Contents

1. Introduction
BASIC QUALITY CONTROL
IN DIAGNOSTIC RADIOLOGY

1. INTRODUCTION

Diagnostic Imaging is a multi-step process by which information concerning patient anatomy and
physiology is gathered and displayed with the use of modern technology. There are various sources of
variability in both human factors and equipment factors that can produce subquality images if not properly
controlled.

Sub quality images can result in decreased accuracy of image interpretation, repeat exposures that
increase patient dose, increase department cost. This in turn can result in decreased customer
(physicians, patients, employees) satisfaction, lost business & revenue.

2. PURPOSE

This document is designed to offer assistance and guidance to a radiologic technologist implementing
and operating a quality assurance program in diagnostic radiology. It is designed for implementation at
any level of service from a single unit that is infrequently operated to a large number of units operating at
maximum capacity in a large institution. The equipment and test tools described in the protocol are
simple, relatively inexpensive and easy to procure from several suppliers. This document is meant for
field use. It is hoped that a large number of institutions will use it and present criticisms and suggestions
for further improvement. Since we have had a broad based input to the document from many groups in
the field of Diagnostic Radiology, we desire that the protocol be considered as a product of the
Radiological Community. We hope that the interested groups in the field of Diagnostic Radiology will
endorse it and recommend its use.

DEFINITION OF QA/QC
Quality Control (QC) is a system of routine technical activities, to measure and control the
quality of the inventory as it is being developed. The QC system is designed to:
(i) Provide routine and consistent checks to ensure data integrity, correctness, and
completeness; (ii) Identify and address errors and omissions; (iii) Document and archive
inventory material and record all QC activities.
QC activities include general methods such as accuracy checks on data acquisition and
calculations and the use of approved standardised procedures for emission calculations,
measurements, estimating uncertainties, archiving information and reporting. Higher tier QC
activities include technical reviews of source categories, activity and emission factor data,
and methods.
Quality Assurance (QA) activities include a planned system of review procedures conducted
by personnel not directly involved in the inventory compilation/development process.
Reviews, preferably by independent third parties, should be performed upon a finalised
inventory following the implementation of QC procedures. Reviews verify that data quality
objectives were met, ensure that the inventory represents the best possible estimates of
emissions and sinks given the current state of scientific knowledge and data available, and
support the effectiveness of the QC programme.
3. QA/QC PLAN

A QA/QC plan is a fundamental element of a QA/QC system, and it is good practice to develop one. The
plan should, in general, outline QA/QC activities that will be implemented, and include a scheduled time
frame that follows inventory preparation from its initial development through to final reporting in any year.
It should contain an outline of the processes and schedule to review all source categories.
The QA/QC plan is an internal document to organise, plan, and implement QA/QC activities. Once
developed, it can be referenced and used in subsequent inventory preparation, or modified as appropriate
(i.e. when changes in processes occur or on advice of independent reviewers). This plan should be
available for external review.

The focus of QAQC Plan is on the processing, handling, documenting, archiving and reporting
procedures that are common to all the Radiology area. Table 3.1, QAQC Plan
Procedures, lists the general QC checks that the inventory should use routinely throughout the
preparation of the annual inventory. Most of the checks shown in Table 3.1 (per area) could be performed
by cross-checks, recalculation, or through visual inspections.

Table 3.1 ULTRASOUND MACHINE

Check the scanner console, transducers and
cable if there is any presence of ultrasound gel
and body fluids.
Check if the connected transducers are placed
in the probe holder when not in use.
Check if there are any tape, paper or foreign
body from the ultrasound equipment.
Check all fittings and accessories are mounted
correctly.
Check cables are not twisted and not at risk of
being run over by scanner or bed.
Monitors and probe holders are free of dust, gel
and etc.
Check operation of main scanner controls.
Inspect the transducers used during the session
for damage.
Inspect switches, knobs and other controls for
damage.
Inspect all probe, power and network cables for
damage including examination couch and
sockets.
Inspect the ultrasound system for damage such
as cracks and dents.
Test brake and wheel functions.
Check the availability of the equipment
operation manual.
Check that the monitor's brightness and
contrast controls have been appropriately
adjusted.
Check if the image quality is poor.
Room temperature/ Air-conditioned
X-RAY MACHINE
Power on/off is functional
Exposure switch is functional.
Check for table motor or cable problem.
Check for poor x-ray image quality.
Check collimator bulb, replace if busted.

Check if the mammogram machine is exposing.

Check table, cassette holders and grids for smooth
movement.

Check all parts if present and connected.

Check lead aprons for any defects.

Check for any loose panels or sections particularly on
the mounting of the collimator.
Manuals need to be kept in a safe designated area.
Check plugs, cables or socket for any form of
damage.
Check the red warning light if functional.
Warning signs are available in all areas with x-ray
emitting machine.
Room temperature/ Air-conditioned

MAMMOGRAM MACHINE
Power on/off is functional
Exposure switch is functional.
Check for poor image quality.
Check if theres dust or any forieng body on the top of
the potter-bucky and compression paddle.
Check collimator bulb, replace if busted.
Check if the X-ray machine is exposing.
Check all parts if present, connected and functioning.
Check lead aprons for any defects.
Manuals need to be kept in a safe designated area.
Check plugs, cables or socket for any form of
damage.
Check the red warning light if functional.
Warning signs are available in all areas with x-ray
emitting machine.
Check mammo cassettes
Room temperature/ Air-conditioned
CT SCAN MACHINE
Warm up the machine.
Room temperature/ Room humidity
Check laser alignment.
Check intercom system
Check lead aprons for any defects.
Check all fittings and accessories are mounted
correctly.
Check all parts if present and connected.
Inspect all power and network cables for
damage including examination couch and
sockets.
Inspect switches, knobs and other controls for
damage.
Manuals need to be kept in a safe designated
area.
Check plugs, cables or socket for any form of
damage.
Check the red warning light if functional.
Warning signs are available in all areas with x-
ray emitting machine.
Check emergency cart.

MRI MACHINE
Table position and other displays.
Laser Alignment
Horizontal smoothness of motion and stability
Vertical motion smoothness and stability
Patient camera
RF door contacts
RF window-screen integrity
Check all RF coils for damage and integrity
Operator console switches/ lights/meters
Patient monitor
Patient intercom
Room temperature/ Room humidity
Check emergency cart
Safety warning signage
Cryogen level indicator
Inspect switches, knobs and other controls for
damage.
Manuals need to be kept in a safe designated
area.
 DARKROOM
Cleanliness of the darkroom.
Check the temperature of the processing
solutions.
Check if all the solutions were maintained
and replenished.
Check if the processor was cleaned.
Check the level of water and processing
solutions.
Check for external scratches, breakage,
artifacts and defects on closure of cassettes
and intensifying screens.
Check if viewboxes are clean and light level
is kept consistent throughout.
Check for light leaks.
Check for room temperature/humidity.
Check if the rotation of film storage is
maintained.
Check the roller racks for signs of wear and
damage.

3.2 STAFFING CONSIDERATIONS

Routine (daily, weekly, and monthly) QC testing should be performed by a Radiologic technologist. This
testing is normally performed with simple QC instruments and phantoms..