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									                                                 Breast Ultrasound Accreditation Program
                1891 Preston White Drive, Reston, VA 20191-4397 Testing Material Checklist
Complete and return this checklist along with the following materials. The ACR will not process your
application if any items are missing. Be sure to keep copies of the completed application, images and any
additional submitted information.

     Quality Assurance Questionnaire
     Medical physicist or service engineer report (containing the serial number of the
     unit tested and labeled with a Quality Control label for each unit)
     Test Image Data form completed in full and appropriately labeled (incomplete forms
     will be returned and will delay accreditation)
     Clinical images (appropriately labeled). The supervising physician must review
     and approve the clinical image selection. All sonograms and mammograms must be
     from the same 60-day period; the sonograms may not be older than 6 months from
     the date of your application.

            Important: Remember to circle the mass or cyst being evaluated on
            the mammograms. Circle only one. ACR reviewers will fail the case
            if the mass or cyst is not circled or if multiple ones are circled.

Ship all of your testing materials to the ACR at the address below. Please take care in
packaging your materials. Damaged testing materials will be returned to your site for
replacement. Send your materials via a traceable shipping method. Track the
shipment with your shipping company to verify delivery.
                         Breast Ultrasound Accreditation Program
                             American College of Radiology
                                 1891 Preston White Drive
                                  Reston, VA 20191-4397

The enclosed labels show when your testing materials are due to the ACR. Failure
  to meet this due date will jeopardize completion of your accreditation. If your
facility is renewing its accreditation, we cannot guarantee completion before your
                               ACR certificate expires.

Document1                                                                                      Revised: 9/23/11

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