QA Flashcards
Why is QA used?
IRR 2017
IRR 2017- employers duty to ensure the equipment remains in a working state which will then restrict the dose to patients (comply with regulations)
Meet with RPA and come up with appropriate testing programme to comply with IRR 2017
New equipment must be suitable for the purpose which it is bought
Once this equipment is in place it must be checked regularly it must remain fit for the purpose it was bought
Why is QA important?
Ensures equipment is safe:
Identifies equipment deterioration
Used to achieve ALARA
ensures patient and staff safety
Ensures Legislative compliance
Testing before equipment enter service?
Stage 1:
Who and why?
Critical examination:
Performed by installer of new equipment
The purpose is to ensure all safety features and warning devices work correctly – also includes tube leakage and total filtration
Testing before equipment enter service?
Stage 2:
Acceptance testing:
Verify that the contractor has supplied all the equipment specified and has performed adequate test to demonstrate specified requirements are met - done by radiographers (customer)
Tests with RPA while engineer is still present to ensure its both mechanically and electronically safe
Testing before equipment enter service?
Stage 3:
Commissioning
Will be done by medical physics
- set of tests to ensure the equipment is ready for clinical use + establish baseline values for QA to be compared
( tools to see if there is:
Scatter behind control panel
leaks outside designated area)
- tests will be repeated when any major maintenance is undertaken - e.g. new x-Ray tube
What is routine testing: 
Regular test throughout the lifetime of the equipment
Look for change in performance that indicate remedial action required
Generally routine and a subset of the commissioning test
HSE guidance:
Why and what?
HSE guidance can be used to ensure that you’re complying with IRR 2017
What is the IPEM report and what does it say?
It contains detailed instructions on how to undertake tests
Parameters
Frequency - how often
Priority level - 1 necessary 2 good but not necessary
Level of expertise - who - A - frequent B- not frequent
Action levels - remedial and suspension
What are action levels?
Remedial - If the performance of the equipment lies outside of the recognised
Tolerance limits and so actions must be taken – call engineer within a reasonable time scale
( if so repeat test or get colleague to do test to confirm)
Suspension - A level of performance at which it is recommended that the equipment should be removed from clinical use immediately
QA tests questions asked:
Is the equipment giving the same dose to patients it was giving when it was first used? – probably not – but within safe limits
Do all the components to work properly?
How frequently is machine used? - deterioration more depending on use
What kind of equipment is it and how is it used? – mobile, image intensifier
Is it safe?
What are the three types of testing?
Mechanical
Brakes
Mechanical interlocks
Movement of tube, table top etc
Electrical
Cable connections, fraying
Warning lights etc
Radiation
Radiation QA tests:
Light beam diaphragm (LBD) – alignment: vertical and horizontal beam; fixed equipment on mobile
Radiation output repeatability; fixed and mobile
Bucky tray alignment; erect and table
Automatic exposure control device- consistency between chambers; erect and table Bucky
Emergency stop buttons; fixed equipment and mobile
Other QA tests:
CR uniformity
DR detector calibration
Screening of PPE
Setting up a QA programme:
Look at legislation/guidance documents - what tests are required
Establish what testing equipment is available
Work out tolerance levels
Document step by step instructions for staff - to ensure consistency
Ensure results are documented each time
 radiation output monitoring test:
Purpose
Frequency
Equipment required
Method

Purpose - to determine the consistency of output of the x-ray unit
Frequency - Monthly
Equipment required - 
dap meter
Collimator test tool
Measuring tape
Method -
Sid -100
Collimator to inner rectangle of collimator test tool
DAP meter reset before and after each exposure
Exposure factors - 80kv 20mAs broad focus direct
4 successive exposures noting the meter reading for each one
Record and compare to tolerance levels
Action – report unacceptable results to RPS
Calculating the tolerance levels:
Carry out detailed test 10 times
Calculate the mean value
IPEM report 91:
Remedial +/- 10%
Suspension +/- 20%
Test equipment for LBD checks + tolerance
Light beam diaphragm tool
+/- 1cm of markers per 1cm of SID
Fluoro test tools:
Leeds test objects
Used for imaging:
Threshold contrast
Limiting spatial resolution
Threshold contrast
Leeds test object
on exposure dots appear
Dots are counted
+/- 2 from baseline
Spatial resolution:
Ability of a system To show two objects together and for them still appear a separate
Lines pairs per mm (squares in middle)
Smallest line pair group that can be visualised
(Determine if we can see fine details)
PPE QA checks:
Lead rubber aprons should be screened – fluoroscopy
Annually or when quality is suspect

What is reject analysis?
And why is it beneficial?
Highlights area of practice that can be improved by examining why we are rejecting/repeating an image
Technical
Staff
Training
Understanding why better performance - reduces waiting time, radiation burden on patients
What is a reject?
An image that has to be repeated which means re-exposure for the patient
An exposure event that fails to result in a diagnostically utilised image
Issues with ALARA
Why analyse a reject?
To identify basic areas of weakness within the department – locate equipment faults quickly and rectify if possible - minimise wasted time and effort
maintain standards and improve them
Justification for equipment, personnel through figures
Setting up a reject analysis program:
Digital imaging means system now calculates much of this for you – records total images taken during period - usually four weekly
Records any equipment Faults in said time period
The radiographer categorises the rejected image and has to give info why
Calculate % reject rates and report on results
What can we achieve with the project analysis?
Any training issues identified
Individuals with a high rate may need to be investigated
It gives clues as to how the department can function better
May identify specific room/area which warrants further investigation
And to improve overall quality
