BASIC QUALITY CONTROL IN DIAGNOSTIC RADIOLOGY

1 AAPM REPORT No. 4 BASIC QUALITY CONTROLIN DIAGNOSTIC RADIOLOGYA merican Association of Physicists in MedicineFOREWORDThis document , BASIC QUALITY CONTROL in DiagnosticRadiology ,is the fourth in a series of AAPM document is designed to enable technologists workingwith the guidance and supervision of a medical physicistto set up a viable QUALITY assurance program in diagnosticradiology with minimal AAPM, through itsDiagnostic RADIOLOGY Committee, plans to issue additionaldocuments detailing physicist/engineer level test methodswhich utilize more sophisticated additionaltests will be suitable for installation and acceptance test-ing and for determining compliance with requirements of theBureau of Radiological Health and state and local radiationcontrol American Association of Physicists in Medicine isorganized, as one of its declared purposes.

2 To prepare andto disseminate technical information in medical physicsand related fulfillment of this purpose, theAAPM through a structure of Task Forces, Committees, andCouncils prepares recommendations, policy and state-of-theart reviews in the form of reports covertopics which may be scientific,educational or professionalin nature,and final approval of them is given by thatCouncil of the Association charged with responsibilityfor the particular concerns of the Publications Committee of the AAPM hopes that thisreport will effectively continue the record of publishedwork previously reported by other scientific committeesand so ably inaugurated by the previous S. Laughlin, , Publications CommitteeFurther copies of this report may be obtained from:Executive Secretary,American Association of Physicists in Medicine335 East 45th StreetNew York, New York 10017(212) 661-9404 x 525 Price: $ of a related monograph, Medical Physics MonographNo.

3 4: QUALITY Assurance in DIAGNOSTIC RADIOLOGY , arealso available from the Office of the Executive Secretaryat $ prepaid for AAPM Members ($ prepaid fornon-members).AAPM REPORT No. 4 BASIC QUALITY CONTROLIN DIAGNOSTIC RADIOLOGYD iagnostic RADIOLOGY CommitteeTask Force on QUALITY Assurance ProtocolM. Siedband. ChairmanS. BaiterL. BratemanW. BrittG. DeutschR. DobrinR. DuerkesT. FieldsD. LawrenceP. LinT. MorganW. ProperzioR. RossiL. RothenbergC. ScheidD. StarchmanJ. WinklerNovember 1977 CopyrightAmerican Association of Physicists in Medicine1978 Reprinted - of and Task Force Test ToolsQuality Assurance LogC. Recording Test of X-Say Radiograph as a QA ToolQuality Assurance Processor MonitoringOverload Protective Circuit TestExposure TimemAs ReciprocityPeak Tube Potential - kVpX-Ray Output and Beam QualityLight/X-Ray Field CongruenceAutomatic Collimator Field SizeFluoroscopic Collimator Field SizeGrid AlignmentBucky Grid CenteringFocal Spot SizeAutomatic Exposure TerminationOptical System FocusAutomatic Brightness ControlP.

4 Geometric TomographyCassettes: Speed, Film ContactRadiographic IlluminatorsTest Schedules and Data of TestingC. Type of Test ProgramD. Quick ChecksE. Test document describes a QUALITY assurance protocol for diagnosticx-ray equipment at the radiologic technologist series of testsare described using equipment and test tools designed for that of the important parameters in DIAGNOSTIC x-ray qualityassurance are Origin of DocumentThis document originated as a charge to Robert Waggener of theDiagnostic RADIOLOGY Committee of the American Association of Physicistsin Medicine (AAPM) from the President at that time, Jack S. Krohmer. Atask force of the DIAGNOSTIC RADIOLOGY Committee was formed for thispurpose with Melvin P. Siedband as recognized early that noone individual, group, or Scientific/Professional Society contains all ofthe expertise or knowledge in a field as large as DIAGNOSTIC RadiologyQuality that reason, input was solicited and receivedfrom a wide spectrum of individuals working in the area of DiagnosticRadiology QUALITY Assurance, who were not necessarily members of input is gratefully acknowledged.

5 The value of the document hasbeen immeasurably strengthened by that PurposeThis document is designed to offer assistance and guidance to aradiologic technologist implementing and operating a QUALITY assuranceprogram in DIAGNOSTIC is designed for implementation atany level of service from a single unit that is infrequently operatedto a large number of units operating at maximum capacity in a equipment and test tools described in the protocolare simple,relatively inexpensive and easy to procure from document is meant for field is hoped that a largenumber of institutions will use it and present criticisms and suggestionsfor further we have had a broad based input to thedocument from many groups in the field of DIAGNOSTIC RADIOLOGY , we desirethat the protocol be considered as a product of the Radiological hope that the interested groups in the field of DIAGNOSTIC Radiologywill endorse it and recommend its Personnel and Task Force MeetingsThe AAPM Task Force met several times at AAPM and RSNA form of the document was developed at two meetings held at theRockville, Maryland facilities of the Bureau of Radiological Health (BRH).

6 Individuals contributing to this document were:Dr. Stephen Balter - Philips MedicalMr. William Britt - Machlett Deutsch - Picker Corporation-2-Dr. Richard Dobrin - NYU Medical CenterMr. Robert Deurkes - El Paso Cancer CenterMr. Theodore Fields - Fields, Griffith AssociatesMr. Daniel Lawrence - Eastman KodakMr. Pei-Jan Paul Lin - Northwestern UniversityDr. Tommie Morgan - BRHDr. William Properzio - BRHMr. Raymond Rossi - University of Colorado Medical CenterDr. Lawrence Rothenberg - Memorial Hospital, New YorkMr. Carl Scheid - GE MedicalMr. Melvin Siedband - University of Wisconsin (Chrmn, Task Force)Ms. Libby Brateman - NIHDr. Dale Starchman - Medical Physics Services, Inc., Canton, OhioMr. James Vucich - BRHDr. Robert Waggener - University of TexasMr. Norlin Winkler - Mayo Clinicand many others whose contributions and suggestions are meetings in Washington for the task group were made possible bysupport from support is gratefully acknowledged as it madepossible putting together the final form of the dissemination of this document was supported by the DIAGNOSTIC Equip-ment Committee of the American College of RADIOLOGY (ACR)

7 , Albert Dunn, support is also gratefully Test RequirementsMany of the test tools can be made by the items includetest phantoms, mesh patterns, alignment fixtures, and timing construction is described in the test tools, such asthe test cassette, require calibration and adjustment which is feasibleonly when a quantity can be other test tools are madecommercially and are available through the manufacturer or his tests have been designed to make repeated use of the same simple Test ToolsSeveral suppliers have tools which meet the requirementsof these tests. As an aid to those individuals wishing toinitiate a QUALITY assurance testing program a partial listingof manufacturers and/or distributors of equipment is given list is not is provided for convenience, andno endorsement of any product is the development ofthe level one test methods, the AAPM committee has made no attemptto develop testing procedures geared to a specific manufacturer'sproduct or test tool, nor has an effort been made to evaluatetest equipment currently commercially available as to , E.

8 Sandford BoulevardMt. Vernon, New York 10550 Eastman KodakQC Apparatus Division400 Plymouth Avenue, NorthRochester, New York DuPont De Nemours and CompanyMedical Photo Products RunWilmington, Delaware 19898 General Electric CompanyBox 414 Milwaukee, Wisconsin 53201 International Radiographic Supplies Unlimited1100 Royal StreetNew Orleans, Louisiana 70116 Keithley Instruments, Aurora RoadCleveland, Ohio 44139 MacbethColor and Photometry DivisionLittle Britain RoadDraw 950 Newburgh, New York 12550 Machlett Laboratories, Hope StreetStamford, Connecticut 06907 MDH Industries, East Foothill BoulevardPasadena, California 91107-4-Minnesota Mining and Manufacturing CompanyPhoto Products Division3M CenterSt. Paul, Minnesota 55101 Nuclear Associates100 Voice RoadCarle Place, New York 11514 Philips Medical Systems, Box 848 Shelton, Connecticut 06484 Picker Corporation595 Miner RoadCleveland, Ohio 44043 Radiation Measurements, Box 327 Middleton, Wisconsin 53562 Sakura Medical57 Bushes LaneElmwood Park, New Jersey 07407 Sargent-Welch7300 N.

9 Linder AvenueSkokie, Illinois 60076 Tobias Associates, Industrial DriveNorth Hampton Industrial ParkIvyland, Pennsylvania 18974 Victoreen Instruments Division10101 Woodland AvenueCleveland, Ohio 44104 Xonics Medical Systems515 East Touhy AvenueDes Plaines, Illinois Assurance ProgramA. General ConsiderationsAn adequate DIAGNOSTIC QUALITY assurance (QA) program involvesperiodic checks of the components in a DIAGNOSTIC x-ray imaging optimum QA program for any individual facility will depend on anumber of factors which include,but may not necessarily be limited to,-5-items such as the type of procedures performed, type of equipmentutilized, and patient program should be developedunder the guidance and supervision of a medical physicist qualifiedin this area of expertise by education, training, and qualified medical physicist should be involved in close con-sultation during design, initiation, implementation, and evaluationphases of the medical physicist may be a full-timeemployee or a consultant to the important considerationsare that he is qualified in this area and is available as ,especially as the program matures.

10 May include someon-site responsibility and frequent telephone consultation as medical physicist should be prepared to perform higherlevel testing as documented QA program should be developedspecifically to address the needs of the individual should identify the items to be monitored and establish thetesting test results should be recorded and periodicreviews of the results of the testing programs should be carried outto identify needed tests described in this document werespecifically designed to be performed by a qualified technologist asfirst level technologist may receive training throughformal short courses available in several areas of the country and in-service training by the Medical :This program does not provide means for assuring the radiation safety ofstaff or separate radiation safety program is essentialin every radiological facility under the direction of a qualified expertin radiation protection as specified by the Joint Commission onAccreditation of Hospitals which requires that the Recommendations ofthe National Council on Radiation Protection and Measurements be knownand adhered to by the LogAn individual equipment log should be maintained on each x-ray unitin a equipment log must be kept at some convenient locationwhere anyone using the facility (physicians, technologists, physicists,service engineer,etc.)