Appendix A Appendix B Appendix C - Sample Test Procedures Appendix D Appendix E Appendix F - Policy and Procedures Appendix G Appendix H Appendix A: Quality Control Test FrequencyEach Day of OperationEquipment functioning Processing QuarterlyCollimators Fluoroscopic image receptor/x-ray field alignment Semi-annuallyAnnuallyOn Installation of New Equipment/Tube or Output ChangeAppendix B: Processor Problem TroubleshootingSome 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. Increased Base + Fog - High developer temperature; safelight problems; film storage and handling problem; lack of starter in fresh developer; dirty rollers; contaminated developer; depleted fixer; improper replenishment. 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. Appendix C-1: Light Field/X-ray Field alignment TestPurposeTo assure that the x-ray field and light field are congruent. Limits2% of Source-Image-Distance (SID) misalignment along either the horizontal or vertical edges of the light field vs. the x-ray field. 2% of 40" = 0.8 inches Test Frequency:Annually SID40" Technique Factors:60 kVp, 5 mAs Test Tools:Loaded 8"x10" or similar size cassette, 9 pennies ProceduresAppendix C-2: Positive Beam Limitation SizingPurposeTo assure that the automatic collimation system adjusts to the cassette size used. LimitsThe x-ray beam shall not differ from the image receptor size by more than 3% of the SID in any one dimension or a total of 4% of the SID in both dimensions. Test FrequencyAnnually SID40" Test ToolsOne 8"x10" or similar size cassette, one larger cassette, film and a ruler. ProceduresTriangulation Appendix C-3: X-ray Field/Image Receptor alignmentPurposeTo assure that the x-ray field is centered to the cassette and the bucky tray. LimitsThe misalignment of the center of the x-ray field as compared to the center of the film shall not exceed 2% of the SID. 2% of 40" = 0.8 inches Test FrequencyAnnually SID40" Technique Factors70 kVp @ 10mAs Test ToolsLoaded cassette, ruler ProcedureCompare the result to the acceptance limit previously identified. At a 40" SID, the maximum acceptable misalignment would be 0.8 inches. Appendix D: Repeat-Reject AnalysisPurposeTo 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. Equipment NeededRejected radiographs and a count of the total number of films consumed during the survey period. ProcedureNote: An "Analysis of Retakes: Understanding, Managing and Using an Analysis of Retakes for Quality Assurance", FDA 79-8097, is another excellent reference. Appendix E: Performance Specifications CriteriaAppendix F-1: Policy and Procedures for Patient HoldingThe facility shall include the following information in its Policy and Procedures Manual item for those situations where patient holding may be necessary: Appendix F-2: Policy and Procedures for Pregnant WorkersThe facility must use the requirements in Part 16 of 10NYCRR to establish their Policy and Procedure Manual item regarding pregnant employees. The following information shall be included: Appendix F-3: Policy and Procedures Regarding the Use of Gonad Shielding The facility must use the requirements contained in Section 16.53(b)(6), 16.56(c)(3) and 16.57(c)(2) of Part 16 and may use the information provided in the attached Federal regulations for the administration of the "Radiation Control of Health and Safety Act of 1968" to establish their Policy and Procedures Manual item regarding the use of gonad shielding. The following information shall be included: The x-ray examinations which require gonad shielding; The method(s) of shielding available; and The age limit for use of gonad shielding.Title 21 - Food and DrugsChapter I - Food and Drug Administration, Department of Health and Human ServicesPart 1000 - GeneralSubpart C--Radiation Protection RecommendationsSec. 1000.50 Recommendation for the use of specific area gonad shielding on patients during medical diagnostic x-ray procedures. 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: Expected Number of Future Children Versus Age of Potential Parent
Appendix F-4: Policy and Procedure Regarding the Use of Shielding for Scoliosis PatientsThe facility shall include the following information in its Policy and Procedures manual when a patient has films taken to evaluate scoliosis: Appendix F-5: Policy and Procedures for Pregnant PatientsThe facility shall include the following information in its Policy and Procedures manual item regarding pregnant and potentially pregnant patients: Appendix F-6: Policy and Procedures of Personnel MonitoringThe facility using personnel monitoring shall include the following information in its Policy and Procedures manual: Appendix G: Radiation Output Measurements
Procedure for Chest or SpineAppendix H: FormsFrom: "Quality Control in Diagnostic Imaging" Gray, Winkler, Stears and Frank, Aspen Publishers, 1983 From: "Quality Control in Diagnostic Imaging" Gray, Winkler, Stears and FrankReject/Repeat Location ______________________________
From: "Quality Control in Diagnostic Imaging" Gray, Winkler, Stears and FrankVisual and Manual Building: ___________________ Section:________________ Room #: ___________ Tube: _________
Pass = O Fail = F Does not apply - NA |