March 18, 2010

Mammography Quality Control


  • In the US, the Food and Drug Administration (FDA) developed the Mammography Quality Standard Act (MQSA) requiring all mammography facilities to be "certified" (currently there are more than 10,000 facilities)
  • The MQSA became effective since April 1999
  • It is against federal law to practice mammography without certification by FDA
  • To obtain "certification" by the FDA, the facility must be "accredited" by an approved body such as the American College of Radiology (ACR)
What Are Accreditation Requirements of the ACR?
  • Requires combined effort of physicians, technologists and medical physicists
  • Physician requirements: all interpreting physicians must participate in medical outcome audit, have documentation that they have interpreted at least 200 mammograms in the previous 24 months, ensure qualification of technologist training, assign one technologist to oversee Quality Control (QC) program, assign one physicist to perform annual testing and select one individual to oversee the radiation protection program
  • Technologist requirements: QC program is performed on different aspects of mammography on a daily, weekly, monthly, quarterly and semiannual basis. For example, processor QC is performed daily.
  • Physicist requirements: medical physicists must be trained in mammography, perform at least 6 annual medical physics surveys every 2 years and receive the required CME credits; image quality, equipments and patient dose are assessed by medical physicists
  • ACR phantom is used to check image quality; to pass the test, the phantom image must show a minimum of 4 fibers, 3 speck groups and 3 masses (out of 6 fibers, 5 speck groups and 5 masses on the phantom) and image artifacts are minimal
  • Average glandular dose (AGD) for a 4.2 cm thick breast should be less than 3 mGy per image with a grid. If there is no grid, AGD should be less than 1 mGy per image
Author's Notes
  • In a new era of quality-minded health care, it is inevitable that medical practice will be increasingly overseen by the public, government and other non-medical authorities. In the case of MQSA, the FDA gives credits to the ACR for certification of each facility.
  • It is important for us not only to do best at our routine interpretative work, but also to get involve in quality procedures in the department and professional society. This will help ensure that we serve our patients well and we are the one who will define our own destiny.
Huda W. Review of Radiologic Physics, 3rd edition, 2009.

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