Charles R. Wilson, Ph.D., F.A.C.R.
Medical College of Wisconsin
Milwaukee, Wisconsin
ACR Radiography and
Fluoroscopy Accre...
Who is the ACR?
We serve more than 32,000 radiology professionals nationwide
• Diagnostic / interventional radiologists
• ...
Accreditation Programs
• 1966 - first practice accreditation program
• 1987 – mammography accreditation
• 1987 – radiation...
What is ACR Accreditation?
Peer review process developed and monitored by experts
• Concept must be approved by the ACR Co...
Diagnostic Modality Accreditation Program
Streamlined application process
• Single application for group practice
• 10 per...
Diagnostic Modality Accreditation Program
ACR Practice Guidelines and Technical Standards
• Evidence based
• Jointly devel...
Diagnostic Modality Accreditation Program
Medical expertise
• Practice Guidelines and Technical Standards Development
– Ov...
Diagnostic Modality Accreditation Program
ACR Quality and Safety staff
• Career healthcare professionals
• Imaging technol...
Radiography/Fluoroscopy Accreditation Program
• Committee
• Personnel qualifications
• Clinical requirements
• Phantom req...
Radiography/Fluoroscopy Accreditation Program
Committee
• Stephen Baker, M.D., Co Chairman
• Robert Steiner, M.D., Co Chai...
Radiography/Fluoroscopy Accreditation Program
Modules Included
• Chest Radiography
• General Radiography
• Fluoroscopy
Equ...
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications
• Physician
• Medical Physicist/MR Scientist (if ap...
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications - Physician
Radiologists Other Physicians
Initial B...
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications - Medical Physicist
Medical Physicist
Initial Board...
Radiography/Fluoroscopy Accreditation Program
Personnel qualifications – Radiological Technologist
Radiological Technologi...
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• Chest Module
– Two sets of chest exams must be submitted (...
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• General Radiography Module
– Abdomen exam
– Cervical spine...
Radiography/Fluoroscopy Accreditation Program
Clinical Images
• Fluoroscopy Module
– Double-contrast barium enema exam fro...
Radiography/Fluoroscopy Accreditation Program
Phantom image quality evaluation(score and artifacts)
• Radiographic- chest/...
Radiography/Fluoroscopy Accreditation Program
Phantom Images
• All image receptors must be tested with the phantom
Radiography/Fluoroscopy and Interventional Accreditation Phantom
Fluoro Spot Interventional
(undertable tubes)
Abdomen
(ov...
Radiography/Fluoroscopy Accreditation Program
Phantom Images
• Specific performance criteria evaluated using the phantom:
...
Radiography/Fluoroscopy Accreditation Program
Quality control program and equipment QC
• Annual Medical Physicist’s QC Tes...
Radiography/Fluoroscopy Accreditation Program
Quality control program and equipment QC
• Annual Medical Physicist’s QC Tes...
Radiography/Fluoroscopy Accreditation Program
Quality control program and equipment QC
Radiologic Technologist’s Quality C...
Radiography/Fluoroscopy Accreditation Program
Reviewer qualifications
• Reviewers must be:
– ABR certified
– ACR members
•...
Radiography/Fluoroscopy Accreditation Program
Validation
• Random on-site visits
– Prior notification
– Validate submitted...
Radiography/Fluoroscopy Accreditation Program
Mobile services
• Must meet the same criteria as a fixed site
Radiography/Fluoroscopy Accreditation Program
Fees
• Facility fee $650
• Plus an additional $200 for each room being accre...
Radiography/Fluoroscopy Accreditation Program
Accreditation Granted
• All units at the site must pass evaluation for accre...
Radiography/Fluoroscopy Accreditation Program
If the site does not pass the first time
• Retest
– A facility will have the...
Why ACR Accreditation?
Improved quality
• Patient confidence
– Better informed patients are seeking high quality care
• He...
American College of Radiology
1891 Preston White Drive
Reston, VA 20191-4397
Accreditation Hotline: 800-770-0145
Mammograp...
ACR Radiography and Fluoroscopy Accreditation - Charles R ...
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  • First let me give you a little background about who we are.
    The American College of Radiology is a national organization serving more then 32,000 radiology professionals, including diagnostic and interventional radiologists, radiation oncologists, medical physicists, nuclear medicine physicians and clinical researchers.
    We are a leader in federally funded clinical research.
  • The ACR is nationally recognized for our commitment to quality patient care.
    We implemented our first voluntary practice accreditation program in 1966. The mammography accreditation program was introduced in 1987 in response to the American Cancer Society's recommendations for breast cancer screening. As a result of the federal legislation, the Mammography Quality Standards Act, the FDA approved the ACR as the only national accrediting body for mammography.
    All of the ACR diagnostic imaging accreditation programs are based on the mammography program model.
  • An accreditation program is a peer review process developed and monitored by experts in the field. They assess specific parameters for each imaging modality and are based on the ACR Standards.
  • In order to make participation in the ACR accreditation programs a manageable process, we have recently introduced a new program called the Diagnostic Modality Accreditation Program.
    This program features a streamlined application process which will allow a group practice to submit personnel, and policy and procedure information in a single application. All accreditation programs are included in this program, except mammography and radiation oncology
    The ACR Web site will list all the modalities accredited at each practice
  • The ACR accreditation programs are based on the ACR Standards.
    ACR Standards are developed through an evidence based, consensus process using peer review literature. Frequently they are developed jointly with other medical specialty organizations. The 1997 Physician Insurers Association of America (PIAA) study shows ACR standards to be good risk management tools.
  • All of the ACR projects and programs, including the Standards and Accreditation programs are developed and overseen by physician and physicist member volunteers.
    Over 450 members participate in practice standards development.
    Over 400 radiologists, radiation oncologists and medical physicists work on ACR accreditation programs.
  • Physician experts together with professional staff, coordinate these programs into a useful body of services and publications designed to sustain and enhance continued quality improvement in radiologic medicine.
  • The radiography/Fluoroscopy accreditation program has three modules from which to choose: chest, general radiography, and fluoroscopy. A facility may apply for all three modules or any combination of them. Facilities must accredit all RF rooms used to provide these services.
  • Initial Qualifications
            A qualified medical physicist is an individual who is competent to practice independently one or more of the subfields in medical physics. The ACR considers that certification and continuing education in the appropriate subfield(s) demonstrate that an individual is competent to practice in one or more of the subfields in medical physics and to be a qualified medical physicist. The ACR recommends that the individual be certified in the appropriate subfield(s) by the American Board of Radiology (ABR) (see Table 2).
     
            The appropriate subfields of medical physics are Diagnostic Radiological Physics and Radiological Physics.
     
            The qualified medical physicist must be familiar with the principles of imaging physics and of radiation protection; the guidelines of the National Council on Radiation Protection and Measurements; laws and regulations pertaining to the performance of the equipment being tested; the function, clinical uses, and performance specifications of the imaging equipment; and calibration processes and limitations of the instruments used for performance testing.
     
            The qualified medical physicist may be assisted by properly trained individuals in obtaining data. These individuals must be approved by the qualified medical physicist in the techniques of performing tests, the function and limitations of the imaging equipment and test instruments, the reason for the tests, and the importance of the test results. The qualified medical physicist is responsible for and must be present during initial and annual surveys and must review, interpret, and approve all data as well as provide a signed report of conclusions. The qualified medical physicist should be available for consultation regarding patient dosimetry issues within a reasonable period of time.
  • Insert your required exams and the criteria that they are tested on.
    Multiple factors are assessed when examining image quality of patient exams, including proper patient identification, appropriate exposure, correct positioning, and adequate anatomic coverage. Images are evaluated for the presence of artifacts that may interfere with diagnosis as well as the techniques used to produce the images.
  • Insert your required exams and the criteria that they are tested on.
    Multiple factors are assessed when examining image quality of patient exams, including proper patient identification, appropriate exposure, correct positioning, and adequate anatomic coverage. Images are evaluated for the presence of artifacts that may interfere with diagnosis as well as the techniques used to produce the images.
  • Insert your required exams and the criteria that they are tested on.
    Multiple factors are assessed when examining image quality of patient exams, including proper patient identification, appropriate exposure, correct positioning, and adequate anatomic coverage. Images are evaluated for the presence of artifacts that may interfere with diagnosis as well as the techniques used to produce the images.
  • Insert your required phantom exams and the criteria that they are tested on.
  • Insert your required phantom exams and the criteria that they are tested on.
  • Insert your required phantom exams and the criteria that they are tested on.
  • Who assesses the quality of the patient exams that are submitted? Physicians who are board certified and recognized as experts in the field, with at least 50% of their practice in the specific modality being evaluated assess the quality of the clinical images.
    In order for the review process be fair, it is essential that cases are reviewed in an accurate and reproducible manner. Reviewers must be familiar with the evaluation criteria and apply them in a consistent fashion.
  • I don’t think this slide applies to RF
  • NOTE: Insert your modality’s fees.
  • The primary goal is improved quality.
    Accreditation also improves patient confidence, in addition to being a valuable educational process.
    Today’s patients are better informed then ever before and are actively seeking quality care.
    In fact, studies show that 73 million Americans use the Internet to answer health questions. As many as 68 percent of these say the material they found “influenced their medical decisions”!
  • In closing, we hope that this presentation gives you a better understanding of how accreditation ensures high quality imaging and radiation therapy.
    The ACR stands ready to assist your providers with becoming accredited as well as providing evidence to you, your patients and buyers of coverage that your organization is committed to quality patient care.
  • ACR Radiography and Fluoroscopy Accreditation - Charles R ...

    1. 1. Charles R. Wilson, Ph.D., F.A.C.R. Medical College of Wisconsin Milwaukee, Wisconsin ACR Radiography and Fluoroscopy Accreditation
    2. 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. 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. 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. 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. 6. Diagnostic Modality Accreditation Program ACR Practice Guidelines and Technical Standards • Evidence based • Jointly developed • Good risk management tools
    7. 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. 8. Diagnostic Modality Accreditation Program ACR Quality and Safety staff • Career healthcare professionals • Imaging technologists and radiation therapists
    9. 9. Radiography/Fluoroscopy Accreditation Program • Committee • Personnel qualifications • Clinical requirements • Phantom requirements/dose • Quality Control program and equipment QC • Reviewer qualifications • Program statistics
    10. 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. 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. 12. Radiography/Fluoroscopy Accreditation Program Personnel qualifications • Physician • Medical Physicist/MR Scientist (if applicable) • Technologist
    13. 13. Radiography/Fluoroscopy Accreditation Program Personnel qualifications - Physician Radiologists Other Physicians Initial Board certification •Six months formal training in an ACGME-approved program, and •Interpretation and formal reporting of 1000 general radiographs Continued Experience •200 general radiographs per year (recommended), and •If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended) •200 general radiographs per year (recommended), and •If interpreting fluoroscopy, 50 fluoroscopic exams per year (recommended) Continuing Education 150 hours every three years (recommended) 150 hours every three years (recommended)
    14. 14. Radiography/Fluoroscopy Accreditation Program Personnel qualifications - Medical Physicist Medical Physicist Initial Board certification in diagnostic radiologic physics or radiologic physics (recommended) Continuing Education 150 hours every three years (recommended)
    15. 15. Radiography/Fluoroscopy Accreditation Program Personnel qualifications – Radiological Technologist Radiological Technologist Initial ARRT registered or unlimited state license Continuing Education 24 credits in a 2-year period
    16. 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. 17. Radiography/Fluoroscopy Accreditation Program Clinical Images • General Radiography Module – Abdomen exam – Cervical spine exam – Elbow exam
    18. 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. 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. 20. Radiography/Fluoroscopy Accreditation Program Phantom Images • All image receptors must be tested with the phantom
    21. 21. Radiography/Fluoroscopy and Interventional Accreditation Phantom Fluoro Spot Interventional (undertable tubes) Abdomen (overtable tube) Chest (horizontal tube)Total Acrylic = 19.3 cm 4.6 mm Al Air gap Test object plate (3/8 in thick) 4.1 cm 7.6 cm 7.6 cm 7.6 cm 7.6cm 7.6 cm 7.6 cm 7.6 cm 7.6 cm 7.6 cm slot block with a slot to accept a 2.5 x 15.3 cm thick artery block. The artery block is commercially available from Nuclear Associates. 4.1 cm4.1 cm 4.1 cm Top View 25 cm 25 cm The distance from the center of the block to the lead markers is 7 cm 4.1 cm block Lead markers ©This document is copyright protected by the American College of Radiology. Any attempt to reproduce, copy, modify, alter or otherwise change or use this document without the express written permission of the American College of Radiology is prohibited. Test plate object 25 cm 25 cm Contrast-Detail test object, (placed 7cm from center of Test Plate object on axis that bisects corners of Test plate object and does not overlay lead markers from 4.1 cm block) Small aluminum disk ( 6cm from center of Test plate object and 12.5 cm from adjacent sides) Mesh patterns and low contrast holes (centered) Side View Air gap
    22. 22. 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
    23. 23. 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
    24. 24. 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)
    25. 25. Radiography/Fluoroscopy Accreditation Program Quality control program and equipment QC Radiologic Technologist’s Quality Control Tests Test Frequency Processor quality control (laser printers excluded Daily Darkroom cleanliness Weekly Phantom images Quarterly Visual checklist Monthly Viewboxes and viewing conditions Quarterly Repeat analysis Quarterly Analysis of fixer retention in film Semiannually Darkroom fog Semiannually Screen cleanliness As needed or annually Screen-film contact (auto film changers only) Annually
    26. 26. 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)
    27. 27. 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
    28. 28. Radiography/Fluoroscopy Accreditation Program Mobile services • Must meet the same criteria as a fixed site
    29. 29. Radiography/Fluoroscopy Accreditation Program Fees • Facility fee $650 • Plus an additional $200 for each room being accredited
    30. 30. 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
    31. 31. 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
    32. 32. 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!
    33. 33. 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™

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