How does this work? A radiographer takes a thorax image of each participant: an X-ray picture of the lungs. This is done in a radiographic unit. A radiographic unit only uses equipment with an LRCB type approval. After an acceptance test, LRCB’s physics group periodically checks all equipment. Next, a physician (pneumonologist or tuberculosis physician) assesses each thorax image on the computer. Around 30 physicians in the Netherlands work in tuberculosis screening.
The GGD organization (Community Health Service) is distributed across four regions. The LRCB audits each region once in every two years. The LRCB audit team looks back, to evaluate the screening performance of the region. The learning effect of the audit is paramount in this respect. The region fills out a questionnaire, which provides the audit team, among other things, with information on quality indicators, such as the detection rate and the additional examination that has been carried out. In addition, the radiological reviews are important. The audit team reassesses the thorax images of hundred clients which were subjected to additional examination, based on the screening. Finally, the team reassesses the images of the found tuberculosis cases. The audit protocol describes the entire process, the parties involved, the scope of the audit, and how it should be established that an item is OK or not.
Prior to the audit day, the positioning technique of the radiographers of the region is assessed. For each radiographer, 25 anonymous thorax images are submitted in advance. The LRCB expert radiographer assesses the positioning technique of them, according to the LRCB quality criteria. During the audit day the expert radiographer discusses the results of this reassessment. The equipment audit looks back upon the yearly quality tests of the past two years. This results in an overview of the most important findings: a summary of the test results. In addition, each physician (pneumonologist or tuberculosis physician) and each screening radiographer must be listed in the WBO Register. Finally, the audit assesses how the GGD’s have handled recommendations. Have they been implemented or not? The equipment audit also assesses the thorax image quality.
Every audit day ends with a discussion and the audit report to the Public Health directors of the GGD’s involved in the region, the region managers, and to GGD GHOR Nederland.
The teams of the tuberculosis screening programme are only allowed to purchase thorax equipment and workstations with an LRCB type approval. The physics group of the LRCB performs an acceptance test prior to first use. The acceptance test examines if the system meets the specifications established during the type test. This is done according to a measurement protocol, describing all quality measurements. The LRCB has based this protocol on various other protocols. After that, a constancy test is performed every year, based on the same measurement protocol, to check if the equipment still delivers sufficient quality. In addition, the LRCB has developed tests focusing on image quality. The LRCB describes the results of these tests in a report. If there are problems or abnormalities, the LRCB recommends possible improvements to the GGD. Furthermore, at any time radiographers and physicians can ask questions on equipment, for example for advice on malfunctions or visual artefacts.
Audits on request
The audit team of the LRCB can also perform a medical audit on request, for screening programmes abroad. You can also call in the physics group for equipment check support at your screening units or hospital. The LRCB can also provide support on consultancy questions regarding radiation hygienics. For example, to perform a risc analysis for a new system or for building a new room. For there an other questions we are happy to help.