Performing Quality Control

A gamma camera is a sophisticated piece of technology. The device is used for diagnostic and therapeutic procedures and thus is critical to providing quality patient care. In order to assure quality patient care, the gamma camera must be maintained in the best possible working order, and to that end, a comprehensive Quality Control (QC) Program must be developed and executed. The primary goal of a QC program is to assure the equipment is operating in the best possible manner and this is done by designing a QC program that can detect and correct performance issues with the equipment.

To develop and execute a comprehensive QC program, the QC program manager must perform the following 4 activities:

Gain knowledge of the equipment,
Document the QC plan,
Monitor the results
Respond to detected problems.

First, the manager must be knowledgeable of the pieces of equipment that are to be covered in the program. To do this, the manager must start by determining which of the many devices are to be covered, and then the manager must be knowledgeable of the specific tests required by each device. All imaging and diagnostic devices in the imaging facility should be included. The typical devices include gamma cameras, imaging probes and dose calibrators. The manager must be knowledgeable of the specific tests each device requires and the frequency the tests should be performed. To this end, specific details can be learned by reading the device manual, speaking with the device manufacturer service/support personnel, or consulting with an outsource QC service provider. One of the more difficult issues is testing frequency. Fortunately, there are many professional organizations that have made detailed recommendations on the appropriate tests and testing frequency. Also, an outsource QC provider will have many years of experience working with the equipment and can thus design a plan that will maximize the device’s performance and minimize the effort required to keep the device operating optimally.

Second, the manager must document the QC plan, once the detailed requirements of the equipment are understood. The documentation should describe the 5 basic parts of the plan. These parts are: (1) each test to be performed, (2) the testing frequency, (3) the specific testing protocol and procedures, (4) the expected results and (5) corrective actions. A common method for documenting the plan is to create a separate log book for each device. In the log books, pages should be included that describes or allow recording of the following information:

The name of the test and reason each test is to be performed
The optimum frequency that each test is to be performed
Detailed instructions on how to perform the test (protocol and procedure), including equipment and supplies required, how to evaluate the results and the expected results
Date of the test, Operator Name, Test Results and Comments
Corrective Actions taken or person notified, if any.

The plan should be very detail intense, such that an inexperienced staff member would be able to produce useable results when following the plan. In order for the results to be valid and generate usable trending data, the tests must be performed using the same protocol and parameters each time. Inter-operator differences must be minimized wherever possible. In the case of test failure, instructions must clearly state whether the device can continue to be used, or must be removed from service until repairs are completed.

Third, the manager must monitor the results once the solid QC plan is created and documented and assure the tests are performed based on the plan. Clearly, this is one of the most important steps because it helps assure that all the previous steps are working correctly. The goal of the QC program is to find and correct errors and assure that the equipment is working correctly. Conversely, if the results are not monitored, problems will go uncorrected. Also, the QC procedures are the first thing to be skipped during busy times, or during staff shortages. When a manager closely monitors the QC program, the tests are unlikely to be skipped. Unfortunately, this is a step that is commonly missed. After the manager expends significant effort on developing and instigating the plan, too often the required follow up is not performed. The busy manager moves on to the next task and assumes the plan will be successfully executed. A good solution would be to require a monthly or quarterly review of the log books and a one page summary report that highlights problems and corrective actions. A supervisor can prepare this as an informal report or report on the results during staff meetings. If the QC procedures are outsourced, the company should provide this information as requested.

Fourth, the manager must quickly respond to any detected issues, once the QC plan is operating successfully. By monitoring and trending the results a manager can proactively schedule Maintenance or Preventative Maintenance, reducing unscheduled equipment down-time. Unscheduled equipment down-time is very disruptive to smooth operations, upsetting staff and patients, and is very costly in terms of lost revenue from cancelled exams and costly emergency repairs. Basically, there are two types of performance problems that the manager will detect and need to correct. The first is obvious failure of the device, based on the expected test results detailed in the plan. In this case, the test operator, by following the plan, knows if the device can be used or not, when to call for service and when to notify the manager. The manager is made aware of the issue and is involved in the process of returning the device to service. The second case is not an obvious failure, but rather an assessment of the results that demonstrate a trending towards failure or deteriorating performance. Here the manager evaluates the data to determine overall and long-term performance issues and decide when preventative maintenance is required. By managing the equipment in this manner, the manager knows which pieces of equipment are operating efficiently, which are trending down, and which devices should be scheduled for preventative maintenance or replacement. By knowing this information, the manager can more effectively manage the operational and capital costs associated with the equipment. Additionally, adjustments to the scheduling of patient exams can be made to minimize patient inconvenience and maximize department throughput.