Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1. X-ray equipment may cause injury if not properly used. No feasible design of equipment can provide complete protection from all potential injury.
Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1. X-ray equipment may cause injury if not properly used. No feasible design of equipment can provide complete protection from all potential injury.
Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1. X-ray equipment may cause injury if not properly used. No feasible design of equipment can provide complete protection from all potential injury.
Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1. X-ray equipment may cause injury if not properly used. No feasible design of equipment can provide complete protection from all potential injury.
If not properly used, x-ray equipment may cause injury. Accordingly, it is your obligation to confirm that the instructions herein contained are thoroughly read and understood by everyone who will use the equipment before you attempt to place this equipment in operation. The General Electric Company, Healthcare Technologies, will be glad to assist and cooperate in placing this equipment in use. Although this apparatus incorporates a high degree of certain protections against x-radiation other than the useful beam, no feasible design of equipment can provide complete protection from all potential injury. Nor can any feasible design force the operator to take adequate precautions to prevent the possibility of any persons carelessly exposing themselves or others to radiation. It is important that anyone having anything to do with x-radiation be properly trained and fully knowledgeable about the recommendations of the National Council on Radiation Protection and Measurements as published in NCRP Reports available from NCRP Publications, 7910 Woodmont Avenue, Room 1016, Bethesda, Maryland 20814, and of the International Commission on Radiation Protection. It is your obligation and responsibility to take adequate steps to protect against injury. The equipment is sold with the understanding that the General Electric Company, Healthcare Technologies, its agents, and representatives have no responsibility for injury or damage, which may result from improper use of the equipment. Various protective materials and devices are available. It is urged that such materials or devices be used in accordance your sites clinical practice. Page no. 4 radiation warning.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Table of Contents Seno DS-Ess QCTOC.fm Page no. 5 Table of Contents Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Publication Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1. Applicability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. How to order a paper version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. How to access the electronic version of a manual on a website . . . . . . . . . . . . . . . . . . . 10 4. Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4-1. Copyright Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4-2. Trademark Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 5. Regulatory considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 6. Scope of this Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7. Overview of this Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 8. Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Chapter 1. QC Tests for the Radiologic Technologist 1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2. QC Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3. Monitor Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4. Flat Field and Phantom IQ Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 4-1. Flat Field Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 4-2. Phantom IQ on AWS and Printer Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 5. CNR and MTF Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 6. Viewbox and Viewing Conditions Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 7. AOP Mode and SNR Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 8. Visual Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 9. Repeat Analysis Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 9-1. Repeat Analysis - Manual Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 9-2. Repeat Analysis - Automated Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 9-3. Repeat Analysis - Database backup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 9-4. Repeat Analysis - PC Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 10. Compression Force Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 11. Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 12. Test Results Record Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Chapter 2. QC Tests for the Medical Physicist 1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 2. Test Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Chart 0. Site and System Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette . . . . . . . . . . . . . . . . 57 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips . . . . . . . . 63 Page no. 6 Seno DS-Ess QCTOC.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Table of Contents Chart 1 - Collimation Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Job Card VF-P02 - Evaluation of Focal Spot Performance. . . . . . . . . . . . . . . . . . . . . . . 87 Chart 2 - Evaluation of Focal Spot Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Job Card VF-P02A - Sub-System MTF Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Chart 2A - Sub-System MTF Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (1/2) 117 Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (2/2) 118 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity . . . . . . . . . . . . . . . . . . 119 Chart 4 - Artifact Evaluation and Flat Field Uniformity . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Job Card VF-P05 - Test for flexible paddle deflection in compression . . . . . . . . . . . . . . 125 Chapter 3. Guidance 1. Wet Chemistry Film Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 2. Flat Field Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 3. Phantom Image Quality Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 3-1. Quality Control Phantom. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 3-2. Scoring the Phantom Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 3-3. Failure of Phantom Image Quality Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 3-4. Appearance of Collimator Blades in Image. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 3-5. Failure of Phantom Image Quality Test for Printer . . . . . . . . . . . . . . . . . . . . . . . . . . 129 4. CNR and MTF Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 4-1. Failure of MTF Measurement Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 4-2. Failure of Change in CNR Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 5. AOP Mode and SNR Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 6. Repeat Analysis Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 6-1. Manual Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 6-2. Automated Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 6-3. Record of loss of data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 7. Compression Force Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 8. Visual, Monitor, and Filming Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 8-1. Viewboxes and Viewing Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 8-2. Monitor Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 8-3. Printer QC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 9. Annual Physicist Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9-1. kVp Accuracy and Reproducibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9-2. Beam Quality Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9-3. Mammography Unit Assembly Evaluation and Radiation Output . . . . . . . . . . . . . . . 132 10. Collimation Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 11. Evaluation of Focal Spot Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Table of Contents Seno DS-Ess QCTOC.fm Page no. 7 12. Sub-System MTF Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 12-1. Suitable Bar Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 12-2. Variation of MTF with ROI Width. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 12-3. Use of Dual-Orthogonal Test Patterns for the MTF Measurement . . . . . . . . . . . . . . 133 12-4. Bar Pattern Frequency Inaccuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 12-5. Sensitivity of MTF Measurement to Bar Pattern Frequency Error. . . . . . . . . . . . . . . 134 12-6. Ellipse Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 12-7. References for MTF Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 12-8. Actions to be taken if specifications are not met . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 13. Breast Entrance Exposure, Average Glandular Dose, and Reproducibility . . . . . . . . . . . 136 14. Artifact Evaluation and Flat Field Uniformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 15. Summary of Mammography Equipment Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Revision History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Page no. 8 Seno DS-Ess QCTOC.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Table of Contents This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Publication Presentation foreword.fm Page no. 9 Publication Presentation Publication Presentation 1 Applicability This document Quality Control Manual constitutes an element of the Quality Assurance Program of the mammographic facility. CAUTION Quality assurance checks must be performed regularly according to the schedules detailed in QC Intervals Chapter 1, section 2 QC Intervals and Chapter 2, section 1 Introduction to maintain safe and effective operation of Senographe Essential. Note: Parts of this document are applicable only to facilities subject to the MQSA. These paragraphs are shown in italic text and remain in English, regardless of the language of the document. 2 How to order a paper version A paper copy of the Quality Control Manual can be ordered at no additional cost: Please send a request to your Sales or Service representative indicating the Quality Control Manual Part Number (5305863-9-1EN). They will transfer your request to CEMEURDIST@med.ge.com. In the European Union, in application of the EU Commission Regulation on electronic instructions for use of medical devices, your request should be processed within seven days. Publication Presentation Page no. 10 foreword.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Publication Presentation 3 How to access the electronic version of a manual on a website The Quality Control Manual is available on the Internet at: http://apps.gehealthcare.com/servlet/ClientServlet?REQ=Enter+Documentation+Library Note: A file compression/archival (zip/unzip) utility must be installed on the users computer. 1. On the home page, enter the manual direction number (QC_5305863-9-899) (where 5305863-9-899 is the manual identification number located in the right part of the document header) in the search field and click [Search] to launch the search. 2. Click on the underlined Filename. 3. In the next window, click [ACCEPT] to view the file. 4. From the zip file, choose your language (EN). 4 Legal Information 4-1 Copyright Information All Licensed Software is protected by the copyright laws of the United States and by applicable international treaties. 4-2 Trademark Information GE, the GE Monogram, and Senographe Essential are trademarks or registered trademarks of the General Electric Company. Microsoft and Windows are trademarks or registered trademarks of Microsoft Corporation. All other product names and logos are trademarks or registered trademarks of their respective owners. 5 Regulatory considerations In facilities subject to the MQSA, the procedures in the document Senographe Essential Acquisition System QC Manual must be followed. Failure to follow these quality assurance procedures can result in loss of MQSA certification at facilities subject to U.S. regulations. search field Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Publication Presentation foreword.fm Page no. 11 Publication Presentation Alternative Standard on Use of Test Results An amended Alternative Requirement to 21 CFR 900.12(e)(8)(ii)(A) was approved by FDA on 31 August 2007. The original alternative requirement dealt with the action to be taken by an operator upon the failure of a test in the QC plan of a GE Senographe full-field digital mammography system. The amendment separates the actions into those associated with an image acquisition system and those associated with an image display system. The actions to be taken in regard to the QC plan for the GE Senographe Essential Acquisition System are as follows: 21 CFR 900.12(e)(8): Use of test results. For the image acquisition system (i) If the test results for the image acquisition system of the FDA-approved GE full-field digital mammography (FFDM) equipment fall outside of the action limits, the source of the problem shall be identified and corrective actions shall be taken: (A) Before any further mammographic images are acquired using the image acquisition system that failed any of the following tests: (1) Monitor cleaning for the Acquisition Work Station (AWS) (2) Flat Field Test (3) CNR Test (4) Phantom Image Quality Test for the AWS (5) MTF Measurement (6) AOP Mode and SNR Check (7) Visual Check List (8) Compression Force Test (9) Average Glandular Dose (10) Post-move, Pre-examination Tests for a mobile FDA-approved GE FFDM (11) Sub-system MTF Measurement (B) Before any further films of mammographic images are printed or processed using the component of the FDA- approved GE FFDM equipment that failed any of the following tests: (1) Phantom Image Quality Test for the Printer (2) Viewbox and Viewing Conditions Test (3) Printer QC (C) Within 30 days of the test date for the following tests: (1) Repeat Analysis (2) Collimation Assessment (3) Evaluation of Focal Spot Performance (4) Exposure and mAs Reproducibility (5) Artifact Evaluation; Flat Field Uniformity (6) kVp Accuracy and Reproducibility (7) Beam Quality Assessment (Half-Value Layer Measurement) (8) Radiation Output (9) Mammographic Unit Assembly Evaluation Publication Presentation Page no. 12 foreword.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Publication Presentation 6 Scope of this Manual The scope of this document is the quality control (QC) tests to be applied to the Senographe Essential, the image acquisition and pre-processing sub-system of an FFDM system. QC tests to be applied to the display systems intended for clinical image review are included in a separate manual. Two kinds of QC tests are listed: 1. QC Tests specific to Digital Mammography. Procedures for performing these tests are extensively described in this manual. 2. QC Tests not specific to Digital Mammography. These are tests which are already performed on Analog Mammography systems and which still apply for some features of the Senographe Essential. Procedures for performing these tests are not extensively described in this manual. 7 Overview of this Manual This Quality Control (QC) Manual consists of three main sections: 1. QC Tests for the Radiologic Technologist for Senographe Essential (see Chapter 1 QC Tests for the Radiologic Technologist on page 13) 2. QC Tests for the Medical Physicist for Senographe Essential (see Chapter 2 QC Tests for the Medical Physicist on page 51). 3. Guidance for Senographe Essential (see Chapter 3 Guidance on page 127). The QC Test sections contain full descriptions of test procedures, testing frequency, and action limits for tests specific to Digital Mammography. For tests not specific to Digital Mammography, testing frequencies and action limits are provided but procedures are not fully described. The Guidance section contains recommendations on procedures for performing tests not specific to Digital Mammography, as well as supplementary material for user information. References to this section are made at appropriate points in the QC Test sections. 8 Acknowledgment Some elements of the QC Tests have been reprinted with permission of the American College of Radiology, Reston, Virginia. No reproduction or use of that material for any purpose other than for Senographe Essential quality control is authorized without express and written permission from the American College of Radiology. We thank the College for its cooperation. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 13 Chapter 1 Chapter 1 QC Tests for the Radiologic Technologist 1 Introduction QC tests are simple checks which ensure that the Senographe Essential system is operating to its design standards. They are designed to detect any changes in settings which might compromise image quality, as well as any deterioration in equipment performance over time. QC tests for the Senographe Essential are described in the following sections: Section 3 Monitor Cleaning on page 15. Section 4 Flat Field and Phantom IQ Tests on page 16. Checks for consistency of image quality. Section 5 CNR and MTF Measurement on page 21. Checks for consistent production of good contrast images. Section 6 Viewbox and Viewing Conditions Test on page 23. Section 7 AOP Mode and SNR Check on page 24. Checks for correct operation of AOP mode. Using the STD mode should satisfy most needs. However, if a higher priority is given to the dose delivered to the patient, the DOSE mode may be selected instead. If a higher priority is given to the contrast to noise ratio in images, the CNT mode may be selected. It is important to understand that any improvement in contrast to noise ratio is done at the cost of an increase in glandular dose and vice versa; a decrease in glandular dose will yield a reduction in contrast to noise ratio. For more information on evaluating which priority to select consult with your interpreting physician, radiologist, or medical physicist. Section 8 Visual Checklist on page 26. Section 9 Repeat Analysis Check on page 27. Analysis of the number and cause of repeated mammograms. Depending on your Senographe Essential version, the method used may be manual or automated. Section 10 Compression Force Test on page 38. Checks for the correct level of compression force. Section 11 Printer on page 39 addresses the QC testing of the printer used with the Senographe Essential. To ensure optimal quality of the film printer output, follow the QC program developed by the manufacturer of the device. Refer to the Printer Operators Manual or ancillary documentation provided by the manufacturer of the printer. If the printer is used with a film processor incorporating wet chemistry processing, refer to the Printer Operators Manual or ancillary documentation provided by the manufacturer of the printer. If such documentation is not available, refer to Chapter 3 Guidance section 1 Wet Chemistry Film Processing on page 127. Section12 Test Results Record Forms on page 41 provides charts for use in recording the results of the various checks. It is recommended that you use these chart pages to make copies for the results. For further analysis, data generated on the Acquisition Workstation (AWS) for Flat Field, CNR, MTF, AOP and SNR tests can be exported as text files to either a floppy disk or to a CD-R. The available option will be indicated by the pop-up described below. To export the QC data files: From the Browser, click the QAP button, then select Extract Data. A pop-up is displayed instructing you to insert either a floppy disk or a CD-R, the choice of medium depending on the drive installed in the workstation. Insert the appropriate medium in the AWS drive and click OK. Chapter 1 Page no. 14 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist This action saves the data generated since the last data export. Exported files can be easily opened on a computer using a word processing application. They contain the data displayed on the screen at the end of each test. Note: Files exported once cannot be exported a second time. 2 QC Intervals The Quality Assurance Procedures described here must be performed at least as frequently as the intervals specified in the test descriptions and summarized below. For the frequency of QC tests to be performed on the film printer, refer to the Printer Operators Manual or ancillary documentation provided by the manufacturer of the printer. Refer to Chapter 3 Guidance for additional information regarding application of the QC Tests. Minimum Frequency Procedure Section Daily Monitor Cleaning 3 Weekly Flat Field Test 4-1 Phantom Image Quality Tests 4-2 CNR and MTF Measurement 5 Viewbox and Viewing Conditions Test 6 Monthly AOP Mode and SNR Check 7 Visual Checklist 8 Quarterly Repeat Analysis Check 9 Semi-annually Compression Force Test 10 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 15 Chapter 1 3 Monitor Cleaning Frequency: Daily or on days when clinical image acquisitions are planned. Objective: To ensure good image review conditions by keeping the monitor screen free of dust, finger prints, and other marks. Equipment required: Microfiber cloth. If necessary, the cloth may be moistened with either water or ethyl alcohol (up to 96%). ! Notice: Do not use isopropyl (rubbing) alcohol. Do not use cleaning agents which attack the surface, such as petroleum (mineral) spirits. The front panel is extremely sensitive to mechanical damage. Avoid all scratches, knocks, etc. Do not apply the cleaning liquid directly to the monitor housing or screen. Do not allow the cleaning liquid to enter the monitor housing; be sure to dampen the cloth sparingly. Procedure: 1. Check the screen to verify that it is free from dust, finger prints, and other marks. 2. If the front panel is dirty, clean it using a microfiber cloth. If necessary, moisten the cloth with either water or ethyl alcohol (up to 96%). Remove any drops of cleaning liquid immediately; extended contact may discolor the surface. If it is necessary to clean the housing, use the microfiber cloth, moistened if necessary with water or ethyl alcohol. 3. Record completion of the check on Chart 1. Daily and Weekly Tests on page 41. Action Limit: The screen must be free from dust, finger prints, and other marks. Use of Test Results: If these results are not obtained, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential FFDM system that failed. Refer to Chapter 3 Guidance section 8-2 Monitor Cleaning on page 131. Chapter 1 Page no. 16 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 4 Flat Field and Phantom IQ Tests 4-1 Flat Field Test Note: The Flat Field Test must be run before the Phantom IQ Test and the CNR and MTF Measurement. Frequency: Weekly. Objective: Tests carried out when the Flat Field Test is selected. They check brightness nonuniformity, high frequency modulation (HFM), SNR nonuniformity, bad ROI, bad pixels, and bad pixel map check. Equipment required: Flat Field test object. This is an Xray attenuator composed of 25 mm thick acrylic (PMMA) covering the entire image receptor (240 mm x 307 mm). ! Notice: To avoid false results, the acrylic must be clean and free from imperfections. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warm-up period, see Chapter 3 Guidance section 2 Flat Field Test on page 127. Procedure: 1. Click on the QAP button in the right column of the Browser window. A list of tests is displayed. Select Flat Field. 2. Use the light field to ensure that the collimators are set for the largest field of view. 3. Set the tube arm angle to zero degrees. 4. Follow the onscreen instructions. 5. After the last image has been captured, the results of the test are displayed. If all of the tests are passed, note in Chart 1. Daily and Weekly Tests on page 41 that the test was completed and record the results inChart 2. Image Quality and MTF Measurement Test Record (1/3) on page 42. Note: The display of test results will indicate if the system finds a test failure during the procedure 6. If all tests are not passed, check the test conditions and repeat the test. - Ensure that the detector has been allowed to warm up for at least 10 minutes before acquiring the test images. - Ensure that the compression paddle and Bucky have been removed. - Ensure that no object but the Flat Field Test Object is in the field. - Ensure that the collimator is open to the largest field size. - Ensure that the tube arm angle is at zero degrees. - Ensure that the Flat Field Test Object is clean and free from scratches or other imperfections: - Clean or replace the test object as necessary. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 17 Chapter 1 - If there is a scratch or defect near an edge of the test object, attempt to orient the test object so that the imperfection is outside the field of view of the image receptor. After re-orienting the test object, ensure that it still fills the field of view of the image receptor. - Ensure that the surface of the image receptor is clean. - Ensure that the Flat Field Test Object fully covers the field of view of the image receptor. Action Limit: All Flat Field tests must pass. Use of Test Results: If the system fails the test, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential system that failed. Refer to Chapter 3 Guidance section 2 Flat Field Test on page 127. 4-2 Phantom IQ on AWS and Printer Test Frequency: Weekly. This test must be run only after successful completion of the Flat Field Test. The Phantom Image Quality Test of the printer must be run only after successful completion of the daily QC test for the printer. Objective: The test is designed to ensure adequate and consistent quality of images acquired by the detector and displayed on the AWS monitor and the printer. Note: The image needed for this test is acquired using the Manual mode of the Senographe Essential. The test is intended to check the consistency of the detector and display sub-systems independently of the functioning of the AOP automatic exposure control system. Operation of AOP is checked in section 7 AOP Mode and SNR Check on page 24. At the users discretion, additional images may be acquired and analyzed using one or more of the AOP modes and the applicable procedures given below. While such additional images may be of interest to some users, they are not required as part of these QC tests and no Action Limits are provided. Chapter 1 Page no. 18 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Equipment required: Mammographic Quality Control phantom. Refer to Chapter 3 Guidance section 3-1 Quality Control Phantom on page 128. Note: To avoid false results, the phantom must be clean and free from imperfections. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warmup period, see Chapter 3 Guidance section 3-3 Failure of Phantom Image Quality Test on page 128. 4-2-1 Image Acquisition Procedure: Run the normal Medical Application; follow the sequence of instructions below. 1. Install the grid if it is not already in place. 2. Position the phantom on the breast support surface in the field of view of the image receptor. One edge of the phantom must be flush with the chest wall edge of the breast support surface. When viewed from the patients position, i.e., facing the mammography unit, the cut-out corner of the wax insert of the phantom must be opposite to the chest wall and toward the left side of the detector, as indicated below. Select the 9 x 9 cm X-ray field size and use the light localizer to center the phantom laterally. 3. Reset the collimator to the maximum field of view. 4. Install the 19 x 23 cm compression paddle in the centered position and apply about 5 daN of compression force to the phantom. 5. Select the following parameters: large focal spot, Rh/Rh track/filter, 29 kV, 56 mAs. 6. On the AWS select a new patient, e.g., Phantom Image, under Medical Applications. 7. On the Control Console select Left breast laterality. 8. Make an exposure. Check that the collimator blades are not visible on the image. If collimator blades are visible, refer to Chapter 3 Guidance section 3-4 Appearance of Collimator Blades in Image on page 128. Cut-out corner of wax insert of phantom Detector surface Chest wall side of detector Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 19 Chapter 1 4-2-2 Phantom IQ test on AWS Procedure: 1. Observe the image and provide a score for each target in the phantom image on the AWS screen. Scores must include deduction for artifacts. For a recommendation on a method for determining the score, including artifact deduction, see Chapter 3 Guidance section 3-2 Scoring the Phantom Image on page 128. If objects are not easy to see, make sure that the phantom image is positioned for optimal viewing, and use the Zoom, Rotation, Magnifying Glass, Brightness, and Contrast controls as necessary so that the most accurate score can be obtained. 2. Record the display settings and results in Chart 2. Image Quality and MTF Measurement Test Record (1/3) on page 42. Action Limit: The score for fibers must be at least 4, the score for masses must be at least 3, and the score for speck groups must be at least 3. Use of Test Results: If the system fails the test, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential system that failed. See Chapter 3 Guidance section 3-3 Failure of Phantom Image Quality Test on page 128. 4-2-3 Phantom IQ Test on the Printer Note: Printer Phantom IQ testing is only required when a site uses hardcopy images for diagnostic review. Procedure: 1. Before testing the printer, first do the daily QC test for the printer. 2. Push the Processed Phantom Image to the Printer. 3. Observe the printed image of the phantom and provide a score for each target in the same way as described above. Scores must include deduction for artifacts. For a recommendation on a method for determining the score, including artifact deduction, see Chapter 3 Guidance section 3- 2 Scoring the Phantom Image on page 128. 4. Record the results in Chart 2. Image Quality and MTF Measurement Test Record (1/3) on page 42. Action Limit: The score for fibers must be at least 4, the score for masses must be at least 3, and the score for speck groups must be at least 3. Use of Test Results If the system fails the test, the source of the problem must be identified, and corrective action taken, before any further mammographic images are reviewed or interpreted using the printer. See Chapter 3 Guidance section 3-5 Failure of Phantom Image Quality Test for Printer on page 129. 4-2-4 Completion of Phantom Image Quality Test Recording of completion of tests After completing all elements of the Phantom Image Quality Test, record the completion of the test in Chart 1. Daily and Weekly Tests on page 41. Chapter 1 Page no. 20 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist The applicable MQSA Quality Mammography Standard is: 900.12(e)(2) Weekly quality control tests. Facilities with screen-film systems shall perform an image quality evaluation test, using an FDA-approved phantom, at least weekly. (iii) The phantom image shall achieve at least the minimum score established by the accreditation body and accepted by FDA in accordance with Sec. 900.3(d) or Sec. 900.4(a)(8). Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 21 Chapter 1 5 CNR and MTF Measurement Frequency: Weekly. The measurement must be made only after successful completion of the Flat Field Test (section 4-1 Flat Field Test on page 16). Objective: The test is designed to check the consistency of the contrast to noise ratio (CNR) and to ensure that contrast is adequate over the 0-5 lp/mm spatial frequency range by obtaining an estimate of the MTF (Modulation Transfer Function) values at 2 and 4 lp/mm. CNR measurement is done in two steps: - Establishment of a baseline operating level CNR ol (CNR Operating Level). - Comparison of CNR value to this operating level. Note: The phantom image quality test for screen-film imaging systems as described in the MQSA Quality Mammography Standards includes a test for the consistency of image contrast as represented by the density difference (DD) between the image of a test object, e.g., a 4 mm thick acrylic disk, and the background density of the phantom. In digital imaging the relative level of a signal or contrast to the image noise is the more relevant measure of image quality. Hence, the measure of consistency of ContrasttoNoise Ratio (CNR) is introduced as a replacement for the measure of consistency of DD. Equipment required: IQST device shipped with the Senographe Essential system. Note: To avoid false results, the device must be clean and free from scratches. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warmup period, see Chapter 3 Guidance section 4 CNR and MTF Measurement on page 129. Establishing a baseline operating level for the CNR measurement, CNR ol : It is first necessary to establish an operating level for the Contrast-to-Noise Ratio (CNR) measurement, CNR ol . To do so, on each of five consecutive days, begin with the Flat Field Test (section 4-1 Flat Field Test on page 16), then follow steps 1 through 8 of the procedure below in order to acquire a new image and record the CNR. The CNR will be automatically calculated as well as the average of the first five CNR values. The average is used as the operating level. Record the daily values and the resulting operating level in Chart 2. Image Quality and MTF Measurement Test Record (2/3) on page 43. The subsequent weekly measurements are to be compared to this operating level. Chapter 1 Page no. 22 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Changes to the baseline operating level for the CNR measurement, CNR ol : Under certain conditions it will be necessary to re-establish the CNR ol . These include, but are not limited to: - Replacement of the X-ray tube. - Replacement of the Rh X-ray beam filter. - Replacement of the IQST device. - Replacement of the anti-scatter grid. - Replacement of the detector. - Re-calibration of detector gain. Following any of these events it is necessary to again average the CNR values measured on five consecutive days and use the average as the new CNR ol . To initiate the establishment of a new CNR ol, use the Reset button in the Results pop-up window. This Reset button is available only if five CNR values have been measured and a CNR ol has been calculated; the Erase button allows you to cancel the last CNR value. Procedure: 1. Click on the QAP button on the right column of the Browser window. A list of tests is displayed. Select the CNR and MTF test. 2. Enter or verify the reference of the IQST device (Serial Number or SN, written on the side of the device) on the AWS screen, then click Start. Note: If the device reference entered is different from the previous one, you will be asked if you want to restart the calibration process with this new reference. 3. Install the Bucky on the digital detector if it is not already installed. 4. Remove the compression paddle. 5. Position the IQST device on top of the Bucky. 6. The following parameters are selected automatically: Rh/Rh/30kV/56mAs. 7. Perform one exposure. 8. After the image has been captured, the results of the tests are displayed: - The values of MTF at 2 lp/mm and MTF at 4 lp/mm. - The value of the change in CNR, computed as follows: Change in CNR = |CNR - CNR ol | / CNR ol
where CNR ol = the CNR Operating Level as described above. If CNR ol has not been calculated yet, the change in CNR is computed as follows: Change in CNR = |CNR - mean| / mean where mean = the mean of the CNR values previously stored. 9. If the results are passed, record the results in Chart 2. Image Quality and MTF Measurement Test Record (3/3) on page 44. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 23 Chapter 1 Action Limit: The system passes the MTF Measurement test if all of the following conditions are met: MTF Parallel at 2 lp/mm > 49% MTF Parallel at 4 lp/mm > 18% MTF Perpendicular at 2 lp/mm > 49% MTF Perpendicular at 4 lp/mm > 18% For each condition that is met, the Status will be Pass. The system passes the CNR Measurement test: - if the change in CNR does not exceed 0.2 when computed with an existing CNR ol value, such that Change in CNR = |CNR - CNR ol | / CNR ol . - if the change in CNR does not exceed 0.4 when computed with the mean of the CNR values previously stored, such that Change in CNR = |CNR - mean| / mean. If this condition is met, the Status will be Pass. Use of Test Results: If the system fails either of these tests, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential system that failed. See Chapter 3 Guidance section 4 CNR and MTF Measurement on page 129. 6 Viewbox and Viewing Conditions Test Frequency: Weekly. Objective: To ensure good image review conditions by keeping the viewboxes free of dust, finger prints, and other marks and the viewing conditions optimized. Procedure: 1. This test is not specific to digital mammographic systems. Follow accepted mammographic QC procedures to perform this test. See Chapter 3 Guidance section 8-1 Viewboxes and Viewing Conditions on page 131. 2. Indicate completion of the test in Chart 1. Daily and Weekly Tests on page 41. Action Limit: The viewboxes must be free from dust, finger prints, and other marks. Viewing conditions must meet accepted standards for mammographic image review. Use of Test Results: If these results are not obtained, the source of the problem must be identified, and corrective action taken, before any further mammographic images are reviewed or interpreted using the viewboxes. Chapter 1 Page no. 24 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 7 AOP Mode and SNR Check Frequency: Monthly. Objective: The test is designed to check the following aspects of system operation: - Correct choice of parameters in AOP (Automatic Optimization of Parameters) mode. - Correct level of SNR (SignaltoNoise Ratio) in the image. Using the STD mode should satisfy most needs. However, if a higher priority is given to the dose delivered to the patient, the DOSE mode may be selected instead. If a higher priority is given to the contrast to noise ratio in images, the CNT mode may be selected. It is important to understand that any improvement in contrast to noise ratio is done at the cost of an increase in glandular dose and vice versa; a decrease in glandular dose will yield a reduction in contrast to noise ratio. For more information on evaluating which priority to select consult with your interpreting physician, radiologist, or medical physicist. Equipment required: Set of acrylic (PMMA) plates allowing thicknesses of 25 0.1 mm, 50 0.1 mm and 60 0.1 mm. ! Notice: To avoid false results, the plates must be clean and free from scratches. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warmup period, see Chapter 3 Guidance section 5 AOP Mode and SNR Check on page 129. Procedure: 1. Click on the QAP button in the right column of the Browser window. A list of tests is displayed. Select AOP and SNR Check. 2. Install the 24 x 31 cm compression paddle in the centered position. 3. The following steps must be carried out with each of the three thicknesses of acrylic (25, 50 and 60 mm) positioned in turn in the field of view, starting with the 25 mm thickness: - Select the 25 mm button. - Place the stack of acrylic plates on the breast support surface of the Bucky so that the stack lies flat on the surface. - Position the plates with the longest side aligned with the chestwall edge of the Bucky. - Center the plates left-to-right. - Apply a compression force of 5 daN to the plates. Note: For precision and ease of selection, the maximum compression force limit can be set to 5 daN using the Medical/Force menu on the X-ray console menu. If this is done, return the maximum to the clinically used value following completion of the test. For information on setting the maximum compression force see Chapter 3 Guidance section 5 AOP Mode and SNR Check on page 129. - AOP STD mode is selected automatically. - Take an exposure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 25 Chapter 1 - After the image has been captured, the results are displayed (exposure parameters used as well as SNR). - Record the results in Chart 3. AOP Mode and SNR Check Records on page 45. See Chapter 3 Guidance section 5 AOP Mode and SNR Check on page 129 regarding a method to record these results. - Repeat these steps for the 50 and 60 mm thicknesses. Action Limit: - If, at the end of the results, AOP B is displayed, the AOP Mode test is successful if the exposure parameters are in accord with the values specified in the following table: - If at the end of the results, AOP B is not displayed, the AOP Mode test is successful if the exposure parameters are in accord with the values specified in the following table: The value of SNR must exceed 50. Note: Either of two values of kVp, 30 or 31, may be selected by the AOP algorithm for the 60 mm acrylic thickness. This is normal operation. It is also normal operation that the mAs used with 30 kVp will be greater than the value used with 31 kVp. It is only necessary that the mAs remain within the range given in the previous table. Use of Test Results: If the system fails the test, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential FFDM system that failed. See Chapter 3 Guidance section 5 AOP Mode and SNR Check on page 129. Acrylic Thickness (mm) Exposure Parameters For AOP STD mode only Track/Filter mAs kV 25 Mo/Mo 20-60 26 50 Rh/Rh 40-90 29 60 Rh/Rh 60-120 30 ou 31 Acrylic Thickness (mm) Exposure Parameters For AOP STD mode only Track/filter mAs kV 25 Mo/Mo 20 - 60 26 50 Rh/Rh 40 - 90 29 60 Rh/Rh 45 - 95 30 or 31 Chapter 1 Page no. 26 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 8 Visual Checklist Frequency: Monthly and after any service or maintenance on the mammographic Xray system. Objective: To assure that mammographic Xray system indicator lights, displays, and mechanical locks and detents are working properly and that the system is mechanically stable. Equipment required: Visual checklist Chart 4. Visual Checklist Record on page 46. Procedure: 1. Review each item on the visual checklist and indicate its status. 2. Date and initial the checklist where indicated. 3. Note on Chart 5. Record of Checks on page 47 the completion of the Visual Checklist. Action Limit: Each of the items listed in the Visual Checklist must pass or receive a check mark. Use of Test Results: Items missing from the room must be replaced immediately. If an item does not pass the visual check, the source of the problem must be identified and corrective actions shall be taken before any further mammographic images are acquired using the Senographe Essential FFDM system that failed. See Chapter 3 Guidance section 8 Visual, Monitor, and Filming Checks on page 131. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 27 Chapter 1 9 Repeat Analysis Check Depending on the version of your Senographe Essential, the method used may be manual or automated: The applicable MQSA Quality Mammography Standard is: 900.12(e)(3)(ii) Quarterly quality control tests. Facilities with screen-film systems shall perform the following quality control tests at least quarterly: (ii) Repeat analysis. If the total repeat or reject rate changes from the previously determined rate by more than 2.0 percent of the total films included in the analysis, the reason(s) for the change shall be determined. Any corrective actions shall be recorded and the results of these corrective actions shall be assessed. Method Senographe Essential version Description Manual All versions Data are recorded on a paper chart. Repeat rates are calculated manually, and the results recorded on a paper chart. Automated Versions with Repeat and Reject Analysis. Verify presence of RRA button after selecting QAP from the Browser. Each image must be qualified during the examination as Accepted, Rejected, or Repeated. See Chapter 3 Guidance section 6-2 Automated Method on page 130. Repeat and reject rates are calculated automatically. Chapter 1 Page no. 28 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 9-1 Repeat Analysis - Manual Method Frequency: Quarterly. For the repeat rates to be meaningful, an analysis period that yields a patient volume of at least 250 patients or 1,000 exposures is needed. Objective: To determine the number and cause of repeated digital mammograms. Analysis of these data can help identify ways to improve system efficiency and reduce digital image retakes and patient exposure. Equipment required: - Records of all exposures made during the period being analyzed. - Repeat exposure record sheet(s) Chart 6. Repeat Exposure Record Sheet - Manual Method on page 48. - Repeat analysis data sheet Chart 7. Repeat Exposure Analysis - Manual Method on page 49. Procedure: 1. Identify all exposures which had to be repeated. Record each one on Chart 6. Repeat Exposure Record Sheet - Manual Method on page 48, entering the Study Number, cause of repeated exposure, date, etc. 2. At the end of each analysis period, use the repeat exposure analysis form Chart 7. Repeat Exposure Analysis - Manual Method on page 49 to summarize the number of repeats in each category and record your analysis of results. - Estimate the total number of exposures taken during the analysis period. See Chapter 3 Guidance section 6 Repeat Analysis Check on page 130. - Calculate the overall repeat rate as the total of repeated exposures (R) divided by the total number of exposures (T) during the analysis period, multiplied by 100%. - Determine the percentage of repeats in each category by dividing the number of repeats in the category by the total number of repeated exposures (R) from all categories. 3. Record completion of the Repeat Analysis Check on Chart 5. Record of Checks on page 47. Action Limit: The total repeat rate or reject rate must not change by more than 2.0% of the total exposures included in the analysis from the rate determined for the previous analysis period. Use of Test Results: If the total repeat rate or reject rate changes from the rate determined for the previous analysis period by more than 2.0% of the total exposures included in the analysis, the source of the problem must be identified, and corrective action taken, within 30 days of the test date. Any corrective actions taken must be recorded, and an assessment must be made of their effectiveness. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 29 Chapter 1 9-2 Repeat Analysis - Automated Method Note: The procedure described below performs Repeat and Reject Exposure analysis using the Senographe Essential Control Station computer. It is also possible to export the recorded data and perform the analysis on another computer (PC-compatible) using the PC Tool. To export the data on CD, click the Export database button in the Repeat and Reject Analysis window described below. Use of the PC Tool to analyze the data is described in section 9-4 Repeat Analysis - PC Tool on page 33. Frequency: Quarterly. For the repeat rates to be meaningful, an analysis period that yields a patient volume of at least 250 patients or 1,000 exposures is needed. Objective: To determine the number and cause of repeated and rejected digital mammograms. Analysis of these data can help to identify ways to improve system efficiency and reduce digital image retakes and patient exposure to radiation. Equipment required: - Repeat and Reject analysis data sheet Chart 8. Repeat and Reject Exposure Analysis - Automated Method on page 50. Procedure: - Ensure that all exposures made during the analysis period have been qualified. - Select the QAP icon in the Browser, then click the RRA button to display the Repeat and Reject Analysis window. Repeat and Reject Analysis From : 07/24/2004 12:42:47 To : 08/31/2005 12:23:32 Reset to Today Reset to last R&R analysis Preview analysis Export database Repeat and Reject Analysis OK Close window The last QC Analysis was performed on 12/01/2004, at 12:30:56, 176 days ago 26875 exposures have been performed. 1 - Select period of time you want to preview: To obtain a more detailed analysis using a PC tool, please select "Export Database" to burn database on CD-ROM Select "Repeat and Reject Analysis OK" when you complete analysis Chapter 1 Page no. 30 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist - In the Repeat and Reject Analysis window, select From and To dates for the analysis, then click Preview analysis to display the Repeat Reject Exposures Analysis table in the format shown in the example below. The table summarizes all exposures made during the chosen period, and gives the percentages for Repeated and Rejected exposures, together with their respective causes. ! Notice: Data are ignored from any technologist whose name has been entered with two or more consecutive space characters. Check that the names of all technologists are entered correctly and make any corrections for future analyses. Repeat Reject Exposures Analysis Note: The MQSA does not specify the statistics to be used in calculating a repeat or reject rate. Cause Number of Repeats Percentage of Repeats Number of Rejects Percentage of Rejects Positioning 7 27% 0 0% Patient Motion 8 31% 0 0% Poor Compression 4 15% 0 0% Improper Detector Exposure 0 0% 1 2% X-Ray Equipment Failure 0 0% 0 0% Equipment Artifacts 1 4% 0 0% Blank Image 0 0% 0 0% Clinical Artifacts 6 23% 0 0% Incorrect View Marker 0 0% 0 0% QC, Acceptance Tests, Calibration 0 0% 24 58% Interventional Image (e.g., wire loc.) 0 0% 13 32% Other 0 0% 3 7% Total Repeats + Rejects 67 Total Repeats 26 Total Rejects 41 Non-Clinical Repeats+Rejects 37 Total number of exposures 1430 Total Repeat+Reject rate 4.7% Total Repeat rate 1.8% Clinical Repeat rate 1.9% Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 31 Chapter 1 Three rates are provided by this analysis tool. They are calculated as follows: - Total Repeats + Rejects is the sum of all images qualified as either Repeated or Rejected in the analysis period. - Total Repeats is the sum of all images qualified as Repeated in the analysis period. - Total number of exposures is the count of images acquired in the analysis period. - Non-Clinical Repeats+Rejects is the sum of Repeats plus Rejects for the causes QC, Acceptance Tests, Calibration and Interventional Image (e.g., wire loc.) in the analysis period. It is the responsibility of the facility to decide which repeat or reject rate to monitor as part of its quality assurance plan. The facility may choose one of those provided in the automated analysis, or calculate rates by other means using the statistics accumulated by the analysis tool. The facility must identify the chosen method in its QC log. Action Limit: The total repeat rate or reject rate must not change by more than 2.0% of the total exposures included in the analysis from the rate determined for the previous analysis period. Use of Test Results: If the total repeat rate or reject rate changes from the rate determined for the previous analysis period by more than 2.0% of the total exposures included in the analysis, the source of the problem must be identified, and corrective action taken, within 30 days of the test date. Any corrective actions taken must be recorded, and an assessment must be made of their effectiveness. Total Repeat+Reject rate (%) = 100 x Total Repeats + Rejects Total number of exposures Total Repeat rate (%) = 100 x Total Repeats Total number of exposures Clinical Repeat rate (%) = 100 x Total Repeats Total number of exposures - Non-Clinical Repeats+Rejects Chapter 1 Page no. 32 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 9-3 Repeat Analysis - Database backup Frequency After each repeat analysis, at least quarterly or more often if repeat analysis is done more frequently. See Chapter 3 Guidance section 6-3 Record of loss of data on page 130. Objective To backup the repeat analysis database and limit the loss of data due to a failure of system hardware. Equipment required A blank CD. Procedure - Select the QAP icon in the Browser, then click the RRA button to display the Repeat and Reject Analysis window. - Click the Export database button in the Repeat and Reject Analysis window. - A pop-up is displayed, asking you to insert a blank CD in the CD writer. Insert a blank CD in the AWS CD writer and click OK. - This action saves the entire database to the CD. The database is also retained in the AWS computer. - A pop-up is displayed to confirm the completion of the CD burn. Repeat and Reject Analysis From : 07/24/2004 12:42:47 To : 08/31/2005 12:23:32 Reset to Today Reset to last R&R analysis Preview analysis Export database Repeat and Reject Analysis OK Close window The last QC Analysis was performed on 12/01/2004, at 12:30:56, 176 days ago 26875 exposures have been performed. 1 - Select period of time you want to preview: To obtain a more detailed analysis using a PC tool, please select "Export Database" to burn database on CD-ROM Select "Repeat and Reject Analysis OK" when you complete analysis Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 33 Chapter 1 9-4 Repeat Analysis - PC Tool Note: This procedure provides an alternative to section 9-2 Repeat Analysis - Automated Method on page 29 as a means to perform the repeat analysis. It describes the use of the PC Tool to analyze on another computer (PC-compatible) the repeat and reject data exported to a CD. Frequency Quarterly Objective To perform the repeat analysis on another computer (PC-compatible), with supplementary statistics, e.g., results sorted by technologist or in order of decreasing frequency. Equipment required - The CD that contains the repeat analysis database. Refer to section 9-3 Repeat Analysis - Database backup on page 32 for the procedure to export the database. - A PC-compatible computer, - Windows operating system, - Internet Explorer V6.0 or higher. Chapter 1 Page no. 34 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Procedure - Insert the CD in the CD drive of your computer. - Double click the CD icon to get the list of files on the CD. Note: If you copy the files onto your computer, make sure you put all the files in the same folder. - Double click the RRA_PC_TOOL.html file to launch the application. - Internet Explorer is automatically launched. - The Selection page is displayed: - Enter the period of time you would like to consider for the analysis. Note: By default, From date and From Time are the date and time of the last repeat analysis performed on the Acquisition Workstation. To date and To Time are the current date and time on the computer. Note that time is entered using a 24-hour clock. - Select the technologist for whom you would like to get analysis results. Note: By default, the field is empty. Exposures by all the technologists will be taken into account for the analysis. Selection of a technologist is optional. If selected, results will be provided for the selected technologist, followed by the cumulative results for all technologists. Note: The list of technologists comes from the Acquisition Workstation. No modification of the list is possible in the PC Tool. Repeat and Reject Analysis Select period of time you want to preview Click on button to preview the analysis From date From Time Show the results for technologist Show the results by decreasing percentage (YYYYMMDD) (HHMMSS) Preview Analysis From date From Time (YYYYMMDD) (HHMMSS) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 35 Chapter 1 - Click in the box Show the results by decreasing percentage if you want to display the causes ranked by decreasing percentage of occurrence. Note: This is optional. Whether the box is selected or not, the causes are displayed. - Click the Preview Analysis button to display the results of the requested repeat analysis. - The Results page is displayed. Note: The repeat analysis data displayed with PC Tool are identical to the data obtained on the Acquisition Workstation for the same analysis period, apart from the display of results for a specific technologist that is available with the PC Tool only. - If you selected a technologist, his/her results are first displayed. Results for technologist Cause Positioning Patient Motion Poor Compression Improper Detector Exposure X-Ray Equipment Failure Equipment Artifacts Blank Image Clinical Artifacts Incorrect View Marker QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Number of Repeats Percentage of Repeats Number of Rejects Percentage of Rejects Total Repeats + Rejects Percentage of Rejects Total Repeats Total Rejects Non-Clinical Repeats+Rejects Total number of exposures Total Repeat+Reject rate Total Repeat rate Clinical Repeat rate Repeat and Reject Analysis Positioning Cause Number of Repeats Percentage of Repeats Number of Rejects Percentage of Rejects Chapter 1 Page no. 36 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist - The table containing the cumulative results of the analysis for all technologists is then displayed, regardless of the selection of the technologist (either all technologists or a specific one). - A list of "other" causes is automatically displayed if any are found in the analysis. Repeat and Reject Analysis Positioning Patient Motion Poor Compression Improper Detector Exposure X-Ray Equipment Failure Equipment Artifacts Blank Image Clinical Artifacts Incorrect View Marker QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Total Repeats + Rejects Total Repeats Total Rejects Non-Clinical Repeats+Rejects Total number of exposures Total Repeat+Reject rate Total Repeat rate Clinical Repeat rate Cause Number of Repeats Percentage of Repeats Number of Rejects Percentage of Rejects Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 37 Chapter 1 - If you requested the display of the causes by decreasing percentage of occurrence, then two tables are displayed: a table showing the list of repeat causes, ranked by decreasing percentage and a table showing the list of reject causes, also ranked by decreasing percentage. Each table shows the most frequent cause of repeat or reject on the first line. Note: If you did not select the decreasing percentage ranking, these tables are not displayed. - To print the results, select Print in the File menu of Internet Explorer. - To return to the Selection page, click the blue arrow at the bottom of the Results page. - To close the tool, close Internet Explorer (select Close in the File menu). Incorrect View Marker QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Total Repeats + Rejects Total Repeats Total Rejects Non-Clinical Repeats+Rejects Total number of exposures Total Repeat+Reject rate Total Repeat rate Clinical Repeat rate Reasons classified by Decreasing Repeat rates Cause Repeat rates Cause Positioning Patient Motion Poor Compression Improper Detector Exposure X-Ray Equipment Failure Equipment Artifacts Blank Image Clinical Artifacts Incorrect View Marker QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Blank Image Positioning Incorrect View Marker Equipment Artifacts X-Ray Equipment Failure Patient Motion Poor Compression Improper Detector Exposure Clinical Artifacts QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Decreasing Reject rates Chapter 1 Page no. 38 Chap 1 QC_tests_technologist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist 10 Compression Force Test Frequency: On first installation and then every six months. See Chapter 3 Guidance section 7 Compression Force Test on page 131 for additional information. Objective: To assure that the mammographic system can provide adequate compression in power driven and Manual modes and that the equipment does not allow too much compression to be applied. Procedure: 1. This test is not specific to digital mammographic systems. Follow accepted mammographic QC procedures to perform this test. See Chapter 3 Guidance section 7 Compression Force Test on page 131. 2. Record the compression force on Chart 5. Record of Checks on page 47. Note: 1 decaNewton (daN) = 2.2 lbs. Action Limit: The maximum compression force for the initial power drive must be between 11 and 20 daN (25 to 45 lb.). Use of Test Results: If these results are not obtained, the source of the problem must be identified, and corrective action taken, before any further mammographic images are acquired using the Senographe Essential FFDM system that failed. See Chapter 3 Guidance section 7 Compression Force Test on page 131. The applicable MQSA Quality Mammography Standard is: 900.12(e)(4)(iii) Semiannual quality control tests. Facilities with screen-film systems shall perform the following quality control tests at least semiannually: (iii) Compression device performance. (A) A compression force of at least 111 newtons (25 pounds) shall be provided. (B) Effective October 28, 2002, the maximum compression force for the initial power drive shall be between 111 newtons (25 pounds) and 200 newtons (45 pounds). Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Radiologic Technologist Chap 1 QC_tests_technologist.fm Page no. 39 Chapter 1 11 Printer To ensure optimal quality of the film printer output, follow the QC program developed by the manufacturer of the device. If the printer is used with a film processor incorporating wet chemistry processing, follow the QC program developed by the manufacturer of the printer. If such documentation is not available, refer to Chapter 3 Guidance section 1 Wet Chemistry Film Processing on page 127. Action Limit: The printer must pass all tests in the manufacturer's QC program. Use of Test Results: If the printer fails a test, the source of the problem must be identified, and corrective action taken, before the printer is used for any further reviews. 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Chap 1 Test_Results_Record_Forms.fm Page no. 41 Chapter 1 Chapter 1 12 Test Results Record Forms Chart 1. Daily and Weekly Tests Notes: Facility: Room: Year Month Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Initials Monitor cleaning (daily) Flat Field test (weekly) Image Quality test (weekly) Viewing Conditions (weekly) Year Month Date 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Initials Monitor cleaning (daily) Flat Field test (weekly) Image Quality test (weekly) Viewing Conditions (weekly) Chapter 1 Page no. 42 Chap 1 Test_Results_Record_Forms.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chart 2. Image Quality and MTF Measurement Test Record (1/3) Use this form to record the results of Flat Field, Phantom Image Quality and CNR and MTF measurement tests: Year Month Date Initials Flat Field Test object used: Mark Pass/Fail brightness non-uniformity High frequency modulation Bad pixels Bad ROI Bad Pixel Map check Note: Not available on all systems SNR non-uniformity Phantom Image Quality Phantom Used: AWS Zoom Window Width (WW) Window Level (WL) No. of fibers No. of specks groups No. of masses Printer No. of fibers No. of speck groups No. of masses Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chap 1 Test_Results_Record_Forms.fm Page no. 43 Chapter 1 Chart 2. Image Quality and MTF Measurement Test Record (2/3) Determination of Operating Level CNR CNR ol (Operating Level CNR) = Average of 5 CNR values, one acquired on each of five consecutive days. Notes: Date CNR Date CNR Date CNR Day 1 Day 2 Day 3 Day 4 Day 5 CNR ol Chapter 1 Page no. 44 Chap 1 Test_Results_Record_Forms.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chart 2. Image Quality and MTF Measurement Test Record (3/3) Notes: Year Month Date Initials MTF + CNR Measurements IQST Device Reference No: MTF parallel at 2 lp/mm MTF parallel at 4 lp/mm MTF perpendicular at 2 lp/mm MTF perpendicular at 4 lp/mm Contrast-to-Noise Ratio (CNR) Change in CNR Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chap 1 Test_Results_Record_Forms.fm Page no. 45 Chapter 1 Chart 3. AOP Mode and SNR Check Records Frequency: Monthly Notes: Room: . . . . . . . . . . . . .. . . . . . . . . . . . . Unit: . . . . . . . . . . . . . . . . . . . . . . . . . Year Month Date Initials AOP Mode Check; mAs or F/n. See Chapter 3 Guidance section 5 AOP Mode and SNR Check on page 129 regarding a method to record these results. 25 mm acrylic 50 mm acrylic 60 mm acrylic AOP Mode Check; SNR values: 25 mm acrylic 50 mm acrylic 60 mm acrylic Chapter 1 Page no. 46 Chap 1 Test_Results_Record_Forms.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chart 4. Visual Checklist Record Frequency: Monthly Pass: P Fail: F Does not Apply: N/A Room: . . . . . . . . . . . . .. . . . . . . . . . . . . Unit: . . . . . . . . . . . . . . . . . . . . . . . . . Year Month Date Initials Gantry: Angulation Indicator Locks (all) Field Light Smoothness of motion Inspect all paddles for cracks Control Panel: Switches/indicators Display Technique charts Other: Cleaning fluid Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chap 1 Test_Results_Record_Forms.fm Page no. 47 Chapter 1 Chart 5. Record of Checks Year Month Date Initials Visual Inspection Repeat Analysis Compression: Auto Manual Radiologist Review Physicist Review Chapter 1 Page no. 48 Chap 1 Test_Results_Record_Forms.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chart 6. Repeat Exposure Record Sheet - Manual Method Use this chart to record all repeated exposures that caused the patient to receive additional dose beyond that of the normal exam. Period covered: Causes: Dates . . . . . . . . . . . . From . . . . . . . . . . . . . To . . . . . . . . . . . . . Study # Causes No. of Times Date Technologist 1 Positioning 5 Incorrect Patient ID 2 Patient Motion 6 X-ray Equipment Failure 3 Exposure too low (noisy image) 7 Blank Image 4 Exposure too high (image saturation) 8 Other Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chap 1 Test_Results_Record_Forms.fm Page no. 49 Chapter 1 Chart 7. Repeat Exposure Analysis - Manual Method Use this chart to analyze all repeated exposures that caused the patient to receive additional dose beyond that of the normal exam. Period covered: Dates . . . . . . . . . . . . From . . . . . . . . . . . . To . . . . . . . . . . . . Cause No. of Repeat Exposures Percentage of repeats by category 1 Positioning 2 Patient Motion 3 Exposure too low (noisy image) 4 Exposure too high (image saturation) 5 Incorrect Patient ID 6 X-ray Equipment Failure 7 Blank Image 8 Other Total of Repeat Exposures (R) Total of All Exposures (T) Repeat Exposure Percentage (R/T x 100) Chapter 1 Page no. 50 Chap 1 Test_Results_Record_Forms.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Chart 8. Repeat and Reject Exposure Analysis - Automated Method Use this chart to record the results of the automated analysis of repeated and rejected exposures. Period covered: Dates . . . . . . . . . . . . From . . . . . . . . . . . . . To . . . . . . . . . . . . . Cause Number of Repeats Percentage of Repeats Number of Rejects Percentage of Rejects Positioning Patient Motion Poor Compression Improper Detector Exposure X-Ray Equipment Failure Equipment Artifacts Blank Image Clinical Artifacts Incorrect View Marker QC, Acceptance Tests, Calibration Interventional Image (e.g., wire loc.) Other Total Repeats + Rejects Total Repeats Total Rejects Non-Clinical Repeats+Rejects Total number of exposures Total Repeat+Reject rate Total Repeat rate Clinical Repeat rate Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Medical Physicist Chap 2 QC_tests_med_physicist.fm Page no. 51 Chapter 2 Chapter 2 QC Tests for the Medical Physicist 1 Introduction The QC tests listed in this section must be performed by the Medical Physicist to ensure that the Senographe Essential provides a high level of mammographic image quality. These tests also form the basis of the mammography equipment evaluation (MEE) that must be performed following the installation of a new mammography system or the repair or replacement of a major component of the system. Additional information regarding MEEs can be found in Chapter 3 Guidance section 15 Summary of Mammography Equipment Evaluation on page 136 and a form to summarize the results of the evaluation is included following that section. All processed images in Medical Application are in logarithmic format. To make measurements on an image acquired in Medical Application, the Raw image (which is in linear format) must be used. In addition to that, a physicist's measurements (e.g. MTF and noise) performed using methods other than those described in this manual can be affected when Fineview processing is applied. When test procedures are run which do not require the capture of X-rays by the detector and require the presence of an object in the X-ray beam (e.g., the measurement of dose using a dosimeter), the detector must be protected by a 3 mm thick (minimum) steel plate or equivalent attenuator. This will prevent any possibility of ghost images 2 Test Sequence The QC tests to be performed by the Medical Physicist are summarized in the following table. Test Description Minimum Frequency Section 1 Flat Field and Phantom IQ Tests Annually Chapter 1 section 4 Flat Field and Phantom IQ Tests, page 16 2 CNR and MTF Measurement Annually Chapter 1 section 5 CNR and MTF Measurement, page 21 3 AOP Mode and SNR Check Annually Chapter 1 section 7 AOP Mode and SNR Check, page 24 4 Artifact Evaluation; Flat Field Uniformity Annually Chapter 2 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity on page 119 5a Collimation Assessment with X-ray cassette * Annually Chapter 2 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette on page 57 5b Collimation Assessment with radiation sensitive strips * Annually Chapter 2 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips on page 63 6a Sub-system MTF Measurement * Annually Chapter 2 Job Card VF-P02A - Sub-System MTF Measurement on page 93 Chapter 2 Page no. 52 Chap 2 QC_tests_med_physicist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Medical Physicist *The physicist may choose any method for which he has the required test equipment. Any local approved method may also be applied. 6b Evaluation of Focal Spot Performance * Annually Chapter 2 Job Card VF-P02 - Evaluation of Focal Spot Performance on page 87 7 Breast Entrance Exposure, Average Glandular Dose, and Reproducibility Annually Chapter 2 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility on page 113 8 Test for flexible paddle deflection in compression Annually Chapter 2 Job Card VF-P05 - Test for flexible paddle deflection in compression on page 125 9 kVp Accuracy and Reproducibility Annually Chapter 3 section 9-1 kVp Accuracy and Reproducibility on page 132 10 Beam Quality Assessment (Halfvalue Layer Measurement) Annually Chapter 3 section 9-2 Beam Quality Assessment on page 132 11 Radiation Output Annually Chapter 3 section 9-3 Mammography Unit Assembly Evaluation and Radiation Output on page 132 12 Mammographic Unit Assembly Evaluation Annually Chapter 3 section 9-3 Mammography Unit Assembly Evaluation and Radiation Output on page 132 Test Description Minimum Frequency Section Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Medical Physicist Chap 2 QC_tests_med_physicist.fm Page no. 53 Chapter 2 The MQSA Quality Mammography Standards applicable to the last four tests are: 900.12(e)(5)(ii) Kilovoltage peak (kVp) accuracy and reproducibility. (A) The kVp shall be accurate within 5 percent of the indicated or selected kVp at: (1) The lowest clinical kVp that can be measured by a kVp test device; (2) The most commonly used clinical kVp; (3) The highest available clinical kVp, and (B) At the most commonly used clinical settings of kVp, the coefficient of variation of reproducibility of the kVp shall be equal to or less than 0.02. 900.12(e)(5)(iv) Beam quality and half-value layer (HVL). The HVL shall meet the specifications of Sec. 1020.30(m)(1) of this chapter for the minimum HVL. These values, extrapolated to the mammographic range, are shown in the table below. Values not shown in the table below may be determined by linear interpolation or extrapolation. 900.12(b)(3) Motion of tube-image receptor assembly. (i) The assembly shall be capable of being fixed in any position where it is designed to operate. Once fixed in any such position, it shall not undergo unintended motion. (ii) The mechanism ensuring compliance with paragraph (b)(3)(i) of this section shall not fail in the event of power interruption. 900.12(e)(5)(x) Radiation output. (A) The system shall be capable of producing a minimum output of 4.5 mGy air kerma per second (513 milliRoentgen (mR) per second) when operating at 28 kVp in the standard mammography (moly/moly) mode at any SID where the system is designed to operate and when measured by a detector with its center located 4.5 cm above the breast support surface with the compression paddle in place between the source and the detector. After October 28, 2002, the system, under the same measuring conditions shall be capable of producing a minimum output of 7.0 mGy air kerma per second (800 mR per second) when operating at 28 kVp in the standard (moly/moly) mammography mode at any SID where the system is designed to operate. (B) The system shall be capable of maintaining the required minimum radiation output averaged over a 3.0 second period. X-ray Tube Voltage (kilovolt peak) and Minimum HVL Designed Operating Range (kV) Measured Operating Voltage (kV) Minimum HVL (millimeters of aluminum) Below 50 20 0.20 25 0.25 30 0.30 Chapter 2 Page no. 54 Chap 2 QC_tests_med_physicist.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 QC Tests for the Medical Physicist 900.12(e)(5)(xi) Decompression. If the system is equipped with a provision for automatic decompression after completion of an exposure or interruption of power to the system, the system shall be tested to confirm that it provides: (A) An override capability to allow maintenance of compression; (B) A continuous display of the override status; and (C) A manual emergency compression release that can be activated in the event of power or automatic release failure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 0. Site and System Summary Chap 2 Chart_0_Site_&_System_Summary.fm Page no. 55 Chapter 2 Chapter 2 Chart 0. Site and System Summary Facility Name: Address: Date of Installation Date of Survey Room ID Mammographic Unit Serial Number Medical Physicist Signature Chapter 2 Page no. 56 Chap 2 Chart_0_Site_&_System_Summary.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 0. Site and System Summary This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette Chap 2 Job_Card_VFP01A.fm Page no. 57 Chapter 2 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette Objective: To assure that there is no excessive extension of the X-ray field beyond the edges of the image receptor, that the X-ray field aligns with the light field, and that the chest wall edge of the compression paddle aligns with the chest wall edge of the image receptor (digital detector). Scope of Measurements: - Collimation During an annual QC survey: 24 cm x 30.7 cm field of view. At system installation and after a major repair, the following fields of view and configurations: 24 cm x 30.7 cm 19 cm x 23 cm, centered 19 cm x 23 cm, offset right 19 cm x 23 cm, offset left - Paddle border Both the Mo and Rh X-ray sources must be tested. Perform the test for the following paddles, if they are used clinically: 24 x 31 paddle Sliding 19 x 23 paddle Flexible 24 x 31 paddle Flexible sliding 19 x 23 paddle Required Test Equipment: - Five coins, four of one size (e.g., pennies or 1-eurocent coins), one of a larger size (e.g., a nickel or a 5-eurocent coin). - An auxiliary image receptor sufficiently large to extend beyond the edges of the 24 cm x 30.7 cm field of view of the primary image receptor, i.e., the digital detector. This may be a 24 cm x 30 cm mammographic cassette with film. The cassette may be either rotated or elevated above the breast support surface in order to image the edges of the x-ray field. This auxiliary image receptor may also be a general radiographic screen-film cassette or a computed radiography (CR) cassette. It is also permissible to use a set of small image receptors positioned at each location where an image of the edge of the field is to be acquired. - Aluminium attenuator plate or Flat Field test object. X-ray to Light Field Test Procedure: 1. Install the Bucky on the image receptor and remove the compression paddle. 2. Set the collimator to the field size and location to be tested. 3. Position the auxiliary image receptor to intercept the four edges of the x-ray field. 4. Turn on the collimator light and place one of each of the four identical smaller coins on the auxiliary image receptor and inside each edge of the light field, with the edge of the coin just touching the edge of the light field. 5. Make an exposure using parameters that will provide usable signals on both the primary and auxiliary image receptors. Chapter 2 Page no. 58 Chap 2 Job_Card_VFP01A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette Note: If it is not possible to obtain usable signals on both image receptors using a single exposure, it will be necessary to acquire the data from two exposures, one with the auxiliary image receptor in the field and a second with it removed. Position each coin at the same relative position along the edge of the light field for each exposure. 6. Perform Steps 1 through 5 for the large focal spot of both the Mo and the Rh anode tracks. 7. If the test is being done following installation of the system or a major repair, perform Steps 1 through 6 for all field sizes and configurations identified in the Scope of Measurements section above. Measurements In this section, the image acquired from the auxiliary image receptor will be referred to as the film. From the film and AWS (Acquisition Workstation), measure the appropriate dimensions for the following tests. Use the Segment tool on the AWS for measurements on the primary image receptor. Measurements both from the film and the AWS must be scaled to the primary image receptor plane. 1. From the film image, determine the deviations Y f , between the x-ray field and the light field at each edge of the field. If the coin is only partially visible, as shown in Illustration 1, Y f
can be determined as Y f = W f P f Eq. 1 where W f = the diameter of the coin as measured from the film and P f = the partial diameter of the coin measured perpendicular to the edge of the x-ray field. 2. From the AWS, use the Segment tool to determine the deviations, X, between the edge of the x-ray field and the edge of the image receptor at each edge of the field. Note: The reference plane of the Segment tool is located 2 cm above the breast support surface. Hence, to scale Segment tool measurements to the image receptor plane, apply the following scaling: X = X M Eq. 2 where X = the measurement referenced to the image receptor plane, X = the measurement made using the Segment tool, M = 1.063 Edge of light field Edge of X-ray field Illustration 1 Image on film; coin at edge of light field Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette Chap 2 Job_Card_VFP01A.fm Page no. 59 Chapter 2 When the edge of the x-ray field is visible in the digital image, the distance between the edge of the x- ray field and the edge of the image receptor is measured directly using the Segment tool and application of the magnification factor, M, as indicated in Eq. 2. In other cases, the deviation between the x-ray field and the image receptor, can be determined as follows: a. If the light field is outside of the x-ray field and the x-ray field is outside the image receptor, as shown in Illustration 2, then X = X M = (W d P d Y d ) M Eq. 3 where W d = the diameter of the coin measured in the digital image, P d = the partial diameter of the coin measured perpendicular to the edge of the image receptor, and Y d = the deviation between the light field and the x-ray field scaled to the Segment tool reference plane. Y d is calculated as Y d = Y f x (W d / W f ) Eq. 4 b. If the x-ray field is outside of the light field and both are outside the image receptor, as shown in Illustration 3, then X = (W d P d + Y d ) M Eq. 5 c. If the x-ray field is outside of the light field, and the edge of the image receptor is between the two, as shown in Illustration 4, then X = (Y d F) M Eq. 6 where F = the measured perpendicular distance from the image receptor edge to the coin image edge in the digital image. 3. Convert all deviations Y f measured in the film plane to deviations in the image receptor plane using Eq. 4 and the scaling factor M. Edge of light field Edge of X-ray field Edge of detector Illustration 2 Image on AWS; coin at edge of light field, light field outside X-ray field Edge of light field Edge of X-ray field Edge of detector Illustration 3 Image on AWS; coin at edge of light field, X-ray field outside light field Chapter 2 Page no. 60 Chap 2 Job_Card_VFP01A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette 4. Enter measured deviations between the Xray field and light field on the data form as follows: - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. 5. Check that the chest wall edge of the x-ray field extends to the chest wall edge of the image receptor. Compression Paddle Chest Wall Test Procedure: 1. Install the Bucky on the image receptor. 2. Place the aluminium attenuator plate or the Flat Field test object on the surface of the Bucky. Each side of the plate must extend about 4 cm beyond each edge of the light field. Note: The x-ray doses used in this procedure can saturate the image receptor if the aluminium attenuator (or the Flat Field test object), is not used and not correctly positioned. If the attenuator does not completely cover the field of view, a ghost image may be imposed on the digital image receptor at the edge of the attenuator. Ensure that the entire field of view of the light field is covered by the attenuator. 3. Refer to Compression Paddle Chest Wall Test part of the Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips. Measurements: Refer to Compression Paddle (Coin) Measurements part of the Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips. Edge of light field Edge of X-ray field Edge of detector Illustration 4 Image on AWS; coin at edge of light field, X-ray field outside light field Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette Chap 2 Job_Card_VFP01A.fm Page no. 61 Chapter 2 Action Limit: - Congruence of the light field with the X-ray field must be such that the total misalignment (sum of misalignments on opposite sides) is within 2% of the SID. - The X-ray field must extend at least to the edge of the active image receptor at the chest wall. The X- ray field must not extend beyond any edge of the image receptor by more than quoted in Table 1, where X is the deviation between the X-ray field and the edge of the active image receptor. Table 1 X-ray Field - Image Receptor Action Limits - The chest wall edge of the compression paddle must be aligned just beyond the chest wall edge of the image receptor such that the chest wall edge of the compression paddle does not appear in the mammogram. In addition, the chest wall edge of the compression paddle must not extend beyond the chest wall edge of the image receptor by more than 1% of the SID. Use of Test Results: If the Action Limits are not met, the source of the problem shall be identified and corrective actions shall be taken within 30 days of the test date. See Chapter 3 Guidance section 10 Collimation Assessment on page 132. Edge Action Limit Left If X is below 10 mm, the test has passed, and no further action required. If X is between 10 mm and 13.2 mm, the test may have failed. Consult the physicist regarding the local requirements, and if the test has failed contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. If X is above 13.2 mm, the test has failed. Contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. Right Anterior Posterior (chest wall) If X is between 4 mm and 7 mm, the test has passed, and no further action required. If X is between 0 mm and 4 mm or between 7 mm and 10 mm, the test may have failed. Consult the physicist regarding the local requirements, and if the test has failed contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. If X is above 10 mm, the test has failed. Contact your Field Engineer to re- calibrate the Collimator, then re-perform the Collimator Checks. Chapter 2 Page no. 62 Chap 2 Job_Card_VFP01A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01A - Collimation Assessment with X-Ray Cassette The applicable MQSA Quality Mammography Standard is: 900.12(e)(5)(vii) X-ray field/light field/image receptor/compression paddle alignment. (A) All systems shall have beam-limiting devices that allow the entire chest wall edge of the X-ray field to extend to the chest wall edge of the image receptor and provide means to assure that the X-ray field does not extend beyond any edge of the image receptor by more than 2 percent of the SID. (B) If a light field that passes through the X-ray beam limitation device is provided, it shall be aligned with the X-ray field so that the total of any misalignment of the edges of the light field and the X-ray field along either the length or the width of the visually defined field at the plane of the breast support surface shall not exceed 2 percent of the SID. (C) The chest wall edge of the compression paddle shall not extend beyond the chest wall edge of the image receptor by more than one percent of the SID when tested with the compression paddle placed above the breast support surface at a distance equivalent to standard breast thickness. The shadow of the vertical edge of the compression paddle shall not be visible on the image. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 63 Chapter 2 Chapter 2 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Objective: To assure that: - there is no excessive extension of the X-ray field beyond the edges of the image receptor, - the X-ray field aligns with the light field, - the chest wall edge of the compression paddle aligns with the chest wall edge of the image receptor (digital detector). Scope of Measurements: During an annual QC survey: 24 cm x 30.7 cm field of view. At system installation and after a major repair, the following fields of view and configurations: 24 cm x 30.7 cm 19 cm x 23 cm, centered 19 cm x 23 cm, offset right 19 cm x 23 cm, offset left Required Test Equipment: - One coin (e.g., a nickel, or a 5-Eurocent coin). - 4 strips of GAFCHROMIC XR-M film for each FOV and track tested. - Aluminium attenuator plate. Exposures: Mo/Mo and Rh/Rh X-ray to Light Field Test Both the Mo and Rh X-ray sources must be tested. Therefore, perform steps 1 through 7 for the large focal spot for both the Mo and the Rh anode tracks. If the test is being done following installation of the system or a major repair, perform steps 1 through 7 for all field sizes and configurations identified in the Scope of Measurements: section above for both the Mo and the Rh anode tracks. 1. Install the Bucky on the image receptor. 2. Place the aluminium attenuator on the surface of the Bucky. Each side of the aluminium attenuator must extend about 4 cm beyond each edge of the light field. Note: The x-ray doses used in this procedure can saturate the image receptor if the aluminium attenuator is not used and not correctly positioned. If the aluminium attenuator does not completely cover the field of view, a ghost image may be imposed on the digital image receptor at the edge of the aluminium attenuator. Ensure that the entire field of view of the light field is covered by the aluminium attenuator. Note: To achieve better contrast of the edge of the light field, it is recommended to tape a sheet of white paper to the top of the aluminum attenuator. 3. Set the collimator to the field size and location to be tested. Chapter 2 Page no. 64 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 4. Label each of the four XR-M film strips corresponding to the anode track (Mo or Rh), and the field edge (CW - chest wall, Ant - anterior, L - left, R - right) being tested. In the example below, the XR-M film strip is labelled for the Mo anode track, and the chest wall edge. 5. Turn on the collimator light. Place each of the corresponding XR-M film strips near the center of each light field. Illustration 1 Positioning of XR-M Film Strips Anode track being tested : Mo or Rh Light field edge being tested : Right (R), Left (L), anterior (Ant), or chest wall (CW) X-RM Film A Coin Coin attached to chest wall of compression paddle (not shown) Chest wall edge of light field Left edge of light field Anterior edge of light field Right edge of light field X-RM Film D X - R M
F i l m
B X - R M
F i l m
C Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 65 Chapter 2 Note: To achieve better contrast of the edge of the light field, it is recommended to place the XR-M film strips with the white side facing the collimator, orange side down. Note: When positioning the XR-M film strips, you must ensure that positive markers (+1, +2, and +3) are inside the light field as shown above. 6. When placing each of the XR-M film strips, ensure that edge of the light field is aligned with the X marker on the XR-M film strip. Note: When aligning the light field with the X marker on the XR-M film strip, to ensure the light edges are sharply resolved light, it is recommended that you perform this aligment with the room lights off. Sheet of paper Collimator light field XR-M film strip placed white side up Aluminium attenuator plate Edge of light field There may be a shadow towards the edge of the light field. Ensure the X marker is on the outer edge of the shadow. Outer edge Inner edge Chapter 2 Page no. 66 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Note: At the anterior edge of the light field (opposite the chestwall edge), the Bucky cover might obstruct the XR-M, such that it cannot lie flat with the surface of the aluminium attenuator. If there is obstruction from the Bucky, align the "-2" reference line of the XR-M film (instead of the "X" reference line) so that the XR-M film avoids the obstruction and can lie flat with the surface of the aluminium attenuator. 7. Make a manual exposure using the following parameters: track/filter combination: either Mo/Mo or Rh/Rh 30 kVp 250 mAs Bucky cover can obstruct the XR-M film such that it does not lie flat against the aluminium attenuator. Anterior edge of light field Repositioning the XR-M film to use the "-2" reference instead of the "X" reference can avoid the obstruction from the Bucky cover. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 67 Chapter 2 Compression Paddle Chest Wall Test Both the Mo and Rh X-ray sources must be tested. Perform the steps 1 through 3 for the following paddles, if they are used clinically: 24 x 31 paddle Sliding 19 x 23 paddle Flexible 24 x 31 paddle Flexible sliding 19 x 23 paddle 1. Tape the coin to the underside of the compression paddle as illustrated below. The coin must be as close as possible to the tangent of the inner, vertical surface of the compression paddle at the chest wall edge. Position the coin near the center of the chest wall edge. 2. Insert the compression paddle and position it approximately 4.2 cm from the Breast Support. 3. Make a manual exposure using the following parameters: track/filter combination: either Mo/Mo or Rh/Rh 30 kVp 250 mAs Measurements X-ray Field Passing All Four Edges From the digital image on the AWS determine, whether each of the four edges of the X-ray field are outside of the edge of the image receptor. That is, you should not be able to see any of the four edges of the X-ray field in the digital image. If you can see any of the four edges of the X-ray field in the digital image, there is a problem with the Collimator blade alignment. In this case, you must re-calibrate the Collimator. Once you have re-calibrated the Collimator you must take new exposures before you continue with the measurements described in XR-M Film Measurements and Compression Paddle (Coin) Measurements. If you cannot see any of the four edges of the X-ray field in the digital image, the Collimator blades are aligned correctly. You can continue with the measurements described in XR-M Film Measurements and Compression Paddle (Coin) Measurements. Compression Paddle outer vertical surface Compression Paddle inner vertical surface Compression Paddle inner vertical surface Coin The large coin must be as close as possible, but inside of the tangent to the inner vertical suface Chest Wall Edge Coin Chest Wall Edge Compression Paddle Side View Compression Paddle Plan View Chapter 2 Page no. 68 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips XR-M Film Measurements From the film and AWS (Acquisition Workstation) digital image, you must make various measurements as described below. Use the Segment tool on the AWS for measurements on the image receptor. Measurements both from the film and the AWS must be scaled to the image receptor plane. You must follow the measurements and calculations described below for each edge of the field (each XR-M film strip A, B, C and D), and complete the following tables. In the tables below, items in bold italics are measured/determined and items in bold are calculated. 24 cm x 30.7 cm FOV results Mo/Mo 24 cm x 30.7 cm FOV results Rh/Rh 19 cm x 23 cm centered FOV results Mo/Mo Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 69 Chapter 2 19 cm x 23 cm centered FOV results Rh/Rh 19 cm x 23 cm offset-left FOV results Mo/Mo 19 cm x 23 cm offset-left FOV results Rh/Rh 19 cm x 23 cm offset-right FOV results Mo/Mo Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Chapter 2 Page no. 70 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 19 cm x 23 cm offset-right FOV results Rh/Rh 1. In order to complete the tables above and the tables in the Action limits section, perform the following steps for each edge of the field (each XR-M film strip) for both Mo and Rh anode tracks, and if necessary for all field offset positions. Directly from the XR-M film strip, determine the deviation Y f , between the X-ray field and the light field in the plane of the film. Y f can be directly read from the incorprated ruler on the XR-M film strip. In the example illustration below, Y f is 5 mm. Note: On the XR-M film strip, the distance between the major "teeth" of the saw tooth pattern is 10 mm, and the tooth-to-tooth distance is 2 mm. Insert the measured value of Y f in the tables above and in the tables for action limit 1 on page 75. Step 1 Step 2 Step 3 Step 4 Y f D Z f = D - Y f Global Scaling Factor (S) = 1.063 x d (in mm) / 10 Z i (S x Z f ) Left edge (Film A) Anterior edge (Film B) CW edge (Film C) Right edge (Film D) Edge of light field (in the plane of the film) Edge of X-ray field (in the plane of the film) Y f = deviation between X-ray field and light field in the plane of the film Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 71 Chapter 2 2. Determine the deviation Z f , between the X-ray field from the edge of the detector in the plane of the film. To determine the deviation Z f , proceed as follows: a. From the digital image in the AWS, view the digital image of the XR-M film strip, and determine the location of the detector edge (D) based on the extent of the XR-M film strip imaged. In the example image below, the edge of the detector (D) is 9 mm from the "X" reference marker. Insert the determined value of D in the tables above. b. Knowing the location of the x-ray field edge from step 1 above (i.e. Y f ), determine the deviation of the x-ray field edge from the detector edge in the plane of the film (Z f ) by using the following equation: Z f = D - Y f Eq. 1 For this example, the edge of the x-ray field is 5 mm from the "X" and the edge of the detector is 9 mm from the "X", and hence, Z f is 4 mm. The relative positions of the edges of the light field, x- ray field, and detector become more apparent when the x-ray image is scaled and superimposed on the film strip as illustrated in the example below. Insert the calculated value of Z f in the tables above. Edge of detector Edge of light field (in the plane of the film) Edge of X-ray field (in the plane of the film) Y f = deviation between X-ray field and light field in the plane of the film Edge of detector Z f = deviation between X-ray field and detector in the plane of the film Chapter 2 Page no. 72 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 3. Determine the global scaling factor (S) that you need to apply to Z f as follows: a. From the digital image in the AWS, use the Segment tool of the Viewer to measure the distance between two contiguous major reference markers. b. Knowing that the distance between two contiguous major markers is 10 mm, calculate the global scaling factor (S) using the following equation: S = 1.063 x d / 10 Eq. 2 Note: Because the reference plane of the Segment tool is 2 cm above the Breast Support surface, a magnification factor 1.063 is applied to value of S as shown in the Eq 2 above. Note: You only need to calculate the global scaling factor (S) once for one of the field edges. You can globally apply the determined global scaling factor (S) to each of the field edges. Insert the determined global scaling factor (S) in the tables above. 4. Finally, determine the deviation of the x-ray field edge from the detector edge in the plane of the image (Z i ) by using the following equation: Z i = S x Z f Eq. 3 Insert the calculated value of Z i in the table above and in the tables for action limit 2 on page 80. Compression Paddle (Coin) Measurements You must follow the measurements and calculations described below for the coin with the paddles used clinically, and complete the relevant tables described below. In these tables, items in bold italics are measured and items in bold are calculated. Regardless of whether you are doing a system installation, major repair, or an annual QC Survey, you only have to perform these measurements and complete the table for the 24 cm x 30.7 cm FOV or 19 cm x 23 cm FOV. Mo/Mo - 24 x 31 paddle Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Measure distance (d) in mm between two contiguous major markers Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 73 Chapter 2 Mo/Mo - Sliding 19 x 23 paddle Mo/Mo - Flexible 24 x 31 paddle Mo/Mo - Flexible sliding 19 x 23 paddle Rh/Rh - 24 x 31 paddle Rh/Rh - Sliding 19 x 23 paddle Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Chapter 2 Page no. 74 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Rh/Rh - Flexible 24 x 31 paddle Rh/Rh - Flexible sliding 19 x 23 paddle 1. There are two possible geometric cases for the coin. Case 1: The outer edge of the coin on the compression paddle goes past the detector edge. Part of the coin is therefore outside of the detector. Case 2: The outer edge of the coin on the compression paddle does not go past the detector edge. All of the coin is therefore in the detector. Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Step 1 & 2 Step 3 Step 4 Step 5 Geometric Case W d P d Z d Z d (1.063 x Z d ) Coin (Bottom Edge) (Chest Wall) Edge of x-ray field Edge of detector Edge of x-ray field Edge of detector Case 1 Case 2 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 75 Chapter 2 2. Examine the image and determine the geometric case. If all of the coin is in the detector (case 2), there is a problem with the position of the compression paddle relative to the chest wall edge of the detector. Either change the compression paddle or make adjustments to it, then make another exposure and return to step 1 in this section. If part of the coin passes past the edge of the detector (case 1), there is no problem with the position of the compression paddle relative to the chest wall edge of the detector. Continue with the measurements in this procedure to determine whether the edge of the compression paddle passes. 3. From the digital image in the AWS, use the Segment tool to measure the following in the plane of the segment tool: diameter of the coin (W d ) partial diameter of the coin perpendicular to the edge of the image receptor (P d ) Insert the measured values of W d and P d in the table above. 4. From the measured values of W d and P d , calculate the deviation (Z d ) between the alignment of the edge of the compression paddle and the edge of the image receptor (in the plane of the segment tool), from the following equation: Z d = (W d P d ) Eq 6 5. Because the reference plane of the Segment tool is 2 cm above the Breast Support surface, use the following equation to scale the calculated deviation (Z d ) in the plane of the segment tool to the plane of the image receptor: Z d = Z d M Eq. 7 where: Z d = the calculation referenced to the image receptor plane. Z d = the calculation made using the Segment tool. M = 1.063. Insert the calculated value of Z d in the tables above and in the tables for action limit 3 on page 82. Action Limit The results from the Mo/Mo and Rh/Rh tests above must adhere to the following three action limits: 1. Congruence of the light field with the X-ray field must be such that the total misalignment (sum of misalignments on opposite sides) is within 2% of the SID. As required by 21 CFR chapter I, Subchapter J, 1020.31(d)(2)(i). Enter measured deviations between the X-ray field and light field on the data form as follows (i.e. Y f
for each XR-M film strip determined in step 1 of XR-M Film Measurements) (see illustration 1 on page 64 for film positions): If both | Y d A| + |Y d D| and | Y d B| + |Y d C| are less than 13.2 mm then this action limit has passed. If either | Y d A| + |Y d D| or | Y d B| + |Y d C| is more than or equal to 13.2 mm then this action limit has failed. Note: If either | Y d A| + |Y d D| or | Y d B| + |Y d C| is more than or equal to 10 mm, it is recommended to adjust the position of the Collimator Lamp ( call your FE for help ), then re-perform the Collimator Checks. Chapter 2 Page no. 76 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 24 cm x 30.7 cm FOV Mo/Mo - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. 24 cm x 30.7 cm FOV Rh/Rh - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 77 Chapter 2 19 cm x 23 cm centered FOV Mo/Mo - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. 19 cm x 23 cm centered FOV Rh/Rh - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Chapter 2 Page no. 78 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 19 cm x 23 cm offset-left FOV Mo/Mo - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. 19 cm x 23 cm offset-left FOV Rh/Rh - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 79 Chapter 2 19 cm x 23 cm offset-right FOV Mo/Mo - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. 19 cm x 23 cm offset-right FOV Rh/Rh - The magnitudes of deviations at the left edge and right edge (ignoring + or signs) are entered on the data form and added together. - Similarly, the deviations at the anterior and posterior (chest wall) edges are entered (without regard to sign) and the magnitudes added together. Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Film Edge Y f | Y f A| + |Y f D| Is | Y f A| + |Y f D| less than 13.2 mm? A Left D Right Film Edge Y f | Y f B| + |Y f C| Is | Y f B| + |Y f C| less than 13.2 mm? B Anterior C Posterior (chest wall) Chapter 2 Page no. 80 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 2. The X-ray field must extend beyond all edges of the active image receptor. The X-ray field must not extend beyond any edge of the image receptor by more than that quoted in Table 1. For each of the exposure configurations below, enter the determined deviations between the edge of the X-ray field and the edge of the image receptor in the plane of the image receptor for each of the four XR-M film strips. That is, the value Z i for each XR-M film strip determined in step 4 of XR-M Film Measurements. For each of the exposure configurations below, determine whether the action limit for each edge has passed or failed according to the table below (see illustration 1 on page 64 for film positions): Table 1 X-ray Field - Image Receptor Action Limits 24 cm x 30.7 cm FOV Mo/Mo Film Edge Action Limit A Left If Z i is below 10 mm, the test has passed, and no further action required. If Z i is between 10 mm and 13.2 mm, the test may have failed. Consult the physicist regarding the local requirements, and if the test has failed contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. If Z i is above 13.2 mm, the test has failed. Contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. D Right B Anterior C Posterior (chest wall) If Z i is between 4 mm and 7 mm, the test has passed, and no further action required. If Z i is between 0 mm and 4 mm or between 7 mm and 10 mm, the test may have failed. Consult the physicist regarding the local requirements, and if the test has failed contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. If Z i is above 10 mm, the test has failed. Contact your Field Engineer to re-calibrate the Collimator, then re-perform the Collimator Checks. Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 81 Chapter 2 24 cm x 30.7 cm FOV Rh/Rh 19 cm x 23 cm centered FOV Mo/Mo 19 cm x 23 cm centered FOV Rh/Rh 19 cm x 23 cm offset-left FOV Mo/Mo 19 cm x 23 cm offset-left FOV Rh/Rh Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Chapter 2 Page no. 82 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 19 cm x 23 cm offset-right FOV Mo/Mo 19 cm x 23 cm offset-right FOV Rh/Rh 3. The chest wall edge of the compression paddle must be aligned just beyond the chest wall edge of the image receptor, such that the chest wall edge of the compression paddle does not appear in the mammogram. In addition, the chest wall edge of the compression paddle must not extend beyond the chest wall edge of the image receptor by more than 1% of the SID. Enter the determined deviation between the alignment of the edge of the compression paddle and the edge of the image receptor in the plane of the image receptor for the coin. That is, the value Z d
determined in step 5 of Compression Paddle (Coin) Measurements with the paddles used clinically. If the value of Z d for the coin is less than 6.6 mm then this action limit has passed. If the value of Z d for the coin is more than or equal to 6.6 mm then this action limit has failed. Complete only the required tables (paddles used clinically): Mo/Mo - 24 x 31 paddle Mo/Mo - Sliding 19 x 23 paddle Mo/Mo - Flexible 24 x 31 paddle Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Film Edge Z i Pass / Fail / Comment (see Table 1) A Left D Right B Anterior C Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips Chap 2 Job_Card_VFP01B.fm Page no. 83 Chapter 2 Mo/Mo - Flexible sliding 19 x 23 paddle Rh/Rh - 24 x 31 paddle Rh/Rh - Sliding 19 x 23 paddle Rh/Rh - Flexible 24 x 31 paddle Rh/Rh - Flexible sliding 19 x 23 paddle If any of these Action Limits are exceeded, the source of the problem must be identified, and corrective actions must be taken. If necessary, call your FE for help if any of these Action Limits are exceeded. Use of Test Results: If the Action Limits are not met, the source of the problem must be identified and corrective actions must be taken within 30 days of the test date. See Chapter 3 Guidance section 10 Collimation Assessment on page 132. Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Edge Z d Is the value of Z d less than 6.6 mm? Posterior (chest wall) Chapter 2 Page no. 84 Chap 2 Job_Card_VFP01B.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips The applicable MQSA Quality Mammography Standard is: 900.12(e)(5)(vii) X-ray field/light field/image receptor/compression paddle alignment. (A) All systems shall have beam-limiting devices that allow the entire chest wall edge of the X-ray field to extend to the chest wall edge of the image receptor and provide means to assure that the X-ray field does not extend beyond any edge of the image receptor by more than 2 percent of the SID. (B) If a light field that passes through the X-ray beam limitation device is provided, it shall be aligned with the X-ray field so that the total of any misalignment of the edges of the light field and the X-ray field along either the length or the width of the visually defined field at the plane of the breast support surface shall not exceed 2 percent of the SID. (C) The chest wall edge of the compression paddle shall not extend beyond the chest wall edge of the image receptor by more than one percent of the SID when tested with the compression paddle placed above the breast support surface at a distance equivalent to standard breast thickness. The shadow of the vertical edge of the compression paddle shall not be visible on the image. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 1 - Collimation Assessment Chap 2 Chart 1 - Collimation Assessment.fm Page no. 85 Chapter 2 Chapter 2 Chart 1 - Collimation Assessment Date: . . . . . . . . . . . . . . . . . . . . . . . . . . Source to Image Receptor Distance (SID): . . . . . . . . . . . . . . . . . . . . . . . . . Deviation between X-ray field and light field: Field of View X-ray Tube Target Left Edge Deviation Right Edge Deviation Sum of magnitudes of left and right edge deviations Sum as % of SID Anterior Edge Deviation Chest Wall Edge Deviation Sum of magnitudes of anterior and chest wall edge deviations Sum as % of SID Use of Test Results: If the sum of left plus right deviations or anterior plus chest wall edge deviations exceeds 2% of the SID, the source of the problem must be identified and corrective action taken within 30 days of the test date. Deviation between X-ray field and image receptor Field of View X-ray Tube Target Left Edge Deviation (absolute) Left Edge Deviation (% of SID) Right Edge Deviation (absolute) Right Edge Deviation (% of SID) Anterior Edge Deviation (absolute) Anterior Edge Deviation (% of SID) Chest Wall Edge Deviation (absolute) Chest Wall Edge Deviation (% of SID) Chest wall edge of the field extends to the chest wall edge of the image receptor (yes/no) Use of Test Results: If the entire chest wall edge of the x-ray field does not extend to the chest wall edge of the image receptor, or if the X-ray field extends beyond the image receptor by more than that quoted in the table 1 X-ray Field - Image Receptor Action Limits, page 80, the source of the problem must be identified and corrective action taken within 30 days of the test date. Chapter 2 Page no. 86 Chap 2 Chart 1 - Collimation Assessment.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 1 - Collimation Assessment Alignment of chest wall edges of compression paddle and image receptor X-ray Tube Target Paddle Size Difference between compression paddle edge and image receptor edge at chest wall (absolute) Difference (% of SID), edge visible (Yes/No) Paddle Size Difference between compression paddle edge and image receptor edge at chest wall (absolute) Difference (% of SID), edge visible (Yes/No) Paddle Size Difference between compression paddle edge and image receptor edge at chest wall (absolute) Difference (% of SID), edge visible (Yes/No) Paddle Size Difference between compression paddle edge and image receptor edge at chest wall (absolute) Difference (% of SID), edge visible (Yes/No) Use of Test Results: If the chest wall edge of the compression paddle is within the image receptor or projects beyond the chest wall edge of the image receptor by more than 1% of SID, the source of the problem must be identified and corrective action taken within 30 days of the test date. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02 - Evaluation of Focal Spot Performance Chap 2 Job_Card_VFP02.fm Page no. 87 Chapter 2 Chapter 2 Job Card VF-P02 - Evaluation of Focal Spot Performance Objective: To evaluate focal spot performance by using a high-contrast resolution pattern. Note: The physicist may substitute Job Card VF-P02A - Sub-System MTF Measurement on page 93 for the two tests CNR and MTF Measurement on page 21 and Job Card VF-P02 - Evaluation of Focal Spot Performance on page 87. Required Test Equipment: - High-contrast resolution bar pattern for use in mammographic system evaluation providing spatial frequencies up to 16 lp/mm and preferably 20 lp/mm. The thickness of the pattern shall not exceed 0.025 mm. - A film-based image receptor, for example, either a direct exposure, ready-pack film (such as Kodak XTL-2) or a loaded mammographic screen-film cassette for which the screen-film combination does not limit the measured resolution (this can be tested by imaging the test pattern in contact with the cassette). - Acrylic block, 4.5 cm thick and approximately 10 cm x 10 cm in cross-section. - Lead marker to designate the anode-cathode axis direction. - An optical magnifier providing 10x to 30x magnification. Procedure: Contact configuration 1. Remove the compression paddle. 2. Place the film-based image receptor on top of the breast support surface. 3. Place the 4.5 cm block on the film-based receptor and place the bar pattern on top of the block. Place the lead marker on the receptor to indicate the direction of the anode-cathode axis. 4. To measure the limiting resolution of the focal spot width: - Orient the patterns bars parallel to the anode-cathode axis. - Position the edge of the pattern within 1 cm of the chest wall edge of the digital image receptor, centered laterally. Note: It is important that the test pattern be positioned in a reproducible manner. See Chapter 3 Guidance section 11 Evaluation of Focal Spot Performance on page 132. 5. Select the manual exposure control mode, molybdenum target material, large focal spot, and the kVp, mAs, and filter material used for imaging an average breast during normal mammography. 6. Make an exposure. 7. Remove the film-based image receptor, replace it with an unexposed one, and reposition the acrylic block and bar pattern. 8. To measure the limiting resolution of the focal spot length: - Orient the patterns bars perpendicular to the anode-cathode axis with the lowest frequency pattern nearest the chest wall edge of the digital image receptor. - Position the edge of the pattern within 1 cm of the chest wall edge of the digital image receptor, centered laterally. 9. Make a second exposure. 10. Repeat steps 1 through 9 for the rhodium target material using the same geometry. Chapter 2 Page no. 88 Chap 2 Job_Card_VFP02.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02 - Evaluation of Focal Spot Performance Magnification configuration If the small focal spot is used clinically, the following steps 11 through 13 must be performed to test the magnification configuration. As the action limit described below is applicable with 1.5x magnification stand, use this magnification stand to perform this procedure even if the 1.8x magnification stand is used clinically. The test result is valid whatever the magnification stand used clinically. 11. Evaluate the molybdenum and rhodium targets of the small focal spot in magnification configuration with the resolution pattern positioned 4.5 cm above the magnification breast support and a magnification factor of 1.5x: a. Remove the Bucky and install the 1.5x magnification stand. b. Place the 4.5 cm block on the breast support surface of the magnification stand and place the bar pattern on top of the block. c. Place the film-based image receptor on the detector cover. If the film-based image receptor cannot be placed on the detector cover, for example because of interference with the structure of the magnification stand, the film-based image receptor may be supported with its image receptor plane parallel to the plane of the detector cover and at a distance up to 45 mm above the detector cover. For example, a mammographic screen-film cassette may be supported by three of the 10 mm plates used for the AOP Mode and SNR Check. d. Repeat steps 4 through 9 for each target material. Note that it will not be necessary to reposition the acrylic block as stated in step 7. 12. Under masked viewbox conditions, view the high-contrast resolution pattern images with 10x to 30x magnification. 13. Note the highest frequency pattern whose lines are distinctly visible throughout at least half of the bar length and record the highest frequency visible for each test image. Action Limit: In the contact configuration or the 1.5x magnification configuration, measurements made with the bars parallel to the anode-cathode axis must be at least 13 lp/mm; measurements with the bars perpendicular to the anode-cathode axis must be at least 11 lp/mm. Use of Test Results: If the above specifications are not met, the source of the problem must be identified and corrective action taken within 30 days of the test date. Refer to Chapter 3 Guidance section 11 Evaluation of Focal Spot Performance on page 132 for additional information Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02 - Evaluation of Focal Spot Performance Chap 2 Job_Card_VFP02.fm Page no. 89 Chapter 2 The applicable MQSA Quality Mammography Standard is: 900.12(e)(5)(iii) Focal spot condition. Until October 28, 2002, focal spot condition shall be evaluated either by determining system resolution or by measuring focal spot dimensions. After October 28, 2002, facilities shall evaluate focal spot condition only by determining the system resolution. (A) System Resolution. (1) Each X-ray system used for mammography, in combination with the mammography screen-film combination used in the facility, shall provide a minimum resolution of 11 Cycles/millimeters (mm) (line-pairs/mm) when a high contrast resolution bar test pattern is oriented with the bars perpendicular to the anode-cathode axis, and a minimum resolution of 13 line-pairs/mm when the bars are parallel to that axis. (2) The bar pattern shall be placed 4.5 cm above the breast support surface, centered with respect to the chest wall edge of the image receptor, and with the edge of the pattern within 1 cm of the chest wall edge of the image receptor. (3) When more than one target material is provided, the measurement in paragraph (e)(5)(iii)(A) of this section shall be made using the appropriate focal spot for each target material. (4) When more than one SID is provided, the test shall be performed at SID most commonly used clinically. (5) Test kVp shall be set at the value used clinically by the facility for a standard breast and shall be performed in the AEC mode, if available. If necessary, a suitable absorber may be placed in the beam to increase exposure times. The screen-film cassette combination used by the facility shall be used to test for this requirement and shall be placed in the normal location used for clinical procedures. Chapter 2 Page no. 90 Chap 2 Job_Card_VFP02.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02 - Evaluation of Focal Spot Performance This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 2 - Evaluation of Focal Spot Performance Chap 2 Chart 2 - Focal Spot Performance.fm Page no. 91 Chapter 2 Chapter 2 Chart 2 - Evaluation of Focal Spot Performance High contrast resolution pattern measurement of focal spot limiting resolution. Resolution Test Tool: . . . . . . . . . . . . . . . . . . . . . . . . . Patient ID #: . . . . . . . . . . . . . . . . . . . . . . . . . Nominal Focal Spot Size, f nom Anode track Nominal kVp setting mAs Magnification Factor 1 (contact) Limiting Resolution Bars parallel to AC axis Bars perpendicular to AC axis Action Limit: In the contact configuration or the 1.5x magnification configuration, measurements made with the bars parallel to the anode-cathode axis must be at least 13 lp/mm; measurements with the bars perpendicular to the anode- cathode axis must be at least 11 lp/mm. Use of Test Results: If the above specifications are not met, the source of the problem must be identified and corrective action taken within 30 days of the test date. Chapter 2 Page no. 92 Chap 2 Chart 2 - Focal Spot Performance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 2 - Evaluation of Focal Spot Performance This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 93 Chapter 2 Chapter 2 Job Card VF-P02A - Sub-System MTF Measurement Objective: The test is designed to ensure that contrast is adequate over the 0 to 5 lp/mm spatial frequency range at the detector plane, by obtaining an estimate of the Sub-System MTF (Modulation Transfer Function): - at object frequencies of 2.09 and 3.93 lp/mm for the large focal spot, - and, if the small focal spot is used clinically, at object frequencies of 5 and 8 lp/mm for the small focal spot. The result obtained is a measure of the MTF of the sub-system consisting of the x-ray tube focal spot and the detector. CAUTION To perform this measurement it is necessary that the image processing algorithm FineView be disabled. If the FineView algorithm is normally enabled during clinical use, you must re-enable FineView at the completion of this measurement. Note: This procedure provides a measurement of the sub-system resolution of the FFDM image acquisition system without the need for a film. When performing QC survey or mammography equipment evaluation, the physicist may use this procedure instead of the following two tests: - Chapter 1 QC Tests for the Radiologic Technologist, section 5 CNR and MTF Measurement, "MTF measurement" part - Chapter 2 , Chapter Job Card VF-P02 - Evaluation of Focal Spot Performance. Equipment required: - Resolution bar pattern including spatial frequency groups of 2.09 and 3.93 lp/mm and having a thickness equivalent to at least 0.1 mm of lead. Suitable bar patterns are identified in Chapter 3 Guidance section 12-1 Suitable Bar Patterns on page 133. - Resolution bar pattern including spatial frequency groups of 5 and 8 lp/mm and having a thickness equivalent to at least 25 m of lead. For this bar pattern: - The distance from the low-frequency end of the bar pattern to the center of the 5 lp/mm pattern group must be no greater than 6 mm. - The distance from the low-frequency end of the bar pattern to the center of the 8 lp/mm pattern group must be no greater than 12 mm. Suitable bar patterns are identified in Chapter 3 Guidance section 12-1 Suitable Bar Patterns on page 133. - Acrylic block or stack of acrylic plates, 4.5 cm thick and at least 12 cm x 12 cm in cross-section. The trapezoidal acrylic plates used for the AOP Mode and SNR Check may also be used for this measurement by following the specific instructions included in this procedure. Suitable material is provided with Senographe Essential systems for facilities subject to the rules of the United States Mammography Quality Standards Act and optionally available to other facilities. Note: In this procedure, whether the 4.5 cm of acrylic used to support the bar pattern consists of a single block or a stack of plates, it is referred to as the acrylic block. Chapter 2 Page no. 94 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Note: Certain resolution test devices contain two bar patterns positioned at right angles to each other. Concerns regarding these patterns include the angle between the two patterns and the ability to position the patterns according to the requirements of this procedure. For additional information see Chapter 3 Guidance section 12-3 Use of Dual-Orthogonal Test Patterns for the MTF Measurement on page 133. Note: Inaccurate bar pattern frequencies can lead to systematic errors in the MTF. See Chapter 3 Guidance section 12-4 Bar Pattern Frequency Inaccuracy on page 134 regarding bar pattern frequency inaccuracy and Chapter 3 Guidance section 12-5 Sensitivity of MTF Measurement to Bar Pattern Frequency Error on page 134 regarding sensitivity of the MTF to spatial frequency error. Note: To avoid false results, the bar patterns and the acrylic block must be clean and free from scratches. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warm-up period, see Chapter 3 Guidance section 12-8 Actions to be taken if specifications are not met on page 135. Procedures: The procedures necessary for Sub-System MTF measurement are described under the following headings: - Procedure 1 Disable FineView on page 95. - Procedure 2 Preparation for Large Focal Spot exposures on page 95. - Procedure 3 Setup and image acquisition for large focal spot width on page 96. - Procedure 4 Setup and image acquisition for large focal spot length on page 98. - Procedure 5 Preparation for Small Focal Spot exposures on page 100. - Procedure 6 Setup and image acquisition for small focal spot width on page 100. - Procedure 7 Setup and exposures for MTF measurements of small focal spot length on page 102. - Procedure 8 Measurements on images acquired using the large focal spot on page 104. - Procedure 9 Measurements on images acquired using the small focal spot on page 106. - Procedure 10 MTF calculations on page 109. - Procedure 11 Restore FineView Setting on page 110. The procedures 5, 6, 7 and 9 must be performed only if the small focal spot is used clinically. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 95 Chapter 2 Procedure 1 Disable FineView 1. From the Browser click the Tools menu button (near the top right of the Browser screen) to display the utilities menu. 2. Select Medical Application preferences from the drop-down menu. 3. In the Medical Application preferences window, click on the button labeledImage Process . 4. Record the current FineView status in Chart 2A - Sub-System MTF Measurement on page 111. 5. If FineView is enabled: - Disable FineView. - Click Save. - Click Close. 6. If FineView is already disabled: - Click Close. Procedure 2 Preparation for Large Focal Spot exposures 1. Run the normal Medical Application. Note: Running the Medical Application with FineView disabled will cause the presentation of a pop-up window to determine if the operator is intending to perform a QC test. Respond by clicking the QC procedure button. 2. Open a new patient (named, for example, Sub-System MTF) in the Medical Application. 3. Install the Bucky on the image receptor if it is not already installed. 4. Remove the compression paddle. 5. Set the collimator for the centered 19 x 23 cm field size. Image Process. Fine View Enable Disable Save Close Close Chapter 2 Page no. 96 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 3 Setup and image acquisition for large focal spot width 1. Place the acrylic block on the breast support surface of the Bucky. 2. Place the resolution pattern with the 2.09 and 3.93 lp/mm groups on the acrylic block. 3. Orient the patterns bars parallel to the anode-cathode axis (perpendicular to the chest wall edge of the Bucky). - If you are using a square acrylic block: Refer to Illustration 1. Align one side of the block with the chest-wall edge of the Bucky. Center the block left-to-right. Center the pattern left-to-right. Position the edge of the pattern within 1 cm of the chest wall edge of the image receptor (see Illustration 3). Note: The requirement for the position of the edge of the pattern (see Illustration 3) is referenced to the image receptor, not to the image. For the large focal spot, the distance from the chest wall edge of the image receptor to the edge of the pattern must not exceed 10.5 mm when measured from the image using the Segment tool. - If you are using a trapezoidal acrylic block: Refer to Illustration 2. Align one of the non-parallel sides of the block with the chest wall edge of the Bucky. Position the bar pattern on the block with one of its corners at the low-frequency end of the bar pattern tangent to the shorter base of the trapezoid at the mid-point of the base. Move the block and pattern together to center the pattern left-to-right. 4. Select the manual exposure control mode and set the following parameters: Mo target; Mo filter; 30 kVp; 140 mAs. 5. Select Left breast laterality and make an exposure. 6. Select the manual exposure control mode and set the following parameters: Rh target; Rh filter; 30 kVp; 140 mAs. 7. Select Left breast laterality and make an exposure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 97 Chapter 2 Illustration 1 MTF evaluation of large focal spot width - Positioning of square acrylic block and bar pattern Illustration 2 MTF evaluation of large focal spot width - Positioning of trapezoidal acrylic block and bar pattern Illustration 3 MTF evaluation of large focal spot Length and width - Positioning of acrylic block and bar pattern View from focal spot 4.5 cm acrylic block Bar pattern Breast support surface of Bucky Chest wall edge of Bucky Breast support surface of Bucky View from focal spot 4.5 cm acrylic block Chest wall edge of Bucky Low frequency end of bar pattern Corner of bar pattern at mid-point of short base of trapezoid View from side of system Image receptor 4.5 cm acrylic block Chest wall edge of Bucky Bar pattern <1 cm Chapter 2 Page no. 98 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 4 Setup and image acquisition for large focal spot length 1. Orient the patterns bars perpendicular to the anode-cathode axis (parallel to the chest wall edge of the Bucky). 2. Position the low-frequency end of the bar pattern toward the chest-wall edge of the image receptor. - If you are using a square acrylic block: Refer to Illustration 4. Maintain the acrylic block placement set in Procedure 3, above. Center the pattern left-to-right. Position the edge of the pattern within 1 cm of the chest wall edge of the image receptor. - If you are using a trapezoidal acrylic block: Refer to Illustration 5. Position the bar pattern so that one of the corners at the low-frequency end of the bar pattern is tangent to the shorter base of the trapezoid at the mid-point of the base. Move the block and pattern together to center the pattern left-to-right while aligning one of the non-parallel sides of the block with the chest wall edge of the Bucky. 3. Select the manual exposure control mode and set the following parameters: Mo target; Mo filter; 30 kVp; 140 mAs. 4. Select Left breast laterality and make an exposure. 5. Select the manual exposure control mode and set the following parameters: Rh target; Rh filter; 30 kVp; 140 mAs. 6. Select Left breast laterality and make an exposure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 99 Chapter 2 Illustration 4 MTF evaluation of large focal spot length - Orientation of bar pattern on square acrylic block Illustration 5 MTF evaluation of large focal spot length - Orientation of bar pattern on trapezoidal acrylic block View from focal spot Breast support surface of Bucky 4.5 cm acrylic block Chest wall edge of Bucky Low frequency end of bar pattern < 1 cm to chest wall edge of image receptor Chest wall edge of image receptor View from focal spot Breast support surface of Bucky 4.5 cm acrylic block Chest wall edge of Bucky Low frequency end of bar pattern Corner of bar pattern at mid-point of short base of trapezoid Chapter 2 Page no. 100 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 5 Preparation for Small Focal Spot exposures If the small focal spot is used clinically, the following procedure must be performed. As the action limit described in this job card is applicable with 1.8x magnification stand, use this magnification stand to perform these procedures even if the 1.5x magnification stand is used clinically. The test result is valid whatever the magnification stand used clinically. 1. Continue to run the normal Medical Application. 2. Remove the Bucky from the image receptor. 3. Remove the compression paddle if it has not already been removed. 4. Install the magnification stand intended to provide 1.8x magnification. Note: When the magnification stand is installed, the collimator will automatically adjust to set the maximum field size (13 cm x 23 cm). 5. Set the collimator for the 13 cm x 18 cm field size. Procedure 6 Setup and image acquisition for small focal spot width If the small focal spot is used clinically, the following procedure must be performed. As the action limit described in this job card is applicable with 1.8x magnification stand, use this magnification stand to perform these procedures even if the 1.5x magnification stand is used clinically. The test result is valid whatever the magnification stand used clinically. 1. Position the acrylic block on the breast support surface of the magnification stand. 2. Place the resolution pattern with the 5 and 8 lp/mm groups on the acrylic block. 3. Orient the patterns bars parallel to the anode-cathode axis. - If you are using a square acrylic block: Align one side of the block with the chest-wall surface of the magnification stand. Center the block left-to-right. Center the pattern left-to-right. Position the edge of the bar pattern 50 mm from the chest wall surface of the magnification stand (see Illustration 7). - If you are using a trapezoidal acrylic block: Refer to Illustration 6. Align one of the non-parallel sides of the block with the chest wall surface of the magnification stand. Align the other non-parallel side with the lateral edge of the light field. Orient the low-frequency end of the bar pattern toward the side of block aligned with the lateral edge of the light field. Position the edge of the bar pattern 50 mm from the chest wall surface of the magnification stand (see Illustration 7). 4. Select the manual exposure control mode and set the following parameters: Mo target; Mo filter; 30 kVp; 140 mAs. 5. Select Left breast laterality and make an exposure. 6. Select the manual exposure control mode and set the following parameters: Rh target; Rh filter; 30 kVp; 140 mAs. 7. Select Left breast laterality and make an exposure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 101 Chapter 2 Illustration 6 MTF evaluation of small focal spot width - Positioning of trapezoidal acrylic block and bar pattern Illustration 7 MTF evaluation of small focal spot width and Length - Positioning of trapezoidal acrylic block and bar pattern View from focal spot 4.5 cm acrylic block Low frequency end of bar pattern Light field; 13 x 18 FOV 50 mm Chest wall edge of Mag Stand Edge of light field aligned with side of trapezoid Breast support surface of Mag Stand View from side of system Chest wall surface of magnification stand 50 mm 4.5 cm acrylic block Image receptor Bar pattern Chapter 2 Page no. 102 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 7 Setup and exposures for MTF measurements of small focal spot length If the small focal spot is used clinically, the following procedure must be performed. As the action limit described in this job card is applicable with 1.8x magnification stand, use this magnification stand to perform these procedures even if the 1.5x magnification stand is used clinically. The test result is valid whatever the magnification stand used clinically. 1. Maintain the acrylic block placement set in Procedure 6, above. 2. Orient the patterns bars perpendicular to the anode-cathode axis. 3. Position the low frequency end of the bar pattern toward the chest wall edge of the image receptor (see Illustration 8). 4. Position the edge of the bar pattern 50 mm from the chest wall surface of the magnification stand. 5. Center the pattern left-to-right. Note: Because of the change in the effective length of the focal spot with position along the direction of the anode-cathode axis, the MTF measurement for the focal spot length is sensitive to the position of the bar pattern along that direction. For the small focal spot in the neighborhood of 50 mm from the chest wall surface of the magnification stand, the sub-system MTF has been observed to increase with increasing distance from the chest wall edge of the field at the rate of 0.0032/mm at 5 lp/mm and 0.0042/mm at 8 lp/mm. For consistent results, the bar pattern position must be carefully reproduced for each measurement. 6. Select the manual exposure control mode and set the following parameters: Mo target; Mo filter; 30 kVp; 140 mAs. 7. Select Left breast laterality and make an exposure. 8. Select the manual exposure control mode and set the following parameters: Rh target; Rh filter; 30 kVp; 140 mAs. 9. Select Left breast laterality and make an exposure. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 103 Chapter 2 Illustration 8 MTF evaluation of small focal spot Length - Positioning of trapezoidal acrylic block and bar pattern
View from focal spot 4.5 cm acrylic block Low frequency end of bar pattern Light field; 13 x 18 FOV 50 mm Chest wall edge of Mag Stand Edge of light field aligned with side of trapezoid Breast support surface of Mag Stand Chapter 2 Page no. 104 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 8 Measurements on images acquired using the large focal spot 1. After completion of all Procedures 1 through 7, close the exam. 2. From the Browser, select the patient Sub-System MTF. Open the Raw images for exam review. Do not make measurements on processed images. 3. Select Zoom 1 in the View Control control panel of the Viewer window. 4. Adjust Window Width and Window Level for optimum visibility of the bar pattern image. 5. For each image acquired using the large focal spot, use the ellipse tool to make the measurements described below. Refer to Illustration 9. If the pattern is at a small angle, e.g., less than 10, with respect to the pixel matrix, the ellipse may be rotated to improve alignment of the ROI with the pattern group (refer to Chapter 3 Guidance section 12-6 Ellipse Tool on page 134 for information on the use of the ellipse tool). If the angle of the pattern exceeds 10, either repeat the acquisition of the bar pattern image or apply the frequency correction to the MTF as described in Chapter 3 Guidance section 12-5 Sensitivity of MTF Measurement to Bar Pattern Frequency Error on page 134. a. Set the largest ROI containing only the 2.09 lp/mm pattern (see Illustration 9, ROI 1 and inset a). Adjust the size of the ROI to include as much of the 2.09 lp/mm pattern group as possible without allowing the ROI to extend beyond the image of the pattern group. See Chapter 3 Guidance section 12-2 Variation of MTF with ROI Width on page 133 regarding the effect of ROI size on the measurement. b. Record the ROI standard deviation, N(2.09). c. Set the largest ROI containing only the 3.93 p/mm pattern (see Illustration 9, ROI 2 and inset b). Adjust the size of the ROI to include as much of the 3.93 lp/mm pattern group as possible without allowing the ROI to extend beyond the image of the pattern group. d. Record the ROI standard deviation, N(3.93). Note: At the low-frequency end of the pattern there is a large area in which the highly attenuating pattern material has been removed. In the following this is referred to as space material. The nearby area of highly attenuating material is referred to as bar material. e. Select an ROI of the default size and containing only space material (see Illustration 9, ROI 3). Record the ROI mean, S s , and standard deviation, N s . f. Select an ROI of the default size and containing only bar material (see Illustration 9, ROI 4). Record the ROI mean, S b , and standard deviation, N b . View Composition Zoom TrueSize Fit to Screen Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 105 Chapter 2 Note: Analysis of the large focal spot sub-system MTF involves acquiring data for four cases - Mo track, focal spot length; Mo track, focal spot width; Rh track, focal spot length; and Rh track, focal spot width. All values of N(2.09), N(3.93), S s , N s , S b , and N b that will be used in the evaluation of a particular case must come from the image for that case. If the operator uses a resolution test tool incorporating two orthogonal bar patterns, only two images need to be acquired, but each set of values N(2.09), N(3.93), S s , N s , S b , and N b must come from measurements on the same bar pattern. For example, values of S s , N s , S b , and N b
acquired from the image of the bar pattern oriented to analyze the focal spot width must not be used in the analysis of the focal spot length unless the operator has previously verified that the two bar patterns produce the same degree of x-ray beam attenuation for the spectra used in this procedure. Illustration 9 MTF analysis for the large focal spot 3.93 4.37 1.0 1.11 1.23 1.37 1.52 1.69 1.88 2.09 2.32 2.58 2.87 3.19 3.54 4.86 2.09 3.93 3 4 1 1 2 2 (a) (b) Chapter 2 Page no. 106 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 9 Measurements on images acquired using the small focal spot If the small focal spot is used clinically, the following procedure must be performed. As the action limit described in this job card is applicable with 1.8x magnification stand, use this magnification stand to perform these procedures even if the 1.5x magnification stand is used clinically. The test result is valid whatever the magnification stand used clinically. 1. Open the Raw images acquired with the small focal spot. Do not make measurements on processed images. View the images using Zoom 1. 2. For each image acquired using the small focal spot, use the ellipse tool to make the measurements described below. Refer to Illustration 10. If the pattern is at a small angle, e.g., less than 10, with respect to the pixel matrix, the ellipse may be rotated to improve alignment of the ROI with the pattern group (refer to Chapter 3 Guidance section 12-6 Ellipse Tool on page 134 for information on the use of the ellipse tool). If the angle of the pattern exceeds 10, either repeat the acquisition of the bar pattern image or apply the frequency correction to the MTF as described in Chapter 3 Guidance section 12-5 Sensitivity of MTF Measurement to Bar Pattern Frequency Error on page 134. a. Set the largest ROI containing only the 5 lp/mm pattern (see Illustration 10, ROI 1, inset a). Adjust the size of the ROI to include as much of the 5 lp/mm pattern group as possible without allowing the ROI to extend beyond the image of the pattern group. See Chapter 3 Guidance section 12-2 Variation of MTF with ROI Width on page 133 regarding the effect of ROI size on the measurement. b. Record the ROI standard deviation, N(5). c. Set the largest ROI containing only the 8 lp/mm pattern (see Illustration 10, ROI 2 and inset b). Adjust the size of the ROI to include as much of the 8 lp/mm pattern group as possible without allowing the ROI to extend beyond the image of the pattern group. d. Record the ROI standard deviation, N(8). Note: Test patterns used for evaluation of the small focal spot are of two general types those with a high-attenuation substrate and those with a low-attenuation substrate. The key differences for this test are the locations of the space material and the bar material at the low-frequency end of the pattern. The regions of space material and bar material for each type of pattern are indicated in Illustration 11. e. Select a region of interest containing only space material (Illustration 11(a) ROI 3a for a high-attenuation substrate pattern; Illustration 11 (b) ROI 3b for a low-attenuation substrate pattern). Record the ROI mean, S s , and standard deviation, N s . f. Select an ROI containing only bar material (Illustration 11(a) ROI 4a for a high-attenuation substrate pattern; Illustration 11(b) ROI 4b for a low-attenuation substrate pattern). Record the ROI mean, S b , and standard deviation, N b . Note: The size and positioning of the ROIs used for sampling the bar and space material will depend on the characteristics of the particular bar pattern used for the test. Set two ROIs that are substantially the same shape and positioned at the same end of the bar pattern. Set the area of each ROI within 25% of the area of the ROI used to measure the standard deviation in the 8 lp/mm pattern. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 107 Chapter 2 Note: Analysis of the small focal spot sub-system MTF involves acquiring data for four cases - Mo track, focal spot length; Mo track, focal spot width; Rh track, focal spot length; and Rh track, focal spot width. All values of N(5), N(8), S s , N s , S b , and N b that will be used in the evaluation of a particular case must come from the image for that case. If the operator uses a resolution test tool incorporating two orthogonal bar patterns, only two images need to be acquired, but each set of values N(5), N(8), S s, N s , S b , and N b must come from measurements on the same bar pattern. For example, values of S s , N s , S b , and N b acquired from the image of the bar pattern oriented to analyze the focal spot width must not be used in the analysis of the focal spot length unless the operator has previously verified that the two bar patterns produce the same degree of x-ray beam attenuation for the spectra used in this procedure. Chapter 2 Page no. 108 Chap 2 Job_Card_VFP02A.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement This illustration shows the image of a pattern made from a high-attenuation substrate. Illustration 10 MTF analysis for the small focal spot This illustration shows images of test patterns made from a high-attenuation substrate (left), e.g.,gold foil, and from a low-attenuation substrate (right), e.g., plastic. For the purpose of this test, the main differences are the locations of the "space" material and the "bar" material. Illustration 11 Images of High and Low attenuation test patterns 2 0 5 8 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 5 8 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 3 4 1 2 5 1 5 1 8 2 8 2 (a) (b) 20 5 8 10 11 12 13 14 15 16 17 18 19 20 5 8 10 11 12 13 14 15 16 17 18 19 3a 4a 20 5 8 10 11 12 13 14 15 16 17 18 19 20 5 8 10 11 12 13 14 15 16 17 18 19 20 5 8 10 11 12 13 14 15 16 17 18 19 3b 4b "Space" material "Bar" material Low-attenuation substrate High-attenuation substrate (a) (b) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Chap 2 Job_Card_VFP02A.fm Page no. 109 Chapter 2 Procedure 10 MTF calculations 1. For each case (each focal spot size, each anode track, and each axis), use the following equations to estimate the MTF M(f) for the two frequency points: where: S s = the mean value in a region of interest (ROI) including only space material, S b = the mean value in an ROI including only bar material, N s = the standard deviation in an ROI including only space material, N b = the standard deviation in an ROI including only bar material, N(f) = the standard deviation in an ROI including the bar pattern group of frequency f, and M(f) = the MTF at frequency f. f = 2.09 and 3.93 lp/mm for the large focal spot. f = 5 and 8 lp/mm for the small focal spot. See Chapter 3 Guidance section 12-7 References for MTF Calculations on page 135 for reference material on these calculations. 2. If necessary, correct the MTF for bar pattern frequency inaccuracy. See Chapter 3 Guidance section 12-5 Sensitivity of MTF Measurement to Bar Pattern Frequency Error on page 134 regarding sensitivity of the MTF to bar pattern frequency error. 3. Record the results in Chart 2A - Sub-System MTF Measurement on page 111. 4. Close the Viewer window. Note: The MTF measured from the Raw image may have a magnitude similar to, although not the same as, the MTF measured from a Processed image. If the magnitude of the MTF changes suddenly, check to make sure that the analysis is being made from the Raw image. If the measurement is made from a Processed image, the calculations described above will produce negative MTF values. This is because in the Processed image S s is less than S b . If the MTF is negative, or S s is observed to be less than S b , then the wrong image is being used for the MTF measurement. Select the Raw image.
0 2 2 2 b 2 s 2 b s b s 0 M N ) f ( N ) f ( M 2 N N N S S 45 . 0 S S 2 M
Chapter 2 Page no. 110 Chap 2 Job_Card_VFP02A.fm
Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P02A - Sub-System MTF Measurement Procedure 11 Restore FineView Setting If FineView was enabled before starting this test, re-enable FineView: 1. From the Browser click the Tools menu button (near the top right of the Browser screen) to display the utilities menu. 2. Select Medical Application preferences from the drop-down menu. 3. In the Medical Application preferences window, click on the button labeled Image Process. 4. Enable FineView: 5. Record the current FineView status in Chart 2A - Sub-System MTF Measurement on page 111. - Click Save. - Click Close. Action Limit: The MTF values obtained in the test must exceed the Action Limits specified in the following table. Use of Test Results: If the above specifications are not met, the source of the problem must be identified and corrective action taken before any further mammographic images are acquired using the Senographe Essential system that failed. Refer to Chapter 3 Guidance section 12-8 Actions to be taken if specifications are not met on page 135 for additional information. Large Focal Spot Small Focal Spot (If it is used clinically) Track Axis Freq. (lp/mm) Action Limit Freq. (lp/mm) Action Limit Mo Width 2.09 0.48 5 0.30 Rh Width 2.09 0.48 5 0.30 Mo Length 2.09 0.51 5 0.34 Rh Length 2.09 0.51 5 0.34 Mo Width 3.93 0.18 8 0.08 Rh Width 3.93 0.18 8 0.08 Mo Length 3.93 0.19 8 0.11 Rh Length 3.93 0.19 8 0.11 Image Process. Fine View Enable Disable Save Close Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 2A - Sub-System MTF Measurement Chap 2 Chart 2A - SubSystem MTF Measurement.fm Page no. 111 Chapter 2 Chapter 2 Chart 2A - Sub-System MTF Measurement Note: Be sure to return the FineView selection to the one normally chosen during clinical use. Date: . . . . . . . . . . . . . . . . . . . . . . . . . FineView status at the start of the measurement (circle one) Disabled Enabled FineView status at the end of the measurement (circle one) Disabled Enabled Large Focal Spot MTF Measurements: Track Axis N(2.09) N(3.93) S s N s S b N b M(2.09) M(3.93) Mo Width Rh Width Mo Length Rh Length Small Focal Spot MTF Measurements (If it is used clinically): Track Axis N(5) N(8) S s N s S b N b M(5) M(8) Mo Width Rh Width Mo Length Rh Length
0 2 2 2 b 2 s 2 b s b s 0 M N ) f ( N ) f ( M 2 N N N S S 45 . 0 S S 2 M
Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 2A - Sub-System MTF Measurement Action Limit: The MTF values obtained in the test must exceed the Action Limits specified in the following table. Use of Test Results: If the above specifications are not met, the source of the problem must be identified and corrective action taken before any further mammographic images are acquired using the Senographe Essential system that failed. Refer to Chapter 3 Guidance section 12-8 Actions to be taken if specifications are not met on page 135 for additional information. Large Focal Spot Small Focal Spot (If it is used clinically) Track Axis Freq. (lp/mm) Action Limit Freq. (lp/mm) Action Limit Mo Width 2.09 0.48 5 0.30 Rh Width 2.09 0.48 5 0.30 Mo Length 2.09 0.51 5 0.34 Rh Length 2.09 0.51 5 0.34 Mo Width 3.93 0.18 8 0.08 Rh Width 3.93 0.18 8 0.08 Mo Length 3.93 0.19 8 0.11 Rh Length 3.93 0.19 8 0.11 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility Chap 2 Job_Card_VFP03.fm Page no. 113 Chapter 2 Chapter 2 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility Objective: To measure the typical entrance exposure for an average patient (approximately 4.2-cm compressed breast thickness -50% adipose, 50% glandular composition), to calculate the associated average glandular dose, and to assess short-term exposure reproducibility. Required Test Equipment: - Ionization chamber and electrometer calibrated at mammographic X-ray beam energies (calibration factor constant to within 1% over the HVL range from 0.2 to 0.5 mm Al) - Mammographic phantom (equivalent to approximately 4.2 cm compressed breast tissue 50/50 composition at mammographic energies). Acceptable phantoms are listed in Chapter 3 Guidance section 13 Breast Entrance Exposure, Average Glandular Dose, and Reproducibility on page 136. Note: If the phantom has thumbscrews that extend above the surface of the phantom or an acrylic disk attached to the surface of the phantom, these screws and disk must be removed before acquiring the image of the phantom. The phantom surfaces that contact the breast support and the compression paddle must both be flat. Procedure: 1. Prepare the mammographic imaging system as follows: - operation in the contact geometry with the grid installed - 24 cm x 31 cm field of view selected. Record these conditions on the data form. 2. Position the mammographic phantom on the breast support surface of the image receptor assembly, laterally centered in the X-ray field with one edge coincident with the chest wall edge of the breast support surface. Note: The phantom must be rotated 180 from its normal orientation. Position the wide edge of the frame surrounding the wax insert away from the chest wall edge of the image receptor. 3. Position the ionization chamber in the X-ray field with its center approximately 4 cm in from the chest wall edge of the image receptor and with the top surface of the chamber near the top surface of the phantom. The interior edge of the chamber must be no more than 3.5 cm from the lateral edge of the X-ray field as indicated by the light localizer. See Illustration 1 and Illustration 2. Note: If AOP is used for establishing the entrance exposure, it is important that the parameter selection be based only on the phantom and not the ion chamber. Hence, the ion chamber must be positioned outside the sensing area used by AOP to avoid having the parameter selection determined by any highly attenuating elements of the chamber. The ion chamber is first used to monitor output reproducibility and not the entrance exposure; hence its exact position in the field is not critical. Chapter 2 Page no. 114 Chap 2 Job_Card_VFP03.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility Illustration 1 Set up to monitor output reproducibility in AOP mode (top view) Illustration 2 Set up to monitor output reproducibility in AOP mode (front view) 4. Secure the chamber in position and do not change the position of the chamber during the following measurements. Note: Mammographic imaging systems have a significant X-ray intensity gradient in the X-ray field along the anode-cathode direction. Maintaining a constant chamber position during measurements is critical. When measurements are to be compared with others made previously, it is also critical that the original measurement position be re-established as closely as possible. 5. Position the compression device in the X-ray beam, just in contact with the phantom and chamber. Note: If measurements will be done using AOP, apply a compression force of 5 daN to activate the algorithm. The compressed breast thickness is used by the AOP algorithm to determine the imaging parameters. Therefore, it is important to position the phantom and apply the compression force consistently for each measurement since variations in paddle deflection may be interpreted as variations in compressed breast thickness leading to inconsistency in parameter selection. Wide edge of wax insert frame Ion chamber must not be placed further inside the field of view Ion chamber X-ray field as indicated by light field Chest wall edge of image receptor Cut out corner of wax insert Phantom 24 cm 30.7 cm 4 cm 3.5 cm Paddle (5 daN compression) Bucky Phantom Ion chamber Edge of X-ray field 30.7 cm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility Chap 2 Job_Card_VFP03.fm Page no. 115 Chapter 2 6. Select the image acquisition mode, i.e., AOP or Manual, most commonly used clinically to image the standard breast. For AOP mode select the clinically used setting of CNT, STD, or DOSE. For Manual mode select the clinically used settings of kVp, anode track, X-ray beam filter, and mAs. Record the settings on the data form. Using the STD mode should satisfy most needs. However, if a higher priority is given to the dose delivered to the patient, the DOSE mode may be selected instead. If a higher priority is given to the contrast to noise ratio in images, the CNT mode may be selected. It is important to understand that any improvement in contrast to noise ratio is done at the cost of an increase in glandular dose and vice versa; a decrease in glandular dose will yield a reduction in contrast to noise ratio. For more information on evaluating which priority to select consult with your interpreting physician, radiologist, or medical physicist. 7. Make an exposure. 8. Record the mAs and the reading of the ion chamber. For AOP mode also record the selections of kVp, anode track, and filter. 9. Make additional exposures and record the results until a total of four exposures have been recorded. 10. If necessary, raise the compression paddle, then position the reference line of the ion chamber level with the top surface of the phantom. 11. Remove the phantom and position the ion chamber centered left-to-right and 4 cm from the chest wall edge of the image receptor. 12. Position the compression paddle to just contact the ionization chamber. 13. Select Manual mode and set the kVp, anode track, and filter used when exposing the phantom. Select an mAs as close as possible to the mAs used when exposing the phantom. 14. Make an exposure and record the ion chamber reading. 15. Compute the averages and standard deviations for mAs and exposure for the four exposures acquired with identical technique settings. Record the values. Determine the coefficients of variation (standard deviation divided by the mean). 16. Correct the ion chamber reading from Step 14 to the value appropriate for Step 7 using the ratio of the mAs recorded in Step 8 to the mAs selected in Step 13. Using the corrected ion chamber reading, calculate the average glandular dose using generally accepted methods for mammography quality control. See Chapter 3 Guidance section 13 Breast Entrance Exposure, Average Glandular Dose, and Reproducibility on page 136. Action Limit: mAs and Air Kerma Reproducibility The maximum acceptable coefficient of variation for both mAs and air kerma in the reproducibility test is 0.05. Use of Test Results: If these conditions are not met, the source of the problem must be identified, and corrective action taken, within 30 days of the test date. 4. Action Limit: Mean Glandular Dose The mean glandular dose to the Standard breast must not exceed 3 mGy (0.3 rad) per view. Use of Test Results: If this condition is not met, the source of the problem must be identified, and corrective actions taken, before any further mammographic images are acquired using the Senographe Essential FFDM system that failed. See Chapter 3 Guidance section 13 Breast Entrance Exposure, Average Glandular Dose, and Reproducibility on page 136. Chapter 2 Page no. 116 Chap 2 Job_Card_VFP03.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility The applicable MQSA Quality Mammography Standards are: 900.12(e)(5)(v) Breast entrance air kerma and AEC reproducibility. The coefficient of variation for both air kerma and mAs shall not exceed 0.05. 900.12(e)(5)(vi) Dosimetry The average glandular dose delivered during a single cranio-caudal view of an FDA-accepted phantom simulating a standard breast shall not exceed 3.0 milligray (mGy) (0.3 rad) per exposure. The dose shall be determined with technique factors and conditions used clinically for a standard breast. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (1/2) Chap 2 Chart 3 - Breast Entrance Exposure.fm Page no. 117 Chapter 2 Chapter 2 Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (1/2) Imaging Parameters and Reproducibility Dosimetry system used . . . . . . . . . . . . . . . . . . . . . . . . . Field size . . . . . . . . . . . . . . . . . . . . . . . . . Phantom ID . . . . . . . . . . . . . . . . . . . . . . . . . Breast thickness 4.2 cm Phantom Exposure Control Mode (AOP, Man.) Nominal kVp setting Target/Filter mAs setting Measured HVL (mm Al) Exposure Readings R mAs R mAs R mAs R mAs Exposure #1 Exposure #2 Exposure #3 Exposure #4 Mean Values Standard Deviations (SD) Coefficients of Variation (CV) Chapter 2 Page no. 118 Chap 2 Chart 3 - Breast Entrance Exposure.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (2/2) Chart 3 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility (2/2) Dosimetry Ion Chamber Reading mAs Energy & mAs Corrected Exposure Dose Conversion Factor (mrad/R) Computed Avg. Glandular Dose (mrad) Action Limit: The Coefficient of Variation for both air kerma and mAs must not exceed 0.05. Use of Test Results: If these conditions are not met, the source of the problem must be identified, and corrective action taken, within 30 days of the test date. Action Limit: The average glandular dose must not exceed 3 mGy (0.3 rad) for a 4.2 cm effective breast thickness. Use of Test Results: If this condition is not met, the source of the problem must be identified, and corrective action taken, before further mammographic images are acquired using the Senographe Essential FFDM system that failed. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity Chap 2 Job_Card_VFP04.fm Page no. 119 Chapter 2 Chapter 2 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity Objective: To assess the degree and source of artifacts visualized in full field digital mammograms or phantom images. To assure that the Flat Field image is uniform. Required Test Equipment: - A 25 mm thick uniform sheet of acrylic (PMMA) that is clean and free from defects. The acrylic sheet must be sufficiently large to cover the entire image receptor. Note: To allow for temperature stabilization of the detector, the system must be powered on for at least 10 minutes before performing any measurements related to detector image quality. If any test is not passed after allowing a 10-minute warmup period, see Chapter 3 Guidance section 14 Artifact Evaluation and Flat Field Uniformity on page 136. Procedure: 1. Use technique factors normally used clinically, choosing the lowest kVp setting (to be most sensitive to artifacts). Record the technique factors on the data form. 2. Install the anti-scatter grid. Place the attenuator sheet on top of the image receptor. Set collimation that permits irradiation of the entire image receptor. 3. Make an exposure. 4. Repeat steps 1 through 3 for the Mo/Mo, Mo/Rh, and Rh/Rh target/filter combinations. 5. If the small focal spot is used clinically: a. Remove the attenuator sheet and the anti-scatter grid. b. Install a magnification stand clinically used. c. Place the attenuator sheet on the breast support surface of the magnification stand. d. Set the collimation to the largest field of view. e. Acquire images for the Mo/Mo, Mo/Rh, and Rh/Rh target/filter combinations. f. Repeat step 5 for all the magnification stands used clinically. 6. Select the Raw image for review. 7. Set the window width in the range of about 400 to 450 and the window level to a setting that allows visualization of artifacts if present. Examine the image for gridlines, plus or minus signal variations, streaking in the horizontal or vertical directions, residual images left over from repeated test or clinical exposures, acrylic sheet artifacts, or bad pixels. Chapter 2 Page no. 120 Chap 2 Job_Card_VFP04.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity 8. With a window width in the range of about 400 to 450, examine the image for Flat Field uniformity. Note: When reviewing the raw images acquired in the magnification configuration, it is normal to observe a series of bands as shown here. This is a result of the nature of the application of the gain correction to the acquired image, and the fact that the recorded field of view exceeds the irradiated field of view. The irradiated field is indicated by the area labeled a. It is terminated on the right by the anterior collimator blade. The band b is the region between the collimator blade edge and the limitation of the field of view set by the anode angle (heel effect). The third band c is due to application of Flat Field correction beyond the anode cut-off. It does not represent an area of irradiation when the magnification configuration is used. In processed images used for final interpretation bands b and c are masked. The evaluation of the image for artifacts is to be limited to the area marked a. 9. Review the images for the three target/filter combinations. 10. Review at least one of the images on all display devices, e.g., acquisition workstation, laser printer. 11. If any artifacts or non-uniformities are present, rotate the acrylic sheet 90 and repeat the exposure and acquisition procedure. 12. If any artifacts or non-uniformities keep a fixed orientation relative to the image receptor in both images and are expected to simulate or mask visualization of breast structures or breast pathology, determine whether the artifact or non-uniformity is due to the detector or the display. If And if Then The artifact or non-uniformity is present on all monitors or the artifact moves as the image is moved using the Roam tool, it is most likely associated with the image acquisition system the artifact can be related to a latent image from previous exposures, for example the artifact has a breast shape, or the artifact looks like collimator blades corresponding to a collimated view a. Remove the anti-scatter grid and the attenuator PMMA sheet. b. Remove the compression paddle. c. Make sure no object is present in the X-ray field of view. d. Make five exposures using the following technique: RhRh, 30kV, 125mAs. The artifact appears only on one monitor Clean the faceplate of the display (See Chapter 1 QC Tests for the Radiologic Technologist, section 3 Monitor Cleaning on page 15). The artifact appears only on printed images Follow the directions provided by the manufacturer of the printer. chest wall a b c Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity Chap 2 Job_Card_VFP04.fm Page no. 121 Chapter 2 13. If any corrective actions were taken, repeat the artifact evaluation and review the image. Action Limit: There must be no artifact or non-uniformity that is expected to mimic or obscure clinical information. Use of Test Results: If the artifact or non-uniformity is still present, and is expected to mimic or obscure clinical information, the source of the problem must be identified and corrective actions taken within 30 days of the test date. See Chapter 3 Guidance section 14 Artifact Evaluation and Flat Field Uniformity on page 136. The applicable MQSA Quality Mammography Standard is: 900.12(e)(5)(ix) System artifacts. System artifacts shall be evaluated with a high-grade, defect-free sheet of homogeneous material large enough to cover the mammography cassette and shall be performed for all cassette sizes used in the facility using a grid appropriate for the cassette size being tested. System artifacts shall also be evaluated for all available focal spot sizes and target filter combinations used clinically. Chapter 2 Page no. 122 Chap 2 Job_Card_VFP04.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 4 - Artifact Evaluation and Flat Field Uniformity Chap 2 Chart 4 - Artifact Evaluation.fm Page no. 123 Chapter 2 Chapter 2 Chart 4 - Artifact Evaluation and Flat Field Uniformity Type of Attenuator . . . . . . . . . . . . . . . . . . . . . . . . . Thickness of Attenuator . . . . . . . . . . . . . . . . . . . . . . . . . kVp setting . . . . . . . . . . . . . . . . . . . . . . . . . mAs setting . . . . . . . . . . . . . . . . . . . . . . . . . Image Receptor size . . . . . . . . . . . . . . . . . . . . . . . . . Patient ID # . . . . . . . . . . . . . . . . . . . . . . . . . Field size . . . . . . . . . . . . . . . . . . . . . . . . . Mo/Mo Mo/Rh Rh/Rh Mo/Mo Mo/Rh Rh/Rh Focal Spot Magnification factor of 1.5x (if used clinically) Magnification factor of 1.8x (if used clinically) kVp mAs Artifact visible? Flat Field Non-Uniformity Equipment Artifact Detector Grid Attenuator Defect Other Description of Artifacts: Use of Test Results: If an artifact or non-uniformity is present, and is expected to mimic or obscure clinical information, the source of the problem must be identified and corrective actions taken within 30 days of the test date. Chapter 2 Page no. 124 Chap 2 Chart 4 - Artifact Evaluation.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Chart 4 - Artifact Evaluation and Flat Field Uniformity This page is intentionally left blank. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P05 - Test for flexible paddle deflection in compression Chap 2 Job_Card_VFP05.fm Page no. 125 Chapter 2 Chapter 2 Job Card VF-P05 - Test for flexible paddle deflection in compression Objective To ensure that the flexible compression paddle is capable of applying effective compression to the breast. Frequency This test should be performed annually or when a loss in performance is suspected. Test objects - Four triangular acrylic plates (10 mm thick, 150x150 mm) provided with the system. Procedure Execute the following two tests: 1. Test the moderate compression performance. a. Mount the flexible paddle to be tested on the paddle carriage. b. Position and compress three triangular acrylic plates provided with the system. They shall be centered on the chest wall axis, with the triangle base intruding approx. 20mm into the X-ray area and the triangles (dashed lines) extending mostly outside the field of view, as depicted in this top view. c. Apply a 10 1 daN compression on the stack. d. Determine by visual inspection whether the rear bottom edge of the paddle and the breast support are in contact.If a clearance is observed, the test is PASSED. If contact is observed, the test is FAILED. The picture on the right illustrates a side view where no contact is observed: the test is PASSED. 2. Test the maximum performance compression. a. Decompress and remove the previous setup. 20 mm Chapter 2 Page no. 126 Chap 2 Job_Card_VFP05.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Job Card VF-P05 - Test for flexible paddle deflection in compression Corrective action If contact is observed between the paddle and the breast support at steps 1.d or 2.d of the above procedure, the paddle must be replaced. b. Position on the breast support four triangular acrylic plates (1) (two on each side) provided with the system. They shall be centered along the flex paddle lateral edges, with the triangles pointing towards nipple (dashed lines). c. In that configuration, bring the compression to maximum compression, using first the motorized compression, then the manual compression after the motorized limit is reached. d. Determine by visual inspection whether the rear bottom edge of the paddle and the breast support are in contact. If a clearance is observed, the test is PASSED. If contact is observed, the test is FAILED. e. With the 19x23 sliding flexible paddle, repeat steps a to d for all paddle positions. 1 1 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance Chap 3 Guidance.fm Page no. 127 Chapter 3 Chapter 3 Guidance United States regulations consider the image receptor manufacturers QC Test procedures as a requirement for compliance with the MQSA regulations. This Guidance section is not considered an element of those regulations. It is intended to provide guidance to mammography facilities and their personnel. It represents the image receptor manufacturers current thinking on appropriate procedures for conducting the QC tests. Procedures described in guidance represent supplementary information on acceptable ways of doing a test but, unlike regulations, do not bind the facility to using that way only. An alternative procedure may be used if such a procedure satisfies the requirements of the applicable statute, regulations, or both. Mandatory language, such as shall, must, and require, is used when referring to statutory or regulatory requirements. Non-mandatory language, such as should, may, can and recommend is used when referring to guidance. It is the responsibility of the facility to read, understand, and follow the final regulations. Under its own authority, a state may impose more stringent requirements beyond those specified under MQSA and its implementing regulations. A facility may want to check with the state or local authorities regarding their requirements. Tests may be performed more frequently than specified in the QC tests if required by local regulations or hospital policies. QC tests may be used as a check for correct operation, for example, after a change of operating parameters. The following sections provide specific guidance for sections in the QC tests. 1 Wet Chemistry Film Processing If the film from the printer requires wet chemistry processing and if specific instructions are not provided by the manufacturer of the printer, it is recommended that the facility follow accepted procedures for the QC of darkroom cleanliness, darkroom fog, and analysis of fixer retention such as those included in the Mammography Quality Control Manual published by the American College of Radiology. 2 Flat Field Test If the system fails any of the elements of the Flat Field test, you should ensure that all test conditions are met and then repeat the test. If the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. Chapter 3 Page no. 128 Chap 3 Guidance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance 3 Phantom Image Quality Test 3-1 Quality Control Phantom The equipment required is an FDA-approved phantom. Following is a list of suitable mammographic phantoms made according to ACR specifications: - Radiation Measurements, Inc., Model 156. - Fluke Biomedical (Nuclear Associates), Model 18-220. - Computerized Imaging Reference Systems, Model 15. The phantom is an acrylic block containing 16 cells. Each cell simulates an anatomical structure which may be found in breast tissue. Starting from the top left hand corner, as shown in the illustration, the cells are of three types: - Fibers: Six cells represent fibrous structures; they contain fibers with cross-sections from 1.56 mm to 0.40 mm. - Speck groups: Five cells represent micro-calcifications, with diameters from 0.54 mm to 0.16 mm. - Masses: Five cells represent tumors or masses, with thicknesses from 2 mm to 0.25 mm. 3-2 Scoring the Phantom Image A recommended method of scoring the phantom image, including deduction of the score for artifacts, is included in the Mammography Quality Control Manual published by the American College of Radiology. 3-3 Failure of Phantom Image Quality Test If the system fails the Phantom Image Quality Test, you should ensure that all test conditions are met and then repeat the test. If the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. Situations have occurred in which inability to achieve a passing score has been attributable to artifacts in the phantom or defects in the test objects. If this is a possibility, try using a different phantom and repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 3-4 Appearance of Collimator Blades in Image If collimator blades are visible in the image, it is recommended that you contact your GE Medical Systems Service Engineer. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance Chap 3 Guidance.fm Page no. 129 Chapter 3 3-5 Failure of Phantom Image Quality Test for Printer If the printer fails the Phantom Image Quality Test, you should ensure that all test conditions are met and then repeat the test. If the system still fails, it is recommended that you consult the documentation provided with the printer for information on quality control and troubleshooting procedures. 4 CNR and MTF Measurement 4-1 Failure of MTF Measurement Test If the system fails the MTF Measurement Test, you should ensure that all test conditions are met and then repeat the test. If the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 4-2 Failure of Change in CNR Test If the system fails the Change in CNR Test, and the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 5 AOP Mode and SNR Check A flow chart illustrating how to access the menu for adjusting the maximum compression force is shown in the Senographe Essential Acquisition system Operator Manual. Press the SET UP menu key , then the button under Medical, and then the button under Force. Press the button under the + sign to increase the compression force; press the button under the - sign to decrease the force. After achieving the desired maximum force value, press the button under Valid, then press the SET UP menu key until the Applications menu returns and the lamp under the button goes out. For the AOP Mode Check, if the test passes enter the mAs observed for each object thickness. If the test fails, enter F/n where n refers to the number of a note. Use the same number to record a note below the table to state the nature of the failure and what was done to correct it. If the system fails the AOP Mode Check or the SNR Check, you should ensure that all test conditions are met and then repeat the test. If the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. Chapter 3 Page no. 130 Chap 3 Guidance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance 6 Repeat Analysis Check Depending on your version of the Senographe Essential, the method used for Repeat and Reject analysis can be manual or automated, as described in Chapter 1 section 9 Repeat Analysis Check on page 27. 6-1 Manual Method The total number of exposures taken during the analysis period can be estimated from the exposure counter available on the Control Console. When the setup button is pressed, a count of the number of exposures since the last software installation appears in the upper right hand corner of the control console display. This value can be recorded at the beginning and end of the analysis period and the difference in the two values is the number of exposures made during this time. If the value of the counter is also monitored during QC testing and physicist surveys, the exposure count can be corrected for the non-clinical exposures. The counter should also be monitored before and after any servicing of the unit in case the service work results in the resetting of the counter. 6-2 Automated Method To use the automated method of Repeat and Reject Analysis (when available), each image must be qualified during the examination as Accepted, Rejected, or Repeated, as described in the Operator Manual. 6-3 Record of loss of data The data for the automated repeat analysis are stored in a computer in the acquisition workstation (AWS). In the event of an AWS hardware failure, there is some risk that these data will be lost. That is why periodic data backup is included in the automated repeat analysis procedure (refer to section 9-3 Repeat Analysis - Database backup on page 32). In the event of a system failure that results in the loss of information from your repeat analysis database, you should record the occurrence and cause of the data loss in the QC log to provide documentation on why an analysis may not have been completed for a particular quarter. You should also request a copy of the service record prepared by the Field Service Engineer indicating the nature of the failure and the loss of information in the database. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance Chap 3 Guidance.fm Page no. 131 Chapter 3 7 Compression Force Test In addition to the testing interval specified in the test procedure, the Compression Force Test should also be performed when reduced compression is suspected. The procedures for the Compression Force Test given in the Mammography Quality Control Manual published by the American College of Radiology are recommended. If the system fails the Compression Force Test, you should ensure that all test conditions are met and then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 8 Visual, Monitor, and Filming Checks If a malfunction of the Senographe Essential is observed during the Visual Check, it is recommended that you contact your GE Medical Systems Service Engineer. 8-1 Viewboxes and Viewing Conditions Recommended methods for assessing viewing conditions and caring for viewboxes are included in the Mammography Quality Control Manual published by the American College of Radiology. 8-2 Monitor Cleaning If a monitor cannot be satisfactorily cleaned, it is recommended that you contact your GE Medical Systems Service Engineer. 8-3 Printer QC For information on the recommended QC procedures for the printer, the user should refer to the Printer Operators Manual or ancillary documentation provided by the manufacturer of the printer. Chapter 3 Page no. 132 Chap 3 Guidance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance 9 Annual Physicist Checks 9-1 kVp Accuracy and Reproducibility Acceptable procedures for the measurement of kVp accuracy and reproducibility can be found in the Mammography Quality Control Manual published by the American College of Radiology. Note: If the action limits for kVp accuracy or coefficient of variation are exceeded using the results of four (4) exposures, then make six (6) additional readings and recalculate using all 10 readings. If the results calculated using all ten (10) measurements exceed action limits, the source of the problem must be identified and corrective action taken within 30 days of the test date. It is recommended that you contact your service engineer. 9-2 Beam Quality Assessment Acceptable procedures for the measurement of half-value layer can be found in the Mammography Quality Control Manual published by the American College of Radiology. The thicknesses of the aluminum filters should be known to within 1%. The use of type 1100 aluminum alloy for HVL measurement can give (depending on specific samples) HVL values up to 7.5% lower than those measured using pure aluminum. If type 1100 aluminum is used, results should be corrected to agree with those obtained using pure aluminum. 9-3 Mammography Unit Assembly Evaluation and Radiation Output The mammographic unit assembly evaluation and measurement of radiation output, may be performed as described in the Mammography Quality Control Manual published by the American College of Radiology. 10 Collimation Assessment If the system does not pass the collimation assessment test, you should ensure that all test conditions are met and then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 11 Evaluation of Focal Spot Performance It is important that the test pattern be positioned in a reproducible manner. A test stand may be helpful. If the required specifications are not met, remove the compression paddle if it was included in the original setup and retest with the same geometry. If the results are still below the specifications, a more detailed investigation of the reason should be made. For example, make a measurement of the focal spot dimensions (slit camera measurement) or limiting resolution (star pattern measurement). Information on additional procedures to apply to the evaluation of the focal spot performance can be found in the Mammography Quality Control Manual published by the American College of Radiology. If the system does not pass the Evaluation of Focal Spot Performance test, it is recommended that you contact your GE Medical Systems Service Engineer. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance Chap 3 Guidance.fm Page no. 133 Chapter 3 12 Sub-System MTF Measurement 12-1 Suitable Bar Patterns Suitable bar patterns for performing the Sub-System MTF measurement at 2.09 and 3.93 lp/mm include the Fluke Biomedical Models 07-501-1000 and 07-501-2000 and the Gammex/RMI Model MA0436. Suitable bar patterns for performing the Sub-System MTF measurement at 5 and 8 lp/mm include the Fluke Biomedical Model 07-555, the Gammex/RMI Model MA0647, and the Computerized Imaging Reference Systems Model 016A. 12-2 Variation of MTF with ROI Width Theoretical analysis of the effect of the ROI width on the MTF measurement suggests that it is better to err on the side of setting the width too small rather than too large. It is expected that when the ROI width exceeds the pattern group width, the standard deviation in the ROI, and consequently the MTF, will increase with further increases of the ROI width. To determine an appropriate ROI width to use, the physicist can vary the width and observe the ROI standard deviation. If the ROI width is too large, the standard deviation in the ROI will tend to increase with further increases of the ROI width. When the ROI is inside the pattern group image, the standard deviation will fluctuate as the ROI width is changed, but it is not expected to change consistently in one direction as the ROI width is changed in one direction (wider or narrower). 12-3 Use of Dual-Orthogonal Test Patterns for the MTF Measurement Certain resolution test devices contain two bar patterns disposed at right angles to each other. Two concerns regarding these patterns have been identified - the angle between the two patterns and the ability to position the patterns according to the requirements of this procedure. In some cases the angle between the two patterns is apparent to be other than 90. The bar pattern frequency along a particular axis varies as the cosine of the angle between the axis and the normal to the bars of the frequency pattern group. At an angle of 10, the frequency error would be about 1.5%. Based on the sensitivity information below, that would change the sub-system MTF for the magnification configuration by less than 0.01, which is not significant. An approach one could take when using a test device with non-orthogonal patterns is to split the difference of the error. For example, if the angle between the patterns is 80 instead of 90, the physicist could rotate the pattern a few degrees so that both patterns were about 5 off the intended axis. At 5 the frequency error is about 0.4%, resulting in an MTF error of not more than 0.0023. The other concern regarding the dual pattern devices is the ability to position the patterns according to the requirements of the procedure. Two of the positioning requirements are: - Position the edge of the pattern at the specified distance from the chest wall edge of the image receptor or magnification stand. - When evaluating the focal spot length, position the low-frequency end of the bar pattern toward the chest wall edge of the image receptor. Due to the way that the two patterns are disposed in some versions of these devices, it is not possible to meet these requirements simultaneously for both patterns. Of course, the device may be separately positioned to meet the requirements for each measurement. But, if a single image is being used to evaluate the MTF along two axes, the physicist should take care to ensure that the positioning of the bar patterns meets the requirements of the procedure. Chapter 3 Page no. 134 Chap 3 Guidance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance 12-4 Bar Pattern Frequency Inaccuracy Inaccuracy of the pattern group frequencies can lead to errors in the MTF estimate. Errors of 0.5 lp/mm have been observed which can (based on estimates as suggested below) lead to errors in the MTF of about 0.06 at 5 lp/mm and 0.05 at 8 lp/mm. It is recommended that the physicist measure the frequencies of the pattern groups to establish their accuracy and correct the MTF measurements as necessary. 12-5 Sensitivity of MTF Measurement to Bar Pattern Frequency Error The following table shows values of the increase in sub-system MTF associated with a 1% decrease in the spatial frequency at the spatial frequency points used for the test. These values can be used to estimate the effect on the MTF due to errors not exceeding 10% in the spatial frequency of the bar pattern used for the evaluation. 12-6 Ellipse Tool Information on the use of the ellipse tool may be found in the Viewer chapter of the Operator Manual for the Senographe Essential Acquisition System. Large Focal Spot Small Focal Spot Track Axis Freq. (lp/mm) MTF Freq. (lp/mm) MTF Mo Width 2.09 0.0037 5 0.0056 Rh Width 2.09 0.0037 5 0.0057 Mo Length 2.09 0.0037 5 0.0053 Rh Length 2.09 0.0037 5 0.0052 Mo Width 3.93 0.0053 8 0.0051 Rh Width 3.93 0.0053 8 0.0051 Mo Length 3.93 0.0053 8 0.0051 Rh Length 3.93 0.0053 8 0.0051 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance Chap 3 Guidance.fm Page no. 135 Chapter 3 12-7 References for MTF Calculations The method of determining MTF based on calculations of means and standard deviations in images of bar patterns is described in the following references: Droege, R.T. and R.L. Morin, A practical method to measure the MTF of CT scanners, Med. Phys., v. 9, n. 5, 758-760,1982. Droege, R.T., A practical method to routinely monitor resolution in digital images, Med. Phys., v. 10, n. 3, 337-343, 1983. Droege, R.T. and M.S. Rzeszotarski, Modulation transfer function from the variance of cyclic bar images, Optical Engineering, v. 23, n. 1, 1984. Droege, R.T. and M.S. Rzeszotarski, An MTF method immune to aliasing, Med. Phys., v. 12, n. 6, 1985. 12-8 Actions to be taken if specifications are not met If the required specifications are not met, ensure that all test conditions are met and then retest with the same geometry. If the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the results are still below the specifications, a more detailed investigation of the reason should be made. The operator could perform the CNR and MTF Measurement, Chapter 1, Section 5, or make a measurement of the dimensions (slit camera measurement) or limiting resolution (star pattern measurement) of the focal spot. Information on additional procedures to apply to the evaluation of the focal spot performance can be found in the Mammography Quality Control Manual published by the American College of Radiology. If the above actions do not lead to a satisfactory test result, it is recommended that you contact your GE Medical Systems Service Engineer. Chapter 3 Page no. 136 Chap 3 Guidance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Guidance 13 Breast Entrance Exposure, Average Glandular Dose, and Reproducibility Phantoms suitable for mammographic dosimetry include mammographic phantoms sold by Radiation Measurements, Inc., Model 156; by Nuclear Associates, Model 18-220; and by Computerized Imaging Reference Systems, Model 15. Methods for dose calculation and dose conversion tables can be found in the Mammography Quality Control Manual published by the American College of Radiology. If the system does not pass the Breast Entrance Exposure, Average Glandular Dose, and Reproducibility test, you should ensure that all test conditions are met and then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 14 Artifact Evaluation and Flat Field Uniformity If the system does not pass the Artifact Evaluation and Flat Field Uniformity test, and the detector has been allowed to warm up for at least 10 minutes, but less than 30 minutes, allow an additional 20 minutes for the detector to warm up (total of 30 minutes) then repeat the test. If the system still fails, it is recommended that you contact your GE Medical Systems Service Engineer. 15 Summary of Mammography Equipment Evaluation The form given on the following pages may be used to summarize the data acquired during a Senographe Essential mammography equipment evaluation (MEE). The detailed data acquired for each test is expected to satisfy MQSA requirements as stated below. Although Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility on page 113 in Chapter 2 QC Tests for the Medical Physicist states that it is only necessary to measure the dose to the phantom for the one image acquisition mode most commonly used clinically to image the standard breast, this limitation is intended to apply only to QC testing. During the MEE, it is recommended that dose measurements be made in all three AOP modes CNT, STD, and DOSE. Measurements under other conditions may be made at the discretion of the medical physicist. The applicable MQSA Quality Mammography Standard is: 900.12(e)(10) Mammography equipment evaluations. Additional evaluations of mammography units or image processors shall be conducted whenever a new unit or processor is installed, a unit or processor is disassembled and reassembled at the same or a new location, or major components of a mammography unit or processor equipment are changed or repaired. These evaluations shall be used to determine whether the new or changed equipment meets the requirements of applicable standards in paragraphs (b) and (e) of this section. All problems shall be corrected before the new or changed equipment is put into service for examinations or film processing. The mammography equipment evaluation shall be performed by a medical physicist or by an individual under the direct supervision of a medical physicist. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System Summary of equipment performance.fm Page no. 137 Chapter 3 Chapter 3 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System Test Results 1. Flat Field and Image Quality Checks Reference: QC tests Chapter 1, section 4 Flat Field and Phantom IQ Tests on page 16 Requirement: All Flat Field checks must pass. Requirement: 4 largest fibers, 3 largest speck groups, and 3 largest masses must be detected. Facility Name: Address: Date of Installation Unit Ser. No. Date of Survey Room ID Medical Physicist Signature Pass Fail Brightness Nonuniformity High Frequency Modulation Bad Pixels Bad ROI Bad Pixel Map check Note: Not available on all systems SNR Nonuniformity AWS Printer No. of Fibers No. of Speck Groups No. of Masses Chapter 3 Page no. 138 Summary of equipment performance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System 2. CNR and MTF Measurement Reference: QC tests Chapter 1, section 5 CNR and MTF Measurement on page 21 Requirement: MTF Parallel at 2 lp/mm > 49% MTF Parallel at 4 lp/mm > 18% MTF Perpendicular at 2 lp/mm > 49% MTF Perpendicular at 4 lp/mm > 18%. 3. AOP Mode and SNR Check Reference: QC tests Chapter 1, section 7 AOP Mode and SNR Check on page 24 Requirement: MTF parallel at 2 lp/mm MTF parallel at 4 lp/mm MTF perpendicular at 2 lp/mm MTF perpendicular at 4 lp/mm CNR Exposure Parameters AOP, STD Mode Acrylic Thickness (mm) Track/filter mAs kV SNR 25 50 60 Exposure Parameters AOP, STD Mode Acrylic Thickness (mm) Track/filter mAs kV SNR 25 Mo/Mo 20 - 60 26 > 50 50 Rh/Rh 40 - 90 29 > 50 60 Rh/Rh 45 - 95 30 or 31 > 50 Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System Summary of equipment performance.fm Page no. 139 Chapter 3 4. Collimation Assessment Reference: QC tests Chapter 2; Job Card VF-P01A - Collimation Assessment with X-Ray Cassette on page 57 or Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips on page 63 Requirement: All collimation requirements must pass. 5. Evaluation of Focal Spot Performance Reference: QC tests Chapter 2, Job Card VF-P02 - Evaluation of Focal Spot Performance on page 87 Requirement: In the contact configuration or the 1.5 X magnification configuration, measurements made with the bars parallel to the anode-cathode axis must be at least 13 lp/mm; measurements with the bars perpendicular to the anode-cathode axis must be at least 11 lp/mm. The procedure of magnification stand test is performed with the 1.5x magnification stand only, but this test result is valid whatever the magnification stand used clinically. Pass Fail Deviation between X-ray field and light field is less than 2% of SID. X-ray field does not extend beyond any side of the image receptor by more than that quoted in table 1 X-ray Field - Image Receptor Action Limits, page 80. Chest wall edge of the X-ray field extends to the chest wall edge of the image receptor. Chest wall edge of compression paddle not visible in image and does not extend beyond image receptor by more than 1% of SID. Resolution Limit (lp/mm) Bars para. AC axis Bars perp. AC axis Anode track Mo Rh Mo Rh Contact geometry 1.5X Magnification Chapter 3 Page no. 140 Summary of equipment performance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System 6. Sub-system MTF Reference: QC tests Chapter 2, Job Card VF-P02A - Sub-System MTF Measurement on page 93 Requirement: All sub-system MTF requirements must pass. 7. Breast Entrance Exposure, Average Glandular Dose, and Reproducibility Reference: QC tests Chapter 2, Job Card VF-P03 - Breast Entrance Exposure, Average Glandular Dose and Reproducibility on page 113 Requirement: The maximum acceptable coefficient of variation for both mAs and air kerma is 0.05. The mean glandular dose to the Standard breast must not exceed 3 mGy (0.3 rad) per view. Large Focal Spot Small Focal Spot (If it is used clinically) Track Axis Freq. (lp/mm) Pass Fail Freq. (lp/mm) Pass Fail Mo Width 2.09 5 Rh Width 2.09 5 Mo Length 2.09 5 Rh Length 2.09 5 Mo Width 3.93 8 Rh Width 3.93 8 Mo Length 3.93 8 Rh Length 3.93 8 Coefficient of Variation of mAs Coefficient of Variation of air kerma Mean glandular dose to Standard breast AOP, CNT mode AOP, STD mode AOP, DOSE mode other (specify parameters) Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System Summary of equipment performance.fm Page no. 141 Chapter 3 8. Artifact Evaluation and Flat Field Uniformity Reference: QC tests Chapter 2, Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity on page 119 Requirement: Artifact requirements must pass. 9. kVp Accuracy and Reproducibility Reference: QC tests Chapter 2, section 1 Introduction on page 51 Requirement: The kVp shall be accurate within 5 percent of the indicated or selected kVp at each of the above measurement points. Requirement: At the most commonly used clinical setting of kVp, the coefficient of variation of reproducibility of the kVp shall be equal to or less than 0.02. 10. Beam Quality Assessment (Half-Value Layer Measurement) Reference: QC tests Chapter 2, section 1 Introduction on page 51 Requirement: Half-value layer must equal or exceed MQSA minimum value. 11. Radiation Output Reference: QC tests Chapter 2, section 1 Introduction on page 51 Requirement: The system shall be capable of producing a minimum output of 7.0 mGy air kerma per second (800 mR per second) under specified conditions. Requirement: The system shall be capable of maintaining the required minimum radiation output averaged over a 3.0 second period. Pass Fail Artifacts are not apparent or are not expected to mimic or obscure clinical information. kVp error at lowest measurable clinical kVp (%) kVp error at most commonly used clinical kVp (%) kVp error at highest available clinical kVp (%) Coefficient of variation at most commonly used clinical kVp setting Pass Fail Half-value layer equals or exceeds minimum allowed under MQSA. Value Units Radiation output Pass Fail Output maintained for at least 3.0 sec. Chapter 3 Page no. 142 Summary of equipment performance.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1 Summary of Mammography Equipment Evaluation for Senographe Essential Mammographic System 12. Mammographic Unit Evaluation Reference: QC tests Chapter 2, section 1 Introduction on page 51 Requirement: The system shall meet the MQSA requirements for motion of the tube-image receptor assembly and for compression paddle decompression. Pass Fail System meets requirements for motion of tube-image receptor assembly. System meets requirements for compression paddle decompression. Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Revision History.fm Page no. 143 Revision History This table is intentionally left in English. Note for the Technical Writer: This publication is contained in a multibook "Master Folder". It is a slave publication. To maintain this publication, it is mandatory to use "Master Folder" 5339408-X-899 as the FrameMaker source. The "Master Folder" contains a "Read Me" which explains how to proceed. File Name DATE REASON FOR CHANGE 5305863-6-S- 1EN rev 1 December 11, 2009 - Compression paddle size changed in Chapter 1, 7, step2. - Job Card VF-P01A (Collimation assessment with cassette) added and VF-P01 changed to VF-P01B (Collimation Assessment with aluminium attenuator plate) 5305863-7-S- 1EN rev 1 May 2012 Update of Job Card VF-P01A 5305863-8-1EN rev 1 March 2013 Updates are the following: - Added JC VFP05 -Test for flexible paddle deflection in compression - Bad Pixels Verification changed to Bad pixels - Total Bad Pixels changed to Bad Pixel Map check - Modified last page (address and China information) - Added eIFU information - Added Legal information. Page no. 144 Revision History.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
5305863-9-1EN rev 1 December 2013 Updates are the following: - Updated PN in entire manual - Updated X-ray Warning to a "Important... X-ray Protection" statement (HCSDM00196149). - Updated Chapter 1, Section 7 - AOP Mode and SNR Check: removed "Left Breast Laterality" from the procedure (SPR HCSDM00095581). - Updated JC VF-P01A Title changed to "Collimation Assessment with X-ray cassette" Test description changed to "Collimation Assessment with X-Ray Cassette". - Updated JC VF-P01B Title changed to "Collimation Assessment with radiation sensitive strips"" Test description changed to "Collimation Assessment with Radiation Sensitive Strips". - Updated Note in section "Objective" of JC VF-P02A - Sub- System MTF Measurement. - Updated Chapter 2 QC Tests for the Medical Physicist, Section 1 - Introduction, the additional tests sequence has been modified: Job Card VF-P04 - Artifact Evaluation and Flat Field Uniformity has been moved to step 4 of table (SPR HCSDM00245924). - Updated JC VF-P04 - Artifact Evaluation and Flat Field Uniformity: sub-steps have been added to step 12.of procedure (SPR HCSDM00245924). - Updated JC VF-P05 - Test for flexible paddle deflection in compression (SPR HCSDM00241093). - Removed "GE Healthcare" and "Imagination at work" from manual (SPR HCSDM00229067). File Name DATE REASON FOR CHANGE Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
Last Page.fm Page no. 145 This page is intentionally left blank. Page no. 146 Last Page.fm Senographe Essential 5305863-9-1EN Quality Control Manual Revision 1
To contact your local GE representative, please go to: http://www.gehealthcare.com/helpcenter.html China Service Agent Address: ( 96 1 200131) Manufacturer and Manufacturing Site: GE MEDICAL SYSTEMS SCS 283 RUE DE LA MINIERE 78530 BUC - FRANCE