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HISTORY OF QC:
1920s 30s photographic industry
motion picture
photography (colored picture)

76-77 photographic processor QC

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83 book on photographic processor QC 2
 - conformance to requirements

- capacity to achieve goals

- compliance to standards & criteria

based on current knowledge
sound experience

DOING THE RIGHT THING, RIGHT AWAY

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statement of principle
level of desirable

practice or procedure

goal oriented statement

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dimensions used on relevant
measure for evaluation

help to meet goal

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maintaining and formally accounting

for quality & appropriateness of care

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Those planned and systematic
actions necessary to provide
adequate confidence that a
structure, system or component
will perform satisfactorily in
service.
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an organized effort by the staff
operating a facility, to ensure
that the diagnostic images
produced by the facility are
sufficiently high quality so that
they consistently provide adequate
diagnostic information at the lowest
possible cost and the least possible
exposure of the patient to radiation
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 refers to the entire system

rather than individual

processes

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PERFORMANCE
IMPROVEMENT

IMAGE
QUALITY
IMPROVEMENT

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 - requires the dedication & commitment
of management radiologists, technical
staff & support staff

- reduction of radiation exposure

(patient & staff)

- reduction of cost

- improvement of medical imaging services

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- improvement of diagnosis 11
 Quality Management

Performance Image Quality

Improvement Improvement

Radiographic Quality Assurance

Radiographic Quality Control

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Dose risk

Diagnosis benefit RISK

BENEFIT

Dollar cost
DOSE

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 S atisfactory
* quality of the images fulfills
the needs of the radiologist

A dequate
* quality of the images should
be sufficient for a specific
measurement

D ependable
* quality should be consistent

E conomic
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*costs should be kept as low as possible 14
overall system of activities
whose purpose is to provide
a quality of product or service
that meets the needs of the
users

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 set of tests performed to

determine the quality of

the output of a procedure

or process
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 Quality Control Quality Assurance
Product Process
Reactive Pro-active

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 nature & extent of radiological
practice

magnitude of the of radiation dose

cost of providing radiological

services
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 PRIMARY Enhancement radiographic of image
quality

SECONDARY Reduction of unnecessary patient

exposure by using quality
administrative procedures and QC
techniques
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kind of care w/c is expected to maximize

an inclusive measure of patient welfare

after one has taken amount of the balance

expected gains and losses that attend the

process of care in all its parts

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 QUALITY CARE has to meet standards

has to meet the needs of the

target beneficiaries or clients

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 PATIENT SERVICE DELIVERED
BY THE
SATISFACTION
CAREGIVER

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 S
PATIENTS CHOICE T
OF HOSPITAL & A COURTESY &
REASON FOR RETURNING F QUALITY OF CARE
TO THAT HOSPITAL
F

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 PRIMARY REASON BALANCE BETWEEN
FOR PATIENT HIGH-TECH. &
HIGH TOUCH
SATISFACTION

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 INSIDE
OUTSIDE
CUSTOMERS
CUSTOMERS

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 MEETING STANDARDS FOR
ADEQUATE CARE

ACHIEVING HIGH STANDARDS

OF EXCELLENCE

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 technical quality of care

nontechnical aspects of service delivery

clients waiting time
staff attitude
programmatic elements
policies
infrastructure
access
management

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 * Respect
* Understanding
* Complete & accurate
Information
* Technical competence
* Access
* Fairness
* Results
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 Service gives the customers
what they want
Measured by customer satisfaction
& complaints

Customer
Quality

Design & operation of

of the service Service meets customers
Process to use resources needs as defined
in the most efficient
Process Professional Professional procedures &
way to customer
requirements
Quality Q Quality standards are observed
to produce the required
outcomes

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 1. STRUCTURE

Setting/ service capability of the

organization providing care
* equipment & facilities
* organization
* personnel
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 2. PROCESS
actual interaction between
provider and client
* sequence of care
* relevance to the
* needs
* usefulness

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 3. OUTCOMES
Attributable to the care
evaluated
* result to the patient
* community or family
* receiving the care

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 Immediate

Short term

Long term
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Patient hopes to obtain the correct
examination & courtesy from the staff.

Requesting physician hopes to obtain a report

7 days of the procedure
 Correct examination

Procedure performed in a reasonable amount of time

Requesting physician receives a written report w/in

3 to 5 days
 All personnel in the Medical Imaging Department
treating the patient at all levels of the radiology
visit w/ courtesy & respect

Promptly performing the procedure & if necessary

necessary explaining why the examination was
delayed

Providing the requesting physician w/ a preliminary

phone call upon completion of the procedure,
plus a written report w/in 24 to 48 hrs
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 achieved by understanding, meeting

& exceeding the needs of the customers

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 teams formed at different levels

within the framework of TQM

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 systematic managerial approach in

an organization based on a continues

improvement of all operations,

process & functions

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 1. Quality Planning
- various processes are designed to
meet customers needs

2. Quality Improvement
- process of raising performance

3. QC
- process of evaluating performance
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 Visible executive leadership
One vision, common goal
Everyones participation
Continuous improvement
Customer focus
Active community role

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 focused & took corrective action
on outlying values

seeks to act on the entire

process
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 installation & acceptance testing
of equipment

release of equipment for clinical

use

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 monitoring of equipment

performance

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1. QC Technique
* test components of the
radiological system to verify
that the equipment is operating
satisfactorily
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 2. Quality Administration Procedures
* management actions to verify QC
monitoring techniques are performed
regularly & properly
* results are evaluated promptly &
properly
* corrective measures are taken to
these results

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TO ENSURE THAT THE IMAGING
PHYSICIAN PROVIDES THE
HIGHEST QUALITY MEDICAL
CARE POSSIBLE TO THE
PATIENT.

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 T otal improvement & teamwork

L eadership PEOPLE
C ustomer Focus

P rocess improvement

M anagement by fact & measurement MNGT.

S tandard
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 - Assign responsibility for QA actions

- Establishment of standards of quality

- Provision of adequate training

-Selection of appropriate equipment

for each examination
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 1. PLANNED, SYSTEMATIC

2. COMPREHENSIVE

3. BASED ON INDICATORS &

CRITERIA

4. ROUTINE COLLECTION & PERIODIC

EVALUATION OF DATA

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 5. DESIGNED TO RESULT IN APPROPRIATE
ACTIONS TO SOLVE /RESOLVE PROBLEMS

6. CONTINUOUS TO ENSURE THAT IMPROVEMENTS

IN CARE & PERFORMANCE ARE SUSTAINED

7. INTEGRATED SO THAT THE INFORMATION IS

SHARED W/ OTHER DEPARTMENTS &
SERVICES

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 HUMAN FACTORS
minimize

MACHINE FACTORS
function properly

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 ANALYSIS OF REJECTED FILMS

PURPOSE:
* evaluate problems leading to poor image
quality

* self-improvement too for the staff

* management data base

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 TEST
OBJECTS

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 - Chief Radiologist
- Chief Technologist
- Hospital Physicist
- other radiologist & radiology res.
phy.
- other technologists

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 - Med. Director/ COH
A.O.
Chief Radiologist
Chief Technologist
Chief Physicist
Maintenance Engr./Tech.
Others

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 1. Commitment and support of personnel to
sustain the program

2. Establish standards of image quality to

categorize radiographs as POOR, GOOD
or REJECT

3. Conduct monthly film analysis

4. Establish standard darkroom techniques

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 5. Conduct PM & QC tests/ checks

6. Establish standard protocols in performing

different examinations

7. Establish Radiation Safety Program

8. Continuous education and training

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 Level I Noninvasive & simple
- can be performed by any technologist

Wire mesh for screen film contact , spinning top test

for spinning top test

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 Level II Noninvasive & complex

- Performed by a technologist who has been

specifically trained in QC procedures

Sophisticated QC test tools is used

e.g. Noninvasive Evaluation of Radiation Output (NERO)
computerized multiple function unit etc

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 Level III Invasive & complex
-Involve some disassembly of the equipment and are
normally performed by engineers or physicists

Types of QC tests:
1. acceptance testing

2. Routine perfromance

3. Error correction

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 Look for loose screws
Check of indicator meter
Stability, stiffness of XRT assembly ,
chest stand etc. . .
Working movement - locks of tube
Checks of control panel switches &
movement

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 kV p accuracy
timer accuracy
Optical - radiation congruence
Beam alignment test
Focal spot size
Evaluation of total filtration
Constancy of x-ray output
mA linearity
Timer linearity

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 F/S resolution
Relative speed of screen
F/S contact
Checks on viewboxes
Compatibility of safelight
Check on SID indicator
Test on auto-processor
Radiological protection
survey
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 1.Personnel cost

2.Test equipment

3.Decrease in patient flow

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 - Film and chemical savings

- Less downtime of equipment

- Savings of technologist time

- Improvement of patient flow

- Decrease cost of equipment

service
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REFERENCES:

1. Adams H.G., Arora S.: Total Quality in Radiology; St. Lucie Press, 1994
2. Juran, Gryna F. M.: Quality Planning & Analysis; McGraw-Hill International Eds.,
3rd Ed 1993
3. Moores B.M, et al, :Practical Guide to QA in Med Imaging, John Wiley & Sons
1987
4. Papp, J.: Quality Management in the Imaging Sciences, 2006, Elsevier, 3rd Ed
5. Stevens, A.T.,: Quality Management for Radiographic Imaging, 2001,
McGrawHill

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 ORGANIZATION WITH MIS-
ALIGNED CULTURE

QUALITY
SERVICE

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 ORGANIZATION WITH ALIGNED
CULTURE

QUALITY
CULTURE

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 QUALITY SERVICE IS NO
ACCIDENT!

HIGH QUALITY, VALUE-

ADDED SERVICE
IS WHAT THE PATIENT
EXPECTS.

AS A HEALTH CARE
PROFESSIONAL, YOU
WILL WANT TO DELIVER
THE BEST CARE AND
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SERVICE POSSIBLE !!!!!!! 82
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