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Radiology > 8 Quality Assurance > Flashcards

8 Quality Assurance Flashcards

1
Q

How can human error be eliminated?

A
  • introduce simple systems (SOP - standard operating procedures
  • improve the working environment (is it efficient?)
  • Encourage reporting mistakes without blame
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2
Q

What are the 2 legislations for QA?

A
  • IR(MR)R 2017 (ionising radiation (medical exposure) regulation 2017)
  • IRR 2017 (Ionising radiation regularion 2017)
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3
Q

Who does IR(ME)R 2017 protect?

A

protects the patient

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4
Q

Who does IRR 2017 protect?

A

Protects staff and public but also deals with patient protection in relation to equipment

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5
Q

What are the roles defined by IR(ME)R 2017?

A
  • employer (the boss)
  • practitioner (justification)
  • operator (anybody involved in the production of a radiograph)
  • referrer (one who refers the patient for radiographs)
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6
Q

What are the 2 specific regulations by IR(ME)R 17?

A
  • employer shall establish QA programmes for standard operating procedures
  • employer shall ensure that every practitioner and operator undertakes CPD (5 hours specific to radiation every 5 years)
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7
Q

In the x-ray department what are the SOPs?

A
  • how we justify the exposure
  • how we correctly identify the patient
  • how we collect the equipment
  • how we expose the patient
  • how we clean the phosphor plates and develop them
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8
Q

What should a quality assurance programme entail?

A
  • named person in charge of overseeing compliance (usually RPS)
  • details of procedures involved
  • frequency procedures carried out
  • frequency records will be audited
  • all the above must be put in writing
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9
Q

What do we look at in a quality assurance programme?

A
  • image quality
  • x-ray equipment
  • processing (film and digital)
  • working procedures
  • training
  • audit
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10
Q

How do we ensure high quality images?

A

We must audit the images we produce
- Quality rating system
- Periodically conducting reject film analysis

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11
Q

Describe the image quality rating system

A
  • assess all images produced
  • grade films by image quality
  • images are rating a 1, 2 or 3
  • collate results - anaylse monthly, quarterly or at least every 6 months
  • feed back results to staff
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12
Q

What are the image quality ratings?

A
  • 1 = excellent (no errors of patient preparation, exposure, positioning, processing or film handling)
  • 2 = diagnostically acceptable (some errors in patient preparation, exposure, positioning, processing or film handling which do not detract from the diagnostic utility of the radiograph)
  • 3 = unacceptable (errors of patient preparation, exposure, positioning, processing or film handling which render the radiograph diagnostically unacceptable)
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13
Q

what is the target for number of films rated an image quality 1?

A

> 70%

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14
Q

From the quality assurance ratings what are we aiming to do?

A

We are aiming to reduce the number of 3 rated radiographs.
It is important to spot possible trends such as:
- one particular examination being repeated
- one particular staff member repeating etc
Is it due to bad practice or patient

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15
Q

How do you carry out reject film analysis?

A
  • collect all 3 rated films
  • at the end of the month assess these films
  • categorise faults (e.g. exposure, positioning, processing etc)
  • ACT
  • Repeat every month and compare results
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16
Q

What are the stages of the IQRS audit cycle?

A
  • Assess (evaluate images)
  • Grade (1,2,3)
  • Results (analyse - look for ways to improve)
  • Feedback
17
Q

How often do DDH test their x-ray equipment to check that is working satisfactorily?

A

DDH test every 3 months
Medical physics expert (Radiation protection advisor) test every 3 years

MI health care (suitably qualified engineer) service the equipment annually

18
Q

How should PSP plates be stored?

A
  • in a cool and not too humid environment
  • avoid direct sunlight and UV
  • preferably in light protection/ cross infection barrier envelope
  • if not used for more than 24 hours after plate erased (exposure to bright light) it should be erased again
19
Q

Explain sensitometry

A

Daily check of the developer
- compared the film processed with fresh chemistry with images produced as developer gets exhausted
- make a simple step wedge (different thicknesses of metal)
- check film for obvious changes in densities (e.g. drop of one step from stand reference film)
- for consistency, same person should carry our the testing

20
Q

What is the main method of checking processor performance?

A

Sensitometry

21
Q

Apart from the step wedge, what is another method of sensitometry testing?

A

Ready exposed test film
- pop developed film in reader and it will give you an answer (e.g. green = developer is good)

22
Q

What are the common problems during film processing?

A

Damage due to
- poor handling - bends, crimps etc
- insufficient training - overlapped
- LIGHT - fogging

23
Q

What causes fogged film?

A

Light entering daylight loading system/dark room
Safe light - is the filter the correct colour for the film being used

24
Q

How can you check your dark room conditions?

A

Coin test

25
Q

How do you carry out a coin test? What is it used for?

A
  • Check your dark room conditions (for light)
  • Ope an intra-oral x-ray packet and remove film - while hands are inside glove box or in dark room under safe light conditions
  • place a coin on the film
  • leave coin on film for a specified amount of time (5 minutes or average working time)
  • remove coin and process film
  • check the processed film for light fogging
  • repeat test for every different type and speed of film used in the practice
  • act on your findings
26
Q

For digital receptors, how often should these be checked?

A

Solid state sensors and PSP - visual check for physical damage weekly and radiographic monthly
- always replace with new ones if you notice damage between checks

27
Q

What is involved in working procedures?

A

IR(ME)R 2017 employed must provide written procedures
- Local rules - should define what types of x-ray procedures are to be carried out within your designated controlled area, who has access to it and who is responsible for safety in each controlled area
- Patient identification - SOP for identifying correct patient and who is responsibility it is to check

28
Q
A

Radiology (16 decks)

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