Testing Instructions - American College of Radiology
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1. Upload the DICOM image into your online Testing Package using TRIAD Windows Client or TRIAD Web Client see User Instructions for Electronic Submission of Images c Your supervising radiologist must review and approve the DICOM image selection prior to submitting your online Testing Package d Fill out the Test Image Data Form in your online Testing Package o 1 e IMPORTANT Submit only clinical images that are negative If ACR reviewers determine that any submitted cases require additional evaluation or follow up they will be returned immediately In these situations the supervising radiologist must attest that he or she will review the findings and follow up with the patient as appropriate before a final accreditation report is issued 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 the express written permission of the American College of Radiology is prohibited Page 5 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS _8 28 15 docx Revised 8 28 15 There should be one phantom image and or eight clinical images for each unit Submitting Clinical Images In order for the ACR Clinical Image Reviewers to assess your image quality for a range of breast types you must submit one complete exam of fatty breasts and one complete exam of dense breasts If you are REPEATING because2. object locations Set up the system as described in the Dimensions QC manual for exposing the phantom o Select an ACR Phantom Conv view from the Procedure screen on the acquisition station o Lower the compression device to compress the phantom lightly o Set clinical technical factors Mode Focal Spot Compensation Step currently used for a 4 2 cm compressed breast of average density o Select AEC sensor position 2 Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until it just touches the phantom Make an exposure Record the technical factors on the Test Image Data form 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 the express written permission of the American College of Radiology is prohibited Page 3 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 Philips Sectra Q Position the phantom as shown in the photo on the first page It may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image o Do NOT use an acrylic disc on the phantom o Compress the phantom with 5 to 7 daN o Make an exposure using the SmartAEC o Record the technical factors kVp and mAs displayed in the acquired image on the Test Image
3. Data form o Take preliminary images of the phantom to ensure correct positioning of the phantom Q Lower the compression device until it just touches the phantom Q Using manually set technical factors select a kVp and mAs as close as possible to the one determined in the first step Make an exposure QO Record the technical factors on the Test Image Data form Planmed QO Position the phantom as shown in the photo on the first page The chest wall side of the phantom must be completely flush with the chest wall side of the image receptor QO Setup the system as described in the QC manual for exposing the phantom Do NOT use an acrylic disc on the phantom Q Take preliminary images of the phantom to ensure correct positioning of the phantom Q Lower the compression device until it just touches the phantom Make an exposure QO Record the technical factors on the Test Image Data form Siemens QO Position the phantom as shown in the photo on the first page The chest wall side of the phantom must be completely flush with the chest wall side of the image receptor Do not use an acrylic disc on the phantom Q Take preliminary images of the phantom to ensure correct positioning of the phantom Q Lower the compression device until it just touches the phantom QO Select AEC mode AUTO and the center AEC chamber position O Set the clinical technical factors currently used for a 4 2 cm compressed breast of average d
4. change or use this document without the express written permission of the American College of Radiology is prohibited Page 7 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 MAILING INSTRUCTIONS For facilities submitting by hard copy film Return the required forms and documents see table above along with your phantom image and or the clinical images to the following address by a traceable method Mammography Accreditation Program American College of Radiology 1891 Preston White Drive Reston VA 20191 4397 The images submitted for review will be returned once the accreditation evaluation is complete However you should maintain copies of all images as well as a record of the patient names whose clinical images were sent for accreditation purposes until you receive official notification your accreditation is approved For facilities submitting images electronically Upload all images forms and documents see table above into your online testing package in the ACRedit Database https acredit acr org 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 the express written permission of the American College of Radiology is prohibited Page 8 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15
5. A CR Mammography Accreditation Program Testing Instructions AMERICAN COLLEGE OF RADIOLOGY 1891 Preston White Drive Reston VA 20191 4397 These instructions refer to both paper and online applications If you have applied in the ACRedit online database httos acredit acr org there are additional instructions within the online Testing Package Your Barcode labels describe the accreditation cycle that your facility is currently undergoing Submit both clinical and phantom images for INITIAL accreditation accreditation RENEWAL REINSTATEMENT or a VALIDATION FILM CHECK If you are REPEATING a test for a deficiency only submit images from the deficient test i e all clinical images or the phantom PHANTOM IMAGE A Required items for testing 1 One approved accreditation mammographic phantom Gammex RMI Model 156 Nuclear Associates Fluke Model 18 220 or CIRS Model 015 2 Bar coded identification labels to be affixed to the phantom image and the Test Image Data form If you chose to upload your images you will not have image labels IMPORTANT These labels are for a specific unit and are marked Phantom Image and Test Image Data Be sure to put the appropriate label on the appropriate item 3 One Test Image Data form for each mammography unit you are testing Note If you are accrediting both FFDM computed radiography and screen film on a single mammography unit you will test that unit twice once for CR and on
6. ally done for digital mammography 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 the express written permission of the American College of Radiology is prohibited Page 1 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 b Upload the DICOM image into your online Testing Package using TRIAD Windows Client or TRIAD Web Client see User Instructions for Electronic Submission of Images c Your supervising radiologist must review and approve the DICOM phantom image prior to submitting your online Testing Package d Complete the Phantom Test Image Data Form in your online Testing Package There should be only one phantom image for each unit PHANTOM EXPOSURE INSTRUCTIONS Full Field Digital Mammography Computed Radiography CR Agfa Carestream Fuji iCRco and Konica Minolta m OO OOOO O Position the phantom as shown in the photo on the first page With some units it may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Place the acrylic disk on the phantom as it would be for routine QC Be sure that the disk does not cover any test object locations Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until
7. ce for screen film Be sure to use the labels marked CR for the computed radiography testing B Procedure 1 The phantom and clinical images from each unit must be taken within 30 days of each other Validation film check images must be from the requested date 2 When positioning the ACR phantom center it laterally on the image receptor so that the chest wall edge of the phantom is aligned with the chest wall edge of the image receptor as shown in the photo Follow the Phantom Exposure Instructions below that are specific to your unit 3 For Hard Copy Film submission a For FFDM 1 Process the image as typically done for digital mammography 2 Window and level the display to best show the test objects 3 Do not zoom or rotate the image 4 Using the film printer normally used to make hardcopies of digital mammograms for transfer purposes print the phantom image so that e Calcifications appear white and e The phantom image is as close to true size as possible i e no magnification or minification b For screen film process the image using the processor normally used to process mammograms c Your supervising radiologist must review and approve the hardcopy phantom image prior to labeling it and sending it to the ACR d Label the film with the appropriate bar coded label e Complete one Test Image Data form for each mammography unit tested 4 For Electronic Submission a Process the images as typic
8. e Test Image Data form IMPORTANT These labels are for a specific unit and are marked Fatty Images Dense Images Clinical Images for validation film checks and Test Image Data Be sure to put the appropriate label on the appropriate item If you are REPEATING this test for a clinical accreditation deficiency you must submit both fatty and dense cases performed after the date on your DEFICIENCY REPORT 2 One Test Image Data form in your online Testing Package for each examination and mammography unit you are testing B Procedure 1 The clinical and phantom images from each unit must be taken within 30 days of each other All clinical images should be clearly dated Validation film check images must be from the date specified in the cover memorandum 2 Submit the following cases see Submitting Clinical Images for further guidance a For accreditation initial renewal repeat or reinstatement one dense case and one fatty case b For validation film checks two cases one each of fatty and dense breast examples if available 3 Select cases consisting of CC and MLO images of both breasts All images for each exam must be from the same patient a The cases must be negative BI RADS Assessment Category 1 Do not submit benign Category 2 cases or incomplete Category 0 cases If you cannot submit negative images e g you do diagnostic exams only call the ACR b For accr
9. e an acrylic disc on the phantom Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until it just touches the phantom Make an exposure Record the technical factors on the Test Image Data form Lorad Hologic Selenia Without the phantom in place o Set the system to the AEC mode that is used clinically e g AUTO KV AUTO FILTER o Lower the compression paddle until the compression thickness reads 4 5 cm o Make a note of the kVp and filter indicated on the AWS screen o Raise the compression paddle Position the phantom as shown in the photo on the first page The chest wall side of the phantom must be completely flush with the chest wall side of the image receptor Place the acrylic disk on the phantom as it would be for routine QC Be sure that the disk does not cover any test object locations Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until it just touches the phantom Change the AEC mode to AUTO TIME and the kVp and filter to the values noted above Select AEC sensor position 2 Make an exposure Record the technical factors on the Test Image Data form Lorad Hologic Selenia Dimensions m Q m OOOO Position the phantom as shown in the photo on the first page Place the acrylic disk on the phantom as it would be for routine QC Be sure that the disk does not cover any test
10. editation select examples of your facility s best work The ACR reviewers will evaluate them accordingly See the Clinical Image Evaluation section of the 1999 ACR Mammography Quality Control Manual for the review criteria c Do not submit images that are performed on models or volunteers d Only select cases where the entire breast can be imaged in a single exposure on each projection e Images must be labeled with the MQSA required identification information ACR reviewers will evaluate this f The images must be of final interpretation quality 4 For Hard Copy Film Submission a FFDM 1 Adjust the image display and process the image as typically done when interpreting digital mammography 2 Print the clinical images as close to true size as possible i e without magnification or minification Use the film printer normally used to make hardcopies of digital mammograms for transfer purposes b Complete the Phantom Test Image Data Form in your online Testing Package c Important Your supervising radiologist must review and approve the hardcopy image selection prior to labeling them and sending them to the ACR d Label each image with the bar coded labels do not cover the patient ID information or any part of the breast with the label e Fill out one Test Image Data form for each mammography unit you have tested Electronic Submission a Process the images as typically done for digital mammography b
11. ensity Make an exposure QO Record the technical factors on the Test Image Data form Screen Film All Units QO Position the phantom as shown in the photo on the first page With some units it may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Place the acrylic disk on the phantom as it would be for routine QC Be sure that the disk does not cover any test object locations Q Take preliminary images of the phantom to ensure correct positioning of the phantom Q Lower the compression device until it just touches the phantom Move the AEC detector so that it is under the center of the wax insert Q Set the clinical technical factors AEC mode target filter kVp density control setting etc currently used for a 4 2 cm compressed breast of average density Make an exposure QO Record the technical factors on the Test Image Data form 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 the express written permission of the American College of Radiology is prohibited Page 4 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 CLINICAL IMAGES A Required items for testing 1 If submitting hard copy film Bar coded identification labels to be affixed to the clinical images and th
12. it just touches the phantom Move the AEC detector so that it is under the center of the wax insert Set the clinical technical factors AEC mode target filter kVp density control setting etc currently used for a 4 2 cm compressed breast of average density Make an exposure Record the technical factors on the Test Image Data form Full Field Digital Mammography Direct Radiography Fischer CPOOOOCOO0O O D D OOOO Position the phantom as shown in the photo on the first page It may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Take preliminary images of the phantom to ensure correct positioning of the phantom At the Technique Screen turn Automatic Technique Recommendation OFF Select the manual clinical technical factors used for a 4 2 cm compressed breast of average density Make an exposure Record the technical factors on the Test Image Data form Display the image using an image size of fit width Review the image using full resolution Ensure that the Displayed Processed image mode is not enabled Position the phantom as shown in the photo on the first page It may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Place the acrylic disk on the phantom as it would be for routine QC Be sure that the disk does not cover any test ob
13. ject locations Set up the system as described in the QC manual for exposing the phantom o Lower the compression device so it comes in contact with the phantom o Set clinical AEC mode Auto Semi or Fixed and technical factors currently used for a 4 2 cm compressed breast of average density Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until it just touches the phantom Make an exposure with the routine AEC clinical conditions used above Record the technical factors on the Test Image Data form 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 the express written permission of the American College of Radiology is prohibited Page 2 of 8 S MammoMaster Test Materials Pkg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 General Electric Q OO OOOO DO OOOOCOCOOC Oz D OOOO0O0o O O If you are using the Automatic Optimization of Parameters AOP AEC mode which involves auto timing with auto kVp and or auto selection of target and filter for your clinical examinations the phantom will not appropriately simulate the attenuation of an average breast due to the nature of the unit s automatic parameter selection and exposure control Consequently you must first use GE s 4 0 cm thick acrylic plates to find a manual technique to exp
14. kg TESTING INSTRUCTIONS_8 28 15 docx Revised 8 28 15 REQUIRED FORMS AND DOCUMENTS Locate the type of accreditation cycle listed on your testing package and follow the column to see the items required for submission If your testing package is online through the ACRedit database you will complete some forms online instead of on paper If you have chosen to upload these documents do not send them to the ACR in addition to uploading p New Unit New Unit Personnel Summary Form N A Enter Data Online Yes if this is your facility s 1 Personnel Forms submission for a Sections G H new modality Forms Available at N A if this is not Www acr org your facility s 1st submission for a new modality Medical Physicist Summary Include a completed Evaluation of Yes Site s Tech QC Program Summary Full Physicist Report Equipment QC Section J Enter Data Online Test Image Data Enter Data Online Mammography QC Checklists Daily and Weekly Checklist send 1 month must include the dates that the accreditation clinical and phantom images wer taken if this is a new unit send all available Monthly Quarterly and Semi Annual Checklist send previous calendar 12 months if this is a new unit send all available Forms Available at www acr org This document is copyright protected by the American College of Radiology Any attempt to reproduce copy modify alter or otherwise
15. ose the phantom o Position the acrylic plates on the image receptor as typically done for the AOP and SNR Check o Lower the compression device onto the acrylic plates and apply moderate compression force o Make an exposure under routine clinical AOP conditions CNT STD or DOSE currently used for a 4 2 cm compressed breast of average density o Record the technical factors AOP mode kVp mAs focal spot size target and filter on the Test Image Data form Position the phantom as shown in the photo on the first page It may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Do NOT use an acrylic disc on the phantom Take preliminary images of the phantom to ensure correct positioning of the phantom Lower the compression device until it just touches the phantom Reproduce the kVp focal spot size target and filter and select a manual mAs as close as possible to the one determined by the acrylic plates in the first step Do not use the technical factors in the GE QC Manual Make an exposure Record the technical factors on the Test Image Data form S Giotto Image 3D 3DL Position the phantom as shown in the photo on the first page It may be necessary to move the phantom slightly in from the chest wall to ensure that the entire phantom will be visible on the image Set up the system as described in the QC manual for exposing the phantom Do NOT us
16. you received a deficiency for clinical image quality you must resubmit both fatty and dense cases If the ACR Reviewers do not believe that your images are of an appropriate density we will return them to you and request another examination Note Validation Film Check images may be of any breast density In addition ALL FILMS MUST BE INTERPRETED AS NEGATIVE i e BI RADS Assessment Category 1 There is nothing to comment on The breasts are symmetrical and no masses architectural disturbances or suspicious calcifications are present If you have difficulty submitting negative images please call the ACR EXAMPLES OF FATTY BREAST IMAGES 3 The fatty breast images must meet one of the two fatty breast BI RADS Breast Composition Categories the breast is almost entirely fat or there are scattered areas of fibroglandular density 4 z The dense breast image must meet one of the two dense breast BI RADS Breast Composition Categories The breasts are heterogeneously dense which may obscure small masses or the breasts are extremely dense which lowers the sensitivity of mammography EXAMPLES OF DENSE BREAST IMAGES 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 the express written permission of the American College of Radiology is prohibited Page 6 of 8 S MammoMaster Test Materials P
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