Eliminating Poor Image Quality
in Nuclear Medical Imaging
Informational Abstract
Introduction
Poor Image Quality Defined
Detrimental Effects of Poor Image Quality
Causes of Poor Image Quality
Common (Unsuccessful) QC Programs
Resolving Poor Image Quality
Recommendation
Informational Abstract
Medical Imaging is an important part of the diagnosis and treatment of patients in today’s health care environment. Poor quality of diagnostic images can lead to serious errors and can be a life and death matter. The main causes for poor image quality are Equipment Issues, Procedural Issues and Operator Issues. Many imaging departments are addressing the situation of poor image quality with an unstructured Quality Control (QC) plan where QC and calibration procedures are performed inconsistently. Resolving the situation of poor image quality requires a solid and consistent QC program. Outsourcing the QC program to Gamma Quality, who specializes in managing and performing QC procedures, can solve an imaging department’s poor image quality situation. Outsourcing the QC program to Gamma Quality assures that an imaging facility’s program is performed timely, with the proper equipment, with the appropriate and updated protocols. It also can reduce the imaging facility’s overall cost of operations by eliminating expensive phantom purchases, reducing technologist overtime, reducing equipment service calls, and by maximizing camera utilization and uptime.
Back to the Top
Introduction
Medical Imaging is a very important part of the diagnosis and treatment of patients in today’s health care environment. Often, medical imaging provides the clinician with one of the first pieces of information about the condition of the patient being seen. In order to provide the clinician with the correct information, the imaging equipment must be in proper working order. The information provided by medical imaging may direct the rest of the patient’s treatment or diagnosis and is thus of paramount importance. This report will investigate the situation of poor image quality and recommend a solution.
Back to the Top
Poor Image Quality Defined
The situation at hand is the poor image quality of some diagnostic images in Nuclear Medicine. Poor image quality is evident in the review of images that demonstrate poor sensitivity, low spatial resolution, poor reconstructed resolution or various image artifacts. Such artifacts may include “star”, “bull’s-eye”, “ring”, “motion” to name a few.
Back to the Top
Detrimental Effects of Poor Image Quality
The poor quality of diagnostic images can lead to many serious and some minor situations. The most serious situation is where a misdiagnosis is made based on the poor quality images. False Negative or False Positive diagnosis may be a matter of life or death for a patient whose subsequent treatment, therapy, or lack there-of, depends on the interpretation of the medical images. Poor quality images may hide a cancer, delaying or precluding a potentially life saving treatment or therapy. An artifact may lead the interpreting physician to diagnose a cancer where none exists, causing mental anguish for the patient and family, and may expose the patient to possibly risky, expensive and unnecessary treatment or surgery. Minor situations include requiring the patient to repeat the exam. Repeat exam exposes the patient to the additional radiation dose, may require the patient to take additional time from work, and may cost the Hospital more as Inpatient-Bed-Days are increased. The patient may no longer seek medical care from the particular facility due to perceived poor service.
Back to the Top
Causes of Poor Image Quality
The situation of poor image quality has many causes. The main causes for poor image quality can be divided into the following three categories:
- Equipment Issues,
- Procedural Issues
- Operator Issues.
Equipment Issues are those that are directly related to the hardware device. These causes of poor image quality include aged or obsolete equipment, damaged equipment, incorrectly or inconsistently calibrated equipment, incorrectly or inconsistently maintained equipment. The calibration and maintenance procedures on imaging equipment can be very complicated, time consuming, may require specialized and expensive calibration equipment. Equipment Vendor Service charges for such calibration and maintenance visits are very expensive. Additionally, in today’s hospital management plans, many equipment service contracts are being replaced by in-house Biomedical Engineering staff servicing the equipment, often the in-house staff have no or very little knowledge of or experience with these sophisticated systems.
Procedural Issues are those imaging department procedures that are designed to detect the situation of poor image quality. In order to avoid poor image quality, various procedures must be performed on a routine basis to detect performance that is suboptimal. The Nuclear Medicine community has made numerous recommendations concerning this issue and the body of literature concerning what constitutes a “good program” is quite extensive. The failure of an imaging department to develop and document these procedures, the failure to correctly analyze the results, and more often, the failure of the department personnel to even perform these procedures often leads to poor image quality. This is common on today’s work environment, where a shortage of technologists, increasing cost and cost controls, reduced overtime, raising patient workloads all conspire to force staff to choose between imaging patients and performing Quality Control (QC) procedures.
Operator Issues causing poor image quality are those that are based on the actions of the Technologist performing the individual imaging procedure and producing the medical image. The tech may be inexperienced, poorly trained on the equipment, or may not have the skill or desire to minimize the factors that result in poor image quality. These factors include minimizing patient to detector distance when appropriate and minimizing patient motion, and others.
We will focus on those components that can be effectively mitigated with a solid equipment quality control program.
Back to the Top
Common (Unsuccessful) QC Programs
Many imaging departments are addressing the situation of poor image quality with an unstructured QC plan where QC and calibration procedures are performed “as time allows”. Unfortunately, this often means that the procedures are simply NEVER performed, or performed only when image quality is so poor that images are not of diagnostic quality. Too often in today’s busy clinical settings, quality control procedures simply are not performed or are performed without adequate knowledge of the expected results or appropriate corrective actions.
Back to the Top
Resolving Poor Image Quality
Resolving the situation of poor image quality requires a solid and consistent QC program. A Quality Control Program must meet several criteria to be effective, among which are:
The proper tests must be performed regularly and reproducibly by an experienced individual capable of detecting minor problems and taking corrective actions. These tests assure the proper calibration and functioning of the cameras used in diagnostic imaging procedures.
The proper techniques and equipment must be used. The testing should follow NEMA Standards, standards that are recognized by the Nuclear Medicine Community. The proper phantoms required to measure camera performance based on standardized testing procedures must be used. Improper testing procedures, phantoms or evaluation may invalidate the results and render a Quality Control Program ineffective.
The results must be monitored, analyzed and documented. The results reports summarize the performance of the gamma cameras, summaries which include highlighting any problems or negative trends. The reports also facilitate proactive maintenance of an Institution’s assets. A well monitored and documented program is not only crucial to providing excellent patient care, but would be valuable in demonstrating, to accreditation bodies (JCAHO, ACR, ICANL, etc.) or internal quality monitoring committees, an Institution’s dedication to quality assurance.
A solid, documented Quality Control Program would also be valuable in defending against litigation. A solid Gamma Camera Quality Control Program is one that meets or exceeds the requirements, and assures that the diagnostic images are free of camera based artifacts. The tests must be performed in a consistent, high quality manner, which yields consistent results for trending analysis and are not subject to variations based on different operators or different protocols.
Back to the Top
Recommendation
Outsourcing the QC program to a company that specializes in managing and performing QC procedures can help solve an imaging department’s poor image quality situation when the causes are equipment or procedural based. Operational based causes must be addressed by technologist training and incentive. Outsourcing the QC program to Gamma Quality assures that an imaging facility’s program is performed timely, with the proper equipment, with the appropriate and updated protocols. It also can reduce the imaging facility’s overall cost of operations by eliminating technologist overtime, and by maximizing camera utilization and uptime.
Outsourcing the QC program can be accomplished by the imaging facility first defining their equipment and procedural needs and then contacting Gamma Quality for providing the outsource service. Based on the age, and model of the equipment owned, the Gamma Quality can provide a proposal to meet the needs identified. If there is difficulty in determining needs, the Gamma Quality can assist in developing those needs, and can make recommendations to create a solid QC program.
Back to the Top
|
