SErIES IAEA HumAn HEAltH SErIES IAEA Hum

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Annex IV WORKSHEET FORMS FOR PHYSICS PROCEDURES The audit team members should use the following worksheet forms for physics procedures as internal tools to assist them in conducting the audit review. 176
TECHNIQUE OBSERVATION SHEET Radiographer/physicist _______________________ Technique demonstrated ____________________________________ Step 1: What guidelines were used Were they clear Were they documented Were they appropriate Step 2: Technique demonstration. Radiographer: Was the task accurately performed Physicist: Was the rationale for the task understood and were the results interpreted Step 3: Monitoring the record process. Were the results documented adequately Step 4: Follow-up response. Was the suggested follow-up action appropriate Did it suggest an understanding of the reason for the procedure 177
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IAEA HumAn HEAltH SErIES no. 4 Comp
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COMPREHENSIVE CLINICAL AUDITS OF DI
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IAEA HUMAN HEALTH SERIES No. 4 COMP
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FOREWORD The application of radiati
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CONTENTS 1. INTRODUCTION . . . . .
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5.1.3. Quality assurance processes
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1. INTRODUCTION 1.1. CLINICAL AUDIT
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1.1.3. Confidentiality of audits Co
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evidence based medical research is
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As a result of the comprehensive cl
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The facility/institution is respons
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2.4.2. Review The review process wi
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2.5.1. Title page and contents page
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2.6. DISSEMINATION OF THE REPORT Th
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A QA committee should be establishe
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Lines of authority should be reflec
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—Medical support equipment such a
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(g) (h) (i) Make an assessment of t
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(c) (d) (e) (f) Examine the facilit
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(c) (d) Consider policy in regard t
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equire a written policy and procedu
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Once examination scheduling has bee
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Documentation of the details of the
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There should be a radiographer resp
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—Recorded; —Systematically eval
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4.2.1.5. Pre-procedure screening an
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(f) (g) (h) (i) (j) (k) (l) (m) (n)
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4.2.5. Report communication The aud
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—Digital image receptors (compute
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(b) (c) (d) Ensuring that appropria
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5.1.2.2. Occupational and public ex
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(f) (g) Performance criteria for al
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Dosimetry for those subjected to ra
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5.2.1.3. Management support The aud
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(b) (c) Discuss the facility’s po
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(g) (h) (i) Discuss with the medica
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Professionals engaging in such prog
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6.2. THE AUDIT PROGRAMME 6.2.1. Edu
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(d) (v) Regularity of research meet
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Six months before audit Audited ins
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Day 1: Morning: All audit team memb
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Appendix III AUDIT REPORT FORMAT: S
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Appendix IV AUDIT REPORT FORMS The
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Audit criteria Adequacy Comments Su
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5.3. AUDIT REPORT FORMS FOR TECHNIC
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6.3. AUDIT REPORT FORMS FOR EDUCATI
Page 138 and 139: Audit criteria Adequacy Comments Su
Page 144 and 145: Appendix V NOTES ON PHYSICIST MEASU
Page 146 and 147: V.2.3. Other measurements The other
Page 148 and 149: [16] COMMISSION OF THE EUROPEAN COM
Page 151 and 152: Annex I APPLICATION FORM IAEA Clini
Page 153 and 154: Department Vision Statement and imm
Page 155 and 156: List of equipment Equipment type Id
Page 157 and 158: Annex II LIST OF ITEMS REQUESTED TO
Page 159 and 160: Annex III EQUIPMENT-SPECIFIC CHECKL
Page 161 and 162: Form RXR — Items to be reviewed b
Page 163 and 164: Form RXR — Items to be reviewed b
Page 165 and 166: Form FIF — Items to be reviewed b
Page 167 and 168: FORM FOR A MAMMOGRAPHY QA PROGRAMME
Page 169 and 170: Form MAM — Items to be reviewed b
Page 171 and 172: Form CTQ — Items to be reviewed b
Page 173 and 174: FORM FOR A SCREEN-FILM AND PROCESSO
Page 175 and 176: FORM FOR A COMPUTED OR DIGITAL RADI
Page 177 and 178: FORM FOR A VIEWING CONDITIONS (ANAL
Page 179 and 180: FORM FOR A QA PROGRAMME FOR HARD CO
Page 181 and 182: Form DPQ — Items to be reviewed b
Page 183 and 184: FORM FOR A QA PROGRAMME FOR ULTRASO
Page 185 and 186: FORM FOR A QA PROGRAMME FOR MRI For
Page 187: Form MRI — Items to be reviewed b
Page 191 and 192: Tube focus to tabletop distance d F
Page 193 and 194: K i Patient: Radiographic Calculati
Page 195 and 196: Manufacturer of phantom: __________
Page 197 and 198: P KA Patient: Fluoro 1 DETERMINATIO
Page 199 and 200: Phantom: MGD 1 CALCULATION OF INCID
Page 201 and 202: Phantom: CT1 MEASUREMENT OF C a,100
Page 203 and 204: REFERENCE TO ANNEX IV [IV-1] INTERN
Page 205: CONTRIBUTORS TO DRAFTING AND REVIEW
Page 208 and 209: Korea, Republic of KINS Inc., Infor
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SErIES IAEA HumAn HEAltH SErIES IAEA Hum

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