Quality assurance programs radiology

The expenses on personnel, test equipment, and test images are offset by savings on repeat imaging and use of supplies, lower workload, increased lifespan of equipment, and greater workflow efficiency and patient throughput.

The radiology quality assurance program at a healthcare facility is designed to ensure optimal performance by all equipment and every radiographer. This is of immense value in reducing radiation dose, improving the information obtained from images, and lowering operational costs. Poor equipment performance is a significant cause of poor image quality. Poor quality images do not provide all the possible diagnostic information to providers.

In addition, poor image quality may lead to repeat imaging and therefore increased radiation exposure and cost. Finally, when radiographs of inadequate quality are produced due to poor equipment performance or suboptimal technique, the patient may be exposed to unnecessary radiation.

Therefore, a good quality control program is extremely important for the delivery of quality healthcare. Radiologic technologists should familiarize themselves with the following aspects of the radiology quality assurance program at their facility:. Quality control tests and procedures for X-ray equipment are designed to verify the mechanical stability of the device and the integrity of the safety mechanisms, such as interlocks and audio alarms.

In addition, QC tests verify the performance of display monitors and other ancillary equipment. Importantly, of course, the diagnostic performance of the system is tested, including a measurement of radiation dose.

This is all a part of the radiology quality assurance program. Daily quality control tests for digital radiography equipment include equipment warm up of all components routinely used during imaging, including display monitors and printers. Warm up must be performed every time the equipment has been idle for a period of time. Set up the examination room for the proper procedure by making sure the radiographic tube, table, and other items are in a position that facilitates moving the patient into the room and into position for the examination.

Explain to the patient that you are locating the exact area to be imaged; then touch gently as you position them. Provide comfort items as necessary, such as sponges to assist in holding uncomfortable positions and pillows and sheets for modesty. The radiology department administration is usually very interested in how staff technologists deal with patient problems.

Managers might use any of the following techniques to discover the quality of patient care. Observing other technologists at their jobs is often a good way to see if patients are comfortable, properly dressed, properly protected from radiation, and treated courteously. Informal discussions with patients who are waiting for radiographic examination results are an excellent way to discover how they were treated.

Formal written comments are also sometimes requested. An in-service workshop on patient care or an informal discussion about dealing with patient problems often brings to light particular problems with which radiologic technologists need help. All of these techniques help managers discover the quality of patient care services in radiology. Quality Assurance in Radiology. Image Processing Radiographic Equipment. Key terms Acceptance limits exposure factors image processing positioning skills scope of practice.

Administrative pyramid Most radiology departments operate under a pyramidal administrative structure. Patient You will encounter a significant number of roadblocks in your efforts to achieve an optimal quality rating. Psychologic and Emotional Aspects You should learn to evaluate your patients before you begin to prepare them for examination. Purchase Specifications and Acceptance Testing Before purchasing new equipment, the facility is encouraged to determine the desired performance specifications for any new equipment including film, screens, and chemistry.

Cassette Maintenance Cassettes and screens shall be maintained to minimize the occurrence of artifacts. FDA Acceptance Testing of Radiological Imaging Equipment. Edmons, British Journal of Radiology, 57 Quality Control in Diagnostic Radiology. Burns, Radiologic Technology, 54, Evaluation of Cassette Performance. Schmidt, Radiology, March Performance Specifications for Diagnostic X-ray Exposure. Hendee, et. Physics of Medical Imaging. Edited by A. Haus, AAPM Quality Control in Diagnostic Imaging.

Gary, Winkler, Stears, and Frank. Aspen Publishers, Rockville, MD Quality Assurance for Diagnostic Imaging Equipment. Quality Assurance in Diagnostic Radiology. McLemore, Yearbook Medical Radiographic Latent Image Processing. Radiologic Science for Technologist. Bushong, Mosby Company Center light field to the center of the cassette at a 40" cm SID.

Collimate beam to approximately a 5"x7" beam. Mark the four sides of the light field. One method is to place two pennies together so that the pennies touch at the edge of the light field. Do this on each of the four sides.

Facing the film, place a penny in the light field to identify the lower right corner of the film. Expose and develop the film. Examine each of the four sides of the exposed film. The inside pennies closest to the center of the field shall lie partially or completely in the radiation field.

The outside pennies may partially lie in the exposed field but no outside penny may be fully covered by the radiation field. Misalignment in either dimension horizontal misalignment is the sum of the deviation of the right and left edges, vertical misalignment is the sum of the top and bottom edges cannot exceed 0. Appendix C Positive Beam Limitation Sizing Purpose To assure that the automatic collimation system adjusts to the cassette size used.

Procedures Place the empty, smaller cassette in the bucky tray. Check that the collimator is in the automatic mode. Set the SID to 40" and lock the vertical travel of the tube suspension. Place the loaded, larger cassette on the tabletop. Center the tube longitudinally and transversely, check that the x-ray tube is perpendicular to the cassette. Activate the light localizer and center the x-ray tube to the bucky tray. Make sure that the cassette on the tabletop is centered as well.

Make an exposure and process the film from the larger cassette. If the exposed field size from the larger cassette does not exceed the film size in the bucky tray, the PBL system meets requirements. If the exposed field size from the larger cassette exceeds the film size for the cassette in the bucky tray, then triangulation utilizing the exposed film from the large cassette must be done to determine the actual field size at the bucky tray.

Triangulation Measure the x-ray field along the table on the tabletop film and record. Measure the x-ray field across the table on the tabletop film and record. W1 - measured width of the x-ray field on the table top film. D1 - measured source to tabletop distance. D2 - the indicated SID of the unit 40". L2 - length of the x-ray field at the plane of the film in the bucky tray D1 - measured source to tabletop distance. Make sure that the x-ray tube is centered to the table using the transverse locking mechanism on the x-ray tube.

Center the bucky tray to the collimator centering light. Set x-ray tube to 40" SID. Manually collimate light field to leave to 1 inch border on the film. This will leave an unexposed border on the film after processing. Expose and process the film. To find the center of the film, place a ruler at opposite corners of the film and draw a line.

The point where the two lines cross is the center of the film. Because film has rounded edges, some estimating will have to be done when positioning the ruler in opposite corners.

To find the center of the exposed portion of the film, place the ruler at opposite corners of the exposed portion of the film and draw a line. The point where the two lines cross is the center of the exposed field. Measure the distance between the center point of the film and the center point of the exposed field. Record this information. Equipment Needed Rejected radiographs and a count of the total number of films consumed during the survey period.

Procedure Start the test with an empty reject film container. Establish a method to accurately determine the amount of raw film consumed starting on the day that you collect the reject film. Decide on the length of the survey period. The facilitators are senior radiology residents who perform the same duties as the navigators on nights and weekends, when fewer staff radiologists and residents are available to read all of the ED and inpatient exams.

In addition to answering the phone, the facilitators protocol imaging studies performed at UMMC during nights and weekends and assist with consultations on outside imaging from referring hospitals. This makes the interpretation more efficient and provides a quicker answer to the clinical question. Araujo and his team are in the process of data mining to determine how much turnaround times have improved since the navigators and facilitators joined the department.

Forming Partnerships With the success of these programs, the quality and safety team is working to expand some of its existing projects where needed and launch new initiatives to further enhance patient care. Through these multifaceted quality and safety projects, Araujo and his team have elevated the UMMC radiology department from a place where imaging exams are simply interpreted to a critical junction along the path to coordinated care.

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