The New Jersey radiographic quality assurance program at 5 years

Five years ago, the New Jersey Bureau of Radiological Health decided to develop and implement a proactive, outcome-based quality assurance and quality control program. The specific goals were reducing unnecessary patient radiation exposure and improving image quality (IQ).

From inception, input was obtained from the regulated community, which included all medical facilities providing diagnostic radiographic services. The program monitored entrance skin exposure (ESE) and quantitative IQ for 3 radiographic examinations: posteroanterior chest, anteroposterior lumbar spine, and anteroposterior foot.

Within 1 year, the mean ESE for postanterior chest x-rays had dropped by 39%, the ESE for anteroposterior lumbar spine films had decreased by 18%, and the ESE for anteroposterior foot x-rays had declined by 48%. After the second year, the decreases in ESE were 44%, 29%, and 61%, respectively. There was a corresponding improvement in quantitative IQ.

Reductions in mean patient radiation exposure can be accomplished for specific radiographic examinations while achieving significant improvement in quantitative IQ. This requires the education of and cooperation with the regulated community. Details of the program and the response of the regulated community are presented.