QC and Dosimetry

for CR and DR

Ika Bayuadi
LFMB FMIPA Universitas Indonesia
ikabayu201717@yahoo.co.id
Outline
▪ Urgency
▪ Quality Control
▪ Dose in DR

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Screen-Film World
▪ The film-screen characteristic (H&D) curve defined the air
kerma required at the detector
▪ OD gives immediate feedback on the x-ray factors selected by
the technologist
– Helps technologist to monitor image quality and (effectively) patient
dose (an overexposed film implies an overexposed patient…)

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Digital World
▪ Technologist has lost feedback between exposure setting and
the output image – the image brightness is always the same
▪ Noise in the image changes
– Low exposure = noisy image and chance of incorrect diagnosis
– High exposure = ‘clean’ image, radiologist gets an nice image, patient
gets a high(er) dose
▪ “Dose Creep” –tendency to set higher exposure factors to
produce ‘pleasing’ images (no complaints about IQ), but patient
dose is increased (not ALARA)
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Detector Characteristic

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Recommended testing (AAPM Report 93)
▪ 1. Component and Imaging Plate Physical Inspection and Inventory
▪ 2. Imaging Plate Dark Noise and Uniformity
▪ 3. Exposure Indicator Calibration
▪ 4. Linearity and Auto-ranging Response
▪ 5. Laser Beam Function
▪ 6. Limiting Resolution and Resolution Uniformity
▪ 7. Noise and Low-Contrast Resolution
▪ 8. Spatial accuracy
▪ 9. Erasure Thoroughness
▪ 10. Aliasing/Grid Response

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Standard Radiographic Testing
Many of these tests require x-ray exposure to the IP in a known and
reproducible manner
Generator calibration consisting of
– Output
– mR/mAs linearity
– HVL
– kVp accuracy
– Reproducibility (CV < 0,05) TG 93

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Beam characterization
The recommended setup

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Dark Noise and Uniformity
▪ Dark Noise
– No exposure, Erased IP
– Scan, with automatic scaling algorithm or fixed scaling algorithm (raw image,
AAPM Report No.93)
– ROI over 80% of image
– Criteria : uniform image, no artefact, specific EI (exposure index for each vendor)
▪ Uniformity
– verifies appropriate response of the IPs to a high incident exposure (10 mR, 80
kVp, 0,5 mm Cu and 1 mm Al, 180 cm SID)
– Processing and image post-processing → raw image!
– ROI over 80% of image
– Criteria : Uniform image without any visible artefacts with window/level
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adjustments, specific EI
Dark Noise and Unformity
Sample image dark noise and uniformity CR
Kodak (carestream), Processing: pattern
(Agfa : system diagnosis flat field, speed
class =200,
Fuji ; Test/sensitivity (L=1), semi EDR)
Image post-processing: Raw data no edge
enhancement settings, Window 512, Level
→ depend on exposure index
Criteria : Uniform image,artifacts artifacts
no artifacts, except profile bands in IP
direction
Quantitative : EIGP < 80

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Exposure Indicator Calibration
EI is an indicator of the average incident exposure on the IP, which is as only an estimate
of the incident exposure on the detector
200
Fuji PSP systems use a sensitivity number 𝑆≅
𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒(𝑚𝑅)

Kodak PSP use exposure index (EI), 𝐸𝐼 ≅ 1000 𝑥 𝑙𝑜𝑔 𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒 𝑖𝑛 𝑚𝑅 + 2000

Agfa system use lgM, logarithm of the median exposure value of the raw histogram and
SAL (Scan Average Level)
– 𝑆𝐴𝐿200 = 1214 𝑥 𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒 (𝑚𝑅) , lgM = 3.2768 − 𝑙𝑜𝑔 (4095Τ𝑆𝐴𝐿)²

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Exposure Indicator Calibration
▪ Incident exposure to the plate of ~1 mR is used to establish “exposure index”
accuracy. (SID 180 cm)
– Agfa CR: 75 kVp, 1.5 mm Cu, no delay to readout
– Fuji CR: 80 kVp, no added filtration, 10 minutes delay
– Kodak CR: 80 kVp, 0.5 mm Cu + 1 mm Al, 15 minutes delay
– TG 116: 80 kVp, 1 mm Al + 1 mm Cu + 1 mm Al, 10 minutes delay
– HVL requirements
– Scan and Criteria → table.5 AAPM Report No.93

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System Linearity and Autoranging Response
▪ Determines the response of the detector and readout systems to at least three
decades of exposure variation (1000 times difference).
– 0.1, 1.0, and 10 mR incident exposures at 80 kVp with 0.5 mm Cu and 1 mm Al filtration and 180
cm SID, consistent delay time between exposure and readout
– Scan, processing and image post-processing detail → table.6 AAPM Report No.93)
– The slope of the system response (expressed in terms of logarithm of exposure) vs. logarithm of
actual exposure

The beam filtration does not conform to the Agfa and Fuji, recommendations the lgM and S numbers might
not give the exact calibrated exposure indicator, response expected. An option is to use the manufacturer’s
recommended filtration, as this is a relative test.

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System Linearity and Autoranging Response
Kodak (carestream) CR
Log (E) vs Pixel value
3000
Log (E) vs Exposure Index
2500
3000,00
2000 y = 976,91x + 1905,4
Pixel Value

R² = 0,9999 2500,00
1500

Exposure Index
2000,00 y = 976,46x + 1900,8
R² = 0,9999
1000
1500,00
500
1000,00
0
500,00
-1,000 -0,500 0,000 0,500 1,000
Log (E) 0,00
-1,000 -0,500 0,000 0,500 1,000
Log (E)

𝑆𝑙𝑜𝑝𝑒𝑃𝑉 Τ1000 − 1 < ±0.1

CCs>0.95 𝑆𝑙𝑜𝑝𝑒𝐸𝐼 Τ1000 − 1 < ±0.1

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Laser Beam Function
▪ Evaluate scan line integrity, beam jitter, signal dropout
– 60 kVp, 5 mR and 180 cm SID, no filter
– Place the steel ruler on a 35 x 43 cm
– Scan, processing and image post-processing detail → Table.7 AAPM Report No.93)
– Ruler edges should be straight and continuous over the full length using 10 x magnification

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Limiting Resolution and Resolution Uniformity
▪ Spatial resolution tests measurement
– central and peripheral along the scan and sub-scan
directions and third at 45°.
– 5 mR, 60 kVp and unfiltered at 180 cm SID
– Scan, processing and image post-processing detail →
Table.8 AAPM Report No.93)
– Wire mesh image should be uniform and free of any
blurring across the image, using 10 x magnification

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Noise and Low-Contrast Resolution
▪ Method depends on manufacturer
– Leeds TO.12 acquire 0,5 ; 1,0 ; 5 mR using 75 kVp and 1 mm Cu with 10 minutes delay after exposure
– Scan, processing and image post-processing detail → table.9 AAPM Report No.93)
– criteria Contrast-detail threshold should be proportionately lower at higher exposures.

0,5 mR 1 mR 5 mR

0,5 mR 1 mR 5 mR 17
Spatial distance accuracy
▪ Verification on distance accuracy
– Calibrated “x-ray” ruler lead markers, eg : Leeds M1
– 5 mR using 60 kVp, no filtration, 180 cm SID
– Scan, processing and image post-processing detail on table.10 AAPM Report No.93)
– Measured distance should be within 2%

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Erasure Thoroughness
▪ The erasure test, evaluates the ability of the read/erase cycle to
remove residual signals from previous overexposures
– Place a lead block at the centre of cassette
– First Expose 50 mR using 60 kVp,no filtration, at 180 cm SID
– Process the IP
– 2nd expose 1 mR without lead object, with collimator positioned in 5 cm on each side of the IP
– reprocess one more time using “dark noise” setting
– Absence of a ghost image of the lead block in the 2nd image

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Erasure Thoroughness

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Aliasing/Grid Response
▪ Evaluated Moiré patterns
– Place the imaging plate/cassette in a bucky that contains an antiscatter grid (moving grid) so that
condition the grid lines are parallel to the laser-scan direction (cek perpendicular to)
– Expose 1 mR using 80 kVp, 0,5 mm Cu/ 1 mm Al filtration, a SID according to the specification of
the grid
– Moiré pattern should not be visible with grid lines perpendicular to scan direction
– For moving grid no moiré pattern should be visible in either direction

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Aliasing/Grid Response

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Recommended QC
▪ Daily (Technologist)
– Inspect system operation and verify operational status
– Erase cassettes before use, if unsure of status.
– When performing image QC, look for dust particles, scratches, and mechanical
friction marks in the images.
▪ Monthly (Technologist)
– Erase all plates in the inventory, perform spot checks on randomly chosen plates
(dark noise)
– Acquire QC phantom image and implement QC measurements (uniformity)

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Recommended QC
▪ Quaterly (Technologist)
– A cleaning program for all cassettes and imaging plates is necessary
– Perform qualitative and quantitative QC phantom analysis, including
resolution,contrast/noise, laser jitter, and exposure indicator accuracy.
– Review image retake rate; determine causes of unacceptable PSP images.
– Review QC exposure indicator database; determine cause of
under/overexposures,implement corrective action; generate quarterly reports.

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Recommended QC
▪ Annually (Physicist)
– Inspection/evaluation of image quality; spot check image processing algorithms
for appropriateness.
– Acceptance test procedures to verify and/or re-establish baseline values. Use
complete
– Review technologist QC activities and reports; evaluate retake activity, patient
exposure trends, QC records, and service history of the equipment

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 Calibration Energy
(AAPM TG116), determine Kstd
Added Nominal IEC
kVp
Filtration HVL Surrogate

0.5 mm Cu + (0-4)mm
66 - 74 6.8 mmAl RQA5
Al or 21 mm pure Al

• Establish the relationship between receptor dose and pixel value

using RQA5
• Normalization at RQA5 condition on phantom as a reference to
estimate the dose value on imaging plate (IP) in left and right lung
and heart in the thorax examination

METHODS 26
 ▪ Agfa CR ▪ Fuji CR
6 7 y = 4.4822e-0.008x
y= 2.1436e-1E-04x R² = 0.9402
5 6
R² = 0.8042
5 Pixel Value/mAs vs air
4

air kerma (mR)

kerma (mR)
air kerma (mR)

pixel value/mAs vs air

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kerma RQA5
3
Expon. (pixel value/mAs 3 Expon. (Pixel
2 vs air kerma RQA5) Value/mAs vs air
2 kerma (mR))

1 1

0 ▪ Kodak CR 0
0 200 400 600
0 20.000 40.000
Pixel value (PV)/mAs pixel Value/mAs
7
y = 3,7691e-0,002x
6 R² = 0,9202
5
air kerma (mR)

RESULTS 4
3
2
pixel value/mAs vs air
kerma RQA5

Expon. (pixel value/mAs vs

air kerma RQA5)
1
0
0 1000 2000
Pixel value/mAs
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 7

5
RESULTS

air kerma (mR)

4 Agfa

Fuji
3
Kodak
2

0
0 10.000 20.000 30.000 40.000 50.000
pixel value/mAs

X-Ray CR
Filter kVp set mAs
HVL
mm Cu mm Al
A Agfa 0.5 4 80 20 6.73
B Kodak 0.5 4 79 20 6.79
C Fuji 0.5 4 78 20 6.87
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 Estimate dose on IP (mR)

CR Right Lungs Left Lungs Heart

Agfa 1.807 ± 0.001 1.801 ± 0.001 1.868 ± 0.001

Fuji 3.678 ± 0.004 3.66 ± 0.001 3.875 ± 0.001

Kodak 3.125 ± 0.001 3.108 ± 0.002 3.292 ± 0.002

RESULTS
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Thank You

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