Submission of Radiology

7/31/2019 Submission of Radiology

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Summer Training in

Sterling Hospital, Ahmedabad

(14st

April - 26th

May2012)

A Report on

Quality Management in Radiology Department

In Sterling Hospital, Ahmedabad

Kartika Singh Naruka

Post Graduate Diploma in Hospital and Health Management

2011-2013/25

Institute of Health Management Research

Bangalore.


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DECLARATION BY THE STUDENT

This is to declare that the Report is made for the Partial fulfillment of completion of the Course:

Summer Training in Term-II of PGP (PGDHM 2011-13 Batch) by me in STERLING

HOSPITAL, AHMEDABAD under the supervision of Dr. / Ms. SHRUTI THAKKAR and my

Mentor was Dr. /Mr. RAVI PRAKASH.I confirm that this report truly represents my work and

accomplishment undertaken as a part of my Dissertation work. This work is not a replication of

work done previously by any other person. I also confirm that the contents of the report and the

views contained therein have been discussed and deliberated with the (Supervisor) as well as the

Mentor.

Name of the Student: KARTIKA SINGH NARUKA

Register No: IHMRB/PGDHM/2011-13/25


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Abstract

Background

The aim of the Radiology Department at Sterling Hospital is to forge links between medicine and science to improve

the diagnostics and treatment of diseases. The department offers a wide range of clinical diagnostic and high quality

therapeutic imaging and efficient services to the patients and their physicians. This is very effective in evaluation of

Polytrauma patients and critical patients.

METHODS

1) Turnaround time

2) Flow chart

3) Data recording

4) Observation method

5) Feedback Form (with Graphs)

RESULTS

Quality in radiology may be defined in many ways and from different angles. One of these is: A timely

access to and delivery of integrated and appropriate radiological services and interventions in a safe and

responsive facility and prompt delivery of accurately interpreted reports by capable personnel in anefficient, effective and sustainable manner. TQM is used in the hospitals due to concerns about the

quality of care. Which differentiates it from other hospitals and the best class services because this is

what which makes sterling one of the best multispecialty hospital in Gujarat, with the applying of Total

quality management the OPD Patient will come as well as the departments in which patients visit more

(IPD ,OPD ,Health -Check -UP, and ER) will be there and more and more no. of increase in the patients as

well as profit maximization with proper utilization of human resources that too with minimum cost. The

purpose of my project is to find out how quality is maintained in radiology department.

CONCLUSION

In my project I have used various methods to look for that, proper quality. I have used different methods

to assess main areas where quality needs to be addressed for a complete quality and safety program in

radiology. Safety, assessment, and satisfaction. These areas need to be coordinated by individuals who

belong to a quality oversight committee. The ultimate goal is a cultural shift in which all departmental

workers assume responsibility for quality and safety improvements and behave consistently with the

core values of the organization. A road map for thinking about quality and safety issues in radiology

allows all of these areas to be tied together.


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.

ACKNOWLEDGEMENT

It is with great pleasure that I express my deep sense of gratitude & heartfelt thanks to Dr. K.S

RAO& all the faculty members for providing the opportunity to exercise the practical aspect ofstudies.

I extend my gratitude to our course coordinator & my mentor Dr. RAVI PRAKASH for her

suggestions & immense help in accomplishing the summer training program. I would like to

thank our supervisors.

I am highly fortunate to express my deep sense of gratitude & indebtedness to Ms. Gayatri Singh

& Ms. Shruti Thakkar for permitting me to carry out the project work in STERLING

HOSPITAL, AHMEDABAD .Finally my special thanks to all staff members of Sterling

Hospital for their cooperation.


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INDEX

S.NO. CONTENTS

1. Title of Project

2. Declaration by the student

3. Certificate

4. Acknowledgement

5. Abstract

6. Abbreviations

7. Executive Summary

8. Methods

9. Flow Charts(IPD & OPD)

10. Organization Profile

11. Organogram

12. Radiology Department

a) Familiar with the department

b) Location

c) Related Department

d) Time Duration

e) Staffing

f) Rooms

g) General Overview Of Sonography


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h) Types of Limb Doppler

i) Types of CT Scan

j) Radiology Services

k) Services not available

l) Types of X-Ray

m) Machines in X-Ray Room

n) Facility in radiology department

o) Equipments in radiology department

p)

Various process in radiology department

1)Reporting

2)x-ray procedures in in-patients

3)Patients recall for out-patient

4)Dispatch

13.

Total Quality management

1)Quality Assurance

2)The components of the quality assurance for radiology &

imaging

3)Quality Assurance program for medical exposure include

4)Radiation Safety-Regulatory Requirement

14. Radiation Safety(Procedure)


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1)x-ray room

2)Equipments

3)Patient

4)Radiology staff

5)Policy

6)Precautions

15. Patient information

16. Scope of Services

17.Chart illustrating a process of engaging radiologist in quality

& safety programs


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ABBREVIATIONS:

TAT- TURN AROUND TIME

BPBLOOD PRESSURE

IPDINPATIENT DEPARTMENT

HRHUMAN RESOURCE

HODHEAD OF DEPATMENT


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EXECUTIVE SUMMARY

TQM is used in the hospitals due to concerns about the quality of care. which differentiates it from other

hospitals and the best class services because this is what which makes sterling one of the best

multispecialty hospital in Gujarat, with the applying of total quality management the OPD patient

turnaround time will come as well as the departments which patients visit more (IPD, OPD, Health

Check UP, and ER) will be there and more and more no. of increase in the patients as well as profit

maximization with proper utilization of human resources that too with minimum cost. The purpose of

my project is to find the flaws in the current working procedures and maintenance of quality in radiology

department.

Quality in medical imaging and interventional radiology may be defined in many ways and from different

angles. One of these is: A timely access to and delivery of integrated and appropriate radiological

studies and interventions in a safe and responsive facility and prompt delivery of accurately interpreted

reports by capable personnel in an efficient, effective and sustainable manner. Some factors which all

together add up to quality of a department are mentioned below:

1.) Access: the ability of a patient to obtain medical imaging and interventional radiology at the right

place and right time irrespective of income, physical location and cultural background

2.) Integrated: the ability to provide uninterrupted and coordinated care across facilities and

practitioners. In medical imaging and interventional radiology, the availability of and access to relevant

clinical history, indications and findings of previous radiological studies of interventions, and the

opportunity to discuss with the referring physician or patient are essential components, which can

significantly influence the diagnostic study, intervention selection, interpretation and follow-up

management options

3.) Appropriate: the care, intervention or action provided is relevant to a patients need and is based on

established standards. The radiologist is the consultant assisting the referring physician and patient in

selecting the most appropriate radiological study or intervention for the clinical condition, based on

evidence based practice guidelines

4.) Safe: the avoidance or minimization of actual or potential harm from medical imaging or

interventional radiology, including radiation exposure, magnetic fields, contrast media etc

5.) Responsive: the primacy of a patient is recognized and respected. The facility is patient-oriented and

practices these aspects: respect for patients dignity and confidentiality, participation in choices or

decision-making, prompt, and good quality of amenities and choice of provider

6.) Timely report and accurate interpretation: the medical imaging report should be accurately

interpreted and the interventional procedure precisely documented and delivered to the referring


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physician in a timely manner for optimal patient management. Reliable means of report delivery and

confirmatory mechanisms are essential especially in the case of urgent or unexpected findings

7.) Capable: the facilitys and individuals capacity to provide medical imaging and interventional

radiology based on skill and knowledge

8.) Efficient: achievement of the desired results with the most cost-effective use of resources

9.) Effective: the care, intervention or action should be effective in achieving the desired outcome

10.) Sustainable: the system must be capable in providing infrastructure such as workforce, facilities

and equipment, and be innovative and responsive to emerging needs.


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METHODS

Data collected using excel sheet template for, Operation theatre utilization was studied with

respect to the starting and closing of the operation theatre, interval between surgical procedures,cancellation of surgical procedures and reasons thereof.

METHODS FOR DATA COLLECTION:

With the help of the template framed by the researcher which comprised of following indicators:

TAT (TURN AROUND TIME)

Date

Investigation and procedure name

OP NO. ( Outpatient no.)

Name of the patient

Arrival time

Waiting time for the investigation and procedure

Investigation and procedure time(Starting time and Completing time)

Film time

Waiting time to collect the report(Authenticate and Dispatch)

Report collection time

Remarks

Sign

TAT is the continuous improvement monitoring sheet. Monitoring of turnaround time for

radiological procedures and investigations. After every 3 months the collected TAT Form

in the radiology reception goes in the MRD.


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DATA ANALYSIS : RADIOLOGY

S. NO. WAITING

TIME (hrs)

PROCEDURE

TIME (hrs)

DISPATCH

TIME (hrs)10.1 0.07 0.43

20.07 0.05 0.46

30.27 0.08 3.18

40.14 0.46 3.3

50.22 1 2.15

6

0.5 0.09 2.017

0.33 0.13 2.14

81.02 0.07 2.53

90.37 0.06 1.59

100.3 0.06 1.24

110.19 0.07 1.41

12 0.27 0.07 1.33

130.05 0.04 1.02

140.06 0.09 1.25

150.45 0.57 2.33

161.24 0.07 0.46

170.06 0.15 0.14

180.4 0.09 3.41

190.59 0.59 2.18

200.45 0.07 3.33

210.55 0.15 2.45


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221.27 0.23 2.05

230.4 0.07 3.33

240.38 0.15 3.27

250.53 0.07 3.2

261.47 0.4 1.23

271.52 0.06 1.14

281.2 0.08 0.28

290.5 0.1 5.41

30

1.56 0.08 3.4531

1.33 0.09 3.53

320.55 0.11 1.36

331.43 0.05 3.41

340.09 0.08 1.05

351.5 0.54 4.26

36

1.08 0.02 5.1137

1.03 0.15 5.5

380.44 0.53 5.22

390.43 0.04 5.17

401.08 0.05 3.35

411.46 0.37 2.25

42 1.01 0.13 2.54

430.11 0.49 1.56

440.09 0.27 5.55

451.12 0.25 4.4


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461.15 0.55 4.45

473.04 0.2 2.45

482.06 0.05 3.4

491.52 0.06 3.29

500.3 0.23 3.07

510.04 0.11 2.17

520.36 1.1 0.1

530.18 0.49 1.41

54

0.1 0.12 1.1455

0.15 0.21 1.12

560.55 0.1 1.02

570.2 0.29 0.33

580.26 0.06 3.37

591.41 0.55 2.08

60

0.16 0.08 2.361

0.58 0.25 3.02

610.18 0.19 1.34

630.57 0.08 1.15

640.1 0.05 1.45

650.25 0.06 1.01

66 0.25 0.06 1.01

671.08 0.04 3.47

781.02 0.1 3.36

691.21 0.08 3.59


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700.46 0.07 3.28

710.47 0.07 3.51

720.2 0.11 6.06

730.22 0.1 5.55

740.03 0.09 4.03

750.04 0.06 1.5

761 0.08 0.47

770.24 0.05 4.38

78

1.12 0.05 3.4679

0.19 0.06 1.16

801.31 0.51 1.16

TOTAL51.21 14.8 201.62

TOTAL MINS3081 880 12082

AVERAGE MINS38.5125 11 151.025


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INTERPRETATION:

1) As shown in the graph total turnaround time for radiology is 200.53 minutes.

2) It comprises of waiting time, procedure time & dispatch time.

3) Waiting time is the time duration between registering patient & patient coming in for

procedure .

It Is Around 38.51 Minutes For A Patient Coming For Radiology.

4) Procedure time is the time duration Between patients entry in the depatment for procedure to

patints Exit after completion of it.

It is around 11 minutes for Radiology.

5) Dispatch time is the time taken after completion of procedure to dispatching of report.

It is around151minutes which is nearly about2.5 hrs for Radiology.

It is a large duration taking patients valuable time.

6) The above mentioned facts can also be understood from the table given above.


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FEEDBACK FORMS

Q1.

Friendliness &

helpfulness of front

desk staff:

EXCELLENT 12

GOOD 34

FAIR 4

POOR 0

0

5

10

15

20

25

30

35

EXCELLENTGOOD

FAIRPOOR

12

34

4

0

Friendliness & helpfulness of front desk staff

Series1


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Q2.

Waiting time in reception area

EXCELLENT 12

GOOD 22

FAIR 10

POOR 6

12

22

10

6

Waiting Time in Reception Area

EXCELLENT

GOOD

FAIR

POOR


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Q3.

clean &tidy :

EXCELLENT 21

GOOD 20

FAIR 3

POOR 6

21

20

3

6

Clean and Tidy

EXCELLENT

GOOD

FAIR

POOR


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Q4.

well signposted :

EXCELLENT 10

GOOD 10

FAIR 21

POOR 9

0

5

10

15

20

25

EXCELLENTGOOD

FAIRPOOR

1010

21

9

Well signposted

Series1


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Q5.

convenient to get to:

EXCELLENT 9

GOOD 18

FAIR 10

POOR 13

Series1

0

5

10

15

20

EXCELLENTGOOD

FAIRPOOR

9

18

1013

Convenient to get to

Series1


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Q6.

waiting area

EXCELLENT 24

GOOD 17

FAIR 4

POOR 5

Series1

0

5

10

15

20

25

EXCELLENTGOOD

FAIRPOOR

24

17

45

Waiting Area

Series1


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Q7.

Sinologists/Radiographer's

explanation of your procedure:

EXCELLENT 11

GOOD 8

FAIR 12

POOR 19

0

2

4

6

8

10

12

14

16

18

20

EXCELLENT GOOD FAIR POOR

Sonologist's/Radiologist's explanation of your procedure

Series1


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Q8.

Respect of your privacy &

confidentiality :

EXCELLENT 14

GOOD 13

FAIR 13

POOR 10

0

2

4

6

8

10

12

14

EXCELLENTGOOD

FAIRPOOR

14

13 13

10

Respect of your privacy & Confidentiality

Series1


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Q9.

Reason for using SDMH

radiology Services

Other 10

Recommendation 13

Doctor's Choice 9

Personal Experience 14

02

4

6

8

10

12

14

Reason for using SDMH radiology services

Series1


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FLOW CHART

X-ray for Outdoor patient:

Does the

investigation need

re aration?

Is the Pt. with

necessary

re aration?

Can the pt. be

allocated for

investi ation?

After investigation entry is done

in Radiology Room

Pt. is told about the

requirement of appointment

and iven for the earliest

Pt. will come on that

date and time of

appointment with

preparationPatient is asked to wait for stated hrs. for

collecting report. Only In case of request by

consultants for unreported film are given in 1 hrs.

YesNo

Yes

No

Yes

No

X-ray Reception- Patient comes

with the requisition form for

investigation.


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FLOW CHART

X-ray for Indoor patient

During working hours

Nurse will inform about the investigation and the pt.

details to the Radiology department on requisition form.

The Reception will check the type of test

and the need for pt. preparation

Is pt.

Preparation

needed?Time of

investigation

informed to nurse

Patients are taken for

Investigation

Inform the nurse about

thepreparation

The appointment is given

according to the preparation If Pt. isprepared?

The nurse is told to send

the pt. to the department.

Investigation is done and

entry is made in DigitalRoom.

Patient is transferred back to

the wing accompanied with

Ward Boy/Lady


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ORGANIZATION PROFILE:

About the organization

History

Sterling Hospitals is one of the largest hospital chains in Gujarat, considered to be the leading one

by the levels of independent certification, facilities and equipment, as well as size and capacities. It

is owned and managed by Sterling Add Life India Ltd.

The specialties in which it provides medical care include: Cardiology, Neurology, GI Medicine,

Hematology, Oncology, Reproductive Medicine, Critical and Emergency treatment, Trauma and

Orthopedic, Neonatology and General Medicine. Surgery treatments include CVTS-, Neuro- and

Onco-surgeries, Nephrology (with Kidney Transplant), GI surgeries and General Surgeries.

Infrastructure

Sterling's multi-specialty hospitals have presence in six major cities of Gujarat.

1) Ahmadabad (310 beds)- NABH & NABL Accredited

2) Vadodara (196 beds)- NABH Accredited

3) Rajkot(190 beds)

4) Mundra (100 beds)

5) Bhavnagar (180 beds)

6) Gandhidham

It also has three satellite centers atKalol, Mehsana and Himmatnagar.

STERLING HOSPITAL, the company's largest hospital complex in Ahmedabad has 310 beds, 7 major

operation theatres and 84 ICU beds. Multiple facilities are also available at Vadodara complex.

Patients treated by Sterling Hospitals come from Gujarat, Madhya Pradesh, Maharashtra, Rajasthan,

as well as from abroad.

Recognitions

In 2009 Sterling became the first hospital in Gujaratto be fully accredited by NABH. Its laboratorieswere also the first in Gujaratto be accredited by NABL.

In 2010, for the second consecutive year, Sterling Hospital had been named the No. 1 hospitalin Ahmadabad based on the latest THE WEEK - IMRB surveys.
http://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Vadodarahttp://en.wikipedia.org/wiki/Rajkothttp://en.wikipedia.org/wiki/Mundrahttp://en.wikipedia.org/wiki/Bhavnagarhttp://en.wikipedia.org/wiki/Gandhidhamhttp://en.wikipedia.org/wiki/Kalolhttp://en.wikipedia.org/wiki/Mehsanahttp://en.wikipedia.org/wiki/Himmatnagarhttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Madhya_Pradeshhttp://en.wikipedia.org/wiki/Maharashtrahttp://en.wikipedia.org/wiki/Rajasthanhttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Rajasthanhttp://en.wikipedia.org/wiki/Maharashtrahttp://en.wikipedia.org/wiki/Madhya_Pradeshhttp://en.wikipedia.org/wiki/Gujarathttp://en.wikipedia.org/wiki/Himmatnagarhttp://en.wikipedia.org/wiki/Mehsanahttp://en.wikipedia.org/wiki/Kalolhttp://en.wikipedia.org/wiki/Gandhidhamhttp://en.wikipedia.org/wiki/Bhavnagarhttp://en.wikipedia.org/wiki/Mundrahttp://en.wikipedia.org/wiki/Rajkothttp://en.wikipedia.org/wiki/Vadodarahttp://en.wikipedia.org/wiki/Gujarat


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Other specialty care unit

We at Sterling Hospitals are committed to your health. Conforming to the best practices worldwide,

Sterling Hospitals offer you more options, better choices and greater flexibility of treatmentServices are the backbone & core part of our healthcare deliveries. Patient comfort & satisfaction

are the areas of our focus & Concern and to deliver the highest standard of health care services.

Key Services

33 Specialties all under one roof

24 hrs Emergency Stroke and Cardiac Helpline Services

Continuous Renal Replacement Therapy (CRRT) to treat multi-organ dysfunction

Special programmes include Bone Marrow Transplant, Liver Transplant & Renal Transplant

Specialized services include Diabetes Clinic, Pain Clinic, Stroke Clinic, Wellness Clinic and

Sleep Lab

Ancillary services include Blood Bank, Dietetics, Dialysis Unit, Molecular Lab, Pathology,Pharmacy, Physiotherapy and Radiology

Special Services for Corporate including medical holidays, health check-ups and health

seminars

Specialty

Bone Marrow Transplant

Cardiology

Critical Care and Pulmonary Division

Dentistry

Department of Diabetology & Endocrinology

Department of Neuro SciencesDepartment of Psychiatry & Behavioral Psychology

Ear, Nose and Throat (ENT)

Gastroenterology

Gynecology & High Risk Pregnancy

Hematology- Oncology

Infectious Diseases

Joint Replacement Unit

Neonatology

Nephrology

Neurosurgery

Pediatric Surgery

Plastic reconstructive and cosmetic surgery

Polytrauma / Multiple InjuryRenal Transplantation Unit

Rheumatology Department

Skin Diseases

Spine Surgery

Surgical Gastroenterology & Minimally Invasive Surgery
http://www.sterlinghospitals.com/content.php?CategoryID=17&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=18&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=19&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=20&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=21&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=22&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=23&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=24&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=25&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=26&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=27&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=28&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=29&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=30&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=31&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=32&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=33&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=34&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=36&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=37&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=38&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=39&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=40&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=41&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=41&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=40&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=39&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=38&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=37&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=36&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=34&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=33&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=32&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=31&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=30&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=29&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=28&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=27&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=26&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=25&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=24&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=23&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=22&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=21&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=20&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=19&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=18&CenterID=1http://www.sterlinghospitals.com/content.php?CategoryID=17&CenterID=1


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ORGANOGRAM OF HOSPITAL

CEO

COO

CMA

HOD+ Medical Supritendent

4 Radiologist(full time)

1 Radiologist(Part time)

Technicians+ Nsursing Staff


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RADIOLOGY DEPARTMENT

Familiar with the department:

Location: The radiology department is located at ground floor

Related department: Emergency(ER),Health checkup department

Time duration:24 hrs

Staffing:

STAFF NO.

RADIOLOGIST 5

TECHNICIAN 10

NURSING STAFF 5

ATTENDANT 2

MAMMOGRAPHER 1

RECEPTIONIST 2

MT 3

In sterling hospital radiology department has total 19 staff members

ROOMS

1)USG-1(Ultra sonography)

2)USG-2

3)Preparation room

4)CT Scan

5)CT Scan console room

6)X-Ray -1

7)X-Ray-2

General overview of Types of sonography

USG Abdomen

USG Neck

USG Breast

USG Chest or Thorax

Local part (Particular part of soft tissue)

General overview of Types of limb Doppler

ARTAL DOPPLER(Left and right upper limb),(Both lower limb arteal Doppler)

VENUS DOPPLER


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General overview of Types of CT Scan(Over body)

1 Brain

2 Abdomen

3 Chest

4 Neck

5 PNS(related to nasal sinus)

Radiology Services

1 Digital X-Ray and fluoroscopy

2 Mammography

3 Sonography

4 Color Doppler study

5 Multi slice CT-Scan(MSCT)

6 MSCT Angiography

7 Interventional Radiology

Services not available

1 PET SCAN

2 NUCLEAR MEDICINE

3 MRI

Machines in X-Ray room

1 Phillips

2 Siemens

Types of x-ray1 Conventional x-ray

2 Non- conventional x-ray (not done here)


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Facility in Radiology Department:

1)Digital X-Ray like chest ,abdomen, limbs

2) Special procedures like barium studies etc.

3)Ultrasonography

4)Angiographies5)CT Scan

6)Breast Imaging

Equipments in the department

1)X-Ray Machines

2)Color Doppler

3)CT Scan

4)USG Machine

5)Mammography Machine

Various process in the Radiology Department

Reporting

X-Ray and Procedures:

The x-ray technician performs the x-rays, other process and put them in a labeled folder.

These are then given to the radiologist for reporting. The radiologist writes the report.

Thereafter, the unit (radiology) enters the report in the HIS Radiology Module.

The normal report templates are saved into the system, which can be modified for the

reports.MT prepares computer typed report. The typed report is verified and signed by the


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radiologist and sent for dispatch. The PRO (Radiology) the prepares, verifies the folders

before dispatch.

In case of In-Patients:

In some special cases (emergency hours or physician request the films are dispatched

without reports. These are recorded in the x-ray dispatch register.The films are then sent back by the ward boy/staff for reporting

Patients recall for Out-Patient

If the radiologist needs to repeat the x-ray or perform other additional views or requires any

other additional history of a patient to aid in reporting, the patient needs to be recalled, the

customer care officer (radiology) or the technician on duty will call the patient on the available

contact no. and recall the patient with proper examination for the need of the same. The extra

films are not charged.

A) SonographyThe radiologist while performing the ultrasound dictates the report to the sonography

technician. Who then types the report in the HIS radiology module.The normal report templates

are saved in the system, which can be modified for reporting. The typed report is verified and

signed by the radiologist and sent for dispatch. The technician or customer care officer

(radiology) then prepares the folders and sent to dispatch.

B) Dispatch:

X-Ray and Procedures:

All out-patients x-ray reports are dispatched by 5pm on the same day. The technician will

dispatch the x-rays to the main reception desk for dispatch.

The in-patient reports are dispatched to the respective wards/icu by the staff. If the films

are taken without reports for any reason, the films should be sent back for reporting.

The dispatched x-rays are recorded in the registers and maintained for out patients and in

patients .All emergency cases will be reported and dispatched of reports within 24hrs.

Sonography:

The outpatient sonography reports are dispatched by 5pm.The sonography technician

dispatches the reports to the main reception desk. The inpatient reports dispatched to the

respective ward/icu

By the staff. The dispatched reports are recorded in registers maintained for outpatients

and inpatients.

All emergency cases will be reported and reports will be dispatched with (1) hour. If any

emergency report is required its given within 15 min.


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TOTAL QUALITY MANAGEMENT

Quality is never ending cycle of continuous improvement. Quality is not a static goal but a

progressively improving state, and interventional radiology is a rapidly moving, technology-driven

subspecialty in which high-quality patient care should be the norm. The health care which is

delivered after must be better than the health care which is delivered today. In order to attain suchessential goals, radiology department must initiate specialty wise continuous quality improvement

Quality Assurance

A quality assurance program in diagnostic radiology as defined by the WHO is an organized effort

by the staff operating a facility to ensure that the diagnostic images produced are of sufficiently

high quality so that they consistently provide adequate diagnostic information at the lowest

possible cost and with the least possible exposure of the patient to radiation

Registrants and licensees shall establish a comprehensive Quality Assurance program for medical

exposures with the participation of appropriate qualified experts in radiation physics taking into

account the principles established by the WHO

The components of the Quality Assurance for Radiology & Imaging

1. A list of the individuals responsible for monitoring and maintenance techniques.

1. Policy statement

2. Organization and responsibilities

3. Quality Assurance (and Radiation Protection) Committee

4. Radiation Protection Officer (these duties could be assumed by the medical physics

expert, the radiologist or the radiographer)

2. A list of the parameters to be monitored and the frequency of monitoring.

Medical Practitioner (Radiologist, other Physicians)


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Qualified Expert in Diagnostic radiology Physics (Medical Physicist, Hospital Physicist)

Justification and optimization of radiological procedures

3. A description of the standards, criteria of quality, or limits of acceptability, which have been

established for each of the parameters monitored.

Patient dosimetry and image quality evaluation

Reject analysis

Quality control procedures

Acceptance test and commissioning

Constancy tests

Status tests

Verification of RP and QC equipment and material

Follow up of the corrective actions proposed

Staffing levels and responsibilities

4. A brief description of the procedures to be used for monitoring each parameter.

The acceptance testof the equipment after installation should be performed by the supplier in

presence of the local medical physicist to confirm that the equipment actually performs at the level

described in the technical specifications agreed upon by the manufacturer and the purchaser

Commissioningis the process of acquiring all the data from equipment that is required to make it

clinically useable in a specific department. This commissioning test will give the baseline values for

the QC procedures

5. A description of procedures to be followed when difficulties are detected to call these

difficulties to the attention of those responsible for correcting them.


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6. A list of the publications in which detailed instructions for monitoring and maintenance

procedures can be found. Copies of these publications should also be readily available to the entire

staff, but they should be separate from the manual.

7. A list of the records (including sample forms) that should be kept. The facility staff should

also determine and note in the manual the length of time each type of record should be kept before

discarding.

8. A copy of each set of purchase specifications developed for new equipment and the results

of the acceptance testing for that equipment.

Patient dosimetry and image quality evaluation

Education and training

9. A list of who to call for answers to quality control questions.

QA programs for medical exposures shall include:

Measurements of the physical parameters of the radiation generators and imaging devices

at the time of commissioning and periodically thereafter

Verification of the appropriate physical and clinical factors used in patient diagnosis (or

treatment). Measurements of the physical parameters of the radiation generators and

imaging devices at the time of commissioning and periodically thereafter

Verification of the appropriate physical and clinical factors used in patient diagnosis (or

treatment)

Written records of relevant procedures and results

the assignment of responsibility for quality assurance actions

the establishment of standards of quality for equipment in the facility

The provision of adequate training

The selection of the appropriate equipment for each examination


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Verification of the appropriate calibration and conditions of operation of dosimetry and

monitoring equipment

Regular and independent quality audit reviews of the QA program

QA programs are designed to ensure that the radiology equipment can yield the desired

information. They include:

Quality control techniques used to test the components of the radiological system and verify

that the equipment is operating satisfactorily

Administrative procedures or management actions designed to verify that:

The quality control techniques are performed properly and according to a planned

timetable,

The results of these techniques are evaluated promptly and accurately,

The necessary corrective measures are taken in response to these results.

Radiation Safety - Regulatory Requirements

No person other than those specifically concerned with a particular X-Ray examination shall

stay in the X-Ray / CT gantry room during radiological examinations. The room shall be kept

closed during the radiation exposure.

Holding of children or infirm patients for X-Ray examination shall be done only by an adult

relative or escort of the patient and not by a staff member. Such a person shall be provided with

protective aprons. No pregnant women shall hold the patient during X-Ray examination.

Immobilization devices shall be used to prevent movement of children during exposure. In no

case shall the film or X-Ray tube be held by hand.

Notice in local language shall be displayed in the X-Ray department at a conspicuous place

asking every female patient to inform the radiographer or radiologist whether she is pregnant.

Examination of women know to be pregnant shall be given special consideration, such as

avoiding fetus dose by using protective devices.

Gonad shield shall be employed to shield the reproductive organs of the patient unless it would

interfere with the information desired. Eye shield shall be provided to protect eyes of the

patient undergoing such special examinations as carotid angiography. Thyroid shield shall be

used where necessary.


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A Mobile X-Ray equipment shall be used with appropriate safety measures to distance from

occupied areas and temporary shields shall be employed for the purpose. .

All radiation workers shall use appropriate personnel monitoring devices. Do not leave

personnel monitoring badges in side the drawer of the table in the X-Ray room or do not leave

the apron with badge inside the X-Ray room after the working hours.

To ensure minimum possible dose to the patient, the field size shall be restricted to the

minimum that is consistent with the diagnostic requirement. Particular attention should be paid

to restricting field size in pediatrics radiology. Gonads, unless required, should not be exposed

to primary beam.

Radiation safety:

Procedure:

The department has taken to the radiation hazards to the staff and patients.

A) X-Ray room design:

1) The room housing of the x-ray is designed under the guidelines of the bhabha atomic

research centre, which is the local governing body for radiation protection and

monitoring.

2) There is incorporation of lead within the walls and the doors to prevent radiation

leakage

3) Room size is big enough to house the machine

4) There is warning light outside the room to indicate that the procedure is on

5) The patient waiting area is away from the x-ray room

B) Equipment:

The equipment is checked regularly to look for any mal functioning, to prevent radiation

leakage (Bio-medical engineering SOP)


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C) Patients

1) The x-ray will be taken using proper collimation when applicable to reduce radiation

dose to the patient

2) Gonadal shields are used

3) In case of adult female patients, proper history will be obtained to rule out the

possibility of a pregnancy

4) No one is allowed in the x-ray room accept for the patient to be examined

5) In case of a need to hold the patient, the attendant will wear a lead apron for

protection

D) Radiology Staff

1) Lead aprons are provided to the radiology technician .These will be worn for any procedures

involving the us of fluoroscopy

2) During radiography, a lead shield of glass is provided next to the control panel. The

technician stands behind this shield while performing the x-ray.

E) TLD Badges

1) All doctors and staff exposed to radiation will wear the tld badge provided to them,

compulsorily

2) These are radiation monitoring badges provided by for personal radiation dose monitoring


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3) These are worn on the apron near the chest, at all times on duty. The badges are changed

every 3 months. The used badges are sent to bhabha atomic research centre for readings and

new ones are provided for the same

4) The readings of all personnel are maintained in a file by the head of the department of

radiology

5)In case of an abnormally high reading the matter is discussed with the personnel and if

required further steps to prevent radiation is taken

-Training of all staff regarding radiation protection is done

-While performing portable x-rays, the technician will wear a lead apron

F) Pregnant Staff

The female will be move doubt of the work involving radiation. She will work in sonography

departmental

G) Policy

1) For each employee joining the radiology department of the personnel monitoring form

supplied by BARC is to be filled

2) The TLD badge is being issued to each employee working in radiology department

who are exposed to radiations

3) Each member of the staff is responsible for wearing the TLD batch all the time when at

work .They should not be taken home, as there is record of occupational exposure

4) TLD badge are maintained at interval of 3 months. The badges are sent to BARC for

measuring radiation dose upon receipt of new badges

5) The readings of all personnel are maintained in a file by head of department

6) In case of an abnormally high reading, the matter is discussed with the personnel and

if request further steps to prevent radiation are taken. The concerned technician will be

granted leave for 15-30 days or will be given work not involving radiation till 15-30 days

Precautions to be taken

1. Always use the TLD sachet inside the holder. The holder incorporates filters whichallow an assessment of radiation quality.

2. Do not damage the badge3. Do not store TLD badge near radiation sources when not being worn4. If it is suspected that a person has received a significant radiation dose, return the

TLD badge for assessment immediately


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8) If it is not an emergency, a prior appointment is necessary for all USG, Doppler, x-ray

procedures and ct scan

9) You are requested to provide the medical history or any information relevant to your

medical history. In case of any allergy or reaction towards any medicine, you are requested

to inform the nurse or technician in advance

10) Any query or information regarding tests related to radiology, please feel free to contact

the radiology reception

Scope of ServicesProcess

Stations/

counter/ area

Process

General Radiology

(Conventional and

Digital)

X-rays are a form of radiation, like light or radio waves that can be

focused into a beam. Once it is carefully aimed at the part of the body

being examined, an X-ray machine produces a small burst of

radiation that passes through the body, recording an image on


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photographic film or a special image recording cassette.

Mobile radiography

Mobile unit used to X-ray bed ridden patients and sometimes used

to

X-ray during operative procedures in Operating Room.

Doppler

Color Ultra sound study which reveals signal of vascular structures

Ultrasound

Ultrasound, or Sonography, uses high frequency sound waves to see

inside the body. As the sound waves pass through the body, echoes

are produced, and bounce back to the transducer. These echoes can

help doctors determine the location of a structure or abnormality, as

well as information about its makeup. Ultrasound is a painless way

to examine internal organs.

M.R.I. (Magnetic

Resonance Imaging

Out sourced (Samved Hospital)


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Pet Scan Out sourced (Samved Hospital)

NUCLEARMEDICINE Out sourced (Samved Hospital)


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Chart illustrates a process for engaging radiologists in quality and safety programs

This chart is suggestion from my side for further improvement of quality in radiology

departments


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Documents

Submission of Radiology