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QC & QA
Quality Control and Assurance
| Question | Answer |
|---|---|
| What are the divisions of a quality assurance program? | Quality Assurance Quality Control |
| Quality Assurance | Deals with People and activities that provide confidence that dept will render hgih quality services and images |
| Quality Control | Monitors technical equipment to maintain quality standards |
| Examples of QA | Interpretation of exam Maintenance of Equipment Performance of Procedure Filing Systems Staff Development Scheduling Examinations Supply Lines |
| Interpretation of exam | Ensures that interpretation of exam is accurate |
| How is the exam interpretation checked on? | Radiologist QA (Peer Review) Overreads Radiologist checking behind ER dr's |
| Maintenance of Equipment | Ensures that equipment is on a routine maintenance schedule and are maintained properly |
| Performance of procedure | Repeat/Reject Analysis |
| What does the permance of procedure in QA do? | Id's areas for improvement Id's specific procedures Id's specific causes |
| Filing systems | Ensures that films can be located & marked w/accurate info |
| Why is a filing system necessary? | Legal ramifications Using Correct markers Correct Patient Info |
| What is the info on the film that needs to be accurate? | Name SSN Patient ID # DOB Facility Name Date Reffering physician Markers |
| Staff Development | Arranging of inservices for staff on equipment operation |
| Why is staff develpment important? | Reduces Repeats Reduces Patient Exposure |
| What are some examples of things that could have inservices? | Restraints Immobilization IV sticks Dressing out for Contact Patients |
| Scheduling examinations | This ensures patients length of stay is kept to a minimum & that there is a proper sequence of exam - BE, US, IVP |
| Supply lines | Ensures adequate supplies so procedures can be performed |
| What principle doe QA operate on? | FOCUS-PDCA |
| FOCUS-PDCA | Find Organize Clarify Understand Select Plan Do Check Act |
| What 3 methods operate a QA program? | Identify Monitor Resolve |
| Identify | This is used to idenitify problem areas that may exist |
| What is in each dept to let staff know which problem has been identified and being monitored that month? | A QA calendar |
| What are some example of problems that could be identified? | Equipment Downtime No shows Improper prep for procedures IV sticks Patient Complaints |
| What an example of real problems today? | NPO for CT ab scans Full bladder for US pelvis # of No shows for MRI |
| Monitor | The problem has been ID - so this sets criteria threshold and monitors with random evaluations each month |
| How long should the monitor process go on? | At least two weeks |
| What is the best length of time for the monitor phase of QA? | The longer the better |
| Resolve | Try to isolate particular problems, certain floors, dr offices, and trends Establish new criteria to know what's required and set threshold limits |
| What is the best lenth of time to monitor? | Monthly w/periodic re-evaluated criteria and threshold limits |
| During the resolve process what happens | Info collected analyzing and evaluating data Take corrective action Re-evaluate to see if problem has improved |
| JCAHO | Joint Commission on Accreditation of Health Care Organizations |
| What is the largest accrediting agency for hospitals? | JCAHO |
| 1968 stated Quality Assurance in Radiology | Radiation Health and Safety Act |
| Mammo Quality Standards Act (1992) | Mammo Quality Standards Act |
| Who does the MQSA says that Mammo facilities must be approved by? | FDA - Food and Drug Administration |
| According to MQSA, why to Mammo facilities have to be approved by the FDA? | To receive Medicare funding |
| What does the MQSA state about technologists? | They must be certified in mammography specialty |
| Stated accrediting agency of SC | DHEC - Department of health and enviroment control |
| Branch of DHEC in SC that deals with radiological inspections and compliance issues | BRH - Bureau of Radiological Health |
| Regulations in Radiology under BRH that DHEC enforces | Title B |
| What two things does a QC program accomplish? | A system of checks to measure the consistency of beam output A method of controlling the radiographic image from start to finish |
| What 3 steps are in a QC program? | Routine evaluation Acceptance Testing Error Correction |
| What are the two areas of monitoring/evaluation | Film processing systems External beam evaluation |
| What is the goal of QC? | To stabilize the various equipment components of the radiographic imaging chain |
| What needs to be taken into consideration when purchasing equipment? | ID the equipment requirements Development of the specifications Selection of Equipment Installation and acceptance testing Continuing Education |
| How are the equipment requirements ID? | Radiologist Requirements Radiographer's Requirements |
| What might be included in the Radiologist's Requirements? | What type of procedures be performed? Is Digital or CR better? What type of Generator (Speed) is needed? What size tube? What size and type II? |
| What might be included in the Radiographer's Requirements? | How will the tube be located? Will a stretcher fit in the room? What type of generator (Technique) Will be 3 phase or single phase? (adequate penetration) |
| Who is needed for Development of Specifications in purchasing equipment? | An imaging physicist |
| What does an imaging physicist do with reguard to development of specifications? | Has the technical background to determine what is needed to meet state/fed requirements |
| What is the Ma linearity range? | +/- 10% and reproducible |
| What should be the # 1 reasons for choosing a certain vendor? | Service Support Upgrades Parts |
| Selection of Equipment | Should be easy if ID of requirements and development of specifications have been thoroughly accomplished |
| What can cause problems in selection of equipment? | Radiologist/Radiographer Vendor Preference Sales Rep Exerting Influence |
| Who must approve the Installation and acceptance testing of QC? | DHEC |
| Who is responsible for Installation and acceptance testing? | Vendor/Manufacturer |
| Who verifies that the specifications of installation and acceptance testting are met? | QC tech |
| What is the job of the physicist with installation and acceptance testing? | Verify specifications b4 patient radiographed Check behind vendor the ensure room compliance |
| What is the exposure that fluoro rooms should not exceed? | 10R/min |
| What is continuing education? | An application specialist will provide onsite training with examinations and demos to at least 2 radiographers that will primarily be using the equipment |
| Why is training as many techs as possible with continuing education important? | B/C the primary tech's could be sick or leave |
| Monitoring Equipment Performance is whose responsibility? | QC Technologist |
| What are the objectives of monitoing Equipment Performance? | Monitor the quality of film processing Meaure quality of external radiation beams Specify faults to allow for corrective action |
| There are 2 major areas for monitoring & evaluation. | Processor External Beam |
| Processor Monitoring involves what? | QC tech performs tests using a sensitometer (stepwedge), and densitometer. Processor Maintenance Person Daily tests |
| Device used to give precise, reproducible, and uniform exposures to photographic film | Sensitometer |
| The sensitometer determines if the what is operating within tolerance limits? | Processor |
| Device used to measure the OD of photographic film? | Densitometer |
| What does the densitometer check? | X-ray equipment |
| What does the processor maintenance person do? | Corrects processor problems |
| What type of daily tests should be done for processor monitoring? | Darkroom fog test (safelight), light leaks Sensitometry (Monitor: speed, contrast, & base fog) |
| Who is involved in External Beam Evaluation? | QC Tech - Tests Physicist - Interprets Service Personnel - Corrects |
| What are some of the test performed by QC techs for external beam evaluation? | Kvp Ma Time Cassette cleaning Film Screen Contact Reproducibility Linearity FS size HVL Output etc... |
| What should be used in moitoring equipment for external beam? | Dosimeter Room logs |
| What is kept is room logs? | Record Tests Maintenance Repairs |
| These tests should be done to ensure that x-ray equipment is calibrated properly | Kvp Timer mAs Reciprocity |
| What piece of equipment is used to perform tests on kvp, timer, mAs, and reciprocity for external beam? | Computerized dosimeter |
| What tests can be performed to test the x-ray tube? | Focal Spot Tests HVL Filtration Tests Collimator Distance and centering accuracy Angulator and protractor accuracy |
| How often are focal spot test done on x-ray tube? | Semi-Annually |
| line pair resolution tool | |
| used to check FS of .3 mm and smaller | star test patterns |
| used to check FS sizes larger than .3mm | pinhole camera or slit camera |
| Which focal spot size test is the most accurate | Pinhole camera/slit camera |
| A Pinhole/Slit Camera ensures what? | Proper detail |
| What happens when the FSS grows to an unacceptable size? | Tube must be replaced |
| What percentage of increase can a FS smaller than .8mm be and still be within tolerance limits? | 50% |
| What happens to the focal spot as it gets older? | Gets bigger |
| Can the FS ever get smaller as it gets older? | No |
| The thickness of an absorbing material that will reduce the x-ray beam to half of its original intensity | HVL - half value layer |
| As the tube gets older what happens to the HVL? | It increases |
| Why does the HVL increase as the tube gets older? | Due to gassing and pitting of the anode |
| And increase in the HVL requires what? | An increase in technique |
| Inherent filtration | 0.55 - 1.0 mm al/eq |
| Added Filtration | 1.0 mm al/eq |
| Where is the added filtration? | On the Collimator |
| Total Filtration | Min of 2.5 mm al/eq for tubes w/ output greater than 70kvp |
| What makes up total filtration? | inherent + added |
| What is the percentage of erro allowed for collimator, central ray, bucky tray accuracy, and PBL? | 2% |
| What is used to test the collimator? | Collimator test tool |
| What is used to test the central ray? | Beam alignment test tool |
| What is used to test the bucky tray? | Coin Test |
| What is the percentage of error allowed for distance accuracy? | 10% |
| An example of 10% distance accuracy? | 1/4" at 40" |
| What is the percentage of error allowed for centering accuracy? | 2% |
| What is the percentage of error allowed for angulator and protractor accuracy? | + or - 1% |
| What is the purposed of the angulator and protractor accuracy? | To verify that the degree of angulation is correct |
| Why does the degree of angulation need to be correct? | B/c of the primary beam and central ray |
| What is the RAD Check Quality Control device used to measure? | Timer accuracey for 3 phase Output intensity |
| What test can be performed on the generator? | Kvp accuracy Timer accuracy mR/mas & ma linearity exposure reproducibility |
| What is the percentage of kvp drift allowed iver time due to the tube aging | + or - 5% |
| How can kvp drift be tested? | Kvp test cassette |
| What are some kvp test cassettes? | Wisconsin Test Cassette Ardran-Crook Test Cassette |
| Are there other test besides kvp test cassettes available to test kvp drift? | Yes |
| Why are other test besides kvp test cassettes not used to test kvp drift? | They are time consuming |
| What is used to test kvp drift today? | Computerized dosimeter or kvp meter |
| What does a computerized dosimeter or kvp meter provide? | A digital readout/printout of the average kvp |
| What is an example of the + or - 5% kvp error tolerance? | At 70 kvp the tolerance would be + or - 3.5 (range from 66-74) |
| Why is consistant kvp very important? | It's the controlling factor of contrast |
| A computerized dosimeter is the best choice for testing what? | Timer Accuracy |
| Ma x s = | mAs |
| What affects the exposure? | Mas |
| Timer accuracy ensures what? | Image Quality |
| Used on single phase generator | Spinning top test |
| Used to check the accuracy of 3 phase generator | Synchronous top test |
| What is the error allowance for timer accuracy? | 5% of the setting |
| What can drift on the generator? | Ma stations |
| What is used to test the mR.mas and ma linearity? | Computerized dosimeters |
| What has to happen to generators sometimes to correct drifint ma stations? | Recalibration |
| What is the OVERALL accuracy of ma linearity? | 10% |
| What is the linearity accuracy b/t adjacent ma stations? | 5% |
| What cannot be predicted if Ma is not accurate? | Density |
| If Ma linearity is out of tolerance, what must occur? | Correction |
| When testing ma linearity the mAs stays the same, but what varies? | Ma and Time |
| Reproducing the same mas | Exposure reproducibility |
| When testing exposure reproducibility how many exposures must be done? | At least 5 at the same setting |
| Give an example of Exposure reproducibility | 5 exposures of 100 ma x .5 sec |
| Wht is the accuracy tolerance for exposure reproducibility? | 5% |
| What must generators be able to produce? | Consistent exposures accurately w/varying Ma & time |
| What is the exposure accuracy tolerance when it is checked at different times? | = or - 5% |
| What can be tested on fluorscopic systems? | Exposure Reproducibility Exposure Rate Field Size Accuracy and Beam Alignment Source to skin distance limit Intensifier Resolution Intensifier Contrst TV monitors and recorders Automatic Brightness Control |
| What is the purpose of exposure reproducibility with fluoro systems? | Verifies that the AEC is working properly |
| What is used to set kvp and make 5 identical exposures to test fluoro system exposure reproducibility? | Phantom (Clear pyrex block) |
| If the AEC is working properly what will the 5 exposures on a Phantom read for fluoro system exposure reproducibility? | The recorded optical density readings should be similar |
| What can the fluoro exposure rate not exceed? | 5R/min (5,000mrem) |
| What is the maximum output that the fluoro unit cannot exceed overall? | 10R |
| What is used to test exposure rate of fluoro? | A phantom and an apron doubled over |
| What ensures that tissue outside the image receptor area cannot be irradiated? | Field Size Accuracy and beam alignment |
| The image should be within 1 cm of what? | Edges of the II tube |
| What is the source to skin distance for fluoro? | 15" Fixed 12" Mobile |
| What checks to see if the resolution is poor? | Intensifier resolution |
| What is used to check for intensifier resolution? | Fluoroscopic resolution test tool Fluoroscopic mesh test |
| What in the mesh test or Intensifier resolution measured in? | Lp/mm |
| What evaluates low contrast in a fluoroscopic image? | Intensifier Contrast |
| What is used to test Intensifier Contrast | Low Contrast Test Tool |
| Normally contrast in fluoro is what? | Very high |
| What is used to test fluoro TV monitors and recorders? | Fluoro resolution test tool |
| What is the fluor resolution test tool measured in? | Lp/mm |
| Conditions that are caused by problems with resolution on the monitor | Vignetting Distortion Veil Glare Quantum mottle |
| Automatic Brightness Control | ABC |
| How does ABC function? | Like AEC |
| ABC compensates for variations in subject density allowing for what? | Uniform Image Density |
| Example of ABC working properly? | 10cm phantom 5cm phantom 5 cm exposure is half that of the 10cm |
| What needs to be tested for tomographic systems? | Tube motion and Uniformity Selection Depth indicator accuracy Section thickness Accuracy Resolution |
| Tomo systems need what? | Uniformity and Completeness of the tube motion |
| What does erratic tube motion cause? | Uneven densities in the image |
| What test uniformity and completeness of the tube motion? | Tomographic test tool |
| What ensures that the fulcrum level indicated is in sharp focus? | Selection depth indicator accuracy |
| Example of selection depth indicator accuracy | 5cm is cut selected - this area is the sharpest/clearest |
| What is used to test the section thickness accuracy of tomos? | tomographic test tool or angled wire mesh |
| What is used to test tomo resolution? | Resolution test pattern - Tomographic test tool |
| What ensures that the SEC gives consistent densities on the film regardless of patient size and subject density? | Exposure Reproducibility |
| Ensures that all Ion-chambers are operating uniformly | Ion Chamber Sensitivity |
| How is Ion Chamber Sensitivity tested? | Use a Phantom process the film Densitometer to record OD Compare readings |
| Ensures that the AEC minimum response time is not greater than specified | Response Capability |
| What does response capability verify? | Short exposure times can be made |
| What is the tolerance of response capability? | 10% |
| Verifies that the back up timer is working properly? | Back-up timer verification |
| How is a check of the back up timer performed? | Set back up timer to 1 sec Make an exposure with a thick phantom Audible alarm should go off w/in 1 sec |
| What should be checked for alighnment and uniformity and grid lines? | Grids |
| What is used to check grids? | Grid alignment test tool |
| When should cassette cleaning/inspections be performed? | 3-6 months |
| What are cassette screens checked for? | Artifacts |
| What type of screen cleaner should be used on screens? | Manufacturers recommended screen cleaner |
| Used to show artifacts | Film screen contact |
| What test is used for film screen contact? | Wire mesh test |
| How do artifacts appear on a wire mesh test? | A black area or dark circle that is blurry |
| This test checks the number of candela or lumens in each view box? | View box uniformity |
| With the view box uniformity what should the brightness not do? | Vary |
| View box uniformity must have a minimum of what? | 2,500 nit (candela) |
| Obtain data Save all repeats Conducted for at least a week | Repeat film studies |
Created by:
rcclaussen