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IAC Newsletter

Delayed ICACTL Accreditation
WHAT IT MEANS AND HOW TO AVOID IT [continued]


ICACTL DIVISION NEWS \| Spring 2009	<<BACK \| 1 \| 2 \| 3

CASE STUDY DELAYS

50% of the applications received in 2008 were delayed for issues related to case studies.

Components of the ICACTL Case Study Evaluation

Appropriate clinical indication
Protocol selection
Extent of coverage for the indication
The use of dose reduction techniques*
Patient motion
Bolus timing/tracking
Reconstructions/reformats

*Dose reduction techniques may include, but are not limited to, reduction of tube current(mAs); field size(extent of coverage); auto dose reduction techniques available on the CT system; lower dose protocols for pediatric and small patients; limiting the number of sequences performed; and only acquiring anatomical data for the given clinical indication unless pathology is seen.

A primary factor resulting in the delay of ICACTL accreditation is incomplete documentation and overall poor quality of submitted case studies. As a random selection is not required, it is crucial that the submitted cases represent the laboratories “best work”. The cases must include all of the hardcopy documentation required by The ICACTL Standards, while demonstrating good testing techniques. The technical expertise of the operator becomes evident to the application reviewers when they are evaluating the submitted case studies. The manipulation of the scan parameter factors to balance the resolution, contrast and patient exposure is crucial to producing quality diagnostic images. CT relevant CME are required every three years by the medical and technical staff to further their education in CT imaging, as related to current safety practices and protocol selection. Applicant laboratories that have been delayed for not adhering to the As Low As Reasonably Achievable (ALARA) principle in their protocol selection and for various image quality issues are encouraged to engage the manufacturer’s applications specialist to get specific guidance on their particular CT scanner. A thorough and regular review of The ICACTL Standards, including Section 4, Elements and Components of CT Examination Performance, will assist in assuring that testing procedures are being performed in a standardized method, in compliance with the requirements of the ICACTL process.

FINAL REPORT COMPLETION TIME DELAYS

18% of the applications received in 2008 were delayed for issues related to timeliness of final reports.

The ICACTL Standards require that the physician’s final interpretation be available within two working days of the examination date and the final, verified, signed report sent to the referring physician within four working days, unless awaiting additional clinical information. The laboratory must have a policy that outlines the process for generating reports inclusive of signing, dating, proofreading for accuracy and verification by the interpreting physician. In addition, details on the timeframe in which final reports are sent to the referring physician must be documented within the report policy. An interpretation can be in the form of paper, digital storage or an accessible voice system.

STEPS TO AVOID DELAY

There are several steps that laboratories can take to increase the likelihood that accreditation is granted outright, without any delay.

Laboratory staff should verify that they are adhering to the current version of The ICACTL Standards. The website [www.icactl.org] contains the current version, and the links within the Online Accreditation application interact with this version.
The article, “Working Through The Application: Steps, Questions & Answers for a Successful Submission”, as published in the Autumn 2008 issue of the IAC Newsletter, can be found on the website.
Contact the ICACTL staff with any questions about the process.
Allow adequate time to prepare the application materials for submission.
Carefully review all the material, prior to submission, for accuracy and completeness.
Submit all documentation that is required in the application.
The policies and procedures must be laboratory specific and reflect current practices.
Each of the case studies submitted must include all of the images, including reformats used in the interpretation, and the applicable final report.
The case studies should be representative of “best work” and submitted on CDs with the DICOM viewer installed.

IN CONCLUSION

In summary, laboratories that receive notification that their accreditation application has been delayed are often surprised and frustrated with the results of the application review. As the first group of laboratories accredited by the ICACTL will be due for reaccreditation in 2010, it is worth noting that previous granting of accreditation does not ensure that the laboratory will automatically be granted accreditation at the time of reaccreditation. It is the philosophy of the ICACTL that with each reaccreditation cycle, the applicant laboratory should be coming ever closer to being in compliance with every one of The ICACTL Standards, thus offering the best possible quality of computed tomography testing available to its patients. While laboratories seeking ICACTL accreditation and reaccreditation are held to extremely high standards, these expectations have enabled the ICACTL process to gain recognition and be highly regarded amongst referring physicians, payers and patients.