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XRIS Guide to HARP Testing

Section 6: Fluoroscopy
Introduction
This chapter provides information on the requirements and procedures for quality assurance testing on
fluoroscopic x-ray machines, including spot film, camera, cine and digital systems.
Mandatory HARP Tests
Automatic Brightness Control
Collimation
Half-value Layer
High Level Control
Limit Timer
Patient Entrance Exposure
Maximum Exposure
Resolution (High & Low Contrast)
Other Technical Tests
Exposure Switch
Interlock Function
Kilovoltage Accuracy
mA Meter Function
Target to Image Distance
X-ray Beam Alignment
Equipment List
The following equipment is required for all fluoroscopic testing procedures.
Twenty (20) cm of water in a plastic container that is wide enough to cover the entire Image
Intensifier (I/I) field and not more than 25 cm in height.
Note:
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For units with II greater than 30 cm (12") it may be difficult to find a phantom that is wide enough to cover
the entire I/I and it would be too heavy to carry once filled with water. For these, we suggest that you use
your regular phantom and collimate to the phantom rather than the II.
A dosemeter capable of measuring dose and dose rate
Measuring tape
Rigid foam blocks or support bocks to support water phantom above the dosemeter
Stand to hold the dosemeter above water for remotes and C-arms
1/8" lead plate, wide enough to cover the Ill
High contrast resolution test tool
Low contrast resolution test tool
Two sheets of copper, 30 x 30 cm wide
Beam alignment test tool with level
14 x 17 inch (35 x 43 cm) loaded cassette
Type 1100 aluminum sheets (5 x 1 mm and 1 x 0.5 mm)
kVp Meter
General Information
Rules of Thumb
1. Pulse Fluoroscopy
If a unit has the capability of pulse fluoroscopy, we recommend that the PEE be measured
with the pulse mode OFF to determine the PEE accurately. You may attempt to measure the
dose rate on pulse mode but keep in mind that this measurement may be inaccurate. It will all
depend on how accurately the dosemeter can respond to the "ON" and "OFF" pulses of
radiation during pulse fluoroscopy.
2. Distances Used to Measure PEE and Maximum Output
Average and maximum dose rates for C-arms, remotes and special procedural units are not
measured at the shortest target to skin distance as noted in the regulation. Otherwise, all
measurements for most C-arms and some remotes would have to be taken at the tip of the
cone or at the collimator. This would not reflect the true patient skin dose under which the
xray machines are normally used. For this reason the following standards have been
established.
If for some reason these standards are not applicable, then we recommend that the facility's
Radiation Protection Officer (RPO) sets up the protocol under which the testing is done.
These distances must be clearly identified in the quality assurance records.
Remote Units
The average dose is measured at 21 cm from the table top, with the unit set at the distance normally used.
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If several distances are used, select the shortest one unless it only applies to a very specific exam not
routinely done.
The maximum dose is measured at 30 cm from the table top at the shortest target to I/I distance normally
used.
C-arms
In order to reflect skin dose (PEE and maximum rates) with these units, both average and maximum dose
rates are to be measured 30 cm from the I/I unless otherwise specified (such as if the c-arm is used in a
fixed position with bed).
Special Procedure's C-Arm
Unless otherwise specified, the measurements are taken with the target to I/I distance at 102 cm. For AP
tubes the average dose rate is taken at 21 cm from the Ill and the maximum dose at 30 cm. For the Lateral
tubes, both average and maximum dose rates are taken at 30 cm from the I/I.
3. Backscatter
In fluoroscopy the backscatter is included in the reading, however for any radiographic exam the
backscatter must be eliminated from the reading, as per HARP standard. See Automatic Exposure Control
- Section 5 for the Backscatter Table.
Automatic Brightness Control (ABC)
The fluoroscopic automatic brightness control is designed to produce an acceptable image regardless of
patient thickness. This is done by a feedback system which monitors the brightness of the output and
controls the x-ray generator to adjust kilovoltage, mA or both.
The simplest method to check for proper automatic brightness control (ABC) operation is to measure the
exposure at a fixed point as various thicknesses of phantom material are successively placed in the x-ray
beam. The rate should increase with additional thickness until the maximum allowable exposure rate is
reached. At this point the rate should remain constant even though thickness is increased.
If you prefer, ABC testing can be done while testing for Patient Entrance Exposure (PEE) and maximum
dose measurements. Simply record the changes in output, mA and kVp when changing the phantom from
20 cm of water to water plus lead.
Determining AUTO (ABC) Functions
Equipment
Dosemeter
Phantoms:
copper sheets or 5, 10 and 20 cm of water or several pieces of plexiglass lead - 1/8" thickness
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Support blocks or stand
Procedure
Position the dosemeter on the x-ray table with the thinnest phantom available above or below the
dosemeter, depending on the type of x-ray machine. The dosemeter is always placed toward the
side of the x-ray tube. Therefore with Under Table tube systems, the dosemeter is placed under the
phantom and with Over Table tubes the dosemeter is placed above the phantom.
1.
Expose using fluoroscopy. Collimate to adjust the x-ray field size to the size of the phantom used.
Ensure that the dosemeter is seen in the middle of the viewing apparatus (TV or mirror). Record the
following:
(e) intensifier size (I/I).
(f) kVp set and kVp indicated at time of fluoroscopy.
(g) mA set and mA registered at time of fluoroscopy.
(h) phantom used.
(i) measured output in R/min
2.
Change the phantom thickness by adding copper or going to next largest phantom available. 3.
Expose using fluoroscopy and record information as in step 2. 4.
Increase the phantom by adding lead. Expose using fluoroscopy and record as above. 5.
Return to the original phantom and repeat to ensure reproducibility. 6.
Evaluate as follows:
If there is no change in output, kVp and mA then the unit is a manual system by which the operator
must adjust the kVp and mA to obtain an optimum image while using fluoroscopy. Therefore, if you
increase the kVp and/or mA the output must follow. Increase the kVp then the mA and note the
dose. The output should increase as the kVp and mA increase. If the output does not increase,
check with the service company and have the unit serviced.
Return to original values. Ensure the output is the same as it was prior to testing.
A.
If there is a change in output the unit is operating automatically with either:
auto kVp and manual mA, or i.
auto mA and manual kVp, or ii.
auto kVp and auto mA. iii.
This can be determined by simply noting which values changed (kVp, mA or both) when increasing
the phantom size.
B.
Note: While carrying out this test, verify that the output is reproducible. Also note, if the image stabilizes
quickly and maintains it's stability. If not, there might be a problem with the ABC stabilizing functions and
this should be serviced.
Patient Entrance Exposure (PEE) in Fluoroscopy
Standard
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Section 17 (4b and 5b) of the HARP Regulation states:
"(4) The exposure rate limits of a fluoroscopic x-ray machine that uses a zinc cadmium
sulphide input phosphor or a phosphor of similar efficiency calculated where the centre of the
useful beam enters the patient at the shortest target-to-skin distance specified for the
machine shall not exceed,
(b) an entrance exposure rate of five roentgens per minute for an average
patient represented for test purposes by a twenty centimetre water phantom.
(5) The exposure rate limits of a fluoroscopic x-ray machine that uses a cesium iodide input
phosphor or a phosphor of similar efficiency calculated where the centre of the useful beam
enters the patient at the shortest target-to-skin distance specified for the machine shall not
exceed,
(b) an entrance exposure rate of 2. 5 Roentgens per minute for an average
patient represented for test purposes by a twenty centimetre water phantom."
Under-Table X-ray Tube
Equipment
20 cm of water in a plastic container
Radiation dosemeter that will measure in R/min.
Tape measure
Ionization chamber holder or rigid foam block or support blocks
1/8" lead plate
Procedure
The PEE is measured using 20 cm of water. The bottom edge of the I/I (carriage) is 30 cm from the table.
See diagram.
Figure 6-1 Under-Table Tube Setup
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Set the fluoroscopy mode and the technique factors normally used for an
abdomen exam. Eg. upper G.I..
1.
Position the bucky tray at the foot end of the table so that it will be out of the
x-ray beam. Ensure that the bucky slot cover is in position.
2.
Position the dosemeter detector on the table top, away from the bucky. (Middle of
table is always best).
3.
Position the support blocks to ensure that when the phantom is placed over the
dosemeter no pressure will be exerted on the detector. However, the dosemeter
should be as close as possible to the water. The support blocks should not be
much thicker than the dosemeter.
4.
Place the 20 cm water phantom on the support blocks over the dosemeter. 5.
Position the I/I 30 cm above the table top. Secure the vertical lock. See Figure
6-1.
6.
Position the scatter curtain (and table board if applicable) to provide maximum
protection to the operator.
7.
Expose using fluoroscopy. With the use of the image either on the television or
mirror, adjust the x-ray unit so that the centre of the detector is to the centre of
the viewing area (I/I). Lock the carriage in position.
8.
Collimate, so that the shutters are barely seen at the edges of the field of view.
For systems with an I/I greater than the size of the width of your phantom, you
will need to collimate to the edges of the water phantom. This is to ensure that
the I/I is not subject to any primary beam which would alter the dose reading,
especially if there are any ABC functions.
9.
Expose using fluoroscopy and record the output, kVp and mA. Repeat three
times. As long as the output is reproducible then the average of these three
measurements is the PEE in R/min. If the unit is not reproducible then it must not
be used until it is serviced. See General Radiograph - Section 4 for
reproducibility standard.
10.
Repeat steps 9 and 10 on all MAG views as well as on High Level control (if
applicable).
11.
Evaluate as follows:
The PEE rate must not exceed 2.5 R/min on the most commonly used I/I size. For special views using
MAG mode or high level, the dose can be higher.
Continue testing for maximum fluoroscopic dose/rate.
Over-Table Tubes
Equipment
20 cm of Water
Tape Measure
Ionization Chamber Holder (stand)
l/8" Lead Plate
Procedure
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The PEE measurement is taken at 21 cm from the table top. The maximum dose rate is measured at 30
cm from the table top.
See diagram.
Figure 6-2 Over-Table Tube
Place the 20 cm water phantom on the table under the x-ray tube. The
radiographic collimation light field is useful to centre and collimate the x-ray field
to the water phantom.
1.
Place the dosemeter in its holder (stand) and position it over the water phantom
at its centre. The dosemeter should be as close as possible to the water
phantom. See Figure 6-2.
2.
Select the fluoroscopy mode and fluoroscopy technique factors normally used
Position the x-ray tube at the target-panel distance most commonly used.
3.
5
If the fluoroscopy machine is used for both general fluoroscopy and special
procedures, the PEE should be measured for both types of examinations.
From the remote control, use fluoroscopy to align the dosemeter, phantom and I/I
so that the dosemeter is in the middle of the viewing apparatus (monitor).
4.
Collimate, so that the shutters are barely seen at the edges of the monitor's field
of view. For systems with I/I greater than the size of the width of your phantom,
you will need to collimate to the edges of the water phantom. This is to ensure
that the I/I is not subject to any primary beam radiation which would alter the
dose reading, especially if there is any ABC functions. Always use the largest
x-ray field size in keeping with the phantom size.
5.
Expose using fluoroscopy. Record dose rate, kVp and mA. Repeat three times.
As long as the output is reproducible then the average of these three
measurements is the PEE in R/min. If the unit is not reproducible, then it must
not be used until it is serviced. See General Radiography - Section 4 for
reproducibility standard.
6.
Repeat step 6 on all MAG views as well as on High Level control (if applicable). 7.
Evaluate as follows:
The PEE rate must not exceed 2.5 R/min on the most commonly used I/I size. For special views using
MAG mode or high level, the dose can be higher.
Continue testing for Maximum Fluoroscopic Dose Rate.
C-arms
Equipment
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20 cm of Water
Tape Measure
Ionization Chamber Holder
1/8" Lead Plate
The PEE and Maximum Dose rate are both measured at 30 cm from the I/I unless indicated otherwise by
the RPO or dictated by the way the C-Arm is used.
If the unit has the capability of pulse fluoroscopy, we recommend that the PEE be measured with the pulse
mode OFF to determine the PEE accurately. You may attempt to measure the dose rate on pulse mode,
but keep in mind, this measurement may be inaccurate. It will all depend on how accurately the dosemeter
can respond to the "ON" and "OFF" of the radiation during pulse fluoroscopy.
Procedure
Figure 6-3 C-Arm Setup
Set the C-Arm as it normally is used. 1.
If a C-arm is used in a fixed fashion with a particular patient support device,
position this device (bed, OR table, etc.) in place. If a support device is not used,
proceed to step 5.
2.
Place the water phantom on the support device. If the C-arm is used with the
x-ray tube above the table, position the dosemeter above the water as close as
possible to the water phantom. If the x-ray unit is used with the x-ray tube under
the table, position the dosemeter under the water phantom with the help of the
support blocks. Note, the dosemeter must always be located on the x-ray tube
side of the water phantom.
3.
Position the C-Arm as it normally would be used. If used at a fixed distance then
measure the PEE at that distance. If the unit is used at several distances then
measure the PEE at 30 cm from the I/I. Use fluoroscopy to collimate the x-ray
field to the edges of the water phantom or to the edges of the I/I, whichever is
greatest. Proceed with evaluation
4.
When a patient support device is not routinely used, the PEE is to be measured
30 cm from the I/I unless indicated otherwise. Ensure that the I/I is nearest the
floor. Lower the I/I very carefully until it reaches the floor.
6
Place the water
phantom on the I/I.
5.
6
To protect the I/I, ensure that a cushion (eg. sand bag, foam cushion, etc.) Is
placed between the 1/I and the floor. This will provide protection and give the I/I
more support when the water phantom is placed on top of it.
Expose using fluoroscopy, collimate the x-ray field to the edges of the water
phantom or to the edges of the I/I, whichever is greatest. Measure the PEE rate
at 30 cm from the face of the I/I. This can be done two ways:
6.
Position a 9 to 10 cm rigid foam block on the face of the I/I. Place the 20
cm water phantom on top of it. Place the dosemeter on top of phantom
and as close to the water as possible.
Note: to carry this out you might need a side table to rest the dosemeter
and the stand on
i.
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or
Position the water phantom directly on the face of the I/I. Place the
dosemeter on top of the water phantom and as close to the water
phantom as possible. Record the distance from the target to the
dosemeter and the target to the I/I. Once the output is known, use the
inverse square law to determine the dose rate at 30 cm from the I/I.
Inverse Square Law:
(Target - dosemeter distance)
2
x (Dose rate measured)
(Target - I/I distance minus 30 cm)
2
ii.
Expose using fluoroscopy. Record dose rate, kVp and mA. Repeat three times.
As long as the output is reproducible then the average of these three
measurements is the PEE in R/min. If the unit is not reproducible, then it must
not be used until it is serviced. See General Radiography - Section 4 for
reproducibility standard.
7.
Repeat on MAG modes and high level control (if applicable). 8.
Evaluate as follows:
The PEE on the most commonly used I/I size at 30 cm from the face of the I/I, or as used, must not
exceed 2.5 R/min. On MAG modes and high level it is permissible to exceed this limit.
Continue testing for maximum output, HVL, kVp, etc. See the following.
Radiographic/AEC Option with C-arms
If the radiographic mode is used with the C-Arm, then all radiographic PEEs used must be measured.
Also, test for Half-Value Layer (if not already done in the fluoroscopy mode) radiographic kVp, timer
accuracy and proper collimation. See General Radiography - Section 4 for standards.
If the C-Arm offers the possibility of phototiming in the radiographic mode and is used, the phototiming
parameters must also be checked. See Automatic Exposure Control - Section 5.
Special Procedure Units
AP and Lateral Tubes
See diagram for C-arms &/or remote units.
As these units are used at several different distances and angles, to establish consistency from test to test
and ensure accuracy in dose measurements we recommend:
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Seeking advice from the RPO set the protocol to follow when measuring radiation doses with these
type of units and/or,
1.
For AP tubes, selecting 102 cm (40") target to I/I distance and measuring the PEE at 21 cm from
the I/I and the maximtun dose rate at 30 cm from the I/I. For the lateral tubes, we recommend that
both the average dose rate and maximum dose rate be taken at 30 cm from the I/I with the target to
I/I distance of 102 cm (40").
2.
If the unit has the capability of pulse fluoroscopy, we recommend that the PEE be measured with the pulse
mode "OFF" to determine the PEE accurately.
You may attempt to measure the dose rate on pulse mode, but keep in mind, that this measurement may
be inaccurate. It will all depend on how accurately the dosemeter can respond to the "ON" and "OFF" of
the radiation during pulse fluoroscopy.
Note: if the frame rate at which the pulse mode is set in fluoroscopy is known, you may wish to
mathematically calculate the PEE for the pulse mode by using the dose reading taken with the pulse mode
"OFF".
AP Tubes
Procedure
Set up the fluoroscopy machine so that the distance from the x-ray tube target to the face of the I/I
is 102 cm (40"), or at the distance most commonly used and identified by the RPO. Select the
technique most commonly used with the pulse mode "OFF."
1.
Place the 20 cm water phantom on the floating table (support blocks may be required if the xray
tube is under the floating table). Position the dosemeter in place. The dosemeter must be on the
x-ray tube side of the water phantom.
2.
Adjust the height of the floating table so that the dosemeter is approximately 21 cm from the face of
the I/I. All PEE (fluoroscopy, digital, cine etc.) will be recorded at this distance. The maximum output
will be recorded with the dosemeter at 30 cm from the face of the I/I.
3.
Expose using fluoroscopy. Adjust the table so that the dosemeter, water phantom and I/I are all
aligned. The dosemeter should appear to be in the middle of the TV screen.
4.
Collimate, so that the shutters are barely seen at the edges of the monitor's field of view. For
systems with I/I greater than the size of the width of your phantom, you will need to collimate to the
edges of the water phantom. This is to ensure that the I/I is not subject to any primary beam
radiation and hence alter the dose reading, especially if there are any ABC functions. Always use
the largest x-ray field size in keeping with the phantom size.
5.
Expose using fiuoroscopy and record the output (fluoroscopy kVp and mA). Repeat three times. As
long as the output is reproducible then the average of these three measurements is the PEE in
R/min. If the unit is not reproducible, then it must not be used until it is serviced. See General
Radiography - Section 4 for Reproducibility Standard.
6.
Repeat steps 5 and 6 on all MAG views as well as on high level control (if applicable). 7.
Evaluate as follows:
The PEE rate must not exceed 2.5 R/min on the most commonly used I/I size. For special views
using MAG mode or high level control, the dose rate can be higher.
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Maximum Fluoroscopic Dose
Add copper sheets to the water phantom so that these are placed between the water phantom and
the I/I. Expose using fluoroscopy and record kVp, mA and dose.
8.
Add the lead plate to the water phantom and copper. Ensure that the lead is wide enough to cover
the entire I/I size so that no radiation is picked up by the I/I.
9.
Expose using fluoroscopy and record the output, kVp and mA. With automatic units the addition of
the copper and lead will drive the kVp and/or the mA to its maximum value.
10.
Note: When performing maximum fluoroscopy output, ensure that all controls that effect the outputs
are on maximum value. Eg. this is normally described somewhere on xray control panel or other
panels such as (2X), (I)(II)(III), low to high gain, brightness control, mAl.mA2.mA3, picture of a light
bulb (I/I) emitting rays etc.
To verify that the maximum setting has been reached, close the shutters, expose using fluoroscopy
and record the kVp and mA. These values should be the same as those recorded in step 10 above.
If it varies by more than 20%, then it is possible that not enough lead was added in step 9. Reopen
the shutters and repeat step 9 with additional lead sheets. Ensure that the lead covers the entire I/I.
11.
If high level control is available, switch "ON" and. measure maximum output. 12.
Return to original phantom and all other features as used for PEE. Expose using fluoroscopy and
ensure that kVp, mA and dose rate return to original values in PEE measurements.
13.
Evaluate as follows:
Whether on normal I/I size or on magnification the maximum output must not exceed 10 R/min unless the
unit is on HIGH LEVEL control for which no maximum has been legislated.
Lateral Tubes
Lateral tubes ("B" plane), can be a bit of a challenge to test simply because you have to work sideways
and must always ensure that the water phantom is always 20 cm in width. If possible, it is acceptable to
carry out the test of the "B" plane in the "A" plane position. Test the "A" plane first, then replace it with the
"B" plane, except measure both average dose and maximum dose rate at 30 cm from the I/I. If for any
reason this is not acceptable or impossible to do then refer to the description on testing Lateral tubes.
Procedure
Set up the fluoroscopy machine so that the distance from the x-ray tube target to the face of the I/I
is 102 cm (40"). Position in a lateral position across the table.
1.
Place the water phantom on the table between the x-ray tube and I/I. Position the dosemeter with
the help of a stand so that:
2.
It is located in mid line of the water phantom A.
It is as close as possible to the water phantom B.
It is toward the x-ray tube side of the water phantom. C.
Adjust the floating table (and water phantom if necessary) so that the dosemeter is approximately
30 cm from the face of the I/I. Record all PEE measurements (fluoroscopy, digital, cine etc.) at this
distance.
3.
Expose using fluoroscopy and with the use of the imaging system (TV monitor) make final
adjustments to ensure that the dosemeter, water phantom and I/I are all aligned. The dosemeter
should appear to be in the middle of the screen.
4.
Collimate, so that the shutters are barely seen at the edges of the monitor's field of view. For 5.
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systems with I/I greater than the size of the width of your phantom, you will need to collimate to the
edges of the water phantom. This ensures that the I/I is not subject to any primary beam radiation
that alters the dose reading, especially if there are any ABC functions. Always use the largest x-ray
field size in keeping with the phantom size.
Expose using fluoroscopy and record the output, fluoroscopy dose, kVp and mA. Repeat three
times. As long as the output is reproducible then the average of these three measurements is the
PEE in R/min. If the unit is not reproducible, then it must not be used until it is serviced. See
General Radiography - Section 4 for Reproducibility Standard.
6.
Repeat step 6 on all MAG views as well as on high level control (if applicable). 7.
Evaluate as follows:
The PEE rate must not exceed 2.5 R/min on the most commonly used I/I size. For special views using
MAG mode or high level control, the dose can be higher.
Continue testing for maximum fluoroscopic dose/rate, see step 8 under AP tubes.
Pulse Fluoroscopy Mode
Please see Fluoroscopy - Section 6 for general information.
Patient Entrance Exposure (Spot Film/Camera) for Radiography
Photofluorography (70, 100 and 105 mm Cameras)
Equipment
See Fluoroscopy - Section 6 for Patient Entrance Exposure setup.
Note: Patient Entrance Exposure for cameras is measured per frame.
Procedure
The procedure continues from the last test performed under PEE in fluoroscopy. The water phantom and
dosemeter are in place with the collimation properly adjusted to I/I or the outer edges of the water
phantom.
Select a single frame. If this is not possible, select the most common exposure series used. 1.
Check that camera is loaded with film and select the technique most commonly used for a 23 cm
patient for an upper GI exam or an abdomen examination most commonly done in that room.
2.
Record the radiographic or camera kVp, mA, density selected. Take an exposure and record the
dose. Note: if it is not possible to take a single exposure, then turn to procedure explained in the
section on Cine regarding how to determine PEE.
3.
Repeat the above technique twice to check for reproducibility. Reproducibility must meet HARP
standards. See General Radiography - Section 4 for reproducibilty standard. If reproducible, the
4.
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PEE is the average of these 3 exposures with the back scatter factor applied.
Test all other AEC functions (if applicable) such as density control and kVp response, etc. See
Automatic Exposure Control - Section 5.
5.
Develop the x-ray film. 6.
Note: The film can be developed at the end of the testing procedure since films of the resolution test tools
must also be taken later.
Evaluate as follows:
Check the density on several films to ensure consistency and reproducibility. For 100 and 105 cameras
the PEE must not exceed 200 mR with the backscatter factor applied. See Automatic Exposure Control -
Section for the Backscatter Table.
All other phototiming parameters must meet HARP and internal quality assurance standards.
Cine
These PEE are measured and recorded as dose per frame.
The difficulty is to have a dosemeter that can respond quickly enough to measure the dose for each frame
during a run, or that can measure the total output without being affected by the "ON" and "OFF" of the
x-rays during a run. Also, it may be difficult to eliminate the first several exposures (scouts) which are used
by the x-ray unit to set the appropriate kVp and mA. If this is the case, then take a run of at least 5
seconds and include the scout measurements in the dose reading. The percentage of effect that the scout
measurements could have on the final reading in dose per frame will be negligible. If there is a freeze or
hold function, use it to eliminate the scout exposure in the 2nd run and use this 2nd or 3rd run to calculate
PEE/frame.
Procedure
The procedure continues from the last test performed under PEE in fluoroscopy. The water phantom and
dosemeter are in place with the collimation properly adjusted to I/I or the outer edges of the water
phantom.
Select the most common exposure frame rate used. 1.
Ensure there is a label or marking on the water phantom that will permit you to identify each run
once the film is developed. Eg. you could use one penny for the first run, two pennies for the
second run and so on. The use of lead numbers is even better.
2.
Set the dosemeter to read accumulated dose and total dose per run. Expose using Cine for
approximately 3 seconds with newer units and 6 seconds for older equipment. This is to allow
sufficient time for the ABC to stabilize. If a freeze or hold function is available, use it once kVp and
mA have stabilized. Repeat the run with the freeze "ON" to record dose.
3.
Record kVp, mA, frame rate used and the dose. If your dosemeter has the capability to record time
of exposure, record this as well. Repeat to check for reproducibility. From these measurements
calculate the PEE per frame.
4.
Develop the film and count the number of frames exposed for each run and divide this into the dose
reading recorded for that particular run as a double check to step 4.
5.
If magnification is frequently used, repeat the PEE on all magnification modes used and record the
results.
6.
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When a unit is first installed, we suggest that the maximum dose per frame be determined. This can
be achieved by adding 1/8 of inch lead in from of the I/I. PLEASE carry out this test only once, not
every six months. This information is to be recorded in the facility's quality assurance manual so
that it can be used in the event of an accident to calculate the dose a patient received.
7.
Evaluate as follows:
No specific standards have been established. However, our inspections have shown that the exposure can
vary between 12 and 25 mR/frame with the backscatter factor applied. See Automatic Exposure Control -
Section 5 for the Backscatter Table.
Digital X-ray Systems
The object here is to determine the PEE exposure per frame. Similar to techniques previously described
for cine and camera.
Procedure
The procedure may continue from the last test performed under PEE in fluoroscopy. The water phantom
and dosemeter are in place with the collimation properly adjusted to the I/I or the outer edges of the water
phantom.
Set the fluoroscopic machine to digital mode. With the newer units, it is possible to select 1 frame at
a time. If this is available, choose it and follow steps described to test PEE for the camera. If not
possible then choose the frame rate most commonly used.
1.
The difficulty is to have a dosemeter that can respond quickly enough to either measure the dose
for each frame during a run, or measure the total output accurately without being affected by the
"ON" and "OFF" of the x-ray during a run. Select the dosemeter to read an accumulated dose (total
dose).
2.
Take a run and try to measure output without the scout exposures. With some units this can be
achieved by setting sufficient time, between the scouts and the actual run, to give you enough time
to set the dosemeter "ON" at the start of the run. Record the dose and simply divide this by the total
number of exposures (frames) used for this run. The computer of the digital system will give the
total number of frames used. If the scout films at the beginning of the run cannot be separated from
the reading, then take a run of at least 10 exposures and include the scout measurements in your
reading. With more than ten exposures, the percentage of effect that the scout measurements could
have on the final reading of the dose per frame will be negligible.
3.
Evaluate as follows:
Determine the PEE per frame by dividing the total output (mR) by the number of frames (backscatter
factors must be applied). No standards for digital exposures have been established. However, at the XRIS
we have noted that the PEE based on a 20 cm water phantom can vary anywhere from 60 mR to 600 mR
per frame. This test is performed for information only and should be repeated every six months as part of
the routine quality assurance program to ensure consistency.
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Repeat the test on magnification mode (if applicable and if the unit is used that way). 4.
The automatic function can also be checked by varying the amount of water and/or adding copper
to the water phantom.
5.
Resolution should also be checked with an appropriate phantom. 6.
Maximum Fluoroscopy Output
The object of this test is to measure the output in R/min at the maximum kVp and mA values that the x-ray
unit can attain.
Note: When performing maximum output testing always bear in mind the tube rating and follow it.
For ABC systems, to drive the unit to it's maximum kVp and mA potential, increase the phantom until the
maximum kVp and mA values are reached. For partial ABC systems, where only one value (either the kVp
or mA) is automatic it will be necessary to add lead to drive the auto function to its limit and manually
select the maximum value of the one parmeter that is not automatic. Also, when performing maximum
fluoroscopy output, ensure all controls that effect the outputs are on maximum value, eg. this is normally
described somewhere on x-ray control panel or other panels such as (2X), (I) (II) (III), low to high gain,
brightness control, mA1, mA2, mA3, picture of a light bulb (I/I) emitting rays etc.
Standard
Section 17 (4a and 5a) of the HARP Regulation states:
(4) The exposure rate limits of a fluoroscopic x-ray machine that uses a zinc cadmium
sulphide input phosphor or a phosphor of similar efficiency calculated where the centre of the
useful beam enters the patient at the shortest target-to-skin distance specified for the
machine shall not exceed,
(a) a maximum exposure rate of 12.5 roentgens per minute; and
(5) The exposure rate limits of a fluoroscopic x-ray machine that uses a cesium iodide input
phosphor or a phosphor of similar efficiency calculated where the centre of the useful beam
enters the patient at the shortest target-to-skin distance specified for the machine shall not
exceed,
(a) a maximum exposure rate of 10 roentgens per minute;"
Equipment
Copper Sheets
Lead block (at least 1/8" thick)
20 cm water phantom Support blocks, stand
Measuring tape
Under Table / Over Table Systems with ABC
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Procedure
The procedure continues from the last test performed under PEE whether it's an under table, remote
system or c-arm. The water phantom and dosemeter are in place with the collimation properly adjusted to
the I/I or the outer edges of the water phantom.
Add two sheets of copper to the water phantom such that these are in between the water and the
I/I. Use fluoroscopy to expose, record output, kVp and mA
7
1.
7For a fluoroscopy unit equipped with automatic brightness control, the output will increase accompanied
by an increase in one or both of kilovoltage and milliamperage.
Add the lead plate to the copper and water such that the lead is in between the water and the I/I.
Ensure that the lead is positioned such that no radiation is picked up by the I/I. Note: the reason the
lead is placed between the water and I/I is to not eliminate the back scatter radiation from the
reading. The back scatter must be included in this reading.
2.
Use fluoroscopy to expose and record the output, kVp and mA.
8
3.
8If the output, kVp and mA do not change, the fluoroscopy unit is operating in manual mode. Refer
to the procedure previously mentioned.
If the system has one parameter that is manual, for example, Auto kVp with manual mA or Auto mA
with manual kVp, then to complete this test, adjust the manual feature to its maximum value. When
performing Maximum Fluoroscopy output, ensure that all controls that effects the outputs are on
maximum value, eg. this can be described somewhere on x-ray control or other panels such as
(2X), (I) (II)(III), Low to high gain, brightness control, mA1, mA2, mA3, picture of a light bulb(I/l)
emitting rays etc.
4.
If high level is available, repeat the test with it "ON." 5.
For over table tube systems calculate the maximum dose rate at 30 cm from the table top. Use the
inverse square law. Return all technique factors to their original values.
6.
Evaluate as follows:
Ensure that maximum dose rate does not exceed 10 R/min. unless it's on High Level or cesium iodide
input phosphor.
To double check that the maximum outputs have been reached, close the shutters, use fluoroscopy and
record the kVp and mA. The kVp and mA should remain the same as in step 3 above. If there is a
variance greater than 20%, it could be that the maximum values were not reached when shutters were
open in step 2. Therefore, repeat step 2 with additional lead.
Manual Systems
Procedure
The procedure continues from the last test performed under PEE. Water phantom and dosemeter are in
place with the collimation properly adjusted to I/I or to the outer edges of the water phantom.
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The use of additional lead is optional.
To determine the maximum output for manual systems you must select, the maximum fluoroscopy kVp
and mA. When performing this test, ensure that the tube rating of the xray machine is not exceeded. After
completing this test, ensure that the kVp and mA are returned to their original settings.
Set the mA at maximum. 1.
Set kVp at maximum. 2.
Ensure that the tube rating is not exceeded. 3.
Expose using fluoroscopy and record the output, kVp and mA. 4.
Evaluate as follows:
The maximum output must not exceed 10 R/min for cesium iodide input phosphors.
C-arms and Special Procedure
With C-arms, Remotes and special procedural units the maximum dose rate is not measured at the
shortest target to skin distance. The exposure should be measured at 30 cm from the I/I.
Half-Value Layer
Standard
Section 9(3b) of the HARP Regulation states:
"Every diagnostic x-ray machine shall be provided with filters that,
are located in the exit port of the x-ray tube housing or beam limiting device or both, i.
intercept the entire useful beam. and ii.
at a measured potential set out in Column 1 of Table 8 with a thickness of aluminum set out
opposite thereto in Column 2 of Table 8, reduce the exposure at least by half R.R.O. 1990
Reg. 543, s. 9."
iii.
Table 8
Item COLUMN 1 COLUMN 2
Measured Potential
(kilovolts peak)
Minimum
Half-Value Layer
(millimetres of
aluminum)
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1. 30 0.3
2. 40 0.4
3. 49 0.5
4. 50 1.2
5. 60 1.3
6. 70 1.5
7. 71 2.1
8. 80 2.3
9. 90 2.5
10. 100 2.7
11. 110 3.0
12. 120 3.2
13. 130 3.5
14. 140 3.8
15. 150 4.1
Notes:
To ensure accurate results, HVL should be compared against measured kVp. 1.
If an automatic fluoroscopy unit can be used in manual mode, do so. It is much easier to maintain
the kVp and mA constant throughout the test.
2.
For remote units and C-arms, perform the HVL test in the radiographic mode if possible. The
filtration does not change when the same tube is used in different functions. (Unless the filtration is
changed purposely).
3.
Perform the HVL test in the kVp range routinely used with that particular unit. 4.
With some ABC units you may find that the aluminum filters and copper alone are not sufficient a
phantom to drive the kVp/mA in the range required. In these cases, build up your phantom with
either the use of aluminum blocks used for resolution testing or with plexiglass. Ensure that this
additional phantom material is placed between the dosemeter and the I/I.
5.
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Equipment
Dosemeter with the ability to read in the rate mode
Several aluminum sheets (type 1100), 1.0 and 0.5 mm thicknesses
Copper sheets or the aluminum blocks used for low contrast testing
Masking tape
Tape measure
Conventional Under-Table Tube -- Manual kVp and Manual mA
Procedure
Tape one sheet of copper to the underside of the I/I. This protects the I/I. 1.
Position the dosemeter on the table top. Expose using fluoroscopy. Centre the dosemeter to the
x-ray beam and collimate to a 10 cmx 10 cm field size at the table. Maintain the I/I to table top
distance of 30 cm or collimation should be adjusted to the size of the aluminum filters.
2.
Select a kilovoltage that has already been assessed for accuracy if possible. 3.
Expose using fluoroscopy and record the output. Repeat. The average is now the zero reading. 4.
Insert 3.0 mm of aluminum between the dosemeter and table. 5.
Expose using fluoroscopy and record the output. 6.
Evaluate as follows:
If the half-value has not been reached, insert an additional 1.0 mm aluminum and repeat. Keep adding
filtration until the half-value has been reached or surpassed. If the half-value has already been reached,
remove 1.0 mm aluminum and repeat the exposure. Measure at least one step above and one below the
half-value mark. Refer to Table 8 of the HARP Regulation and ensure the half-value is equal to or more
than that stipulated in Table 8. If the HVL is not sufficient for the kVp tested, additional filtration must be
added to the x-ray tube and the test repeated.
Under-Table Tubes - Automatic Responding Systems (ABC)
ABC systems are designed to alter radiation output with any corresponding changes to patient or phantom
thickness. With this in mind, the addition of aluminum filters while performing HVL testing will affect the
kVp and/or mA and thus the output. The zero reading will consistently change as filtration is added,
rendering the test result unacceptable. In order to perform HVL testing with ABC systems, you must find a
means to keep the kVp and mA constant throughout the procedure. That is why we suggest that all the
aluminum filters be placed between the dosemeter and I/I when first taking the zero reading. Then remove
some of the filters and place them between the dosemeter and x-ray tube. This allows the input phosphor
of the I/I to always see the same phantom and hence keep the kVp and mA constant throughout the
testing procedure.
Procedure
Position the dosemeter on the table top. 1.
Support the copper sheets above the dosemeter or tape them to I/I in order to protect the I/I. 2.
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Place 4.5 to 5.0 mm of aluminum directly above the dosemeter. You may need to add the copper as
well as the aluminum blocks used in resolution testing in order to create a phantom sufficient to
increase the kVp and mA at an acceptable value.
3.
Expose using fluoroscopy, centre the aluminum and dosemeter, collimate to filters and maintain the
I/I to table distance at 30 cm.
4.
Expose using fluoroscopy. Record the output, kVp and mA. 5.
Remove 3.0 mm of aluminum from the stacked aluminum above the dosemeter and place it under
the dosemeter.
6.
Expose using fluoroscopy, and record the output, assuring that the automatic functions (kVp and
mA) did not change. Also, make sure that the alignment between the x-ray system and dosemeter
did not change.
7.
Evaluate as follows:
If the half-value for the kilovoltage tested has been reached or passed, then remove 1.0 mm of aluminum
from below the dosemeter and place it back above the dosemeter. Repeat the exposure. Reassess. Keep
removing filters from below the dosemeter and placing them on top of dosemeter until the half-value has
been reached or passed.
If the half-value has not been reached, then place another 1.0 mm alnminnm from the top of the
dosemeter under the dosemeter. Repeat the exposure and reassess.
Measure at least one step above and one below the half-value mark.
Refer to Table 8 of the HARP Regulation and ensure the half-value is equal to or more than that stipulated
in the Table. If the HVL is not sufficient for the kVp tested, additional filtration must be added to the x-ray
tube and the test repeated.
Remote units and C-Arm
Test the half-value in the radiographic mode. See General Radiography - Section 4 for Halfvalue Layer.
In the event the unit cannot be used in the radiographic mode then refer to the following procedure.
Procedure
Place all filters on the table top for remote units or on the face of the I/I with C-Arm. Position the
dosemeter 30 cm from the table top or I/I. You may need to add the copper as well as the aluminum
blocks used in resolution testing in order to create a phantom sufficient to increase the kVp and mA
at an acceptable value.
1.
Centre and align the dosemeter, filters and I/I. Collimate to the filters. 2.
Expose using fluoroscopy and record kVp, mA and dose. 3.
Take 3.0 mm of aluminum filters from the table or I/I and tape these to the end of the collimator
ensuring that they completely intercept the x-ray beam.
4.
Expose using fluoroscopy and record kVp, mA and dose. 5.
If the half-value has not been reached, insert an additional 1.0 mm alminum taken from table top or at I/I
and repeat. Keep adding filtration until the half-value has been reached or passed. If the half-value has
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already been reached, remove 1.0 mm aluminum at the collimator and return to the stacked filters on the
table top or I/I and repeat the exposure. Measure at least one step above and one below the half-value
mark.
Evaluate as follows:
Refer to Table 8 of the HARP Regulation to ensure the half-value is equal to or more than that stipulated in
the Table.
If the HVL is not sufficient for the kVp tested, additional filtration must be added to the x-ray tube and the
test repeated.
Beam Alignment and Maximum X-ray Field Size
The following tests are performed to:
Verify that the maximum x-ray field size is within the size of the I/I. 1.
Verify that the x-ray tube and I/I are properly aligned. 2.
The beam alignment and collimation tests are performed with the x-ray tube and the I/I set at the distance
routinely used as per the PEE setup.
Standard
Section 17 (l f ii) of the HARP Regulation states:
"Every fluoroscopic x-ray machine shall be equipped with an x-ray beam limiting device that
aligns the x-ray field with the image receptor in such a manner that the x-ray field is always
confined within the boundaries of the image receptor."
Figure 6-4 Placement of Collimator and Beam Alignment Test Tool
Equipment
Beam alignment test tool Level
14 x 17" loaded cassette
Measuring tape
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Testing for Beam Alignment
Under Table Tube and Remote Fluoroscopy
The beam alignment test tool is a plastic cylinder approximately 12 cm tall with a 1/16" diameter steel ball
at each end. The steel ball located at the top is directly above the one in the base. The collimator test tool
is a fLat, plastic plate with a rectangular outline and markings etched on its surface in copper.
Procedure
Tape a penny in the lower right quadrant of the collimation plate. The penny will act as a marker,
later identifying the direction of any shift of the x-ray field when assessing the results later.
1.
Ensure that the table is level, place the beam alignment cylinder on the collimation plate so that the
steel ball in the base of the cylinder is directly over the centre of the plate. Position this on the x-ray
table and centre it with the fluoroscopy system.
2.
For a manual fluoroscopy system, use the following technique factors: 3.
60 kVp, 0.5 mA
Automatic systems should be able to adjust the kVp and mA at appropriate level, if not then
override the ABC functions and use the manual mode.
For under table tube systems position the I/I carriage 30 cm above the table top. For remote units,
use the target to I/I distance normally used.
4.
Expose using fluoroscopy and adjust the position of the fluoroscopy system until the two steel balls
of the beam alignment test tool converge and appear to be one spot on the viewing system (TV or
Mirror). This point identifies the central ray.
5.
Open the fluoroscope shutters fully or to the collimation plate, whichever is greatest. 6.
Expose using fluoroscopy and note the collimation plate numbers seen at the outer edges of the
viewing apparatus. Also, note the position of the penny. Take a camera (cine, 70, 100 or 105 mm)
exposure of this if available. Ensure that the camera kVp is set in the 60 to 70 kVp range.
7.
Repeat steps 4 - 7 above on all magnification modes, if so equipped. Develop the camera film. 8.
Continue testing for maximum x-ray field size.
Evaluate as follows:
On the TV or mirror system the position of the two steel balls (now appearing as one) should be located in
the middle of the screen. This indicates good alignment between the x-ray tube, I/I and TV camera. The
same applies for camera film. The two steel balls should appear as one in the middle of the film.
If the two steel balls (now appearing as one) are off to one side of the screen, then the x-ray tube and I/I
are probably not aligned properly. Allow an error of up to 3% of the source image distance (SID) in shift. If
the error is greater than this, the unit must be serviced to correct the misalignment.
Testing for Maximum X-ray Field Size
Continued from previous test.
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If automatic collimation is used then the test is to be done with automatic collimation "ON."
Under Table Tube Systems
Maintaining the position of the I/I carriage from the above test, open the shutters to their maximum
capability. Hold a 14 x 17" cassette at the surface of the carriage and expose using fluoroscopy for
a split second
9
. Repeat this step for all magnification modes available, on the same film if you so
wish. You may need to repeat this test a few times to get the proper density on the film.
9.
9
Lead gloves must be worn for personal protection.
Remote Units
Place the loaded cassette on the table top directly over the I/I. Use the collimator's positioning light
to centre the collimation plate to the x-ray film. Just prior to fluoroscoping, open the fluoroscopy
shutters fully. Quickly expose the cassette with the fluoroscopy switch.
10.
Develop the film. The developed film should show an x-ray field size for each of the I/I sizes used
superimposed onto each other if the same film was used all the time.
11.
Evaluate as follows:
Ensure that the maximum x-ray field size is within the I/I size used. For each I/I size used, the numerical
values seen at the outer edges of the collimation plate on the developed film should match those seen and
noted at the outer edges of the TV or mirror (step 7). Another method of doing this is to simply measure
the width of the x-ray field size on the film and compare this to the selected I/I size. The x-ray field size on
the film must be equal to or smaller than the I/I size.
If the x-ray field size is bigger than the I/I, then the unit must be serviced to correct this.
If there is no automatic collimation system, it is permissible for the x-ray field size to be larger than the I/I
on the magnification modes but must be within the normal I/I size.
C-arms
C-arms are tested in the same manner as remote units. A 10 x 12" cassette may be used instead of a 14 x
17. If the collimation plate cannot be centred properly, measure the size of the input I/I with a measuring
tape and compare this measurement to the x-ray field size on the x-ray film.
The size of the x-ray field on the film must be equal or less than that measured at the face of the I/I. When
using magnification mode, the maximum x-ray field size should not exceed the selected I/I size.
These tests can also be done with a fluorescent screen instead of using film.
Collimation
Standard
Section 17 l(f) of the HARP Regulation states:
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"Every fluoroscopic x-ray machine shall be equipped with an x-ray beam limiting device that
allows the operator to adjust the dimensions of the x-ray field at the image receptor to a size
smaller than the dimensions of the image receptor."
Fluoroscopy Shutters
While performing other fluoroscopy tests, open and close the shutters. The shutters should move freely
and symmetrically on all four sides.
Evaluate as follows:
If the shutters do not move symmetrically, the fluoroscopy machine must be repaired.
Spot Film/Camera
If proper collimation can be seen on actual films of patients for different exams, then this can be used to
show proof that proper collimation is in place. If collimation cannot be seen on actual films then the
following tests must be done. Continue from beam alignment testing.
Position the beam alignment and collimator tools on the table as stated in the previous section. 1.
Place a loaded cassette in the spot film device and/or load the camera. 2.
Hold a loaded cassette (14x17), that is larger than the spot film cassette size on to the face of the
spot film device or grid. Make a full spot film exposure using a low kVp technique eg. 60 kVp. With
another film take a camera exposure.
3.
You may wish to check four spots on one and any other split film. Ensure that there is no overlap. 4.
Evaluate as follows:
The x-ray field on the cassette position on the outside of the grid will indicate the x-ray field size. This must
be within the size of film used.
Resolution Testing
High Contrast
This test must be performed for fluoroscopy machines and all photofluorographic attachments. The ability
to see anatomic detail is proportional to the overall resolution properties of the system. This test allows for
a simple evaluation of system resolution to ensure that optimal anatomic detail is visible to the practitioner.
High contrast resolution is important for all fluoroscopic procedures.
Equipment
Copper Mesh High Contrast Tool
Measuring Tape
The copper mesh high contrast tool is composed of eight pie-shaped segments of 16, 20, 24, 30, 35, 40,
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50 and 60 lines per inch, in a total area of 7 x 7 inches with lead numbers to identify each mesh resolution
section. A pattern such as this allows easy measurement of central, general and edge resolution of an
imaging system.
Fluoroscopic Systems with Mirror Optics or Television Viewing
Procedure
Centre and tape the high resolution test tool as closely as possible to the middle of the I/I's input
surface.
1.
Under-table tubes: 2.
Tape the mesh as close as possible to the input surface of the I/I. Position the bottom of the I/I
carriage 30 cm above the table top.
Note: Do not place the pattern on the table-top because an inaccurate reading will result from
excessive image magnification.
Remote units:
Place the mesh on the table top. Note: with some units it is possible to position the mesh directly on
the I/I. This is the best option but not always possible.
Collimate the shutters to the size of the test tool and adjust the fluoroscopic factors.
For manual systems, adjust the fluoroscopic factors to best visualize the mesh, ie. about 50
to 60 kVp, 0.5 to 1 mA.
a.
For automatic brightness systems, collimate to the mesh. The system should automatically
adjust to allow for optimum visualization of the mesh. Some systems might need further
manual adjustments. For example, units with minimum or fixed kVp should be set to
approximately 50 kVp.
b.
3.
On television systems adjust the contrast and brightness control to best visualize the mesh. 4.
You may need to position the mesh at 45 degrees to the TV scan lines. 5.
Expose using fluoroscopy and note the finest wire mesh visible in the centre and at the edges of the
image.
6.
Repeat step 6 on all magnification modes if applicable. 7.
Camera Systems
Leave the mesh in the same position as used in the fluoroscopic mode. 8.
Collimate the beam to the size of the mesh. 9.
Set the camera kVp in the range of 60 to 70. Ensure that the appropriate kVp control is chosen.
(The kVp control with most camera systems is the radiographic kVp.)
10.
If the kVp is automatically selected, depending on the thickness of the phantom, take several
exposures of the mesh to allow the x-ray unit sufficient time to stabilize. For a cine unit, run the unit
for a sufficient length of time to allow the automatic brightness system to stabilize (approx. 5
seconds).
Process and view the films. 11.
Repeat the test on all magnification modes. 12.
The density on the resultant image should be such that you can visualize the mesh. Note the finest
detail visible in the centre and at the edges of the mesh. Compare these results to the
13.
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recommended results found in the table on the next page. Also compare them to baseline and
previous quality assurance test.
Evaluate as follows:
The recommended standards listed in the following table are enforced.
Twenty (20) lines per inch is the minimum acceptable standard. If, under any conditions, the image quality
results are less than 20 lines per inch, the x-ray machine must not be used until it has been serviced and
image quality improved.
If the observed image quality results are less than the recommended values stated below, we recommend
steps be taken to improve resolution to values set in table.
NUMBER OF MESH RESOLVABLE
Viewing Modes Film Recording Modes
Image
Intensifier Size
(Inches)
Mirror Optics (lines
per inch)
Television
Monitor
(lines/inch)
Camera
(70, 100,
105mm)
Cine
(16mm)
14.0 n/a 24 30 30
11.0 n/a 24 30 30
9.0 40 24 40 30
6.0 40 30 50 40
4.5 40 35 60 50
Low Contrast
This test gives a measure of the information of the total imaging system. The information is subjective and
can be influenced by the monitor settings and room lighting as well as the orientation of the test object.
Problems noted in the images cannot be readily identified without further testing.
Equipment
The low contrast test tool consist of two 3/4 inch aluminum plates (type 1100), 7 x 7 inches (18 x 18
cm)
One sheet of 1.0 mm aluminum, 7 x 7 inches (18 x 18 cm) with two sets of four holes of the
following sizes: 1.0, 3.0, 5.0 and 7.0 mm (1/16, 1/8, 3/16 and 1/4 inch)
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Procedure
Under Table Fluoroscopy Systems
Place the aluminum plate with drilled holes between the 2 aluminum blocks. Place this on the x-ray
table.
1.
Set the I/I 12 inches (30 cm) above the x-ray table top and centre over Low Contrast tool. 2.
Collimate the beam to aluminum blocks and adjust the fluoroscopic factors.
Collimate the beam to the test object and allow the automatic brightness system to adjust the
fluoroscopic factors. The kilovoltage should be in the range of 85 - 90 kVp.
a.
If fluoroscopic exposure factors are controlled manually, set the kVp between 85 and 90 and
adjust the mA to attain the best image.
b.
3.
Record the smallest set of holes seen. There are two linear rows of equally sized and spaced holes.
Both holes of the same size should be visualized in order to be counted as a hole set.
4.
Repeat the above steps for different magnification modes and with the camera, if applicable. 5.
Over-table Tubes and C-arms
Place the aluminum plate with holes drilled between the 2 aluminum blocks. Place this on the x-ray
table for remote units and on the I/I for C-arms.
1.
Expose using fiuoroscopy and collimate the beam to the test object. For automatic brightness
system allow the unit to stabilize. For manual systems set the kVp in the 85 to 90 kVp range and
adjust the mA for a good image.
2.
View the image on the TV monitor and adjust the contrast and brightness controls to attain the best
visualization of the holes.
3.
Record the smallest set of holes seen, kVp and operating mA. 4.
Repeat the above steps for different magnification modes and camera, if applicable. 5.
Camera Systems
Leave the phantom in the same position as it was for the fluoroscopy testing. 1.
Ensure that the camera kVp is within the 80 to 90 kVp range. 2.
Take an exposure. If the system has an automatic brightness control, cine, take a ran, long enough
to allow the system to stabilize. Usually 5 to 10 seconds.
3.
Repeat on all magnification modes if applicable. 4.
Develop the film and evaluate. 5.
Evaluate as follows:
The following guidelines have been established for low contrast resolution.
Under-Table Fluoroscopy Systems
Three sets of holes may be considered an acceptable standard (1/4", 3/16" and 1/8"). If you are only able
to see the 1/4" (largest) set of holes, the x-ray machine should not be used until it has been serviced. If
only two sets of holes are seen, it is recommended that the unit be serviced to improve low resolution
contrast.
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Camera systems (100 mm and Cine)
Acceptable performance is indicated if 3 sets of holes are seen, the 1/4", 3/16" and 1/8". If the results
reveal only the 1/8" set of holes, the system should be serviced to improve resolution.
Notes: The density of the photofluorographic film should be between 0.8 and 1.2 optical
density units. If the density falls beyond those parameters the test should be repeated and
adjust the factors to give the proper density.
Depending on the usage of the system, the inability to resolve the test holes may be of little
consequence. Systems that are not used for chest fluoroscopy or other low contrast
procedures may be unaffected by the lack of low-contrast resolution.
Fluoroscopy Limit Timer
Standard
Section 17 (lc) of the HARP Regulation states:
"Every fluoroscopic x-ray machine shah be equipped with an audible signal that,
indicates completion of any preset time of use up to a maximum of five minutes and i.
continues to sound until the timer is reset whenever x-rays are produced after the preset time
of use has expired, or, a timer circuit that will,
ii.
cut off the high tension voltage to the x-ray tube after a preset time of use up to a maximum
of ftve minutes, and
iii.
continues to prevent fiuoroscopy until the timer has been reset manually" iv.
Procedure
No special testing procedure is necessary to perform this test. The limit timer can be checked while
carrying out all other fluoroscopic functions.
In addition, ensure that the timer:
Is limited to 5 minutes. 1.
Functions properly. Alarms or turns off power after 5 minutes of fluoroscopy time. 2.
Locks/Interlocks
Locks
All position locks must be functional. This applies to all type of fluoroscopic machines.
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Section 9 (2)(c) of the HARP Regulation states:
"the x-ray tube housing maintains its required exposure position without significant drifting, tipping or
vibration so as to affect the quality of the image."
Ensure that all locks are functional.
Interlocks
This applies to all types of fluoroscopic machines.
Section 17 1 (a and b) of the HARP Regulation states:
"(1) Every fluoroscopic x-ray machine shall be equipped with,
(a) an image intensification system that,
(i) includes a shielded protective barrier and shielding such that,
the entire cross-section of the useful beam is intercepted within the protective
barrier for any target-to-image distance, and
A.
the fluoroscopic x-ray tube is not capable of producing x-rays unless the
shielding is in place to intercept the useful beam,
B.
(ii) in the case of a mobile fluoroscopic x-ray machine, is an integral part of the
machine or is interlocked in such manner that its removal prevents x-rays from being
produced;
(b) where it is a stationary machine, a means to prevent the X-ray tube from producing X-rays
unless there is an image receptor in place to intercept the X-ray beam;"
Test for both x-ray tube to carriage interlock and I/l to carriage interlock.
X-ray Tube to Carriage Interlock(s)
Equipment
Fluoroscopy Wand, or
Dosemeter
Procedure
Set the x-ray machine as it would normally be used. 1.
Open the shutters and expose using fluoroscopy quickly to ensure that the x-ray machine is
operational.
2.
Place the carriage in the park position. 3.
Locate the position of the under-table x-ray tube. 4.
Place the fluoroscopy wand or the dosemeter detector on the table top directly above the x-ray 5.
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tube.
Depress in turn, the foot switch, exposure button on the carriage and exposure button at the control
panel, whichever is applicable.
6.
Check visually for fluorescence of the wand or for a reading registering on the dosemeter.
Alternatively check the fluoroscopy mA at the control panel for any signs that x-rays are being
produced.
7.
Evaluate as follows:
Ensure that no x-rays are produced when the unit is in its park position. If fluorescence of the wand is
seen, or, if a reading is registered on the dosemeter or mA meter, there is no carriage-to-tube interlock.
This must be corrected.
Intensifier to Carriage Interlock
It must not be possible to produce radiation when the I/I and the carriage are disconnected.
Equipment
Fluoroscopy wand, or
Dosemeter
Procedure
Set the x-ray unit as it would normally be used. Ensure that it is operational. 1.
Disconnect the intensifier from the carriage. 2.
Place the fluoroscopy wand or dosemeter detector on the table top, above the under-table tube. 3.
Depress in turn, the foot switch, the exposure button on the carriage and the exposure button on the
control panel, whichever is applicable.
4.
Check visually for fluorescence of the wand or for a reading registering on the dosemeter or mA
reading at the control.
5.
Evaluate as follows:
If fluorescence of the wand is seen, or if a reading is registered on the dosemeter or mA reading, there is
no intensifier-to-carriage interlock. This must be corrected.
Minimum Target to Cone Tip Distances
Standard
Section 17(1)(e) of the HARP Regulation states:
"Every fluoroscopic x-ray machine shall be equipped with, a means to limit the target-to-skin distance to
not less than,
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twenty-five centimetres for a mobile fluoroscopic machine, i.
thirty-eight centimetres for a stationary fluoroscopic machine, or ii.
twenty centimetres for an image-intensified fluoroscopic machine used for special procedures
that would not be possible at the minimum target-to-skin distance set out in subclause (ii)."
iii.
Amendment(Adopted by XRIS in November 2001): In agreement with the provisions of the
new (2001) RED Act, small format mini c-arms are exempt from the above requirements, but
are subject to the condition that at the minimum target to skin distance, the maximum
exposure rate is less than 5.75R/min. This applies to current and new devices.
iv.
Procedure
Simply measure the distance from the x-ray source to the tip of the collimating device. Ensure it meets the
standard listed above.
Exposure Switch
Standard
Sections 10(3) and (5) of the HARP Regulation states:
Deadman,
"Every exposure switch on an x-ray machine shall be so constructed that it requires continuous pressure
by the x-ray operator to produce x-rays, except where the x-ray machine is equipped with a serial changer.
"
Unintentional Exposure,
"Every exposure switch on an x-ray machine that is a foot switch shall be so constructed as to prevent an
unintended exposure if the switch is overturned"
Deadman
Procedure
To test the deadman switch on fluoroscopy units, position the dosemeter in the centre of the x-ray
beam.
1.
Expose using fluoroscopy and observe the dosemeter or fluoroscopy mA meter. 2.
Stop fluoroing and observe either meter. If the meters keep reading after releasing the exposure
switch it means that the exposure switch does not require continuous pressure and therefore does
not meet the standard. Note: a lag of approximately 2 to 3 seconds is acceptable.
3.
Test for deadman function with all other exposure switches such as spot film device, camera digital and
cine by following the testing procedure outlined in the radiographic mode (See General Radiography -
Section 4).
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Unintentional Exposure
To test for unintended exposure.
Turn the foot switch upside down. The unit should not permit the production of x-rays. Verify this either by
observing the fiuoroscopy mA meter or use a dosemeter.
Serial Changer, Cine or Digital
For serial changer, cine or digital ensure that the switch is so constructed that it will permit the x-ray
operator to terminate an irradiation at any time (i.e. an emergency stop switch).
kVp Accuracy for Fluoroscopy, Spot Film and Camera
Follow manufacturer's directions on the use of the kVp meter and ensure that fluoroscopic, spot film and
camera kVp's are within +/- 8%.
Mini Portable Fluoroscopic Units (Xi-Scan, Fluoroscan, etc.)
The Xi-Scan and Fluoroscan units are hand held or mobile fluoroscopic/radiographic used by podiatrists or
orthopaedic surgeons. The units are specifically designed for extremity work (hands and feet). There are
no specific standards set in the HARP Act for these units. However, the XRIS has established the
following policies:
Measure fluoroscopic PEE based on 8 cm of water. The dose should not exceed 1.5 R/min. Take
the measurement at 9 cm from the I/I.
1.
REVOKED by XRIS November, 2001: Measure the maximum fluoroscopic output at 9 cm from the
I/I. This should be less than 6.0 R/min.
2.
INVOKED by XRIS November, 2001: Measure the maximum fluoroscopic output the tip of the cone
or tube output. This should be less than 5.75 R/min.
3.
Test for Half-value. 4.
Check for high contrast it should be better than 20 line pairs. 5.
The minimum target cone tip distance standards do not apply, (jdr - revised: provided that the
maximum exposure rate is below 5.75R/min at the tip of the cone.)
6.
Maximum x-ray field must be within the size of the I/I. 7.
Check scatter at operator's eye level and gonadal area. 8.
In the radiographic mode (if applicable) check:
Collimation. 1.
kVp accuracy. 2.
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Half-value Layer. 3.
Patient Entrance Exposure for an AP foot (measuring 8 cm). 4.
Protective Devices
Purpose
To provide protection from scattered radiation.
Standard
Section 8 (3) of the HARP Regulation states:
"Every radiation protection officer shall ensure that protective accessories of at least O.5 millimetres lead
equivalent at 150 kilovolts peak are available for use by persons who may receive exposure to x-rays in
the facility. "
Section 17 (1)(g) of the HARP Regulation states:
"Every fluoroscopic x-ray machine shall be equipped with,
(g) a shield of at least O. 25 millimetres lead equivalent at 1O0 kilovolts peak that intercepts
scattered radiation originating in the patient that would otherwise reach the x-ray operator or other
persons in the facility."
Additional information on protective devices may be obtained from Health Canada, Safety Code 20A and
the Ontario Ministry of Labour, Occupational Health and Safety Act, Ontario Regulation 632/86.
Evaluate as follows:
With all remote units, special procedures and cysto rooms additional shielding must be available
such as a mobile shield and/or ceiling suspended shield. Ensure that the shield is at at least 0.25
millimetres lead equivalent at 100 kilovolts peak and that it intercepts scattered radiation originating
in the patient that would otherwise reach the x-ray operator or other persons in the facility.
A.
Ensure that lead aprons, gloves and thyroid shields:
Are in good condition. 1.
There are enough for all personnel. 2.
B.
With under table tubes, ensure that there is a bucky slot cover and a scatter apron in place. C.
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