Guidance Supplement for ACR Computed Tomography Accreditation on the MX16-slice CT

Transcription

1 Guidace Suppleme for ACR Compued Tomography Accrediaio o he MX16-slice CT ACR Docume: Phaom Tesig Isrucios I is recommeded o have a Philips Preveive Maieace (PM) service call performed prior o performig he phaom esig; icludig laser ligh aligme, phaom ad air calibraios ad HCOR. If you are submiig films o he ACR, please be cerai ha your film processor is properly calibraed. Table of Coes: Guidace Suppleme for ACR Compued Tomography Accrediaio o a Philips MX16-slice CT... 1 ACR Docume: Phaom Tesig Isrucios... 1 Table of Coes:... 1 Secio 1- Fill ou he firs wo pages of Phaom Scaig Daa Form... 3 Secio 2. Calibrae Scaer... 5 Isrucio 2 Page, 3 of 16:... 5 Secio 3. Esure proper calibraio of Laser Imager... 5 Isrucio 3, Page 3 of 16:... 5 Secio 4. Module 1 Phaom ad Scaer Aligme... 6 Isrucio 4.1, Page 4 of 16:... 6 Isrucio 4.2, Page 5 of 16:... 7 Isrucio 4.2, Page 5 of 16:... 8 Isrucio 4.3, Page 5 of 16:... 9 Isrucio 4.6, Page 5 of 16: Secio 5. Module 1 CT Number Calibraio ad Slice Thickess Isrucio 5.1, Page 6 of 16: Isrucio 5.2, Page 6 of 16: Isrucio 5.3, Page 6 of 16: Isrucio 5.4, Page 6 of 16: Isrucio 5.5, Page 6 of 16: Repea Secio Repea Secio Isrucio 5.6, Page 6 of 16: Isrucio 5.7, Page 7 of 16: of 31 8/2/2010

2 Isrucio 5.8, Page 7 of 16: Repea Secio for 140kV Secio 6. Module 2 Low Coras Resoluio Isrucio 6.1, Page 7 of 16: Isrucio 6.2, Page 7 of 16: Isrucio 6.3, Page 8 of 16: Isrucio 6.4, Page 8 of 16: Secio 7. Module 3 Uiformiy ad Noise Isrucio 7.1, Page 9 of 16: Secio 8. Module 4 High-Coras Spaial Resoluio Isrucio 8.1, Page 9 of 16: Isrucio 8.2, Page 10 of 16: Appedix 1: Frequely Asked Quesios Appedix 2: Film Layou of 31 8/2/2010

3 Please be aware ha we will be referecig he ACR Phaom Tesig Isrucio Maual ad he ACR CT Phaom Sie Scaig Daa Form hroughou his docume - wih he docume ad perie page umbers i each secio. Secio 1- Fill ou he firs wo pages of Phaom Scaig Daa Form Below is he Produc Specificaios for he MX16-slice CT. This form correlaes wih page 1 of 7 o he Phaom Scaig Daa Form. Produc Specificaios # ACR Reques MX 16-slice CT 1 CT Maufacurer PHC Philips 2 Model Name MX16-slice CT, 16-chael cofiguraio 3 Sie Scaer ID Code 4 Geomery Roae/Roae (3rd geeraio) 5 Spiral/Helical Capabiliy Yes 6 Muli-Slice Capabiliy Yes 7 Max # of axial images able o be acquired simulaeously i oe roaio (Nmax) [Max # of daa chaels alog he z-axis] 16 8 Miimum Time for oe ube roaio 0.6 Sadard 0.5 Opioal 9 Slice Thickesses 0.75, 0.8, 1.0, 1.2, 1.5, 2.0, 3.0, 3.3, 4.0, 4.5, 5.0, 6.0, 7.5, 9.0, Available Beam Eergy (i kvp) 90, 120, Type of Deecors Solid-Sae 12 Type of Dose Reducio Opios Available ACS, DOM Serial Number of ACR CT Accrediaio Phaom used for daa 13 collecio 3 of 31 8/2/2010

4 The parameers lised below are examples represeig Philips proocols. Noe: I is crucial ha he acquisiio parameers repored i Table 1 should be represeaive of he sca proocols used for he sie s rouie cliical scas. These parameers will be used for scaig he image qualiy ad dose phaoms. They should be cosise wih he acquisiio parameers used for he cliical exams submied as par of he accrediaio process. Adul Head High Res Ches Adul Abdome Pediaric Abdome kvp ma / mas 314 / / / /140 Time per roaio (s) Sca FOV (cm) Display FOV (cm) Recosrucio Algorihm SB Lug B SB SB Axial (A) or Helical (H) Axial Axial Helical Helical Z-axis collimaio (T) 4, # daa chaels (N) Table Icreme or Table Speed Pich N/A N/A Recosruced Sca Widh Recosruced Sca Ierval Dose Reducio Techique N/A N/A N/A N/A Please check he ACR websie for curre dose recommedaios. 4 of 31 8/2/2010

5 Secio 2. Calibrae Scaer Isrucio 2 Page, 3 of 16: Perform Tube Warm Up ad Air Calibraios. From Layou secio i filmig, Selec Film Forma buo ad selec 12 (3x4), he OK. From he Opios ab i he Filmig widow, uclick he Do No Mix Paies opio. If you are burig o CD for submissio, please review he iformaio provided from he ACR Noe: Do No Mix Paies opio is uavailable o EBW 3.0 ad laer versios. Filmig mus be doe from he scaer. Secio 3. Esure proper calibraio of Laser Imager The SMPTE paer is a video display ha is used o calibrae he moior ad oupu from your hard copy camera. Isrucio 3, Page 3 of 16: From he Home Page, access he SMPTE paer by clickig o he Device Lis ad selecig he Demo buo. If SMPTE is o available i Demo, coac your Field Service Egieer. Highligh he SMPTE es paer ad sed SMPTE paer o Filmig Esseial Crieria for SMPTE es paer SMPTE or oher video es paer mus be prese i he firs box of each film shee. The 95% square mus be visible (whies mus o be sauraed). The 5% square mus be visible (blacks mus o be sauraed). There should be o arifacs or disorios prese. If he SMPTE image from he moior does o mach he hard copy image, your camera may eed o be calibraed. Noe: Use he Zoom ad Pa fucios o esure ha ex does o overlap or i ay way obscures he SMPTE Tes Paer. 5 of 31 8/2/2010

6 Secio 4. Module 1 Phaom ad Scaer Aligme Isrucio 4.1, Page 4 of 16: This is oe of he mos impora ad ime cosumig par of he process. Figure 1 Take he able pad off he able. Place phaom o he able. The screw ed of he phaom holder should be placed away from he gary, oward he foo ed of he able. (See Figure 1.) Alig he op ad side lasers o he firs whie lie closes o he foo ed. (This is he ceer of Module 1). The screw o he phaom holder adjuss he sla of he phaom i he superior ad iferior direcios so ha i may be properly aliged wih he laeral lasers. (Figure 1). Hi: A level is a grea ool o aid i aligme. 6 of 31 8/2/2010

7 You mus ake special care whe aempig o alig he ceer ad laeral phaom lies o CT laser lies (see image above). Carefully recheck aligme afer each small ad deliberae moveme of he phaom. Use he able up/dow corols, he rear phaom kob ad maual ceerig, roaig, ad skewig movemes o alig he phaom. The whie lies o he phaom represe he ceer of each module. Oce aliged, move he phaom io he gary. Alig he ieral laser ligh wih he ceer of Module 1 he firs whie lie closes o he foo ed. Zero he gary posiio by pressig he zero buo o he gary paels. Isrucio 4.2, Page 5 of 16: There are 4 modules wihi he phaom. Each secio measures 40mm ad has a specific purpose i he phaom esig. Module 1- Aligme, CT umber ad slice widh (foo ed of he phaom) Module 2- Low coras resoluio Module 3- Uiformiy ad oise- Disace accuracy ad SSP Module 4- High Coras resoluio (head ed of he phaom) Deailed descripios of each Module are foud i he Phaom Tesig Isrucios, page 2 of 16. The firs es for Module 1 is BB ad ceral wire evaluaio. There are 4 BB s. They are locaed a he op, boom, ad sides of he ceer of Module 1. The goal i his secio is o be able o see all 4 BB s wih similar appearace (equal brighess). Addiioally, he ceral wire of he slice widh ramps (he ceer of he group of visible wires ha is loger ha he res) should be i he ceer of he oher visible wires (+/-1 wire) for boh he 12 o clock (op) ad 6 o clock (boom) ramps. There are muliple ways o ge he BB s aliged properly. We describe i his docume oe mehod. A quick check for BB aligme may be doe for aligme by acquirig a spiral 1.0mm daa se usig he followig parameers. This sep allows you o ge a approximae locaio of he BB s ad see he aligme. Fier aligme modificaios ca he be performed o ge he desired image. The followig sca is oly used o help you alig he phaom for Module 1 Sar STUDY Selec EAR proocol group Selec IAC spiral proocol Delee surview Apply he followig parameers 7 of 31 8/2/2010

8 Scaer Label Sar Ed Legh Thickess Icreme kv mas Direcio MX16 Aligme IN Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme C W Ceer X Ceer Y Marix sadard 8 x B Afer scaig, view images, adjus phaom accordigly. This sca may eed o be repeaed a few imes for geeral aligme. Afer he phaom is aliged, END STUDY. Fid he image ad able posiio ha visualizes all 4BB s ad ceral wires. Move able o he posiio ad ZERO he able. Coiue o he ex sep whe all 4BB s are aliged. You may ow begi he ACR phaom esig porio. Isrucio 4.2, Page 5 of 16: Scaig Module 1 for Phaom ad Scaer Aligme Sca usig he parameers below for he Aligme sca o Module 4: Use a display field of view (recosruced image diameer) as close o, bu o smaller ha 21cm. A example acquisiio is show below Use your sie s High Resoluio Ches proocol o acquire a sigle axial sca. Phaom should ow be ceered i he ceer of Module 1. Se Paie ID o ACR MX16 Se Geder o Oher. Se Age Group o Adul. Se Posiio o Head Firs Supie. Selec Lug Exam Group Selec HRCT Axial Delee he Surview sca Check Maual Type Film1 Box 1:2 i label. A example acquisiio is show below for he Aligme sca o Module 1: 8 of 31 8/2/2010

9 Scaer Label Sar Ed Legh Thickes s Icreme kv mas Cycle Time MX16 Film1 Box Cycles Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Ceer X high 2 x Lug B Ceer Y Marix Perform he acquisiio ad review he resulig images ad esure ha all four bb s (aerior, poserior, ad laerals) are prese o he image. If o, make mior phaom adjusmes ad repea he sca as required (4.5) Page 5 of 16(Phaom Tesig Isrucios.) The fial image should look like he image below: Figure 2 Isrucio 4.3, Page 5 of 16: If bb s are o aliged : 9 of 31 8/2/2010

10 R. Click o he image ad selec Grid o display he grid o he phaom image. This will help you see which way you eed o adjus he phaom if your phaom is o perfecly aliged. Check ha he BBs are aliged (horizoally ad verically). Use he able up/dow corols, he rear phaom kob ad maual ceerig, roaig, ad skewig movemes o alig he phaom. Repea acquisiio o check aligme. If here is a leas oe image i which all four BBs are visible ad he ceral wires are symmerically locaed i he ceer of he ramps, record PASS for Module 1 BB aligme. Tur off grid by righ clickig o he image ad sed o film. Film Box 1:2 To film image for Film 1, Box 2: Selec Sigle Image Ico from viewer oolbar ad sed o filmig. Sed o film from oolbar Check o see ha he image has bee placed ex o SMPTE image by selecig he Filmig ab. Isrucio 4.6, Page 5 of 16: Scaig Module 4 for Phaom ad Scaer Aligme Sca usig he parameers below for he Aligme sca o Module 4: Use a display field of view (recosruced image diameer) as close o, bu o smaller ha 21cm. A example acquisiio is show below: 10 of 31 8/2/2010

11 Scaer Label Sar Ed Thickess Icreme kv mas Cycle Time MX16 Film 1 Box Cycles Resoluio Collimaio Til Roaio FOV Filer Ehaceme Ceer X Ceer Y Marix Time C W High 2x SB Perform he acquisiio ad review he resulig image ad esure ha all four bb s (aerior, poserior, ad laerals) are prese. If o, make mior phaom adjusmes ad repea he sca as required (4.5). If here is a leas oe image i which all four BBs are visible, record PASS for Module 1 BB aligme ad film image o Film 1, Box 3. The fial image should look like he image below: 11 of 31 8/2/2010

12 Figure 3 To film image for Film 1, Box 3 : Selec Sigle Image Ico from viewer oolbar ad sed o filmig. Sed o film from oolbar (camera ico) 12 of 31 8/2/2010

13 Secio 5. Module 1 CT Number Calibraio ad Slice Thickess Be sure o record he able locaio foud o corol box. Eer his value io he Phaom Sie Scaig Daa Form, Secio 5, Page 3 of 7, eiled; Locaio of Ceer of Module 1. The ceer of module 1 should be zero. Isrucio 5.1, Page 6 of 16: Move phaom back o Module 1. The able posiio should be zero. From he Proocols ab, selec Abdome, Axial Scas, Body Sadard QA. The Body Sadard QA should be adjused o mimic he Isiuio s cliical abdome proocol: specifically mas, collimaio, ad slice hickess. If your adul abdome proocol is a spiral acquisiio, perform a axial sca isead while keepig he remaiig echical parameers uchaged. If he slice hickess ha you ypically use is o available i he axial mode, please refer o he ACR-Compued Tomography Frequely Asked Quesios for furher clarificaio. A example acquisiio is show below. These parameers lised below are examples represeig Philips MX16-slice CT proocols. I is crucial ha he acquisiio parameers repored i Table 1 should be represeaive of he sca proocols used for he sie s rouie cliical scas. Scae r Label Sar Ed Legh Thickes s Icreme kv mas Cycle Time MX16 Film 1 Box 4 6mm Cycles Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme Wido w L Wido w W Ceer X Ceer Y Sadard 16x SB Marix 13 of 31 8/2/2010

14 Isrucio 5.2, Page 6 of 16: The images should be viewed a a Widh of 400 ad Level of 0. Film he image wih 4 ceered BB s. [Film 1, Box 4] Go o Filmig Click o he Circular ROI ico ad creae a ROI ha is approximaely 200mm2 ( ) o each cylider (brigh ad dark shaded circles). Use he Move Graphic Eleme ico o move he correspodig ex for each ROI ouside of he phaom. Creae a 200mm2 Waer ROI locaed midway bewee he Poly ad Acrylic ROI s. The waer ROI is very difficul o see. I is locaed a he 9 o clock posiio. Referece waer ROI: See Image 4 below. Record he ROI values ( Av : ) i he Phaom Sie Scaig Daa Form, secio 5 Module 1 (foud o page 3 of 7) i he Poly, Waer, Acrylic, Boe, ad Air secios. Record he Slice Widh i he Phaom Sie Scaig Daa Form, secio 5 Module 1 (foud o page 3 of 7) i he Top ad Boom secios usig he isrucios below. Slice Widh Isrucios: Firs, cou he visible wires i he op secio ad divide by 2. Eer his umber i he op secio. Secod, cou he visible wires i he boom secio ad divide by 2. Eer his umber i he boom secio. CT Number Calibraio ROIs mus be placed wihi he cyliders Polyehylee mea CT umbers should be bewee -107 ad -87 HU Waer mea CT umbers should be bewee -7 ad +7 HU (+/- 5 HU preferred) Acrylic mea CT umbers should be 14 bewee of ad /2/2010 Boe mea CT umbers should be bewee +850 ad +970 Air mea CT umber should be bewee ad -970 HU

15 If Waer is o 0 +/- 7 HU, please coac Philips Service. If ay value is ouside of he hreshold (eered values fall ouside of he acceped rage), refer o he Philips FAQ (Appedix 1). Noe: This Slice Widh measureme is ieded o measure slice widh ad should be +/- 0.5mm of he Thickess parameer used for he acquisiio. The fial image should look like he image below: Figure 4 Isrucio 5.3, Page 6 of 16: This secio will docume slice widh. Repea he adul axial abdome sca as above for he followig slice hickesses. Keep all oher parameers he same as hose i he Adul Abdome Proocol: he slice widh used for he High Resoluio Ches proocol ad he slice widhs seigs closes o 3, 5, ad 7mm. If he slice hickess ha you ypically use is o available i he axial mode, please refer o he ACR- 15 of 31 8/2/2010

16 Compued Tomography Frequely Asked Quesios pages 5-7 for furher clarificaio. Do o resca he already acquired sca ha used he ypical slice hickess for your adul abdome proocol; however, you mus refilm he image i he appropriae box. Use a display field of view as close o bu o smaller ha 21cm. Selec Pla Sca Use he HiRes Thickess: A example acquisiio is show below. Scae r Label Sar Ed Legh Thickess Icreme kv mas Cycle Time MX16 Film 1 Box 5-1.5mm Cycles Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Ceer X Ceer Y Sadard 16x SB Marix Isrucio 5.4, Page 6 of 16: Film he image wih 4 ceered BB s. [Film 1, Box 5] I Filmig, creae a 200mm2 Waer ROI. Record he Slice Widh ad Mea CT Number values io he Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module 1, eiled; Hi Res Ches. Be sure ROI ex is moved ouside of he phaom. 16 of 31 8/2/2010

17 Isrucio 5.5, Page 6 of 16: Repea Secio For he Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module 1, eiled; ~3mm Secio. Use he ~3mm: A example acquisiio is show below. Scae r Label Sar Ed Legh Thickess Icreme kv mas Cycle Time MX16 Film 1, Box 6 3 mm Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Ceer X Ceer Y Sadard 16x SB Film he image wih 4 ceered BB s. [Film 1, Box 6] I Filmig, creae a 200mm2 Waer ROI. Record he Slice Widh ad Mea CT Number values. I Filmig, duplicae he image from Film 1 Box 4 o Film 1, Box There is o eed o resca he already acquired sca ha used he ypical slice hickess for your adul abdome proocol. Repea Secio For he Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module 1, eiled; ~7mm Secio. Use he ~7mm: A example acquisiio is show below. Scae r Label Sar Ed Legh Thickess Icreme kv mas Cycle Time MX16 Film 1 Box 8 9mm Cycles Marix Cycles Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Sadard 12 x SB of 31 8/2/2010 Ceer X Ceer Y Marix

18 Film he image wih 4 ceered BB s. [Film 1, Box 8] I Filmig, creae a 200mm2 Waer ROI. Record he Slice Widh ad Mea CT Number values Isrucio 5.6, Page 6 of 16: Selec Pla Sca Selec he 90kV. A example acquisiio is show below. Scae r Label Sar Ed Legh Thickes s Icreme kv mas Cycle Time MX16 Film 1 Box9 90kV Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme C W Ceer X Ceer Y Sadard 16x SB Cycles Marix Isrucio 5.7, Page 7 of 16: Film he image wih 4 ceered BB s. [Film 1, Box 9] I Filmig, creae a 200mm2 Waer ROI. Eer he value recorded i Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module of 31 8/2/2010

19 Isrucio 5.8, Page 7 of 16: I Filmig, duplicae he image from Film 1 Box 4 o Film 1, Box 10 Simply eer he value for 120kVp previously recorded Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module 1 for Waer. Repea Secio for 140kV Use he 140kV. A example acquisiio is show below. Scae r Label Sar Ed Legh Thickess Icreme kv mas Cycle Time MX16 Film 1 Box 11, 140kV Cycles Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme C W Ceer X Ceer Y Sadard 16x B Marix Film he image wih 4 ceered BB s. [Film 1, Box 11] I Filmig, creae a 200mm2 Waer ROI. Eer he value recorded i Phaom Sie Scaig Daa Form, Page 3 of 7, Secio 5 of Module 1. Leave Film 1, Box 12 empy. 19 of 31 8/2/2010

20 NEXT SHEET OF FILM Film he SMTPE paer agai. [Film 2, Box 1] Noe: Te SMPTE paer will be he firs image o boh films. 20 of 31 8/2/2010

21 Secio 6 Module 2 Low Coras Resoluio Isrucio 6.1, Page 7 of 16: From he Proocols ab, selec your sadard adul Abdome proocol. A example acquisiio is show below. Scae r MX16 Label Sar Ed Legh Thickess Icreme kv mas Evolvig Film 2 Box 2 Low Coras Off Resoluio Collimaio Pich Roaio Time FOV Filer Ehaceme L W Ceer X Ceer Y Sadard 16x SB Marix Isrucio 6.2, Page 7 of 16: Display Image 1 of he Series. Se he C = 100 ad W = 100. Wih room lighs lowered, deermie he cylider se havig he smalles diameer for which all for cyliders are visualized. Record he diameer of he smalles cyliders see o he Phaom Sie Scaig Daa Form, Page 4 of 7, Module 2 Secio of 31 8/2/2010

22 Noe: All 4 6mm s cyliders mus be see! See diagram foud i he Phaom Tesig Isrucios, page 2 of 16 Isrucio 6.3, Page 8 of 16: Film his image. [Film 2, Box 2] Creae wo 100mm2 ROI (may be mm) Firs ROI over he large (25mm diameer) cylider Secod ROI ex o he large cylider Zoom ad Pa o esure ha ex ad ROIs do o overlap or i ay way obscure he pis. Record Mea CT (Average) for boh ROI s i he Phaom Sie Scaig Daa Form, Page 4 of 7, Module 2 Secio 6. Record Measured coras (ROI 1 Avg. ROI 2 Avg.) i he Phaom Sie Scaig Daa Form, Page 4 of 7, Module 2 Secio of 31 8/2/2010

23 The fial image should look like he image below: Isrucio 6.4, Page 8 of 16: Figure 5 From he Proocols ab, selec your sadard adul Brai proocol. A example acquisiio is show below. Scae r Label Sar Ed Legh Thickes s Icreme kv mas Cycle Time MX16 Film 2 Box Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Ceer X Ceer Y Sadard 12 X SB Display Image 1 of he Series. Film his image. [Film 2, Box 3] Creae wo 100mm2 ROI (may be mm) Cycles Marix 23 of 31 8/2/2010

24 Zoom ad Pa o esure ha ex ad ROIs do o overlap or i ay way obscure he pis. Se he C = 100 ad W = 100. Record he value of he smalles diameer cylider for which all 4 cyliders ca be visualized o he char i Secio 6 Module 2 This char is locaed o Page 4 of 7 of he CT Sie Scaig Daa Form. Noe: You mus visualize he four 6mm rods! See diagram foud i he Phaom Tesig Isrucios, page 2 of of 31 8/2/2010

25 Secio 7. Module 3 Uiformiy ad Noise Isrucio 7.1, Page 9 of 16: Display he images acquired i Isrucio 6.1. This is he previously scaed Adul Abdome image a he ceer of Module 3. Film his image. [Film 2, Box 4] Display he image ha correspods o he ceer of module 3 posiio (80mm superior o he sar posiio). Se he L = 0 ad W = 100. Creae a 400mm2 ROI s (may be mm) a he ceer ad four edge posiios. For he edge ROI s, place he ceer of he ROI approximaely oe ROI diameer away from he edge. Zoom ad Pa o esure ha ex ad ROIs do o overlap or i ay way obscure he pis. Record he mea CT umbers for all 5 ROI values o Phaom Sie Scaig Daa Form, Page 4 of 7, Secio 7 of Module 3, Uiformiy ad Noise. Addiioally, Record he sadard deviaio of he ceer ROI The fial image should look like he image below: Figure 6 25 of 31 8/2/2010

26 Wih all graphics ured off, view he image carefully wih he room lighig reduced. Examie he image for arifacs such as rigs or sreaks ad record he presece ad appearace of ay arifacs o he daa shee. If arifacs are prese, a service egieer may be eeded o ivesigae hem. Noe: You may have o make sligh locaio adjusmes o he ceer ad peripheral ROI s o achieve a differece of 5 or less HU s. 26 of 31 8/2/2010

27 Secio 8. Module 4 High-Coras Spaial Resoluio Isrucio 8.1, Page 9 of 16: Display he images acquired i Isrucio 6.1. This image was acquired a he ceer of Module 4 posiio. (120mm superior o he sar posiio) Deermie he highes spaial frequecy for which he bars ad spaces are disicly visualized. Film his image. [Film 2, Box 5] Se he L = 1100 ad W = 100. Noe: The Widh value ca be adjused slighly o opimize visualizaio of he bar paers. Approximaely +/-20 Record he values o Phaom Sie Scaig Daa Form, Page 4, Secio 8 - Module 4, Adul Abdome Techique. The fial image should look like he image below: Figure 7 Noe: You mus visualize a leas 5 lp/cm! 27 of 31 8/2/2010

28 Isrucio 8.2, Page 10 of 16: From he Proocols ab, selec your High Resoluio Ches proocol. A example acquisiio is show below. Scae r Label Sar Ed Legh Thickes s Icreme kv mas Cycle Time MX16 Film 2 Box Resoluio Collimaio Til Roaio Time FOV Filer Ehaceme L W Ceer X Ceer Y high 2x Lug B Film his image. [Film 2, Box 6] Se he C = 1100 ad W = 100. Record he values i Secio 8 of Module 4, High Resoluio Ches Techique i he Phaom Sie Scaig Daa Form, Page 4 of 7. Noe: You mus visualize a leas 6 lp/cm! Cycles Marix Noe: Do o remove he Phaom uil boh Films have bee pried ad double checked for accuracy. Usig Appedix 2: Film Layou, double check all of he film boxes for accuracy 28 of 31 8/2/2010

29 Appedix 1: Frequely Asked Quesios (1) How do I fid he Mea CT Number? Aswer: The Mea CT Number shows up as Av: or Average o Philips scaers. (2) My measuremes o scree differ from hose o pried film. Aswer: Docume ROI s o he ACR paperwork usig ROIs from he pried films- keep everyhig cosise. (3) If we sca hi slices, bu sed hick slices o PACS, which slice hickess should we docume? Aswer: The slice hickess for he ACR phaom should be approximaely he same as he cliical images submied o he radiologis for readig. Make cerai ha hese images are he same parameers as he submied phaom images. Effecive Jauary 1, 2008 (from ACR websie) Examiaio Pass/Fail Crieria New* CTDIvol (mgy) Referece Levels Old CTDIw (mgy) Adul Head New* CTDIvol (mgy) Referece levels help ideify siuaios i which doses are above expeced values ad should be ivesigaed. Uis exceedig hese referece levels (bu remaiig below he pass/fail crieria) will o fail accrediaio. However, eve if he ui is graed accrediaio, he ACR will srogly urge he faciliy o cosul wih is medical physicis o deermie if i is possible o reduce he exam dose wihou sacrificig image qualiy. (4) My cylider CT umbers i Module 1 are o wihi he specified ACR rages. Aswer: I is recommeded ha he cusomer call ACR direcly a (800) [Press 7 ad he 1] for iformaio o he Pass / Fail crieria ad oher iquiries. I is highly recommeded o provide he ACR wih oes ad commes regardig he elephoe iquiry i he ACR submissio - icludig dae called, represeaive spoke o, represeaive's recommedaio, ec. Philips CT represeaives, who have called he ACR help lie, have bee old he discrepacies i he CT umbers measuremes i Module 1 are cosidered 'mior' ad aloe are o a cause for submissio failure. Furhermore, Philips represeaives have bee old a submissio may sill pass wih up o 7 'mior' discrepacies. (5) I ca pri SMPTE Paer o same film as ACR Phaom es images. Aswer: I he Film Queue Maager, Click Opios from he op meu. Ucheck Do No Mix Paies. O he EBW3.0 ad laer versios, The Do No Mix Paies is o a opio. Please film from he scaer. (6) How do I view he image sca parameers? Aswer: To show he basic parameers: I he CT Viewer, selec he 2D mode, selec he or from he Viewer, selec he View meu ad he Image Parameers. ico (10) ACR asks for submissio o film, bu our sie does film. Aswer: The ACR does make excepios for sies ha do o have access o priers. You mus coac he ACR a o ge special permissio ad addiioal isrucios o how o submi he images. 29 of 31

30 Appedix 2: Film Layou 3.1 Isrucios Film # 1 Box # 1 SMPTE Paer Film # 1 Box # Mod # 1 CT# & Slice Thickess Adul Abdome 0 Axial Sca - No Table Icreme Ceered Peg ROIs - Areas = 200mm W=400, L=0 Film # 1 Box # 7 Film # 1 Box # Mod # 1 Aligme Sca High Res Ches 0 Sigle Axial - SW 2mm, or less FOV ~ 210mm, bu o less Four BB s Visible SW Ramps Correc Log Wire Ceered +/- 1 W = 1000, L = 0 Film # 1 Box # Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW from High Res Ches Proocol FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm Meas d SW w/i 1.5mm of prescribed W=400, L=0 Film # 1 Box # 8 Film # 1 Box # Mod # 1 Aligme Sca High Res Ches 0 Sigle Axial - SW 2mm, or less FOV ~ 210mm, bu o less Four BB s Visible W = 1000, L = 0 Film # 1 Box # Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW ~3mm FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm Meas d SW w/i 1.5mm of prescribed W=400, L=0 Film # 1 Box # Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW ~5mm FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm Meas d SW w/i 1.5mm of prescribed W=400, L=0 5.5 Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW ~7mm FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm Meas d SW w/i 1.5mm of prescribed W=400, L=0 5.8 Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW Proocol Origial kvp = 80 or 90 FOV ~ 210mm, bu o less Waer ROI (0 +/- 5) - Area = 200mm W=400, L=0 Film # 1 Box # Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW Proocol Origial kvp = 120 FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm W=400, L=0 Film # 1 Box # Mod # 1 CT# & Slice Thickess Axial Adul Abdome 0 SW Proocol Origial kvp = 140 FOV ~ 210mm, bu o less Waer ROI (0 +/- 7) - Area = 200mm W=400, L=0 Film # 1 Box # 12 EMPTY 30 of 31

31 Film # 2 Box # 1 SMPTE Paer Film # 2 Box # Mod #3 Uif, Noise & Dis Reuse Adul Abdome mm 0, 12, 3, 6 ad 9 Edge circles oe diameer from edge. Record Uiformiy ad Sadard Deviaio 0 +/- 5 ad less ha 5 HU differece bewee edge ad ceer circles. W = 100, L = 0 Film # 2 Box # Radiaio Dosimery (Head) Rouie Head Proocol Axial Sca - No Table Icreme Film Image from 3 rd Exposure CTDI Limi = 60 mgy W=400, L=100 Mus be performed by physicis Film #2-Box #10 Film # 2 Box # Mod #2 Low Coras Resoluio Adul Abdome 40 FOV ~ 210mm, bu o less ROI Large Peg Area = 100mm ROI ear Large Peg Area = 100mm All four 6mm rods should be visible. W = 100, L = 100 Film # 2 Box # Mod # 4 High (Spaial) Co Res Reuse Adul Abdome 120 Record highes visible spaial resoluio 5 lp/cm should be resolvable W = 100, L = 1100 Film # 2 Box # Radiaio Dosimery (Ped Body) Pediaric Abdome Proocol Axial Sca - No Table Icreme Film Image from 3 rd Exposure CTDI Limi = 25 mgy W=400, L=100 Mus be performed by physicis Film #2-Box #11 Film # 2 Box # Mod #2 Low Co Res Film # 2 Box # Mod #2 Low Coras Resoluio Rouie Head 40 FOV ~ 210mm, bu o less ROI Large Peg Area = 100mm ROI ear Large Peg Area = 100mm All four 6mm rods should be visible. W = 100, L = 100 Film # 2 Box # Mod # 4 - High (Spaial) Co Res High Res Ches 120 FOV ~ 210mm, bu o less Record highes visible spaial resoluio 6 lp/cm should be resolvable W = 100, L = 1100 Film # 2 Box # Radiaio Dosimery (Adul Body) Adul Abdome Proocol Axial Sca - No Table Icreme Film Image from 3 rd Exposure CTDI Limi = 35 mgy W=400, L=100 Mus be performed by physicis Film #2-Box #12 Empy Empy Empy 31 of 31