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with the optimization team, following the establishment of a quality assurance program and the delineation of tasks for each team member, as well as the definition of a baseline for reference. While contemporary medical technology offers various tools for this purpose, engaging in dose optimization necessitates an indepth understanding of machine performance and the impact of technical parameters, post-processing algorithms, and other features on image quality and radiation dose. Therefore, the medical physicist must thoroughly study technical documentation to comprehend the unique features and optimization tools of each machine. Manufacturer-provided application specialists play a fundamental role in offering advanced knowledge, best practices, and valuable insights specific to the model under consideration( Gingold, 2017; Sensakovic et al., 2017).
3.4 Quality: an essential component of optimization in radiology
3.4.1 Definitions for quality
To comprehensively establish criteria for quality services in diagnostic radiology, a clear definition of quality is imperative at the first level. Consequently, and according to the International Organization for Standardization( ISO), quality is defined as the " degree to which a set of inherent characteristics of an object( product, service, process, system) fulfills requirements( need or expectation that is stated, generally implied or obligatory)"( ISO, 2015).
At the second level, quality definition should be escalated to the healthcare context. In that regard, WHO delineates six essential dimensions of quality that a healthcare system must encompass( WHO, 2006): Effectiveness, Efficiency, Accessibility, Patient-Centeredness, Equity and Safety.
These six dimensions require different levels containing various objectives and procedures, this is why a quality management system must be clearly defined and include three fundamental components: – Quality Control. – Quality Assurance. – Quality Management.
The International Basic Safety Standards( BSS) requires the existence of a solid system of management and also presents a definition of each of the three mentioned components( IAEA, 2014): – Quality Control( QC) as a reactive process to control the products quality. Its evolution should be followed through a QA program.
– Quality Assurance( QA) as a program that ensures the products quality.
– Quality Management as the complete activities for managing the products quality and it encompasses both QA and QC.
3.4.1.1 Quality control
QC is a foundational element of quality management and defined as the most basic form of quality-related activities, ensuring that systems meet established standards. It offers a snapshot of performance, comparing it to benchmarks
( ISO, 2015). Despite its importance, QC is sometimes limited to equipment measurements, which can lead to a misconception of quality control at this basic scale. Consequently, in that regard the AAPM through the Task 151 has noted that“ Quality control in medical imaging is an ongoing process and not just a series of infrequent evaluations of medical imaging equipment”( Jones et al., 2015).
Performance testing verifies medical radiological equipment reliability and safety, guided by various recommendations. Medical physicists play a central role in performing or supervising these measurements, occasionally delegating responsibilities to radiation technologists. In this context, it is noteworthy to precise that QC is not the only role of medical physicists in diagnostic radiology as noted by the AAPM( Moores et al., 1991).
Carefully reviewing literature in both IAEA and AAPM reports has led us to propose the next table which presents the distribution of responsibilities among radiological professionals in the context of a comprehensive QC program in diagnostic radiology( Appendix 2)( AAPM, 2002; IAEA, 2013).
3.4.1.2 Quality assurance
A reactive process is needed to follow the evolution of QC. For this, QA is defined to be the process which ensures and provide confidence that the concerned system performance will keep matching to the established benchmarks( ISO, 2015).
In accordance with international BSS guidelines, radiological facilities must establish QA systems overseen by medical physicists to meet specific requirements. In diagnostic radiology, this QA program covers QC and spans the entire imaging process, starting with a needs analysis and system evaluation before installation( Part, 2011; IAEA, 2015). QA includes aspects such as room design, equipment selection, installation oversight, acceptance testing, ongoing maintenance, and equipment disposal.
3.4.1.3 Quality management
Quality management, as defined by ISO 9000, is the comprehensive framework governing all aspects of quality within organizations. It involves setting quality policies, defining objectives, and implementing processes like planning, assurance, control, and improvement( ISO, 2015). ISO identifies seven key quality management principles( West, 2000): prioritizing customer satisfaction, effective leadership, engaging and empowering employees, adopting a processoriented approach, continuous improvement, making decisions based on evidence, nurturing positive relationships.
Effectively applying these principles in radiology can lead to substantial advantages for the department. It is advisable for the department to designate a quality manager or team responsible for establishing and sustaining the quality management system. To ensure the smooth operation of this system, it is beneficial to establish a quality committee. This committee’ s role is to periodically assess and evaluate the facility’ s QA program. The committee should comprise individuals such as physicians, radiographers, medical physicists, nurses, administrative staff, and others as relevant to the department’ s operations.