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Informatics Driven Quality Initiatives - Using the Tools of Six Sigma


W Pavlicek


W Pavlicek*, Mayo Clinic Arizona, Scottsdale, AZ

TH-F-217A-1 Thursday 2:00:00 PM - 2:50:00 PM Room: 217A

An informatics technique that can be used for improving image quality, dose prescription and delivery and other imaging services is Six Sigma. Six Sigma is a quality improvement process that strives for near perfection (99.99966%) in the organizations ‘product’. This may be the appropriate dose prescription for every patient or the absence of repeated scans or artifact free examinations or the number of finalized reports completed by the end of the business day. In Six Sigma a DMAIC (Define, Measure, Analyze, Improve, Control) process is applied to systematically inspect and review quantified data (chosen by the Six Sigma team) to improve the delivered services. Patients may ‘feel’ unacceptable variations (a repeated exam due to noise, motion, etc) and quantified data can be used to identify instances of high dose prescriptions permitting an opportunity for improvements.

Informatics enables collection of requisite data using modality, RIS (HL7) and PACS (DICOM) data to add knowledge that is actionable for improving the outcome of the delivered service. These systems provide information that are strongly interconnected in the users understanding of what is the ideal dose prescription. Understanding critical quality components and reducing variation in these actions are keys for improvements. For example, small patient size can easily result a patient not being accurately centered in a CT scanner which is (interconnected) to the dose modulation prescription. A Six Sigma approach uses statistical thinking and statistical tools. It:

Defines and identifies the improvement opportunity (e.g., lower dose, improve Imaging Quality (IQ), shorten exam time, patient positioning etc.)

Measures critical information that relates to performance goal (dose index or metric, added or extra scans, reduced IQ, etc). We suggest an Informatics environment for this.
Analyze data to identify variation and its causes. Formulate solutions and validate root cause hypothesis prior to introducing change.

Improve performance by introducing change. Verify improvements as measured by the metric – iterate improvements and gain group approval for current final solution. (technique charts, education modules, purchase technology that adds robustness to the prescription of radiation or another imaging service etc)

Control and monitor variability in the chosen metric. As it relates to the skills and ability of physicists, accept the challenge of having a mistake proof process.

This lecture will provide an introductory overview of Six Sigma concepts and review some practical examples from mammography, CT, and interventional fluoroscopy.

Learning Objectives:

1. Understand the origin and evolution of Six Sigma and DMAIC processes.
2. Provide examples of measurement data from Informatic sources and tools
3. Present issues and opportunities related to improving patient care using Six Sigma.


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