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TABLE OF CONTENTS

0 INTRODUCTION........................................................................................................................................ 1
0.1 HOW TO USE THE GUIDE ........................................................................................................................ 3
1 PROCUREMENT ....................................................................................................................................... 5
1.1 PROCUREMENT READINESS .................................................................................................................... 5
1.1.1 Strategic Plan and Policies ........................................................................................................... 6
1.1.2 Readiness Factors ........................................................................................................................ 7
1.1.3 Needs Analysis ............................................................................................................................. 9
1.2 VENDOR SELECTION PROCESS ............................................................................................................. 11
1.2.1 Request for Proposal (RFP) ....................................................................................................... 11
1.2.2 RFP Analysis .............................................................................................................................. 14
1.3 VENDOR CONTRACT NEGOTIATIONS ..................................................................................................... 15
1.3.1 Contract Components................................................................................................................. 15
1.3.2 Contract Negotiation ................................................................................................................... 17
ESSAY QUESTIONS:.................................................................................................................................... 20
TEST QUESTIONS..................................................................................................................................... 21
2 PROJECT MANAGEMENT ..................................................................................................................... 25
2.1 PROJECT SCOPE AND GOALS ............................................................................................................... 25
2.1.1 Project Clarification ..................................................................................................................... 26
2.1.2 Project Risks ............................................................................................................................... 27
2.2 PROJECT FEASIBILITY .......................................................................................................................... 28
2.2.1 Needs Assessment ..................................................................................................................... 29
2.2.2 Financial Assessment................................................................................................................. 30
2.3 PROJECT MANAGEMENT TOOLS ............................................................................................................ 32
2.3.1 Implementation Forms ................................................................................................................ 33
2.3.2 Financial Documentation ............................................................................................................ 35
ESSAY QUESTIONS:.................................................................................................................................... 37
TEST QUESTIONS..................................................................................................................................... 38
3 OPERATIONS ......................................................................................................................................... 41
3.1 QUALITY IMPROVEMENT AND ASSURANCE (QI/QA)................................................................................ 41
3.1.1 Basis of QI/QA ............................................................................................................................ 42
3.1.2 QI Strategies ............................................................................................................................... 44
3.1.3 QI/QA Tools ................................................................................................................................ 45
3.1.4 QI/QA Areas................................................................................................................................ 47
3.2 POLICIES AND PROCEDURES ................................................................................................................ 49
3.2.1 IT System QI/QA......................................................................................................................... 49
3.2.2 User QI/QA ................................................................................................................................. 51
3.3 FEDERAL COMPLIANCE ......................................................................................................................... 52
3.3.1 HIPAA Compliance ..................................................................................................................... 52
3.3.2 MQSA ......................................................................................................................................... 54
ESSAY QUESTIONS:.................................................................................................................................... 56
TEST QUESTIONS..................................................................................................................................... 57
4 COMMUNICATIONS ............................................................................................................................... 61
4.1 HEALTHCARE ROLES AND RELATIONSHIPS ............................................................................................ 62
4.1.1 Organizational Structure ............................................................................................................. 62
4.1.2 Medical Specialties ..................................................................................................................... 63
4.1.3 Organizational Theory ................................................................................................................ 65
4.1.4 Customer Service ....................................................................................................................... 66
4.2 MEDICAL TERMINOLOGY ....................................................................................................................... 67
4.2.1 Anatomy, Pathology, and Physiology ......................................................................................... 68
4.2.2 Radiographic Positions ............................................................................................................... 69
4.2.3 Imaging Planes ........................................................................................................................... 71
4.2.4 ICD and CPT Coding .................................................................................................................. 73
4.2.5 Imaging Modalities ...................................................................................................................... 74
4.3 CLINICAL ALERTS ................................................................................................................................. 76
4.3.1 System Downtime ....................................................................................................................... 76
4.3.2 System Upgrades ....................................................................................................................... 77
4.3.3 Workflow Changes...................................................................................................................... 79
4.3.4 Alert Methods.............................................................................................................................. 80
4.3.5 Alert Planning and Implementation............................................................................................. 81
4.4 SYSTEM CHANGE INFORMATION............................................................................................................ 82
4.4.1 Planning ...................................................................................................................................... 82
4.4.2 Managing Technology/Procedure Changes ............................................................................... 83
4.4.3 Analyzing Outcomes ................................................................................................................... 84
4.5 USER FEEDBACK.................................................................................................................................. 86
4.5.1 User Feedback Tools.................................................................................................................. 86
4.5.2 Survey Methodology ................................................................................................................... 87
ESSAY QUESTIONS:.................................................................................................................................... 89
TEST QUESTIONS..................................................................................................................................... 90
5 TRAINING AND EDUCATION ................................................................................................................ 93
5.1 EDUCATIONAL NEEDS ASSESSMENT ..................................................................................................... 93
5.1.1 Learner Types............................................................................................................................. 94
5.1.2 Learning Styles ........................................................................................................................... 95
5.1.3 Learning Methods ....................................................................................................................... 96
5.1.4 Learning Objectives .................................................................................................................... 98
5.2 EDUCATION PROGRAM EVALUATION AND SELECTION ............................................................................. 99
5.2.1 Adult Education Characteristics.................................................................................................. 99
5.2.2 Education Methods ................................................................................................................... 100
5.2.3 Education Tools ........................................................................................................................ 102
5.2.4 Education Resources................................................................................................................ 103
5.3 EDUCATIONAL PROGRAM IMPLEMENTATION ......................................................................................... 105
5.3.1 Training Types .......................................................................................................................... 105
5.3.2 Organization Training Resources ............................................................................................. 106
5.4 EDUCATION EVALUATION .................................................................................................................... 108
5.4.1 Assessment Methods ............................................................................................................... 108
ESSAY QUESTIONS:.................................................................................................................................. 110
TEST QUESTIONS................................................................................................................................... 111
6 IMAGE MANAGEMENT ........................................................................................................................ 115
6.1 IMAGE VIEWING AND INTERPRETATION ENVIRONMENT .......................................................................... 116
6.1.1 Ergonomics ............................................................................................................................... 116
6.1.2 Physical Environment ............................................................................................................... 117
6.1.3 Physical Layout......................................................................................................................... 119
6.2 IMAGE SYSTEM INTERFACES ............................................................................................................... 120
6.2.1 EMR, RIS, PACS and Dictation Integration.............................................................................. 121
6.2.2 Usability Considerations ........................................................................................................... 123
6.2.3 Key Image Selection/Image Annotation ................................................................................... 124
6.2.4 Input Devices ............................................................................................................................ 126
6.2.5 Display Devices ........................................................................................................................ 127
6.3 OPTIMIZING IMAGE PROCESS AND WORKFLOW .................................................................................... 128
6.3.1 Post Acquisition Processing ..................................................................................................... 129
6.3.2 Compression............................................................................................................................. 131
6.3.3 Image Workflow ........................................................................................................................ 133
6.3.4 Teaching Files........................................................................................................................... 134
6.3.5 Clinical Trials............................................................................................................................. 136
6.3.6 Acquisition and Display Terminology........................................................................................ 137
6.3.7 Image Reporting and Results Communication ......................................................................... 139
6.4 IMPORTING AND EXPORTING STUDIES ................................................................................................. 141
6.4.1 Policies and Procedures ........................................................................................................... 141
6.4.2 IHE and PDI .............................................................................................................................. 142
6.4.3 Data Integrity............................................................................................................................. 143
6.4.4 Recording and Digitizing Technology ....................................................................................... 145
6.4.5 File Exchange Standards.......................................................................................................... 146
ESSAY QUESTIONS:.................................................................................................................................. 148
TEST QUESTIONS................................................................................................................................... 149
7 INFORMATION TECHNOLOGY ........................................................................................................... 153
7.1 STORAGE AND ARCHIVE ASSESSMENT AND ARCHITECTURE ................................................................. 154
7.1.1 Storage Architecture ................................................................................................................. 154
7.1.2 Network Storage Protocols ....................................................................................................... 156
7.1.3 Storage Media........................................................................................................................... 158
7.1.4 Storage Management Methods ................................................................................................ 159
7.1.5 Archive and Storage Metrics..................................................................................................... 160
7.2 NETWORK DESIGN AND ARCHITECTURE .............................................................................................. 162
7.2.1 Network Protocols..................................................................................................................... 162
7.2.2 Data Transmission Protocols.................................................................................................... 164
7.2.3 Fault Tolerance and Load Balancing ........................................................................................ 166
7.2.4 Network and Hardware Components........................................................................................ 167
7.2.5 Network Configuration .............................................................................................................. 169
7.2.6 Network Metrics ........................................................................................................................ 170
7.3 HARD- SOFT-WARE IMPLEMENTATION AND MAINTENANCE .................................................................... 172
7.3.1 Hardware .................................................................................................................................. 172
7.3.2 Software.................................................................................................................................... 173
7.3.3 Server Architecture ................................................................................................................... 175
7.4 DATABASE UTILIZATION ...................................................................................................................... 176
7.4.1 SQL........................................................................................................................................... 176
7.4.2 Performance Indicators............................................................................................................. 178
7.4.3 Database Design ...................................................................................................................... 180
7.4.4 Dashboards............................................................................................................................... 181
7.5 IT STANDARDS AND IMPLEMENTATION ................................................................................................. 182
7.5.1 Standards Identification ............................................................................................................ 182
7.5.2 XML over HTTP ........................................................................................................................ 184
7.5.3 W3C .......................................................................................................................................... 186
7.6 IT REPLACEMENT SCHEDULE.............................................................................................................. 187
7.6.1 Obsolescence Planning ............................................................................................................ 187
7.6.2 Technology Lifetime.................................................................................................................. 188
7.6.3 Moores Law.............................................................................................................................. 189
ESSAY QUESTIONS:.................................................................................................................................. 191
TEST QUESTIONS................................................................................................................................... 192
8 SYSTEMS MANAGEMENT................................................................................................................... 195
8.1 SYSTEM CAPACITY AND THROUGHPUT REQUIREMENTS ....................................................................... 196
8.1.1 Calculating Study Size.............................................................................................................. 196
8.1.2 Scalability.................................................................................................................................. 198
8.1.3 New Technology Implications ................................................................................................... 199
8.1.4 Licensing Models ...................................................................................................................... 201
8.2 DISASTER RECOVERY AND BUSINESS CONTINUITY STRATEGIES ........................................................... 202
8.2.1 Policies and Procedures ........................................................................................................... 202
8.2.2 FMEA ........................................................................................................................................ 204
8.2.3 System and Data Recovery ...................................................................................................... 205
8.3 SYSTEM AVAILABILITY TOOLS AND STRATEGIES ................................................................................... 207
8.3.1 Availability Monitoring and Problem Detection ......................................................................... 207
8.3.2 Troubleshooting ........................................................................................................................ 208
8.4 DATA MIGRATION PLANNING ............................................................................................................... 210
8.4.1 Migration Strategies .................................................................................................................. 210
8.4.2 Data Transfer Considerations................................................................................................... 211
8.4.3 Data Integrity and DICOM ........................................................................................................ 213
8.4.4 Work Product Migrations .......................................................................................................... 214
8.4.5 Cost and Performance Modeling .............................................................................................. 215
8.4.6 User Impact............................................................................................................................... 216
8.5 IT DATA SECURITY AND PRIVACY ........................................................................................................ 217
8.5.1 Standards, Policies and Guidelines .......................................................................................... 218
8.5.2 Security Requirements and Strategies .....................................................................................220
8.5.3 Privacy Requirements and Strategies ......................................................................................221
ESSAY QUESTIONS:.................................................................................................................................. 223
TEST QUESTIONS................................................................................................................................... 224
9 CLINICAL ENGINEERING .................................................................................................................... 227
9.1 IMAGING CAPABILITY ASSESSMENT ..................................................................................................... 228
9.1.1 DR, CR and Mammography ..................................................................................................... 228
9.1.2 Fluoroscopy .............................................................................................................................. 230
9.1.3 Interventional Radiography and Cardiology ............................................................................. 231
9.1.4 CT ............................................................................................................................................. 233
9.1.5 MRI ........................................................................................................................................... 235
9.1.6 Ultrasound................................................................................................................................. 237
9.1.7 NM, SPECT and PET/CT ......................................................................................................... 238
9.1.8 Radiation Therapy..................................................................................................................... 241
9.1.9 Other Imaging Domains............................................................................................................ 243
9.2 MODALITY INTEGRATION SUPERVISION ................................................................................................ 244
9.2.1 DICOM Configuration ............................................................................................................... 244
9.2.2 DICOM Validation ..................................................................................................................... 247
9.2.3 DICOM Transfer Syntax ........................................................................................................... 248
9.2.4 DICOM Tools ............................................................................................................................ 249
9.3 IMAGE DISPLAY QA............................................................................................................................ 251
9.3.1 GSDF ........................................................................................................................................ 251
9.3.2 AAPM TG-18............................................................................................................................. 253
9.4 HEALTHCARE ENVIRONMENTAL HAZARDS............................................................................................ 254
9.4.1 Electrical Hazards ..................................................................................................................... 254
9.4.2 Radiation Safety........................................................................................................................ 255
9.4.3 Magnetic Fields......................................................................................................................... 256
9.4.4 Biohazards and Infection .......................................................................................................... 258
9.4.5 Sterile Fields ............................................................................................................................. 258
ESSAY QUESTIONS:.................................................................................................................................. 260
TEST QUESTIONS................................................................................................................................... 261
10 MEDICAL INFORMATICS................................................................................................................... 265
10.1 STANDARDS IMPLEMENTATION .......................................................................................................... 265
10.1.1 DICOM .................................................................................................................................... 266
10.1.2 HL7 ......................................................................................................................................... 269
10.1.3 MQSA ..................................................................................................................................... 271
10.1.4 ACR ........................................................................................................................................ 272
10.1.5 ICD-9, CPT and SNOMED-CT ............................................................................................... 274
10.2 IHE GUIDELINES .............................................................................................................................. 276
10.2.1 Integration Profiles .................................................................................................................. 276
10.2.2 IHE Connectathon................................................................................................................... 280
10.3 ENTERPRISE IMAGE ARCHITECTURE IMPLEMENTATION ....................................................................... 281
10.3.1 Enterprise Archiving................................................................................................................ 281
10.3.2 MPI.......................................................................................................................................... 283
10.3.3 RHIO ....................................................................................................................................... 284
10.3.4 Enterprise Imaging Specialties ............................................................................................... 285
ESSAY QUESTIONS:.................................................................................................................................. 288
TEST QUESTIONS................................................................................................................................... 289
ANSWERS TO EXERCISES .................................................................................................................... 293
TEST QUESTIONS ANSWER KEY ......................................................................................................... 319
SAMPLE EXAM........................................................................................................................................ 321
SAMPLE EXAM ANSWER KEY .............................................................................................................. 341
STUDY GUIDE MAP................................................................................................................................. 343

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