For midterm

Topics to be covered  Repeat Analysis  Analysis Of Reject Versus Repeated Films  Determination Of Rejection Rate  Distribution Of Rejected Film  Guide To Good Practice

The desired outcome of a diagnostic x-ray study is the creation of an acceptable diagnostic image, a correct diagnosis, and the satisfaction of all internal and external customer.

 Quality control testing can only minimize the risk of obtaining sub- quality images but cannot prevent them entirely.  Quality management program must also include looking at the final outcome of a diagnostic x-ray procedure and determining the quality of outcome to see if further improvement can be achieved.

Outcome assessment  Repeat analysis of images  Artifact analysis of images  Accuracy, sensitivity and specificity analysis of diagnosis.

Repeat analysis It is a systematic process of cataloging rejected films and determining the nature of the repeat so that repeat images can be minimized or eliminated in the future

Importance of repeat analysis  It provides knowledge of data about: Equipment and accessory performance Departmental procedures Skill level of the technical staff  With this knowledge, solutions can be found to minimize repeats and also document the effectiveness of quality control and quality assurance protocols

Advantages  Repeat analysis can show how many repeats in the depart w/c in turns address the party concerns of what are the problems.  With lower department repeat rates: Improved department efficiency Lower department cost Lower patient doses

Improved department efficiency  With number of repeats are kept low, the amount of time that patient must spend undergoing diagnostic procedures decreases.  This in turns increases patient satisfaction and allows the department to service more patients in the same period.

Lower department costs  When the number of repeats are reduced, the costs associated with film, processing, labor and depreciation of the equipment decrease significantly.

Lower patient doses  Images that are unacceptable results in the repeat of the particular view, which means that the patient must be re-exposed to ionizing radiation.

Causal Repeat rate  In repeat analysis studies performed on departments without quality control procedures for the darkroom, processor and equipment, 75% of all repeats were caused by improper optical density of film.  With quality control protocol in place, studies shows that most repeats are results of positioning errors.

National average of repeat causes for departments with quality control procedures Category% Repeat Positioning30 Light films14 Misc. (artifacts)14 Darkrooms11 Black films9 Tomography scouts8 Fog5 Patient motion5 Mechanical problems4

Repeat analysis  For a study to be done, a worksheet for radiographic imaging departments should be used, so that the proper statistical information is obtained and recorded.

Worksheet  A worksheet should include the radiographic procedures performed in the department, along with the possible causes of rejection, such as positioning, overexposure, under exposure, motion, artifacts, and miscellaneous causes

Causal repeat rate  The causal repeat rate is the percentage of repeats from a specific cause and is calculated with the following equation: Causal repeat = rate Number of repeats for a specific cause Total Number of repeats X 100

Example  A total repeat of a department has 200 films in a month, and 90 out of 200 films are the result of positioning errors.  So the percent of repeats caused by positioning error is 45% of the total repeat films.

Total repeat rate  The total department repeat rate is determined with the following equation: Total repeat rate = Number of repeat films Total number of views taken X 100

Example  If a department has a total of 2300 views during a month and has incurred a 300 rejected film.  A 13% percent the department has incurred in a month

 Department repeat rates should not exceed 4% to 6% and should be less that 2% for mammographic procedures.  Any department exceeding 10% to 12% should be examined seriously, because of inefficiency and contribute to high patient dose.

 For a department to evaluate its efficiency a worksheet should be used for any repeat film.  As a QA/QC officers a worksheet can aide in identifying problems if it is mechanical/technical or by human errors.

Laboratory Exercise  Instruction Each group are assigned with a number of films. Analyze the films. After analyzing the films, the film should be rotated to other groups for analysis.

Survey period to location repeat category examinati on PositionOver- exposed Under- expose MotionArtifactsOtherTotal% UGI % Ba. Enema % IVP % OTHER % TOTAL %29%6%7%23%28%8% Total films viewed 1320Total repeat 144TotalRepeatRate11%