Papp: Quality Management in the Imaging Sciences, 6th Edition

Chapter 1: Introduction to Quality Management

Instructor’s Manual

A basic understanding of quality management is vital to the radiologic technology student. This should include definitions of key terms such as quality control, quality assurance, quality assessment, and quality management, as well as the history of quality management in radiology. This information is contained in the first half of this chapter and can be adequately covered during a 50-minute lecture period. The remainder of the chapter discusses more advanced topics such as process improvement, problem identification and analysis, and specific quality management processes. These topics could be incorporated into the second year of a 2-year radiography program or into an advanced-level course for students enrolled in a baccalaureate program. The instructor should allow 2 to 4 hours of lecture time (especially if group discussions are incorporated) to cover this material adequately.

Objectives
At the completion of this chapter, the reader should be able to do the following:
•	Identify the need for quality management in diagnostic imaging
•	Discuss the impact of government regulation and The Joint Commission accreditation on quality management
•	Explain the differences between quality assurance, quality control, and quality management
•	Identify the five steps of a process
•	List the basic administrative responsibilities of a quality management program
•	Describe the various components of a risk management program
•	Describe the radiation safety protocols for patients and radiation personnel

Outline
History of Quality Management in Diagnostic Imaging
Governmental Action
The Joint Commission
DNV-GL Healthcare
Quality Assurance
Quality Control
Continuous Quality Improvement
Process Improvement through Continuous Quality Improvement
Key Quality Characteristics
Key Process Variables
Components of a Quality Management Program in Diagnostic Imaging
Equipment Quality Control
Administrative Responsibilities
Threshold of Acceptability
Communication Network
Patient Comfort
Personnel Performance
Record-Keeping System
Corrective Action
Risk Management
Risk Analysis
Policies and Procedures
 Safety Program
Patient Radiation Protection
Visitor Protection
Personnel Protection
Summary

QUESTIONS FOR ANALYSIS AND CRITICAL THINKING
1. What are the main changes in healthcare delivery that have affected diagnostic imaging departments since the early 1980s?
2. Discuss the influence of federal legislation on quality management in diagnostic imaging.
3. Discuss the influence of accrediting agencies on quality management in diagnostic imaging.
4. Explain the three levels of quality control testing.
5. What is the first step in developing risk management policies and procedures for diagnostic imaging departments?
6. List the key concepts of an effective risk management program.
7. What is the most effective method of reducing patient exposure?
8. What is the dose area product for a 10-  10-cm area that receives an exposure of 2 R?
9. What is the maximum effective dose equivalent limit for radiography students younger than 18 years old?
10. Explain the concept of a Diagnostic Reference Level.

Chapter Review Questions
1. Which levels of quality control testing can usually be performed by a quality assurance (QA)–quality management (QM) technologist, level I, level II, and/or level III?
a. I and II
b. I and III
c. II and III
d. I, II, and III

2. Which government agency mandates a policy on exposure to blood-borne pathogens?
a. FDA
b. EPA
c. OSHA
d. CDRH

3. Which of the following terms best describes information or knowledge necessary to achieve a desired outcome?
a. Supplier
b. Input
c. Action
d. Output

4. Which of the following terms best describes a person, department, or organization that needs       or wants a desired outcome?
     a. Supplier
     b. Input
     c. Action
     d. Customer

5. Who is considered to be the “Father of Scientific Management”?
     a. W. Edwards Deming
     b. Joseph Juran
     c. Raymond Smith
     d. Frederick Winslow Taylor

6. The unit of measure used to express the dose equivalent to occupational workers is which of     the following?
       a. Coulomb/kg of air
       b. Gray 
       c. Sievert
       d. Relative biological effectiveness (RBE)

7. Which of the following does not affect patient dose during diagnostic radiography?
       a. Inherent filtration
       b. Added filtration
       c. Focal spot size
       d. Source-to-image distance (SID)

  8. The current U.S. regulatory dose limit to the fetus of a radiation worker is:
        a. 0.1 mSv/month
        b. 0.2 mSv/month
        c. 0.5 mSv/month
        d. 1.0 mSv/month

   9. The current U.S. regulatory dose limit for the annual whole body effective dose to radiation          workers is:
         a. 1 mSv
         b. 5 mSv
         c. 20 mSv
         d. 50 mSv

 10. Who regulates the use of radioactive materials in the United States?
        a. NAS-BEIR
        b. NRC
        c. NCRP
        d. FDA

Answers to Chapter Review Questions
1. a
2. c
3. b
4. d
5. d
6. c
7. c
8. c
9. d
10. b