Charles R. Wilson, Ph.D., F.A.C.R. Medical College of Wisconsin Milwaukee, Wisconsin ACR Radiography and Fluoroscopy Accreditation
May 07, 2015
Charles R. Wilson, Ph.D., F.A.C.R.
Medical College of Wisconsin
Milwaukee, Wisconsin
ACR Radiography and Fluoroscopy Accreditation
Who is the ACR?
We serve more than 32,000 radiology professionals nationwide
• Diagnostic / interventional radiologists
• Radiation oncologists
• Medical physicists
• Nuclear medicine physicians
• Clinical researchers
Accreditation Programs
• 1966 - first practice accreditation program
• 1987 – mammography accreditation
• 1987 – radiation oncology
• 1994 – FDA adopts ACR’s mammography accreditation program
• 1995 – ultrasound
• 1996 – stereotactic breast biopsy
• 1997 – MRI
• 1998 – ultrasound guided breast biopsy
• 1999 – nuclear medicine
• 2002 – CT and radiography/fluoroscopy
What is ACR Accreditation?
Peer review process developed and monitored by experts
• Concept must be approved by the ACR Council
• Assesses specific parameters for each imaging modality
• Based on ACR Practice Guidelines and Technical Standards
• Pilot tested before being launched
• Ongoing review of accreditation program by the committee
Diagnostic Modality Accreditation Program
Streamlined application process
• Single application for group practice
• 10 percent discount for each facility that applies for three or more
modalities
• Each facility will have the option of submitting the clinical and phantom
images for different modalities all at once or in 30-day increments
• ACR web site will list all modalities accredited at each practice
Diagnostic Modality Accreditation Program
ACR Practice Guidelines and Technical Standards
• Evidence based
• Jointly developed
• Good risk management tools
Diagnostic Modality Accreditation Program
Medical expertise
• Practice Guidelines and Technical Standards Development– Over 450 members participate
• Accreditation Development and Implementation– Over 400 radiologists, radiation oncologists, and medical physicists
Diagnostic Modality Accreditation Program
ACR Quality and Safety staff
• Career healthcare professionals
• Imaging technologists and radiation therapists
Radiography/Fluoroscopy Accreditation Program
• Committee
• Personnel qualifications
• Clinical requirements
• Phantom requirements/dose
• Quality Control program and equipment QC
• Reviewer qualifications
• Program statistics
Radiography/Fluoroscopy Accreditation Program
Committee• Stephen Baker, M.D., Co Chairman• Robert Steiner, M.D., Co Chairman• Theodore Ditchek, M.D.• Robert Dixon, Ph.D.• Seth Glick, M.D.• Robert Halvorsen, M.D.• Heber McMahon, M.D.• Dean Maglinte, M.D.• Kathleen McCarroll, M.D.• Diego Nunez, M.D.• Beth Ann Schueler, Ph.D.• Carlos Sivit, M.D.• Richard Wechsler, M.D.• Charles Wilson, Ph.D.• Helen Winer-Muram, M.D.
Radiography/Fluoroscopy Accreditation Program
Modules Included
• Chest Radiography
• General Radiography
• Fluoroscopy
Equipment not included dedicated head units dental units portable c-arm units bone density units dedicated cystography units dedicated vascular and cardiac interventional units lithotripter units
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications
• Physician
• Medical Physicist/MR Scientist (if applicable)
• Technologist
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications - Physician
Radiologists Other Physicians
Initial Board certification •Six months formal training in an ACGME-approved program, and•Interpretation and formal reporting of 1000 general radiographs
Continued Experience
•200 general radiographs per year (recommended), and•If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended)
•200 general radiographs per year (recommended), and•If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended)
Continuing Education
150 hours every three years (recommended)
150 hours every three years (recommended)
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications - Medical Physicist
Medical Physicist
Initial Board certification in diagnostic radiologic physics or radiologic physics (recommended)
Continuing Education
150 hours every three years (recommended)
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications – Radiological Technologist
Radiological Technologist
Initial ARRT registered or unlimited state license
Continuing Education
24 credits in a 2-year period
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• Chest Module
– Two sets of chest exams must be submitted (PA and Lateral)
• Small patient – 16 cm or less
• Large patient – 23 cm or more
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• General Radiography Module
– Abdomen exam
– Cervical spine exam
– Elbow exam
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• Fluoroscopy Module
– Double-contrast barium enema exam from one adult patient
– One single-contrast barium enema exams for pediatric-only sites
Radiography/Fluoroscopy Accreditation Program
Phantom image quality evaluation(score and artifacts)• Radiographic- chest/ abdomen• Fluoro- real time• Fluoro- Spot film
• ESE for all the above
Radiography/Fluoroscopy Accreditation Program
Phantom Images
• All image receptors must be tested with the phantom
Radiography/Fluoroscopy and Interventional Accreditation Phantom
Fluoro Spot Interventional(undertable tubes)
Abdomen(overtabletube) Chest
(horizontaltube)Total
Acrylic =19.3 cm
4.6 mm Al
Air gap
Test object plate(3/8 in thick)
4.1 cm
7.6 cm
7.6 cm
7.6 cm
7.6
cm7.6 cm 7.6 cm 7.6 cm
7.6 cm
7.6 cm slot block with a slot to accept a 2.5 x 15.3 cmthick artery block. The artery block is commerciallyavailable from Nuclear Associates.
4.1 cm4.1 cm
4.1 cm
Top View25 cm
25 cm
The distance from thecenter of the block to thelead markers is 7 cm
4.1 cmblock
Lead markers
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Test plateobject
25 cm
25 cm
Contrast-Detailtest object, (placed 7cmfrom center of Test Plateobject on axis that bisectscorners of Test plate objectand does not overlay leadmarkers from 4.1 cm block)
Small aluminum disk ( 6cm fromcenter of Test plate object and 12.5cm from adjacent sides)
Mesh patterns and lowcontrast holes (centered)
Side View
Air gap
Radiography/Fluoroscopy Accreditation Program
Phantom Images
• Specific performance criteria evaluated using the phantom:
– Minimum detectable contrast (%)
– Low-contrast resolution (contrast-detail)
– Optical density
– High-contrast resolution
– Entrance skin dose
Radiography/Fluoroscopy Accreditation Program Quality control program and equipment QC • Annual Medical Physicist’s QC Tests – Radiographic Unit
– System assembly evaluation
– Collimation assessment
– Timer accuracy
– Linearity of air kerma (exposure) with mA and mAs
– kVp accuracy and reproducibility
– Exposure reproducibility and beam quantity (mR/mAs)
– Radiographic AEC system performance assessment
– Entrance skin air kerma (exposure) for chest and abdomen phantom
– Beam quality assessment (HVL)
– Phantom image quality evaluation
– Artifact evaluation
– Review of technologist QC program and tests
Radiography/Fluoroscopy Accreditation Program Quality control program and equipment QC • Annual Medical Physicist’s QC Tests – Fluoroscopic Unit
– System assembly evaluation
– Collimation assessment
– kVp accuracy and reproducibility
– Spot film AEC system performance
– Entrance skin air kerma (exposure) for spot film mode and air kerma (exposure)
rate for fluoroscopic mode (both using the abdomen phantom)
– Maximum air kerma (exposure) rate
– Beam quality assessment (HVL)
– High contrast resolution at image intensifier input plane
– Artifact evaluation
– Phantom image quality evaluation (fluoroscopy and spot film images)
Radiography/Fluoroscopy Accreditation Program Quality control program and equipment QC
Radiologic Technologist’s Quality Control Tests
Test Frequency
Processor quality control (laser printers excluded Daily
Darkroom cleanliness Weekly
Phantom images Quarterly
Visual checklist Monthly
Viewboxes and viewing conditions Quarterly
Repeat analysis Quarterly
Analysis of fixer retention in film Semiannually
Darkroom fog Semiannually
Screen cleanliness As needed or annually
Screen-film contact (auto film changers only) Annually
Radiography/Fluoroscopy Accreditation ProgramReviewer qualifications
• Reviewers must be:– ABR certified
– ACR members
• Must participate in formal training program
• Reviewer QC is performed by ACR
• Minimum 5 years experience
• In clinical or physics practice across the U.S.
• Conflict of interest addressed (i.e. may not review images from own
state)
Radiography/Fluoroscopy Accreditation ProgramValidation
• Random on-site visits
– Prior notification
– Validate submitted data
– Respond to legitimate complaints
• Validation film checks (currently this is for mammo only)
– Done through mail
• Consumer complaint process
Radiography/Fluoroscopy Accreditation Program
Mobile services
• Must meet the same criteria as a fixed site
Radiography/Fluoroscopy Accreditation Program
Fees
• Facility fee $650
• Plus an additional $200 for each room being accredited
Radiography/Fluoroscopy Accreditation ProgramAccreditation Granted
• All units at the site must pass evaluation for accreditation to be
maintained
• A certificate and decal will be issued for each unit
• Accreditation is granted for three years
Radiography/Fluoroscopy Accreditation ProgramIf the site does not pass the first time
• Retest
– A facility will have the option to retest
• Appeal
– Sites have the option to appeal the final outcome
– The films are reviewed by a senior reviewer, not involved with the first
review
Why ACR Accreditation?
Improved quality
• Patient confidence– Better informed patients are seeking high quality care
• Health care and the Internet:
– 73 million Americans use the Internet to answer health questions
– 68 percent say the material found “influenced” their medical decisions!
American College of Radiology
1891 Preston White Drive
Reston, VA 20191-4397
Accreditation Hotline: 800-770-0145
Mammography hotline: 800-227-6440
Radiation oncology hotline: 888-726-8956
www.acr.org
Quality is our Image™