CONCLUSIONES Y RECOMENDACIONES GENERALES

6. IMPLEMENTING A REMOTE

under the supervision of, a medical physicist” [16]. However, the lack of CQMPs in certain countries, regions and areas makes the implementation of these requirements difficult. Nonetheless, local authorities can make sure that proper procedures for adequate QA and medical physics support are in place.

The scope of the methodologies described in this publication does not intend to replace or minimize the need for the on-site support of CQMPs or to replace the requirements for frequent comprehensive QC. The aim is to provide an additional tool for the CQMP and optimize the use of resources, especially in underserved areas.

The guidelines in this publication can be used by Member States as a starting point to develop structured regulatory requirements for evaluating and monitoring the performance of imaging equipment. For example, evidence of regular QC could be required as part of the licensing process. The methodology presented in this publication, or a similar method, can be used for this purpose. At the same time, national authorities could acknowledge the efforts of a department to develop regular QC procedures as evidence of good practice; when a CQMP cannot be physically present, remote and automated QC is a feasible option.

6.1.2. Role of professional societies

Further to the use of the existing methodologies for remote and automated QC, professional societies can play a vital role in developing a general quality and safety culture in Member States. National or regional societies of radiologists, medical radiation technologists (radiographers) and medical physicists can promote and support the following:

— The need for and advantages of a quality and safety culture, reflecting it in all programmes and activities;

— Education, in terms of continued professional development workshops and seminars which can be frequently organized to introduce members to this model framework of QC and disseminate the benefits expected from the implementation of a comprehensive QA programme;

— Dissemination of the framework described in this publication;

— Uniform QC processes, programmes and testing, allowing for comparison and establishment of performance standards;

— Research into clinically relevant QC testing.

6.1.3. Role of the manufacturer

Although this publication is mostly aimed at imaging facilities and their supporting CQMPs, the importance of the imaging equipment manufacturers

cannot be underestimated. The successful implementation of a programme of this type is highly dependent upon the tools made available in the marketplace.

Of primary importance are the availability and accessibility of ‘for processing’ images. Without access to these images, many QC functions cannot be adequately established or performed. The most important aspects of the standard unprocessed image are that the signals are proportional (either directly or logarithmically) to the detector pixel exposure, and that no edge enhancement, smoothing, frequency based processing or averaging has been applied to the file.

It is important to note that it is acceptable for the following to have been applied to the unprocessed image [22]:

— Data replacement for defective pixels;

— Flat field correction;

— Pixel gain and offset corrections;

— Geometric distortion correction.

Any other corrections or modifications can yield faulty results in QC tests.

Manufacturers are encouraged to remember that QC is nearly as important as the clinical imaging. Just as appropriately processed images are necessary and beneficial for clinical imaging, images without processing are necessary and beneficial for QC of imaging.

Basic image analysis tools are usually also provided at the acquisition workstation. Window width and level adjustment is needed to be able to verify that the exposed image is diagnostically acceptable. Simple ROI statistics and measurement tools allow the medical radiation technologist to make elementary QC tests at the workstation.

Additionally, the importance of implementing a standardized exposure index [22] is emphasized by this publication. This standardized system makes it much easier for imaging facilities to implement uniform imaging protocols and QC measures, especially when equipment from different manufacturers is installed within the same facility.

This publication suggests a framework for advanced, comprehensive image QC evaluation. It would be very helpful for manufacturers to include the ATIA, or an equivalent providing similar evaluations, on their workstations. It is to the manufacturer’s benefit to provide tools to ensure that their equipment is operating optimally. Including such software on the acquisition unit would also make it easier for facilities to work towards optimizing their imaging protocols, as d′

relates directly to some of the clinical imaging tasks. Facilities could experiment with additional filtration and technical settings to optimally balance dose and d′

for their practice.

Along with the ATIA or an equivalent, it is advisable that manufacturers provide the simple test tool described in subsections 4.2.1.4 and 4.2.2.4 with their imaging systems, or one providing equivalent capabilities. The phantom test tool is inexpensive and simple to construct, but some facilities may have challenges in acquiring the necessary parts or getting the edges of the copper MTF target fine enough for proper analysis. Imaging equipment manufacturers have access to much better fabrication facilities than do most medical institutions. Further, manufacturers benefit from significant cost savings due to economies of scale, making it even less expensive for them to produce the test tool than for the users to do so. Manufacturers of test tools are encouraged to produce this phantom, as it may be to the advantage of many facilities to be able to purchase such a test tool independently for their installed systems, recognizing that many may not have the ability to fabricate the tool themselves.

The manufacturers of PACSs also have a role to play in implementing the guidelines in this publication. PACSs are ideal for the central storage, analysis and database platform that is called for. They already generally have the ability to accept and store sent images, provide analysis tools and notify individuals when certain conditions are met. Few additional functions are needed to implement the guidelines in this publication. PACS providers are encouraged to consider incorporating the functionality to implement this programme within their structure. Similarly, it is conceivable that many dose monitoring packages would be easily capable of implementing this QC framework.