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					                                                                           ASHA CPG 102 Revision 5


 1   Clinical Practice Guideline:                 Radiographic Quality and Safety Parameters
 2
 3   Date of Implementation:                      October 26, 2006
 4
 5   Contact:                      Clinical Care Management
 6                                 Clinical Quality Management
 7   _______________________________________________________________________
 8
 9   The goal of radiography is to establish the presence or absence and nature of disease by
10   demonstration of the disease process itself or the effects of the disease process on the
11   normal anatomy. All studies should be done with the minimal radiation dose necessary to
12   achieve an optimal image.
13
14   The following specifications for radiological examination and equipment are intended to
15   ensure optimum diagnostic quality, while minimizing radiation exposure to patients,
16   practitioner/technician, and support personnel.
17
18   Education and Training of Practitioner
19   A practitioner performing radiographic examinations must have documented training and
20   understanding of the physics of diagnostic radiography, experience with the equipment,
21   demonstrate an understanding of the principles of radiation protection, knowledge of the
22   hazards of radiation exposure to both patients and radiology personnel, and utilize
23   appropriate radiation monitoring devices in the facility. The practitioner should also
24   possess knowledge and competency in the principles and procedures of general
25   radiography, screen-film combinations, and image processing (conventional and/or
26   digital as applicable to the facility).
27
28   The practitioner should perform, interpret, and report radiographic examinations in
29   accordance with nationally recognized standards of practice1, 2, 3. The practitioner’s
30   continuing clinical education should include continuing medical education in general
31   radiography as is appropriate to his/her practice and in accordance with applicable state
32   law.
33
34   If a radiology technologist or qualified assistant performs radiographic examinations, the
35   technologist/assistant must maintain a state approved license/certification, as required.
36
37   Quality Assurance, Safety, and Infection Control
38      Appropriate collimation and shielding should be utilized to limit exposure to the
39          anatomical area(s) of interest and improve image quality by limiting scatter
40          radiation. A properly centered and focused square-leaf collimator with light must
41          be employed. Collimation must be used to exclude the eyes and other sensitive
42          organs whenever possible, and should not be any wider than is necessary.
                                                                                        Page 1 of 4
     ASHA CPG 102 Revision 5
     Radiographic Quality and Safety Parameters
     Revised – June 16, 2011
     To CQT for review 05/17/11
     CQT reviewed 05/17/11
     To CPRC for review and approval 05/31/11
     CPRC reviewed and approved 05/31/11
     To CQOC for review and approval 06/16/11
     CQOC reviewed and approved 06/16/11
                                                                           ASHA CPG 102 Revision 5


 1             Collimations should at least be evident on three sides of the film.
 2            All facilities producing radiographs should have policies and procedures for
 3             appropriate shielding of patients and healthcare workers.
 4            Facilities should have policies and procedures to reasonably attempt to identify
 5             pregnant patients prior to the performance of any diagnostic examination
 6             involving ionizing radiation. Pregnancy, especially in the early trimesters,
 7             significantly impacts the risk:benefit ratio and the decision whether to obtain
 8             radiographs needs to be carefully considered. If a decision is made to obtain
 9             radiographs of a pregnant or a potentially pregnant patient, a written informed
10             consent should be obtained prior to performing the procedure.
11            Notices regarding pregnancy should be posted in compliance with all applicable
12             state regulatory requirements, and include language such as, “If it is possible that
13             you might be pregnant, notify the physician or other staff before your x-ray
14             examination.”
15            Suitable gonadal shielding must be utilized whenever possible on all patients.
16            Facilities providing radiographic services should have documented policies and
17             procedures related to quality control, patient education, infection control, and
18             safety.
19            The quality control program should include documented protocols and procedures
20             for maintaining imaging equipment; maintenance and cleaning of film processors;
21             and orientation and training of staff. All applicable state regulatory requirements
22             must also be maintained.
23
24   Specifications of Radiographic Examination
25       Objects which may produce unacceptable artifacts (e.g., jewelry, hair ornaments,
26          patient’s clothing in the area of the study) should be removed before exposure is
27          made. A supply of clean gowns should be available to avoid clothing artifacts
28          such as zippers and buttons.
29       All radiographic studies should be permanently imprinted with patient’s complete
30          name; facility name and location; and date of the examination. The side (right or
31          left) of the anatomic site radiographed should be permanently labeled (e.g., use of
32          Mitchel marker).
33       All facilities performing radiography should have written protocols for standard
34          views of each anatomic area that will be imaged. These should be designed to
35          optimize diagnostic information while minimizing radiation exposure.
36       All facilities performing radiography should have a Supertech calculator and/or
37          technique charts listing exposure factors that will reliably produce diagnostic
38          radiographs of anatomic parts of patients of various dimensions to minimize the
39          need for repeat exposures. Images of non-diagnostic quality should be repeated.
40          Causes and frequency for repeating x-rays due to non-diagnostic quality should be
41          identified as part of a routine quality control process.

                                                                                         Page 2 of 4
     ASHA CPG 102 Revision 5
     Radiographic Quality and Safety Parameters
     Revised – June 16, 2011
     To CQT for review 05/17/11
     CQT reviewed 05/17/11
     To CPRC for review and approval 05/31/11
     CPRC reviewed and approved 05/31/11
     To CQOC for review and approval 06/16/11
     CQOC reviewed and approved 06/16/11
                                                                          ASHA CPG 102 Revision 5


 1            All radiographs should be reviewed for positioning and diagnostic quality at the
 2             facility before the patient is released for the day. X-rays must be of diagnostic
 3             quality. A minimum of two views at 90 degrees to each other are the professional
 4             standard and may be a regulatory requirement.
 5            Radiographic examinations of the spine or extremities should completely
 6             demonstrate the designated regions, or the levels of clinical interest in a limited
 7             examination.
 8
 9   Radiographic Reporting Documentation Standards
10   All radiography examinations must include a documented interpretation of the findings
11   (radiology report). This report must be maintained as a permanent part of the patient’s
12   medical record, and include at a minimum:
13        Patient name or other identifier
14        Facility name and location
15        Date of the examination
16        Relevant clinical information and diagnosis
17        Description of the studies (anatomical location and views taken)
18        Report should include appropriate anatomic, pathologic, and radiologic
19           terminology to describe all findings
20        Limitations impacting the ability to read/interpret radiographic findings should be
21           identified (e.g., artifacts, poor quality of film, technical factors)
22        The report should address any specific clinical questions; if there are factors that
23           prevent answering the clinical question, this should be stated explicitly.
24        Comparison with relevant examinations and reports (e.g., previous x-rays, CT,
25           MRI) should be included in the radiologic report when appropriate.
26        Impression should include a precise differential diagnosis, any significant patient
27           reaction, and recommendations for follow-up or additional diagnostic studies to
28           clarify or confirm the impression when appropriate.
29        Person providing the interpretation of the study must be identified on the report.
30
31   Specifications of Equipment
32        The mandatory minimum power for radiographic equipment is 100 kVp / 200
33            MA or greater for standard, digital and high speed digital imaging.
34        The diagnostic radiographic equipment and facility should meet all applicable
35            federal and state radiation standards.
36        For non-digital imaging, automated film processing is preferred. Carefully
37            controlled temperature and regularly scheduled processor maintenance should
38            be included in a quality control program. A constant time and temperature
39            should be maintained for manual processing. The chemicals must also be
40            replenished appropriately.
41

                                                                                        Page 3 of 4
     ASHA CPG 102 Revision 5
     Radiographic Quality and Safety Parameters
     Revised – June 16, 2011
     To CQT for review 05/17/11
     CQT reviewed 05/17/11
     To CPRC for review and approval 05/31/11
     CPRC reviewed and approved 05/31/11
     To CQOC for review and approval 06/16/11
     CQOC reviewed and approved 06/16/11
                                                                       ASHA CPG 102 Revision 5


 1   References
 2   1. American College of Radiology. (2002). ACR Practice Guideline for General
 3       Radiography. Retrieved August 27, 2006 from
 4       http://www.acr.org/s_acr/bin.asp?CID=541&DID=12225&DOC=FILE.PDF
 5
 6   2. American College of Radiology. (2002). ACR Practice Guideline for the Performance
 7       of Spine Radiography in Children and Adults. Retrieved August 27, 2006 from
 8       http://www.acr.org/s_acr/bin.asp?CID=542&DID=12289&DOC=FILE.PDF
 9
10   3. American College of Radiology. (2005). ACR Practice Guideline for Communication
11       of Diagnostic Imaging Findings. Retrieved August 27, 2006 from
12       http://www.acr.org/s_acr/bin.asp?CID=541&DID=12196&DOC=FILE.PDF
13
14   4. American Specialty Health. (2006). Preparing for a Site Visit. Retrieved August 27,
15       2006 from http://www.ashcompanies.com/data/pdf/resources/NtlDCInsert05-24-
16       04.pdf
17
18   5. International Commission on Radiological Protection. (1990). Radiation And Your
19        Patient: A Guide For Medical Practitioners. Retrieved August 27, 2006 from
20        http://www.icrp.org/docs/Rad_for_GP_for_web.pdf




                                                                                     Page 4 of 4
     ASHA CPG 102 Revision 5
     Radiographic Quality and Safety Parameters
     Revised – June 16, 2011
     To CQT for review 05/17/11
     CQT reviewed 05/17/11
     To CPRC for review and approval 05/31/11
     CPRC reviewed and approved 05/31/11
     To CQOC for review and approval 06/16/11
     CQOC reviewed and approved 06/16/11

				
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