2. Unit IV
Analyzing the Image

3. Chapter 33
Quality Management

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Objectives
Define quality assurance and quality control and discuss their relationship to excellence in radiography
Describe process of identifying imaging requirements, selecting equipment, specifications, and training
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Objectives
Describe objectives and responsibilities of monitoring equipment performance
Discuss primary automatic film processor quality control monitoring and maintenance procedures
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Objectives
Discuss primary quality control tests for:
External radiation beam monitoring of diagnostic radiographic systems
Fluoroscopic systems
Tomographic systems
Automatic exposure controls
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Objectives
List primary quality control tests for miscellaneous ancillary equipment, including cassettes and view boxes
Explain rationale behind data collection process and basic analysis of a radiographic repeat-rate study
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Objectives
Describe a basic troubleshooting procedure
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9. Quality Assurance and Quality Control
Regulation and accreditation
Quality assurance
Quality control
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10. Regulation and Accreditation
Radiation Control and Safety Act
1981- Consumer-Patient Radiation Health and Safety Act
Safe Medical Devices Act
Mammography Quality Standards Act
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11. Regulation and Accreditation
Enforced by Center for Devices and Radiological Health (CDRH)
Branch of the Food and Drug Administration (FDA)
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
State and federal reimbursement
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12. Accreditation Agencies
Establish quality standards
Assess them
Provide certification that individual facilities have met quality standards
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Quality Assurance
Evolutionary process that provides quality images and services
Medical, technical, or managerial in nature
Identifies, monitors, and resolves problems
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Monitoring Problems
Establish criteria
Monitor performance
Collect data
Analyze data
Evaluate data
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Quality Control
Aspect of QA that is concerned with the equipment’s technical standards
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Purchasing Equipment
Identification of imaging requirements
Development of equipment specifications
Selection of equipment
Installation and testing of equipment
Continuing education
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17. Identification of Imaging Requirements
Team input
Radiologists, administrators, supervisors, and staff technologists
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18. Development of Equipment Specifications
Person determining specifications must have technical background
Once specifications have been selected, send to vendors for bidding
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19. Selection of Equipment
Compare bids for:
Ability to meet required specifications
Cost
Service
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20. Installation and Acceptance Testing of Equipment
Responsibility of vendor/manufacturer
QC must verify that acceptance testing specification has been met
Include full disclosure of exact evaluation methods in specifications
Provides baseline to reference with future QC testing
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Continuing Education
Applications
QC and education coordinators
Should include orientation and periodic updates
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22. Monitoring Equipment Performance
Monitor quality of image processing systems
Measure quality of external radiation beam
Specify faults within these systems to allow corrective measures to be taken
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Responsibility
Professional service personnel or medical physicists not required
Radiographers can perform necessary daily testing
Initial cost to purchase test equipment
Time must be allotted in technologists work day to complete tests
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Processor Monitoring
Ensures that the processor is operating within proper limits
Can be performed by anyone trained on the equipment used
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Processor Monitoring
Tests include safelight test and processor sensitometry to monitor speed, contrast, and base fog of film
Corrective actions should be made by radiographer or processor maintenance person
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26. External Beam Evaluation
Tests should be performed by a radiographer
Corrective action by authorized service person
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27. Diagnostic Radiographic Systems
Semi-annual schedule
Focal spot size estimation
Half-value layer
Angulator or protractor accuracy
Kilovoltage accuracy
Timer accuracy
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28. Diagnostic Radiographic Systems
Collimator, central ray, and Bucky tray accuracy
Distance and centering indicators’ accuracy
mR/mAs and milliamperage linearity
Exposure reproducibility
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29. Focal Spot Size Estimation
Important for proper recorded detail
Three types of focal spot test tools:
Line pair resolution tools
Star test patterns
Pinhole cameras
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Half-Value Layer
Measured by using dosimetry equipment to determine amount of filtration that will reduce beam intensity to one-half of its original value
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31. Collimator, Central Ray, and Bucky Tray Accuracy
Light field and x-ray beam congruence crucial
+/- 2% of SID allowance
Central ray
1% allowance
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32. Distance and Centering Indicators
Distance indicator
+/- 10%
Centering indicator
+/- 2%
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33. Angulator or Protractor Accuracy
Can be evaluated using a large protractor
+/- 1%
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Kilovoltage Accuracy
Computerized dosimeter
+/- 5%
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Timer Accuracy
Computerized dosimeters
Spinning top
Single phase
Motorized spinning top
Three phase
+/- 5%
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36. mR/mAs and Milliamperage Linearity
mA station accuracy is confirmed by mR/mAs measurement
Computerized dosimeter
+/- 10% between mA stations
+/- 10% between high and low mA stations
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37. Exposure Reproducibility
Computerized dosimeter
+/- 5%
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Fluoroscopic Systems
Exposure reproducibility
Exposure rate
Field size accuracy and beam alignment
Source-to-skin distance limits
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Fluoroscopic Systems
Intensifier viewing system resolution
Intensifier viewing system contrast
TV monitors and recorders
Automatic brightness control
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Tomographic Systems
Uniformity and completeness of motion
Section depth indicator accuracy
Section thickness accuracy
Resolution
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41. Automatic Exposure Controls
Exposure reproducibility
Ion chamber sensitivity
Density variation control accuracy
Response capability
Backup timer verification
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Ancillary Equipment
Cassette cleaning and inspection
Film/screen contact
View Box Uniformity
Display monitors
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PACS Systems
Accuracy of interface between PACS and EMR, HIS, and RIS
Fix-queue
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Repeat Image Studies
Obtaining data
Analysis of data
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Troubleshooting
Diagnostic process
Beginning with assessment of symptoms
Radiographer works through problem-solving process to determine the cause
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