Quality Assurance in Radiology

Quality assurance is a term that has emerged in the past few years that is intended to connote a broader sphere of action than was usually assigned to the older term quality control. Quality assurance, as practiced in hospital radiography departments today, encompasses equipment, accessories, and radiography personnel. Generally, quality control is a term referring to the hardware or equipment in radiology departments.

Every hospital radiology department has a quality assurance program. (This type of program is a requirement by law.) It involves all radiology personnel in how they will perform their tasks, as well as the equipment for function and safety. Large departments may designate one person to be responsible for the program. However, the current trend is toward making all technologists responsible for quality assurance within their scope of practice.

Quality is often defined as a degree of excellence. Everyone who enters a health care facility expects to receive the highest possible quality—or excellence—of service. The radiologic technologist plays an important role in maintaining that quality of service.

Every new radiologic technology student is overwhelmed by the complexity of the equipment and the sophisticated techniques used by staff radiologic technologists. However, as a student, several steps can be taken to ensure quality, even in the early stage of your clinical education, such as making sure the cassettes are free of dirt and debris, checking for broken hinges and latches, making sure barcode labels are in good condition, and making sure imaging plates are erased before reuse. As you spend more time in clinical education, you will soon become accustomed to using complex machines and methods to produce radiographs. However, an important point to remember is that radiographic services are very complex and sophisticated, no matter how familiar they may become. In fact, this complexity is the primary problem in maintaining quality radiographic services in today’s radiology departments.

Remember that no matter how complex the problem may seem, the solution is usually very simple and obvious. In this chapter, you will be presented with a few simple rules that will assist you in solving some of your early problems and help you maintain an optimal level of quality in the radiographic services you provide your patients.

Administrative pyramid

Most radiology departments operate under a pyramidal administrative structure. This type of structure allows a few administrators to manage a large number of employees (Fig. 17-1). Generally, the tip of the pyramid represents the highest-paid employees and the bottom of the scale the lowest-paid employees. This arrangement is economical in that most employees are on the lower end of the wage scale. Communication from the top down is usually formal so that when an order is issued from a top administrator, it is passed down to the lower levels of the pyramid without undue difficulty. However, when attempts are made to transmit a message back up the pyramid, a problem similar to what occurs in the telephone game played by children is encountered. In this game, participants relay a message from one end of a line of people to the other end by each participant whispering it to the next. In this manner, a statement such as “I’m happy to be here” may exit the telephone line as “I’ve snapped the beads, dear.” Although each participant tried to relay an accurate message, each one introduced a personal perception of the message into the original, thereby changing the real meaning as the message progressed along the telephone line (Fig. 17-2).

FIGURE 17-1 Pyramidal administrative structure.

FIGURE 17-2 The “telephone line” effect.

Fig. 17-3 demonstrates how the production of a radiograph can be described by a pyramid that is, in many ways, very similar to the pyramid in Fig. 17-1. The various administrative levels shown in Fig. 17-1 are replaced by various radiographic equipment and personnel to create Fig. 17-3.