2017-09-15 17:28:11 - 8

The importance of CBR Quality Seals

The Brazilian College of Radiology and Image Diagnosis (CBR) started quality assurance programs in 1992, with the Quality Certification Program in Mammography. “Since its creation, the main objective has been to improve the quality of the exams, to bring to our country the benefits of screening, such as the reduction of mortality and the early detection of tumors”, says Dr. Linei Urban, current coordinator of the National Commission on Mammography, formed by CBR, the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and the Brazilian Society of Mastology (SBM). Through the accumulated experience, the results achieved and the recognition received over the years, the program was expanded to the areas of Ultrasound, Computed Tomography and Magnetic Resonance, and is currently known as CBR Quality Seal. Today, having certification gives requesting physicians, the population and healthcare providers greater confidence in the results of the tests performed, in addition to being a differential for the services. In view of this, it is worth mentioning that the stamp program evaluates the quality of the method, through information about the equipment, clinical staff, images and reports. Therefore, the certification is exclusive to that evaluated modality. “The Seal of Quality represents, for patients who see it on their exam report, the guarantee that the clinic, laboratory or service has been submitted to the evaluation of the CBR, which judged that the quality of the images, technique and reports of the exams were adequate. up to its rigorous standards”, explains the coordinator of the Ultrasound Commission, Dr. Wagner Yared. “Another point that deserves attention is the qualification of the clinical staff of radiologists and operators of the equipment that perform the exams”, emphasizes Dr. Marco Antônio Rocha Mello, coordinator of the Magnetic Resonance Commission. Meeting several times a year, the CBR Committees in each area have contributed decisively to the evolution of the specialty. They have autonomy and inclusive character, without punitive characteristics, and are composed of renowned members with extensive experience in the respective method. “Adequate documentation of the images is the way for the doctor who performs the exam to demonstrate that he used all the resources of the method to arrive at his diagnosis”, comments Dr. Wagner. He explains that the committee defines and evaluates whether the clinic adequately follows several criteria, such as: the number of images acquired, the organs and structures evaluated, the planes in which the images must be obtained, the adjustment of technical parameters, such as focus and gain , in addition to checking the adequacy of measurements, when relevant, and consistency with the report, for different types of examination. According to the coordinator of the Computed Tomography Committee, Dr. Hilton Muniz Leão Filho, one of the main tasks is to validate the equipment of the clinics. “For example, if a clinic has five devices, each device will have its own badge. This evaluation takes into account the most common tomography exams: skull, lung, ear and abdomen”, he clarifies. When evaluating equipment, quality and time of use are taken into account. The clinic cannot be approved if it uses devices that do not have the appropriate technology or that are close to obsolescence. “Qualification of the clinic’s physical facilities and equipment is also required in relation to compliance with mandatory public licenses,” says Dr. Marco Antônio Rocha Mello, coordinator of the Magnetic Resonance Commission. “In addition, it is necessary to ensure that the applicant clinics and hospitals keep up with technological development through the incorporation of new exams and techniques”, he adds. The inspection of the services is carried out by a member of the Committee, who, in addition to analyzing whether the structure is adequate, verifies that the routine images and reports are at the same level as those sent for submission. It is worth remembering that the service must undergo a new assessment every three years in order to remain certified by the program. main difficulties “In these 25 years, we have experienced some problems within the Mammography program. First, the inadequate positioning of the breasts was detected in the mammography exam. After an exhaustive discussion and approach to the subject in most courses and congresses, the exams started to present an adequate positioning pattern, fulfilling the required quality parameters”, recalls Dr. Linei. “Next came the higher-than-expected radiation dose phase, especially at the time of the introduction of CR digital mammography devices. This is because several places only introduced the scanning device without improving the mammography device. However, after a progressive improvement of the technology used, as well as greater control of the relationship between dose and image quality, this item was progressively overcome. Currently, a new fact that has been worrying the program is the quality of interpretation of mammography exams.” modernization In order to make the process faster, less laborious for the services and more dynamic, the CBR extended the system used in the Accreditation Program in Diagnostic Imaging (PADI) to Quality Seals for submitting images in electronic format and no longer in film and paper printing. “The difference is that the commissions can make the assessments from anywhere and take advantage of the meetings at the CBR headquarters to discuss other technical matters”, highlights Dr. Hilton. The quality program committees are working together with the CBR board to modernize the process. “We hope that, soon, the sending of images for evaluation can be done electronically, via the Web, and that the seal will also become digital and traceable”, concludes Dr. Wagner.