A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

Assessing Mean Glandular Dose in Mammography in Jordan According to American College of Radiology (ACR) Standards

Introduction

Breast cancer is a significant worldwide health issue, particularly in Jordan, where early detection via mammography is essential for effective disease management. Despite the little radiation risk associated with mammography, it is crucial to monitor radiation exposure to guarantee patient safety. This study intends to assess skin entrance exposure and compute the Mean Glandular Dose (MGD) in mammography units to determine adherence to established criteria and pinpoint areas for enhancement.

Methods

To assess MGD, the study utilized the American College of Radiologists (ACR) phantom alongside a RaySafe X2 MAM dosimeter. Measurements of entrance kerma and half-value layer (HVL) were taken across 25 mammography units in Jordan. The MGD was calculated according to the ACR's 2018 protocol, which provides a standardized approach to ensure accurate and comparable dose estimations. These measurements were then analyzed against the ACR's threshold of 3 mGy to assess compliance.

Results

The study found that the average MGD across all units was 2.3 mGy, with individual values ranging from 0.95 to 4.10 mGy. Although 67% of the units maintained MGD values within the ACR threshold, 33% exceeded the recommended limit of 3 mGy. Higher MGD values were particularly common in non-accredited facilities, where the average MGD reached 2.7 mGy, compared to 1.6 mGy in accredited units, suggesting gaps in quality control and adherence to best practices in non-accredited centers.

Conclusion

This study emphasizes the critical role of accreditation and adherence to quality standards in maintaining safe and effective mammography practices. While most mammography units in Jordan meet the ACR's recommended MGD limits, the elevated dose levels in some non-accredited facilities highlight the need for more rigorous implementation of accreditation standards. Improving compliance with established guidelines will enhance breast cancer screening effectiveness, ultimately supporting better early detection and outcomes for breast cancer in Jordan.

An introduction to key performance indicators for medical physicists

Qualified medical physicists (QMPs) are in a unique position to influence the creation and application of key performance indicators (KPIs) across diverse practices in health care. Developing KPIs requires the involvement of stakeholders in the area of interest. Fundamentally, KPIs should provide actionable information for the stakeholders using or viewing them. During development, it is important to strongly consider the underlying data collection for the KPI, making it automatic whenever possible. Once the KPI has been validated, it is important to setup a review cycle and be prepared to adjust the underlying data or action levels if the KPI is not performing as intended. Examples of specific KPIs for QMPs of common scopes of practice are provided to act as models to aid in implementation. KPIs are a useful tool for QMPs, regardless of the scope of practice or practice environment, to enhance the safety and quality of care being delivered.

Optimizing integrated imaging service delivery by tier in low-resource health systems

Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.