ACR Radiography and Fluoroscopy Accreditation

1. ACR Radiography and Fluoroscopy Accreditation Charles R. Wilson, Ph.D., F.A.C.R. Medical College of Wisconsin Milwaukee, Wisconsin

2. 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

3. 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

4. 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

5. 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

6. Diagnostic Modality Accreditation Program ACR Practice Guidelines and Technical Standards • Evidence based • Jointly developed • Good risk management tools

7. 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

8. Diagnostic Modality Accreditation Program ACR Quality and Safety staff • Career healthcare professionals • Imaging technologists and radiation therapists

9. Radiography/Fluoroscopy Accreditation Program • Committee • Personnel qualifications • Clinical requirements • Phantom requirements/dose • Quality Control program and equipment QC • Reviewer qualifications • Program statistics

10. 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.

11. 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

12. Radiography/Fluoroscopy Accreditation Program Personnel qualifications • Physician • Medical Physicist/MR Scientist (if applicable) • Technologist

13. Radiography/Fluoroscopy Accreditation Program Personnel qualifications - Physician

14. Radiography/Fluoroscopy Accreditation Program Personnel qualifications - Medical Physicist

15. Radiography/Fluoroscopy Accreditation Program Personnel qualifications – Radiological Technologist

16. 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

17. Radiography/Fluoroscopy Accreditation Program Clinical Images • General Radiography Module • Abdomen exam • Cervical spine exam • Elbow exam

18. 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

19. 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

20. Radiography/Fluoroscopy Accreditation Program Phantom Images • All image receptors must be tested with the phantom

23. 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

24. 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

25. 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)

26. Radiography/Fluoroscopy Accreditation Program Quality control program and equipment QC

27. Radiography/Fluoroscopy Accreditation Program Reviewer 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)

28. Radiography/Fluoroscopy Accreditation Program Validation • 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

29. Radiography/Fluoroscopy Accreditation Program Mobile services • Must meet the same criteria as a fixed site

30. Radiography/Fluoroscopy Accreditation Program Fees • Facility fee $650 • Plus an additional $200 for each room being accredited

31. Radiography/Fluoroscopy Accreditation Program Accreditation 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

32. Radiography/Fluoroscopy Accreditation Program If 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

33. 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!

34. 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™