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Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

ABSTRACT: The purpose of this study was to develop a method of performing routine periodical quality controls (QC) of CT systems by automatically analyzing key performance indicators (KPIs), obtainable from images of manufacturers' quality assurance (QA) phantoms. A KPI pertains to a measurable or determinable QC parameter that is influenced by other underlying fundamental QC parameters. The established KPIs are based on relationships between existing QC parameters used in the annual testing program of CT scanners at the Karolinska University Hospital in Stockholm, Sweden. The KPIs include positioning, image noise, uniformity, homogeneity, the CT number of water, and the CT number of air. An application (MonitorCT) was developed to automatically evaluate phantom images in terms of the established KPIs. The developed methodology has been used for two years in clinical routine, where CT technologists perform daily scans of the manufacturer's QA phantom and automatically send the images to MonitorCT for KPI evaluation. In the cases where results were out of tolerance, actions could be initiated in less than 10 min. 900 QC scans from two CT scanners have been collected and analyzed over the two-year period that MonitorCT has been active. Two types of errors have been registered in this period: a ring artifact was discovered with the image noise test, and a calibration error was detected multiple times with the CT number test. In both cases, results were outside the tolerances defined for MonitorCT, as well as by the vendor. Automated monitoring of KPIs is a powerful tool that can be used to supplement established QC methodologies. Medical physicists and other professionals concerned with the performance of a CT system will, using such methods, have access to comprehensive data on the current and historical (trend) status of the system such that swift actions can be taken in order to ensure the quality of the CT examinations, patient safety, and minimal disruption of service.

SUBMITTER: Nowik P

PROVIDER: S-EPMC5690007 | biostudies-other | 2015 Jul

REPOSITORIES: biostudies-other

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Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

Nowik Patrik P Bujila Robert R Poludniowski Gavin G Fransson Annette A

Journal of applied clinical medical physics 20150708 4

The purpose of this study was to develop a method of performing routine periodical quality controls (QC) of CT systems by automatically analyzing key performance indicators (KPIs), obtainable from images of manufacturers' quality assurance (QA) phantoms. A KPI pertains to a measurable or determinable QC parameter that is influenced by other underlying fundamental QC parameters. The established KPIs are based on relationships between existing QC parameters used in the annual testing program of CT ...[more]

PMID: 26219012

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Project description:PurposeTo develop and validate an informatics toolkit that extracts anatomy-specific computed tomography (CT) radiation exposure metrics (volume CT dose index and dose-length product) from existing digital image archives through optical character recognition of CT dose report screen captures (dose screens) combined with Digital Imaging and Communications in Medicine attributes.Materials and methodsThis institutional review board-approved HIPAA-compliant study was performed in a large urban health care delivery network. Data were drawn from a random sample of CT encounters that occurred between 2000 and 2010; images from these encounters were contained within the enterprise image archive, which encompassed images obtained at an adult academic tertiary referral hospital and its affiliated sites, including a cancer center, a community hospital, and outpatient imaging centers, as well as images imported from other facilities. Software was validated by using 150 randomly selected encounters for each major CT scanner manufacturer, with outcome measures of dose screen retrieval rate (proportion of correctly located dose screens) and anatomic assignment precision (proportion of extracted exposure data with correctly assigned anatomic region, such as head, chest, or abdomen and pelvis). The 95% binomial confidence intervals (CIs) were calculated for discrete proportions, and CIs were derived from the standard error of the mean for continuous variables. After validation, the informatics toolkit was used to populate an exposure repository from a cohort of 54 549 CT encounters; of which 29 948 had available dose screens.ResultsValidation yielded a dose screen retrieval rate of 99% (597 of 605 CT encounters; 95% CI: 98%, 100%) and an anatomic assignment precision of 94% (summed DLP fraction correct 563 in 600 CT encounters; 95% CI: 92%, 96%). Patient safety applications of the resulting data repository include benchmarking between institutions, CT protocol quality control and optimization, and cumulative patient- and anatomy-specific radiation exposure monitoring.ConclusionLarge-scale anatomy-specific radiation exposure data repositories can be created with high fidelity from existing digital image archives by using open-source informatics tools.

Project description:BackgroundCross-country comparisons of health system performance have become increasingly important. Clear evidence is needed on the prioritization of health system performance assessment (HSPA) indicators. Selected "leading" or "headline" HSPA indicators may provide early warnings of policy impacts. The goal of this paper is to propose a set of headline indicators to frame and describe health system performance.MethodsWe identified overlaps and gaps in the availability of reported indicators by looking at HSPA initiatives in Member States (MSs) of the European Union (EU), the European Commission as well as international institutions (e.g. OECD, WHO-EUR). On that basis, we conducted a two-stage online survey, the european Health System_Indicator (euHS_I) survey. The survey sought to elicit preferences from a wide range of HSPA experts on i) the most relevant HSPA domain(s), i.e. access, efficiency, quality of care, equity, for a specific indicator, and ii) the importance of indicators regarding their information content, i.e. headline, operational, explanatory. Frequency analysis was performed.ResultsWe identified 2168 health and health system indicators listed in 43 relevant initiatives. After adjusting for overlaps, a total of 361 indicators were assessed by 28 experts in the 1st stage of the survey. In the 2nd stage, a more balanced set of 95 indicators was constructed and assessed by 72 experts from 22 EU MSs and 3 non-EU countries. In the domain access experts assessed share of population covered by health insurance as the top headline indicator. In the domain efficiency, the highest rank was given to Total health care expenditure by all financing agents, and in the domain quality of care to rate of hospital-acquired infections. Percentage of households experiencing high levels/catastrophic of out-of-pocket health expenditures results as the top headline indicator for domain equity.ConclusionsHSPA indicators from different initiatives largely overlap and public health indicators dominate over health systems aspects. The survey allowed to quantify overlaps and gaps in HSPA indicators, their expert allocation to domain areas and establishment of an informed hierarchy structure. Yet, results show that more multidisciplinary work is needed to ensure the availability of accurate efficiency indicators which are comparable across countries.

Dataset Information

Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

Publications

Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

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