A TOTAL QUALITY CONTROL SYSTEM

IDENTIFICATION OF IMAGING REQUIREMENTS

DEVELOPMENT OF EQUIPMENT SPECIFICATIONS

SELECTION OF EQUIPMENT

INSTALLATION AND ACCEPTANCE TESTING

CONTINUING EDUCATION

MONITORING EQUIPMENT PERFORMANCE

PROCESSING SYSTEM

EXTERNAL BEAM

EVALUATION

IDENTIFICATION OF IMAGING REQUIREMENT

It is not always apparent exactly what type of equipment is needed when new purchases are being
considered. Historically, this decision was made by the chief radiologist or administrative technologists.
Rarely are the actual operators of the equipment, the radiographer, consulted. The result has been
that nearly every x-ray department owns a radiological monstrosity that is avoided by radiographers
and radiologist alike. These units are often inconvenient, overly sophisticated, or unable to produce
quality images. Careful identification of imaging requirements can prevent these problems.
It is not necessary to be an expert in imaging physics and technology in order to be capable of
contributing to the process of identifying the imaging requirements. Each member of the radiological
team can contribute his or her expertise. The person who will make the final decision should interview
the radiologist, administrators, supervisors and staff technologist who will use the equipment. In many
instances the needs of the radiologist will determine the basic parameters for the purchase.
Administrators must often impose financial and space restraints, although they can also create new
funds and space when necessary. Supervisors are often able to provide important information on
patient flow and staffing needs. After the radiologist, the radiographers are the most important
persons to have input because their experiences with equipment provide a wealth of information.

DEVELOPMENT OF EQUIPMENT SPECIFICATIONS

Generic equipment specification should be developed from the interview information. It is important
that the person formulating the specifications have the technical background to state exactly what is
needed to meet the imaging requirements. An imaging physicist should be involved at this point. The
best specification includes detailed statements of what the equipment should be capable of doing. For
example, maintain mA linearity within =/-10 percent to produce equal film density when mAs is
maintained but mA is varied. This must be Include a change from highest to lowest setting. When the
specifications are complete they are sent to vendors for bidding.
SELECTION OF EQUIPMENT
The actual selection of equipment becomes simple if the investigation into the first steps has been
thorough. When the bids arrive they can be compared for meeting specifications, cost and service. The
actual decision is then academic. A pitfall in the process can occur when radiologist in the institution
show a preference to a particular vendor, thus weakening the bargaining position of the department
administrator. In many institutions this pitfall should be expanded to include interference by
administrative officers unfamiliar with imaging equipment.
INSTALLATION AND ACCEPTANCE TESTING OF EQUIPMENT
Installation and acceptance testing of equipment is the responsibility of the vendor and/or the
manufacturer. The quality control technologist must verify that the equipment specifications have been
met. Normally this includes supervising the testing procedures and results. It is suggested that the
exact methods for acceptance testing be included in the original specifications. The data from these
tests will form the standard for all future quality control monitoring.
CONTINUING EDUCATION
It is normally the responsibility of the vendor to familiarize the users of the equipment with its proper
operation. With simple equipment, such as ancillary devices, the equipment manual may be sufficient
for use in service training. More complex equipment should be demonstrated and explained by the
vendor to at least two people as part of the purchase contract. Continuing education must be ongoing
procedure. It is advisable to include both quality control and in-service education coordinators in the
initial training demonstrations. A good in-service program will include an orientation procedure as well
as period updates on all complex equipment.
MONITORING OF EQUIPMENT PERFORMANCE
The final procedure of a total program is commonly considered to be the whole of quality control.
Monitoring equipment performance includes routine checks of all radiographic equipment. Although
they are interdependent, monitoring can be divided into two parts:
1
2

Film processing systems, and

External beam evaluation.

Objectives for a performance monitoring system are to:

Monitor the quality of the film processing system
Measure the quality of the external radiation beams, and
Specify faults within these systems to allow corrective measures to be taken.
Evidence shows that a properly working quality control system will reduce equipment down-tine and
the number of repeated exposures. This will also reduce patient dose, patient waiting time, and supply
cost, as well as increase confidence in diagnostic consultation and boost departmental morale.
RESPONSIBILITY
Professional service personnel or medical physicists are not required to perform routine quality control
procedures. Many procedures must be done daily, and to use these experts would be too costly.
Radiographers, who are more available and knowledgeable about potential problems, should do the
equipment monitoring. An initial cost outlay for testing equipment is required. To maintain a program,
stall technologists must be given time to perform the procedures and to evaluate them.

PROCESSOR MONITORING
Processor monitoring is designed to permit an automatic film processor to fluctuate within set limits.
These tests may be performed by anyone who has been oriented to the use of equipment involved.
Only a radiographer or processor maintenance person should perform the corrective actions.
Action must be to correct problems whenever the limits are exceeded. A quality control program that
is not backed up by a commitment to shut down processors that ate outside limits is of little value.
Manufactures suggestion should be followed for the start-up and for the regular maintenance of the
processor.
There are also several monitoring tests that should be done on a daily basis. These include a darkroom
fog test, also known as a safelight test, and processor sensitometry to monitor speed, contrast and
base fog of film.
EXTERNAL BEAM EVALUATION:
The second part of performance monitoring involves the evaluation of the external primary radiation
beam. These tests must be performed by a radiographer who has knowledge of the physical operation
of the equipment and all related accessories. Corrective action should be taken only by an authorized
service person.
Some monitoring equipment can be made very inexpensively; other equipment must be purchased. A
dosimeter is an essential piece of equipment and reasonable quality control cannot be performed
without one. Computerized dosimeters are available that permit read-outs and print-outs of many
quality control parameters from single exposure. A room log should be kept to record test results,
maintenance, and repair s performed on each x-ray tube and other system in each room.