Anda di halaman 1dari 183

(/.

J'

WHO/DIUOU
DISTRIBUTION: GENERAL
ORIGINAL: ENGLISH

Quality assurance
workbook
for
radiographers &
radiological technologists

by
Peter J Lloyd
MIR, OCR, ARMI~ Grad Dip FEd
Lecturer (retired),
School of Medical Radiation,
University of South Australia

Diagnostic Imaging and Laboratory Technology


Blood Safety and Clinical Technology
Health Technology' and Pharmaceuticals
WORLD HEALTH ORGANIZATION
Geneva
© World Health Organization, 2001

This document is not a formal publication of the World Health Organization (WHO), and all
rights are reserved by the Organization. The document may, however, be freely reviewed,
abstracted, reproduced and translated, in part or in whole, but not for sale for use in
conjunction with commercial purposes.

The views expressed in documents by named authors are solely the responsibility of those
authors.

Designed in New Zealand


Typeset in Hong l<ong
Printed in Malta

2001/13663- minimum graphics/Best Set/Interprint- 3000


Ill

Contents

Introductory remarks vii

Acknowledgements viii

Introduction 1
Purpose of this workbook 1
Who this workbook is aimed at 2
What this workbook aims to achieve 2
Summary of this workbook 2
How to use this workbook 2
Roles and responsibilities 3

Questionnaire-student's own department 5

Pretest 7

Teaching techniques 10
Overview of teaching methods in common use 10
Assessment 10
Teacher performance 12
Suggested method of teaching with this workbook 12
Conclusions 12

Health and safety 15


Machinery 15
Electrical 15
Fire 15
Hazardous chemicals 16
Radiation 16
Working with the patient 17
Disaster 17

Module 1. Reject film analysis 19


Setting up a reject film analysis program 19
Method 20
Analysis 20
Action 20
Tasks to be carried out by the student 24

Module 2. Accessory equipment 29


Collimator 29
Cassettes and intensifying screens 31
Grid 35
Lead rubber aprons and gloves 37
QUALITY ASSURANCE WORKBOOK
IV

Viewing box 38
Patient positioning aids 40
Patient measuring callipers 41
Tasks to be carried out by the student 44

Module 3. X-ray equipment 56


Choosing X-ray equipment 56
Acceptance of new X-ray equipment 57
Generator 57
X-ray tube, column, table and upright bucky 63
Tomography 65
Potter bucky 68
Portable and mobile X-ray units 70
Tasks to be carried out by the student 73

Module 4. Manual film processing 78


The darkroom 78
Film and chemical storage 81
Film processing 83
Tasks to be carried out by the student 95

Module 5. Automatic film processing 107


Choosing an automatic processor 107
Use of an automatic processor 108
Processor maintenance schedule 109
Sensitometry 112
Tasks to be carried out by the student 120

Module 6. Radiographic exposures 124


Exposure chart 124
The step system 126
Tasks to be carried out by the student 127

Appendix A. Mal<ing simple test tools 133


Water phantom 133
Aluminium step wedge 133
Film/screen contact test tool 134
Spinning top timer test tool 134
Measuring callipers 135
Tomography test tools 136
X-ray beam/grid alignment test tool 137

Appendix B. Graphs, checl< sheets and record sheets 138


Reject film analysis 138
Remedial action record 141
Collimator check records 142
Record of all cassettes 143
Cassettes and screens 144
Lead rubber aprons and gloves 146
Viewing box 147
Fault report 148
Equipment record 149
Equipment maintenance and repair log 152
CONTENTS
V

X-ray unit 153


Constancy of radiation output at different mA settings 155
Darkroom inspection checklist 156
Specific gravity/temperature graph 157
. Automatic film processor 158
Processor maintenance checklist 160
Developer activity chart 161
Characteristic curve chart 162
Quality control processing chart 163
Exposure chart 164

Post test 169

Glossary 172

References 175
r
VII

Introductory remarks
This document, which is developed by the International Society of Radiographers and Radiological Technologists
(ISRRT) under the umbrella of the WHO Global Steering Group for Education and Training in Diagnostic Imaging,
is the first in a series targeting technical aspects, including quality control of diagnostic imaging services. The
document is primarily aiming at assisting radiographers and radiological technologists working in small and mid-
size hospitals where resources often are limited, to optimize and improve diagnostic imaging, and to ensure the
best possible use of resources according to local needs.
The document is distributed free of charge and can be obtained by contacting the following address:

Team of Diagnostic Imaging and LaboratoryTechnology <DIU,


World Health Organization
20, Avenue Appia
CH-1211 GENEVA 27
Switzerland

Fax: +41 22 7914836


Tel: +41 22 7913648
e-mail: ingolfsdottirg@who.ch

Harald Ostensen, MD
Geneva, April 2001
VIII

Acknowledgements
Profound thanks are offered to everyone in Kenya who provided their wholehearted assistance, co-operation and
enthusiasm in helping to produce this first workbook on quality assurance and pilot its implementation.

Thanks in particular to:

Kenya Ministry of Health


University of Nairobi
Nairobi Medical Training College
Kenya Association of Radiologists
Kenya Association of Radiographers
Kenyatta Hospital, Nairobi
and all other hospitals and government departments and individuals who participated in the initial research.

Than I< you very much Asante sana

Thanks also to all the people who assisted me in the production of this workbook:

Roger Wind le, University of South Australia.


R.ronda MilleG University of South Australia.
Dean Hogben, Royal Adelaide Hospital.
Michael FulleG Flinders Medical Centre.
David Lesley, South Australian Radiation Protection Branch.
Steven Johnson, South Australian Radiation Protection Branch.
Graham Truman Rtd, Adelaide Womens and Childrens Hospital.
Michael Canavan, Agfa-Gevaert Ltd.
Graham BlucheG Hanimex Pty Ltd.
Kenneth Gifkins, Kodak (Australasia) Pty Ltd.
Introduction

The World Health Organization (WHO) was founded Purpose of thjs workbook
in 1948 and is a specialised agency of the United
It is preferred to call this a workbook rather than a
Nations. It promotes technical eo operation for health
manual or textbook, because the intent is to, not only
among nations, carries out programs to control and
give technical information, but to set practical exer-
eradicate disease and strives to improve the quality of
cises that students can work through, responding to
human life. WHO has four main functions:
specific questions. Above all, the students should feel
• To give world wide guidance in the field of health. that they have actually carried out the tasks them-
• To set global standards for health. selves and will be more confident to teach others and
• To co-operate with governments in strengthen- ensure that these exercises continue to be carried out
ing national health programs. in their respective areas.
• To develop and transfer appropriate health tech- The topic of this workbook is quality assurance, so
nology, information and standards. all material is designed to assist in the maintenance
of the highest quality of work that can be achieved,
The WHO definition of health under the prevailing conditions.

"Health is a state of complete physical, mental and


social well-being and not merely the absence of
disease or infirmity." Quality assurance
The overall management program, put in place
The International Society of Radiographers and Ra-
to ensure that a comprehensive range of quality
diological Technologists <ISRRT) was formed in 1959
control activities work effectively.
to act as a link between radiographers and radiologi-
cal technologists throughout the world. The Society is
Quality control
dedicated to the improvement of standards of prac-
The means bywhich,each area of interest is moni-
tice in radiation medicine technology. It is a non-
tored and evaluated.
political organisation and is not a trade union. It is a
not-for-profit organisation.
The ISRRT is recognised as the international repre-
A Quality Assurance Program should be comprehen-
sentative of radiation medicine technology through-
sive, looking at all aspects of the work involved in pro-
out its official relationship as an international
ducing high quality radiographs. This program should
non-governmental organisation with WHO. It also has
be cost effective and achieve its aims.
association with the United Nations and other organi-
The ultimate responsibility for setting up, running,
sations such as the International Society of Radiology,
evaluating and taking remedial action lies with the head
the European Society of Radiology, and the Interna-
of department, although appropriate delegation may
tional Commission for Radiological Education.
be necessary. It is important that someone accepts that
WHO recognised the need to improve the standards
responsibility and ensures that the program happens
of radiation medicine throughout all regions of the
effectively.
world. ISRRT; as part of this project, has entered into
This workbook will be used by radiographers
an agreement with WHO to produce a number of radi-
who are being trained through a Centre of Excellence
ography technical workbooks, on various topics, for use
to:
in developing countries. This workbook on quality as-
surance is the first of these books. • achieve a good working knowledge of quality
Kenya was the country chosen to pilot the project. control routines.
QUALITY ASSURANCE WORKBOOK
2

• return to their respective areas after completed • Provide a comprehensive knowledge, advice and
training to teach other members of their staff to experience in quality control methods.
carry out the routines that they have learned. • Provide the knowledge and skills to carry out basic
care and maintenance of imaging equipment.
In this way it is hoped that quality assurance will be
• Raise standards.
practised routinely and effectively.
• Reduce imaging costs.
• Improve job satisfaction.
If so: • Improve health and safety issues.
• Heads of departments will find that the stand-
ard of radiography will be maintained at the high- Summary of this workbook
est level.
This workbook contains:
• Work environments will be improved.
• Tasks will become easier. • Background information.
• Repeat films will be kept to a minimum. • A questionnaire seeking information about each
• Staff job satisfaction will increase. students own department.
• Patients will receive less radiation and less • A pre test of student's knowledge.
inconvenience. • Advice on teaching methods.
• There will be fewer equipment failures. • Health and safety issues.
• Costs will be kept down. • Six modules giving technical information
• A record and audit trail will exist as proof of high regarding effective routines and quality control
standards. techniques.
• Each module contains relevant tasks the student
Achieve some of these and this worl<book has been
must perform.
worth while!
• How to make simple test tools.
• Copies of quality control documentation.
Who the workbook is aimed at • A post test of student's knowledge.
This workbook is aimed directly at radiographic staff • Glossary of terms.
members of any X-ray department, who: • Reference list.
• A feedback questionnaire.
• are considered to have an adequate background • A final assessment of student performance dur-
and training in radiography, ing the course.
• are concerned about the need to achieve the high-
est possible standards,
• have the ability and interest to learn and to teach How to use this workbook
others. Once a radiographer ha,s been selected and training
Indirectly this workbook is aimed at all radiographic dates set, this workbook should be made available to
and darkroom staffs through the selected member of the student at least two weeks in advance of the com-
staff chosen to undergo the initial training. mencement of the training period, so that adequate
Heads of departments selecting the member of pre reading and discussion can be carried out.
staff who is to undergo training should consider the The student must be encouraged to discuss the con-
personal attributes of their staff members and nomi- tent of the workbook with other members of staff
nate the person who is most lil<ely to achieve all of the during this pre reading period.
aims. The section headed STUDENT'S OWN DEPARTMEN1
must be completed by the student before commence-
ment of the course. This takes the form of a question-
What this workbook aims to achieve naire which, when completed should give the tutor a
• Increase awareness, interest and understanding background knowledge of the student and their work
of quality assurance issues. environment. This background information will allow
• Enable radiographers to establish and continue the tutor to apply the correct emphasis when provid-
to carry out an effective quality assurance ing and supervising the training.
program. The student must complete a PRE TEST prior to
starting the course. This is an assessment of the stu-
INTRODUCTION
3

dent's relevant knowledge before the course. This will Roles and responsibilities
be compared to the results of a similar POST TEST
The Head, Centre of Excellence
completed by the student after completion of the
course. These tests are for student information and The Head, Centre of Excellence will:
course evaluation only and are not used in student • Hold the overall responsibility for the organisa-
assessment. tion and presentation of the training program
The section on TEACHING TECHNIQUES first gives related to this workbook.
a broad overview of teaching methods. This is followed • Be responsible for the selection of suitable tu-
by the recommended approach to teaching with this tors and ensure that they are fully trained and
workbook. Both tutor and student should read this aware of their obligations.
section. • Ensure that all necessary facilities and equipment
The section on HEALTH AND SAFE1Y draws atten- are available.
tion to all the health and safety issues appropriate to • Arrange for workbooks to be in the hands of
an X-ray department and how to make the work envi- students at least two weeks before they start
ronment a safe and healthy one. their course, for pre reading and discussion with
The workbook is divided into modules. colleagues.
• The student should work through one module at • Ensure that all training related to this workbook
a time, studying the technical information and is carried out satisfactorily.
testing methods. • Receive, review and sign all completed workbooks
• At the end of each module, tasks have been set. and return them to the tutor for onward trans-
The student must carry out each task and an- mission to the student.
swer the questions asked. • Take any necessary action arising from completed
- The tutor will assess the completed tasks and workbooks 1 student performance or student
answers, adding any appropriate comments. behaviour.
- A Satisfactory/Unsatisfactory grade will be • Review the feedback questionnaire/ completed by
given. the student1 and take any appropriate action.
- All Unsatisfactory exercises must be repeated • Give feedback to the tutor.
before beginning the next module. • Arrange for follow up checks to be carried out1
after a suitable period of time1 on each student
All necessary equipment will be provided by the Centre
and what they have achieved in their own de-
of Excellence. The tutor will ensure that the student
partment since completing the course.
understands the technical information given in the
• Evaluate follow up reports and take any neces-
workbook and will supervise and advise during the
sary action.
practical exercises.
The APPENDICES contain information on making
simple test tools, report forms, record sheets, test re- The tutor, Centre of Excellence
sult sheets and exposure charts, for use in the student's Each student will be allocated a tutor from the staff
own department. of the Centre of Excellence. The tutor will:
The GLOSSARY contains a list of terms, found in the
text, with meanings. • Be responsible for students to whom they have
The REFERENCES provide a source of further been allocated.
reading. • Be readily available to students during their
The POSTTEST must be answered on completion of training.
the course. • Supervise and teach students during their
The FEEDBACK QUESTIONNAIRE must then be training.
completed and the workbook handed to the tutor for • Familiarise his/her self with the workbook, in
final assessment and handing on to the Head, Centre particular the section on teaching techniques.
of Excellence, for final approval. • Formulate a strategy for teaching this course and
The workbook will then be handed back to the stu- implement it.
dent who will use it, on returning to their own depart- e Read the questionnaire STUDENT'S OWN DE-
ment, to train other members of staff and to ensure PARTMEN~ completed by the student1 and de-

that a quality assurance program is established and vise an appropriate training program.
carried out on a regular basis. • Ensure that all necessary equipment is available.
QUALITY ASSURANCE WORKBOOK
4

• Ensure that the training program is carried out. STUDENT'S OWN DEPARTMEN~ before starting
• Evaluate all tasks carried out by the student and the course.
write appropriate comments and a grading at the • Carry out the PRETEST immediately before start-
end of each task sheet. ing the course.
• Ensure that tasks graded "Unsatisfactory" are • Attend all scheduled teaching, practical and ad-
repeated before the student progresses to the ministrative sessions.
next module. • Complete all modules, by first reading the tech-
• Mark pre and post course tests, completed by the nical information, carrying out the allotted tasks
student, and make the student aware ofthe results. under the supervision of their tutor, and then
• Write a final report on the student's performance. answering the questions.
• Submit the student's completed workbook to the • Submit the workbook to the tutor; for evaluation,
Head, Centre of Excellence for final approval. upon completion of each task.
• Return the workbook to the student. • Repeat any task assessed as "Unsatisfactory"
• Give adequate feedback to the student. before progressing to the next module.
• Ensure that the student is fully aware of their • Carry out the POSTTEST immediately upon com-
responsibility to teach the course topics to fel- pletion of the course.
low staff members on returning to their own e Complete the FEEDBACK QUESTIONNAIRE.
department. • At the end of the training period, and when all
• Discuss with and advice students on how to carry tasks have been satisfactorily completed, hand
out their own training programs. the workbook to their tutor for final evaluation
• Advise the student that a follow up check will be and submission to the Head, Centre of Excellence
made to assess the benefits of the course. for formal approval. The workbook will be
returned.
• On return to their own department, use the work-
The student
book and newly gained knowledge and expertise
The student will: to establish a quality assurance program and train
• Complete all pre reading, discuss the material colleagues, under the direction of their Chief
with colleagues and fill in the questionnaire, Radiographer.
5

Questionnaire
Student's own department

In order for this course to meet your needs, your tutor must know something about the department in which you
worl<. Please answer the following questions in the spaces provided, before you commence the course.

l. How many X-ray examination rooms are there?


-----------------------------------------
2. Tell us what X-ray equipment you have. e.g. general purpose table with bucky etc.

ROOM 1

ROOM 2

ROOM 3

3. Tell us what accessory equipment you have. e.g. Cassettes, positioning pads etc.

4. How many darkrooms are there?


---------------------------------------------------
5. State the type of film processor in each darkroom. e.g. manual/auto, type, make, model, processing cycle.

DARKROOM 1

DARKROOM 2
QUALITY ASSURANCE WORKBOOK
6

DARKROOM 3

6. How many staff act as radiographers? Qualified radiographers _ _ _ Others _ __

7. Is there an "out of hours service"? YES/NO

8. How many darkroom technicians are there?


-----------------------
9. Do you already run any form of Quality Assurance Program? YES/NO

10. If YES state here what you do

11. List any quality control test tools you have

12. If you have any quality assurance issues you particularly want covered, state them here

13. Give an indication of how busy your department is. Number of examinations per year/week/day _ _ _ __

14. Summarise the types of examinations carried out. e.g. extremities, chest, spine.

Thank you
7

Pretest

This test must be completed by the student before start- 3. Reject film analysis means?
ing the course. The intention is to test your knowledge a) To ask the radiographers how many films
on the topics covered by this worl<bool< before the were repeated that day.
course.
b) A detailed study of film wasted over a pe-
You will be tested again when you have completed
riod of time.
the course so that you have an idea of how much you
have learned. c) Counting all the films accidentally fogged in
The results of these tests are for information only the darkroom.
and will not affect your course result.
4. A grid ratio is?
Instructions a) Ratio of the width of a grid to its length.

This is a multiple choice test. In each question you are b) Ratio of the height of the lead strips to their
given three possible answers. length.
Read each question carefully. c) Ratio of the height of the lead strips to the
Indicate the answer that you feel is the most accu- distance between them.
rate by placing an "X" in front of the letter preceding it.

Example: 5. A stationary grid is?


A personal radiation monitor (TLD) should be worn a) A grid that is fitted in a bucky.
a) Outside a lead rubber apron. b) A grid that can be carried around.
X b) Under a lead rubber apron.
c) A series of shelves for filing papers.
c) There is no need to use one when wearing a
lead rubber apron.
Answer: b) 6. To test for poor film screen contact:

All questions must be answered a) X-ray a lot of paper clips on the face of the
cassette.
l. What is meant by the term "quality assurance"? b) Open the cassette and look.
a) The equipment is covered by an insurance c) Place a sheet of fine wire mesh inside
policy. the cassette with the film and make an
b) Everyone must produce perfect films. exposure.

c) A system which attempts to maintain a high


quality of work all round. 7. To check if the light field and the X-ray field of a
collimator are correctly aligned:

2. What is meant by the term "quality control"? a) Look into the collimator mirror.

a) A practical exercise which carries out qual- b) Open and close the collimator shutters
ity checks. rapidly.

b) A staff member who supervises quality. c) Place metal markers on the face of a loaded
cassette to indicate the light field and make
c) An X-ray machine system that gives the cor-
an exposure.
rect exposure.
QUALITY ASSURANCE WORKBOOK
8

8. The coincidence of the X-ray and light fields of a 15. Stock rotation, related to film storage, means:
collimator are said to be acceptable when: a) Turning the film boxes around.
a) The X-ray field is 15 mm inside the light field b) First in first out.
at lOOcm FFD.
c) First in last out.
b) The X-ray field is 3 mm outside the light field
at lOO cm FFD.
16. A characteristic curve:
c) The X- ray field is 8 mm inside the light field
at lOO cm FFD. a) Determines the shape of an object.
b) Represents the characteristics of the
developer.
9. The wattage of a light bulb in a darkroom safelight
facing down should be: c) Is a graphical representation of the relation-
ship between the exposure received by the
a) 15 watts.
film and the density produced, following
b) 50 watts. processing.
c) lOO watts.

17. Safelights facing down should be installed:


10. Static electricity: a) No less than l30cm above the workbench.
a) Produces an overall grey fog on processed b) No less than lOO cm above the workbench.
film.
c) At least 150 cm above the workbench.
b) Produces black lightning like marks on proc-
essed film.
18. Automatic processing developer temperatures
c) Reduces the effect of the intensifying
should be:
screens.
a) 20°C.
b) 25°C.
11. A densitometer:
c) 35 °C.
a) Accurately assesses film density.
b) Determines the efficiency of lead rubber.
19. In manual processing the film should be:
c) Determines the light output of intensifying
screens. a) Agitated every 30 seconds in the developer.
b) Placed in the developer and not touched until
the timer sounds.
12. A Sensitometer:
c) Agitated by moving the film sideways.
a) Is a motion detector.
b) Is a radiation detector.
20. In manual processing, when transferring the film
c) Is a device for making test strips used in
from the rinse to the fixer, the film should be
film processor monitoring.
drained into:
a) The rinse.
13. Fixing time in manual processing should be:
b) The fixer.
a) Two minutes.
c) Doesn't matter.
b) Twice the clearing time.
c) Twenty minutes.
21. In addition to a visual safelight check you should:
a) Hold an unexposed film against the safe light
14. X-ray film should be: for one minute.
a) Stored at a temperature of 10 o to 20 °C. b) Expose sections of a film to safelight for pro-
b) Stored lying flat. gressively longer times.
c) Handled only in total darkness. c) Stand in the centre of the darkroom hold-
ing a film for one minute.
PRETEST
9

22. If the lid has accidentally been left off a box of 27. Replenishment rates in automatic processors are
unexposed films in white light: checked by:
a) Throw all the films away. a) Catching the amount pumped in a gradu-
b) Put the lid back on and do nothing until ated flask.
someone tells you their films are fogged. b) Asking the manufacturer.
c) Process three films and inspect. c) Measuring the drop in level of the replenish-
ment bottle/tank.

23. The First Aid treatment for a processing chemical


splash in the eye is: 28. To check that a generator always gives the
a) Blink continuously for 30 seconds. same output when using the same exposure
factors:
b) Wash thoroughly.
a) Watch the mA meter during the exposure.
c) Wipe the eye with a tissue.
b) Expose three separate on the same film,
using the same exposure factors.
24. The test to determine optimum development time
cl Expose three different cassettes using the
is:
same exposure factors.
a) Develop test strips for differing times and
compare.
29. A spinning top test is used to:
b) Develop an unexposed film and inspect.
a) Check the accuracy of the timer.
c) Develop test strips for the same length of
time. bl Check the accuracy of the mA.
cl Check the accuracy of the kV.

25. When shutting down an automatic processor:


a) Clean crossovers and leave lid partially lifted. 30. To test for constancy of t·adiation output of an X-
ray unit:
b) Switch off and leave it.
a) Make several exposures using a different kV
c) Turn water off only.
each time.
bl Make three exposures keeping the kV the
26. Developer temperature should be checked: same1 but vat·ying the mA.
a) Only when film densities look different. cl Make three exposures keeping the kV and
b) Once a week. mAs the same but varying the mA and
c) Daily. time.
10

Teaching techniques

How you teach a subject is very important. The most Demonstration


highly sl<illed and knowledgeable person can fail to pass • Given by the teacher to illustrate a particular
on the necessary information to students by not using point.
the correct teaching sl<ills or methods. • May be carried out as a supplement to a lecture
Following is a broad coverage of teaching methods, or tutorial or an introduction to a practical.
some of which will be appropriate to your situation
and others not. Role P.lay
You should consider how you may perform and what • Students act out specific sets of circumstances.
method you will use. Choose a method suited to your
subject and what you aim to achieve. Reading
Planning is all-important. Research your topic well. • Students are given topics or specific references
to read up on.
• Often used as a preliminary before a tutorial or
Overview of teaching methods in
instead of a lecture.
common use
Methods of presentation Self directed learning
Lecture • The student is given the topic and the expected
• Stand or sit in front of a class and verbally give outcome.
the relevant information. • The student does their own research and prob-
• Suitable for large and small classes. lem solving.
• Rather inflexible. • Exchange of information and group problem solv-
• Can be boring. ing is encouraged.
• Audio visual aids can be used. • Usually followed up by a tutorial and a written
• Printed notes can be given out in support of the confirmation of the student's knowledge.
spoken word.
Context based learning
Tutorial • Problem solving, in groups.
• More informal than the lecture.
• Suitable for smaller classes. Presentation
• Students are encouraged to present material and • The student researches the topic and gives a talk
enter into group discussion. to other students.
• The teacher acts more as a facilitator. • The teacher acts as facilitator and assessor.
• Participants can sit around a table or in a circle.
• Feedback is important. Assignment
• The student researches a set topic and hands up
Practical a written presentation to the teacher.
• Students carry out a practical exercise under
teacher supervision. Workbook
• Verbal or written instructions may be made avail- • A specialised book that poses questions and/or
able to the student. sets practical tasks.
• The practical should be relevant to recently ac- • Answers are generally recorded in the book.
quired information.
TEACHING TECHNIQUES
11

Book review • In the case of a practical, ensure before hand


• To encourage students to read certain books. that it will work.
• The student is asked to present a written sum-
mary and comment on the book. Running a practical
• Identify each piece of equipment.
Posters • Explain the procedure.
• Can be done in work groups. • Outline the aim.
• May be used as teaching material at a later stage. • Demonstrate if necessary.
• Could be displayed in department to convey • Identify likely problems.
information. • Observe student carrying out the task.
• Comment as necessary.
• Be available to assist or answer questions.
Presentation technique
In any form of presentation by a teacher to a class, the Feedback to the student
following points should be considered: Following any learning activity performed by the stu-
• Stand or sit where students can see you. dent, the teacher should give feedback to the student
• Address them clearly. regarding their performance.
• Use language they can understand. • Mark I grade achieved.
• Present your facts logically. • Method.
• Speak directly to the class. • Content.
• Cast your eyes around the class as you speak. • Technique.
• Use visual aids where necessary. • Performance.
• May use flip charts. • Presentation.
• In a tutorial or practical situation the teacher • Or whatever is appropriate.
acts largely as a facilitator.

Assessment
Teaching aids
• 35 mm slides. • Written examination.
• Overhead projection COHPJ. - Multiple choice.
• Video - Short answer.
• White Board I chalk Board - Essay.
• Butchers paper. - Numerical answer.
• Models, - Problem solving.
• Charts. - Open book.
• Radiographs. - Fill in a missing word.
• Pieces of relevant equipment. -Tick a box.
• Printed notes. • Practical task (written question and answer).
• Practical task (teacher observed-must have a
Preparation pre-determined mark sheet).
• Select the topic. • Assignment.
• Research the topic. • Book review.
• Assess the educational and technical level of the • Oral examination.
students.
• Decide on the breadth and depth of the material
Grading student work
to be covered.
• Select the method of teaching to be used. • Written.
• Select the teaching environment. • Verbal.
• Prepare relevant teaching notes. • Practical.
• Prepare relevant teaching aids.
• The length of the session must match the time Forms of grading
slot available. • Pass I Fail/Referred.
• The amount of material to be presented must e ABCDEF
match the length of the time slot. - Where A is the highest and F is the lowest.
QUALITY ASSURANCE WORKBOOK
12

- A to E are graded passes. Sample evaluation puestionnaire of


- E to F are graded fails. teacher performance
• Distinction I Credit I Pass I Fail. • Were you able to hear? YES I NO
• Marks out of 100. • Did the teacher start and finish
• Marks out of 10. on time? YES I NO
• Combined projectCs)/examCs) e.g. 50%/50% or • Was the material presented in a
25%/25%/50% logical way? YES I NO
• Satisfactory/Unsatisfactory. • Was the material covered
• No grading, the student simply attends classes adequately? YES I NO
and completes all work set. • Was the presentation carried
• Outcome based out satisfactorily? YES I NO
• Can the student perform a task satisfactorily. • Was the attitude of the teacher
• The student must be made aware of the grading satisfactory? YES I NO
system. • Were the aim and objectives of
• The student must be made aware of the results the course achieved? YES I NO
of any assessment. • Further comment:
• The teacher must allocate marks to the various
parts of the material before marking Takes
place.

Teacher performance
• Instead ofYES I NO the student could be asked
• Start and finish on time.
to choose from the following:
• Plan content to fit the time frame.
- Excellent.
• Encourage questions.
-Good.
• Speak clearly.
- Acceptable
• Maintain a friendly discipline.
- Needs improvement
• Be well prepared:
- Knowledge.
- Notes. Conclusion
- Teaching aids. • This section has set out to give you an overall
• Mark all work fairly and accurately. insight into teaching.
• Return all marked work as soon as possible. • Much of the material given will not directly apply
• Give feedback. to your situation.
• Regularly look around your audience. • You must choose what you feel is relevant to you
• Humour is a useful tool if used properly. and carry out your teaching to suit your own needs
• Don't be sexist, superio~ aggressive or con- and those of the student.
descending.
Suggested method of teaching with
How good are you at teaching? this workbook
This book sets out to give the relevant information on
Some ways of understanding how you perform as a
the topics listed in the contents, regarding quality
teacher:
assurance, then sets simple tasks that students are
• Evaluation questionnaire filled in by the student expected to carry out, responding to any questions
at the end of a class or series of classes. asked. The teaching method used should therefore be
• Ask someone to watch you teach and give you practically oriented.
feedback.
• Watch student reaction during a class.
The tutor
• Videotape a lecture, view it and then evaluate
yourself. A tutor using this book must:

• Become thoroughly familiar with the book.


• Understand its contents and know how to per-
form all tasks set.
TEACHING TECHNIQUES
13

• Know the answers to all questions asked. weeks before they start the course, for pre read-
• Understand and be able to run practical exer- ing discussion with colleagues and completion of
cises and carry out any other form of teaching the information about their department.
considered appropriate. • Read the completed questionnaire, Student's own
• Be able to select and use the most appropriate department1 and discuss with the student in
method of teaching. order to determine their needs.
• Make sure that all equipment needed is available. • Before starting the course the student must com-
• Make sure the student understands what is re- plete the Pretest.
quired of them. • Outline the teaching format to the student.
• Be available to advice while the student is carry- • Identify the topics to be covered.
ing out the exercises. • Give a copy of the teaching program to the student.
• Assess student's work fairly and accurately. • Cover one topic at a time.
• Give useful feedback. • With each topic 1 first give formal instructions
• Be sympathetic to student needs. covering all the relevant information.
• Answer any questions.
• Allow the students to carry out the exercises.
Method
• The tutor should be available in an advisory capacity.
It is suggested that a tutor use the following basic • Give the student time to complete the exercise
teaching format: and any necessary written work.

• Understand the student's needs. • Assess the practical component.


• Devise an appropriate teaching program (lecture, • Assess the answers on the task sheet and make
tutorial, practical etc.). written comment.
• Ensure that you have all the equipment and teach- • Grade the answers and practical performance
ing aids that you require. Satisfactory/Unsatisfactory.
• You should carry out a practical exercises your- • Give feedback to the student.
self first to ensure it works. • If the student's performance is unsatisfactory the
task must be repeated.
• Ensure that you have the correct answers/
• Continue with the next topic when a satisfactory
results.
• Issue the workbook to the student, at least two grade has been achieved.
QUALITY ASSURANCE WORKBOOK
14

Notes
15

Health and safety

Health and safety issues in any work environment are nections. Do not attempt to repair anything you do not
very important. It is the responsibility of all Heads of understand.
Department to ensure that injury or sickness, due to When carrying out any simple maintenance, repair,
working conditions, is kept to a minimum. Injury or or cleaning of electrical equipment:
sickness may increase absenteeism of staff members
• Switch off and disconnect before starting.
and reduce efficiency. Staff must not put patients, col-
• Do not tamper with anything you do not fully
leagues or self at risk.
understand.
X- ray departments should be prepared for emergen-
• Unless you are qualified, restrict your actions to
cies such as fire, major disaster or any life threatening
replacing light bulbs, simple electrical parts, tight-
situation. Radiography involves working with:
ening connections, replacing fuses and inspect-
• Machinery. ing cables.
• Electricity. • Ensure that all parts are correctly and safely in-
• Hazardous chemicals. stalled or adjusted.
• Radiation. • Ensure that all protective panels are replaced.
• Patients. • Never use excessive amounts of water when clean-
ing electrical equipment.
Fire and major disaster plans should be in place.
• Report all faults to your immediate senior or
Cardiac arrest training should be given.
through the recognised channel.
The first thing to consider is making the work envi-
• Ensure that other members of staff are aware of
ronment as safe as possible, by minimising the risk of
any problem.
problems arising.To achieve this, ensure that:

• Regular maintenance inspections are carried out.


Fire
• Safety procedures are followed.
• Adequate staff instruction is given. Adequate fire fighting equipment, instructions,
• Safety equipment is readily available. and evacuation procedures must be in place at all
times.

Machinery
Equipment
Regularly inspect all machinery. Do not attempt to re- • Fire extinguishers.
pair anything you do not understand. Call an X-ray en- - Suitable for electrical fires, near electrical
gineer if you are unable to fix the problem. equipment and switchboards.
Take care with all moving parts, to minimise the - General purpose in all other areas.
risk of: • Smoke detectors in all rooms.
• Trapping fingers. • Hoses in central areas.
• Loose parts falling off onto staff or patient. • Fire alarms easily accessible.
• Equipment moving unexpectedly and striking • Regular maintenance of alarms and equipment.
staff or patient. • Illuminated EXIT signs in all public area.
• Staff or patient striking head on overhead equipment. • Emergency exit doors not locked or blocked.

Fire fighting instructions


Electricity • Readily available.
Consult a qualified electrician or X- ray engineer. Regu- • Staff training.
larly inspect all electrical equipment, cables and con- • Annual refresher courses.
QUALITY ASSURANCE WORKBOOK
16

Evacuation procedure • Select a suitable site where the chemicals can


• Instructions readily available. be buried and are not likely to get into the local
• Clearly defined evacuation routes. water supply or in any way affect humans, ani-
• Recognised assembly points. mals or crops.
• Responsibilities clearly defined. • Further refinements of the "bury method" is to
• Staff training. use a sand trap first, then bury the residual sand
or use an evaporative trench lined with sand and
bury the sand when the water has evaporated.
Hazardous chemicals (laws and
• Local soil, terrain and weather conditions should
regulations to be followed)
be considered.
Developer and fixer are hazardous chemicals and should
be handled with care. Display manufacturer's instruc- First aid treatment
tions for mixing, care and first aid treatment, in a promi- • Follow manufacture's recommendations.
nent place in the area in which the chemicals are to used. • Skin contact.
- Wash thoroughly in water immediately.
The risks involved are: • Eye contact.
• Inhaling fumes or powders. - Wash eye thoroughly, immediately.
• Swallowing. - Darkrooms should be equipped with emer-
• Contact with the skin or eyes. gency eye wash kits.
• Inhaled
When mixing solutions: - Move out into fresh air immediately.
• Work in a well-ventilated room. - Seek medical advice.
• Avoid skin or eye contact with chemicals. • Swallowed
• Wear a mask, goggles, rubber gloves and a plas- - Wash mouth and lips in clean water.
tic apron. - Seek medical advice immediately.
• Avoid splashes.
• Wash all equipment used after mixing.
• Clean up any spills or splashes.
Radiation
Follow national laws and regulations.
When processing films: • Use an ongoing personal monitoring system.
• Avoid skin or eye contact with chemicals. • Do not produce x-radiation unnecessarily.
• Ensure that the darkroom is adequately ven- • Requests for X-ray examinations should be justi-
tilated. fied.
• Minimise splashes. • Avoid the use of X-ray examinations on pregnant
• Clean up any splashes as soon as possible. women wherever possible, especially in the first
• Replace any tank lids when finished. trimester.
• l<eep clear of the primary radiation beam.
Disposal of empty chemical bottles • l<eep clear of any scattered radiation.
• Should not be used as drinking water containers. • Collimate the beam as much as practicable.
• Puncture and place in a sealed plastic bag be- • Minimise repeat films.
fore disposal. • Use lead rubber shielding whenever possible, es-
pecially of radiosensitive organs.
Disposal of exhausted chemistry. Things NOT to do. • Make sure that all items of lead rubber are in
• Do not flush into common drains or simply throw good condition and effective.
away. The chemicals may get into the local water • Make sure that shielding to the control panel is
supply or contaminate crops. effective.
• Do not flush into a septic tank system.The chemi- • Make sure that X-ray room walls effectively pro-
cals will kill the "good" bacteria and stop the tect people in adjacent areas.
breakdown of solid matter. • Close door to X-ray room when exposing.
• Standard radiation warning symbols must be
Disposal of exhausted chemistry. Helpful suggestions. placed on the doors of all X-ray rooms.
• Ideally use a silver recovery unit and dispose of • Illuminated signs should be placed at the en-
the chemistry through a recognised hazardous trance to all X-ray rooms where prolonged X-ray
chemicals agency.
HEALTH AND SAFETY
17

exposures are made, warning when X-rays are • Use appropriate moving/handling aids when nec-
being used. e.g. screening rooms. essary and when available.
• Make sure that all unnecessary personnel are • Encourage patients to move themselves where
clear of the radiation area when exposing. possible.
• Make sure that X-ray equipment is working prop-
erly and is safe, by carrying out regular quality Cross infection:
control checks. • Be aware of any indications that the patient may
• X- ray equipment should be switched off when not be infectious.
in use and any safety lock keys removed. • Follow infection control procedures.
• Use correct filtration of the X-ray beam. • Have gowns, gloves and masks readily avail-
• Special care must be taken when using mobile/ able and ensure that they are worn when
portable X-ray units, in ward or operating theatre necessary.
situations. • Disinfect all equipment used, immediately after
• Apply the ALARA or ALARP Principle when ex- use, not forgetting cassettes.
posing anyone to radiation. • Where possible wrap cassette in towel or cloth
before using, with an infectious patient.
• Wash hands before and after each contact.

ALARA principle
When exposing anyone to ionizing radiation the Disaster
dose should be kept
A disaster is any major catastrophic event, earth
As Low As Reasonably Achievable
quake, major accident involving many people, civil dis-
turbance or war. A hospital must have an established
An extension of this principle is the
disaster plan that will allow it to cope with this type of
ALARP principle event. An X-ray department must have its own emer-
When exposing anyone to ionizing radiation the gency plan that will fit in with the overall hospital
dose should be kept plan.
As Low As Reasonably Practicable
Designing a plan:
The inference here is that there may be other
• Become familiar with the hospital plan.
important factors which may limit the dose
• Design an X-ray department plan that is com-
reduction.
patible with that of the hospital.
• Determine:
- Individual responsibilities.
Working with the patient - Staff call-out procedure.
Moving and handling: - Organisation.
• Use recognised moving/handling techniques to - Amount of stock to hold.
reduce the risk of back injury.
QUALITY ASSURANCE WORKBOOK
18

Notes
19

MODULE I
Reject film analysis

Aim Benefits
• Able to identify the main errors and put meas-
To provide the knowledge necessary to set up a system
ures in place to reduce them.
which will give a detailed analysis of the rejected films
• Save money by reducing wastage.
and the reason for the rejections, in order to put in
• Reduce radiation dose to the patient by mini-
place remedial action.
mising the number of repeat films.
• Save time and effort by reducing the number of
Objectives repeat films.
To provide all relevant information and give the oppor- • Provide ongoing data for comparison.
tunity to gain practical experience in: • Provide possible source of statistics to support
• Designing a reject film analysis program. claims for more funding to replace, modify or
Ill Setting up and running a reject film analysis repair faulty equipment.
program.
Ill Analysing the results of that program. Potential problems
Ill Setting up remedial action based on those
• Staff members do not co operate fully.
results.
• Radiologist and clinicians tend to retain substand-
Ill Instigating a follow up program to assess the
ard films on the grounds that they provide some
effectiveness of the remedial action taken.
information.
• Reject film records not always kept up to date.
In every department a number of films are discarded
for one reason or another. Incorrect exposure, poor
positioning and processing are some of the common Frequency
causes. • Monthly.
Knowing exactly what the major reasons are is a big
step towards correcting the faults and therefore
Setting up a reject film analysis
reducing the number of unacceptable radiographs. It
is not satisfactory to make judgements on impressions
program
alone. A reject analysis can be an important part of • Design the program.
your ongoing quality assurance program. • Determine the period over which the program will
From a radiographers point of view a reject analysis run.
may be seen as a threat. It is important to fully explain • Nominate a starting and finishing date and time.
to all concerned: • Inform staff (the full eo operation of the staff is
important):
• Why the analysis is being carried out.
- Why the program is necessary.
• How it will be carried out.
- How it will operate.
• When it will be carried out.
- When it will take place.
• The benefit.
- Who is responsible for the program.
Sensitometry and radiation consistency tests should • Decide what data you need.
be run in parallel with a reject film analysis as process- • Design data recording sheets.
ing or radiation output irregularities may be causing • Place reject film boxes in appropriate areas.
some of the problems.
QUALITY ASSURANCE WORKBOOK
20

It is usual to collect reject films from individual X-ray • Overall number of reject films.
rooms. It may be necessary to relate the collections to • Number of reject films by size.
the individual radiographer as well. • Number of reject films by faults.
.e Number of reject films by rooms Cor
• Immediately before program starts:
radiographers).
- Count all films in store by sizes.
• Overall cost of rejected films.
- Add to this count all unexposed films in cas-
• Identification of common faults.
settes, film hoppers and partially empty boxes.
• Reject films as a percentage of films used.
- Record this information.
- Dispose of all current reject films. Study the data. Compare current data with that of
previous programs.
A reject rate of 10% or more should be considered
Method
unacceptable. A reject rate of 5% to 10% justifies con-
• Collect all reject films daily. tinued monitoring.
• Record numbers of reject films on data sheets
daily (see Fig 1-1, Fig 1-2, Fig 1-3 and Appendix
B, pages 138-140).
Action
• Immediately the program has finished re-count • Rank the faults in order of frequency.
the films in the store, cassettes and half empty • Identify the most common faults.
boxes. • Set up remedial programs to correct errors (see
• Original film count, minus end film count, equals Appendix B, page 141).
number of films used. • Inform staff of findings and planned remedial
• Analyse the data. action.
• Start remedial action program.
• Nominate dates for another analysis if felt
Analysis
necessary.
The following information can be obtained from an • File data for future reference.
analysis of the data:
MODULE I, REJECT FILM ANALYSIS
21

Reject film analysis


Daily totals by location

Date:
Cause Location
Room l Room 2 Room 3 Room 4 Total
Projection
Movement
Under exposed
Over exposed
Static
Fog (darkroom)
Fog (cassette)
Equipment
Processing
Other

Total

Total films rejected today: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __


Fig 1-1. Reject film analysis, daily record sheet by location
QUALITY ASSURANCE WORKBOOK
22

Reject film analysis


Daily totals by film size

Date:
Film size Ccm) No. of films Film used Csq m)
1 35 X 43
2 35 X 35
3 30 X 40
4 24 X 30
5 18 X 24
6 18 X 43
7 DENT I OCC
8 Other
Total

Total number of films: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __


Total square meters of film: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Total cost of rejected film today: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Fig 1-2. Reject film analysis, daily record sheet by film sizes
MODULE I. REJECT FILM ANALYSIS
23

Reject film analysis


Daily totals

Period: From: _ _ __ To: _ _ __

Cause Dates Total


I

I I
j I
'I

Projection I I
I
Movement
Under Exp.
Over Exp.
Static
Fog (darkroom)
Fog (cassette)
Equipment
Processing
Other

i
I
I
i

I
i

Totals

Total films rejected: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __


Total films used: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Rejected films as a percentage of films used: _ _ _ _ _ _ _ _ _ _ __
Cost of films rejected this period: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Fig 1-3. Reject film analysis daily totals sheet
QUALITY ASSURANCE WORKBOOK
24

Notes
MODULE I. REJECT FILM ANALYSIS
25

TASK I
Reject film analysis

You have become aware that the number of rejected films is increasing, but you have no idea what the main faults
are and what is causing them. You decide to investigate the situation. Take the first step and practise analysing
films for faults.

a) Select any three rejected films.


b) Study these films.
c) List all faults seen, in order of importance, that you believe led to the rejection of the film.

FILM 1 FILM 2 FILM 3

I
I
I

l. How do you think these faults were caused?

Film 1

Film 2
QUALITY ASSURANCE WORKBOOK
26

Film 3

2. What would you do to eliminate these errors?

Film 1

Film 2

Film 3

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE I. REJECT FILM ANALYSIS
27

TASK2
Reject film analysis

Your next step is to carry out a small pilot reject film analysis.

a) Carry out a one room reject film analysis over a period of 5 to 6 days (see notes).
b) Analyse your results.
c) Answer the following questions in the spaces provided.

1. Total number of reject f i l m s : - - - - - - - - - - - - - - - - - - - - - - - - - - - -

2. Reject films as a percentage of total films u s e d : - - - - - - - - - - - - - - - - - - - - -

3. Total area in square metres, of rejected f i l m : - - - - - - - - - - - - - - - - - - - - - - -

4. Cost of rejected f i l m ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

5. List the three main causes of film rejection:

6. Explain what measures you would put in place to eliminate these causes:
QUALITY ASSURANCE WORKBOOK
28

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
29

MODULE 2

Accessory equipment

Aim Grid
Grid types 1 ratio and line.
To provide the knowledge and practical skills neces-
·•· _ Care and cleaning.
sary to establish and carry out a quality control pro-
Visual inspection.
gram for accessory equipment.
Grid line damage.

Objectives Lead rubber apron, gloves and sheets


On completion of this module you will be able to un- Visual inspection.
derstand and carry out quality control procedures1 Cracking.
evaluation and recommend action for: X-t·ay testing.
• Care and cleaning.
Collimator Storage.
Ill Visual inspection.
Ill Accuracy of scales. Viewing box
Ill Change a light bulb. Electrical inspection.
Ill Light beam/X-ray beam alignment and Efficiency/consistency.
centring. Location.
Ill Lead shutter efficiency. Cleaning.

Cassette/intensifying screens Patient positioning aids


Ill Visual inspection. Visual inspection.
Ill Light tightness of cassette. Radiolucency.
Ill Film/Screen contact. Condition.
Ill Intensifying screen light colour emission. Cleaning.
Ill Care and cleaning.
Patient measuring callipers
Accuracy.
Damage.

Collimator Visual inspection (see Appendix 81 page 142)


• Rotation.
The collimator/sometimes referred to as the light beam
• Stability.
diaphragm (LBD) 1 provides the radiographer with an
• Knobs fot· shutter control.
easy to use/ accurate/ method of controlling the size of
• Accuracy of shutter setting scales (if present).
the X-ray field and placing it over the area of interestr
• Shutter chain drive.
thus reducing the radiation dose to the patient and
• Shutters.
improving the quality of the image.
• Housing.
The collimator receives much use and is vulnerable
• Window.
to knocks/ often resulting in inaccuracy of the light
• Light timer.
beam/X-ray beam coincidence1 blown light bulbs1 elec-
• Timer switch.
trical and mechanical problems.
• Cables.
QUALITY ASSURANCE WORKBOOK
30

• Plugs. Method
• Light bulb. • Switch off the power.
• Light/X-ray beam alignment. • Remove relevant collimator housing.
• Check that spare is the correct type.
Accuracy of scales test • Before removing the old bulb, check to see if the
Not everyone uses the aperture size scales on the col- replacement bulb must befitted a specific way round.
limator to set the aperture size, it being more common • Replace faulty bulb with the new one.
practice to use visual assessment of the light field size. • If the bulb is of the quartz type, ensure that it is
However if staff do practice this method, it is advisable not handled with bare fingers, as body oil on the
to make sure that the scales are accurate. bulb will shorten its life.
Inaccuracy of scales may lead to inaccurate col- • Replace housing and tighten screws.
limation. • Test.
• Ensure that the spare bulb is replaced as soon as
Frequency of test possible.
• 6 monthly.
Light beam/X-ray beam alignment test
Equipment required The purpose of the light in a collimator is to allow more
• Collimator to be tested. accurate collimation of the X-ray beam. The light must,
• lOO cm rule. therefore, coincide with the X- ray beam.The light beam
relies on the accurate positioning of the light bulb and
Method angled mirror inside the collimator.
• Set lOO cm focus to tabletop distance. Should either the mirror or light bulb be dislodged,
e Using the lOOcm FFD CSID) scale on the colli- then errors in collimation could occur, resulting in
mator, set various aperture sizes with the light areas of interest being excluded from the field, or too
on and measure the resultant light areas at table large an area being irradiated.
top level.
• Compare with settings on the collimator. Frequency of test
• 6 monthly.
Evaluation • As necessary.
• Light area measured should be the same as the
setting on collimator. Equipment required
• One 24 x 30 cm loaded cassette.
Action • Alignment test tool. Commercially made test tools
• If settings are not accurate and the solution is are available, but a simple alternative is to use
not a simple one, call an X-ray engineer. eight coins or four paper clips (see Fig 2-l, Fig
• File a report. 2-2).
• Lead marker or ninth coin.
Changing a light bulb
A light bulb can fail at anytime without warning. It is Method
important then, to have the correct spare bulb readily • Make sure that the table is level and the central
available. ray at 90 o to the tabletop.
Staff should be capable of replacing a faulty bulb. • Place a loaded cassette on the tabletop face up.
DO NOT ATIEMPTTHIS UNLESS YOU HAVE HAD AD- e Set a FFD CSID) of lOO cm.
EQUATE INSTRUCTION. If unsure, call an electrician. • Switch on the collimator light.
• Centre to the middle of the cassette.
Frequency • Collimate to within the edge of the cassette, leav-
• As necessary. ing a 3cm border all round, that is outside the
light field.
Equipment required • Place the coins in pairs, so that, where the coins
• Suitable light bulb. touch, coincides with the edge of the light area.
• Cloth or tissue. • All four borders of the light must be marked in
• Screwdriver. this way.
MODULE 1. ACCESSORY EQUIPMENT
31

• At lOO cm FFD (SID) the irradiated area must not


be more than 10 mm smaller than the area cov-
ered by the light. This represents a l% tolerance.

Action
• If the alignment is unacceptable it must be
adjusted.
• Call an X-ray engineer.
Note: Cones and diaphragms can also be checked us-
ing a similar method.

Shutter efficiency test


Fig 2-1. Light/X-ray beam alignment test
Closing the shutters in the collimator fully should
using eight coins
prevent any radiation from reaching the film. Useful
for testing radiation safety when discharging cap-
acitor discharge mobiles or making tube warm up
exposures.

Frequency of test
• 6 monthly.

Equipment required
• One loaded 24 x 30 cm cassette.

Method
• Place the cassette on the tabletop face up.
e Set a FFD (SID) of lOO cm.
Fig 2-2. Light/X-ray beam alignment test tool. • Set an exposut·e of approximately 80 kV and
Radiation Measurements Inc. 40mAs.
• Open one set of shutters fully, leaving the other
closed.
• Place the lead marker within one corner of the
• Make an exposure.
light field so that the film can be related to
• Fully close the open shutters and open fully the
the light/X-ray field and hence the collimator
closed ones.
shutters.
• Make another exposure.
• Make an exposure sufficient to blacken the film.
• Process the film.
• Process the film.

Evaluation
Alternative method instead of using coins
• Study the film. If the shutters are efficient the
• Use four paper clips, each bent to form right an-
film will not have been affected by radiation.
gles.
• Place paper clips at corners of light field.
Action
Note: Collimators are known to become less accurate • If the shutters are allowing radiation to pass, call
as the field size is increased. To check this make two an X-t·ay engineer.
flash exposures on the same film, following the method
described above, using different field sizes, remember-
Cassettes and intensifying screens
ing to re position the markers for the second exposure.
Cassettes are the light tight containers that hold the
Evaluation X-ray film between the intensifying screens. They are
• For perfect alignment, the light field (where the avaiiable in a range of sizes to suit every need.
coins touch) should coincide with the X- ray field. Intensifying screens fluoresce when struck by ra-
• The irradiated area must not be greater than the diation, the light emitted significantly contributing to
area covered by the light. the blackening effect on the film.
QUALITY ASSURANCE WORKBOOK
32

Cassettes are easily damaged and likely to wea~ result- Equipment required
ing in possible light leakage and poorfilm screen contact. • Cassettes to be tested.
Intensifying screens deteriorate over time and are
easily damaged. Foreign material on their surface or Method
damage will create marks on films. • Load cassette with new film.
All cassettes should be clearly numbered on the • Place cassette under bright light for approxi-
outside. A corresponding number being placed inside, mately 15 to 30 minutes.
on the edge of one of the screens, using an indelible • Turn cassette and repeat.
marker, where it will not affect the image, but is visible • Process film.
on the radiograph.
All cassettes should be marked on the outside, iden- Evaluation
tifying the type of intensifying screens fitted. • Black fogging around the edge of the film is an
If different film/screen combinations are used in the indication of light leakage.
department, screen speed should be clearly indicated
on the outside of the cassette. It is usual for manufac- Action
turers to supply appropriate labels with their screens. • Repair or replace cassette.
Both cassettes and screens should be inspected and • File report.
cleaned regularly. Records must be kept of all inspec-
Note: Similar fogging can be caused by a lid being left
tions, maintenance and replacements.
off a box of film or the film hopper left open, allowing
white light exposure of the upper edge of the films.
Cassettes (see Appendix B, pages 143, 144 & 145)

Cassette inspection Intensifying screens


Frequency of inspection Most cassettes are fitted with a pair of intensifying
• Yearly. screens and should be used with double emulsion film.
• As necessary. Blue light emitting screens should be used with blue
light sensitive film.
Equipment required Green light emitting screens should be used with
• Cassettes to be inspected. green light sensitive film.
Any damage, deterioration or foreign matter will be
Method seen in resultant images.
• Inspect:
• Hinges. Intensifying screen inspection
• Catches.
Frequency of inspection
• Casing.
• Monthly.
• Cleanliness.

Equipment required
Evaluation
• Screens to be inspected.
• Faulty parts, distortion and inadequate cleanli-
ness must be attended to.
Method
• Inspect in bright light conditions.
Action
• Screens firmly fitted.
• Repair faults or replace cassette.
• Correct screens fitted (see label on back of
• Carry out film/screen contact test.
cassette).
• Clean with damp cloth and wipe dry.
• Correct number on edge of screen (see number
• l<eep records of work carried out.
on back of cassette).
• File report.
• Condition of screen surface.

Light leakage test


Evaluation
Frequency of test • Abrasions.
• Yearly. • Foreign material on surface of screen.
• As necessary. • Discolouration Can indicator of deterioration).
MODULE 2. ACCESSORY EQUIPMENT
33

• Fitted correctly. Equipment required


• Correct screens. • Cassette to be tested.
• Test tool (box of paper clips or sheet of perfo-
Action rated zinc or fine wire mesh, large enough to cover
• Loose screens should be re-fitted with double- a 35 x 43 cm film, with a square hole, about 10 cm
sided tape. from one edge, approximately 2 to 2 cm square).
• Surface damage or deterioration, which is unac- (see Fig 2-3 and Appendix A, page 134).
ceptable-rep/ace screens. • Lead marker if cassettes do not have a lead
• Clean if necessary. blanked area for patient details.
• File report.

Intensifying screen cleaning


Frequency of cleaning
• Monthly.

Equipment required
• Soft brush.
• Puffer.
• Lint-free cloth, such as gauze.
• Screen cleaner (available from manufacturer) or
mild soap (not detergent).

Method
• Clean in bright light conditions.
• Remove all loose dirt with a soft brush or puffer.
• Apply screen cleaner sparingly, with a lint free
cloth, such as a gauze swab.
• Use circular motion over whole surface. Fig 2-3. Film/screen contact test, using paper
• Finish off with Joug strokes from top to bottom. clips as a test tool
• Do not pour cleaner directly on to the screen.
• Wipe with dry lint free cloth. Method
• Stand cassette open for 30 minutes to dry. • Load the cassette to be tested and place it face
• Inspect. ~1p on the tabletop.
• Cover the whole of the cassette with the test tool
Evaluation (if using paper clips, distribute evenly).
• Have all dirt particles been removed? e Set a FFD (SID) of 150 cm (the longer FFD CSID)
• Are there any smears? reduces geometric unsharpness).
• Collimate to cover whole of cassette.
Action • If appropriate, place lead marker in the corner
• If dirt particles or smears remain, re clean. of the cassette face, in order to relate resultant
• If, after repeated cleaning, dirt particles remain, radiograph to cassette.
decide if they are likely to be a problem. • Make an exposure using about 50 kV and 6 mAs
• If they are considered to be a problem, replace (film density of 1 to 2).
the screens. • Process the film.

Film/screen contact test Evaluation


If an area of localised blurring is detected on a radio- • If a densitometer is available the film density can
graph, poor film/screen contact should be suspected. be measured at the image created by the hole in
the test tool.
Frequency of test • Inspect the image, looking for areas that look
• Yearly. blurred.
• As necessary. • A noticeable area of unsharpness could be caused by:
QUALITY ASSURANCE WORKBOOK
34

- A damaged cassette. change the type of film you use so that they are
- Screen packing, deterioration. compatible.
- An air pocket. • If the light intensity comparison between pairs
• When using a close mesh wire test tool the poor of screens is noticeably different, check the la-
film/screen contact areas may also have a higher belling of your cassettes for screen type and/or
density. carry out the intensifying screen consistency
test.
Action • Re label the outside of the cassette if necessary.
• Repair or replace cassette.
• Replace packing. Intensifying screens consistency test
• Re-test. The efficiency of screens tends to deteriorate over time.
• File a report. If you have screens of the same type, but of differing
ages, you cannot assume that they will all give the same
Film/screen compatibility-colour of light result. It is therefore necessary to check the efficiency
emission test of all screens periodically in order to achieve consist-
Different types of intensifying screens may emit differ- ent results.
ent light colours and/or intensities. The colour of light
emitted by screens must be the same as the colour Frequency of test
sensitivity of the film used with them. Check with your • Yearly.
film and screen suppliers if in doubt. • As required.
If there is any doubt about the colour compatibility
of the light emitted by the screens, the following sim- METHOD I
ple test can be used.
Equipment required
• Step wedge (see Appendix A, page 133).
Frequency of test
• Loaded cassettes with screens to be tested (all
• As necessary.
cassettes should be loaded from the same box of
film).
Equipment required
• Densitometer, if available.
• Screens to be tested.

Method
Method
• Cut a sheet of film into strips large enough to
• Open the cassette.
easily cover the step wedge.
• Remove the film.
• Load each cassette to be tested with one strip of
• Place the open cassette, screen facing up, on the
film, placed centrally.
tabletop.
• Place the first cassette on the tabletop, face up.
• Set a FFD (SID) of lOO cm and collimate to cover
• Place the step wedge in the centre of the cas-
the open cassette.
sette so that it is directly over the film strip
• Reduce room lighting to a minimum.
inside.
• Make an exposure using a relatively high kV
• Set a lOO cm FFD (SID) and collimate to cover
and long time, e.g. 80 kV and maximum time
the step wedge.
possible.
• Set an exposure that will give a full range of den-
• Observe the screens during the exposure. Remem-
sities on the step wedge image (you may need to
ber to follow normal radiation safety rules.
do test exposures first).
• Expose.
Evaluation
• Process the film.
• Note the colour of light given off by the screens.
• Repeat the procedure for all the other cassettes
• Note the intensity of the light given off by the
being tested, using exactly the same conditions.
screens.
• Label the film strips with date and cassette
number.
Action
• For accuracy of this test, the X-ray output and
• If the colour sensitivity of the film is not the same
processing must be consistent throughout.
as the screen light emission colour, you should
MODULE 2. ACCESSORY EQUIPMENT
35

Evaluation • If this is impractical, work out the exposure dif-


• Place the test strips side by side on the same ferences to achieve similar results and label each
viewing box. cassette accordingly.
• Compare the densities (a densitometer will give
When equipping a department with all new screens it
a more accurate result).
is advisable to carry out this test as a basis for future
• Assess the density differences between the strips.
comparison.
• If the film strip images, using screens of similar
types, are seen to vary noticeably, this is unac-
ceptable (densitometer readings of similar steps Grid
should be within 10% of each other). The purpose of the grid is to reduce the amount of
• Assess the density differences between the strips. scattered radiation reaching the film. This greatly im-
proves the quality of the image. Although the quality
METHOD 2 of the image is improved, it does mean a significant
Equipment required increase in exposure, and therefore dose to the
• Phantom (water filled flagon, or other suitable, patient.
even density material, of at least 30 x 30 cm area). A grid looks like a simple thin sheet of soft metal,
(see Appendix A, page 133). but it is in fact a precision made piece of equipment
• Loaded cassettes with screens to be tested (all and easily damaged. It is made up of a large number
cassettes must be loaded from the same box of of fine lead strips interspaced between radiolucent
film). strips. If the lead strips become distorted the grid will
• Densitometer, if available. be less efficient and irregular densities will be created
on the film.
Method If the grid is used wrongly, abnormal densities (grid
• Place four of the cassettes together, face up on cut off) will be produced. e.g. a focussed grid used up-
the tabletop, so that one corner of each cassette side down will create a reduction in density the further
meets the others and the appropriate edges are the area is from the centre line.
in contact.
e Set a FFD (SID) of 100cm. Grid types
• Centre to the touching corners of the cassettes.
• Place the phantom to partially cover all four Stationary
cassettes. • A loose grid which can be placed directly over
• Collimate to within the phantom so that a por- the face of the cassette.
tion of each cassette will be irradiated. • The grid and cassette size must be the same.
• Set an exposure that will produce a measurable • The grid ratio is usually 6: 1 or 8: 1.
density on the film and expose. • Cassettes are available with a built in, or added,
• All screens to be assessed should be tested in grid.
this way, keeping one of the cassettes unchanged
throughout. Remember to reload the control cas- Moving
sette each time. • A grid used in a potter bucky system, which moves
• Identify all films using the cassette numbers. from side to side during the X-ray exposure, in
• Process the films as soon as possible using the order to defuse out the images of the lead
same processor. strips.
• The grid ratio is usually 10: 1 or 12: 1.
Evaluation • The grid ratio should be 16: 1 if used for high kV
• Compare the densities produced on each radio- work.
graph (a densitometer will give a more accurate
result). Parallel line
• Densitometer readings should be within 10% of • Lead strips run parallel to one another in one
each other. direction only.
• There are two types of parallel line grid, focused
Action and non-focused.
• If significant differences are seen you may wish • Moving and stationary grids are all of parallel
to re screen all cassettes tested. construction.
QUALITY ASSURANCE WORKBOOK
36

Focused
• A parallel line grid.
• Differs from the non focused grid only in that
the lead strips progressively incline more inward,
the further they are from the centre line, so that
they are focused to a pre-determined point above
the grid.

Fig 2-4. Diagram of a parallel line grid. Plan


view
/ : . \.
/ i
Cross-hatch j
• Two sets of lead strips superimposed and run- .!
ning at 90 o to one another. / '
\
··.
•.
• Generally a stationary grid, used only for rela-
tively high kV work and when no tube angulation
is necessary.
• This design is used only in stationary grids.
Cal (b)

Fig 2-7. Diagram of a parallel line focused


grid, (a) Plan view, (b) End view

Structure
• Thin lead strips interspaced between equally thin
strips of radiolucent material.
• Covered top and bottom with thin aluminium
Fig 2-5. Diagram of a cross-hatch grid. Plan sheet.
view

Non-Focused
Radiolucent strips
• A parallel line grid. (distance between lead strips)
• Relationship of lead strips uniform to one an-
other throughout.

Lead strips
1111111111111
(b)
Fig 2-8. Diagram of grid construction, end
view

Specifications
The detail of the grid structure should be marked on
Cal the surface of the grid either by a label or imprinted
Fig 2-6. Diagram of a parallel line, non- into the metal.
focused grid, (a) Plan view, (b) End view
MODULE l. ACCESSORY EQUIPMENT
37

Grid ratio The ratio of the height of the lead strips Equipment required
to the distance between them. • Grid to be tested.
Grid line The number of lead strips in a grid. • One loaded cassette, same size as grid.
Stated as the number of lead strips to • One lead marker.
the centimetre (or to the inch).
Focal range Grids are designed to be used within METHOD
given focus film distances {source image
Visual inspection:
distances} dependent on the way the
• Dents, bends, creases, damaged corners.
lead strips have been focused.
• Specifications marked.
Grid line The direction in which the grid lines
• Cleanliness.
direction travel is indicated by a line down the cen-
tre of the grid on the tube side. Cross-
X-ray:
hatch grids have a second line running
• Place cassette on table top, face up.
at 90° to the first.
• Place grid to cover cassette, tube side up.
Tube side The tube side is shown by a label stating
• Set a FFD (SIDJ in the middle of the known focal
TUBE SIDE, or an X-ray tube symboi.The
range of the test grid or lOO cm.
lead strips direction line also indicates
• Centre to middle of grid.
the tube side.
• Central ray at 90 o to cassette/grid.
• Collimate to cover cassette/grid.
Care of the grid • Set an exposure of 50 kV 10 mAs (you may need
to experiment prior to the test).
• Stationary grids should have an added, rigid, PVC
• Expose.
protective cover.
• Process film.
• When a protective cover is added the grid speci-
fications must be recorded on the new cover for
Evaluation
future reference.
• Is grid line pattern regular?
• Do not bend, drop or dent the grid.
• Is overall density even?
• Clean regularly.
• Store in a safe place.
Action
• If the grid line pattern or density is unacceptable
Use of a stationary grid repeat the test using FFDs (SIDsl of 10 cm
• Use a grid that is the same size as the either side of that used in the first test.
cassette. • If the images are still unacceptable, replace the
• Place the grid against face of cassette with noth- grid.
ing between it and the cassette face. • File a report.
• Check that the tube side of the grid is toward Note: This test can also be used to check the focal
the tube. range.
• Use strips of adhesive tape to hold the grid in
place.
Lead rubber aprons and gloves
• Use the recommended focus film distance (source
image distance) for that grid. Lead readily absorbs t·adiation and is used in many
• The X-ray beam must not be angled across grid forms and thicknesses in the field of radiation
lines. protection. e.g. lead sheet, lead rubber, lead
acrylic.
When using a grid cassette, only the last two points
Lead rubber has the advantage of being flexible and
are relevant.
can therefore be made into items which can be worn
e.g. aprons and gloves. Lead rubber tends to deterio-
Grid line damage test
rate over a period of time, with regular use and mis-
Frequency of test handling. Regular care, cleaning and testing are
• 6 monthly. important (see Appendix B, page 146).
• As necessary.
QUALITY ASSURANCE WORKBOOK
38

Other lead rubber items • Relocate storage location if unsuitable.


• Gonad shields. • Re-design hangers if unsuitable.
• Thyroid shields. • Re-educate staff if they are not hanging/storing
• Small sheets of differing sizes. items correctly.
• Shielding on screening units. • Replace if necessary.
• File a report.
Care
• Weekly cleaning or as necessary. Clean with soap Test to detect cracking of aprons or gloves
and water.
Frequency of test
• Never fold any item of lead rubber.
• Yearly.
• Aprons should be hung up using strong, specially
• As necessary.
designed hangers.
• Store gloves flat or upright on a custom made
Equipment required
holder.
• Screening X-ray unit Cif a screening unit is not
• Do not store near a heat source.
available, use a general purpose unit and 35 cm x
The lead equivalent (effectiveness) of all forms of 43 cm cassettes).
lead rubber should be known. Aprons for instance are • Items to be tested.
designed only to protect against scatter. They have
a lead equivalent of between 0.25 mm and 0.5 mm. Method
Lead sheet may have a lead equivalent of 2.0 mm or • Spread article to be tested on the tabletop.
3.0 mm. • Use screening system to examine whole article.
• Use different kV s.
Visual inspection test • If a general purpose X- ray unit is to be used, place
cassettes under test article and make separate
Frequency of test
exposures. Ensure that the whole article is
• 6 monthly.
examined.
• As necessary.

Evaluation
Equipment required
• Look for cracks or other abnormal variations of
• Items to be tested.
density in the image.

Method
Action
• Check effectiveness and condition of fastenings
• Items found to be defective should be replaced.
on aprons Cif any).
• Items being withdrawn can be cut up into smaller
• Inspect surface covering for tears or sign of
pieces, avoiding the cracked sections. These can
deterioration.
be used for gonad shielding or shielding parts of
• Inspect all seams where appropriate.
the film.
• Check flexibility, feeling for cracks not seen on
• File a report.
the surface.
• Inspect for cleanliness.
• Check apron hanger devices. Viewing box
• Assess storage location.
A viewing box, or light box, is a simple but important
aid to viewing radiographs and is commonly used
Evaluation
throughout X-ray departments. It consists of an even
• General condition and cleanliness.
light source of sufficient light intensity to allow opti-
• Possibility of cracks.
mum viewing.
• Storage location and hanging devices.
Viewing a radiograph under good viewing conditions
• Are staff using the apron hangers?
is important in order to visualise the maximum amount
of information. Regular maintenance and cleaning
Action
should be carried out (see Appendix A, page 147). All
• Initiate any repairs or cleaning required.
viewing boxes should:
• Carry out X-ray check.
MODULE l. ACCESSORY EQUIPMENT
39

• Be conveniently placed. Electrical check


• Be safely fixed to a wall or stable mobile This check should be carried out by or under the
structure. supervision of an electrician. Switches, fluorescent
• Be in good working order. tubes, starters and electrical connections should be
• Be of satisfactory design. checked.
• Have an all over even light.
• Be clean inside and out.
• Be electrically safe.
• Have an adequate light output.

Design
• Two parallel fluorescent tubes of equal light out-
put, with starters.
• A built in, or attached, spotlight is an advantage.
• The film anchor should hold the film firmly.
• A good quality switch.
• Safe electrical wiring.

Cleaning
Dust on the window or tube will reduce the light out-
put. Marks on the window can be misleading.

Frequency of cleaning
• Outside daily.
• Inside 6 monthly. Fig 2-9.Viewing box with front window
removed
Equipment required
• Viewing box to be cleaned.
Frequency of check
• Clean cloth.
• 6 monthly.
• Screw driver.

Equipment required
Method
• Viewing box to be checked.
• Remove plug from power socket.
• Screw driver.
• Remove the front window.
• Clean window on both sides (intensifying screen
Method
cleaner is a useful cleaning agent as it has anti
• Remove plug from socket.
static properties).
• Remove front window.
• Clean the back plate and fluorescent tubes.
• Check condition of wiring.
• Inspect window for damage.
• Check electrical connections.
• Make sure that tubes and starters are firmly in
• Check stability of switch.
place.
• Check installation of fluorescent tubes and
• Replace window.
starters.
• Test.
• Replace front window.
• Replace plug in socket.
Evaluation
• Test.
• Any dust on inside or outside?
• Any marks on viewing window?
Evaluation
• Electrical connections firm?
Action
• Electt·ical wiring in good condition?
• Wipe over with a cloth.
• Tubes and starters located properly and
• Use spirit to clean window of hard-to-remove
working?
marks.
QUALITY ASSURANCE WORKBOOK
40

• Light source even and comparable to other view- Routine care


ing boxes? Care of positioning pads should be ongoing.
• Replacing fluorescent tubes at different time in-
• Try to minimise the risk of contamination by:
tervals, or with a different type of tube, may pro-
- Contrast media
duce a difference in light intensity from one side of
- Plaster of Paris
the screen to the other or one viewing box to another.
-Blood
- Urine
Action
• Inspect and wash regularly.
• Tighten electrical connections.
• Do not use for any other purpose.
• Refit fluorescent tubes or starters.
• It may be preferable to cover with waterproof
• Replace tubes or starters if necessary.
radiolucent material, or removable cotton covers
• If, after replacing only one tube, it is found to be
or both.
brighter than the remaining one, replace both.
The working tube that has been removed can be
Positioning pad tests
matched with another one at a later date.
• Visual
• Replace any faulty parts.
• X-ray
• File a report.

Visual test
Viewing conditions
• Room light levels in the film viewing area should Frequency of test
not be too high. • Weekly.
• A bright spotlight should be available for viewing • As necessary.
dark areas of the film.
• The viewing box should be mounted at the cor- Equipment required
rect height for easy viewing. • Pads to be inspected.
• Light source should be even and the same as other
boxes. Inspect for:
• Likelihood of contamination.
• General cleanliness.
Patient positioning aids
• Shape.
Positioning pads • Smell.
• Particles breaking off.
A useful aid to maintaining the position of the patient.
• Firmness.
A range of pad sizes and shapes should be available in
each X-ray room. They must be radiolucent.
Evaluation
Sets of firm foam pads are available from manufac-
• Unhygienic?
turers (a polyethylene foam is commonly used). Pads
• Likelihood of contamination by radio opaque sub-
may be improvised using other materials but they must
stances?
be checked for radiolucency.
• Shape, firmness, general deterioration?

Action
• Wash and re-test if necessary.
• If there is a likelihood of contamination with a ra-
diopaque substance then carry out the X- ray test.
• If the pad has deteriorated to the extent that it
no longer fulfils its function effectively then re-
place it.
• File a report.

X-ray test
Frequency of test
Fig 2-1 0. Positioning aids-selection of foam • 6 monthly.
pads, sand bag & polystyrene block • As necessary.
MODULE 2. ACCESSORY EQUIPMENT
41

Equipment required If the band is plastic, simply wipe over


• X-ray unit. with a damp cloth. The ratchet and fix-
• Pads to be tested. ing mechanisms should be inspected
• Loaded cassettes as necessary. and tested six monthly or as necessary.
• Lead marker. The band should also be tested every
six months, or as necessary, for radio-
Method paque substance contamination.
• Place a loaded cassette on the tabletop face Water Bottle Empty fixer or developer bottles full of
up. water are useful as cassette supports,
• Place the pad on the cassette (ensure that the or in weight bearing views of ale joints.
cassette is big enough to cover whole pad). Water is relatively radio-opaque. Little
e Set a FFD (SID) of lOO cm. care is required, simply wipe over the
• Collimate to cover the pad. outside of the bottle with a damp cloth
• Place the marker in one corner of the X- ray field as necessary. Ensure that the lid is on
(note which corner of the pad it relates to). tightly and that the bottle does not
• Set an exposure of 50 kV and 6 mAs. leak.
• Expose.
• Polystyrene blocks used to pack equipment can
• Process the film.
be cut to required shapes.
• Polystyrene chips used in packing can be sealed
Evaluation
into suitable sized cotton or linen bags.
• Look for radio opaque shadows within the
• Cardboard boxes can be cut down to suitable sizes
pad.
and shapes and re-stuck.
• Wooden blocks can be cut to shape.
Action
• Folded blankets can also be useful.
• If radiopaque shadows are detected, wash and
dry the pad. Note: It should be remembered that any improvised
• Re-test. positioning aid must be checked as to its radiolucency
• If opacities are still seen, replace the pad. before use.
• Continued use of the pad may be considered, pro-
vided it is identified as containing radiopaque Patient measuring callipers
material and not used where it might show on
the films. Measuring callipers are a simple device that allow easy

• File a report. and accurate measurement of a body part.


Calculating radiographic exposure factors can be
made more accurate by relating them to the thickness
Other positioning aids of the body pat't (see Module 6. Radiographic expo-
A range of materials can be used to assist in position- sures, page 124 and Appendix A, page 135). In order to
ing the patient in specific positions, some radiolucent do this, it is more convenient to use measuring calli-
and some not. pers.
Care should always be taken to ensure that radio-
paque positioning aids do not obscure the image. Care
• Handle with care as they are easily bent or
Sandbags These are radiopaque. They should have broken.
waterproof or removable cotton or linen • Any distortion may mean that they are no longer
covers that must be washed regularly. accurate.
Flour bags Similar to sandbags but are radiolu- • Store in a safe but convenient place.
cent. They mould to different shapes • Clean regularly.
more readily, but are not so heavy as
sandbags. Callipers accuracy test
Compression If the band is linen, detach from the Frequency of test
band end fixing mechanisms and wash as • Monthly.
necessary. • As necessary.
QUALITY ASSURANCE WORKBOOK
42

Equipment required Evaluation


• Callipers to be tested. • The measurements should be accurate to within
• Measuring device. +or -2mm.

Method Action
• Check that the moveable arm is not loose. • If the measurements are not accurate, carefully
• Measure the distance between the outer ends of bend the arm.
the two arms at minimal, mid and maximum • If the arm is loose, attempt to tighten it. If un-
distances. able to correct faults, arrange to have it repaired
• Repeat these measurements at the base of the or replaced.
arms. • File a report.
• Check against scale.
MODULE 2. ACCESSORY EQUIPMENT
43

Notes
QUALITY ASSURANCE WORKBOOK
44

TASK3
Collimator

Several staff have had to repeat films because they have coned off part of the image. The problem seems to be
associated with one X-ray room only. What would you do?

a) Select an X-ray room and carry out the test you think is appropriate.
b) Give a brief summary of what you did.
c) Write a report of your findings.
d) Recommend appropriate action, if any.
e) Write your report below.
f) If there is insufficient space, use additional sheets of paper and attach.

Brief summary of procedure

Report
MODULE 2. ACCESSORY EQUIPMENT
45

Recommendation for action, if any

Include any test films with this report

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
46

TASK4
Changing a collimator light bulb

The light in the collimator does not work. You suspect a blown bulb.
a) Select a collimator and carry out the appropriate remedial action.
b) Answer the following questions in the spaces provided.
c) Ask your tutor or an electrician to supervise your actions.

l. What type of light bulb in u s e ? - - - - - - - - - - - - - - - - - - - - - - - - - -

2. Does this bulb have to be fitted a certain way round? YES/NO

3. If YES, describe t h i s : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

4. Where are the spare bulbs k e p t ? - - - - - - - - - - - - - - - - - - - - - - - - - -

5. Is a correct spare readily available? YES/NO

6. Who supplies the spare bulbs? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 2. ACCESSORY EQUIPMENT
47

TASKS
Film/screens

You have detected a localised area of unsharpness in an image, carry out the test you would do to investigate the
problem.

a) Select any cassette and carry out the appropriate test.


b) Briefly describe the test you carried out.
c) Report on your findings.
d) Recommend any action you consider necessary.
e) Write your responses in the spaces provided.

Brief description of test carried out

Report on your findings

Recommended action

Include your test film with this report

Tutor's comments:

Satisfactory/Unsatisfactory

Sigature Date
Tutor
QUALITY ASSURANCE WORKBOOK
48

TASK6
Intensifying screens

The densities of your radiographs have not been consistent.You are confident that your choice of exposures and the
X-ray equipment is not the problem. You suspect the problem may lie with the efficiency of some of your screens.

a) Select any three cassettes of similar size, fitted with the same type of screens and using the same type of
film.
b) Carry out the appropriate test to check the consistency of those screens.
c) Briefly describe the test you carried out.
d) Inspect the resultant films and make a report on your findings.
e) Recommend any action you consider necessary.
f) Write your responses below in the spaces provided.

Brief description of test carried out

Report of your findings

Recommended action

Include your test films with this report

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 2. ACCESSORY EQUIPMENT
49

TASK?
Stationary grid

It is time to carry out the regular QC checks on your stationary grids.


(a) Select a stationary grid.
(b) Carry out the appropriate stationary grid tests/checks.
Cc) Answer the questions below, in the spaces provided.

l. Record the grid specifications:

Grid R a t i o - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Grid L i n e - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Focal Range _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

2. Is the tube side identified? Yes/No

3. How was the tube side identified?

4. Is the direction of the lead strips indicated? Yes/No

5. How was the direction of the lead strips indicated?

6. Write your visual report here

7. Write your evaluation of the X-ray image here


QUALITY ASSURANCE WORKBOOK
50

8. What action do you recommend?

Include your test films with this report

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 2. ACCESSORY EQUIPMENT
51

TASKS
Lead rubber apron and gloves

It is time to carry out the regular QC checks on your lead rubber items.
a) Select a lead rubber apron and pair of gloves.
b) Carry out the appropriate tests/checks.
c) Answer the following in the spaces provided.

1. Write your visual inspection report:


General Condition:

Cleanliness:

Possibility of Cracks:

Storage Location:

Hanging Devices:

Staff use of Hanging Devices:

2. Write your test report:


QUALITY ASSURANCE WORKBOOK
52

3. Write your recommendations for action, if any

Include your test films with this report

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 2. ACCESSORY EQUIPMENT
53

TASK9
Viewing box

It is time to carry out your routine QC checks on your viewing boxes.


a) Select a viewing box.
b) Carry out the appropriate procedures.
c) Ask your tutor or an electrician to supervise this.
d) Answer the following questions in the spaces provided.

l. Is the viewing box

• Conveniently placed? YES/NO

• Safely fixed to the wall/mobile structure? YES/NO

• In good working order? YES/NO

• Of satisfactory design? YES/NO

2. Does it have

• An adequate light output? YES/NO

• An all over even light? YES/NO

What action would you recommend, based on your answers above?

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
54

TASI< 10
Positioning pad inspection

It is time for the regular QC checks of your positioning pads.


a) Select any one positioning pad.
b) Carry out the appropriate tests/checks.
c) Answer the following questions in the spaces provided.

l. Write a visual inspection report


General Cleanliness

Likelihood of radiopaque contamination

Shape

Firmness

Smell

2. Write your X-ray test report

3. Write your recommended action, if any


MODULE l. ACCESSORY EQUIPMENT
55

Include your films with these answers

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUAliTY ASSURANCE WORK~OOK

56

MODULE 3

X-ray equipment

Aim 11 Alignment.
ll FFD (SID).
To provide the technical information and testing rou-
tines that will allow simple care, maintenance and test-
X-ray table
ing to be carried out on basic X-ray equipment. To
Ill Mechanical.
provide an insight into the choosing and accepting of
11 Electrical.
basic x-ray equipment.
11 Alignment.

Objectives Tomography
On completion of this module the student will have the 11 Mechanical.
technical knowledge and practical skills to carry out 11 Electrical.
simple cleaning, maintenance and testing on: ll Cut (layer) level.
11 Image quality.
Generator
11 Radiation output reproducibility. Potter bucl<y
11!1 Constancy of radiation output at different mA 11 Mechanical.
settings. Ill Electrical.
11!1 Accuracy of kVp. 11 Alignment.
11!1 Accuracy of timer.
Portable and mobile units
X-ray tube and high tension (HT) cables 11 Moving.
Ill Electrical. 11 Setting up.
Ill Mechanical.
Tube support 11 Electrical.
11 Mechanical. 11 Checking the X-ray output.

The term "X-ray equipment" covers generator, tube, • kV, mA, time ranges.
cables, control panel, table, tube stand and bucky. • Tube mounting (overhead or column).
Specific types of equipment considered are general • Table (tilting, fixed, floating top, bucky).
purpose, tomography, portable and mobile. • Upright bucky.
It is important to ensure that all equipment is worl<- • Anticipated patient through put.
ing efficiently and accurate records are kept (see
Appendix A, pages 133 to 137). Resources available
• Power.
• Space.
Choosing X-ray equipment
• Maintenance and repair.
Identify your need • Finance.
• General purpose, fluoroscopy, specialised,
mobile. Manufacturer warranty
• Generator (design/output). • Warranty period.
• To suite power supply. • Warranty cover.
• Determine responsibilities.
MODULE 3. X-RAY EQUIPMENT
57

Supplier service • Fluctuations in the main electrical supply.


• Installation. • Inconsistency or inaccuracies in kVp, mA and
• Initial QC tests. time.
• Maintenance.
• Repairs. Fluctuation in main electrical supply
• Parts. Most X- ray units have a mains compensator that auto-
• Speed of response. matically compensates for mains fluctuations. Howevet;
in some less sophisticated units this must be done by
Making the choice hand. The radiographer must always check the mains
• Establish your specification requirements. compensator meter before making an exposure and
• Review manufacturer's specifications. make any corrections necessary.
• Make a short list of suitable equipment.
• Submit your requirements to the selected manu- Radiation output reproducibility test
facturers for quotations. To check that the radiation output is consistent when
• Review quotations. identical exposures and conditions are used.
• Make selection.
Frequency of test
Ensure that you have the written agreement of the • At the start of a quality control program.
manufacturer or supplier, to supply and install the equip- • Yearly.
ment chosen, at the price quoted and that there are • As necessary.
no hidden extras.
Equipment required
• A water phantom, consisting of a plastic flagon
Acceptance of new X-ray equipment
or bucket filled to a depth of lOcm (see Appen-
Upon completion of the installation and before accept- dix A, page 133).
ing responsibility for the new equipment, you must • Two sheets of lead rubber.
check that • One 24 x 30 cm loaded cassette.
• Specifications of equipment installed are the
same as that ordered. Method
• Installation has been carried out as stated in the • Place the cassette face up on the X-ray table.
contract. • Cover three quarters of the cassette with lead
• Installation is complete and equipment is work- rubber, crosswise, leaving an end section
ing efficiently and to your satisfaction. uncovered.
• All QC tests have been carried out and are e Set a lOO cm FFD CSIDl.
satisfactory. • Collimate the beam to cover the uncovered
section.
• All accessory equipment has been supplied and
is in good order. • Place the water phantom over the area to be
• Operating manual has been supplied and is the irradiated.
correct one. • Set an exposure that will produce a low density
on the film (density of 1). 80 kV and a low mAs is
Only when you are sure that the installation has been suggested. It should be just possible to read news-
carried out satisfactorily should you sign the ac- paper print through the density produced (you
ceptance papers. may find it necessary to experiment before start-
ing the test).
Generator • Check that the mains compensator is correctly
set.
A generator is part of the electrical system of an X-ray
• Make an exposure.
machine which determines radiation output. Any in-
• Repeat this procedure for each of the remaining
consistency in radiation output will adversely influence
three sections. Making sure that you have identi-
the quality of the radiograph.
cal conditions. When placing the lead rubber al-
The kV, mA and time must be consistent on all set-
low for a space of about 2 mm between each
tings. Many factors can influence the radiation output.
exposed area.
The ones to be considered are:
• Process the film.
QUALITY ASSURANCE WORKBOOK
58

• The same cassette should be used each time the • Use three exposures with the same kV and mAs
test is carried out. values, but differing combinations of mA and
time.
Evaluation • Suggested exposures: (you may find it necessary
• Compare the densities. If you have a densitom- to experiment before doing the test)
eter, take readings from the centre of each im- - Exposure 1: 80kV 10mAs (SOmA 0.2sec)
age and compare these too. - Exposure 2: 80kV 10mAs ClOOmA 0.1sec)
• The conditions for all four exposures were identi- - Exposure 3: 80kV 10mAs (200mA 0.05sec)
cal; therefore all densities should be the same.
• If they are not then the unit is not producing a Evaluation
consistent output. • Despite the fact that the mA and time vary,
• Compare with any previous test films. the mAs value remains the same, as does the
kV, therefore all film densities should be the
Action same.
• If the densities are not the same repeat the test • If the densities are not the same, then it must
at different times of the day. Mains fluctuations be assumed that one or more of the exposure
may be the problem. factors are inaccurate or inconsistent.
• If the densities remain inconsistent, call the X- • By varying the mAs and time factors, but retain-
ray engineer. ing the same m A and kV values as before, it should
• If the inconsistencies are minimal continue to use be possible to identify which of the factors is at
the unit. fault.
• If the inconsistencies are unacceptable, then stop • If the out of step density in each test was the
using the unit until the fault has been corrected. second exposure ClOO mAl, this indicates that the
• Mark all films with date and time, and keep for fault lies with the 100mA setting.
reference. e.g. 80 kV 50 mAs (50 m A l.O sec)
• Record exposure factors, FFD (SIDl, water phan- 80kV SOmAs ClOOmA O.Ssec)
tom details, size of the X-ray field, cassette number 80 kV 50 mAs (200 mA 0.25)
and type of film used, for future reference. • kV and time checks should be carried out in con-
• File a report. junction with this test.

Constancy of radiation output at different Action


mA settings test (see Appendix B, page 155) • Repeat the test several times, varying the expo-
A test to check the reliability of the mA and time set- sures, but always keeping the kV and mAs con-
tings (most importantly the mAl. The photographic ef- stant, within any one test.
fect for a given mAs value should remain constant even • If the densities continue to be inconsistent, call
though the mA and time factors may be varied.AII other an X-ray technician.
factors being constant. • If the inconsistencies are minimal continue to use
the unit.
Frequency of test • If the inconsistencies are large, stop using the
• At the start of a quality control program. unit until the fault has been corrected.
• Yearly. • Mark all films with date, time and exposures and
• As necessary. keep for reference.
• Record exposure factors, FFD (SIDl, water phan-
Equipment required tom/step wedge details, size of X-ray field, cas-
• A step wedge or10 cm water phantom, as used in sette number and type of film used.
previous test (see Appendix A, page 133). • File a report.
• Two sheets of lead rubber.
• One 24 x 30 cm cassette. Accuracy of timer test
A test to check the accuracy of the X-ray unit timer.
Method This test should only be carried out on a 1 or 2 pulse
• Carry out the procedure used for the reproduc- unit. Timers of 3-phase and capacitor discharge units
ibility test (see page 34), with the following cannot be checked by this method.
exceptions.
MODULE 3. X-RAY EQUIPMENT
59

• The accuracy of the timer is checked by counting


the number of spots.
• If the mains supply has a frequency of 50Hz
(50 cycles per second):
- A one-pulse (self rectified) unit will generate
50 pulses of radiation per second (50 spots
on the film).
- Therefore a 0.1 sec exposure should produce
5 spots (see Fig 3-2).

Fig 3-l.Accuracy of timer test using spinning


top

Frequency of test
• At the start of a quality control program.
• Yearly.
• As necessary.

Equipment required Fig 3-2. Spinning top image of a single pulsed


• Manually operated spinning top (see Fig 3-1 and unit using a 50Hz mains supply
Appendix A, page 135).
• One loaded 24 x 30 cm cassette.
• Two sheets of lead rubber. - A two-pulse (full-wave rectified) unit will gen-
erate 100. pulses of radiation in one second
Method ClOO spots on the film).
• Place the cassette on the X-ray table face up. - Therefore a 0.1 sec exposure should produce
• Place the spinning top in one quarter of the 10 spots (see Fig 3-3).
cassette.
• Cover the other three quarters of the cassette
with lead rubber.
• Set a 100 cm FFD CSID) and collimate to cover
the spinning top.
• Set an exposure of 70 kV, lOO mA and a time of
0.1 sec.
• Manually spin the top. After it has settled to a
medium speed, make an exposure (it may be
necessary to experiment before starting the
test).
• Repeat the process on each of the remaining
Fig 3-3. Spinning top image of a two pulsed
quarters of the film.
unit using a 50Hz mains supply
• Process the film.

Evaluation
• The film will show four images, each having a • If a mains supply has a frequency of 60Hz (60
series of spots forming an arc. cycles per second):
• The distance between the spots is not important - A one-pulse unit will generate 60 pulses
as this only represents the speed at which the of radiation per second (60 spots on the
disc rotates. fiim).
• The spots should easily be counted, so do notal- - A 0.1 sec exposure will produce 6 spots (see
low the spots to complete a circle and overlap. Fig 3-4).
QUALITY ASSURANCE WORKBOOK
60

Note
• Three-phase and capacitor discharge units will
show a continuous line image (see Fig 3-6).

Fig 3-4. Spinning top image of a single pulsed


unit using a 60Hz mains supply

- A two pulse unit will generate 120 pulses of


radiation in one second (120 spots on the Fig 3-6. Spinning Top Continuous line Image
film).
- A 0.1 sec exposure will produce 12 spots (see
• These images are of no value in checking the timer.
Fig 3-5).
• The capacitor discharge unit may show a con-
tinuous line image of reducing density.
• If your unit is the type that produces a line of
reducing density,you may wish to do spinning top
tests on the three highest time settings. Study
the low density end of the line. If the density
is very low, the radiation at that exposure time
is of little value in image production and only
adds to patient dose. Consider not using that
setting.

Fig 3-5. Spinning top image of a two pulsed Accuracy of kVp test
unit using a 60Hz mains supply To check that the generator is producing the kVp set
on the control panel. This can be carried out by using
a kVp meter or a kVp test cassette. One of the most
• Other exposure times will produce a different
widely used is the Wisconsin peak kilovoltage test
number of spots.
cassette.

Action
• If the number of spots on the images is different
Using a kVp meter
from the number expected, the timer may be in- Frequency of test
accurate. Repeat the test using different time • When the equipment is first installed.
settings. • Yearly.
• If the number of spots on all four images on the • As necessary.
film is the same, but different from the number
expected, the fault wou Id seem to be consistent. Equipment required
The unit can still be used, but compensatory • kVp meter.
changes to exposures must be made. • Generator to be tested.
• If the number of spots on the images is not the
same, the fault would seem to be inconsistent. A Method
decision must then be made whether to use the • Place the sensor in the middle of the X-ray beam
unit or not. at a FFD CSID) of lOO cm.
• If the fault appears to be related to a specific • Collimate to a standard area sufficient to cover
time setting, the unit can continue to be used, the sensor.
avoiding this time setting. • Take readings at 10 I<Vp intervals from 50 kVp to
• Call an X-ray engineer. the maximum kVp available.
• File a report • Use a standard mA and time throughout.
MODULE 3. X-RAY EQUIPMENT
61

• Repeat this procedure for each tube focus Method


available. • Place the cassette on the tabletop, face up (side
marked with kVp divisions) and long dimension
Evaluation of the cassette parallel to the anode-cathode axis.
• Compare each kVp reading with the appropriate • Set a lOO cm FFD (SIDl.
kVp setting. • Collimate to the area of the cassette marked with
• The measured kVp must be within+ o1· -5 kVp o1· the lowest kVp (60 kVpl.
5%. • Set a kVp of 60.
• Set an mAs value that will give a density of ap-
Action proximately l in the region of the dots (you may
• If the measured kVp s do not fall within the ac- need to experiment).
ceptable limits, call an X-ray engineer. • Shield the remainder of the cassette with lead
rubbe1·.
Using a kVp test cassette • Make an exposure.
• Expose each of the othe1· section of the cassette
Frequency of test
(marked 80, lOO and 120 kVpl separately, using
• When equipment is first installed.
the appropriate kVp each time.
• Yearly.
• The time setting should be adjusted for each ex-
• As necessary.
posure, to maintain an optical density of l in the
region of the dots each time. The mA remains the
Equipment required
same for each exposure.
• Loaded kVp test cassette (see Fig 3-7 (a)).
• Remember to adjust the lead rubber each
• Two sheets of lead rubber, one 10 x 23 cm and
time.
the other 23 x 23 cm.
• Test cassette calibration graphs for each kVp level used.
• Densitometer. Approximate mAs settings

kVp Single phase unit Three phase unit


60 500 400
80 75 40
lOO 15 10
120 12 8

Joel E Gray et al, Quality Control in Diagnostic Imaging.

• Pmcess the film.


• Repeat this p1·ocess at low, mid and high mAs
settings.
(a)

Evaluation
• On the 1·adiog1·aph the regions are identified as A
(60 kVpl, B (80 kVpl, C (lOO kVp), D (120 kVp).
• Each k'lp region contains two columns of clots
(see Fig 3-7 (bll.
• The ho1·izontal rows are numbe1·ecll to 10,1 be-
ing at the darker end of the column.
• One column of dots is of uniform density, in each
region, and is called the reference column.
• The clots in the other column, in each region, will
show a density gradient, darkest at the top
(b)
(120 kVp i'egion) and lightest at the bottom
Fig 3-7. (a) kVp test cassette, (b) test cassette (60 kVp region).
image of one kVp region
QUALITY ASSURANCE WORKBOOK
62

• Look for a density match between the two col- Action


umns, in each region. This should be done with a • If the measured kVp s do not fall within the ac-
densitometer. cepted limits, call an X-ray engineer.
• If an exact match is not found an average must
be determined using the following method. Control panel check
Frequency of checl<
Example:
• Yearly.
Step No. Optical density Optical density
• As necessary.
of step of reference
5 1.40 1.15
Equipment required
6 1.10 1.15
• Control panel to be checked.
1
Match step 5 = 6 + .4°- 1.
15
= 5 + 0· 25 = 5.38
1.40- 1.10 0.30 Method
• Check that all meters are working and all illumi-
• When a match has been determined for each nated panels are lit.
region, refer to the calibration chart for the ap- • Check that all knobs, switches and buttons are
propriate region (charts for each of the four kVp firmly attached and work effectively.
regions are supplied with the cassette). • Check that all read outs are visible and are
• The chart will have two graphs on it, one for a accurate.
single phase unit and one for a three phase unit • Check that all signage is readable and correct.
(see Fig 3-8) • Check that hand switch operates effectively and
is not damaged.
• Check that the cable to any extension hand or
10 foot switch is not damaged or showing signs of
Three phase wear and that the electrical connections are
9
secure (exposure switches on cables are not
8 recommended).

7
Action
Step No. 6 • Correct any simple faults.
• For more complicated faults call an X-ray
5 engineer.
4 • Inform staff.
• File a report.
3
Single phase
2
X-ray tube and high voltage cables check
Frequency of checl<
1
• Yearly.
0 • As necessary.
50 60 70 80 90 lOO llO 120

kVp Equipment required


Fig 3-8. kVp test cassette calibration chart, • Equipment to be checked.
suitable for region C (I 00 kVp)
Method
• Check that the tube is securely fixed to its sup-
• Using the appropriate graph, plot the match step port and that any movement locks are working
level for each kVp region on the vertical axis, then effectively.
read off the corresponding kVp s from the hori- • Check that the collimator is securely fixed to the
zontal axis. These kVp s shou Id, correspond to the tube and that it rotates freely.
kVp s used. • Inspect the high tension (HTI cables.
• The measured I<Vp must be within + or SI<Vp or - Check for damage, wear or acute bending.
5%. - Check that any cable support brackets are
MODULE 3. X-RAY EQUIPMENT
63

firmly fixed and that the cables lie in them cult to adjust accurately. This test can also be applied
correctly. to the upright Bucky.
- Check that the cables hang freely, do not
catch on anything and extend to their required Frequency of test
limits without unnecessary tension. • Yearly.
• As necessary.
Evaluation
• Anything that is damaged, considered unsafe or Equipment required
has potential for wear or damage should be cor- • Equipment to be tested.
rected as soon as possible.
Method
Action • First check the alignment of the light field and
• Correct any simple faults immediately. X-ray field in the collimator (see Module 2,
• For more complicated faults, call an X-ray Accessory equipmen( page 30). If an error is
engineer. found this must be corrected before starting
• Inform staff. further tests.
• File a report. • Ensure that the tube is perfectly straight.
• Switch on the collimator light.
• Lower the tube until the window of the collima-
X-ray tube, column, table and
tor is just above the table top.
upright bucky
• Adjust the tube until the centre line of the light
Locks and movements check field is on the centre line of the table.
Frequency of check • If you have a floating top table, centre the
tabletop first.
• Yearly.
• Check to see if the automatic centring notch on
• As necessary.
the tube arm has been located, if there is one.
Equipment required • Move the tube to the top of the column.
• Equipment to be checked. • Look to see if the centre line of the light field has
moved away from the centre line of the table.
Method e Set a FFD (SID) of lOO cm.
• Test all movement locks for effectiveness and ease • Angle the tube up and down the table, watching
to see if the centre line of the light field remains
of use.
• Test the freedom of movement of the column on the centre line of the table.
. along the floor and if it travels the full length of • Re set the X- ray beam at 90 a to the tabletop .
the track. • Move the tube column from end to end of the
• Any ceiling tracks should be tested in the same table, watching to see if the centre line of the
way. light field remains on the centre line of the table.
• Look for any wear or damage.
• Check for loose or missing screws, bolts or Evaluation
fittings. • If the centre line of the light field does not re-
main on the centre line of the table during tube
movement there is an alignment problem.
Action
• Correct any simple faults immediately. • If the centring notch cannot be located when
• For more complex faults, call an X-ray engineer. the tube is correctly centred to the table there is
• Notify staff. · an alignment problem. The possible causes are:
- The X-ray tube has slipped in its mounting.
• File report.
- The tube column is not vertical.
Alignment of X-ray beam to table test - The cross arm (if there is one) is not
The X-ray beam must be perpendicular to the tabletop, horizontal.
when in the normal over-couch position. Most X-ray - The tube column track is not parallel to the
tube mountings allow limited angling across the table. table.
The lock for this movement sometimes slips, or is diffi- - The table is not level.
QUALITY ASSURANCE WORKBOOK
64

- The centring notch is wrongly located. Method


- The tube column track is the wrong distance • Place the spirit level horizontally on the centre
from the table. line, at one end of the table.
• Note the position of the bubble.
Action • Rotate the spirit level through 90°.
• Carry out the following tests to determine the • Note the position of the bubble.
exact cause of the problem. • Repeat this procedure at the other end of the
table.
Check that column is vertical test • The bowl of water can be used instead of the
spirit level by measuring the height of the water
Frequency of test
surface above the table around the bowl.
• Yearly.
• As necessary.
Evaluation
• If the spirit level bubble is not centred, the table
Equipment required
is not level.
• Spirit level with vertical capability, or a plumb
• If the surface of the water is not parallel to the
bob (weight on a length of string)
tabletop, the table is not level.
• Equipment to be tested.

Action
Method
• If the fault is a problem, it may be possible to put
• Hold the spirit level vertically against the side of
packing under the legs or base of the table or
the tube column and note the position of the
call an X-ray engineer.
bubble.
• File a report.
• Move the spirit level a quarter of the way around
the column and repeat the procedure, or
Check that the cross-arm is horizontal
• Hold the end of the string high against the cen-
tre of the column so that the weight holds the Frequency of test
string straight and unobstructed. • Yearly.
• Check to see if the string and column are • As necessary.
parallel.
• Move the string a quarter of the way round the Equipment required
column and repeat the procedure. • Spirit level or a metre rule.
• Equipment to be checked.
Evaluation
• If the spirit level bubble is not centred, the col- Method
umn is not vertical. • Place the spirit level on the top of the cross-arm,
• If the string is not parallel to the column, the or hold against the underside of the cross-arm.
column is not vertical. Note the position of the bubble, or
• Measure the distance from the cross-arm to
Action the table top at the front and back of the
• Call an X-ray enginee~ to make adjustments. cross-arm.
• File a report.
Evaluation
Check that the table top is horizontal • If the spirit level bubble is not centred, the cross-
arm is not horizontal, or
Frequency of test
• If the two measurements are not the same, the
• Yearly.
cross-arm is not horizontal.
• As necessary.

Action
Equipment required
• If the misalignment is considered to be a prob-
• A spirit level or an improvised system (bowl or
lem, call an X-ray engineer.
bucket of water) can be used.
• Notify staff.
• Large diameter bowl or bucket and a ruler.
• File a report.
• Equipment to be checked.
MODULE 3. X-RAY EQUIPMENT
65

Test alignment of X-ray beam to Action


upright bucky • Inform staff of any inaccuracies if the problem
• It is usual to align an upright bucky against a cannot be corrected immediately.
wall in line with the end of the X-ray table. • Temporary corrections could be made by stick-
• If this is so, it is useful to have the centre line of ing a strip of adhesive plaster over the scale and
the upright bucky in line with the centre line of accurately re marking the scale.
the table. • Arrange to have pointers or scale moved to cor-
• The tube can then easily be angled from the rect location.
table to the upright bucky. • If only one pointer is fitted, arrange for a second
• Similar alignment tests to those carried out on to be fitted or notify staff of the adjustment nec-
the table can be used. essary when setting the FFD CSID).
• File a report.
Test accuracy of FFD (SI D) scale • Carry out the test again after remedial work has
Many basic fixed X-ray units have a scale fixed to the been completed.
tube column. This allows the radiographer to easily set
the FFD CSID) above the table.
Tomography
A pointer is fixed to the tube arm mounting, allow
accurate measurement to the tabletop.There may be a A system which allows prolonged exposures whilst tube
second pointer giving the FFD CSID) to the under table and bucky move in harmony.
bucky tray. If there is no second pointer it will be nec- In simple linear tomography the tube and bucky are
essary to measure the table top to bucky distance and connected by an arm, the centre of which is pivoted.
make allowance when using the bucky. The height of the pivot above the tabletop determines
the level of image clarity, while all other levels appear
Frequency of test blurred.
• Following new installation The size of the angle of swing determines the thick-
• Following any changes to equipment. ness of cut. The bigger the angle the thinner the cut,
• As necessary. the smaller the angle the thicker the cut.
It is a useful technique in blurring out unwanted
Equipment required parts of the X-ray image. It can be a dedicated unit or
• Tape measure. an attachment to a general-purpose X-ray unit.
• Equipment to be tested.
Mechanical and electrical check
Method Frequency of check
• Check to see if there is a pointer and that it is • Each time the tomographic equipment is set up
firmly attached and pointing at the correct angle. if an attachment
• Adjust the pointer if necessary. • Yearly if a dedicated unit.
• Measure lOO cm from focal spot location dot, on
the tube housing, to the tabletop. Equipment required
• Check to see if the pointer is on the lOO cm mark • Tomographic unit to be checked.
on the scale.
• If there is a second pointer measure lOO cm from Method
the dot on the tube to the bucky tray.
• Check to see if the correct pointer is on the Inspect:
lOOcm mark on the scale. • Fulcrum attachment attaches securely to the
• If there is only one pointer, record whether it table.
measures to the tabletop or bucky. • Connecting arm attaches securely to the bucky
• Record the measurement from the tabletop to and tube.
the bucky tray. • Connecting arm pivots correctly.
• FFD CSID) readout displays can be checked in • Cut height adjustment moves freely.
the same way. • Tube mounting column runs freely on tracks.
• Electrical cable, connections and plugs.
Evaluation • Tomography ON/OFF switch.
• Any inaccuracies require remedial action. • Carry out a test run.
QUALITY ASSURANCE WORKBOOK
66

Evaluation Method
• Electrical cables, switches and plugs fitted prop- • Set up the tomography equipment.
erly and show no signs of wear. • Place the cassette face up in the bucky.
• Mechanical parts move freely and show no signs • Set an exposure of about 50 kV, lowest mA and a
of wear. normal tomography time.
• Locks effective. • Place the phantom longitudinally (nails at 90° to
• Drive motor works effectively. the direction of tube travel) on the centre line of
• Cut height adjustment works effectively. the table, directly over the middle of the cassette
• No tube vibration during travel. when the X-ray beam is vertical.
• Collimate to cover the phantom.
Action • Set the fulcrum height.
• Correct any minor faults. • Place a lead marker within the light field, indi-
• Call an X-ray engineer for more complex faults. cating the height of the fulcrum.
• File a report. • Position the tube column in its normal start
position.
Cut (layer) height accuracy test • Make an exposure.
• Observe movements.
Frequency of test
• Process the films.
• Yearly.
• As necessary. Note: MESH TEST TOOL-must be placed at 45 o to
the line of tube travel, otherwise there will be incom-
Equipment required plete blurring of the wires running in the same direc-
• Tomography test tool (see Fig 3-9, Fig 3-10 and tion as that of the tube travel. For ease of use, a wire
Appendix A, page 136). should be taped across the mesh at the height of the
• One 18 x 24cm loaded cassette. fulcrum. NAIL TESTTOOL-note the number of nails in
• Equipment to be tested. the row at the height of the fulcrum.

Evaluation
• Study the image. In linear tomography there
should be one area of clearly defined, in focus,
mesh, or row of nails, with the remainder of the
image on either side being blurred.
• Note the height of the sharply defined area in
the image and check against the actual cut
height. Within + or -5 mm is acceptable.

Action
• You may wish to repeat the procedure with dif-
ferent fulcrum heights.
Fig 3-9.Tomography test tool using nails • If the clearly defined image height and set height
do not coincide, carry out the test again to make
sure that no errors have occurred.
• If the inaccuracy is still present call the X-ray
engineer.
• If the inaccuracy is consistent, the unit can con-
tinue to be used, with appropriate temporary
changes made to the scale.
• If the observed movements were not smooth, fur-
ther investigation is necessary.
• File a report.

Cut thickness accuracy test


Although this is not a highly accurate assessment of
Fig 3-1 0. Tomography test tool using mesh
cut thickness, it is still quite useful. The wire mesh test
MODULE :J. X-RAY EQUIPMENT
67

tool is more suitable for this test (see Appendix A, page of the central darker spot indicate that the tube
136). A similar test is carried out to that described for is not travelling the full length of its travel, either
the "cut height" test. Repeat the test using different at the start or end of its movement.
angles of swing, if available.
Action
Evaluation • Check that the equipment is set up correctly and
• Measure the depth of the clearly defined areas there is nothing obstructing its travel.
· of mesh and compare. • If the fault is still present call an X-ray engineer.
Note: this test can also be used to check the angle of
Action
swing by using the formula
• If the cut thickness does not appear to be what
it should be, call an X-ray engineer. Tan 8 = ~

Where a = the distance between the lead sheet and


Pinhole trace test the film
The quality of the image can be assessed by using the b = the distance between the one end of the
pinhole trace test image to the central darker spot.
8 =the angle formed by the central ray when
Frequency of test vertical and when at the furthest point of
• Yearly. its travel during the exposure.
• As necessary.
Checking the radiation output
Equipment required • Use a similar test to that described under
• A sheet of lead, approximately 150 mm x 150 mm, Pinhole Trace test (see page 57).
with a 2 to 3 mm diameter hole drilled in the • If the density of the black line is regular through-
centre. out (except for the black dot in the middle) the
• One 18 x 24 cm loaded cassette. radiation output is considered to be consistent.
• Rule or tape measure. • If there is some variation in density then the ra-
diation output has not been consistent.
Method • This is not an accurate test, but does give some
• With the central ray vertical, place the cassette idea of radiation consistency.
on the table top, face up, so that the central ray
is directed to the middle of the cassette. Cleanliness of equipment
• Position the lead sheet at the same height above Cleaning equipment should be treated as part of the
the table top as the fulcrum, with the pinhole quality assurance program. Regular cleaning of all
directly over the middle of the cassette. equipment is very important from a hygiene and work
• Collimate to the hole in the lead. environment point of view.
• Make an exposure with the tube stationary.
• With the same cassette still in position, make a Frequency of cleaning
second exposure while the tube moves through
• Daily
its cycle. • As necessary.
• Process the film.
Equipment required
Evaluation • Clean cleaning cloths.
• The radiographic image should be a black line
with straight sides and of even density, with a Method
darker spot in the middle of it. The distance from • Wipe over all equipment surfaces using a dry
the ends of the black line to the darker central cloth.
spot should be equal. • If dirt/marks on non electrical equipment cannot
• An uneven image indicates vibration of the tube be removed, dampen the cloth slightly with water.
during movement. • Be very careful when using liquids near any elec-
• Uneven densities in the image indicate variations trical apparatus as most liquids are good con-
in the speed of tube travel. ductors of electricity and may cause a short and
• Differences in the length of the image either side equipment damage.
QUALITY ASSURANCE WORKBOOK
68

• Methylated spirit or cleaning fluids may be used Grid movement test


with care, if necessary. The grid in a potter bucky is designed to move from
side to side during the exposure, when switched on.
Action Movement may be too fast, too slow, erratic or not take
• Keep records of daily cleaning routines. place at all.
• Record condition of equipment.
Frequency of test
• Yearly.
Potter bucky
• As necessary.
Mounted under an X-ray table, or in upright form, it
consists of a cassette tray, above which is mounted a Equipment required
grid, which move during the exposure. Provides the • Bucky to be tested.
benefits of a grid, but with the movement diffusing out • One.35 x 43cm loaded cassette.
the image of the gridlines.
Method
Operation test • Place the cassette, face up, in the bucky tray and
Frequency of test push the tray in.
• Yearly. e Set a lOO cm FFD (SIO).
• As necessary. • Centre the X-ray beam to the bucky and colli-
mate to cover the film.
Equipment required • Set an exposure to give a density of 1 (ap-
• Potter-Bucky to be tested. proximately 55 kV 20 mAs). You may need to
experiment before carrying out the test.
Method • Switch the bucky on.
• Check bucky movement on mounting rails. • Make an exposure.
• Check efficiency of locks. • Process the film.
• Check bucky tray movement and cassette clamp.
• Check that grid movement takes place during Evaluation
exposure. • If there is an even, clear pattern of grid lines over
• Remember that this is a test. Close the collima- the whole of the film the grid did not move at all,
tor shutters and direct the X-ray beam well away or moved too slowly, orfor only part of the exposure.
from the person carrying out the checl<. • If there is an uneven pattern of grid lines over
the film the grid moved erratically.
Action • If the grid lines could not be seen, the grid moved,
• If bucky does not run freely on rails: as it should.
- Look for obstruction and free it.
- Lubricate rails. Action
- Request replacements if appropriate. • Check to see if anything is stopping the grid
• If locks are faulty: movement.
- Adjust or request replacement. • Check the cable and electrical connections.
• If bucky tray movement is faulty: • Re test.
- Look for obstruction. • If you have been unsuccessful call an X-ray
- Lubricate. engineer.
• If cassette clamp is faulty: • Inform staff.
- Adjust and/or lubricate. • File a report.
- Repair or request replacement.
• If grid movement appears to be erratic, carry out Cassette centered to the middle of the
grid movement test. bucky test
• If it is not possible to fix the problem, call an X- Frequency of test
ray engineer. • Yearly.
• File report. • As necessary.
MODULE 3. X-RAY EQUIPMENT
69

Equipment required
• Bucky to be tested.
• Marker (small coin).
• One 35 x 43 cm loaded cassette.

Method
• Place the cassette in the bucky tray face up.
• ~heck that cassette clamp is firmly and correctly
closed.
(a)
• Push bucky tray fully in and lock bucky in
position.
e Set a FFD (SID) of lOO cm.
• Centre the beam to the middle of the table.
• Adjust the bucky so that the central ray coin-
cides with the centreline of the cassette.
• Place the marker on the tabletop so that
it coincides with the centre of the X-ray
beam. (b)
• Adjust the collimation to cover the cassette. Fig 3-1 I. Central ray centered to the middle
• Make an exposure. of the bucky test, (a) shielding in place ready
• Process the film. for first exposure, (b) test tool in place prior
to covering holes
Evaluation
• The marker should be in the middle of the
film.
• Measure from the image of the coin to all four Method
sides of the film. • Switch on the bucky.
• P!ace the cassette crosswise in the bucky
Action tray.
If coin image is not in the middle of the film. e Set lOOcm FFD (SID).
• Check bucky tray movement. • Center the tube to the center of the bucky.
• Check cassette clamp. • Place the test tool crosswise on the tabletop so
• Adjust as necessary that the central hole (the one with the two small
• If unsuccessful call an X-ray engineer. holes either side of it) is directly over the center
• Inform staff. of the bucky and tape it down. The central ray is
• File a report. therefore centered to the middle of the middle
hole of the test tool.
Central ray centered to the middle of the • Note which side the three small identification
bucky test holes are on.
If the X-ray beam is not aligned correctly to the • Collimate to cover only the center holes.
bucky the grid will create an uneven density • Cover all other holes with the lead rubber.
image. • Make an exposure.
• Do not move test tool.
Frequency of test • Off center the tube so that it is centered over
• Yearly. the next hole.
• As necessary. • Adjust the lead rubber so that only this hole is
uncovered.
Equipment required • Leave all other parameters unchanged.
• One 24 x 30 cm loaded cassette. • Make an exposure.
• Test tool (see Fig 3-11 and Appendix A, page • Repeat the procedure for all five holes and the
137). identification holes, six exposures in all.
• X-ray unit to be tested. • Process the film.
QUALITY ASSURANCE WORKBOOK
70

Evaluation _maximum mA about 50 to 100. May have a pulsed


• The density of the central hole should be the high- output or capacitor discharge. Uses a 240 volt power
est, the holes on either side a little lighter, but of supply. More sophisticated mobile units may be me-
the same density as each other. The two outer dium or high frequency and may have motor driven
holes a little lighter again, but the same density movement.
as each other.
• The three small holes are simply to allow correct Moving the unit
orientation of the image. • Mobile units which need to be pushed, have brakes
which operate on the "dead man's handle" prin-
Action ciple. The breal< handle must be depressed to re-
• If the densities of the holes do not appear as lease the bral<e. Letting go of the bral<e handle
described, and tube alignment has been checked, puts the bral<e on.
there is some misalignment. • Units which are motor driven, have a lever or but-
• If this is considered to be a problem call an X-ray ton which operates the motor. When released the
engineer. motor stops and the brakes are applied.
• File a report. • Before moving the unit, make sure that the tube
arm is in the correct "park" position and firmly
locked in place (see operator's manual).
Portable and mobile X-ray units
• Remove the power cable plug from the power
Portable socket and store in the correct location on the
Portable X-ray unit is defined as a small X-ray unit ca- unit.
pable of being dismantled and carried from one loca- • Coil the cable neatly and systematically, ensuring
tion to another. It is relatively simple in design, has a that it does not twist and will not tangle when
maximum kV of about 80-90, a maximum mA of about uncoiled.
30-50, a clockwork timer and a stationary anode tube. • If the hand switch is on a cable, make sure that
Uses a 240-volt power supply. the cable is stowed away so that it will not catch
in the wheels or passing objects.
Moving the unit • When pushing the unit ensure that you do not
• Switch off and remove the plug from the power run into anything or any person.
supply. • Take care when passing over uneven ground.
• Coil the cable. • Take care when going up or down a slope.
• Unplug the component parts and coil cables.
• Dismantle tube stand if necessary. Checking the X-ray output
• The unit may now be carried. • Similar tests can be carried out to those already
• Take care that you do not drop any of the parts. described in this module (see pages 6 7 to 68).
• Do not carry too much at the same time.
Routine maintenance
Setting up the unit Mechanical
• Place the component parts close enough for the • Check all locks.
cables to reach. • Check brakes.
• Fit plugs firmly into correct sockets. • Check tube arm movements.
• Assemble tube stand if necessary. • Check collimator (see Module 2. Accessory equip-
• Plug in to a 240-volt power supply. ment, page 29).

Mobile Electrical
• HT cables for wear and abnormal bends.
Mobile X-ray unit is defined as an X-ray unit on wheels, • Hand switch cable for wear, if fitted (modern
capable of being moved from one location to another safety regulations do not recommend the use of
with relative ease. It is bigger than the portable, has a hand switches on extension cables.
higher output and is usually a little more sophisticated. • Power supply cable for wear and twisting.
May or may not have a stationary anode tube. Has an • Plugs and connections.
electronic timer. The maximum kV is about 90-100,
MODULE 3. X-RAY EQUIPMENT
71

• Check collimator (see Module 2. Accessory equip- Cleaning


ment, page 29). • Dust daily with a clean dry cloth.
• All control panel display lights are working. • Dirt that resists a dry cloth should be wiped with
• All switches are tight and working. a cloth very lightly dampened with water (do not
• Meters working. use excessive water as this may get into the elec-
• Unit exposes when exposure button depressed. trical components and cause corrosion or
Any faults must be fixed or reported immediately. shorting).
QUALITY ASSURANCE WORKBOOK
72

Notes
MODULE 3. X-RAY EQUIPMENT
73

TASK 11
Consistency of radiation output

The density of your radiographs is not consistent, despite using proven exposure factors and techniques.

a) Carry out an initial test that will demonstrate any inconsistency in radiation output.
b) Evaluate your results.
c) Answer the following questions, in the spaces provided.

l. Record the exposure used. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

2. What is your evaluation of the resultant film?

3. Is this a satisfactory result? Yes/No

4. What action do you recommend?

Include your test film with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
74

TASK 12
Constancy of radiation output at
di erent mA settings test

You have carried out an initial test and proved that the radiation output is inconsistent. Carry out a test that will
attempt to identify the problem.

a) Carry out a test to investigate the consistency of mA settings.


b) Evaluate your results.
c) Answer the following questions, in the spaces provided.

l. Record the exposure used.

2. What is your evaluation of the resultant film?

3. Is this a satisfactory result? Yes/No

4. What action do you recommend?

Include your test film with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 3. X-RAY EQUIPMENT
75

TASK 13
X-ray timer test

Your radiography densities are still inconsistent. You have already checked the mA and found it to be consistent.
Carry out a further test to try and identify the problem.

a) Carry out a test that will demonstrate inconsistency in the X-ray timer.
b) Evaluate the results.
c) Answer the questions below in the spaces provided.

l. Record the frequency of the electrical mains power supply to the unit you used?

2. Indicate with a tick, which of the following describe the unit you used?
• One pulse, self rectifies. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

• Two [lUise, full-wave r e c t i f i e d . - - - - - - - - - - - - - - - - - - - - - - - - - - -

3. Is the timer accurate? YES/NO

4. Explain how you arrived at your answer to question 3.

5. What action do you recommend?

Include your film with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
76

TASK 14
Mechanical and electrical check

The routine mechanical and electrical checks are due on your X- ray unit. Carry out checks for function and safety.

a) Carry out routine mechanical and electrical checks on an X-ray unit.


b) Complete the following check list.

Item to be checked Yes/No Comments

Control panel

Table

Tube & ht cables

Tube column & arm

Other

Action

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 3. X-RAY EQUIPMENT
77

TASK IS
Potter bucky
Electrical & mechanical check

The routine electrical and mechanical check is due on your bucky. Carry out checks for function and safety.

a) Carry out routine electrical and mechanical checks on a bucky.


b) Complete the following check list.

Item Checked Comment


Movement-Bucky on rails

-Tray

Locks -BUci<Y

-Tray

Electrical -Cables

-Plugs

-Switches

-Grid movement

Other

Recommended action

Tutor's report

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY A:'S:!li~JL~ANC~ WORKBOOK
78

MODULE4
Manual film processing

ardous chemicals are used, under low light conditions


Aim
(see Appendix B, page 156).
To provide the knowledge and practical skills neces-
sary to effectively maintain a darkroom and manual The darkroom must:
processing equipment, carry out manual film process- • Be of suitable size.
ing and establish and run a quality control program. • Must not allow white light to enter.
• Have a suitable secure entrance.
Objectives • Have appropriate safe lighting.
• Have adequate white lighting.
On completion of this module you will be able to • Have adequate ventilation.
understand and carry out manual processing routines, • Have adequate drainage.
quality control procedures, evaluate and recommend • Have a hot and cold running water supply.
action for: • Have a convenient layout.
• Have a flat smooth surfaced workbench of
A darkroom adequate size and location.
11 Light proof. • Be in good condition.
11 Safe lights. • Be effectively and regularly cleaned.
11 Ventilation. • Have adequate storage space.
11 Storage. • Have a safe and reliable electrical supply.
11 Condition. • Maintain temperature and humidity at suitable
levels.
Film and chemical storage • Be radiation proof.
11 Stock rotation. • Be fitted out with film processing and accessory
11 Conditions. equipment.
11 Security.
Other issues involving the darl<room
Manual processing • Efficient working routines.
11 Processing unit. • Adequate staff training.
11 Processing chemicals. • Regular maintenance checks.
11 Processing routine. • Suitable fault reporting system.
11 Accessory equipment. • Rapid repair and replacement response.
11 Health and safety. • Safe disposal of exhausted chemistry.
• Safe disposal of contaminated water.
• Safe disposal of empty chemical containers.
• Safe disposal of unwanted film.
The darkroom
The light-tight room in which, the processing of radio- Responsibilities of staff using the darl<room
graphs is carried out. The darkroom is a vital link in the • Use correct processing routines.
chain leading to standard high quality radiographs. A • Use the darkroom correctly and safely.
well positioned and exposed radiograph can easily be • Carry out correct QC routines regularly.
ruined by poor processing. • Ensure that regula~ thorough cleaning is carried out.
Health issues must also be considered, as the dark- • Report or fix all faults immediately.
room is invariably a small, confined space where haz- • Ensure that sufficient stock is maintained.
MODULE 4. MANUAL FILM PROCESSING
79

White light leaking into darkroom • Cover half of the film with the sheet of card.
• Leave for 3 minutes.
Film should only be handled in correct safelight condi-
• Process the film.
tions. White light should not be allowed to leak into
the darkroom.
Evaluation
• If the density of the uncovered part of the film
White light leakage test
is greater than the covered part, then some
Frequency of test fogging has occurred.
• 6 monthly.
• After work has been carried out on the darkroom. Action
• As necessary. • Seal any areas of light leakage.
• Repeat the white light leakage test.
Equipment required • File a report
• Insulation tape to temporarily cover holes.
• Chalk to mark holes.
Safe lights
Method A darkroom should be fitted with appropriate safe light-
• Turn on all lights in areas adjacent to the ing. There are several different forms of safelighting
darkroom. available.
• Switch off all darkroom lights, including
• Conventional safelight-smalllight tight box with
safelights.
a light filter window, fitted with bulb and socket.
• Ensure that any doors are closed.
• Simple bulb with filter coating.
• Remain in the darkroom for 10 minutes to allow
• Coloured fluorescent light tube.
the eyes to get used to the dark.
• Look around the darkroom for signs of white light
Safelights should:
leaks.
• Be in good condition.
• Pay particular attention to doors, windows,
• Have the correct filters to suit the light sensitiv-
extractor fans, air vent and entry of pipes.
ity of the film used.
• Have the correct light bulb wattage, as recom-
Action
mended by the manufacturer.
• Identify then seal any white light leaks.
• Be electrically safe.
• Repeat the test.
• Be installed correctly.
• Carry out a test to see if any film fogging is
occurring, if felt necessary.
Check that:
• File a report.
• Each safelight is no less than 130 cm above the
workbench.
If you have difficulty in eliminating all white light, e.g.
• The light bulb is correct (usually 15 watt if facing
around doors, you may wish to try the following test.
down).
• The safelight filter is in good condition.
White light fogging test
• The safelight filter is compatible with the light
Frequency of test sensitivity of the film being used (check with film
• 6 monthly. manufacturer's information).
• As necessary. • The safelight does not leak white light.
• The wiring and fittings are in good condition.
Equipment required
• 1 sheet of new 18 x 24 cm film. Safelight efficiency test
• 1 sheet of 18 x 24 cm card.
Frequency of test
• 6 or 12 monthly.
Method
• Turn on all lights in areas adjacent to darkroom.
Equipment required
• Switch off darkroom lights including safelights.
• One 24 x 30cm cassette loaded with new film.
• Ensure that any doors are closed.
• Two sheets of 24 x 30 cm card.
• Place the sheet of film on the workbench.
QUALITY ASSURANCE WORKBOOK
80

• One timing clock or watch with second hand. - Exposed to safelight in 8 strips
• One 24 x 30 cm sheet of lead or lead rubber. varying in length of exposure from
30 seconds to 4 minutes.
Method • Identify the strip in Section B which has a
• Place cassette face up on the X-ray table. noticeable increase in density compared to its
e Set a FFD (SID) of lOO cm. equivalent strip in Section C.
• Cover one third of the cassette with lead rubber, • Double check by comparing B with A.
lengthways (area C). • Note the safelight exposure time of this
• Collimate to the uncovered area of the cassette. strip.
• Expose the film using a minimum exposure • This exposure time is the extreme limit of film
(suggested exposure 45 kV 2 mAs). handling time.
• Unload the cassette in the darkroom in total • 3 minutes is considered to be the limit of
darkness. acceptable film· handling time.
• Place the film on the workbench.
• Cover one third of the exposed side of the film Action
with the sheet of card, lengthways (area A). • If the identified safe handling time is considered
• Cover areas Band C of the film, horizontally, with to be too short, consider one or more of the
the second sheet of card, except for a 3 cm strip following modifications:
at the top. - Increase safelight height above workbench.
• Switch on the safelights. - Reduce wattage of bulb.
• Start clock immediately. - Replace filter.
• Wait 30 seconds. - Stop white light leak from safelight.
• Move second sheet of card down 3 cm (the first - Remove one safelight, if more than one.
sheet of card must remain in place throughout). • Re-test after modification.
• Wait 30 seconds. • File a report.
• Repeat this process every 30 seconds until the
bottom of the film is reached. Ventilation
• Switch off the safelights immediately.
It is important for the darkroom to have adequate ven-
• Process the film.
tilation. Ideally, a ducted air conditioning system with
·Note: Lightly pre-exposing the film makes it more light light tight vents.
sensitive. A less efficient, but perfectly adequate system is an
extractor fan, ducted to a safe area outside the dark-
room. The extractor fan should be sited near the
A B C
processing unit, with the air intake vent sited at the
1---1----1 4 m in
1------'1----1 3 m in 3 0 sec opposite end of the darkroom to ensure complete air
1------11----1 3 min circulation. The air exchange should be at the rate of
Area not exposed 1------11-----1 2 m in 3 0 sec
--------1•
to safelights 15 changes an hour.
1-----lf----1 2 m in
(control strip)
1---1----1 1 min 30 sec

L -_t=:::t::::j 1 min
30 sec Storage
Area exposed Cassette pass box radiation proof test
to radiation
If radiation fogging is suspected whilst cassettes are
Fig 4-1. Diagram of the test film image in the pass box.

Frequency of test
Evaluation (see Fig 4-l)
• Yearly.
Section A - Sensitised by radiation.
• As necessary.
- Not exposed to safelights.
Section B - Sensitised by radiation.
- Exposed to safelights in 8 strips Equipment required
varying in length of exposure from • 3 coins or lead markers.
30 seconds to 4 minutes. • Adhesive tape.
Section C - Not sensitised by radiation. • lloaded 35 x 43cm cassette.
MODULE 4. MANUAL FILM PROCESSING
81

Method Evaluation
• Stick the 3 markers, at intervals, down the • Assess the degree of fogging on each film.
long edge of the front of the cassette with the • Decide whether this fogging is acceptable or not.
tape.
• Place the cassette in the pass box, with the Action
markers nearest to the X-ray room. • If fogging is acceptable or there is no fogging,
• Leave the cassette there for a week. take no further action.
• Process the film. • If fogging is unacceptable:
-Use as "clean up" film for an automatic
Evaluation processo~ or

• If fogging has occurred to the extent that the - Discard, or


markers can be seen, repeat the test over a - Remove fogged portion by cutting down to
shorter period. smaller size.
• Establish a period of time when fogging does not • Remind staff to be more careful.
occur. • File a report.

Action
Static electricity
• Do not store cassettes in the pass box.
• Remove cassettes from the pass box within the Static electricity charges tend to build up, due to fric-
no fog period. tion. Low humidity and nylon clothing increase the risk
• Increase lead shielding to pass box. of static build up. Most film manufacturers recommend
• File a report an· ideal film handling humidity of 40% to 60%. Static
build up on X-ray film is fairly common in dry areas.
Note: Radiation fogging may be occurring in the X-ray
Static discharge is seen in the dark as an instanta-
room. Carry out the above test in the cassette storage
neous flash of bluish white light. If this discharge takes
bin and other areas where cassettes are temporarily or
place on the surface of an unprocessed film, it will be
permanently stored.
seen as areas of blackening, often "lightning like", on
the processed film. If static marks appear on films it
Accidental light fogging of film will be necessary to carry out remedial work.

Occasionally staff may leave a film hopper open or the


Action
lid off a film box when a white light is switched on.This
• Wipe over all film handling surfaces regularly with
of course, will fog the films, but not necessarily to the
an anti-static solution (intensifying screen cleaner
extent that they are unusable.
may be used as it contains an anti-static agenO.
Due to the fact that films are closely packed,
• Clean intensifying screens with a cleaner contain-
the light may not penetrate much below the top
ing an anti-static agent.
edge.
• Instruct staff not to slide films into cassettes or
across working surfaces.
Degree of light fogging of films
• Encourage staff not to wear nylon clothing.
assessment test
• Check humidity levels. If found to be low, install a
Equipment required humidifier.
• Pencil. • All film handling surfaces, film bins and pass boxes
• Films to be tested. should be electrically grounded.

Method
Film and chemical storage
• Under safelight conditions:
- Remove the front film, rear film and one from Film storage
the middle of each pack of film that is likely
X-ray film should be stored according to manufac-
to be affected.
turer's recommendations.
- Identify which film is which, using pencil
Unexposed film is sensitive to radiation, light,
marks.
temperature, humidity, chemical fumes, bending and
- Process the films.
pressure. It is important that unexposed film is stored
QUALITY ASSURANCE WORKBOOK
82

correctly, both in the long term (main film store) and in • Clearly mark all film boxes with the date they
the short term (darkroom). arrived in the store to ensure the rotation system
All film is given an expiry date, beyond which the fog will work.
level is likely to increase. This date can be found printed • Film boxes should only be stored one deep, to
on the outside of the film box. Some film has been ensure easy access and correct operation of the
known to age prematurely. Adequate stock rotation is rotation system.
therefore important. • Film boxes should always be tal<en from the left
and new stock shelved on the right.
Long term storage • Keep strict stock records (see Fig 4-2).
• The store room should: - Film in-Film out.
- Be well ventilated. -Film in store.
- Be away from the source of any radiation. -Quantities by size.
- Be away from any chemical fumes. -Type of film.
- Be of adequate size. -Dates.
- Have a temperature inside of between l0°C -Manufacturer.
and 20°C. -Supplier.
- Have a humidity between 40% and 60%. -Keep daily record of temperature and humidity.
- Be dry. - Order stock regularly.
- Have shutters or blinds over any windows. - Keep record of costs.
- Have wooden shelving to avoid condensation. • Specialised film with low usage:
- Be kept locked, allowing access only to - May need to be kept in a refrigerator to
authorised personnel. extend expiry dates.
• Store films upright to minimise the risk of pres- - Must be in sealed plastic to avoid condensa-
sure marks. tion problems.
• Store films in size groups. - When removing the film from the refrigera-
• Do not store films on the floor. tor to use, a period of 8 to 12 hours must
• Use a rotation system so that oldest films are elapse before breaking the seal, to avoid con-
used first. densation forming on the colder film.

Film stock record


Film size _ _ _ _ _ _ _ _ _ _ _ _ _ __ Manufacturer _ _ _ _ _ _ _ _ _ _ _ _ __

Type of film _ _ _ _ _ _ _ _ _ _ _ _ __

Boxes of lOO Films

Date In Out Total Supplier Destination Signature

Fig 4-2. Example of a film stock record sheet


MODULE 4. MANUAL FILM PROCESSING
83

Short term storage • Room temperature should be between 10 oc and


• Store only films for immediate use in the darkroom. 20°C.
• If possible, store films in a specialised, lockable • Clearly mark chemical boxes with date of arrival.
film hopper. • Use a rotation system, first in first out.
• Preferably a hopper fitted with a micro switch • Take from the left, shelve on the right.
that switches off the white light when opened. • Do not store too high, this may cause handling
• Place a warning label on the front of the hopper problems or injury.
stating "DO NOT OPEN IN WHITE LIGHT". • Keep strict stock records (see Fig 4-3).
• Store films by size. • Check regularly for any chemical leaks.
• Standardise the film size location in the hopper. • Clean up any leaks immediately.
• Do not overfill the hopper. • Any windows must have blinds or shutters.
• If no hopper is available, store in original boxes, • Keep daily records of temperatures.
conveniently located. • Keep store locked. Allow access only to author-
ised personnel.
Care must be taken to ensure that film box lids are
always replaced or hopper closed, before switching on
Short term storage
the white light or opening the door.
• Only keep a small stock of chemicals in the
Care must be taken not to damage film boxes.
darkroom.
• Store away from working area.
Chemical storage • Check regularly for leaks.
X-ray processing chemicals should be stored accord- • Clean up spills or leaks immediately.
ing to manufacturers recommendations, preferably
away from stored films. Film processing
There are several types of film processing units:
Long term storage
• Store in a well ventilated room. • Manual.
• Store away from the film store. If this is not • Bench top automatic.
possible then chemicals must be kept at least 4 • Full size automatic-varying degrees of
metres away from stored film. sophistication.

Chemicals stock record


Devel oper/fixer Manufacturer _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

(Cross out the one not applicable) Supplier _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Type

Date In Out Total


l Supplier Destination Signature

Fig 4-3. Example of a chemical stock record


QUALITY ASSURANCE WORKBOOK
84

Whichever type of unit is used, a regular quality con- • Adequate ventilation (15 air changes per hour is
trol program should be followed in order to continually recommended).
produce high quality radiographs. • Vent exhaust ducts to an appropriate outside
area.
• Check that airflow in the darkroom does remove
Safety precautions in (1/m processing (see Health
all fumes adequately.
and safety, page 15)
• Faults and problems should be reported or
Exposure to processing chemicals and their fumes can remedied immediately.
be harmful • Safely dispose of exhausted chemistry.
• Processing chemicals should not come into • Safely dispose of contaminated water.
contact with the skin or eyes. • Safely dispose of empty chemical containers
• Processing chemicals should not be swallowed. (do not allow others to use as drinking water
• Processing chemical fumes should not be containers).
inhaled. • Safely dispose of unwanted film.

Notes: Remember that film, film processing chemicals


Wear protective clothing when mixing chemicals:
and their containers are hazardous and must not be
• Waterproof apron.
disposed of in any way that may pollute the environ-
• Rubber gloves.
ment or cause sickness or injury.
• Goggles.
Silver can be reclaimed from exhausted fixer
• Face mask.
and film. You may be able to sell this to a recognised
dealer.
First aid
If chemicals come in contact with the sl<in or eyes:
• Wash thoroughly, immediately. Emergency eye
Manual processing
wash l<its should be readily available in all Before setting standards for a quality control program,
darl<rooms. the processing unit should be emptied, thoroughly
cleaned and checked and refilled with fresh chemicals,
Other safety issues mixed to manufacturer's instructions.
• Chemical spills should be cleaned up immediately.
• Always follow manufacturer's instructions. Manual processing unit design (see Fig 4-4)
• Check processing equipment plumbing for leak- There are two common designs for manual processing
age, cracks or blockages. units:
• Check that all taps/stop cocks work effectively. A common design includes a thermostatically con-
• Ensure that processing solution containers are trolled water jacket surrounding all tanks.
sealed and safely stored. A more simple design may have no water jacket, but
• Do not consume food, sit next to or use the proc- a thermostatically controlled heater'in the developer
essor as a source of heat. or no heater at all.

Overflow Standpipe
L
/
0 .. 0

D w F D R F w

(a) (b)

D = Developer F = Fixer R = Rinse W = Wash


Fig 4-4. Diagrams of the layouts of two different manual processing units
MODULE 4. MANUAL FILM PROCESSING
85

Equipment • Wash all tanks thoroughly and scrub until


• Deep tank - Develope~ fixe~rinse and clean.
processing unit wash tanks with lids • Use different brush/scouring pad for developer
Thermostat. Suitably and fixer.
plumbed. • Flush drainage pipes and ensure they allow free
• Film hangers - Tension type to fit all film flow.
sizes. Suitable hanging • Replace overflow stand pipes.
brackets for hanger • Close all other tank outlets.
storage. • Scrub inside of film hanger clips.
• Drying cabinet - With variable heating
control and timer. Mixing chemicals
or • Check that tank sizes are standard and that the
• Drying racks - Suspended or wall fixture. manufacturer's quantities are correct for your
• Thermometer - Alcohol or electronic. tanks.
• Hydrometer - Scale range SG 1.075 to • Mix according to manufacturer's instructions.
1.115. • Follow manufacturer's safety precautions.
• pH paper - Litmus paper. • Use different stirring rods/paddles for developer
• Silver - Specialised rolls may be and fixer.
estimating available from the film • Wear protective clothing.
paper manufacturer. • Check that room ventilation is adequate.
• Thiosulphate - Bottle of specialised test • Minimise splashing.
retention test fluid. • Ensure that fixer does not contaminate developer.
fluid • Clean up any spills immediately.
• Timer - Specialised photographic
timers are preferred as Water supply
they are more versatile and • Should have hot and cold running water
reliable. available.
- Mechanical kitchen timers • Should be reliable.
are not recommended. • Must be clean.
Timer accuracy should be • Do not mix chemistry with water that has a
checked regularly. very high chlorine content. This may cause the
• Chemical - 2 PVC or stainless steel active fixing agent (sodium thiosulphate) to drop
stirrin~ rods rods or paddles. One out of suspension, reducing the action of the
labelled "devel oper" the fixer.
other "fixer". There must
be no cross use. Refilling water tanks
• Measuring - lOOml, graduated, glass or • Refill to top of stand pipes.
cylinder plastic. • Regulate flow.
• Protective - Waterproof apron, rubber • The wash tank water should flow at the rate of
clothing gloves, goggles, face mask. four exchanges an hour.
• Cleaning - Clean disposable cloths.
materials Clean hand towels. Rate of water flow test
Tank cleaning brushes. • Time how long it takes for the tank to fill with
Scouring pads (plastic water once. This should be approximately 15 min-
type). utes, to make four changes in one hour.
• Adjust water flow accordingly.
Cleaning • If too slow, and the tap is fully open, there may
• Switch off any heating or cooling devices in the be a partial blockage, or this may simply be due
unit. to normally low water pressure.
• Drain developer, fixer and water tanks.
• Fixer may be retained for silver recovery. Heating I cooling units
• Ensure that chemistry and contaminated water • Switch on.
is disposed of in a safe manner. • Ensure they are working.
QUALITY ASSURANCE WORKBOOK
86

Clean up the time/temperature graph is not available it will be


• Wipe over all exposed sutfaces. necessary to carry out a test to determine the correct
• Wash and store accessory equipment. development temperature.
• Safely dispose of all empty chemical bottles and
cartons (puncture and place in a sealed plastic Frequency
bag before disposal). • As required.
• Wipe down aprons, gloves and goggles.
• Replace any tank lids. Equipment required
• Six sensitometry test strips (see Module 5.
Before using the unit Automatic processing, page 107).
• Wait for processing temperature to reach the • Thermometer (not mercury).
required level. This may take several hours. • Six film clips or safety pins.
• Check temperature. • Developer stirring rod.
• Check water flow rate. • Timing clock.
• Check chemical levels. • Densitometer.

Method
Developer
This test can only provide a development time for one
The chemical treatment that converts the latent film temperature level. If a range of temperatures prevail
image into a visual image. then this test must be repeated for each temperature
required.
Developer temperature and
• First, regularly check the developer temperature.
development time
• Determine the prevailing temperature.
Development time and temperature directly affect
• Before commencing the test, stir the developer
the density, contrast and amount of base fog of a
and check the temperature.
radiograph.
• In safelight conditions number the test strips in
• Follow manufacturer's time/temperature pencil, 1 to 6.
recommendations. • Attach the test strips to the film clips Cor safety
• Use manufacturer's time/temperature adjustment pins) and suspend in the developer. All strips must
graph when necessary (see Fig 4-5). enter the developer at the same time.
• Start the time clock immediately.
Determining the best development time • After 30 seconds remove test strip 1, rinse and
If local conditions make it difficult to use the manu- place in fixer.
facturer's recommended development temperature and • After a further 30 seconds Cone minute of devel-
opment) remove test strip 2, rinse and place in
fixer.
24 • Repeat this process every 30 seconds until all test
strips are in the fixer.
23
• Fix, wash and dry test strips.
22
Evaluation
21
• Arrange strips on a viewing box, side by side, in
Temperature ac 20 numerical order, with all unexposed steps at the
same end Csee Fig 4-6). ·
19 • Study the unexposed steps.
18 • Identify the strips that do not show any base +
fog level increase.
17
• Study the middle density steps and identify the
16 strips which do not show a density level increase.
01234567 • The most suitable development time, at the tem-
Development Time (minutes)
perature used, is the time that gives maximum
Fig 4-5. Time/Temperature Development density but shows no increase in base fog.
Graph
MODULE 4. MANUAL FILM PROCESSING

••.
87

:~ • Constantly monitor developer temperature.


l/2 min dev Strip l • Remove bag when temperature falls to a
satisfactory level.
• Great care should be taken to avoid bursting
the bag in the developer.

Under no circumstances add ice directly to the


ll/2 min dev Strip 3
developer.
2. • Use a coil of copper tubing, large enough to
just fit into the developer tank.
• Fit a hose to one end of the copper tubing,
long enough to reach from the tap to the
2 l/2 min dev Strip 5
developer tank. Fit hose to tap.
• Fit a hose to the other end of the copper tub-
ing; long enough to reach from the developer
3 MIN DEV STRIP 6
tank to a drain or sink.
Fig 4-6. Development time assessment strips • Submerge copper coil in the developer.
arranged for comparison • Turn on cold water.
• Constantly monitor developer temperature.
• Remove coil when temperature falls to a
• A densitometer may be used to determine satisfactory level.
density levels if available. • Turn off water.
• If a range of temperatures need to be investi-
gated to determine the best development time To increase developer temperature
for each, the test is repeated for each tempera- • The two methods described above can be used.
ture and the result charted or a graph produced. Replace ice and cold water with hot water.
• Electric immersion heaters can also be use.
Action
• Establish a time/temperature chart (see Fig 4-7).
Developer activity
The activity of the developer affects the density,
Emergency measures
contrast and amount of base fog of a radiograph.
To reduce developer temperature It is important, therefore, to regularly check devel-
l. • Fill a strong plastic bag with ice. oper activity. Developer activity tests should be carried
• Firmly tie off the neck of the bag with cord. out immediately after the developer has been renewed
• Submerge the bag of ice in the developer or and at least once a week.
water jacket if there is one. Some departments do them daily or even twice daily
• Agitate. when mammography is involved.

Temperature/development time chart

Temperature of developer oc !
Development time
I

I.

Fig 4-7.Time/temperature chart used for recording data when assessing development time
QUALITY ASSURANCE WORKBOOK
88

Developer activity test (Elementary method) One step difference =acceptable


(see Module 5. Automatic processing, page 107, for a Two steps difference =acceptable but be warned
more accurate method). Three steps difference =unacceptable take action
• If the test strip is moved up, compared to the
Frequency of test control strip, the result is regarded as positive.
• Daily. • If the test strip is moved down, compared to the
control strip, the result is regarded as negative.
Equipment required • Graph the results (see Fig 4-8).
• One sensitometric strip (see Module 5.Automatic
processing, page 107). Action
• Sensitometric strips from previous tests. l. If densities are lower than previously:
• Graph paper. • Developer - Exhausted.
may be - Incorrectly mixed-too
Method much water.
• Stir developer. - Water added instead of
• Check temperature of developer. replenisher.
• Adjust temperature to pre-determined standard 2. If densities are higher than previously:
if necessary. • Developer - Too active because of
• When temperature is correct, develop the test may be incorrect mixing.
strip. - Too much replenishment.
• Mark the strip with the date. 3. Higher basic fog level than previously:
• Chemical contamination.
Evaluation
• Compare the test strip with the control strip (see Developer activity using a hydrometer test
Fig 4-9). • An hydrometer will measure the specific gravity
• The equivalent steps should have the same den- (SG) of developer.
sity. This confirms consistent developer activity. • Specific gravity measures the relative weight of a
• If the strips are not comparable, adjust them until solution, when compared to water, at 23 °C.
they are. • Specific Gravity measurement can therefore be
• If adjustment has been necessary, count the used to show if correct dilution is present.
number of steps difference between the two • The specific gravity (or density) of water is
strips. 1.000.

3
Positive
2

Steps 1 2 3 4 56 7 8 910 1112 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30


l DATES
2
Negative
3

Fig 4-8. Developer activity graph chart

New strip

Old strip

Fig 4-9. Developer activity test strips. Comparison of old against new
MODULE 4. MANUAL FILM PROCESSING
89

1.088
1.087
1.086
1.085
Specific 1 _084
Gravity 1.083
1.082
1.080
1.079 ' - - - - - - - - - - - - - - - - - - - - - - - - -
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Temperature oc

Fig 4-1 0. Specific gravity/temperature graph

• The specific gravity of developer falls into a range Equipment required


of 1.070 to 1.100. • pH paper (litmus paper).
• Specific gravity will vary with developer tempera-
ture (see Fig 4-10). Method
• Hold a strip of test paper in the developer for
Frequency of test approximately 10 seconds.
• Daily. • Observe colour change.
• Compare with control strip.
Equipment required
• Hydrometer Can hydrometer designed for testing Evaluation
car batteries can be used, but the scale will need • Note manufacturer's recommended pH range
to be extended). (usually around 10.0 to 10.5).
• Manufacturer's recommended specific gravity for • Compare test strip reading to recommended
the developer being tested. range.
• A reading of more than 0.4 below manufactur-
Method er's recommendations suggests contamination.
• Place the hydrometer in the developer. It will float. • A reading of 0.8 below suggests oxidation.
• Note the reading on the scale at the level of the
developer surface. Action
• Replace developer if readings are too high or too
Evaluation low.
• The Specific Gravity reading should be within
plus or minus 0.004 of the manufacturer's
Developer replenisher
recommendations.
• If the reading is lower than that recommended, Replenisher is the chemistry added to the developer to
the developer is over diluted. maintain its volume and activity.
• If the reading is higher than that recommended, • Replenisher is generally more active than the
the developer is too concentrated. original developer.
• Mix according to manufacturers instructions.
Action • Have a quantity of replenisher mixed and stored
• If too concentrated add water. in the darkroom for convenient use.
• If too dilute add replenisher or replace the • Add replenisher when developer level falls.
developer. • Do not allow level of developer to fall below the
top of films.
Developer activity using pH paper (litmus
paper) test
Can be used for freshly mixed develope~ but is more Rinse
useful to show contamination or oxidation. The process of using clean water to wash residual
developer from the film, so avoiding contamination
Frequency of test and reduction in efficiency of the fixer.
• Daily.
QUALITY ASSURANCE WORKBOOK
90

• Separate rinse water tanks between developer • A high specific gravity reading-not dilute
and fixer should have running water. enough.
• Static rinses should have the water changed • A low specific gravity reading-too dilute.
· regularly.
• Agitate films vertically in static rinses. Action
• Rinse for 15 seconds. • Dilute if specific gravity reading too high.
• Add undiluted fixer if specific gravity too low.

Fixer
Silver estimation test
Dissolves off all unwanted film emulsion. Indicates level of silver concentration in fixer solution.
Makes image permanent.
Fixing temperature and fixing time, although impor- Frequency of test
tant, are not as critical as those of the developer. • Daily.

Clearing time Equipment required


• The time it takes to clear the film (dissolving off • Silver estimation paper.
the unwanted film emulsion).
• Can take from 30 seconds, but should not be more Method
than 2 minutes. • Place paper in fixer.
• The film may be viewed in white light once it has • Compare with control.
fully cleared. • Take reading.

Permanent fixing Evaluation


• This is usually twice the length of the clearing • Below 2 gm/1 is over replenished.
time. • Above 6gm/l is under replenishment.
• It is recommended that all films be fixed for at
least 4 minutes to avoid image deterioration later. Note: Freshly mixed fixer will have a zero reading.
• Remove films from the fixer as soon as adequately
fixed, as excessive time in the fixer will remove
Action
the image. • Below 2 gm/1 add water.
• Above 6gm/l add undiluted fixer.
Fixer activity using a hydrometer test
Specific gravity of the fixer is an indication of its activ- Wash
ity (see Developer activity test, pagej_ BBljThe specific
The use of clean water to wash all residual fixer from
gravity of fixer should be in the region of 0.004 (see
the film, so avoiding the deterioration of the image
manufacturer's recommendations).
over time.

Frequency of test • Wash films for 20 minutes in running water, at


• Daily. a rate of four exchanges an hour, in order to
ensure satisfactory long term storage of
Equipment required rad i og rap hs.
• Hydrometer. • Should there be a need to conserve water, then
slower flow rates and shorter wash times can be
Method used, but it must be remembered that the wash-
• Place the hydrometer in the fixer. ing process will be less efficient and radiographs
• Note the reading at the surface of the fixer. will deteriorate quicker during storage. Consid-
eration should be given to manual vertical agita-
Evaluation tion when water flow is slower, or wash times
• Specific gravity reading should be within shorter, than recommended, in order to improve
plus or minus 0.004 of manufacturer's the washing efficiency.
recommendations. • Where there are no facilities for a running water
• Specific gravity should be in the region of 1.110. wash, it is recommended that radiographs remain
MODULE 4. MANUAL FILM PROCESSING
91

in the water tank for 2 hours, then given 30 Unprocessed film handling
seconds of manual, vertical agitation.
Correct film handling will avoid film damage.
Water level must be above top of film hangers to • Handle only under correct safelight conditions,
ensure hangers are completely washed. to avoid fogging.
• Handling time should be kept to less than
Hypo retention test 3 minutes/ to avoid fogging.
This test indicates the amount of residual thiosulphate • Keep hands dry when handling films 1 to avoid
remaining in the film emulsion, after film processing marking the film.
has been completed. An indication of adequate/inad- • Hold film only on the edges, with tips of fingers1
equate washing. to avoid marking the film.
An excessive amount of residual thiosulphate in a • Do not allow film to bend (bending affects the
film emulsion may cause a brown stain to appear on film emulsion producing artefacts).
the film. • Do not allow film to slide over any surface (this
may create static marks).
Frequency of test • Do not allow film to come into contact with any
• Weekly. moisture 1 before entering the developer (water
• As necessary. or developer will cause premature development
and create dark areas, fixer will stop the devel-
Equipment required opment process and create clear areas).
• ljypo (thiosulphate) retention test fluid. • Tension film correctly in hanger.
• Test strip. • Always handle the film with care.
• Radiographs to be tested.

Labelling film
Method
• Put a drop of test fluid on the surface of the film All films must carry the patient's name1 date X-ray
well clear of the image. examination carried out and any other information
• Wait for one or two minutes. considered necessary, to allow correct and easy
identification of the radiographs.
Evaluation
• Inspect the moistened area. Methods of labelling films
• Compare colour with test strip. • Print directly onto the film with a written or typed
ticket and a light source1 under safelight condi-
Action tions in the darkroom.
• If colour indicates a high level of thiosulphate, • Print directly onto the film with written or typed
check wash water flow and washing time. ticket and a light source while the film is still in
• Adjust and re test. the cassette. This system can be used under white
light conditions (special cassettes and printer are
required).
Drying • Write on the film in pencil, under safelight condi-
To remove all moisture, harden the image and make tions, before processing, and then stick a written
the radiograph durable. or typed label onto the film after processing. Writ-
ing on the film in white ink after processing is
• Drying cabinet or air drying.
also acceptable.
• Ensure that films are fully dried before removing
• Directly onto the film using radiation. Write or
from the hangers.
type on a specially prepared radio-opaque slip.
• For emergency drying, a hair drier on warm can
This slip is placed on the face of the cassette 1
be used:
within the radiation field 1 prior to exposure.
- Hold film vertical.
- Sweep warm air horizontally across surface The preferred method is to have the patient identify-
of film, working from top to bottom. ing information in the film emulsion and not written
- Do both sides. on after processing. The most commonly used is the
- Do not get nozzle of drier too close to film. first method given above.
QUALITY ASSURANCE WORKBOOK
92

The printer • Is the density control knob tight?


• Study the resultant test film.
An easy and accurate method of radiograph
• Do the printed areas get progressively darker in
identification.
the right order Cl to 4)?
There are two main types of printer, both using a
• Which of the printed areas is the most
light source and requiring electricity to power them.
satisfactory?
• Darkroom printer for use under safelight condi-
• Is the clarity of this image acceptable?
tions only.
• Is this the setting that is routinely used?
• The printer used under white light conditions,
requiring special cassettes.
Action
• If th~ printer is unsafe or is not working efficiently
Darkroom printer check
arrange for repair.
Frequency of checl< • Select the image that best demonstrates the
• 6 monthly. typed/written information.
• As necessary. • If this is the setting routinely used take no
action.
Equipment required • If the selected setting is different from that rou-
• Printing ticket of the type that is routinely used. tinely used, inform staff of the new setting.
• One sheet of 18 x 24cm unexposed film. • If the writing/ typing is not clearly seen in any of
• Printer to be checked. the images, carry out the test again using a dif-
ferent thickness of ticket and/or looking for ticket
Method movement when printing, until a satisfactory
• Inspect electrical cable and plug. result is obtained.
• Check that the light comes on when activated. • File a report.
• Check light intensity control is not loose.
• Check that the light is not obstructed.
• Using a pencil, mark the maximum, minimum and
Processing routine
two evenly spaced intermediate settings of the The method by which films are processed in order to
light intensity control, around the control knob. produce high quality images.
Label these marks 1 to 4 starting with the light-
est setting. Method
• Write or type a printing ticket and insert it into • Stir solutions.
the printer using the recommended practice. • Take the developer temperature. Read while
• Set the light density control to setting 1 (mini- thermometer is still in developer.
mum intensity). • Check correct development time at this tempera-
• Under safelight conditions, use a pencil to write ture. Refer to manufacturer's time/temperature
identifying numbers 1 to 4 in the respective cor- graph or your own time/temperature chart (see
ners of the film. page 87).
• Insert the corner of the film marked l into the • In safelight conditions load film into hanger.
printer, ensuring that it goes in correctly. • Keep fingers to edge of film only.
• Activate the light in the printer. • Ensure correct tension of film in hanger.
• Remove the film and insert the corner marked 2. • Set timer for correct developing time.
• Re set the light intensity control to setting 2. • Lower hanger and film into developer.
• Activate the light in the printer. • Hold hanger so that fingers do not come into
• Repeat this procedure using setting 3 for corner contact with developer.
3 and setting 4 for corner 4. • Agitate film in vertical direction two or three times
• Process the film. to remove air bubbles and distribute developer
evenly over the film.
Evaluation • Place hanger in developer so that film is fully
• Electrical cable wear or damage? immersed.
• Plug damage or unsafe electrical connections? • Agitate film every 30 seconds during development.
• Is anything obstructing the light? • When timer alarm sounds, lift film from the
• Does the light work? developer and drain into the rinse (exhausted
MODULE 4. MANUAL FILM PROCESSING
93

developer should not be drained back into the • Leave in running water for 20 minutes.
developer). • Lift film from wash and allow to drain back into
• Lower film into rinse for 15 seconds (agitate if the wash tank. This will minimise amount of
rinse is static). water being transferred to drying area.
• Lift films from rinse and allow to drain back into • Place film in drying cabinet or on an air drying
the rinse (rinse water should not be drained into rack.
the fixer as this will result in dilution of the fixer). • Do not remove until fully dry.
• Lower film into the fixer.
• Agitate two or three times. Notes
• Ensure that film is fully covered by fixer. • All film movement in the chemicals or water must
• The film may be viewed in white light conditions be carried out in a vertical direction or the film
once it has cleared. may come off the hanger.
• Leave film in fixer for at least 4 minutes to fully • When moving or draining films, always tilt away
fix. from you, to avoid chemicals or water draining
• Lift film from fixer and transfer directly to wash back toward you.
(exhausted fixer from the film should not be
allowed to drain back into the fixer tank).
QUALITY ASSURANCE WORKBOOK
94

Notes
MODULE 4. MANUAL FILM PROCESSING
95

TASK 16
Assess a darkroom for
white light leaks

An increasing number of radiographs have a grey fog. Equipment, radiation safety measures and processing have all
been checked and found to be satisfactory. Check to see if the problem lies with the darkroom itself.

a) Select a darkroom.
b) Carry out the white light leak test.
c) Answer the following questions in the spaces provided below.

l. Were there any white light leaks? YES/NO

2. Briefly describe where you saw light: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

3. Are these white light leaks likely to be a problem? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4. What is your recommended a c t i o n ? - - - - - - - - - - - - - - - - - - - - - - - - -

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
96

TASK 17
Are films being fogged by white
light leaking into a darkroomt

You have noticed white light leaking into your darkroom around the door. It will be difficult to fix it. Check to see
if this light is likely to fog films.

a) Select a darkroom.
b) Carry out the test to see if white light leaks are fogging films.
c) Evaluate the film.
d) Answer the following questions in the spaces provided below.

l. Outline the procedure you carried out: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

2. Give your evaluation of the film: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

3. What action do you recommend based on your evaluation of the film: _ _ _ _ _ _ _ _ _ _ _ __

Include your films with these answers

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 4. MANUAL FILM PROCESSING
97

TASK 18
Safelight evaluation

Film is being slightly fogged. You have checked the darkroom for white light leaks 1 the cassettes are in good
condition and it isn't radiation fog. You suspect the safelight.
a) Carry out a safelight evaluation test.
b) Evaluate your results.
c) Answer the following questions in the spaces provided below.

l. How many safelights are t h e r e ? - - - - - - - - - - - - - - - - - - - - - - - - - - -

2. What colour are the safelight f i l t e r s ? - - - - - - - - - - - - - - - - - - - - - - - - -


3. What is the colour sensitivity of the films used? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
4. Is the safelight filter colour the correct one? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

5. What condition are the filters i n ? - - - - - - - - - - - - - - - - - - - - - - - - - -


6. What is the wattage of the light bulb in the safelights? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
7. Is this the correct wattage? YES/NO
8. What is the distance between the safelights and the workbench top? _ _ _ _ _ _ _ _ _ _ _ __
9. Is this distance acceptable? YES/NO
10. If the distance is not acceptable1 why not? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
11. Are there any white light leaks from the safelights? - - - - - - - - - - - - - - - - - - - -
12. What is your evaluation of the test film? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

13. Based on your answers1 what action do you recommend?

Include your test films with these answers.


QUALITY ASSURANCE WORKBOOK
98

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 4. MANUAL FILM PROCESSING
99

TASK 19
Film and chemical stores

You are concerned about the conditions under which your films and processing chemicals are stored.
a) Assess the long term storage of films and chemicals.
b) Answer the following questions in the spaces provided.

l. Are films and chemicals stored separately? YES/NO


2. Are the locations of these stores satisfactory? YES/NO
3. Ifnot,whynot? _________________________________________________________________

4. How are the films stored? ---------------------------------------------------------

5. Is this satisfactory? YES/NO


6. Ifnot,whynot? _________________________________________________________________

7. How is satisfactory stock rotation achieved?

Films:--------------------------------------

Chemicals: --------------------------------------------------------------------

8. What is the temperature inside the Film Store?-----------------------------------------


9. Is this temperature satisfactory? YES/NO
10. Ifnot,whynot? _______________________________________________________________
QUALITY ASSURANCE WORKBOOK
100

ll. Are the film and chemical stores kept locked? YES/NO

12. What records are kept regarding stock m o v e m e n t ? - - - - - - - - - - - - - - - - - - - -

13. Based on your evaluation of the film and chemical stores, what recommendations would you make?

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 4. MANUAL FILM PROCESSING
101

TASK 20
Safety in film processing

You have just been appointed safety officer for your department. You need to find out if the darkroom is a safe
working environment.

a) Select a darkroom.
b) Make a check list and investigate the points on it.
c) Make brief comments on your findings alongside each point on your list.
d) In each case write in your recommended actions.

Write your findings below.


If there is insufficient space, use additional sheets of paper and attach.
QUALITY ASSURANCE WORKBOOK
102

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 4. MANUAL FILM PROCESSING
103

TASK 21
Checking manual development time

Radiographic density is inconsistent, you have fully tested your X-ray unit, the chemistry is freshly mixed and the
developer thermostat is working effectively. You suspect that the development time is not appropriate for the
prevailing conditions.
a) Select a manual darkroom.
b) Carry out a manual development time check.
c) Answer the following questions in the spaces provided.

l. What is the commonly used development t i m e ? - - - - - - - - - - - - - - - - - - - - - -

2. How is this time arrived a t ? - - - - - - - - - - - - - - - - - - - - - - - - - - - -

3. What is the developer temperature after stirring? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4. What is your recommended development time after evaluating the test strips?

5. How does this temperature compare to the established practice for this darkroom?

6. What is your recommendation for action? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Include your test films with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
104

TASK22

Assess developer activity

Radiographs consistently look light and lacking in detail. You have checked development time and temperature.
a) Carry out a developer activity check.
b) Carry out the same test 2 days later with the same processing unit.
c) Answer the following questions in the paces provided.

l. Developer temperature at first t e s t : - - - - - - - - - - - - - - - - - - - - - - - - - -

2. Developer temperature at second test: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

3. What is your evaluation of the test s t r i p s ? - - - - - - - - - - - - - - - - - - - - - - - -

4. What are your c o n c l u s i o n s ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

5. What are your recommendations for a c t i o n ? - - - - - - - - - - - - - - - - - - - - - - -

Include your test films with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
MODULE 4. MANUAL FILM PROCESSING
105

TASK 23
Manual film processing

Radiographic quality has fallen. It is NOT related to positioning, exposures or X-ray equipment. Someone has
suggested that you are getting lazy with your manual processing. Check out your processing routine. Answer the
following questions in the spaces provided.

l. What was the development t i m e ? - - - - - - - - - - - - - - - - - - - - - - - - -

2. How did you select the development time?

3. What was the film clearing t i m e ? - - - - - - - - - - - - - - - - - - - - - - - - - -

4. What was the full fixing t i m e ? - - - - - - - - - - - - - - - - - - - - - - - - - - -

5. Why should the film be drained into the rinse after development? _ _ _ _ _ _ _ _ _ _ _ _ _ __

6. Why should the film be drained into the rinse after rinsing? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

7. Why should the film be drained into the wash after fixing? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

8. Why agitate the f i l m ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

9. Why agitate the film v e r t i c a l l y ? - - - - - - - - - - - - - - - - - - - - - - - - - -


QUALITY ASSURANCE WORKBOOK
106

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
107

MODULE 5

Automatic film processing

Aim Choosing an automatic processor


Identify your needs
To provide the knowledge and practical skills neces-
• Throughput of films.
sary to use an automatic processor correctly and es-
• Complexity of unit.
tablish an effective, regular maintenance and quality
control program. To provide an insight into choosing
Resources available
and accepting a new automatic processor.
• Power.
• Water.
Objectives • Space.
On completion of this module you will: • Exhaust systems and ventilation.
• Maintenance and repairs.
&I Have an understanding of the function of auto- • Finance.
matic processors.
il Have the knowledge and skills to carry out Manufacturer warranty
basic maintenance checks on automatic • Warranty period.
processors. • Warranty cover.
il Have the knowledge and skills to set up a quality • Determine responsibilities.
control program for automatic processing.
il Have the knowledge and skills to carry out Supplier service
specific quality control tests on automatic • Installation.
processors. • Initial QC tests.
Ill Have the knowledge to be able to evaluate the • Maintenance.
quality control results and recommend remedial • Repairs.
action.
• Parts.
• Have an understanding of how to choose a new • Chemistry.
automatic processor and the acceptance proce- • Speed of response.
dures following installation.
Making the choice
• Establish your processor specification
Automatic film processing follows the same basic prin- requirements.
ciples as those of manual processing, but under auto- • Do you want a silver recovery unit?
mated and controlled conditions. The automatic • Review the manufacturer's specifications.
processor and its chemistry must be maintained at a • Make a short list of suitable processors.
high level of efficiency. Regular quality control moni- • Submit your requirements to the selected manu-
toring and maintenance is essential to ensure that high facturers for quotations.
quality images can be produced consistently. • Review quotations.
There is a range of automatic processors available, • Make your selection.
from the small, simple bench top to the deep tank,
more complex, models. The principles and methods
Acceptance of new processor
used to monitor processor performance are the same
regardless of the type of automatic processor Upon completion of the installation and before accept-
used. ing responsibility for the new processo~you must check
that:
QUALITY ASSURANCE WORKBOOK
108

• Specifications of the processor installed are the • Film drying is carried out by, variable tempera-
same as that ordered. ture, hot air blowers.
• Installation has been carried out as stated in the
contract.
Use of an automatic processor
• Installation is complete and equipment is work-
ing efficiently and to your satisfaction. • Follow manufacturer's instructions.
• All QC tests have been carried out and are • Place the film on the feed tray.
satisfactory. • Ensure that the longer edge of the film leads and
• All accessory equipment has been supplied and the shorter edge is in contact with the side of
is in good order. the feed tray (smaller films may not mal<e con-
• Operating manual has been supplied and is the tact with the replenishment microswitches).
correct one. • Advance the film until it is taken up by the first
set of rollers.
Only when you are sure that the installation has
• Do not advance the film until the audio and/or
been carried out satisfactorily should you accept the
visual signal indicates that the previous film has
processor.
advanced far enough.
• Processing time, dry to dry, could be 60 seconds
Setting up an automatic processor to 4 minutes, depending on the type or make.
Most manufacturers make a range of processors
The manufacturer or supplier should:
to suite all needs, with varying degrees of sophis-
• Ensure that pre installation requirements are tication and processing times.
adequate, e.g. ventilation, water pressure, drain-
age, power supply.
• Carry out the installation correctly and make sure
Potential problems
it is working properly. It is important to be aware of potential problems in
• Carry out the initial quality control procedures order to watch out for them during use and inspections.
and leave the results for future reference.
• Give staff adequate instruction regarding its use, Mechanical
care and maintenance. • Broken cog teeth.
• Provide the relevant operating manual. • Roller wear or splitting.
• Provide a contact for service and repairs. • Transport system breakdown.
• Provide service under the conditions of the • Film jam.
warranty. • Film damage.
• Provide ongoing maintenance if required by the
buyer. Electrical
• Power failure.
• Drive motor failure.
Principles of the automatic processor • Heating element failure.
• The film is transported through the processor by • Drying section failure.
motor driven rollers, at a standard, regulated • Replenishment pump failure.
speed. • Recirculation pump failure.
• The film passes through the developer; fixer, wash
and drying sections for pre set periods of time. Chemistry
• The developer and fixer are automatically replen- • Wrongly mixed.
ished, by pre determined amounts, each time a • Contaminated.
film is fed into the processor. • Inadequate or incorrect replenishment.
• The replenishment rates can be adjusted to • Blocked or partially blocked replenishment hoses.
cater for the size and quantity of films being put • Incorrect temperature.
through.
• The wash watet; either runs continuously, or only Water
when films are fed through, depending on proc- • Inadequate supply.
essor design. • Blocked or restricted flow.
• The temperature of the chemistry is maintained • Contaminated.
by thermostatically controlled heating elements. • Algae growth.
MODULE S.AUTOMATIC FILM PROCESSING
109

Cleanliness (lack of) • When the processor has reached normal operat-
• Marked films. ing conditions carry out routine sensitometry
• Contamination of chemistry. procedures (see Sensitometry1 page 112).
• Build up of chemical deposit resulting in mechani-
cal failure. Normal working
• Health hazard. • Follow operating instructions.
• Constantly be aware of any abnormal noises1
changes in operation 1 leaks or deterioration of
Processor maintenance schedule
processed films.
A processor maintenance schedule should be followed • Do not pull processed films out before they are
regularly in order to detect or forestall faults. Read the clear of the rollers.
maintenance and cleaning section of the operator's • Do not allow anyone to stand next to or lean
manual. Closely follow the manufacturer's recom- against the processor.
mendations. Remember that cleanliness is vitally
important. Shut down
• Remove processor lid. Remember it will be nec-
Following are suggested schedules you essary to reactivate microswitches when lid is
may find useful removed (see manufacturer's instructions).
• Observe level of solutions.
DAILY • Listen for abnormal noise or vibration.
Before start up: • Observe transport system.
• Remove crossovers and wash in warm water; with • Look for any leaks.
a sponge or plastic cleaning pad (always do de- • Switch processor off.
veloper first, then fixer, to avoid contamination • Remove and wash all crossovers1 splash guards
of developer). and tank lids.
• Wash tank covers and splash guards. • Wipe over all deep rack rollers above solution
• Wipe over all deep rack rollers that are above levels.
solution levels. • Inspect and wash roller-drive cogs and drive
• Clean all interior exposed surfaces. mechanisms.
• Check replenishment tanks/bottles levels1 color • Replace tank lids.
and smell. • Turn off wash water if appropriate.
• Check replenishment hoses for bends or leaks. • Remove water dt·ain stand pipe if appropriate.
• Replace water drain stand pipe if appropriate. • Wash off all chemical splashes on interior exposed
• Turn on water and check that the tank is filling surfaces.
(time flow if felt necessary). • Wipe any splashes from exterior surfaces.
• Replace crossovers and tank lids. • Repiace processor lid 1 leaving it slightly raised
at one end to avoid build up of fumes and
Start up condensation.
• Switch processor on (you will need to activate • Door of darkroom should be left open with venti-
microswitches manually with the lid offl. lation system operating 1 if power supply con-
• Listen for any abnormal noise or vibration. straints allow.
• Check film transport system. • Place crossovers on top of processor/ with wash
• Check replenishment system is working. stand pipe if appropriate/ and cover with a cloth 1
• Replace processor lid. or store in a convenient cupboard.
• Feed in one unprocessed 35 x 43 cm film (do not • Re stock1 chemicals 1 films and any other depleted
use processed film as these are harder and con- supplies.
tain fixer). • Recot·d ali restocking.
• Inspect processed "clean up film". Feed in a • Report all faults.
second film if felt necessary.
• Clean exterior surfaces1 including the feed tray WEEKLY
and receiving bin. Pay particular attention to the • Follow manufacturer's recommendations.
feed tray. • Check solution temperatures, in particular the
• Wipe over all darkroom work surfaces. developer (see Temperature check, page 110).
QUALITY ASSURANCE WORKBOOK
110

- Compare with any readout on unit and • Record costs.


manufacturers recommendations. • Continually review procedures, repairs, costs and
- Adjust if necessary. quality of radiographs.
• Check replenishment rates (see Replenishment
rate check, page llD. By maintaining and using your processor correctly there
- Adjust if necessary. will be:
• Remove and wash all deep rack rollers in warm
• less down time.
water.
• less inconvenience.
- Inspect for correct function, wear or
• lower costs.
damage.
• greater through put.
- Rinse and re install.
• greater efficiency.
• Check main drive shaft and drive chains.
• greater job satisfaction.
• Carry out any other maintenance recommended
by the manufacturer.
It is up to you!
• Report all faults.
Electrical/mechanical systems check
MONTHLY Frequency of checl<
• Follow manufacturer's recommendations. • Daily.
• Inspect all racks and component parts, during • Yearly by service engineer.
cleaning.
• Clean filters. Items to be checl<ed:
• Drain all tanks, clean and re fill with fresh • Electrical connections and cables.
solutions. This may not be economically possible • Micro switches.
however. • Indicator lights.
- An alternative is to inspect the condition of
• Audio signals.
the solutions and tanks and change as felt • Heaters and thermostats.
necessary.
• Motors.
• Carry out any other maintenance recommended • Roller drives.
by the manufacturer or felt necessary.
• Pumps.
• Report all faults.
• Hoses.
• Readouts.
QUARTERLY
• Follow manufacturer's recommendations.
• Discard remaining chemicals in replenishment Temperature
tanks. Temperature of the developer is critical and is usually
• Wash out replenishment tanks and flush hoses. about 35-37 oc
(see chemical and film manufacturer's
• Re fill with fresh chemicals. recommendations).
• Inspect electrical connections. Temperature of the fixer is less critical but should
• Carry out any other maintenance recommended be similar to that of the developer.
by the manufacturer. Developer temperature should be tested regularly.
• Report all faults.
Temperature check
YEARLY
Frequency of checl<
• If you do not have an ongoing service contract
with the supplier or their agent and carry out • Daily.
the routine maintenance yourselt it is advisable
Equipment required
to have them service your unit yearly.
• Thermometer-non-mercury (preferably digitaD.

Record l<eeping
Method
• It is essential to keep records of all quality con-
• Test at the same time each day, when developer
trol procedures, maintenance and repairs carried
temperature has stabilized.
out.
• Place thermometer in developer.
• Record all parts purchased.
MODULE S. AUTOMATIC FILM PROCESSING
Ill

• Read while in developer. • Place the end of the developer replenishment hose
• Compare thermometer reading with the built-in in the graduated cylinder.
readout temperature. • Feed a film into the processor.
• A pre-set amount of developer will automatically
Evaluation be pumped into the cylinder. Record this amount.
• Compare test temperature with: • Empty cylinder and repeat for fixer.
- Manufacturer's recommended temperature.
- Built-in temperature. Evaluation
• Record daily temperatures for comparison. • Compare amount of developer and fixer in cylin-
• Graphs may be plotted to show variations over der with manufacturer's recommendations.
time (see Sensitometry, page 112).
• look for variations of temperature: Action
-Too high. • If amounts do not compare with recommenda-
-Too low. tions, adjust quantity regulator accordingly (see
- Irregular. manufacturer's instructions).
• Re-check.
Action • File a report.
• Regular variations of more than one or two
degrees should be investigated.
Cleaning
• Check for likely cause:
- Heater. Adequate cleaning avoids the risk of film contamina-
- Thermostat. tion, chemical build up on working parts and improves
- Tests done at different times of the day. general health and safety.
- Developer temperature not reaching operat-
ing level after start up. DAILY
• If necessary, call the processor service technician. At start up
• Feed a 35 x 43 cm waste unprocessed film into
Replenishment of developer and fixer the processoG to clean any deposits from rollers.
It may be necessary to feed in a second film if
Similarly to manual replenishment, automatic replen-
you feel it is necessary. Do not use processed film
ishment maintains the level and activity of the process-
as this will be too hard and may contain residual
ing chemistry. Pumps automatically replenish developer
fixer.
and fixer tanks each time a film enters the processor.
• Do not proceed with the daily workload until you
The replenishment rate is pre-set but can be varied
are satisfied the rollers are clean.
within manufacturer's recommendation. It should
be based on the area of film passing through the
At shut down
processor.
• Remove and clean all crossover rollers or plates.
• Wipe off all chemical deposits on or around the
Replenishment rate test
processor. Take special care with film feed tray.
Frequency of test • Drain the wash tank.
• Monthly.
WEEKLY
Equipment required • Remove, clean and replace developeG fixer and
• One graduated lOOml cylinder. wash roller racks.

Method MONTHLY
• Check that replenishment hoses do not have any • Drain the system completely, including
bends that may restrict the flow. recirculation hoses and rinse with water.
• Switch on the processor. • Charge the system with a dilute concentration of
• Remove lid of processor. hypochlorite bleach (e.g. a 0.5% hypochlorite
• Place activate micro switches, if present, to en- solution). Take note of precautionary information
sure that processor will function with the lid off. on hypochlorite container.
QUALITY ASSURANCE WORKBOOK
112

• Let the solution sit in the system for up to 30 When to do processor control sensitometry
minutes. Higher concentrations of hypochlorite
• First thing every morning.
or longer dwell times may harm some construc-
• After the processor has reached the correct
tion materials.
operating temperature.
• Rinse the bleach from the system and dislodge
• After feeding clean up film through.
easily removable biogrowth.
• Before processing any patient radiographs.
• Scrub the biogrowth off accessible surfaces. Use
• After cleaning or servicing the processor.
a clean, stiff brush or other tools recommended,
for cleaning the surface.
• Flush the system thoroughly with water before . Outline of procedure
returning it to normal use. • A standard step wedge image must be produced.
DO NOT allow concentrated sodium hypochlorite bleach • This image consists of a range of clearly defined
to come in contact with photographic processing so- densities.
lutions. Dangerous fumes can be produced. • Production of this image must be consistent.
Methods for its production are described
following.
Summary of daily solution checks • The film is processed in the film processor to be
Developer assessed.
• Check temperature at least once a day (ideally 3 • The resultant image densities are determined
times per day). using a densitometer, recorded, graphed and the
• Check developer level at time of temperature graphs evaluated.
check. • The first graph produced is known as a charac-
teristic curve.
Fixer • To draw a characteristic curve, plot test film den-
• Check fixer level at time of temperature check. sities against test film density step numbers. Step
l must be the lightest density.
Water • From this characteristic curve, several other
• Check water level and flow at time of tempera- graphs may be plotted, each giving additional
ture check. information.
• This combined information will give a compre-
hensive picture of processor performance.
Sensitometry
Sensitometry is the study and measurement of the
relationship between exposures, films, screens and
The test fflm
processing. The image on the test film must be a standard series
of clearly defined densities, ranging from barely visible
to black.
Principle use
• These densities are usually over a range of 21
• Our interest lies more in its use in checking film steps.
processor performance, in particular that of au- • A smaller number of steps may be used.
tomatic processing. • Number the steps from l Clightest step).
• By standardizing exposure, film and screen types,
conditions under which films are exposed, han- Producing the test film
dled and stored, leaves only one variable, that of There are several ways of preparing the test film.
film processing.
• Any variation in film image must therefore be due METHOD I
to film processing. The best and most reliable method is to use a
• A very elementary form of evaluating film process- sensitometer, which produces a standard range of
ing performance has already been dealt with (see densities.
Module 4. Manual processing, page 78).
• Sensitometry is a more comprehensive and Using the sensitometer
accurate form of monitoring processing • Use a dedicated box of film of the type commonly
performance. used in your department.
MODULE S. AUTOMATIC FILM PROCESSING
113

• Use the sensitometer in the darkroom where the • Standard conditions must be used each time a
processor is to be monitored. step wedge image is made.
• Select the light colour relevant to your films
colour sensitivity (blue or green). METHOD 3
• Under safelight conditions insert a sheet of Producing a standard range of densities, using X-ray,
film into the sensitometer until it reaches the without the step wedge.
back-stop.
• Press cover down and hold until signal (audio or Making the Image
light) has stopped. • Place an 18 x 24cm cassette, loaded with your
• Raise the cover and remove film. standard film, face up on the X-ray table.
• Process the film in the processor to be monitored. • Divide the face of the cassette into 11 strips.
• The film should always be placed in the same spot • Cover all but the end strip with lead rubber.
on the feed tray, with the image parallel to the • Set a lOO cm FFD (SIDl, centre and collimate to
rollers. the uncovered area (strip 1).
• Expose using a low exposure (enough to produce
METHOD 2 a barely visible density).
Make an X-ray image of aluminium step wedge under • Move the lead rubber so that strips 1 and 2 are
standard conditions. uncovered.
• Using the same exposure, expose both strips (strip
Mal<ing the step wedge image (see Fig 5-l) 1 has now been exposed twice).
• Place an 18 x 24 cm cassette, loaded with your • Move the lead rubber so that strips 1, 2 and 3
standard film, face up on the X-ray table. are uncovered and expose all three strips, using
• Place the step wedge on the face of the cassette. the same exposure (strip 1 has now been exposed
• Using a lOO cm FFD (SID), centre and collimate three times and strip 2 twice).
to the step wedge. The cassette can be divided • Repeat this process until all strips have been
with lead rubber in order to make more than one exposed.
image on the same film. • Process the film, under safelight conditions, in
• Set an exposure that will produce a full range of the processor to be monitored.
step wedge densities and make an exposure. You • Feed the film into the processor in the same way
may need to experiment first in order to deter- as that described in Method 2.
mine the correct exposure for your step wedge/ • The film may be cut down the middle lengthways,
film/screen combination. when removed from the cassette, in order to cre-
• Process the film, under safelight conditions, in ate a second strip. The unused strip should be
the processor to be monitored. placed in a light tight box for future use.
• The film should always be placed in the same spot
on the feed tray, with the image parallel to the METHOD 4
rollers. • Purchase pre-exposed sensitometryfilm produced
by a film manufacturer.

Terminology
To understand the process of sensitometry it is
necessary to have an understanding of some basic
terminology.

Sensitometer
A consistent light source, that produces a standard
range of densities, when exposed on film.

Densitometer
A consistent light source, combined with a light meas-
uring sensor, used for accurately measuring film
Fig 5-1. Making a sensitometry test strip density.
using an aluminium step wedge
QUALITY ASSURANCE WORKBOOK
114

Film density that is said to have a "wide latitude" has the ability to
The degree of film blackening. You will see from the accept large changes in exposure, without excessive
characteristic curve graph, and your own experience, density changes.
that density increases as exposure increases.
Carrying out the sensitometric test
Contrast
Frequency of test
The difference between two or more densities on a film.
• Daily.
The straight line portion and shape of the characteris-
tic curve gives us information about contrast. A high
Equipment required
contrast film curve will lie toward the left, whilst a lower
• Sensitometer, to produce image by Method 1
contrast curve will lie more to the right (see exposure
described above, or
latitude, page 116).
• Step wedge to produce image by Method 2
described above, or
Gradient
• Lead rubber sheet and cassette to produce
The contrast of a film at a given density. When a straight
image by Method 3 described above.
line is drawn tangent to the characteristic curve at a
• Unexposed film or manufacturer's pre exposed
particular density, this line forms the slope which is
sensitometry film.
the gradient of that density.
• Densitometer.
• Specialised graph paper supplied by a film manu-
Average fradient
facturer, or
A line drawn between the 0.25 and 2.00 density levels
• Simple small grid, graph pape~ available from
on the characteristic curve.
stationary shops, drawn up in the same way.
• Any scale graph paper may be used, but it is com-
Toe gradient
mon to use a ratio, X axis toY axis of 0.15: 1.0.
A line drawn between the 0.25 and 1.00 density levels
The important thing is that you do not vary the
on the characteristic curve.
ratio once your quality control program is under
way.
Mid gradient
A line drawn between the 1.0 and 2.0 density levels on
Method
the characteristic curve.
• Allow the processor to stabilise.
• Process the test film in the processor to be
Upper gradient
checked.
A line drawn between the 2.0 and 3.0 density levels on
• Tests must be carried out at the same time each
the characteristic curve.
day under the same conditions.
• Developer temperature must be taken at the time
Base plus fog
of test.
The density of a processed film, without the effects of
• Using the densitometer, read the density of each
light or radiation. The density at which the character-
step on the test film image.
istic curve starts.
• Record the densities against their step numbers.
• Plot a graph of step numbers on the horizontal
Exposure
axis against densities on the vertical axis and join
Intensity of radiation x time CmAs).
up the plots (see Fig 5-2).

Speed
Indicated by the location of the curve along the step Using the densitometer
(exposure) axis. A faster film curve will lie more toward
• Switch on the densitometer and allow unit to
the left, whilst a slower film will lie more toward the stabilise.
right. To calculate film speed use a density level of 1.0 • Set densitometer readout to zero.
(this is considered to be the average of the useful den- • Place the centre of the density to be read, di-
sity range of 0.25 to 2.0). rectly over the aperture and under the reading
arm.
Exposure latitude • Lower the reading arm to the film, press the "read"
The range of exposure factors, within which the result- switch and hold for a few seconds, until the
ant radiograph is considered to be acceptable. A film readout stabilises.
MODULE S.AUTOMATIC FILM PROCESSING
115

Characteristic Curve - Speed


GRAPH OF DENSITY/STEP :NUMBER
• Select the step number that has a density
within a range of 1.0 to 1.3 on the step wedge
image. This step number becomes the speed
step.
• Record the step number on the speed chart
in the space provided (speed step
No ........ J. Do this only on day 1, after
the chemistry has been freshly mixed.
• Plot the density reading on the zero line
under Day 1. Do this only on day 1, after the
chemistry has been freshly mixed.
• Measure and plot the density of the Speed
9 IOsTEP l'<TMBER Steps daily (see Fig 5-3, Fig 5-4 and Appen-
dix B, page 163).
• Observe how much the speed plot varies from
the zero line.
• An acceptable variation is plus or minus 0.15.
• Variations above this may need corrective
action.
- Contrast
Fig 5-2.A typical characteristic graph
• Select densities of the steps, two steps above
showing relationship of density to step
number and two steps below, the speed step.
• Record these steps on the contrast chart, in
the spaces provided (Step Below ........ .
• Lift the arm. and Step Above ..........).
• Record the reading against the step number. • Subtract the smaller from the greater of these
• Repeat for all density steps on the image. two densities. This difference is the contrast
of your standard reference.
Plotting the characteristic curve • Record this standard reference against the
• The graph paper must have "Density" on the zero line on the Contrast Chart. Do this only
Y (vertical) axis and "Step Number" on the X on day 1, after the chemistry has been freshly
(horizontal) axis. mixed.
• Plot density of step 1 Cthe lightest density) at the • Repeat this procedure daily, plotting the con-
appropriate level on theY axis and directly above trast indicator under appropriate dates (see
Step 1 on the X axis. Fig 5-3, Fig 5-4 and Appendix B, page 163).
• Repeat for all other step densities. • Observe how much the contrast indicator
• Join up all plots to form a free flowing curve (see varies from the zero line.
Fig 5-2). • An acceptable variation is plus or minus 0.15.
• Draw in the toe, mid and average gradients as - Base plus fog CD-Min)
described above. • Using the densitometer; measure the density
of the film that has received no exposure.
Evaluation • Record this reading against the zero line on
• Compare your characteristic curve with the con- the Base Plus Fog Chart. Do this only on day
trol characteristic curve that was plotted when 1, after the chemistry has been freshly mixed.
the chemistry was first mixed and the processor • Repeat this procedure daily, plotting the base
set up. plus fog density under appropriate dates (see
• If these curves vary markedly there is reason to Fig 5-3, Fig 5-4 and Appendix B, page 163).
believe that the processor is not functioning • Observe how much the base plus fog indica-
correctly. tor varies from the zero line.
• Calculate the "Speed", "Contrast", "Base plus Fog • Ideally it should not go above 0.02. Action
CD-Min)", "Temperature" and "D-Max" and enter should be considered if it exceeds 0.023.
on the appropriate graphs (see Fig 5-3 & Fig - Temperature
5-4).
QUALITY ASSURANCE WORKBOOK
116

Characteristic Curve

GRAPH OF DENSITY/STEP NUMBER

3.o lL
H--1--+--+--+--+-+-+-+-+-+-+-+-,_L~-;-.,.....-r--r--r-""'1"1

_L
1/
I
2.0 H--t-+--+-+-+-+-t-H~-tj_ff-t-t---t---t--t--t--1--t--H
V
r.

t.o t-t--t--t--t--r--t-+-+-+--t-...,.,.."'
L--t---t-t-r--t--t-.,....-r--t--r-""'1"1
V
.T, lL
_v
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
STEP NUMBER

Speed Index = 1.06 Base+ Fog= 0.16 Average Gradient


Contrast Index = 1.88 D-Max = 3.52 =3.08
Fig 5-l.An example of a characteristic curve

• Take the temperature of the developer. • Record this against the zero line on the D-
• Record against the zero line of the Tempera- Max Chart. Do this only on day 1, after the
ture Chart. Do this only on day 1, after the chemistry has been freshly mixed (see Fig 5-
chemistry has been freshly mixed. 3, Fig 5-4 and Appendix B, page 163).
• Repeat this procedure daily, plotting the • Repeat this daily, recording the D-Max on the
Temperature under appropriate dates (see chart under appropriate dates.
Fig 5-3 & Fig 5-4 and Appendix B, page • Noticeable variations give advanced warning
163). of chemistry problems.
• Observe how much the temperature varies.
• Action should be considered if the tempera-
How to use the sensitometry graphs
ture varies more than a few degrees.
- D-Max All processors will show some variation in results from
• Using the densitometer, measure the maxi- day to day. However, action should be taken if the vari-
mum density step on the step wedge ations are sudden or continue to increase or decrease
image. over a period of time and pass beyond the acceptable
limits.
MODULE S. AUTOMATIC FILM PROCESSING
117

Quality Control Processing Chart

Processor: I Month: I
Speed
Speed Step No
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+0.20 = ! i
+0.15 :;;
! I

+0.10 ==
=
I
+0.05 == I
==
~
' I
I
-0.05 =
~
I ! I
: l
-010 == I I I
.
-0.15
~

~
i I
-0.20
I

Contrast
2 Steps Above No. 2 Steps Below No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+0.20
~
+0.15 =
+0.10
=
+0.05 ~ f
I
'
~ I i
-0.05 = ' .
~ '
': I
-0.10 =
I
-0.15 = I
;
-0.20 == I i

Base+ Fog
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+0.06
~
+0.04 =
=
+0.02 ~
I I I
~
-0.02 =
~
I
i j
-0.04 = I

! I
-0.06 ==
Temperature
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+4C ~
+2C = I I I
I
I I l
~ I I i I
I
' I I
-2 c ==
'------=" I
I
I I
i ! I I I
-4C ~ I I
I
I
I
i I I I I I ! I

D-Max.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

I
i ) :II
I
I i
:
/I
i II I
I
I

I
I
I
I I l
I

Fig 5-4. Sensitometry charts for recording Speed, Contrast, Base+ Fog, Temperature and D-Max
data
QUALITY ASSURANCE WORKBOOK
118

If the change is sudden, then all possible influenc- limits, especially if the change is sudden or continues
ing factors should be checked, or a mistake may have to increase or decrease, then the processor is said
been made. The test should be repeated. to be "out of control" and immediate action should be
taken.
In control:
When results remain within acceptable limits the Action to be taken if the processor
processor is said to be "in control" and no action is is out of control
necessary. • Immediately stop using the processor.
• Inform other users
Out of control: • Start problem solving process
If one or more of the charts (speed, contrast or fog) • File a report
is showing results that are outside the acceptable

Chart changes Possible cause Action

• Speed and contrast First stage of over development l Adjust temp.


increase 1 Developer temp. high 2 Adjust replenishment
• D min acceptable 2 Excessive replenishment 3 Change developer
3 Developer too concentrated 4 Developing time too long
• Speed & contrast up 4 Check processing time add starter
• D min increases

• Sudden increase in Excessive over development Add starter to developer


Speed, D min & D Starter omitted or insufficient
max after service Starter in developer

• Speed decreases Under development l Check & adjust temp.


• Loss of image l Developer temp. low 2 Check & adjust
contrast 2 Developer exhausted replenishment
• D min normal 3 Insufficient replenishment 3 Check & refill
4 Replenisher used up replenisher tank
• Image density low 5 Developer too dilute 4 Replace replenisher
over whole image 6 Developing time too short 5 Check processing time
Speed & contrast low
• D min also low

• Sudden decrease in Excessive amount of starter Replace developeG add


speed and D max in developer correct amount of starter
after service
• Small decrease in
D min

• Increase in speed l Aerial oxidation Replace developer after

• Shoulder decreases 2 Contaminated developer washing out tank

•• Increase in fog
Loss of contrast Add correct amount of
starter

Fig 5-5. Example of the possible interpretation of sensitometric charts and recommended
action.
MODULE 5. AUTOMATIC FILM PROCESSING
119

Notes
QUALITY ASSURANCE WORKBOOK
120

TASK 24
Sensitometry test

JDWY ___________________________________
DJ.TB
EXPOSURB--------------------~----------

4.0 4.0
E ~ E !:=
~ = !:= §
t= § !:= g = ~ g
g ~
.... 1::
-
~

= E = ~

= g
t:: I=
E: :;: :
=
~ !"=' 1:: g § e; ~
:;:
E E: E
3.5 § § § t: : 3.5
- !=:'
= t:: ~ ~

STEP DENSITY ~ E E E .F ;_ ~-- ~ ~ § !:= :


E: g -
E
g = = -
= E: E §
:: 1 ; !;
= ~ I= f e; =
t:
t:
::: g - g F :::
2 = ;::
:::
~ -
3 - E ~ ~ E § :
3.0
4 ~ §
I=
~ ~ ; E t:
~ = =
= =
~ ~
~
§ ~
=
§ ..
.... :
3.0

::s g
5 E
~

E E ~ §
!:=
-
g=
~ ~ ~ = = § § §
g
§ § - :
~ :::: E ::: ~ ~ ~ = = ~ ~ 1:::
-
~7 ~ !:: t:

..- ~
E E E
B E §= § § § g E ; ; ~
=
J
2.5 9 ;::t: = = ::: 2.5
:: ~ ~ - § § ~ :: E !=:' § :
§ 10 g ~ ~ §
- § ~ E ;;
.= :
§ 11 E
E12 §
~

=
g
E
-
-
-
E
....
;::
-
- 1:
r::=
t:
g § ~
=
;::

-
2.0
13 § ; - E ~ ~ = = § e g !:= E
2.0
-14 :: :: ~ - E § _g ;:
::: g g ~

g .. = ..::
E:
15 ::: - ::
.....- - E
16 = = ;: § = =
17 ~ := ::: E... - e :: § § § e; :::
- ::
-
18 § :r::
t: ~ - E - :: § ~ E: § § § -
1.5
19 ; ::: t:
~ ::: E: E:
- :: 1.5
- - r
-
20§ :::= § ~ E: ; § ::
::: = - - - ::

21:::
= g E: - = - =~ - § t: - = ::: E
= - :
t: t: ·- ~ ::: :::
::
- §
§
§
§ §
= = - -
:::
- E:
:: t: ;
-
1.0 ::: - ;_ - - ~
- - 1.0
:::
-
-
;
§
-;
§
:::
§
::: ~
= -
-
E
-!§ -
-
:: ::
::: =
:::
:::
:::
:::
-
t:

- g - :: E § E E :::
--
.... E
....
- E [ E !:
- = § E:
·- ~- E 1:::
; § § §
- ...t: E: !:
-c:
- = E_= =
F
0.5 0.5
- 1::: E E: §
....
- = = =
I=
t= !=-_
::: e e; :
;;
= I= E :::
= - E §ct= E
....
g
::: E
::: = ..-
§
e-
E - E ::: - E.
= ;::

g :: g ::: ::
;:; ~ E :: § - - = E I:' = ~ - ~

0.0 - e - ::
- ~ g :: ~ ::: g -
0.0
ltep no. 3 5 7 9 ll 13 15 17 19 21 23
MODULE S.AUTOMATIC FILM PROCESSING
121

You are required to carry out the daily monitoring sensitometry check of your processor.

a) Select an automatic processor.


b) Carry out the routine sensitometry test.
c) Plot the Characteristic Curve on the graph sheet below.
d) Answer the following questions in the spaces provided.

l. How does this graph compare with the Characteristic Curve shown in the notes?

2. Give the following figures: SPEED


CONTRAST _ _ _ _ _ _ _ _ __
BASE+FOG _____________________
D-MAX

Include your step wedge film with these answers.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
122

TASK 25
utomatic processor start up
routine

You have been asked to start up the automatic processor at the beginning of a working day.

a) Select an automatic processor.


b) Carry out the automatic processor start up routine using the following check list.
c) Answer the following questions in the spaces provided.

Checl< Satisfactory/Unsatisfactory Comment

Developer level

Developer replenisher level

Developer replenishment rate

Developer condition

Developer temperature

Fixer level

Fixer replenisher level

Fixer replenishment rate

Fixer condition

Water flow

Condition of rollers

Condition of drive cogs

Drive motor

Dryer
MODULE S. AUTOMATIC FILM PROCESSING
123

Feed warning signal

Passage of clean up film

Abnormal noises

Cleanliness

l. What was the developer replenishment rate? ________________________

2. What was the fixer replenishment r a t e ? - - - - - - - - - - - - - - - - - - - - - - - - -

3. What was the developer t e m p e r a t u r e ? - - - - - - - - - - - - - - - - - - - - - - - - - -

4. What are your recommendations?

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
124

MODULE 6

Radiographic exposures

Aim mA
• Controls the intensity of radiation and there-
To provide sufficient knowledge of exposure selection fore film density and patient dose. The higher
and manipulation, to enable accurate selection of ex- the mA, the higher the film density and patient
posures, in order to produce maximum information on dose.
the resultant radiographs.
time
Objectives • Controls the length of time of radiation flow, and
therefore film density and patient dose.The longer
On completion of this module the student will the exposure time the higher the film density and
11 Understand the effect each exposure factor has patient dose.
on the resultant radiograph.
• Be able to use this knowledge effectively. mAs
• Be able to select the correct exposure factors • The multiple of mA and time (in seconds).
required. • Many modern X-ray units are designed to use mAs
11 Understand and use the step system of exposure rather than mA and time separately.
calculation.
11 Be able to manipulate exposure factors using the FFD (SID)
step system. • The greater the distance an X-ray beam travels
li Be able to establish and maintain a reliable the less effective it will be, the less distance it
exposure chart. travels the more effective it will be.
li Be able to modify an existing exposure chart. • Exposure compensation is therefore necessary
with changes in FFD (SIDl.

Strictly speal<ing the term, "exposure" refers to the


For the radiographer it is important to set the correct
quantity of radiation to which the patient is exposed.
exposure factors required to produce a high quality
In practical radiography we tend to talk of "expo-
radiograph, which will give the maximum amount of
sure" as the collective exposure factors, kV, mA and
information yet minimise the dose to the patient.
time, which together will produce the radiation expo-
It is important to have systems in place that will
sure that will give the required penetration, density and
help the radiographer to select and manipulate expo-
contrast on the radiograph.
sure factors effectively.
There are several other factors, which influence film
quality, but here we will only consider kV, mA, time and
FFD (SIDl. Exposure chart
Each X-ray unit should have a list of commonly used
kV
exposures for easy reference (see Appendix B, page 164).
• Controls largely the penetrating power (better
This list will, of course, be limited, but will at least pro-
described as the quality of the beam), and to a
vide a guide.
lesser degree, the intensity of radiation and there-
fore film density and patient dose.
Methods of recording exposures
• Affects contrast. The higher the kV the lower
• Written chart.
the contrast. The lower the kV the higher the
• Notebook.
contrast.
• Computerised "chart" within the X-ray unit.
MODULE 6. RADIOGRAPHIC EXPOSURES
125

Here we will deal with: • Measure the thickness of the patient's hand in
• Establishing and modifying an exposure chart. all projections used. e.g. PA, Oblique, lateral (see
• Manipulating exposure factors using the step Module 2. Accessory equipmen( page 41 and
system. Appendix A, page 135).
• Measure thickness at the level of entry of the
Establishing an exposure chart central ray, for each position of the hand.
• Measure all other areas/positions in the same
Method
group (these can be obtained from a colleague
• Draw up a blank exposure chart (see Fig 6-l and
or ft·iend of similar size rather than inconvenience
Appendix B, page 168).
the patient).
• Fill in all the anatomical areas to be covered, list-
• Calculate the exposures for all other areas/posi-
ing the views for each.
tions in the group, based on the following chart
• Divide these into groups using the same set of
(patient thickness related to exposure change),
conditions. e.g. all extremities using detail screens,
using the hand as your base level:
no grid, lOO cm FFD (SIDl.
• Produce a well exposed set of radiographs of an Patient thickness related to exposure change
extremity, e.g. hand. (this can be done in the - 1.5 cm increase in thickness requires a 25%
course of a routine examination.) increase in exposure (+ l step)
• Record the exposures used against HAND on the - 5.0 cm increase in thickness requires a lOO%
chart. increase in exposure (+ 3 steps)

Exposure chart
Room _________________________________

Area kV mAs mA Time FFD (SID) cm Grid Screens Remarks

Hand
PA lOO - Detail
Oblique lOO - Detail
Lateral lOO - Detail
Wrist
PA lOO - Detail
Oblique lOO - Detail
Lateral lOO - Detail
Forearm
AP lOO - Detail
Lateral lOO - Detail
Elbow
AP lOO - Detail
Oblique lOO - Detail
Lateral lOO - Detail
Foot
DP lOO - Detail
Oblique lOO - Detail
Lateral lOO - Detail
Ankle
AP lOO - Detail
Oblique lOO - Detail
Lateral lOO - Detail

i
I

l
Fig 6-I.An example of a partially completed exposure chart
QUALITY ASSURANCE WORKBOOK
126

- 5.0 cm decrease in thickness requires a 50% Note: Step changes can be applied to any one of the
decrease in exposure C-3 steps) charts or split between the charts.
- 1.5 cm decrease in thickness requires a 23%
• The step system provides step charts for kV, mA,
decrease in exposure C-1 step)
mAs, time and FFD CSIO), <see Fig 6-2, Fig 6-3,
Note: The reference to"+ or- steps" is explained below Fig 6-4 & Fig 6-5).
The step system. • To use the step system to make exposure changes,
it is necessary to talk in terms of steps.
Example • Each step on any of the charts will alter the ex-
e PA HAND C2cm thick) Exposure SOkV 6mAs. posure by approximately 25%.
• Calculate an exposure for a lateral WRIST C7 cm • For a noticeable change in film density to be seen,
thicl<). the exposure must be altered by at least 25%.
• Thickness difference between PA HAND and Lat- • If a film is considered to be too light or too darl<
eral WRIST is 5 cm. it will be necessary to change one of the expo-
• For an increase of 5 cm the exposure is increased sure factors by at least three steps up or down.
by 100% (see "Patient thickness related to expo-
sure change", figures above).
• Therefore the lateral WRIST exposure will be SO I<V
12mAs. mAs mA seconds
• The exposures for all other areas of the body can .010
be calculated in this way. .012
.016
2 20 .020
2.5 25 .025
The step system 3.2 32 .032
4 40 .040
The step system is a simple, standardised form of ex- 5 50 .050
posure factor manipulation, designed to remove some 6.4 64 .064
8 80 .080
of the guess work and make exposure setting more 10 lOO .lOO
accurate. 12.5 125 .125
16 160 .160
It works on a series of step charts allowing the use 20 200 .200
of standard step changes in exposure. 25 250 .250
32 320 .320
It is also related to patient thickness (see Appendix 40 400 .400
A, pages 135 & 136) and medical condition (see Fig 50 500 .500
6-5). 64 640 .640
so soo .800
lOO 1000 1.00
125 1.25
160 1.60
kV 200 2.00
250 2.50
40 320 3.25
41 400 4.00
44 5.00
46
48
50 Fig 6-3. mA, mAs and time step charts.
52
55
57
60
63
66 FFD CSIDl cm
70
73 200
77 178
81 l5S
85 140
90 125
96 112
102 lOO
109 89
117 so
7l

Fig 6-2. kV step chart Fig 6-4. FFD (SID) step chart
MODULE 6. RADIOGRAPHIC EXPOSURES
127

• Any step change required to modify an exposure • An increase of 10 kV =three steps on the kV step
can be applied to any of the Step Charts, although chart.
other factors will influence this decision (contrast, • To retain the same density film, the mAs must be
penetration, patient dose, movement, limitations reduced by the same number of steps (three
of the X-ray unit). steps) on the mAs chart.
• Step changes need not be limited to one chart • New Exposure= 70 kV 10 mAs
only. The necessary step changes can be split up
between charts if necessary, providing that the
Step charts
overall number of required step changes is made.
All step charts reproduced from "Course Notes in Ba-
Example sic Radiography", Radiation Protection Branch, South
• Original Exposure= 60 kV 20 mAs Australian Health Commission.
• New kV = 70 kV (an increase of 10 kV)

Exposure modification for changes in conditions

Pathology Step changes suggested


Ascites +2
Asthmatic -1 or 2
Bowel Obstruction -1 or 2
Emaciated 0
Emphysema I -1 or 2
f ~
"Flabby" Fat -1
I
I
Muscular Physique +1
Osteoporosis -1 or 2
Paget's Disease +1 or 2
Pleural Effusion +1 or 2
Pneumonia +1 or 2
Pulmonary Oedema +1 or 2
Tuberculosis +1

Plaster of paris
Half +1 or 2
Dry +3
Wet +4 or 5
Fibreglass 0 or +1

Grid
Up to Ratio 8.1, 40 lines/cm at 80 kV +5

Screens
Detail to Fast -3
Fast to Detail +3
(idealiy use mAs steps)

Note: These step changes are a guide only.You may need to modify this chart to
suit your own conditions.
Fig 6-5. Suggested step changes for specific changes in conditions
QUALITY ASSURANCE WORKBOOK
128

Notes
MODULE 6. RADIOGRAPHIC EXPOSURES
129

TASK 26
Radiographic exposures

You have been asked to complete the exposure chart shown below

a) Calculate all other exposures on the chart1 based on the information given against DP Foot and AP Hip.
b) Fill in all other relevant information.

Exposure chart

Area kV mAs Thickness FFD Grid Screens


of Part csrm
cm cm

Foot
DP 50 10 8 lOO Detail
Oblique
Lateral
Ankle
AP
Oblique
Lateral
Tibia & fibula
AP
Lateral
Knee
AP
Lateral
Femur (Lower 2/3)
AP
Lateral
Hip
AP 70 50 18 lOO Bucky Fast
Lateral
Pelvis
AP
I
Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
130

TASK 27
Modify an exposure chart

Your department has just been supplied with new intensifying screens and your exposure charts are no longer
accurate. Someone has worked out some exposures already and has asked you to modify the remainder.

a) Modify the following exposure chart.


b) Start by replacing the relevant exposures with the following exposures.
HAND, PA 50 kV 8 mAs
SHOULDER,AP 65 kV 16 mAs
CHES~ PA lOO kV 5 mAs
c) Now modify all other exposures on the chart, using the step charts.
d) Enter the new exposures alongside the old ones.

Exposure chart

Area kV mAs FFD cm (SID) Grid Screen

Hand
PA 50 16 100 No Detail
Oblique 50 20 100 No Detail
Lateral 50 32 lOO No Detail
Wrist
PA 50 16 100 No Detail
Oblique 50 20 100 No Detail
Lateral 50 25 lOO No Detail
Forearm
AP 55 20 100 No Detail
Lateral 55 25 lOO No Detail
Elbow
AP 55 25 lOO No Detail
Oblique 55 25 lOO No Detail
Lateral 60 20 lOO No Detail
Humerus
AP 60 32 lOO Bucky Fast
Lateral 60 32 lOO Bucky Fast
Shoulder
AP 65 32 100 Bucky Fast
SI 65 32 100 Bucky Fast
Chest
PA 90 5 180 Bucky Fast
Oblique 90 5 180 Bucky Fast
Lateral 100 5 180 Bucky Fast
MODULE 6. RADIOGRAPHIC EXPOSURES
I3 I

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
QUALITY ASSURANCE WORKBOOK
132

TASK 28
Creating a new exposure chart

Your department has just been equipped with a new X-ray unit and you have been asked to produce an exposure
chart for it.

a) Select an X-ray room.


b) Using the knowledge you have gained to date, establish a completely new exposure chart, for the X-ray unit
in that room.
c) Draw up a chart and fill in all relevant information on your chart. e.g. patient positions, exposure factors, grid,
screens, FFD CSID), patient size.
d) Submit the chart to your tutor for assessment.

Tutor's comments:

Satisfactory/Unsatisfactory

Signed Date
Tutor
133

APPENDIX A

Making simple test tools

Water phantom • Several books or phone directories.


• A pile of particle board (chip board) sheets.
Purpose
• To simulate a patient.
• To provide an overall even image. Aluminium step wedge
Purpose
Equipment required
• To produce a standard range of densities on film.
• 20 litre plastic flagon (other plastic containers
• Sensitometry.
of a suitable size can be used).
• Film comparison.
• Ruler.
• Generator output consistency.
• Thick tipped waterproof marking pen.
• mAs consistency.

METHOD I
Equipment required
• Aluminium block1 105 mm long x 42 mm high.
• Hacksaw.
• File.
• Pencil.
• Rule.

Method
• Draft a template and stick it on the side of the
aluminium wedge or draft the measurements
directly on to the aluminium
• Cut or file the sloping surface of the wedge into
21 steps, each 5 mm long and 2 mm high.
• Check that the height of each step is accurate.
• Smooth off rough edges.

Fig A-l. Plastic flagon being used as an X-ray


phantom

Method
• Lie the container on its side
• Using the pen and the ruler1 mark the side of
the container with various depths above the
lower side of the container (lO cm 1 20 cm and
30cm).
• The container can be filled with varying depths
of wate~ depending on need.

Note: Other items that can be used:


• Aluminium or wax block. Fig A-2.Aiuminium step wedge
QUALITY ASSURANCE WORKBOOK
134

METHOD 2 • Box of large headed tacks, drawing pins or


staples.
Equipment required
• An aluminium strip 1.2 meters long 10 mm wide
Method
and 2 mm thief<.
• Make up the frame if necessary.
• Adhesive suitable for gluing aluminium.
• Tack the wire mesh/perforated sheet to the frame
• Hacksaw.
so that it is perfectly flat.
• File.
• Pencil.
• Rule.

Method
• Cut the aluminium strip into 21 shorter strips.
• The first strip must be 105 mm long.
• The remaining 20 strips must be cut progressively
5 mm shorter than the preceding strip, making
the last strip 5 mm long.
• There may be a little wastage.
• Place the strips one on top of the other, star-
ting with the longest and getting progressively
smaller until a series of even steps have been
built up.
• Glue the strips together. Fig A-3. Perforated zinc sheet-used as film/
• Place the vertical end of the wedge against a firm screen contact test tool
upright surface and tap each strip back against
it.
• Leave to harden.
• Smooth off the rough edges. Note:
The wire mesh/perforated sheet can be used without
Note: the frame, provided it is kept perfectly flat. Care must
• The dimensions of the step wedge are not criti- be taken not to bend or damage it. Plastic sheets can
cal providing, the steps are standard. be mounted either side to protect it.
• A simple step wedge can be made with only 11 A small hole, approximately 2 cm square, sited about
steps. 10 cm from one edge of the sheet helps to gauge the
• The steps need not necessarily be glued, but are correct exposure and film density (densitometer
less likely to get lost if they are. readings would be taken here).

Film/screen contact test tool Spinning top timer test tool


Purpose Purpose
• To test for poor film/screen contact within a • Check accuracy of X-ray unit timer.
cassette.
Equipment required
Equipment required • Brass or mild steel disc, 100 mm in diameter, 2-
• A sheet of fine gauge wire mesh or sheet of thin 3mm thick.
perforated zinc (do not use aluminium). • Steel disc 60 mm in diameter, 10 mm thick.
• The size of the sheet should be slightly larger than • Small steel block 20 mm x 20 mm x 20 mm.
a 35 x 43 cm cassette. • Bolt 3 mm thief<, 40 mm long, with 2 nuts and a
• An old picture frame with an internal measure- countersink head.
ment slightly larger than a 35 x 43 cm cassette, • Drill and 3 metal drill bits, 3 mm, 5 mm and a
or timber to make a frame. countersink bit.
• The frame and wire mesh/perforated zinc must • Spanner.
be compatible in size. • File.
APPENDIX A. MAKING SIMPLE TEST TOOLS
135

• Pencil.
• Rule.
• Welding outfit.

Method 1
• Weld the small steel block to the centre of the
large diameter disc.
• Drill a 5 mm hole through the centre of the larger
disc and 15 mm up into the small block. (do not
drill right through the small block).
• File all sharp edges off the small block. Cal
• Drill a 3 mm hole in the large disc 10 mm from
its outer edge.
• Drill a 3 mm hole right through the centre of
the smaller disc and countersink one end of the
hole.
• Insert the bolt into the hole in the smaller disc/
so that the head is countersunk below the sur-
face of the disc and fix firmly in place with both


nuts.
• File the tip of the bolt to a point.
• Place the smaller disc on a firm surface with the
bolt up.
• Hold the larger disc by the small welded block
and fit the sharpened bolt into the central hole
in the larger disc.
• By holding the small welded block the larger disc
can be spun.
(b)

Fig A-S.A simple brass spinning top, (a)


assembled ready for use, (b) with top lifted to
show base

Measuring callipers
Purpose
• Measuring patient thickness in order to calcu-
late exposure (see Module 6. Radiographic expo-
sures, page 124).

Equipment required
• 2 strips of aluminium 600 mm long, 20 mm wide,
Fig A-4.A commercially made spinning top 2 mm thick (mild steel may be used, but it is more
difficult to work with).
• Drill and 2 mm metal drill bit Cor felt tip pen).
Method 2 • Hacksaw.
• A wooden block or section of broom handle can • File.
be used instead of the small steel block, previ- • Pencil.
ously described/ and fixed in place with two • Ruler.
screws, after first drilling the disc to accommo-
date the screws. Method
• A wooden base 150 mm square can be used in- • Form a flattened loop at one end of one of the
stead of the smaller of the metal discs. strips1 forming aT shape.
QUALITY ASSURANCE WORKBOOK
136

• This flattened loop should fit snugly over the other


strip and slide up and down it.
• Bend the second strip to form a 90 ° angle.
• File all rough edges smooth.
• Slide the flattened loop over one end of the other
strip of metal.
• Adjust so that the one strip slides easily up and
down the other.
• Check that the two opposing arms are parallel to
one another.
• Measure the distances in centimetres between
FigA-7. Diagram of a the tomography test
the bottom of the adjustable arm and the op- tool described in Method I
posing fixed arm.
• Mark these distances on the arm that the move- Method
able arm slides on. • Accurately measure from the base of the block,
• A hacksaw blade can be used to mark the metal, up the vertical side, marking the block every 1 cm.
or drill small holes. • Repeat along the base.
• The numbers can be written against the marks • Draw in the intersecting lines.
with felt tip pen. • Partially hammer in nails, to the same depth, at
the intersection of every line.
• It is important that the height of each nail above
Moveable Arm the base is accurate.
• Mark each horizontal line with its height above

/ the base.
• On the resultant film the nails/pins that are clearly
defined are those at the level of the tomographic cut.

Note: A polystyrene block and sewing pins can be used


instead of the wood and nails.

METHOD 2
Equipment required
Fig A-6. Diagram of simple measuring • Strip of fine metal gauze (the dimensions of the
callipers strip of gauze should match those of the sloping
surface of the wedge).
• Set of small lead numbers 1 to 9.
• Small tube of adhesive.
Tomography test tool • Rule.
• Pen or pencil.
Purpose
• To check the accuracy of tomography cut
levels

METHOD I
Equipment required
• A wooden wedge 15 cm base x 15 cm vertical x
21 cm slope and approximately 3 cm wide.
• Ruler.
• Pen or pencil.
• 91 small nails 2-3 cm long.
Fig A-8. Diagram of the tomography test tool
• Hammer.
described in Method 2
APPENDIX A. MAKING SIMPLE TEST TOOLS
137

Method X-ray beam/grid alignment test tool


• Measure and mark every 1 cm along the base, as
Purpose
in method 1.
e To check the alignment of the X-ray beam to the
• Draw in the vertical lines and measure the height
grid lines.
of each one.
• Write the height against each line.
Equipment required
• Place the metal gauze on the sloping surface and
• Sheet of lead or lead rubbe~2 to 3 mm lead equivalent.
fix with adhesive.
• Drill and two drill bits, one 2 mm and one 10 mm.
• Glue the lead numbers on the surface of the
• Knife or hacksaw.
gauze, keeping them all toward the outer edge
on the same side.
Method
• Cut the lead into one strip measuring 230x 50 mm
Note: 1. A polystyrene block can be used instead of
and two strips measuring 90 x 50 mm each.
wood.
• Drill five 10 mm holes in the large lead strip.
2. If difficulty is experienced in producing a clear
• Drill two 2 mm holes in the large lead strip, one
enough image of the mesh, try placing a strip
either side of the central 10 mm hole.
of thin lead (the thickness of that used in the
• Drill a group of three 2 mm holes at one end of
back of cassettes), or copper, under the test
the large lead strip.
tool.
• See diagram below for measurements.

90mm
=-I
t
50mm

L....--_j_
40mm
-=-

0
0

0 0
0

0 0
t
50mm

0
j_
230mm
~I
Large holes -lOmm diameter. Small holes- 2mm diameter.
I Material: 2mm Lead sheet or Lead rubber sheet. I

X - ray Beam/Grid Alignment Test Tool.


fig A-9. Diagram of an X-ray beam/grid alignment test tool with dimensions
138

APPENDIX B

Graphs, check sheets & record


sheets
Reject film analysis
Daily totals
Period: From _ _ _ _ _ _ __ To _ _ _ _ _ _ __

Cause Daily totals Weekly totals


Dates

Projection
Movement
Under exp.
Over exp.
Static
Fog (darkroom)
Fog (cassette)
Equipment
Processing
Other

Totals

Total film rejected: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __


Total film used: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Rejected film as a percentage of film used: _ _ _ _ _ _ _ _ _ __
Cost of film rejected this week: _ _ _ _ _ _ _ _ _ _ _ _ __

Comments/action
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
139

Reject film analysis


Daily totals by film size
Date: _ _ _ _ _ _ __

Film size cm No. of films Amount of film Csq. m)


1 35 X 43
2 35 X 35
3 30 X 40
4 24 X 30
5 18 X 24
6 18 X 43
7 Dent I Occ
8 Other
Totals

Total number of films: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __


Total square meters of film : _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Cost of rejected film today: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Comments/action
QUALITY ASSURANCE WORKBOOK
140

eject film analysis


Daily totals by location
Date: _ _ _ _ _ _ _ __

Cause Location
Room l Room 2 Room 3 Room 4 Total
Projection
Movement
Under exposed
Over exposed
Static
Fog (darkroom)
Fog (cassette)
Equipment
Processing
Other

Total

Total films rejected today: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Comments/action
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
141

Remedial action record


Following reject film analysis

Date reject film analysis completed _ _ _ _ __

Date started Remedial action Date finished Outcome

I
QUALITY ASSURANCE WORKBOOK
142

Collimator check records


Room _______ FFD CSID) _ _ _ _ Light field size _ _ __
kV _ _ _ mA _ _ _ Sec _ _ _ mAs _ __

Date Light/X-ray Visual Electrical Shutter Remarks


coincidence test inspection inspection efficiency
A B c D

• The letters A,B,C,D, under "Light/X-ray coincidence test" above, refer to indi-
vidual collimator shutters, "A" being the shutter on the control knob side,
then rotating clockwise.
• Record the difference in mm between the light and X-ray images, indicate if
the light field is outside or inside the X-ray field.
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
143

Record of all cassettes


No. Size Type of screens Date Date cassette
cm I fitted put into service
i
iI

l
i
I

I
i'I
I
I
I
I
I
I
QUALITY ASSURANCE WORKBOOK
144

Cassettes and screens


Maintenance and testing

Record dates of maintenance/tests


Cassette Screen Film/screen Screen Cassette Cassette Comment
No. comparison contact test cleaning maint. light tight
test test
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
145

Cassettes and screens


Routine maintenance and cleaning record

Date Cassette numbers Comments

!
QUALITY ASSURANCE WORKBOOK
146

Lead rubber aprons and gloves


Testing record
Dates inspected
Fasteners
Cover
Stitching
X-ray test
Hangers
Are hangers used?
Cleanliness

• Enter the date checks carried out


• Place a tick in the box if satisfactory
• Place a cross in the box if unsatisfactory and enter comment below

Comments: (Enter date, comment and signature)

Date Comment Signature


APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
147

Viewing box
Maintenance and inspection

Dates inspected I
I

Position
I
Safely fixed
Light
-even
- brightness
Electrical
-plug
-wiring
-switch I

- tubes
- starters
Window
Film clip I

'
Cleanliness
- inside
- outside
Other

Comments: (Enter date and signature)

Date Comment Signature


QUALITY ASSURANCE WORKBOOK
148

Fault report
To be completed by person reporting fault

Name Time
Date
Room Priority (circle a number)
1 2 3 4 5 6 7 8 9 10
urgent not urgent
Description of problem (Please be specific)

Signed
Action

Signed
Outcome

Signed
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
149

Equipment record
Room No. _ _ _ _ _ _ _ _ __

X-ray generator

Manufacturer _ _ _ _ _ _ __ Supplier _ _ _ _ _ _ _ _ __

Model _ _ _ _ _ _ _ _ __ Serial No. _ _ _ _ _ _ _ _ __

Date installed _ _ _ _ _ _ __ Date accepted _ _ _ _ _ _ __

Warranty expiry date _ _ _ _ __

Sing phase _ _ _ _ _ _ _ __ Three phase _ _ _ _ _ _ _ __

Maximum kVp _ _ _ _ _ _ __ Maximum mA _ _ _ _ _ _ __

X-ray tube
Manufacturer _ _ _ _ _ _ __ Su pp Iier __________________

Model _____________ Serial No. _ _ _ _ _ _ _ _ __

Focus sizes
Broad _ _ _ _ Fine _ _ __ Warranty expiry date _ _ _ _ __

Date installed _____________ Date accepted _ _ _ _ _ _ __

Tube suspension
Manufacturer _ _ _ _ _ _ __ Supplier _ _ _ _ _ _ _ _ __

Model _______________ Serial No. _ _ _ _ _ _ _ _ __

Mounting-Floor/Ceiling ______ Locks-Manual/Magnetic

Date installed _ _ _ _ _ _ __ Date accepted _ _ _ _ _ _ __

Warranty expiry date _ _ _ _ __


QUALITY ASSURANCE WORKBOOK
ISO

Collimator
Manufacturer _ _ _ _ _ _ __ Supplier _ _ _ _ _ _ _ _ __

Model No. _ _ _ _ _ _ _ __ Serial No. _ _ _ _ _ _ _ __

Light switch-Clockwork/Electronic Warranty expiry date _ _ _ __

Date installed _ _ _ _ _ _ __ Date accepted _ _ _ _ _ _ __

Table
Manufacturer _ _ _ _ _ _ __ Supplier-~--------

Model No. _ _ _ _ _ _ _ __ Serial No. _ _ _ _ _ _ _ __

Movement-lilt/Fixed Potter-Bucky-YES/N 0

Potter-buci<Y grid
Ratio Line _ _ _ _ __ Focal range _ _ _ __
M ovement-YES/N 0

Upright potter-buci<Y
Manufacturer _ _ _ _ _ _ __ Supplier _ _ _ _ _ _ _ _ __

Model No. _ _ _ _ _ _ _ ___ Serial No. _ _ _ _ _ _ _ __

Grid Ratio _ _ _ _ _ _ _ __ Grid line _ _ _ _ _ _ _ _ __

Focal range _ _ _ _ _ _ _ __ Grid movement-YES/NO

Date installed _ _ _ _ _ _ __ Date accepted _ _ _ _ _ _ __

Warranty expiry date _ _ _ ___

Control panel
Manufacturer _ _ _ _ _ _ __ Supplier _ _ _ _ _ _ _ _ __

Model No. _ _ _ _ _ _ _ __ Serial No. _ _ _ _ _ _ _ __

Date installed _ _ _ _ _ _ __ Date accepted _ _ _ _ _ _ __

Warranty expiry Date _ _ _ __


APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
151

Stationary grids
Manufacturer
Supplier
Model
Serial No.
Grid ratio
Grid line
Focal range
Date supplied

Notes
QUALITY ASSURANCE WORKBOOK
152

Equipment maintenance and


repair log
Date Action Repair Service QC
hours hours hours
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
153

X-ray unit
Record of visual/manual quality control checks
Room No. _______________
Pass="'
Faii=X
Does not apply= NA
Date
Tube and FFD Scales
tube
Angulation indicator
suspension
Locks (aiD

Perpendicularity

Collimator

Tracks

High tension cable/other


i

cables

Cleanliness

Table and Bucky mobility

upright 'f
Bucky lock
bucky
Cassette lock

Bucky grid movement I

'
Cables I
I I
I
Table
I
Cleanliness
i I i
I
Control Hand switch and cable

panel
Panel switches, lights and

meters
I
j
I

Technique charts
i I
I
I
Overload protection I
1
I
Cleanliness i
' I !
QUALITY ASSURANCE WORKBOOK
154

Fluoro. Locks Call)


system
Power assist

Motion smoothness

Switches/lights/meters

Compression device

Fluoro. monitor

Fluoro. grid

Fluoro. timer

Fluoro. shutters visible

Cleanliness

Other Gonad shield, aprons


and gloves

Measuring callipers

Stationary Grids

Patient Positioning Aids


APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
155

Constancy of radiation output at


different mA settings
Test record
Room ___________________ X-ray Unit ____________
kV ____________ Focal Spot. Size ________ FFD _________

Exposure l Exposure 2 Exposure 3


mA
Time
mAs

I
Dates I I

l
I

6 I
I
I
5
Darker 4
3
2
l l

Control 0
l
2 I
3 II

Lighter 4 :;

I
5 :1

I ]I
I'

6 I I
I

• The numbers represent step differences between test films and control film.
• Plot step differences under dates.
QUALITY ASSURANCE WORKBOOK
156

Darkroom inspection checklist


Location _ _ _ _ _ _ _ _ __ Date _ _ _ _ _ _ _ _ __
Inspected by _ _ _ _ _ _ __

Item 01< Not 01< Comments

Darkroom:
• Ten'lperature Cl0-20 °C)
• Humidity (40% to 60%)
• White light leaks.
• Ventilation.
• Clean & tidy.
Safelight:
• Working.
• Filter faded or cracked.
• Correct distance from bench.
• Leaking white light.
• Correct wattage light bulb.
• Safe for film handling time.
Film hopper:
• Firmly anchored.
• Earthed.
• Damage free.
• Works effectively.
Bench top:
•• Damage free.
Earthed .

• Clean.
Processor:
• Working 01<.
• QA checks carried out.
• Clean.
Accessory equipment:
• Timer. (working)
• Chemical mixing paddles.
• Thermometer. (working)
• Aprons, gloves, goggles.
(damage free, clean)
• Name printer.
(working, clean)
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
157

Specific gravity/temperature graph


S.G.

1.088

1.087

1.086

1.085

1.084

1.083

1.082

1.081

1.080

1.079
• 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Temperature o C
QUALITY ASSURANCE WORKBOOK
158

Automatic processor
Daily checks record

Developer: Fixer: Water: Cycle:


Repl. Rate _ __ Repl. _ __ Exch. rate _ __ lime _ __
Temp. _ __ Temp. _ __ Temp> _ __ Dryer temp. _ __

Two week period:


Commencing _ _ _ _ _ __ Ending _ _ _ _ _ __

DATES
Dev. temp
Water temp
Dryer temp.
Developer repl.
Rate
Fixer repl. Rate
Cross over rollers
Cleaned
Circulation Check
Water flow Rate
Feed tray Cleaned
Micro switches
Checked
Filters changed
Bi monthly******

Remember that filters must be changed monthly


APPENDIX B. 'GRAPHS, CHECK SHEETS & RECORD SHEETS
159

Automatic processor
Checklist and periodic replacement of parts

Replacement parts Replacement period


a Springs, gears, shaft retainers, and E rings. Every year
b Fuses, temperature control le~ safety thermostat, and Every two years
developer submerged rack rollers.
c Fixer submerged rack rollers, wash water Every three years
sub-merged Rack rollers, and dryer rack rollers.

Inspection period
(months) 12 24 36 48 60
Replacement a * * * * *
parts
b * *
c *
(* ... replacement period)
Checl< list
Racl< sections, drive systems
• Rack looseness and geometry
• Rack shaft retainers, gear wear
• Rack helical gear looseness
• Rack roller foreign matter buildup
• Drive motor chain tension
• Abnormal noises

Replenishment system
• Photoelectric detection section function
• Developer and fixer replenisher amounts check
• Replenisher solenoid valve function
• Replenisher pump function

Circulation and temperature control systems


• Processing tank internal foreign matter buildup
• Supply hose solution leaks
• Developer temperature check
• Fixer temperature check
• Circulation pump functions
• Dryer system
• Dryer section temperature check

Miscellaneous
• Finished product photographic quality
• Upper lids, lower lids, and side plate checks
• Water supply and ventilation checks
-Q
O'C:
Processor maintenance checklist OJ>
r-
:::j
Processor Type Month _ _ _ _ _ _ _ __ -<
3>
Ill
Developer type Developer temperature Cycle time _ _ _ _ __ Ill
c:
Developer replenishment rate Fixer replenishment rate Water temperature _ _ __ ~
z
n
"'
~
Daily checks Date l 2 3 4 5 6 7 8 9 l l l l l l l l l l 2 2 2 2 2 2 2 2 2 2 3 3 :11:1

;
Dev. temp. 0 l 2 3 4 5 6 7 8 9 0 l 2 3 4 5 6 7 8 9 0 l 0
0
~
Water temp.
Dryer temp.
Cross over rollers cleaned
-

Dev. replenishment rate


Fixer replenishment rate
Recirculation check
Water flow
Feed tray cleaned
Check micro switches
Bi monthly checl<s
Dev. filter changed
Water filter changed
Deep racks cleaned/adjusted
Dryer drive belt
Drive gears
Water flow measured
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
161

Developer activity chart


Developer Activity

5 6 7 8 9 10 22 23 24 25 26 27 28 29 30 31
5
~
4
~
3
2 ~
Positive
~

0 ===
~
1
~
• 2
Negat1ve ::=:::::: i I
3
4
::=:::::: I ! I
5
::=:::::: l
QUALITY ASSURANCE WORKBOOK
162

Characteristic curve chart


Characteristic Curve

I
PROCESSOR : I DATE:

4.0 4.0
SPEED INDEX
CONTRAST INDEX t==

AVERAGE GRADIENT F:t==


BASE+FOG F=
D-MAX.
3.5 3.5
~TEI DENSITY F= I=
l-e
1 t:
2 f-
3 t:
j::_
I=
4
3.0 3.0
5
6 l:: F:t:
I=
7
8
9 F=
2.5 t:::
2.5
10
11 F:
12 t:
]::_
13 ~
14
2.0 2.0
15 t:
16 f- t:
17 != ~
F
18 F:t:
t==
f::
1.5
19 E t:
1.5
t:::
20 F= I=

21 I=t== t:
!=
F: E E
F=
F:
1.0 1.0
f- ~
F= r ~ F=
F
t== I=
F: f- F= t=
!= F:F
I= F:t: I=t: F
I=
0.5 0.5
F:
F:t:
F=
F=
t:
0.0 0.0
3 5 7 9 11 13 15 17 19 21 23
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
163

Quality control processing chart


~· ,,

Quality Control Processing Chart

Processor Month J--: ) :-·} i ; ; · · · · ~

l'f------------::----,-:---:-:--Sp_ee_d_ _ _ _ _ _ _ _ _ _ _ _---ij .~-


i"' .
..: ..
.I Speed Step No _

.-~(" --~<J"'-''L~ " : ' .. -.- . ; ";·-•· ·:" ,''' "~' '"'·'~"''"'"'.''"''"f { "

>0.20
. ~:L::t-1----------z~s~t-ees~A~bo-ve-:-:N-o.---C_o_n_t_r_a_s_t-::-z-::st-:e-es-:Be:-:--la-w~N-o.-_-=------------t[~~
! : 1: 2' 3 4 5 6' 7 8 9•10•11'12'13 14.15'16 1 17:18;19'20;21!22123:24•25'26"27 2829130;31:
~>~ ~:E ···1:_ ..:.0; _~ __; .·~· ...I·;·. :.·... :·;-:c·.. ·· .:: ..·.1····•-·.:; l_-·;1 . . ,·,1::,·:
•9.-15 .. ·::::::::: . .

if~:-
.

···~=== ~;·'"":;:.:::--· ,·.:1::::·.:·:··


,: J < ... ·. . . .
...

,....

. :.
. ..·..<·.
;·, ·:.
••. . - c
_·;_;· :::: :_--:_·,
I
··

.• ·••.

., ,, ': .'.: :::: .:


·:·.. ·'_

"'

+_2 c .. :I··
.. -~··· .
.~ ....... _:::
,. :==
;;,: .1::' ...· - . :.
. ·. .. :·· · .. ·:.·.·.:: .
-2C
;: .. . :..
· .
.:4C 1: ~-= ' '" .... "

D- Max
--·1--T-..;:2,.-'3;'--'4T•_s:.,...;;G,...;.7r--'BT--'-9r.1.;.0;...;1...;.1,.;.12,.-'1'-'3.-14_,.r1'"'5r1-'-6r·1;..;7"T""1""'Br1-'9'-r-"2"'orz1..-'2"'2r2"13r2;;_4,_."'z-'-sr·2:;..6i',""'2"""7r•2"-a,._2_9r;_3()"i'r3"'"i1
QUALITY ASSURANCE WORKBOOK
164

Exposure chart
FFD
Pat. mA (SI D)
Examination meas. I<V mAs Sec cm Grid Screen Remarl<s
FOOT
DP/Obl. lOO - Detail
Lat. lOO - Detail
CALCANEUM
Lat. lOO - Detail
Axial 40 o i lOO - Detail
ANI<LE
AP lOO - Detail
Lat. lOO - Detail
TIB. & FIB.
AP lOO - Fast
Lat. lOO - Fast
l<NEE
AP lOO - Fast
Lat. lOO - Fast
PATELLA
PA lOO - Fast
Lat. lOO - Fast
IS lOO - Fast
FEMUR
AP Lower lOO - Fast
Lat. Lower lOO - Fast
AP Upper lOO Bucky Fast
Lat. Upper lOO Bucky Fast
/Stat.
HIP
AP lOO Bucky Fast
Lat. lOO Bucky Fast
Lat. Horizontal lOO Stat. Fast
Ray
PELVIS
AP lOO Bucky Fast
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
165

HAND
AP/PA/Obl. lOO Detail
Lat lOO Detail
WRIST
PA lOO Detail
Lat. lOO Detail
FOREARM
AP lOO Detail
Lat. lOO Detail
ELBOW
AP lOO Detail
Lat. lOO Detail
HUMERUS
AP lOO Fast
Lat. lOO Fast
SHOULDER
AP lOO Fast
SI lOO Fast
TransThoracic lOO Bucky Fast
Clavicle AP lOO Bucky Fast
Clavicle I lOO Bucky Fast
Scapula AP lOO Bucky Fast
Scapula Lat. lOO Bucky Fast
CERVICAL
SPINE
AP l-3 lOO Bucky Fast
AP 3-7 t lOO Bucky Fast
Ob I. 180 Bucky Fast
Lat. 180 Bucky Fast
Lat. Supine 180 Stat. Fast
CERVICO
THERACIC
SPINE I

AP I lOO Bucky Fast


Lat. ' lOO Bucky Fast
i 1

Swimmers I I lOO Stat. Fast


QUALITY ASSURANCE WORKBOOK
166

THERACIC
SPINE
AP lOO Bucky Fast
Lat. Upper lOO Bucky Fast
Lat. 10-12 lOO Bucky Fast
LUMBAR
SPINE
AP lOO Bucky Fast
AP L5-Sl i lOO Bucky Fast
PA lOO Bucky Fast
Ob I. lOO Bucky Fast
Lat. lOO Bucky Fast
Lat. L5-Sl lOO Bucky Fast
SACRAL
SPINE
AP i lOO Bucky Fast
Lat. lOO Bucky Fast
COCCYX
AP i lOO Bucky Fast
Lat. lOO Bucky Fast
CHEST
PA 180 Bucky Fast
Ob I. 180 Bucky Fast
Lat. 180 Bucky Fast
Lordotic 180 Bucky Fast

RIBS
AP Upper lOO Bucky Fast
Obl. Upper lOO Bucky Fast
AP Lower lOO Bucky Fast
Obl. Lower lOO Bucky Fast
STERNUM
Obl. lOO Bucky Fast
Lat. lOO Bucky Fast
Lat. 180 Bucky Fast
SCJ
Ob I. lOO Bucky Fast
Lat. lOO Bucky Fast
Lat. 180 Bucky Fast
APPENDIX B. GRAPHS, CHECK SHEETS & RECORD SHEETS
167

PA Close
Distance 60 Bucky Fast
SI<ULL
Townes 100 Bucky Fast
AP/PA 100 Bucky Fast
Lat. 100 Stat. Fast
SMV 100 Bucky Fast
FACIAL
BONES
OM 100 Bucky Fast
Lat. 100 Bucky Fast
Lat. Nose 100 - Detail
SINUSES
OM 100 Bucky Fast
I!

PA 100 I Bucky Fast


Lat. 100 I Bucky Fast
MANDIBLE
PA 100 Bucky Fast
Lat. 100 Bucky Fast
Ob I. 100 Bucky Fast
T.M.J.'s
APt lOO Bucky Fast
Lat. Obl. li
lOO Bucky Fast
QUALITY ASSURANCE WORKBOOK
168

Exposure chart

Examination Pat. I<V mA Sec FFD Grid Screen Remarl<s


meas. mAs (SI D)
cm
169

Post test

Now that you have completed the course your lmowl- 4. Grid ratio is:
edge of the subjects should be much greater. You a) The ratio of the height of the lead strip to
should now complete this post course test and its thickness.
compare the results with the results of the pre course
b) An indication of the focal range.
test.
You will then have an idea of how much knowledge c) The height of the lead strips to the distance
you have gained from the course. between them.

Instructions 5. To test the alignment of the X-ray beam to a grid,


the following test tool should be used:
This is a multiple choice test. In each question you are
a) A sheet of perforated zinc.
given three possible answers.
Read each question carefully. b) A lead strip with a series of l cm holes in it.
Indicate the answer that you feel is the most cl Eight coins.
accurate by placing a "X" in front of the letter preced-
ing it.
6. To test a lead rubber apron for cracks:
All questions must be answered a) Use fluoroscopy.
b) Feel it.
1. Intensifying screens must be cleaned by using:
c) Hold it up to the light.
a) Plenty of water.
b) Small circular motions followed by top to
7. Lead rubber items should be tested every:
bottom sweeps.
a) Month.
c) Pouring screen cleaner onto the screen then
wiping off. b) 6 months.
c) Once a year.

2. Film/Screen contact test tool can be:


a) Plastic sheet. 8. Setting up a reject film analysis you should:

b) Perforated aluminium sheet. a) Count all the unexposed films.

c) Fine metal mesh. b) Count only the film boxes in the film store.
c) Carry out the analysis without the staff
knowing.
3. Blue light emitting intensifying screens should:
a) Be used with blue sensitive film.
9. A reject film analysis could indicate:
b) Be used only for extremities.
a) Which is the most common fault.
c) Need an exposure reduction of 10 kV.
b) How much money has been wasted.
c) Both of the above.
QUALITY ASSURANCE WORKBOOK
170

10. The wattage of a safelight bulb should be, if fac- 18. A step wedge is:
ing down: a) A foam positioning pad.
a) 100. b) A tool for testing tomography cut levels.
b) 60. c) A tool for producing a standard set of densi-
c) 15. ties.

11. A Wisconsin cassette is used for testing: 19. Consistency of output can be checked by:
a) mA. a) Recording how many patients are X-rayed
b) Exposure time. each day.

C) I<Vp. b) Making four exposures under identical


conditions.
c) Running a Reject Film Analysis program.
12. A spinning top can be used to check the:
a) Timer of a capacitor discharge X-ray
unit. 20. A single pulse X-ray unit with a 50 cycles per sec-
ond mains supply should produce how many dots
b) Timer of a single phase X-ray unit.
on a spinning top image with a 0.1sec exposure
c) Timer of a three phase X-ray unit.
time?
a) 5
13. Developer temperature should be checked: b) 10
a) Weekly.
c) 15
b) Twice a week.
c) Daily.
21. To test film screen contact use:
a) Aluminium sheet.
14. Sensitometry testing on automatic processors b) Fast screens.
should be carried out:
c) Fine wire mesh.
a) At 5-0pm every day.
b) Every Monday.
22. Specific Gravity level in developer is an indication of:
c) Before the start of work every day.
a) Its activity.
b) Its colour.
15. A densitometer:
c) Its age.
a) Measures the specific gravity of developer.
b) Is used to make a test film for monitoring
23. Film is most sensitive when:
film processor performance.
a) It is new.
c) Measures the density of an X-ray image.
b) Before it has been exposed to radiation.
c) After it has been exposed to radiation and
16. Empty developer and fixer bottles:
before processing.
a) Should have holes put in them and disposed
of.
b) Can be washed out thoroughly and used as 24. The Step System refers to:
water containers. a) A method of calculating exposures.
c) Can be sold after rinsing. b) How to make a step wedge.
c) Sensitometry.
17. B + Fog stands for:
a) Film fog caused by scattered radiation.
b) Film fog caused by light leakage.
c) Fog present in all film, created in manufacture.
POST TEST
171

25. Clearing time refers to: 28. Quality control refers to:
a) The film processing time. a) The number of good films produced over a

b) The time the film should be in the wash. given period.

c) The time it takes for the film to get rid of b) Making sure the processor is clean.
the "cloudy look" in the fixer. c) A system which assesses and evaluates a
particular activity.

26. Latitude is defined as:


a) The range of exposure factors which will pro- 29. To make a noticeable change in film density the
duce an acceptable image. exposure must be changed by A minimum of how
many steps?
b) The range of pH values of developer.
a) 1
c) The amount of light produced by an inten-
sifying screen. b) 3
c) 5

27. Radiolucent means:


a) X-rays will pass through. 30. mAs determines:

b) X-rays will not pass through. a) Penetration.

c) The colour of the light given off by intensi- b) Contrast.


fying screens. c) Density.
QUAliTY '"'"'"'""""',.'''"•'"' WOR~mOOK
172

Glossary

Acid A solution with a pH less than 7. It reacts with are few shades of grey between the lightest and
blue litmus paper and turns it red. darkest areas of the image. Low contrast is when
there are many more shades of grey in the image.
All<ali A solution with a pH greater than 7. It reacts
with red litmus paper and turns it blue. Compression band A strip of material, usually linen
or plastic, approximately 20cm wide, attached at
Artefact Marks on a radiograph that are foreign to
one end to a ratchet device, and at the other to a
the image, such as scratches, finger prints or static.
hook. It is used for compressing or immobilising
Base+ fog The density normally found in unexposed patients.
film, caused by manufacture and storage.
Densitometer A device for measuring the density of
Bench top processor A small, automatic film proces- any specific spot on a radiograph, by measuring the
so~ best sited on a bench top. Suited to low throughput. light that is allowed to pass through it.
Beam The beam of radiation produced by the X-ray Density: radiographic Radiographic density is the
tube. degree of blackening of a radiograph caused by the
Bucl<y A commonly used abbreviation of the Potter- deposit of metallic silver.
Bucky moving grid system. Density: tissue Tissue density is the mass of body
Callipers A device used to measure the thickness of tissue in a given volume, or the concentration of
body parts. atoms. The greater the tissue density the more X- ray
absorption takes place and the lighter the image
Central ray The centre of the X-ray beam. Often used on the radiograph. COo not confuse radiographic
to define the direction of the beam, or, its position, density with tissue density.)
related to a body part.
Detail: radiographic image The amount and quality
Cassette A light tight holder that contains a pair of of information contained in a radiographic image.
intensifying screens, between which, is placed the The amount of detail seen in a radiograph. Is deter-
film. mined by image sharpness, contrast and density.
Characteristic curve Also known as H & D Curve or Detail: intensifying screens The name applied to a
sensitometric curve. It is a plotted graph of the vari- type of intensifying screen that gives better image
ous densities of a step wedge image. Any variation detail, but is less responsive to radiation and there-
in type of film/screen, exposure or processing will fore requires a higher exposure. Commonly used for
vary the shape, or Position, of the curve. extremities.
Clearing time The time it takes for a film to lose the Development The chemical process of converting the
cloudy appearance when placed in the fixer during latent film image into a visible one.
film processing. In other words the time it takes for
the unwanted film emulsion to be dissolved off by Distortion Misrepresentation of a body part outline,
the fixer. in the image, due to changes in X-ray beam/body
part alignment or unacceptable object film distance.
Collimator A device used to control the coverage
of the X-ray beam. Also known as a Light Beam Emulsion The active layer of chemical crystals sus-
Diaphragm CLBD). pended in a gelatine laye~ of film, which is sensitive
to light and radiation. The word emulsion can also
Contrast The difference between the light and dark be used to describe the radiation sensitive layer of
areas of a radiograph. High contrast is when there intensifying screens.
GLOSSARY
173

Exposure The amount of radiation produced from the Intensifying screens Radiation sensitive screens,
X- ray tube, by a pre determined set of exposure fac- placed inside a cassette, on either side of the film.
tors, kV, mA, seconds. In practice the term tends to When struck by radiation the screens give off a blue
be used loosely. The term "exposure" being used to or green light that has a blackening effect on the
mean exposure factors". radiographic image produced. The colour of light
emitted depends on the type of fluorescent materi-
FFD Focus/film distance. More accurately, SID (source
als used. Remember that the film colour sensitivity
image distance).
must match the colour of light given off by the
Focal range The range of focal film distances at which, screens.
a grid is designed to be used.
kV Kilovoltage ClOOO volts). Controls the quality
Focal spot The area on the X-ray tube anode where (penetrating power) of the X-ray beam. Affects
the X-rays are produced. contrast of resultant image (high kV-Iow contrast,
Focussed grid Grid lines are inclined toward the low kV-high contrast). Affects intensity of radia-
centre of the grid, to better accommodate the tion and therefore patient dose, to a lesser extent
spreading X-ray beam. CmAs has a greater effect on intensity and patient
dose).
Fog Radiation fogging of a film is commonly caused
by scattered radiation reaching the unprocessed film. Latitude: exposure Exposure latitude is the range of
Light fog is caused by unwanted white light reach- exposure factors that will produce an acceptable
ing the unprocessed film. Base fog is inherent fog, image.
caused in film manufacture. Latitude: film Is a film emulsion characteristic that
Filter: safelight A specialised, coloured glass, window, increases or reduces exposure latitude.
fitted to a safelight, that enables the safe handling mA (milliampere, 1/lOOOth of an ampere) A radio-
of X-ray film. graphic exposure factor that controls the intensity
Filter: X-ray A sheet of metal (usually aluminium) fit- of radiation, influences image density and patient
ted to the port of an X-ray tube to filter out the low dose.
wavelength X-ray photons. mAs (milliampere-seconds) A radiographic exposure
Grid A device consisting of alternate radiopaque and factor. mA x seconds.
radiolucent strips. Designed to allow the primary Non-focused A grid that does not have focused grid
X-rays to pass through, but absorb scattered lines.
radiation.
Oxidation A weakening of developer strength caused
Grid ratio The ratio of the height of the radiopaque by prolonged exposure to air.
(lead) strips to the distance between them (radiolu-
Penetration The ability of the X-ray beam to penetrate
cent strips).
structures. Determined by the energy of the beam
Grid line The number of lead strips to the cm/inch. (controlled by kVJ.
Grid cut off A reduction in grid efficiency due to pH Indicates the degree of acidity/alkalinity of a so-
misalignment of the X-ray beam to the grid. lution. Water is neutral and has a pH of 7. Solutions
Hanger Film hanger is a stainless steel frame with with pH of less than 7 are acid. Solutions with pH
clips at each corne~ for holding the film when manual more than 7 are alkaline. Developer is strongly alka-
processing takes place. line with a pH of about 14. Fixer is strongly acidic
with a pH of about 3.
Hazardous chemicals Any chemical which may have
an injurious affect. Developer and fixer both fall into Phantom An object that substitutes as a patient,
this category. when performing X-ray tests. The material used can
be anything that is similar in density and thickness
Hydrometer A sealed, weighted glass tube, with a vis- to the appropriate body part.
ible scale marked on i( which will float in a liquid.
Used for assessing the specific gravity CS.G.J of de- Potter-bucky A moving grid system designed to re-
veloper and fixer, the level of which is an indication duce the amount of scattered radiation reaching
of the concentration. the film. Often abbreviated to "bucky".
QUALITY ASSURANCE WORKBOOK
174

Primary radiation Radiation emitted from the X-ray Scattered radiation Secondary radiation which has
tube that has not reached the patient, or object, been changed in direction from that of the primary
being X-rayed. beam.

Processing The chemical treatment of an exposed Sensitometry The study of the response of film to
X-ray film that results in the production of an X-ray exposure and processing conditions.
image, It involves the processes of developing,
Sensitometer A standard light source that is used
rinsing, fixing, washing and drying.
to produce consistent step wedge images for
Polyethylene foam An artificial substitute for foam sensitometric monitoring of processors.
rubber. Is ideal for use as patient positioning pads.
SID Source/image distance. Refers to the distance
Can be easily cut to required shapes.
between the source of the X-ray beam (focal spot)
Puffer A rubber bulb with a nozzle for blowing dirt and the image receptor Cin conventional radiogra-
particles from cassettes. Often has a soft bristle phy, the film). Is a more accurate form ot focus/film
brush on the end of the nozzle for the same distance CFFD).
purpose.
Specific gravity The weight of a substance compared
Quality assurance (QA) An overall management to an equal volume of water. Specific gravity meas-
program to monitor the various quality control urement, using a hydrometer, can be used to meas-
measures being used. ure the concentration of developer and fixer.

Quality control (QC) The quality control measures Stand pipe A pipe which fits into the inside of a
used to evaluate performance and outcome. manual processing units wash and rinse tanks drain
holes. Its height is just below the top edge of the
Quality: radiograph A radiograph is said to have
tank, allowing the tank to fill up and drain through
good quality, when the contrast and definition are
the top of the pipe. They are also found in the devel-
sufficient to demonstrate all required body parts
oper and fixer tanks of most automatic processing
well.
units.
Quality: X-ray beam X- ray beam quality is determined
Step chart A system of exposure calculation using
by its ability to penetrate objects Cthe higher the
a series of exposure factor steps. Step charts are
penetrating power, the higher the quality).
available for kV, mA, mAs, time and FFD CSID).
Radiolucent (radiotransparent) The property of a
Step wedge Usually made of aluminium, is a block
structure to wholly or partially allow the passage of
cut to form a standard number and sized steps. Used
X-rays.
as a test tool for various quality control tests.
Radiopaque The property of a structure to wholly or
Test tool Specialised items of equipment that can be
partially stop the passage of X-rays.
used to evaluate X-ray or accessory equipment.
Replenisher The chemical solutions that are added
Thermostat A device for controlling heat output from
to developer or fixer to maintain their volume and
a heating unit. Used in X-ray film processing to
working strength.
control the temperature of developer.
Replenishment Adding replenishment solutions to
Thiosulphate Usually sodium thiosulphate. Is the
developer or fixer to maintain their volume and
fixing agent in X-ray fixing solutions.
working strength.
Timer: darl<room An accurate time clock for timing
Rinsing In manual processing it is necessary to wash
X-ray film development during manual processing.
off as much of the alkaline developer as possible,
before placing the film in the acid fixer. Transfer of Timer: X-ray A device for determining the length of
excessive amounts of developer into the fixer will radiographic exposure in an X-ray unit.
result in the fixer becoming prematurely exhausted,
Washing All film must be adequately washed to
lessening its hardening properties and artefacts may
remove the acid fixer and avoid future film
appear on the films. In automatic processing a rinse
deterioration.
bath is not used as the rollers effectively remove
the developer from the film and the processing time Wisconsin cassette A specialised X-ray cassette, used
is shortened. to determine X-ray kVp. Used to check the accuracy
of kVp in an X-ray unit.
175

References

Gray J E et al, Quality control in diagnostic imaging, National Radiation Laboratory, New Zealand, A glossary
Aspen Publishers Inc, 1982. of physics, radiatioin protection and dosimetry in
diagnostic organ imaging, International Society of
Gunn C, Radiographic imaging, a practical approach,
Radiographers and Radiological Technicians, 1985.
Churchill Livingstone, 1988.
Quinn H C, Fuch's principles of radiographic exposure
HendeeW R et ai,Radiologic physics, equipment and qual-
control, Charles Thomas Publishers, 1985.
ity control, Year Book Publishers. 1977.
Radiation Protection Branch, South Australian Health
ISRRT; Quality control handbook, International Society of
Commission, Course notes in basic radiography, 1996.
Radiographers and Radiological Technicians, 1986.
Tortorici M, Concepts in medical radiographic imaging,
Jenkins D, Radiographic photography and imaging
Circuitry, Exposure & Quality Control, W.B.Saunders
processess, MTP Press Ltd, 1980.
Company, 1992.
Lloyd P and Warren J, Basic radiography for general
World Health Organization, Eastern Mediterranean
practitioners, Techsearch Inc, 1982.
Regional Office, Quality systems for medical imaging.
Mcl<inney W E J, Radiographic processing and quality Guidelines for implementation and monitoring, 1999.
control, J.B.Lippincott Co, 1988.
World Health Organization, Basic radiological system,
Mclemore J M, Quality assurance in diagnostic radiology, manual of darkroom technique, 1985.
Year Book Medical Publishers, Inc, 1981.
National Council on Radiation Protection and Measure-
ments, NCRP Report No. 99, Quality assurance for
diagnostic imaging, 1988.