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Quality Assurance & Quality Control

Two areas of activity designed to ensure the
best possible diagnosis at an acceptable
radiation dose & with minimum cost

CHAPTER 18
QUALITY CONTROL

performance a& resulting in minimal patient

radiation dose
Begins with: x-ray imaging system
Continues with: routine evaluation of image
processing facilities

The Joint Commission (TJC)

Promotes The Ten-Step Monitoring &
Evaluation Process
o Purpose: to resolve identified patient
care problems

Acceptance Testing
It should be done to a new radiologic
equipment before it is applied clinically

QUALITY ASSURANCE

Maintenance or Repair
Necessary when periodic monitoring is not
performing as it was intended to perform

Quality Assurance (QA)

It deals with people
Task of: radiologist
Program of QA monitors:
o Proper patient scheduling
o Reception
o Preparation
It involves image interpretation (outcome
analysis)
TJC 10-Step Quality Assurance Program
1. Assign responsibility
2. Delineate scope of care
3. Identify aspects of care
4. Identify outcomes that affect the aspect of
care
5. Establish limits of the scope of assessment
6. Collect and organize data
7. Evaluate care when outcomes are reached
8. Take action to improve care
9. Assess and document actions
10. Communicate information to organizationwide quality assurance program
QUALITY CONTROL
Quality Control (QC)
It deals with instrumentation and equipment
Task of: medical physicist
More tangible & obvious than QA
Program of QC: designed to ensure that the
radiologist is provided with an optimal
image produced through good equipment
STEWART C. BUSHONG

Preventive Maintenance
It makes repair unnecessary
Three Steps In An Acceptable QC Program
Acceptance testing
Routine performance monitoring
Maintenance
Council of Radiation Control Program Directors
(CRCPD)
It guides the QC program of states
Nature of a QC Program
Its determined somewhat by
characteristics of the image produced

the

RADIOGRAPHIC QUALITY CONTROL

ELEMENTS OF A QUALITY CONTROL
PROGRAM FOR RADIOGRAPHIC SYSTEM
Measurement
Frequency
Tolerance
2.5 mm Al
Filtration
Annually
Collimation
Semiannually 2% SID
Focal-Spot Size
Annually
50%
Calibration of
Annually
10%
kVp
Exposure Timer
5% > 10 ms
Annually
Accuracy
20% 10 ms
Exposure
Annually
10%
Linearity
Exposure
Annually
5%
Reproducibility
SUMMARIZED BY: MEYNARD Y. CASTRO

CHAPTER 18
QUALITY CONTROL
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CHARACTERISTICS OF VARIOUS DIAGNOSTIC IMAGING SYSTEMS

Spatial
Contrast
Temporal
Signal-toProcedure
Resolution
Resolution
Resolution
Noise Ratio
Radiography
E
F
E
E
Mammography
E
G
G
E
Fluoroscopy
G
F
E
G
Digital R & F
G
E
G
G
Computed Tomography F
E
G
F
Magnetic Resonance
F
E
G
F
Imaging
Ultrasonography
F
G
G
G
Nuclear Medicine
F
G
F
F
E = Excellent; F = Fair; G = Good; R & F = Radiography & Fluoroscopy
Filtration
The most important patient protection
characteristics of a radiographic imaging
system
Minimum Total Filtration: 2.5 mm Al
Measured By: half-value layer (HVL)
Frequency: annually or any time after a
change has occurred in the x-ray tube or
housing
MINIMUM HVL REQUIRED TO ENSURE
ADEQUATE X-RAY BEAM FILTRATION
Minimum HVL
OPERATING kVp
(mm Al)
30
50
70
90
130
Single-Phase
0.3 1.2 1.6 2.6 3.6
Three-Phase/High
0.4 1.5 2.0 3.1 4.2
Frequency
Collimation
X-ray field must coincide with the light field
of the variable-aperture light-localizing
collimator
Distance Indicator:
o Must be accurate within 2% & 1% of
the SID
o Checking: use tape measure
Location of Focal Spot: marked on the x-ray
tube housing
Centering Indicator:
o Must be accurate within 2% & 1% of
the SID
STEWART C. BUSHONG

Artifacts
F
F
F
G
G
F
F
F

o Checking: visually checked with markers for the

exposure field
Positive Beam-Limiting Collimators (PBL)
Automatic collimators that sense the size of
the image receptor & adjust the collimating
shutters to that size
It must be evaluated for all possible receptor
sizes
The x-ray beam must not be larger than the
image receptor
Misalignment must not exceed 2% of the
source-to-image receptor distance (SID)!
Focal-Spot Size (FSS)
It principally determines the spatial
resolution of a radiographic imaging system
Measured:
o When new equipment is installed
o When a replacement of x-ray tube is
installed
Three Tools Used To Measure FSS:
o Pinhole Camera, Star Pattern & Slit
Camera
Frequency:
o Annually
o When an x-ray tube is replaced
Pinhole Camera
SUMMARIZED BY: MEYNARD Y. CASTRO

Exposure timer accuracy should be within 5%

of the indicated time for exposure times
greater than 10ms!

It is difficult to use
It requires excessive exposure time

Star Pattern
It is easy to use
Significant Limitation: focal-spot sizes less
than 3 mm
Slit Camera
The standard for measurement of focal-spot
size
Specification of Focal-Spot Size
Depends on the geometry of the tube
Depends on the focusing of the electron
beam
Line-Pair Test Tool
An acceptable alternative to focal-spot size
measurement
It determines limiting spatial frequency
kVp Calibration
The x-ray generator must be properly
calibrated
Devices Used:
o Based on filtered ion chamber
o Based on filtered photodiodes
Frequency:
o Annually
o Whenever high-voltage components
have changed significantly
4% Variation in kVp: necessary to affect
image OD & radiographic contrast
The measured kVp should be within 10% of
the indicated kVp!
Exposure Timer Accuracy
Exposure Time: responsible for patient dose
& OD
Devices Used:
o Based on irradiation time of an ion
chamber
STEWART C. BUSHONG

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CHAPTER 18
QUALITY CONTROL

o Based on irradiation time of

photodiode assembly
Frequency:
o Annually
o More frequently
If the system has undergone
major repairs
20% Accuracy: acceptable for exposure
times of 10 ms or less

Exposure timer accuracy should be within 5%

of the indicated time for exposure times
greater than 10 ms!
Automatic Exposure Control (AEC)
Designed to provide a constant OD
regardless of tissue thickness, composition
or failure of the reciprocity law
It also must be evaluated
Evaluate By:
o Exposing an IR through various
thicknesses of aluminum or acrylic
o Regardless of material thickness &
absolute exposure time, OD of the
image must be constant
Insertion of a Lead Filter
It allows one to adequately assess the
functioning of the backup timer
It should terminate the exposure at 6 s or
600 mAs if phototimer fails
Exposure Linearity
The ability of a radiographic unit to produce
a constant radiation output for various
combination of mA & exposure time
Determined By: a precision radiation
dosimeter that measures radiation intensity
at various combinations of mA & exposure
time
Frequency:
o Annually
o After any significant change or
repair of operating console or highvoltage generator
SUMMARIZED BY: MEYNARD Y. CASTRO

Method of assessment is not valid if the

exposure timer is inaccurate

Exposure linearity must be within 10% for

adjacent mA stations!
Exposure Reproducibility
The ability of a radiographic unit to produce
a precisely the same radiation exposure
when all the techniques are changed &
returned to previous value
Two Methods of Evaluation:
o Make a series of at least three
exposures at the same technique
factors, having changed technique
controls between exposure
Error in the kVp Control: if
result is not reproducible
o Select a combination of technique
factors & hold them constant for a
series of 10 exposure
Sequential radiation exposure should be
reproducible to within 5%!
Radiographic Intensifying Screens
Frequency of Cleaning:
o Depends on the workload in the
department
o Not less often than every other
month
Materials:
o Soft, lint-free cloth
o Cleaning solution
Provided by the manufacturer
Screen-Film Contact
Frequency: once or twice a year
Method of Evaluation:
o Radiographing a wiremesh pattern
o Analyzing the image for areas of blur
Replaced Felt or Foam
Pressure Pad: if blur appears
STEWART C. BUSHONG

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CHAPTER 18
QUALITY CONTROL

Replaced
Cassette:
if
replacement of foam or
pressure pad does not correct
the problem

Protective Apparel
It should be radiographed or fluoroscoped
Frequency: annually
Replaced Protective Apparel: if cracks,
tears, or holes are evident
Film Illuminators
It should be analyzed photometrically
Frequency: annually
Device Used: photometer
Photometer: measures light intensity at
several areas of the illuminator
Intensity:
o It should be at least 1500 cd/m2
o Not more than 10% over the
surface of the illuminator
Bulb Replacement:
o If a bulb requires replacement, all
should be replaced & matched to the
type of bulb used in adjacent
illuminators
FLUOROSCOPY QUALITY CONTROL
Fluoroscopy
Entrance Skin Exposure (ESE)
o Average Adult: 3-5 R/min (30-50
mGya)
Skin Dose: 10 rad (100 mGyt)
Interventional Procedure
Skin Dose: 100 rad (1 Gyt)
Exposure Rate
Normal Operation
o ESE Rate: 10 R/min (100
mGya/min)
Interventional Procedures
o ESE Rate: 20 R/min (200 mGya)
Cineradiography
o Exposure Rate: unlimited
SUMMARIZED BY: MEYNARD Y. CASTRO

Spot-Film Exposures
Two
Types:
cassette
spot-film
&
photofluorospot
Cassette Spot-Film
Proper Exposure:
o Depends on kVp
o Depends on mAs value
o Depends on sensitivity characteristic
of screen-film combination
Automatic Exposure System
Fluoroscopes: equipped with Automatic
Brightness System (ABS) or Automatic
Exposure Control (AEC)
Fluoroscopic ABC
o Frequency: annually
Input Exposure Rate
o Range: 10-40 R/s
TOMOGRAPHIC QUALITY CONTROL
QC Measurement
Designed to ensure that the characteristics
evaluated remain constant
Patient Exposure
It should be measure for the most frequent
type of tomographic examination
Indicated Section Level & Measured Level
Agreement: within 5 mm
Section Level
Accuracy: within 2 mm
QC Evaluation
Constancy: 1 mm

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Lucite, Aluminum, Copper & Lead Filters

These are used to determine the adequacy of
any automatic brightness stabilization (ABS)
system

CHAPTER 18
QUALITY CONTROL

Evaluated by imaging a hole in a lead sheet

OD: should be
o Uniform
o No perceptible variations
o No gaps
o No overlaps

PROCESSOR QUALITY CONTROL

QC Evaluation Program
Periodic cleaning
System maintenance
Daily monitoring
First Automatic Processor
Dry-To-Dry Time: 7 minutes
Double-Capacity Processor
Dry-To-Dry Time: 3 minutes
Quality Control Program for Radiographic
Processor
Activity
Procedure/Item
Schedule
Crossover racks
Daily
Processor
Cleaning
Entire rack assembly Weekly
and processing tanks
Observation of belts, Weekly
pulleys, and gears
Scheduled
Maintenance
Lubrication
Weekly or
Monthly
Planned parts
Regularly
replacement
Check developer
Daily
temperature
Processor
Check wash water
Daily
Monitoring
temperature
Check replenishment Daily
rates
Sensitometry and
Daily
densitometry
Processor Cleaning
Frequency: weekly

Section Uniformity
STEWART C. BUSHONG

SUMMARIZED BY: MEYNARD Y. CASTRO

RT removes the transport and crossover

racks & cleans them & the processing tanks
with appropriate fluids

Fast-Access System
Dry-To-Dry Time: 90 seconds
Processing Rate: 500 films/hr
It Requires:
o High concentration of processing
chemistry
o High development temperature (35o
C/95o F)
o Wash water temperature (31 o C/87o
F)
Thermostatically Controlled Heater: it
maintains temperature
Processor Maintenance
Three Types:
o Scheduled maintenance
o Preventive maintenance
o Nonscheduled maintenance
Scheduled Maintenance
Routine procedures that are performed
usually weekly or monthly
Procedures:
o Observation of all moving parts for
wear
o Adjustment of all belts, pulleys &
gears
o Application of proper lubrication

STEWART C. BUSHONG

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CHAPTER 18
QUALITY CONTROL
Preventive Maintenance
A planned program of parts replacement at
regular intervals
It requires that a part be replace before it
fails
Nonscheduled Maintenance
The worst kind
A failure in the system that necessitates
processor repair
Minimize By: proper program of scheduled
and preventive maintenance
Processor Monitoring
Processor Operation: once per day
Procedures:
o Developer
&
wash
water
temperature:
o Developer & Fixer Replenishment
Rates
o Processing tanks
o pH & specific gravity of developer
&fixer solutions
o Residual hypo
o Sensitometric strip evaluation

SUMMARIZED BY: MEYNARD Y. CASTRO