QUALITY ASSURANCE AND QUALITY CONTROL

QUALITY ASSURANCE
 It includes: scheduling, reception, patients, relationship with the RT, the promptness of performing the
examination or treatment and promptness of reporting the results.

QUALITY ASSURANCE PROGRAM IN DIAGNOSTIC IMAGING DEPARTMENT

 Monitors each phase of operation of the diagnostic radiological facility beginning with the request for
an examination and ending with the interpretation of the examination and the communication of these
interpretations to the referring physician.
 Quality Assurance deals primarily with personnel and their interactions with the patients and other
staff.

SCHEDULING OF RADIOGRAPHIC EXAMINATIONS

A. General Considerations
• Schedule in AM appropriate and timely sequence to ensure patient comfort.
• Make sequence so that examinations do not interfere with one another.
• Barium Studies are scheduled last.
• Several examinations are scheduled in one day if patient is able to tolerate them.
• Seriously ill or weak patients may be able to tolerate only 1 examination per day or must have a rest
between examinations.
• If sedation is used, patients must be given time to recover from sedation before beginning fluoroscopic
studies.
• Thyroid assessment must precede any examination involving iodinated contrast media.
• Radiographic examinations not requiring contrast agents are scheduled first.
• Total doses of iodinated contrast media should be calculated if series of examinations using it will be
performed.
• Patients who have been held NPO should be scheduled early.
• Pediatric and geriatric patients should be scheduled early.
• Diabetic patients must be scheduled early because of their need for insulin.

B. SEQUENCING
1. Fiber optic studies are conducted first in a series.
2. Radiography of the urinary tract.
3. Radiography of the biliary system.
4. Computed tomography studies should be scheduled before examinations involving the use of BaSO 4.
5. Lower GIS – Ba Enema
 6. UGIS

RECEPTION
 Main entrance  Patient hx and tentative diagnosis
 Requests or results  Traumatic / non-traumatic

7C’S OF MALPRACTICE PREVENTION:

 Competence  Confidentiality
 Compliance  Courtesy
 Charting  Carefulness
 Communication

RESPONSIBILITIES OF X-RAY/RADIOLOGIC TECHNOLOGISTS IN RADIOGRPAHIC REQUEST:

1. To make sure that the signatures are appropriate
2. To assure that critical questions have been asked. (allergies, Child Bearing-pregnancy 12-50)
3. To determine that the patients medical history relating to the radiographic examination is written on
the request
4. Patient Preparation (before radiographic examination)
a. Physical Preparation
 Proper clothing, remove metallic objects, radiopaque materials should be removed
on the POI.
b. Psychological Preparation
 Explanation of the procedure to the patient
 Reduce patient anxiety, successful examination and cooperation of the patient.
 Gain the patients trust and confidence.
c. Physiologic Preparation
 Vary on the examination
 Example:
• light, low residue diet night before the examination
• b. intake of 60cc castor oil 1 hour after evening meal or 2 dulcolax tablets and a follow up of 1 dulcolax
suppository at 4 am.
• c. NPO after midnight
• d. No breakfast, coffee and no smoking
• e. to the diagnostic imaging department as scheduled
 IVP, Ba Enema, KUB
• Take one bottle phospo-soda (45ml) ginger lemon flavored with half-glass of sprite or 7 up or cold
water followed with 3 glasses of water in 20-30 mins. Interval per glass.
 Oral Cholecystography
 Fatty lunch day before the examination
 Scout film is taken at 4 pm
 Non-fatty low residue evening meal
 Intake of 6 capsules of biloptin at 8 pm
 NPO after midnight, no breakfast, no smoking
Relationship of PT with staff.
 Rapport - harmonious relationship with staff and patient, sympathy and confidence
Promptness of reporting the result
 Soonest possible time (physician dependent)

• SIGNATURE:
a. Attending physician
b. LMP Patients signature
c. Informed consent is necessary
 Agreement; persons agreement to allow something to happen (ex. Angiography)
that is based on the full disclosure of facts needed to make the decisions
intelligently, that is knowledge of risk involved, alternate and probable duration of
incapacitation.
 Purpose: a. to protect the patient from unnecessary or unwarranted procedure
applied on him/her without his/her knowledge.
 • b. to protect the physician and health care providers from any consequence
for failure to comply with the legal requirements.

GUIDELINES: (TO AVOID LITIGATION)

1. Explained procedure 5. Physician will only sign and perform the
2. Legal age procedure
3. Mentally competent 6. Form must be completely signed
4. Legal Guardian will sign 7. Can be revoked anytime

TYPES OF COMMUNICATION:
• Verbal Communication – spoken or written words
• Non-Verbal Communication – gesture or facial expression
• 38% - tone of voice, speed of speech clarity of words, volume
• 53% - facial expression, eye contact, gesture
• <10% - verbal communication

EVALUATING ACTIVITIES IN QUALITY ASSURANCE

Areas to Evaluate:
1. SUPPLY LINES
materials needed in the department are available

2. Scheduling of Examination
efficient system in scheduling of examination

3. Staff Development
evaluate the ability of staff to perform the procedure
 It is our professional obligation to maintain current knowledge of diagnostic imaging
procedures and the ability to perform competently and efficiently / effectively any procedure to
which he/she is assigned.

4. Maintenance of Equipment
• is defined as the periodic attendance to keep the machine in good working condition (XRT and Engr.).
Repair is for an engineer who is specially trained in this work hence, the care of the equipment is the
responsibility of the staff.

5. Performance of Radiographic Procedures

actual procedure that the tech will perform
• 3 aspects to consider:
a. Thorough knowledge of procedures to be performed
b. Adhering to professional standards of patient care (7C’s)
c. Gaining the patients trust and confidence

6. Interpretation of Radiographic Examinations

a. Evaluate that the patients dx / condition must agree with the radiologist diagnosis (encoding /
typing of the results)
b. The report of the dx is promptly;
• b.1. prepared
• b.2. distributed
• b.3. filed for subsequent evaluation
• b.4. if clinician or pt. is informed of the examination result in a timely fashion

7. Filing Systems
3 Sections of the Filing System:
Active File:
contains the radiographs that are provided with temporary location for the duration of 1 month
following the examination when they are not in greatest demand.
 Hospital owns radiograph, borrowed by physician, should provide separate log book, kept in
envelope with interpretation, filed alphabetically.
Permanent File:
after 1 month in active file. Contains all radiographs made in the department during the past 5 – 10
years except those in the active file and the teaching file.
 Depending on size of the filing room, file must be accurate, arranged according to case number

Teaching File:
holds radiographs selected for their educational value. It is designed to provide radiographs of both
rare and representative cases for use in the training of physicians undergoing residency in the Radiology
Department or diagnostic imaging department and other resident physician of other medical specialties
including medical interns.
 Arranged / organized and maintained according to the diagnostic codes for anatomic and
pathologic fields which is based on the index of Roentgen diagnoses.

REASONS WHY RADIOGRAPHS ARE NEEDED:

 Comparative purpose  For teaching purposes
 Used for medico-legal procedures  For teaching purposes

DARKROOM / PROCESSING ROOM

• beginning and end of a radiographic work.
 It is a place where the necessary handling and processing of radiographic film can be carried out safely
and efficiently without the hazard of producing film fog by accidental exposure to light or x-rays.
• A room devoid of all white light in which the processing cycle of the exposed film may take place. The
room is not entirely dark but has illumination of safe densities to allow the technologist to perform
their work accurately and safely.

REQUIREMENTS OF AN IDEAL DARKROOM:

The Darkroom must be:
Be of suitable size
 Enough to accommodate all equipments, not too large and not too small
 2 factors to consider
o Manner or condition of operation
o Size of the diagnostic imaging department

Must not allow white light to enter

 Should be light tight, depends on darkroom entrance
• TESTS: (light leaks) – To determine if light leaks can produce light fog.

WHITE LIGHT LEAKAGE TEST (ocular / visual inspection)

 The frequency of test should be 6 months or semi-annually
 Eqpts. Required – insulation tape to temporarily cover holes
 Method/procedure:
a.1 Turn on all lights in areas adjacent to the darkroom.
a.2 Switch off all darkroom lights including safelights.
a.3 Insuring that the door/s are closed.
a.4 Remain in the darkroom for 10 mins. To allow the eyes to get used to in the dark.
a.5 Look around the darkroom for signs of white light leaks.
a.6 Pay particular attention to doors, windows, extractor fans, air ventilation and entry of pipes.
 Action:
a.1 identify then seal any white light leaks.
a.2 repeat the test.
a.3 carry out a test to see if any film fogging is occurring if felt necessary.
a.4 file a report.

WHITE LIGHT FOGGING TEST – done every 6 months or as necessary.

 Eqpts. Required – 1 sheet of new 18 x 24cm film (8 x 10)
1 sheet of new 18 x 24cm card (8 x 10)
 Method:
b.1 turn on all lights in areas adjacent to the darkroom.
b.2 switch off all darkroom lights including safelights.
b.3 insuring that the door/s are closed.
b.4 place the sheet of film on the work bench.
b.5 cover half of the film with the sheet of card board
b.6 leave for 3 mins.
b.7 process the film
 Evaluation:
b.1 seal any areas of light leakage
b.2 repeat the white light leakage test
b.3 file a report.

REQUIREMENTS OF AN IDEAL DARKROOM:

1. Have a suitable secure entrance
• Types of Darkroom Entrances:
a. Single Hinged Door
 Simpliest, common
 Advantages: cheap
 Disadvantages:
b. Double interlocking door
 Door A is open, Door B cannot be opened
 Disadvantages: expensive
a. Maze or Labyrinth
 Wall should have black paint
 Advantages:
 Disadvantages:
a. Sliding curved revolving door
 Outer = 35 in, inner = 32 in, ent = 20 in
Have appropriate safe lighting
• SAFELIGHT – conventional safelight is a small light tight box with a light filter window fitted with bulb
and socket.

Ideal req’t.s for a safelight:

a. Be in good condition
b. Have correct filter to suit the light sensitivity of the film used.
c. The safelight should have the correct light bulb wattage as recommended by the manufacturer.
d. Be electrically safe
e. Be installed correctly.
REQUIREMENTS OF AN IDEAL DARKROOM:
• Check that:
a. Each safelight is no less than 130 cm. (51 in.) above the work bench
b. The light bulb is correct. (usually 15 Watts if facing down)
c. The safelight filter is in good condition – no cracks
d. The safelight filter is compatible with the light sensitivity of the film being used. (check with film
manufacturers information)
e. The safelight does not leak whitelight
f. The wiring and fittings are in good condition.

• TYPES OF SAFELIGHT:
Wall mounted Type – facing down,
uses Na vapor (orange yellow) (big darkroom)
Ceiling mounted type – facing up

3 FACTORS THAT WILL AFFECT THE AMOUNT OF LIGHT EMITTED BY THE SAFELIGHT:
a. Type of filter b. Wattage of light bulb c. Distance

REQ’TS. OF IDEAL SAFELIGHT:

a. Should be equipped with ideal filter
• Kodak Wratten 6B – blue – orange brown
 • Kodak GBX – green – deep cherry red
a. Filter is fitted on safelight housing
b. Safelight housing should be light tight / proof
c. It should be equipped with incandescent bulb
 7.5 – 15 Watts – direct lighting
 25 Watts – indirect lighting
d. Distance
 1.25m or 48 in. – direct lighting
 2.5m or 96 in. – indirect lighting

Safelight should be tested for safety

 LATENSIFICATION TEST:
• Is a safelight test which calculates how long a radiographic film maybe handled safely or before it will
be fogged.
**Safe- if same density throughout the film
**Unsafe - 3rdstrip increase in density
• SAFELIGHT EFFICIENCY TEST – Frequency of test 6 months or once a year. (semi-annually)

REQUIREMENTS OF AN IDEAL DARKROOM:

Have adequate white lighting
 General illumination / overhead lighting – designed to provide illumination for cleaning, changing
solutions and carrying out other procedures that do not require safelight. Incandescent bulb
recommended.

Have adequate ventilation

 Process of supplying and moving air by natural or mechanical means to and from any space.
 Hygrometer/psychrometer – used to measure humidity
 Polyethylene bag / aluminum foil – used to protect the films from excessive humidity
a. Temperature for film storage - 50˚F - 70˚F with 40% to 60% relative humidity
b. Darkroom - 70˚F - 80˚F with 50% to 60% relative humidity
• Extractor fan (exhaust fan) – outside the DR, it should be seen. Air exchange should be at the rate of 15
changes an hour.
• Inadequate ventilation – smell fixer

Importance of adequate ventilation:

1. To prevent the smell of chemical fumes
2. To prevent the impedance of film take-up by field rollers of the AP
• Remedy: high: install aircon, low: install humidifier

REQUIREMENTS OF AN IDEAL DARKROOM:

• Have adequate drainage for continuous use of water. Have a hot and cold running water supply
a. Manual - 68˚F = chemical solution
b. Automatic – 90 - 95˚F or 94˚F
c. Time Temperature method – inversely proportional.
• For every degree increase in temp. = ¼ min dec. in processing
• For every degree decrease in temp. = ¼ min inc. in processing
• Hot Water: mixing solution

Have a convenient layout “Floor Plan”, ideal location of equipments

• The workbench is opposite from processing tank to avoid contamination., AP – adjacent
lOCATION OF THE PROCESSING ROOM:
The processing room must be centrally located in relation to the RR to provide accessibility.
 Advantages: minimizes walking distance, reduces personnel fatigue, reduces exam’n time.
It should be away from sources of radiation.
• 5mR = can give radiation fog
• DR must be away / adjacent to RR
• XR tube must be far from the radiographic film
It should be readily accessible to plumbing and electrical connections. Pipes should not be embedded on the
concrete for easy repair.

 IDEAL SIZE OF A PROCESSING ROOM:

1. Conditions of operation
2. Size of the dept. – as long as it can accommodate the eqpt’s.

Have a flat smooth surfaced work bench of adequate size and location.
 Condition:
a. Material of workbench: formica = durable
b. 60cm/2ft in width, 150cm/5ft in length
c. Should be grounded to avoid static marks
d. Choose a color that will help you be ready to recognize the materials you are going to use.
e. It must be made with durable static resistant material and for added protection, it should be grounded
to prevent static discharge during film handling.
f. Must be dry and clean.
g. The opposite location of the WB in relation to the processing tank is to avoid the contamination of the
film.

Be in good condition – operational / functional darkroom including eqpts, pipes, etc…

• WALL – ceramic tiles which is chemical resistant
• Alternative: Plastic wall covering
• FLOOR – should be chemical resistant and stain proof ASPHALT TILE

Be effectively and regularly cleaned – cleaned in order for own convenience to prevent microorganisms to
multiply.
Have adequate storage space – material keeping: cabinets, storage shelves
Have a safe and reliable electrical supply – safety of electrical connections
Maintain temperature and humidity at suitable levels

Be radiation proof
 Wall should be lined with 1.5 mm lead
 Density of lead: 11.36 g/cm3
 Substitute: Poured concrete 6 inches thick / 15cm
• Density of concrete= 2.53 g/cm3
 Bricks: 25 cm.
 Start lead lining: Ceiling to Floor

• Be fitted out with film processing and accessory equipment – to be efficient in processing the films.

The DR must be equipped with passbox/es.

- It is where C#T’s are inserted. It is divided into two, exposed and unexposed.
- It is a steel box mounted on the wall with doors opening into the DR and another set of doors opening
into the RR.

• C#T PASSBOX RADIATION PROOF TEST – conducted yearly or as necessary

 Eqpts. Used: 3 coins or lead markers, adhesive tape, 1 loaded 35 x 43cm (14 x 17) C#T
 Method:
a. Stick the 3 markers at intervals down the long edge of the front of the C#T with a tape
b. Place the C#T in the passbox, with the markers nearest to the XR beam
c. Leave the C#T there for a week
d. Process the film
 Evaluation:
a. If fogging has occurred to the extent that the markers could be seen, repeat the test over a shorter
period.
b. Establish a period of time when fogging does not occur.
 Action:
a. Do not store C#T’s in the passbox
 b. Remove C#T’s from the passbox w/n the no fog period
c. Increase lead shielding to passbox
d. File a report

TEST FOR DARKROOM RADIATION PROOF

 Materials:
• periapical dental film masking tape dental film hanger
• pair of scissors coins chemical solutions
• mixing paddles interval timer thermometer
• wall to be tested
 Procedure:
1. Attach the coin in front of the film. 4. Leave it for 2 weeks then process.
2. Secure it with a masking tape. 5. Evaluate the film.
3. Attach it to the wall.
 PRODUCT:
 Evaluation:
- Blue / transparent – radiation proof / safe
- Unsafe – leakage and scattered radiation is measured.

DARKROOM QUALITY CONTROL AND STANDARD DARKROOM PROCESSING TECHNIQUES

• Most of the problems identified on film analysis is mishandling of films during storage, loading and
unloading, and processing. Since these problems take place in the darkroom, corrective actions should
be undertaken.

BASIC TEST FOR DARKROOM FACILITY

CLEANLINESS
a. Keep the room clean. Loading bench tops and other darkroom accessories must be used only for
specific purposes.
b. Promptly wipe off chemical spills on the loading bench, cassettes, floor and walls.
c. Store fresh films, cassettes, hangers and other accessories in a proper place. Arrange and organize
them systematically.
d. Provide a separate box for spoiled films.
e. Provide a waste basket inside the darkroom.
f. Clean the master and insert tanks properly before mixing processing chemicals.

LIGHT LEAKAGE
a. Check for the presence of light leaks inside the darkroom, paying particular attention to the
surrounding doors, windows and exhaust fans where pipes enter and leave the darkroom
b. Inspect the doors and windows, etc., from the position where films are handled.
c. Correct light leaks immediately. Seal them by using black cardboard, cloth, rubbers strips, etc.

WATER SUPPLY
a. Check for the adequate supply of fresh water.
b. Provide running water for rinsing and washing films.
c. Check for drainage clogging especially in processing tanks.

VENTILATION
a. Have proper darkroom ventilation. An electric fan or air conditioning unit must be installed and
cleaned periodically.
b. Install an exhaust fan with a light tight cover. This must be cleaned periodically.

PROCESSING SOLUTION
a. Stir processing chemicals at the start of the day.
b. Paddles must be clearly identified. Use the fixer paddle only for the mixer and the developer paddle
only for the developer.
c. Cover each processing tanks when not in use.
 d. Check for the level of the processing solution on each tank. If the solution level is low, never add water
to bring solution to desired level. Use a replenisher solution, when available.

DARKROOM QUALITY CONTROL

FILM HANGERS
 Equipment needed: hand brush
 To keep the hangers clean and in good shape, follow these procedures:
a. “Scrub” film hangers with a hand brush using hot water to remove chemicals.
b. Rinse and dry
c. Check for any damage to clips, distorted shape or broken corners.
d. Note the action taken for the damaged hangers.

FILM VIEWER
 Eqpt. Needed: mild soap and soft cloth
 For better viewing of radiographs follow these procedure:
a. Unplug the film viewer.
b. Clean the viewer (front) with a damp cloth. Dry the viewer completely with a clean soft cloth.
c. “Make sure that all the fluorescent tubes are operating correctly and provide an even overall
illumination. Fluorescent tubes should always be checked and cleaned.
d. The inside of the film viewer box and the back of the glass front should be cleaned by an electrician or
any other authorized person every six (6) months.

DARKROOM LUMINOUS INTERVAL TIMER

 This should be checked weekly to make sure that it measures the time accurately and
indicates clearly when the selected time is over.
 Eqpts. Needed: darkroom interval timer, a watch or another clock
 Procedure:
a. Under white light illumination, set the interval timer to be checked to the usual developing time. Look
at the clock as soon as the starting lever or button of the interval timer clock will continue for the set
time and will sound the alarm when the time is complete.
b. The time interval should be checked by comparing it with a watch or another clock.
c. “The checks described should be done several times to make sure that the interval timer operates
correctly every time.
d. If the time interval is consistently wrong, either too long or too short, the interval timer can be used as
necessary adjustments for the error can be made by the operator.
e. If the interval timer gives inconsistent results, it should not be used until it has been repaired /
replaced.

FILMS
 The following should be followed in handling films:
a. Check expiry dates on the boxes as soon as they are delivered.
b. Organize the stored films in such way that “the oldest films are always used first, ensuring strict
rotation of the stock”
c. Keep the storage room temperature as low as possible about 20˚C to 25˚C.
d. Store boxes of films away from sources of heat such as hot pipes where gas like vapors of formalin,
hydrogen peroxide, or ammonia may leak the air fog.
e. Do not store boxes of film on the floor. Stack the films vertically to eliminate unnecessary pressure
marks on the film.
f. Do not allow unauthorized personnel to open boxes of films.

DARKROOM THERMOMETER
1. The darkroom thermometer is either a metallic stem dial type thermometer or an alcohol
thermometer with a metal casing to protect it from breaking.
2. The thermometer should be washed properly after immersing it in the processing solution.

MIXING PADDLES
a. Each processing chemical must have a matching mixing paddle.
 b. Mixing paddles used for developer and fixer solutions should be made from stainless steel, plastic or
hardened rubber.
c. The mixing paddles must be marked “DEVELOPER” for mixing developer solution and “FIXER” for
mixing fixer solution. This is important; otherwise, the developer and fixer solutions will become
contaminated if mixing paddles were accidentally interchanged.

DARKROOM SAFELIGHT
a. Check if safelight has the correct bulb fitted. “It should be a 15-watt bulb. If this is not available, a 25-
watt bulb may be used instead. If a 25-watt bulb is fitted, it is very important to check whether there is
any safelight fogging.
b. Install safelight housing at least 4 feet (130cm) high above the working table. The height of the
safelight may have to be increased if there is safelight fogging on the films because of the unavoidable
use of a higher wattage bulb.
c. Check if the safelight has the correct safelight filter fitted to suit the type of the film being used. Check
for cracks to avoid unfiltered light from the lamp from getting out to fog the film. It is also important to
check that there is no light getting out around a loosely-fitted electrical connection.
d. Clean safelight housing and filters periodically.
e. Turn “OFF” the safelight when not in use.

STANDARD DARKROOM PROCESSING TECHNIQUE:

 limited to manual film processing
 common in the Philippines
 time temp method – standard technique
 silip – method must be avoided (leads to under / overdev), wrong exposure technique
 overexp – underdev underexp – overdev
 can show fogging and poor density

CHOOSING AN AUTOMATIC PROCESSOR:

1. Identify your needs
- Thoroughput of films - Complexity of units

2. RESOURCES AVAILABLE
- Power supply of eqpt. - Exhaust system and ventilation
- Water - Maintenance and repairs
- Space available in the dept. - finance

3. Manufacturer warranty
- Warrant period (evaluate eqpt.) - Determine responsibilities
- Warranty cover (items covered by
warranty)

4. SUPPLIER SERVICE
- Installation (charge / free) - Repairs and parts
- Initial quality control test - Chemistry (chemical solutions)
- Maintenance - Speed f response – order(delivery)

5. Making the choice

- Establish your processor specification requirements
- Do you want a silver recovery unit? (silver extractor)
- Review the manufacturer specification
- Make a short list of suitable processor
- Submit your requirements to the selected manufacturers for quotations
- Review quotations
- Make your selection

6. ACCEPTANCE OF THE NEW AP

Upon completion of the installation and before accepting responsibility for the new processor, must
check that:
 a. Specifications of the processor installed are the same as that order
b. Installation has been carried out as stated in the contract
c. Installation is complete and eqpt. Is working efficiently and to your satisfaction
d. All quality control test had been carried out and are satisfactory
e. All accessory eqpt. Has been supplied and is in good order
f. Operating manual has been supplied and is the correct one.
• NOTE: only when you are sure that the installation had been carried out satisfactorily should you
accept the processor. Make sure it is in good condition and is efficient.

7. SETTING UP AN AP
- Manufacturer or supplier should:
a. Ensure that the preinstallation reqts are adequate (ex. Ventilation, water pressure, drainage and power
supply)
b. Carry out the installation correctly and make sure it is working properly
c. Carry out the initial quality control procedure and leave the results for future reference.
d. Give staff adequate instruction regarding its use, care and maintenance.
e. Provide the relevant operating manual.
f. Provide a contact for service and repairs
g. Provide service under the conditions of the warranty
h. Provide ongoing maintenance if reqd by the buyer.

FEW PRACTICES TO REDUCE PROCESSING ARTIFACTS:

1. Purchase high quality processor, use manufacturer recommended processing chemicals and
replenishment rates.
2. Install maintain and clean processors as recommended by the manufacturer.
3. Train personnel to properly operate, maintain and clean the processor.
4. Have your processors serviced regularly.
5. Develop a processor quality control program, monitor changes and trend and take appropriate
corrective actions.

START-UP PROCEDURE OF AP:

1. Close the wash tank drainage valve.
2. Turn on the wash water source.
3. Turn on the processor.
4. Check if the processor lid is in place.
5. Run several 14 x 17 inch films (spoiled) through the processor.
6. Check the replenishment rates.
7. Check the developer temp after the processor has warmed up.

SHUT DOWN PROCEDURE:

1. Turn off the wash water source.
2. Turn off the processor.
3. Open the wash tank drainage valve. (to remove the water used)
4. Leave the processor lid partially opened to prevent chemical condensation, w/c can cause
contamination of the developer solution with fixer solution.

MAINTENANCE SCHEDULE: (AP)

DAILY:
1. Wash evaporation covers
2. Clean cross over racks
3. Rotate and clean rollers
4. Clean tank deposits above solution level
5. Clean deposits from dryer area
6. Leave processor lid partially opened overnight to prevent fumes and reduce chemical condensation on
underside of lid.
• -rotate rollers due to gelatin sticking.
WEEKLY:
1. Removal, cleaning and inspection of the transport roller racks, inspection includes checking gears,
chains and roller from wear and ease of movement.
2. Inspect solutions for foreign matter after removing transport roller racks.
3. Turn on circulation pumps and observe solution circulation.
4. Inspect all filters
5. Clean dryer air tubes
6. Check replenishment lines for bends, kinks or debris.

MONTHLY:
1. Check alignment of feed tray
2. Check replenishment rates and adjust if needed
3. Drain and clean all processor tanks
4. Inspect all tubing and their connections for leaks.
5. Lubricate gears according to manufacturers recommendations.
6. Check for proper function of entrance roller micro switch and adjust if needed.
7. Clean cross over racks and check for any needed repairs.

FACTORS CAUSING EXCESSIVE DENSITY:

1. Developer temp too high – hydroquinone
2. Developer over replenishment
3. Developer contaminated with fixer
4. Processor running too slow
5. Developer improperly mixed – highly concentrated
6. Processor light leaks.

FACTORS CAUSING INSUFFICIENT DENSITY:

1. Developer temp. too low
2. Developer under replenishment, exhausted developer
3. Processor running too fast.
4. Developer improperly mixed.

FILM FOG – the image produced cannot be seen clearly, additional density superimposed with the original
density.
a. Light fog c. Chemical fog
b. Radiation fog d. Age fog

FILM ANALYSIS:
• Subjective evaluation of radiographic image quality based on the standards or general requirements
for good and rejected radiographs set by the diagnostic imaging department

Objective of Film Analysis:

To evaluate the problems leading to poor image quality and rejects. Classify the problem into 1 of
the 3 major categories:
a. Technical Factor b. Procedural Factor c. Equipment Malfunction
Problem Problem Problem

To serve as a self improvement tool for the staff.

To establish a management database.
• Film analysis should be done regularly by the technologist or the radiologist following these procedures:
a. Collect all the radiographs for the desired period and determine the number of rejects, poor radiographs
and the actual number of radiographs used during these period.
b. Together with a radiologist, analyze all of the films and determine the single contributing / major
problem for each radiograph. Determine if the film is good, poor or rejected. Record the number of
these radiographs on the film analysis form.
c. As the radiologist reads the radiograph for clinical diagnosis, he can also note down the problem. The
technologist will collate and record these problems in the form
***Determine the overall reject rate while reviewing the film making use of the following formulas:
•
• Total # of rejects
• % rejected film = -----------------------------
• Total # of films used
•
• Total # of poor quality films
• % poor film = -----------------------------------------------
• Total # of films used
•
• Total # of good quality films
• % good quality film = ----------------------------------------
• Total # of films used

“I AM EXPERT”

• I - IDENTIFICATION
•
• A - ANATOMY
• M - MARKINGS
•
• E - EXPOSURE
• X-
• P -PROCESSING
• E – ESTHETIC CONSIDERATION
• R – RADIATION SAFETY
• T – TROUBLE SHOOTING

 The result of the film analysis will determine what problems affect the technical quality of the film.
 ESTHETIC QUALITY – refers to eye appeal of radiograph. Sometimes called artistic merit. (a value that is placed
on the excellence of the radiographs general appearance) alignment and centering of the image.

QUALITY CONTROL OF
X-RAY EQUIPMENT:

A. CONTROL CONSOLE
a. Clean the console with a dry cloth
b. Check the physical condition of the switches, control knobs and buttons
c. Check the line voltage meter before making an exposure
d. Check the function of the kVp and mAs meter.
e. Set all the control knobs to the minimum values when not in use.
f. Turn off the main switch on the control console and fuse box when not in use.

B. GENERATOR
a. Clean the high tension (HT) transformer box regularly
b. Check transformer for oil leaks.
c. Monitor the oil level of the (HT) transformer
d. Check that the eqpt. Is earthed either by a copper tape attached to the metal covers of the unit or by an earth
conductor carried in the main cable of the unit.

C. X-RAY TUBE, TUBE ASSEMBLY AND HIGH TENSION CABLES

a. Check the physical condition of the XR tube. (i.e. leaks on tube housing)
b. Check if the tube is securely attached to its support.
c. Check function of locking mechanism
d. Check locks for x-ray tube rotation
e. Check the physical condition of high tension cables. It should never be pulled, bent or twisted because it can
cause serious damage to the electrical conductors they contain and their electrical safety.
f. Warm up using the low exposure technique before beginning any radiographic procedure.
g. Check the collimator head rotation and locking mechanism.
h. Check the function of the light beam diaphragms.
i. Check the alignment of the x-ray tube column and the x-ray table.

THANK YOU FOR READING! J