Quality Control Consolidation session copy.pptx

Quality Control Consolidation session Prepared By: Sarah Abousrafa Reading materials  Radiation safety codes (2023)  Quality Quality assurance control QA QC (T...

Quality Control Consolidation session Prepared By: Sarah Abousrafa Reading materials  Radiation safety codes (2023)  Quality Quality assurance control QA QC (The big brother) (The younger brother) Definition Definition All-encompassing Is part of the QA that deals management program used with techniques used in to ensure excellence in monitoring and maintaining health care through the the technical elements of the systematic collection and systems that affect the evaluation of data. quality of the image. So it is the part of QA that deals with the instrumentation and equipment. Papp (2015) QA QC Quality assurance (QA) Quality control objectives (QC) objectives  Enhance patient care  Deal with technical factors  management techniques that contribute to image  departmental policies quality  technical effectiveness  Monitoring and and efficiency maintaining the technical  in-service education elements of the system  Image interpretation and  Instrumentation and timely report availability equipment Papp (2015) Acceptance testing Acceptance testing in medical imaging is a critical quality assurance process that ensures new or upgraded imaging equipment meets specified performance standards and regulatory requirements before being put into clinical use. This type of testing is conducted by medical physicists or other qualified professionals 1. Verification of Specifications: Ensuring the 4. Regulatory Compliance: Ensuring the equipment equipment meets the manufacturer’s performance complies with relevant regulatory standards and specifications, such as image quality, resolution, guidelines set by local and/or international bodies and contrast. 5. Baseline data collection: Baseline Data Collection: 2. Safety Checks: Confirming the equipment operates Establishing baseline performance data for future safely for both patients and operators, including reference and ongoing quality control. radiation dose levels for radiological devices. 3. Functional Testing: Assessing the operational aspects of the equipment, such as calibration, user interface functionality, and overall system integration. Acceptance testing is crucial for guaranteeing the reliability, safety, and accuracy of medical imaging equipment, ultimately ensuring high-quality patient care. Questio n Several professionals and bodies Whos’ job is include it ?  Radiology technologist/Radiographer  Medical Physicist Answer  Biomedical engineer The quality control of radiographic  Engineers assigned by the vendors equipment such as X-ray, CT, MRI, and mammography involves several  Official regulatory bodies (both national professionals, each playing a crucial role in and international) ensuring the safety, accuracy, and efficiency of the imaging devices. Levels of testing Level I (Non-invasive and Level II (Non-invasive and Level III (Invasive and simple) Complex) Complex) Can be performed by a Can be performed by Includes the technologist any technologist disassembly of specifically trained in Quality Control equipment and is procedures and special performed by tools Engineers and Physicists This consolidation session will cover some of the routine tests performed by the technologist Papp (2015) Quality control testing (Medical physicists & engineers) Biomedical engineer 1. Overseeing the proper installation of radiology equipment. 2. Ensuring the initial calibration of machines to manufacturer specifications and clinical requirements. 3. Conducting regular preventive maintenance (PPM) to ensure equipment reliability. 4. troubleshooting technical issues 5. Software and hardware upgrades 6. Documentation and compliance with local and/or international regulations Medical Physicist 1. Performing acceptance testing on new or upgraded equipment to verify it meets required specifications. 2. Conducting phantom tests to evaluate image quality parameters like contrast, resolution, and noise. Preventive maintenance (PPM) Definition : Preventive maintenance in radiology involves regular, scheduled servicing and inspection of radiological equipment to ensure optimal performance, safety, and longevity. “General Preventive Maintenance—Preventive maintenance of the X-ray equipment and accessories is necessary to prolong the life of the equipment. An annual inspection must be conducted for structural integrity, cleanliness, ease of movement of all components and any other procedures recommended by the manufacturers”. (SC 35) Each Modality has a recommended frequency for performing PPM. Follow the regulations set by the department and institution Quality control testing (Technologist) Radiologic Technologists/Radiographers: Roles & Responsibilities:  Operate the imaging equipment and ensure that it is functioning correctly on a day-to-day basis.  Perform routine checks, calibrate equipment, maintain proper records, and ensure images are of high diagnostic quality. We will see examples of QC tests done by Radiology technologists BMD CT MAMMOGRAPHY Daily QC tests (X-ray equipment) (SC 35) By the radiology technologist Various X-ray equipment Recommended procedures to be conducted daily Daily QC tests (Mammographic equipment) Daily quality control tests must be performed at the beginning of each day that mammography is conducted before commencing patient examinations and processing any patient images. SC 36 Daily QC tests (X-ray equipment) Daily Quality Control Tests “Daily Quality Control tests must be performed at the beginning of each day before commencing patient examinations.” SC 35, 36 Equipment Warm-up The manufacturer’s recommended warm up procedure must be followed. The warm-up procedure must be repeated if the equipment is left idle for an extended period of time, including computer display devices and printers. Performed in DR, Radioscopic, and CT systems, mammography Meters Operation Meters, visual and audible indicators should be checked for proper function. Performed in DR, Radioscopic, and CT systems, mammography Equipment Conditions Visually inspect all components of the imaging components. Inspect for loose or broken components and cleanliness. Check the X-ray source assembly for motion or vibration during operation. Performed in DR, Radioscopic, and CT systems, mammography Daily QC tests System movement System movement should be checked for proper function. For systems where the X-ray source is below the table, verify the performance of the power assist and locks by moving the tower in all directions. For systems where the X-ray source is above the table, verify the motion of the X-ray tube assembly. Performed in DR, and radioscopic systems Overall visual assessment of electronic display devices The performance of electronic display devices used for interpretation of clinical images must be assessed. Displaying the image of a test pattern, an assessment must be made of the general image quality and for the presence of artifacts. The SMPTE or the TG18-QC test patterns can be used Performed in DR, Radioscopic, CT systems, and mammography NOTE : Different guidelines worldwide provide different recommendations on the frequency of testing and acceptable limits of variation. Always adhere to the local guidelines and regulations proposed by your institution Acceptable limits “Acceptable limits” refer to the defined range of values within which radiological imaging parameters must fall to ensure that the equipment is functioning correctly and producing high-quality images. These limits are established based on regulatory standards, guidelines, and best practices to ensure patient safety, diagnostic accuracy, and the consistency of imaging results. What is variation ? Variation refers to anything that would cause a process to deviate from acceptable limits/standards. Papp (2015) Examples of acceptable limits of variation in X-ray equipment Safety code 35 1. CT Number Accuracy Using a uniform water phantom, the mean CT number of water and the standard deviation, must remain within the established baseline and acceptable limits of variation. The CT number for water must be in the range of 0 ± 4HU. 2. Accuracy of Loading Factors (For digital X-Ray) The loading factors must not deviate from the selected factors by more than 10% X-ray tube voltage (10% + 1 ms) for loading time 20% X-ray tube current (10% + 0.2 mAs) current-time product 3. Focal Spot-to-Skin Distance (Fluoroscopic equipment) The equipment must be equipped with a device that limits the focal spot to skin distance it must not be less than 30 cm for mobile equipment 38 cm for stationary equipment 4. Others Examples of common equipment used in QC and QA tests 1- Checklist 2- Phantom (If advised by the manufacturer) 3- Test Pattern Image e.g., SMPTE or TG18-QC Checklist Test name  Frequency 1- CT Checklist (Monthly) Frequency (daily)  Tools and instructions Abbreviations Initials Acceptable limits Notes and instructions (Computed Tomography Radiologist’s Section Radiologic Technologist’s Section Qualified Medical Physicist’s Section QUALITY CONTROL MANUAL, 2017) Example of weekly CT QA record sheet advised by Siemens for the Siemens Somatom in UDST lab SOMATOM Go.Now – Made to Match (n.d.) 2- Mammography Checklist Date and time Performer initials Tools Frequency Notes and instructions Technologist Quality Control Forms - Mammography (n.d.). Downloaded from ACR accreditation, mammography, technologist QC form 2- MRI Checklist Visual checklist Frequency Technologist Quality Control Forms – Magnetic Resonance Imaging (n.d.). Downloaded from ACR accreditation, MRI, technologist QC form Example of a daily MRI QA record sheet Coil Signal to frequency Noise Ratio Why do we need QC/QA Checklist ? 1- Consistency 2- Documentation 3- Compliance 4- Accreditation  2- Phantoms Park et al. (2023) DEXA Accuracy and Calibration | Amnuaywattakorn et al. (2016) Sydney Lou Bonnick and Lori Ann Lewis BodySpec (n.d.) (2013) ACR Digital BMD Hologic spine BMD Hologic spine Mammography phantom BMD QA Block (GE) phantom phantom GE Lunar Aluminum Spine Phantom (2023) Aluminum spine phantom (GE) Helios QA Phantom 5215028, Computed Tomography (CT) | GE HealthCare Service Shop USA (n.d.) Kim et al. (2020) Helios QA Siemens MRI 3- Test pattern image (SMPTE/TG18-QC) SMPTE (Society of Motion Picture and Television Engineers) and TG 18 (Task Group 18) are both standards and guidelines used in the context of imaging and display systems, but they serve different purposes and are used in different domains. In simple language these tests are used to evaluate the quality of our monitors (Shiao et al., 2007) Soh et al. (2013) SMPTE TG18-QC  Video (Olympic Health Physics (2022) https://www.youtube.com/watch?v=CXT8k6nWD4I Bone Mineral densitometry (BMD)/ Dual Energy X-Ray Absorptiometry (DEXA) BMD (Bone Mineral Densitometry) Daily QA on a GE Lunar Equipment required 1- Quality assurance block or spine phantom 2- Software 3- Scanner Lunar Idxa for Bone and Metabolic Health (n.d.)  Video, Frontliner Lpdurian (2022) https://www.youtube.com/watch?v=a-YOaaaul3k Areas checked Startup Calibration Database validation BMD high Results Scanner self-test BMD medium Status QA-Block search BMD low Peaking Tissue lean Mechanical Tissue normal Beam stop Tissue Fat Transverse distance Trend analysis Longitudinal distance Phantom X-Ray/Detector BMD Spectrum BMC Proceed with Check what might Reference counts Area scanning have gone wrong, Detector status Edge detection patients if it persists do NOT scan patients and inform the supervisor or call the service engineer  This report is a result of an automated QA procedure. Phantom values are plotted over time Prompts messages of pass or fail Mammography SC 35 Quality control testing of a mammography system includes several major steps. The verification of x-ray the system mechanical integrity and stability, including safety mechanisms, automatic patient release, power drives and interlocks The verification of the performance of ancillary equipment such as imaging processors and display units the verification of x-ray performance; the verification of imaging or diagnostic performance, including assessment of dose. Repeat analysis Repeat/Reject analysis SC 35 Repeat analysis is a QC measure used to identify and assess and trends and correct errors  Repeat images are defined as images taken due to inadequate quality  It does not include images taken for quality control purposes and additional views  Facilities must maintain records for every repeat with reason for repeat and corrective actions  The repeat rate must less than 5 percent  Video, Integrity Medical Systems, Inc (2017) https://www.youtube.com/watch? v=eM7xKm0Ow0A&t=129s Computed Tomography (CT) Example of CT QC Test date Readings from the Body phantom Readings from the Head phantom HU values of water Introduction to Safety Codes “Safety codes are a series of documents prepared by Health Canada that provide radiation protection information. They help promote consistent radiation protection practices to support the safe installation and use of radiation emitting devices in Canada” Radiation safety codes (2023)  Medical X-ray Radiation safety codes (2023) Safety Code 35: Safety Procedures for the Installation, Use and Control of X-ray Equipment in Large Medical Radiological Facilities This Safety Code is composed of three sections: Section A: Responsibilities and Protection Section B: Facility and Equipment Requirements Section C: Quality Assurance Program Page 38 Safety Code 36: Safety Procedures for the Installation, Use and Control of Mammographic X-ray This Safety Code is composed of three sections: Section A: Responsibilities and Protection Section B: Facility and Equipment Requirements Section C: Quality Assurance Program Page 42 Regulatory bodies 1. Nuclear Regulatory Commission (NRC) Federal agency that enforces radiation safety guidelines. “to ensure the safe use of radioactive materials for beneficial civilian purposes while protecting people and the environment” Nuclear Regulatory Commission (2022) 2. Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Administration (OSHA) Federal agency that oversees the workplace environment. OSHA (2019) 3. Ministry of environment and climate change (MECC) MECC Offcial Website (2023) Monitor the circulation of chemical and radioactive materials, manage radioactive waste, and follow up on the proper uses of nuclear energy. QC terminologies 1. Acceptance testing 2. Quality assurance 3. Quality control 4. Acceptance testing  Q1 Which levels of quality control testing can usually be performed by a quality assurance/quality management technologist: level I, level II, or level III? a. I and II b. I and III c. II and III d. I, II, and III  Q2 What is an anthropometric phantom ?  Q3 Name 2 recommended daily tests according to the SC 35 ?  Q4 According to SC 35 what is the accepted range of the deviation in the value of CT number in the CT number accuracy test ?  Q5 What does OSHA stand for ?  Q6 When is acceptance testing done ?  Q7 Which organ does this phantom mimic ? References Radiation safety codes. www.canada.ca. 2023. Available from: https://www.canada.ca/en/health-canada/services/health-risks-safety/radiation/radiation-emitting-devices/safety-codes.html Shiao, Y.-H., Chen, T.-J., Chuang, K.-S., Lin, C.-H., & Chuang, C.-C. (2007). Quality of Compressed Medical Images. Journal of Digital Imaging, 20(2). https://doi.org/10.1007/s10278-007-9013-z Park, S. S., Ku, Y. M., Seo, K. J., Whang, I. Y., Hwang, Y. S., Kim, M. J., & Jung, N. Y. (2023). Devising a deep neural network based mammography phantom image filtering algorithm using images obtained under mAs and kVp control. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-30780-z Lunar Idxa for Bone and Metabolic Health. (n.d.). Www.gehealthcare.com. https://www.gehealthcare.com/products/bone-and-metabolic-health/lunar-idxa Technologist Quality Control Forms - Mammography. (n.d.). Www.acraccreditation.org. https://www.acraccreditation.org/modalities/mammography/tech-qc-forms Amnuaywattakorn, S., Sritara, C., Utamakul, C., Chamroonrat, W., Kositwattanarerk, A., Thamnirat, K., & Ongphiphadhanakul, B. (2016). Simulated increased soft tissue thickness artefactually decreases trabecular bone score: a phantom study. BMC Musculoskeletal Disorders, 17(1). https://doi.org/10.1186/s12891-016-0886-1 Sydney Lou Bonnick, & Lori Ann Lewis. (2013). Bone Densitometry for Technologists. In Springer eBooks. Springer Nature. https://doi.org/10.1007/978-1-4614-3625-6 Helios QA Phantom 5215028, Computed Tomography (CT) | GE HealthCare Service Shop USA. (n.d.). Services.gehealthcare.com. Retrieved May 23, 2024, from https://services.gehealthcare.com/gehcstorefront/p/5215028 GE Lunar Aluminum Spine Phantom. (2023, June 5). Radiology OneSource, Inc. https://radiologyonesource.com/shop/replacement-parts-and-components/phantom/ge-lunar-aluminum-spine-phantom/ Soh, B. P., Lee, W., Diffey, J. L., McEntee, M. F., Kench, P. L., Reed, W. M., & Brennan, P. C. (2013). Breast Screen New South Wales Generally Demonstrates Good Radiologic Viewing Conditions. Journal of Digital Imaging, 26(4), 759–767. https://doi.org/10.1007/s10278-013-9571-1 Kim, T., Gu, B., Borna Maraghechi, Green, O., Lewis, B., Sasa Mutic, & H Michael Gach. (2020). Characterizing MR Imaging isocenter variation in MRgRT. Biomedical Physics & Engineering Express, 6(3), 035009–035009. https://doi.org/10.1088/2057-1976/ab7bc6 SOMATOM go.Now – Made to match. (n.d.). Www.siemens-Healthineers.com. Retrieved June 1, 2024, from https://www.siemens-healthineers.com/computed-tomography/single-source-ct-scanner/somatom-go-now Nuclear Regulatory Commission. (2022, January 25). NRC: About NRC. Www.nrc.gov. https://www.nrc.gov/about-nrc.html Olympic Health Physics. (2022, September 19). How to Evaluate a SMPTE Pattern. YouTube. https://www.youtube.com/watch?v=CXT8k6nWD4I Integrity Medical Systems, Inc. (2017, February 27). GE Senographe Essential Digital Mammography. YouTube. https://www.youtube.com/watch?v=eM7xKm0Ow0A&t=129s