Identify equipment used in Medical Imaging

Medical imaging department

o Function
o Personnel
o Equipment in the department
o Quality control in the department
o Quality assurance in the department

18.6.1 Identify equipment in a medical imaging department

Unit C18.6 Maintaining Medical Imaging Equipment
Module 279 19 C Medical Instrumentation II

© dr. Chris R. Mol, BME, NORTEC, 2016

 The ‘Medical Imaging’ or ‘Radiology’ Department
Radiology is the medical specialty that applies Medical Imaging to support
diagnosis and treatment of patients in the hospital. Radiologists are the
‘photographers’ or ‘image makers’ of the hospital.
Radiology is a separate department in the hospital since medical imaging is so
complex that it requires a specialization (additional training) to create and
interpret the images. There is a trend that more simple imaging techniques, such
as ultrasound, are located at - and owned by - ‘clinical departments’.
In general, patients are not ‘treated’ by Radiologists. Patients are referred to the
Radiology department by ‘clinical departments, such as Cardiology, Neurology,
Gynaecology, etc.

Radiology is (mostly) a Diagnostic department. Images are collected to support the

diagnosis of a patient.
For a full diagnosis, not only images are required but also other patient data, such
as patient history and medication. This diagnosis is made by the ‘referring
physician’.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Main activities in the department
1. Scheduling the patient for the appropriate test
2. Provide proper equipment to perform the test (including stable reliable electricity, etc.)
3. Appropriately trained personnel to operate the equipment
4. System to visualize, store and transmit the imaging data
5. Radiologist to interpret imaging data
6. Generation of a report of the findings from the imaging data
7. System to transmit the report to the referring healthcare provider
8. Equipment maintenance program
9. System of continuing education and quality assurance to make sure all equipment is
properly maintained and personnel are appropriately trained
10. Financial method of reimbursement to make the system viable and sustainable

Radiology in advanced healthcare systems has become mainly digital with all interpretations occurring from a
computer workstation enabling advanced manipulation of images. This requires new staff, responsibilities, and skill
sets.
© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging
 Personnel in Medical Imaging Department

Personnel at the Medical Imaging Department can include:

• Administrators: to schedule patients, record payments, manage
human resources, ….
• Nurses: Perform procedures on patients that require imaging
exam, ensure patient safety,
• Radiographers or Radiologic Technologists: operate imaging Radiographer
hardware, transmit images (print or electronic) to radiologists
• Physicists: manage quality (resolution, calibrations) of imaging
equipment, manage safety (radiation dose
• Radiologists: are Medical Doctors. Interpret/read the images.
His/her report is transmitted to the clinician who requested the
imaging.

Radiologist

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Imaging Modalities

In the following slides we will go over the main imaging modalities in the Medical Imaging
department.

In subsequent lectures we will go into further detail on X-ray an Ultrasound images

A final lecture in this ‘Medical Imaging’ section will elaborate some more on
‘advanced’ 3D imaging techniques, including CT, MR, Nuclear Medicine and Tele-radiology.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Digital Radiography
Over the last 10-20 years, film-screen radiography is being replaced by digital radiography. Just as film-
based consumer photography has been replaced by digital photography.

In digital radiography, X-rays strike a semi-conductor based Flat Detector that converts
the X-ray intensity into digital information, which is transmitted and converted
immediately (no need for chemical processing!) into an image displayed on a computer
screen.

Digital Chest
X-ray Imaging

a detachable Flat Detector

can easily be repositioned

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 X-ray Fluoroscopy
Fluoroscopy uses X-ray to make film, rather than still photo’s, to
investigate objects that move. This is called dynamic imaging.

Conventionally, this is achieved by receiving the X-ray radiation on a

fluorescent screen, coupled to an image intensifier tube. The
Diagram of Image Intensifier
optical light output of the Image Intensifier is picked up by a CCD
based system for dynamic X-ray
camera and displayed on a monitor.
imaging
However, also for dynamic imaging, detector technology
has moved to Flat Detector technology.

X-ray ‘C-arm’ - with

Image Intensifier -
for use during
surgery
Image Intensifiers with
different sizes
© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging
 Ultrasound
Medical ultrasonography uses ultrasound to visualize soft tissue structures in
the body in real time.
The quality of the images obtained using ultrasound is highly dependent on
the skill of the person (ultrasonographer) performing the exam and the
patient's body size (obesity).

Examinations of larger, overweight patients may have a decrease in image quality as their
subcutaneous fat absorbs more of the sound waves. This results in fewer sound waves
penetrating to underlying organs and reflecting back to the transducer, resulting in poorer
quality image. Ultrasound is also limited by its inability to image through air pockets (e.g.
lungs) or bone.

Advantages of ultrasound imaging are that it provides images in real-time, it is

portable and can be brought to the bedside. It is substantially lower in cost, and it
does not use harmful ionizing radiation. This is a good reason why it is used so much
in gynaecology/obstetrics to diagnose and measure progress of the fetal growth.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Quality Assurance and Quality Control
The Quality Assurance (QA) Program is a program designed by management to assure quality of a product or service.
Such a program can have wide-ranging aspects, including customer feedback, employee empowerment, and quality
control.
In Quality Assurance you aim to avoid defects. It is In Quality Control, you try to find defects and correct
about prevention. It is a process based approach: them. It is about detection of problems. It is used to verify
processes are described and analysed so that problems the quality of a device.
cannot occur.

It is essential that one person at a given facility, the QA Coordinator,

is in charge of maintaining the QA program and that (s)he is allotted
the time, equipment, and space necessary to carry out the duties
that are required. The facility’s QA Coordinator may choose to
assign specific duties to other personnel but should maintain
oversight and realize that consistency is compromised when several
people share the responsibility of carrying out these tasks.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Quality control
A Quality Control Program allows a facility to efficiently monitor the components of the imaging process. It consists of a
series of standardized tests developed to detect changes in X-ray equipment function from its original level of
performance. The results of such tests, when carried out routinely, allow prompt corrective action to maintain image
quality.
As an example, QC program for radiography equipment
should include regular checks of:
• the film processor unit
• the darkroom
• the view boxes
• the film and chemical storage
• the intensifying screen cleaning
• the screen-film contact test
• the integrity of lead aprons and gloves

These actions typically involve measurement of a process variable, checking the measured value against a limit,
and performing corrective action if the limit is exceeded.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Quality control

A good QC program at the

radiology department executes
such a program for each medical
imaging device…..

For X-ray systems, quality control is

particularly important since
radiation exposure cannot be seen
and can be easily neglected without
the presence of qualified personnel
who are actively monitoring risk.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 QC Programs are not totally free…. (example only)
In order to perform the QC tests outlined in this manual, an initial outlay of about $1,600 will be necessary. Minimal
annual costs can be expected to keep your QA and QC programs running.
• Sensitometer, approximately $700,
• Densitometer, approximately $700,
• Box of film (clinically used),
• Aluminum step wedge, approximately $70,
• Brass or copper mesh screens large enough to cover largest cassette in use at facility, approximately $10,
• Measuring tape,
• Non-mercury thermometer, approximately $10,
• Cleaning equipment for screens, cassettes and darkroom,
• Fluoroscopic test tool, approximately $100

Once you have become proficient at performing the tests the time spent will be minimal.
• Daily tests should take about 5 minutes to perform and should be done prior to the first patient of the day.
• Monthly tests will add an additional 10 minutes to the daily tests.
• Quarterly tests will take about 45 minutes to perform.
• The semi-annual test for darkroom fog should take no more than 5 minutes to perform and analyze.
• The annual tests will probably take 1 to 2 hours to perform.

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 Quality Control Manual
A QC Manual should be created and reviewed at least annually. The manual should include the facility’s
objectives, QC instructions, QC results, and personnel responsibility.

Items that should be included in a QC Manual are:

• A list of the tests to be performed and the frequency for each test, including acceptable test limits,
test procedures, maintenance, and service records.
• A list of equipment to be used for testing. Policy and procedures for QC tests as well as for the
facility.
• Sample forms.
Questions asked during a review might include:
• is image quality maintained at the desired level?
• Do all personnel meet required or established qualifications? Does any equipment need to be replaced?
• Do any QC procedures need to be changed or updated?
• Are personnel adequately performing assigned tasks?
• Is patient and personnel radiation exposure as low as see for further detail:
reasonably achievable? QUALITY CONTROL RECOMMENDATIONS FOR
• Are all documents up-to-date and accurate? DIAGNOSTIC RADIOGRAPHY, July 2001 available at http
://www.crcpd.org/Pubs/QC-Docs/QC-Vol3-Web.pdf

© dr. Chris R. Mol, BME, NORTEC, 2016 Medical Imaging

 END
The creation of this presentation was supported by a grant from THET:
see https://www.thet.org/