It’s amazing to me how often I see or hear Imaging Professionals blow by the simple, everyday, and mundane exam QA.  I’m not talking about whether your monitor is up to specs, or your keyboard is clean but the serious bread and butter QA.

The first thing I tell my staff to do daily is, make sure that everything that’s marked as Dictated, is Dictated.  There’s no one magical bullet to doing this and one person’s method may be easier than another’s but the end result is what matters, did we truly leave something unread?

Let’s first understand that although reading images on PACS is much easier than a roto-viewer, fat fingers cause massive waves.  There never seems to be a week that goes by, that someone reading doesn’t close an exam the exact same way they always do.  Whether it’s an interruption by a clinician or technologist, a phone call, or just getting up for a stretch, workflow has been changed.  Some of these interruptions cause exams to have their status changed to Dictated or even Finalized, depending on the system, just by a simple press of button.

Our method is quite simple.  We check anything marked Dictated in our PACS and compare this to our dictation system.  Dictated in PACS and report in VR means read but not signed off.  That’s cool, we’ll give the Rad a nudge and all’s good with the world.  BUT, what if we show an exam marked Dictated and no report shows in our VR?  What happened here?  First things first, get it back out to be read and follow it through.  After completion or during the process, if your radiologist is on top of it, check you logs to see where this mishap occurred.  Most of the time it was changed by a radiologist that was interrupted or got out of their workflow. Hopefully this is a one time occurrence and you’ll never see it again 😉 but not likely.  If it seems to happen often to the same MD, it time to sit with them and watch.  Give an example of what you found in your logs and assist by coming up with a plan to reengage after an interruption.

There are plenty more reasons why a final report may not be your PACS but it won’t be because it wasn’t read and signed off.  Do yourself a favor and make this your first and last functions of the day.  Your radiologists, directors, and more importantly, your patients will appreciate it.