Chief Diagnostic Medical Physicist Inspector University of ...
Transcript of Chief Diagnostic Medical Physicist Inspector University of ...
4/26/2016
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Steven J. Backes President and CEO Atirix Medical Systems
Angela Snyder, Ph.D. Director, Research Atirix Medical Systems
Allen Goode, M.S., DABR Chief Diagnostic Medical Physicist
Department of Radiology & Medical Imaging
University of Virginia Health System
QC Zen and the Art of Inspector Happiness
April 27, 2016
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen DISCLOSURES
CONTRIBUTORS Andrea Browne, Medical Physicist, Dept. of Engineering, TJC
Marion Boston, Assistant Director, ACR
Eric Berns, Chair ACR Mammography Committee, Assistant Professor and Diagnostic Medical Physicist, Denver Health, UC Denver
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Steven J. Backes President and CEO Atirix Medical Systems
Angela Snyder, Ph.D. Director, Research Atirix Medical Systems
Atirix sells the QC-Track® system for enterprise QC
Allen Goode, M.S., DABR Chief Diagnostic Medical Physicist
Department of Radiology & Medical Imaging University of Virginia Health System
- Atirix client, informal advisor - Member, Global Advisory
Board, Radimetrics/Bayer - Member, AAPM TG 272 - Inspector, State of Virginia
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Learning Objectives
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• The latest device QC regulations, including from TJC and ACR
• Features of enterprise QC systems
• Features of cost justification tools, including the SBAR
• Recent inspection priorities and areas of interest
• Upcoming regulations and areas of QC concern
Dose? CQC?
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Agenda • QC Zen
– Inspection Cycle model
– Survey of recent QC regulations and trends
– Review today’s enterprise Quality Control model
– Quality control technologies and alternatives
• Inspector Happiness – Case studies
• What’s on the horizon – TJC Fluoroscopy, ACR Mammography
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Dr. Stewart Bushong
Baylor Medical Center
“Medical Imaging: More Than Fifty Shades of Grey.”
AHRA Annual Conference
July 20, 2015
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc.
“All the world now follows MQSA”
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Alright, what was the life like back when the early ‘90s as the Mammography Quality Standards Act (MQSA) was being introduced?
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1992 was an election year!
George Bush Bill Clinton Ross Perot
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Minneapolis’ own Prince was rocking the culture
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Yes, there were computers and cell phones…
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IBM PS1
Windows 3.1
Motorola “bag phone”
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
There were early imaging systems, but it was 1994 before the first 2 slice CTs hit the market
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Elscint 2 slice CT
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
And in 1994 inspectors were getting ready for MQSA
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen HCFA (now CMS) had a challenge… figure out how to do an annual inspection of 11,000 MQSA facilities
• Medicare had been inspecting Mammo screening facilities
• OIG gathered data, including 87 interviews with facilities, on – # of Medicare certified facilities
– Length of time and cost of on-site inspections
– Inspector training
– Inspection results
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6,800 Mammo Screening facilities under quality regs
11,000 Mammo Screening and
Diagnostic facilities under MQSA quality
regs and needing an
annual survey
Medicare
MQSA
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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State inspectors say that facilities’ unfamiliarity with regulations is the biggest problem encountered during inspections.
It is possible that many of these procedures are being performed, but are not properly documented...
Nevertheless, documentation of such activities are often the only way that inspectors have of determining the presence of quality assurance activities.
What did HCFA find out about inspections?
“45 of 87 facilities had
no knowledge of the
regulations”
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen … and more…
The facilities’ initial unfamiliarity with [Medicare] requirements contributed to unnecessary noncompliance by the facilities.
This in turn required that the State inspectors spend additional time and effort filling out paper work and conducting follow-up visits.
Furthermore, a lack of documentation of QA process measurements prevents trend analysis which is essential to a QA program.
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“86% of inspected
facilities had at least one
failure”
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen … so back to now, 2016
• Regulation Compliance Cycle
– Knowledge -> Performance -> Documentation
• Why are we here today?
– Lots of new regulations, and inspectors are facing a lot of new requirements – it’s 1994 all over again!
– The challenge:
• Then – how to implement broad inspections for 1 modality
• Now – 4 modalities, and soon 5
– Any reason to believe it will be easier?
• Maybe…
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Compliance Cycle
13,000 units
30,000+ CT MR PET
Nuc Med
MQSA
TJC
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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MQSA QC
Service reports Radiologist
credentials
Sign-offs Technologist credentials
Physicist reports
Failure Tracking
MRI QC
???
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Compliance Cycle
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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“All the world now follows MQSA”
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Device Quality Control
Credentials
Inspections
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen The Joint Commission and diagnostic imaging QC
TJC “Diagnostic Imaging Requirements”
August 10, 2015
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen TJC Diagnostic Imaging Requirements: Impact on day-to-day QC • Per TJC briefing, the facility is responsible for identifying the
appropriate QC for CT, MRI, PET, and Nuc Med systems, and the facility needs to prove it is following its QC plans
• Per Dr. Browne:
– Plan: “The organization identifies QC and activities to maintain the quality…”
• Equipment and activities
– Includes any CT system with billing for diagnostic imaging
• Frequency and by whom
– Prove: “The organization maintains the quality…”
• TJC review: Observation? Logs?
April 27, 2016
Dr. Andrea Browne, TJC AHRA Annual Meeting,
Jul 21-24, Las Vegas
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Diagnostic Imaging Requirements & technologists
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MRI safety risks
Quarterly dosimetry review
Quality Control CT Annual Dose Analysis and
Physics
MR Annual Physics Nuc Med
Annual Physics
PET Annual Physics
Construction shielding
CT Physicist Credentials
CT Technologist Credentials
MR Technologist Credentials
CT Dose Tracking by Exam
Correct Patient
Protocols
CT dose incidents
MRI injury data
Inspector
happiness hint: So far the most common issu es seen by TJC are in MRI Safety
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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TJC Diagnostic Imaging
Requirements
Prove it. Plan it.
“The organization maintains the quality of the... images produced.”
TJC review: Observation
Logs
“The organization identifies quality control and maintenance activities”
for CT, PET, MRI, and NucMed.
Equipment and activities Frequency and by whom
Dr. Andrea Browne, TJC AHRA Annual Meeting, Jul 21-24, Las Vegas
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Device Quality Control
• Printers and Monitors • Visual Checklist • Mechanical • Image Uniformity and
Artifacts • Geometric Accuracy • Resolution • Sensitivity/SNR • Scaling • Dose
Inspector happiness hint: The
physicist annu al inspection is requ ired every year on every device
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen American College of Radiology accreditation
• 38,000 facilities accredited since 1987, per ACR
• Wide variety of accreditation options – New compliance requirements, e.g. BICOE
– New web site: http://www.acraccreditation.org/
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Continuous Quality Control A continuous quality control (QC) program must be established for all CT units with the assistance of a qualified medical physicist. An on-site radiological technologist should be identified to be responsible for conducting routine quality control. The continuous QC program must include, but not be limited to, the following: • Water CT Number & Standard Deviation- Daily • Artifact Evaluation- Daily • Wet Laser Printer Quality Control- Weekly (if applicable) • Visual Checklist- Monthly • Dry Laser Printer Quality Control- Monthly (if applicable) • Display Monitor Quality Control- Monthly
CT Accreditation Program Requirements
ACR Accreditation and Quality Control
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• Continuous Quality Control program – Details are found in the modality
Accreditation Program Requirements document
• Includes: – Quality Control
– Personnel Qualifications
– Preventive Maintenance/Service requirements
Inspector Happiness
Hint: If you r CT, MR, PET and Nu c Med u nits are not ACR accredited th en you r TJC inspector wi ll be looking for you to follow th e QC defined by you r manu facturer
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen ACR Accreditation – BICOE
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1,034 995
2015 2016
Breast Imaging Center of Excellence
REQUIREMENTS SUMMARY
• Mammography by the ACR (or an FDA-approved state accrediting body)
• Stereotactic Breast Biopsy by the ACR
• Breast Ultrasound by the ACR (including the Ultrasound-Guided Breast Biopsy module), and
• New: Enhanced Breast MRI requirements, with higher minimum volumes
• Effective: January 1, 2016
• Centers may also satisfy this requirement if they refer their patients to another facility for breast MRI and breast MR-guided biopsy outside their center.
• This facility must be accredited by the ACR in Breast MRI and may be within their facility system or in a referral relationship with the
Center of Excellence.
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen ACR Accreditation – DICOE
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174
2015 2016
Diagnostic Imaging Center of
Excellence
REQUIREMENTS SUMMARY
• ACR accreditation in all modalities provided where ACR accreditation is offered
• Dose Index Registry® (DIR) and General Radiology Improvement Database (GRID) participation
• Image Gently® and Image Wisely® pledges
• Site survey assessing multiple areas of quality, safety, procedures and personnel by an ACR survey team that includes a radiologist, medical physicist and technologist working with your team members
• 21 facilities in process
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen New: ACR – Basic vs. Advanced
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10 Modality Accreditations
Breast Imaging Center of Excellence
Diagnostic Imaging Center of
Excellence
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
MIPPA – # of sites by CMS-accredited accreditors
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May 2013, GAO Report MEDICARE IMAGING ACCREDITATION Establishing Minimum National Standards and an Oversight Framework Would Help Ensure Quality and Safety of Advanced Diagnostic Imaging Services
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Regulations
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MQSA TJC
MIPPA
ACR
State
AIUM
IAC
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Device Quality Control
Credentials
Inspections
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Imaging credentials
• CME/CEU and Exams
• Required at the point of inspection
• Challenge: Clinical professionals work in multiple locations, and each location required to have a copy
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Inspector Happiness Hint:
A common inspection issu e is physician and physicist credentials not on -site
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Credentials
MQSA/ACR MG ACR CT and MR TJC/ARRT
Continuing Experience (exams/months)
200/24 CT – dose training MR – safety training
Continuing Education (CEU/months)
15/36 24/24 ARRT - 24/24 or NMTCB
Continuing Experience (exams/months)
960/24 General - 200 /36 Specific - 60 /36 Cardiac – 50/24
Continuing Education (hours CME/months)
15/36 General - 150/36 Specific - 15/36
Continuing Experience (surveys/months)
Facilities: 2/24 Units: 6/24
Units: 2/24 ABR - 1 PQI project/36
Continuing Education (CEU or CME/months)
15/36 15/36 ABR – 75/36
Ph
ysic
ist
Rad
iolo
gist
Te
chn
olo
gist
TJC: Advanced-level certification in CT required (effective Jan 1, 2018) – new 2/16/16
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Device Quality Control
Credentials
Inspections
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Inspections
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MQSA TJC
MIPPA
ACR
State
1 year
3 year 18 – 36 month
depends
random
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Inspection Stats • Annual inspection at all 8,740 certified facilities (April 1,
2016) • Plus: ACR inspections
• 50 random on-site inspections per year • Random off-site inspections of 3% of facilities, about
260/yr total
• 38,000 certified facilities, 995 BICOE, 174 DICOE • Approx. 6,500 MIPPA ADI (Advanced Diagnostic Imaging)
suppliers receive an ACR inspection every three years • MIPPA inspection teams will also review other ACR facilities
in the area
• TJC accredits approx. 88% of accredited US hospitals, including 4,000+ accredited hospitals and 361 critical access hospitals (per TJC web site)
• Imaging inspection statistics not yet available (only about 8 months into program)
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen TJC and Imaging Inspection • Today: observational, due to imaging skill levels of inspectors
– Plan to add more imaging skills as time goes on
• Professional latitude accepted, but need professional guideline
support
• Tracer method – TJC uses three types of tracers:
• Program-specific tracers, which identify safety concerns within different levels and types of care, treatment, or services;
• Individual tracers, which “trace” the care, treatment, or services received by individual patients; and
• System tracers, which explore one specific system or process across the organization.
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Dr. Browne’s best advice on how to survive your inspection?
“If you say it, you’d better do it!”
Examples: • If your policy is for a daily QC test,
– be prepared to actually do it daily, and
– be able to show that you’ve been doing it daily
• If you’re running a test and the results are out of limits – Be prepared to show that indication was given to appropriate parties
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Compliance Cycle
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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University of Virginia’s approach to QC Performance
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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The case for QA – a physicist’s perspective
• QA is simply an aid to determine the “health” of an Imaging System – Mammography is good example [MQSA]
• Accrediting bodies beginning to request to view – and the ACR is starting to do spot inspections!
• Sets stage for how to deal with Quality issues when they arise. – Many times - used to indicate “Go - No Go” when in question
– Depending on personnel and situation- provides a “consultation opportunity”
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Accrediting Bodies and QA
• QA now being mandated for diagnostic imaging
• Physicists reports are being examined for ACR accreditation – Physicist needs to represent an “adequate QC process in place”
• Doses more closely monitored between what is specified in sites’ protocols and the dose delivered in images submitted
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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How do you accomplish your QA goals?
Thorough analysis of what is required vs. what is important or desired
State Regulations
Vendor Recommended
Societal Recommended
What the physicist wants
Accreditation Required
Your QA program
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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The Decision Tree: When do you do QA, who do you call when it fails?
• Having the process defined up front removes the burden from the tech to determine what to do in tricky situations
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Overview of 3 Tiered Approach: UVA CT QA Method
➡ LEVEL 1 - Annual Inspections or Major check-ups
➡ LEVEL 2 - Weekly/ Monthly or Quarterly QA work
➡ LEVEL 3 - Daily QA work
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Overview of 3 Tiered Approach: UVA CT QA Method- Details
Who Does? When Done? What Done? What Goal?
Level 1 Physicist Annual or post-major service
Catphan 600 Dose Phantoms - 32cm & 16 cm
Dose monitoring- typical/standard protocols + random audits, collimation, High level Image Quality: Recon slice thickness, MTF, detailed linearity, detailed contrast
Level 2 QA Tech or Tech
Weekly or post-service
ACR 464 Gammex Phantom
Low level Image Quality: Evaluation of Uniformity, System Integrity, gross resolution, contrast/noise, system linearity and laser/slice table position accuracy
Level 3 Tech Daily Water Phantom or other vendor supplied phantom(s)
Evaluation of Uniformity, System Integrity
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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What makes a Quality QA program? Dedicated or Designated QA Technologist
ACR Accreditation Coordinator
Good list of written procedures
QA /Issues workflow document
UVA Method- Whether Vendor, Tech or Physicist initiated - all under Heading of “QA”
Good Communication
And… structure
A database or other cataloging software tool for trend analysis
We like digital archives of QA data
We REALLY like flags set that remind us when QA is overdue or FAILS
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen University of Virginia Charlottesville, VA
• 578 bed academic hospital
• 12 affiliated locations
• 220+ imaging units (CT, MRI, FFDM, US…)
• 3 full time medical physicists
• TJC, ACR Accredited
• Situation in 2010 – Seeking automated solution to support vision for QC as a key component
of overall image quality
– Explored cost of building in-house QC system…
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
UVA and the QC-Track journey
2012 2013 2014 2011
1. FFDM
2. CT
3. Aprons
4. New FFDM
site
5. PM/Service Tracking
2015
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6. Nuclear Medicine
2016
7. US
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Situation today… • Full digital QC for 3 modalities
• 9 FFDMs in 5 locations • 5 CTs in 2 locations • 6 Nuc Med units in 2 locations
• Apron tracking
• 3,000+ aprons in 41 locations
• 125+ users trained • Synergy between Physics and Biomed teams
Result: Responsible Parties now have centralized system to track status across locations
41 UVA Sites
QC Data
UVA Intranet
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Compliance Cycle
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen So, you need a QC tracking system. What do you do?
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Apron ID Who? Type
Date
Checked
1234 Dr. Smith skirt 1/1/2013
1235 Dr. Smith collar 1/1/2013
1236 Al 1/5/2013
?
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Options
1. Binders
2. Spreadsheets
3. Products
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• Meet physicist requirements and inspector needs
– Need to have a QC plan, follow the plan, keep records
• Which means:
– Define QC workflow – by modality, room, location, tests, who performs QC and when
– Schedule QC activities and monitor that QC activities have been completed
– Record QC data, and process with calculations, baselines, limits/thresholds, date/time/user stamps
– Detect, notify and track QC failures
– Enforce security – access to QC records, changes to forms
– Generate reports needed to monitor QC processes and meet the information requirements of responsible parties
– Be able to back up the QC data (and recover)
Requirements
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Option 1: Binders • Source: Usually made up of forms provided by
ACR, physicists or manufacturer
• Advantages – “business as usual” – Inexpensive
– Accepted by inspectors
• Disadvantages – Manual scheduling, manual calculations, manual
failure notices
– Monitoring? difficult, not timely
– Usually need to “clean things up” before inspection
– Difficult to meet remote data access needs
– Only one person can use a binder at a time
– Security and control
– Backup and recovery
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Inspector experience?
Binders vs. today’s complex facilities vs. today’s inspection requirements
• Per Dr. Browne: “a common issue is the organization of documents”
“I know we have it somewhere…”
• Result: inspector unhappiness! – A citation, if the requested document can’t be produced
by the time the inspector leaves
– Appeals are time consuming and expensive
– Even if appeal successful the citation remains on the record
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Needed at point
of inspection
• QC Records • Credentials • PM/Service docs • Safety documents • …
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Option 2: Spreadsheets • Source: Usually “in house”
• Advantages
– Inexpensive – Able to build in calculations – Backup
• Disadvantages
– Testing? – Facility still relies on manual scheduling, manual failure
notices – Monitoring can be difficult – Reports can be difficult to build – Few controls around data modification or deletions so
difficult to identify if occurred – Only one person can use a spreadsheet at a time – Security limited to network access, cell locking – On-going support, if changes needed
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Apron ID Who? Type
Date
Checked
1234 Dr. Smith skirt 1/1/2013
1235 Dr. Smith collar 1/1/2013
1236 Al 1/5/2013
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 57
How many technologists are “spreadsheeters”?
• Scenario: – Physicist preps spreadsheets and sends them to
the QC team
– What does the QC team do? • Not trained in Excel so they print the spreadsheets
and continue writing down QC data
• Result: inspector unhappiness! – Calculations (for limits)? Lost
– Any chance at remote monitoring? Lost
– Any chance at trend reporting? Lost
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Option 3: Products • Source: professional software engineers
– Scope: “point” (apron tracking) or “complete” (Enterprise QC across modalities, per SEA 47)
– User: QC dashboard, QC scheduler, tests specialized for QC, reporting, multi-user, provisioning, secure
– Server: database, centralized, secure, revision management, audit logging
– Workflow: standardized or customized
– Other: on-going improvements, training, documentation, testing per professional standards
• Advantages – Complete solution – that can cover normal and uncommon (holidays, down for PM)
circumstances
– Training and documentation
– On-going support and upgrades
– Collective needs and ideas from multiple locations are built into a product
• Disadvantages – Expenses for licensing + support
– Vendor might have limited experience with your specific area of interest
– Control over improvements
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Enterprise web-based device QC and credential tracking
59 April 27, 2016
Atirix product: the QC-Track® system
Copyright (c) 2016 Atirix Medical Systems, Inc.
Aprons DBT/FFDM/CR-FFDM CT MRI Nuc Med/PET/Fusion Fluoro US CR/DR DXA CEU/CME/Exams PM/Service
Modality QC • MQSA device QC for DBT/FFDM/CR FFDM and accessories • State, ACR/AAPM, and vendor QC for fluoroscopy/C-Arm,
US/Breast US, DXA, stereo biopsy and CR/DR • ACR and vendor QC for MRI/Breast MRI • ACR and vendor QC for CT • ACR and vendor QC for Nuc Med, PET and Fusion
Credentials • ACR CEU/CME and exam tracking
Aprons • Apron QC with integrated barcode tags
PM/Service Tracking • Preventive Maintenance and Service Tracking, with integrated
email and failure tracking
Enterprise QC Tools • Enterprise Dashboard • Document Management
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Email Notices, Reminders, Warnings
QC Data, Electronic Documents
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QC Data Repository
Dashboards, Email Notices, Reminders, Warnings , Reports
Copyright (c) 2016 Atirix Medical Systems, Inc.
QCIS™ Quality Control Information System
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
61
So, how does it work? 1. QC notification The QC Dashboard or a QC-Track email notice indicates QC tests are due for a device or an apron.
April 27, 2016
4. QC Reporting QC data available for tracking and reporting, including MQSA, TJC aprons, ACR, and custom reports.
3. QC Data entry. Results are matched to devices and tests, comments added, and data is entered into QC-Track. Failures are recorded and tracked. Apron Tag indicators are updated.
Copyright (c) 2016 Atirix Medical Systems, Inc.
2. QC data gathering QC data is gathered from the room, device or apron. Phantom data is gathered and processed.
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
CASE STUDY:
ENTERPRISE QC AT SUTTER PAMF
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Sutter PAMF
January, 2015
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Case Study: Palo Alto Medical Foundation
• Background – Sutter Health, 10th largest US healthcare
system, is based in Sacramento
• Sutter PAMF – 20+ hospitals and outpatient clinics
– Jim Holder, Director of Imaging • 1981, Nuc Med Tech
• 2000, Manager
• 2013, Director
– Enterprise QC project
– Funded: 2015, with IS involvement • IS requested an SBAR as part of the funding process
The Palo Alto Medical Foundation has hospitals and clinics all over the bay area with convenient locations located in the California Bay Area of San Francisco, San Jose, Santa Cruz, Los Gatos and the East Bay.
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen PAMF situation prior to QC-Track
• Manual QC practices
• Lots of Binders
• Lots of modalities, with inconsistent practices across locations
• Lots of locations, so difficult to easily monitor QC status
• Lots of inspectors: California DPH, ACR, MQSA, NRC, IMQ,… – DPH, ACR – “on the spot” inspections
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 64
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen So, why enterprise QC?
• Jim Holder: “back to my nuc med days”
– Reality: 30+ years being regularly inspected
– Jim’s Goal: Make it as easy as possible for the inspectors
• QC as simplistic as possible
– Electronic system: “big benefits”
• Easier and faster for inspectors
– In California, inspectors regularly perform soft reviews using QC-Track
• Minimizes/eliminates staff disruption prepping for inspection
• Minimizes staff disruption when the inspector is in the department
“The shorter the time the
inspector is in the
department, the easier it is
on me!”
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
– 30 QC Departments across 20+ physical locations
– Standardized device QC for 8 modalities across 116 imaging units • Mammo 19 • Stereo 3 • CT 12 • MR 9 • Fluoro/C-arm 27 • US 32 • Nuc Med 5 • PET/SPECT 3 • Dexa 6
– Plus:
• 1,100 aprons
• 145 professional credentials
• PM/Service tracking
Implementation Summary
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Aprons (1,000 across 30 locations)
Credentials (145)
Device QC (116 units, 8 modalities, 30 QC dashboards, 100+ users)
Camino Division
Santa Cruz Division
Alameda Division
Palo Alto Division
QC-Track.Planner for PM/Service Tracking
Enterprise Dashboard
Trend Reporting
Worksheet Editor
Sutter PAMF QC-Track Enterprise Server
Enterprise QC Data Repository (data, documents)
QC
Do
cum
ent
Man
agem
en
t
Security Mgmt
Device Mgmt
Audit Logging
Failure Tracking
Scheduler
Worksheet Mgmt
Rep
ort
ing
Engi
ne
Email Engine
DICOM-Connector
Test Server
Test QC Data Repository
SMTP
LDAP System Health Monitor
Atirix Support
Monitoring
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
CASE STUDY:
THE SBAR AT SUTTER PAMF
Sutter PAMF
January 2015
68 Copyright (c) 2016 Atirix Medical Systems, Inc. April 27, 2016
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen SBAR decision document used by PAMF to help justify centralized QC system
Situation
Background
Assessment
Recommendation
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen SBAR Primer
SBAR is an effective and efficient way to communicate important information.
S=Situation - a concise statement of the problem
B=Background - pertinent and brief information related to the situation
A=Assessment - analysis and considerations of options — what you found/think
R=Recommendation - action requested/recommended — what you want
SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured. • The safety attitudes questionnaire administered at Kaiser Permanente identified that physician and nurse
perceptions of teamwork were significantly different. Physicians tended to view the care environment as fairly collaborative, whereas nurses saw it as much less so.
• To address the issue, Kaiser developed a communication tool that was adapted from the US Navy, called SBAR.
• Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique.
Institute for Healthcare Improvement, ihi.org
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“Conversational Return On Investment Analysis”
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
• MQSA and the ACR require each site that performs Mammography to complete several quality control tests on the Mammography unit, (daily, weekly, monthly, etc). The recording of these results is currently done manually, where the Technologist documents the test results on paper graphs and charts and kept in a binder.
• Technologists, Radiologists, and Physicists (Tech/Rad/Phys) are required to maintain their license current, keep copy of their initial training in Mammography, and maintain a certain number of credits over a rolling time period. This is currently done manually, where copies of each are kept in a binder at each site that performs Mammography.
Actual SBAR: Situation
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
Each site performing Mammography must perform daily, weekly, monthly, quarterly, semi-annually, and annual quality control tests, which are all documented by hand on paper. These original paper logs are subject to be destroyed by a flood, fire, or person, or even lost. It is required that these documents be kept from inspection to inspection, which is done annually.
Each Tech/Rad/Phys maintains their initial training, licenses, and continuing education credits from year to year. They must send a copy of everything to each site that performs Mammography whenever there is a change. Because each person is on a different schedule, there are always changes and updates to the person’s file, which is maintained by the site.
Actual SBAR: Background
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
• Any manual process opens up the potential for errors. An error in the Mammography quality control process can result in the department being shut down or subjected to fines.
• A back up or copy of all quality control tests would also be a manual process because the originals are all done by hand. All original charts and graphs have the potential to be lost or tampered with, and are exposed to fire or water damage.
• At least 1 person in charge of maintaining the training, licenses, and continuing education credits for each Tech/Rad/Phys at each Mammography site. This person requests copies of the updated material when it expires for each Tech/Rad/Phys that works at that site. This ultimately is the responsibility of the individual, but lack of compliance can result in fines and/or closures for the site.
• During each annual inspection, the inspector goes through all the binders that hold the QC test results and Tech/Rad/Phys credentials. Their assessment of the site is based on what they find/don’t find in those manual logs.
Actual SBAR: Assessment
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
• Provide a web-based system to record quality control tests and required Technologist, Radiologist, and Physicist documentation.
• This system can/will: • Streamline how each site records the data collected so it’s the same,
correct way across all of the [hospital] sites, reducing the chance for human error.
• Provide automatic quality alerts throughout the [hospital] network so the proper people are notified as soon as a QC test does not pass or when a Tech/Rad/Phys has expired credentialing.
• Allow the sites’ Imaging Technical Consultants and Physicists to review the QC process and track credentials remotely.
• Provide inspectors a neatly organized report of all test results and credentialing, which will streamline and speed up the inspection process.
• Speed up the time it takes for the QC Mammography Tech to complete the recording process of all the required tests, which can allow for additional patients to be seen.
Actual SBAR: Recommendation
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
CASE STUDY:
ACR INSPECTION EXPERIENCE
University of Virginia
February 2016
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen ACR Inspection Process
• UVA got a one week notice
• The ACR sent an inspection prep package – 25 pages!
• The ACR inspector was on-site for one day
• The ACR provided a post-review report
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Here’s how to think about ACR inspections
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 77
ACR List Inspected by physicist
On site day of the inspection
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Case Study: CT
• Situation: – QC-Track installed for past 4 years
– Follow UVA workflow daily
– Automated analysis in place
• Inspection Process: – Structure in place so very fast -- 5 minutes! – Reviewed each scanner and reviewed
credentials
• Results: – Site needed to have all credentials –
including non-ACR for cardiologists – Ensure that the actual serial # of the
Console agrees with the physicist report agrees with the device serial # at the ACR
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ACR Inspection 2016
Inspector Happiness Hint:
Some ACR inspectors do look for serial nu mbers, bu t knowing th is is di fficu lt to track, mismatch ed serial nu mbers wi ll not be noted in th e written report.
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Case Study: NM
• Situation: – Started using QC-Track in September, 2015 – 6 units, 12 counters and probes
• Inspection Process:
– Matched the records to their inspection documents
• Results: – Needed to prove annual review of safety documents – Recommended that the technologist team use a phantom more
frequently – quarterly, instead of semi-annual
• Response:
– Added an Annual Document Review worksheet within QC-Track – Considering Jaszczak Phantom for possible automated analysis
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Inspector Happiness
Hint: With a QCIS you can respond immediately to an issu e and SHOW the inspector the fix. For example, “recommend testing the phantom qu arterly not semi-annually” , s imply show them the changed test schedule.
ACR Inspection 2016
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Case Study: US
• Situation: – Lots of units: 27 base units and 77 probes
– No QC-Track, all binders and spreadsheets
– QC work divided between physicists and biomed at main location and remote
• Inspection Process: – Less structured and more time consuming because no
electronic tracking system
• Results: – On-site physicist needs to own the QC process – Suggested the site perform the QC at the high end of the
recommendations
• Response: – Implement a structured QC system, with physicist
overseeing the QC process and biomed performing
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 80
ACR Inspection 2016
Inspector
Happiness Hint: We were su rprised by the recommendation to do QC at the h igh end. Then we saw a recent informal su rvey on the physicist l is tserv indicating an average fai lu re rate of 10% on transdu cer QC du ring yearly physicist su rveys
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
CASE STUDY:
TJC INSPECTION EXPERIENCE
University of Virginia
March 2015
81 Copyright (c) 2016 Atirix Medical Systems, Inc. April 27, 2016
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Case Study: Aprons
• Situation: – 2,400+ aprons across 38 locations – QC-Track for four years
• Inspection Process, Spring 2015:
– TJC Inspector found apron item with tracking tag
– “I see you have it tracked. Can I see the report that shows it has been inspected”
• Results: – UVA Response: Scanned the Tag and brought up the
QC-Track Apron Inspection report – Post inspection – TJC complimented the tracking
approach
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 82
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Apron QC – Fluoro? • Advice from Dr. Browne: consider other
clinically supported methods for apron QC
– Tactile inspection minimizes dose exposure to the professionals
• Advice from Allen:
– Do what your state says you need to do
– If OK, use a tactile inspection – does it feel like all of the material has fallen to the bottom of the item?
• If so – CT scout to confirm
• CT is preferred as an alternative to fluoro since zero dose to the tech
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 83
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
WHAT’S ON THE HORIZON?
FLUOROSCOPY, TJC AND AAPM TG272
NEW ACR MAMMOGRAPHY QC PROCESS
84 Copyright (c) 2016 Atirix Medical Systems, Inc. April 27, 2016
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Fluoroscopy and heightened QC requirements
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• The Joint Commission is likely to add fluoroscopy QC to Diagnostic Imaging Requirements – Goal: circulate plans for comment in
2017, introduce regulations in 2018
• States aren’t waiting – California Department of Public Health
• TJC is moving in parallel with the AAPM’s Task Group 272
“The industry has responded to dose concerns with CT.
Are we now going to focus on the rooms that have the capacity to generate equivalent if not more patient dose?
Does QC emphasize checking the dose metrics of the devices?”
Allen Goode
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen TG 272
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen AAPM - TG 272
• Formed in 2015 to unify previous work on dose checking to create a common understanding, including:
– Output parameters coming from a room to more accurately determine dose
– How to make different systems give equivalent information
• Shades of XR-27/XR-29? FDA may be looking to add a phantom requirement to the QC manuals for new fluoroscopy units
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Mammography and the unified ACR QC program – 2/17/2016
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Mammography and the unified ACR QC program
• Chair: Eric Berns, PhD – “I’d love to talk, but… we’re in a quiet period“
• What a process! – ACR committee started in 2008, then tomo systems emerged…
– FDA approval in Feb 2016 of new program and phantom – but only for 2D (FFDM) systems
• “The FDA alternative standard specifies that the new manual may be used only for full-field digital mammography systems without advanced imaging capabilities (e.g., tomosynthesis and contrast enhancement).” (ACR website, FAQ)
– Per ACR web site: “The manual is currently undergoing preparation for publication and should be available this spring”
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
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Standardize: ACR for Mammography
Advantages • Simpler, with few or no
calculations for the techs
• Easier for the inspector, esp. in multi-manufacturer settings
Current approach Manufacturer-specific or ACR QC
ACR approach Standardized QC for all units
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
• Remaining ACR Deployment Steps
– Near term: Phantom and manual availability
– Then: Tomography, Contrast
• Interested? You will need a physics inspection with new method before starting
April 27, 2016 Copyright (c) 2016 Atirix Medical Systems, Inc. 91
Standardize: ACR for Mammography
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen
92 Copyright (c) 2016 Atirix Medical Systems, Inc. April 27, 2016
“You look at where you’re going and where you are and it never makes sense, but then you look back at where you’ve been and a pattern seems to emerge.”
Zen and the Art of Motorcycle Maintenance Robert M. Pirsig
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen A recap of tips to stay on the path to Inspector Happiness
• Structure, structure, structure!
– QC: “Plan it – Prove it”, and “Say it – do it!”
– Credentials
– Organized documents, accessible at time of inspection
• Work closely with your physicist!
• Inspector happiness = radiology director happiness!
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Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Atirix Sponsorships
Thank you!
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Copyright © 2016 Atirix Medical Systems, Inc. All rights reserved. Atirix® and QC-Track® are registered trademarks of Atirix Medical Systems, Inc.
QC-Track is protected by issued and pending patents, including U.S. 8,428,969 “System and method for tracking medical imaging quality” and continuations
Special thanks to Eric Berns, Chair ACR Mammography Committee,
Assistant Professor and Diagnostic Medical Physicist, Denver Health, UC Denver
Marion Boston, Assistant Director, ACR Andrea Browne, Medical Physicist, Dept. of
Engineering, TJC Jim Holder, Director of Imaging, Sutter PAMF Rania Johnson, Senior Director of Product
Management, Atirix Medical Systems Nancy Prouty, Medical Center Administrator, UVA
- For more information [email protected]
Atirix sponsors MTMI Mammography courses for technologists and physicists
Atirix is a Director’s Circle sponsor of the AHRA
Educational Foundation
Steven J. Backes, President and CEO, Atirix Angela Snyder, Director, Research, Atirix Allen Goode, Lead Diagnostic Medical Physicist, UVA
QC Zen Additional information on QC-Track
• Contact [email protected] for private briefings, demos and QC reviews
• See www.Atirix.com for QC-Track information, brochures, QC blog, and recent presentations. A sample SBAR is available for download
• AHRA 2016, Nashville – Booth 621. Please stop by to say hi and get a demo!
– Atirix sponsors the Lean Six Sigma Workshop
• Also:
– MTMI Webinar on enterprise QC, Sept 22, 2016, 6PM CDT – details coming soon!
– California Society of Radiological Technologists (CSRT)
• Atirix will be a presenter in the CSRT Fall Virtual Conference, Mid November, 2016 – details coming soon!
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