Abstract
BackgroundRegular and precise inspection of the realization of the local nuclear medicine standard operation procedures (SOPs) is very complex and time-consuming, especially when large amount of patient data is obtained from a wide scale of different scan procedures on a daily basis. DICOM metadata comprise a complete set of data related to the patient and the imaging procedure, and consequently all information necessary to evaluate the compliance with the actual SOP.MethodsQ-Bot, an automatic DICOM metadata monitoring tool which is capable to verify SOP conformities, was tested for 11 months at two nuclear medicine departments. Relevant parameters, such as patient ID, patient mass and height, injected activity, and uptake time, were investigated in the case of adult 18F-FDG whole-body PET/CT and 99mTc-MDP gamma camera bone scans on a daily basis. Q-Bot automatically inspected the actual SOP compliance of these relevant DICOM parameters. Q-Bot graphical user interface (GUI) provided a summary of the outliers in a table format to be investigated by a dedicated technologist. In addition, information related to the error handling was also collected for retrospective analysis of long-term tendencies.ResultsIn total, 6702 PET/CT and 2502 gamma camera scans were inspected, from which 8581 were confirmed as valid patient study without errors. Discrepancies related to the lack of a parameter, not appropriate format, or improper scan procedures were found in 623 cases, and 156 out of these were corrected before the medical reading and reporting. SOP non-conformities explored with Q-Bot were found to be non-correctable in 467 cases. Systematic errors to our practice turned out to be the manual radiopharmaceutical injection, the allowance to use both SI and non-SI units, and the clear definition of decimal point symbol to use.ConclusionThe daily evaluation of Q-Bot results provided early detection of errors and consequently ensured the minimization of error propagation. Integration of a QM software that inspects protocol compliance at a nuclear medicine department provides significant support to detect non-conformities for technologists, and much higher confidence in image quality for physicians.
Highlights
Quality management (QM) plays an essential role in the nuclear medicine clinical workflow, driven by the desire for high diagnostic accuracy standards
We present a software tool named the Quality Management Bot (Q-Bot), which is capable to automatically monitor Digital Imaging and Communications in Medicine (DICOM) metadata and perform evaluations in the aspect of QM focusing on nuclear medicine studies
Errors and discrepancies due to the lack of a parameter or not appropriate format or improper scan procedures were found in 623 cases (233 for Positron emission tomography (PET)/Computed tomography (CT) and 390 for gamma camera)
Summary
Quality management (QM) plays an essential role in the nuclear medicine clinical workflow, driven by the desire for high diagnostic accuracy standards. International standards for medical equipment were introduced for QM purposes [1], as well as recommendations and guidelines became available for the standardization of patient examination protocols for both PET/ CT [2, 3] and conventional nuclear medicine techniques [4] The scope of these guidelines is to comprehensively describe the optimal workflow from the patient registration to the medical report. Longitudinal studies aiming to explore temporal consistency highlighted variations in SPECT system stability [13], as well as standardized uptake value (SUV) of 18F-FDG PET/CT [14,15,16,17], showing fluctuations related to several sources including dose calibrator accuracy [18] These investigations, deal only with instrumentation and are not considering errors related to human sources, inappropriate patient logistics, or instable instrumentation
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