PQI Guidelines: Diagnostic Medical Physics

Project Examples

1. Category: Safety for Patients, Employees and the Public
2. Category: Safety for Patients, Employees and the Public
3. Category: Practice Guidelines and Standards

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

1. Category: Safety for Patients, Employees and the Public
Project: Monitoring of Dose Indices for Lumbar Spine Radiography

BACKGROUND:
With computed radiography (CR) it is quite likely that patient exposures will increase because there are few imaging consequences of overexposure. In addition, the monitoring of this process is more difficult as there are no "waste films."

OBJECTIVE:
To establish a program to monitor exposure indicators and assure that they are as low as reasonably achievable.

PROGRAM:
Dose iIndex parameters will be monitored for all lumbar spine radiographs. These will be tracked and reviewed with the supervisor and overseeing radiologist.

PROCEDURES:

- Metrics

1. Develop software to extract dose indices from DICOM headers.
2. Using archived examinations, establish the mean and standard deviation for these indices over the last two years.

- Improvement Plan

1. Contact other leading institutions to determine practice standards.
2. Review the ACR Practice Guidelines for Diagnostic Reference Levels.
3. Institute program to extract data for all lumbar spine examinations.

- Remeasurement

1. Review performance on monthly basis for six months, and then quarterly.
2. Meet with supervisor and radiologist to assess trends and outliers.
3. Oversee continuing monitoring.

- Evaluation

The diplomate will annually oversee the program to assure that lLumbar spine radiography produces quality images using radiation levels as low as reasonably achievable.

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2. Category: Safety for Patients, Employees and the Public
Project: Women's CT Doses

BACKGROUND:
The increased use of CT as a diagnostic imaging modality and the associated rise in radiation dose to patients has been the topic of active discussion in recent years. This PQI project will raise awareness of CT radiation dose to female patients in specific and willestablish practice patterns that lead to decreasing radiation exposure.

OBJECTIVE:
To determine the dose indices for chest, abdomen, and pelvis CT examinations for women.

PROGRAM:
Technologists will record the CTDIvol and DLP for all chest, abdomen, and pelvis examinations for all women above 12 years of age. The data will be reviewed by age stratification to determine trends and state of the practice. These will be compared to reference levels and, where possible, will be decreased without compromising image quality.

PROCEDURES:

- Metrics

1. Develop recording system for CT technologists.
2. Accumulate data for three months.

- Improvement Plan

1. Review ACR reference Level data.
2. Review the acquired data.
3. Meet with supervisor and lead body CT radiologist.

- Remeasurement

1. Review protocols to ascertain dose-reduction techniques.
2. Oversee program on a quarterly basis.

- Evaluation

The diplomate will use medical physics knowledge to establish the program and maintain continuing quality improvement for CT examinations of women using radiation levels as low as reasonably achievable.

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3. Category: Practice Guidelines and Standards
Project: Report Turnaround Times and Communication Issues

BACKGROUND:
After medical physics consultation, It is important to provide timely and meaningful reports to practices.

OBJECTIVE:
To determine the report turnaround time and quality of consultation following a physics equipment evaluation.

PROGRAM:
Review past report times and establish procedures for a continuous quality improvement program. Determine how often serious issues were discussed with administration and the chief radiologist.

PROCEDURES:

- Metrics

1. Gather all consultation reports for the past two years.
2. Determine the average and standard deviation for the time between the evaluation and the report transmission.

- Improvement Plan

1. If more than 48 hours, determine reasons for elapsed time
2. Determine the frequencies with which important issues were discussed person-to-person.
3. If important issues were not discussed 100 percent of the time, determine reasons for the lack of communication.

- Remeasurement

1. Repeat quarterly.

- Evaluation

At annual intervals the diplomate will review the overall progress to determine that consultation reports are communicated in a timely and professional manner.