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    Radiology Radiology Document Transcript

    • Initial Assessment - Radiology Legal Operating Name      AddressStreet City, Province Postal                  Medical Director     Telephone: (     )     -      Email:       Fax: (     )     -      Facility Manager     Telephone: (     )     -      Email:       Fax: (     )     -      Chief TechnologistTelephone: (     )     -      Email:       Fax: (     )     -     Scope of Service: Radiography Fluoroscopy Angiography Interventional Radiology Other:      Number of Radiology Rooms:      PersonnelDays and Hours of Number of Technologists:       List of radiologists interpreting examinations:     Operation:      Are all examinations interpreted on-site? Yes NoIf no, provide the following information:Reporting facility name:      Name of qualified interpreting physician at reporting facility:      How are images delivered to other facilities for reporting? Digital Delivery (Also, complete and return the PACS Initial Assessment) Other, explain:      Indicate when a radiologist is present at the radiology facility.      Are examinations received from other facilities for interpretation? Yes No(If yes, and images are digitally transmitted, also complete and return the PACS Initial Assessment.)Comment       Page 1 of 9July 2007
    • For all questions below, Electronically check or manually indicate the appropriate responses. Please provide narrative response, where appropriate. Human Resources DAP Use Only1.1 Is orientation provided to all new staff that includes initial Yes No training and information about the organization, facility and Comment:       their position? Yes No, explain:      1.2 Are all technologists currently registered with their Yes No professional association? (Please provide C.V.’s) Comment:       Yes No, explain:      1.3 Are all physicians who interpret examinations licensed as Yes No recognized by the College of Physicians and Surgeons of Comment:       BC? (Please provide C.V.’s) Yes No, explain:      1.4 Are any examinations performed by staff members who are Yes No not registered? Comment:       Yes No, explain:      1.5 Diagnostic Image quality is verified by the Medical Director or Comment:       designated physician at the facility. Please include the name of the physician who reviews images to confirm diagnostic quality. Name:       Page 2 of 9July 2007
    • Quality Assurance DAP Use Only2.1 Are there staff member(s) in the radiology facility who are Yes No responsible for monitoring quality control and assessing Comment:       relative changes in system performance? Yes No, explain:      2.2 Is there a policy for regular quality control program tests? Yes No Yes No, explain:       Comment:      2.3 Is there a policy for retention of QC test results? Yes No Yes No, explain:       Comment:      2.4 Technical staff members are familiar with the BCCDC (British Yes No Columbia Centre for Disease Control) standards for Comment:       Diagnostic X-ray equipment? See associated link: Quality Control standards of x-ary equipment in BC Yes No, explain:       Page 3 of 9July 2007
    • Equipment DAP Use Only3.1 List all x-ray units: (Manufacturer, Model, and Year) Yes No 1.       Comment:       2.       3.       4.      3.2 Is ancillary equipment adequate to meet the needs of Yes No examinations performed? Comment:       Yes No, explain:      3.3 Did x-ray units undergo comprehensive acceptance testing Yes No on installation? Comment:       Yes No, explain:      3.4 Is there a policy to perform routine preventative maintenance Yes No on the equipment? Comment:       Yes No, explain:      3.5 Is there a policy to retain routine maintenance checks and Yes No repair records? Comment:       Yes No, explain:       Page 4 of 9July 2007
    • Safety DAP Use Only4.1 Is there signage in all patient areas that is clearly visible, Yes No alerting women who may be pregnant to notify the Comment:       technologist? Yes No, explain:      4.2 Are there procedures for post-sedation patient recovery? Yes No Yes No, explain:       Comment:      4.3 Is an emergency drug tray, suction, and oxygen readily Yes No available? For IV contrast administration, is there an Comment:       emergency crash cart readily available? Yes No, explain:      4.4 Does the radiology facility have a radiation safety officer or Yes No designated individual responsible for overseeing radiation Comment:       protection? Yes No, explain:       Page 5 of 9July 2007
    • Image Recording DAP Use Only5.1 Are images recorded on film? Yes No Yes No, explain:       Comment:      5.2 What media device is used for long-term storage? Yes No       Comment:       Page 6 of 9July 2007
    • Electronic Storage of Images DAP Use Only6.1 Can all electronically stored images be sent to film//CD-ROM Yes No or other devices in a timely fashion for off-site review? Comment:       Yes No, explain:      6.2 Do you have a protocol to manage and report data integrity Yes No errors? For example, is there a protocol to address when the Comment:       incorrect name is displayed on the image? Yes No, explain:      6.3 Do you have Picture Archive and Communication Systems Yes No (PACS) at your facility? Comment:       Yes No, explain:      If yes:6.3.1Do you have a designated individual responsible for Yes No quality control and data integrity? Comment:       Yes No, explain:      6.3.2Do you backup image and database data? Yes No Yes No, explain:       Comment:      6.3.3If images are sent to PACS, do you have a downtime Yes No protocol? Comment:       Yes No, explain:       Page 7 of 9July 2007
    • Safety-Appropriate Physical Environment DAP Use Only7.1 Does the design and layout of the facility space meet laws, Yes No regulations and codes? (e.g. building codes, fire codes etc.) Comment:       Yes No, explain:      7.2 Is the location of the facility accessible and appropriate for the Yes No patient population it serves? Comment:       Yes No, explain:      7.3 Does the physical environment of the facility meet patient Yes No needs? Comment:       Yes No, explain:      7.4 Does the design and layout of the space allow for the patient Yes No privacy and confidentiality? Comment:       Yes No, explain:      7.5 Does the physical environment of the facility meet the needs Yes No of staff and support efficient workflow? Comment:       Yes No, explain:       Page 8 of 9July 2007
    • Name of the person completing this form:      Medical Director SignatureThis Initial Assessment must be signed-off by the Senior Medical Leader/Director. Please complete, print, sign and faxthis page to the Diagnostic Accreditation Program. 604-739-6659. All previous sections of the document may beelectronically returned.Facility Name:      Imaging Service Name:      I have reviewed the information in this document and acknowledge that it is accurate and correct.______________________________________________Senior Medical Leader/Director (printed name)______________________________________________Signature of Senior Medical Leader/Director___________________________DateComments:       Page 9 of 9July 2007