An Introduction to Clinical Audit for Radiographers
12. Examples of audits relevant to a mobile chest radiography service
12.3. Technical Aspects
| Service Requirement | Section C - Technical Aspects | ||||
|---|---|---|---|---|---|
| Criteria | C1 | C2 | C3 | C4 | C5 |
| No. CXR referrals with appropriate clinical information | No. CXRs diagnostically acceptable 'right first time' | Monitor and act upon any safety concerns raised | Monitor and act upon staff dose monitoring indicators | Patient doses | |
| Example audit statement | All CXRs have sufficient clinical information for justification by the radiographer | All CXRs should be diagnostically acceptable | No safety concerns should be raised by radiographers undertaking CXRs | Staff doses should be <10% of median dose values (* insert local standard) | Patient doses should be recorded (e.g. DAP) and remain within acceptable local DRLs and DAP and EI ranges |
| Purpose | Safety: Appropriateness of clinical information to enable justification, and appropriate use of limited PPE. CXRs NOT required for screening or for mild symptoms. | Safety and efficiency: the number of CXRs repeated and the reason (reject analysis) should be monitored | Safety - e.g. PPE availability; radiation protection issues, lack of available assistance to safely undertake CXR; staff Covid infection | Safety: compliance with good practice; rotation of imaging staff into high risk areas; consider ICU staff monitoring and rotation | Safety: compliance with good practice in view of some patients receiving multiple imaging examinations: As Low as Reasonably Practicable (ALARP) |
| Indicator / Standard | 100% compliance. Review referrals against justification criteria - all Covid-19 positive patients should be classed as moderate to severe symptoms. | 100% Compliance (ideal) Local optimum standard set | 100% compliance | 100% compliance | Review locally - there are no dose limits set. |
| Audit type | Compliance / on-going | Compliance / improvement | Compliance | Monitoring / Compliance (N.B. will be retrospective) | Monitoring |
| Evidence / Previous audits / literature | No imaging for screening or mild Covid-19 symptoms: https://pubs.rsna.org/doi/10.1148/radiol.2020201365 Covid-19 referral criteria available at: https://www.bsti.org.uk/media/resources/files/BSTI_COVID-19_Radiology_Guidance_version_2_16.03.20.pdf |
Review against any national Diagnostic Reference Levels and local reject analysis rates. Review CXRs against 10 point plan (Image review and reporting): https://www.elearning.isrrt.org/mod/book/view.php?id=255 |
Refer to WHO and subsequent national guidance on PPE: https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf ISRRT PPE document: https://www.isrrt.org/full-guideline-protective-measures |
Refer to local staff dose records and consult with Radiation Protection Advisor if concerns are raised. |
Moloney F et al . Radiation exposure in ICU patients https://www.ncbi.nlm.nih.gov/pubmed/27158429 Patient doses in critical care (McAvoy et al 2019): https://search.informit.com.au/documentSummary;dn=623334492317151;res=IELHEA |
Did all exposures have a recorded clinical evaluation (report)? Regulation 12(9) of IR(ME)R, Ionising Radiation (Medical Exposure) Regulations 2017. These regulations implement some provisions of the European Council Directive 2013/59/Euratom. Ref:
The Ionising Radiation (Medical Exposure) Regulations 2017 No.1322 (2017). (Queen’s Printer of Acts of Parliament) Available at: http://www. legislation.gov.uk/uksi/2017/1322/contents/made [accessed 27.06.2019]
European
Commission (2013), Council Directive 2013/59/EURATOM. Official Journal of the European Union (2013) Available at: https://eur-lex. europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2014:013:0001:0073:EN:PDF [accessed 27.06.2019].