ACMP 28th Annual Meeting

Transcription

1 Survying and QC of Strotactic Brast Biopsy Units for ACR Accrditation Larning Objctiv ACMP 28th Annual Mting Chattanooga, TN April 30, 2011 Mlissa C. Martin, M.S., FACR, FAAPM, FACMP Thrapy Physics, Inc. 879 Wst 190th St., St 419, Gardna, CA Offic: Cll: ail: Bco failiar with th rcondations and rquirnts of th ACR Strotactic Brast Biopsy Accrditation Progra (SBBAP) Quality Control Manual Inforation By product of conducting Quality Control tsts for Strotactic Brast Biopsy units is gratr failiarity with th opration and prforanc of your SBB syst, particularly iag quality and th accuracy of ndl placnt during SBB. LORAD Strotactic Brast Biopsy Syst

2 LORAD Strotactic Brast Biopsy Syst LORAD Strotactic Brast Biopsy Syst Control Pndant Cartsian coordinat syst Gotry is rst for ach patint Sins (Fischr) MaoVision Biopsy Syst Don Jacobson 2/07 x x y z

3 Sins (Fischr) MaoVision Biopsy Syst Fixd rlationship btwn Autoguid and brast support Sphrical coordinat syst Distanc Vrtical angl Horizontal angl Don Jacobson 2/07 Don Jacobson 2/07

4 ACR SBB Progra Statistics As of Octobr 1, 2010, ACR has accrditd 810 units at 789 facilitis providing Strotactic Brast Biopsy Procdurs In 2009, th first attpt pass rat for nw or rnwing units was 81%. Alost all facilitis pass on thir scond attpt at accrditation aftr taking appropriat corrctiv action to iprov iag quality Don Jacobson 2/07 ACR SBB Progra Statistics ACR Accrditation of SBB Units Th procss typically taks 4 to 6 onths. Th rviw procss taks approxiatly 90 days aftr th ACR rcivs th subittd atrial. Thr ar currntly no MQSA rquirnts for prsonnl prforing SBB procdurs but thr ar training and xprinc rquirnts for accrditation by th ACR Currntly, aography units usd xclusivly for SBB procdurs ar not rquird to b crtifid undr MQSA Facilitis ust hav an accrditd SBB progra to b nad as a Cntr of Excllnc for Brast Car by th ACR

5 Goals of QC for Strotactic Brast Biopsy Gnral Rquirnts for SBBAP To nsur that iag quality in Strotactic Brast Biopsy quals or xcds that of scrning and diagnostic aography To nsur that quipnt dsignd spcifically for Stro Brast Biopsy prfors proprly To nsur that ndl localizations ar accurat Qualifid TEAM: Physicians, Tchnologist, and Mdical Physicist Equipnt: Tabl or add-on ; fil or digital QA Progra, Manual, and Coitt Tchnologist s QC Tsting - daily, wkly, onthly, si-annual - 6 tsts Mdical Physicist s QC Tsting - accptanc and annual - 11 tsts Th Quality Assuranc Ta: Mdical Physicist s Qualifications for SBBAP: Initial Physician QC Tchnologist Mdical Physicist Crtification by ABR, ABMP in Diagnostic Mdical Physics OR Altrnat Education, Training and Exprinc AND >6/1/97: Hav Prford 1 SBB Survy Undr th Guidanc of a Mdical Physicist Qualifid to Prfor SBB Survys <6/1/97: Hav Prford 3 SBB Survys

6 Mdical Physicist Qualifications for SBBAP: R-Accrditation Aftr 3 Yars Quality Control: Mdical Physicist s Evaluation At Last 1 SBB Physics Survy Pr Yar At Last 3 Hours of Continuing Education in SBB Physics Docuntation of Abov Accptanc Tst Bfor Patint Us Annually Thraftr Rport Rquird as Part of ACR Application Quality Control: Mdical Physicist s Evaluation Th 1999 ACR SBB Quality Control Manual has a sction for th Mdical Physicist It has suggstd Tst Procdurs, Fors, and Suary Rport Forat Dtaild instructions on 11 Rquird Physicist s tsts ACR Quality Control Manuals Maography QC Manual (1990, 1992, 1994, 1999) Bariu Ena QC Manual (1998) Strotactic Brast Biopsy QC Manual (1999) MRI QC Manual (2001) Snt fr to all facilitis in progra To purchas, call ACR Pubs: (800) QC fors availabl to anyon on Wb sit

7 Rad Tch QC Tsts Mao QC Tsts Also Apply if Scrn-Fil Usd Mdical Physicist s Quality Control Tsts Localization Accuracy - daily Phanto Iag - wkly Hardcopy Output Quality - onthly, if app Visual Chcklist - onthly Coprssion Forc - si-annually Rpat Analysis - si-annually Zro Alignnt Tst bfor a patint, if app 1. Strotactic Unit Assbly Evaluation 2. Colliation Assssnt 3. Focal Spot Prforanc & Digital Syst Liiting Rsolution 4. kvp Accuracy and Rproducibility 5. Ba Quality Assssnt (HVL) 6. AEC or Manual Exposur Prforanc Mdical Physicist s Quality Control Tsts Strotactic Unit Assbly Evaluation 7A. Unifority of Scrn Spd 7B. Digital Rcptor Unifority 8. Brast Entranc Exposur, Avrag Glandular Dos, and Exposur Rproducibility 9. Iag Quality Evaluation 10. Artifact Evaluation 11. Localization Accuracy Tst

8 Colliation Assssnt Colliation Assssnt Colliation Assssnt Colliation Assssnt SID = 84 c

9 Digital Liiting Rsolution/Focal Spot Digital Liiting Rsolution/Focal Spot Digital Liiting Rsolution/Focal Spot kvp Accuracy and Rproducibility Hologic rquirs at last 7 lp/ rsolution

10 kvp Accuracy and Rproducibility Ba Quality Assssnt Ba Quality Spcifications for SBB Units Iag Quality Evaluation (Phanto) Th iniu accptabl Half-Valu Layr asurnt on a digital or fil/scrn SBB unit is Action Liit: If asurd HVL < (kvp/100) (in Al) or if asurd HVL > (kvp/100) + C (in Al) Objctiv: Ensur Iag Quality for SBB ts or xcds that of aography, and to dtct tporal changs in iag quality Procdur: Sa as for Maography, xcpt ACR phanto ust b iagd in 4 sparat quadrants for digital bcaus of sall fild of viw whr C = 0.12 for Mo/Mo, C = 0.19 for Mo/Rh, and C = 0.22 for Rh/Rh, thn sk srvic corrction.

11 Two Typs of Approvd Phantos Mini Strotactic Brast Biopsy Accrditation Phanto Mini Strotactic Brast Biopsy Accrditation Phanto Nuclar Associats Maography Accrditation Phanto RMI 156 Nuclar Associats Chst Wall Sid SBBAP Tsting Critria Dos and Phanto Iag Quality for SBB Units Dos - Must b lss than 300 rads (3 Gy) Phanto iag quality RMI 156 or NA MAP Phanto MAP Phanto Mini Phanto F/S Digital F/S Digital Fibrs Spck Groups Masss

12 RMI 156 Accrditation Phanto NA Mini- Phanto Don Jacobson 2/07 Nuclar Associats Digital Mini Phanto AEC or Manual Exposur Prforanc 2 c Thicknss

13 AEC or Manual Exposur Prforanc AEC or Manual Exposur Prforanc 4 c Thicknss - Also usd for Unifority and Artifacts 6 c Thicknss 8 c Thicknss AEC or Manual Exposur Prforanc g n AEC or Manual Exposur Control a l Prforanc Rquirnt x Action Liit (Digital): c If th signal rang xcds ±20% of signal for 4 c phanto, d s rvis tchniqu chart. ± 2 0 % Action Liit (Scrn-Fil): If th dnsity o f rang xcds ±0.15 of an, rvis tchniqu chart. s i r a n g s i g n a l f o r 4 c p

14 Digital Rcptor Unifority Rquirnts For Units with ROI statistics asurnt capability: Action Liit: If SNR(I) / SNR(Cntr) is > 1.15 or < 0.85, sk srvic corrction. I f a s u r d H V L < ( k V p / ) ( i n A l ) I f a s u r d H V L < ( k V p / ) ( i n A l ) Digital Rcptor Unifority Rquirnts For Units without ROI statistics asurnt capability: I f a s u r d H V L < ( k V p / ) ( i n A l ) I f a s u r d H V L < ( k V p / ) ( i n A l ) Action Liits: If gotric pincushioning > 1 c fro dg of iag or If non-unifor aras (w/o black dots) > 10% of iag or If lin w/o black dots > 1/4 lngth of iag, sk srvic corrction Digital Rcptor Unifority Digital Rcptor Unifority - Iag Statistics

15 Brast Entranc Exposur, Avrag Glandular Dos, and Exposur Rproducibility Entranc Exposur/Mid-Glandular Doss Sa Procdur as for Maography Rcondd Signal Lvl for Digital Digital Matrix Sizs Prforanc Critria: a) Cofficint of Variation < 0.05 b) Av. Glandular Dos < 3 Gy for Scrn/Fil and for Digital Iag Rcptors Entranc Exposur/Mid-Glandular Doss Entranc Exposur/Mid-Glandular Doss

16 Artifact Evaluation 11. Localization Accuracy: Glatin Phanto Objctiv: To assur that th biopsy ndl is accuratly placd for sapling as dirctd fro th strotactic scout iags Tchnologist to prfor tst Physicist to obsrv and analyz rsults End-to-End tst which supplnts th daily in-air positioning accuracy tst Localization Accuracy: Glatin Phanto Mthod Localization Accuracy: Mthod Glatin Phanto 1. Position Ndl: - Targt Lsion Using Stro Viws - Position Cor Ndl to Propr X, Y, and Z Coordinats 2. Vrify Ndl Position: - Acquir Stro Pr-fir Iags - Ndl Tip should b within Lsion 3. Fir Gun 4. Vrify Post-Fir Position - Acquir Post-Fir Stro Iags - Ndl Tip should b byond Cntr of Lsion 5. Vrify Sapling of Lsion - Exain Contnts of Cor Sapl

17 Glatin Phanto Biopsy Glatin Biopsy Iags Localization Accuracy

18 Qustions Qustion # 1 Qustion # 1 Th half-valu layr accptabl for 28 kvp with a Mo/Mo targt/filtr on a Strotactic Brast Biopsy Unit is 13% A: 0.25 Al 31% B: 0.27 Al 56% C: 0.35 Al 0% D: 0.43 Al Th half-valu layr accptabl for 28 kvp with a Mo/Mo targt/filtr on a Strotactic Brast Biopsy Unit is A: 0.25 Al B: 0.27 Al C: 0.35 Al *Corrct* D: 0.43 Al Rf: ACR QC Manual for Strotactic Brast Biopsy (1999), p

19 Qustion # 2: Qustion # 2 Th Man Glandular Dos calculatd for a Mo/Mo targt/filtr cobination on a Strotactic Brast Biopsy Unit for a 512 x 512 atrix ay not xcd 6% A: 150 rad 19% B: 200 rad 0% C: 250 rad 75% D: 300 rad Th Man Glandular Dos calculatd for a Mo/Mo targt/filtr cobination on a Strotactic Brast Biopsy Unit for a 512 x 512 atrix ay not xcd A: 150 rad B: 200 rad C: 250 rad D: 300 rad *Corrct* Rf: QC Manual for Strotactic Brast Biopsy (1999), pag 80. Qustion # 3 Qustion # 3 Which of th following statnts is corrct rgarding rgulatory coplianc rquirnts of SBB units? A: All SBB units ust t MQSA rquirnts 14% B: All SBB units ust b Accrditd by th ACR 36% C: All SBB units ust t Stat Rgulatory Rquirnts 50% D: All SBB units ar xpt fro all MQSA and Stat Rgulatory Rquirnts 0% Which of th following statnts is corrct rgarding rgulatory coplianc rquirnts of SBB units? A: All SBB units ust t MQSA rquirnts B: All SBB units ust b Accrditd by th ACR C: All SBB units ust t Stat Rgulatory Rquirnts *Corrct* D: All SBB units ar xpt fro all MQSA and Stat Rgulatory Rquirnts Rf: ACR SBB Accrditation FAQ Wbsit

20 Whn using th Mini phanto for SBB unit iag quality valuation, which of th following options is th iniu accptabl iag quality scors whn viwd on a digital iaging syst? 0% Qustion # 4 A: 3 fibrs, 3 spck groups, 2.5 asss 25% asss 19% 56% B: 3 fibrs, 3 spck groups, 3 asss C: 3 fibrs, 3 spck groups, 4 asss D: 3.5 fibrs, 3 spck groups, 3.5 Qustion # 4 Whn using th Mini phanto for SBB unit iag quality valuation, which of th following options is th iniu accptabl iag quality scors whn viwd on a digital iaging syst? A: 3 fibrs, 3 spck groups, 2.5 asss *Corrct* B: 3 fibrs, 3 spck groups, 3 asss C: 3 fibrs, 3 spck groups, 4 asss D: 3.5 fibrs, 3 spck groups, 3.5 asss Rf: ACR Strotactic Brast Biopsy Quality Control Manual (1999), pag 91. Qustion # 5 Whn valuating th AEC or Manual Exposur Control Prforanc with a unifor dnsity phanto varying fro 2 to 8 c in thicknss, th an signal valu rang should not xcd which of th following? B: For phantos of 2 to 6 c thicknss, th an signal should b within +/- 20% of th an signal valu for th 4 c phanto. 31% C: For phantos of 4 to 8 c thicknss, th an signal should b within +/- 15% of th an signal valu for th 4 c phanto. 19% D. For phantos of 4 to 8 c thicknss, th an signal should b within +/- 20% of th an signal valu for th 4 c phanto. 0% A: For phantos of 2 to 6 c thicknss, th an signal should b within +/- 15% of th an signal valu for 50% th 4 c phanto. Qustion # 5 Whn valuating th AEC or Manual Exposur Control Prforanc with a unifor dnsity phanto varying fro 2 to 8 c in thicknss, th an signal valu rang should not xcd which of th following? A: For phantos of 2 to 6 c thicknss, th an signal should b within +/- 15% of th an signal valu for th 4 c phanto. B: For phantos of 2 to 6 c thicknss, th an signal should b within +/- 20% of th an signal valu for th 4 c phanto. *Corrct* C: For phantos of 4 to 8 c thicknss, th an signal should b within +/- 15% of th an signal valu for th 4 c phanto. D. For phantos of 4 to 8 c thicknss, th an signal should b within +/- 20% of th an signal valu for th 4 c phanto. Rf: ACR Strotactic Brast Biopsy Quality Control Manual (1999), pag 71.