digital projection images
1K-2K cross-sectional images
Up to 4K for mammography
QC recommendations for display monitors from AAPM Document entitled:
Assessment for Display Performance for Medical Imaging Systems
Testing should be completed both by _____ & by _______ on a daily & monthly/quarterly
basis on all monitors used to view images
physicists,
technologists/users
Daily Monitor QC
- Turn on the monitor, allow it ample time to warm up.
- Make sure that the monitor is dust free on the
viewing surface & near the airflow areas. - Retrieve a QC monitor test pattern (SMPTE or AAPM
TG18-QC) - General image quality & appearance
- Geometric distortion
- Luminance, reflection, noise & glare (luminance
meter or photometer) - Resolution
A device used to
measure luminescence
of areas on the
monitor
Photometer
Evaluate the results in
comparison to previous
measurements
Photometer
Printer Image Quality
- Wet Laser Imager
- Dry Laser Imager
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
speed,
speed
Speed
- Workstation Processing Speed
- Image Transfer Speed
Data Quality Control
- Data Integrity
2. Compression Recall
Technologist should check on a daily basis to make sure all images sent to the PACS arrived on the PACS
• Daily/Weekly/Monthly
Data Integrity
Used to reduce the size of the image files to
increase the speed of the network transfer of the
images
Compression Recall
established the compression protocol, and they determine the level of compression that will be acceptable for the institution
Radiologist/Radiation physicists
PACS Continuous Quality Improvement
- Recognition of Nondiagnostic Images
- System Up-Time
- System Training
Documentation of nondiagnostic image being forwarded to the PACS
Recognition of Nondiagnostic Images
Poor-quality Image Causes:
- Equipment Malfunction
2. Operator Error
QC test & appropriate service protocol
should be used
Equipment Malfunction
Additional training or counselling
Operator Error
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 Up-Time
An important activity that must never stop
System Training
The vendor applications training is supposed to train several _______ (people who are trained on all aspects of the system & are prepared to train others)
super users
