QUALITY ASSURANCE AND

QUALITY CONTROL IN
GENERAL RADIOGRAPHY

AN MARI CAPUZ, RRT

QUALITY ASSURANCE

▪ A program of QA monitors proper patient scheduling, reception, and

preparation. QA deals with people.
▪ Quality assurance also involves image interpretation. This is called outcome
analysis.
▪ All these QA activities require attention from the imaging team, but they are
principally the responsibility of the radiologist and the imaging service
management
QUALITY CONTROL
▪ Quality control is more tangible and obvious than QA. A program of QC is
designed to ensure that the radiologist is provided with an optimal image
produced through good imaging system performance and resulting in minimal
patient radiation dose.
▪ QC deals with instrumentation and equipment
▪ Each new piece of radiologic equipment, whether it is x-ray producing or
image processing, should be acceptance tested before it is applied clinically.
The acceptance test must be done by someone other than the manufacturer’s
representative.
▪ Periodic monitoring of equipment performance is required. On most systems,
annual monitoring is satisfactory unless a major component such as an x-ray
tube has been replaced.
 QUALITY CONTROL
▪ Preventive maintenance usually makes
repair unnecessary
▪ An acceptable QC program consists of
three steps: acceptance testing, routine
performance monitoring, and maintenance.
▪ QC requires a team effort, but QC is
principally the responsibility of the medical
physicist.
▪ Usually, the QC program focuses on the
strengths of the image to ensure that those
strengths are maintained
IMAGE QUALITY PER IMAGING SYSTEM
 COLLIMATION TEST
TOOL
▪ The x-ray field must coincide with
the light field of the variable-
aperture light-localizing collimator.
If these fields are misaligned, the
intended anatomy will be missed
and unintended anatomy
irradiated. Adequate collimation
can be confirmed with any of a
number of test tools designed for
that purpose
▪ Misalignment must not exceed 2%
of the SID.
▪ Most systems today are equipped
with positive beam–limiting (PBL)
collimators. These devices are
automatic collimators that sense
the size of the image receptor and
adjust the collimating shutters to
that size
 FILTRATION
▪ Perhaps the most important
patient protection
characteristic of a radiographic
imaging system is filtration of the
x-ray beam. State statutes
require that general purpose
radiographic units have a
minimum total filtration of 2.5
mm Al.
▪ Filtration should be evaluated
annually or at any time after a
change has occurred in the x-
ray tube or tube housing.
 FOCAL
SPOT SIZE
▪ The spatial resolution of a
radiographic imaging system is
determined principally by the
focal-spot size of the x-ray tube
▪ Three tools are used for
measurement of focal spot size:
the pinhole camera, the star
pattern, and the slit camera.
▪ Focal-spot size should be
evaluated annually or whenever
an x-ray tube is replaced.
▪ An acceptable alternative to
focal-spot size measurement is
use of a line-pair test tool to
determine limiting spatial
frequency
 kVp Calibration
▪ Several methods are available to evaluate
the accuracy of kVp. Today, most medical
physicists use one of a few devices that are
based on filtered ion chambers or filtered
photodiodes. Other methods that use voltage
diodes and oscilloscopes are more accurate
but require an exceptional amount of time.
▪ The measured kVp should be within 10% of
the indicated kVp.
▪ The kVp calibration should be evaluated
annually or whenever high-voltage generator
components have changed significantly.
▪ A variation in kVp of approximately 4% is
necessary to affect image optical density
and radiographic contrast.
 Exposure timer accuracy
• Exposure timer accuracy can be assessed in
several ways. Most medical physicists use one of
several commercially available products that
measure exposure time based on irradiation time
of an ion chamber or photodiode assembly
• Solid-state radiation detectors are now used for
exposure-timer checks.
• Exposure timer accuracy should be within 5% of
the indicated time for exposure times greater
than 10 ms
• The accuracy of the exposure timer should be
assessed annually
• Accuracy of 20% is acceptable for exposure
times of 10 ms or
 Exposure
Linearity
• Many combinations of mA and
exposure time produce the same
mAs value.
• Produce a constant radiation
output for various combinations of
mA and exposure time is called
exposure linearity.
• Exposure linearity must be within
10% for adjacent mA stations
• Exposure linearity is determined by
a precision radiation dosimeter that
measures radiation intensity at
various combinations of mA and
exposure time.
Exposure Reproducibility
• Radiation exposure should be reproducible
• Sequential radiation exposures should be
reproducible to within ±5%
Screen-film contact
• Screen-film contact should be evaluated once or
twice a year. This is done by radiographing a wire
mesh pattern and analyzing the image for areas of
blur
Film Illuminators Check
• View box illumination should be analyzed
photometrically on an annual basis.
• This is done with an instrument called a luminance
meter, which measures light intensity at several areas
of the illuminator.
• Intensity should be at least 1500 cd/m2 and should
not vary by more than ±10% over the surface of the
illuminator.
Processor maintenance
1. Scheduled maintenance refers to routine
procedures that are performed usually weekly or
monthly. Such maintenance includes observation
of all moving parts for wear; adjustment of all
belts, pulleys, and gears; and application of
proper lubrication to minimize wear. During
processor lubrication, it is especially important to
keep the lubricant off your hands, thereby
keeping it away from film and rollers and, of
course, out of processor chemistry.
2. Preventive maintenance is a planned program of
parts replacement at regular intervals. Preventive
maintenance requires that a part be replaced
before it fails. Such a program should avoid
unexpected downtime.
3. Nonscheduled maintenance is, of course, the
worst kind. A failure in the system that necessitates
processor repair is a nonscheduled event. A
proper program of scheduled maintenance and
preventive maintenance keeps nonscheduled
maintenance to a minimum
THANK YOU
FOR
LISTENING!
REFERENCES:
Bushong, S.C. (2017). Radiologic
Science For Technologists: Physics,
Biology, And Protection (11th
edition). Philadelphia, PA: Elsevier