Charles R' Wilson, Ph'D', F'A'C'R'

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ACR Radiography and Fluoroscopy Accreditation

• Charles R. Wilson, Ph.D., F.A.C.R.
• Medical College of Wisconsin
• Milwaukee, Wisconsin

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• 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

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• Accreditation Programs
• 1966 - first practice accreditation program
• 1987 mammography accreditation
• 1987 radiation oncology
• 1994 FDA adopts ACRs mammography accreditation
  program
• 1995 ultrasound
• 1996 stereotactic breast biopsy
• 1997 MRI
• 1998 ultrasound guided breast biopsy
• 1999 nuclear medicine
• 2002 CT and radiography/fluoroscopy

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• 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

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• 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

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• Diagnostic Modality Accreditation Program
• ACR Practice Guidelines and Technical Standards
• Evidence based
• Jointly developed
• Good risk management tools

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• 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

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• Diagnostic Modality Accreditation Program
• ACR Quality and Safety staff
• Career healthcare professionals
• Imaging technologists and radiation therapists

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• Radiography/Fluoroscopy Accreditation Program
• Committee
• Personnel qualifications
• Clinical requirements
• Phantom requirements/dose
• Quality Control program and equipment QC
• Reviewer qualifications
• Program statistics

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• 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.

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• 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

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• Radiography/Fluoroscopy Accreditation Program
• Personnel qualifications
• Physician
• Medical Physicist/MR Scientist (if applicable)
• Technologist

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Radiography/Fluoroscopy Accreditation
Program Personnel qualifications - Physician
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Radiography/Fluoroscopy Accreditation
Program Personnel qualifications - Medical
Physicist
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Radiography/Fluoroscopy Accreditation
Program Personnel qualifications Radiological
Technologist
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• 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

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• Radiography/Fluoroscopy Accreditation Program
• Clinical Images
• General Radiography Module
• Abdomen exam
• Cervical spine exam
• Elbow exam

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• 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

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• 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

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• Radiography/Fluoroscopy Accreditation Program
• Phantom Images
• All image receptors must be tested with the
  phantom

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• 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

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• Radiography/Fluoroscopy Accreditation Program
• Quality control program and equipment QC
• Annual Medical Physicists 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

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• Radiography/Fluoroscopy Accreditation Program
• Quality control program and equipment QC
• Annual Medical Physicists 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)

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Radiography/Fluoroscopy Accreditation Program
Quality control program and equipment QC
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• 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)

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• 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

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• Radiography/Fluoroscopy Accreditation Program
• Mobile services
• Must meet the same criteria as a fixed site

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• Radiography/Fluoroscopy Accreditation Program
• Fees
• Facility fee 650
• Plus an additional 200 for each room being
  accredited

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• 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

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• 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

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• 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!

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American College of Radiology 1891 Preston White
Drive Reston, VA 20191-4397 Accreditation
Hotline [phone] Mammography hotline
800-227-6440 Radiation oncology hotline
888-726-8956 www.acr.org
Quality is our Image