Reviewing processes with a view to maximising workflow efficiency is a good idea once in a while. Vanessa Knivett, communications specialist for RTI, explains how the company’s innovative software and all-in-one meters can help improve the quality of your quality assurance.

Improving patient and staff safety, and ensuring healthcare excellence are the primary goals of every quality assurance (QA) programme for X-ray devices. However, advances in imaging technology and a growing, aging population means that the number of scans performed is increasing. These factors ensure that whenever QA processes are discussed, efficiency is a key watchword from a cost and test-time perspective.

A basic QA programme to control diagnostic image quality consists of a series of routine, standardised tests to detect changes in X-ray equipment function, using original performance as the baseline. QA measurement efficiency is determined by two factors: appropriate processes to test, evaluate and record data; and equipment performance.

Hit me with your best shot

While there are differences in hardware sold for X-ray QA programmes in terms of accuracy, precision, sensitivity and range, these are not as great as they used to be, thanks to improvements in semiconductor technology. Many X-ray meters boast ‘one-shot’ operation, requiring just one exposure to capture all the relevant beam parameters. Similarly, all-in-one devices combining radiography, fluoroscopy, mammography, dental and CT capabilities are now commonplace. Arguably, selecting an all-in-one multimeter capable of one-shot measurement is a first step towards ensuring workflow efficiency.

Potentially the greatest workflow efficiency improvements can be realised by refining the measurement-gathering process, and access to the latest software is key in this. With appropriate set-up, contemporary test software can semi-automate test procedures by directing users through a prescribed set of test protocols. By applying an appropriate test workflow, errors can be minimised and, ultimately, test times decreased.

Henrik Bertilsson is medical physicist for the Kronoberg region of Sweden and in charge of the QA of X-ray equipment for two hospitals. He explains: "I am currently responsible for more than 30 X-ray units, including four CT scanners, three interventional systems, six conventional radiographic systems, four mobile units, nine surgical C-arms and six panoramic systems, plus a CBCT machine for dental radiology. In addition, I am in charge of acceptance-testing over a hundred intra-oral units for dental applications throughout our region."

As with any standard QA programme, all imaging equipment in Kronoberg undergoes an initial acceptance test prior to routine service, plus a comprehensive annual check-up. This process examines all the usual performance parameters, such as radiation dose and image quality, with a view to detecting performance deviations so that corrective action can be taken. The medical physicist checks all imaging equipment after service, and operating staff calibrate CT equipment on a daily basis.

The Kronoberg hospitals use RTI’s Piranha all-in-one X-ray meter, Cobia Smart, for measuring radiography and fluoroscopy parameters, as well as the firm’s Ocean diagnostic software. Bertilsson says: "Ocean allows me to set up measurement templates for many different types of equipment. It is convenient, as it collects all the data at once and performs automatic analysis."

Time for a check-up

With time in the X-ray room often limited, speed is essential with these processes. Ocean 2014 has a ‘quick check’ mode that detects the instrument and detectors connected, allowing users to start measuring immediately. It displays all measured parameters on one screen and saves them in Ocean for later review outside of the X-ray room.

While one-shot measurement accelerates data gathering, Bertilsson confirms that the reporting capabilities of RTI’s Ocean deliver the greatest improvements to workflow, stating that "annual QA test time has been cut to between two and four hours per unit on average, and down to just one hour for some systems".

Other customers have reported cuts in more-routine measurements from two hours to as low as 20 minutes, delivering real cost savings and greatly reducing downtime.

Crucially, a medical physicist’s time and expertise is best employed in many other ways than taking measurements and performing repetitive data entry. Contemporary test software in no way eliminates the need for highly skilled medical physicists in the X-ray QA process, but it can certainly optimise workflow and drive measurable efficiency improvements.