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Test Bank for Quality Management in the Imaging Sciences, 4th Edition: Papp

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This is completed downloadable of Test Bank for Quality Management in the Imaging Sciences, 4th Edition: Papp

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ISBN-10 ‏ : ‎ 0323057616
ISBN-13 ‏ : ‎ 978-0323057615
Author: Jeffrey Papp

With this single resource, you can access quality management and quality control information for all major imaging modalities! Updated with the latest changes in technology and federal regulations, Quality Management in the Imaging Sciences provides a thorough description of Quality Management and explains why it is so important to imaging technology. Step-by-step QM procedures include full-size evaluation forms, with instructions on how to evaluate equipment and document results. This book also helps you prepare effectively for the ARRT advanced certification exam in quality management.

Table of Content:

CHAPTER 1 Introduction to Quality Management
OBJECTIVES
KEY TERMS
HISTORY OF QUALITY MANAGEMENT IN RADIOLOGY
Governmental Action
TABLE 1-1 Mandatory Reporting Requirements for User Facilities
The Joint Commission
Quality Assurance
Quality Control
Continuous Quality Improvement
BOX 1-1 Fourteen Points of Management
PROCESS IMPROVEMENT THROUGH CONTINUOUS QUALITY IMPROVEMENT
Key Quality Characteristics
Key Process Variables
Problem Identification and Analysis
Group Dynamics
Brainstorming
Focus Groups
Quality Improvement Team
Quality Circles
Multi-voting
Consensus
Work Teams
Problem-Solving Teams
Specific Quality Management Quality Improvement Processes
TJC 10-Step Process
TJC Cycle for Improving Performance
Figure 1-1 Model for a storyboard.
Figure 1-2 Cycle for improving performance, showing the important steps, including inputs and outputs, of a systematic approach to improvement.
Other Quality Management/Quality Improvement Models
Figure 1-3 Phases of FADE problem solving.
Figure 1-4 The FOCUS-PDCA Model.
SUMMARY
REVIEW QUESTIONS
CHAPTER 2 Quality Management Tools and Procedures
OBJECTIVES
KEY TERMS
INFORMATION ANALYSIS
Terminology Used in Statistical Analysis
Population
Sample
Data Set
Frequency
Dependent Variables
Independent Variables
Continuous Variables
Dichotomous Variables
Central Tendency
Reliability
Accuracy
Bias
Error
Range
Standard Deviation
Variance
Poisson Distribution
Gaussian Distribution
FIGURE 2-1 Gaussian probability (normal) distribution.
Variation
Validity
Information Analysis Tools
Flowchart
BOX 2-1 The Flowchart
Cause-and-Effect Diagram
Histogram
Pareto Chart
Scatter Plot
FIGURE 2-2 Flowchart diagrams the process of eliminating scratches on images caused by film processors.
FIGURE 2-3 A fishbone chart shows the effect of various parameters on key quality characteristics or outcomes of proper image quality.
Trend Chart
FIGURE 2-4 Histogram. Frequency of occurrence is demonstrated on the y-axis, and category or class interval is demonstrated on the x-axis. This example plots percentage of patients undergoing diagnostic procedures versus ages of patients.
FIGURE 2-5 A Pareto chart indicates specific areas that cause unsatisfactory outcomes, so that improvement actions can be appropriately directed. IVP, Intravenous pyelography.
FIGURE 2-6 A scatter plot graph shows relationship between a key outcome or characteristic (y-axis) and a key process variable (x-axis). Graph A indicates a positive correlation between two values, and graph B indicates that no correlation exists. mA, Milliampere; mR, milliroentgen.
FIGURE 2-7 A trend graph displays amount of variation of indicator (radiation emitted from an x-ray generator) as a function of time. mAs, Milliampere-second; mR, milliroentgen.
FIGURE 2-8 A control graph displays amount of variation of indicator (speed or medium density value from a sensitometry film) as a function of time, with upper and lower control limits indicated.
Control Chart
MISCELLANEOUS ADMINISTRATIVE RESPONSIBILITIES
BOX 2-2 Administrative Procedures
BOX 2-3 Quality Management Technologist Duties
Threshold of Acceptability
Communication Network
Patient Comfort
Personnel Performance
Record-Keeping System
Corrective Action
RISK MANAGEMENT
Risk Analysis
Policies and Procedures
RADIATION SAFETY PROGRAM
Patient Radiation Protection
Radiographic Examinations
Fluoroscopic Examinations
Visitor Protection
Personnel Protection
Time
Distance
Shielding
SUMMARY
REVIEW QUESTIONS
CHAPTER 3 Film/Screen Image Receptors, Darkrooms, and Viewing Conditions
OBJECTIVES
KEY TERMS
DARKROOM FUNCTION
DARKROOM ENVIRONMENT
Darkroom Characteristics
FIGURE 3-1 Psychrometer for measuring relative humidity.
Darkroom Lighting
FIGURE 3-2 Standard darkroom film bin.
Overhead Lighting
Safelight
Blue-Violet-Sensitive Film
FIGURE 3-3 Visible light spectrum.
FIGURE 3-4 Fixture type of darkroom safelight.
FIGURE 3-5 Sodium vapor lamp darkroom safelight.
Orthochromatic Film
New Modality Film
Other Film Types
Light and Leakage Testing
Safelight Testing
FIGURE 3-6 Image of penetrometer showing safelight fog.
PROCEDURE
PROCEDURE
Leakage Testing and Processing Area Condition
PROCEDURE
Film and Chemical Storage
VIEWBOX QUALITY CONTROL
Viewbox Illuminators
Viewbox Quality Control Test
FIGURE 3-7 Photographic light meter (photometer) for viewbox evaluation.
BOX 3-1 Photometry
Illuminance
Luminance
IMAGE DUPLICATING UNITS
FIGURE 3-8 Duplicating unit for copying diagnostic images.
PROCEDURE
FILM/SCREEN IMAGE RECEPTORS
Intensifying Screen Speed
Intensification Factor
Relative Speed Value
Name of Screen
TABLE 3-1 Older Names for Screen Speed
Factors Affecting Screen Speed
Type of Phosphor Material
Thickness of Phosphor Layer
Size of Phosphor Crystals
Reflective Layer
FIGURE 3-9 Effect of screen active layer on light diffusion and image sharpness.
TABLE 3-2 Emission Color of Common Rare Earth Phosphors
Light-Absorbing Dyes
Ambient Temperature
Kilovolt (Peak) Selection
FIGURE 3-10 Reflected light within phosphor layer.
TABLE 3-3 K-Shell Binding Energies for Some Phosphor Materials
PROCEDURE
Quality Control Testing of Screen Speed
PROCEDURE
Spectral Matching
Screen Resolution
Contrast Resolution
FIGURE 3-11 Broadband spectrum from non-rare earth phosphor.
FIGURE 3-12 Line spectrum from rare earth screen phosphor.
Spatial Resolution
FIGURE 3-13 Line pairs per millimeter resolution chart.
TABLE 3-4 Comparison of Spatial Resolution and Line Size
Point Spread Function
FIGURE 3-14 Point spread function (PSF) graph.
FIGURE 3-15 Line spread function (LSF) graph.
Line Spread Function
Edge Spread Function
Modulation Transfer Function
FIGURE 3-16 Edge spread function (ESF) graph.
FIGURE 3-17 Weiner spectrum indicating the modulation transfer function (MTF).
FIGURE 3-18 Effect of film/screen contact on light diffusion.
FIGURE 3-19 Wire mesh image.
PROCEDURE
Screen Condition
FIGURE 3-20 Ultraviolet (UV) lamp for inspecting intensifying screens.
PROCEDURE
SUMMARY
REVIEW QUESTIONS
CHAPTER 4 Film Processing
OBJECTIVES
KEY TERMS
MANUAL AND AUTOMATIC FILM PROCESSING
Manual Processing
Procedure
Automatic Processing
PROCESSING CHEMICALS
Developer
Developer Components
Developing or Reducing Agents
Phenidone (Elon or Metol in Manual Developer)
Hydroquinone
Preservative
Accelerator, Activator, or Buffering Agent
FIGURE 4-1 Graph demonstrating superadditivity effect of phenidone and hydroquinone.
FIGURE 4-2 Potential hydrogen (pH) scale.
Restrainer, Regulator, Antifoggant, or Starter
Hardener
Solvent
Sequestering Agent
Developer Activity
Solution Temperature (Fig. 4-3)
FIGURE 4-3 Radiographs showing effect of solution temperature on optical density and contrast.
Immersion Time (Fig. 4-4)
Solution Concentration
FIGURE 4-4 Radiographs showing effect of developer time on optical density and contrast.
Type of Chemicals Used
Solution pH
Developer Mixing Procedure
Premix or Ready-Mix
Concentrate
Fixer
Fixer Ingredients
Fixing Agent, Clearing Agent, or Hypo
PROCEDURE
Preservative
Hardener or Tanning Agent
Acidifier, Activator, or Buffer
Sequestering Agent
Solvent
Fixer Mixing Procedure
Washing
FIGURE 4-5 Hyporetention kit for evaluating residual fixer in processed films.
Chemical Safety
AUTOMATIC PROCESSOR MAIN SYSTEMS
Transport System
Roller Subsystem
FIGURE 4-6 Entrance rollers for automatic film processor.
FIGURE 4-7 Transport rollers for automatic film processor.
Transport Rack Subsystem
FIGURE 4-8 Vertical rack assembly.
FIGURE 4-9 Turnaround rack assembly.
Drive Subsystem
FIGURE 4-10 Drive system.
FIGURE 4-11 Worm and drive gears.
Temperature Control System
Water-Controlled System
Thermostatically Controlled System
FIGURE 4-12 Mixing valve for warm-water automatic processors.
FIGURE 4-13 Heat exchanger located in bottom of water tank in thermostatically controlled temperature system.
Circulation System
FIGURE 4-14 Developer circulation system filter.
Replenishment System
Volume Replenishment
Flood Replenishment
Dryer System
FIGURE 4-15 Dryer air tubes.
Electrical System
TYPES OF AUTOMATIC PROCESSORS
Processor Size
Floor-Size Processor
Intermediate-Size Processor
Tabletop-Size Processor
Processor Location
Totally Inside
Bulk Inside
Bulk Outside
Daylight Processing Systems and Processors
SUMMARY
REVIEW QUESTIONS
CHAPTER 5 Processor Quality Control
OBJECTIVES
KEY TERMS
CHEMICAL ACTIVITY
Solution Temperature
Processing Time
FIGURE 5-1 Digital thermometer for monitoring solution temperatures.
Replenishment Rate
FIGURE 5-2 Time-in-solution (TIS) test tool.
Solution pH
Specific Gravity and Proper Mixing
PROCESSOR CLEANING PROCEDURES
FIGURE 5-3 Floating hydrometer for measurement of specific gravity (indicating value of 0.87 g/cm3).
Daily
PROCEDURE
Monthly
PROCEDURE
Quarterly
PROCEDURE
Yearly
PROCESSOR MAINTENANCE
Scheduled Maintenance
Preventative Maintenance
Nonscheduled Maintenance
Daily at Start-Up
PROCEDURE
Daily During Operation
PROCEDURE
Daily at Shutdown
PROCEDURE
Weekly
PROCEDURE
Monthly
PROCEDURE
Quarterly
PROCEDURE
Yearly
PROCEDURE
PROCESSOR MONITORING
Sensitometer
FIGURE 5-4 Sensitometer.
FIGURE 5-5 Twenty-one–step sensitometry film image.
Densitometer
FIGURE 5-6 Densitometer for measurement of optical density.
FIGURE 5-7 Diagram of incident and transmitted light. Io, Original intensity; It, transmitted intensity.
Control Chart
PROCEDURE
Quality Control Film
CHARACTERISTIC CURVE
PROCESSOR TROUBLESHOOTING
DAYLIGHT SYSTEMS
FIGURE 5-8 Processor control chart.
FIGURE 5-9 Crossover worksheet for determining new operating levels.
FIGURE 5-10 Sample plotting of a characteristic curve.
FIGURE 5-11 Daylight systems. LED, Light-emitting diode.
PROCEDURE
PROCEDURE
TABLE 5-1 Processor Control Chart Troubleshooting Guide
SUMMARY
REVIEW QUESTIONS
CHAPTER 6 Silver Recovery
OBJECTIVES
KEY TERMS
JUSTIFICATION FOR SILVER RECOVERY
Worldwide Supply of Silver
Monetary Return to Department
Federal and State Pollution Laws
BOX 6-1 Important Federal Pollution Laws
Water Pollution Control Act of 1972
Resources Conservation/Hazardous Waste Act of 1976
Clean Water Act of 1984
Resource Conservation and Recovery Act of 1987
SILVER RECOVERY FROM PROCESSING CHEMICALS
Metallic Replacement
Figure 6-1 Metallic replacement silver recovery unit.
Figure 6-2 Diagram of metallic replacement cartridge.
Steel Wool Cartridge
Channeling
Rusting
Drain Stoppage
BOX 6-2 Advantages of the Metallic Replacement Method
BOX 6-3 Disadvantages of the Metallic Replacement Method
Iron-Impregnated Foam Cartridge
Electrolytic Silver Recovery
Figure 6-3 “Piggybacking” or “tailing” of metallic replacement units.
Figure 6-4 Diagram of electrolytic silver recovery unit.
Figure 6-5 Cathodes from electrolytic silver recovery unit. Top cathode is clean and unused. Left cathode contains more than 20 lb of silver flake after correct amperage has been used. Right cathode contains silver that has been “burned” by too high of an amperage setting.
Figure 6-6 Silver flake that has been removed from a cathode after correct amperage has been used.
Terminal Electrolytic System
Recirculating Electrolytic System
BOX 6-4 Advantages of Electrolytic Silver Recovery
BOX 6-5 Disadvantages of Electrolytic Silver Recovery
Direct Sale of Used Fixer
Chemical Precipitation
Ion Exchange or Resin Systems
BOX 6-6 Factors Affecting the Efficiency of Silver Recovery from Processing Solutions
SILVER RECOVERY FROM FILM
Green Film
Scrap Exposed Film
Archival Film
SUMMARY
REVIEW QUESTIONS
CHAPTER 7 Quality Control of X-Ray Generators and Ancillary Radiographic Equipment
OBJECTIVES
KEY TERMS
X-RAY GENERATORS
Single-Phase Generator
Half-Wave Rectified
FIGURE 7-1 Voltage waveform graph of single-phase alternating current.
FIGURE 7-2 Voltage waveform graph of half-wave rectified, single-phase current.
Full-Wave Rectified
Three-Phase Generator
FIGURE 7-3 Voltage waveform graph of full-wave rectified, single-phase current.
FIGURE 7-4 Voltage waveform graph of 3-phase alternating current.
Three-Phase, Six-Pulse
Three-Phase, 12-Pulse
FIGURE 7-5 Voltage waveform graph of 3-phase, 6-pulse current.
FIGURE 7-6 Voltage waveform graph of 3-phase, 12-pulse current.
High-Frequency Generator
Voltage Ripple
FIGURE 7-7 Voltage waveform graph showing resultant current through the x-ray tube in a high frequency x-ray generator.
Power Ratings
CONTROL OR OPERATING CONSOLE
HIGH-VOLTAGE GENERATOR
X-RAY TUBE, TUBE ACCESSORIES, AND X-RAY TABLE
QUALITY CONTROL PROGRAM FOR RADIOGRAPHIC UNITS
Visual Inspection
Control Panel
Overhead Tube Crane
Radiographic Table
Protective Lead Apparel
FIGURE 7-8 Image of lead apron demonstrating a large hole in the center.
Miscellaneous Equipment
Environmental Inspection
Performance Testing
Radiation Measurement
FIGURE 7-9 The Noninvasive Evaluation of Radiation Output (NERO) is a microprocessor that can be programmed to acquire and analyze exposure data, providing quality control test results for numerous parameters.
FIGURE 7-10 Schematic diagram of an ion chamber.
Ion Chamber
Proportional Counter
Geiger-Müller Counter
FIGURE 7-11 Graph showing how the intensity of the signal from a gas-filled detector increases as the voltage across the chamber increases. A, Region of recombination. B, Ionization region. C, Proportional region. D, Geiger-Müller region. E, Region of continuous discharge.
FIGURE 7-12 Digital dosimeter.
Reproducibility of Exposure
PROCEDURE
Radiation Output
PROCEDURE
Filtration Check
PROCEDURE
Kilovolt (Peak) Accuracy
FIGURE 7-13 Semilog plot of radiation intensity versus attenuator thickness for determination of half-value layer (HVL).
FIGURE 7-14 Wisconsin Test Cassette.
FIGURE 7-15 Digital kilovolt (peak) meter.
TABLE 7-1 Minimum HVL Values for Diagnostic X-Ray Units
PROCEDURE
Timer Accuracy
FIGURE 7-16 Digital timer for radiographic units.
FIGURE 7-17 Manual spinning top.
FIGURE 7-18 Image from manual spinning top on a single-phase x-ray generator.
FIGURE 7-19 Synchronous spinning top.
FIGURE 7-20 A, Radiograph produced at 200 mA and 1/20-second exposure. B, RMI protractor template. C, Radiograph A with template showing acceptable results for a 1/20-second exposure. D, Radiograph produced at 200 mA and 1/30 second showing unacceptable results. mAs, Milliampere-second.
Voltage Waveform
Milliampere and Exposure Time Linearity and Reciprocity
FIGURE 7-21 Voltage waveforms indicating various conditions within the x-ray generator.
FIGURE 7-22 Output detector for obtaining voltage waveforms.
PROCEDURE
PROCEDURE
Focal Spot Size
FIGURE 7-23 Line focus principle.
Pinhole Camera
FIGURE 7-24 Concept of the pinhole camera.
PROCEDURE
Focal Spot Test Tool
Resolution Chart
FIGURE 7-25 Image from the focal spot test tool.
FIGURE 7-26 Star resolution patterns.
TABLE 7-2 Guide to Accompany Focal Spot Test Tool*
TABLE 7-3 NEMA Values for Nominal Focal Spot Size Variation
Beam Restriction System
Light Field–Radiation Field Congruence
FIGURE 7-27 Schematic of variable aperture collimator.
FIGURE 7-28 Image obtained with a collimator test tool showing collimator is within accepted limits.
FIGURE 7-29 Image obtained with the eight-penny test.
PROCEDURE
Collimator Test Tool
PROCEDURE
Eight-Penny (Nine-Penny) Test
Image Receptor–Radiation Field Alignment
Accuracy of the X-Y Scales
PROCEDURE
Illuminator Bulb Brightness
PROCEDURE
Beam Alignment
Perpendicular
FIGURE 7-30 Beam alignment tool.
PROCEDURE
Beam Alignment Tool
X-Ray Beam-Bucky Tray Alignment or Central Ray Congruency
Source-to-Image Distance and Tube Angulation Indicators
FIGURE 7-31 A, Acceptable beam perpendicularity and beam-light field alignment. B, Unacceptable beam perpendicularity and beam-light alignment. Radiation beam (arrows) does not agree with collimator light field (broken arrows). Perpendicularity is out of alignment. Note top head is shifted to the right (arrowhead).
PROCEDURE
Beam Alignment Test Tool
PROCEDURE
Washer or Coin Method
Overload Protection
X-Ray Tube Heat Sensors
FIGURE 7-32 Similar triangle configuration for determination of SID.
PROCEDURE
ANCILLARY EQUIPMENT
AUTOMATIC EXPOSURE CONTROL SYSTEMS
Detectors
FIGURE 7-33 Sensor cell location for automatic exposure control (AEC) systems. A, Single-cell option. B, Three-sensor option.
FIGURE 7-34 Schematic for photomultiplier tube and scintillation crystal.
Photodetectors
Ion Chambers
Solid-State Detectors
Comparator
Automatic Exposure Control Testing
FIGURE 7-35 Automatic exposure control (AEC) density selector settings.
Backup, or Maximum Exposure, Time
PROCEDURE
Minimum Exposure Time
Quality Control for Automatic Exposure Control
Consistency of Exposure with Varying Milliampere
PROCEDURE
Consistency of Exposure with Varying Kilovolt (Peak)
FIGURE 7-36 Automatic exposure control (AEC) test tool consisting of acrylic sheets of varying thickness.
PROCEDURE
Consistency of Exposure with Varying Part Thickness
PROCEDURE
Consistency of Exposure with Varying Field Sizes
PROCEDURE
Consistency of Automatic Exposure Control Detectors
PROCEDURE
Reproducibility
PROCEDURE
Density Control Function
PROCEDURE
Reciprocity Law Failure
CONVENTIONAL TOMOGRAPHIC SYSTEMS
FIGURE 7-37 Principle of linear tomography.
FIGURE 7-38 Effect of tomographic angle on section thickness.
FIGURE 7-39 Pluridirectional tomographic patterns.
Quality Control of Tomographic Systems
FIGURE 7-40 Tomographic test tool.
Section Level
FIGURE 7-41 Image from tomographic test tool indicating the level of tomographic section.
Section Thickness
TABLE 7-4 Section Thickness at Various Tomographic Angles
FIGURE 7-42 Multipurpose tomographic test tool with section thickness ruler.
Level Incrementation
Exposure Angle
Spatial Resolution
FIGURE 7-43 Image from tomographic test tool indicating the resolution pattern.
Section Uniformity and Beam Path
FIGURE 7-44 Lead aperture of tomographic test tool.
FIGURE 7-45 Image of lead aperture with linear tomography.
FIGURE 7-46 Image of lead aperture with elliptical motion.
PROCEDURE
Patient Exposure
Grids
Grid Uniformity
PROCEDURE
Grid Alignment
FIGURE 7-47 Grid alignment tool.
PORTABLE AND MOBILE X-RAY GENERATORS
Portable X-Ray Generator
Mobile X-Ray Generator
Direct-Power Units
TABLE 7-5 Comparison of Mobile Radiographic Units
Capacitor Discharge Units
Cordless, or Battery-Powered, Mobile Units
High-Frequency Mobile Units
SUMMARY
REVIEW QUESTIONS
CHAPTER 8 Quality Control of Fluoroscopic Equipment
OBJECTIVES
KEY TERMS
INTRODUCTION TO FLUOROSCOPIC EQUIPMENT
Image Intensifiers
Components
Glass Envelope
FIGURE 8-1 Schematic of image intensifier tube. CsI, Cesium iodide; Cs-Sb, cesium antimony.
FIGURE 8-2 Cesium iodide light pipe.
Input Phosphor
Photocathode
Electrostatic Focusing Lenses
Anode
Output Phosphor
Image Brightness
BOX 8-1 Factors Affecting the Brightness of Fluoroscopic Images
Milliampere
Kilovolt (Peak)
Patient Thickness and Tissue Density
Automatic Brightness Control or Automatic Brightness Stabilization
Multifield Image Intensifiers
Dual Focus
Trifocus
Image Intensifier Artifacts
FIGURE 8-3 Multifield image intensifier showing normal and magnification modes.
Veiling Glare, or Flare
Pincushion Distortion
Barrel Distortion
Vignetting
FIGURE 8-4 S, pincushion, and barrel distortion.
S Distortion
Image Monitoring Systems
Mirror Optics
Closed-Circuit Television Monitoring
Television Camera
Orthicon
Plumbicon
Vidicon
Charge-Coupled Device
FIGURE 8-5 Orthicon television camera tube.
FIGURE 8-6 Representation of photodetector/pixel arrangement in charge-coupled device (CCD).
Linkage from the Television Camera to Output Phosphor
Fiber Optics
Lens Coupling
Television Monitor
FIGURE 8-7 Principle of fiber optics.
FIGURE 8-8 Split mirror for monitoring fluoroscopic images.
Cinefluorography
Photofluorospot, or Spot Film, Camera
Film/Screen Spot Film Devices
Digital Image Recorders
QUALITY CONTROL OF FLUOROSCOPIC EQUIPMENT
Visual Inspection
FIGURE 8-9 Film/screen spot film formats.
FIGURE 8-10 Fluoroscopic beam alignment device.
Environmental Inspection
Performance Testing
Reproducibility of Exposure
PROCEDURE
Focal Spot Size
PROCEDURE
Filtration Check
PROCEDURE
TABLE 8-1 Half-Value Layer Valves for Common Fluoroscopic Kilovolts (Peak)
Kilovolt (Peak) Accuracy
PROCEDURE
Milliampere Linearity
PROCEDURE
X-Ray Tube Heat Sensors
PROCEDURE
Grid Uniformity and Alignment
PROCEDURE
Voltage Waveform
Automatic Brightness Stabilization Systems
PROCEDURE
Automatic Gain Control
PROCEDURE
Maximum Entrance Exposure Rate
PROCEDURE
Standard Entrance Exposure Rates
FIGURE 8-11 Diagram of fluoroscopic units with the image intensifier mounted above or below the tabletop.
FIGURE 8-12 Fluoroscopic phantom of the Centers for Devices and Radiological Health (CDRH).
PROCEDURE
High-Contrast Resolution
FIGURE 8-13 Image of fluoroscopic high-contrast resolution test tool.
Low-Contrast Resolution
PROCEDURE
Source–Skin Distance
FIGURE 8-14 Low-contrast resolution rest tool.
PROCEDURE
Distortion
Image Lag
PROCEDURE
Image Noise
PROCEDURE
Relative Conversion Factor
Veiling Glare, or Flare
Fluoroscopic Systems for Cardiac Catheterization and Interventional Procedures
FIGURE 8-15 Video waveforms.
FIGURE 8-16 Rotatable spoke test pattern.
Video Monitor Performance
FIGURE 8-17 Test pattern of the Society of Motion Picture and Television Engineers (SMPTE).
PROCEDURE
SUMMARY
REVIEW QUESTIONS
CHAPTER 9 Digital and Advanced Imaging Equipment
OBJECTIVES
KEY TERMS
DIGITAL RADIOGRAPHIC IMAGING SYSTEMS
FIGURE 9-1 Images showing the difference in spatial resolution as the size of the matrix increases.
Secondary Capture
Laser Scanning Digitizer
FIGURE 9-2 Laser scanning digitizer.
Charge-Coupled Device Scanner
Computed Radiography (CR)
FIGURE 9-3 The computed radiography (CR) Image Reader Device (IRD).
FIGURE 9-4 Schematic diagram of a computed radiography (CR) reader system. PMT, Photomultiplier tube.
FIGURE 9-5 A histogram from a CR system.
FIGURE 9-6 The computed radiography (CR) system workstation.
FIGURE 9-7 Effect of contrast enhancement on a radiographic image.
FIGURE 9-8 Effect of edge enhancement on a radiographic image.
FIGURE 9-9 Look-up tables for digital image processing. The curve shape defines the relationship between the intensity of exposure and image brightness (comparable to optical density in film images). (A) High contrast curve. (B) Low-contrast (wide latitude) curve. (C) Linear response curve with a reversed grayscale.
Advantages of Computed Radiography versus Conventional Radiography
FIGURE 9-10 Effect of energy subtraction on a chest examination. The image on the left has bony structures subtracted while the image on the right shows soft tissue subtraction.
TABLE 9-1 Percentage Dose Reduction for Various Radiographic Examinations
FIGURE 9-11 Plot of system response of film/screen imaging system and digital radiographic imaging plate.
Disadvantages of Computed Radiography versus Conventional Radiography
TABLE 9-2 List of CR Manufacturers (Selling in the United States)
Digital Radiography
FIGURE 9-12 Flat-panel x-ray image receptor. ADC, Analog-to- digital converter.
FIGURE 9-13 Illustration of a section of the active matrix array (AMA) showing the switch associated with each pixel.
Indirect-conversion or Scintillator Digital Radiography System
Direct-conversion or Photoconductor Digital Radiography System
Comparison of Computed Radiography with Digital Radiography
TABLE 9-3 List of DR Manufacturers (Selling in the United States)
Quality Control of Digital Radiographic Imaging Systems
FIGURE 9-14 Digital radiographic image with artifact caused by dirt on plate.
FIGURE 9-15 Boston CR Test Tool.
BOX 9-1 Digital Radiography Phantom Image Testing
Digital Fluoroscopy
Last Frame–Hold
Road Mapping
Digital Temporal Filtering
BOX 9-2 Summary of QC Tests for CR and DR Systems
Acceptance Tests—performed by medical physicist
Daily Tests—performed by technologist
Weekly Tests—performed by technologist
Monthly Tests—performed by technologist
Semiannual/Annual Tests—performed by medical physicist
Image Enhancement
Image Restoration
Image Intensifier Tube Digital Fluoroscopy Systems
FIGURE 9-16 Block diagram of digital fluoroscopic system.
Flat-panel Digital Fluoroscopy Systems
Continuous Fluoroscopy Mode
Pulsed Interlaced Scan Mode
Pulsed Progressive Scan Mode
Slow Scan Mode
Digital Subtraction Angiography
FIGURE 9-17 Image obtained during digital subtraction angiography (DSA).
Temporal Mask Subtraction
Time-Interval Difference Subtraction
FIGURE 9-18 Block diagram of DSA.
FIGURE 9-19 Images demonstrating temporal subtraction. Figures A and B show subtraction, while C shows the original image.
FIGURE 9-20 Images showing the effect of TID subtraction process.
Dual-Energy Subtraction
Quality Control of Digital Fluoroscopy Units
FIGURE 9-21 Digital subtraction angiography (DSA) phantom. A, Slot block. B, Bone block. C, Step wedge. D, Block insert. E, High-contrast resolution pattern insert. F, Linearity insert. G, Low-contrast artery insert. H, Low-contrast iodine line pair insert.
ELECTRONIC DISPLAY DEVICES
Cathode-Ray Tube Displays
FIGURE 9-22 Block diagram showing various classifications of electronic display devices.
FIGURE 9-23 Basic components of a cathode-ray tube display device.
Liquid Crystal Displays
FIGURE 9-24 Basic components of a liquid crystal display device.
Plasma Displays
Quality Control of Electronic Display Devices
FIGURE 9-25 AAPM TG-18 QC Test Pattern.
PROCEDURE
Monthly/Quarterly
MULTIFORMAT CAMERAS
Components
FIGURE 9-26 AAPM TG18-LN01 Test Pattern.
FIGURE 9-27 AAPM TG18-LN08 Test Pattern.
FIGURE 9-28 AAPM TG18-LN18 Test Pattern.
FIGURE 9-29 AAPM TG18-CT Test Pattern.
Brightness
Contrast
FIGURE 9-30 AAPM TG18-MP Test Pattern.
FIGURE 9-31 AAPM TG18-UNL10 Test Pattern.
Exposure Time
FIGURE 9-32 AAPM TG18-UNL80 Test Pattern.
FIGURE 9-33 AAPM TG18-CX Test Pattern.
Quality Control of Multiformat Cameras
FIGURE 9-34 AAPM TG18-AD Test Pattern.
FIGURE 9-35 AAPM TG18 PQC Test Pattern.
LASER CAMERAS
Components
FIGURE 9-36 Format patterns for multiformat cameras.
BOX 9-3 Summary of Viewing Monitor QC
Monthly/Quarterly
Annual
PROCEDURE
FIGURE 9-37 Schematic diagram of multiformat camera. CRT, Cathode-ray tube.
FIGURE 9-38 Society of Motion Picture and Television Engineers (SMPTE) test pattern.
FIGURE 9-39 Schematic diagram of a laser camera.
Quality Control of Laser Cameras
PROCEDURE
DRY LASER PRINTERS
FIGURE 9-40 Schematic diagram of a dry laser printer.
FIGURE 9-41 Demonstration of step test pattern for evaluation of dry laser printer.
CATHODE-RAY TUBE CAMERAS
Components
Quality Control of Cathode-Ray Tube Cameras
VIDEOTAPE, VIDEODISC, AND DIGITAL RECORDERS
Components
Quality Control of Analog and Digital Recorders
PROCEDURE
CINEFLUOROGRAPHY AND PHOTOFLUOROGRAPHY
FIGURE 9-42 Diagram of a cine camera.
FIGURE 9-43 Cine-video quality control phantom.
FIGURE 9-44 Diagram of a cine film processor.
IMAGE ARCHIVING AND MANAGEMENT NETWORKS
FIGURE 9-45 Picture archiving and communication system (PACS) test pattern.
MISCELLANEOUS SPECIAL PROCEDURES EQUIPMENT
PROCEDURE
Film Changers
Pressure Injectors
BONE DENSITOMETRY SYSTEMS
Single-Photon Absorptiometry
Single-Energy X-Ray Absorptiometry
Dual-Photon Absorptiometry
Dual-Energy X-Ray Absorptiometry
TABLE 9-4 World Health Organization Definitions of Bone Density Levels
Quantitative Computed Tomography
Quantitative Ultrasound
Digital X-Ray Radiogrammetry
Quality Control of Bone Densitometry Equipment
FIGURE 9-46 Dual-energy x-ray absorptiometry (DEXA) phantom used for determining the accuracy of bone density measurements.
SUMMARY
REVIEW QUESTIONS
CHAPTER 10 Outcomes Assessment of Radiographic Images
OBJECTIVES
KEY TERMS
REPEAT ANALYSIS
Advantages
Improved Department Efficiency
Lower Department Costs
Lower Patient Doses
Causal Repeat Rate
TABLE 10-1 Nationwide Averages of Repeat Causes for Departments with Quality Control Procedures
Total Repeat Rate
ARTIFACT ANALYSIS
Film/Screen Radiography
Processing Artifacts
Emulsion Pickoff
Figure 10-1 Repeat analysis worksheet (Film/screen). C-Spine, Cervical spine; IVP, intravenous pylelography; LGI, lower gastrointestinal tract; L-Spine, lumbar spine; T-Spine, thoracic spine; UGI, upper gastrointestinal tract.
Figure 10-2 Repeat analysis worksheet (CR/DR).
Gelatin Buildup
Curtain Effect
Chemical Fog
Guide Shoe Marks
Figure 10-3 Curtain effect.
Pi Lines
Figure 10-4 Chemical fog.
Figure 10-5 Guide shoe marks.
Figure 10-6 Pi lines.
Chatter
Dichroic Stain
Reticulation Marks
Streaking
Hesitation Marks
Figure 10-7 Streaking.
Water Spots
Wet-Pressure Sensitization
Figure 10-8 Hesitation marks.
Figure 10-9 Water spots.
Hyporetention
Insufficient Optical Density
Excessive Optical Density
Figure 10-10 Wet-pressure sensitization.
Exposure Artifacts
Motion
Patient Artifacts
Improper Optical Density
Improper Patient Position or Missing Anatomy of Interest
Figure 10-11 Hyporetention.
Quantum Mottle
Poor Film-to-Screen Contact
Double Exposure
Grid Artifacts
Grid Lines
Figure 10-12 Grid lines.
Figure 10-13 Grid cutoff.
Figure 10-14 Moiré effect, or zebra pattern, artifact.
Grid Cutoff
Moiré Effect
Handling and Storage Artifacts
Light Fog
Age Fog
Safelight Fog
Radiation Fog
Pressure Marks
Static
Tree Static
Crown Static
Smudge Static
Crescent or Crinkle Marks
Scratches
Cassette Marks
Computed Radiography and Digital Radiography Artifacts
Figure 10-15 Image demonstrating static artifacts.
Figure 10-16 Crescent marks.
Heat Blur
Improper Image Brightness
Figure 10-17 Cassette marks.
Quantum Mottle
Defects in the Imaging Plate
Phantom Image Artifact
Increased Sensitivity to Scatter
Figure 10-18 Quantum mottle occurring in a CR image.
Figure 10-19 Artifact caused by scratches on a CR image plate.
Double Exposure
Computed Radiography Scanner Malfunction
Foreign Objects
Halo Artifacts
Printer Errors
Figure 10-20 Phantom image caused by incomplete erasure of CR imaging plate.
Figure 10-21 Double exposure.
Figure 10-22 Scan lines appearing on digital image.
DIAGNOSTIC PERFORMANCE MEASUREMENT
Figure 10-23 Artifact caused by dirt on CR imaging plate.
Figure 10-24 Shading occurring during hard copy printing.
Figure 10-25 Corduroy effect.
Figure 10-26 Graph showing patients with disease versus healthy patients.
Accuracy
Sensitivity
Specificity
Positive Predictive Value
Negative Predictive Value
Figure 10-27 Statistical phantoms for A, radiographic; B, mammographic; and C, fluoroscopic images.
Receiver Operator Characteristic Curve
Figure 10-28 ROC Curve. The 45 degree diagonal line in the graph indicates pure guesswork by the observer. The curve on the left hand side of the graph depicts an accurate imaging procedure.
SUMMARY
REVIEW QUESTIONS
CHAPTER 11 Mammographic Quality Standards
OBJECTIVES
KEY TERMS
DEDICATED MAMMOGRAPHIC EQUIPMENT
X-Ray Generator
FIGURE 11-1 Dedicated mammographic unit.
X-Ray Tube
X-Ray Tube Window
Target Composition
FIGURE 11-2 Emission spectrum for tungsten-rhenium target. keV, Kiloelectron volt.
Milliampere
Kilovolt (Peak)
Added Filtration
Target Material
FIGURE 11-3 Effect of mA on emission spectrum. keV, Kiloelectron volt; mA, milliampere.
FIGURE 11-4 Effect of kVp on emission spectrum. keV, Kiloelectron; kVp, kilovolt (peak).
FIGURE 11-5 Effect of added filtration on emission spectrum. Al, Aluminum; keV, kiloelectron volt.
Tungsten (Atomic Number, 74)
FIGURE 11-6 Effect of target material on emission spectrum. keV, Kiloelectron volt; z, atomic number.
Molybdenum (Atomic Number, 42)
Rhodium (Atomic Number, 45)
Molybdenum-Rhodium-Tungsten Alloy
Voltage Waveform/Ripple
Focal Spot Size
FIGURE 11-7 Effect of voltage waveform on emission spectrum. keV, Kiloelectron volt.
Source-to-Image Distance and Target Angle
Compression
BOX 11-1 Advantages of Breast Compression
Grids
Image Receptors
Film Processors
Magnification Mammography
FIGURE 11-8 Technique chart for mammographic imaging with AEC.
Digital Mammography Systems
Stereotactic Localization
MAMMOGRAPHIC QUALITY ASSURANCE
MQSA and Mammography Quality Standards Reauthorization Act
Quality Control Responsibilities
Radiologist (Interpreting Physician)
Medical Physicist
Film/Screen Systems
Automatic Exposure Control
Kilovolt (Peak) Accuracy and Reproducibility
Focal Spot Condition
Beam Quality and Half-Value Layer
Breast Entrance Air Kerma and Automatic Exposure Control Reproducibility
Dosimetry
TABLE 11-1 Standards of the National Electrical Manufacturers Association
TABLE 11-2 Values for Minimum Acceptable Half-Value Layer X-Ray Tube Voltage (kVp) and Minimum HVL
FIGURE 11-9 Conventional mammographic phantom (A) and anthropomorphic (lifelike) phantom (B).
X-Ray Field/Light Field/Image Receptor/Compression Paddle Alignment
Uniformity of Screen Speed
System Artifacts
Radiation Output
Decompression
Quality Control Tests-Other Modalities
Viewbox Illuminators and Viewing Conditions
Comparison of Test Results with Action Limits
Additional Evaluations
Digital Mammography Systems
Quality Control Tests—Other Modalities
FIGURE 11-10 American College of Radiology (ACR) Medical Physicist MQSA Checklist.
FIGURE 11-11 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for Film/Screen Systems.
Radiologic Technologist (Mammographer)
FIGURE 11-12 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for GE FFDM Systems.
FIGURE 11-13 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for Fischer FFDM System.
Film/Screen Systems
Daily Duties
Darkroom Cleanliness
Processor Quality Control
FIGURE 11-14 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for Lorad FFDM Systems.
FIGURE 11-15 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for Siemens FFDM.
Weekly Duties
Screen Cleanliness
FIGURE 11-16 American College of Radiology (ACR) Physicist’s Mammography QC Test Summary for Fuji FCRm.
Phantom Images
FIGURE 11-17 American College of Radiology (ACR) processor control chart.
Monthly Duties
Quarterly Duties
Repeat Analysis
FIGURE 11-18 American College of Radiology (ACR) accreditation phantom.
PROCEDURE
Archival Quality
PROCEDURE
Semiannual Duties
Darkroom Fog
FIGURE 11-19 American College of Radiology (ACR) phantom control chart.
FIGURE 11-20 American College of Radiology (ACR) Mammographer QC checklist for daily/weekly duties.
PROCEDURE
FIGURE 11-21 American College of Radiology (ACR) visual checklist.
FIGURE 11-22 American College of Radiology (ACR) Repeat-Reject Analysis Chart.
Film/Screen Contact
PROCEDURE
FIGURE 11-23 Hyporetention estimator test strip.
Compression
Full-Field Digital Mammography Systems
Daily Duties
FIGURE 11-24 Wire mesh test images showing (A) good and (B) poor film screen contrast.
FIGURE 11-25 Mammographic compression scale.
Weekly Duties
FIGURE 11-26 American College of Radiology (ACR) Mammographer QC checklist for monthly, quarterly, and semi-annual duties.
Monthly Duties
Quarterly Duties
Semi-annual Duties
FIGURE 11-27 American College of Radiology (ACR) Mammography QC checklist for daily and weekly tests for GE FFDM systems.
FIGURE 11-28 American College of Radiology (ACR) Mammography QC checklist for daily and weekly tests for Lorad FFDM systems.
Inspection by the Food and Drug Administration
FIGURE 11-29 American College of Radiology (ACR) Mammography QC checklist for daily and weekly tests for Fischer FFDM systems.
Equipment Performance
Records
FIGURE 11-30 American College of Radiology (ACR) Mammography QC checklist for daily and weekly tests for Siemens FFDM systems.
FIGURE 11-31 American College of Radiology (ACR) Mammography QC checklist for daily and weekly tests for Fuji FCRm systems.
FIGURE 11-32 American College of Radiology (ACR) Mammography QC checklist for monthly, quarterly, and semi-annual duties for GE FFDM systems.
FIGURE 11-33 American College of Radiology (ACR) mammography QC checklist for monthly, quarterly, and semi-annual duties for Lorad FFDM systems.
Inspection Report
Level 1
FIGURE 11-34 American College of Radiology (ACR) Mammography QC checklist for monthly, quarterly, and semi-annual duties for Fischer FFDM systems.
FIGURE 11-35 American College of Radiology (ACR) Mammography QC checklist for monthly, quarterly, and semi-annual duties for Siemens FFDM systems.
FIGURE 11-36 American College of Radiology (ACR) Mammography QC checklist for monthly, quarterly, and semi-annual duties for Fuji FCRm system.
PROCEDURE
TABLE 11-3 Summary of Responsibilities for Mammography
BOX 11-2 Definitions by the Food and Drug Administration
Level 2
Level 3
No Findings
SUMMARY
REVIEW QUESTIONS
CHAPTER 12 Quality Control in Computed Tomography
OBJECTIVES
KEY TERMS
ACCEPTANCE TESTING
ROUTINE TESTING
Figure 12-1 This computed tomography (CT) phantom is used to evaluate noise, spatial resolution, contrast resolution, slice thickness, linearity, and uniformity.
Figure 12-2 Photograph (A) and computed tomography (CT) image (B) of the five-pin test phantom designed by the American Association of Physicists in Medicine. The attenuation coefficient for each pin is known precisely and the CT number computed.
Alignment Light Accuracy
PROCEDURE
Figure 12-3 Sample quality assurance data form.
Image Quality
High-Contrast (Spatial) Resolution
Figure 12-4 Technique for assessing laser light accuracy.
PROCEDURE
Test—High-Contrast Resolution
American College of Radiology Acceptance Criteria
Low-Contrast Resolution
PROCEDURE
Test—Low-Contrast Resolution
Figure 12-5 CT image from module 2 of the ACR, CT accreditation Phantom demonstrating placement of ROIs for assessing low-contrast resolution.
American College of Radiology Acceptance Criteria
Image Uniformity
PROCEDURE
Figure 12-6 Test for noise and uniformity. ROI, Region of interest.
Test—Image Uniformity
American College of Radiology Acceptance Criteria
Noise
Test—Noise
American College of Radiology Acceptance Criteria
Computed Tomography Number Accuracy
PROCEDURE
Figure 12-7 Test for contrast scale. ROI, Region of interest.
Test–Computed Tomography Number Accuracy
American College of Radiology Acceptance Criteria
Slice Thickness
PROCEDURE
Test—Slice Thickness
American College of Radiology Acceptance Criteria
Figure 12-8 Test objects used for determining slice thickness.
Linearity
PROCEDURE
Patient Dose
Figure 12-9 Phantom with known physical and x-ray absorption properties used for measuring linearity. HU, Hounsfield unit.
Figure 12-10 Graph showing computed tomography (CT) linearity. L, Lexan; N, nylon; P, Plexiglas; PE, polyethylene; PS, polystyrene; W, water.
Figure 12-11 Isodose curves for a typical computed tomography (CT) scanner.
PROCEDURE
TABLE 12-1 Computed Tomography Dose Index
TABLE 12-2 ACR CT Accreditation Dose Pass/Fail Criteria and Reference Levels
SUMMARY
REVIEW QUESTIONS
CHAPTER 13 Quality Control for Magnetic Resonance Imaging Equipment
OBJECTIVES
KEY TERMS
PHANTOMS
FIGURE 13-1 Left, Body coil phantom and holder. Right, Head coil phantom and holder.
QC TESTING FREQUENCY
WEEKLY TESTS
Setup and Table Positioning Accuracy
PROCEDURE
Center (Resonance) Frequency
PROCEDURE
Transmit Gain (Attenuation)
Geometric Accuracy (Three Axes)
PROCEDURE
FIGURE 13-2 Example of gradient amplitude falloff resulting in A-P minification of a T1-weighted (T1W) axial image of the upper abdomen.
High-Contrast Resolution (Spatial Resolution)
FIGURE 13-3 Sagittal localizer with end-to-end measurement shown (arrow).
FIGURE 13-4 Slice 1 from ACR T1 series with diameter measurements shown (arrows).
FIGURE 13-5 Slice 5 from ACR T1 series with diameter measurements shown (arrows).
PROCEDURE
FIGURE 13-6 Slice 1 from ACR T2 series demonstrating resolution insert and hole array pairs.
FIGURE 13-7 Magnified portion of slice 1 displayed for visual assessment of high-contrast resolution.
Low-Contrast Resolution (Detectability)
PROCEDURE
FIGURE 13-8 Slice 2 of ACR T1 series with the circle of low-contrast objects displayed.
Artifact Analysis
Film Quality Control
PROCEDURE
Visual Checklist
ANNUAL TESTS
Magnetic Field Homogeneity
BOX 13-1 Quality Control Tests Performed by a Medical Physicist or System Engineer
Slice Position Accuracy
PROCEDURE
FIGURE 13-9 Slice 1 of ACR T1 series with pair of dark vertical bars from the 45° crossed wedges indicated.
FIGURE 13-10 Slice 2 of ACR T1 series with pair of dark vertical bars from the 45° crossed wedges indicated.
FIGURE 13-11 Magnified portion of slice 1 showing measurement for slice position error. The arrows indicate the difference in bar length.
Slice Thickness Accuracy
PROCEDURE
Radiofrequency Coils (Fig. 13-15)
FIGURE 13-12 Slice 1 from ACR T2 series demonstrating the slice thickness insert and signal ramps.
FIGURE 13-13 Magnified portion of slice 1 showing placement for rectangular ROIs to measure average signal in the ramps.
FIGURE 13-14 Magnified portion of slice 1 showing measurements for the slice thickness signal ramps.
FIGURE 13-15 Nonuniformity of image intensity produced by radiofrequency (RF) field inhomogeneity. Note the region of hypointensity in the left flank. The cause in this case is improper setting of active shim coil current; an unwanted focal gradient is produced in the main magnetic field.
Signal-to-Noise Ratio
PROCEDURE
FIGURE 13-16 Radiofrequency (RF) interference from a steady carrier frequency source. A strong signal from the nitrogen fill–monitor circuit is detected within the pass-band of the magnetic resonance imaging (MRI) receiver. It is displayed as a full vertical column perpendicular to the x coordinate that corresponds to the frequency of the spurious signal. The overall receiver performance is degraded by intermodulation distortion, which causes the background noise level to rise in comparison with the signal of the phantom.
Image Intensity Uniformity
Percent Signal Ghosting (PSG)
FIGURE 13-17 A, A signal-to-noise ratio (SNR) test performed with the body coil phantom. B, An SNR test performed with the head coil phantom. Note that the head coil yields a higher SNR.
BOX 13-2 Image Uniformity Calculation
Interslice Radiofrequency Interference
Soft-copy Display Devices
PROCEDURE
OPTIONAL TESTS
Signal-to-Noise Ratio Consistency
Magnetic Fringe Field
SUMMARY
REVIEW QUESTIONS
CHAPTER 14 Ultrasound Equipment Quality Assurance
OBJECTIVES
KEY TERMS
COMPONENTS OF AN ULTRASOUND QUALITY ASSURANCE PROGRAM
Quality Assurance and Preventive Maintenance
Tissue-Mimicking Phantoms
Tissue Properties Represented in Phantoms
Typical Quality Assurance Phantom Design
FIGURE 14-1 Example of a general-purpose quality assurance phantom. A, Phantom being imaged with an ultrasound scanner. B, Close-up of phantom, with diagram of interior contents. C, B-mode image of the phantom.
BOX 14-1 Tissue Attenuation Coefficients
Cautions About Phantom Desiccation
FIGURE 14-2 A phantom with rubber-based, tissue-mimicking small parts. Although the acoustic properties are not as precise as the water-based phantoms, less care is required during manufacturing and with on-site storage to minimize changes over time.
BASIC QUALITY CONTROL TESTS
Visual Inspection
Transducer Choice
System Sensitivity
FIGURE 14-3 Images obtained for the maximum depth of the visualization quality assurance test with a multifrequency array transducer. The phantom has an attenuation coefficient of 0.7 dB/cm per megahertz. A, At 4 MHz the maximum depth of visualization is 16.8 cm. B, At 2 MHz the maximum depth of visualization cannot be determined with this phantom because visualization remains excellent all the way to the bottom of the phantom.
Photography and Gray-Scale Hard Copy
Monitor Setup and Recording Devices
FIGURE 14-4 A test pattern of the Society of Motion Picture and Television Engineers (SMPTE). The pattern contains a gray-scale range in increments of 10% video level. There are also 5% contrast patches at the 0% (black) and 100% (white) levels, a mesh pattern to check for spatial distortions, and several resolution patterns.
Routine Quality Assurance of Image Recording
Scan Image Uniformity
FIGURE 14-5 Image uniformity tests. A, Good uniformity. B, Results with a transducer that should be repaired or replaced. Note the vertical streaks that are evidence of element dropout for this linear array transducer.
Distance Measurement Accuracy
Vertical Distance Measurements
FIGURE 14-6 Vertical distance measurement check. The caliper reading (13.94 cm) is compared with the actual separation (14 cm) between pins positioned along a vertical column in the phantom. Shorter distances should be used when high-frequency transducers are evaluated.
FIGURE 14-7 Horizontal distance measurement check. The caliper reading (90.7 mm) is for a measurement taken horizontally on the image and compared with the actual pin separation (90 mm).
Horizontal Distance Measurements
Other Important Instrument Quality Assurance Tasks
DOCUMENTATION
SPATIAL RESOLUTION TESTS
Axial Resolution
FIGURE 14-8 Axial resolution measurement. The thickness of the pin target is 0.65 mm. In the axial resolution target set (vertical separation 2 mm, 1 mm, 0.5 mm, and 0.25 mm), the 1-mm pair is separated a sufficient distance vertically so that there is no vertical overlap of the images of these two targets, whereas the 0.5-mm pair overlaps if the two targets are on a vertical line. The axial resolution is just over 0.5 mm, in agreement with the estimate made from the thickness of the single target image.
BOX 14-2 Ultrasound Quality Control Results
Lateral Resolution
Cautions About Resolution Tests with Discrete Targets
FIGURE 14-9 Lateral resolution measurement. The horizontal size of the pin target is 0.7 mm.
OTHER TEST OBJECTS AND PHANTOMS
Anechoic Voids
FIGURE 14-10 B-mode image of a phantom containing 3 anechoic cylinders of different sizes (6, 4, and 2 mm diameter) acquired with a 4-MHz linear transducer. Some echoes are evident within the voids, and the edges are well-defined. The smallest void is easily detectable.
Objects of Various Echogenicity
FIGURE 14-11 Image of a phantom containing four triangular-shaped objects of different contrast values acquired with a 6.5-MHz curvilinear transducer. The higher contrast objects (the outer two) are clearly visualized. The second object from the right is barely visible. The corners of the two inner objects are poorly defined.
Spherical Object Phantom
FIGURE 14-12 B-mode image of a phantom containing 4-mm low-scattering spheres that mimic cysts. The spheres are centered in a regular array within a plane, and the scanning plane is carefully aligned to coincide with the plane containing the spheres. They can be visualized from depths of 5.0 through 12.0 cm with this transducer.
DOPPLER TESTING
String Test Objects
Doppler Flow Phantoms
FIGURE 14-13 B-mode and spectral Doppler display of a flow phantom for evaluating Doppler penetration. A, A strong Doppler signal and a good signal-to-noise ratio is obtained when the sample volume is at a depth of 9.8 cm. B, The Doppler signal is just detectable above the electronic noise when the sample volume is at a depth of 10.8 cm. The maximum depth of detection of the Doppler signal in this case is 10.8 cm.
FIGURE 14-14 An example of a color flow image of a Doppler flow phantom used to determine the maximum penetration in color.
ELECTRONIC PROBE TESTS
FIGURE 14-15 A, Arrangement for testing transducers using an electronic probe tester. The transducer is connected to the tester through its port. The tester may have various special ports to adapt to different manufacturer’s transducer connectors. The face of the probe is immersed in water and directed towards a smooth reflector. A computer controls the tester and produces printouts of test reports. B, Typical arrangement for testing a linear array transducer. Positioners on the holder enable users to orient the transducer so that beams are perpendicular to the smooth reflecting surface. The mount is immersed in a water bath so that the path from the transducer to the reflector is water.
FIGURE 14-16 Typical probe test result for a transducer with 8 dead elements. “Volts p-p” in the top record indicates the relative amplitude of the echo signal detected by each element from the specular reflector. For 8 of the elements the signal clearly is much weaker than for the other elements. The lower record displays the electrical capacitance of each element and its electric lead.
REVIEW QUESTIONS
REFERENCES
CHAPTER 15 Quality Assurance in Nuclear Medicine
OBJECTIVES
KEY TERMS
THE SCINTILLATION GAMMA CAMERA
FIGURE 15-1 Basic scintillation camera detector components. PMTS, photomultiplier tubes.
FIGURE 15-2 Four common types of collimators used on gamma cameras.
BOX 15-1 NEMA Acceptance Tests for Scintillation Cameras (SPECT)
TABLE 15-1 Gamma Camera Quality Control
QUALITY CONTROL PROCEDURES FOR IMAGING EQUIPMENT
Energy Resolution and Photopeaking
FIGURE 15-3 Energy spectrum of the radionuclide technetium-99m (99mTc). kcts, kilocounts; keV, kiloelecron volt.
FIGURE 15-4 Energy spectrum of technetium-99m (99mTc). The full width at half maximum (FWHM) is 18 kiloelectron volts (keV). The energy resolution is 13%. ΔE, Change in energy.
Counting Rate Limits
Field Uniformity
FIGURE 15-5 A, Field uniformity flood and resolution pattern. B, Nuclear medicine technologist preparing to obtain a field flood uniformity on a dual-head camera system.
FIGURE 15-6 Mispositioned photopeak resulting in a nonuniform flood.
FIGURE 15-7 Example of a nonfunctioning photomultiplier tube (PMT) seen in the flood field (A), the orthogonal hole resolution pattern (B), and the parallel-line equal space (PLES) phantom (C). D, Examples of nonuniform flood fields caused by a cracked crystal.
FIGURE 15-8 Extrinsic flood uniformity with a cobalt-57 (57Co) sheet source.
FIGURE 15-9 Note the photopenic area in the flood field and the resolution bar pattern. These are due to collimator damage.
Spatial Resolution and Spatial Linearity
FIGURE 15-10 An uncorrected and a microprocessor-corrected uniformity flood.
FIGURE 15-11 Spatial resolution with a four-quadrant bar pattern. Four images are obtained 90 degrees apart.
FIGURE 15-12 Parallel-line equal space (PLES) bar resolution pattern.
Sensitivity
FIGURE 15-13 Sensitivity testing with a known cobalt-57 (57Co) source.
Multiple-Window Spatial Registration
FIGURE 15-14 Multiwindow spatial resolution testing. Ga-67, Gallium 67.
QUALITY ASSURANCE OF SPECT CAMERAS
Uniformity Correction Flood
TABLE 15-2 SPECT Gamma Camera Quality Control*
Center of Rotation
FIGURE 15-15 Top, Ring artifact. Bottom, Normal image without the artifact.
Pixel Size
SPECT Quality Control During and After Patient Procedures
FIGURE 15-16 Problems identified with the patient motion quality control displays. A, Single-photon emission computerized tomography (SPECT) catches patient’s bed during rotation. B, Patient sits up during acquisition. C, Patient’s bed translates axial during acquisition. D, Gantry stops before completion of study.
POSITRON EMISSION TOMOGRAPHY
POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY SYSTEMS
QUALITY CONTROL OF NONIMAGING EQUIPMENT
Gas-Filled Detectors
Ion-Detecting Radiation Detectors
Geiger-Müller Meters
Dose Calibrator
FIGURE 15-17 Nuclear medicine technologist performing the quality control tests on a dose calibrator.
Nonimaging Scintillation Detectors
TABLE 15-3 Scintillation Detector Quality Control
FIGURE 15-18 Thyroid probe quality control with a neck phantom.
QUALITY ASSURANCE IN THE RADIOPHARMACY
Sealed Radioactive Source
Molybdenum-99/Technetium-99 Radionuclide Generator
Radiopharmaceuticals
Radiation Protection of Nuclear Medicine Personnel
FIGURE 15-19 Eluting chromatography strips.
FIGURE 15-20 Typical chromatography strips.
TABLE 15-4 Nuclear Regulatory Commission Dose Equivalent Limits per Year
Personnel Monitoring
Area Monitors
FIGURE 15-21 The three-bladed international warning symbol for ionizing radiation.
Radioactivity Signposting
Package Shipment, Receipt, and Opening
TABLE 15-5 Radiation Signs
Infection and Radiation Exposure Control
FIGURE 15-22 Following Universal Precautions.
Radiopharmaceutical Administration
REVIEW QUESTIONS
REFERENCES
Back Matter
APPENDIX A Review of Radiographic Quality
OPTICAL DENSITY
Factors That Influence Optical Density
Inherent Densities
Optical Density and Digital Imaging
CONTRAST
Radiographic Contrast
Subject Contrast
Film or Inherent Contrast
Sensitometric Curve
FIGURE A-1 The three main portions of the sensitometric curve.
FIGURE A-2 Film A demonstrates a higher contrast and faster speed than film B.
FIGURE A-3 Average gradient determination from a Hunter and Driffield (H & D) curve with the optical density values of 0.25 above base + fog (B + F) and 2.0 above B + F.
FIGURE A-4 Film A demonstrates a narrower exposure latitude than film B.
FIGURE A-5 Sensitometric curve demonstrating the effect of solarization. A decrease in optical densities occurs after the maximum density has been achieved.
Image Contrast with Digital Systems
RECORDED DETAIL
Geometric Factors
FIGURE A-6 Comparison of image contrast with a conventional image (top) and a digital image (bottom).
FIGURE A-7 Look-up tables for digital image processing. The curve shape defines the relationship between the intensity of exposure and image brightness (comparable to optical density in film images). A, High contrast curve. B, Low-contrast (wide latitude) curve. C, Linear response curve with a reversed grayscale.
Motion Factors
Image Receptor Factors
Absorption Factors
Recorded Detail or Spatial Resolution with Digital Imaging
DISTORTION
Size Distortion
Shape Distortion
Spatial Distortion
Image Distortion with Digital Imaging
APPENDIX B Agencies, Organizations, and Committees in Quality Assurance
Bibliography
Glossary
Answers to Review Questions
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15

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