Note: The examples address some of the many possibilities for individual PQI projects. Other PQI options are available including participation in a peer review of a self-assessment report or activity within a qualified national project sponsored by a society.

Category: Safety for Patients, Employees and the Public

Practice Quality Improvement Project: Radiation Badge Monitoring

Background: Workers should have radiation exposure As Low As Reasonably Achievable (ALARA). Their actual badge readings will depend on their work load, type of work done and radiation hygiene practices.

Objective: To determine if any nuclear medicine technologists are receiving radiation exposures that are not ALARA; i.e. that the badge readings are higher than other technologists doing the same work or their badge readings are frequently above ALARA Level 1.

Program: The radiation badges will be reviewed to establish the baseline levels. Graphical techniques will be used to establish if any of the nuclear medicine technologists are consistently above the levels for the group as a whole or frequently above ALARA Level 1. If any such technologists are found their work habits will be reviewed to see if there are any interventions that would help reduce their badge readings. They will also be offered additional radiation safety training.

Procedures:

Metrics
1. Collect radiation badge data for 6 months
2. Determine the mean and standard deviation for the group as a whole
3. The following will be used as the metrics for this project:
Create a control chart to show the mean and standard deviation for the group and identify individuals who:
- Exceed the mean for the group by more than 1 standard deviation
- Exceed ALARA Level 1 more than 2 times in the period

Improvement Plan
1. Review the work habits of technologists identified and develop an improvement plan. Discuss changes that might reduce radiation exposure. Provide training in radiation protection as necessary
Remeasurement
1. Collect data for an additional 6 months.
2. Determine if there has been a reduction in the mean or standard deviation for the group.
3. Determine if the intervention reduced the radiation dose for the identified technologists
4. Determine if any new technologists have moved into the group of technologists that have been identified as having high radiation badge readings by the criteria in Step 3.

Category: Practice Guidelines and Standards

Practice Quality Improvement Project: PET Specific Uptake Value (SUV) - Accuracy and Stability

Background:In PET imaging SUVs are used as an indicator to determine whether tissues and organs are within normal ranges. However there is great variation from patient to patient and physicians sometimes have concerns that the measurement is not accurate. Routine measurement of SUVs in a phantom can provide reassurance that the system is working correctly and that the SUVs are properly determined by the system.

Objective: To establish a long term monitoring process to measure SUVs in a phantom.

Program: Initially SUVs will be measured on a monthly basis. Monitoring SUVs is to provide assurance to radiologists that the system determines SUVs accurately.

Procedures:

Metrics
1. Collect data and measure SUV as described in the ACRIN Protocol for PET Lung Imaging
2. Plot the measured SUV on a control chart
3. If the SUV is outside of the 90%-110% range investigate to determine the cause of the deviation
4. On a quarterly basis the physicians reading the PET scans will be given a questionnaire to determine if they have any concerns about the accuracy of the SUVs. Concerns of physicians and technologists will be resolved.
5. After 6 months set new control limits based on the standard deviation of the SUV (assuming that the control limits are more restrictive than 10%).
6. Collect data for an additional 6 months.
7. If the control charts are show good performance increase monitoring interval to 3 months.
8. Continue monitoring as required.

Summary/Overview of the PQI Project:
At annual intervals the overall progress of the project will be reviewed to determine if the project is 1) insuring the phantom SUVs are accurately measured and 2) the radiologists are satisfied that the SUV measurements meet their clinical needs.

Improvement Plan
1. At 6 months review the data to determine:
1. That SUVs are within the 10% limits of the control chart
2. That physicians are satisfied with the clinically measured SUVs
3. If the limits should be reduced to less than 10% based on the data collected
Remeasurement
1. Collect data for an additional 6 months.
Evaluation:
Determine if the objectives have been achieved. If the objectives have not been achieved, repeat the Improvement Plan, Remeasurement, and Evaluation. At annual intervals the diplomate will review the overall progress of the project to determine if the project is 1) having a positive effect on physician satisfaction with SUV measurements and 2) Phantom measurements are consistent and reproducible over time.

Category: Surveys

Practice Quality Improvement Project: Survey of Satisfaction of Physicians

Background: Medical Physics should have a positive effect on the practice of radiology by physicians. However, it is sometimes difficult, especially in the consulting environment, to determine if the medical physicist is having a positive effect on the practice of radiology.

Objective: To determine if physicians are satisfied with the activities of the medical physicist and to determine if the physicians feel that the activities of the medical physicist are having a positive effect on their practice.

Program: Physicians will be surveyed (See Survey Instrument below)

Procedures:

Metrics
1. The survey will be sent to physicians with whom the diplomate works.
2. The results will be tabulated on a radar (spider) chart (See figure below)
Improvement Plan
1. The survey data will be used to develop an improvement plan to make the diplomate's work more relevant and visible to the physicians.
2. Set a goal for results at 6 months
Remeasurement
1. Collect a second set of data at 6 months.
2. Determine if there has been an improvement

Evaluation:
Determine if the objectives have been achieved. If the objectives have not been achieved, repeat the Improvement Plan, Remeasurement, and Evaluation. At annual intervals the diplomate will review the overall progress of the project to determine if the project is 1) having a positive effect by improving the survey results.

Survey Instrument: Performance

Diagnostic/Medical Nuclear Radiologic Physicist

Physicist name:___________________________

Areas covered by this survey:

Diagnostic Imaging

Radionuclide Imaging

Other________________________________





To Be Filled Out By Physician Most Familiar With Radiologic Physicist's Work

	Always	Frequently	Sometimes	Occasionally	Never	NA
I find the physicist's reports helpful to my work
The physicist's recommendations are clear and useful
The physicist is available to help me with my imaging problems
The physicist is available to help me with patient radiation issues
The physicist's reports arrive within 2 weeks of the survey

 



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