Charles R. Wilson, Ph.D., F.A.C.R.

Medical College of Wisconsin

Milwaukee, Wisconsin

ACR Radiography and Fluoroscopy Accreditation

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 Other Physicians

Initial Board certification •Six months formal training in an ACGME-approved program, and•Interpretation and formal reporting of 1000 general radiographs

Continued Experience

•200 general radiographs per year (recommended), and•If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended)

•200 general radiographs per year (recommended), and•If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended)

Continuing Education

150 hours every three years (recommended)

150 hours every three years (recommended)

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

Fluoro Spot Interventional(undertable tubes)

Abdomen(overtabletube) Chest

(horizontaltube)Total

Acrylic =19.3 cm

4.6 mm Al

Air gap

Test object plate(3/8 in thick)

4.1 cm

7.6 cm

7.6 cm

7.6 cm

7.6

cm7.6 cm 7.6 cm 7.6 cm

7.6 cm

7.6 cm slot block with a slot to accept a 2.5 x 15.3 cmthick artery block. The artery block is commerciallyavailable from Nuclear Associates.

4.1 cm4.1 cm

4.1 cm

Top View25 cm

25 cm

The distance from thecenter of the block to thelead markers is 7 cm

4.1 cmblock

Lead markers

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 withoutthe express written permission of the American College of Radiology is prohibited.

Test plateobject

25 cm

25 cm

Contrast-Detailtest object, (placed 7cmfrom center of Test Plateobject on axis that bisectscorners of Test plate objectand does not overlay leadmarkers from 4.1 cm block)

Small aluminum disk ( 6cm fromcenter of Test plate object and 12.5cm from adjacent sides)

Mesh patterns and lowcontrast holes (centered)

Side View

Air gap

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 Frequency

Processor quality control (laser printers excluded Daily

Darkroom cleanliness Weekly

Phantom images Quarterly

Visual checklist Monthly

Viewboxes and viewing conditions Quarterly

Repeat analysis Quarterly

Analysis of fixer retention in film Semiannually

Darkroom fog Semiannually

Screen cleanliness As needed or annually

Screen-film contact (auto film changers only) Annually

Radiography/Fluoroscopy Accreditation ProgramReviewer 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 ProgramValidation

• 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 ProgramAccreditation 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 ProgramIf 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™