Practical Aspects of Medical Physics Surveys of Mammography Equipment

and FacilitiesMelissa Martin, M.S., FAAPM, FACR, FACMP

AAPM Annual Meeting - PhiladelphiaJuly 19, 2010

MO-B-204C-1

Educational Objectives

To cover the annual tests to be performed by the medical physicist for both film/screen and digital mammography units

To discuss efficient methods of performing these required tests

To discuss the required tests for laser printers and monitors or processors and view boxes

Film/Screen MQSA Required Tests

Follow the tests outlined in the ACR 1999 QC Manual for Film/Screen Mammography

Physicists must use the Summary Forms from the ACR Website: www.ACR.org

Download forms for both Equipment Evaluations and Annual Surveys

FILM/SCREEN Summary Sheet

FFDM Equipment Evaluations and Surveys

At the present time, the FDA requires the physicist to use the FFDM Manufacturer’s QC Manual and Procedures.

Physicist must download the Summary Forms for both Equipment Evaluations and Annual Surveys from the ACR website for the particular manufacturer’s unit tested.

FFDM Equipment Evaluations and Surveys

Physicist must follow the latest version of the Manufacturers QC Manual procedures for the unit tested (may not be the latest version available from that particular manufacturer if the unit has not had the latest upgrade/update installed)

Test results must meet manufacturer’s performance standards

FFDM Equipment Evaluations and Surveys

Failures must be fixed before use on patients or within 30 days as specified for each particular test

GE, Fuji, Hologic and Siemens have received FDA Approval for alternative standards for some QC test results to allow 30 days to achieve compliance with manufacturer’s specifications

ACR’s Current FFDM QC Requirements

same as FDA’s ACR suggests using Manufacturer’s data

forms Medical Physicists MUST complete the

ACR’s Summary FormsIf the medical physicist passes a test, ACR accepts it.If the medical physicist fails a test, ACR requires corrective action documentation.If the medical physicist says NA or “see comments”, the ACR requests further clarification.

Lorad Selenia

LORAD Selenia QC TestsQC Manual tests: Medical Physicist Annually

Radiologic Technologist Daily Weekly Biweekly Monthly Quarterly Semiannually

Medical Physics Annual Tests Mammographic Unit Assembly Evaluation Collimation Assessment Artifact Evaluation kVp Accuracy and Reproducibility HVL Measurement Evaluation of System Resolution Breast Entrance Exposure and Glandular Average

Dose Radiation Output Rate Phantom Image Quality Evaluation Signal-To-Noise and Contrast-To-Noise

Measurements Viewbox Luminance and Room Illuminance Softcopy Workstation QC

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ACR Required Tests

The ACR does require specific tests, common to all vendors:

Weekly: Viewboxes and Viewing Conditions

Monthly: Visual ChecklistSemi-Annual: Compression force

Taken from the ACR Mammography Quality Control Manual 1999

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Test GE Fuji CR Siemens Hologic Fischer

Monitor Cleaning Daily

Laser Image Quality Test Weekly Daily

Daily and Weekly QC Tests(per Vendor)

Flat Field Calibration Weekly Weekly Weekly Weekly

Artifact Evaluation Weekly Weekly

Phantom Image Quality Weekly Weekly Daily Weekly Weekly

Phantom Acquisition Test Weekly

Signal-to-noise-ratio Weekly Weekly

Contrast-to-noise ratio Weekly Weekly Weekly Weekly

Viewbox and Viewing Conditions Weekly Weekly

Compression Thickness Indicator Test Bi-weekly

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Monthly and Quarterly QC TestsTest GE Fuji CR Siemens Hologic Fischer

MTF MeasurementDS/Essential –weekly

2000D - monthly

AOP Mode and SNR Monthly SNR Weekly SNR Weekly

System Resolution Monthly

System Operation Monthly

Visual Checklist Monthly Monthly Monthly

Repeat Analysis Quarterly Quarterly Quarterly Quarterly Quarterly

Compression Force Semi-annuallySemi-annually Semi-annually Semi-annually

Semi-annually

Soft Copy Workstation QC FDA guidance

FDA guidance FDA guidance FDA guidance FDA guidance

Laser Film Printer QC Per printer mfgPer printer mfg Daily Weekly

Mobile Unit QC At every move Unknown At every move At every moveAt every move

Image Plate FogSemi-annually

Laser Printer -must be able to print images on mammography

laser film

Laser Printer Quality Control SMPTE Pattern from Acquisition

Workstation Measure 10%, 40% and 90% Density

Patches Daily Performance40% density tracks within ±15% (40% - 10%) density tracks within ±15%90% density tracks within ±15%

NOTE: Printer uses linear LUT

OD Requirements for Hi-Resolution Laser Imagers

Dmax > 3.5 OD

Mid-density > 1.5 OD

Kodak daily sensitometry

Laser Processor QC

Base + Fog

Density Difference – OD closest to 2.20 minus OD closest but not less than 0.45

Mid-density – step closest to but not less than 1.20

Dmax

Action Limits:

MD & DD + 0.15 OD

B+Fog = 0.03

Dmax + 0.25

FDA Required Laser Printer QC GE 2000D & Senographe DS: Follow the laser

printer manufacturer’s QC manual Fischer Senoscan: Follow the laser printer

manufacturer’s QC manual Lorad Selenia: Follow the Lorad Selenia QC Manual Siemens Mammomat Novation DR: Follow the laser

printer manufacturer’s QC manual but conduct QC every day that images are printed.

Fuji MammoCR System: Follow the laser printer manufacturer’s QC manual

Viewing Conditions for Monitors

From the ACR QC Manual, 1999, the room illuminance must be below 50 lux.

From the February 2006 version of the Medical Physicist Equipment Evaluation forms from ACR, room illuminance for soft copy displays must be below 20 lux.

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Hologic QC tests on SecurView

Required testing is determined by monitor type CRT LCD (Flat panel)

CRT Manually perform QC tests using photometer on each

monitor to document the testing LCD

QC tests are set up to run automatically at night Technologist must check results and record

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Hologic QC tests on SecurView

CRT: Cathode Ray Tube

Weekly Calibration Settings

Check Measure Display White Measure Display Black

Monthly Measure Display Black Measure Display White

Quarterly Uniformity Measurement

LCD: Liquid Crystal Display

Weekly Automatic I-Guard Check Calibration Settings

Check Measure Display White

Monthly Measure Quality Level

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Softcopy Workstation QC

1 3 . D i a g n o s t i c R e v i e w W o r k s t a t i o n Q C

Date: 18-May-10

Review Station Model: SVDX-00400

Review Station SN: 29808071104

Left Monitor Right Monitor Comments

Monitor Serial Number 1890097709 1890097714 Barco 5K Monitors

White Level Performance 599.57 599.58 Target = 600 cd/sq m

Black Level Performance NA - LCD Monitors NA - LCD Monitors

Quality Level Performance OK OK Within 3% of 100% target

Uniformity Performance NA - LCD Monitors NA - LCD Monitors

Action Limit: The white level shall not be different from the monitor

calibration level by more than 6%. The quality level performance

shall not exceed 10%.

Phantom Image - Hologic Selenia FFDM Units

Review Weekly Phantom Image ResultsMeasured film densitiesPhantom objects seen (printer,

monitors)5 fibers4 speck groups4 masses

SNR and CNR MeasurementsACR Accreditation Phantom with

Disc (Weekly)Measure SNR and CNR from

ImageSelenia FFDM Units

SNR and CNR Measurements

Passing Criteria - Selenia FFDM UnitsSNR at least equal or greater than

40CNR should stay within ±15% of

measurement obtained during acceptance testing of system

GE Senographe FFDM Units

QC Manuals for GE Senographe FFDM Units

GE Display Systems

CNR Test for Senographe 2000D

MTF Measurement - 2000D

Artifacts

Physicist must test all Target/Filter combinations and both sizes of focal spots for artifacts

GE Senographe Essential

Large and Small Fields Require Collimation Assessment of all three positions of small field plus large field for both target materials

GE Senographe Essential Control Panel

Laterality must be selected prior to each exposure

GE Senographe Essential

Measure Entrance Skin Exposurewith Ion Chamber at 5 cm from outside edge of detector area.

Senographe DS & Essential

Seno DS & Essential -IQST Phantom

Tabs to position IQST with respect to chest wall edge of image receptor.

Rails to position the IQST left-to-right

Uniform area for noise power spectrum measurement

Step wedge for contrast measurement

Edge object for MTF measurement

Mesh for resolution uniformity measurement

Rulers for measuring distance of detector from chest wall edge of Bucky

QA Phantom OverviewGE Senographe DS &

Essential

AOP Mode and SNR Check

AOP Test Materials

AOP Phantom Techniques

AOP Expected Parameters

Fuji CRm System

CR Plate Reader

CR Plates

Fuji CRm System

Measure Exposure Rate at Surface of Breast Support

S-Value Confirmation

Fuji CRm System

Dynamic Range Test

Fuji CRm System - CNR Test

CNR PER OBJECT THICKNESS

Image Mode: Auto Time

Focal Spot: 3

Density Control: 0

AEC Mode: Auto Time

Phantom Thickness Target Filter kVp mAs (Auto)

mAs (Manual) CNR

CNR (relative to

4cm PMMA)

Acceptable level

2 cm Mo Mo 25.0 27.2 28.0 17.197 114.4% >110%

4 cm Mo Mo 25.0 135.0 130.0 15.030 100.0% 100%

6 cm Mo Rh 30.0 282.0 280.0 13.765 91.6% >90%

PASS

Exposure Unite ID: Lorad M-III

AEC-mode

Target Filter kVp

Exposure conditionsAuto Time Mo Mo 25

Group: Small Cassettes

Cassette IDmAs

Acceptable

SNR

Acceptable

A456, #3 132 Yes70.946 Yes

A234, #2 132 Yes70.952 Yes

A123, #1 132 Yes70.152 Yes

A222, #4 132 Yes70.166 Yes

A111, #5 132 Yes69.521 Yes

A777, #6 133 Yes69.662 Yes

mAs limit is plus or minus 10 % from mean.SNR limit is plus or minus 15 % from mean.

Inter Plate Consistency

Fuji CRm - Monitor TestsSite: Med. Img Ctr of So Cal Date of Survey: 4/19/2007

Room #: Reading Room Date of Installation: Apr-07

DOME©E5

Target Value = 500 cd/sq-m

499.2

Serial Numbers

Luminance Value Setting (cd/sq-m)

Left Monitor Right Monitor

703PNKN00028

500.88

703PNKN00011

Is the CXtra icon present in thetaskbar and shown as a green

check mark?

Manual Conformance report forboth displays attached?

Is DICOM calibration Graph forboth displays attached?

NoYes

Yes

Yes

No

No

Thank You !!!

Melissa C. Martin, M.S., FACRTherapy Physics Inc.

879 West 190 St., Ste 419Gardena, CA 90248

Office Phone: 310-217-4114e-mail:

Melissa@TherapyPhysics.com