Image Quality Assurance-#705

1. Image Quality Assurance-#705 Bonnie Matlack, R.T. VistA Imaging Coordinator Kansas City VA Medical Center

2. Introduction • Background • Clinical – Radiology for 23 years • Vista Imaging Coordinator since 1999 • I truly am a “Jack-of-all-trades” however, can’t possibly know everything! • Maintain a close working relationship with clinical staff as well as Bio-Medical Eng. • These individuals assist with the evaluation of image quality and serve as reference and/or subject matter “experts”

3. Class Overview • Image Quality: Who Cares? • It’s Not Just Radiology Anymore! • Is there a difference between “Diagnostic” Image Quality vs. a “Review” Quality Image? • Image Display – Basics • High Resolution Display • Scanned Documents • Image Quality Concerns Hold Questions to End of Presentation

4. Who Cares? • Everyone! • Clinical decisions are being made every day based on images displayed via VI. and……….. • Everyone is counting on you, the VI (imaging) expert! • Help solve problems • Aide in improving or changing image quality/display • Evaluate equipment performance • Interface with vendors

5. Image QualityNot Just Radiology Anymore! • Radiology Images • Dental Images • Eye Images • Imported Images • Scanned Documents • Digital Pictures

6. Diagnostic vs. Review Quality • “Diagnostic” Quality – • Primary Interpretation of an image is performed • Who does this? • Does every clinician do this? • Technical Standards to consider • Monitor Resolution • Grayscale Performance • Graphics/Display cards • “Review” Quality- - No Specific Standards

7. Image Display Quality Basics Question: Appropriate Equipment? • Has the equipment been “validated” by VistA Imaging? Check the approved equipment lists at: Question: Is the Equipment in Good, Working Condition? Final Question to ask: What is the Intended Use? (Clinical Review vs. Diagnostic Review)

8. Image Display QualityBasics What are you doing? • CLINICAL REVIEW • Most standard monitors serve this function adequately • Abstracts • JPEG • Scanned Documents • Pictures • TIFF • DIAGNOSTIC REVIEW • Depending upon the application, • Tele-retinal • Dental • Radiology • Check the display specifications and/or requirements of that particular program or imaging device manufacturer. Bottom Line: You need to have the appropriate display monitor for resolution of image matrix to be displayed.

9. Image Display Quality Basics • PIXEL: • A pixel is the individual imaging element of a CCD. It is also the individual output point of a display device. (640x480,800x600,1024x768,1280x960 typical computer monitor resolution settings) • MEGA PIXEL: • CCD resolution of one million pixels. • Multiply the horizontal resolution by the vertical resolution to get the pixel count. (i.e. 5mp= 2500x2000) • RESOLUTION: • The number of pixels used to create an image. • Resolution required depends on what will be done with the images that are taken and/or acquired.

10. High Resolution Image Display (Radiology) • Radiology Images-Demand MEGA!! • MEGAPIXEL that is Larger image matrices require “Megapixels” to ensure the appropriate display of the higher resolution image. Simply put, you need a monitor that is considered to be “high” resolution to appropriate display an image that provides high resolution quality. • However, not all images are created the same: 2MP: CT, MR, US 3MP to 5PM: CR, DR 5MP Mammography • Many Environmental Concerns for image quality Darkened Room, Light Sources, Glare, Ergonomics and standardization

11. High Resolution Image Display (Radiology) • Display Monitor Calibration is a MUST! What is Calibration? • Set Gamma Curve to comply with DICOM Part 14 DICOM - Digital Imaging and Communication in Medicine. http://dicom.nema.org/ DICOM Part 14 sets standards for “Diagnostic” Display performance Very detailed document, Engineer’s reading material. • Uses a calibration “sensor” to perform test • Software can be used & is available to aide in the calibration process • Use SMPTE to verify 5% and 95% visible

12. High Resolution Image Display (Radiology) • Challenges to Calibration? • Drift • Equipment Changes (Monitor Swaps) separating monitor from its LUT • Must be consistently checked (QA’d) • Automated Calibration is available on some monitors • Automated system, does not mitigate need for periodic manual QA and/or visual checks. • Are there mandates (JCAHO, NEMA etc.)? • Not at this time, only guidelines & manufacturer recommendations. • Recommend that documentation of monitor calibration dates, monitor replacement etc. is maintained.

13. Document Scanning • Quality control process should be on-going • Correction process of • Erroneously scanned documents • Poor quality documents • Incorrect Note Title

14. Document Scanning/QANew VI Functionality – Patch 93

15. Document Scanning QAVI Patch 93

16. Document Scanning QAVI Patch 93

17. Document Scanning/QAFuture VI Functionality Currently, only those that hold the MAG Edit key can use the new P93 Document QA Utility. Changes are on the horizon. VistA Imaging Development has plans to enable peer-to-peer Document QA in the future. This new functionality will introduce an additional/new Security key: MAG QA

18. Document Scanning QAVI Patch 93 • HIMS Website: • http://vaww.vhaco.va.gov/him/docscanning.html • Patch 93 Training Modules – Specific to Document QA Process Module 8 – “QA Review & QA Review Reports”

19. Image Quality What Do You Look At or Check? • Basic Items to Review- • Is the image in focus, and exposed properly? • Does the image show the region/area of interest? • Do you recognize what the image is? • Is the image labeled properly? • Is the image upside down or sideways? • Can you read the document? • Does the image belong to the correct patient? • Was it attached to the correct Note Title or Procedure? So, you think it looks good? Final Check: Have a clinical expert review the image for quality and appropriateness.

20. Quality • PREVENTION: • Is the key to prevent mistakes! • QA/QI as part of the process • A written Policy and/or Procedure is a must, especially for document scanning & high resolution monitors • Refer to HIMS website for additional Document Scanning guidance: http://vaww.vhaco.va.gov/him/refsresources.html http://vaww.vhaco.va.gov/him/docscanning.html • CORRECTING MISTAKES: • Make it a “High” Priority • Work with the Clinical Staff and HIMs • Make yourself available and/or know who to direct individuals to contact who holds the MAGJ Delete key that can assist with the request.

21. References • http://vaww.va.gov/imaging/Approved_Clinical_Capture_Devices.pdf • http://vaww.va.gov/imaging/IMGNewHardwr_OpSys.htm • http://dicom.nema.org • http://www1.va.gov/imaging/docs/VistA_Imaging_DICOM_Modality_Interfaces.pdf • http://vaww4.va.gov/IMAGING/SA_Image_Quality_Cert_Form_2004.pdf • http://vaww4.va.gov/IMAGING/SA_Tech_Datasheet_for_Clinical_Capture.pdf • http://vaww4.va.gov/IMAGING/SA_Tech_Datasheet_for_DICOM.pdf • http://vaww4.va.gov/IMAGING/IMGNewHardwr_OpSys.htm • http://vaww.vhaco.va.gov/him/refsresources.html • http://vaww.vhaco.va.gov/him/docscanning.html

22. Image Quality (Again) • Again, good Image Quality is a priority that benefits everyone. • Challenges • Greater number & type of image files than in past • Variance in Equipment • User Accessible Controls • Variance in Environment • Quality/Age of Equipment • Updates to Equipment Software

23. Remember, I am always learning too, let’s talk…… • What are you doing at your facility? • Have you installed VI Patch 93? • Is the HIMS staff using the new QA utility? • Do you have any suggestions, additional information or helpful hints to share with everyone? Questions?