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The Importance of CBR Quality Seals

The Brazilian College of Radiology and Diagnostic Imaging (CBR) began quality assurance programs in 1992 with the Mammography Quality Certification Program. “Since its inception, the main goal has been to improve the quality of the tests to bring the benefits of screening to our country, such as reduced mortality and early detection of tumors,” says Dr. Linei Urban, current National Commission coordinator. of Mammography, formed by CBR, Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Society of Mastology (SBM).

Through the accumulated experience, results achieved and recognition received over the years, the program has been expanded to the areas of Ultrasound, Computed Tomography and Magnetic Resonance, and is now known as the CBR Quality Seal. Today, having the certification gives the requesting doctors, the population and the healthcare operators greater security in the results of the tests performed, besides being a differential for the services.

Given this, it is noteworthy that the stamp program evaluates the quality of the method, through information about equipment, clinical staff, images and reports. Therefore, certification is exclusive to that evaluated modality.

“The Quality Seal represents, for patients who see it on their examination report, the assurance that the clinic, laboratory or service has been subjected to CBR assessment, which judged that the quality of the images, technique and examination reports are adequate. to their exacting standards, ”explains the coordinator of the Ultrasound Commission, Dr. Wagner Iared.

"Another point that deserves attention is the qualification of the medical staff of radiologists and operators of the equipment that perform the tests," says Dr. Marco Antonio Rocha Mello, coordinator of the Magnetic Resonance Commission.

Meeting several times a year, the CBR Commissions of each area have made a decisive contribution to the evolution of the specialty. They have autonomy and inclusive character, without punitive characteristics, and are composed of renowned members with vast experience in the respective method.

“Proper documentation of the images is how the examiner demonstrates that he used all the method's resources to reach his diagnosis,” says Dr. Wagner. He explains that the committee defines and assesses whether the clinic properly follows several criteria, such as: the number of images acquired, the organs and structures evaluated, the plans in which the images should be obtained, the adjustment of technical parameters such as focus and gain. , as well as checking the appropriateness of the measures, when relevant, and consistency with the report, for different types of examination.

According to the coordinator of the Computed Tomography Commission, Dr. Hilton Muniz Leão Filho, one of the main tasks is to validate the devices of the clinics. “For example, if a clinic has five devices, each device will have its own label. This evaluation takes into account the most common tomography exams: skull, lung, ear and abdomen ”, he explains. In the evaluation of the equipment, the quality and the time of use are taken into account. The clinic cannot be approved if you use devices that do not have appropriate technology or are close to obsolescence. “It is also necessary to qualify the clinic's physical facilities and equipment for compliance with mandatory public licenses,” says Dr. Marco Antonio Rocha Mello, coordinator of the MRI Commission. “In addition, it is necessary to ensure that postulant clinics and hospitals keep up with technological development by incorporating new tests and techniques,” he adds.

The inspection of the services is carried out by a member of the Commission, who, in addition to analyzing whether the structure is appropriate, verifies that the images and reports of the routine have the same level as those sent for submission.

Remember that the service must undergo a new evaluation every three years in order to remain certified by the program.

Main difficulties

“In these 25 years, we have had some problems within the Mammography program. First, inadequate breast positioning was detected on mammography examination. After exhaustive discussion and approach to the theme in most courses and congresses, the exams started to present an adequate positioning standard, being fulfilled the required quality parameters ”, recalls Dr. Linei.

“Then 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 the improvement of the mammography device. However, after a progressive improvement of the technology used, as well as a better control of the relationship between dose and image quality, progressively overcoming this item was observed. Currently, a new fact that has been worrying the program is the quality of the interpretation of mammography exams. ”

Modernization

In order to make the process faster, less labor intensive and more dynamic, CBR has extended the system used in the Diagnostic Imaging Accreditation Program (Padi) to Quality Stamps for electronic image submission and no longer. in film and paper printing. "The difference is that committees can make assessments from anywhere and leverage meetings at CBR headquarters to discuss other technical issues," says Dr. Hilton.

Quality program committees are working closely with the CBR Board to modernize the process. “We hope that soon the images can be sent for evaluation electronically via the web, and the label will also become digital and traceable,” concludes Dr. Wagner.

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Written by

Thiago Braga

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