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7.4.2. Repeat image analysis7.4.2.1. Scope— Objective: To determine the number and cause of repeated digital mammograms. Analysis of these datashould help to identify ways to improve system performance and to reduce digital image repeats, associatedincreased patient dose and costs.— Frequency: At least quarterly. For the repeat rates to be meaningful, a volume of at least 250 clinicalexaminations is needed, if possible.Note: The analysis is carried out for each individual acquisition unit, rather than for the combined facility asis done in screen film mammography.7.4.2.2. Instrumentation(1) Chart showing the digital mammography repeat records (see, e.g., Fig. 28 and Chart 13(a) in Annex I) or repeatlog obtained from the acquisition workstation, provided it complies with the guidance in this publication.(2) Chart for performing the quarterly digital mammography repeat analysis (see, e.g., Fig. 29 and Chart 13(b) inAnnex I).(3) Method for counting or estimating the total number of clinical images acquired during the test period.Note: A repeated image is one that is taken for reasons of inadequate quality. It does not include additionalviews required to image selected tissue seen on the first image. It also does not include images takenfor the purposes of including tissue that could not be positioned on the image receptor due to the sizeof the breast. Images performed for QC purposes are also excluded from repeat analysis.Repeated images include those that are rejected at the acquisition workstation and those that areaborted before the exposure is complete. Causes of repeated exposures include problems withpositioning, blurred images due to patient motion, detector under- or overexposure, unacceptableartefacts, X ray equipment failures (such as generator faults), software failures (such as the acquisitionsoftware freezing or crashing), blank images, no image appearing on the acquisition workstationalthough an exposure was made and other miscellaneous problems.7.4.2.3. Methodology(1) Record each repeated exposure on the repeat record chart (Chart 13(a) in Annex I), entering the cause ofrepeated exposure, date, etc. Some acquisition systems and some PACSs allow for automated logging of thecauses of repeated exposures. This may be an acceptable means of recording the majority of repeats, providedthat the log can be easily retrieved for any specified date range and that the stated causes of repeats make upa complete list. Note that repeated exposures taken on a different date (i.e. because the radiologist remarkedthat the image was blurred) may not be logged by such software, and thus it is recommended that a chart bemaintained for such repeats, even if repeat logging software is used.Note: A ‘blank image’ occurs when an exposure is made and all the pixels in the resulting image file have thesame value such that the image displayed is all one shade. ‘No image’ occurs when an exposure ismade and no image at all appears on the screen — there is no image file and no digital record of theexposure exists.(2) At the end of each quarter, use the repeat analysis form (Chart 13(b) in Annex I) to summarize the number ofrepeats in each category.72
RECORD OF DIGITAL MAMMOGRAPHY REPEATSFacility: ABC Room: 1 Unit: Novation DRDate from: 1 Oct 2010 Date to: 31 Dec 2010Repeat initiated byStudy # Cause Frequency Date Physician Radiographer1234 1 1 2/10 41561 2 2 4/10 41345 4 1 7/10 41392 1 1 11/10 4Causes1. Positioning2. Patient motion3. Improper detector exposure4. Artefact5. X ray equipment failure6. Software failure7. Blank image8. No image9. OtherFIG. 28. Sample digital repeat chart. Data shown here are for illustrative purposes only.(3) Estimate the number of clinical exposures taken during the quarter. This can be done by subtracting thepatient number at the beginning of the quarter from the patient number at the end of the quarter andmultiplying by the average number of images per patient (typically 4–5). This method assumes sequentialnumbering of all patients. It may also be possible to obtain the number of exposures from a log maintained bythe acquisition workstation (this varies with manufacturer and model). Be sure not to include images taken forQC purposes.(4) Calculate the overall repeat rate as the total number of repeated exposures divided by the total number ofpatient exposures during the analysis period, multiplied by 100.(5) Determine the percentage of repeated exposures in each category by dividing the number of repeatedexposures in that category by the total number of repeated exposures from all categories and multiply by 100.(6) Record completion of the repeat analysis on the monthly, quarterly and semi-annual chart (Chart 2 inAnnex I).73
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X raysdel matrixCs scintillatorLine
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QUALITY ASSURANCE PROGRAMMEFOR DIGI
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IAEA HUMAN HEALTH SERIES No. 17QUAL
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FOREWORDThe application of radiatio
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An effective QA programme is necess
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The Integrating the Healthcare Ente
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technology. Systems containing othe
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X raysTop electrodea-Se layerCharge
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dose received by inhomogeneous real
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2.3.8.1. Soft copy displayFlat pane
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3. ELEMENTS OF HIGH QUALITY MAMMOGR
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— The ability to mask edges of ma
Page 34 and 35: Disposal orsaleNew facility(start h
Page 36 and 37: 4.2.3. Radiographer (mammography te
Page 38 and 39: 5.2.2. Electronic versus geometric
Page 40 and 41: To allow full utilization of the di
Page 42 and 43: 5.7. ARTEFACTSWhile the incidence o
Page 44 and 45: FIG. 10. Detector crystallization.
Page 46 and 47: FIG. 13. A more subtle example of a
Page 48 and 49: FIG. 16. An example of poor collima
Page 51 and 52: 7. RADIOGRAPHER’S QUALITY CONTROL
Page 53 and 54: 7.1. DAILY TESTS7.1.1. Monitor insp
Page 55 and 56: 7.1.3. Daily flat field phantom ima
Page 57 and 58: 7.1.4. Visual inspection for artefa
Page 59 and 60: 7.1.5. Laser printer sensitometry7.
Page 61 and 62: 7.1.6. Image plate erasure (CR syst
Page 63 and 64: FIG. 19. Modified TG18-QC pattern w
Page 65 and 66: FIG. 21. Radiologist workstation wi
Page 67 and 68: 7.2.1.6. Time frame for corrective
Page 69 and 70: 7.2.3. Weekly quality control test
Page 71 and 72: Note: It is not necessary to view t
Page 73 and 74: TABLE 7. TOLERANCES FOR IMAGING WEE
Page 75 and 76: 7.2.4.4. Interpretation of results
Page 77 and 78: 7.3.1.5. Recommendations and correc
Page 79 and 80: artefacts are typically best seen w
Page 81 and 82: 7.3.3.5. Recommendations and correc
Page 83: 7.4.1.3. Methodology(1) Annotate th
Page 87 and 88: (3) Including examinations of at le
Page 89 and 90: 7.5. SEMI-ANNUAL TESTS7.5.1. Comput
Page 91 and 92: 8. MEDICAL PHYSICIST’S QUALITY CO
Page 93 and 94: 8.1. NOTE ON IMAGE NAMING CONVENTIO
Page 95 and 96: (16) On any randomly selected patie
Page 97 and 98: FIG. 30. Positioning of bathroom sc
Page 99 and 100: (6) The target, filter, kV, grid, d
Page 101 and 102: (2) Stack the 20 and 25 mm PMMA sla
Page 103 and 104: TABLE 13. ACCEPTABLE AND ACHIEVABLE
Page 105 and 106: 8.5. DETECTOR PERFORMANCE8.5.1. Bas
Page 107 and 108: 8.5.2. Detector response and noise8
Page 109 and 110: the service engineer responsible fo
Page 111 and 112: (13) Using the annotation tool on t
Page 113 and 114: Breast supportPMMA slabBreast suppo
Page 115 and 116: (10) Place the thinner test object
Page 117 and 118: 8.6. EVALUATION OF SYSTEM RESOLUTIO
Page 119 and 120: TABLE 17. ACCEPTABLE FREQUENCIES AT
Page 121 and 122: 8.7. X RAY EQUIPMENT CHARACTERISTIC
Page 123 and 124: 8.7.2. Incident air kerma at the en
Page 125 and 126: 8.8. DOSIMETRY8.8.1. Mean glandular
Page 127 and 128: TABLE 21. ACCEPTABLE AND ACHIEVABLE
Page 129 and 130: FIG. 34. Suggested layout for ruler
Page 131 and 132: 8.10. IMAGE DISPLAY QUALITYThe accu
Page 133 and 134: FIG. 35. Modified TG18-QC test patt
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8.10.1.5. Interpretation of results
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8.10.2. Monitor luminance response
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TABLE 22. MONITOR PERFORMANCE TOLER
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FIG. 38. Measurement of illuminatio
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8.11. LASER PRINTER8.11.1. Laser pr
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8.11.1.5. Recommendations and corre
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8.12.1.4. Interpretation of results
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iopsies are performed, a sink is of
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Appendix IISPECIFICATIONS OF TEST E
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TABLE 24. SPECIFICATIONS OF TEST EQ
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FIG. 40. Image acquired with a unif
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FIG. 43. The left hand image is par
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FIG. 45. A TG18-QC test pattern dis
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[29] ALSAGER, A., YOUNG, K.C., ODUK
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Annex IRADIOGRAPHER DATA COLLECTION
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Chart 2 — DIGITAL MAMMOGRAPHY (DM
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Chart 4 LASER PRINTER SENSITOMETRY
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Chart 6 — WEEKLY DISPLAY MONITOR
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Chart 7(b) WEEKLY QC TEST OBJECT:
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Chart 9 — SAFETY AND FUNCTION CHE
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Chart 11 — LASER PRINTER ARTEFACT
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Chart 13(a) — RECORD OF DIGITAL M
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Chart 14 — CR PLATE SENSITIVITY M
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Annex IIITHE MAMMOGRAPHY EXTRACTThe
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GLOSSARYair kerma. The energy depos
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image quality. The overall merit of
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CONTRIBUTORS TO DRAFTING AND REVIEW
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