Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 1
Quality Control in CT
CE - CT 2
AAPM Montreal, July 17, 2002
Lawrence N. Rothenberg, Ph.D.
Department of Medical Physics
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
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Slide 2 Preventive Maintenance and ___________________________________

Quality Control ___________________________________
◆ Proper performance of x-ray units
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◆ Optimum Image Quality
◆ Minimum Dose to Patients ___________________________________
◆ Problems Found Before Seriously Affecting
– Image Quality ___________________________________
– Patient & Personnel Safety
◆ Avoid repeats ___________________________________
– Save Time & Money
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Slide 3 ___________________________________
Quality Control Tests† ___________________________________
◆ Radiography
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◆ Fluoroscopy
◆ Conventional Tomography ___________________________________
◆ Computed Tomography
◆ Film Processing ___________________________________

†
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Based on NYC/NYS Regulations
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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 4 ___________________________________
Computed Tomography ___________________________________
◆ Weekly Tests (Some Perform Daily)
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◆ Monthly Tests
◆ Semi-Annual Tests ___________________________________
◆ Annual Tests
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Slide 5 ___________________________________
Weekly Tests (Technologist) ___________________________________
◆ Noise
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◆ CT Number of Water

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Slide 6 ___________________________________
Noise & CT # Water ___________________________________
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400 mm2 Area ___________________________________
Measure Mean
and Std. Dev.
1 ___________________________________
(0 +/- 3)
water ___________________________________
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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 7 Monthly Tests ___________________________________

(Service Personnel or Technologist ) ___________________________________
◆ CT Number Uniformity
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◆ Low Contrast Resolution
◆ High Contrast Spatial Resolution ___________________________________
◆ Hard Copy Output Devices
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Slide 8 ___________________________________
CT Number Uniformity ___________________________________
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400 mm2 Area 2
Measure Mean ___________________________________
at Center and
at Edge 1 3 ___________________________________
water
Center Value +/- 3 ___________________________________
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Slide 9 ___________________________________
Low Contrast Resolution - GE ___________________________________
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9.5 6.4 4.8 3.2 1.6 mm

1 mm thick polyethylene in 10 mm thickness of water ___________________________________

See 4 holes in 8% contrast phantom
See 3 holes in 4% contrast phantom ___________________________________
 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 10 ___________________________________
High Contrast Spatial Resolution ___________________________________
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Slots/Spaces: 0.5, 0.6, 0.8., 1.0, 1.3, 1.6 mm
See 0.8 mm with standard algorithm and 0.6 mm with bone algorithm
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Slide 11 ___________________________________
Monitor & Hard Copy - SMPTE Pattern ___________________________________
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Slide 12 ___________________________________
Semi-Annual Tests (Physicist) ___________________________________
◆ All Weekly and Quarterly Tests
◆ Laser Alignment ___________________________________
◆ Slice Thickness
◆ Low Contrast Resolution ___________________________________
◆ High Contrast Resolution
◆ Index Accuracy and Couch Positioning ___________________________________
◆ Contrast Scale
◆ Linearity of CT# with attenuation coefficient (µ) ___________________________________
◆ Distance Accuracy
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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 13 ___________________________________
Laser Alignment ___________________________________
0
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270 90
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Table ___________________________________
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Slide 14 ___________________________________
Slice Thickness ___________________________________
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Side
Holes: ___________________________________
1 mm
Space
in Z-
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Direction
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Nominal Thickness ±1mm
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Slide 15 ___________________________________
2 Water
Contrast Scale ___________________________________
1 ___________________________________
CT#1-CT#2 Acrylic
= 120 ± 12 ___________________________________
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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 16 ___________________________________
Indexing Accuracy ___________________________________
◆ Construct ruler with opaque markers separated by
fixed distance – 10 mm
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◆ Move couch to position of first marker
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◆ Run series of scans to verify indexing – each
additional marker appears in one of the scans in ___________________________________
the series
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Slide 17 ___________________________________
Couch Positioning and Laser Accuracy ___________________________________
◆ Place thin opaque marker (part of metal paper
clip) on phantom
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◆ Position phantom with laser so that marker is
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centered in scan plane
◆ Run thin scan and look for marker in image ___________________________________
◆ Move couch by serveral cm, then return
◆ Run thin scan and look for marker in image ___________________________________
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Slide 18 ___________________________________
Annual Tests (Physicist) ___________________________________
◆ Semi-Annual Tests
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◆ Patient Dose

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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 19 ___________________________________
CT Head Dose - Head Phantom & Ion Chamber ___________________________________
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Slide 20 ___________________________________
After Tube Change (Physicist) ___________________________________
◆ Semi - Annual Tests
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◆ Annual Tests

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Slide 21 ___________________________________
Marconi / Picker CT Phantom ___________________________________
Water ___________________________________
Screw 1 Screw 2

Peg #1 - Acrylic Peg #2 - Polyethylene ___________________________________

Screw 3 0.35% Medium Screw 4

Water
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Hole diameters in 0.35% Medium: 2.0, 2.5, 3.0, 4.0, 5.0, 8.0 mm
Distance between Screws: 45 mm, 111 mm (± 1mm)
CT Numbers: Acrylic 121HU, Polyethylene -91HU (±5 HU) ___________________________________
 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 22
Philips / Marconi / Picker CT Phantom
◆ Noise and Std. Dev. - Scan Uniform Water Bath
◆ MTF - Scan 1 mm Diameter Metal Pin
◆ Slice Thickness - Scan Angled Aluminum Ramps
◆ System Software Performs Calculations for MTF
and Slice Thickness
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Slide 23
Additional Tests
◆ Technique factors: kVp, mA, sec (rotation time)
◆ Dose: CTDI, MSAD, CTDI100, CTDIw, CTDIw,
effective dose, DLP, scout view dose
◆ Half-value layer
◆ All mechanical operations: tile, table vert & horiz
◆ Room scatter and shielding survey
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Slide 24 ___________________________________
ACR CT Accreditation ___________________________________
◆ Phantom Testing: Image Quality
– Slice thickness ___________________________________
– CT# accuracy
– Low contrast resolution ___________________________________
– High contrast resolution
– Image uniformity
◆ Dose – Reference CTDIw
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– Adult Head: 60 mGy
– Adult Abdomen: 35 mGy ___________________________________
– Pediatric Abdomen: 25 mGy
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 Quality Control in CT – Lawrence N. Rothenberg, Ph.D.

Slide 25 ___________________________________
ACR CT Accreditation Phantom ___________________________________
◆ Four contiguous modules – 20 cm diam, 4 cm wide
– Positioning and alignment, CT# accuracy, slice thickness
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– Low contrast resolution
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– CT# uniformity and noise, distance accuracy
– High contrast resolution ___________________________________
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Slide 26 ___________________________________
Additional Phantoms ___________________________________
◆ Other manufacturers phantoms and QC protocols
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◆ CATPHAN
◆ CIRS Spiral Phantom ___________________________________
◆ ACR CT Accreditation Phantom – RMI
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Slide 27 ___________________________________
References ___________________________________
◆ Manuals supplied by manufacturer of CT
◆ McCullough CH and Zink FE: Performance evaluation of CT ___________________________________
systems. In RSNA Categorical Course in Diagnostic
Radiology Physics: CT and US Cross-Sectional Imaging ___________________________________
2000: pp 189-207
◆ AAPM Reports No. 1 and No. 39 at www.aapm.org
◆ FDA Web Site: fda.gov/cdrh/ct
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◆ UK Web Site: www.impactscan.org
◆ ACR CT Accreditation Web Site: www.acr.org
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