Ensuring Quality in PACS

What is the first thing that comes to mind when you think of quality?

Quality Assurance Can be defined as a plan for the systematic observation and assessment of the different aspects of a project, service, or facility to make certain that standards of quality are being met. QA activities are focused around “people and service”.

Quality Control Can be defined as a comprehensive set of activities designed to monitor and maintain systems that produce a product. There are three major categories of QC testing. 1)Acceptance testing: Performed before newly installed or majorly repaired equipment. 2)Routine Maintenance: Performed to ensure that the equipment is performing as expected. 3)Error Maintenance: When errors occur in equipment performance, corrective action must occur.

PACS Equipment QC  Documentation is very important in any QC activity, and it must be kept up to date to make a valid performance measure.  The ACR(American College of Radiology) suggests that all the quality tests must be carried out with a SMPTE(Society of Motion Pictures and Television Engineer’s) test pattern.  Test patterns have recently been developed by the AAPM(American Association of Physicists in Medicine) which are now being accepted for use in QC testing.

Example SMPTE test Pattern

Spatial Resolution Test Pattern

AGFA Test Pattern

Monitor Quality The monitor is often the weakest link in the digital imaging chain. The monitor has a direct effect on the quality of the image that is presented to the radiologist for reading or to the referring physician for review. Generally, the physician review workstations and the technologist QC work stations have high quality commercial monitors. They usually have a resolution of 1K.

Daily/Monthly Monitor QC I.Turn on the monitor, and allow it ample time to warm up. II.Make sure the monitor is dust free and near the air-flow areas. III.Retrieve a QC monitor test pattern. IV.Test for geometric distortions using a SMPTE test pattern. V.Test for reflection: determine whether other light sources are reflecting back off the monitor.

Printer Image Quality Besides the PACS, the printed image in another was to distribute images around the hospital. There are several steps that should be taken to ensure that the image being seen is of constant quality. Two different types of imaging systems: 1.Wet laser imager. 2.Dry laser imager.

Example Wet Laser Imager

Example Dry Laser Printed

PACS CQI Continuous quality improvement (CQI) should be monitored weekly/monthly/quarterly to make sure that the PACS is functioning up to its capabilities. Remember that CQI activities revolve around process rather then people and systems. Each PACS vender may have different activities that they recommend.

Summary QA can be defined as a plan for the systematic observation and assessment of the different aspects of a project, service, or facility to make certain that standards of quality are being met. QC can be defined as a comprehensive set of activities designed to monitor and maintain systems that produce a product.

Summary (cont.) 1)Acceptance testing: Performed before newly installed or majorly repaired equipment. 2)Routine Maintenance: Performed to ensure that the equipment is performing as expected. 3)Error Maintenance: When errors occur in equipment performance, corrective action must occur.

Summary (cont.) Important abbreviations to remember: 1.ACR – American College of Radiology 2.SMPTE – Society of Motion Pictures and Television Engineer’s 3.AAPM – American Association of Physicists in Medicine 4.CQI – Continuous Quality Improvement 5.S.R. – Spatial Resolution