Introduction. Digital Mammography QA: Comparing the Manufacturers Recommendations. What is QC and why is it important? Review & compare QC tests

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1 Slide 1 Digital Mammography QA: Comparing the Manufacturers Recommendations Eric A. Berns, Ph.D. Slide 2 Introduction What is QC and why is it important? Review & compare QC tests Key take home points Northwestern University Medical School Lynn Sage Comprehensive Breast Center Chicago, IL Slide 3 Introduction Slide 4 MQSA Screen-Film Mammography Quality Standards Act ACR American College of Radiology

2 Slide 5 Slide 6 Screen-Film Screen-Film Slide 7 Slide 8 Screen-Film Screen-Film

3 Slide 9 Slide 10 Screen-Film FFDM In FFDM, the manufacturer designs and mandates their own QC program In FFDM, you must the manufacturers QC program Slide 11 Slide 12 Quality Control: Why? Reduce exposure to patients and personnel Consistent image quality RWS Detect and correct for potential problems, before they impact image quality

4 Slide 13 What is Quality Control? Slide 14 Before You Begin QC Determination of what is Normal Detection of what is Abnormal Understanding of how to return to Normal from Abnormal In particular, in FFDM, how do you know what you are seeing is what it is supposed to be? Golden Rules for Medical Physicist & Tech QC Must use manufacturer s s QC procedures Manufacturers QC may refer to Monitor Manufacturers QC Multimodality Workstations have own separate QC Printers may have their own QC Slide 15 Before You Begin ACR Accreditation - Physics forms GE Senographe 2000D, DS, and Essential Fischer Senoscan Lorad Selenia Siemens Novation Note: : if using unit for both screen-film & CR, you must accredit for both FDA Accreditation Other vendors when approved Slide 16 Before You Begin

5 Slide 17 Before You Begin Slide 18 Before You Begin Slide 19 Before You Begin Slide 20 Before You Begin

6 Slide 21 Before You Begin Slide 22 Note: Note: For new unit: : Must use most current version For renewal unit: : Can use older version (version used when tested previously) Vs. Slide 23 Mammo Unit Evaluation Slide 24 Collimation Screen-Film Mammo Ensure locks, detents, angulation indicators, and mechanical support devices operate properly FFDM Same Screen-Film Mammo Assure -ray field aligns with the light field Collimator allows full coverage of receptor Chest wall edge of compression paddle aligns with chest wall of receptor FFDM Same Multiple targe/filters and/or multiple paddle positions Chest Wall Missed Tissue Compression Plate Overlap on the Chest Wall Side

7 Slide 25 Collimation Slide 26 GE 2000D, DS, Essential Fischer Senoscan Lorad Selenia Siemens Novation Same as Screen-Film Multiple target/filter combo s Multiple paddle positions Chest Wall & Missed Tissue Compression Plate Overlap on Chest Wall Collimation Test for routinely used Collimator, bucky, compression paddle combo s target materials Slide 27 GE Collimation Mo/Mo Rh/Rh Different paddle positions Slide 28 Fischer Senoscan Collimation

8 Slide 29 Fischer Senoscan Slide 30 Lorad Selenia Collimation Collimation Assessment Use coin techniques as described in ACR Manual 24 x 30 cm 18 x 24 cm (left, center, right paddle shifts) Slide 31 Siemens Novation DR Slide 32 Siemens Novation DR Chest Wall and Missed Tissue Place coin tangent to chest wall edge of bucky Measure coin and subtract from full diameter Missed tissue must be < 5 mm Compression Plate Overlap on Chest Wall Mount paddle Measure overlapping distance Add the missed tissue value for total Must be < 6.5 mm Must evaluate for ALL compression paddles including mag

9 Slide 33 Limiting Spatial Resolution Slide 34 Spatial Resolution Screen-Film Mammo Line-pair test tool FFDM Focal spot Line-pair test tool Focal spot Detector & imaging chain Same as Screen-Film (Focal Spot Eval) Measure using LP phantom on top of acrylic GE 2000D, DS, Essential Fischer Senoscan Lorad Selenia Siemens Novation MTF Slide 35 Slide 36 Fischer Senoscan System Resolution Up to 10 lp/mm Test Pattern 4 cm acrylic Parallel & Perpendicular to tube with 3-53 degree angle Evaluation of System Resolution lp/mm Test Pattern Modulation in Normal 7 lp/mm must be > 10% Modulation in Hi Res mode at 11.1 lp/mm must be > 5% The system limiting spatial resolution must be: > 8 lp/mm + 2 lp/mm (6 to 10 lp/mm)

10 Slide 37 GE 2000D, DS, & Essential Focal Spot Evaluation Slide 38 GE 2000D MTF Measurement Monthly Raw Image Mo/Mo Rh/Rh Large & Small Spots (1.5 mag) MTF (%) = (Std. Dev.) x 222 / (Mean Dark ROI Mean Light ROI) MTF 2 lp/mm > 58% MTF 4 lp/mm > 25% Slide 39 GE 2000D 2000D Addendum: Sub-system MTF Optional replacement for MTF & Focal spot No need for film Use specific bar pattern & 4.5 cm acrylic block Use ROI tools to calculate sub-system system MTF Repeat at 1.8 mag Slide 40 GE DS & Essential MTF and CNR Measurement - Weekly Test consistency of CNR and ensure contrast is adequate IQST Test tool Action Limit: 2 lp/mm > 58%, 4 lp/mm > 25% Change in CNR must not exceed 0.2

11 Slide 41 Lorad & Siemens Slide 42 AEC Performance Evaluation of System Resolution lp/mm Test Pattern The system limiting spatial resolution must be: > 7 lp/mm Screen-Film Mammo Measure optical densities Different thicknesses using clinical modes Different density settings (-2,( -1, 0, +1, +2, etc.) FFDM Measure resultant techniques Measure signal, exposure, & SNR values Slide 43 AEC Slide 44 Same as Screen-Film GE 2000D, DS, Essential Fischer Senoscan Lorad Selenia Siemens Novation Density Control Function ACR Reproducibility Image Mode Tracking CNR SNR Density Control Function 4 cm acrylic, ACR phantom technique Repeat at -2, -1, 0, +1, +2 etc. density Record mas mas change should be 5 to 15% per step

12 Slide 45 Slide 46 Reproducibility & Image Mode Tracking 4 cm acrylic with clinical technique Position ion chamber in beam Record mas and Repeat 3 times Repeat in each mode (small, large, mag, no grid) Action Limits: Coefficient of variation for Exposure or mas must not exceed 0.05 No significant difference in exposure between small and large bucky when using similar grids CNR Per Object Thickness CNR using clinical technique for 2 cm Repeat for 4 and 6 cm Action Limits: CNR of 2 cm relative to 4 cm must be > 100% CNR of 6 cm relative to 4 cm must be > 75% Slide 47 GE 2000D Slide 48 GE DS & Essential AOP Mode and SNR Check Variable thicknesses of acrylic Std, Auto Evaluate: Acrylic Thickness Correct techniques? Adequate SNR? Target- Filter Selected kvp Selected mas 2.5 cm Mo-Mo 27 kvp cm Mo-Rh 28 kvp cm Rh-Rh 32 kvp cm Acrylic Each raw image must have a measured SNR of at least cm Acrylic 6.0 cm Acrylic DS specific QC tests AOP Mode and SNR Check Use built-in in software for image acquisition AOP: STD/Auto Acrylic Thickness (mm) Track/Filter 25 Mo/Mo 50 Rh/Rh 60 Rh/Rh SNR must be > 50 Exposure Parameters For AOP STD mode oly mas kv Mo/Mo Rh/Rh Rh/Rh

13 Slide 49 Lorad Selenia Slide 50 Siemens Novation Automatic Exposure Control AUTO-FILTER 2, 4, 6, 8 cm 4 cm (-5( 5 thru +5) Use ROI to measure mean pixel value inside virtual AEC detector Performance Criteria Pixel value should not vary by more than 10% of mean Exposure compensation steps shall meet requirements in pixel value table AEC Image Stability and Reproducibility and SNR ACR Phantom Mo/Mo, 28 kv, H,, sensor 1 Record mas, SNR, Mean, Entrance Exposure (5 times) Action Limits: Coef. of Var for mas and < 5% SNR and Mean shall not vary by + 15% of Mean Slide 51 Siemens Novation DR AEC Thickness Tracking 2, 4, and 6 cm Slide 52 Uniformity of Screen Speed & Detector Performance Screen-Film Mammo H mode Measure if OD s s are consistent Max deviation = (Max difference / mean value ) * 100 Check for artifacts FFDM Flat-field uniformity Detector calibration Pixel correction test CR Reader Scanner Performance

14 Slide 53 Detector Performance GE 2000D, DS, Fischer Senoscan Lorad Selenia Siemens Novation Essential Same as Screen-Film (Screen Uniformity) Flat-Field Field Uniformity Detector Calibration CR Reader Scanner Performance Dynamic Range Primary Erasure Inter-Plate Consistency Geometric Distortion Pixel Correction Ghosting Slide 54 Dynamic Range To confirm the dynamic range of reader and plate Use 2 & 4 cm acrylic Technique for 6 cm View image to determine if 3 regions are visible and discernable Slide 55 Slide 56 CR Reader Scanner Performance Establish that IP reader & optics do not exhibit scan or print jitter Non-grid exposure Position rulers in T formation Expose & process Action Limit: Image must have smooth borders free from jagged edges or defects Primary Erasure (Additive & Multiplicative) To assess the erasure performance of reader and plates Additive: Shoot phantom, process, wait 1 minute, reprocess, change S value to 10 original, inspect for visibility of phantom image Multiplicative: Shoot & process phantom, shoot 4 cm acrylic on same cassette, process and inspect for visibility of phantom image

15 Slide 57 Inter-Plate Consistency To confirm x-rayx absorption & SNR consistency Expose plates using clinical technique with 4cm acrylic Record mas (must be within +10%) Calculate SNR (must be within +15%) 15%) Slide 58 GE 2000D, DS, & Essential Flat-field uniformity Test to ensure detector performance acceptable Measures detector uniformity (signal & noise) Measures bad pixels System automatically calculates pass/fail QAP Slide 59 Fischer Slide 60 Fischer Senoscan Flat Field and Detector Calibration Run daily calibration using software Use 4 cm acrylic Exposure resulting in 1000 ADU s No Artifacts at WW > 800 Compute deviation between corner and center means Must be within + 20% of center ROI Geometric Distortion Use a 40 mesh Cu screen Acquire image at low technique Visually inspect for distortions or blurring

16 Slide 61 Lorad Selenia Slide 62 Lorad Selenia Detector Calibration Every two weeks 4 cm acrylic block no paddle Built in Calibration software Follow on-screen instructions Review image for artifacts Repeat until you have 8 images End calibration Calibration is performed automatically Detector Ghosting Assure ghosting does not interfere with image quality 4 cm acrylic covering half of detector Set AEC clinically Make exposure 4 cm acrylic covering entire detector Place 0.1 mm AL on top Make 2 nd exposure (AEC) as soon as possible (~ 1 minute after first) Calculate Ghost Image Factor = (Mean R3 Mean R2 / Mean R1 Mean R2 ) Must be within Slide 63 Siemens Novation DR Slide 64 Siemens Novation Detector Uniformity Make exposure: 28 kv, 50 mas, Mo/Mo Select ROI 128 x 128 pixels Record measurements in corners and center Pixel value inside each of 5 ROI s shall not differ by more than 10% of mean Detector Calibration Test Objective: to determine if system was correctly gain calibrated Must be done weekly (technologist) Follow on-screen instructions Acquire 8 images Images should be free of artifacts

17 Slide 65 Siemens Novation DR Slide 66 Siemens Novation DR Ghost Image Evaluation Setup with 2mm steel bar Exp 1: Mo/Mo, 23 kv, 2 mas record mean Exp 2: Mo/Mo, 28 kv, 200 mas - remove steel Wait 180 seconds, place 4 cm Acrylic on top Exp 3: Mo/Mo, 28 kv, 14 mas Calculate % Ghosting = (PV1 PV2) / PV1 +PV2 Action Limit: : % Ghosting < 3% Pixel Correction Test Calibration mode Create new pixel map Follow on-screen instructions Acquire image Evaluate image is free from collimator or debris artifacts System compiles new pixel map System display results must meet requirements Slide 67 Artifacts Slide 68 Artifacts Screen-Film Mammo Evaluate cassettes Same as Screen-Film GE 2000D, DS, Essential Fischer Senoscan Lorad Selenia Siemens Novation FFDM Expose Using Acrylic Evaluate detector CR: Imaging Plates

18 Slide 69 Artifacts Slide 70 Artifacts Artifact evaluation Mo/Mo Mo/Rh Rh/Rh Slide 71 Artifacts Slide 72 Artifacts

19 Slide 73 Artifacts Slide 74 Artifacts Possible cause: condensation on detector Possible Cause: Detector dropout or mis-registration Slide 75 Image Detection Calibration File Artifacts Processing Steps for Digital Images Image Correction Raw Image Processing Processed Image Display Slide 76 Image Quality Screen-Film Mammo ACR Phantom Scores Optical Density & Contrast FFDM ACR Phantom Scores Pass/fail requirements differ by vendor Signal-to to-noise Ratio (SNR) Contrast-to to-noise Ratio (CNR)

20 Slide 77 Image Quality Slide 78 Image Quality Same as Screen-Film GE 2000D, DS, Essential Fischer Senoscan Manual Techniques Lorad Selenia Siemens Novation Clinical Technique Partial CNR ACR Phantom Imaging GE & Fischer & Fuji Lorad & Siemens Fibers 4 5 Specks 3 4 Masses 3 4 Slide 79 GE 2000D Slide 80 GE 2000D ACR Phantom Imaging Manual technique (Mo/Mo, 26 kvp, 125 mas) Score the processed image Acquisition workstation Each monitor of the RWS Contrast-to to-noise Test (CNR) To examine consistency of CNR ratio measured over time Use the raw image + 20% of baseline Background ROI Mass ROI Laser imager CNR = (Mean background - Mean Mean mass )/SD background

21 Slide 81 GE DS Slide 82 Fischer Senoscan DS specific QC tests Phantom Image Quality Manual technique: Rh/Rh, 29 kvp, 56 mas MTF and CNR Measurement Phantom Image Acquisition Test and Image Quality Select Techniques to give 1000 ADU Compare background mean, StdDev, and ADU level difference to baseline values Score : 4 fibers, 3 speck groups, and 3 masses Use IQST test tool Use built-in in software for image acquisition Manual technique: Rh/Rh 30 kvp, 56 mas Results are automatically displayed (pass/fail) Same action limits as 2000D Slide 83 Lorad Selenia Slide 84 Siemens Novation DR Phantom Image Quality Select clinical exposure mode (i.e. AUTO-FILTER) Print film Measure background OD and density difference Plot on tech worksheets Background must be > 1.20 OD DD must be > Score on each Soft Copy Workstation 5 fibers 4 speck groups 4 masses Phantom Image Quality Position phantom 1 cm over chest wall edge Select: 28 kv, AEC-Auto, Auto, Mo/Mo Score on RWS or Film Fiber > 5 Specks > 4 Masses > 4

22 Slide 85 Lorad & Siemens Slide 86 SNR and CNR Measurements SNR at least > 40 CNR should stay within ±15% of baseline Contrast-to to-noise Test (CNR) To examine consistency of CNR ratio measured over time Use 4 cm acrylic & 0.2 mm Al Manual technique (Mo/Mo, 26 kvp, 125 mas) Calculate CNR using software + 20% of baseline Obtained during acceptance testing Slide 87 kvp Slide 88 HVL Screen-Film Mammo Assure that actual kvp is FFDM Accurate (+( 5% of indicated) Reproducible (Coeff. Var. < 2%) Same Screen-Film Mammo Assure HVL is adequate to minimize patient dose HVL shall meet FDA s s Performance Standards FFDM Same Note the lead sheet

23 Slide 89 Dose Slide 90 Radiation Output Screen-Film Mammo Dose for single CC view of ACR phantom shall not exceed 3.0 mgy per exposure FFDM Same Screen-Film Mammo System shall be capable of producing a minimum output of kvp Mo/Mo over 3.0 second period FFDM Same S value confirmation Exposure Linearity Slide 91 Radiation Output Slide 92 GE 2000D, DS, Essential Fischer Senoscan Lorad Selenia Siemens Novation Same as Screen-Film S Value Confirmation Exposure Linearity S Value Confirmation Make exposure at 25 kv Mo/Mo to give > 20 mr Exposure cassette at this technique (wait 10 min. & process) Record S value Calculate Corrected S value Action Limit: : Corrected S value should not exceed the range of % (96 < S < 144)

24 Slide 93 Fischer Senoscan Slide 94 Viewing & Viewing Conditions Exposure Linearity and Reproducibility Procedure: Measure exposure at specified techniques Calculate: Output = Average exposure reading/ma Linearity = (A-B)/(A+B) < 0.08 Reproducibility = StdDev/Avg < for each technique Screen-Film Mammo Luminance (>( 3000 cd/m 2 ) Room illuminance (<( 50 lux) Viewbox cleaning FFDM Same Slide 95 Assessing Tech QC Slide 96 Film Processing Screen-Film Mammo Assess site s s QC program Check that QC tests are properly performed Independent checks of tech QC tests FFDM Same Screen-Film Mammo Measure optical densities FFDM Density difference, mid-density, density, base+fog Measures consistency Manufacturers recommendations Some refer to printer manufacturers recommendations Typically identical to ACR SFM Manual

25 MD Step=12 Mid-Density Upper Control Limit = 2.06 Mid-Density Daily Value Mid-Density Daily Value Operating Level = 1.91 Mid-Density Lower Control Limit = Mid-Density Upper Control Limit = 1.48 Mid-Density Daily Value Mid-Density Daily Value Operating Level = 1.33 Mid-Density Lower Control Limit = HD Step=13 LD Step=10 Base + Fog Action Limit = 0.22 Base + Fog Daily Value Base + Fog - Operating Level = 0.19 Density Difference Upper Control Limit = 2.25 Density Difference Daily Value Density Difference Daily Value Operating Level = 2.1 Density Difference Lower Control Limit = Base + Fog Action Limit = 0.23 Base + Fog Daily Value Base + Fog - Operating Level = 0.2 Density Difference Upper Control Limit = 1.77 Density Difference Daily Value Density Difference Daily Value Operating Level = 1.62 Density Difference Lower Control Limit = 1.47 Slide 97 Film Processor QC Slide 98 Film Processing GE 2000D, DS, Essential Fischer Senoscan Follow Printer Manufacturers QC If Not, Use Theirs Lorad Selenia Siemens Novation Follow FFDMs QC Wet Processing Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006 Base + Fog Base + Fog Laser Printer Northwestern Memorial Hospital - Processor ID: Kodak Oct 2006 Base + Fog 1-Mar-06 2-Mar-06 3-Mar-06 6-Mar-06 7-Mar-06 8-Mar-06 9-Mar Mar Mar Mar-06 service 3/14 15-Mar Mar-06 Date 17-Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar-06 October 2, 2006 October 3, 2006 October 4, 2006 October 5, 2006 October 6, 2006 October 9, 2006 October 10, 2006 October 11, 2006 October 12, 2006 October 13, 2006 October 16, 2006 October 17, 2006 Date October 18, 2006 October 19, 2006 October 20, 2006 October 23, 2006 October 24, 2006 October 25, 2006 October 26, 2006 October 27, 2006 October 30, 2006 Slide 99 Film Processing Slide 100 Film Processing Mid-Density Density Difference Wet Processing Laser Printer Wet Processing Laser Printer Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006 Mid-Density Northwestern Memorial Hospital - Processor ID: Kodak Oct 2006 Mid-Density Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006 Density Difference Northwestern Memorial Hospital - Processor ID: Kodak Oct 2006 Density Difference 1-Mar-06 2-Mar-06 3-Mar-06 6-Mar-06 7-Mar-06 8-Mar-06 9-Mar Mar Mar Mar-06 service 3/14 15-Mar Mar-06 Date 17-Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar-06 October 2, 2006 October 3, 2006 October 4, 2006 October 5, 2006 October 6, 2006 October 9, 2006 October 10, 2006 October 11, 2006 October 12, 2006 October 13, 2006 October 16, 2006 October 17, 2006 Date October 18, 2006 October 19, 2006 October 20, 2006 October 23, 2006 October 24, 2006 October 25, 2006 October 26, 2006 October 27, 2006 October 30, Mar-06 2-Mar-06 3-Mar-06 6-Mar-06 7-Mar-06 8-Mar-06 9-Mar Mar Mar Mar-06 service 3/14 15-Mar Mar-06 Date 17-Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar-06 October 2, 2006 October 3, 2006 October 4, 2006 October 5, 2006 October 6, 2006 October 9, 2006 October 10, 2006 October 11, 2006 October 12, 2006 October 13, 2006 October 16, 2006 October 17, 2006 Date October 18, 2006 October 19, 2006 October 20, 2006 October 23, 2006 October 24, 2006 October 25, 2006 October 26, 2006 October 27, 2006 October 30, 2006

26 Slide 101 Film Processing Slide 102 Lorad October 2, 2006 D max Northwestern Memorial Hospital - Processor ID: Kodak Oct 2006 Dmax October 3, 2006 October 4, 2006 October 5, 2006 October 6, 2006 October 9, 2006 October 10, 2006 Laser Printer October 11, 2006 October 12, 2006 October 13, 2006 October 16, 2006 October 17, 2006 October 18, 2006 Date October 19, 2006 Dmax Daily Value Dmax - Operating Level = 3.44 Dmax Action Limit = 3.19 October 20, 2006 October 23, 2006 October 24, 2006 October 25, 2006 October 26, 2006 October 27, 2006 October 30, 2006 October 31, % Laser Printer QC - Daily 10% 90% SMPTE pattern from AWS Measure OD 10%, 40% and 90% Plot mid-density density (40%), density difference (40-10%), lower density (90%) + 15 from baseline Slide 103 RWS QC Slide 104 Multimodality Workstations GE 2000D, DS, Fischer Senoscan Lorad Selenia Essential Follow monitor manufacturers QC If Not, Use FFDM s Siemens Novation FDA Approved Multimodality Workstations AGFA IMPA MA3000 Sectra IDS5/mx Kodak DirectView PACS System 5 McKesson s s PACS Mammo Station Use FFDM manufacturers s s QC icad Second Look 500M Cedera I-ReadMammoI Fuji Synapse GE Seno Advantage & Centricity Fischer Senoview Plus (Cedera) Hologic SecureView D Siemens MammoReportPlus

27 Slide 105 Slide 106 AGFA IMPA MA3000 Clean monitor surface Measure display white & black Measure quality level Measure uniformity Calibrate displays View SMPTE pattern Viewing conditions GE Seno Advantage Viewing conditions check and setting Monitor calibration Image quality SMPTE pattern Analysis of screen uniformity Siemens MammoReport Plus Geometric distortion Reflection Luminance Response Luminance Uniformity Resolution Noise Overall Evaluation Barco I-Guard Check Quality Level Display White Calibration Settings Check Eizo Pattern Check Luminance Check Grayscale Check Uniformity Check Planar Monitor Cleaning Viewing Conditions Check Monitor Calibration Check Image Quality SMPTE Visual Inspection for Display Defects Slide 107 Suggestions Slide 108 Troubleshooting QC Keep a good file system for naming & numbering the different QC tests Archive all digital QC images on a CD Keep QC test tools in a safe place Perform flat-field field imaging before phantom imaging tests Perform testing in the morning Have a system for monitoring the Auto Print/Auto Push functions Repeat test Clean plexiglass & move slightly Questions to ask yourself: Are you using the correct image? Raw vs. Processed? Are the ROI s s in the correct location? Re-boot system Call service Re-calibration solves most image quality problems

28 Slide 109 Key Take Home Points Slide 110 Key Take Home Points Obtain proper hands-on training Must perform manufacturer specific QC tests Artifacts most problems can be seen here Re-booting and/or re-calibrating fixes most problems Laser Printer D max at least 3.5 OD Mid-density density about 1.5 OD Review workstation monitors look at the clinical images! Do they match? Appropriate dark and light levels Be aware of separate QC for review workstations Know, and be involved with, your site QC program Slide 111 Slide 112 Thank You SAM Questions Digital Mammography Quality Assurance: Comparing the Manufacturers Recommendations

29 Slide % 62% 0% 18% In digital mammography, who mandates the pass/fail criteria for site QC? 1. The American College of Radiology 2. The FDA 3. The FFDM unit manufacturer 4. NEMA 5. MQSA 4% 1. Slide 114 Answer: 3 - The FFDM unit manufacturer References MQSA Regulations (e)(6) PHY/frmamcom2.html#s90012 Slide 115 Answer 3: The FFDM unit manufacturer Explanation the quality assurance program shall be substantially the same as the quality assurance program recommended by the image receptor manufacturer, except that the minimum allowable dose for screen- film systems in this section Slide 116 4% 1. 92% 4% 0% How do you accredit a Fuji CR Mammography system which uses both CR and screen-film on the same x-ray system? 1. As 1 mammography unit? 2. As 2 mammography units? 3. You cannot use CR and film on the same unit. 4. CR is exempt from accreditation

30 Slide 117 Answer: 2 As 2 mammography units References Slide 118 Answer: 2 - As 2 mammography units Explanation mammo_faq/mammo_faq_mamac.aspx#8.0.1 As of November 15, 2006 facilities using both screen-film and CR on the same mammography units must accredit these 2 systems as 2 separate units. Slide 119 4% 1. 11% 80% 0% 4% What are the minimum passing ACR phantom scores for the Lorad Selenia for weekly QC? 1. 5 Fibers, 4 Speck Groups, 3 Masses 2. 4 Fibers, 3 Speck Groups, 3 Masses 3. 5 Fibers, 4 Speck Groups, 4 Masses 4. 4 Fibers, 4 Speck Groups, 3 Masses 5. 4 Fibers, 4 Speck Groups, 4 Masses Slide 120 Answer 3: 3 5 Fibers, 4 Speck Groups, 4 Masses References Hologic. Lorad Selenia Quality Control Manual MAN-00093, Revision 003, Bedford (MA): Hologic, 2005

31 Slide 121 Answer 3: 3 5 Fibers, 4 Speck Groups, 4 Masses Explanation The Lorad Selenia QC manual states that the ACR Phantom minimum passing scores are as follows: 5 Fibers 4 Speck Groups 4 Masses