Interim policy effective January 1, 2016, through December 31, 2017

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1 IMPORTANT NOTICE Interim policy announced for post-primary structured education requirement Interim policy relaxes exam content outline requirement (November 12, 2015) The ARRT announces an interim policy that modifies the post-primary certification and registration structured education requirement effective January 1, In 2010, ARRT announced an additional requirement for individuals seeking post-primary credentials. Sixteen hours of structured education reflecting the content of the examination content outline with at least one credit from each major content category of the outline would be required beginning this January 1, The structured education requirement will enhance post-primary certification and registration by providing additional documentation that candidates have mastered the knowledge determined through the practice analysis process to be part of being qualified. Relaxed interim requirement takes effect In November 2015, ARRT announced a two-year interim phase-in period for the requirement. During the phase-in candidates must report 16 structured education credits from activities whose content pertains to the discipline rather than the stricter criterion of reflecting the content of the examination content outline. The provision that candidates earn at least one credit from each of the exam content outline s major categories will not be enforced during the 2-year period. The activities must still meet the same criteria as activities reported for compliance with ARRT s biennial CE requirements (i.e., must be approved by a RCEEM, RCEEM+ or must meet ARRT s definition of an Approved Academic Course as described in the ARRT Continuing Education Requirements). Interim policy effective January 1, 2016, through December 31, 2017 The two-year interim policy will allow CE sponsors additional time to create more activity options and better align existing activities with the subject matter of the post-primary exam content outlines. This will increase access for candidates to the education necessary to comply with the requirement. The interim policy will apply to activities completed prior to January 1, Activities completed January 1, 2018 and thereafter must meet the full structured education requirement as originally announced.

2 Quality Management The purpose of structured education is to provide the opportunity for individuals to develop mastery of discipline-specific knowledge that, when coupled with selected clinical experiences, helps to document qualifications. Candidates for Quality Management Certification and Registration must document at least 16 hours of structured education. Structured education activities may be academic courses from an institution accredited by a mechanism recognized by the ARRT 1, CE opportunities approved by a RCEEM or RCEEM+, or a combination of the two. Structured education documentation must include at least one CE credit or its equivalent in each content area listed below (i.e., Patient Care, Safety, Image Production and Procedures). The remaining hours may be earned from any one or more of the content areas. Content Areas * Patient Care (includes) 1. Patient Management through Quality Improvement Safety (includes) 1. Laws, Regulations, Standards and Guidelines Image Production (includes) 1. Physical Principles Procedures (includes) 1. Collection and Analysis of QC Data Minimum Credits Total 16 Acceptable Examples: Example 1 Example 2 Example 3 Patient Care 3 hours Safety 2 hours Image Production 4 hours Procedures 7 hours Patient Care 1 hour Safety 1 hour Image Production 1 hour Procedures 13 hours Patient Care 1 hour Safety 5 hours Image Production 5 hours Procedures 5 hours TOTAL 16 hours TOTAL 16 hours TOTAL 16 hours * The number of questions and organization of content for the Quality Management Examination are located in the Quality Management Examination Content Specifications document. 1 Activities meeting the definition of an approved academic course will be awarded credit at the rate of 12 CE credits for each academic quarter credit or 16 CE credits for each academic semester credit. See the ARRT Continuing Education Requirements document for additional information. 1 COPYRIGHT 2015 THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS ALL RIGHTS RESERVED.

3 Patient Care 1. Patient Management through Quality Improvement A. Concepts and Principles of Quality Improvement 1. foundations of QI a. customer focus b. planned, systematic evaluation c. process orientation d. data driven 2. problem solving strategies a. define basic process components 1. supplier 2. input 3. action (activity) 4. output (outcome) 5. customer b. identify process variables 1. supplier 2. input 3. action (activity) c. identify quality characteristics 1. output (outcome) 2. customer 3. process improvement models a. find, organize, clarify, understand, select (FOCUS) b. plan, do, check, act (PDCA) c. focus, analyze, develop, execute (FADE) d. strengths, weaknesses, opportunities, threats (SWOT) e. failure mode and effects analysis (FMEA) f. Six Sigma g. Lean Process Improvement 4. tools for problem identification and analysis a. group dynamics (e.g., focus groups, brainstorming) b. problem solving tools (e.g., flow charts, decision matrices, affinity charts, nine block grids) c. information analysis (e.g., histograms, Pareto charts, control charts, Shewhart charts) d. root cause analysis (e.g., fishbone diagrams) (Patient Care continues on the following page.) 2

4 Patient Care (continued) B. Applications of Quality Improvement 1. development of indicators a. dimensions of clinical performance 1. appropriateness of care 2. continuity of care 3. effectiveness of care 4. efficacy of care 5. efficiency of care 6. respect and caring 7. safety in the care environment 8. timeliness of care 9. cost of care 10. availability of care b. target areas for improvement 1. high volume (e.g., chest x-ray) 2. high risk (e.g., angiography) 3. problem prone (e.g., IV contrast use, dose creep) 4. sentinel events 2. data collection methods a. surveys and questionnaires b. facility database (e.g., staff credential verification and sentinel events) c. focus groups d. log entries e. record audits and reviews f. peer review g. reject/repeat analysis h. national and regional registries (e.g., dose reporting) 3. data analysis a. measures of frequency (e.g., counts, percents, rates, and ratios) b. measures of central tendency (e.g.,mean, median, mode) c. measures of variation (e.g.,range, standard deviation, variance, reproducibility, validity, reliability, precision, accuracy) 4. assessment of outcomes a. identification of reference standards 1. internal benchmarks (e.g., baseline performance, local customer expectations) 2. external (e.g., government regulations, national norms, practice standards) b. comparison of outcomes to reference standards 5. evidence based improvement implementation a. action plans b. update policies and procedures c. incident response d. equipment evaluation/purchase recommendations e. staffing recommendations f. update technique charts and/or CT scan protocols C. operational management 1. staffing education 2. maintenance and preventative maintenance 3. committee membership and activities 4. recommendation for staffing assignments 5. maintain QC/QI documentation 6. utilization and appropriateness management 7. maintain policies and procedures 3

5 Safety 1. Laws, Regulations, Standards and Guidelines A. Laws and Regulations 1. Food and Drug Administration (FDA) a. Code of Federal Regulations (CFR) TITLE 21, PART 1020 b. Mammography Quality Standards Act (MQSA) CFR TITLE 21, PART QC tests 2. frequency of QC tests 3. performance criteria for QC tests 4. documentation requirements (e.g., credentials, continuing experience and education, surveys, policies and procedures) 5. medical outcomes audit c. Safe Medical Devices Act (SMDA) CFR TITLE 21, PART general provisions 2. reporting procedures d. Occupational Safety and Health Administration (OSHA) CFR TITLE 29, PART blood borne pathogens/ CDC Standard Precautions 2. material safety data sheet 3. reporting procedures e. Health Insurance Portability and Accounting Act (HIPAA) CFR TITLE 45, PART general provisions 2. reporting procedures f. Medicare Improvements for Patients and Providers Act (MIPPA) CFR TITLE 42, PART 414 and designated accreditation agency programs 1. American College of Radiology (ACR) 2. Intersocietal Accreditation Commission (IAC) 3. The Joint Commission (TJC) B. Standards and Guidelines 1. National Council on Radiation Protection (NCRP) Recommendations a. Report No. 99, Sections 1, 6 and 7 b. Report No.105, Sections 1, 2, 6, 7 and 8.4 c. Report No.114 d. Report No.147, Sections 1, 2 and 3 e. Report No.160, Sections 3, and 7 f. Report No.168, Sections 3, 4, 5 and 6 g. Report No. 172, exclude dental and nuclear medicine sections 2. American College of Radiology (ACR) Technical Standards 3. American Association of Physicists in Medicine (AAPM) a. Task Group 18 b. Report No. 60 c. Report No. 74 d. Report No. 93 e. Report No. 94 f. Report No. 96 g. Report No. 111 h. Report No. 116 i. Report No American Society of Radiologic Technologists (ASRT) Practice Standards 5. Conference of Radiation Control Program Directors (CRCPD) publications 6. American Registry of Radiologic Technologists (ARRT) Standards of Ethics 4

6 Image Production 1. Physical Principles A. Radiation Production 1. waveform characteristics a. single phase b. three phase c. high frequency 2. target design a. target angle b. target material B. X-Ray Beam Characteristics 1. beam quality 2. radiation output 3. beam modification a. filtration b. collimation C. Analog Radiography 1. image receptors a. speed b. resolution c. film-screen contact d. spectral matching 2. conventional film processing a. chemical factors b. development time c. developer temperature 3. sensitometric factors a. base-plus-fog b. d max c. density difference d. mid-density 4. environmental factors a. darkroom cleanliness b. darkroom fog c. temperature and humidity d. silver recovery e. film inventory and storage control D. Digital Radiography 1. computed radiography (CR) 2. digital radiography (DR) 3. speed 4. resolution 5. exposure indicator value (e.g., S, EI, mean log, target exposure indicator (EI T ), deviation index (DI)) 6. image processing 7. picture archiving communication systems (PACS) 8. image display devices 9. environmental factors 5

7 Procedures 1. Collection and Analysis of Quality Control (QC) Data A. Equipment Performance Evaluation 1. timer accuracy and reproducibility 2. kvp accuracy and reproducibility 3. exposure output as a function of tube potential (kvp) 4. ma or mas linearity 5. x-ray output (mr/mas) 6. entrance skin exposure (ESE)/ entrance skin air KERMA (ESAK) 7. AEC response 8. exposure reproducibility 9. beam quality (half-value layer) 10. beam restriction system a. light field-radiation field congruence b. image receptor-radiation field alignment c. positive beam limitation (PBL) d. light localizer illuminance 11. spatial resolution 12. compression (mammography) 13. grid performance a. artifact analysis b. alignment 14. source-to-image distance (SID) indicator accuracy B. Ancillary Equipment Evaluation 1. viewboxes a. luminance b. uniformity c. ambient light (illuminance) 2. monitors a. luminance b. ambient light (illuminance) c. spatial resolution d. contrast resolution/dynamic range e. digital display test pattern (SMPTE, AAPM TG-18) 3. hard copy printers 4. hard copy digitizers 5. radiation protection devices a. protective apparel b. shielding devices C. Fluoroscopic Systems 1. automatic brightness control (ABC) 2. beam quality (half-value layer) 3. beam limitation/collimation 4. low and high contrast resolution 5. entrance exposure rate (EER)/ entrance skin air KERMA rate (ESAKR) 6. five-minute timer 7. evaluate source to skin distance (SSD) (e.g., C-arm spacers) 8. patient dose tracking 9. AAPM TG-125 data collection methodology for fluoroscopic ABC/ADRC in cardiovascular and angiography systems D. Analog Imaging (including mammography) 1. image receptors a. phantom analysis b. background density c. contrast d. recorded detail and resolution e. artifact analysis f. exposure artifacts g. processing artifacts h. film-screen contact 2. processor performance a. film processor temperatures b. replenishment rates c. daily sensitometry 1. base-plus-fog 2. mid-density 3. density difference 3. darkroom cleanliness and environmental integrity (Procedures continue on the following page.) 6

8 Procedures (continued) E. Digital Imaging (including mammography) 1. image receptor 2. phantom tests to evaluate for spatial resolution, noise and contrast 3. system malfunctions (e.g., ghost image, banding, erasure, dead pixels, printer distortion) 4. image artifacts 5. PACS troubleshooting 6. CR reader function F. Bone Densitometry (BD) 1. calibration 2. phantom analysis G. Computed Tomography (CT) 1. image quality 2. spatial resolution (high contrast) 3. low contrast resolution 4. image uniformity 5. noise 6. artifact evaluation 7. alignment light accuracy 8. reconstructed slice thickness 9. CT number accuracy 10. protocol review 11. dose monitoring 12. beam width 13. displayed CTDI vol accuracy H. Test Instrumentation 1. kvp evaluation a. kvp meter 2. exposure measurement devices a. ion chamber b. solid state detector 3. exposure duration a. digital timer meter b. mas meter 4. testing devices a. anthropomorphic phantoms b. system performance test tools and phantoms c. resolution patterns d. screen-film contact mesh e. collimation test tool f. radiochromic film g. absorber materials (e.g., aluminum, lead, copper) 5. sensitometer a. design characteristics b. function 6. densitometer a. design characteristics b. function 7. photometer (light meter) a. design characteristics b. function 1. luminance 2. illuminance (ambient light) 7 V

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