Radiographic Equipments

1. kV accuracy

kV Accuracy

Frequency Annually

Objective
● To determine how the measured kVp compares with
the generator setting.

● To determine the accuracy of tube voltage.

Equipment ● Digital kV meter

● X-ray tube

Method 1. Position kV meter at the distance recommended by

the manufacturer.
2. Collimate to size of detector.
3. Observe radiation waveform at 70 kVp.
4. Make a series of exposures across the clinically used
range.
5. Result is recorded.

Analysis ● Check radiation waveform for any unusual

characteristics that may affect subsequent
measurements.
● Measured kVp(avg) must be within ±5% of the
nominal value.
● For capacitor discharge apparatus kV(max) must be
within ±5% of nominal value.
● For dental apparatus the measured KVp(avg) must
be within ±5kVp of nominal value.
2. kV reproducibility

kV reproducibility
the test should be done after new installation or any major
Frequency Annually repair of the system

Objective To ensure that the reproducibility of an x-ray unit is within the

acceptable limit so that the same result will be obtained
when the same technical factor is selected

Equipment Kv meter
Lead backing sheet

Method 1. Place the Kv metre on top of the detector with a lead sheet
placed in between. The lead was placed to absorb back
scatter

2. Set SID 110cm with 60 kVp and 5 mAs ( can use different
technical factor as well but make sure the kV and the MAs is
maintain in all set of exposure)

3.collimated beam to the size of ion chamber of Kv meter

4. Make 10 separate exposure (ensure the Kv and mAs is

maintained for all exposure!!)

5. Record the reading

Analysis Calculate the coefficient of variance and mean value using

the formula given

Coefficient of variance :
 Mean value :

The coefficient of variation should not be greater than 0.05%

(S.C. 35) or 0.08% (HARP)

The mean value should be within 15% (S.C. 35) or 20%

(HARP)

3. mAs linearity

mAs Linearity

Frequency · Annually

Objective · To determine the linearity of the radiation output over a range of

mA or mAs settings by keeping the kVp and time constant.

Equipment · Dosimeter

· Lead backing sheet

Method 1. Set up the test equipment according to the directions provided in
the general setup.

2. Place the ionization dosimeter chamber in the x-ray field.

3. Position the ion chamber in the primary beam at 75 cm from the

focal spot and record the distance. Set dosimeter to Exposure
mode.

4. Select 80 kVp, 0.2 seconds and the lowest mA station within the
normal range of use.

5. Place lead sheet under chamber to absorb backscatter.

Collimate beam to the size of the chamber.

6. Take an exposure and record the output.

7. Select the next higher mA station adjacent to the first mA station.

Ensure that the Kilovoltage is maintained at 80 kVp throughout
the test.

8. Take an exposure and record the output.

9. Repeat steps 7 and 8 until all adjacent mA stations in the normal

range of use have been checked.

10. Calculate the mAs for each station checked.

Analysis · Calculate μGy/mAs (X) by dividing with nominal mAs

· Linearity coefficient: = Xmax – Xmin

Xmin + Xmax

Linearity coefficient MUST NOT exceed 0.1

· Linearity should be measured for all focal spot sizes as μGy/mAs

may vary

· An improperly functioning room could result in overexposure to

patient, thus fails to comply with the ALARA principle.
 4. Timer accuracy

Summary

Purpose/Aim -To determine how the exposure time compares with the selected time.

-To ensure that the amount of radiation time emitted from the X-ray tube
corresponds to the time selected by the operator.

Test Annually
frequency

1. X-ray tube
Equipment 2. X-ray machine console
used 3. Digital timer
● used to measure the time it took for it to receive the set
energy from the x-ray beam.

Method STEPS:

1. Position digital timer or beam analyser at the distance

recommended by the manufacturer.
2. Collimate to the size of the detector.
3. Make a series of exposures commencing at the shortest
exposure time, then across the range of the timer at commonly
used settings up to 1 second.
Test analysis ANALYSIS:

● Calculate the deviation between the nominal and

measured values of the exposure time.
● PAPP (2011) states that exposures >10 ms should be
within ±5% and exposures <10 ms can be within ±20%.
(Using standards set by PAPP 2011).

CORRECTIVE ACTIONS:

1. Repeat the test.

2. After receiving a consistent deviation (same result), we should

check the sensitivity settings of the instrument and observe if the
waveforms are consistent for the same exposure settings.
5. Grid Alignment

Grid Alignment

Frequency Annually

Objective
To detect an upside-down focused grid / incorrect tube to grid
distance

Equipment ● X-ray tube

● 2 Lead blockers
● Lead test plate with 5 large holes (centers spaced
25mm apart) and 3 small holes
● A moving focused grid
● 8 x 10 inch film-screen cassette

Method ● Moving focused grid is used and placed in the bucky

● The beam was centered to the bucky
● The test is performed by taking an exposure centered
to each hole while the others were covered
● The film was then processed

Analysis ● Grid should be centered towards the 3rd large hole

(highest optical density)
● Possible causes of grid misalignment:
- incorrect position or construction of the grid
- grid motion is not aligned to the x-ray exposure
● Factors that may have caused beam-grid
misalignment:
- improper centering of the beam to the bucky
- misalignment of the grid within the bucky
mechanism

The results of the central ray when moved over the other
holes of the grid alignment test tool should show the optical
densities of the corresponding dot on the film were
decreasing symmetrically away from the central dot that was
indicated to indicate that the grid is in perfect alignment with
the center lock position of the x-ray tube.
6. Half-value layer

Half-value Layer

Frequency Annually

Objective Indicator of the XRT status the measurement of the useful beam
(low energy x-ray filtered)

Equipment Used
● Dosimeter
● 99.9% of aluminium attenuators
● Measuring tape
● Lead plate
● Micropore tape

Method ● Ensure the IR is in free exposure mode (remove

from the Bucky / move the XRT away the IR)
● Set 80 kV & 40 mAs for exposure factor
● Place dosimeter 1m (or minimum 50 cm) centered
below XRT & collimate it at sensitive area of
dosimeter
● Exposure made without an attenuator & record the
reading
● Repeat the test with increment / decrement of
attenuators until two dose values fall below or
above 50% of the unattenuated value
● Plot a graph (x-ray quantity against thickness of
the filter) and draw dotted line to indicate the HVL
(determine half of the x-ray quantity first)

Test Analysis ● Initial reading without attenuator is to record initial

x-ray quantity of XRT
● Dosimeter place 1m below XRT is to avoid
additional filtration from table bucky
● Proper collimation avoids x-ray beam to not
included in the sensitive area of dosimeter
(under-collimate) and inaccurate reading
(over-collimate)
● If the measured HVL doesn’t meet the specified
national minimum requirements; repeat the test,
check the instruments, geometry of the set-up &
ensure the attenuators are appropriate
● If the 4 factors is clear, check the kV-accuracy &
radiation output
● If HVL is too low indicates placement of additional
and non-removable filtration
● If HVL is higher than expected, check if removable
additional filtration is present
 7. Beam and collimation alignment

BEAM & COLLIMATION ALIGNMENT

Frequency Quarterly

Objectives To verify misalignment of the light field and the x-ray field in order to
ensure accurate collimation and full coverage of image receptors without
giving unnecessary exposure to patients.

Equipment 1. Collimator Test Tool And Beam Alignment Test Tool

2. Cassette 8 inch x 10 inch
3. Bubble level

Method 1. A bubble level was used to level the table. Place image receptor
on flat surface and set the X ray tube’s axis to be perpendicular on
the image.
2. Position the test object on the image detector with the cylinder at
the centre of the light beam crosshair.
3. Set the SID to be 100 cm. Another SID may be used as well, but it
is easier to interpret the results if 100 cm is set.
4. Use the light field and the markings on the test tool for accurate
field alignment.
5. Make an exposure using the following exposure parameters: 50
kV, 3 mAs, or the values recommended by the medical physicist.
Process the film and take measurement.

Analysis : 1. The X-ray field falls within the rectangular frame.

Measurement 2. Rectangular regions of interest were drawn to cover 90% of the
of Collimator border area of an individual edge.
Alignment 3. The profiles of the gray values measured from the selected ROIs
were plotted. Distances between the highest ( a lead line at the
border of the test tool) and lowest (the outermost region of the
x‐ray field) points of gray values were measured.
4. Misalignments of collimators were measured in both short and
long axes.
5. The deviation of the X ray field and light field does not exceed ±2
cm of the SID.
6. The coincidence of the collimator light beam crosshair with the
X-ray beam centre does not exceed ±1 cm at a SID=100 cm
7. For SID other than 100 cm the distance between the rectangular
image and the edges of the x-ray field should be measured using
a ruler and compared to the value in the table to the given
distance.
8. Backup timer

Frequency Semi-annually

Objective To ensure the AEC device terminates the exposure at the

proper setting of the guard timer

Equipment Stop watch, Lead sheet

● Centre the x-ray tube to the image receptor, and set

Methods the SID at a sufficient distance which is 100 cm.
● Place the lead sheet in front of the beam.
● Arrange the instrument to be in the main axis of the
x-ray beam, while its sensitive area is facing the
x-ray tube.
● Collimate on the area where the AEC sensors are
situated.
● Select a low tube voltage value and set the guard
timer at a reasonably low level. Select the most often
used AEC sensor for this test.
● Make an exposure with the above settings.
● Record the exposure time and take notes of the
error messages which may appear as feedback from
this exposure.

Test analysis Check that the AEC terminates at the set guard time or prior
reaching the setting.

- If the AEC terminates before the set guard time, image

that produced will be underexposed

- If the AEC terminates after the set guard time, image that
produced will be overexposed
Processing Equipment

9. Processor cleaning

Objective To confirm and verify that the film processor-chemical system is

working in a consistent manner according to pre-established
specifications (manufacturer’s specifications).

Frequency •Weekly
•Monthly
•Quarterly

Equipments •Sponge
•Soft towel
•Water
•Soft brush
•Processor

Method
Weekly

1. Turn off the processor and remove the cover.

2. Carefully remove the rack pulling straight up and then to the
side. Be very careful not to suspend one rack over another
tub. The solution could drip from the rack into another tub. This
is a very common way to contaminate your chemistry.
3. Place each rack in its own cleaning tub. Many manufacturers
provide colour-coded tubs for this purpose. If not, use of your
own colour-coded tubs is recommended.
4. Clean the racks with a soft brush or sponge and warm water
only (do not use detergents). Use separate brushes or
sponges for each rack. Colour-coding to match the racks is a
good idea to avoid inadvertently contaminating the racks.
Some manufacturers have special cleaning solutions they
recommend using for cleaning. Typically, these are only to be
used with the monthly or even quarterly cleaning routines.
Check the directions for your processor and cleaning solution.
5. While cleaning, inspect the racks for signs of wear or damage.
They should spin freely when rotated by hand. Rotate the
racks while cleaning to be certain to clean all surfaces (for
those racks with rollers) as well as to verify that they spin
properly.
6. Thoroughly rinse and allow racks to dry.

Monthly

1. Remove and clean racks as above (“Weekly”).

2. Drain chemistry and remove tubs. Dispose of chemistry in
accordance with local codes.
3. For processors with a chain drive (e.g. Dent-X 810) lubricate
the chain using 3 drops of oil in each port labelled “oil” and
then run the processor.
4. Peri Pro processors- visually inspect transport to verify arms
 are correctly aligned. Adjust if necessary.
5. Thoroughly rinse and scrub tubs. Once again, be certain to
use a dedicated brush or sponge for each tub to avoid
cross-contamination of chemistry. Colour coding will help avoid
confusion.
6. Remove drain plugs, agitators, stand pipes or other
components from the chemistry tubs and clean. It may be
helpful to clean in the same wash tub as the corresponding
rack to avoid mixing chemistry.
7. Allow all components time to dry thoroughly (usually over the
weekend).
8. At the beginning of the next work day, return components to
the tubs, refill chemistry, install racks, and process a cleaning
film (if such is available for your processor).

Quarterly

1. Clean all components as above under “Monthly”. Use of a

processor cleaning solution should be incorporated at this
time. Most manufacturers have their own solutions although
some after-market solutions are available as well. However,
DO NOT use soaps or detergents, only solutions
specifically made for x-ray processors.
2. Thoroughly rinse cleaning solution from all components.
(NOTE: some manufacturers recommend allowing the racks to
soak overnight (or longer) in the cleaning solution.) Check the
directions for your solution/processor. In such a case, rinse
and re-install the racks on the next work day.
3. For processors with a direct water connection- check the
solenoid for clogs by disconnecting from the water source and
inspecting the connection. Normally, there will be a screen
inside the fitting which can be cleaned.
4. Make a visual inspection of all electrical connections as well as
any water, drain lines, or chemistry feed lines. Make certain
that all connections are secure, that all hoses are free from
kinks, and that there are no loose or frayed wires. Note any
discrepancies and correct or replace worn components.
5. Verify solution temperature using a thermometer. Most
processors heat the chemistry to 81°-83°F. If the temperature
is off, you may need to calibrate it or replace a component.
Call our tech support staff for specifics of your machine.
6. Some processors (e.g. AT2000) will have an automated
cleaning cycle which should be run at this time.
7. If using a daylight loader, check the seals of the loader for
signs of wear and light leaks. One method of testing for light
leaks is to put a coin on a fresh film inside the loader. Process
the film. If you can see the coin you have a light leak.

Analysis
General Precautions

➔ For roller-type processors, use only a sponge or soft-bristled

 brush for cleaning. Abrasives or hard bristled brushes can
damage the rollers.
➔ Use colour-coded cleaning supplies to avoid contaminating
chemistry. An ammonia-like odour is a sign of contaminated
chemistry.
➔ Be observant. Watch and listen to a complete cycle at least
once a day. Make certain all the appropriate indicators
illuminate when appropriate. Strange noises or erratic
performance can be the first sign of a problem.

10. Processor Maintenance

Objectives: Maintains the processor efficiency to ensure optimum quality of image

produced.

Equipment: Sensitometer, densitometer, thermometer(alcohol/electric), tank

cleaning brushes, Sodium Hypochlorite bleach (used in cleaning the tank), clean
disposal cloth.

Method: (do the test at the same time every morning after developer temp have
stabilised)
i) Daily - Check Solution Temp, First film as clean up procedure, Run sensitometry
test

Sensitometry test
1. Run start-up procedure.

2. Wait for the temperature to stabilize.

3. Adjust wash water temperature properly.

4. Check solution temperature, replenishment & water flow rates, and dryer

temperature.

5. Run several clean-up film procedure.

6. Expose film from designated box with sensitometer in darkroom.

7. Process the strips.

8. Reset densitometer.

9. Calculate the base + fog, contrast, speed, & developer temperature. Then,
plot in the charts.
 ii) Weekly - Check replenishment rate,Clean the rollers and webs in warm water.
iii) Monthly - Replace all chemicals, clean all tanks and components . At the same
time check the overall condition.

Tank Cleaning Procedure

1. Use a system-cleaner chemical kit.

2. Pay attention to wash water tank. (May be filled with dilute concentration of
0.5% hypochlorite solution)

3. Let solution sit in system about 30 minutes.

4. Rinse the system using clean stiff brush to dislodge algae or ‘bio-growth’
sediment.

5. Rinse the system thoroughly.

iv) Annually - Replacement of the processor part (Rollers, ’E’ ring, developer filter,
‘poppet’ valve in replenishment pumps)

Analysis: (depends on manufacturer recommendation)

a) Sensitometry test ; base + fog (+-10%)
Speed (+-15%)
Contrast (+-20%)
Temp (+-2 degrees)
If the data fall outside the control limit, repeat the test, if persist, take a corrective
action (call the engineer)
b) Precaution: Completely switch off the processor, wear protective equipment,
ensure the darkroom is ventilated and clean from any spill or splashes.

11. Processor monitoring

 Test PROCESSOR MONITORING

Purpose of Test -To ensure that the processor is functioning well at an optimum
temperature

-To detect problem that might have happen

-Taking action to solve the problem

-To confirm and verify that the film processor-chemical systems is

working in a

consistent manner according to the pre-established specifications

Frequency of Daily (this procedure is also carried out when significant change is
test made in imaging procedures, i.e., different film, chemicals, or
processing conditions.)

Equipment used 1. Sensitometer

- An instrument designed to exposed a reproducible,
uniform, optical step-wedge pattern onto a film. It is
used to measure the film’s emulsions reaction
(sensitivity) to light.
- The film are place in contact and exposure made
through the sensitometer.
2. Densitometer
- Densitometer is used to measure the density of a film
by the amount of light which shines through or tissue
density by the amount of radiation transmission.
- Densitometer has a photoelectric sensor that
measures the amount of light transmitted through a
piece of film that is placed between the light source
and the sensor

Method -Sensitometry test is used in the establishment of processor quality

control operating level, daily processor quality control and control film
cross-over

STEPS:
 1. Make sure the processor has been cleaned, the chemistry is
fresh, and the processor is operating at the recommended
temperature, replenishment rate, and cycle time specified by
the film manufacturer.
2. Designate one box of film for processor quality control.
3. Take one piece of film from this designated box, expose it
with a sensitometer in the darkroom, process the film,
measure the appropriate steps with a densitometer, and
record the data to determine Speed Index, Contrast Index,
and Base + Fog.
4. Repeat this procedure for five consecutive days.
5. Read and record the densities of each step of the
sensitometric strip using the densitometer, including an area
of processed film that has not been exposed.

Test analysis 1.Control limits are the boundaries within which measurements must
be maintained.

2.Read and record the densities of each step of the sensitometric

strip using the densitometer, including an area of processed film that
has not been exposed. Measure the densities of the steps in the
center of each step.

3.Determine the average of the densities for each step using the
densities from the same step of the 5 strips done on 5 consecutive
days.

4.Speed Index, Contrast Index, and Base + Fog measurements

should then be determined and compared to reference values.

Considerations:

1. Films should always be introduced in the same direction and on

the same side of the processor feed tray.

2. If a technician processes single emulsion films with the emulsion

side up, the Q.C. film must be treated in the same way.

3. Do it every day at the same time. This test should be done first
thing in the morning, when the processor developer temperature has
stabilised, before visiting patients.
Fluoroscopic Equipment

12. Exposure rates

● Reproducibility
● kV Accuracy
● Milliampere linearity

Frequency: Annually

Reproducibility

Objective:

To determine the variation in reproducibility over a number of exposures at the same

generator setting.

Equipment:

Dosimeter, lead shielding, stopwatch

Methods:

-A dosimeter is placed on the fluoroscopic table-top

- Place the shielding under the dosimeter

- Collimate beam in the size of dosimeter

- Select 70 kVp and 10 mAs

- Center the dosimeter probe to the center of the fluoroscopic x-ray beam at 1 meter
distance from the focal spot

-Then, depress the expose button for 10 sec(use stopwatch) and record the reading

- Clear the dosimeter and repeat this procedure

Analysis:

-Determine the ratio for each second exposure of the dosimeter

-Reproducibility variance :(mRmax-mRmin) x100%

(mRmax+mRmin)

-must be less than 5%

-if exceeding the limit, it can lead to fluctuation in image quality and patient dose. The
cause is most likely caused by problems with x-ray generators or fluoroscopy tubes.

kV Accuracy
Objective:

To determine the variation in average kV over a number of exposures at the same

generator setting.

Equipment:

Digital kilovolt meter, lead rubber sheet

Methods:

- Position kV meter at the distance recommended by the manufacturer.

- Collimate to size of detector.
- Observe radiation waveform at 70 kVp and obtain hard copy if possible.
- Make a series of exposures across the clinically used range.

Analysis:

-kilovolt variance :(kVmax-kVmin) / (kVmax+kVmin)

-failed kVp accuracy test could be attributed to alighted problems being faced by
radiographers/operators

-one of the implications of failed kVp is the production of lower energy photons
(X-rays), which in most cases are of no diagnostic purpose thereby affecting the
outcome of the radiograph

Milliampere linearity

Objective:

To evaluate the linearity of the generator for commonly used exposure settings.

Equipment:

Dosimeter, lead shielding

Methods:

- Place a dosimeter on the fluoroscopic table-top, and centered to the

fluoroscopic x-ray field or beam at the distance specified by manufactured
- Place the lead shielding under the dosimeter
- Collimate beam in the size of dosimeter
- Use 80 kV and 20 mAs exposure. Each exposure should have a different mA
and time combination to equal 20 mAs.
- Ensure the SID is 100 cm
- Take 3 exposure using kV and 20 mAs. Each exposure should have a
different mA and time combination to equal 20 mAs (as listed below)
● 80 kV 200 mA 100 mAs
 ● 80 kV 100 mA 2oo mAs
● 80 kV 250 mA 80 mAs

Analysis:

-determine the milliroentgen-second values for each milliampere tested

-linearity variance: [(𝑚𝑅/𝑚𝐴𝑠𝑚𝑎𝑥 − 𝑚𝑅/𝑚𝐴𝑠𝑚𝑖𝑛) ÷ 𝑚𝑅/𝑚𝐴𝑠 𝑎𝑣𝑒𝑟𝑎𝑔𝑒] ÷ 2

-the linearity variance should be within 0.1/10%

-If exceed the limits, corrective action are needed

13. Beam alignment:

Frequency Quarterly

Objective To ensure that the x-ray field is aligned to the image

receptor field, so it is not larger than normal collimation.

Equipment: Method 1:
● Collimator test tool
● Beam alignment test tool
● Image receptor
Method 2:

● Fluoroscopic beam alignment device

● X-ray film
● Protection shielding
● Energised fluoroscopy unit

Method 1
1. Place the collimator test tool on the film-cassette.
2. Keep the beam alignment test too at the centre of
the collimator test tool.
3. Direct the x-ray tube over the collimator test tool at
the distance of 100 cm from the film cassette and
optical field is collimated at the marked rectangle of
the collimator test tool.
4. Expose and develop the film.
Method 2
If clipping is visible:

1. Fully open the collimator shutters.

2. If clipping is visible on all four sides and at various
SIDs, enter "0" percent, record a passing result, and
continue onto the next test.

If clipping is not visible:

1. Place Fluoroscopic Beam Alignment Device on the

table.
2. Move the four brass strips up, down, left, and right 3
dots.
3. Make a fluoroscopy exposure to ensure Fluoroscopic
Beam Alignment Device alignment on screen.
4. Place 14 x 17 cassette under Fluoroscopic Beam
Alignment Device.
5. Make a fluoroscopy exposure and process cassette.
6. The ends of the brass strips should correspond with
the edges of the exposure as defined by the
Fluoroscopic Beam Alignment Device. If not, the
system is out of alignment.
7. Measure the total sum of the length and width offset
of the actual field.
8. Use the following formulas:

- Length error = L1 + L2

- Width error = W1 + W2

- Length DIV/SID (% Error) = Length

error/SID (12") * 100

- Width DIV/SID (% Error) = Width

error/SID (12") *100

- Total Sum of length and width error

= Length DIV/SID (% Error) + Width
DIV/SID (% Error)

- Center Offset (% error) = centre

offset/SID (12") * 100 (3% per
dimension; 4% sum error).

Analysis
Method 1:
 ● If the images of the two steel balls overlap, the
central ray is perpendicular to within 0.5°.
● If the image of the top ball (larger shadow) intercepts
the first circle, the beam is about 1.5° away from the
perpendicular.
● If the image of the top ball intercepts the second
circle, the misalignment is approximately 3°.
● The tolerance is around 1.5 to 3 degrees only.
● If the centering is off by more than 3% of the SID, it
should be corrected by qualified service personnel.

Method 2:
● The edges of the beam field are not aligned, and
therefore the beam field and image receptor are
misaligned.
● The centre of the field is indicated by the central dot
and any misalignment of the beam can be checked
by counting the number of dots visible in each
channel.
● Supposedly, the dot at the intersection of the two
lines should be at the centre of the image.
● There should be an equal number of dots visible on
each of the channels when counted from the centre.

14. Source to skinfar distance

Name of the test: Patient entrance surface air kerma rate

Purpose - To verify the maximum achievable patient entrance

surface air kerma rate (ESAK rate) is under the limits.
- It is important to emphasize that monitoring of the peak
skin dose during a given procedure and the
assessment of patient exposure should be
complementary to this test

Frequency - Annually

Equipment Used
- Dosimeter with calibrated ionization chamber or
solid-state detector
- 20 cm thick water phantom, covering the image
receptor.

Method
1) Position the phantom on the couch. To simulate a larger
patient, an additional 10 cm of water may be added.
 2) Position the measuring instrument in contact with the
phantom and at the center of its entrance surface, facing the
X-ray beam.

3) Set the focal spot to image receptor distance equal to that

used in clinical practice. There are no standard values for this;
however, 100 cm or the nearest possible distance to 100 cm
could be used.

4) Open the collimators to the size of the image receptor.

5) Measure and record the focal spot-image receptor, and the

focal spot-radiation detector (instrument) distances.

6) Expose the phantom using a clinical imaging protocol and

record the dosimeter reading, kV, mA and the image receptor
settings, then repeat this exposure two more times.

7) Repeat the previous step for all FOVs, dose rate settings
and differing imaging protocols used under normal clinical
conditions.

Test Analysis Apply the appropriate correction factors for the instrument and
correct the measured ESAK rates to the reference point using
the inverse square law. When performing the evaluation, keep
in mind that ESAK includes backscatter, while incident air
kerma does not.

Name of the test: Image receptor entrance surface air kerma rate

Purpose - This test monitors the constancy of the imaging chain.

- To verify that the air kerma rate at the entrance of the
detector conforms to the maximum allowed level.

Frequency - Annually

Equipment Used
- Dosimeter with calibrated ionization chamber or
solid-state detector
- An aluminium attenuator with a thickness of 25 mm
and copper plates.

Method
1. Position the phantom on the couch. To simulate a
different patient size, 10 cm of water or equivalent
PMMA may be added.
2. Position the instrument in contact with the image
receptor, as close as possible to its entrance surface,
facing the X ray beam.
3. Set the focal spot to image receptor distance equal to
 that used in clinical practice. There are no standard
values for this, however, 100 cm or the nearest
possible distance to 100 cm could be used, similarly to
the other tests.
4. Open the collimators to the size of the image receptor.
5. Measure and record the focal spot-image receptor, and
the focal spot-radiation detector distances.
6. Expose the phantom using a clinical imaging protocol
and record the instrument’s reading, kV, mA, and the
image receptor settings, then repeat this exposure two
more times. Note: The IEC, International
Electrotechnical Commission recommends using
additional copper attenuators to let the AERC set a
tube voltage between 70 and 80 kV.
7. Repeat the previous step for all field sizes, dose rate
settings and differing imaging protocols used under
normal clinical conditions.

Test Analysis - Apply the appropriate correction factors for the

instrument and correct the measured air kerma rates to
the entrance surface of the detector using the inverse
square law.
- Correct for the attenuating layers present between the
instrument and the image receptor. The transmission
factors could be usually found in the documentation
provided by the manufacturer.
 15. Intensifier viewing system high and low contrast

FREQUENCY

OBJECTIVE High Contrast:To resolve small, thin, black-and-white areas and is a

measure of spatial resolution.

Low Contrast: To resolve relatively large objects with slightly different

radiolucency from the surrounding area.

EQUIPMENT 1. Energized fluoroscopy unit

2. High contrast resolution test tools
3. Low contrast resolution test tools

METHOD High Contrast:

1) Centre and tape the high resolution test tool as closely as possible
to the middle of the I/I's input surface.
2) Collimate the shutters to the size of the test tool and adjust the
fluoroscopic factors.
3) On television systems, adjust the contrast and brightness control to
best visualize the mesh.
4) Expose using fluoroscopy and note the finest wire mesh visible in
the centre and at the edges of the image.
5)
Low Contrast:
1) Place the aluminum plate with drilled holes between the 2
aluminum blocks. Place this on the x-ray table.
2) Set the I/I 12 inches (30 cm) above the x-ray table top Collimate the
beam to aluminum blocks and adjust the fluoroscopic factors.
3) and centre over Low Contrast tool.
4) Record the smallest set of holes seen. There are two linear rows of
equally sized and spaced holes.

ANALYSIS High contrast

- The 9 inches input phosphor should able to resolve at least 24

holes/inch at the center and at least 20 holes/inch at the edge.
- The 6 inches input phosphor should be able to resolve at least 30
holes/inch at the center and at least 24 holes/inch at the edge.

Low contrast
1. Low contrast evaluation can be made based on the shallowest
visible hole when the plates are sandwiched together and imaged
on a fluoroscopic system.
 2. Using low contrast resolution test tool, the contrast between the
holes and the surrounding area is 2%.
3. With CDRH phantom, the deepest holes should be visible clearly.
4. Better system are able to visualize the smaller holes on the test
tools or the shallower holes on the CDRH phantom.

16. TV monitors and recorders

Frequency Monthly

Objective
-Detects any errors inside the TV monitor system in order to ensure
the real-time image quality is maintained at an optimum level.

Equipment
- Energized fluoro unit

- Test tool

- Phantom

Method
- Follow the manufacturer's instructions for setting up
the Fluoroscopic Quality Control Phantom used.

- Set up the fluoroscopy unit. The field of view (FOV)

of the image intensifier is set to the mode that allows
the entire phantom to be imaged. The grid should be
in place if it is regularly used for fluoroscopy.

- Set the kVp and mA on the control panel.

- Activate the fluoro beam and adjust the fluoro tower

as needed to center the phantom on the image field.
Reduce the collimators so that just the phantom's
edges are visible.

- Fill in the date and initials of the person who is

administering the test on the form.

- Activate fluoro with the phantom in place. Fill in the

appropriate areas on the form with the correct kVp
and mA from the control panel.
 - Observe the image produced on TV monitors and
record the baseline values for kVp and mA, amount
of meshes seen and amount of holes seen.

- Repeat the test. Identify the source of the problem

and rectify it if any item on the form is not within the
permitted range.

Analysis
For kVp and mA changes:

- Recheck the phantom and fluoro system settings if the

stated kVp changes from the baseline value by more than
5% or the mA by more than 10%.

Decrease in number of meshes seen:

- If two or more mesh groups cannot be viewed despite the

fact that the kVp and mA values are the same, consider
changing the display brightness to improve visualization.

Decrease number of holes seen:

- If two holes are not visible but the kVp value is the same,
consider changing the monitor brightness to see if that
helps.

17. Automatic brightness control

Frequency Annually.

Objective To ensure that the automatic brightness control (ABC)

is performing as expected.

Equipment ● Dosimeter
● Phantom with different sizes
● Energized fluoroscopy unit

Method 1. Place the dosimeter on the table with the

thinnest phantom available. The phantom is
placed above the dosimeter and is positioned
on the x-ray tube's side.
 2. The phantom is exposed using the fluoroscopy
machine. Collimate the x-ray field size to the
size of the phantom. Ensure that the dosimeter
is visible in the centre of the viewing device
(mirror or TV). Keep the following in mind:

● size of the intensifier (II)

● kVp set and kVp indicated at time of fluoroscopy
● mA set and mA indicated at time of fluoroscopy
● phantom used
● measured output in R/min

3. Alter the thickness of the phantom by adding

the next largest phantom available.

4. Use fluoroscopy machine to expose the

phantom and record the data as in step 2.

5. Add next largest phantom. Use fluoroscopy

machine to expose the phantom and record the
image as described above.

6. To check reproducibility, return to the initial

phantom and repeat.

Analysis & Discussion ❖ As the structure's thickness increases, the

brightness or contrast remains constant.
❖ ABC automatically adjusts the contrast.
❖ Enables the fluoroscopic unit to maintain the
image's brightness level automatically
(variations of thickness and attenuation).
❖ A High Dose ABC mode can be used to reduce
the kVp while increasing the mA to improve
image contrast while maintaining the same
image brightness, while a Low Dose mode can
be used to increase the kVp while decreasing
the mA to achieve a similar result.
Darkroom and Accessory Equipments

18. Safe light test

Frequency Annually

Objective To ensure the light that has been emitted is safe and has
not affected the x-ray film while processing.

Equipment Unexposed film, darkroom with safelight, opaque object

phantom, stopwatch,densitometer.

Method 1. The cassette is placed on a flat surface after filling it

with film.

2. Center the attenuation block to the cassette and

expose it using an x-ray technique that will result in an
optical density of about 1.0 after the film is processed.

3. With the safelights on, place the exposed film on the

work area in the darkroom. Cover half of the film with
opaque material, bisecting the latent image parallel to the
long axis of the film.

4. Leave exposed film on the counter for 2 minutes, then

process as usual.

5. While waiting 2 minutes for darkroom fog test, look for

any sources of extraneous light. Any light leaks identified
should be repaired as soon as possible.

6.Inspect the processed film. If there is no discernible

delineation between the shielded and unshielded sides of
the film, there is no fog problem.

7. If there is evident of line, measure the optical densities

of both sides of the line with the densitometer. If the
density difference is greater than 0.05, corrective action
should be taken.

8. Record results on the Checklist.

Analysis & discussion With the safelight turned off, repeat the test. If the
outcomes stay the same, it may be because of a light leak
or extraneous light. If the fog level disappears, the
safelight must be the cause of the fog, and the issue
needs to be fixed.
19. Cassettes test

There are two cassette tests which are:

a) Film-screen contact test

b) Light tightness test

Test Name Film-screen contact test

Frequency Annually, during acceptance of new cassette or as

needed.

Objective To assure the optimum contact is maintained between the

screen and film in each cassette.

Equipment Cassette, mesh wire and densitometer, view box

Method 1. Load a film into the cassette and face up on the table
bucky.

2. Place the mesh wire on top of the cassette.

3. Centre the X-ray tube at about 150 cm from the

cassette, then open the collimator to let the radiation field
cover the whole cassette.

4. Make an exposure using 50 kVp, 6 mAs.

5. Process the film as usual and examined the film

through the view box.

Analysis & Discussion 1. Measure the film density using densitometer.

2. View each film on a view box in a dimly lit room from

approximately 6 feet to 8 feet away.

3. Look for areas that are darker and/or blurrier than the
rest of the film. This indicates poor contact.

4. This could be caused by:

-Damaged cassette
-Screen deterioration
-Air pocket
 Test Name Light tightness test

Frequency Six monthly

Objective To ensure there is no fogging of the unexposed film or

some regions of it due to light leakage from damaged
cassette.

Equipment Cassette, unexposed film, view box

Method 1. Load the unexposed film into the cassette.

2. Place the cassette on the film view box or any strong

light area to expose it.

3. Leave the cassette exposed for 10 minutes for each

side.

4. Process the film as usual and examined the film

through the view box.

Analysis & Discussion 1. Visually inspecting the processed film to determine if

there are foggy region vizualise.

2. Reject the cassette if there is any foggy area seen on

the film.

20. Viewbox test

Viewbox test

Frequency - Semi- annually

Objective - to regulate all illuminators in the medical imaging

department and adjacent departments are of the
same illumination intensity
Method - Lower the light of surrounding (ambient light) to
normal viewing levels.
- Set the photometer to read unit (cd/m2). Follow the
manufacturer’s guideline.
- Position the photometer 9 inches from the
illuminator for every reading taken for every
illuminator.
- The readings is advised to be taken in 5 places
from the illuminator which is the centre, right and
left upper quadrants, and the right and left lower
quadrants of the illuminator.
- Calculate the average reading for every illuminator
and record the final value.
- Repeat steps for all remaining illuminators in the
imaging department and adjacent areas.

Analysis

- For general radiographic illuminator, the luminance

should be between 1500 and 3000 nit.
- In a given illuminator, illumination variations should
not exceed 10%.
- In a group of illuminators, illumination variations
should not exceed 20%.

Equipment - Photometer
- Measuring tape
- Viewbox/illuminator
- Calculator