European Journal of Radiology 80 (2011) 519–525

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European Journal of Radiology

journal homepage: www.elsevier.com/locate/ejrad

Quality assurance in diagnostic ultrasound

Outi Sipilä a,∗ , Vilma Mannila a,b,1 , Eija Vartiainen c,2
a
HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Finland
b
Department of Physics, University of Helsinki, P.O. Box 64, 00014 Helsinki University, Finland
c
HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, P.O. Box 750, 00029 HUS, Finland

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To setup a practical ultrasound quality assurance protocol in a large radiological center, results
Received 1 July 2010 from transducer tests, phantom measurements and visual checks for physical faults were compared.
Received in revised form 30 October 2010 Materials and methods: Altogether 151 transducers from 54 ultrasound scanners, from seven different
Accepted 9 November 2010
manufacturers, were tested with a Sonora FirstCall aPerioTM system (Sonora Medical Systems, Inc., Long-
mont, CO, USA) to detect non-functional elements. Phantom measurements using a CIRS General Purpose
Keywords:
Phantom Model 040 (CIRS Tissue Simulation and Phantom Technology, VA, USA) were available for 135
Ultrasound
transducers. The transducers and scanners were also checked visually for physical faults. The percentages
QA/QC
Technical aspects
of defective findings in these tests were computed.
Results: Defective results in the FirstCall tests were found in 17% of the 151 transducers, and in 16% of the
135 transducers. Defective image quality resulted with 15% of the transducers, and 25% of the transducers
had a physical flaw. In 16% of the scanners, a physical fault elsewhere than in the transducer was found.
Seven percent of the transducers had a concurrent defective result both in the FirstCall test and in the
phantom measurements, 8% in the FirstCall test and in the visual check, 4% in the phantom measurements
and in the visual check, and 2% in all three tests.
Conclusion: The tested methods produced partly complementary results and seemed all to be necessary.
Thus a quality assurance protocol is forced to be rather labored, and therefore the benefits and costs must
be closely followed.
© 2010 Elsevier Ireland Ltd. All rights reserved.

1. Introduction example, in the recent American College of Radiology (ACR) stan-

The benefits from continuous ultrasound (US) image quality
assurance (QA) are widely recognized [1–11]. However, in practice,
systematic QA is often neglected. One obvious reason for that is the
lack of formal requirements for QA, as opposed to modalities using
ionizing radiation. Ultrasound equipment is also relatively cheap,
meaning that the man power needed for systematic maintenance
including QA can quickly be relatively costly. Also, there are addi-
tional facts, which further increase the threshold to implement QA:
prudent use of diagnostic ultrasound has generally been considered
to be safe, e.g. [12], and there are many different professional groups
utilizing it. Although the parameters for good image quality, e.g.
contrast-to-noise ratio and resolution, are not different than in the
other modalities, there is no consensus of the methods to be utilized
in measuring the parameters and the relative benefits of them. For
∗ Corresponding author. Tel.: +358 50 427 0807; fax: +358 9 471 75893.
E-mail addresses: outi.sipila@hus.fi (O. Sipilä), vilma.mannila@hus.fi
(V. Mannila), eija.vartiainen@hus.fi (E. Vartiainen).
1
Tel.: +358 50 427 2561; fax. +358 9 471 71345.
2
Tel.: +358 50 427 9600; fax. +358 9 471 71354.
dard on monitoring the performance of real time US equipment [11]
the choice for the methodology in performing QA and analyzing the
results was partly left to the user. At the same time, the technical
development of US equipment is fast and modern scanners have
new imaging modes, e.g. harmonic and compound imaging, with
ever increasing choice of user parameters. Additionally, the base-
line image quality parameters seem to be seldom available to the
customer when purchasing the equipment.
Continuing performance assessment can include inspection
of the physical condition and electrical safety of the US equip-
ment, evaluating image quality and Doppler measurements with
a phantom and testing the functionality of the elements of the
transducers [1–11,13–16]. Also, the quality and proper adjustments
of the monitor should be verified [17]. International organizations
have recommendations or standards for phantom measurements
to show adequate image or Doppler quality [1,2,13]. Often, the
analysis of the images has been performed visually with man-
ual measurements [1–5], but automatic image analysis has also
been utilized [6–10]. The usefulness of phantom based measure-
ments with modern US equipment has also been questioned [5,14].
Recently, a transducer test checking the functional condition of
each element of the transducer has become available [14–16]. It

0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejrad.2010.11.015
520 O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525
has been shown that when performing Doppler two consecutive
dead elements in the active aperture can have an impact on the
velocity results [15]. In a recent study utilizing transducer tests,
nearly 40% of 676 transducers used daily in clinical departments
was found to be defective [16].
Our imaging center has been expanded rapidly during the last
years, now including 19 imaging units performing about 110 000
radiological US exams every year in a totally digital environ-
ment. Some of the imaging units are concentrating on the basic
healthcare, some are a part of a central or a university hospital.
The working methods and culture differ. Maintenance of the US
equipment has often been minimal. A common protocol for QA is
necessary for ensuring optimal image quality for different types of
exams and to gain synergy benefits in managing the vast amount
of equipment cost-effectively. The purpose of this work, as a part
of a larger project in setting up US QA, was to compare the results
of visual checks for physical faults, phantom measurements and
transducer tests in order to form a practical QA protocol in a large
radiological imaging center.
2. Materials and methods
2.1. Transducer tests
Altogether 151 transducers from 54 US scanners (28 models),
from 7 different manufacturers, were measured with a Sonora First-
Call aPerioTM system (Sonora Medical Systems, Inc., Longmont, CO,
USA) [18]. The scanners were purchased in 1998–2009, with the
median purchase year of 2004 (Table 1). At the time of purchase,
most of them were high-end scanners for radiological studies.
The 151 transducers were 85% of the total amount of transducers
in these scanners. The FirstCall system needed a specific adapter,
to which the transducer was connected during the test. Also, each
transducer type had a specific definition file for the FirstCall system.
The adapter for one scanner model was not available, except for
one transducer attachable in an older type of transducer port. Also,
the definition file was lacking for a few transducer types. For some
transducers, the definition file was not optimal, and the results
were unambiguous. The FirstCall system was rented from BBSMed-
ical AB (Sweden) for three days, including a person to operate the
equipment.
The test system analyzed the sensitivity, pulse width, center
frequency and fractional bandwidth for each element of the trans-
ducer. Also, the accumulated capacitance of every element and its
wiring was displayed for almost every measurable transducer type.
The functionality of the elements of a transducer was catego-
rized as in Mårtensson et al. [16]: The sensitivity of a functionally
acceptable element was at least 75% of the mean sensitivity of the
elements in the transducer. For a weak element, the correspond-
ing value was 10–75%. The sensitivity of a dead element was less
than 10% of the highest sensitivity value in the transducer. The
transducer was considered defective, if there were more than four
consecutive weak elements, or at least two consecutive dead ele-
ments, or at least three dead elements altogether. In Fig. 1, an
example of the sensitivity and capacitance values for a defective
transducer are shown. The percentage of defective transducers was
computed, as well as the percentage of transducers with unambigu-
ous results.
2.2. Phantom measurements
Phantom measurements were carried out on 51 scanners during
three months by the same physicist using a CIRS General Purpose
Phantom Model 040 (CIRS Tissue Simulation and Phantom Technol-
ogy, VA, USA) [19]. Of the 151 transducers with the FirstCall result,
135 transducers (89%) were also measured with the phantom. The
tissue mimicking material of the phantom simulated the acous-
tical properties of the human tissue, and the speed of the sound
in the phantom was 1540 ± 6 m/s. The attenuation coefficient was
0.5 dB/(cm MHz) in this study.
Before the phantom measurements, the quality of the monitor
was checked utilizing the test image in the scanner, if available, and
a Pehamed CD/Lux light intensity measuring device (PEHA med.
Geräte GmbH, Germany).
The phantom measurement protocol included measurements of
the homogeneity, penetration depth, beam profile, near field, axial
and lateral resolution, vertical and horizontal calliper accuracy, and
size of anechoic and high scatter masses [19]. Also, the symmetry
of the reverberations and the noise pattern of a clean transducer
imaging the air was checked (the air image). This did not require a
phantom, but was performed during the phantom measurements.
Due to the variety of the equipment, exactly the same imaging
parameter settings in the measurements were not always possible.
The main principle in selecting the parameters was to include min-
imum processing of the signal. The following choices were made
for the parameters: Output power was set to the maximum level,
time-gain-compensation (TGC) to achieve uniform signal across the
field of view, and dynamic range to 60 dB. A linear gray map was
selected. Individual gain settings were allowed to obtain the best
possible visibility for each measurement. Rejection, edge enhance-
ment, filtering and frame averaging were set to the lowest level
possible. Line density was selected as the highest possible. A sin-
gle focus at the same depth as the structure studied was utilized,
and the image depth was selected to allow the best field of view
for the structure. Whenever possible, abdomen was selected as the
body part to be imaged. The more sophisticated features, e.g. sec-
ond harmonic imaging and spatial/frequency compounding, were
switched off. The two frequencies utilized in the measurements of
each transducer type are listed in Table 1, mainly being the mini-
mum and the maximum frequency of the transducer. Besides the
results, the TI, MI and frame rate values for every transducer and
measurement were noted down, in order to verify the same user
parameter settings in the future measurements. Also, an image
from each measurement was saved to PACS.
Due to the lack of baseline parameters for the phantom mea-
surements, the defects in image quality were detected utilizing only
the homogeneity measurement and the air image. In the homo-
geneity measurements, the defects could usually be seen as clear
vertical streaks or larger areas lacking signal near the transducer
surface when imaging homogeneous region of the phantom (Fig. 2).
The areas of signal drop were most clearly seen in a real-time image
when moving the transducer. In the air image, clear vertical streaks
or asymmetry in the reverberation pattern were interpreted as
defects (Fig. 3). The percentage of the transducers with defective
image quality was computed.
2.3. Visual checks for physical faults
During the phantom measurements, the 51 scanners were also
checked for possible flaws in casing, power cord, keyboard, knobs
and connectors. The 135 transducers with both the FirstCall test and
the phantom measurements were inspected to find changes in the
lens, cable, cable jacket, casing and connector of the transducer. The
percentages of defective scanners and transducers were computed.
2.4. Concurrent defects
For the 135 transducers with results from the FirstCall test,
phantom measurements and visual checks, it was analyzed how
many of them had (1) a defective result in both the transducer
test and the phantom measurement, (2) a defective result in the
Table 1
Scanners and transducers measured with the Sonora FirstCall aPerioTM system and using a CIRS General Purpose Phantom Model 040. The numbers of specific models and transducers included in the study are listed as well as
the frequencies utilized in the phantom measurements. Also, the earliest and latest as well as the median purchase year of every scanner model are included.

Manufacturer Model Number of Purchase Median Transducer Number of Number of Frequencies in phantom measurements
models years purchase year model transducers transducers
with FirstCall with phantom

Aloka SSD-ALPHA 10 1 2007 2007 UST-5411 1 1 5.0 13.0

Premier
UST-5548 1 1 3.8 7.5
UST-9130 1 1 3.0 6.0
SSD-ALPHA 5 1 2004 2004 UST-5410 1 1 5.0 13.0
UST-5712 1 1 5.0 10.0
UST-9126 1 1 3.0 6.0
SSD-5500/SSD- 10 1998–2004 2001 UST-5545 7 7 5.0 10.0/13.0
5500SV/SSD5000
UST-5543 2 2 7.5 13.0
UST-5548 2 2 3.8 7.5
UST-5524 1 1 3.8 7.5
UST-5712 3 3 5.0 10.0
UST-5710 1 1 5.0 10.0
UST-9128 1 1 3.0 6.0
UST-9126 4 4 3.0 6.0
UST-9119 4 4 2.5 5.0
UST-9114 2 2 3.0 6.0
SSD-3500 1 2003 2003 UST-5546 1 1 5.0 10.0
UST-5710 1 1 5.0 10.0
SSD-500 1 2003 2003 UST-5512U 1 1 7.5
UST-934N 1 1 3.5

Esaote MyLab70 XVG 1 2009 2009 LA523 1 1 4.0 13.0

LA522 1 1 3.0 9.0
CA631 1 1 1.0 8.0
CA123 1 1 3.0 9.0

GE Logiq E9 1 2008 2008 S1-5 1 1 2.0 4.0

LOGIQ 9 14 2001–2007 2005 M12L 13 12 9.0 12.0
10L 4 4 7.0 8.0
i12L 3 2 9.0 10.0
4C 12 11 2.0 4.0
3.5C 4 4 2.5 4.0
8C 4 4 5.0 8.0
O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525

10S 1 0 – –
4S 2 1 2.0 4.0
LOGIQ 7 1 2004 2004 M12L 1 1 7.0 12.0
10L 1 1 7.0 8.0
3.5 C 1 1 2.0 4.0
LOGIQ S6 3 2006 2006 M12L 3 3 7.0 12.0
10L 3 3 6.0 8.0
4C 3 3 2.0 4.0
LOGIQ 5 Pro 1 2004 2004 10L 1 1 6.0 8.0
3.5C 1 1 2.0 4.0
Logiq 2 1999 1999 10L 1 1 7.0 9.0
500/LOGIQ 500
PRO
LA39 1 1 4.6 6.6
C364 1 1 3.0 4.0
C358 1 1 2.0 5.0
VOLUSONi 1 2006 2006 12L-RS 1 1 pena resa
(4–13 MHz) (4–13 MHz)
4C-RS 1 1 pena resa
(2–5 MHz) (2–5 MHz)
521
 522
Table 1
(Continued)

Manufacturer Model Number of Purchase Median Transducer Number of Number of Frequencies in

models years purchase year model transducers transducers phantom
with FirstCall with phantom measurements

LOGIQBOOK 1 2002 2002 10Lb-RS 1 0 – –

3C-RS 1 0 – –

Philips/ATL iU22 2 2007 2007 L15-7io 1 1 gena resa

(7–15 MHz) (7–15 MHz)
C8-5 2 2 pena resa
(5–8 MHz) (5–8 MHz)
ATL HDI 3500 1 2000 2000 C8-5 1 0 – –
C9-5 1 0 – –
C4-2 1 0 – –
ATL HDI 5000 1 1998 1998 C8-5 1 0 – –
C7-4 1 0 – –
C5-2 1 0 – –
P3-2 1 0 – –

Siemens Acuson X300 1 2009 2009 VF13-5 1 1 7.3 11.4

P4-2 1 1 2.5 4.6
Sonoline G40 1 2005 2005 VF10-5 1 1 6.2 10.0
CH5-2 1 1 2.5 5.0
Acuson 1 2001 2001 15L8 1 1 8.0 14.0
SEQUOIA 512
8L5 1 1 5.0 8.0
10V4 1 1 5.0 10.0
8V5 1 0 – –

Sonosite Micromaxx 1 2006 2006 L38e 1 1 pena resa

(5–10 MHz) (5–10 MHz)
C60e 1 1 pena resa
(2–5 MHz) (2–5 MHz)

Toshiba Aplio XG 3 2008 2008 PLT-1204AX 1 1 7.2 14.0

PLT-1204BX 2 2 7.2 14.0
O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525

PLT-805AT 1 0 – –
PLT-704SBT 2 2 4.8 11.0
PVT-375BT 3 3 1.9 6.0
PVT-674BT 1 1 3.6 9.2
PVT-382BT 2 2 1.8 5.5
Aplio/Aplio 80 3 2002–2004 2003 PLT-1204AT 2 2 7.2 14.0
PLT-704AT 1 1 5.0 11.0
PLT-805AT 1 1 5.0 12.0
PVT-375BT 3 3 1.9 6.0
PST-37CT 2 2 2.5 5.5
PST-25AT 1 1 2.0 4.0
Nemio 20 1 2002 2002 PLM-805 AT 1 1 6.0 12.0
PVM-375 AT 1 1 3.0 6.0
a
In some transducers, the user can choose only between three frequency ranges: penetration, general and resolution. The total frequency ranges of these transducers, specified by the manufacturers, are given in parentheses.
 O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525 523

Fig. 1. Sensitivity drops (upper image) and lower capacitance values (lower image) in elements 1–23 of a defective transducer are shown in a test result from the Sonora
FirstCall aPerioTM system. Also a sensitivity drop in the middle of the transducer is evident.

Fig. 2. (a) An example of signal drop in the left edge of an image (white arrow) from a CIRS General Purpose Phantom, Model 040, scanned with a defective linear transducer.
Note the gradual drop of intensities towards the left edge of the image, especially in the upper part of the field of view, when compared to the right edge of the image.
(b) Another example of imaging the phantom with a defective linear transducer. The two vertical streaks with signal drop in the homogenous region of the phantom are
indicated with white arrows. The bright spots in (a) and (b) and the small anechoic elliptic structure in the right edge of (a) are structures belonging to the phantom.

Fig. 3. (a) The air image with the same defective transducer as in Fig. 2a. Non-uniform reverberation pattern can be seen in the left upper corner of the image (white arrow).
(b) An example of vertical streaks in the reverberation pattern of a convex transducer in the air image (white arrows).
524 O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525
Table 2
The percentage of transducers with defective results in the measurements using
the Sonora FirstCall aPerioTM system (FirstCall), a CIRS General Purpose Phantom
Model 040 (Phantom) and visual assessment of physical condition of the transducer
(Visual). Also, the percentages of transducers with concurrent defects using two of
these measurements or all three are listed. All three measurements were available
for 135 transducers. The FirstCall tests were available with a total number of 151
transducers.
Test type Number of transducers Defective result (%)
FirstCall 151 17
FirstCall 135 16
Phantom 135 15
Visual 135 25
FirstCall + phantom 135 7
FirstCall + visual 135 8 dead element with a very low capacitance value in the test should
Phantom + visual 135 4 always be checked again: In 11 transducers out of 32 transducers,
FirstCall + phantom + visual 135 2 re-tested about one year later by the medical engineering center
transducer test and also a physical fault, (3) a defective result in
the phantom measurements and also a physical fault, and (4) a
defective result in both the transducer test and the phantom mea-
surements and also a physical fault.
3. Results
In the transducer tests, 117 (78%) of the 151 transducers were
considered fully functional and 26 (17%) defective. For 8 transduc-
ers (5%), the results were unambiguous. Out of the 135 transducers
with phantom measurements available, 21 (16%) had a defective
result in the transducer test and 3 (2%) had an unambiguous result.
For the 135 transducers, defective image quality was detected
in 20 (15%) during phantom measurements.
A physical fault was found in 34 out of the 135 transducers (25%).
In eight scanners out of 51 (16%), a fault elsewhere than in the
transducer was found.
For the 135 transducers with the transducer test, phantom mea-
surements and visual checks, the following concurrent defects were
found: (1) transducers with a defect in the phantom measurements
and a defect in the transducer test added up to 10 (7%). In three
transducers (2%), a defect in the phantom measurements and an
unambiguous result in the transducer test were detected. (2) A
physical fault and a defect in the transducer test were discovered
in 11 transducers (8%). In one transducer (1%), a physical fault and
an unambiguous result in the transducer test were found. (3) The
number of transducers with both a physical fault and a defect in
the phantom measurements was 5 (4%). (4) Three transducers (2%)
had a physical fault and defective transducer test and phantom
measurements.
The main results for the transducers are collected in Table 2.
4. Discussion
Different methods for technical QA in diagnostic US were com-
pared. Transducer tests, phantom measurements and visual checks
for physical faults were performed for 51 US scanners in a large
radiological imaging center.
Sixteen percent of the 135 transducers were found defective
in the transducer tests. In Mårtensson et al. [16], 48% of 40 trans-
ducers in radiological use were defective. The results cannot be
compared with our results, since the age, the frequency of use and
the amount of mobile use of the scanners might differ. In Mårtens-
son et al. [16], statistically significant variations in the amount
of defective transducers between the manufacturers were found,
when including all 676 transducers utilized in different clinics in
the comparison. In our study, the mean ages of the transducers by
different manufacturers varied considerably, not allowing unbiased
statistical comparison. Also, the number of transducers by some
manufacturers was small.
A major drawback in the FirstCall system was the lack of an
adapter or a correct definition file for some manufacturers’ newest
transducers. The classification of a transducer to be functional or
defective was based in Mårtensson et al. [16]. However, the num-
ber of weak or dead elements required to have significant impact
on the quality of diagnostic ultrasound with different transducer
types and active apertures should be studied more closely, although
Weigang et al. [15] have shown as an example that two consec-
utive dead elements in a linear array were enough to have an
effect on Doppler studies. Also, in our experience, an occasional
of our hospital, occasional dead elements had disappeared. One
of the re-tested transducer had four occasional dead elements,
which disappeared in the second measurement, thus changing
the classification of the transducer from defective to fully func-
tional. One possible reason for the changes in the results could be
occasional bad connections between the FirstCall adapter and the
transducer.
The functionality of the transducer obviously has a crucial
impact on the image quality, and verifying it is an important step
in image QA. However, checking the transducer is not necessarily
enough to ensure the quality of the whole chain of image forma-
tion. For example, three transducers utilized in the same scanner
were found fully functional in the transducer test, but they all gave
similar defective results in the phantom measurements. This led to
the conclusion that the scanner itself had a fault, which was unno-
ticeable with only the transducer tests. Although phantom based
QA has been claimed even to be a major step backward in US QA
[14], at the current there is no other validated method, at least to
the authors’ knowledge, for checking the image quality through the
whole imaging chain.
In the phantom measurements, defective image quality was
detected with 15% of the 135 transducers. A general purpose phan-
tom with manual analysis was utilized, since this is still the most
straight forward approach for US QA, with existing standards and
recommendations [1,2]. A weak point in utilizing phantom based
QA is the possible dependence of the results on the experience of
the user. Automatic estimation of the QA parameters could result in
more repeatable and less subjective analysis [6–10], although con-
sistent scanning of the images or a less practical transducer holder
[9] would still be needed.
In this study, only the homogeneity measurement and the air
image were utilized. Most of the other results from the phantom
measurements would have required a baseline to compare the
results with. The baseline parameters were not available from the
manufacturers, and we did not have several consecutive measure-
ments for all transducers nor a large set of transducers of the same
model for all the models. Comparing the results from transduc-
ers for similar purposes (e.g. low-frequency convex transducers)
but from different models or manufacturers was not an option,
due to the differences in user selectable parameters in different
equipment.
The comparison of the results from different tests indicated that
none of these methods was adequate alone. There were defec-
tive phantom measurements with 20 transducers. For ten of these
(50%), also the transducer test indicated a fault. For three trans-
ducers (15%), an unambiguous transducer test was found. Three
transducers (15%) were used with the same scanner and the scan-
ner itself was suspected to be faulty. With four transducers (20%),
the bad quality of the phantom image was left unanswered, at least
not relating directly to the classification criteria of the transduc-
ers in the FirstCall tests. On the other hand, when considering the
 O. Sipilä et al. / European Journal of Radiology 80 (2011) 519–525
21 defective results from the transducer tests, only ten of these
(48%) also had an impact on the phantom images. The effect on the
Doppler measurements is not known, since they were not included
in this study. Of the 34 transducers with a physical fault, in 11 (32%)
the fault was such that the transducer test also indicated a fault.
Although the rest of the physical faults seemed not to affect the
functioning of the transducer, the possible compromises in electri-
cal safety and in hygiene issues with a broken transducer should
not be overlooked.
The time difference between phantom measurements, visual
checks and transducer measurements was in the maximum three
months. This could have had a minor effect in the comparisons of
different methods.
The information about the quality of the scanners and trans-
ducers had a clear positive impact on managing the equipment.
For example, relating to the four new scanners purchased in 2008,
three transducers were found defective in the phantom measure-
ments and changed to the new ones before the warranty ended.
With some transducers, vain repairing of the damaged lens was
avoided when the FirstCall test showed plenty of non-functioning
elements or their wiring, too. On the other hand, for some trans-
ducers, known to have fully functional elements, effective repairing
of the lens or the cable jacket could be performed instead of
purchasing a new transducer. Re-use of the old but functional
transducers of otherwise expendable equipment was possible. Also,
when the image quality of the older equipment was known, some
of them could still be utilized in more modest non-diagnostic
applications.
5. Conclusion
Ultrasound QA offered benefits in optimizing the quality of US
scanners for patient studies and managing the diverging equip-
ment. The methods studied in this work – transducer tests,
phantom measurements and visual checks for physical faults – pro-
duced partly complementary results and seemed all be necessary
for the QA of US scanners. This means that a QA protocol is forced
to be rather labored, including several professional groups. There-
fore, the impact of the QA protocol must be closely followed and, if
necessary, the protocol revised.
525
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