An initiative to standardize the quality control (QC) program in the hospital medical imaging department has led to improvements in safety and quality. This interdepartmental collaboration uses QATrack+ (http://qatrackplus.com/): a tool originally developed for applications within radiation medicine and now adapted for use within the medical imaging department.
QATrack+ was implemented in the radiation medicine program in 2012, and extended to the nuclear medicine program in 2015. QATrack+ is a robust recording and monitoring tool for over 1100 QC tests performed monthly on 20 treatment and imaging units across two departments and three campuses. A distinct installation of the software is now in use in the medical imaging department.
The use of QATrack+ has facilitated rigorous quality assurance testing in medical imaging. Tests of basic safety systems such as x-ray warning lights can now be tracked to ensure functionality and compliance. The centralized QC database has also improved monitoring and tracking of results. This program is in keeping with the hospital core values of quality care and a safe environment for patients and employees.
QATrack+ has been successfully implemented in a medical imaging department. QATrack+ improves the organization of QC data while aiding the standardization of tests within the program. This leads to improved monitoring of the machine performance and contributes to a more robust safety program, thereby enhancing the overall safety culture of the institution. Collaboration and sharing of expertise between radiation medicine and medical imaging has strengthened the QC programs in both departments.
QATrack+ was first implemented in the Radiation Medicine program in September 2012 and as a separate installation in the Nuclear Medicine department in 2015. QATrack+ is used at over 14 cancer centres in Canada and over 27 centres worldwide. Due to its highly configurable design, applying QATrack+ to quality control in diagnostic imaging is completely seamless and yet there is currently no documented use of QATrack+ in a dedicated imaging department. The present work has leveraged in house expertise with QATrack+ to facilitate the transition of the quality control (QC) program in medical imaging to a QATrack+ based system.
At a large institution, with imaging equipment at three geographic campuses, oversight and standardization of the QC program poses unique challenges. The hospital QC program in medical imaging manages 7 CT scanners, over 80 x-ray and fluoroscopy machines as well as administrative and regulatory tasks. The program oversight and all of the tests are performed by two diagnostic imaging technologists.
Regulation of x-ray machines varies with jurisdiction. This has contributed to a lack of standardization in QC practices. In Ontario, the Healing Arts Radiation Protection Act (HARP) governs the regulatory requirements for operating x-ray devices. This Act gives some descriptions of quality assurance tests but does not lay out a comprehensive QC program. Guidance documents such as Health Canada’s Safety Code 35 and the American Association of Physicists Task Group report 151 go further in offering recommendations for imaging quality control programs.
Radiation therapy departments by contrast have generally adopted a fairly congruous set of quality control tests due in part to stricter regulations set out by the Canadian Nuclear Safety Commission. This standardization is also due to initiatives such as the collaboration between the Canadian Partnership for Quality Radiotherapy and COMP to establish detailed recommendations for QC programs. With this backdrop, radiation therapy programs have established comprehensive QC programs, requiring sophisticated tracking and monitoring capabilities to manage the amount of data generated.
QATrack+, http://qatrackplus.com/, was developed as a web application in which QC test data are entered through an online interface accessible using a web browser. All data is stored in a centralized database. The software also includes the ability to schedule tests, trend data and is highly configurable. It is ideal for QC program management within a large institution.
QATrack+ has been implemented within the medical imaging department of a large, multi-site hospital. In parallel, a review of the QC program has been undertaken to improve quality and safety within the department. This initiative has been undertaken through collaboration between medical imaging and the department of physics in radiation medicine.
The initial configuration of the QC program for diagnostic imaging in QATrack+ was done for the 7 CT scanners in the department. Existing tests performed under the requirements of HARP were maintained and test data were entered retrospectively in order validate test configuration and to permit meaningful data trending.
Part of the larger initiative was to implement a wider suite of tests on a daily basis to be performed by the imaging technologists. These daily tests focus primarily on machine warm-up (which was already being performed) as well as a verification of the safety systems such as warning lights and table brakes. This change in practice serves the dual purpose of improving attention to imaging suite safety systems and of engaging the front-line technologists in the safety program. Figure 1 shows a subsection of a typical set of daily tests on a CT scanner.
Improving the safety culture at an institution requires awareness and engagement on the part of the employees. Implementing QATrack+ in the medical imaging department has led to improved oversight of the quality control program and has facilitated a shift in practice for the front line technologists. This has highlighted x-ray safety and has led to a more robust verification of these systems. It also represents a novel use for QATrack+ outside of the radiation therapy sphere in which its use continues to expand. The use of a tool previously used in radiation therapy was the result of collaboration between the radiation medicine and diagnostic imaging departments. This has led to a sharing of expertise in imaging between the two groups and will likely lead to further standardization of tests and regulatory reports across the entire institution.