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Quality Assurance in Diagnostic Radiology AAPM REPORT NO. 74 QUALITY CONTROL IN DIAGNOSTIC RADIOLOGY Report of Task Group #12 Diagnostic X-ray Imaging Committee Members S. Jeff Shepard, Chairman Pei-Jan Paul Lin, Co-Chairman John M. Boone Dianna D. Cody Jane R. Fisher G. Donald Frey Hy Glasser* Joel E. Gray Arthur G. Haus Lance V. Hefner Richard L. Holmes, Jr. Robert J. Kobistek Frank N. Ranallo Philip L. Rauch Raymond P. Rossi* J. Anthony Seibert Keith J. Strauss Orhan H. Suleiman Joel R. Schenck Stephen K. Thompson July 2002 Published for the American Association of Physicists in Medicine by Medical Physics Publishing *Deceased DISCLAIMER: This publication is based on sources and information believed to be reliable, but the AAPM and the editors disclaim any warranty or liability based on or relating to the contents of this publication. The AAPM does not endorse any products, manufacturers, or suppliers. Nothing in this publication should be interpreted as implying such endorsement. Further copies of this report ($15 prepaid) may be obtained from: Medical Physics Publishing 4513 Vernon Blvd. Madison, WI 53705-4964 Telephone: 1-800-442-5778 or 608-262-4021 Fax: 608-265-2121 Email: [email protected] Web site: www.medicalphysics.org International Standard Book Number: 1-888340-33-9 International Standard Serial Number: 0271-7344 © 2002 by American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3843 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photo- copying, recording, or otherwise) without the prior written permission of the publisher. Published by Medical Physics Publishing 4513 Vernon Blvd., Madison, WI 53705-4964 Printed in the United States of America This report is dedicated to the memory of Raymond P. Rossi Mentor, Colleague, Friend The task group also wishes to honor Hy Glasser A leader in the field of QC instrumentation development and marketing iii TABLE OF CONTENTS INTRODUCTION ...............................................................................................1 1 THE QUALITY CONTROL PROCESS ......................................................2 1.1 Equipment Selection...........................................................................2 1.2 Acceptance Testing.............................................................................3 1.3 Quality Control...................................................................................3 1.4 Documentation....................................................................................5 1.5 Staffing Considerations ......................................................................5 2 QC INSTRUMENTATION...........................................................................5 3 THE PHYSICS REPORT .............................................................................6 3.1 The Environment of the Report ..........................................................6 3.2 Report Structure..................................................................................7 3.2.1 Recommendations .................................................................7 3.3 Description of Tests and Data.............................................................9 3.4 Special Cases ....................................................................................10 3.5 Notes on Medical Physics Communication in the Academic Environment ......................................................................................10 3.6 Conclusions ......................................................................................11 4 REPEAT RATE ANALYSIS.......................................................................11 5QUALITY CONTROL OF RADIOGRAPHIC UNITS .............................13 5.1 Daily Visual Checks..........................................................................13 5.2 X-ray Tubes and Collimators............................................................13 5.2.1 Beam Quality.......................................................................13 5.2.2 Light Field/X-ray Field Alignment (Congruence)...............13 5.2.3 X–Y Scale (Field Size Indicator) Accuracy ........................13 5.2.4 Positive Beam Limitation System (PBL) ............................14 5.2.5 X-ray Beam–Bucky Alignment ...........................................14 5.2.6 Focal Spot Size ....................................................................14 5.3 X-ray Generators ..............................................................................15 5.3.1 Kilovoltage Calibration .......................................................15 5.3.2 Exposure Timer ...................................................................16 5.3.3 Beam Quality (mR/mAs).....................................................17 5.3.4 Automatic Exposure Control (AEC) ...................................17 5.4 Grids .................................................................................................18 5.4.1 Artifacts ...............................................................................18 5.4.2 X-ray Beam - Grid Alignment and Timing..........................19 5.5 Electrical Safety................................................................................19 6QUALITY CONTROL OF FILM-SCREEN MAMMOGRAPHIC SYSTEMS ..................................................................................................19 v 7QUALITY CONTROL OF CONVENTIONAL TOMOGRAPHY UNITS............................................................................19 7.1 Motion ..............................................................................................20 7.2 Tomographic Exposure Angle Accuracy ..........................................20 7.3 System Spatial Resolution................................................................20 7.4 Accuracy of Cut Level......................................................................20 7.5 Section Thickness .............................................................................20 8QUALITY CONTROL OF PORTABLE X-RAY SYSTEMS....................21 8.1 High-Frequency Systems..................................................................21 8.1.1 X-ray Tube and Generator ...................................................21 8.1.2 Radiation Output During Extended Use..............................21 8.2 Capacitive Discharge Systems..........................................................21 8.2.1 kV Calibration .....................................................................21 8.2.2 Leagage Radiation ...............................................................22 8.2.3 Beam Quantity.....................................................................22 8.3 Additional Tests................................................................................22 9QUALITY CONTROL OF FLUOROSCOPIC EQUIPMENT ..................22 9.1 Daily .................................................................................................22 9.2 Monthly or More Frequently If Indicated.........................................23 9.3 Fluoroscopic Mode: Tested Annually or More Frequently If Indicated ......................................................................23 9.3.1 Typical Exposure Rates .......................................................23 9.3.2 Maximum Exposure Rates ..................................................24 9.3.3 Image Quality ......................................................................25 9.4 Radiographic Mode: Tested Annually or More Frequently If Indicated ......................................................................25 9.4.1 Kilovoltage Calibration .......................................................25 9.4.2 Radiation Quality (HVL).....................................................26 9.4.3 X-ray Anti-scatter Grid........................................................26 9.4.4 Collimation..........................................................................26 9.4.5 Image Intensifier Input Exposure Rate (IIIER) ...................27 9.5 Acceptance Testing...........................................................................28 10 QUALITY CONTROL FOR DIGITAL SUBTRACTION ANGIOGRAPHY (DSA) SYSTEMS.........................................................28 10.1 Daily .................................................................................................28 10.2 Annually or More Frequently If Indicated .......................................28 10.2.1 Fluoroscopic System Evaluation .........................................28 10.2.2 Radiographic System Evaluation.........................................28 10.2.3 Spatial Resolution................................................................29 10.2.4 Contrast Resolution .............................................................29 10.2.5 Detector Sensitivity .............................................................30 10.3 At Acceptance and As Needed..........................................................30 vi 11 QUALITY CONTROL OF CINERADIOGRAPHY SYSTEMS..............31 11.1 Daily .................................................................................................31 11.1.1 System Status Check ...........................................................31 11.1.2 Processor..............................................................................32 11.2 Weekly ..............................................................................................32 11.3 Semiannually
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