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Demystifying Conundrum of Quality and Safety Management in Radiology

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The key experts from the radiology segment shared the virtual platform of the first edition of the Radiology and Imaging Summit discussed the importance of managing the COVID-19, other infectious diseases and urged on the need for strong public health strategies.

Moderating the session, Kaustabh Kolwankar Assistant Manager – Operations, Administrator – Radiology and Imaging, Nanavati Super Speciality Hospital, said, “To improve the safety, quality of care that radiologists provide and to allow radiology personnel to remain competitive it is essential that all imaging departments establish and maintain comprehensive, effective and quality radiology programs. The basic component of quality in radiology is patient’s safety, process improvement, customer service, professional staff assessment, and education each of which requires strategies for implementing continuous programs to monitor performance, analyze data implementing and meet regulatory requirements.”

Informing that quality and safety are two major dimensions in radiology, Kolwankar said, “Quality is always process-oriented and safety is patient-centered so the combination of these two will always help in the improvement and overall operations of the radiology departments. Important components of quality in radiology are 100 percent statutory compliance, easy access and assessment of the patient care, well-defined imaging procedures and interpretations, facility management and safety, management of equipment material and medications, human resource management, information management system. The statutory compliance which is required to fulfill the quality in radiology and imaging is licence of registration of a facility, PCPNDT registration, Elora AERB registrations, MPCB, shop and establishment if applicable and fire.”

Also read: Public Health Strategies to Control Infectious Disease

He detailed risk management in the radiology department informed that major processes that are involved in the radiology department which may lead to the risk that is major spill management, electrical maintenance in a department, employee safety, facility management, pest control, inventory control, fire safety management.

Touching upon the aspects of quality and the role of Atomic Energy Regulatory Board (AERB), Dr. Avinash U Sonawane Head, Directorate of Regulatory Affairs and Communication, AERB said, “AERB has a very focused mission to ensure that use of ionizing radiation like x-rays does not cause undue risk to the health of the people and environment. AERB has the regulatory framework and lays down the standards required for regulatory safety clearance for manufacturing and supply of the medical equipment, which uses the ionizing radiations.

He also added that there are a lot of misconceptions about radiation one such is the continuous access to radiation tools can give headaches. With great advancements in radiology particularly in CT radiological risks are probabilistic. It depends on the individual defense or response to the change which occurs at the cellular level because of radiation.

Listing out the important principles of radiation protection Sonawane said, “If a patient has to undergo x-rays the clinicians need to decide if it is really needed or if he/she has done it previously or any alternative like MRI or UGC is possible. As the radiation passes through the human body we do not know what sort of cellular level changes will be there as such so justification is really important. In optimization, the regulators should look into the design layout of the facility, equipment type approval, quality assurance of the equipment.

Talking about the quality aspect of radiation, Dr. Atul Mohan Kochhar, CEO, National Accreditation Board for Hospitals & Healthcare Providers (NABH) said, “AERB symbolizes the true safety as far as the radiation and an unintentional exposure whether to staff or the patient is concerned. Radiology is the most favorite branch of all conditions it always has been at the very top of all counseling, post-graduate counseling, and most intelligent students are known to choose this branch. It is a technologically intensive branch with the very latest and even the futuristic technology like Artificial Intelligence, telemedicine the teleradiology they are at the forefront of this specialty so it’s only natural that with such a wonderful compendium of extremely learned academia they adapt the quality assurance standards.”

Adding to it Kochhar said, “Most clinicians still are unfortunately not very familiar with the NABH they confuse us with the regulator just like PCPNDT OR AERB, we are not a regulatory body we are purely a voluntary body we are an autonomous body and NABH is one board which takes care about the health care providers we have lab board called NABL which is doing exemplary work during COVID RT PCR testing there is a quality promotion board called NAPPQ and there’s a certification body called NAPCP, education and training NABT for education and training so NABH is currently operating 21 programs under the three broad headings of accreditation, certification, and management. Our medical imaging system is a popular program launched in 2010, 10 years back the first standards were initiated and also built around a matrix of safety and quality unfortunately the program did not pick up. I think these were ahead of time, technology was changing, the rules and regulations were being formed up but now we have tried to cover all the gaps. January this year at IRIA we re-released the second edition of the medical imaging standard which is now in the public domain for the consumption of all our stand-alone as well as medical imaging organization organizations. The difference between the first edition and the second edition is the latter is totally homegrown standards and generic standards. There is no compulsion for any center to adopt if they adopt it will improve the outcomes on all fronts. Standards are free of charge, freely downloadable from our website. All our standards suggest protocol, radiology, and imaging is a branch where there are inbuilt safety descriptive standards which are prescribed even by the manufacturer by the practitioner but the NABH standard takes care of the patient emotional aspects and how to handle patients, which are well drafted to take care and about the satisfaction of this patient. It mainly governs unintentional patient harm, medication harm. It improves the mental health and working quality of everybody be it patient, staff working at the clinic, or the owner. The pandemic has taught us to introspect is that the quality is the only way forward. Time will tell and data will prove me right that going forward that every organization which has accredited by any agency has performed better in adapting to the changing dynamics scenarios and with which has been proved for years now and every organization which adapts these standards which goes forward into any accreditation system is better tuned to handle an emergency is better to tune to handle the crisis.”

Highlighting the importance of quality standards in a radiology department, Dr. Sanjay Patel Chief Consultant Radiologist Sterling Addlife India Pvt. Ltd, said, “We follow NABH standards have periodical re-accreditation process going on time to time and inspection. In the clinical safety of patients in the radiology department, I would inform that doctors and paramedics make some errors these are an inevitable aspect of our work pattern. Even in the best hands and the best standards evidence of system flaws not as character flaws occur. We should make sure on avoiding the recurrence of the error make full proof of our systems. The most important errors in radiology only come at the interpretation level. Diagnostic errors, communication errors, and identification errors do happen which need to be taken care of. Quality assessment, improving the clinical safety, and doing yearly reviews for all modalities mostly – x-rays, CT & MR is vital. Optimizing radiation process comes under clinical safety of the patients we have to be very cautious.”

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