The College developed seven guiding principles for what became known as the RANZCR Quality and Accreditation Program. Those principles are that the Program will:

1. be developed, controlled and administered by RANZCR
   
2. be designed to ensure quality radiological practice which meets community needs
   
3. aim to enrol all practices providing medical imaging services
   
4. be credible, effective and implementable
   
5. address professional, technical and administrative standards
   
6. focus initially on major factors critical to the delivery of quality medical imaging services and will be refined over time
   
7. be global in its scope but may be incremental in its implementation
   

In short, the RANZCR wished to develop a program that would result in quality services for both referring doctors and patients of medical imaging practices. The aim is for continuous improvement of those services to meet best practice criteria. It is important to note that "quality", in this context, means "fitness for purpose", and hence there are no degrees of quality: a service either meets a quality objective, or it does not.

• Development of Standards
  
• Assistance from the Australian Government
  
• Collaboration with NATA
  
• Achievement of Accreditation
  
• Stage 1
• Stage 2
• Stage 3
  
• Relationship to IANZ-accredited Medical Imaging Practices in New Zealand

Development of Standards
In order to meet these objectives, a Committee of College Fellows was appointed - the Accreditation Guidelines and Quality Committee (AG&QC). This Committee, with input from other College members and the support of the College secretariat, has developed a set of professional, technical and administrative Standards which practices are expected to meet. The Standards have been developed over time to incorporate changes in regulations, and in accordance with the Program principles, to continually strive for best practice.

Assistance from the Australian Government
The RANZCR is being encouraged in its endeavours by the Commonwealth Department of Health and Ageing which is contributing funds for the development and implementation of the Program.

Collaboration with NATA
Along with developing the Standards, the AG&QC considered how best to offer a program in which medical imaging practices meeting those Standards could be recognised. After thorough consideration of various alternatives, the RANZCR signed a Memorandum of Understanding with the National Association of Testing Authorities, Australia (NATA).

Under this Memorandum, the RANZCR and NATA have agreed to collaborate in the further development and operation of the RANZCR Quality and Accreditation Program. To this end, the RANZCR/NATA Medical Imaging Accreditation Steering Committee (MIASC) was been established to provide advice on the further development of the Program, including image reviews. Both the College and NATA are represented on this Committee.

Achievement of Accreditation
In line with its guiding principles for this Program, the RANZCR developed a multistage timetable for the recognition of practices meeting the RANZCR Standards and associated criteria. This "walk then run" philosophy was intended to maximise the number of practices able to participate in the Program and hence ensure the best overall results for medical imaging.

The overall accreditation process comprised of three stages: Stages 1 and 2 were for "registration" and Stage 3 will be for "accreditation".

Stage 1:
Practices were able to apply for Stage 1 Registration of some or all of their practice locations.

Practices applying to the RANZCR for recognition in Stage 1 were asked to complete a hardcopy questionnaire which measured their compliance with the Stage 1 criteria in the RANZCR Accreditation Standards for Diagnostic and Interventional Radiology.

Practices providing MRI services, and up to 5% of all other practices, also participated in an Image Review process.

Based on the questionnaire responses from the practices, along with the outcome of the MRI Image Review, and any supporting information requested by NATA, recommendations for the granting of Stage 1 Registration registration were made to the College.

Stage 1 site visits were conducted with NATA staff to assist in the development of the Program. The object of the visits was to assess the relevance of the Program and to seek practices' views on the Program to date.

Stage 1 Registration was available from 1 November 1999 to 31 October 2001. All Stage 1 registrations expired on 31 October 2003 and were not renewable at this level.

Stage 2:
In Stage 2, practices had to apply for registration of all of their practice locations and for all modalities within the site.

Practices applying to the RANZCR Quality and Accreditation Program after 1 November 2001 were eligible for Stage 2 registration. Stage 2 participants completed questionnaires, which measured their compliance with the Stage 2 criteria in the RANZCR Accreditation Standards for Diagnostic and Interventional Radiology. Questionnaires were available for medical imaging, mammography, MRI, nuclear medicine, interventional radiology, ultrasound and BMD.

Additional requirements for MRI were participation in the clinical and phantom image review programs.
All sites with mammography had to meet the requirements of the MQAP.

As in Stage 1, NATA examined the responses to the questionnaires and sought further information when required. On the basis of questionnaire responses, participation in MQAP and the outcome of the MRI Image Reviews, NATA recommended that the RANZCR grant Stage 2 Registration to the practice.

Similar to Stage 1, there were practice visits to a small number of sites that were participating in Stage 2. This was to assist in the development of Stage 3 assessment process and mostly focused on administrative and quality management procedures.

Stage 2 Registration was available from 1 November 2001 to 31 October 2003. Stage 2 registrations will expire in November 2005, with appropriate transitional arrangements and will not be renewable at this level.

Stage 3:
Practices applying to RANZCR/NATA for recognition in Stage 3 will be required to meet all criteria developed for this stage. There will be 3 components:

1. Pre-assessment document review;
   
2. On-site peer assessments; and
   
3. Image review participation, where available.

Once practices meet all Accreditation criteria, they will be granted joint RANZCR/NATA Accreditation. Reassessments are expected to occur every three years.

Accreditation (Stage 3 of the Program) commenced in May 2004. Stage 2 Registration was not available after 1 November 2003. All new applicants after that date were required to apply for RANZCR/NATA Accreditation.

Relationship to IANZ-accredited Medical Imaging Practices in New Zealand
International Accreditation New Zealand (IANZ), an accreditation body similar to, and having a longstanding mutual recognition agreement with, NATA, has been accrediting medical imaging practices in New Zealand for a number of years. The criteria used is The New Zealand Code of Radiological Management Practice and the program includes a large component of on-site peer review.

The registration programs operated in New Zealand in parallel with the IANZ accreditation program. Communication has commenced between IANZ and the College to discuss the future direction of both programs so that the needs of the New Zealand radiologists and practices can be met, as well as recognising the interests of both NATA and IANZ.

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