1. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol Quality assurance of Imaging 23 rd April 2013 Author: G Davies

2. Quality Assurance of Imaging The UK NSC has stated that QA is an essential component of any national screening programme QA processes aim to ensure that the whole screening pathway is functional and safe Screening incurs a reverse ethical position where an approach is made to an apparently healthy person, with the implication of benefit. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

3. Quality Assurance of Imaging In order to ensure a safe and effective service It is imperative that screeners are –trained to the highest standard –continue to be monitored to ensure the quality of the images they take Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

4. Quality Assurance of Imaging WAAASP QA procedures will ensure that there are All Wales and regional components to achieve all of the following: Error prevention and effective management of risks and untoward incidents Year on year performance assessment and, where appropriate, improvement Maintenance of clear responsibility for different aspects of screening and the flow of information between those involved in running different components of the screening programme. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

5. Quality Assurance of Imaging The processes for QA of ultrasound scans performed by WAAASP staff will include assessment of a proportion of USS scans within both –the screening programme –the surveillance programme. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

6. Quality Assurance of Imaging The QA process will be subdivided into a review of scans –measuring less than 3 cms –scans of measurements of more than 3cms –non-visualised aortic scans. All WAAASP staff that perform ultrasound scans will be included in the WAAASP QA process. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

7. Quality Assurance of Imaging Ultrasound scans of <3cms aortic diameter Each WAAASP staff to have 20 random scans of less than 3cms aortic diameter reviewed at least every 3 months by the QA Radiologist A Standard Image Assessment pro-forma for scans less than 3cms aortic diameter will be used to ensure consistency of assessment Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

8. Quality Assurance of Imaging Standard Image Assessment pro-forma for abdominal aortic ultrasound scans where the abdominal aorta measures less than 3cms in diameter. QA Assessor ID Date Screener ID Date of scan Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol No.Image CriteriaDesired Image Criteria for WAAASPImage Criteria met YesNo 1.NHS number and ID Correct man's name and NHS number 2.Caliper placement Set in TRUE AP plane in LS & TS Inner to inner measurement 3.Depth settingAorta in centre of image – appropriately sized 4.Focus settingSet correctly at or just below the ROI 5.Image quality/ Grey scale Overall Gain and TGC set to provide even greyscale throughout depth of image with no over or under amplification of Gain

9. Quality Assurance of Imaging QA Assessment Conclusion Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol 1.Meets ALL the desired image criteria for screening purposes (tick) YESNO If NO see below 2. Acceptable image quality for screening purposes but image does not meet ALL the desired image criteria (meets sufficient criteria for screening purposes) YESNO If NO see below 3. Unacceptable image quality for screening purposes YES COMMENT ACTION RECALL PATIENTYESNO

10. Quality Assurance of Imaging Screening scans measuring > 3cms aortic diameter All screening scans measuring > 3cms to be reviewed every 4 weeks by the QA radiologist not only for QA purposes but to check for accuracy and appropriateness of care pathway A Standard Image Assessment pro-forma for abnormal scans must be used to ensure consistency of assessment Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

11. Quality Assurance of Imaging Standard Image Assessment pro-forma for abnormal aortic ultrasound scans where the abdominal aorta is greater than 3cms in diameter Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol No.Image CriteriaDesired Image Criteria for WAAASPImage Criteria met YesNo 1.NHS number and ID Correct man's NHS number and ID 2.Caliper placement Set in TRUE AP plane in LS & TS Inner to inner measurement 3.Depth settingAorta in centre of image – appropriately sized 4.Focus settingSet correctly at or just below the ROI 5.Image quality/ Grey scale Overall Gain and TGC set to provide even greyscale throughout depth of image with no over or under amplification of Gain

12. Quality Assurance of Imaging QA Assessment Conclusion Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol 1.Meets ALL the desired image criteria for screening purposes (tick) YESNO If NO see below 2. Acceptable image quality for screening purposes but image does not meet ALL the desired image criteria (meets sufficient criteria for screening purposes) YESNO If NO see below 3. Unacceptable image quality for screening purposes YES COMMENT ACTION RECALL PATIENTYESNO

13. Quality Assurance of Imaging Surveillance scans 10% of surveillance scans measuring > 3cms and below 5.4cms to be reviewed every three months by the QA radiologist. A Standard Image Assessment pro-forma for surveillance scans will be used to ensure consistency of assessment Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

14. Quality Assurance of Imaging All non-visualised WAAASP scans should be reviewed by the QA radiologist A standard non-visualised proforma to record: WAAASP staff ID number Reasons for non-visualisation Timing of scan USS equipment ID number Clinic location Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

15. Quality Assurance of Imaging If any of the WAAASP staff undertaking ultrasound fails to meet the standards then the following will be offered –Close mentoring and supervision –Retraining –Continuing review of images from random clinic selection. –Review of past images and possible recall of men. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol