MEDICAL IMAGING

INFORMATICS SYSTEMS
EVALUATION AND QUALITY
ASSURANCE
DEFINITIONS
 DIAGNOSTIC FACILITY

• A diagnostic radiology facility is any facility in which

an x- ray system(s) is used in any procedure that
involves irradiation of any part of the human for the
purpose of diagnosis or visualization.
RADIOLOGY DEPARTMENT ORGANIZATION CHART
 Radiology Information System
(RIS)
A RIS IS AN INFORMATION SYSTEM
WHERE;
 Patients are registered,
 Examinations are scheduled and
 Radiologists’ reports are recorded,
 Stored and distributed.

The RIS can also provide management information and

may hold information that is important for revenue
generation
 Picture Archiving and Communication System
(PACS)
PACS IS A HEALTHCARE TECHNOLOGY
USE FOR;
 The short- and long-term storage,
 Retrieval,
 Management,
 Distribution and
 Presentation of medical images.

PACS and a RIS need to work seamlessly together

PACS WORKFLOW
PACS EVALUATION
PRINCIPLES FOR PACS EVELUATION
-reduction in lost and misplaced films and reports
-reduction of exposures because of the ability to process
images
- improved diagnostic accuracy because of image
processing and ability to associate other clinical data with
image data
- faster diagnosis, with possible shorter length of stay
-increased efficiency of departmental operations
- savings in capital costs for darkrooms and storage space
- saving in archiving personnel
TECHNOLOGICAL EVALUATION OF PACS
• The aspects to be considered for a technical asessment of PACS are related both
to performance criteria and to requirements for integration in the existing
situation (imaging devices, health information systems, public telecommunication
networks, etc. ).
• Main issues should be the following :
- Technical perfomances of the system: Image quality, speed, workstation
capabilities, archiving media, network performances, etc.
- Integration of the system with existing imaging devices: TV frame grabbers, digital
interfaces availability (non-standard, ACR-NEMA, etc.)
- Integration of the system with RIS and HIS: interfaces, data format, access to
operating system, etc.
CLINICAL EVALUATION OF PACS

The evaluation of PACS from a clinical point of view involves a direct

comparison with conventional diagnostic activity carried out on
films. Main issues to consider should be:
- Clinical acceptability of the system
- Ease of use ( user interfaces)
- Diagnostic efficacy (CRT vs. film)
 TELERADIOLOGY
Teleradiology is considered to be the transmission of a full set
of full integrity images to a Centre distant from where the
images were generated.

Purposes of teleradiology includes;

 Primary diagnostic interpretation
 Expert secondary consultation
 Preoperative surgical planning
 TELERADIOLOGY

Benefits of Teleradiology
 Provide access to medical image reporting for underserviced centers.
 Support patient consultations and inform patient treatment decisions
 Provide access to image interpretation for remote regions
 Provide reporting in shifts to provide timely interpretation after
normal working hours
TELERADIOLOGY WORKFLOW
PACS AND TELERADIOLOGY
Quality Assurance
Program
 QUALITY ASSURANCE PROGRAM

What is a Quality Assurance Program ?

An organized effort by the staff operating a facility to ensure that
the diagnostic images produced are of a sufficiently high quality
so that they consistently provide adequate diagnostic information
at the lowest possible cost and with the least possible exposure of
the patient to radiation.
_World Health Organization (WHO)
 QUALITY ASSURANCE PROGRAM

Objectives of QA Program
 to maintain optimal quality of diagnostic images;
 to reduce unnecessary radiation exposure to patient and staff; and
 to be cost effective

The primary goal of a radiology QA program is to ensure the consistent

provision of prompt and accurate diagnosis of patients
 QUALITY ASSURANCE PROGRAM

This program has many facets, including,

1. Quality Control tests,
2. Administrative procedures,
3. Preventive maintenance procedures and
4. Training.
 QUALITY ASSURANCE PROGRAM
1. Quality Control

Quality control (QC) is an integral part of quality assurance

It involves specific actions designed to keep measurable aspects

of the process involved in manufacturing a product (image) or
providing a service within specified limits.
 QUALITY ASSURANCE PROGRAM

QC is summarized in four principal steps.

I. Acceptance testing to detect defects in equipment that is newly
installed or has undergone major repair
II. Establishment of baseline performance of the equipment
(commissioning test)
III. Detection and diagnosis of changes in equipment performance before
they become apparent in images
IV. Verification that the causes of deterioration in equipment performance
have been corrected
 QUALITY ASSURANCE PROGRAM
The frequency of any QC test depends on the following variables;
 The inherent variability of the process or equipment
 The age, reliability, and frequency of use of the equipment
 The criticality of the element in the imaging chain
 QUALITY ASSURANCE PROGRAM
• 2. Administrative Procedure

• These procedures are design to verify that QC testing is effective,

i.e., the tests are performed regularly and correctly, the results
evaluated promptly and accurately, and the necessary action taken.

• They include recommendations regarding the responsibility for

quality assurance action, staff training, equipment standards, and
the selection of the appropriate equipment for each examination
SUMMARY OF ADMINISTRATIVE PROCEDURE
 QUALITY ASSURANCE PROGRAM
3. Preventive Maintenance Procedure

These are performed on a regularly scheduled basis with the goal of preventing
breakdowns due to equipment failing without warning signs detectable by monitoring.
These procedures includes;

 Visual inspection of the mechanical and electrical characteristics of the x-ray system
Assuring cleanliness with respect to spilling of contaminants in the examination
room.
 Following the manufacturer’s recommended procedures for cleaning and
maintenance of the equipment
 Regular inspection and replacement of switches and parts that routinely wear out or
fail
 QUALITY ASSURANCE PROGRAM
4. Training
The QA program include the means to provide appropriate training for all
personnel with QA responsibilities (especially those directly involved with
QC testing) to ensure each meet a minimum level of competency to
perform QC test correctly and consistently.

Companies whose sole purpose is training as well as service and repair

companies and the facility’s medical physicist can provide seminars and
training courses on the how to perform Quality Control tests.
Quality Assurance
Committee
 QUALITY ASSURANCE COMMITTEE

What is the Quality Assurance Committee ?

Personnel in the QA program who are responsibility for oversight of the QA
program, setting the goals and direction, determining policies, and
assessing the effectiveness of QA activities.

They have an overall documented strategy with clearly defined work plans
to achieve the goals and objectives of the radiology department.
 QUALITY ASSURANCE COMMITTEE

QA committee members includes;

 Medical Physicist
 Radiologist
 Biomedical engineer
 Medical Imaging Technologist (MIT) and Radiographer
 Information Technology (IT) Technician
 QUALITY ASSURANCE COMMITTEE
Medical Physicist
An individual who is competent to independently practice in one or more of
the subfields in medical physics.
 Advising the facility on radiation protection of the patient, staff and members of the
public.
 Conducting tests to ensure the safety and proper performance of imaging equipment
used.
 Assignment of Bio-medical engineering service staff for corrective maintenance or
preventive actions.
 Training of personnel utilized for quality control
 Develop and implement a radiation protection program
 QUALITY ASSURANCE COMMITTEE

Radiologist
A medical doctor who specializes in the diagnosis and treatment of disease
and injury by using medical imaging technologies.

 Determine the overall quality of the output image

 Select the technologist to be the primary QC technologist, performing the prescribed
QC tests.
 Ensure that appropriate test equipment and materials are available to perform the QC
tests.
 Ensuring that medical physicists and radiographers have adequate training and
continuous education
 QUALITY ASSURANCE COMMITTEE

Biomedical Engineer
Biomedical engineers use their knowledge of modern biological principles
in their engineering principle to design and develop devices and
procedures that solve medical and health-related problems.

Biomedical engineer are involve in;

 Corrective and preventative maintenance
 Fault Reporting
 QUALITY ASSURANCE COMMITTEE

Medical Imaging Technologist (MIT) and Radiographer

 Ensuring that the appropriate protocol and technique factors are used for
the requested examination.
 Ensuring that the QC tests are performed, interpreted and recorded
appropriately.
 Perform all the checks for the daily, monthly and quarterly QC testing of
equipment
 Report faults immediately any deviation in trend of equipment
performance to QA manager
 Undertaking additional continuous education courses
 QUALITY ASSURANCE COMMITTEE
Information Technology (IT) Technician
IT is a key element of any digital radiology facility that intends to store,
review and distribute images electronically or using hard copy. There
responsibility includes;

 Maintenance of the integrity of system databases to ensure continuous

and accurate operation of the information systems
 Planning,
 Deployment,
 Testing
QUALITY CONTROL

• defined as a comprehensive set of activities

designed to monitor and maintain systems
that produce a product.
1. PURCHASING EQUIPMENT

• Identification of imaging requirements

• Development of equipment specifications
• Selection of equipment
• Installation and testing of equipment
• Continuing education
36
 2. IDENTIFICATION OF IMAGING
REQUIREMENTS

• Team input
• Radiologists, administrators, supervisors, and staff
technologists

37
 3. DEVELOPMENT OF EQUIPMENT
SPECIFICATIONS

• Person determining specifications must have technical

background
• Once specifications have been selected, send to vendors
for bidding

38
4. SELECTION OF EQUIPMENT

• Compare bids for:

• Ability to meet required specifications
• Cost
• Service

39
5. 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
40
CONTINUING EDUCATION

• Applications
• QC and education coordinators
• Should include orientation and periodic updates Main issues to consider
should be:
• - Clinical acceptability of the system - Ease of use ( user interfaces) -
Diagnostic efficacy (CRT vs. film)

41
 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

42
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
43
PROCESSOR MONITORING

• Ensures that the processor is operating within proper

limits
• Can be performed by anyone trained on the equipment
used

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

44
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

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

45
EXTERNAL BEAM EVALUATION

• Tests should be performed by a radiographer

• Corrective action by authorized service person

46
 DIAGNOSTIC RADIOGRAPHIC SYSTEMS

• Angulator or protractor
• Semi-annual schedule
accuracy
• Focal spot size estimation
• Kilovoltage accuracy
• Half-value layer
• Timer accuracy

47
 DIAGNOSTIC RADIOGRAPHIC SYSTEMS

• Collimator, central ray, and

• mR/mAs and milliamperage
Bucky tray accuracy
linearity
• Distance and centering
• Exposure reproducibility
indicators’ accuracy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

48
PACS SYSTEMS

• Accuracy of interface between PACS and EMR, HIS,

and RIS
• Fix-queue

49
CONVENTIONAL
XRAY
 CHEST X-RAY TECHNOLOGY

• The technology use for chest examination is similar to that of any other x-ray examination,

• however it is perform with the patient in an upright position against a tube stand.
 QUALITY CONTROL TEST
Acceptance Test Commissioning Test
 System assembly evaluation
 Collimation assessment
 Equipment Visual Check Test  kVp accuracy and reproducibility
 Control Panel  Exposure reproducibility and beam quantity (mR/mAs)
 Collimator/Indicator/Locks  Radiographic AEC system performance assessment

 Upright Bucky  Focal Spot Size

 General  Beam quality assessment (HVL)

 Equipment warm-up test
 View boxes and viewing conditions
 Phantom image quality evaluation
 Laser Film Printer Quality Control Test
 Protective Shielding Test
QUALITY CONTROL TEST