hrvatski

IAEA expert mission based on QUAADRIL rules at UH Rijeka – what have we achieved?

Purpose/Objective University Hospital Rijeka was the first institution in Croatia that established a comprehensive QA/QC program related to application of ionizing radiation in medicine. It is a known fact that QA/QC program improves quality of medical procedures and radiation safety of patients and staff. In diagnostic and interventional radiology it helps in achieving the highest quality of diagnostic imaging and image guided procedures. At our hospital, Department of Radiology closely collaborates with Department for Medical Physics and Radiation Protection and team work between radiologists, medical physicists and radiographers is present in everyday work. Since we are continuously working on improving our practice and quality of diagnostic imaging we have involved, along with University Hospital Osijek in IAEA Project CRO2016003: Establishment Centers of Competence for QA/QC in diagnostic and interventional radiology at two distant regional university hospitals in Croatia. The project started in 2018 and will last until the end of 2019. The idea is to establish two centers of competence for QA/QC in diagnostic/interventional radiology according to the guidelines given by IAEA RER6028 project: ‘Guidelines and criteria for regional Centers of Competence for QA/QC in diagnostic and interventional radiology’. Material/Methods Starting point of the project was self-assessment based on the QUAADRIL rules. QUAADRIL was set up by IAEA to advice on standards and processes used for comprehensive clinical audits of diagnostic radiology services. It focuses on clinical management and infrastructure, patient related and technical procedures and education and research. After our self-assessment, team of experts organized by the IAEA with the title “Expert Mission to evaluate and review self-assessment and advice on activities to enhance Quality Practices” audited our radiology department. Team consisted of one radiologist and one medical physicist. In three days they reviewed our clinical management and infrastructure, radiological clinical procedures, policies, quality assurance program and radiation protection. The external experts concluded their visit with a written report that assessed the current situation, indicated which areas required strengthening and made suggestions for improvement. Results Report of the mission detailed all elements that are already in place and specified areas that require strengthening and improvement. Close collaboration and a team work between radiologists, medical physicists and radiographers was emphasized as an example of excellent practice. One of the main results of our team work was evaluation and optimization of CT protocols, development of Book of CT protocols and assessment of patient doses from X-ray procedures. Beside CT, diagnostic images at other facilities were also scored as optimal. Our QA program was found as well implemented together with procedures for the acceptance testing and commissioning of new radiological equipment. Procedures for dealing with overexposures and pregnant staff were in place but strengthening was recommended. Experts suggested development of a process for identifying and prioritizing urgent examinations. Also, after well optimized CT protocols for adults one of the proposals was to extent it to pediatric patients and interventional procedures. One of the main suggestions was purchase of dose tracking software. Report of the mission reviled no equipment specific issues except with the 0.5 T MRI scanner in one of the facilities. Images produced on this scanner were of inadequate quality. Immediately after expert mission priorities and main goals were set and working groups were formed. In less than six months we managed to improve guidelines and develop policies regarding pregnant patient and staff and radiologists started to work on standardization of radiologist’s report for patients. Policy for identifying and prioritizing urgent examinations is under development and group for CT optimization started to work on the optimization of pediatric protocols. Specification for dose watching software was written and it should be purchased by the end of the project. Also, above mentioned 0.5 T MRI scanner was decommissioned and a new 1.5 T MRI is installed. Our QA program is currently being extended to MRI and a new medical physicist joined our department for that purpose. Experts also addressed the importance of forming radiation protection committee and a deputy of radiation protection officer so the Committee was formed and deputy was named. Conclusion Expert mission based on QUAADRIL rules was found very useful and both departments responded very enthusiastically to it. It helped us to detect our faults and find areas for improvement along with the suggestions how to change it. Also, it has emphasized the areas that are in place and where we are doing a good work. This expert mission helped us a lot to improve our everyday practice and showed that external audit at Radiology Departments is needed and should be done periodically.

QUAADRIL, audit, diagnostic radiology

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