@syarul iman BKRP QAP form 2017

REPORT OF PERCENTAGE OF RADIOGRAPHS REJECTED

FACILITY : ___________________________________________
ROOM
NO. / Peraturan mudah
: ___________________________________________
LOCATIO
N
--> tekan
YEAR : ___________________________________________
saya
BKRP:
STANDARD : ≤ 2.5 %
% of error
(contribution)

MONTHS
TOTAL PERCENTAGE (%)
TYPE OF ERROR Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
1. Over Exposure 1 4 1 4 1 4 1 4 1 4 1 4 30 22.06
2. Under Exposure 1 1 1 1 1 1 6 4.41
3. Double Exposure 1 2 1 2 1 2 1 2 1 2 1 2 18 13.24
HUMAN FAULTS

4. Wrong Technique 0 0.00

5. Wrong Patient/
1 1 1 1 1 1 6 4.41
Exam
6. No Primary/ Wrong
1 1 1 1 1 1 6 4.41
Marker
7. Collimation Error 1 1 1 1 1 5 3.68
8. Patient Movement 0.00
9. Patient Related
0 0.00
Artifact

10. Equipment Fault

EQUIPMENT

(X-ray Tube/ Grid/ 1 1 1 1 1 1 1 1 1 1 1 1 12 8.82

Bucky)

11. Cassette/ Screen

1 1 1 3 2.21
Fault
12. Darkroom Fault 2 1 2 1 2 1 2 1 2 1 2 1 18 13.24
PROCESSING &

13. Film Artifact 0

0.00
OTHERS

14. Fogged Film 0

15. Processor Fault 5 5 5 5 5 5 30 22.06
16. Miscellaneous.
Please specify…. (e.g 1 1 2 1.47
foreign body)
Total number of error 13 12 12 10 13 10 12 11 12 10 11 10 136 100.00
Total number of radiograph
5 5 5 5 5 5 5 5 5 5 5 5 60 BKRP:
rejected (A)
% TAHUNAN FORM
Total number of radiograph used
500 399 500 150 500 150 500 150 500 150 500 150 4149 1A
(B)

Percentage (%) (A÷B) x 100% 1.00 1.25 1.00 3.33 1.00 3.33 1.00 3.33 1.00 3.33 1.00 3.33 1.45
BKRP:
% of radiograph
rejected Comment : 1.993317 0.55

Corrective Action:

Reported by: Verified by:

............................. .............................
Name: Name of Supervisor*:
Position: Date:
Date: *Supervisor: Radiologist, Ketua Juru X-ray atau Orang yang Bertanggungjawab

1AForm Radiograph Rejected

@syarul iman BKRP QAP form 2017

REPORT OF PERCENTAGE OF RETAKES FOR DIGITAL RADIOGRAPHY

FACILITY : ___________________________________________
ROOM NO. / Peraturan mudah
: ___________________________________________
LOCATION
YEAR : ___________________________________________ --> tekan saya

STANDARD : ≤ 2.5%

BKRP:
MONTHS
TOTAL PERCENTAGE (%)% of error
TYPE OF ERROR Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. (contribution)

1. Over Exposure/
2 1 2 1 2 1 2 1 2 1 2 17 1.18
High Index

2. Under
Exposure/ Low 4 3 4 3 4 3 4 3 4 3 4 39 2.71
Index
3. Double
6 4 6 4 6 4 6 4 6 4 6 56 3.90
Exposure
HUMAN FAULTS

4. Wrong
8 6 8 6 8 6 8 6 8 6 8 78 5.43
Technique
5. Wrong Patient/
10 7 10 7 10 7 10 7 10 7 10 95 6.61
Exam
6. No
Primary/Wrong 12 8 12 8 12 8 12 8 12 8 12 112 7.79
Marker
7. Collimation
14 9 14 9 14 9 14 9 14 9 14 129 8.97
Error
8. Patient
0.00
Movement
9. Patient related 16 10 16 10 16 10 16 10 16 10 16 146 10.16
artifact
10. Equipment
Fault (X-Ray
18 11 18 11 18 11 18 11 18 11 18 163 11.34
Tube/ Grid/
Bucky)
11.
Detector/Imaging 1 1 20 12 20 12 20 12 20 12 20 150 10.43
EQUIPMENT

Plate
12. Image Artifact 1 1 22 13 22 13 22 13 22 13 22 164 11.41
13. Processing
1 1 24 1 1 1 1 1 1 1 24 57 3.96
Fault
14.
Miscellaneous.
Please 25.6 26 15 26 15 26 15 26 15 26 15 1 231.6 16.11
speficy…. (e.g
Foreign Body)

Total number of Error 25.6 119 77 182 100 159 100 159 100 159 100 157 1437.6 100.00

Total number of repeat exposure (A) 100 10 20 10 10 10 10 10 10 10 10 10 220

Total number of images (B) 500 500 500 200 200 200 200 300 200 400 100 7000 10300
BKRP:
% of retakes Percentage (%) (A÷B) x 100% 20 2 4 5 5 5 5 3 5 2.5 10 0.1428571 2.14

BKRP:
Comment : % TAHUNAN FORM
2A

Corrective Action:

Reported by: Verified by:

............................. .............................
Name: Name of Supervisor*:
Position: Date:
Date: *Supervisor: Radiologist, Ketua Juru X-ray atau Orang yang Bertanggungjawab

2A Form Retakes
@syarul iman BKRP QAP Form 2017

PERCENTAGE OF FLUOROSCOPIC PROCEDURES WHERE PATIENT DOSE EXCEED THE MALAYSIAN DIAGNOSTIC REF

FACILITY :
DEPARTMENT :
MONTH/YEAR :
UNIT :
MACHINE
:
MODEL

NO. Examination date Examination No. / Accession No.

*Note: Fill in with

the correct
Cardiac / Non-Cardiac / ERCP / GI Lower / GI Upper
procedure
provided:

** Others include Nephrostomy, Percutaneous Transhepatic Biliary Drainage (PTBD), Sinogram, Anal F
Renal Embolization

3AFluoroscopy Case
 @syarul iman BKRP QAP Form 2017

YSIAN DIAGNOSTIC REFERENCE LEVEL (DRL)

KAP value Exceed DRL

*Examination Type
(mGy.m2)
Yes No

Total

ERCP / GI Lower / GI Upper / MCU / Cerebral / ESWL / PTCA / Vascular / Others

age (PTBD), Sinogram, Anal Fistulogram, Ascending Urethrogram, Lower Limb Angiography, Cystography and

3AFluoroscopy Case
@syarul iman BKRP QAP Form 2017

Malaysian standard DRL value

:

Angiography
Cardiac: 5.44 mGy.m2
Non-Cardiac: 5.22 mGy.m2

Conventional Studies
GI Lower: 0.68 mGy.m2
GI Upper: 0.9 mGy.m2
MCU : 1.41 mGy.m2
ERCP : 0.83 mGy.m2

Interventional Studies
Cerebral: 8.70 mGy.m2
ESWL: 0.81 mGy.m2
PTCA: 15.70 mGy.m2
Vascular: 5.87 mGy.m2
Others**: 2.01 mGy.m2

3AFluoroscopy Case
@syarul iman BKRP QAP Form 2017

ANNUAL ANALYSIS REPORT FOR PERCENTAGE OF FLUOROSCOPIC PROCEDURES

WHERE PATIENT DOSE EXCEED THE MALAYSIAN DIAGNOSTIC REFERENCE LEVEL

FACILITY:
DEPARTMENT:
MACHINE MODEL:
YEAR:

Total Number of
Total Number of Fluoroscopic
Fluoroscopic Procedures % of KAP Value
Procedures where Patient Dose
MONTH Done/ Performed (as Listed that exceed
Exceed the Malaysian Diagnostic
in Guideline on Malaysian DRLs
Reference Level (DRL)
DRLs Performed)

Jan. 300 23 7.67

Feb. 245 15 6.12
Mar. 300 13 4.33
Apr. 356 12 3.37
May 123 11 8.94
June 456 10 2.19
July 789 9 1.14
Aug. 910 8 0.88
Sept. 100 1 1.00
Oct. 100 1 1.00
Nov. 50 1 2.00
Dec. 10 1 10.00
BKRP:
TOTAL 3739 105 2.81
% TAHUNAN FORM 3B
(D) (N)

% of KAP for fluoroscopic procedure that exceed DRL = (N/D x 100%)

Shortfalls in Quality:

Causes:

Corrective Action:

Reported by: Verified by:

............................. .............................
Name: Name of Radiologist
Position: Date:
Date:
3BFluroscopy annual
 Reported by: Verified by:
@syarul iman BKRP QAP Form 2017
............................. .............................
Name: Name of Radiologist
Position: Date:
Date:

3BFluroscopy annual
 @syarul iman BKRP QAP Form 2017

ANNUAL ANALYSIS REPORT FOR PERCENTAGE OF FLUOROSCOPIC PROCEDURES WHERE PATIE

EXCEED THE MALAYSIAN DIAGNOSTIC REFERENCE LEVEL

FACILITY:
DEPARTMENT:
MACHINE MODEL:
YEAR:

Total Number of
Total Number of Fluoroscopic
Fluoroscopic Procedures
Procedures Done/ Performed (as % of K
MONTH where Patient Dose Exceed
Listed in Guideline on Malaysian that ex
the Malaysian Diagnostic
DRLs Performed)
Reference Level (DRL)

Jan.

Feb.

Mar.

Apr.

May
BKRP:
% TAHUNAN FORM 3B June

July

Aug.

Sept.

Oct.

Nov.

Dec.
TOTAL
(D) (N)
% of KAP for fluoroscopic procedure that exceed DRL = (N/D x 100%)

3BFluroscopy annual
 @syarul iman BKRP QAP Form 2017

OCEDURES WHERE PATIENT DOSE

NCE LEVEL

Number of
pic Procedures
% of KAP Value
nt Dose Exceed
that exceed DRLs
ian Diagnostic
e Level (DRL)

(N)
(N/D x 100%)

3BFluroscopy annual
@syarul iman BKRP QAP Form 2017

REPORT OF MONTHLY PERCENTAGE OF ADULT PLAIN CT BRAIN EXAMINATION WHERE DOSE

EXCEED MALAYSIAN DIAGNOSTIC REFERENCE LEVEL (DRL)

Facility:
Department:
Machine Model:
Year of Installation:

Age and Gender Distribution QAP Indicator

Examination CT Scan No./
No. Scan
date Accession No.
Male/Female Age (Years) Length CTDIw
(cm)

Note: Malaysian DRL value for brain is 1050mGy.cm

Number of Adult plain CT brain examinations that exceed the DRL value in a month

Reported by: Verified by:

............................. .............................
Name: Name of Radiologist:
Position: Date:
Date:

4ACT Case
 Verified by:
............................. .............................
@syarul iman
Name: BKRP Name of Radiologist:QAP Form 2017
Position: Date:
Date:

4ACT Case
 @syarul iman BKRP QAP Form 2017

NATION WHERE DOSE LENGTH PRODUCT (DLP)

ENCE LEVEL (DRL)

Month/Year:

QAP Indicator DRL Exceeded

DLP
CTDIw Y N
(mGy.cm)

month

4ACT Case
@syarul iman BKRP QAP Form 2017

4ACT Case
@syarul iman BKRP QAP Form 2017

ANNUAL ANALYSIS REPORT OF ADULT PLAIN CT BRAIN EXAMINATION WHERE

DLP EXCEED MALAYSIAN DIAGNOSTIC LEVEL (DRL)

Facility :
Department :
Machine
:
Model
Year :

Total No. of Adult No. of Adult Plain CT Brain

% of DLP value that
Plain CT Brain Exam That Exceed the DRL
exceed DRL
Examination Value
MONTH
Jan. 500 5 1
Feb. 500 7 1.4
Mar. 500 8 1.6
Apr. 500 9 1.8
May 500 10 2
June 500 10 2
July 500 10 2
Aug. 500 10 2
Sept. 500 10 2
Oct. 500 10 2
Nov. 500 10 2
Dec. 500 10 2
BKRP:
TOTAL 6000 109 1.82 % TAHUNAN FO
(D) (N)

% of DLP for adult plain CT brain exam 1.82

that exceed DRL; (N/D x 100%)

Shortfalls in Quality:

Causes:

Corrective Action:

Reported by: Verified by:

............................. .............................
Name: 4BCT annual
Name of Radiologist
Position: Date:
@syarul iman BKRP QAP Form 2017

Reported by: Verified by:

............................. .............................
Name: Name of Radiologist
Position: Date:
Date:

4BCT annual
@syarul iman BKRP QAP Form 2017

BKRP:
% TAHUNAN FORM 4B

4BCT annual
@syarul iman BKRP QAP Form 2017

PERCENTAGE OF MAMMOGRAM FILMS REJECTED MONTHLY (CONVENTIONAL)

FACILITY :
MACHINE MODEL :
YEAR OF
:
INSTALLATION
IMAGE PROCESSOR
:
TYPE / MODEL
STANDARD : < 3%

Projection Repeated
No. Reason For Reject Left CC Right CC Left MLO Right MLO Left Other Right Other Sub Totals % of Repeats
1. Incorrect Patient ID 1 2 1 1 1 1 7 3.59
2. Wrong Patient Marker 2 1 3 5 2 1 14 7.18

Human Fault
3. Marker Positioning Technique 1 1 1 1 1 1 6 3.08
4. Positioning Techniques Patient Motion 10 1 1 1 1 1 15 7.69
5. Exposure fault Radiographer’s Fault 1 1 1 1 1 1 6 3.08
6. Patient Motion Mechanical Fault (Equipment Failure) 1 1 1 1 1 1 6 3.08
7. Patient Related Artifact Darkroom Processing 1 1 1 1 1 1 6 3.08
8. Mechanical fault Exposure Faults 1 1 1 1 1 1 6 3.08
Equip
ment

9. Aborted AEC 1 1 1 1 1 1 6 3.08

10. film Artifacts 1 1 1 1 1 1 6 3.08
Other Processing

11. Cassette / Film 1 1 1 1 1 1 6 3.08 \

12. Darkroom processing Other Reasons
1 1 1 100 1 1 105 53.85

13. Other reasons. Please specify… 1 1 1 1 1 1 6

3.08
Total Number of Error 23 14 15 116 14 13 195 100.00
Total number of films rejected (A) 10 10 10 10 10 10 60
Total number of films used (B) 200 200 200 200 200 200 1200
Percentage of films rejected (A÷B) x 100 5.00 5.00 5.00 5.00 5.00 5.00 5.00

Remarks:
Corrective Action:

Data analyzed by: Verified by:

............................. .............................
Name: Name:
Position: Position: Senior Radiographer/ Radiologist
Date: Date:

5AMammo Monthly Radio. Reject

@syarul iman BKRP QAP Form 2017

REPORT OF RETAKE ANALYSIS

PERCENTAGE OF MAMMOGRAM IMAGES RETAKE

FACILITY :
MACHINE MODEL / YEAR OF
:
MACHINE
YEAR OF INSTALLATION :
CASSETTE READER
:
TYPE/MODEL

LASER PRINTER TYPE/MODEL :

STANDARD : < 3%

No. Reason For Retake Left CC Right CC

1. Incorrect Patient ID 1 3
HUMAN FAULTS

2. Wrong Patient Marker 1 1

3. Marker 1 1
4. Positioning Technique Patient Motion 1 1
5. Exposure Faults Radiographer’s Fault 1 1
6. Patient Motion Mechanical Fault (Equipment Failure) 1 1
7. Patient Related Artifacts CR Image Reader Fault 1 1
8. CR Image Reader Fault Exposure Faults 1 1
9. Mechanical Faults Blank Image 1 1
EQUIPMENT

10. Blank Image Aborted AEC Reasons 1 1

11. Aborted AEC Software Failure 1 1
12. Software Failure Artifacts 1 1
13. Detector / Imaging Plate 1 1
14. Artifacts Other Reasons 1 1
OTHERS

15. Other Reasons. Please specify ………… 1 1

Total number of error 15 17

Total number of images rejected (A) 20 25

Total number of images used (B) 600 600
BKRP:
Percentage of images
% rejected (A÷B) x 100 3.33333333333333 4.17
radiograph

Remarks:
Corrective Action:

Data analyzed by: Verified by:

............................. .............................
Name: 5BMammo Monthly FFDMCRName:
Position: Position: Senior Radiographer/ Radiologist
Date: Date:
@syarul iman BKRP QAP Form 2017
Data analyzed by: Verified by:

............................. .............................
Name: Name:
Position: Position: Senior Radiographer/ Radiologist
Date: Date:

5BMammo Monthly FFDMCR

 @syarul iman BKRP QAP Form 2017

E ANALYSIS
S RETAKE MONTHLY (FFDM/CR)

Projection Repeated
Left MLO Right MLO Left Other Right Other
3 4 5 6
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

17 18 19 20

30 35 40 20
600 500 500 600
5.00 7.5 8 3.33

5BMammo Monthly FFDMCR

pher/ Radiologist
 @syarul iman BKRP QAP Form 2017

pher/ Radiologist

5BMammo Monthly FFDMCR

@syarul iman BKRP QAP Form 2017

Sub Totals % of Repeats

22 20.75
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66
6 5.66

6 5.66

106 100.00

170
3400
5.00

5BMammo Monthly FFDMCR

@syarul iman BKRP QAP Form 2017

REPORT OF REJECT ANALYSIS: PERCENTAGE OF MAMMOGRAM FILMS REJECTED YEARL

FACILITY :
MACHINE
MODEL
:

IMAGE
PROCESSOR :
TYPE/MODEL

REASON FOR MONTHS

NO.
REJECT Jan. Feb. Mar. Apr. May

1.Incorrect Patient ID 1 2 3 4 5

2. Wrong patinet 2 3 2 3 2
HUMAN FAULTS

3. Marker 3 4 3 4 3
4. Positioning
4 5 4 5 4
Technique
5. Exposure Faults 5 7 5 7 5
6. Patient Motion 6 8 6 8 6
7. Patient related
7 9 7 9 7
artifact
PROCESSING EQUIPMENT

8. Mechanical fault 8 10 8 10 8

9. Aborted AEC 9 11 9 11 9

10. Film Artifact 1 12 10 12 10

11. Cassette/ Film 1 13 11 13 11

12. Darkroom
2 14 12 14 12
Processing
Other

13. Other Reasons:

1 1 1 1 1
Please specify

Total Number of of
50 99 81 101 83
error
Total number of films
10 10 10 10 10
rejected (A)
BKRP:
Total number of films
% radiograph 200 250 300 450 400
used (B) rejected
Percentage of films
rejected (A÷B) x 5.00 4.00 3.33 2.22 2.50
100%

Remarks:
Corrective Action:

Data analyzed by: Verified by:

............................. .............................
Name: 5CMammo Annual Reject Name:
Position: Senior Radiographer Position: Radiologist
Date: Date:
@syarul iman BKRP QAP Form 2017

Data analyzed by: Verified by:

............................. .............................
Name: Name:
Position: Senior Radiographer Position: Radiologist
Date: Date:

5CMammo Annual Reject

 @syarul iman BKRP QAP Form 2017

GRAM FILMS REJECTED YEARLY (CONVENTIONAL)

Peraturan mudah

--> tekan saya

MONTHS
TOTAL PERCENTAGE
June July Aug. Sept. Oct. Nov. Dec.
BKRP:
6 7 8 9 10 11 12 78 7.10 % of error
(contribution)
3 2 3 2 3 2 3 30 2.73
4 3 4 3 4 3 4 42 3.82

5 4 5 4 5 4 5 54 4.91

7 5 7 5 7 5 7 72 6.55
8 6 8 6 8 6 8 84 7.64

9 7 9 7 9 7 9 96 8.74

10 8 10 8 10 8 10 108 9.83

11 9 11 9 11 9 11 120 10.92

12 10 12 10 12 10 12 123 11.19
13 11 13 11 13 11 13 134 12.19

14 12 14 12 14 12 14 146 13.28

1 1 1 1 1 1 1 12 1.09

103 85 105 87 107 89 109 1099

10 10 10 10 10 10 10 120 100.00

500 430 250 300 40 40 400 3560 BKRP:

% TAHUNAN FO

2.00 2.33 4.00 3.33 25.00 25.00 2.50 3.37

5CMammo Annual Reject

ist
 @syarul iman BKRP QAP Form 2017

ist

5CMammo Annual Reject

 @syarul iman BKRP QAP Form 2017

aturan mudah

BKRP:
% of error
(contribution)

BKRP:
% TAHUNAN FORM 5C

5CMammo Annual Reject

@syarul iman BKRP QAP Form 2017

REPORT OF RETAKE ANALYSIS: PERCENTAGE OF MAMMOGR

FACILITY :
MACHINE
:
MODEL
CASSETT
E
READER :
TYPE/MO
DEL
LASER
PRINTER
:
TYPE/MO
DEL

MONTHS
NO. REASON FOR RETAKE
Jan. Feb. Mar. Apr. May June
1. Incorrect patient ID 1 1 10 1 1 10
2. Wrong patient 2 8 2 8
HUMAN FAULTS

3. Marker 3 6 3 6

4. Positioning Technique 4 7 4 7

5. Exposure faults 5 2 6 5 2 6
6. Patient motion 6 5 6 5

7. Patient related artifacts 7 4 7 4

8. CR Image reader fault 8 3 8 3

9. Mechanical fault 9 2 9 2
EQUIPMENT

10. Blank Image 10 1 10 1

11. Aborted AEC 11 6 11 6
12. Software Failure 12 8 12 8
13. Detector/ Imaging
13 9 13 9
Plate
14. Artifacts 14 12 14 12
15. Other Reasons.
Othe

1 1 1 1 1 1
r

Please specify…
Total Number of Error 106 4 88 106 4 88
Total number of images
106 4 88 106 4 5
rejected (A)
Total number of images
500 200 2905 450 299 390
used (B)
Percentage of images
rejected (A÷B) x 100%
21.20 2.00 3.03 23.56 1.34 1.28

BKRP:
% of retakes
Remarks:
Corrective Action:

5DMammo Annual FFDMCR

@syarul iman BKRP QAP Form 2017

Data analyzed by: Verified by:

............................. .............................
Name: Name:
Position: Senior Radiographer Position: Radiologist
Date: Date:

5DMammo Annual FFDMCR

 @syarul iman BKRP QAP Form 2017

ENTAGE OF MAMMOGRAM IMAGES RETAKE YEARLY (FFDM/CR)

Peraturan mudah

--> tekan saya

MONTHS
TOTAL PERCENTAGE
July Aug. Sept. Oct. Nov. Dec.
BKRP:
1 1 10 1 1 10 48 6.06% of error
2 8 2 8 40 5.05(contribution)
3 6 3 6 36 4.55

4 7 4 7 44 5.56

5 2 6 5 2 6 52 6.57
6 5 6 5 44 5.56

7 4 7 4 44 5.56

8 3 8 3 44 5.56

9 2 9 2 44 5.56
10 1 10 1 44 5.56
11 6 11 6 68 8.59
12 8 12 8 80 10.10

13 9 13 9 88 11.11

14 12 14 12 104 13.13

1 1 1 1 1 1 12 1.52

106 4 88 106 4 88 792 100.00

6 7 8 9 10 11 364

280 450 250 600 810 4999 12133

BKRP:
2.14 1.56 3.20 1.50 1.23 0.22 3.00 % TAHUNAN FORM 5D

5DMammo Annual FFDMCR

@syarul iman BKRP QAP Form 2017

5DMammo Annual FFDMCR

 @syarul iman BKRP QAP Form 2017

:
error
ibution)

N FORM 5D

5DMammo Annual FFDMCR