Image Quality Control in the PACS Age

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You couldn’t ask to learn about PACS quality control from a better organization than MD Anderson. In this afternoon’s informatics session “Quality Control in PACS,” S. Jeff Shepard, MS, explained that MD Anderson “is an extremely high volume operation,” doing 400,000 exams a year (80% of which are outpatient). What’s more, patients come from all over the world to be treated there, making throughput paramount and uptime essential. “Delays really impact the satisfaction of patients’ experience,” he said.

Kevin McEnery, MD, of MD Anderson kicked off the talk with a discussion of how techs, radiologists and medical physicists can contribute both individually and collaboratively to image and PACS quality control. “A lot of the quality metrics we currently track in our institutions are quantity metrics,” he noted. “The unfortunate thing is that there are limited QA tools built into standard, commercial PACS.”

McEnery said radiologists should work with medical physicists to establish a standard way for images to be displayed at their institution – a consistent “film look.” Manufacturer’s standard settings should be used as a starting point from which to adjust to accentuate local preference – for instance, edge enhancement isn’t so important to MD Anderson’s radiologists, but contrast is.

Medical physicists and technologists, meanwhile, should collaborate on establishing consistent image parameters, revisiting them over time to ensure they’re not deviating. Comparing a patient’s most recent image with a prior is one way to execute this; image quality over time should remain about the same.

Finally, radiologists and technologists need to collaborate in ways analogous, though different, to how they collaborated during what McEnery referred to as “the film age.” Institutions should establish a mechanism – preferably electronic – for case feedback through which the radiologist can guide techs on an ad hoc basis.

“It’s actually easier, in the PACS age, to maintain image quality,” McEnery opined. “But the radiologist must be involved in the quality process. It’s the radiologist’s job.”