Review components of a QA
program and show how they
apply to DR.
Understand how some
conventional tests should be
modified for a digital
radiographic system integrated
into an electronic image
management system.
Identify key references and
standards that can be useful in
QA of DR.
Quality Assurance
Quality Control
Medical
Maintenance
(scheduled)
(unscheduled)
(admin and technical
support services)
QA Committee
Policies and Procedures
Reject Analysis
Radiologist Film Critique
Operator QC Activities
Service Events
Technologist Inservice training
Medical Physicist QC Activities
Incident investigation/troubleshooting
Quality Control is
Most tangible aspect of QA
a series of distinct technical procedures
which ensure the production of a satisfactory
product.
Four major aspects:
Acceptance testing of new equipment or post
major repair
Establishment of baseline performance
Diagnosis of changes in performance before
radiologically apparent
Whats my motivation?
Regulatory Compliance
Title 12, Code of Federal Regulations (CFR) Part 20, Standards for Protection
against Radiation
State regulations http://www.tdh.state.tx.us/radiation/
Standards of Care
1Gray
JE, Archer BR, Butler PF, Hobbs BB, Mettler FA, Pizzutiello RJ, Jr.,Schueler BA,
Strauss KJ, Suleiman OH, and Yaffe MJ.(2005) "Reference Values for Diagnostic
Radiology: Application and Impact " American Association of Physicists in Medicine Task
Group on Reference Values for Diagnostic X-Ray Examinations. Radiology; 235:354-358.
Contrast
Resolution
Noise
Patient Dose
X
x
(x)
Voltage waveform
(x)
kVp
mA
X
x
x
(x)
(x)
mAs
(x)
SID
X
X
X
X
Field size
Scatter rejection
What is Acceptance?
Acceptance is a process whereby a customer
determines whether
newly installed imaging equipment is functioning as
designed,
kilovoltage (kVp)
tube current (mAs)
exposure duration (msec)
Total filtration (HVL) and leakage radiation are measured the same.
Lesson #1: Tests that rely on the receptor to assess generator performance must be modified.
Sensors in beam
No sensors in beam
Lesson #2. Tests that involve production of large amounts of radiation require
protection of the image receptor.
Input
Output
DEMI-RAD
Gain
Characteristic
Uniformity
Contrast
Sharpness
Noise
Artifacts
Dose
What is output?
software
Gain
Set technique factors according to
manufacturer specification
Measure/calculate the radiation
exposure to the detector
Measure the output of the system
Complications
Auto-ranging
Bucky factor
Fuji
S number, Sensitivity Number
1 mR at 80kVp => 200
200/S X
CareStream
EI, Exposure Index, (mbels)
1mR at 80kVp +1.5mm Al and 0.5mm Cu => 2000
+300 EI = 2X and 300 EI = 1/2X
Agfa
lgM, logarithm of the Median of the histogram, (bels)
20 Gy at 75 kVp +1.5mm Cu => lgM= 2.56
+0.3 lgM = 2X and 0.3 lgM = 1/2X
Konica
S value, similar to Fuji
GE
DAP, Dose Area Product, dGy-cm2
ESE, Entrance Skin Exposure, mGy, at 25 cm (default)
DEI (new)
Philips/Seimens/Thompson (Trexel)
DAP
EI, Exposure Index or Indicator, similar to S (Philips - exception)
EXI (Seimens exception)
Canon (exception)
REX, Reached Exposure Value, f(Brightness, Contrast)
EI (new)
Hologics (semi-exception)
Exam Factor, Center of Mass of log E Histogram, old
DAP and Accumulated Dose for exam, new
SwissRay
mA, sec, field size, kVp, no exposure indicator, old
New: similar to Agfa lgM
Auto-ranging
10000
1000
2
1.5
100
1
10
Intensity (rel)
Density (OD)
2.5
Film/screen
PSL
0.5
1
10
Exposure (mR)
67%
1
100
1023
Histogram re-scaling
High kV
L=2.2, S=50
Over-Exposed
Sensitivity (S)
0.1
EDR Signal
0
0.01
S=200, G=1.0
1000
S=180, G=0.9
S=220,G=0.9
S=180, G=1.1
100
S=220, G=1.1
67%
10
00.1 mR
0.1
1000 mR
10
Expos ure (m R)
Actually EXI
Exposure Indicator
from image of calibrated stepwedge, REX adjusted until
each step disappears
Canon CXDI-22
Change mAs
Stepwedge
700
Reached Exposure (REX)
Characteristic function
600
Measure output
Complications
500
400
y = 115.08x - 9.1053
R2 = 0.998
300
200
100
0
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Ex posure (mR)
hardening
Spectral dependence of
characteristic function
GE DR CT CHEST
80kVp no filter
80kVp 3/4" Al filter
16384
Code Value
14336
y = 1425.2x - 47.347
R2 = 1
125kVp no filter
y = 1042x - 30.611
R2 = 0.9998
8192
6144
4096
2048
0
0.000
10.000
15.000
20.000
Canon CXDI-22
2048
2048
1536
Pixel value
Pixel value
1536
1024
1024
512
512
0
0.01
0.10
1.00
10.00
Ex posure (mR)
Canon (Chest)
2048
1536
Brightness 26,
Contrast 12
1024
Brightness 16,
Contrast 10
512
0
0.01
0.10
1.00
0
0.01
0.10
1.00
10.00
Exposure (mR)
Pixel value
y = 199.14Ln(x) + 1233.7
R2 = 0.9953
10.00
Exposure (mR)
Flat-field
Using large Source-to-image Distance (SID),
produce a uniform input.
Inspect and measure the uniformity of the
output.
Complications
Heel effect: if possible, rotate detector 180o
Backscatter: Pb backing or tabletop
Fixed SID
Seibert JA, Boone JM, Lindfors KK. Flat-field correction
technique for digital detectors. Proc. SPIE 1998; 3336
3336: 348-354.
GE DR
Canon DR
(pretty ! )
Contrast resolution
Detector ability to distinguish features of similar
signal level
Contrast detectability
(darn!)
Lesson #6. A grayscale histogram is also helpful in assessing the receptor.
signal levels
Identical machine,
same exposure conditions
Pixel value
1536
1024
1st Floor
2nd floor
512
0
0.01
0.1
10X Exposure
100X
1
(m R)
10
Spatial resolution
f(digital matrix size), i.e. pixel dimensions
Nyquist frequency = sampling rate
lpxy=1/d 2
2d
Sharpness
lpx=1/2d
lpx
lpxy
d 2
2d
lpx 2
lpxy 2
lpy=1/2d
Swissray DR
Afterglow in fast-scan
dimension in CR
Modulation Transfer
Function (MTF) has
decreased to 10%
1/d 2
lpx 2 =
2d
1/2d
lpx
lpxy
lpxy
Noise
Primary, unavoidable source of noise in
radiographic imaging is quantum noise
Absolute magnitude of quantum noise
increases with 4D
Standard deviation of ROI is an
indication of noise
Complication
Non-linear Characteristic function
y = 2.795x -0.4937
R2 = 0.9983
SD mR/Ave mR
0.01
y = 0.0126x -0.4943
R2 = 0.9982
0.1
0.001
0.1
10
1/SNR
0.1
SD mR/mR
SD pixel
10
SD pixel
Power (SD pixel)
Power (SD mR/Ave
mR)
Exposure (mR)
DR Image
CT Image
95% CI
95% CI
A4
A4
200
200
A6
E1
E1
150
SNR
A1
100
18
E2
150
E2
I1
SNR
21
SNR (dB)
95% CI
250
95% CI
250
24
I10
100
A1
F12
50
A cceptance level at PS
15
7/29/1998
12
Log. (7/29/1998)
A6
50
I1
C3
I10
0
C3
0.1
10
100
C1
C1
0.1
10
De tector Expos ure (mR)
y = 2.4057Ln(x) + 19.987
R2 = 0.9984
9
6
0.01
0.10
1.00
10.00
Before calibration
100
C2
F12
C2
After calibration
Expos ure (m R)
New artifacts
from the discrete
nature of DR
Configuration management
Interference
pattern between
fixed grid lines and
down-sampling
rate for display
Disappeared on
zoom
Bad choices
Display default
magnification
factor
Line rate of grid
Main Department
Orthopedic Department
Entrance Exposure
Anthropomorphic phantoms
Erasure
Re-usable image media
(RIM)
Consequences of poor
erasure
Ghost structures
Noise
Immediately subsequent to
normal exposure, produce
image with no input and
high gain setting. Inspect
output.
Post calibration
S = 895, L = 1.6
S = 283, L=1.8
Imaging
Samei E, Seibert JA, Willis CE, Flynn MJ, Mah E, and Junck
exams
Take action based on the analysis
XQi C1
25
24
23
22
21
20
19
18
17
16
15
2/13/2002
9/1/2002
3/20/2003
10/6/2003
3 years
4/23/2004
11/9/2004
5/28/2005
12/14/2005
Date
A6 QAP data
y = -0.0023x + 104.85
R 2 = 0.2349
25
24
23
Spatial MTF at 2.5 lp/mm
22
21
20
19
18
17
16
15
3/20/03
2 years
6/28/03
10/6/03
1/14/04
4/23/04
8/1/04
Date
11/9/04
2/17/05
5/28/05
9/5/05
References:
Radiologist
Ultimate responsibility for quality of images
Department can provide only the lowest quality that is
acceptable to radiologist
Radiology Administrator
Responsible for efficiency of imaging operations
Clinical Engineer
Responsible for equipment life cycle management
Medical Physicist
No other person has image quality as first priority
Comprehensive
QC Plan for CR