A new concept in radiology QA in a large setting

Determining film quality has traditionally been carried out through review and evaluation of exam retakes. At best, such a system will tell which exam areas the technologist repeated most. Kaiser Permanente Northwest has 80 radiologic technologists and 30 radiologists who rotate through film reading. The program developed at Kaiser is directed toward general diagnostic film quality only and uses the services of two full-time quality assurance (QA) technologists. Working together, the radiologist and QA staff have created a standard of diagnostic image quality. A QA radiologist representative is available to work with the QA technologist if inconsistencies are raised. Every other month, a QA technologist makes a random selection for review of 50 exams performed by each technologist. These evaluations cover view rather than exam, with each view judged on its own merit. The purpose is to look for recurring problems in the technologist's performance. Copies of the review sheet go to each technologist's supervisor who forwards a copy to the technologist. Technologists can request help to understand why certain films meet or fail to meet quality standards. The QA technologists are available to give one-on-one help, and they also offer classes and demonstrations. In turn, radiologist fill out quality control (QC) slips as they read exams. The slips help to educate and correct specific problems, and are a direct communication link between radiologist and technologist. The QA program places importance on having the proper tools for taking quality films. The program also provides several levels of accountability although QA technologists are not responsible for its enforcement. Instead, they give feedback to supervisors who enforce performance levels. An appeals process is also in place. The program helps keep image quality acceptable to both hospital radiologists and customer requirements in the industry. In turn, the technologists use it to further their professional development.