Diagnostic Process

• What is the QUALITY ASSURANCE in imaging and nuclear medicine (NM)?

  Quality assurance (QA) is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services (results of imaging) to customers.
• What is DMAIC?

  Define, Measure, Analyze, Improve, Control.

  DMAIC is a data-driven quality strategy used to improve processes.
• QA is very important in the medical field because it helps to identify the standards of medical equipments and services.
• Hospitals and laboratories make use of external agencies (EA) in order to ensure standards for equipment
• What does SOP mean?

  A Standard Operating Procedure (SOP) is a set of step-by-step instructions compiled by an organization (NM department) to help workers carry out complex routine operations.
• What steps does the diagnostic process in nuclear medicine have?

  1. Prep phase -> exam indication, patient prep, patient admission + data control
  2. Imaging phase -> Rf prep, Rf application, detection, data analysis
  3. Interpretation phase -> report, admin, interpretation + patient management
• What steps does the diagnostic process in radiology have?

  1. Exam indication
  2. Patient prep
  3. Patient admission + data control
  4. Contrast media application
  5. Detection
  6. Data analysis
  7. Report
  8. Admin
  9. Interpretation + patient management
• What are the general indications of imaging methods??

  • Detection / diagnostic
  • Screening
  • Monitoring
  • Targeting
  • Staging
  • Decision of selective therapy
  • Assessment of disease prognosis
  • Trials + research
• What is staging?

  Establishing the state and extent of the disease for TNM (tumors, nodes, metastasis) classification by doing sensitive tests, such as bone scintigraphy
• What is targeting?

  It is the IMAGING method used to visualize the pathological site - the most active site with the disease in the body - to guide a biopsy or direct therapy
• Examples of targeting?

  1. Patient with kidney stones has a high level of potassium in the blood.
  2. The doctor indicates PTH and USG.
  3. If the PTH value is positive, indicates Parathyroid scintigraphy.
• How is the quality of radiopharmaceuticals controlled?

  1. Each RF is controlled – name of patient, dose, type of RF.
  2. Name of patient must be on each injection before application and
  3. Identity of patient must be verified.
  4. All applied doses are registered in database to the name patient and yearly send to Public Health Office - Radiation Protection Department.
  5. During injection we must avoid para venous application.
  6. Control place of application if it is necessary by gamma camera
• Which FACTORS can IMPACT the STUDY RESULT?

  Prep phase (40% of mistakes)

  • indication of examination
  • information provided to the diagnostician
  • patient preparation
  • condition of the patient before and during the examination
  • previous investigation methods (contrast media)
• What does it mean EFFECTIVE DIAGNOSTIC PROCESS?

  way to find a correct diagnosis, the fastest and cheapest
• INFORMATION FLOW PROBLEM?

  feedback
• What can help to improve feedback?

  • Seminars
  • Case reports
  • Transmission of information via hospital information system (HIS)
  • Interdisciplinary cooperation on projects
  • Personal contacts
• What are the consequences of diagnostic delay?

  • symptomatic treatment
  • wait and repeat other tests
  • possible complications = more expensive treatment
  • Irreparable complications (MTS) = poor prognosis
• What is the optimal waiting time for a complex exam?

  1 week
• RULE ON DURATION OF DIAGNOSTICS

  Increased diagnostic time increases the chance of disease detection but decreases the early + successful treatment of the disease.
• What forms of results do we know in nuclear medicine?

  • qualitative
  • semiquantitative
  • quantitative
  • imaging
• Which FACTORS can IMPACT the STUDY RESULT?

  • prep phase = 40%
  • imaging phase = 15%
  • interpretation phase = 45%
• Reporting of nuclear medicine examination consists of?

  • introduction - exam, Rf, anesthesia
  • core - verbal description of what is observed on the exam, lesion size, lesion location
  • conclusion - result of exam
• What are the phases of the diagnostic process in nuclear medicine?

  • prep phase (40%) => exam indication, patient prep, patient admission + data control
  • imaging phase (15%) => Rf prep, Rf application, detection, data analysis
  • interpretation phase (45%) => report, administration, interpretation, patient management