8 Quality Assurance Flashcards
How can human error be eliminated?
- introduce simple systems (SOP - standard operating procedures
- improve the working environment (is it efficient?)
- Encourage reporting mistakes without blame
What are the 2 legislations for QA?
- IR(MR)R 2017 (ionising radiation (medical exposure) regulation 2017)
- IRR 2017 (Ionising radiation regularion 2017)
Who does IR(ME)R 2017 protect?
protects the patient
Who does IRR 2017 protect?
Protects staff and public but also deals with patient protection in relation to equipment
What are the roles defined by IR(ME)R 2017?
- employer (the boss)
- practitioner (justification)
- operator (anybody involved in the production of a radiograph)
- referrer (one who refers the patient for radiographs)
What are the 2 specific regulations by IR(ME)R 17?
- 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)
In the x-ray department what are the SOPs?
- 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
What should a quality assurance programme entail?
- 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
What do we look at in a quality assurance programme?
- image quality
- x-ray equipment
- processing (film and digital)
- working procedures
- training
- audit
How do we ensure high quality images?
We must audit the images we produce
- Quality rating system
- Periodically conducting reject film analysis
Describe the image quality rating system
- 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
What are the image quality ratings?
- 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)
what is the target for number of films rated an image quality 1?
> 70%
From the quality assurance ratings what are we aiming to do?
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
How do you carry out reject film analysis?
- 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
What are the stages of the IQRS audit cycle?
- Assess (evaluate images)
- Grade (1,2,3)
- Results (analyse - look for ways to improve)
- Feedback
How often do DDH test their x-ray equipment to check that is working satisfactorily?
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
How should PSP plates be stored?
- 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
Explain sensitometry
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
What is the main method of checking processor performance?
Sensitometry
Apart from the step wedge, what is another method of sensitometry testing?
Ready exposed test film
- pop developed film in reader and it will give you an answer (e.g. green = developer is good)
What are the common problems during film processing?
Damage due to
- poor handling - bends, crimps etc
- insufficient training - overlapped
- LIGHT - fogging
What causes fogged film?
Light entering daylight loading system/dark room
Safe light - is the filter the correct colour for the film being used
How can you check your dark room conditions?
Coin test
How do you carry out a coin test? What is it used for?
- 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
For digital receptors, how often should these be checked?
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
What is involved in working procedures?
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
