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To ensure professional practice standards and supervision requirements, through uniform standards, guidelines and accreditation that meet consumer and referrer needs and provide evidence based, best practice services that are safe, cost effective and efficient.
The project intended to:
- Review the current regulatory requirements and the current literature (both local and international) with regard to the professional supervision of imaging services;
- Identify the key policy issues that need to be addressed in relation to the use of teleradiology and assess the implications for professional supervision of diagnostic imaging services
- Develop and test, in relation to procedures/examinations supervised by radiologists, best practice standards of:
- professional supervision, or personal attendance, by the radiologist, according to a particular modality or procedural group; and
- professional supervision of, or personal, reporting by the radiologist, of the results of a particular modality or procedural group;
- Identify any changes that may be required to current regulatory requirements; and
- Identify, develop and test appropriate information for inclusion in relevant material for consumers.
Cardiac ultrasound, obstetrics and gynaecological ultrasound, cardiac angiography and nuclear medicine services are outside the scope of this project.
The proposed Standards define the principles and requirements of professional supervision and reporting that radiologists are expected to meet. They are intended for practitioners in both the public and private sectors working in small and large organisations. They aim to promote safe and quality patient care and radiology practice.
A three-stage development approach was adopted:
Stage 1 - was a scoping study to research, identify and assess key issues, and establish
principles and options for standards development
Stage 2 - involved developing the standards
Stage 3 - focused on testing the standards and exploring the implementation requirements
Australian Healthcare Associates
The proposed professional supervision and reporting standards set out by this project recognise that radiologists operate in a diverse range of unique imaging environments, each with their own risks, which should be appropriately managed. The proposed Standards therefore, take a flexible, protocol-based, quality systems approach, rather than a rigid rules-based approach, representing a significant shift in thinking on this topic.
Recognising that the ultimate aim of these Standards should be to ensure radiologist input to the imaging service at the appropriate/critical times, the Standards have a focus on developing an effectively functioning team. This focus manifests itself in the requirement to develop protocols to guide technologists as to when they should seek the input of a radiologist.
Presentation (PDF)
Standards (PDF)
Final report (PDF)
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Although having implications for other non-medical imaging practitioners, the scope of this project focused on the roles of sonographers and radiographers employed by radiologists.
Examination and possible development of evolved roles for non medical diagnostic imagers, including examination of training, accreditation, liability and supervision requirements. It is also aimed at the attraction and retention of non medical diagnostic imagers through changing the roles they currently perform.
1. Literature review and provide interim report outlining progress to date
2. Completion and presentation of an issues paper and project report
3. Consider comments provided by the Technical Reference Group/stakeholders and provide final report.
KL2 Consulting Pty Ltd
The review of relevant literature and consultation provided a number of reasons for the significant change to the medical imaging “service” and its environment in recent years. Radiology teams are managing evolving business and operating environments, changing technology, demands for professional development and increased consumer awareness. These have contributed over time to the creation of highly complex, interdependent roles
Literature review (PDF)
College response (PDF)
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This project is to develop a small number of specific report templates based on input from the RANZCR fellowship, using MRI Knee as the initial context.
There is a need to understand the referrer expectations of and preferences for quality radiology practice clinical reporting.
A national and international review will be carried out to investigate current radiology template report practices, including work carried out by NEHTA. A study will follow to identify current and desired characteristics of quality radiology practice by consulting with Fellows of the College and other key stakeholders to develop a reporting template for MRI knee. After consultation, development of the most suitable format for the draft templates will be examined. A survey will be carried out to obtain referrers’ preferences of the resulting template. After final sign off by key stakeholders of the report template for MRI knee, development of further templates will occur. Once completed, the templates will be published to the College’s website for download into existing RIS systems.
Collaborative Centre for e-Health, University of Ballarat
It is expected that the outcomes of this project will be used to inform the College’s development of standards of practice and inform the College’s curriculum development program.
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The project documented baseline arrangements that are currently in place to ensure closure of medical imaging test result communication loops. Additionally, the Survey explored other related issues of ED Medical Imaging service delivery, including type and timeliness of medical imaging tests and test results, as this information could lead to further more detailed and specific research.
Emergency Departments (ED) are recognized as health care settings where effective and timely communication is critical. The survey findings will establish how effective the current arrangements are, and hope to inform further research if these arrangements are found to be inadequate, or if the risk of non-closure of the communication loop is perceived by ED medical directors to be high.
The research survey was mailed to the Medical Directors of approximately 192 EDs located in public and private hospitals throughout
Australia. The survey mailing, including the provision of the mailing list, and also the coordination of the Survey replies, and any required re-mail, was coordinated and organized by the Australasian College for Emergency Medicine (ACEM). Ethics Committee approval has been obtained from Flinders (FCREC), and liability coverage has been agreed to by DH (South Australia), and Flinders University of South Australia. The Flinders Medical Centre (FMC) ED was used as a case study in this research.
Dr Neil Jones, FRANZCR
Preliminary results confirm the high risk that failure to close the communication loop poses in the Emergency Department, with near misses, as well as minor and major injuries to patients being reported. ED Directors indicate that timely imaging reporting, timely communication of critical test results, and appropriate supporting IT systems, are key for driving improvements in this area.
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The project report details the following elements:
- Current and potential applications of teleradiology in Australia and define each component and the impacts these may have on the clinical practice of radiology.
- A draft set of standards for the use of teleradiology in healthcare in the Australian setting for inclusion in the College Practice Accreditation Standards.
- A set of recommendations on policy and funding arrangement changes that may be needed to implement these standards in clinical practice.
- Definition of the use of teleradiology by all service providers including how and when it should be used.
This project aimed to provide recommendations to guide technical and practice standards for accreditation requirements for teleradiology.
Literature review; stakeholder consultation; draft reporting and feedback; final report
Radiology Accreditation Services
There was universal agreement on the importance of medical imaging specialist supervision of examinations performed using teleradiology. This included the full scope of the examination from ensuring appropriateness of requests, through to monitoring image quality on the monitors. Of note was the need for the medical imaging specialist to have good lines of communication with referrers and staff.
The project team provided RANZCR’s Standards of Practice and Accreditation Committee (SPAC) with recommendations for technical and practice standards as they were developed. These recommendations were considered and used to inform the RANZCR’s standards development process. The resulting RANZCR Standards therefore reflect the project findings but are not identical to the findings in the final report.
Final report
College response
Literature review
Industry snapshot
Recommendations
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The project reviewed current credentialing requirements and applications for diagnostic imaging and interventional procedures. It identified the relevance, benefits and limitations of credentialing with respect to QUDI.
The project aimed to develop credentialing requirements and applications consistent with QUDI Program objectives and in accordance with the National Health Performance Framework.
Review of credentialing and related systems in Australia and inernationally; literature review for empirical evidence.
Sydney Health Projects Group
The development of an Australian system for the credentialing of radiologists is widely supported and could help to enhance and ensure the safety and quality of Australian radiology services. However, credentialing is a complex process that demands substantial resources if it is to be effective, and there is little empirical evidence of its effectiveness in improving radiology practice. Given the arguments for credentialing and the impetus to establish clinical credentialing systems, the consultancy recommended that the RANZCR consider taking a leadership role in establishing a pilot program of credentialing for both diagnostic and interventional radiology. The consultancy also recommended that the RANZCR should undertake a careful evaluation of the pilot program and make the results widely available, preferably via a peer-reviewed publication. The pilot program and its evaluation would put the RANZCR at the forefront of credentialing internationally, not only for radiology but for credentialing in all clinical fields.
Final report (PDF)
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The Radiology Events Register expects to:
1.Collect data on systematic errors that occur in diagnostic radiology
2.Classify and analyse the data to gain a better understanding of the types of incidents that occur, their contributing factors and outcomes
3.Publish information collected in peer review journals
The aim of RAER is to develop a means of systematic data collection and analysis of near misses, adverse incidents, sentinel events and discrepancies in radiology to inform quality improvement and patient safety.
Initially a comprehensive literature review was performed as a discrete QUDI project. This literature review assessed the current state of the knowledge regarding adverse incidents and errors in radiology. In addition it reviewed the classification systems and methodologies for collection of data both in radiology and in other fields. This literature review provided an evidence base for the design of subsequent stages of the project and may inform the development of other projects around the theme.
Following the literature review a trial of data collection involving several sites both in the public and private sectors was performed. An online form to facilitate anonymous data collection was developed for the trial. The data was analysed by the APSF using the methodology previously validated. This stage of the project was designed to assess the feasibility of data collection using this method and to provide a preliminary idea of the number and types of incidents. It was initially proposed that this trial run for 6 months, however due to a lower than expected response rate, this period of time has been extended, with error data being sourced from a variety of other sources.
Once the feasibility of the data collection and analysis is established then the project should be expanded to recruit further sites. Data on the frequency and types of incidents will then start to become available in meaningful quantities and this data can be put to immediate application in a number of areas.
Australian Patient Safety Foundation
The information contributed will be analysed and is expected to have immediate application in the following areas:
1. The data will provide a picture of the current situation of radiology practice. This will allow a realistic evidence based approach the setting of performance standards and inform discussions and negotiations with regulatory bodies.
2. Identification of the most frequent types of incidents will allow strategies to be put in place to alert Radiologists to the source of errors and to trial specific strategies designed to reduce these errors.
3. The successful collection of data will hopefully start to encourage a culture of open disclosure within the profession, as has been the case in anaesthesia.
4. As more specific data becomes available about errors and interpretation this can be used to inform the development of competencies, training, educational activities and decision support in Radiology
This project represents a world first initiative in radiology and would place radiology at the forefront of systematic attempts to improve the quality of care and patient safety. The initiative has obtained broad support both nationally and internationally and is aligned with RANZCR's strategic directions and the Australian Government Department of Health & Ageing’s stated desire to encourage the quality use of diagnostic imaging.
RaER reference list
Final report
College response
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The project proposed to:
- Construct a paediatric CT survey document for acquisition of scanning protocol data from paediatric diagnostic imaging departments in Australia;
- Collect that data for 7-10 of the most commonly performed CT procedures in babies and children; and
- Use that survey data to allow effective dose to be calculated for those procedures
To ultimately change practice by increasing the awareness and use of appropriate radiation doses when imaging children.
This project had three phases:
1. An initial survey to establish the range of doses per procedure using the dose metrics of effective dose (mSv) and dose length product (mGy.cm) for common paediatric MDCT investigations,
2. Following initial dose analysis, a one day workshop where radiologist and radiographer representatives from each surveyed practice would attend a MDCT dose and image quality optimisation seminar, and
3. A re-survey of the practices to assess whether the optimization theory had been put into practice and had resulted in measurable dose reductions.
Austin Health, Monash University and RANZCR
Initial survey data indicated a significant variation in acquisition protocols for various MDCT investigations across various system platforms and paediatric specialist practice sites. Consequent dose efficiencies and inefficiencies were apparent. The 2nd survey, post-workshop, indicated that in the majority of investigations there were significant dose reductions, in some cases up to 50% across most sites.
This initial survey of Australian MDCT paediatric practice indicates that:
- Optimisation training can positively influence paediatric CT patient dosimetry;
- There are no universal ‘right’ or ‘target’ dose answers;
- Appropriate optimisation application depends upon the technical expertise of users and scientific support staff;
- Practices should work towards development of local DRL values and optimized dose-image quality relationships, and
- This survey technique could be expanded into a National survey to establish baseline comparative DRL values for many common CT acquisition protocols.
It is envisaged that ultimately a national service may be made available to all Australian CT facilities that provide services to children and would like to audit the radiation doses they deliver. As part of this audit / feedback process, information regarding dose reduction strategies (based on the “expert group” consensus) will be provided to sites which provide their scanning parameters for dose calculation. However, this latter stage is well beyond the scope of the current project.
Information sheet
Presentation
CT dosimetry overview
CT dose optimisation
Final report
College response
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