Permissions beyond the scope of this license may be available at www. To submit your idea, please click here. Upgrade or install results communication software to timely deliver critical and clinically relevant incidental and pulmonary nodule findings directly to referring clinicians. Create a reading room call center to reduce interruptions and improve communication between radiologists and referring physicians. Author Jenny Jones, Imaging 3. Join the Discussion. Want to join the discussion about how radiologists can lead quality improvement projects for improved image ordering?
Let us know your thoughts on Twitter at imaging3. Have a suggestion for a future case study? Overview Fingerprint. Abstract Four main areas of quality need to be addressed for a complete quality and safety program in radiology: safety, process improvement, professional outcome assessment, and satisfaction. Access to Document Link to publication in Scopus. Link to citation list in Scopus. Fingerprint Dive into the research topics of 'Quality initiatives: Developing a radiology quality and safety program: A primer'.
Set the SID to 40" and lock the vertical travel of the tube suspension. Place the loaded, larger cassette on the tabletop. Center the tube longitudinally and transversely, check that the x-ray tube is perpendicular to the cassette. Activate the light localizer and center the x-ray tube to the bucky tray. Make sure that the cassette on the tabletop is centered as well. Make an exposure and process the film from the larger cassette.
If the exposed field size from the larger cassette does not exceed the film size in the bucky tray, the PBL system meets requirements. If the exposed field size from the larger cassette exceeds the film size for the cassette in the bucky tray, then triangulation utilizing the exposed film from the large cassette must be done to determine the actual field size at the bucky tray. Triangulation Measure the x-ray field along the table on the tabletop film and record.
Measure the x-ray field across the table on the tabletop film and record. W1 - measured width of the x-ray field on the table top film. D1 - measured source to tabletop distance. D2 - the indicated SID of the unit 40". L2 - length of the x-ray field at the plane of the film in the bucky tray D1 - measured source to tabletop distance.
Make sure that the x-ray tube is centered to the table using the transverse locking mechanism on the x-ray tube. Center the bucky tray to the collimator centering light. Set x-ray tube to 40" SID.
Manually collimate light field to leave to 1 inch border on the film. This will leave an unexposed border on the film after processing. Expose and process the film. To find the center of the film, place a ruler at opposite corners of the film and draw a line.
The point where the two lines cross is the center of the film. Because film has rounded edges, some estimating will have to be done when positioning the ruler in opposite corners. To find the center of the exposed portion of the film, place the ruler at opposite corners of the exposed portion of the film and draw a line.
The point where the two lines cross is the center of the exposed field. Measure the distance between the center point of the film and the center point of the exposed field. Record this information. Equipment Needed Rejected radiographs and a count of the total number of films consumed during the survey period. Procedure Start the test with an empty reject film container.
Establish a method to accurately determine the amount of raw film consumed starting on the day that you collect the reject film. Decide on the length of the survey period. At the end of this period, collect all rejected radiographs and determine the actual number of radiographs exposed i. Analyze all of the rejected films and determine the reason that they were probably rejected. See Appendix H for an example. Record these numbers on a tally sheet as you are reviewing the films.
Don't be surprised if there are many radiographs for which you can't determine the cause of rejection. Note: It will be difficult to determine if a light or dark radiograph was rejected because of poor technique or improper processing. Consequently, these must be classed simply as "light" or "dark". Determine the overall reject rate. Determine the percentage of rejects from each of the categories. For example, let's say that 3 films fell into the category labeled "too dark".
This log will include date, number of views, and the name of the holder, their exposure and the reason holding was necessary. The following information shall be included: The method of instructing workers as to the requirements of Sections The method of informing workers of their monthly exposure and total exposure for the gestation period. The facility policy regarding work assignments for declared pregnant workers. The following information shall be included: The x-ray examinations which require gonad shielding; The method s of shielding available; and The age limit for use of gonad shielding.
Such shielding should be provided when the following conditions exist: The gonads will lie within the primary x-ray field, or within close proximity about 5 centimeters , despite proper beam limitation. Except as provided in paragraph b or c of this section: Specific area testicular shielding should always be used during those examinations in which the testes usually are in the primary x-ray field, such as examinations of the pelvis, hip, and upper femur; Specific area testicular shielding may also be warranted during other examinations of the abdominal region in which the testes may lie within or in close proximity to the primary x-ray field, depending upon the size of the patient and the examination techniques and equipment employed.
Some examples of these are: Abdominal, lumbar spine and lumbosacral spine examinations, intravenous pyelograms, and abdominal scout film for barium enemas and upper GI series.
Each x-ray facility should evaluate its procedures, techniques, and equipment and compile a list of such examinations for which specific area testicular shielding should be routinely considered for use.
As a basis for judgment, specific area testicular shielding should be considered for all examinations of male patients in which the pubic symphysis will be visualized on the film; Specific area gonad shielding should never be used as a substitute for careful patient positioning, the use of correct technique factors and film processing, or proper beam limitation confinement of the x-ray field to the area of diagnostic interest , because this could result in unnecessary doses to other sensitive tissues and could adversely affect the quality of the radiograph; and Specific area gonad shielding should provide attenuation of xrays at least equivalent to that afforded by 0.
The clinical objectives of the examination will not be compromised. Specific area testicular shielding usually does not obscure needed information except in a few cases such as oblique views of the hip, retrograde urethrograms and voiding cystourethrograms, visualization of the rectum and, occasionally, the pubic symphysis.
Consequently, specific area testicular shielding should be considered for use in the majority of x-ray examinations of male patients in which the testes will lie within the primary beam or within 5 centimeters of its edge.
It is not always possible to position shields on male patients so that no bone is obscured. Therefore, if all bone structure of the pelvic area must be visualized for a particular patient, the use of shielding should be carefully evaluated. The decision concerning the applicability of shielding for an individual patient is dependent upon consideration of the patient's unique anthropometric characteristics and the diagnostic information needs of the examination.
The use of specific area ovarian shielding is frequently impractical at present because the exact location of the ovaries is difficult to estimate, and the shield may obscure visualization of portions of adjacent structures such as the spine, ureters, and small and large bowels. However, it may be possible for practitioners to use specific area ovarian shielding during selected views in some examinations. The patient has a reasonable reproductive potential. Specific area shielding need not be used on patients who cannot or are not likely to have children in the future.
The following table of statistical data regarding the average number of children expected by potential parents in various age categories during their remaining lifetimes is provided for x-ray facilities that wish to use it as a basis for judging reproductive potential: Expected Number of Future Children Versus Age of Potential Parent Age Male parent Female parent 1 Fetus 2. Appendix F Policy and Procedures for Pregnant Patients The facility shall include the following information in its Policy and Procedures manual item regarding pregnant and potentially pregnant patients: Method of establishing which patients may be pregnant; Policy for determining need for x-ray examination in pregnant patients; X-ray techniques for minimizing fetal exposure; Method of determining exposure to fetus; and Procedures to be followed in advising the woman and her practitioner of the exposure received by the fetus.
Appendix F Policy and Procedures of Personnel Monitoring The facility using personnel monitoring shall include the following information in its Policy and Procedures manual: The name of the person responsible for distribution, collection and records of badges; The location of controls; A prohibition against intentionally exposing the control or personnel badge; and The location of records and policy regarding notification of personnel of exposures.
Spine 40" - 13 cm 95 Lat. Skull 40" - 15 cm 70 84 Procedure for Chest or Spine Center the x-ray tube to the tabletop or vertical cassette holder. Check that the proper SID has been selected. For procedures done on the x-ray table, place the ionization chamber on the table. Current Weekly Issue. Past Weekly Issues. Curated Libraries. The Fundamentals. Continuing Education. Training Catalog. Editorial Team. Technical Expert Panel. Copy Citation.
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