|Year : 2019 | Volume
| Issue : 8 | Page : 1288
Commentary: Quality assurance in ophthalmic imaging
Harshit Vaidya, Muna Bhende
Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
|Date of Web Publication||22-Jul-2019|
Dr. Muna Bhende
Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vaidya H, Bhende M. Commentary: Quality assurance in ophthalmic imaging. Indian J Ophthalmol 2019;67:1288
Ophthalmic imaging has grown leaps and bounds over the past two decades and has not only changed our understanding of pathological processes but also drives insurance schemes and treatment protocols to a major extent. It forms the basis of almost every clinical trial in ophthalmology, and reading centers now interpret data flowing in from innumerable sites worldwide. With the expectations of patients growing higher day by day, ensuring quality care becomes more of a necessity than an option. The article “Quality assurance in ophthalmic imaging” provides guidelines to assure quality imaging including the importance of validation by a medical consultant and methods of auditing the procedures and results to ensure consistency and correction of errors.
With all this comes the huge responsibility of maintaining high-quality uniform standards in the handling of equipment and procuring the desired data through these modalities. Quality checks and guidelines are a must to ensure not only the highest standards of medical care but also encompass the medicolegal issues pertaining to healthcare delivery. Potential limitations of the procedure and complications must be explicitly explained to the patients either orally or in a written format. This ensures that the patient is aware of the implications of the procedure he or she is undergoing.
Critical reports as mentioned by the author can additionally include any suspicious mass lesion picked up on the B-scan or even on an optical coherence tomography scan. Treating physician must be alerted regarding patients with suspicion of a globe dehiscence or intraocular foreign body on B-scan. While performing ultrasound scans in unilateral pathologies, it is good clinical practise to do a preliminary scan of the fellow eye to have comparative values and to rule out any latent pathology in the fellow eye. Biometry readings are generally calibrated for normal eyes with vitreous in the posterior segment, vitrectomized eyes, especially those having silicone oil in situ will give false readings unless the velocity is not adjusted for the tamponading agent.
Fundus photographs or wide-field imaging can alert one to peripheral tumors or unidentified vasculitic pathology. Although as mentioned by the authors noninvasive photography may not need a written consent for clinical purposes, external images of patient and invasive procedures such as fundus fluorescein angiography and indocyanine green angiography must have mandatory written consent prior to the procedure and in presence of an adult attendant. Invasive investigations must be performed in the presence of an anaesthetist and well-trained nursing staff with all the necessary medicines in the emergency kit. In institutions having multiple imaging systems, repeatability must be ensured in terms of the instrument and the operator to the extent possible.
Technology changes faster than one can keep pace with. This makes it essential for every person handling any instrument to have read the manual prior to using them on the patients and keep themselves abreast with the latest developments in the instrument software or upgrade. Periodic review of systems and training in case of upgrades should be a mandatory requirement for every technician. The quality assurance system should also extend throughout the framework of the hospital network.
In the era of smartphone imaging with immediate access to social media and innumerable discussion forums online, it is of utmost importance to maintain patient confidentiality. It is also necessary that information stored on the local network of the hospital systems is not divulged to unconcerned third parties unless authorized to do so. The issue of carrying patient's data when a trainee has completed training or an employee leaves service of an organization is an area that needs to be considered as part of the confidentiality process.
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