Repeat Analysis in the Digital Environment · Repeat Analysis in the Digital Environment Maureen...
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1 Repeat Analysis Repeat Analysis in the Digital Environment in the Digital Environment Maureen Seluta, RT(R) aureen Seluta, RT(R) Operations Manager Operations Manager Faezeh Abedi aezeh Abedi- Tari, RT(R), BS Tari, RT(R), BS Operations Manager Operations Manager 2 3 The third oldest general hospital in the United States and the oldest and largest hospital in New England At our Main Campus and four Health Centers Mass General annually: Admits 47,000 inpatients Handles nearly 1.5 million outpatient visits Records 83,000 emergency room visits Performs 37,000 operations Delivers 3,700 babies Massachusetts General Hospital
Transcript of Repeat Analysis in the Digital Environment · Repeat Analysis in the Digital Environment Maureen...
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Repeat Analysis Repeat Analysis in the Digital Environmentin the Digital Environment
MMaureen Seluta, RT(R)aureen Seluta, RT(R)Operations ManagerOperations Manager
FFaezeh Abediaezeh Abedi--Tari, RT(R), BSTari, RT(R), BSOperations ManagerOperations Manager
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The third oldest general hospital in the United States and the oldest and largest hospital in New England At our Main Campus and four Health Centers Mass General annually:
Admits 47,000 inpatients Handles nearly 1.5 million outpatient visits Records 83,000 emergency room visits Performs 37,000 operations Delivers 3,700 babies
Massachusetts General Hospital
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Emergency and Inpatient Imaging
Total number of technologistsIP 18ER 31
VolumeIP 1900 per weekER 1200 per week
Portables 1750Equipment
IP 2 DR, CR, 4 RFER 3 DR, CR
Portables 12C-ARMS 8
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ContextContext
Problem statementProblem statementObjectiveObjectiveGoalsGoalsPilotsPilotsDepartment rolloutDepartment rolloutQA QA Electronic Repeat AnalysisElectronic Repeat Analysis
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Problem StatementProblem Statement
Repeat Analysis is currently not performed on a regular basis.
Vendors of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department.
However, few vendors, if any, offered software to track and document repeats on the equipment.
The digital x-ray equipment currently installed at MGH do not have software to track repeat rates.
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Exposed
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ObjectiveObjective
Develop and implement a program to identify, document Develop and implement a program to identify, document and track digital xand track digital x--ray repeat rates across the radiology ray repeat rates across the radiology department at MGH.department at MGH.
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GoalsGoals
* According to The Conference of Radiation Control Program Direc* According to The Conference of Radiation Control Program Directorstors--CRCPD; the criteria associated with repeating a film is subjectiCRCPD; the criteria associated with repeating a film is subjective. Each ve. Each
facility should decide on its own, but should strive for a repeafacility should decide on its own, but should strive for a repeat rate of no t rate of no greater than 5 to 7%greater than 5 to 7%
Reduce patient exposureReduce patient exposure
Increase productivity and image quality Increase productivity and image quality
Identify educational opportunitiesIdentify educational opportunities
Develop departmental standards for acceptable Develop departmental standards for acceptable repeat ratesrepeat rates**
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Pilot #1Pilot #1
Where: Emergency Radiology
When: 10/07, 11/07, 12/07 & 5/08
Equipment: CR and DR
Where: Emergency Radiology
When: 10/07, 11/07, 12/07 & 5/08
Equipment: CR and DR
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MaterialsMaterials
Computed Radiography SystemComputed Radiography System
Digital Radiography SystemDigital Radiography System
Resources: Managers, Supervisors Resources: Managers, Supervisors
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MethodMethod
Data was collected using a manual process:
All exams were reviewed at the modalities to determine the total number of images acquired for each patient/exam.
The number of images repeated (not transmitted to PACS) was documented and categorized by exam type and reason for repeat.
The total number of images transmitted to PACS were confirmed by using a script developed by MGH PACS team.
Data was collected using a manual process:
All exams were reviewed at the modalities to determine the total number of images acquired for each patient/exam.
The number of images repeated (not transmitted to PACS) was documented and categorized by exam type and reason for repeat.
The total number of images transmitted to PACS were confirmed by using a script developed by MGH PACS team.
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ChestChest
Abdomen/PelvisAbdomen/Pelvis
ExtremityExtremity
SpineSpine
MiscellaneousMiscellaneous
Exam CategoriesExam Categories Repeat ReasonsRepeat Reasons
PositioningPositioning
MotionMotion
TechniqueTechnique
ArtifactArtifact
Equipment MalfunctionEquipment Malfunction
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8.5% 8.3%
7.6% 7.8%
77.27.47.67.8
88.28.48.6
% of Repeats
Oct 07 Nov 07 Dec 07 May 08
Results Results
ER
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Pilot #2Pilot #2
Where: Inpatient Radiology
When: 12/07, 1/08 and 5/08
Equipment: CR and DR
Where: Inpatient Radiology
When: 12/07, 1/08 and 5/08
Equipment: Equipment: CR and DRCR and DR
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ResultsResults
5.3%
4.7%
5.3%
4.44.54.64.74.84.9
55.15.25.3
Repeat Rate (%)
Dec 07 Jan 08 May 08
% of RepeatsEllison 2
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QA RolloutQA Rollout
Where: Inpatient and Emergency Radiology
When: January 2008
Why: Quality of portable imaging
Equipment: Equipment: CR CR
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Utilization of Data Utilization of Data
Communicate results of Repeat Analysis withstaff
Identify trends (techs/room/exams/equipment)
Target key areas where there is opportunity for Target key areas where there is opportunity for improvementimprovement
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Steps to QASteps to QA
Radiologist inputRadiologist inputCR Vendor CR Vendor Engineers (equipment check)Engineers (equipment check)Target key areas of opportunityTarget key areas of opportunityRetrain technologists in Imaging 101Retrain technologists in Imaging 101InIn--servicesservicesQA AuditsQA Audits
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QA,QA,……
Input from RadiologistsInput from Radiologists
Reviewed results of Repeat AnalysisReviewed results of Repeat AnalysisReviewed images with Radiologists Reviewed images with Radiologists Revised Portable ProtocolRevised Portable ProtocolGreen Cards Green Cards
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Portable QAPortable QA
Portable CXR ProtocolPortable CXR ProtocolUsing Lead Markers with initialsUsing Lead Markers with initialsCollimation Collimation Digital croppingDigital croppingPositioning: supine or upright, no semiPositioning: supine or upright, no semi--uprightuprightCentral Ray Central Ray Artifacts Artifacts SIDSIDAnnotation Annotation Exposure levelExposure level
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QA,QA,……
CR VendorCR VendorChanged the algorithmChanged the algorithmAdded Exposure levelAdded Exposure levelPresentation on Digital ImagingPresentation on Digital Imaging
EngineersEngineersCheck portable equipment for exposure levelCheck portable equipment for exposure levelCheck collimation accuracyCheck collimation accuracyApplications adjusted the chest parameters on Applications adjusted the chest parameters on DR equipmentDR equipment
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QA,QA,……
Retraining TechnologistsRetraining TechnologistsPositioning 101Positioning 101Technique 101Technique 101
InIn--servicesservicesChest ImagingChest Imaging
Installation of PACS Workstations in work areas Installation of PACS Workstations in work areas
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Departmental RolloutDepartmental Rollout
Where: All Diagnostic X-ray Departments
When: January 2009
Equipment: CR and DR
Where: All Diagnostic X-ray Departments
When: January 2009
Equipment: Equipment: CR and DRCR and DR
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Outpatient, Health Centers and Off Campus Imaging
Total number of technologistsOP 27HC 5OCI 3
VolumeOP 1700 per weekHC 335 per weekOCI 125 per week
EquipmentOP 13 DR, CR, 2 RFHC 1 DR, CROCI 1 RF, CR
Department TotalDiagnostic Technologists
84
Department TotalVolume per week5,260 Exams
Department TotalEquipment 19 DR
CR12 Portables
8 C-Arms
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21,164
1,570
5,645
233
16,366
1,010
4,377
3842,310
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0
5,000
10,000
15,000
20,000
25,000
Number of
Images
OP IP ER HC OCI 7.42% 4.13% 6.17% 8.77% 3.68%
Department Wide Repeat Rate: 6.58%
Total # of ImagesTotal # of Repeats
Results: January 2009Results: January 2009
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38.2% 31.9%
17.1%
8.8%4.0%
0
200
400
600
800
1000
1200
1400
Number of
Repeat Images
Extremity Chest Spine Abd / Pelvis Misc.
38.2%
31.9%
17.1%
8.9%4.0%
Exam CategoriesExam CategoriesResults Results –– January 2009January 2009
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Repeat ReasonsRepeat ReasonsResults Results –– January 2009January 2009
87.32%
2.65% 5.24%
3.47%1.32%
2,695
186 103 184 520
500
1000
1500
2000
2500
3000
Positioning Technique Equipment Artifact Motion
# of Repeated Images
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Radiation ExposureRadiation Exposure
Category # RepeatsmSv / Repeat
Collective Dose (mSv)
Extremity 1,255 0.01 12.55
Chest 1,046 0.04 41.84
Spine 562 0.7 393.4
Abdomen/Pelvis 288 0.7 201.6
Misc. 127 0.03 3.81
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Strategic GrowthStrategic GrowthCreates a consistent system of continuous improvement Creates a consistent system of continuous improvement centered around patient safety and operational centered around patient safety and operational excellenceexcellence
Safety & QualitySafety & QualityReduced radiation exposure to patientsReduced radiation exposure to patients
InnovationInnovationDevelop automated tracking systems and/or collaborate Develop automated tracking systems and/or collaborate with Vendors to enhance current product offerings.with Vendors to enhance current product offerings.
PeoplePeopleCollaborative educational inCollaborative educational in--servicesservicesIdentify future educational opportunities for Identify future educational opportunities for technologiststechnologists
Strategic InitiativesStrategic Initiatives
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Collaborate with Enterprise Medical Imaging (EMI) to develop Collaborate with Enterprise Medical Imaging (EMI) to develop automated data collectionautomated data collection
Interdepartmental collaboration on development of educational Interdepartmental collaboration on development of educational inin--services for technologists.services for technologists.
Pilot GE Definium 8000 electronic data collection in Outpatient Pilot GE Definium 8000 electronic data collection in Outpatient RadiologyRadiology
Perform another Repeat AnalysisPerform another Repeat Analysis
Engage Radiologists in review processEngage Radiologists in review process
Next StepsNext Steps
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Electronic Repeat AnalysisElectronic Repeat Analysis
Involved EMIInvolved EMI
Worked with EMI Project ManagerWorked with EMI Project Manager
Dedicated ServerDedicated Server
Pilot Pilot
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Dicom Tags from PACSDicom Tags from PACS
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Report SampleReport Sample
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SpecialtiesSpecialties
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Implementation of Implementation of Electronic Repeat AnalysisElectronic Repeat Analysis
January 2010January 2010
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January 2010 ERA Compare to January 2009
5,645
16,366
4,377
2,310
21,164
1,045
3,678
14,763
4,986
20,763
0
5000
10000
15000
20000
25000
OP IP ER HC OCI
2009 Total2010 Total
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Repeat Rate Comparison 2009 to 2010
8.8%8.74%
4.69%
7.74%
5.83%
3.7%
6.2%
4.1%
7.4%
5.12%
0.00%1.00%
2.00%3.00%4.00%
5.00%6.00%
7.00%8.00%9.00%
10.00%
OP IP ER HC OCI
% o
f Rep
eats
Jan-09Jan-10
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What Came Next?What Came Next?
Repeat or not to Repeat an imageRepeat or not to Repeat an imageRecorded inRecorded in--services on Quality services on Quality Management Educational WebsiteManagement Educational WebsiteQA Audits QA Audits
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QA AUDITSQA AUDITS
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QA AUDITSQA AUDITS
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QA AUDITSQA AUDITS
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The Saga ContinuesThe Saga Continues
Annual Repeat AnalysisAnnual Repeat AnalysisContinue QA auditsContinue QA auditsPeer Review Peer Review Continue education and training for Continue education and training for staff staff Radiologist Feedback Radiologist Feedback Feedback to staffFeedback to staff
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ConclusionConclusion
Performing Repeat Analysis has been Performing Repeat Analysis has been beneficial to our department.beneficial to our department.Improving Image QualityImproving Image QualityDeveloping educational opportunitiesDeveloping educational opportunitiesAnnual Repeat Analysis Annual Repeat Analysis Increased productivityIncreased productivity
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Project TeamProject Team
Mary Theresa Shore & Patti Doyle - Clinical Directors
Inpatient Radiology– Maureen Seluta and Debbie Ricciardelli
Emergency Radiology– Della Abedi-Tari and Jennifer Davenport
Outpatient Radiology – Sharon Gibson and Marie Oliver
OP Health Centers – Trish Daunais
MGH West – Tyler Martin
Mary Theresa Shore & Patti Doyle - Clinical Directors
Inpatient Radiology– Maureen Seluta and Debbie Ricciardelli
Emergency Radiology– Della Abedi-Tari and Jennifer Davenport
Outpatient Radiology – Sharon Gibson and Marie Oliver
OP Health Centers – Trish Daunais
MGH West – Tyler Martin
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QuestionsQuestions
OLD EBBETTSOLD EBBETTS
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Thank you!
