Download MRI Quality Assurance Program Summary

CT Quality Assurance Program Questionnaire
The following information is required for sites applying to participate in ACRIN
trials involving CT imaging and do not have ACR CT accreditation.
Technologist Qualifications
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Number of full-time technologists who perform CT studies:
Number of above technologists who registered:
Number of above technologists who hold CT certification:
Radiologist Qualifications
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Number of board certified radiologists who interpret CT scans:
o Number of above radiologists who have at least 150 hours of CME over a
three-year period:
Type of certifications or fellowships held by CT radiologists and the number of each:
Hours an CT supervising radiologist is available in the CT department daily:
Number of CT body and musculoskeletal cases interpreted for the most recent
calendar year:
o Does the facility or department have dedicated readers for body and
musculoskeletal cases?
o If yes, how many?
Number of CT neuro cases interpreted for the most recent calendar year:
o Does the facility or department have dedicated neuro readers?
o If yes, how many?
Please list any other CT sub-specialties for which the department has dedicated
readers:
Medical Physicist
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Identify medical physicist who oversees the quality control program and attach CV:
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Is medical physicist certified by the American Board of Radiology in the following
sub-fields?
Diagnostic Radiological Physics
Yes
No
Radiological Physics
Yes
No
Quality Assurance Program
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Does your institution have a Quality Assurance program in place that outlines policies
and procedures related to quality, patient education, infection control, and safety?
Yes (attach copy if applicable)
No
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Does your facility maintain documentation on site of any results of an
appropriateness/outcomes analysis and actions taken to correct any deficiencies?
Yes
No
Version Date: 5.15.07
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CT QA Program Questionnaire
CT Quality Assurance Program Questionnaire
CT Equipment Quality Control
Does all CT equipment meet state and federal requirements?
Yes
No
Please complete the following regarding CT equipment performance checks:
Checked Annually by Medical Physicist?
Yes
No
(If no, record frequency of inspection)
Alignment light accuracy*
Alignment of Table to gantry
Table/gantry tilt
Slice localization from scanned projection
radiograph (localization image)
Table incrementation accuracy
Slice thickness*
Image quality
(High-contrast (spatial) resolution, low-contrast
resolution, image uniformity, noise, artifact
evaluation)
CT number accuracy and linearity *
Display devices *
(Video display, hard-copy display)
Dosimetry
(Computed tomography dosimetry index (CTDI),
patient radiation dose for representative
examinations)
Safety evaluation
(Visual inspection, audible/visual signals, posting
requirements and scattered radiation
measurements)
Other tests as required by state or local
regulations
*It is recommended that in addition to conducting annual equipment inspections, the Medical Physicist
designate an on-site radiological technologist who will conduct routine quality control inspections for
these areas. If applicable, identify individual conducting routine quality control inspections of CT
equipment:
Publications
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Attach a list of recent publications related to CT imaging, if any, authored by facility
radiologists.
Name and title of individual completing this questionnaire:
Signature:
Version Date: 5.15.07
Date:
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CT QA Program Questionnaire