Assessment Of The Adoption Of Quality Assurance Policy In Radiology Department

Presently, radiological workers appreciate the concept of quality assurance in theory due to its multi-faceted benefit especially on the economy when considering the overall cost of imaging equipment and the low cost of testing apparatus. However, they tend to neglect the practical aspect of the topic, thus leading to high rate of break down and faulty equipment. This work is therefore geared towards determining if there is any laid down policy in the radiology department in the tertiary hospital in Enugu. The survey revealed that only 42.9% of the respondents claim that there is an agreement on the servicing of the x-ray equipment in the radiological department and a greater percentage disagrees to that fact. 66.7% of the 42.9% affirmed that this servicing is only applied during repairs. It was observed during the survey that in 66.7% of the scope of the study; the operation and circuit manuals had been misplaced, lost, not supplied or taken away by service technicians during repair missions. With regard to service maintenance records, it was also noted that most of the equipment had no maintenance records. Repairs had been done, and the radiological department left without any records to show what had gone wrong and what repairs had been carried out. Although, 85.7%  of the respondent in the radiological department in the tertiary hospitals in Enugu affirmed that radiographers does advise on the choice of equipment; 59.1% and 14.3% (from table 6) of the respondents claims that the employer and the Government respectively does the acquisition of the x-ray equipment. Only 28.6% of the respond affirmed that radiographers are involved in the acquisition. The failure to incorporate the radiographers in the acquisition process could be the result of the observed damaged equipment found some of the radiological department (for instance, presence of non-functional fluoroscopy and x-ray unit at UNTH and NOHE respectively). Finally, it is very important to know that medical imaging requires precision in the production of high quality diagnostic images while restricting the amount of radiation administered to patients. This can only be achieved if there is a laid down quality assurance policy that will help checkmate and triggers a quality assurance practice by the radiographers. This can also be achieved if there is an objective way of monitoring the output of the x-ray equipment in the radiological department in the tertiary hospitals in Enugu.

TABLE 4.1: Shows the distribution of the response on whether Quality Assurance is been carried out on the below items -------34

TABLE 4.2: Shows the distribution of the response on whether there is any objective way of measuring the quality of the items on table-36

TABLE 4.3: Shows the distribution of the response on whether there is any agreement on servicing of the equipment in the radiological department -----38

TABLE 4.4: Shows the distribution of the response on the frequency of servicing of the x-ray equipment in the radiological department -40

TABLE 4.5: Shows the distribution of the response on who advises on the choice of equipment in the radiological department -------42

TABLE 4.6: Shows the distribution of the response on who acquires the x-ray equipment in the radiological department -----46

TITLE PAGE ---------------------------------------------------------------------------i

APPROVAL PAGE -------------------------------------------------------------------ii

CERTIFICATION ---------------------------------------------------------------------iii

DEDICATION -------------------------------------------------------------------------iv

ACKNOWLEDGEMENT ------------------------------------------------------------v

ABSTRACT ----------------------------------------------------------------------------vii

LIST OF TABLES ---------------------------------------------------------------------ix

TABLE OF CONTENT ---------------------------------------------------------------x

CHAPTER ONE     INTRODUCTION

1.0 Background of the study ----------------------------------------------------------1

1.1 Statement of problem ----------------------------------------------------------5

1.2 Purpose of the study ------------------------------------------------------------5

1.3 Significance of the study -------------------------------------------------------6

1.4 Scope of the study -----------------------------------------------------------------7

2.0 Related literatures --------------------------------------------------------------8

2.1.0 Theoretical background---------------------------------------------------------18

2.1.1 Quality control and radiodiagnostic practice -------------------------------18

2.1.2 Prerequisites for Quality Assurance program ------------------------------20

2.1.3 Essential elements of a Quality Assurance program ----------------------20

2.1.4 Specific equipment considerations -------------------------------------------23

2.1.5 Organization within the radiological facility -------------------------------26

3.0 Introduction ---------------------------------------------------------------------28

3.1 Criteria for assessment --------------------------------------------------------28

3.2 Research design ----------------------------------------------------------------29

3.3 Execution of this study --------------------------------------------------------29

3.4  Sample size and population ---------------------------------------------------30

3.5 Source and method of data collection ----------------------------------------3 

4.0 Data presentation and analysis for questionnaire -------------------------32

4.1 Data presentation and analysis for the observation -----------------------44

5.0 Discussion ------------------------------------------------------------------------47

5.1 Summary of Finding ------------------------------------------------------------49

5.2 Conclusion -----------------------------------------------------------------------49

5.3 limitation of the study ---------------------------------------------------------50

5.4 Recommendations --------------------------------------------------------------51

5.5 Areas of further research ------------------------------------------------------51

REFERENCE ---------------------------------------------------------------------------53

Quality assurance is an internationally established concept recommended for practice in radiological equipment and accessories for optimum performance and high quality output of x-ray machine1. In 1990, a recommendation by International Radiological Protection Board (IRPB) was pronounced: this recommends that all x-ray equipment should be subjected to regular performance checks and if necessary corrective or replacement action must be taken1.

Medical imaging demands precision in the production of high quality diagnostics images while restricting the amount of radiation administered to patients. Proper quality assurance (QA) Programs optimizes the caliber of radiographic images, protect patients and personnel from unnecessary exposure to radiation and reduce the occurrence of misdiagnosis caused by failures in all phases of imaging procedures.

So, there is a need to maintain a level of performance which will produce radiographic and fluoroscopic image with the maximum diagnostic information possible within the capacity of the equipment available2. This can be achieved through proper quality assurance practice1. This quality assurance practice can be achieved in radiology departments only if there is a laid down quality assurance policy3. A quality assurance policy that will serve as a rule or routine that every worker must follow so that if there is a change in personnel; the policy is still maintained.

Quality assurance may easily be divided into a number of levels, each requiring a different type of scientific/technical surveillance. In the case of equipment whose status has been established by rigorous acceptance testing the requirement of a quality assurance program; in practice, is to ensure that the installation has not departed from this acceptance level2. Thus, on a day to day basis quality assurance programs may be reduced to having a simple set of tests, or constancy checks to ensure that the status of equipment has not changed since it was established to be acceptable1.

Quality assurance is the planned and organized efforts by staff to ensure the consistent production of adequate diagnostic information at the lowest possible cost with minimum exposure to both patients and personnel to radiation3.

In addition, Susan4 defines quality assurance as the planned and systematic actions that provide adequate confidence that a diagnostic x-ray facility will produce consistently high quality images with minimum exposure of the patients and personnel. Susan4 added that quality assurance actions include both quality control (QC) and quality administration (QAd) procedures. 

The definition above helps to highlight the practical implications of the term as QA=QC + QAd that is, quality assurance equal to quality control plus quality administration or management.

Dr. S. O. I. Ogbu (in one of his unpublished lectures in UNEC) defined quality assurance as “all those plans and systematic actions necessary to provide adequate confidence that our system is working satisfactorily in its day to day services”. Satisfactory performance implies optimum quality of the whole diagnostic procedures. It must be in line with a consistent production of adequate diagnostic information with minimum exposure to both patient and personnel.

Quality control involves the measurement of performance characteristics (tests) and the recording of the results of those characteristics, while quality administration is the evaluation of the results, the coordination and liaison between the groups involved and the organization of corrective measures in response to monitoring results5.

Presently, radiological workers appreciate the concept of quality assurance in theory due to its multi-faceted benefit especially on the economy when considering the overall cost of imaging equipment and the low cost of testing apparatus. However, they tend to neglect the practical aspect of the topic with reasons ranging from lack of time to carry out such procedures to lack or inadequate fund to buy test kits or employ quality assurance trainers1.

In the course of the researcher’s clinical experience; the researcher has observed that quality assurance in the department of radiology is making only slow progress in practical terms. Many radiographers and radiologists are yet to be convinced of the need for involvement in the subject matter4. Others whilst appreciative of the value of quality assurance at least in theory protest that they have neither the money to buy test equipments nor the time to perform the tests4.

Even though, the greater part of radiological practice continues to depend heavily on subjectivity, quality assurance provides the means of introducing objectivity, and even if we cannot actually measure the quality of our work; it is possible by quality assurance to quantity the performance of the x-ray equipment in the endeavor to improve that quality and hopefully improve our overall efficiency4.

In this study, the radiological department in the tertiary hospitals in Enugu will be assessed if there is any laid down quality assurance policy that will serve as a rule or routine that every worker must follow so that if there is a change in personnel; the policy will still be maintained.