Quality Management

A broad term which encompasses both quality assurance and quality improvement, describing a program of evaluating the quality of care

using a variety of methodologies and techniques

This may entail going beyond commonly accepted standards to striving for stricter yet

generally achievable performance levels

Reasons for Inspections

State regulatory requirement 3rd party payer requirement Employer expectations Standards of good practice

It is not uncommon that “inspections” include the minimum set of tests and evaluations needed to

fulfill the expectation or legal requirement (perhaps due to time constraints and priorities)

Philosophy of Inspections

The goal of radiographic and fluoroscopic (R/F) inspections should be to provide value by evaluating and (if necessary) improving:

radiation safety image quality image consistency

Quality Assurance

A planned and systematic pattern of all actions necessary to provide adequate confidence that the item or product conforms to established technical requirements.

Identifies problems Monitors problems Resolves problems

Quality Control The operational techniques and the activities used to fulfill and

verify requirements of quality.

Inspection, analysis and action required to ensure quality of output.

A procedure for keeping quality of inputs or outputs to specifications.

Techniques ensuring that high quality is maintained through various stages of a process. For example, quality control during image capture might include comparing the scanned image to the original.

The control of variation of workmanship, processes, and materials in order to produce a consistent, uniform product.

Sources of Requirements/Guidelines

ACMPACRAAPMNCRPCriteriaRadiographic and Fluoroscopic Units

AnnualAnnualAnnualAnnualCFRVisual Inspection/generalAnnualAnnualAnnualSemiannCFRCollimation:AnnualAnnualAnnualSemiannCFRPBL (if so equiped) AnnualAnnualAnnualAnnualGrid alignment and focusing

--- --- AnnualAnnualCFRLight field illuminationAnnualAnnualAnnualAnnualCFRHalf-value LayerAnnualAnnualAnnualAnnualCFRExposure timer accuracyAnnualAnnualAnnualAnnualCFRExposure reproducibilityAnnualAnnualAnnualAnnualExposure rates (mR/mAs):AnnualAnnualAnnualAnnualCFRmA/mAs Linearity:# 0.1AnnualAnnualAnnualAnnualkVp accuracyAnnual--- NewNewFocal spot sizeAnnualAnnualAnnualAnnualCFRSID Indication AccuracyAnnualAnnualAnnualSemiannAEC (phototiming):

AnnualAnnualAnnualCFRFluoro min source-skin distanceAnnualAnnualAnnualSemiannCFRMax fluoro entrance exposure rates (EER) AnnualAnnualAnnualSemiannTypical EER measurementsAnnualAnnualAnnualSemiannSpot film exposures and rates AnnualAnnualAnnualSemiannAutomatic brightness control functionAnnualAnnualAnnualSemiannFluoro resolution and sensitivity

----AnnualAnnualSemiannFluoro/TV system lag, flare

GUIDELINES

NCRP Report No 102

Manufactureres

Radiographers Oregon Board of Radiologic Technology ARRT

WHO MAKE IT WORK

RADIOGRAPHERS QC TECHNOLOGISTS SERVICE ENGINEERS MEDICAL PHYSICIST

ELEMENTS OF A TYPICAL QUALITY CONTROL PROGRAMVisual Inspections

kVp accuracy testing

mA linearity testing

Timer accuracy testing

Focal spot size test

X-ray beam/light field/Bucky tray alignment evaluation

Intensified screen cleaning and testing

Illuminator cleaning and evaluation

Processor maintenance and control

X-ray evaluation of lead aprons and gloves

Visual Inspection

Visually evident deficiencies often ignored/worked around by staff

Reporting deficiencies often leads to corrective actions

Include:Lights/LEDs workingProper technique indication Locks and interlocks workNo broken/loose dials,

knobsAny obvious electrical or

mechanical defects

Measuring kV: Yesterday

Measuring kVp: Today

mA Linearity

TIMER ACCURACY

Timer Accuracy

Focal Spot Size

Collimation: Congruence

Collimation: Congruence

Simple tools can suffice Relatively frequent issue,

particularly for portables Some uncertainty in

marking light field edges CFR Criteria: 2% of SID for

L/X congruence and indicator accuracy (1.5” at 72” SID !!)

OTHER

CASSETTES: EXTERIOR

SCREENS VISUALLY INSPECTED

ILLUMINATION LIGHT METER

LEAD APRONS AND GLOVES REPEAT RATES

CR/DR QC

Daily Density Check CR Cassettes IP plates

FOCUS – PDCA METHOD

Find and define a problemOrganize a team to work on the improvementClarify the problem with current knowledgeUnderstand the problem and its causesSelect a method to improve the processPlan implementationDo the implementation and measure change.Check the resultsAct to continue improvements

MONITORING IMAGES

PROCESSING SYSTEMS

REDUCES DOWN TIMEREDUCES NUMBER OF REPEATSREDUCES PATIENT DOSEREDUCES PATIENT WAITING TIMESREDUCES COSTSINCREASES CONFIDENCE IN PROFESSIONBOOSTS DEPARTMENT MORALE

EXTERNAL BEAM EVALUATION