Medical X-ray equipment technology has evolved exponentially in the last decades, shifting steadily from analogue to digital radiology, from single slice to multidetector-row computed tomography or from fluoroscopy to complex angiography systems. This, however, comes with associated radiation risk for patients and staff. It is therefore vital that all X-ray equipment is monitored in terms of performance to ensure accurate and safe use. Quality control (QC) represents the basic level of managing safety and quality in diagnostic radiology. This publication compiles all existing QC tests in literature for all X-ray modalities. To facilitate the use of this handbook, spreadsheets and video tutorials have been developed to help with the execution of tests.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. RADIOGRAPHY
  • 2.1. Quality control tests for radiographers
    • 2.1.1. X ray–light beam alignment and centring
    • 2.1.2. Distances and scales
    • 2.1.3. Image uniformity and artefacts
    • 2.1.4. Automatic exposure control constancy
    • 2.1.5. Condition of cassettes and image plates (computed radiography only)
    • 2.1.6. Automatic exposure control sensitivity
  • 2.2. Quality control tests for medical physicists
    • 2.2.1. X ray–light beam alignment and centring
    • 2.2.2. Tube potential accuracy
    • 2.2.3. Radiation output consistency
    • 2.2.4. Short term reproducibility of radiation output and exposure time
    • 2.2.5. Exposure time accuracy
    • 2.2.6. Half-value layer
    • 2.2.7. Kerma–area product meter accuracy
    • 2.2.8. Short term reproducibility of exposure indicator
    • 2.2.9. Exposure indicator accuracy
    • 2.2.10. Image receptor dose
    • 2.2.11. Leakage radiation
    • 2.2.12. Scattered radiation
    • 2.2.13. Low contrast detectability
    • 2.2.14. Limiting spatial resolution
    • 2.2.15. Dark noise
    • 2.2.16. Accuracy of measured dimensions
    • 2.2.17. Automatic exposure control system — consistency between sensors
    • 2.2.18. Automatic exposure control system — short term reproducibility
    • 2.2.19. Automatic exposure control system — kilovoltage and thickness compensation
    • 2.2.20. Operation of the automatic exposure control guard timer
    • 2.2.21. Image uniformity and computed radiography plate sensitivity matching
    • 2.2.22. Erasure efficiency (computed radiography only)
• 3. FLUOROSCOPY AND ANGIOGRAPHY UNITS
  • 3.1. Quality control tests for radiographers
    • 3.1.1. Reproducibility of the automatic exposure rate control
  • 3.2. Quality control tests for medical physicists
    • 3.2.1. Verification of beam collimation
    • 3.2.2. Verification of beam geometry
    • 3.2.3. Verification of different field sizes
    • 3.2.4. Patient entrance surface air kerma rate
    • 3.2.5. Image receptor entrance surface air kerma rate
    • 3.2.6. Kerma–area product meter calibration
    • 3.2.7. Leakage radiation
    • 3.2.8. Scattered radiation
    • 3.2.9. Image quality of fluoroscopy
    • 3.2.10. Image quality of digital subtraction angiography
• 4. MAMMOGRAPHY
  • 4.1. Quality control tests for radiographers
    • 4.1.1. Image receptor uniformity — weekly test (computed radiography and digital radiography only)
    • 4.1.2. Subjective image quality evaluation
  • 4.2. Quality control tests for medical physicists
    • 4.2.1. Compression force and thickness indicator accuracy
    • 4.2.2. Detector alignment, alignment of X ray field to detector area
    • 4.2.3. Tube output
    • 4.2.4. Half-value layer
    • 4.2.5. Automatic exposure control system — reproducibility
    • 4.2.6. Automatic exposure control system — breast thickness compensation
    • 4.2.7. Automatic exposure control system — consistency between sensors
    • 4.2.8. Operation of the automatic exposure control guard timer
    • 4.2.9. Response function and noise evaluation (computed radiography and digital radiography only)
    • 4.2.10. Image receptor uniformity — annual test (computed radiography and digital radiography only)
    • 4.2.11. Spatial resolution
    • 4.2.12. Ghosting (computed radiography and digital radiography only)
    • 4.2.13. Computed radiography plate sensitivity matching
    • 4.2.14. Mean glandular dose
    • 4.2.15. Subjective evaluation of image quality
• 5. COMPUTED TOMOGRAPHY
  • 5.1. Quality control tests for radiographers
    • 5.1.1. Daily startup procedure
    • 5.1.2. Computed tomography laser alignment beams
    • 5.1.3. Scan projection radiograph accuracy
    • 5.1.4. Computed tomography number accuracy, image noise, image uniformity and image artefacts
    • 5.1.5. Accuracy of measured dimensions
  • 5.2. Quality control tests for medical physicists
    • 5.2.1. Computed tomography number accuracy, image noise, image uniformity and image artefacts
    • 5.2.2. Linearity
    • 5.2.3. Low contrast detail detectability
    • 5.2.4. X ray beam width
    • 5.2.5. Reconstructed image slice width
    • 5.2.6. Spatial resolution
    • 5.2.7. Computed tomography dosimetry
• 6. TESTS FOR ALL DIAGNOSTIC RADIOLOGY SYSTEMS
  • 6.1. Quality control tests for radiographers
    • 6.1.1. Routine check of image display
    • 6.1.2. Reject rate assessment
    • 6.1.3. Visual inspection of the workplace
  • 6.2. Quality control tests for medical physicists
    • 6.2.1. Image display systems
  • 6.3. Documentation
  • 6.4. Dose management software
• 7. FILM–SCREEN SYSTEMS
  • 7.1. Quality control tests for radiographers
    • 7.1.1. Temperature of the film processing system
    • 7.1.2. Base and fog, sensitivity and contrast
    • 7.1.3. pH measurement of the fixer solution
    • 7.1.4. Maintenance and visual inspection of cassettes
    • 7.1.5. Maintenance of screens
    • 7.1.6. Light-tightness of cassettes
    • 7.1.7. Film–screen contact
    • 7.1.8. Light-tightness and safelight illumination of the darkroom
    • 7.1.9. X ray film viewer box
• APPENDIX
• REFERENCES
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW