QUALITY CONTROL IN DIAGNOSTIC RADIOLOGY - AAPM

1 AAPM REPORT NO. 74 QUALITY CONTROLIN DIAGNOSTIC RADIOLOGYR eport of Task Group #12 DIAGNOSTIC X-ray Imaging CommitteeMembersS. Jeff Shepard, ChairmanPei-Jan Paul Lin, Co-ChairmanJohn M. BooneDianna D. CodyJane R. FisherG. Donald FreyHy Glasser*Joel E. GrayArthur G. HausLance V. HefnerRichard L. Holmes, J. KobistekFrank N. RanalloPhilip L. RauchRaymond P. Rossi*J. Anthony SeibertKeith J. StraussOrhan H. SuleimanJoel R. SchenckStephen K. ThompsonJuly 2002 Published for theAmerican Association of Physicists in Medicineby Medical Physics Publishing*DeceasedDISCLAIMER: This publication is based on sources and information believed tobe reliable, but the AAPM and the editors disclaim any warranty or liability basedon or relating to the contents of this AAPM does not endorse any products, manufacturers, or suppliers.

2 Nothingin this publication should be interpreted as implying such copies of this report ($15 prepaid) may be obtained from:Medical Physics Publishing4513 Vernon , WI 53705-4964 Telephone: 1-800-442-5778 or608-262-4021 Fax: 608-265-2121 Email: site: Standard Book Number: 1-888340-33-9 International Standard Serial Number: 0271-7344 2002 by American Association of Physicists in MedicineOne Physics EllipseCollege Park, MD 20740-3843 All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted in any form or by any means (electronic, mechanical, photo-copying, recording, or otherwise) without the prior written permission of by Medical Physics Publishing4513 Vernon Blvd., Madison, WI 53705-4964 Printed in the United States of AmericaThis report is dedicated to the memory ofRaymond P.

3 RossiMentor, Colleague, FriendThe task group also wishes to honorHy GlasserA leader in the field of QC instrumentation development and marketingiiiTABLE OF CONTENTSINTRODUCTION ..11 THE QUALITY CONTROL PROCESS .. Testing .. CONTROL .. Considerations ..52QC PHYSICS REPORT .. Environment of the Report .. of Tests and Cases .. on Medical Physics Communication in the Academic Environment ..114 REPEAT RATE ANALYSIS ..115 QUALITY CONTROL OF RADIOGRAPHIC UNITS .. Visual Tubes and Field/X-ray Field Alignment (Congruence).. Y Scale (Field Size Indicator) Accuracy .. Beam Limitation System (PBL) .. Beam Bucky Alignment .. Spot Size .. Generators .. Calibration .. Timer .. QUALITY (mR/mAs).. Exposure CONTROL (AEC) .. Beam - Grid Alignment and CONTROL OF FILM-SCREEN MAMMOGRAPHICSYSTEMS.

4 19v7 QUALITY CONTROL OF CONVENTIONAL TOMOGRAPHY .. Exposure Angle Accuracy .. Spatial Resolution .. of Cut Level .. Thickness ..208 QUALITY CONTROL OF PORTABLE X-RAY Tube and Generator .. Output During Extended Discharge Calibration .. Radiation .. Tests ..229 QUALITY CONTROL OF FLUOROSCOPIC EQUIPMENT .. or More Frequently If Mode: Tested Annually or More Frequently If Indicated .. Exposure Rates .. Exposure Rates .. QUALITY .. Mode: Tested Annually or More Frequently If Indicated .. Calibration .. QUALITY (HVL).. Anti-scatter .. Intensifier Input Exposure Rate (IIIER) .. Testing ..2810 QUALITY CONTROL FOR DIGITAL SUBTRACTION ANGIOGRAPHY (DSA) Daily .. Annually or More Frequently If Indicated .. Fluoroscopic System Evaluation .. Radiographic System Spatial Contrast Resolution.

5 Detector Sensitivity .. At Acceptance and As QUALITY CONTROL OF CINERADIOGRAPHY Daily .. System Status Check .. Weekly .. Semiannually .. The Typical and Maximum Exposure Projection System .. Annually .. Monitor Spatial Contrast Resolution .. TV Camera Lag .. Film Density .. Typical and Maximum Exposure Rates to Generator Calibration .. Image Intensifier Input Exposure Rate (IIIER) .. Half Value Layer (HVL) ..3612 QUALITY CONTROL OF COMPUTED TOMOGRAPHY SYSTEMS .. Daily .. Semiannually or More Frequently If Indicated .. Imaged Slice Thickness (Slice Sensitivity Profile, SSP) .. Dose Profile Width .. Slice Positioning Accuracy .. CT Number Scale Accuracy and Stability .. Spatial Resolution (Image Sharpness).

6 Low Contrast Dosimetry of Axial Scans .. Dosimetry of the Digital Survey Radiograph .. Resolution, Gray Scale, Image Distortion, and Artifacts in the Video Monitor and the Hard Copy .. Multislice CT Considerations .. Visual Inspection .. Radiation Beam Profile .. Z-Axis Characteristics .. Radiation Dose .. After Tube Replacement ..4413 QUALITY CONTROL FOR DARKROOMS, PROCESSORS,FILM, AND Daily .. Weekly .. Darkroom Cleanliness .. Cassettes .. Monthly .. Film Storage .. Darkroom Conditions ..4614 QUALITY CONTROL OF PHOTOSTIMULABLE PHOSPHOR Daily .. Visual Inspection .. Processor Fluid System Sensitometry .. Processor Sensitometry .. Imaging Plate (IP) and Cassette Cleaning .. Film Supply .. IP Status Weekly .. Filters and Vents.

7 Primary Erasure .. Plate Light Leak Check .. Monthly .. Imaging Plate (IP).. QC Repeat Image Trends .. Semiannually .. Linearity and Image QUALITY .. At Acceptance and annually System Inventory and Visual IP Dark Noise .. System Linearity and Sensitivity .. Plate-to-plate Uniformity and Image Geometric Uniformity and Distance Spatial Laser Evaluation .. Low Contrast Resolution .. User-Controlled Density and Contrast Commands .. Miscellaneous CR Issues ..5315 VIEW BOX QC .. Weekly .. Annually or More Frequently If Indicated .. Clean Diffuser Panel and View Box .. Check Diffuser Panel .. Inspect Inspect View Measure Light Annually ..5416 HARD COPY AND SOFT COPY DISPLAY DEVICE QUALITY CONTROL .

8 Hard-Copy Device .. Display ..56 SUGGESTED READING ..63ixINTRODUCTIONIn 1977, the American Association of Physicists in Medicine (AAPM) publisheda QUALITY assurance protocol aimed at providing guidance to a radiologic technolo-gist involved in the implementation of a QUALITY assurance (QA) program in diagnosticradiology. Since the time of that writing, DIAGNOSTIC RADIOLOGY has undergonefunda-mental changes that have directly influenced the requirements of such a has become more complex with the maturation of digital radiographyand fluoroscopy. We have witnessed the proliferation of mid-frequency generatorsfrom primarily portable operations to standard radiographic-fluoroscopic systemsand to cardiac imaging and digital subtraction angiography. Our ability to testradiographic systems without invasive measurement has developed along with thecomputer industry, making possible the capture of test data directly into a databaserunning on a laptop 1994, the AAPM published a task group report on the Role of the ClinicalMedical Physicist in DIAGNOSTIC document includes this statement:A primary responsibility of the medical physicist in an imaging program is thedevelopment and supervision of a quantitative QUALITY assurance responsibility for establishment of a QUALITY CONTROL (QC) program hasclearly moved out of the domain of the radiologic technologist and into that of thediagnostic medical physicist.

9 The DIAGNOSTIC medical physicist must be knowl-edgeable in current equipment designs, intended use, and the appropriateness ofthe various test instruments that may be used in performance evaluation. The diag-nostic medical physicist acts as a local expert on Joint Commission on Accreditationof Healthcare Organizations (JCAHO), state, and federal requirements concern-ing QUALITY CONTROL , equipment performance, and radiation safety. As such, themedical physicist needs to be able to provide a well designed QC program thataddresses the needs of the clinic by assuring consistent optimal image QUALITY , asafe work environment, and compliance with the various regulatory agencies, allat a reasonable cost to the intent is for this report to be used by the consulting or resident diagnosticmedical physicist.

10 As such, it will not provide instructions for how to perform indi-vidual tests. Reference will be made, however, to where the reader may find suchinformation and which resources the authors have found to be most helpful. Weshall restrict our recommendations to the identification of which parameters areessential for a given type of x-ray imaging equipment and what minimum per-formance criteria should be met in order to achieve acceptable image QUALITY . Thereport will outline the essential components of a QC program in DIAGNOSTIC radi-ology that can be used by the DIAGNOSTIC medical physicist as a guide when design-ing such a program for a given clinical operation. Specific tests will be recommendedfor most of the common radiological imaging equipment found in a typical, largeradiology department.