121st World Radiography Day Celebration
Commemoration of the Discovery of X-ray by Dr Conrad Waldheim Roentgen
Mr. Chairman, The President and Members of the National Executive Council of the Ghana Society of Radiographers, Distinguished invited Guests, Members of the Radiography fraternity, Friends from the Media, Ladies and Gentlemen.
It is my greatest pleasure to speak, on the occasion of the 121st World Radiography Day commemoration, which falls today 8th November, 2016.
As we’ve been told, all over the world today, Radiographers and other professionals of the medical radiation fraternity are commemorating the discovery of X-Rays some 121years ago by the German Physicist, Prof Conrad Roentgen.
Importantly, we’ve been reminded that this single and very legendary discovery led to the greatest revolution in the management of patients. It therefore gave birth to many important healthcare professions, of which our noble profession, Radiography, is one.
Radiography as the ‘first born’ of Prof Roentgen’s discovery has since its birth grown, developed and evolved so much, and keeps advancing rapidly.
Because of the significance of this discovery radiographers globally are today marking the day with pomp: creating awareness of the profession, celebrating the achievements of their forebears and educating the generating public of the importance and prospects the profession holds.
The theme: Quality Assurance: the Radiographer takes a central role.
The theme for this year’s celebration is very appropriate because it first speaks to the radiographer- reminding him/her of the professional responsibility. I think it is also a reminder to the other members in the medical radiation sciences team, namely, radiologists, medical physicists and biomedical engineering. Thirdly and importantly, the theme speaks to health facility owners and policy makers.
I will speak on the theme looking at it from the clinical perspective but to enable us understand the Radiographer’s central role in the business of Quality Assurance (QA), Mr. Chairman, I would like to quickly refer to some definitions:
Quality Assurance, in an Imaging setting, is defined as the planned and systematic actions that provide adequate confidence that a (diagnostic medical imaging facility will produce consistently high quality images with minimum exposure of the patients and healthcare personnel.
Thus QA in Radiation Therapy, is the planned and systematic actions that provide adequate confidence that a produce consistently high quality radiation treatment outcome with minimum side effects to the patients and minimum exposure to the healthcare personnel.
Quality assurance actions include both “quality control” (QC) techniques and “quality administration” procedures.
“Quality control techniques” are those techniques used in the monitoring (or testing), maintenance of the components of an x-ray system and verification of corrective action. The quality control techniques thus are concerned directly with the equipment. They are the most tangible aspect of QA.
“Quality administration procedures” are those management actions intended to guarantee that monitoring techniques are properly performed and evaluated and that necessary corrective measures are taken in response to monitoring results. These procedures provide the organizational framework for the quality assurance program.
And finally, a Quality Assurance program means an organized entity designed to provide “quality assurance” for a radiodiagnostic or radiotherapy facility.
The Elements of a QA programme
To remind to us all about the central role the radiographer plays to ensure quality radiodiagnostic or radiotherapy service to our clients I would want to mention the various elements that constitute a quality assurance programme. These are:
- Purchase specifications
- Monitoring and Maintenance
- Standard for Image quality /Standards for treatment quality
The above list quickly reminds us that QA is more than QC
Mr. Chairman, the core of my address will be based on the importance of each of these components of a QA program in our clinical setting:
The owner or the personnel in charge of the facility has primary responsibility for implementing and maintaining the quality assurance program. Radiographers with the right qualification either by training or experience are assigned responsibility for specific quality control monitoring and maintenance techniques or quality administration procedures.
It is the responsibility of the radiographer to identify problems or potential problems requiring actions beyond the level of their training. The radiographer brings these problems to the attention of the personnel in charge, or his or her representative, so that assistance in solving the problems may be obtained from inside or outside of the facility.
- Purchase Specifications
Ideally before the purchase of a new equipment, the staff of the radiology facility should determine the desired performance specifications for the equipment. The final purchase specifications should be in writing and should include performance specifications. Radiographers, as principal end-users should be important members of that decision-making team.
The radiographer together with the service engineer ensures at the time of installation that the vendor conducts equipment performance evaluations. They again ensure that the equipment should not be formally accepted until the vendor has made any necessary corrections.
- Monitoring and maintenance
The purpose of monitoring is to permit evaluation of the performance of the facility’s imaging or therapy system(s) in terms of the standards for image quality or radiation therapy outcome as established by the facility.
The maintenance program should include preventive maintenance which could prevent unexpected breakdowns of equipment and disruption of departmental routine and also corrective maintenance to eliminate problems revealed by monitoring or other means before they have a serious deleterious impact on patient care.
Traditionally, radiographers in every diagnostic radiology facility monitored the following six key components of the x-ray system.
(a) Film-processing. (index of speed, contrast, basic plus fog)
(b) Basic performance characteristics of the x-ray unit.
(c) Cassettes and grids.
(d) View boxes.
(f) Film reject analysis
Most of these QC Tests are still performed, especially in facilities which still use film-screen and wet processing systems.
However, with the advent of Computed Radiography (CR) and Digital radiography (DR) systems many imaging facilities have moved on to more sophisticated tests.
Among the parameters measured in digital imaging systems are:
It is advisable that the radiographer has the service engineer present when carrying out these tests so as to assist in testing equipment, to provide vendor-supplied test, to provide service manual or installations instruction, to correct deficiencies on-the-spot
Other Specific Imaging QC Tests
To ensure that the facility produces consistently high quality images with minimum exposure of the patients and healthcare personnel the radiographer should play a central role in carrying out the following:
- In Fluoroscopic:
Tabletop exposure rates.
kVp accuracy and reproducibility.
mA accuracy and reproducibility.
Exposure time accuracy and reproducibility.
Reproducibility of x-ray output.
Focal spot size consistency.
Representative entrance skin exposures.
- In general radiographic service radiographers should play central role in the performing of the following :
Reproducibility of x-ray output.
Linearity and reproducibility of mA stations.
Reproducibility and accuracy of timer stations.
Reproducibility and accuracy of kVp stations.
Accuracy of source-to-film distance indicators.
Light/x-ray field congruence.
Focal spot size consistency.
Representative entrance skin exposures.
In fact, the list of QC tests radiographers should carry out and should ensure are carried out is long. There are QC tests for AEC systems and View boxes. There are CT, MRI, Mammography and Nuclear Medicine specific QC tests. Quality control tests in Radiation Therapy include those for simulation, brachytherapy and external beam irradiation.
- 4. Standards for image quality
In a QA programme, Standards of acceptable image quality are established. Ideally these should be objective, e.g., acceptability limits for the variations of parameter values.
In this critical area Mr Chairman, Radiographersin ensure standard image quality, through the following ways:
- Establishment of departmental examination protocols, including provision of explicit information for clients and carers; for other members of the healthcare team – for instance ward nurses on the preparation of patients for radiographic procedures
- Making Availability of Standard Operating Procedures
- Supervision of younger cadres, interns and students by more experienced radiographers
- Comparing the departments protocols and images with standard protocols and images
- Frequent clinical meetings among radiographers to appraise radiographic performance
- Frequent clinical meetings between radiographers and radiologists to critique procedures and images
- Frequent meeting with department non-clinical supporting staff for smooth flow of clinical service to the client.
There are several instances where Image Quality becomes subjective, e.g. the opinions of professional personnel, in cases where adequate objective standards cannot be defined. These standards should be routinely reviewed, redefined and well communicated to team players.
The Radiographer in a radiodiagnostic or radiotherapy facility plays a central role in the evaluation of the quality assurance program.
(i) On the first level evaluation he/she ensures that the results of the monitoring procedures
are used to evaluate the performance of the x-ray system(s) to determine whether corrective actions are needed to adjust the equipment so that the image quality or treatment outcome consistently meet the standards.
(ii) The radiographer is and should always be part of the team that evaluates the effectiveness of the program itself. Possible means include carrying out studies of the retake rate and the causes of the repeated radiographs, examination of equipment repair and replacement costs, subjective evaluation of the radiographs being produced, occurrence and reasons for complaints by radiologists, and analysis of trends in the results of monitoring procedures
The radiographer should always remember to record the number of rejects recorded daily or weekly, depending on the facility’s analysis of its needs.
The reasons for the rejection should also be determined and recorded.
The radiographer is the custodian of the records on the results of the monitoring techniques, any difficulties detected, the corrective measures applied to these difficulties, and the effectiveness of these measures.
These records are a tool for maintaining an effective quality assurance program and not to view the data in them as an end in itself but rather as a beginning.
The radiographer is a cardinal part of the facility staff who write the QA Manual. This is normally written in a format that permits convenient revision as needed and should be made readily available to all personnel. The content of the manual is determined by the facility staff, of which the radiographer plays a central role.
A QA program include provisions for appropriate training for all personnel with quality assurance responsibilities and this should be specific to the facility and the equipment. This should include both training provided before the quality assurance responsibilities are assumed and continuing education to keep the personnel up-to-date.
More experienced radiographers train younger and newer colleagues who have QA responsibilities. They train and supervise other clinical and none—clinical personnel who carry out QA duties.
In large facilities such as hospitals where there are QA committee the radiographers have cardinal role to play in the function of such body. They are involved in and maintain lines of communication among all groups with quality assurance and/or image production and interpretation or radiation treatment outcome responsibilities.
This Quality Assurance Committee and/or the senior management member in charge review the facility’s quality assurance program to determine if its effectiveness could be improved.
From the foregoing we see how broad QA is and how central our role as radiographers in every aspect of it. Radiographers should from today reflect on these roles. We have to congratulate ourselves where we have been able to perform these roles effectively:
In the area of taking up QA responsibilities, ensuring and producing consistently quality images which support clinical diagnosis; where we have ensured that these have been done at as low as reasonably achievable dose to our patients.
Some of us, however, in our facilities might not have fully played this role effective, maybe out of lack of information or were not let to assume that role. This could be that you could not avail yourself to acquire the appropriate skills to accomplish these roles. Or it could also be that you were just not allowed to do it.
To these colleagues especially, and to all us, we now understand that there is more we can do.
Facility owners and policy makers should see radiographers as central role players in the quality assurance programme in the radiodiagnostic and radiotherapy facilities.
They are indispensable part of the QA team; they should therefore not be limited but their role rather recognized and appreciated in every phase of the of QA program.
It is the hope that when these are put in place, our clients, the patient will receive the optimum quality care that each of them deserves. Then our slogan of ensuring quality medical imaging and radiation therapy will become a reality. We will then be living with confidence our motto: Service to Humanity.
Rev James William Ampofo
Deputy Chief Radiographer,
Korle Bu Teaching Hospital.
(8th November, 2016).