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HISTORY OF QC:
1920’s – 30’s  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

4
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
 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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 MEDICAL RADIOGRAPHY

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 PATIENT SERVICE DELIVERED
BY THE
SATISFACTION
CAREGIVER

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 S
PATIENT’S 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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  technical quality of care

 nontechnical aspects of service delivery

⬧ client’s waiting time
⬧ staff attitude
⬧ programmatic elements
 policies
 infrastructure
 access
 management

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 SEVEN (7) MAJOR CONCERNS OF
CLIENTS
* Respect
* Understanding
* Complete & accurate
Information
* Technical competence
* Access
* Fairness
* Results
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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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 L
LEVE

⬧Patient hopes to obtain the correct

examination & courtesy from the staff.

⬧Requesting physician hopes to obtain a report

7 days of the procedure
 L
LEVE

⬧ Correct examination

⬧ Procedure performed in a reasonable amount of time

⬧ Requesting physician receives a written report w/in

3 to 5 days
 E V E L
L

⬧ 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
 CAUSES OF DEFECTS IN THE
QUALITY OF CARE?

1. lack of knowledge or
skills

2. wrong attitudes &

behavior

3. defect in the system

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 achieved by understanding, meeting

& exceeding the needs of the customers

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 systematic managerial approach in

an organization based on a continues

improvement of all operations,

process & functions

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 • Visible executive leadership
• One vision, common goal
• Everyone’s 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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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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 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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