Digital radiology enables Orwellian quality assurance

March 5, 2006

George Orwell’s visionary novel 1984 described a society with individuals living under constant surveillance. Radiologists at the Imelda Hospital in Bonheiden, Belgium, could be forgiven for wondering if they are working under the eyes of Big Brother. Implementation of a comprehensive quality assurance system means that every task they perform is now tracked, logged, and evaluated.

George Orwell's visionary novel 1984 described a society with individuals living under constant surveillance. Radiologists at the Imelda Hospital in Bonheiden, Belgium, could be forgiven for wondering if they are working under the eyes of Big Brother. Implementation of a comprehensive quality assurance system means that every task they perform is now tracked, logged, and evaluated.

The move toward rigorous QA procedures was taken with the full backing of department staff, however, said Dr. Jan Schillebeeckx, chief of radiology at Imelda. Radiologists at the 500-bed private institution, which performs 130,000 imaging exams each year, were keen to better standards of service delivery.

"You can measure to punish, or you can measure to improve," he said at the ECR on Sunday. "We as radiologists decided to start this because we wanted to improve."

Radiology departments are well used to checking that their equipment is up to scratch, Schillebeeckx said. Workstations, for instance, undergo regular calibration to ensure that image quality is sufficient for diagnostic reporting. The advent of digital radiology means that a far wider range of elements can be subject to quality control.

"In a digital environment, we have a lot of information. If you can get this information out, then you can improve the quality of service in your radiology department," he said. "For me, QA is much more than controlling the quality of machines."

Monthly figures on the number of reports issued by each radiologist can be collated relatively easily. Future refinements will allow these performance figures to reflect the complexity of studies as well, Schillebeeckx said. Assignment of different weightings to MRI and x-ray exams, for example, may explain why one staff member has reported fewer cases than another.

A centralized cyber tracking system is also being put in place for audits of data security and privacy. Any creation, alteration, or merely accessing of personal data will be logged.

"Whoever did what, and when they did it, we can track that," Schillebeeckx said.

Report quality is evaluated using a system of routine overreads. Any errors are coded on a scale of 1 to 4, depending on the severity of their implications. The most serious mistakes - graded 3 or 4 - automatically generate a significant incident report, which in turn requires departments to take urgent, remedial action.

"The clinical quality of the report is, for me, the most important thing of all," he said.

As yet, however, there is no automated means of checking that clinicians have read and understood the report. This can have important legal implications, Schillebeeckx said. Simply flagging up pathology may not necessarily be the end of a radiologist's duty of care.

The all-encompassing audit at the Imelda's radiology department also covers technical issues. A live system has been installed to watch over equipment 24/7 and, where possible, fix problems remotely. Activity reports are also generated from the hospital's internal network, revealing load distribution.

Patient satisfaction with the radiology department's service is collected via regular patient surveys.