FACULTY OF HUMAN MEDICINE AND SCIENCES

OF HEALTH
ACADEMIC PROFESSIONAL SCHOOL OF
MEDICAL TECHNOLOGY–RADIOLOGY

THEME:
QUALITY CONTROL OF EQUIPMENT
CONVENTIONAL RADIOGRAPHY
STUDENT:
JOSE LUIS MAMANI TTURO
TEACHER:
RAUL URQUIZO BALDOMERO

CYCLE: VIII

AREQUIPA–PERU
2016
QUALITY CONTROL OF EQUIPMENT
X-RAY
QUALITY CONTROL PROCEDURES FOR RADIOGRAPHY EQUIPMENT

INDEX

Preface

Objective and Scope..............................................................................................................................4

GENERALITIES

Chapter 1. TESTING THE X-RAY TEAM

1.1. Physical Inspection of the Installation ..............................................................................................6
1.1.2. Evaluation of the overload protection circuit of the tube ........................................................6
[Link] of Collimation and Mechanical Alignment of the System .............................................7
[Link] of the Indicator Scale of Distance .......................................................................7
[Link] Table-Tube of RaysX ..............................................................................8
[Link] Beam Coincidence with the Luminous Beam and Alignment
from the Radiation Field Center to the Center of the Imagen ......................................................9
1..3. Generator and Tube of X-rays .................................................................10
[Link] Consistency ......................................................................................................10
[Link] and Reproducibility of Time of Exhibitionn........................................................13
[Link] and Reproducibility of the Potential.............................................................................14
[Link] of the Layer Hemireductor (CHR).................................................................15
[Link] of Size of Focal Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Chapter 2. EVALUATION OF RADIOGRAPHIC IMAGE QUALITY.

[Link] considerationss .20
[Link] of Radiographic Image Quality with Patterns of Bars
of Visual Resolution

Chapter 3. DETERMINATION OF THE INITIAL DOSE IN PATIENT

[Link] regarding the measurement....................................................................................22
[Link] of the Entry Dose with chamber deionization.............................................23

TERMS and DEFINITIONS

BIBLIOGRAPHY.................................................................................................................................28
APPENDIX I ............................................................................................................................................29
Preface.

The Technical Guide presented is the product of the work of the Working Group on
Quality Control in Radiodiagnosis, integrated by specialists from the Control Center
State of Medical Equipment (CCEEM), which is working on incorporating, developing and
implement, in our National Health System the procedures, programs of
tests and protocols for quality control in medical radiodiagnosis.

The purpose of this document is to provide a practical guide for quality control of
radiography equipment. The tests and procedures described are based on
in the consulted bibliography and have been the basis for the quality control studies that the
Radiological Physics Group of CCEEM has been working on radiography equipment of
hospitals and polyclinics in the capital. Its implementation, validation, and improvement has
has been carried out during the execution of 2 research projects conducted during
1994-1997 which included 10 hospitals and 8 clinics where 30 teams were evaluated
of X-rays.

We appreciate the collaboration of the Pan American Health Organization/Regional Office

of the World Health Organization for the Americas (PAHO/WHO) and especially to the
regional advisor of Radiological Health, who has provided much of the literature used in
the preparation of this document, as well as its experience and the execution of workshops in this
thematic.

3
Objective and Scope

Objective: To provide a practical guide of technical procedures for carrying out control.
quality in radiography equipment.

Scope: This guide applies to general use radiography equipment, although some
the procedures described can be applied to other types of equipment
radiodiagnosis. The tests described require the indicated instrumentation and
some of these can be implemented in the radiodiagnostic services of
country given their simplicity and others require specific equipment and can be
carried out by specialized external groups to these units.

The guide does not constitute a mandatory document; however, the parameters
evaluated according to the tests described therein and their tolerances will form the basis of the
regulations that the CCEEM will establish regarding these devices.

4
GENERALITIES

To achieve efficiency and reliability in the practice of diagnostic radiology, it is necessary.

necessary the establishment of an adequate program to ensure its quality, in a way
that the results of all procedures involving said service are free of
errors. Consequently, the quality assurance must cover all aspects of the
practice of this service, maintaining quality control over all of them.

This guide deals only with one of the components of this program, the control of
the quality of the equipment and in particular of those used in radiography. The concept of
Quality control is used in reference to the specific measures that are carried out.
to ensure that a particular aspect of a procedure is satisfactory.

The quality control of equipment should begin from the moment of its acquisition and
Once installed, it is necessary to subject it to a series of tests for its acceptance, with the
Objective to determine whether your initial operation complies with the manufacturer's specifications.
Your installation must be appropriate, considering that the availability of space is
enough for the team's requirements and that energy sources are taken into account
electric and environmental factors such as temperature, humidity, and pollution of
air. At the same time, reference tests must be conducted to provide data for
compare its subsequent operation through routine tests which will be executed with
at a certain frequency, depending on the type of test and the parameter being controlled.
Finally, it is necessary to check the team's operations before starting their work.
Daily. The records of the test results must be kept in order to detect
the deficiencies when they occur, indicating the appropriate corrective action.

However, the quality control exercise must be carried out regularly.

preventive maintenance for the equipment has been established. The success of this scheme depends on
everything, of its understanding and acceptance by all involved, of the existence of the
adequate means for the continuous monitoring of results, of a protocol guide
for the tests, of properly trained personnel, as well as a clear definition of
the responsibilities.

5
Chapter 1. TESTS ON THE X-RAY EQUIPMENT

1.1.- Physical Inspection of the Installation

Objective: To verify that all systems and accessory components of the equipment are
they are found in good condition, checking that the mechanical movements and brakes of the
the equipment and its associated devices are functioning correctly, as well as
that the team management indicators are functioning properly.

Daily, before the start of work.

Procedure:
1) Familiarize yourself with the radiological equipment being tested, its controls and commands.
Conduct a visual inspection of the installation, examining externally the condition of all
the equipment accessories (table, X-ray tube support, generator console,
cabinets of the equipment, external conditions of the high voltage cables, etc.).

2) Check the stability of the equipment in a free and stationary position, the external indication of the
localization of the focal point, the proper mechanical functioning of the collimator system,
the checking of the movements and brakes of the X-ray tube support, of the drawer
chassis holder and of the radiological table. Perform the same operation for the vertical bucky.

3) Check the indicators on the generator panel such as: the operation of the
exposure indicator, focal point size selection, and parameters
electrotechnical (voltage, current, exposure time or current-time combination).

Interpretation and actions: Any abnormality detected must be reported and

resolved before starting the work. In case it cannot be corrected, request
the technical services of electromedicine.

Tolerances: All equipment movements and brakes must work properly, so

like the controls and indicators on the equipment dashboard.

1.1.2. Evaluation of the overload protection circuit of the tube

Objective: Ensure the proper functioning of the overload protection circuit of the tube and
so the tube will not be damaged by accidents of this type.

Frequency: Initial or subsequent to changes or repairs that may affect this circuit.

Equipment and accessories: Technical data sheet of the tube.

Procedure:
1) Select a focal size (the test is performed for each focal size
focal separately.

2) Select an exposure time of approximately 50 ms for the minimum value of

current of the size of the bulb to be evaluated.

3) In increments of 20 kVp, from the minimum kVp to the maximum kVp of the generator,
determine the maximum current of the tube for which exposure is possible. This is done
increasing the mA until the overload indicator or exposure lock appears
appears. The value of mA immediately below the blocking condition is the current
maximum allowed of the tube. Write down the current value. Alternatively, the test can be
perform only for the nominal potential values of 60, 80, 100, and 125 kVp.

6
4) Select 100 ms and repeat step 3).

5) Select 1 s and repeat step 3).

6) Select the maximum possible time and repeat step 3).

7) Select another focal size and repeat steps 2) to 6).

Interpretation and actions: From the data of the technical sheet of the tube, determine the Current
Maximum Tolerable Tube (MTTT) for each focal point size, potential and
selected time combination in the test. From the test results determine
the Maximum Allowed Current by the Tube (MACT), this value must not exceed the MTCT.
Due to the design possibilities of the equipment, CMPT can be up to 30% smaller than
the CMTT values of the technical sheet of the pipe. The current acceptance limits have
that are modified in many cases due to the fact that most generators have
discrete mA stations and more continuous potential adjustments.

Tolerance: CMPT/CMTT Relationship: (0.7 - 1.0)

1.2. Evaluation of the collimation and mechanical alignment of the system

1.2.1. Accuracy of the Distance Indicator Scale

Objective: To verify the scale indicators of distance source-receiver image.

(DFP), they are reliable within the established tolerance.

Annual, initial or after changes or repairs that may affect accuracy

from the indicated distance, such as when a tube change is made.

Equipment and accessories: measuring tape or graduated ruler, lead plate with hole and
chassis with radiographic film.

A) If the indication of the focal point is known

Procedure:
1) For those DFPs most commonly used in clinical practice, such as 102 cm and 91 cm,
check with the tape measure the accuracy of the value indicated on the equipment's rangefinder.

Interpretation and actions: Calculate the accuracy (E) as the difference between the measured value.
regarding the indicated value expressed as a percentage of the latter according to:

E(%) = [(DFPmeasureDFPindicated) / DFPindicated100

Remember that the indicator scale of distance often expresses the distance from the focus-
image receptor in the chassis holder drawer, which should be taken into account in the
checks. The results must meet the established tolerance. In case
opposite can redefine the values of the scale or request technical services from
electromedicine.

Toleranceindicated

B) If the location of the focal point is not known

Procedure:
1) Select a DFP=100 cm.

7
2) Place the lead plate with a known dimension hole at the output of the collimator.

3) Place a loaded chassis on the tabletop (or on the bucky tabletop)

vertically) preferably with a grid. Center the tube on it perpendicularly. Measure the
distance from the film placed on the table to the lead plate with a hole
located at the exit of the collimator.

4) Make an exposure at approximately 55 kVp and 10 mAs, adjust if necessary.

exposure parameters.

Process the films in the usual way.

6) Measure the size of the image of the cavity of the lead plate visualized in the film.

Interpretation and actions: The actual focus-film distance (FFD) realcan be calculated at
based on the measurements of the size of the gap visualized in the film, of the distance between
the film and the lead plate and the real size of the hole of the lead plate according to
the following expressions:

DFPrealDFP2/(M - 1)+DFP2+DMP with M1= THP2/THreal

DHP2= M2DHP1 with M2=THP2THP1

E(%) = [(DFPrealDFPindicated)/DFPindicated]*100

where
DFPrealit is the distance from the focus to the film in the chassis holder of the table (or vertical bucky).
THrealit is the actual size of the hole in the lead plate.
DHP1It is the distance from the lead sheet-film placed on the tabletop (or
vertical bucky board
THP1It is the size of the holes in the lead sheet as shown in the film.
Miit is the magnification factor.
The DFPrealit is the distance between the film placed on the table and the image receptor in
the chassis drawer.

Toleranceindicated

1.2.2. Perpendicularity Table-X-Ray Tube

Objective: Verify the perpendicularity between the X-ray tube and its support with the table
radiological.

Frequency: Semiannual, initial or after changes or repairs that may affect this
parameter.

Equipment and accessories: Adhesive tape and a measuring tape or graduated ruler.

Procedure:
1) Place the X-ray tube 100 cm away from the center of the radiological table.
(DFM)

2) Adjust your position so that the center of the light grid is close to the
midline of the table.

3) Mark the center of the axis of the luminous field (reticle) on the radiological table for it
What can adhesive tape be used for?

8
4) Move the tube up to the top of the column. Note the distance and mark it.
about the adhesive tape the displacement of the center of the light field lattice.

5) What is the difference between both brands and calculate the percentage with respect to DFM=100
cm. Also note the quadrant towards which the shift occurs.

6) Repeat the steps from 1) to 5) at both ends of the radiological table.

Interpretation and actions: The center of the reticle of the light field must remain in the
same place, or the difference between the center marks must be within the margin of
the established tolerance. Otherwise, this is an indicator of a lack of verticality of the
column of the tube and/or horizontal alignment of the table. The quadrant towards which it occurs
Shift is an indicator of value for taking corrective actions. Discriminate in which.
part of the system is the lack of alignment for which a level can be used
bubble. Once the fault is detected, request the biomedical engineering service.

Tolerance: Difference between centers: < 2% DFM

1.2.3. Coincidence of the Radiation Beam with the Light Beam and Alignment of the Center
from the field of Radiation with the Center of Imaging

Objective: To verify that the collimation system does not significantly allow the
radiation is outside the edges of the selected light field and there is alignment
between the center of the radiation field and the center of the image. Also verify the
coincidence of radiation/luminous field sizes.

Frequency: Semiannual, initial or after changes or repairs that affect the system
collimation and illumination.

Equipment and accessories: chassis loaded with radiographic film, ruler or measuring tape,
radiopaque markers in the shape of L, coins, and film identifiers.

Procedure:
1) Place the chassis on the table and center the tube over it at a DFP=100 cm.
in the middle of the beam of light, select the luminous field you want to check.

2) Delimit the corners of the illuminated area with radiopaque markers. Note the size.
of the selected field.

3) Place a movie identifier on the chassis at one end within the field.
selected luminaire to identify the position of the film during the test.

4) Set the equipment to a potential value of approximately 55 kVp and 10 mAs.

which will be sufficient to ensure an adequate optical density for interpretation
from the test. Otherwise, adjust the exposure parameters.

Give a presentation.

6) Without moving the geometry, open the collimators until the luminous field overflows.
selected with care not to overflow the radiographic film.

7) Make a second exposure with approximately half of the selected mAs and a
lower potential value in one or two positions of the potential selector.

Process the film in the usual way.

9
Interpretation and actions: With the help of a graduated ruler, determine the discrepancies.
between the edges of the luminous fields and radiation, summing the discrepancies without
import the sign for each axis (DBx=X1+X2, DBy=Y1+Y2). Using a crystallographic pencil,
mark about the movie the diagonals that determine the center of the radiation field and the
center of the luminous field. Measure the discrepancies between both centers (DC).

Measure the sizes of each side of the irradiated and luminous fields. Calculate the
discrepancies between both sides.

If the clips match the corners of the irradiated area, the light beam is coincident.
with the radiation beam (fig.1a), otherwise the direction and sense of the misalignment is given by
the movie identifier (fig.1b).

The sum of the discrepancies between the edges of each axis of the light fields and
radiation (DB), expressed as a percentage of DFP must not exceed the established tolerance.
The same must happen for discrepancies between the centers (DC), which is an indicator
of misalignment of the X-ray source with respect to the image receptor. In case
necessary to request the electromedicine service to determine the cause of the failure, which
it may be in the collimators or in an incorrect location of the light bulb.

The discrepancies between the size of each side of the irradiated area with respect to the
the corresponding side of the selected light area (DL) must be below the tolerance
established.

Tolerances:
Discrepancies between edges for each axis (DB): < 2% of DFP
Discrepancy between sizes of each side (DL): < 2% of DFP
Discrepancy between centers (DC): < 2% of DFP

Clips

First Area
Exposed

Second Area
Exposed

Central Marker

Identifier
of plate
1b.
1a.

Fig.1.- Test of the alignment of the radiation beam with the light beam.
Correct result

1.3.- X-ray Generator and Tube

1.3.1. Consistency of the Generator

It is important to verify that the X-ray generator is consistent in its response. The
consistency test can be carried out according to two different measurement objects: the
optical density in films or through dosimetric measurements; which enables
execute them based on the available resources.

10
Objective: To determine the reproducibility of the generator's response and its linearity with
relationship to mAs for different focal sizes at different mA stations.

Frequency: Annual, initial or subsequent to changes or repairs that may affect these
parameters.

Optical density (OD) as a measurement parameter

Equipment and accessories: Water bucket or acrylic sheets of 30x30 cm up to a total of

20 cm thick, measuring tape, chassis, radiographic films, and densitometer.

Procedure:
1) Place the bucket filled with water on the table up to a height of 20 cm, or the sheets of
acrylic with the desired thickness, on a loaded chassis that has been blocked
previously 2/3 of it with a lead blocker (fig.2). Make a mark on the bucket
so that there is always the same attenuation and dispersion in future evaluations.

Center the tube over the chassis and align the beam just over the area of interest on the chassis.
using a distance DFP=100 cm.

3) Expose the film to the exposure factors (kVp, mA, mAs) used to obtain
approximately optical density 1. Write them down.

Process the film.

5) Repeat steps 1) to 4) on each remaining unexposed third of the film.

Store the film for future comparisons.

7) Repeat steps 1) to 6) for different combinations of mAs and for the different
clinical use mA values.

Interpretation and actions: If you do not have a densitometer, when analyzing the results,
compare them with those obtained on previous occasions. These should not differ.
significantly. If you have a densitometer, the largest difference in densities
Optical measurements, for a given combination of mAs, should not differ by more than 0.2 DO.
otherwise, repeat the test before requesting the electro-medicine service and if you
it has means, check the mA and the exposure time separately.

Tolerances:
Reproducibility of the DO for each combination of mAs separately: ±0.2 DO.

11
 Lead Lead Lead

Mannequin Mannequin Mannequin

2a. 2b. 2c.

Fig. 2. Illustrative example for the execution of the test.

2a. presentation of the first third,
2b. exhibition of the second third and
2c. exposure of the third third.

B - Dosimetry as a measurement parameter

Equipment and accessories: Dosimeter with appropriate detector for radiodiagnosis and tape
metric.

Procedure:
1) Place the detector on the table and position the X-ray tube at a focus-detector distance.
from 75-100 cm.

Adjust the light field to an area of 10x10 cm2about the detector.

3) Prepare the dosimeter for work according to the manufacturer's instructions. Wait
sufficient time for it to heat up and stabilize.

4) Select the option to measure exposure.

5) For an intermediate nominal voltage (approximately 80 kV), select a value of mA.

in the desired focus.

6) Select the largest clinical mAs combination you want to evaluate.

7) Note the results of 3 exposures to the selected parameters, making a

intermediate exhibition between each one with some parameter changed.

8) Decrease the mass to half of the previous one and repeat step 7). Repeat the operation at least 1
once more.

9) Repeat steps 5) to 8) for different values of mA within the same focus and for the
remaining spots.

Interpretation and actions: For each value of mA, determine the yield (R) as the
average of the measured dosimetric magnitude (Xp) divided by the mAs, calculate its deviation
standard (DE) and the coefficient of variation (CV), as well as the linearity coefficient (CL)
according to the expressions:

12
For each combination of mAs:

Xp= (X1+ X2+ X3) / 3

CVmA(%) = (DE/Xp)100

For each mA station: RmA= Xp/mAs

For each focus and between adjacent mA stations:

CL = [RmA, max- RmA] / [ RmA, max+ RmA, min ]

When analyzing the results, they should be compared with previous results. These do not
they must differ significantly. The reproducibility of the exposure is evaluated through the
CV. This should not be greater than 5% for each individual combination of mAs checked.

The CL is evaluated for each focus separately and between adjacent mA stations, not
having to exceed the value of 0.1. This separate evaluation of the sources facilitates the
corrective actions of electromedicine.

The output exposure performance of the generator is calculated for each station of
mA. This result must be compared with the valid range depending on the potential.
measured and the waveform of the generator. A performance value outside the valid range
it may be caused by inadequate tube leakage and/or a miscalibration of the
combination mAs, parameters that must be verified separately to know the
cause.

In case the established criteria are not met, please retake the test before making a request.
the electromedicine services and if resources are available, check the mA and the time of
separate exhibition.

Tolerances:
Reproducibility of exposure for
each combination mAs: +/- 5%.
Linearity of the exposure with the mAs1: < 0.1
Generator output at 80 kVp and 100 cm from the source:
single-phase generator 4.0 ± 1.5 mR/mAs
three-phase generator 6.0 ± 2.0 mR/mAs

Note:1calculated for each focus separately between adjacent mA stations.

1.3.2. Accuracy and Reproducibility of Exposure Time

Objective: Determine the accuracy of the indicated exposure time and verify it.
reproducibility.

Frequency: Annual, initial or after changes or repairs that may affect this
parameter and/or the reproducibility and linearity of the output exposure.

Equipment and accessories: Dosimeter with appropriate detector for radiodiagnosis, with the
exposure measurement option by pulse and exposure time

Procedure:
1) Place the detector on the table and position the X-ray tube at a source-to-detector distance.
from 75-100 cm.

13
Adjust the luminous field to an area of 10x10 cm2about the detector.

3) Prepare the dosimeter for work according to the manufacturer's instructions. Wait.
sufficient time for it to heat up and stabilize.

4) For an intermediate nominal voltage (approximately 80 kV), select a value of mA.

in the desired focus.

5) Select the option on the dosimeter that allows you to measure exposure time.

6) Check the exposure time for the mAs combinations of the test.
reproducibility and linearity of the output exposure, taking 3 measurements for each
selected time.

Interpretation and actions: Determine for each evaluated time, the average of the time.
of measured exposure (tmeasured) and the DE. Calculate the CV. Accuracy is calculated as follows:

E(%) = [(tmeasured- tindicated)/ tindicated]100

This test complements the test of reproducibility and linearity of the exposure of
exit, since the times that are verified are components of the mAs combinations
used in said test, in such a way that it is checked if it is the initiation device and
interruption of the team's presentation (timer) which is affecting the reproducibility of the
system. The CV allows us to evaluate the reproducibility of the selected exposure time,
who exerts a direct influence on the reproducibility of exposure and therefore on
the consistency of a radiographic technique. The test tolerance for accuracy
it depends on the value of the verified exposure time, a result outside the limits
established must be confirmed by repeating the test before requesting the service of
electromedicine for a timer recalibration.

Tolerances:
Reproducibility: < ± 10%
Accuracy: ± 5 ms for texp< 10 ms
+/- 10% for texp10 ms

1.3.3. Accuracy and Reproducibility of the Potential

Objective: To check the degree of correspondence between the measured peak potential with
regarding the indicated nominal potential, as well as its reproducibility.

Frequency: Annual, initial or after changes or repairs that affect this parameter.

Equipment and accessories: non-invasive kilovolt meter according to the potential range, the shape
of wave and the type of anode, measuring tape.

Procedure:
1) Place the geometry recommended by the manufacturer of the kilovolt meter, which always
it must be maintained in future evaluations.

2) Turn on the kilovolt meter and prepare it for use according to the manufacturer's instructions.
Wait long enough for it to heat up and stabilize.

3) If necessary, select the desired waveform and material on the kilovolt meter.
of the anode.

4) Select from the generator's control panel, from the range of most used potentials

14
clinically, one high, one medium, and one low; these values could well be 100, 80, and 60
kVp.

5) For each selected potential, perform 3 exposures for a sufficient mAs value.
according to the potential and note these values for future evaluations, as well as the results
of the measurements. Take the potential measurements starting from the highest value and
in descending order.

Interpretation and actions: Calculate the mean and the CV for each potential value.
the accuracy of the indicated potential is calculated according to:

E(%) = [(kVpmeasuredkVpindicated)/ kVpindicated100

Reproducibility is evaluated by the CV in %. The accuracy and reproducibility of

potential must remain within the limits of the established tolerances. Not
However, it is important to consider the manufacturer's specifications and the inaccuracy.
specific to the potential meter used. Obtaining results outside the limits
established must be confirmed by repeating the test. In case this
If the situation persists, technical services of electromedicine should be requested.

Tolerances:
Accuracy: ±10%
Reproducibility: +/- 5%.

1.3.4. Determination of the Semi-Reducing Layer (CHR)

Objective: Determine the quality of the radiation beam and verify in conjunction with the test
accuracy of the potential if the X-ray tube filtration is correct.

Annual, initial or after changes or repairs that affect the quality of the beam
of radiation.

Equipment and accessories: Dosimeter and appropriate detectors for radiodiagnosis with the option
measurement of exposure and exposure rate. Set of pure aluminum filters
known and calibrated thicknesses (Aluminum alloy type 1100 is sufficient) whose thicknesses
allow the measurement of CHR between 1-4 mm Al, measuring tape and device for the
positioning of the filters at the output of the collimator.

Procedure:
1) Place the detector on the radiological table at a height sufficient to avoid
backscattered radiation (> 10 cm).

2) Select a distance from the focus of the X-ray tube to the detector of 75-100 cm.

3) Select a field size of 10x10 cm2centered over the detector and place the
device for the positioning of filters.

4) Prepare the dosimeter for work according to the manufacturer's instructions. Wait
sufficient time for it to heat up and stabilize.

5) Select the exposure measurement option on the dosimeter.

Select on the generator control the potential station whose measured value
be the closest to 80 kVp. Select a sufficient mAs combination to obtain a
exposure of approximately 500 mR without a filter. This can be achieved by performing a
pre-exposure and calculating the yield (mR/mAs), then it is very easy to adjust the mAs

15
to achieve the desired exposure.

7) Perform 1 unfiltered exposure and record the dosimeter reading.

8) Without moving the geometry, place the thinnest filter and take another exposure. Note down.
the reading of the dosimeter.

9) Repeat step 8) by adding filters to the previous one and thereby increasing the total thickness.
until I achieve a reduction of the dosimeter reading to less than half of the reading without
filter.

10) Repeat the exposure unfiltered. Record the reading of the dosimeter. If the result obtained
differences of less than 5% from the initial reading without filter, the experiment is considered valid
attenuation. Otherwise, repeat the experiment.

Interpretation and actions: The CHR can be obtained by logarithmic interpolation as follows:

CHR = [t2ln(2X1/X0) - t1ln(2X2/X0)]/ln(X1/X2)

where:
X0it is the average of the measured exposure without a filter.
t1and t2these are the thicknesses of Al corresponding to the exposures X1y X2among which
the half-reductive layer is found (value of thickness for which a reduction is obtained
of X0in the middle (X0/2).

If you want to know the effective energy, it can be calculated as follows:

Eeff = 32.6224(µ/ )-0.3721 (r2=0.9961) Range: 10-50 keV

Eeff = 19.9854(µ/ )-0.8902 (r2=0.9840 Range: 50-100 keV

where:
µ: it is the linear attenuation coefficient in the medium, µ = 0.693/CHR.
density of aluminum (2.7 g/cm-3).

Compare the obtained result with previous results and with the established tolerance, the
what depends on the waveform of the generator. If a result is obtained outside of the
valid range, the test must be repeated for confirmation of the same. A value of CHR for
Below the minimum accepted value may be caused by inadequate tube leakage.
This test is recommended to be carried out after the accuracy evaluation and
reproducibility of the potential. Similarly, an excessively high CHR is
indicator of excessive leakage or perhaps an indicator of metallization of the tube. A
Filtration below the required level is a situation that requires immediate action. There are
to take into account the objective of it, which aims to eliminate the beam component
of low energy that do not contribute to the image and instead provide an unnecessary dose to the patient. The
the lack of proper filtration can be solved with the addition or placement of the filter
required when the team allows it. In case this is the solution, it must
repeat the test. In any other case, the test must be repeated before requesting the
electromedicine technical services.

Tolerances:
Single-phase equipment and 80 kVp: > 2.3 mm Al.
Three-phase equipment and 80 kVp: CHR > 2.7 mm Al.

16
1.3.5. Measurement of the Focal Point Size

There are several methods for measuring the size of the focal point. Among these are
they find, the measurement with slot camera, with star patterns and with devices
that are based on resolution bar patterns. This test describes the methods
with the star pattern and with the Radiation Measurement bar pattern device
Incorporated (RMI).

Objective: To determine the gradual deterioration that may occur in the size of the dot.
focus of the X-ray tube due to its significant influence on the detail of the radiological image.

Frequency: Annual, initial or after changes or repairs that affect this parameter.

Equipment and accessories: 2-degree star pattern or measuring device for the
focal point size with visual resolution pattern RMI 112B, measuring tape,
chassis or cardboard cassette and fine-grain radiographic film.

A) Measurement of the Focal Spot Size with Star Pattern

Procedure:
If you have a device for mounting the star pattern, place it with the pattern.
at the output of the collimator, if not, stick the pattern with adhesive tape. In both cases,
Ensure that the central X-ray beam is perpendicular to the pattern and passes through its center.

2) Place a loaded film cassette on the table at a distance from the

star pattern equal to the distance between the focus of the tube and the pattern. This allows
obtain a magnification of 2.

Align everything so that the central ray hits the center of the radiographic film.
Moreover, the movie must be parallel to the pattern.

4) Select a potential and mA for clinical use. The size of the focal spot is dependent on
the electrical factors used. A recommended technique is half of the maximum mA
possible at each target for 75 kVp. Adjust the exposure time until achieving in the image
an optical density of 1.5.

Process the film in the usual way.

6) Determine the magnification factor by dividing the diameter of the star pattern.
radiographed by the true diameter.

7) Explore the image obtained from the periphery until you find the region in which the
image of the sectors disappears. This is the region of zero contrast. Measure the diameter of
this region in its largest extent and also in the perpendicular dimension.

Interpretation and actions: Calculate the focal point size (FPS) for each of these.
two dimensions according to the formula:

TPFmeasured(mm) = (N/57.3)(D/(M-1))

where:
N is the angle of the focal point,
D is the diameter of the zero contrast region in mm and M is the magnification.

Calculate the discrepancy between the measured focal point size and the size
nominal given by the manufacturer or the discrepancy with respect to the reference value according to:

17
 E(%) = [(TPFmeasuredTPFnominal)/TPFnominal100

where:
TPFmeasuredmeasured focal spot size.
TPFnominalnominal focal point size given by the manufacturer or established in measurements
of acceptance or initials with the objective of having reference values.

The size of the measured focal point must be reported for the electrical factors used.
Several zero contrast regions can be found in the same image. It is
it is extremely important that the largest dimension is used in the calculations. If
There is doubt regarding this data, so please repeat the test with lower magnification.
because a lower result may be obtained in the calculation. If the star pattern does not
if centered properly, the image will be distorted. In this case, it is necessary to
realign the pattern and repeat the test. Compare the result with previous values and with
regarding the nominal value set by the manufacturer. A change in the established value can be
cause of a deterioration of this parameter and an indicator to make a decision regarding
The resolution of the equipment has been affected for clinical use purposes.

Tolerances:
Permissible values of the focal point dimensions according to the nominal size value.

Nominal Value (mm) Width (mm) Length (mm)

0.3 0.30 - 0.45 0.45 - 0.65
0.4 0.40 - 0.60 0.60 - 0.85
0.5 0.50 - 0.75 0.70 - 1.10
0.6 0.60 - 0.90 0.90 - 1.30
0.7 0.70 - 1.10 1.00 - 1.50
0.8 0.80 - 1.20 1.10 - 1.60
0.9 0.90 - 1.30 1.30 - 1.80
1.0 1.00 - 1.40 1.40 - 2.00
1.1 1.10 - 1.50 1.60 - 2.20
1.2 1.20 - 1.70 1.70 - 2.40
1.3 1.30 - 1.80 1.90 - 2.60
1.4 1.40 - 1.90 2.00 -2.80
1.5 1.50 - 2.00 2.10 - 3.00
1.6 1.60 - 2.10 2:30 - 3:10
1.7 1.70 - 2.20 2.40 - 3.20
1.8 1.80 - 2.30 2.60 - 3.30
1.9 1.90 - 2.40 2.70 - 3.50
2.0 2.00 - 2.60 2.90 - 3.70
2.2 2.20 - 2.90 3.10 - 4.00
2.4 2.40 - 3.10 3.40 - 4.40
2.6 2.60 - 3.40 3.70 - 4.80
2.8 2.80 - 3.60 4.00 - 5.20
3.0 3.00 - 3.90 4.30 - 5.60

B) Measurement of Focal Point Size with the Bar Pattern Device

RMI112B

Procedure:
Place a radiographic film inside a cardboard cassette, without intensifier.
image.

2) Place the cassette in the center of the radiology table and place directly on it.

18
upper half of this, the base of the device for measuring the size of the focal point
RMI 112B, blocking the remaining half of the cassette with a lead blocker. This
it allows to measure both focal point sizes in a single film. Be careful to place
the device in the correct anode-cathode orientation according to its labels.

3) Select a distance from the focus to the film of 61 cm (DFP), which ensures
a distance of 46 cm between the focus of the X-ray tube and the bar pattern that is
find at the top of the device to achieve a magnification of 4/3.

4) Select a focus size (fine or coarse) and make an exposure at approximately

80 kVp and 10 mAs. If necessary, adjust the mAs until achieving an optical density between
1-1.5
e) Repeat the exposure for the other size of focus in the middle of the plate that was blocked
during the first exhibition.

5) Process the film in the usual way, making sure that both holes appear in the image.
that the device has on its upper part.

Interpretation and actions: Using a magnifying glass, examine the groups of bars displayed in
the image parallel to the cathode-anode axis. Find in the image the smallest group
where the three bars are clearly seen. The focal point is usually not circular and
they are often two spots close to each other. A double focal point can
produce an image with 4 bars. This false resolution should not be confused with the
appropriate resolution which results in an image with three bars. The groups
perpendiculars can be used independently in each direction to estimate the
two dimensions of the focal point or the 6 bars can be used together to determine the
larger dimension of the focal point. The relationship between the visualized bars and the size
The effective focal point for a magnification of 4/3 is obtained from Table 1.

Table 1. Effective focal spot size as a function of resolved line pairs (PL/mm).

Group of bars more PL/mm of the group Size of the Focal Point
small resolved Cash
1 0.84 4.3 mm
2 1.00 3.7 mm
3 1.19 3.1 mm
4 1.41 2.6 mm

5 1.68 2.2 mm
6 2.00 1.8 mm

7 2.38 1.5 mm
8 2.83 1.3 mm

9 3.36 1.1 mm
10 4.00 0.9 mm

11 4.76 0.8 mm
12 5.66 0.7 mm

19
 For both axes of the cathode-anode direction, calculate the discrepancy between the size of
effective focal point measured with respect to the nominal size provided by the manufacturer or the
discrepancy with respect to the reference value, according to the same expression of the test with
star pattern.

To check the required magnification, measure the distance between the centers of the two.
holes visualized in the image. With a magnification of 4/3, the distance between them
It should be 8 cm. If the distance is not 8 cm, adjust the DFP distance and repeat the test.
DFP distance can be calculated using the formula DFP = 15.2(M/M-1), where M is the
magnification which is equal to the measured distance between the visualized openings in the
movie divided by 6. Note the distance at which the appropriate magnification is reached
for future references. The difference between the calculated DFP value and the required 61 cm
it must be less than 2% of DFP=61 cm (1.2 cm). Otherwise, the error must
to be corrected. For evaluations of test consistency, the magnification has to
always be the same.

Tolerances: See the tolerances of the previous test. Also note that this
the method has an inaccuracy of 16% in the calculated value.

Chapter 2. EVALUATION OF RADIOGRAPHIC IMAGE QUALITY

2.1. General Considerations

The acquisition of quality radiological images, which means, with sufficient value for
the realization of the medical diagnosis is the main objective of diagnostic radiology.
here, the importance of periodic evaluation of it. The quality of the image
Radiographic is the result of the state in which each of the components is found.
of the radiological system that are involved in obtaining this. Therefore, its quality is
dependent on multiple parameters, among which are not only those
related to the X-ray team.

There are various methods that allow for the evaluation of radiographic image quality.
This guide describes a test that evaluates the quality of the radiographic image under
clinical simulation, using a mannequin and in terms of spatial resolution through
visual resolution bar patterns.

2.2. Evaluation of Radiographic Image Quality with Bar Patterns

Visual Resolution

Objective: Evaluate the quality of the radiographic image to detect impairments in the
same. Together with the determination of the entry dose, assess the adequacy of the
radiographic procedures.

Frequency: Annual, initial or after changes or repairs in any component of the

radiographic system that affects image quality.

Equipment and Accessories: High and low contrast visual resolution bar patterns,
water bucket or acrylic sheets of 30x30 cm up to a total thickness of 20 cm, tape
metric, chassis, radiographic films, and densitometer.

Procedure:
Fill the bucket with water to a height of 20 cm and place it on the table. Make a
mark on the bucket in such a way that there is always the same attenuation and dispersion in
future evaluations. If you use an acrylic sheet mannequin, always use the same amount.
of sheets.

20
2) Place the high-contrast resolution pattern inside the bucket using some
low atomic number holding device, that allows it to be fixed in the center of the cuvette to
half the depth of water. If you use an acrylic mannequin, position the
pattern between the mannequin's boards, like a sandwich, trying to ensure it stays in
the center and halfway up the height of the mannequin.

3) For a soft tissue radiographic technique, place in the storage tray of the
table, a chassis with film of the typical ones used in the installation for this type of
X-ray (in terms of size and film-screen combination). Center under the tray.
of water or the acrylic mannequin with film. Mark the chassis and note the
characteristics of the film-screen combination used.

4) Place the X-ray tube at the source-film distance that is normally used for the
Technique in question. Note it down.

5) Select a field size over the surface of the water of the bucket or the mannequin
acrylic that corresponds approximately to the size of the field at the entrance that
Use for a normal patient. Write it down.

6) Select in the equipment's control panel the electrical parameters of bulb size,
kVp, mA, and mAs that are normally used in the setup for a normal adult patient
in the treated radiographic projection. Note them down.

7) Make the exposure and process the film as usual.

8) Repeat steps 2) to 7) for the low contrast resolution pattern. Also repeat the
test for other chassis in use and/or other combinations of films-screens that also
use for the study in question.

9) Determine the input dose given in the study for the conditions of
expositions used, according to the procedure described in Chapter 3.

Interpretation and actions: With the help of a magnifying glass and a good negatoscope, read in each
exposed film, the maximum number of line pairs per mm (LP/mm) that are resolved
visually. Use more than one observer for this. Determine with the densitometer the
optical density present in the areas of the film close to the place where it is viewed
resolution pattern. Note down all this data. If you wish, the spatial resolution in mm the
you can calculate, as the inverse of the number of LP/mm divided by two.

Compare the results obtained for the test, as well as the result of the dose of
input, with previous and/or reference results, if they exist. In case they exist
significant differences, repeat the test. If the differences persist, take action.
investigative with the aim of finding the cause or causes that are influencing the
new results. If moreover, the differences obtained indicate a decrease in the
image quality and/or a significant increase in the input dose, take action
corrective actions that proceed.

Tolerances: That the spatial resolution measured in LP/mm does not differ significantly.
regarding the reference results.

21
Chapter 3. DETERMINATION OF THE INITIAL DOSE IN PATIENTS

3.1. Considerations regarding measurement

The magnitude to be determined is the dose absorbed at the surface of the patient, which is called
also entry dose. The entry dose is defined as the dose absorbed in air in
the intersection point of the radiation beam axis with the patient's entrance surface,
including backscattered radiation. The input dose is expressed in milligrays (mGy).

The typical dose given to an average adult should be obtained through techniques.
radiographic equipment and X-ray machines specific to each hospital institution, for the
most common exams that are carried out in it. Measurements can be taken under
3 different variants:

The first, which is the dosimetric technique par excellence, measuring directly with
thermoluminescent dosimetry "in vivo" on selected patients with characteristics
similar to a reference adult patient. Given the characteristics of the dosimeters
thermoluminescent (TLD), it is easy to place on the patient's entry surface
without affecting the study. In this variant, the measurement includes the retrodispersion itself of
patient considering the real conditions of the exposure.

The second, taking the same measurements with TLD but on a mannequin.

The third one, which is described in this Guide, consists of making measurements of the
exposure or air-free input kerma, for the technique of the examination in question and this
value, correct it according to the quality of the incident radiation, the geometry of the measurement with
regarding the patient's position during the actual examination, and the retrodispersal factor
corresponding. For this, calibrated dosimeters in air are required. Alternatively,
the measurement can be carried out with a transmission type ionization chamber located at the
collimator output to measure the dose-area product allowing measurement on the own
moment of conducting the study with the patient. Subsequently, knowing the area
From the irradiated chamber and the remaining necessary data, the entrance dose can be calculated.

To achieve comparative results with this last method, they must first
select the exams to be evaluated, which has to do with the frequency of execution of
the same. Then, for each exam, a conclusion must be reached about the
technique that would be used to achieve a valid diagnosis in an average adult in each
team.

Techniques will vary not only between institutions or even between teams from the same institution,
but also, among the criteria from one technician to another. A combination must be achieved
technical parameters for each equipment and for each exam, which may vary from a period.
to another due to changes the team undergoes and/or changes in the quality of the development that necessitate
a change in techniques, etc.

This is what makes the periodic monitoring of doses valuable, as the values are recorded.
corresponding to a specific technique, which allows making decisions regarding
the optimization of the techniques and the doses administered to the patient. These doses may
to compare with national or international reference levels, and of course
Archive the typical dose values for each exam for future comparisons.

Finally, dose measurements must be accompanied by some testing method that

evaluate the quality of the image, so that criteria can be available for the
achievement of the main objective, obtaining quality diagnostic images with the
least possible risk for the patient and the occupationally exposed worker.

22
3.2. Determination of the Input Dose with Ionization Chamber

Objective: To determine the typical entrance dose received by a reference adult patient.
product of frequent exams and compare those results with the indicative levels
nationally recommended or in the International Basic Safety Standards. This,
as a measure of monitoring and tracking the doses received in order to take
investigative and corrective actions regarding the radiological procedure in case it
the required.

Frequency: Annual, initial or subsequent to changes or repairs that affect exposure

generator output.

Equipment and accessories: Dosimeter and appropriate detectors for radiodiagnosis calibrated
in air, calibrated Al filters, device for placing the filters at the output of the
collimator and measuring tape.

Procedure:
1) Place the detector on the radiological table at a height sufficient to avoid it.
backscattered radiation (a recommended distance is that corresponding to the thickness of a
normal patient in their AP/PA projection, approximately 23 cm.

2) Place a distance from the focus of the X-ray tube to the clinical image receptor 91
or 102 cm (36" or 40"). Note the focus-detector distance.

3) Select a reference field size of 10x10 cm2at the patient's entrance,

that centered the detector on this, avoids including any element within the field
unnecessary dispersant of the detector and its support.

Prepare the dosimeter for work according to the manufacturer's instructions. Wait.
enough time for it to heat up and stabilize.

5) Select the exposure measurement option on the dosimeter.

6) Select the desired exam the electrotechnical factors for clinical use for a
adult referral patient. Write them down.

7) Conduct 5 exposures and record the dosimeter readings.

What does the hemireductive layer for the potential used in the exam according to the instructions mean?
from the test, Determination of the Half-reducing Layer.

9) Repeat steps 6) to 8) for each exam of interest.

Interpretation and actions: Calculate the entrance dose as entrance kerma referred to
air according to:
K = 8.76 X BSF kqkd(DFC/DFS)2

where
8.76: conversion factor of exposure in R to kerma in air in mGy.
X: average of the exposure measured in R.
BSF: backscattering factor of the tissue.
kqcorrection factor for radiation quality.
kdair density correction factor.
DFC: distance from the focus to the reference point of the camera or detector.
DFS: distance from the focus to the patient's entry surface for the study in question.

The backscattering factor depends on the quality of the radiation beam, the size

23
of the field used and of the irradiated tissue. For water, as a tissue simulator of
Reference, its values measured with TLD on a water mannequin are shown in the table that
the following is presented.

Table 2. Retrodispersal factors measured with TLD in a water mannequin (Taken from the
reference 11).
Field Size (cm x cm)
CHR (mm 10x10 15x15 20x20 25x25 30x30
AL)
2.0 1.26 1.28 1.29 1.30 1.30
2.5 1.28 1.31 1.32 1.33 1.34
3.0 1.30 1.33 1.35 1.36 1.37
4.0 1.32 1.37 1.39 1.40 1.41

Alternatively, it can be used for the calculation of the BSF, in the projections
X-rays that are presented below, the resulting numerical expressions for
the data corresponding to a mathematical-anthropomorphic patient obtained by technique of
Monte Carlo (reference 11):

For posteroanterior thorax. Field at the entrance 30x38 cm2:

0.9970 + 0.1475CHR - 0.01545HVL2

For lateral lumbar column. Field at the entrance 11x14 cm2:

BSF = 1.0961 + 0.0849HVL - 0.00919HVL2

For antero-posterior abdomen. Field at the entrance 26x35 cm2:

BSF = 0.9240 + 0.2551HVL - 0.0309HVL2

The quality correction factor of the radiation is the energy dependence of the detector.
and is found in its calibration certificate.

The air density correction is obtained according to:

kd(Po/P)(273.15 + T)/(273.15 + To)

where:
Poy To, are the reference pressure and temperature at which the detector was calibrated at the
Secondary Pattern Laboratory and P and T, the pressure and temperature of the air in the premises where it is
measure the exposure.

For the calculation of the DFS, use the thicknesses of an average adult patient that
presented in the following table:

Table 3. Radiographic thicknesses for a reference patient.

Radiographic Projection Thickness in cm
Chest PA 23
Lateral Chest 32
Abdomen, Pelvis AP 23
Lumbo-Sacral Column PA 23
Lumbar-Sacral Column LAT 30
Skull AP/PA 19
Skull LAT 15
Lower extremities (foot) 8

24
 The resulting input doses should be compared with the established reference levels.
nationally or, failing that, recommended in the International Basic Standards of
Security (NBIS). These levels are an indicator of the amount of radiation sufficient to
achieve a satisfactory result in most radiological systems. Therefore,
results significantly higher than these must imply an investigative action of the
radiographic system and the radiological procedure in general that uncovers the reasons for
these excessive doses. On the other hand, much lower results should prompt evaluations
image quality.

Tolerances: The input doses must not significantly exceed the levels.
established guidelines. As a reference and in the absence of national values
The recommended values in the NBIS (Table 4) can be used.

Table 4. Recommended benchmark levels in the International Basic Standards

Security.

EXAM Entrance Dose (mGy)

Lumbar Spine AP 10
LAT 30
ASL 40
Abdomen, intravenous urography and cholecystography AP 10
Pelvis AP 10
Hip joint AP 10
Thorax PA 0.4
LAT 1.5
Thoracic Spine AP 7
LAT 20
Skull AP 5
PA 5
LAT 3

Given in Havana City on the 5th day of the month of May 1998.

Approved:

Ing. Dulce María Martínez Pereira

Director CCEEM

25
TERMS AND DEFINITIONS

Beam quality: The ability of the beam to penetrate the substance. This is a function of the spectrum of
incident radiation energy. For the purposes of this guide, it is determined by the CHR.

Detector, dosimeter: devices consisting of an electrometer and a detector (chamber

deionization or solid-state detector) calibrated, allow measuring radiation in
electrical and/or radiological units.

Field: Intersection of the radiation beam with a plane perpendicular to the beam axis.

Half-reducing layer (CHR): It is the layer of standard material required to reduce the rate
of the absorbed dose to half of its original value, measured by a calibrated instrument. It is
usually given in mm of Al below 120 kV, while above 120 kV and
up to 400 kV is measured in mm Cu, although Cu can also be used from 50 kV.
CHR is a measure of the effective energy of the radiation beam.

Collimators: Devices of X-ray equipment that limit the radiation beam in its section.
transversal and are used to limit the size of the field to which the patient will be irradiated.
They are also known as diaphragms.

Absorbed dose: Average energy imparted by ionizing radiation to matter in a

mass volume element dm: D = dE/dm. It is measured in J/Kg with the special name of
Gray (Gy).

Optical transmission density (Optical Density, OD): Decimal logarithm of the ratio between
the transmitted radiant energy flow (tthat passes through the specimen and emerges from a
surface different from the one on which the incident flow strikes and the incident flow in the
i
opening defined by the area of the specimen on which the measurement is made: D = - log10( t/
IIt is used in radiology to measure the degree of blackening of an emulsion.
radiographic.

Axis of the beam: Central axis of the beam; normally defined by the line of symmetry through the
collimator.

Effective energy: It is the energy of the photons equivalent to the monoenergetic radiation that
it has the same CHR of the radiation in question. It is measured in keV.

Exhibition: Absolute value of the total charge of ions of a given sign produced in air
when all the electrons released by the incident photons in a mass of air dm are
completely stopped in this. This magnitude has been replaced by the Kerma in air,
measured in Gray (Gy).

eV: Kinetic energy acquired by an electron subjected to a potential difference of 1 Volt.

1 keV = 1000 eV.

Filter, filtration: Material interposed in the useful beam, which preferentially absorbs radiation.
of less penetration (less energy).

Inherent filtration: Permanent filter inserted into the useful beam; includes the tube window.
X-rays and any wrapping or device of the tube that obstructs the beam.

Additional filtration: Any filter additional to the inherent filtration.

Total filtration: Sum of inherent filtration and additional filtration. According to the difference of
the maximum potential of the team the minimum total leakage is as follows:
- up to and including 70 kV: 1.5 mm Al

26
above 70 kV and up to 110 kV including it: 2.0 mm Al
above 110 kV: 2.5 mm Al

Kerma: Sum of the initial kinetic energies of all charged ionizing particles
released by uncharged ionizing particles per unit mass of a material
specified. Kerma is measured in the same units as absorbed dose. In the
The international unit system is measured in J/kg and its special name is the Gray (Gy).

Haz: Region of space traversed by radiation from the source, its boundaries are defined
through the collimator.

kV: Unit of electric potential difference equal to 1000 V.

Kilovoltmeter: An electronic device that allows measuring the potential difference in kV.

Ionizing radiation: Any electromagnetic radiation or particle capable of producing ions

directly or indirectly in their interaction with matter. In this Guide with the term
radiation refers to X-rays.

Mannequin: Volume of equivalent fabric material used to simulate absorption and

characteristic dispersion that occurs in the patient's body or in a portion of it.

Scattered radiation: Radiation that, when passing through matter, is deflected from its path.
address.

Direct radiation: It refers to the radiation that passes through the window, opening, cone, or
any other type of collimation of the source head.

Leak radiation: All radiation coming from the source or the tube head except the
direct or useful radiation.

X-rays: High-frequency electromagnetic radiation (short wavelength) produced

inside a vacuum tube using a high voltage electric field.

Field size: Field area; as a rule, the field area must match
radiation with the area of the light field, since the latter is used to select the
field size to be irradiated.

Dose Rate: Variation of the absorbed dose over time.

27
BIBLIOGRAPHY

1.- American Association of Physicists in Medicine; 'Basic Quality Control in Diagnostic'

Radiology; AAPM report no. 4; reprinted 1981.
2.-Pan American Health Organization; "Quality Assurance in Radiodiagnosis"; PAHO
Scientific Publication 469; Washington DC; 1984.
3.-U.S. Department of Health, Education and Welfare; 'Quality Assurance for Radiographic'
X-ray Units and Associated Equipment; HEW Publication 79-8094; USA; 1979.
4.-U.S. Department of Health and Human Services; “A Basic Quality Assurance Program for
Small Diagnostic Radiology Facilities; National Center for Devices and Radiological Health;
HHS Publication FDA 83-8218; USA; 1983.
5.-International Society of Radiographers and Radiological Technicians; 'Quality Control
Handbook; WHO-ISRRT; 1986.
6.-National Council on Radiation Protection and Measurements; 'Quality Assurance for'
Diagnostic Imaging; NCRP Report No.99; Bethesda MD; 1988.
7.-American Association of Physicists in Medicine; "Protocols for the Radiation Safety Surveys"
of Diagnostic Radiological Equipment”; AAPM report No.25; 1988.
8.-International Electrotechnical Commission; “Radiation Protection in Medical X-ray
equipment 10 kV to 400 kV; IEC Publication 407; Genove Swiss; 1973.
9.-International Electrotechnical Commission; “Characteristics of Focal Spots in Diagnostic X-
Ray Tube Assemblies for Medical Use; IEC Publication 336; Genove Swiss; 1982.
10.- Dosimetry Working Party of the Institute of Physical Science in Medicine; “National
Protocol for Patient Dose Measurements in Diagnostic Radiology; NRPB; UK; 1992.
11.-International Commission on Radiological Protection; “Protection of the Patients in
Diagnostic Radiology; ICRP Publication 34 Volume 9 No. 273; 1982.
12.-National Radiation Protection Board; “Patient Dose Radiation in Diagnostic Radiology”;
NRPB; London; 1990.
13.-International Atomic Energy Agency; "International Basic Safety Standards for
Safety for Protection against Ionizing Radiation and for Safety of the
Sources of Radiation; Safety Collection No. 115; IAEA Vienna; 1997.

28
ANNEX I

Data collection models for quality control in radiography equipment.

MINISTRY OF PUBLIC HEALTH

STATE CONTROL CENTER FOR MEDICAL EQUIPMENT

QUALITY CONTROL IN RADIOGRAPHY EQUIPMENT

General Data:

Date:

Institution:

Address: Telephone:

Radiologist responsible for the service:

Collaborating technician of the service:

Responsible physicist for the evaluations:

Team Data:

Type of Equipment

Generator:

Brand and Model: No de Serie

Waveform: (1P-F, 1P-H, 3P-6, 3P-12, CP)
Maximum potential: kV Maximum current: mA
Fine Focus Current Values: mA
Current values Thick Light: mA

X-Ray Tube:

Brand and Model: No Series:

Type:
Anode material:
Total filtration: mm Al
Inherent: mm Al Additional: mm Al
Fine Focus Size: mm
Thick Bulb Size: mm

29
1. Physical Inspection of the Installation.

A) The free and immobile unit is mechanically stable: If No

B) The X-ray tube has a focal point indicator: Yes No
C) The collimator system is functioning correctly: Yes No
D) Checking the movements and brakes of the X-ray tube and its support:
vertical movement: Brake:
horizontal movement: Brake
vertical/horizontal movement Brake:
angular momentum Brake

E) Checking the movements and brakes of the chassis-support drawer and the support of
patient (radiological table).
movement of the RI system on the radiological table: Brake:
movement of the radiological table: Brake:
vertical bucky assembly movement: Brake:

F) Checking the generator panel indicators:

exposure indicator:
focus indicator:
electrotechnical parameter indicators:

Observations:_____________________________________________________________

1.1. Checking the Overload Block Circuit.

kVp Time CMPT CMTT CMPT/ Result

(s) CMTT

Observations:_____________________________________________________________

30
2. Accuracy of the Distance Indicator Scale.

A) If the location of the focal point is known:

Value indicated in cm Value measured in cm Accuracy in %

B) If the location of the focal point is not known:

Indicated focal-film distance (FFD): cm

Actual size of the slot in the lead plate

Size of the gap visualized in the movie on THI table1
Size of the gap visualized in the film in frame holder
THI2
Magnification M1 of THI1
Magnification M2 of THI2
Distance iron film on DHP table1
Distance of the film plate in DHP holder2
Focal-film distance in the cassette calculated DFPreal
Accuracy in %

Observations:_____________________________________________________________

_________

3. Perpendicularity of the Table-X-Ray Tube.

Focal-Table Distance (FTD): cm Displacement of the Tube: cm

Position Displacement center of Quadrant % of DFM

reticle (cm)
left
right
center

Observations:_____________________________________________________________

31
4. Radiation Field/Luminous Field Match and Alignment of Field Centers
Radiation/Light Field.

Focus-Film Distance (FFD): cm Potential: kVp Current-Time: mAs

Size of the selected light field sides

Size of radiation field sides measured
Discrepancy as % of DFP
Left axis discrepancy (cm)
Right axis discrepancy (cm)
Sum as % of DFP
Anterior axis discrepancy (cm)
Posterior axis discrepancy (cm)
Sum as % of DFP
Deviation of the centers field
rad/luminous
% of DFP

_____________________________________________________________

___________________________________________________________________________
___________________________________

5. A) Measurement of the Focal Point Size according to Star Pattern.

Pattern Model:
Number of pairs of stripes: Angle between stripes: degrees
Number of sectors: Angle between sectors: degrees
Focus-Star Distance: cm
Star-Image Distance: cm
Magnification:

FINE FOCUS.
Nominal Size: mm
Electrical parameters of the exposure: kVp mA y mAs
Movie Identifier:_____________ DO:

Address of Dimension Calculated TPF DIF (%) vs

evaluation Zero Contrast (mm) Nominal
(mm)
parallel anode-
cathode
perpendicular
anode-cathode

32
THICK FOCUS.
Tamaño Nominal mm
Exposure parameters: kVp, mA y mAs
_____________ DO:

TPF Contrast Dimension calculated DIF (%) vs

Evaluation Direction Zero (mm) (mm) TNominal
parallel anode-cathode
perpendicular anode
cathode

Observations:_____________________________________________________________

_____

B) Measurement of the Effective Focal Spot Size according to bar pattern

resolution.

________ Focal Film Distance: cm

Focus No. Size kVp Minor PL/mm DO Size E

from thenominal group cash (%)
movie (mm) resolved (mm)
fine
thick

_____________________________________________________________

______

6. Accuracy and Reproducibility of the Potential.

Kilovolt meter: [Link]

nominal kVp
mA
mAs
DFDetector
kVp1
kVp2
kVp3
Media
DE
CV (%)
E (%)

Observations:_____________________________________________________________

7. Measurement of the Half-Reducing Layer (CHR).

Dosimeter: [Link]:_________________
Detector:____________________________ No. Series:_________________
Filters: [Link]

33
Focal-Filter Distance: cm Focus-Detector Distance: cm

kVp
mA
mAs
Measurement in:
without filter
mm Al
mm Al
mm Al
mm Al
mm Al
mm Al
without filter
CHR

Observations: _____________________________________________________________
translatedText

8. Reproducibility and Linearity of Exposure. Generator Performance.

Dosimeter: [Link]
Detector:________________________ Series No.:_________________
Nominal value of the selector for Potential closest to 80 kVp: kV
Measured potential value: kVp
Focus-Detector Distance: cm

FF FG
Focal kV mA mAs mR mR mR Media CV mR/mAs mR/mAs
(%)

CL

Observations:_____________________________________________________________

___

34
9. Accuracy and Reproducibility of Exposure Time.

Dosimeter: [Link]:_____________
Detector: [Link]
Potential: ________ kVp
Threshold in pulse duration measurement:_________

Focus mA mAs t select. t1 t2 t3 Media DE CV (%)

Observations:_____________________________________________________________

35
10. Evaluation of Radiographic Image Quality with Bar Pattern
Resolution.

Mannequin:_________________________________
Bar Pattern
__________________________Serial No.:
DFP:___________cm Field:___________cmxcm

Combination kVn mA mAs CHR kVp DO PL/mm

movie-screen mmAl

Observations:_____________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_____________

11. Measurement of the Input Dose.

Dosimeter: [Link]
Detector: No. Series:

Study
nominal kV
measured kVp
mA/mAs
DFP studio
Patient thickness cm
Field of study
Focal Detector
Measurement field
X1 in: mR mGy
X2
X3
X4
X5
Xmedia at the entrance
CHR mm Al
Kq
Kd
BSF
Input Dose

_____________________________________________________________

36