ACR Radiography and Fluoroscopy Accreditation

ACR Radiography and Fluoroscopy Accreditation Charles R. Wilson, Ph.D., F.A.C.R. Medical College of Wisconsin Milwaukee, Wisconsin 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 Initial Board certification Other Physicians •Six months formal training in an ACGMEapproved program, and •Interpretation and formal reporting of 1000 general radiographs •200 general radiographs per year (recommended), and •If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended) 150 hours every three years (recommended) Continued Experience •200 general radiographs per year (recommended), and •If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended) 150 hours every three years (recommended) Continuing Education 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 Side View Fluoro Spot (undertable tubes) 4.1 cm 7.6 cm 7.6 cm 7.6 cm 7.6 cm 4.1 cm 7.6 cm Interventional Abdomen (overtable tube) Total Acrylic = 19.3 cm 4.6 mm Al Air gap 4.1 cm 7.6 cm 7.6 cm 4.1 cm 7.6 cm Chest (horizontal tube) Test object plate (3/8 in thick) 7.6 cm slot block with a slot to accept a 2.5 x 15.3 cm thick artery block. The artery block is commercially available from Nuclear Associates. Air gap Contrast-Detail test object, (placed 7cm from center of Test Plate object on axis that bisects corners of Test plate object and does not overlay lead markers from 4.1 cm block) Top View 4.1 cm block 25 cm 25 cm Test plate object Lead markers 25 cm 25 cm Mesh patterns and low contrast holes (centered) The distance from the center of the block to the lead markers is 7 cm the express written permission of the American College of Radiology is prohibited. Small aluminum disk ( 6cm from center of Test plate object and 12.5 cm from adjacent sides) This document is copyright protected by the American College of Radiology. Any attempt to reproduce, copy, modify, alter or otherwise change or use this document without 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 Processor quality control (laser printers excluded Darkroom cleanliness Phantom images Visual checklist Viewboxes and viewing conditions Daily Weekly Frequency Quarterly Monthly Quarterly Repeat analysis Analysis of fixer retention in film Darkroom fog Screen cleanliness Screen-film contact (auto film changers only) Quarterly Semiannually Semiannually As needed or annually Annually Radiography/Fluoroscopy Accreditation Program Reviewer 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 Program Validation • 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 Program Accreditation 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 Program If 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™