Standardizing QA and QC for Technologists
Nikunj DesaiMuch has been written about improving quality assurance (QA) and quality control (QC) in radiology, but little attention has been paid to the processes for which the technologist is responsible—in spite of the technologist’s critical role in ensuring that imaging devices are properly calibrated. Nikunj Desai, algorithms developer for iCRco (Torrance, California), says, “Scanners vary a lot from vendor to vendor, and every vendor has its own criteria for testing the system to assure end users that the system is working correctly. Their needs depend on the technology they’re using, and they can easily become overwhelmed and confused in trying to keep it all straight.” To develop a system for QA and QC that works better for technologists, Desai and his team followed the rapid–application-development methodology. “It entails churning out a lot of prototypes and bringing them out to the end users to try,” he says. “We do a lot of beta testing. We collect user requirements and try to match them, as closely as possible, to standards.” The result of this process is iCRco’s new Digital Physicist product, which combines software written by Desai and his colleagues with a single phantom and a series of filters—to provide a flexible (but automated) means of handling QA. The product, which is designed to work with any of iCRco’s CR and DR platforms, “is easy to use and portable,” Desai says. “It combines qualitative and quantitative results to evaluate whether the system’s performance is good.” An Emerging Imperative Desai notes, however, that developing software of this kind is not as simple as incorporating technologist feedback, although the end-user experience is critical. He observes that with quality increasingly in the spotlight and accreditation/certification the focus of several federal efforts to standardize processes, the end user of a product like Digital Physicist could be defined as the technologist, the medical physicist, or even the administrator responsible for quality projects. “Imaging centers are often audited by the state, and the state inspections are surprise checks,” Desai says. “The facility must have maintained regular QC documentation. With Digital Physicist, the user can perform these tests and, at the end, print a structured report that can be used for these audits, and for compliance with the requirements of other regulatory bodies.” Facilities use the services of medical physicists to determine the criteria by which technologists will abide, making them key users of the device as well, Desai says. “There’s a section of the software that can be used to perform complex physics testing with four image-quality metrics that, over time, require advanced algorithms to calculate,” he says. “This process has been made much easier to perform. The user can then generate these results over time and can easily compare them to make sure the system’s performance is up to the mark.” Lower Errors An additional benefit of using a software-based approach to QA and QC is automation, Desai says. “This is a very simple system—we want to make this as easy as possible for the technologists,” he notes. “They acquire a single test image with the phantom and run it through the software. They can literally click the button, walk away for coffee, come back, and find the report waiting for them.” One benefit of this automation is improvement of workflow. “It ensures higher throughput because performing these tests takes less than five minutes now,” Desai says. “The technologists’ only aid in this process is a medical physicist who comes in once a year—for the most part, they is left to themselves, and now they have an automated tool to facilitate the process. This way, the tests can be performed weekly or monthly, and the records can be on hand when the audit happens, or when it’s time for certification or accreditation.” Errors in calibrating imaging technology can have deleterious consequences, Desai observes, because calibration is one factor governing dose. “The amount of radiation given to a patient is governed by applications—if you were imaging the chest, for instance, you’d give less radiation than for a mammogram because the chest has a high physical contrast,” he says. “We’re monitoring image resolution and contrast, which crucially determine the amount of radiation given to a patient. Tracking these, over time, will ensure the patient is exposed according to the as low as reasonably achievable, or ALARA, protocol.” Using software to make this process as efficient as possible also eliminates the possibility of human error. “The software offers dashboards on the results of four tests—image resolution, image contrast, the laser function of the scanner, and the uniformity of the image,” he says. “It takes a load off the technologists: Lowering human intervention guarantees lower errors.” Digital Physicist is currently available for any CR or DR system from iCRco, but Desai says that there is potential for the technology to be applied to any radiography system. “A lot of vendors put out their quality criteria, and we can use those as a baseline to check other systems to be sure they’re working correctly,” he says. “We are in a position to make this third-party software that anybody can use for any type of system, making sure the systems are in line with recommendations set out by bodies like the American Association of Physicists in Medicine, as well as regulatory bodies like the FDA.” He concludes, “This is a simple process for all end users.” Cat Vasko is editor of and associate editor of Radiology Business Journal.