Quality Assurance Flashcards
define quality assurance
an organised effort by staff to ensure that the DIAGNOSTIC images produced are of sufficiently HIGH QUALITY to consistently provide ADEQUATE DIAGNOSTIC INFORMATION at the LOWEST COST and LEAST EXPOSURE to the patient
give 2 reasons why we need quality assurance
- it is impossible to eliminate human error (QA minimises)
2. we are told to by legislations
3 ways that human error can be minimised are
- SIMPLE systems introduced
- improve working ENVIRONMENT
- encourage REPORTING without BLAME
the 2 legislations are called…
- IR(ME)R 2000
2. IRR 99
what is the main function for IR(ME)R 2000?
to protect the patient
What is the main function for IRR 99?
to protect the public, the staff, the patient (with regards to equipment only)
name the 4 allocated roles of the IR(ME)R 2000 legislation..
- employer
- practitioner
- operator
- referrer
what are the 2 functions of the employer in IR(ME)R 2000 legislation?
- shall establish QA programs
2. shall ensure that all members of staff undertakes CPD
who is called as the operator in IR(ME)R 2000 legislation?
anyone who is involved with the production of a radiograph
who is the referrer in IR(ME)R 2000 legislation?
the one who refers the patient for a radiograph
Five necessities for a quality assurance program are…
- Named person
- Details of procedure involved
- Frequency of procedures carried out
- Frequency records being audited
- All of above in writing
6 main points to look at when carrying out a quality assurance program.
- image quality
- X-ray equipment
- processing
- working procedures
- training
- audit
which two ways can you audit image quality?
- image quality rating system
2. film reject analysis
regarding the image quality rating system, what are the 4 stages of rating?
- assess all images
- rate them 1,2, or 3
- collage results (analyse monthly, quarterly or at least 6 monthly)
- feedback information to staff
The criteria for a grade 1 image is..
- no errors with patient preparation
- no errors with positioning
- no errors with exposure
- no errors with processing or film handling
a grade 1 image can be described as..
excellent (very diagnostically useful)
a grade 2 image can be described as..
diagnostically acceptable, but with some errors
a grade 3 image can be described as..
an image with many errors leaving it diagnostically unacceptable
what are the targets for image quality rating system?
grade 1 = >70%
grade 2 =
what is film reject analysis?
where all graded 3 images are collected and assessed at the end of each month.
what are you looking for in film reject analysis?
- to catagorise faults and detect any trends
what is the IQRS audit cycle?
ASSESS (evaluate images)
^
GRADE images
^
RESULTS (analyse and look for improvement)
^
FEEDBACKWhat is the minimum and ideal time between X-ray equipment tests?
minimum = every 3 years ideal = every 1 year
what must you do to every psp that has not been used in 24hrs?
erase the plate with bright light as background radiation could have tampered with the image.
3 ideal ways to store a psp?
- cool - not too humid
- avoid direct sunlight/UV
- preferably in an envelope - light protection and cross infection
how do you check the processor performance?
the sensitometric test
what is the sensitometric step wedge test?
A test that allows a comparison between a film developed in fresh chemistry and a film developed with an exhausted developer.
- a step-wedge is used (different metal thicknesses)
- when radiographed you should see from pale grey to black and if step not clear then can indicate an exhausted developer
what is the film developed in fresh chemistry called?
the standard reference film
what is the other sensitometric test can be used? what are the benefits of this test over the step-wedge test?
the ‘pre-exposed’ test
- easier to use
- no operator discrepancies
- results not variable on viewer
What are the 4 IR(ME)R 2000 procedures that are subject to audit?
- patient identification
- clinical evaluation of images
- justification of radiographic examination
- image quality
the most common cause for a pale film image is?
underdeveloped (not enough time in developer)
what is another cause for pale film image other than underdeveloped?
underexposed
What may be the 3 causes of an underdevloped film?
- Too COLD a developer
- Too WEAK a developer (not enough chemicals)
- Too OLD a developer
If underdexposed image what may you see other than a pale image? (1. digital & 2. film)
- blank spot - not enough X-rays hitting it
2. grainy image
which common error with film can lead to and underexposed image?
placing the film in the holder the wrong way so that the X-rays hit the lead foil before the film. (lead pattern)
what are the two possible causes of a dark film image?
overexposed and overdeveloped
how may a film be over developed?
- too HOT a developer
- too STRONG a developer
what may you see in addition to a darker image on a overdeveloped film?
grainy (usually due to too hot a developer)
What will give you a blurred image on film?
movement - patient, film or X-ray tube
what 2 things will give a partial image on film?
- failure to directly centre the collimator
- film only placed partially into developer
excessive bending of a film will give you..?
black lines/crimp mark (sometimes known as finger nail marks)
you see a black star appearance on image, thoughts?
static electricity discharge
when are you likely to get static electricity discharge?
when removing the image receptor from the mouth
is static electricity more common in digital or film image receptor?
digital
Fogging and extreme blackening can be cause by what? 3 things
- storage in adverse conditions
- out of date film
- film exposed to white light (commonly before going into processor)
what is a green colour in an image usually caused by? give something else it can be caused by
not enough time to fix during processing but sometimes due to being inadequately washed
clear chemical splashing indicates..
fix splashing on film be processing
a dark chemical splash indicates…
an issue with the developer
if the wash has not worked properly what might you see and how will the film feel?
the map of gb example and will feel rough
a double exposure will cause…
two images to be superimposed upon each other as the receptor used twice
how to avoid double exposure
always put used receptors separate to the unused when taking radiographs on the same patient
for digital, a scratch would appear to be…
thin white line on psp
for digital, the phosphor coating delaminating will look like…
white areas at the edge of the psp
for digital, an area of white ‘burn out’ could be caused by… 2 things
- underexposed
2. plate pre-exposed to light before X-rays hit
for digital, a grainy image is indicatory of..
underexposure
for digital, dust in the scanner at laser level will cause a..
fine uniform (microscopically zig-zag) line
for digital, white cured areas at the corner indicates…
psp corner folded over in mouth
for digital, a finger print will look like..
a paler finger shaped area
for digital, darker curved areas at the corner indicates..
damage to photocells in solid state sensor only
for digital, a bend across the psp will give a..
pale area after bend
for digital, if the psp has been exposed to heat it will look like..
a ‘marble’ effect
if a line is running down a psp image and is not uniform then this indicates..
physical damage
a small white dot will indicate..
a bite mark
the wire over the solid state sensor will cause…
a white line
for DPT, a slight rotation from R to L is cause by..
mid sagittal plane not aligned properly - making one side look larger and more exposed.
for DPT, chin up will cause
a sad looking occlusion
for DPT, chin down will cause a..
smile looking occlusion
for DPT, what is the issue with earring etc..
they create a ghost shadow which will be overlying some teeth which can cause issues for diagnosis
what is the coin test used for?
to test the overall safety of safe lights
“blooming” on a digital receptor can be caused by what…
overexposure of a CCD type solid state sensor
