7/14/2010

Routine Ultrasound Equipment Tests for

Quality Assurance

James A. Zagzebski, Ph.D.

Ph.D.
Nick Rupert, M.S.
Ryan DeWall
DeWall,, M.S.
Tomy Varghese, Ph.D.
Dept. of Medical Physics
University of Wisconsin, Madison, WI, USA

Contents

• Elements of a Routine Test Program

• What system components are considered
most important in routine testing?

Concentrate on transducers!
• Steps to carry out tests on a regular basis
• Activity of Ultrasound Lab Accreditation
Groups
• Basic QA methods

Phantoms and tests

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Routine QA Program

• Guidelines available from US facility

accreditation bodies (ACR; AIUM)
• Emphasis is given to safety, cleanliness, and
very basic performance tests.
• Issues related to image performance, such as
spatial resolution, are not included (except
ACR breast).
• Traditional “parameters” such as distance
measurements are believed by many to be
unnecessary. Includedi n some protocols, but
only briefly.

Routine QA (ACR General US Program)

• System sensitivity and/or penetration capability

1999: Do for 2 probes (?)
• Image Uniformity

Look for element dropout
• Photography and other hard copy recording

2010: workstation monitor display
• Low contrast object detectability
• Assurance of electrical and mechanical safety
and sterility
• Verify measurement accuracy during program
initiation

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American College of Radiology Requirements:

General Sonography
• ACR physics committee developing this standard based it
on measurements using a phantom.

A phantom was selected (fall,1998) but turned out to be much
more costly than originally promised.

Physics Committee chose to leave the choice of phantoms to the
user

ACR staff published the following:
• “Using a phantom will be helpful in responding to questions
about low contrast detectability …. However, the use of a
phantom is optional at this time. Questions relating to
characteristics associated with system sensitivity and image
uniformity may be answered without the use of a phantom or
test object.”

American Institute of Ultrasound in Medicine:

General US QC
• 2008
• Originally called “QA in the
Clinic”

Sonographers and clinicians
helped draft
• Outlines what to do

Sonographers

Physicists/engineers
• Limited information on
methodology

Requires a phantom

Phantom left to users
• See www.aium.org

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American Institute of Ultrasound in Medicine:

General US QC

American Institute of Ultrasound in Medicine:

General Sonography (physicist, engineer)
• Transducer Uniformity

Phantom

Electronic probe tester
• Sensitivity, Maximum depth of visualization into a
phantom
• Distance measurement accuracy
• Target detection and imaging

Focal targets such as simulated cysts or low contrast objects

Choice of phantoms left to users
• Image display fidelity
• Cables OK, air filters clean, mechanical and electrical
inspection
• Minimum frequency

Annual for physicists/engineer tests

Program includes daily, weekly checks by sonographers

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Currently used materials:

 Water-based gels
Water-
 Advantages:
 Speed of sound = 1540
m/s
 Attenuation proportional
to frequency
 Backscatter
 Disadvantages:
 Subject to desiccation
 Must be kept in containers
 Requires scanning
window

Currently used TM materials:

• Solid, non
non--water
water--based
materials (urethane)
• Advantages
Advantages::
 Not subject to desiccation
 No need for scanning
window
 Produce tissue-like
backscatter
 Disadvantages:
 C= 1430-1450 m/s
 Attenuation not proportional
to frequency (~f1.6)
 Surface easily damaged if
not cleaned regularly to
remove gels

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Maximum Depth of Visualization

• Considered by many as a good

overall check of the integrity of
the system
• FOV at 18 cm (or set to match
the phantom)
• Output power (MI) at max
• Transmit focus at deepest
settings
• Gains, TGC for visualization to
the maximum distance
possible

Maximum Depth of Visualization

How far can you see the speckle pattern in the material?

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Objective Maximum Depth of Visualization

• Gibson, Dudley, Griffith, “A computerized Quality Control System for

B-mode Ultrasound,” Ultrasound Med Biol 27:1697
27:1697--1711, 2001.
• Shi, Al-
Al-Sadah
Sadah,, Mackie, Zagzebski, Signal to Noise Ratio Estimates
on Ultrasound Depth of Penetration (abstract only), Medical Physics
30: 11367, 2003.
30:
• Gorny,, Tradup,
Gorny Tradup, Bernatz,
Bernatz, Stekel,
Stekel, and Hangiandreou,
Hangiandreou, “Evaluation of
an Automated Depth of Penetration Measurement ofr the Purpose of
Ultrasonic Scanner Comparison”, (abstract only), J. Ultrasound Med
23: S76, 2004. MPV’
• Compute mean pixel value vs depth for phantom (signal) and for
noise only (noise)
(noise)
• Depth where signal/noise = 1.5 =DOP

SNR’-DOP tracks well Observer-DOP

Observers-DOP & SNR-DOP comparision (ATL C5-2)

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15

14

13
Depth (cm)

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11

10

8
Observer's DOP
DOP using SNR'= 1.5
7
0.0 0.2 0.4 0.6 0.8 1.0 1.2
Mechanical Index MI
(Al-Sadah, UW-Madison)

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Routine QA: Image Uniformity

 Considered to be
the most impor-
impor-
tant and useful
test!
 Ideally:

No evidence of
element dropout

No vertical
‘shadows’

No loss of
sensitivity near
edges

Uniformity

 Turn off spatial

compounding,
speckle reduction
 Use 1 tx focus
 Search for
“shadows”
emanating from
transducer
 Common in new
and old probes!

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Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

• Solution 1: rock transducer from side to side

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Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

• Solutside to side

Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

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Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

• Solution 2: Use a liquid TM material

Difficulties with Uniformity

• Coupling to a flat surface with curvilinear transducers

Sensitivity
1

0.8

0.6
Volts p-p

0.4

0.2

0
1 11 21 31 41 51 61 71 81 91 101 111 121
Elements

Electronic Probe test

• Solution 2: Use a liquid TM material (pseudo liquid TM

slurry; Madsen et al.)

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Difficulties with Uniformity

• Coupling to a flat surface phantom scanning window with

curvilinear transducers

• Solution 3: Use a phantom having concave windows

(Goodsitt et al)

Difficulties with Uniformity

• Visualizing 1-
1-2 element dropouts
• Use persistence; translate transducer.

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Difficulties with Uniformity

• Visualizing 1-
1-2 element dropouts
• Use persistence; translate transducer.

Difficulties with Uniformity

• Visualizing 1-
1-2 element dropouts
• Record Image loops while translating the transducer;
• Compress a 100 frame loop into 1 image (averages
speckle)
1 image

Ultrasonix SonixTouch

Enables masking off

individual elements

Elements 95 and 96
masked

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Difficulties with Uniformity

• Visualizing 1-
1-2 element dropouts
• Record Image loops while translating the transducer;
• Compress a 100 frame loop into 1 image (averages
speckle)
Average image

Ultrasonix SonixTouch

Enables masking off

individual elements

Elements 95 and 96
masked

Difficulties with Uniformity

• Visualizing 1-
1-2 element dropouts
• Use persistence; translate transducer
• Use Record Image loops while translating the transducer;
compress a 100 frame loop into 1 image (averages
speckle)
• Phased array transducer performance

Need electronic probe tester

Transducer test modes on the ultrasound instrument are possible;
manufacturers need to be encouraged to provide these
• Future 2-
2-D probes, probes that do part of the beam
forming within the probe housing

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Gray Scale Photography, Workstation

Fidelity
• Important for monitor on machine
to be set up properly to view all
echo levels available and entire
gray bar pattern.

Set up during acceptance testing

Take steps to avoid the “meat hook”
effect (mark or inscribe contrast and
brightness controls)
• Workstation monitors and/or
hardcopy devices should be
matched to the machine monitor.

AAPM, July, 2010

Check hardcopy, workstation displays.

Are all gray bar transitions visible?

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SMPTE Test Pattern

• Available on most
scanners
• 0% to 100% gray
bar pattern
• Squares for
detecting geometric
distortion
• Are all gray
transitions visible?

Distance Measurement Accuracy: Vertical

 Actual 2.5
 Measure 2.46
 error 1.5%
 Acceptable

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Distance Measurement Accuracy: Horizontal

 Actual 1.0
 Measure 1.01
 error <1%
 Acceptable

Routine QA (ACR General US Program)

• Distance Measurement Accuracy tests as needed

Necessary? (“Scanner is a transducer tied to a computer.”)

May be important for specific uses
• Images reregistered from 3-D data sets
• Workstation measurements
• Radiation seed implants

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ACR Recommended QC for Breast US

Maximum Depth of Semiannually Service eng./physicist
visualization
Vertical and horiz Semiannually Service eng./physicist
measurement accuracy
Hardcopy Recording Semiannually Service eng./physicist
Uniformity Semiannually Service eng./physicist
Elec-mechanical condition Semiannually Service eng./physicist
Anechoic void perception Semiannually Service eng./physicist
Ring down Semiannually Service eng./physicist
Lateral Resolution Semiannually Service eng./physicist
QC Checklist Semiannually Service eng./physicist
Adherence to infection After each biopsy Sonographer
control procedures
Clean transducers After each biopsy Sonographer
Vertical and horiz Quarterly Sonographer
measurement accuracy
Grey-scale photography Quarterly Sonographer

Dead Zone?

 No suitable targets for

dead zone testing,
even in phantoms
that advertise
deadzone tragets
tragets!!

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Anechoic Sphere Imaging, a better choice

Anechoic Sphere Imaging

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Image of a phantom is useful for qualitative

comparisons!

Conventional Spatial Compounding

Images obtained during routine Breast QC testing, 3/2010

Image of a phantom is useful!

Conventional Spatial Compounding

Images obtained 1 month later, after a software change;

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Routine QA: Cleanliness, safety

 Transducer Inspection

Delaminations

Frayed cables

Proper cleaning
 Console

Air filters

Viewing monitor, keyboard clean

Lights, indicators

Wheels, wheel locks

Proper cleaning

Summary

• Setting up, maintaining an equipment QA program is

straight forward
• The ACR listed procedures are a useful, basic QA
program

Directed by physicist or lab personnel

Integrated effort including lab and technical staff

Requires a Phantom

Closely correlates with AIUM list of factors to test
• Transducer uniformity is a frequent fault in today’s
scanning machines
• Computational methods can be developed for
objective tests

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References

• Goodsitt et al, “Real-

“Real-time B-
B-mode ultrasound quality control test
procedures”, Medical Physics 1998; 25:1385-
25:1385-1406.
• J Zagzebski, “US quality assurance with phantoms.” In Categorical
Course in Diagnostic Radiology Physics: CT and US Cross-
Cross-Sectional
Imaging, Edited by L. Goldman and B. Fowlkes, 2000, Oak Brook, IL:
Radiological Society of North America, pp. 159-
159-170.
• J Zagzebski and J Kofler, “Ultrasound Equipment Quality Assurance,”
in Quality Management in the Imaging Sciences, ed. By J Papp, 2002,
St. Louis, Mosby, pp. 207-
207-215.
• QA Manual for Gray Scale Ultrasound Scanners, 1995, American
Institute of Ultrasound in Medicine, Laurel, MA.
• D Groth et al, “Cathode ray tube quality control and acceptance
program: initial results for clinical PACS displays, Radiographics
2001, 21: 719.

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