implementing a mammography quality assurance programme to ... · introduction and purpose: a...
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Introduction and purpose: A significant variation in mammography technical repeat rates and image quality, by hospital and by mammographer, was observed during peer review visits undertaken to breast services within our network of hospitals.
A breast imaging leads quality forum was established, comprising of lead mammographers from each hospital. The remit of the group was to analyse the peer review findings, share good practice and implement a quality assurance programme to address variations in performance and improve overall results.
PURPOSE
Implementing a mammography quality assurance programme to improve technical image quality and reduce technical repeats
Steven C Dixon, London, UNITED KINGDOM; R Halls, BSC,MSc; S E Milner, BSC; N Buckley; M Shah, MBA,RT
METHODSAn action plan was developed to enable the implementation of the quality assurance programme and included the following;
• appointing a group lead QA mammographer
• ensuring all mammography staff have access to a superintendent radiographer highly experienced in mammography as a mentor, as well as
establishing a buddy system
• ensuring staff are suitably trained, including holding, or working towards, a postgraduate certificate of competence in mammography, in
addition to undertaking relevant breast specific CPD
• regularly feeding back results to staff on the quality of their work, including feedback from radiologists regarding technically inadequate
images
• developing and implementing standardised group wide policies, protocols and procedures, including those relating to customer care and
communication.
• developing standardised information leaflets and pre mammography questionnaires
• ensuring sufficient time in between appointments to enable mammographers undertake the procedure according to protocol
• reducing the number of staff performing mammography, where necessary, rotating staff throughout multiple hospitals and limiting the use
of agency staff. Thus enabling each staff member to perform a minimum numbers of mammograms per month
• undertake mammography specific patient experience surveys
• replacement of small plate technology with large plate
• a data collection programme, centrally coordinated, to monitor at group, hospital and mammographer level;
- monthly mammography technical repeat rates
- quarterly image quality reviews consisting of 30 annoymised images for each mammographer. These were graded, using agreed criteria, by
a review panel comprising of the group lead QA mammographer and two rotating mammographers from within the group.
Staff were tasked with completing these actions and progress was monitored at regular intervals.
RESULTSThe improvements put in place led to a decrease in the numbers of staff performing mammography across the group, resulting in increased
numbers of mammograms performed by each member of staff. Quantative measuring of the success of the quality assurance programme was
determined by the monitoring of the technical repeat and image quality rates. The peer review visits showed the technical repeat rate across
the group as a whole to be 13% in December 2011. By December 2013, this had decreased to less than 3.5%, with the rate for 2013 overall
being 3.6%. Using a Perfect, Good, Moderate and Inadequate system of image quality grading, the perfect and good rate was 60% in the final
Quarter of 2011. This result had increased to 88.1% by the final quarter in 2013.
60.00
58.22
73.98
53.94
73.08
67.40
78.51 81.57
88.16
85.69
79.71NHS /EuropeanStandard = > 75%
100
90
80
70
60
50
40
30
20
10
0
P&
G%
Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014
Technical Quality of Mammography Images Audit% of Perfect and Good Images
Technical Report RateDecember 2011 to June 2014
TR
ra
te%
Month
16
14
12
10
8
6
4
2
0
13.30
6.39 6.60
5.89
4.955.32
3.33
4.97
3.883.19
3.383.41
3.44
4.32
3.413.68
2.81
4.10
3.09
3.94
3.353.353.353.353.353.35 3.36
3.29
5.18
3.473.28
3.86
2.693.04 2.80
3.68 NHS /EuropeanStandard = < 3%
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GRAPHS
Quarter
CONCLUSIONThe implementation of the quality assurance programme which
addresses staffing, training, environment, equipment and working
relationships, not only between consultant and mammographer, but
mammographer and patient, has led to a reduction in the technical
repeat rates and improvement in image quality. Most importantly
however, this quality assurance programme has led to an improved
service to patients with a reduction in exposure to radiation and an
increase in efficiency throughout our hospitals.
Key aspects of the programme which have led to the improvements
include; the increased numbers of mammograms performed by each
mammographer, which is particularly important in hospitals with low
volumes; the quarterly image quality reviews, which have provided a
learning environment for mammographers to discuss image quality
and identify trends; the continuation of the breast imaging leads
meeting, enabling ongoing discussion of mammography issues across
our hospitals, with the group increasing its remit to provide training
sessions for staff.
The increased awareness of this initiative and the engagement of all
staff from mammographer to CEO levels, has been an important factor
with the success of the programme and it is now important that this
initiative continue so further improvements can be made.
HCAInt.RSNAposter.indd 1 02/11/2014 20:19