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COURSE OUTLINE:

VII. Quality Assurance and Maintenance Issues

Quality Assurance and
Maintenance Issues
Ms. Danica P. Pardalis, RRT.
Lecturer, B.S. Radiologic Technology Program
La Consolacion University Philippines
Quality Assurance
1. Technologist responsibilities
▪ It is the planned and systematic action that a
1.1. Image quality control
1.1.1 Exposure indicator appropriateness
diagnostic x-ray facility will produce a
consistently high-quality images with minimum
1.1.2. Image Accuracy
exposure of the patients and personnel.
1.2. Plate Maintenance
1.2.1. Cleaning and inspection
Quality Control
1.2.2. Erasure
▪ It deals with the technique used in the monitoring
1.3. Reject analysis
(or testing) and maintenance of the technical
2. Service engineer or medical physicist
elements or components of an X-ray system.
responsibilities

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(CR) Computed Radiography Basic Components of CR CR WORKFLOW

Preview & ID Station
ID Tablet
Cassette with
Digital way of doing general radiography Imaging Plate
with Conventional X-ray machines
Rx Exposure
Printing

It is a process of capturing radiographic data Network

from a conventional X-ray machine and processing Digitizer

Processing Server Laser Camera
the data digitally to produce crisp and high quality
radiographic images.
Processing server
Identification Digitizer

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INTRODUCTION to QA QC of CR and Recommended routine QC tests

Digital Radiography
DR for DR systems
Frequency Test Section

Direct digital radiography (DR) and Daily Checks on acquisition and reporting monitors
Daily System check
▪ Performed by digital X-ray machines computerized radiography (CR) systems are Daily Printer checks using test pattern

with flat panel detectors now being used routine for radiography Weekly Check of contrast-to-noise ratio
Weekly Image quality tests
Screening Programme. Weekly Uniformity check
Monthly AEC thickness check
Monthly Test of reporting monitors
Routine quality control (QC) is essential to Monthly Mechanical safety and function checks
As required Detector flat-field calibration
ensure that the equipment is performing as As required Repeat analysis
expected meets standards. As required Printer checks following software upgrade

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Recommended routine QC tests Artifacts in Computed

for CR systems Artifacts
Radiography
Frequency Test Section
Daily Checks on acquisition and reporting monitors
CR - Dust on the IP, scraches/cracks on IP, dirt on reader,
Daily System check
roller marks ▪ Hardware artifacts
Daily Printer checks using test pattern
Weekly Check of contrast-to-noise ratio DR - Faulty individual pixel, cluster of pixel, loss of resolution
Weekly Image quality tests in one or both direction
▪ Soft ware artifacts
Weekly Uniformity check
Monthly AEC thickness check
Monthly Test of reporting monitors MONITOR – CRT (distortion, possibly due to interference
Monthly Mechanical safety and function checks from other electrical devices)
Six-monthly Image plate matching and artifact check
As required Image plate erasure PRINTER - if artifacts not seen on hard copy, then it is
As required Image plate cleaning caused by printer, bandling, streaking, fine line in direction of
As required Repeat analysis film appear
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As required Printer checks following software upgrade

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Damaged laser beam head in CR

Hard ware artifacts
reader
▪ dust particle & scratches
▪ Damage to the laser beam head of CR system
REASONS APPEARANCE Appearance
Appears as multiple linear white line
REMEDY:
▪ Head must be cleaned by Camel hairbrush by vendor engineer ▪ dust particle & scratches
▪ Damage to the laser
beam head of CR system
Remedy
REMEDY:
▪ Head must be cleaned by Laser beam head
Camel hairbrush by Has to be replaced
vendor engineer Dust on the laser beam head
appear as an irregular
white lines 13

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Software artifacts
Computed Radiography and MONITOR CHECKS
Excessive edge enhancement
Quality Control
A B
▪ Computed radiography still uses conventional ▪ Monitor checks should be performed on both
radiographic equipment so basic radiography quality the acquisition and reporting* monitors
control testing is still needed. This would include:
under recommended working conditions. It
 Calibration of the generator
 Collimation
should be noted that cathode ray tube (CRT)
 Beam Alignment
and flat panel displays (FPD) may have
 Linearity of exposure different types of problems.
 Spatial resolution (focal spot)

Artifact simulate acute phase of Paget's disease as a result of

excessive edge enhancement. (B) normal E.E 14

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Monthly test of reporting

Daily checks on acquisition and reporting
monitors monitors SMPTE
▪ Using the SMPTE Test Pattern
This organization developed a test pattern that can be used to
Method
determine grey scale image quality on videos and computer
display monitor.
• Check for obvious faults such as flicker, gross distortion,
artifacts.
• Check general condition. Other parameter which can be evaluated are:
• Clean if necessary (follow the supplier’s instructions). ➢ Spatial resolution
• Look at the text and lines on the screen – are they sharp and ➢ Brightness
straight?
➢ Contrast Aliasing
• Keep a record of all checks, note any problems and take
action to get them corrected.

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SMPTE
▪ There should be no blurring or bleeding of bright
display areas into dark areas or aliasing of the
spatial imaging patterns.
▪ All monitors used for interpretation should be
tested at least monthly.
▪ For the dynamic range test, both the 5% and 95%
contrast areas should be visible and distinctly
different than the adjacent 0% and 100% areas.
▪ Therefore: The brightness and contrast of the
monitor is adequate if the 5% squares at both
ends of the gray scale are visible.
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SMPTE
▪ The gray scale is shown as a series of squares in
the center of the image that range from black
(0%) to white (100%).
▪ It may be difficult to get the monitor to show
both of these inner squares perfectly.
▪ Most monitors do better showing the 95%
square than the 5% square.
▪ However, you might try adjusting the ambient
light to improve the visibility of the 5% square.
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Diagnostic video monitor luminance &
uniformity
For Digital Systems:
• Display SMPTE test pattern to evaluate initial quality of monitor
▪ Determine manufacturers recommended settings
▪ Ensure monitor is set accordingly
• If no guidance material available follow:
– Video Monitor Manual Brightness & Contrast Setting Procedure
▪ Diagnostic quality monitors typically include this
measurement in calibration check
▪ Perform test following vendor recommendations
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Diagnostic video monitor luminance & Diagnostic video monitor luminance &
uniformity uniformity Monitor type Maximum luminance
Color CRT > 80 Cd/m2
Color LCD > 100Cd/m2
•Determine monitor type
• Use the TG-18 UNL -80 or SMPTE test Grey scale CRT secondary > 150 Cd/m2
•Calculate % difference of each of corners to centre
pattern ,or set an entirely white display
• Use a photo timer to measure Grey scale diagnostic >200 Cd/m2
luminance
Grey scale LCD 350 Cd/m2
-Measure maximum luminance in
the center and four corners of Minimum luminance
display CRT <1.0 Cd/m2
-Measure minimum luminance in LCD <1.5 Cd/m2
center of display % diff
All With in 15%
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Image quality uniformity & Image Quality – High Contrast Image Quality – Low Contrast
artifacts (Spatial) Resolution Resolution (detectability)

For photo stimulable phosphor For photo stimulable phosphor systems:

systems:
▪ Erase cassettes
▪ Determine standard set up & technical ▪ Obtain several contact images of a low contrast phantom
factors - do once process using a high contrast algorithm & edge
▪ low kVp, Extended SID enhancement algorithm.
▪ Use a lead –bar resolution test pattern
phantom
▪ slightly angle phantom
▪ Minimize moiré & line pairing pattern
process with high contrast algorithm
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Image Quality – Low Contrast Weekly check of contrast-to-

Reader Reboot
Resolution (detectability) noise ratio (CNR)
If region of interest (ROI) facility is available: ▪ Reboot weekly or as
required.
Method
• Use the image of the test object from the daily test ▪ Follow the schedule as
• Draw two ROIs prescribed by the
• Record the mean (M1) and standard deviation (SD) of the pixel value in ROI 1.
• Record the mean (M2) of the pixel value in ROI 2. manufacture.
• Subtract M2 from M1 and divide by SD to calculate the signal-to-noise ratio
(CNR):
▪ Daily wiping of the insertion
slot reduces the chance of
CNR = M1- M2
SD
dust getting into the
CNR baseline ± 20% readout chamber.
- If this level is exceeded then take action to correct the problem.

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Weekly uniformity check
▪ Uniformity should be visually checked on a weekly basis
using the image of the test object or plain Perspex from the
daily test.
▪ By setting a narrow grey scale window areas of non-
uniformity will be seen.
▪ Magnify or zoom the image electronically and inspect it in a
systematic fashion to look for artefacts such as faulty clusters
of pixels or areas of unusually low noise (where the
background mottle appears blurred or smoother than other
areas of the image).
▪ This is particularly important for some DR systems.
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Monthly AEC thickness check
▪ Set up test just as done for film.
▪ Make 1st exposure on the thinner phantom.
▪ expose thicker phantom at the same setting
▪ record the mAs
▪ If a printer is available , print both images and
measure optical densities.
▪ If using the on-screen tool , select same size
region-of-interest (ROI) at same location on both
images and record average measurement.
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Monthly AEC thickness check
▪ If region of interest (ROI) facility is available
▪ Measure SNR and compare with baseline values
▪ Measure CNR and compare with baseline values
▪ Remedial levels
▪ Detector dose indicator baseline for that thickness ±
10%
▪ SNR baseline for that thickness ± 20%
▪ CNR baseline for that thickness ± 20%
▪ No disturbing artefacts should be visible.
▪ If any of the levels are exceeded then take action to
correct the problem.
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DETECTOR FLAT-FIELD CALIBRATION
(DR SYSTEMS ONLY)
▪ Some DR detectors may have a non-uniform
response (due to variations in sensitivity, faulty
pixels etc.). Also, there are non-uniformities in the x-
ray beam due to the anode heel effect and x-ray
beam divergence.
▪ Some DR systems correct for these inherent non-
uniformities by a process of flat-fielding. Flat-field
correction maps are obtained using a standard beam
attenuator (usually a Perspex block) for one or more
exposure conditions.
▪ (e.g., different target/filter combinations and focal spot
sizes)
DETECTOR FLAT-FIELD CALIBRATION IMAGE PLATE (IP) CHECKS
(DR SYSTEMS ONLY) (CR SYSTEMS ONLY)
▪ Some system require the user to carry out this flat-
Image plate erasure
fielding process periodically, and it is therefore
included here although it is not strictly a QC test. ▪ It is recommends that any cassettes left in
▪ On other systems this is carried out by the service the x-ray room, or left un-used for a few
engineer at routine service visits. days (e.g., over a weekend)
Method
▪ It should be erased using the image reader
▪ Carry out the flat field calibration according to ‘secondary erasure’ cycle before use, to
remove any ‘fog’ from the IP.
manufacturer’s protocols.
▪ Record and initial that the procedure has been
performed.

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Six-monthly image plate matching Six-monthly image plate matching

• Record the S value.
and artifact check and artifact check
• View image with a narrow display window and check for
Method artefacts.
▪ This procedure should also be carried out on new • Repeat for each IP.
image plates. Then:
Using each IP in turn:
▪ Image plates and cassettes should be matched in • Calculate the mean (average) mAs value for all IPs.
both their sensitivity (S value per unit exposure) • Conduct primary erasure before starting. • Calculate the mean S value for all IPs.
and in the mAs derived under automatic
exposure control. • Place 4 cm thickness of Perspex on the table (if more
convenient, other thicknesses such as 4.5 or 5 cm would also be Remedial levels:
▪ Full size Perspex blocks are preferable for these suitable). ▪ mAs value mean ± 5%
tests so that the whole IP can be checked for • Place IP cassette in the bucky. ▪ S value mean ± 10% (this allows for variation due to mAs and
artefacts. variation in IP sensitivity).
• Operate the unit in a fixed kV, automatic mAs mode –
select kV in normal use ▪ Plates showing scratches or marks should be cleaned and the test
repeated. Plates with permanent scratches or marks should be
• Make an exposure and record the mAs value. removed from service
• Read the IP after a standard delay time (e.g., 1 minute)

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MONTHLY MECHANICAL SAFETY AND
FUNCTION CHECKS
▪ Check the safety and function of the system.
▪ It is recommended that a local checklist is drawn up
for each system to identify relevant features to be
checked (e.g., items that are safety-critical or areas
known to be prone to faults).
▪ The local system, for example:
▪ environmental checks (some digital systems are
particularly sensitive to environmental conditions
such as temperature and humidity)
▪ checks relating to the reporting workstation .
▪ Keep a record of all checks, note any problems and
take action to get them corrected
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PRINTER CHECKS
▪ The printer is set up on installation when the
engineer should ensure that the hard copy
matches the soft copy image.
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▪ Daily printer checks using test pattern
▪ Printer checks should be carried out using standard viewing
conditions each day that the printer is used. Print
▪ SMPTE test pattern or the manufacturer supplied test
pattern and perform the following checks:
• Geometrical distortion – check image is printed without
geometrical distortion; borders should be completely visible
and straight lines should be straight.
• Contrast visibility – SMPTE test pattern, the 5% and 95%
squares should be clearlyvisible.
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Questions?
REFERENCES:
• Printer artefacts – check test pattern for printer
artefacts no disturbing artefacts should
be visible.
• If a densitometer is available, measure densities 1. Bushberg, J., Seibert, J.A., Leidholdt, Jr., E., Boone, J.
and compare with baseline values (2012). The Essential Physics of Medical Imaging. 2nd
. Edition. Philadelphia Lippincott Williams & Wilkins.
▪ Printer checks following software upgrade 2. Bushong, Stewart C. (2013). Radiologic Science for
▪ After software changes or an upgrade, it may be Technologist: Physics, Biology, and Protection. 10th
advisable to print both a test pattern and a clinical Edition. Mosby.
image to confirm that the hard copy remains
similar to the soft copy display 3. Thakur, Anju (2014). Department Of Radiodiagnosis
and Imaging Pgimer, Chandigarh

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