PQI Guidelines: Nuclear Medical Physics
Project Examples
1. Category: Safety for Patients, Employees and the Public 2. Category: Practice Guidelines and Standards 3. Category: Surveys
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: radiation Badge Monitoring
BACKGROUND:
Workers should have radiation exposure As Low As Reasonably Achievable (ALARA). Their actual badge readings will depend on their workload, type of work done, and radiation hygiene practices.
OBJECTIVE:
To determine whether any nuclear medicine technologists are receiving radiation exposures that are not ALARA; i.e., their badge readings are higher than those of 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 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
- Collect radiation badge data for six months.
- Determine the mean and standard deviation for the group as a whole.
- To determine 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 one standard deviation, and/or
- exceed ALARA Level 1 more than twice during the period.
- Improvement Plan
- 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
- Collect data for an additional six months.
- Determine if there has been a reduction in the mean or standard deviation for the group.
- Determine if the intervention reduced the radiation dose for the identified technologists.
- 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.
2. CATEGORY: Practice Guidelines and Standards
PROJECT: PET Specific Uptake Value (SUV) - Accuracy and Stability
BACKGROUND:
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:
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
- Collect data and measure SUV as described in the ACRIN Protocol for PET Lung Imaging.
- Plot the measured SUV on a control chart.
- If the SUV is outside of the 90 - 110 percent range, investigate to determine the cause of the deviation.
- On a quarterly basis, the physicians reading the PET scans will be given a questionnaire to determine whether they have any concerns about the accuracy of the SUVs. Concerns of physicians and technologists will be resolved.
- After six months, set new control limits based on the standard deviation of the SUV (assuming that the control limits are more restrictive than 10 percent).
- Collect data for an additional six months.
- If the control charts are show good performance, increase monitoring interval to three months.
- Continue monitoring as required.
- Summary/Overview of the PQI Project:
Review the overall progress of the project at regular intervals to determine whether 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
- At six months review the data to determine:
- That SUVs are within the 10% limits of the control chart.
- That physicians are satisfied with the clinically measured SUVs.
- If the limits should be reduced to less than 10 percent based on the data collected
- Remeasurement
- Collect data for an additional six months.
- Evaluation
Determine whether the objectives have been achieved. If not, repeat the improvement plan, remeasurement, and evaluation. At annual intervals the diplomate will review the overall progress of the project to determine whether:
- the project is having a positive effect on physician satisfaction with SUV measurements, and
- phantom measurements are consistent and reproducible over time.
3. CATEGORY: Surveys
PROJECT: Survey of Physician Satisfaction
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 whether physicians are satisfied with the activities of the medical physicist and whether 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
- The survey will be sent to physicians with whom the diplomate works.
- The results will be tabulated on a radar (spider) chart ( see figure below ).
- Improvement Plan
- The survey data will be used to develop an improvement plan to make the diplomate's work more relevant and visible to the physicians.
- Set a goal for results at six months.
- Remeasurement
- Collect a second set of data at six months.
- Determine if there has been an improvement.
- Evaluation
Determine whether the objectives have been achieved. If not, repeat the improvement plan, remeasurement, and evaluation. At annual intervals, the diplomate will review the overall progress of the project to determine whether the project is having a positive effect by improving the survey results.
Survey Instrument
| Survey Instrument: Performance | Diagnostic/Medical Nuclear Radiologic Physicist |
Physicist name:___________________________
| Areas covered by this survey: |
| Diagnostic Imaging |
| Radionuclide Imaging |
| Other________________________________ |
| To be completed by physician most familiar with the work of the radiologic physicist: |
| 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 two weeks of the survey. |
Radar Chart
