Radiation quality assurance manual

The best way to do this is to leave an unopened box of film on a shelf at room temperature for at least 8 hours. Once the container seal has been broken the film should not be refrozen. When it is time to use new control film with a different emulsion batch number you will need to run five old and five new control film through the processor on the same day.

The films should be marked to distinguish the new films from the old. The new and old films should be alternately run through the processor. Plot the old film on the charts and add the new values on the same chart so that they run simultaneously. Average the five differences between the old and new film values for the new control film. Add and subtract by the limits to determine the upper and lower limits and mark on the control chart.

Indicate on the chart the date of the change to the new control film. Adjust control limits up or down according to the average difference. The most common cause of poor processor performance is failure to maintain the proper processing temperature. Should problems occur anyway, checking the temperature as a first step will often be all that is needed to locate the cause of the difficulty. An accurate thermometer is needed for this purpose. In general, any glass stemmed thermometer should be avoided because, even if filled with a material such as alcohol, removal of all the glass and liquid after the stem is broken will be difficult and possibly expensive.

Mercury thermometers present a particular hazard because mercury is a contaminant even at a few parts per million. It is virtually impossible to remove all traces of mercury from a developing tank or a darkroom when a mercury thermometer breaks. A digital thermometer is recommended, although a dial type with a 6 or 8 inch probe is an acceptable alternative. Commercially available digital thermometers provide superior accuracy and are relatively inexpensive.

If a dial thermometer is used, the total range of dial readings should be as small as possible while covering the recommended processor operation range. Your readings should always be taken at the same location, one that has been chosen for reproducibility. Such locations must be found by trial and error through taking repeated readings at a number of points after the processor has stabilized. Use the locations with the most reproducible values for future monitoring. Another precaution to follow is to always wipe the thermometer dry immediately after removing it from the developer or fixer tank.

The thermometer should then be rinsed in running water before future use. This procedure will prevent the inadvertent transfer of fixer into developer.

Once a year, or, after changing the battery, you need to check the sensitometer for consistency. Expose five control films and run through the processor. Read the first, last and middle steps for each of 10 strips. If after changing the battery, a change is noted greater than this level, you should modify the control limits if the numbers are not in agreement. Your densitometer should be calibrated when it leaves the manufacturer.

However, the manufacturer should also supply you with a calibrated step tablet covering a density range of 3. Upon receiving your densitometer, carefully follow the manufacturer's instructions for using this tablet to verify that the densitometer is still calibrated over the range specified.

When reading any step tablet, the density should be measured in the center of the step. If any of the steps are out of calibration, you should ask the supplier to correct the defect. The calibration of your densitometer should also be checked daily during use to guarantee that it is not creating additional variability in your data. Again the calibrated wedge supplied by the manufacturer should be used for this.

Some facilities prefer not to use the manufacturer's wedge for these checks in order to minimize the chances of damage or loss. As an alternative, they construct secondary standards using the procedure described on pages of reference However, if reasonable care is taken in the use and storage of the manufacturer's step wedge, production of a secondary standard should not be necessary. Make sure that your processor is set at the film manufacturer's optimum conditions for the filmdeveloper combination that you are using.

If the manufacturer does not supply recommended processing conditions for your film developer combination, you will need to optimize processing conditions yourself. It is generally most desirable from a quality assurance standpoint to use the chemistry recommended by the manufacturer of your film or at least a chemistry for which the manufacturer can provide recommended processing conditions. In such a case your only concern is to make sure the processor is operating as close as possible to the temperature and speed recommended by the manufacturer.

However, you may be using a chemistry for which the manufacturer of your film cannot provide recommended processing conditions. In such a case you should seriously consider going through the process of optimizing your processor as described in Sections 4. Add 0. Subtract 0. The same process is used to determine the upper and lower limits for the contrast step.

An example is as follows: the value for the speed step is determined to be 1. To determine the upper control limit for the speed step, 1. To determine the lower control limit, 1. Occasional use processors would add 0. To stabilize the processing of films.

The processor is the piece of equipment in your facility that is most susceptible to variation. The quality of its performance can fluctuate greatly from day to day and even during a single day. Because of this variability, the frequency of quality assurance actions directed at the processor must be higher than for other equipment if they are to be effective. The control strip should be exposed before any patient film is run in the morning but after the processor is fully operational.

This will determine if the chemistry was contaminated or degraded during the previous day before the new day's workload begins. This will also avoid the possibility that any film processed just prior to the control strip will have upset the chemical equilibrium. It is also recommended that the strips be processed approximately 1 hour after the machine has been brought up to temperature, if there is this much time before the patient work begins, to guarantee temperature stability has been achieved.

By-products of development, especially bromide ions, diffuse out of the film and can retard development particularly if processor agitation is suboptimal. These products will flow over the film affecting the trailing portions of the film. The less exposed end of the strip is fed into the processor first to minimize this effect. Processors exhibit differences in agitation and temperature from one side of the development tank to the other.

Film should always be processed in one location to minimize this problem. In summary the most important thing is that the strips be exposed and processed in the same way each time.

This will lessen the chance that variability in the data will result from causes other than variability in the performance of the processor itself. Processing solutions should be mixed according to the directions on the labels.

Mixing vessels should be made of stainless steel, enamelware, glass, hard rubber, plastic or glazed earthen ware. Aluminum, galvanized iron, tin, copper and zinc will contaminate solutions. Agitators, made of hard rubber, stainless steel, or other material that does not absorb or react with processing solutions are recommended.

Separate agitators should be used for the developer and fixer. Manufacturer's provide chemistry as multi-part liquid concentrates or as a single solution package.

It is imperative that the manufacturer's instructions be followed in the preparation of processing solutions. Your technical sales representative is your best information resource when seeking information about processing especially when different manufacturers products are being combined to complete a system. Processing is the factor that is most susceptible to variation.

Because of this variability, the quality assurance actions directed to processing must be higher than that for other equipment. In summary, the most important thing is that the strips be processed the same way every time. This will lessen the variability in the data. To assure that the safelights and other potential sources of "unsafe" light will not fog the film being handled in the darkroom.

Some day to day fluctuations in control values are to be expected. When these fluctuations exceed the control limits you should make sure that they are real and not just the result of an error.

Repeat the monitoring procedures before taking corrective action. If the limits are still exceeded, immediate corrective action is required. Corrective action is also necessary when a trend indicates a degradation of the system. Below are some common problems and likely causes. Increased Density Difference Contrast - High developer temperature; excessive replenishment rate; improperly mixed developer. Decreased Density Difference Contrast - Low developer temperature; depleted, contaminated or improperly mixed developer; lack of starter in fresh developer; reduced replenishment; depleted fixer; safelights; film storage or handling.

Increased Medium Density Speed - High developer temperature; lack of starter in fresh developer; contaminated, depleted or improperly mixed developer; incorrect replenishment. Decreased Medium Density Speed - Low developer temperature; reduced replenishment; weak developer; improperly mixed developer. Wet or damp films - Depleted fixer; developer either depleted, contaminated or diluted or the temperature too low; loss of circulation.

Dirty films - Water problems; dirty roller; developer problems; loss of circulation; misaligned guideshoes; film handling problems. Scratches - Dirty rollers; misaligned guideshoes; depleted or diluted developer; fixer depleted; dryer problems.

To determine the width of the field at the cassette in the bucky tray, complete the following formula:. The result of this calculation will be the width of the x-ray field in the bucky tray.

The result of this calculation will be the length of the x-ray field in the bucky tray. The maximum misalignment can be calculated using the SID and the values identified under limits at the beginning of the previous page. These numbers can be compared with the calculations made in determining the length and width of the field in the bucky tray. Compare the result to the acceptance limit previously identified. At a 40" SID, the maximum acceptable misalignment would be 0.

To provide a method for the analysis of the rejected radiographs. The results of such an analysis will provide information concerning those aspects of radiologic imaging that need the most attention. If you plan to initiate a quality control program then you should carry out an analysis of your rejects before starting the QC program so you will have an idea of the impact of your efforts. The facility shall include the following information in its Policy and Procedures Manual item for those situations where patient holding may be necessary:.

The facility must use the requirements contained in Section Specific area gonad shielding covers an area slightly larger than the region of the gonads. It may therefore be used without interfering with the objectives of the examination to protect the germinal tissue of patients from radiation exposure that may cause genetic mutations during many medical x-ray procedures in which the gonads lie within or are in close proximity to the x-ray field.

Such shielding should be provided when the following conditions exist:. The facility shall include the following information in its Policy and Procedures manual when a patient has films taken to evaluate scoliosis:. The facility shall include the following information in its Policy and Procedures manual item regarding pregnant and potentially pregnant patients:.

The facility using personnel monitoring shall include the following information in its Policy and Procedures manual:. Navigation menu. Control Limits and Standards The control limits and standards used in this guide have been taken from the Federal Performance Standard for Diagnostic X-ray Equipment, Part 16, and other references listed in the bibliography.

Records Manual Each facility will establish a manual that includes the following items: a list of the tests to be performed and the frequency of performance; the acceptability limits for each test; a brief description of the procedures to be used for each test see Appendix C ; a list of the equipment to be used for testing; and sample forms to be used for each test.

Equipment Records Records shall be maintained for each x-ray tube and include: the initial test results acceptance testing and radiation safety survey as appropriate ; the current year; one set of test results from each intervening year to show changes over time. G The facility shall have available the radiation output measurements for common x-ray examinations they perform for patient and staff information for each x-ray unit.

Processor and Sensitometer Logs App. B and H Control charts of sensitometry shall be maintained and used to regulate processing. Radiation Safety Policies and Procedures App. F The written policy and procedures must be available for the holding of patients, use of gonad shielding, pregnant patients and operators and repeat, reject analysis. Equipment Monitoring Each facility shall make or have made the following tests, at the frequency specified, and maintain records of the data.

A chart of tests and frequencies can be found in Appendix A. Test frequency - Each day of operation Equipment functioning: Each day during the x-ray generator warm-up, and before x-raying the first patient, check for indicator dial malfunction and the mechanical and electrical safety of the x-ray system.

B-6 A sensitized film should show less than 0. Exposure Switch At exposure times of 0. Interlocks All interlocks shall forbid exposure while in the open position. Radiographic Timer Accuracy Certified equipment shall meet the manufacturer's written specifications. Log Book Each facility shall maintain a log book or an equivalent record system containing the patient's name, date of exam, type of examination, number of views taken, and when applicable the reason for holding the patient.

D Each facility shall conduct at least one reject analysis per year of their films. Purchase Specifications and Acceptance Testing App. E Before purchasing new equipment, the practitioner is encouraged to determine the desired performance specifications for any new equipment including film, screens, and chemistry. Cassette Maintenance Cassettes and screens shall be maintained to minimize the occurrence of artifacts. FDA Acceptance Testing of Radiological Imaging Equipment.

Edmons, British Journal of Radiology, 57 Quality Control in Diagnostic Radiology. Burns, Radiologic Technology, 54, Evaluation of Cassette Performance.

Schmidt, Radiology, March Performance Specifications for Diagnostic X-ray Exposure. Hendee, et. Physics of Medical Imaging. Edited by A. Haus, AAPM Quality Control in Diagnostic Imaging. Gary, Winkler, Stears, and Frank. Aspen Publishers, Rockville, MD Quality Assurance for Diagnostic Imaging Equipment. Quality Assurance in Diagnostic Radiology. McLemore, Yearbook Medical Radiographic Latent Image Processing.

Radiologic Science for Technologist. Bushong, Mosby Company Select a Densitometer A densitometer is a device that measures the blackening or density of a developed radiographic film. Obtain Control Film Obtain control film which is produced with an emulsion from the same batch in quantity sufficient to last 2 to 4 months and assure that it is stored properly.

Never use a mercury thermometer in a radiographic darkroom. Check Sensitometer Calibration Once a year, or, after changing the battery, you need to check the sensitometer for consistency. Check Densitometer Calibration Your densitometer should be calibrated when it leaves the manufacturer. Set Processor at Manufacturer's Optimum Conditions Make sure that your processor is set at the film manufacturer's optimum conditions for the filmdeveloper combination that you are using.

Equipment Needed Sensitometer Densitometer Stopwatch Film Fresh Chemistry Digital or metal-stemmed dial thermometer Procedure Drain the developer and fixer tanks in the processor and flush the tanks and racks with fresh water. Note: Do not use systems cleaner at this time.

Even minute traces of the strong acid can contaminate the chemistry. Replace the developer re-circulation filter with a new filter and assure that the processor is functioning normally. Drain and flush the replenisher tanks and hoses with fresh water.

Carefully mix fresh developer, replenisher and fixer. Refill the replenisher tanks, operating the replenisher pumps temporarily to assure that all fresh water is flushed out of the replenisher lines and to assure that the replenisher pumps are functioning properly. Flush the processor fixer tank again with fresh water. Fill the fixer tanks in the processor with fresh fixer and replace the fixer rack.

Again flush the developer tank. Fill the developer tank with fresh developer-replenisher and add the correct amount of starter as noted in the manufacturer's instructions. Carefully replace the developer rack, crossover racks, etc. Allow the processor to operate for 30 minutes. Check the developer temperature, fixer temperature, and wash water temperature.

The developer temperature should be within 0. Check the replenishment rates and the time it takes a film to pass through the processor the time it takes from when the leading edge enters the processor until the leading edge exits the processor.

Allow the processor to be used until it is stable and the films look good. Using the sensitometer, expose a sheet of control film. Expose one side, turn over the film and expose the other end of the other side.

Process the film using the same side of the feed tray for each film. Zero and check the calibration of the densitometer. This means using the accompanying check calibration strip and reading each step. Take several readings across each step and average the readings. The readout should be within a few tenths of the average. Determining Control Limits Read the densities on the two strips. Be sure to read the densities in the center of each strip, not near the edges. Check the zero and calibration of the densitometer after reading each strip.

Mark the value next to the step. Average the two measurements for each step of the tablet. Take three readings of the clear area of the film and average the values.

Identify the step with an optical density closest to 1. This step represents a medium density measurement of 1. Record this value on the control chart as the speed step or medium density. Identify the step with the density closest to but not exceeding 2.

Next select the step with the density closest to 0. Subtract the smaller of the two numbers from the larger.

This difference is the density difference or contrast step. Record this value on the control chart as the contrast or density step. Repeat steps 11 through 21 for the next four days. Use the average of the measurements made over the five days to establish the control limits. Establishing Upper and Lower Level Control Limits The upper and lower control limits are determined through some math calculations.

Utilizing the numbers identified as the speed and contrast steps from the previous section, calculations can be made to set up parameters that will allow for processor variability. Equipment Needed Sensitometer Densitometer Digital Thermometer or metal-stemmed dial thermometer Control Film Procedure Turn on the processor and follow the manufacturer's start-up procedures.

Allow sufficient time for the temperature to stabilize. Check solution temperatures, replenishment rates, water temperature, flow rates, and dryer temperature to make sure they are at the manufacturer's recommended levels. Ideally your unit will have built-in thermometers and flow meters to facilitate this. Process clean-up sheets exposed but unprocessed film to remove any residue from the racks and to check for processor scratches. Expose a sensitometric control strip one on each side of dual emulsion films and process with the light density end of the wedge leading to avoid variability because of direction factor.

In addition, care must be taken to assure that the control strip is processed at the same location on the processor feed shelf left-to-right each time. For consistency the strips should always be processed at the same time interval after exposure as step 16 in Appendix B Flush the tanks with fresh water and drain again. Refill the developer tank with fresh developer. Fill the fixer tank with fresh fixer. Drain the water rinse bath.

Clean bath with fresh water and drain tank. Refill the water rinse bath with fresh water. Check the temperatures in the developer, fixer, and rinse water. Chemistry temperatures should be within 1. Expose a sheet of control film using the sensitometer. Expose one side, turn the film over and expose the other side of the film. Process the film.

Zero and check the calibration of the densitometer utilizing the accompanying check calibration strip. Mark the value next to the strip. Read the densities on the two strips in the center of each strip not near the edges.

Mark the value next to each strip. Average the two measurements for the same step of the tablet. Take three readings of the clear area of the film and average these values. Identify the step on the sensi strip with the optical density closest to 1.

Subtract the smaller number from the larger. The difference is the density difference or contrast step. Repeat steps 7 through 13 for the next four days. Check the solution temperatures for the developer, fixer and rinse. Expose a sensi strip once on each side. Process the sensi strip. Load the hanger by starting at bottom fixed clips. Make sure hands are clean and dry.

Film processing: For each day of operation, the processing system must operate as close to the film manufacturer's temperature and speed recommendations of the product as possible. It is very important that corrective action be made when limits are exceeded or a pattern develops indicating a degradation of the system. Solution temperatures and replenishment rates should be checked when troubleshooting speed and contrast problems. Radiographic units or spot film devices are in compliance, if in field testing, it can be shown that for four exposures at a specific time:.

The most commonly used exposure time settings should be selected for testing. If the results of the four exposures are not compliant, make six additional exposures and calculate the coefficient of variation. The coefficient of variation of the exposure measurements shall be no greater than 0. Unless otherwise specified in the manufacturer's written specifications, all equipment shall meet:. A minimum of four 4 measurements shall be done at each of the mA stations.

The generator should be capable of maintaining the above linearity across all the available mA stations. For linear tomographic units, the exposure field using a pinhole trace, will demonstrate uniformity of exposure on both sides of the center of exposure.

For complex motion tomographic units elliptical, circular, hypo-cycloidal, trispiral, etc. Each tomographic unit should be capable of resolving a 40 mesh pattern and shall be capable of resolving a 20 mesh pattern. Facilities with two or more tomographic units shall maintain those units so that the slice or tomographic cut level is the same for each unit.

It is recommended that for such facilities, a Littleton or comparable phantom be used to evaluate tomographic systems, in particular, those systems performing complex motion. The spatial resolution of the fluoroscopic system shall be measured using a test tool composed of a line pair plate with discreet line pair groups and a maximum lead foil thickness of 0.

The minimum spatial resolution at the center of the beam for a 6 inch field of view FOV is 2 line pairs per mm. The minimum spatial resolution for all other FOVs shall be determined by the following equation:. The low contrast performance of the fluoroscopic system shall resolve a minimum hole size of 3 mm using a test tool composed of a 1. At exposure times of 0. All interlocks shall forbid exposure when in the open position. This includes the fluoroscopic primary barrier, which shall be in position for use in order for fluoroscopic exposure to be possible.

An x-ray sensitized film should show less than 0. Protective garments and drapes shall not have tears, which impair their radiation protection function. Each x-ray unit shall have an appropriate technique chart located in a conspicuous position for reference by the operators. Each facility shall maintain a log book or an equivalent record system containing the patient's name, date of exam, type of examination, number of views taken, amount of fluoroscopic on-time if applicable and when applicable the reason for holding the patient.

Each facility shall conduct at least one reject analysis per year of their films. An ongoing repeat analysis should be conducted more frequently; e. It is important that the facility follow the procedures established to assure that the studies are carried out in the same manner each time. Appendix D is available for reference. Before purchasing new equipment, the facility is encouraged to determine the desired performance specifications for any new equipment including film, screens, and chemistry.

Appendix E contains information which facilities may find useful in preparing performance specifications. This information should be requested by the facility from each prospective vendor, so that the facility will be able to compare the advantages and disadvantages of competing systems. Cassettes and screens shall be maintained to minimize the occurrence of artifacts. Screens should be inspected and cleaned regularly with the cleaning solution recommended by the screen manufacturer. The spectral characteristics of the light emitted by the intensifying screens must match the spectral characteristics of the film.

Some day to day fluctuations in control values are to be expected. When these fluctuations exceed the control limits you should make sure that they are real and not just the result of an error.

Repeat the monitoring procedures before taking corrective action. If the limits are still exceeded, immediate corrective action is required. Corrective action is also necessary when a trend indicates a degradation of the system.

Below are some common problems and likely causes. Increased Density Difference Contrast - High developer temperature; excessive replenishment rate; improperly mixed developer.

Decreased Density Difference Contrast - Low developer temperature; depleted, contaminated or improperly mixed developer; lack of starter in fresh developer; reduced replenishment; depleted fixer; safelights; film storage or handling.

Increased Medium Density Speed - High developer temperature; lack of starter in fresh developer; contaminated, depleted or improperly mixed developer; incorrect replenishment. Decreased Medium Density Speed - Low developer temperature; reduced replenishment; weak developer; improperly mixed developer. Wet or damp films - Depleted fixer; developer either depleted, contaminated or diluted or the temperature too low; loss of circulation.

Dirty films - Water problems; dirty roller; developer problems; loss of circulation; misaligned guideshoes; film handling problems. Scratches - Dirty rollers; misaligned guideshoes; depleted or diluted developer; fixer depleted; dryer problems. To determine the width of the field at the cassette in the bucky tray, complete the following formula:.

The result of this calculation will be the width of the x-ray field in the bucky tray. The result of this calculation will be the length of the x-ray field in the bucky tray. The maximum misalignment can be calculated using the SID and the values identified under limits at the beginning of the previous page. These numbers can be compared with the calculations made in determining the length and width of the field in the bucky tray.

Compare the result to the acceptance limit previously identified. At a 40" SID, the maximum acceptable misalignment would be 0. To provide a method for the analysis of the rejected radiographs. The results of such an analysis will provide information concerning those aspects of radiologic imaging that need the most attention.

If you plan to initiate a quality control program then you should carry out an analysis of your rejects before starting the QC program so you will have an idea of the impact of your efforts. The facility shall include the following information in its Policy and Procedures Manual item for those situations where patient holding may be necessary:. The facility must use the requirements contained in Section The following information shall be included:.

Specific area gonad shielding covers an area slightly larger than the region of the gonads. It may therefore be used without interfering with the objectives of the examination to protect the germinal tissue of patients from radiation exposure that may cause genetic mutations during many medical x-ray procedures in which the gonads lie within or are in close proximity to the x-ray field.

Such shielding should be provided when the following conditions exist:. The facility shall include the following information in its Policy and Procedures manual when a patient has films taken to evaluate scoliosis:.

The facility shall include the following information in its Policy and Procedures manual item regarding pregnant and potentially pregnant patients:.

The facility using personnel monitoring shall include the following information in its Policy and Procedures manual:. Navigation menu. Control Limits and Standards The control limits and standards used in this guide have been taken from the Federal Performance Standard for Diagnostic X-ray Equipment, Part 16, and other references listed in the bibliography. Equipment Records Records shall be maintained for each x-ray room and mobile x-ray unit and include: the initial test results acceptance testing and radiation safety survey as appropriate ; the current year; one set of test results from each intervening year to show changes over time.

Radiation Output and Exposure Rate Measurements for Selected X-ray Examinations The facility shall have available the radiation output measurements for common radiographic examinations they perform for patient and staff information for each x-ray unit. Processor and Sensitometer Logs Control charts of sensitometry shall be maintained and used to regulate processing. Radiation Safety Policies and Procedures The written policy and procedures must be available for the holding of patients, use of gonad and scoliosis if performed shielding, pregnant patients and operators, personnel monitoring, x-ray screening and repeat, reject analysis.

Equipment Monitoring Each facility shall make or have made the following tests, at the frequency specified, and maintain records of the data. A chart of tests and frequencies can be found in Appendix A. Test frequency - Each day of operation Equipment functioning: Each day during the x-ray generator warm-up, and before xraying the first patient, the operator should check for indicator dial malfunction and also the mechanical and electrical safety of the x-ray system. Collimators - Fluorographic This requirement applies to spot film and fluoroscopic beam size in worst case conditions.

For non-image intensified equipment, the x-ray field size shall not extend beyond the visible area of the image receptor. Accuracy Certified equipment shall meet the manufacturers' specifications. Tomographic Equipment Each tomographic unit shall be evaluated for: Slice or tomographic cut level. The slice or cut level shall be within 5 mm of the indicated level. Slice or tomographic cut thickness. Uniformity of Exposure For linear tomographic units, the exposure field using a pinhole trace, will demonstrate uniformity of exposure on both sides of the center of exposure.

Resolution Each tomographic unit should be capable of resolving a 40 mesh pattern and shall be capable of resolving a 20 mesh pattern. Fluoroscopic Image Evaluation Spatial Resolution The spatial resolution of the fluoroscopic system shall be measured using a test tool composed of a line pair plate with discreet line pair groups and a maximum lead foil thickness of 0.

Low Contrast Performance The low contrast performance of the fluoroscopic system shall resolve a minimum hole size of 3 mm using a test tool composed of a 1. Exposure Switch At exposure times of 0. Interlocks All interlocks shall forbid exposure when in the open position. Lead Aprons, Gloves and Drapes Protective garments and drapes shall not have tears, which impair their radiation protection function.

When engaged, the signal must continue until the reset button is depressed. For uncertified equipment the passage of a preset time, not to exceed five 5 minutes, must be noted by a signal audible to the operator or an interruption of the fluoroscopic beam. Certified fluoroscopic equipment manufactured after May 19, and having HLC must meet requirement 2.

Technique Charts Each x-ray unit shall have an appropriate technique chart located in a conspicuous position for reference by the operators. Log Book Each facility shall maintain a log book or an equivalent record system containing the patient's name, date of exam, type of examination, number of views taken, amount of fluoroscopic on-time if applicable and when applicable the reason for holding the patient.

Purchase Specifications and Acceptance Testing Before purchasing new equipment, the facility is encouraged to determine the desired performance specifications for any new equipment including film, screens, and chemistry.

Cassette Maintenance Cassettes and screens shall be maintained to minimize the occurrence of artifacts. FDA Acceptance Testing of Radiological Imaging Equipment. Edmons, British Journal of Radiology, 57 Quality Control in Diagnostic Radiology. Burns, Radiologic Technology, 54, Evaluation of Cassette Performance. Schmidt, Radiology, March Performance Specifications for Diagnostic X-ray Exposure.

Hendee, et. Physics of Medical Imaging. Edited by A. Haus, AAPM Quality Control in Diagnostic Imaging. Gary, Winkler, Stears, and Frank. Aspen Publishers, Rockville, MD Quality Assurance for Diagnostic Imaging Equipment. Quality Assurance in Diagnostic Radiology.

McLemore, Yearbook Medical Radiographic Latent Image Processing. Radiologic Science for Technologist. Bushong, Mosby Company Center light field to the center of the cassette at a 40" cm SID. Collimate beam to approximately a 5"x7" beam. Mark the four sides of the light field. One method is to place two pennies together so that the pennies touch at the edge of the light field. Do this on each of the four sides.

Facing the film, place a penny in the light field to identify the lower right corner of the film. Expose and develop the film. Examine each of the four sides of the exposed film. The inside pennies closest to the center of the field shall lie partially or completely in the radiation field.

The outside pennies may partially lie in the exposed field but no outside penny may be fully covered by the radiation field. Misalignment in either dimension horizontal misalignment is the sum of the deviation of the right and left edges, vertical misalignment is the sum of the top and bottom edges cannot exceed 0. Appendix C Positive Beam Limitation Sizing Purpose To assure that the automatic collimation system adjusts to the cassette size used. Procedures Place the empty, smaller cassette in the bucky tray.

Check that the collimator is in the automatic mode. Set the SID to 40" and lock the vertical travel of the tube suspension. Place the loaded, larger cassette on the tabletop. Center the tube longitudinally and transversely, check that the x-ray tube is perpendicular to the cassette. Activate the light localizer and center the x-ray tube to the bucky tray.