CR QA

Computed Radiography X-Ray Quality Assurance

Quality Assurance Procedures Manual

Medical X-Ray Imaging Department

Revision 4 June 2009

Saskatchewan Digital Quality Assurance Working Group, 2009

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Computed Radiography X-Ray Quality Assurance

Preface

This manual has been prepared by the Saskatchewan Digital Quality Assurance Working Group, with the support and encouragement of the Radiation Safety Unit of the Saskatchewan Ministry of Advanced Education, Employment and Labour. It is a guidance document that is being distributed freely without cost. As it is a compilation and adaptation of the good works of many sources, use of all or any portions of this document must be appropriately acknowledged. Comments or suggestions concerning the Computed Radiography X-Ray Quality Assurance Guidelines should be sent to: Radiation Safety Unit Ministry of Advanced Education, Employment and Labour 400 1870 Albert Street Regina, SK S4P 4W1

Members of the Digital Quality Assurance Working Group were: Bryan Witt
Regional Manager of Safety, Quality, and Technology Saskatoon Health Region

Debbie Lundy
Manager of Quality Services - Diagnostic Imaging Regina Qu'Appelle Health Region

Dwight Short
PACS Project Manager Saskatoon Health Region

Tamara Kubik
Instructor of Medical Radiologic Technology Saskatchewan Institute of Applied Science and Technology

Steve Webster
Health Physicist Ministry of Advanced Education, Employment and Labour

Megan Hunt
Health Physicist Ministry of Advanced Education, Employment and Labour

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Disclaimer

In a field in which technology is advancing rapidly and where unexpected and unique situations continually occur, these guidelines cannot cover all possible situations. Blind adherence to rules cannot substitute for sound judgement. Therefore, this manual may be modified where it is justified by the circumstances in the facility. These modifications must be fully documented. Any revisions to the manual by the authorized working group will be made available to registered users. Vendor-specific requirements, appropriate procedures and protocols must be followed. It is required to have all operation and reference manuals for the imaging equipment on site. This includes material for equipment such as, but not limited to, printers, video monitors, densitometers, test phantoms, photometers and dose meters.

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Mission Statement

Legislation and References

Quality Assurance Tests

Medical Imaging Quality Assurance

Test Procedures

Master Copies

Quality Assurance Logs

RSU, Service & Other Reports

Other Forms

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Mission Statement

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Medical Imaging Quality Assurance

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Computed Radiography X-Ray Quality Assurance

Medical Imaging Mission Statement

It is the mission of the medical imaging department to produce images of optimal diagnostic quality while ensuring that the radiation exposures to our clients, to the facilitys staff and to the public are kept as low as practicable. To achieve this mission, quality assurance procedures will be implemented that will ensure that any problem in the imaging chain will be proactively dealt with before the diagnostic quality of the images has been significantly compromised. In addition, it will be the policy of this facility to make every effort to comply with The Radiation Health and Safety Act, 1985 and The Radiation Health and Safety Regulations, 2005.

Medical Imaging Owner / Manager

Quality Assurance Co-ordinator

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Legislation and References

Medical Imaging Quality Assurance

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Section 6 of the Act

Section 6 of The Radiation Health and Safety Act, 1985

Qualifications for management, control or operation 6(2) An owner of an ionizing radiation installation or any ionizing radiation equipment used for diagnosis or treatment relating to human beings shall ensure that each operator is: (a) a duly qualified medical practitioner with specialized training in radiography; (b) a chiropractor who is registered pursuant to The Chiropractic Act, 1994; (c) a dentist, certified dental assistant or dental hygienist who is licensed pursuant to The Dental Profession Act, 1978; (d) a dental therapist who is licensed pursuant to The Dental Therapists Act; (e) a medical radiation technologist who is registered pursuant to The Medical Radiation Technologists Act; (f) subject to subsection (3), an X-ray technician who possesses the qualifications necessary to become a registered certified active member in good standing of the Saskatchewan Association of Combined Laboratory and X-ray Technicians; (g) a student who is under the direct supervision of a person who possesses the qualifications set out in clause (a), (b), (c), (d), (e) or (f); or (h) a person who: (i) is trained to carry out the procedures for which the equipment is to be used; and (ii) demonstrates to the satisfaction of an officer that he or she possesses adequate knowledge of the equipment, the biological effects associated with the equipments use and the necessary safety procedures. (3) An owner of an ionizing radiation installation or any ionizing radiation equipment used for diagnosis or treatment relating to human beings shall ensure that operators described in clause (2)(f) perform only examinations for which they have been formally trained.

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Section 16 of the Regulations

Section 16 of The Radiation Health and Safety Regulations, 2005

Quality assurance 16(1) An owner of ionizing radiation equipment that is used for diagnosis or treatment of human beings must ensure that a quality assurance procedures manual that meets the requirements of subsection (2) is prepared for use with that equipment. (2) The quality assurance procedures manual must: (a) be acceptable to an officer in form and content; (b) clearly specify the quality assurance procedures that are to be followed by the operators and other occupational workers; and (c) be appropriate to: (i) the extent of use of ionizing radiation by the facility; and (ii) the level of expertise of the operators and other occupational workers. (3) An owner of ionizing radiation equipment that is used for diagnosis relating to human beings must ensure that: (a) at the times specified by an officer, the operators of the equipment participate in the Radiation Safety Units postal quality assurance program by: (i) conducting the tests that are required as part of the program; and (ii) returning the exposed test package to the department promptly; (b) in the case of a hospital, a medical clinic or a chiropractic clinic, the operators have ongoing access to the test phantom and step wedge used for carrying out the tests mentioned in subclause (a)(i); and (c) for each x-ray unit, a quality assurance file is established containing: (i) all raw data for quality assurance carried out on the unit during the last 12 months; and (ii) summaries of results from all quality assurance procedures from when the machine is first used on a patient until three years after a decommissioned machine was last used on a patient.

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References

AGFA Technical Bulletin, CR Cassette TESTING Routine, Private Communication, 2008. American Association of Physicists in Medicine, Quality Control in Diagnostic Radiology, AAPM Report No. 74, Medical Physics Publishing: Madison, WI, 2002. American Association of Physicists in Medicine, Acceptance Testing and Quality Control of Photostimulable Storage Phosphor Imaging Systems, AAPM Report No. 93, Medical Physics Publishing: Madison, WI, 2006. Cowen, A. R. Digital Fluoro Acceptance Testing: The U.K./Leeds Approach, Specification, Acceptance Testing, and Quality Control of Diagnostic X-Ray Imaging Equipment: Proceedings of the 1991 AAPM Summer School. J.A. Seibert, G.T. Barnes, and R. Gould (eds.). American Institute of Physics: New York. 1992, p. 806. Geiser, William and Stephen Thompson. QC Testing of Soft/Hard Copy Display Systems for CT, Proceedings from the Medical Technology Management Institute Hands On MultiSlice CT Workshop for Physicists, Houston, 2007, p. 125-140. (used with permission) Government of Saskatchewan, The Radiation Health and Safety Act, 1985, R.S.S. 2005, c.R-1.1. Government of Saskatchewan, The Radiation Health and Safety Regulations, 2005, R.S.S. 2005, c.R-1.1 Reg. 2. Health Canada, Safety Code 35: Safety Procedures for the Installation, Use and Control of X-ray Equipment in Large Medical Radiological Facilities, Canadian Minister of Health, 2008. Kodak Technical and Scientific Bulletin, Guidelines for Acceptance Testing and Quality Control: Kodak DirectView CR800 System and Kodak DirectView CR900 System, 2001. The Society of Motion Picture and Television Engineers, SMPTE RP-133 Specifications for Medical Diagnostic Imaging Test Pattern for Television Monitors and Hard-Copy Recording Cameras, SMPTE: New York. 2001. Technical Committee HCC/73, Interchangeable X-ray Components, EN 61223-2-5:1994 Evaluation and routine testing in medical imaging departments Part 2-3: Constancy tests Image display devices, European Committee for Electrotechnical Standardization (CENELEC), 1994.

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References

Visual Perception Laboratory, Video Monitor Test Pattern Tutorials, Brigham and Women's Hospital Department of Radiology, Harvard Medical School, BrighamRAD at http://brighamrad.harvard.edu/research/topics/vispercep/tutorial.html, 1997 . Accessed April 2006. Wagner, A. J., G. T. Barnes, and X. Wu. Assessing Fluoroscopic Contrast Resolution: A Practical and Quantitative Test Tool, Med. Phys. 1981; 18:894-899.

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Quality Assurance Tests

Medical Imaging Quality Assurance

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Quality Assurance Tests

Area Quality Assurance Procedure
Noise Uniformity and artifacts Low contrast resolution System response linearity High contrast resolution Reboot Maintenance and repairs Erasure Inspection/Cleaning Artifact analysis and exposure response Check for wear (UV) Visual inspection X-ray beam alignment check Automatic exposure control (AEC) Positive beam limitation field size check Safety and preventive maintenance (SPM) test Test pattern Luminance and Uniformity Calibration Abnormal occurrences, maintenance and repairs Test pattern Luminance and Uniformity Calibration Abnormal occurrences, maintenance and repairs Test pattern Density calibration Abnormal occurrences, maintenance and repairs Software or manual calculation Radiograph (or fluoro) Uniform brightness check Review and update Review and update

Alternative
Vendor Phantom Analysis Preventive Maintenance Vendor Phantom Analysis

Frequency
Q/R Q/R Q/R A/R A/R W/R R W/R M A R M A A R A/R W S A R M A A/R R W M R S A A A A

System Image Quality

Reader Imaging Plates & Cassettes

X-Ray Equipment

Preventive Maintenance

Diagnostic Video Monitor

Secondary Video Monitor

Printer

Reject Analysis Protective Gear Viewboxes Exposure Chart Technique Chart

Frequency: D daily; T three times per week; W weekly; M monthly; Q quarterly; S semi-annually; A annually; R as required.

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Quality Control Equipment

Usage
Postal Test Low Contrast Resolution AEC Function

Item
Postal QA Phantom

Frequency
Annually Annually Annually Monthly

Suggested Site

Each facility (or may be shared between sites)

Densitometer

Printer Calibration

Each facility (if applicable) If you choose to use the vendor system, the dose meter is usually required for initial installation and subsequent exposure monitoring as required. It may be possible to share within the Health Region or with the service provider Usually required to determine the exposure to the cassette to verify the reader exposure indicator. It may be possible to share within the Health Region or with the service provider At least one per Health Region (if applicable) At least one per Health Region or service provider At least one per Health Region (if applicable) or service provider If you choose to use the vendor systems, it may be possible to share within the Health Region Not required if using Vendor QA Phantom or Postal QA Phantom Most sites will not purchase this item, as it is usually available from the service provider, to be used during acceptance testing or troubleshooting system imaging problems

Dose meter

Vendor Phantom Analysis

Monthly to Annually

Artifact Analysis and Exposure Response Light meter Photometer Viewboxes Video monitor luminance and uniformity Video monitor calibration Vendor QA Phantom Vendor Phantom Analysis Low contrast resolution

Annually

Annually (Semi-) Annually Annually Monthly (as required) Quarterly to Annually

Low Contrast Phantom

Resolution Test Object

High contrast resolution

Annually

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To Do List
Frequency
Wednesday Thursday Saturday Tuesday Monday Sunday Friday

Highlight or place an X in the box to indicate when each procedure will be done.

Quality Assurance Procedure

Imaging plate erasure Reader/system reboot Printer test pattern Diagnostic monitor test pattern

W/R W/R

W W September

Frequency

November

March

Quality Assurance Procedure

Imaging plate inspection/cleaning X-ray equipment visual inspection Secondary monitor test pattern Printer density calibration System image noise System image uniformity and artifacts Low contrast resolution Reject analysis Video monitor luminance and uniformity
Imaging plate artifact analysis and response

M M M M
Q/R Q/R Q/R

S
S/A

Video monitor calibration Protective equipment Viewbox - Uniform brightness check Technique chart update Exposure chart update Automatic exposure control X-ray beam alignment check System response linearity High contrast resolution
Safety and preventive maintenance (SPM) test

A A A A A A A A
A/R A/R A/R

Reader maintenance Imaging plate check for wear Positive beam limitation check

R R R

December

February

October

January

August

June

April

July

May

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Computed Radiography X-Ray Quality Assurance

Weekly Checklist

Year:
Initial or place an X in the box to indicate when each procedure was successfully completed. Weekly Quality Assurance Procedures
Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

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Annual Checklist
Year:
September Frequency November December

Initial or place an X in the box to indicate the month when each procedure was successfully completed.

February

March

Quality Assurance Procedure

Imaging plate inspection/cleaning X-ray equipment visual inspection Secondary monitor test pattern Printer density calibration System image noise System image uniformity and artifacts Low contrast resolution Reject analysis Video monitor luminance and uniformity
Imaging plate artifact analysis and response

M M M M
Q/R Q/R Q/R

S
S/A

Video monitor calibration Protective equipment Viewbox - Uniform brightness check Technique chart update Exposure chart update Automatic exposure control X-ray beam alignment check System response linearity High contrast resolution
Safety and preventive maintenance (SPM) test

A A A A A A A A
A/R A/R A/R

Reader maintenance Imaging plate check for wear Positive beam limitation check

R R R

October

January

August

June

April

July

May

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Medical Imaging Quality Assurance

Test Procedures

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Imaging plate erasure Equipment All cassettes needed: Limit of No significant artifacts Acceptability: Procedure:

Follow the schedule prescribed by the manufacturer Through consistent rotation of use of the cassettes, imaging plates will be read and erased. This may allow for longer duration before all cassettes must be erased manually The imaging plates are very sensitive to all forms of radiation. Store them in a radiation-free environment. Do not leave cassettes in the room during the exposure of another plate Determine the schedule for required manual erasure of all cassettes and update the frequency in the To Do List Record this activity in the Weekly Checklist

QA Test: Reader/system reboot Procedure:

Follow the schedule prescribed by the manufacturer Some systems require to be restarted in a timely manner to enjoy continued error-free operation Determine if system reboots are required and update the frequency in the To Do List Record this activity in the Weekly Checklist

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X Test Procedures
QA Test: Printer test pattern Equipment Hardcopy printout of SMPTE 1 or equivalent multiformat test pattern needed: Limit of Acceptable visual reproduction Acceptability: Procedure:

Refer to the printer manual for guidance on required quality control testing and frequency. It may be necessary to augment this and other laser printer tests to conform to manufacturer standards Most laser film printers have an internal multiformat test pattern image that can be printed by selecting the appropriate command at the printer console The printed image should meet the following criteria: (i) no geometric distortion greater than 1 mm (ii) free from artifacts (iii) sharpness of horizontal and vertical patterns in the centre compared to the four corners Archive the first printed image as a reference for future comparisons Determine the schedule for required manufacturer printer quality control manual update the frequency in the appropriate To Do List If you perform this test, record this activity in the Weekly Checklist

The Society of Motion Picture and Television Engineers, SMPTE RP-133 Specifications for Medical Diagnostic Imaging Test Pattern for Television Monitors and Hard-Copy Recording Cameras, SMPTE: New York. 2001.

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X Test Procedures
QA Test: Video monitor test pattern Equipment Digital image file of the SMPTE 2 (or equivalent) Test Pattern needed: Limit of No areas of distortion or damage. Track degradation of resolution, Acceptability: contrast and brightness Procedure: Each diagnostic video monitor in the facility should be tested Follow the monitor cleaning protocol before proceeding Test patterns are either provided with the video monitors or generated through the imaging software Before you start the assessment: Position the monitor to minimize reflections on the screen from ceiling lights, lamps or other illuminators Set the room (ambient) light low Warm up the monitor for 30 minutes prior to testing Load the test pattern Adjust the monitor settings, if required. This may include: (a) window level and width, (b) contrast, (c) brightness, (d) vertical or horizontal size Centre the test pattern in the active area of the monitor. Ensure all borders of the test pattern are visible The following tests have been adapted from the tutorials developed by the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School 3 . Perform the following tests: 1. Resolution The high contrast bar patterns in the test image should be distinct as a pattern of black and white pairs In each corner of the image, as well as in the centre, inspect the 6 squares filled with varying widths of alternating black and white horizontal and vertical lines (these are referred to as high contrast linepair images). Refer to the diagram with arrows to indicate the regions of interest.

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The Society of Motion Picture and Television Engineers, SMPTE RP-133, 2001.

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X Test Procedures
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Verify that the high contrast line-pair images at the centre and corners of the SMPTE pattern are distinguishable. You should be able to differentiate all the lines, from wide to narrow, both horizontal and vertical.

2. Contrast & Brightness The contrast and brightness of the monitor is adequately set if the 5% squares at both ends of the grey scale are visible The grey scale is shown as a series of squares in the centre of the image that range from black (0%) to white (100%) in a semi-rectangle The 0% and 100% squares (see arrows on image at left) each contain smaller squares within them that represent signal level steps of 5% and 95% respectively You should be able to visually differentiate the inner square from the larger square that contains it Verify that the 0%-5% contrast is visible Verify that the 95%-100% contrast is visible 3. Grey Steps & Alphanumerics The grey scale is shown as a series of squares in the centre of the image that range from black (0%) to white (100%) in a semi-rectangle Verify that each step from 0% to 100% is distinguishable from the adjacent ones Verify that the alphanumeric characters that appear on the pattern are sharp and in focus. For example, examine the % signs that label the steps of the grey scale

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Visual Perception Laboratory, Video Monitor Test Pattern Tutorials, Brigham and Women's Hospital Department of Radiology, Harvard Medical School, BrighamRAD at http://brighamrad.harvard.edu/research/topics/vispercep/tutorial.html, 1997.

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X Test Procedures
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4. Geometric Distortion Assess the general appearance of the test pattern Verify that all lines appear straight and continuous without curvature or waviness Verify that the pattern is square Verify that there are no blurred areas or regions that flicker

Record the date and initial to indicate that the monitor passed this inspection on the Diagnostic Monitor Tests log sheet

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X Test Procedures
QA Test: Imaging plate physical inspection and cleaning Equipment Cleaning solution prescribed by manufacturer, lint free gauze, gloves needed: Procedure:

Follow the cleaning procedures recommended by the manufacturer

Note: Screen cleaner used for film-based intensifying screens may damage the phosphor imaging plate

Cleaning frequency depends on patient volume, plate handling, and/or frequency of which artifacts are found Cleaner should not be directly poured onto the phosphor as this may cause staining Damage may be caused by improper handling, such as contact with dirty or wet hands, hand lotions and sanitizers, or non-approved cleaners Although cleaning may be required less frequently, imaging plates and cassettes should be inspected monthly for damage and proper closure Imaging plates accumulate dust, dirt, scratches and cracks, and show wear from abrasions and other types of physical damage to the surface Record this activity in the Imaging Plates Log

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: X-ray equipment inspection Procedure: Note: If anything that may pose an imminent danger is discovered (e.g., loose electrical cable), discontinue the use of the x-ray equipment and call for service.

A visual inspection of the x-ray equipment and associated apparatus should be conducted monthly The date of the inspection should be documented in the X-Ray Equipment Log Viewboxes should be inspected for cleanliness, viewing area discoloration and improper illumination Imaging systems should be inspected for dust and dirt on or near the image reception area For CR systems, the image plate loading/unloading mechanism may be cleaned and lubricated if necessary Anything out of the ordinary (e.g., loose screws, frayed cables, sharp edges, etc.) should also be recorded in the X-Ray Equipment Log Prior to calling the service company to schedule a Safety and Preventive Maintenance (SPM) Inspection, review the X-Ray Equipment Log Discuss the items that you have logged with the service company so that they can bring the necessary parts when they come to do the SPM Inspection

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Printer density calibration Equipment Densitometer needed: Limit of Constancy of printed image density within vendor specifications Acceptability: Procedure:

Printers expose the film media using a source such as a laser or thermal print head. The printed image will depend on the power of the exposing source, the calibration look-up table (LUT) and the media (film) response curve. Refer to the printer manual for required tests and frequencies Update this manual to reflect the vendor specifications and test criteria Typically, the operator will select a test pattern such as the SMPTE from the printer console and obtain a hard copy Measurements will be taken with the densitometer at specified regions of the test pattern. An example is the following: (i) the 5% patch must be just visible inside the 0% patch (ii) the 95% patch must be just visible inside the 100% patch (iii) the 0% patch reads 2.45 0.15 O.D. (iv) the 10% patch reads be 2.10 0.15 O.D. (v) the 40% patch reads 1.15 0.15 O.D. (vi) the 90% patch reads 0.30 0.08 O.D. Some printers perform automated internal calibrations. The date of the automated calibration and any feedback of the results should also be recorded Record all calibration activity and data in the Printer Quality Log or other appropriate chart

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X Test Procedures
QA Test Vendor phantom analysis Alternative: QA Tests: System Image Quality, Reader, and/or Imaging Plates and Cassettes (as applicable for individual vendor)

Equipment Cassettes, dose meter, vendor recommended phantom (may include needed: software) Limit of As specified by vendor Acceptability: Procedure: Note: Most vendors have phantoms available for reader and image quality analysis. Some include software to automate the analysis of the results. There are also QA phantoms that can be used with any CR or DR system. A review of phantom systems currently available from a variety of vendors determined that most of the systems were adequate for the Image Quality tests (noise, uniformity and artifacts, high/low contrast resolution) as well as the Reader and Imaging Plates and Cassette tests. The owner should compare the phantom system analysis with these guidelines to ensure that the testing will be adequate. Also note that most vendors have procedures for Image Quality testing that do not require a vendor phantom system. You may have to ask specifically for these procedures. The purchase of some peripheral equipment, such as a copper filter, may be necessary. Under certain circumstances, it may be beneficial for a Health Region to have a vendor phantom, but it is not necessary for the QA procedures outlined in this manual. If the choice is made to use the vendor phantom system, most manufacturers recommend monthly testing for selected imaging plates, with an annual test of all cassettes in the facility.

Review the recommended test frequencies, procedures and required equipment Update this manual to reflect the vendor recommendations Document that the tests were performed and the pass/fail determination in the Image Quality Test Log or other appropriate record

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X Test Procedures
QA Test: System image noise Equipment Variety of cassettes/sizes needed: Limit of Review image artifacts and exposure value Acceptability: Procedure: Note: The following guideline is provided if no vendor recommendations are available. The test frequency may be adjusted, depending on the completeness and depth of investigation. This test has been adapted from the AAPM Report No. 74, Quality Control in Diagnostic Radiology 4 . Select several cassettes (at least one of each size) Perform a primary erasure on all cassettes Process the unexposed cassettes using a high-contrast processing film print mode for the particular CR reader Determine the incident exposure estimate based on the sensitivity number or exposure index or other exposure value indicator No incident exposure should be recorded on the resultant image Check for any image artifacts on the hard-copy (printed) image, if available Use a window width and level adjustment (small window width and narrow window level) to maximize the sensitivity of the displayed image to any possible artifacts (e.g. fixed point noise, image shading) If more than two cassettes read outside the acceptable limit for exposure value indicator, all cassettes should be tested. Record this activity and data in the System Image Quality Test Log

American Association of Physicists in Medicine, Quality Control in Diagnostic Radiology, AAPM Report No. 74, Medical Physics Publishing: Madison, WI, 2002.

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X Test Procedures
QA Test: System image uniformity and artifacts Equipment Cassette, dose meter needed: Limit of Review flat field image Acceptability: Procedure: Note: The following guideline is provided if no vendor recommendations are available. The test frequency may be adjusted, depending on the completeness and depth of investigation. This test has been adapted from the AAPM Report No. 74, Quality Control in Diagnostic Radiology 5 . Select several cassettes (at least one of each size) Perform a primary erasure on all cassettes Determine a standard set up and technical factors. Usually this test is performed at 75-85 kVp with added filtration (e.g. 1.5 mm Cu), good field coverage (e.g. 80% of the active area of the plate), and geometry (e.g. extended SID such as 180 cm). No grid is used. It may be necessary to lay the cassettes on the floor. To ensure consistent backscatter, first lay down a lead apron with the cassette placed on top Uniformly expose each plate to 1.0 mR, as measured with the dose meter Most manufacturers recommend a time delay between exposure and readout to produce more consistent results, while the AAPM advises 10 minutes. 6
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AAPM Report No. 74, 2002. American Association of Physicists in Medicine, Acceptance Testing and Quality Control of Photostimulable Storage Phosphor Imaging Systems, AAPM Report No. 93, Medical Physics Publishing: Madison, WI, 2006.

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X Test Procedures
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Determine a standard readout and processing algorithm developed for exposure tests (e.g. for Fuji use a semi-automatic readout method, for Agfa use System Diagnosis / Flat Field, for Kodak use Body Part / Pattern with no edge enhancement) The resultant image should have constant image density across the field of view. Look closely for distinct banding due to reader artifacts For hard copy (printed) images, the image density across the field of view should be within 0.2 OD (definitely within 0.5 OD) of the target OD. Measured exposures compare to the exposures determined by the CR system should agree to within 20% Exposure value indicator for the cassettes tested should agree within 10% Record this activity and data in the System Image Quality Test Log

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X Test Procedures
QA Test: Low contrast resolution Low contrast phantom such as Leed 7 or UAB 8 or Postal Test Phantom Equipment Dose meter needed: Each available cassette size Limit of Comparison to baseline measurements Acceptability: Procedure: Note: The following guideline is provided if no vendor recommendations are available. The test frequency may be adjusted, depending on the completeness and depth of investigation, and the operator competency for performing this test. Note: Low contrast resolution is the ability to resolve different objects from the background when the difference in attenuation between the objects and the background is small compared to noise Note: The protocol for the Saskatchewan Medical X-Ray Postal Test may be adequate to assess the low contrast resolving ability of the CR system This test has been adapted from the AAPM Report No. 74, Quality Control in Diagnostic Radiology 9 . Select several cassettes (at least one of each size) Perform a primary erasure on all cassettes The technique (kV, mAs) should be set as recommended by phantom manufacturer
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Cowen, A. R. Digital Fluoro Acceptance Testing: The U.K./Leeds Approach, Specification, Acceptance Testing, and Quality Control of Diagnostic X-Ray Imaging Equipment: Proceedings of the 1991 AAPM Summer School. J.A. Seibert, G.T. Barnes, and R. Gould (eds.). American Institute of Physics: New York. 1992, p. 806. 8 Wagner, A. J., G. T. Barnes, and X. Wu. Assessing Fluoroscopic Contrast Resolution: A Practical and Quantitative Test Tool. Med. Phys. 1981; 18:894-899. 9 AAPM Report No. 74, 2002.

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X Test Procedures
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For the postal phantom, use a small (20 cm) Abdomen technique, AEC with center cell only Most manufacturers recommend a time delay between exposure and readout to produce more consistent results, while the AAPM advises 10 minutes. 10 Obtain several images of the phantom for each cassette size and imaging plate format Process using a high-contrast algorithm as well as edge enhancement algorithm A standardized evaluation routine should be developed for several measurements over an initial period Evaluate the images for detectable contrast as a function of exposure, and compare to baseline measurements. Record this activity and data in the System Image Quality Test Log

10

AAPM Report No. 93, 2006.

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X Test Procedures
QA Test: Reject Analysis (Manual) Equipment Calculator needed: Limit of If the % Rejected rate is greater than 5%, investigate. Acceptability: If it is greater that 10%, investigate vigorously! Procedure:

Establish a monitoring period. For a small facility, six months may be appropriate while for a large facility, monthly analysis may be required Keep the Reject Analysis form available near the console When an image must be repeated, document the deficiency of the original image on the Reject Analysis form At the end of the specified monitoring period, enter the total number of diagnostic images taken during the monitoring period on the Reject Analysis form (do not include quality assurance images that were taken during the monitoring period) Calculate the % Rejected rate at the bottom of the Reject Analysis form File the Reject Analysis form in the QA Procedures Manual Make a copy of the Reject Analysis form in the Master Sheets section and place near the console

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X Test Procedures
QA Test: Reject Analysis (Computer Assisted) Equipment System software needed: Limit of If the % Rejected rate is greater than 5%, investigate. Acceptability: If it is greater that 10%, investigate vigorously! Procedure:

Establish a monitoring period. For a small facility, six months may be appropriate while for a large facility, monthly analysis may be required If your system offers a software analysis tool, each technologist may be required to log into the system in order to tabulate the results appropriately Typically the system will ensure that every image that is kept is categorized as accepted or rejected If an image is labelled Rejected, a list will appear from which to select the type of deficiency The analysis usually takes place under the Statistics menu in the system where the current tabulation of rejected images can be viewed Do not include quality assurance images that were taken during the monitoring period At the end of the specified monitoring period, enter the % Rejected rate on the Reject Analysis form or other appropriate documentation Once the % Rejected rate has been recorded, clear the current statistics to start a fresh session File the Reject Analysis form in the QA Procedures Manual

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Video monitor manual brightness and contrast setting Equipment SMPTE (or equivalent) test pattern needed: Limit of Low contrast patches visible without other image artifacts Acceptability: Procedure: Note: The following guidelines for adjusting the brightness and contrast settings on video monitors were adapted from the presentation of William Geiser and Stephen Thompson, QC Testing of Soft/Hard Copy Display Systems for CT 11 . Display the SMPTE (or equivalent) test pattern For a CRT Set the brightness to approximately 5-10% of maximum Set the contrast to approximately 85-90% of maximum Slowly increase brightness until the 5% patch is just visible The 0% regions should look black, not grey For an LCD Set the brightness to approximately 85-95% of maximum Set the contrast to approximately 50% of maximum Slowly vary the contrast until both the 5% and 95% patches are visible The 0% regions should look black, not grey

Geiser, William and Stephen Thompson. QC Testing of Soft/Hard Copy Display Systems for CT, Proceedings from the Medical Technology Management Institute Hands On Multi-Slice CT Workshop for Physicists, Houston, 2007, p. 125-140.

11

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Video monitor luminance and uniformity Equipment Photometer, either pod or spot style needed: Limit of Monitor luminance within the criteria for monitor type Acceptability: Procedure:

Display the SMPTE test pattern to evaluate the initial quality of the monitor Determine the manufacturers recommended settings, and ensure the monitor is set accordingly If no guidance material is available, review the procedure Video monitor manual brightness and contrast setting Ensure that the 5% and 95% patches are visible Diagnostic quality monitors typically include this measurement in the calibration check. Review the QC manual and perform the test following the vendor recommendations.

Note: The following guidelines for soft copy display quality evaluation were adapted from the presentation of William Geiser and Stephen Thompson, QC Testing of Soft/Hard Copy Display Systems for CT12 .

Use the TG-18 UNL-80 test pattern, or set an entirely white display by adjusting the window width and window level (WW=0, WL=0) Measure and record the maximum luminance in the centre and four corners of the display on the Diagnostic/Secondary Monitor Tests sheet

Continued next page

12

Geiser, William and Stephen Thompson, 2007, p. 125-140.

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
Continued from previous page

Use the TG-18 UNL-10 test pattern, or set the window and level such that the screen is black Measure the minimum luminance in the centre of the display and record on the Diagnostic/Secondary Monitor Tests sheet Determine the monitor type and record the following criteria:
Monitor Type
Color CRT Color LCD Greyscale CRT (secondary) Greyscale CRT (diagnostic) Greyscale LCD CRT LCD All

Maximum Luminance
> 80 Cd/m2 > 100 Cd/m2 > 150 Cd/m2 > 200 Cd/m2 > 350 Cd/m2

Minimum Luminance
< 1.0 Cd/m2 < 1.5 Cd/m2

% Difference
Within 30%

Calculate the % difference of each of the corners to the centre and record the results Verify that the video monitor meets the test criteria and indicate the Pass/Fail for each test on the Diagnostic/Secondary Monitor Tests sheet Arrange for service if the monitor does not pass all tests

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Imaging plate artifact analysis and exposure response Equipment All cassettes currently in use, dose meter, densitometer needed: Limit of Review flat field image Acceptability: Procedure: Note: The following guideline is provided if no vendor recommendations are available. The purpose of the artifact analysis is to assess every imaging plate in use for damage, photo-phosphor efficiency and erasure ability. The purpose of the exposure response is to determine the accuracy and reproducibility of the exposure index or sensitivity value, as a function of the dose to the image receptor. The manufacturer recommended testing procedure should be used. The system image quality tests and reader performance should be evaluated to ensure that the system is operating appropriately before this test is carried out. If no vendor guidance is available, the following method may be adapted for your system. This test has been adapted from the AAPM Report No. 74, Quality Control in Diagnostic Radiology 13 . Perform a primary erasure on all cassettes Determine a standard set up and technical factors. Usually this test is performed at 75-85 kVp with added filtration (e.g. 1.5 mm Cu), good field coverage (e.g. 80% of the active area of the plate), and geometry (e.g. extended SID such as 180 cm). No grid is used. It may be necessary to lay the cassette on the floor. To ensure consistent backscatter, first lay down a lead apron with the cassette placed on top
Continued next page

13

AAPM Report No. 74, 2002.

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
Continued from previous page

Uniformly expose each plate to 1.0 mR, as measured with the dose meter Most manufacturers recommend a time delay between exposure and readout to produce more consistent results, while the AAPM advises 10 minutes. 14 Determine a standard readout and processing algorithm developed for exposure tests The resultant image should have constant image density across the field of view Measured exposures compared to the exposures determined by the CR system should agree to within 10% (or manufacturers specification) of the incident exposure All images should be consistent from plate-to-plate with the same exposure. If printing film, check several images for image uniformity to within 0.25 OD of the central density as measured by a densitometer Record this activity and data in the Imaging Plates Log

14

AAPM Report No. 93, 2006.

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Video monitor calibration Equipment Photometer or luminance meter (and supporting software, if applicable) needed: Limit of Calibration of luminance measurements to vendor specifications Acceptability: Procedure:

Video monitors used by the radiologist for the purpose of rendering an assessment or diagnosis from the x-ray images must be calibrated or have the calibration checked at least annually Secondary video monitors are classified as those used for physician reference or technologist review. If the secondary monitor relies on look-up tables (LUT) and other image enhancements that can be set, the calibration procedure should be carried out annually as well It is expected that the tools and directions for the monitor calibration will be supplied with the diagnostic video monitor The vendor may require more frequent testing. Refer to the operators manual for the diagnostic video monitor and update this manual to reflect the appropriate tests and test frequencies The typical monitor calibration includes measurements with a photometer of various fields of luminance on-screen. These measurements are then recorded in the accompanying software application, which will determine conformity of the display to DICOM standards or Pass/Fail criteria. Verify that the diagnostic video monitor meets vendor specifications and record the results for each monitor on the Diagnostic Monitor Tests sheet Arrange for service if the monitor does not pass all tests

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Protective equipment (radiograph or fluoro) Procedure:

Note: New protective equipment must be imaged before being put into service these films will be used as the baseline for all future observations Note: The first set of images taken of an apron or glove should be kept on file for the life of the equipment. The two most recent sets of films should also be kept on file. If, for example, the 6th set of images of an apron was taken today then the 1st, 5th and 6th sets should be kept on file Note: When imaging a leaded apron with a 400-speed system, use 80 kVp, 5 mAs. When imaging leaded gloves, double the mAs Set the x-ray tube at the source to image distance (SID) that you normally use (e.g., 40 or 100 cm) and align the central ray to the centre of the bucky Place a 36x43 (14x17) cassette on the x-ray table and adjust the collimator to the size of the cassette It will take a number of exposures to image a sufficient portion of the apron so plan on how you will place the apron on the cassette The central region of the apron, from collar to knee, is the region of interest with sufficient coverage to span the width of the average wearer Follow your plan and image the different areas of the apron Record the area of the apron that was imaged with the date, either by making an annotation with the image or including in the filename Review the images for any deterioration or cracks in the lead that will show as darkened areas Compare the current images with previous images taken of the apron or glove Record where the images are located in the Protective Equipment Log Record this activity and observations in the Protective Equipment Log

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Viewboxes uniform brightness test Equipment Light meter needed: Procedure:

The viewboxes should be visually examined for discoloration, uneven lighting, flickering, etc. If the viewer cover is significantly discoloured, it should be replaced If there is uneven lighting or if one of the tubes is flickering, all fluorescent tubes in the viewer should be replaced All viewboxes should be tested for compliance with the following requirements: (i) Brightness at least 400 ftcandles or 1300 Cd/m2 (ii) Light Output Uniformity output uniform to 10% (iii) Light Output Homogeneity light output between a bank of viewboxes should be uniform to within 15% of the mean (iv) Ambient Light Control the ambient light in the reading room should be less than 50 lux (5 to 10 lux is recommended) Record your observations and actions in the Viewboxes Log

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Technique chart review and update Procedure:

Consult the radiologists and/or the radiologists senior technologist to determine if any of the techniques or views for the procedures that you are currently doing require modification Incorporate revisions of the old chart and print out a new revised copy, or update the technical settings programmed into the console Post and date the current technique chart. There should only be one chart available for each x-ray unit in the facility

QA Test: Exposure chart review and update Procedure:

The computed radiography system compensates for under- and overexposures with respect to the image quality and optical density It is important to track, optimize and evaluate patient exposure and image quality using the tools available to the technologist Image quality is first evaluated by visually inspecting the image onscreen and then evaluating the printed image (if available). The mAs (with AEC) and the exposure index or sensitivity value should also be considered for appropriate use of technique All vendors supply a range of acceptable exposure values reported with the read-out of the image It is expected that the high-dose range point of the exposure index or sensitivity value will be adjusted to lower dose through experience and experimentation with the new imaging system The exposure index or sensitivity ranges for a variety of anatomy will be posted and revisions noted Annually, incorporate revisions of the old chart and print out a new revised copy Post and date the current exposure chart

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Automatic exposure control (AEC) Equipment Postal QA Phantom, densitometer needed: Limit of 0.30 OD or within 20% of the on-screen ROI average Acceptability: Procedure:

Note: It is expected that this test will be incorporated into the annual Postal Quality Assurance Test but could be done at other times if there is a suspicion that the automatic exposure control (AEC) system is not functioning correctly Set the x-ray tube at the source to image distance (SID) that you normally use (e.g., 40 or 100 cm) and align the central ray to the centre of the bucky Place the lower block only of the Postal QA Phantom on the x-ray table and centre it to the light field (this is the block that has the plate with holes drilled into it) Adjust the light field so that there is a border around the phantom of approximately 2.5 cm (1 inch) from each edge Place a 24x30 (10x12) cassette in the bucky Expose the phantom using the phototiming technique normally used for the Postal QA Test (centre cell only) Record the mAs and exposure indicator value used during this exposure Most manufacturers recommend a time delay between exposure and readout to produce more consistent results, while the AAPM advises 10 minutes. 15 Read the image Return the same cassette to the bucky tray Using the full phantom (lower+upper block) and the same technique, expose the phantom Record the mAs and exposure indicator value used during this exposure

Continued next page

15

AAPM Report No. 93, 2006.

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
Continued from previous page

Read the image If a printer is available, print both images and measure the optical densities of the two radiographs at similar locations on the phantom images If the density readings differ by more than 0.30 then the AEC system requires calibration If using the on-screen tools, select the same size region-of-interest (ROI) at the same location on both images and record the average measurement The ROI averages should be within 20% of each other, or the AEC system requires calibration The exposure indicator values should also remain similar from year to year. If there are discrepancies noted, further investigation into the accuracy of the exposure indicator value is warranted Record this activity and data in the X-Ray Equipment Log

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: X-ray beam alignment check Equipment Postal QA Phantom, 4 pennies, ruler needed: Limit of 2% of source to image distance (SID) Acceptability: Procedure:

Note: This test is done during the annual Postal Quality Assurance Test but could be done at other times if there is a suspicion that the x-ray field and light field are misaligned Set the x-ray tube at the source to image distance (SID) that you normally use (e.g., 40 or 100 cm) and align the central ray to the centre of the bucky Centre the Postal QA Phantom on the x-ray table Adjust the light field so that there is a border around the phantom of approximately 2.5 cm (1 inch) from each edge Place a penny at each corner of the light field Expose the phantom using the technique used for the Postal Quality Assurance Test (the Postal QA Test Information form should be in the Master Sheets section of the QA Procedures Manual) Process the film On the image, measure the distance from the left edges of the images of the two left pennies to the left edge of the x-ray field Record the larger of these two measurements On the image, measure the distance from the right edges of the images of the two right pennies to the right edge of the x-ray field Record the larger of these two measurements On the image, measure the distance from the upper edges of the images of the two upper pennies to the upper edge of the x-ray field Record the larger of these two measurements On the image, measure the distance from the lower edges of the images of the two lower pennies to the lower edge of the x-ray field Record the larger of these two measurements

Continued next page

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
Continued from previous page

Sum the recorded longitudinal measurements (left + right) Sum the recorded transverse measurements (upper + lower) Measure the diameter of the image of one of the pennies If either sum is greater than the measured diameter of the pennys image, the misalignment of the light field and x-ray field is excessive Record this activity and data in the X-Ray Equipment Log

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: System response linearity Equipment Cassette, dose meter needed: Limit of Review flat field image and exposure indicator value Acceptability: Procedure: Note: The following guideline is provided if no vendor recommendations are available. The test frequency may be adjusted, depending on the completeness and depth of investigation. This test has been adapted from AAPM Report No. 74, Quality Control in Diagnostic Radiology 16 and Kodak Guidelines for Acceptance Testing and Quality Control 17 Select several cassettes (at least one of each size) Perform a primary erasure on all cassettes Determine a standard set up and technical factors. Usually this test is performed at 75-85 kVp with added filtration (e.g. 1.5 mm Cu), good field coverage (e.g. 80% of the active area of the plate), and geometry (e.g. extended SID such as 180 cm). No grid is used. It may be necessary to lay the cassettes on the floor. To ensure consistent backscatter, first lay down a lead apron with the cassette placed on top Uniformly expose each plate to 0.1, 1.0 and 10 mR, as measured with the dose meter Most manufacturers recommend a time delay between exposure and readout to produce more consistent results, while the AAPM advises 10 minutes. 18
Continued next page

16 17

AAPM Report No. 74, 2002. Kodak Technical and Scientific Bulletin, Guidelines for Acceptance Testing and Quality Control: Kodak DirectView CR800 System and Kodak DirectView CR900 System, 2001. 18 AAPM Report No. 93, 2006.

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Computed Radiography X-Ray Quality Assurance

X Test Procedures
Continued from previous page

Determine a standard readout and processing algorithm developed for exposure tests (e.g. for Fuji use a semi-automatic readout method, for Agfa use System Diagnosis / Flat Field, for Kodak use Body Part / Pattern with no edge enhancement) Report the results for each of the exposures for each cassette size in the System Linearity Test Log For hard copy (printed) images, the image density across the field of view should be within 0.2 OD (definitely within 0.5 OD) of the target OD. For the 10 mR exposures, read the cassette twice. In other words, after the initial read of the imaging plate, put the cassette into the scanner again, with no additional exposure. This will test how well a large exposure to the imaging plate is erased. Record whether the these tests are satisfactory or not. Measured exposures compare to the exposures determined by the CR system should agree to within 20% over the 3 orders of magnitude incident exposure Record this activity and data in the System Linearity Test Log

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: High contrast resolution Equipment Test object of lead-bar resolution test pattern capable of 1 to 10 lp/mm needed: Each available cassette size Limit of Within 10% of the theoretical resolution based on the sampling frequency Acceptability: of the imaging plate as specified by the manufacturer Procedure: Note: This test is not a required to be done unless under extenuating circumstances; for example, if there is a noted degradation in image quality. It may also be recommended to perform this test during acceptance testing of the system to establish the baseline resolving power. Note: The following guideline is provided if no vendor recommendations are available. This test has been adapted from the AAPM Report No. 74, Quality Control in Diagnostic Radiology 19 . Select several cassettes (at least one of each size) Perform a primary erasure on all cassettes Determine a standard set up and technical factors. Usually this test is performed at low kV at moderate incident exposure (e.g. 50 kVp and 5 mAs at 180 cm with no filtration). Both horizontal and vertical resolution should be tested. (Note: slightly angle the bar phantom by a couple of degrees to the horizontal and vertical to minimize moir and line-pairing patterns that can interfere with measurements; do not use a large angle such as 45 as this will likely underestimate the resolution capability of the detector. Use of multiple test patterns centrally and peripherally located on the cassette allows simultaneous measurement of the different resolving capability of various locations on imaging plate.
Continued next page

19

AAPM Report No. 74, 2002.

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X Test Procedures
Continued from previous page..

Process the cassette with a high-contrast algorithm, and determine the limiting resolution in the horizontal and vertical directions on the hard copy and soft copy image All clinically used combinations of reduction factor and format should be tested The measured resolution should be within 10% of the theoretical resolution as specified by the manufacturer

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Imaging cassette wear check Equipment Bright light source (or ultraviolet lamp) needed: Procedure:

Note (if using the UV lamp): If you are suspicious that a screen may be worn and is not functioning efficiently you may consider doing this test If you have a UV lamp (black light), go into a dark room and shine it on the screen and look for bright specks (caused by dust) If you see bright specks, clean the screen If you see dark patches, these are areas of excessive wear Without the UV lamp, you may still inspect the screen for wear patterns or cracks by using a bright light source or sunlight Tilt the screen to inspect the surface by the reflection of the bright light or sunlight If there is evidence of wear, discuss the problem with your vendor Record this activity and observations on the appropriate form

CR QA

Computed Radiography X-Ray Quality Assurance

X Test Procedures
QA Test: Positive beam limitation field size check Equipment Postal QA Phantom, ruler or on-screen measurement needed: Limit of 2% of source to image distance (SID) Acceptability: Procedure:

Note: If you are suspicious that the positive beam limitation (PBL) system is not collimating the x-ray field correctly, you should perform this test Set the x-ray tube at the source to image distance (SID) that you normally use (e.g., 40 or 100 cm) and align the central ray to the centre of the bucky Place the Postal QA Phantom on the x-ray table and centre it to the light field Place a 24x30 (10x12) cassette in the bucky and allow the PBL system to adjust the field size Override the PBL system (check the equipments operating manual for the procedure for your particular x-ray unit) Replace the 24x30 cassette with a 36x43 (14x17) cassette DO NOT adjust the field size. Expose the phantom Read the image If a printer is available, print the image. Hold a 24x30 film against the exposed area on the hard copy Measure the distances from the edges of the 24x30 film to the edges of the x-ray field (take image magnification factors into account) If a printer is not available, measure the exposed field on screen and compare to the 24 cm x 30 cm dimensions (take image magnification factors into account) If the difference in either the longitudinal or transverse direction is more than 2% of SID (i.e., 2 cm if SID is 100 cm) then the PBL system requires adjustment Record this activity and data in the X-Ray Equipment Log

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Computed Radiography X-Ray Quality Assurance

Medical Imaging Quality Assurance

Replace this sheet with a divider tab.

Master Copies

CR QA
Computed Radiography X-Ray Quality Assurance

To Do List
Frequency
Wednesday Thursday Saturday Tuesday Monday Sunday Friday

Highlight or place an X in the box to indicate when each procedure will be done.

Quality Assurance Procedure

Imaging plate erasure Reader/system reboot Printer test pattern Diagnostic monitor test pattern

W W W W September

Frequency

November

March

Quality Assurance Procedure

Imaging plate inspection/cleaning X-ray equipment visual inspection Secondary monitor test pattern Printer density calibration System image noise System image uniformity and artifacts Low contrast resolution Reject analysis Video monitor luminance and uniformity
Imaging plate artifact analysis and response

M M M M
Q/R Q/R Q/R

S
S/A

Video monitor calibration Protective equipment Viewbox - Uniform brightness check Technique chart update Exposure chart update Automatic exposure control X-ray beam alignment check System response linearity High contrast resolution
Safety and preventive maintenance (SPM) test

A A A A A A A A
A/R A/R A/R

Reader maintenance Imaging plate check for wear Positive beam limitation check

R R R

December

February

October

January

August

June

April

July

May

CR QA
Computed Radiography X-Ray Quality Assurance

Weekly Checklist

Year:
Initial or place an X in the box to indicate when each procedure was successfully completed. Weekly Quality Assurance Procedures
Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

Month Date Initial Plates Erasure System Reboot Printer Test Diagnostic Monitor

CR QA
Computed Radiography X-Ray Quality Assurance

Annual Checklist

Year:
Initial or place an X in the box to indicate the month when each procedure was successfully completed.

September

Frequency

November

March

Quality Assurance Procedure

Imaging plate inspection/cleaning X-ray equipment visual inspection Secondary monitor test pattern Printer density calibration System image noise System image uniformity and artifacts Low contrast resolution Reject analysis Video monitor luminance and uniformity
Imaging plate artifact analysis and response

M M M M
Q/R Q/R Q/R

S
S/A

Video monitor calibration Protective equipment Viewbox - Uniform brightness check Technique chart update Exposure chart update Automatic exposure control X-ray beam alignment check System response linearity High contrast resolution
Safety and preventive maintenance (SPM) test

A A A A A A A A
A/R A/R A/R

Reader maintenance Imaging plate check for wear Positive beam limitation check

R R R

December

February

October

January

August

June

April

July

May

CR QA
Computed Radiography X-Ray Quality Assurance

Reject Analysis
To 18 x 24 24 x 30 36 x 43 Total REASON

Period of Reject Analysis: From

Underexposure (excessively noisy images) Overexposure (saturation or burn out) Patient Movement Positioning Artifacts X-ray Equipment Failure Software Failure Blank Image Other Reasons Total Number of Rejected Films

Examination Chest Spine Skull Abdomen Extremity Other Procedures

Films

Total

Total Number of Films % Rejected = Total Number of Rejected Films x 100 = Total Number of Films

x 100 =

If the % Rejected exceeds 5%, a review should be conducted to determine the reason or reasons that may be causing it.

CR QA
Computed Radiography X-Ray Quality Assurance

Diagnostic Monitor Tests

Year:

Video Monitor:
Test Pattern

Record the month and date of the week. Initial or place an X in the box to indicate that the monitor passed the test pattern inspection. Month Date Initial Month Date Initial

Luminance Readings
Record the maximum luminance at the centre and corner locations on the monitor. Record the centre minimum luminance. Determine the criteria for the tests depending on the monitor type and indicate pass or fail.

Date:
Upper Left Upper Right

Monitor Type:
Description Minimum luminance Centre Maximum luminance
Centre

Criteria

Pass/Fail

Left upper % difference Right upper % difference Left lower % difference Right lower % difference

Lower Left

Lower Right

Minimum luminance:

Diagnostic Monitor Calibration

Date Comments

CR QA
Computed Radiography X-Ray Quality Assurance

Secondary Monitor Tests

Year:

Video Monitor:
Test Pattern

Record the month and date of the week. Initial or place an X in the box to indicate that the monitor passed the test pattern inspection. Month Date Initial

Luminance Readings
Record the maximum luminance at the centre and corner locations on the monitor. Record the centre minimum luminance. Determine the criteria for the tests depending on the monitor type and indicate pass or fail.

Date:
Upper Left Upper Right

Monitor Type:

Description Minimum luminance Centre Maximum luminance

Criteria

Pass/Fail

Centre

Left upper % difference Right upper % difference Left lower % difference Right lower % difference

Lower Left

Lower Right

Minimum luminance:

CR QA
Computed Radiography X-Ray Quality Assurance

Medical Imaging Quality Assurance

Replace this sheet with a divider tab.

Quality Assurance Logs

CR QA
Computed Radiography X-Ray Quality Assurance

System Image Quality Test Log

Imaging Plate ID Processing Algorithm Exposure Value Artifacts?

NOISE Date:
Select several cassettes, process images and record results. Do not expose cassettes. Cassette Size

UNIFORMITY AND ARTIFACTS Date: Technique (kV, mAs, SID, filtration):

Select several cassettes, expose to 1 mR, process images and record results. Cassette Size Imaging Plate ID Processing Algorithm Exposure Value
% Difference Exposure Value

Hard Copy OD

Artifacts?

LOW CONTRAST RESOLUTION Date: Technique (kV, mAs, SID):

Select several cassettes, expose, process images and record results. Cassette Size Imaging Plate ID Processing Algorithm Exposure Value
Resolution on Video Monitor Resolution on Hard Copy

CR QA
Computed Radiography X-Ray Quality Assurance

System Linearity Test Log

(for 0.1 mR, 1 mR, 10 mR)

SYSTEM LINEARITY RESPONSE Date: Technique: (kV, SID, filtration) mAs:

Select several cassettes, expose to 0.1, 1 and 10 mR, process images and record results. Imaging Plate (ID and Size)
Exposure Value (0.1 mR) Exposure Value (1 mR) Exposure Value (10 mR)

Processing Algorithm

Hard Copy OD

Imaging Plate (ID and Size)

Processing Algorithm

Exposure Value (0.1 mR)

Exposure Value (1 mR)

Exposure Value (10 mR)

Hard Copy OD

Imaging Plate (ID and Size)

Processing Algorithm

Exposure Value (0.1 mR)

Exposure Value (1 mR)

Exposure Value (10 mR)

Hard Copy OD

NOTE: Perform Erasure Test: re-process the 10 mR cassettes after initial read to determine quality of erasing on the imaging plates.

Result of Erasure Tests:

Pass

Fail

CR QA
Computed Radiography X-Ray Quality Assurance

Imaging Plates Log

IMAGING PLATE ARTIFACT ANALYSIS AND RESPONSE Date: Technique (kV, mAs, SID, filtration):
Perform artifact analysis on entire cassette inventory. Cassette Size Imaging Plate ID Processing Algorithm Exposure Value
% Difference Exposure Value

Hard Copy OD

Artifacts?

CR QA
Computed Radiography X-Ray Quality Assurance

X-Ray Equipment Log

Test Comments

Date

CR QA
Computed Radiography X-Ray Quality Assurance

Printer Quality Log

Test Comments

Date

CR QA
Computed Radiography X-Ray Quality Assurance

Protective Equipment
Equipment Description Date Purchased

Equipment Number

CR QA
Computed Radiography X-Ray Quality Assurance

Protective Equipment Tests

Date Comments

Equipment Number

CR QA
Computed Radiography X-Ray Quality Assurance

Imaging Plate Inventory

Imaging Plate / Screen Date Purchased

Cassette Cassette Identification Size

CR QA
Computed Radiography X-Ray Quality Assurance

Viewboxes
Comments

Date

CR QA
Computed Radiography X-Ray Quality Assurance

Medical Imaging Quality Assurance

Replace this sheet with a divider tab.

RSU, Service & Other Reports

CR QA
Computed Radiography X-Ray Quality Assurance

Radiation Safety Unit Reports

Quality Assurance Audits X-Ray Equipment Inspections Postal Quality Assurance Tests

Copy of the Annual Registration Certificate

CR QA
Computed Radiography X-Ray Quality Assurance

X-Ray Service Company Reports

Safety & Preventive Maintenance (SPM) Reports Emergency Service Reports

CR QA
Computed Radiography X-Ray Quality Assurance

Personal Exposure Reports

Quarterly Exposure Reports

CR QA
Computed Radiography X-Ray Quality Assurance

Medical Imaging Quality Assurance

Replace this sheet with a divider tab.

Other Forms

CR QA
Computed Radiography X-Ray Quality Assurance

Other Forms

X-Ray Equipment Registration Form Postal Quality Assurance Master Sheets Other

X-RAY EQUIPMENT REGISTRATION

Radiation Safety Unit 400 - 1870 Albert Street REGINA, SK S4P 4W1
Must be completed and forwarded to the above address within 30 days of an installation or alteration.

DATE: Room Number: Name of Facility: Address:

RSU Code Number:

To be completed by RSU office

Please check one: Tube Use:

New Installation Tube Replacement Unit Decommissioned Lab Mammo Radiographic

mA Table: Manufacturer Model Name Model Number Serial Number Year New Tube Insert: Manufacturer Model Number Serial Number Year New Tube Carriage: Manufacturer Model Number Serial Number Year New -

CT Fluoro Industrial

Simulator Therapy Tomo

X-RAY EQUIPMENT
Maximum tube ratings: kVp Control: Manufacturer Model Name Model Number Serial Number Year New Tube Head: Manufacturer Model Number Serial Number Year New -

Image Intensifier Tube: Manufacturer Model Number Serial Number Year New -

Date of Installation:
July 2007

COMPLETED BY: