8. Quality Control in Digital Radiography Flashcards
Why is QC still needed in DR?
o Even when machines are initially set up
to perform properly, performance can
degrade over time.
o The combination of human and
machine can improve performance, but
at the same time can magnify errors.
o How is it possible to know whether the
imaging operation is going badly or
efficiently without active and objective
measurements of performance
Visible, on-going effort to collect
information about an imaging operation
Quality Control
Visible, on-going effort to collect
information about an imaging operation
Quality Control
Seeks to get the most efficient
performance from both the imaging
facility and the physician.
Quality Control
QC can detect:
o Malfunctions o Unpredictability o Inefficient use of radiation o High fluoroscopic outputs o Radiation not reaching receptor o Inadequate filtration o Oversized collimation
Goals of a QC Program
o Obtain acceptable image with least possible radiation exposure to patients & staff o Attempt to identify problems before they appear on patient films o Without QC, problems only detected on patient films
Components of quality control
- Acceptance Testing
- Establishment of baseline performance
- Diagnosis of changes in performance
- Verification of correction of deterioration
First opportunity to determine whether
the imaging equipment meets the
requirements of state and federal
regulatory agencies
Acceptance Testing
Special features written in the purchase
contract
Acceptance Testing
Conducted before used for patients
Acceptance Testing
Conducted in the presence of vendor
service engineer, so it can be corrected
immediately if possible
Acceptance Testing
Used to establish baseline performance
Acceptance Testing
Limits of maximum deviation from
normal before initiating corrective
action
Diagnosis of changes in performance
If corrective action is taken, verify that the performance has returned to normal levels by conducting the usual test plus some additional comprehensive test
Verification of correction of
deterioration
Quality image that makes accurate
diagnosis possible
Diagnostic quality
Can be described in terms of
contrast, resolution, and noise
Diagnostic quality
o Image containing information required by Radiologist for correct interpretation o Goal minimize exposure while maintaining acceptability o High exposure films often have excellent appearance o Cardboard cassettes
Acceptable image
still uses
conventional radiographic equipment
so basic radiography quality control
resting is still needed
Computed radiography
Computed Radiography & Quality Control
o Calibration of the generator o Collimation o Beam alignment o Linearity of exposure o Spatial resolution (focal spot)
The end product in radiography is the
image and accurate report of _____
findings
Therefore for film, the processor function, screen contact and artifact avoidance was ____
critical
With digital radiography the computer monitor, image transfer and image receptor plate become the ____ areas for quality assurance
critical
Quality of the report
and the communication
between radiologist
and clinicians
Physician’s interpretation of the images
Flowchart of the steps involves in
performing a DR exam
Process Map
Other QA activities are accomplished
through interactions between the
technologist and the patient
Process Map
Exam is explained o the patient
Process Map
Verify the patient identified in
the request, anatomy to be
examined, pregnancy status
and allergies
Process Map
A simple QC method is to include a
_____ on the exam request that the
RT annotates to indicate that all these
actions were taken
checklist
An organized effort by the staff operating a
facility to ensure that the diagnostic images
produced are of a sufficiently high quality so
that they consistently provide adequate
diagnostic information at the lowest possible
cost and with the least possible exposure of the
patient to radiation
Quality assurance program
according to World Health
Organization (WHO)
Objectives of QA Program
o To maintain optimal quality of diagnostic images; o To reduce unnecessary radiation exposure to patient and staff; o To be cost effective
The primary goal of a radiology _____ is
to ensure the consistent provision of prompt
and accurate diagnosis of patients
QA program
QA program has many facets, including
- Quality Control tests
- Administrative procedures
- Preventive maintenance procedures
- Training
An integral part of quality assurance
Quality Control
Involves specific actions designed to keep measurable aspects of the process involved in manufacturing a product (image) or providing a service within specified limits.
Quality Control
Quality Control is summarized in four principal steps:
- Acceptance Testing to detect defects in
equipment that is newly installed or has
undergone major repair - Establishment of baseline performance of the equipment (commissioning test)
- Detection and diagnosis of changes in
equipment performance before they
become apparent in images - Verification that the causes of
deterioration in equipment
performance have been corrected
The frequency of any QC test depends on the
following variables:
o The inherent variability of the process
or equipment
o The age, reliability, and frequency of
use of the equipment
o The criticality of the element in the
imaging chain
These procedures are design to verify that QC
testing is effective, ie.
I. The test are performed reqularly and correctly, II. The results evaluated promptly and accurately III. And the necessary action taken
They include recommendations regarding the responsibility for quality assurance action, staff training, equipment standards, and the selection of the appropriate equipment for each examination
Administrative Procedure
These are performed on regularly scheduled basis with the goal of preventing breakdowns due to equipment failing without warning signs
detectable by monitoring.
Preventive Maintenance Procedure
Preventive Maintenance Procedure includes
- Visual inspection of the mechanical and
electrical characteristics of the x-ray
system assuring cleanliness with respect
to spilling of contaminants in the
examination room. - Following the manufacturer’s
recommended procedures for cleaning
and maintenance of the equipment. - Regular inspection and replacement of
switches and parts that routinely wear
out or fail
The QA program include the means to provide appropriate training for all personnel with QA responsibilities to ensure each meet a minimum level of competency to perform QC test correctly and consistently
Training
Personnel in the QA program who are responsible to oversight of the QA program, setting the goals and direction, determining policies, and assessing the effectiveness of QA activities
Quality Assurance Committee
They have an overall documented
strategy with clearly defined work plans to achieve the goals and objectives of
the radiology department
Quality Assurance Committee
Quality Assurance Committee Includes:
o Medical physicist o Radiologist o Biomedical engineer o Medical imaging technologist (MIT) and Radiographer o Information Technology (IT) Technician
An individual who is competent to
independently practice in one or more of the
subfields in medical physics
Medical Physicist
Medical Physicist
-Advising the facility on radiation protection of the patient, staff, and members of the public -Conducting tests to ensure the safety and proper performance of imaging equipment used -Assignment of bio-medical engineering service staff for corrective maintenance or preventive actions -Training of personnel utilized for quality control - Develop and implement a radiation protection program
A medical doctor who specializes in the
diagnosis and treatment of disease and injury
by using medical imaging technologies
Radiologist
Radiologist
-Determine the overall quality of the output image -Select the technologist to be the primary QC technologist, performing the prescribed QC tests - Ensure that appropriate test equipment and materials are available to perform the QC tests - Ensuring that medical physicists and radiographers have adequate training and continuous education
use their knowledge of modern biological principles in their engineering principle to design and develop devices and procedures that solve medical and health-related problems
Biomedical Engineer
Biomedical Engineer are involve in:
o Corrective and preventive
maintenance
o Fault reporting
Medical Imaging Technologist (MIT) &
Radiographer
-Ensuring that the appropriate protocol and technique factors are used for requested examination - Ensuring that the QC tests are performed, interpreted, and recorded appropriately - Perform all the checks for the daily, monthly, and quarterly QC testing of equipment - Report faults immediately any deviation in trend of equipment performance to QA manager - Undertaking additional continuous education courses
A key element of any digital facility that
intends to store, review and distribute
images electronically or using hard
copy
Information Technology (IT) Technician
Information Technology (IT) Technician
Maintenance of the integrity of system
databases to ensure continuous and
accurate operation of the information
system
QA PROGRAM DRAWBACK
- Costly
- Personnel
The QA program is based on, planning, delegating responsibility, training and purchasing the proper equipment, then establishing a high standard of quality and maintaining it.
Costly
Personnel drawbacks
o Unclear responsibility
o Lack of qualification
o Lack of commitment to perform QC
test
Any program lacking genuine interest from its
staff and initiated only to satisfy a regulatory
requirement is _____ to produce optimal
results
unlikely
issues in any work
environment are very important
Health and safety
All heads of department are responsible
for ensuring that injury or sickness, due
to working conditions, is kept to a
minimum
Health and safety
To make the environment as safe as
possible, make certain the following:
o Regular maintenance inspections are carried out o Safety procedures are followed o Adequate staff instruction is given o Safety equipment is readily available
promote the effective use of
radiation for a diagnostic outcome
trough achieving and maintaining appropriate image quality and
reduction of patient dose
Quality Assurance
An established \_\_\_ program monitor the imaging process from start to finish and reveal potential problems that may otherwise go unrecognized, through a sequences of QC tests
QA
_____ in medical imaging is a rapidly
evolving concept and each facility is
encouraged to continually pursue ways
to improve and expand its program
QA
