Quality Assurance, Quality Control & Equipment Bushong Ch. 19 & 20 MAMMOGRAPHY QA Quality Assurance, Quality Control & Equipment Bushong Ch. 19 & 20 PURPOSE OF QC ASSURES OPTIMUM PATIENT CARE by avoiding unnecessary repeat exposures due to artifacts, processing problems and equipment failure Rev. Spring 2009/2010

EQUIPMENT DESIGN & OPERATION STANDARDS (DEDICATED UNITS) MQSA National Statistics FEDERAL LEGISLATION OCT. 1, 1994 EQUIPMENT DESIGN & OPERATION STANDARDS (DEDICATED UNITS) INTENSIVE QUALITY CONTROL PROGRAM Certification statistics, as of March 1, 2010   12,623 Certified facilities with FFDM2 units / Accredited FFDM units 5,402 / 7,963   Total annual mammography procedures reported, as of March 1, 20101 38,057,377   Percent of inspections with no violation 80.2% WHAT DOES MQSA REPRESENT? __________________ 1 This number is an aggregate of the total number of procedures performed annually as reported by facilities to

MAMMO & Quality Control Quality control is an equipment and processing evaluation program in diagnostic imaging centers. QC involves testing, record keeping and evaluation of imaging equipment and processing QC Team includes Radiographer/Mammographer, Physicists and Radiologist QA involves people – scheduling, reports, waiting time and follow up exams “double reads” See Bushong – CH. ____ PG ____

Elements of QC pg 333 FREQUENCY TASKS Daily Weekly Monthly/Quarterly Darkroom Clean Processor QC – sensitometry/densitometry and DEVELOPER temp Screen Cleaning VISUAL CHECK Phantom Images Repeat Analysis (should be less than 2% repeat rate - diagnostic rad = 5%)

MAMMO QC MONTHLY Checks SEMIANNUALLY DARKROOM FOG SCREEN/FILM CONTACT COMPRESSION NOT MORE THAN 40 PSI (25 PSI is average)

QUALITY CONTROL TOOLS PHANTOM DIGITAL THERMOMETER SCREEN CLEANER LINT FREE CLOTHS FIXER RETENTION TESTING KIT CHARTS

Hypo Retention Checks for what? Fixer left on film – “Archival Properties”

WIRE MESH Checks for what How long should you wait after loading a cassette to use it? 15 min & placed in an upright position

Check for leaks/cracks? Types of Safelights? Wratten 6b GBX Check for leaks/cracks? How often? Bulb Wattage?

For those still using film… clean crossovers daily Use “dedicated” processor for only mammo

Not calcifications in the breast VISUAL CHECKLIST MONTHLY FIXER RETENTION REPEAT ANALYSIS DARKROOM FOG SEMI-ANNUAL FILM/SCREEN CONTACT COMPRESSION (25 PSI) These specks were produced by flakes trapped between the film and the screen – Not calcifications in the breast

PHANTOM IMAGES 4/5 masses 3/4specks 4/6 fibers should be seen WEEKLY - to assure film density, contrast, uniformity and image quality are optimum – Using the SAME cassette and technical factors each time 4/5 masses 3/4specks 4/6 fibers should be seen (see pg 500 review book)

REPEAT ANALYSIS Mammography should be less than 2% Number of repeated film Repeat Rate = --------------------------- X 100 Total # of films Diagnostic Radiology = less than 5% Students = less than 10 %