MARCH/APRIL 2006 RADIOLOGY MANAGEMENT 16 Acceptance of PACS Utilizing a PACS QI Program legent Health is a not-for-profit umbrella corpo- ration that governs 5 metropolitan hospitals, 3 regional hospitals, and more than 100 clinics in Nebraska and Iowa. Each of these hospitals and clinics maintains its independent identity. This means that patients treated at any one of these hospitals maintain their medical records unique to that hospital. The identity that each hospital maintains makes them a multi-entity system in the organization’s network. Alegent Health has made the commitment to embark into areas where technology plays a key role. However, challenges are encountered when new technology is introduced into any system, starting from the culture to the integration of the existing infrastructure. This article describes the steps that were taken by one of these hospitals— Mercy Hospital in Council Bluffs, IA—after it implemented a new technology into its system. Mercy Hospital officially opened its diagnostic center in January 2003. The radiology department then incorporated a radiology information system (RIS) followed by a picture archiving and commu- nication system (PACS) in November 2003. A RIS is responsible for patient registration, film/chart tracking, scheduling, management reporting, and other tools designed to increase the efficiency of radiology offices. 1 PACS is a computer system designed for the acquisition, transmission, display, B y Troy Stockman, BSRT(N,R), CNMT, and Santha Krishnan, MSIE A • This article describes the quality improvement program that Mercy Hospital (Alegent Health System) initiated after it implemented a pic- ture archiving and communication system (PACS) in November 2003. The radiology department encountered numerous PACS-related issues that directly affected the quality and workflow of patient care. • In order to get a better understanding of the situation, the depart- ment developed a quality improvement plan for its PACS program. The first step was to dedicate a resource—in this case, a radiology information technology (RIT) support specialist—who would serve as a PACS subject matter expert while dealing with day-to-day PACS- related issues—specifically, errors. • The error data were collected and categorized for consistency using statistical process control (SPC) tools. The information gathered was then traced back to the team members responsible for the errors and used as a training tool to further educate them. • As a result of this program, the average error rate was reduced from 12% to 4% because the radiology team developed a better understanding of the errors by identifying the root causes and being accountable for eliminating errors within their control. In addition, the radiology staff learned to accept and trust the PACS, resulting in a positive culture change that benefited teamwork and staff morale as well as improve the workflow and the quality of patient care. The credit earned from the Quick Credit test accompanying this article may be applied to the AHRA certified radiology administrator (CRA) operations management domain. E X E C U T I V E S U M M A R Y
Transcript
M A R C H / A P R I L 2 0 0 6 R A D I O L O G Y M A N A G E M E N T1 6
Ac c e p t a n c e o f PACSU t i l i z i n g a PAC S Q I
Program
legent Health is a not-for-profit umbrella corpo-ration that governs 5 metropolitan hospitals, 3
regional hospitals, and more than 100 clinics inNebraska and Iowa. Each of these hospitals and clinicsmaintains its independent identity. This means thatpatients treated at any one of these hospitals maintaintheir medical records unique to that hospital. Theidentity that each hospital maintains makes them amulti-entity system in the organization’s network.
Alegent Health has made the commitment toembark into areas where technology plays a keyrole. However, challenges are encountered whennew technology is introduced into any system,starting from the culture to the integration of theexisting infrastructure. This article describes thesteps that were taken by one of these hospitals—Mercy Hospital in Council Bluffs, IA—after itimplemented a new technology into its system.
Mercy Hospital officially opened its diagnosticcenter in January 2003. The radiology departmentthen incorporated a radiology information system(RIS) followed by a picture archiving and commu-nication system (PACS) in November 2003. A RISis responsible for patient registration, film/charttracking, scheduling, management reporting, andother tools designed to increase the efficiency ofradiology offices.1 PACS is a computer systemdesigned for the acquisition, transmission, display,
B y Troy Stockman, BSRT(N,R), CNMT, a n d Santha Krishnan, MSIE
A• This article describes the quality improvement program that Mercy
Hospital (Alegent Health System) initiated after it implemented a pic-ture archiving and communication system (PACS) in November 2003.The radiology department encountered numerous PACS-related issuesthat directly a ffected the quality and workflow of patient care.
• In order to get a better understanding of the situation, the depart-ment developed a quality improvement plan for i ts PACS program.The first step was to dedicate a resource—in this case, a radiologyinformation technology (RIT) support specialist—who would serve asa PACS subject matter expert while dealing with day-to-day PACS-related issues—specifically, errors.
• The error data were collected and categorized for consistency usingstatistical process control (SPC) tools. The information gathered wasthen traced back to the team members responsible for the errorsand used as a training tool to further educate them.
• A s a result of this program, the average error rate was reducedfrom 12% to 4% because the radiology team developed a betterunderstanding of the errors by identifying the root causes and beingaccountable for eliminating errors within their control. In addition,the radiology staff learned to accept and trust the PACS, resulting ina positive culture change that benefited teamwork and staff moraleas well as improve the workflow and the quality of patient care.
The credit earned from the Quick Credit testaccompanying this article may be applied to theAHRA certified radiology administrator (CRA)
operations management domain.
E X E C U T I V E
S U M M A R Y
RM282_pp16-27_PACS QI.qxp 3/16/2006 11:58 AM Page 16
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storage, and retrieval of digital medical images.PACS distributes radiology images to radiologistsfor diagnosis and reporting, as well as to referringphysicians in the critical care units, operatingrooms, nursing units, outpatient clinics, and evento physicians’ home offices.
Figure 1 shows the patient information work-flow at Alegent Health through theinterrelationship of multiple systems. The patientinformation is entered into the hospital informa-tion system (HIS) which provides the MedicalRecord Number (MRN) unique to that hospital, aswell as an Alegent corporate identifier (CorporateID). The Corporate ID is valid throughout allAlegent facilities. When a radiology order is placedin HIS, the technologists have that order availableelectronically via Digital Imaging andCommunications in Medicine (DICOM) ModalityWorklist on the modality console. Once a radiolo-gy procedure is completed, the images are sent tothe PACS server, where they then are available toall radiologists for interpretation and referringphysicians for review. Transcriptionists then tran-
scribe the dictation to text and prepare the reportfor sign-off by the radiologist. A signed reportbecomes part of the permanent patient record.
The successful implementation of PACS isdependent on the information that flows from allthe integrated units. So, when there is a systemfailure, data integrity becomes an issue. Anotherissue that affects the successful implementation ofPACS is the human aspect. PACS faces a big cul-tural challenge in the radiology world in that it isa filmless environment and alters clinical work-flow. In order to successfully interact in a PACSenvironment, staff and physicians must have com-petent computer skills and knowledge.
Mercy Hospital was the first to implement PACSwithin Alegent Health System. As with any newtechnology the radiology team—including theradiology director, imaging technologists, filmlibrarians, and radiologist—expected to overcomesome hurdles at the beginning. However, theyfound significant errors in data integrity, imagemanagement, image quality, and duplicate files inPACS. This created a burden on the PACS admin-
Figure 1. Alegent Health System patient information workflow.
Mercy Bergan IMC Midlands Lakeside
Radiology Information System (RIS) Accession number, schedule tracking
PACS archive of films
Radiologist ER Dr. OrderingPhysician
ReferringPhysician
Hospital Information System (HIS)
Medical Records & Transcription
FilmLibrary
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Acceptance of PACS Util izing a PACS QI P rogram
istrators and radiology information technology(RIT) support specialist as they were constantlytrying to fix these errors within the PACS databas-es. As more modalities were brought online, theerrors increased. The radiology team then decideda quality improvement program was needed tounderstand the issues causing these errors andimprove the workflow so that the patients’ health-care needs were not affected.
The first step in developing a quality improve-ment program was to dedicate a person full time tobecoming a PACS subject matter expert. A RITsupport specialist was hired in October 2004. Thisposition reported directly to the radiology directorand maintained a matrix relationship with thePACS administrator for guidance and competen-cies. The RIT support specialist’s primary jobresponsibilities included:• serving as a functional expert• providing on-site training and support to radiologists
and staff• supporting off-site radiologists and referring physicians• monitoring RIS interface logs
The RIT support system has become a valuableresource for the radiology team to understand thesystem and to improve the workflow and the qual-ity of patient care.
Method
At first, the RIT support specialist’s focus was on fix-ing errors as they occurred. Over time, it becameapparent that these errors were not random. As aresult, data was collected related to these errors andcategorized for consistency. The errors were furtherdefined by each modality, including diagnostic, ultra-sound, nuclear medicine, and computed tomogra-phy/magnetic resonance imaging (CT/MRI). CT andMRI were considered one modality since they sharedthe same personnel. The data were also collected byeach imaging technologist that worked with a particu-lar patient.
A responsibility chart for each technologist(Figure 2) was developed to assign ownership forerrors and used as a training tool to show theirprogress in reducing the number of errors theygenerated.
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A control chart was developed to monitor theperformance of the error rate by modality. A con-trol chart is a simple quality control tool thatmonitors the performance of a key measurement(number of errors) at a particular time interval.The control chart is drawn with a centerline andtwo control limits. These control limits are theUCL (Upper Control Limit) and LCL (LowerControl Limit). The process is considered to be incontrol as long as all the points lie within the con-trol limits. For this process the LCL was set to zerosince the number of errors could not drop belowzero.2
Many types of control charts are available basedon the type of data (attribute versus variable) thatis studied. In this case a P-Chart was chosenbecause the monitored data was a proportion of asample that had a particular attribute. In this case,the proportion of errors incurred with respect tothe total number of images processed. The sam-pling frequency for each modality was set up basedon the image volume processed by each modality(Table 1).
Results
When the error information was initially collected, theresults showed an overall error rate of 12%. The errorswere classified below.
Duplicate Sent to PACS Server
The term used when an exam was sent more than onceto the server.
Incorrect Corporate I D #
Corporate ID is the unique identifier for the multi-entity system. This error occurs when the RIS isunavailable and the technologists are required to go tothe HIS to look up this number.
Incorrect Text
The term used when an error is made by an individualmanually entering incorrect information. Examplesinclude if an individual enters a name when RIS isdown and uses a middle initial with a period behind it,if he or she misspells a name, or if he or she indicates apatient is male when the patient is female. Each mis-take is counted as 1 error.
Incorrect Marker
Then term used when the technologist marks theimage “right” when it is “left” and vice versa.
Image Not Sent to PACS Server
The term used when the images are not sent to thePACS server or the system “times out” upon sending.
Incorrect Rotation
The term used when the image(s) have not beenchecked properly. This generally happens on extremi-ties, but can happen on any exam if it is not correctlyrotated prior to sending.
Add Imaging
The term used when an exam requires that the patientreturn for additional imaging after the exam hasalready been tracked through to the last procedure inRIS. This causes the exam to disappear from the localmodality worklist, causing the technologist to manual-ly enter the patient information. This occurs mainly inCT and MRI when a radiologist requests that addi-tional sequences need scanned or if he or she decidesto contrast a patient that was ordered as a non-con-
20
Acceptance of PACS Util izing a PACS QI P rogram
Table 1. Modality Sampling Frequency
Modality Frequency
CT/MRI Weekly
Diagnostic Weekly
Ultrasound Biweekly
Nuclear Medicine Monthly
At first , the RIT support specialist ’s focus wa s o n fixing errors
as they occurred. Over time, it became apparent that these
erro r s were n o t ra n d o m . A s a result, data was collecte d related
to these errors and categorized for consistency.
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trast exam. These circumstances can happen the day ofthe exam or, in some cases, the patient is called backdays later, thereby requiring some investigative work ifno communication is received from the performingtechnologist.
Images Not Separated
The term used to describe an error resulting from astudy not being separated via the Mitra Relay. TheMitra Relay is only used in CT and MRI. For example,if a CT head, neck, chest, and abdomen are all per-formed on the same patient, the technologist manual-ly separates the exam via the Mitra Relay before send-ing to PACS. If this procedure is not followed, all thestudies will be held in one folder with one AccessionNumber.
Incorrect Foldering
The term used when an image is incorrectly scannedinto the computed radiography (CR) reader or placedin the incorrect “folder.” For example, if a femur and aforearm are ordered, the technologist may place the
lateral forearm in the femur folder. Another example iswhen bi-lateral orders are placed and the “right” sideimages are placed under the “left” Accession Number.
Incorrect Accession Number
An Accession Number is assigned for every study thatgoes through radiology. Multiple Accession Numbersare available under one Corporate ID. The wrongAccession Number is noted when it does not matchRIS for a particular study.
Figure 3 shows the dispersion of these errors asof July 2005.
21
Figure 3 . Defect type dispersion rate.
Jan 05 to July 05-Defect Type dispersion rate Total Defects = 1093Total Volume = 18781
R A D I O L O G Y M A N A G E M E N T M A R C H / A P R I L 2 0 0 6 23
These classifications do not distinguish theerrors—whether they were system related orhuman related. A root cause analysis (Figure 4)reduced this ambiguity, and the errors were prior-itized in Table 2.
Based on the information in Table 2, the teamwas able to see the errors that were within theircontrol. This guided team members in prioritizingtheir corrective actions. Using the responsibilitychart, the RIT support specialist was able to deter-mine the type of training each technologistrequired. As for the errors that were not related toPACS, the radiology director took the responsibil-ity to reinforce with procedural training. Theseactions reduced the overall error rate to 4%.
In every process, a certain amount of variation isexpected. This type of variation is natural to thesystem and is referred to as a “stable system.” Whenthe variation in the process yields trending pointsor points that are outside the control limits, thenthis is interpreted as unnatural variation and isreferred to as an “out of control process.” Thetrends from the P-Charts for each of the modalities(Figures 5-8) show points that fall outside the con-trol limit. That implies that each modality stillneeds to address the unnatural variation in itsprocess. Unnatural variation can be caused by vari-ous factors such as new employee, new machine,machine breakdown, etc. It is important to notethese factors on a control chart and take action toeliminate similar results if the situation should arisein the future. Table 3 shows the average error rate(p-bar) value for each modality as of July 2005.
Findings
New procedures have been put into place to avoidsome of the errors. For example, “Duplicates Sent to
PACS Server” was 43.6% of the overall error rate inJanuary 2005. The technologists have been trained toread a log that shows all the images that have passedthrough to the PACS server successfully. They havebeen required to check this log twice a day to makesure the images have been sent successfully. This hasresulted in a 13.8% drop as of July 2005.
“Images Not Separated” was 2.6% of the over-all error rate. It is only an issue in the CT/MRImodality, with CT accounting for 95% of thaterror. The existing CT scanner is not compatiblewith PACS. The technologist conducts a manualseparation of the images before sending them toPACS. A new CT scanner has been purchased.This scanner will be compatible with PACS andeliminate the need for manually separatingimages.
The implementation of PACS and the qualityimprovement program had created the need fortraining to further educate the radiology team.
Table 2. Error Description by Source
Error Description Source Type
Duplicate Sent to the PACS Server User New—PACS-related
Incorrect Accession # User and System New—PACS-related
Incorrect Text User New—PACS-related
Image Not Sent to PACS Server User and System New—PACS-related
Incorrect Rotation User Not PACS-related
Add Imaging System Limitation New—PACS-related
Incorrect Foldering User New—PACS-related
Incorrect Corporate ID User and System New—PACS-related
Images Not Separated User New—PACS-related
Incorrect Marker User Not PACS-related
A root cause analys i s reduced
error ambiguity, a n d t h e
erro r s were prioritized. Based
on this information, the team
wa s a b l e to s e e t h e e r rors
that were within their
control. This guided team
members in prioritizing
their corrective actions.
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M A R C H / A P R I L 2 0 0 6 R A D I O L O G Y M A N A G E M E N T24
Acceptance of PACS Util izing a PACS QI P rogram
UCL (Upper Control Limit)—This limit is set by the system and shows h ow capably the system isperforming.Centerline (p-bar)—This represents the overall average performance of the system.Spec Limit—This is a measurement by the client or management as a scorecard measure.
Figure 5 . Contro l chart for CT and MRI.
UCL=0.077344
CEN=0.0299
Spec Limit=0.06
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
Jan (
3-9)
Jan(1
0-16)
Jan(1
7-23)
Jan (
24-30
)
Jan3
1-Feb
6
Feb(7-
13)
Feb(1
4-20)
Feb(2
1-27)
Feb2
8-Mar6
Mar(7-1
3)
Mar(14
-20)
Mar(21
-27)
Mar28-A
pr 3
Apr(4-1
0)
Apr(11
-17)
Apr(18
-24)
Apr25-M
ay1
May(2-
8)
May(9-
15)
May(16
-22)
May(23
-29)
May30
-June
5
June
(6-12
)
June
(13-1
9)
June
(20-26
)
June
27-Ju
ly3
July(
4-10)
July(
11-17
)
July(
18-24
)
July(
25-31
)
The points that are circled represent "out of control" points and show unnatural variation in the process.
P-Chart for CT/MRI
UCL (Upper Control Limit)—This limit is set by the system and shows h ow capably the system isperforming.Centerline (p-bar)—This represents the overall average performance of the system.Spec Limit—This is a measurement by the client or management as a scorecard measure.
Figure 6 . Contro l chart for diagnostic procedures.
P-Chart for Diagnostics Procedures
UCL=0.0726
CEN=0.04123
Spec Limit=0.06
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
Jan (
3-9)
Jan(1
0-16)
Jan(1
7-23)
Jan (
24-30
)
Jan3
1-Feb
6
Feb(7
-13)
Feb(14
-20)
Feb(2
1-27)
Feb2
8-Mar6
Mar(7-1
3)
Mar(14
-20)
Mar(21
-27)
Mar28-A
pr 3
Apr(4-1
0)
Apr(11
-17)
Apr(18
-24)
Apr25-M
ay1
May(2-
8)
May(9-
15)
May(16
-22)
May(23
-29)
May30
-June
5
June
(6-12
)
June
(13-1
9)
June
(20-26
)
June
27-Ju
ly3
July(
4-10)
July(
11-17
)
July(
18-24
)
July(
25-31
)
This point is "out of control" and shows unnatural variation in the process.
R A D I O L O G Y M A N A G E M E N T M A R C H / A P R I L 2 0 0 6 25
UCL (Upper Control Limit)—This limit is set by the system and shows how capably the system isperforming.Centerline (p-bar)—This represents the overall average performance of the system.Spec Limit—This is a measurement by the client or management as a scorecard measure.
Figure 7. Contro l chart for ultrasound.
P-Chart for Ultrasound
UCL=0.14972
CEN=0.07504
Spec Limit=0.06
0
0.05
0.1
0.15
0.2
0.25
Nov(1
-14)
Nov(1
5-28)
Nov29
-Dec
12
Dec(13
-26)
Dec27
-Jan 9
Jan(1
0-23)
Jan2
4-Feb
6
Feb(
7-20)
Feb2
1-Mar
6
Mar(7-
20)
Mar 21
-Apr
3
Apr(4-1
7)
Apr18-M
ay 1
May(2-
15)
May(16
-29)
May30
-June
12
June
(13-2
6)
June
27-Ju
ly 10
July(
11-24
)
July2
5-Aug
ust 1
4
The points that are circled represent "out of control" points and show unnatural variation in the process.
UCL (Upper Control Limit)—This limit is set by the system and shows how capably the system isperforming.Centerline (p-bar)—This represents the overall average performance of the system.Spec Limit—This is a measurement by the client or management as a scorecard measure.
M A R C H / A P R I L 2 0 0 6 R A D I O L O G Y M A N A G E M E N T26
Acceptance of PACS Util izing a PACS QI P rogram
The total time spent on training for fiscal year2005 was 400 hours over a 3-month period at acost of $9,400. However, this training time and costis offset by the overall reduction in error rate from12% to 4%, decreased labor cost associated withfixing errors, and improved workflow.
Initially, 100% of the RIT support specialist’sworkload was dedicated to learning the system andfixing errors that were due to system limitations anduser faults. The quality improvement programtaught the members of the radiology team to use theproper measurement tools, identify the root causes,and take charge in implementing the proper correc-tive actions. As a result, the RIT support specialist’sworkload is now dedicated to resolving system-relat-
ed errors and educating other RIT support special-ists on the other Alegent campuses.
Discussion
Alegent Health System has continued implementingPACS on all the other campuses this past year. UsingMercy Hospital’s example, the organization has dedi-cated RIT support specialists at each of these campus-es. Using the knowledge gained from the Mercy Hos-pital’s RIT support specialist, the other campuses havebeen able to overcome the initial setbacks quickly.Now, all the RIT support specialists work as a teamand have identified each other as subject matterexperts on particular PACS-related issues.
Too many enterprises see their PACS imple-mentation as a distinct project with a start andfinish. They treat the day the project goes live asthe start of the next phase of the journey. This isthe lesson that Mercy Hospital learned the hardway. The implementation of PACS on its campuschallenged first and foremost the culture due tothe drive to become a filmless environment. As anend-user unfamiliar with a new technology, it canbe very intimidating to deal with issues that ariseeveryday. It is easy to lay the blame on the systemand find ways to fight learning it.
Mercy Hospital’s approach in hiring a dedicat-ed resource to become a PACS subject matterexpert was a good first step. This person was ableto monitor the proper day-to-day use of the tech-nology and educate the other team members onaccepting their responsibilities in the process.
The quality improvement journey that MercyHospital took was very beneficial in the end.Quality improvement programs are very prevalentin manufacturing industries and are slowly gain-ing momentum in the service industry. Qualityimprovement tools educate professionals in allareas on how to monitor their processes, identifythe root cause of their errors, and assign propercorrective actions. As a result, they can reducetheir overall error rate and increase acceptance ofthe new technology.
Table 3. Average Error Rate by Modality
Area (Modality) Error Rate (p-bar)
CT/MRI 3.0%
Diagnostic 4.1%
Ultrasound 7.5%
Nuclear Medicine 4.3%
As an end-user unfamiliar
w i t h a n ew technology, i t c a n
b e very intimidating to deal
with issues that arise
everyday. I t i s e a s y to l ay
the blame on the system and
fi n d ways to fi g h t
learning it.
The quality improvement program taught the members of the
radiology te a m to u s e t h e p roper measurement tools, identify
t h e root causes, and take charge in implementing the proper
R A D I O L O G Y M A N A G E M E N T M A R C H / A P R I L 2 0 0 6 27
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This article can serve as a guide to any radiolo-gy administrator who is implementing a PACS inhis or her facility, or who is maintaining a PACSprogram. The tools and approaches that MercyHospital used should offer a better understandingon what to expect and how to go about taking thefirst step. Instilling personal responsibility in allusers forces them to accept change faster. Thisexpedites results, report turnaround time, andultimately increases physician and patient satisfac-tion.
References1VIDAR Systems Corporation. Glossary of Terms. Available
at: www.filmdigitizer.com/about/news/glossary.htm.Accessed June 15, 2005.
2Hayter A. Probability and Statistics for Engineers and Scien-tists. Boston, MA:PWS Publishing Company; 1995.
Troy Stockman is operations director of the diagnosticcenter at Alegent Health Mercy Hospital in Council Bluffs,IA . He i s a member of AHRA and may be contacted [email protected].
Santha Krishnan served as a consultant during AlegentHealth Mercy Hospital’s PACS implementation.
Instilling personal responsibility in all users forc e s t h e m
to accept change faster.
RM282_pp16-27_PACS QI.qxp 3/21/2006 11:45 AM Page 27
M A R C H / A P R I L 2 0 0 6 R A D I O L O G Y M A N A G E M E N T28
1. This article describes a quality improvement programthat was initiated:a. Before the purchase of a PACSb. After the implementation of a PACSc. During the installation of a PACSd. All of the above
2. The person identified to serve as a PACS subject matter expert while dealing with day-to-day PACS-related issues was a(an):a. Picture archiving communications specialistb. Statistical process control expertc. Radiology information technology support specialistd. None of the above
3. As a result of the QI program, the average error raterelated to PACS was reduced from:a. 12% to 4%b. 15% to 12%c. 18% to 15%d. None of the above
4. What is a radiology information system (RIS) responsible for?a. Patient registrationb. Film/chart trackingc. Scheduling/management reportingd. All of the above
5. Which of the following is a computer system designedfor the acquisition, transmission, display, storage, andretrieval of digital medical images?a. RITb. RISc. PACSd. HIS
6. What skills must staff and physicians have in order tosuccessfully interact in a PACS environment?a. Good imaging skillsb. Competent computer skillsc. Interpersonal skillsd. Positioning skills
7. When PACS was first implemented, significant errorsoccurred in:a. Data integrityb. Image management/qualityc. Duplicate filesd. All of the above
8. Related to PACS, what is a Corporate ID?a. Identifier used when the images are not sent to the
PACS serverb. Unique identifier for a multi-entity systemc. Identifier used when the system “times out”d. None of the above
AHRA Home-Study Resources
Acceptance of PACS UtilizingA PACS QI P rogram
AHRAAttn: Continuing Education Credit
490-B Bosto n Post Road, Suite 101Sudbury, M A 01776Fax: (978) 443-8046
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RM282_pp28-30_ PACS QC.qxp 3/21/2006 11:19 AM Page 28
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9. As more modalities were brought online with PACS:a. The errors increasedb. The errors decreasedc. The errors did not changed. None of the above
10. What are the primary job responsibilities for the RITsupport specialist?a. To provide on-site training and support for radiologists
and staffb. To monitor RIS interface logsc. To serve as a functional expertd. All of the above
11. What is the term used to describe a plan devised foreach technologist to assign ownership for errors andto show progress in reducing the number of errors?a. Error chartb. Correction chartc. Responsibility chartd. PACS technologist chart
12. What is the term used to describe a plan developed to monitor the performance of the error rate bymodality?a. Control chartb. Modality chartc. Responsibility chartd. None of the above
13. What was the modality sampling frequency fornuclear medicine?a. Weeklyb. Biweeklyc. Monthlyd. Bimonthly
14. What is the term used to describe an error made by anindividual manually entering incorrect information?a. Incorrect Corporate IDb. Incorrect textc. Incorrect rotationd. Incorrect foldering
15. What is the term used to describe an error made whenthe image(s) have not been checked properly?a. Incorrect markerb. Incorrect textc. Images not separatedd. Incorrect rotation
16. Add imaging is the term used when an exam requiresthat the patient return for additional imaging afterthe exam has already been tracked through to the lastprocedure in RIS.a. Trueb. False
17. A root cause analysis was done to determine whetherthe error where:a. System-relatedb. Human-relatedc. Unidentifiedd. Both a and b
18. What modality had the highest average error ratevalue as of July 2005?a. CT/MRb. Diagnostic proceduresc. Ultrasoundd. Nuclear Medicine
19. What are some of the things the QI program taughtthe members of the radiology team?a. To use the proper measurement toolsb. To identify the root causesc. To take charge in implementing the proper corrective
actionsd. All of the above
20. When is it necessary for the technologists to manualseparate the images before sending them to PACS?a. When the PACS is newb. When the existing CT scanner is not compatible with
PACSc. Before the technologist has adequate PACS trainingd. None of the above
21. What was used to educate staff & physicians in allareas on how to monitor their processes and assignproper corrective actions?a. QI toolsb. A PACS programc. A PACS administratord. None of the above
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Acceptance of PACS Utilizing aPACS QI P rogram
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