CR Quality Control #2 - Creating a Baseline Phantom Image

Before you begin your routine monthly/semi-annual/annual radiographic equipment testing, you need to have a baseline image to compare it to.  The idea is that when you perform your actual tests in the future, you will not be able to tell whether or not your results are good or bad without having something to reference.  This method provides the measurable standard for calculations that will need to be performed later during testing.

We use one phantom with multiple test tools within it at the place I work now.  Select a medium-range kVp (I use 80 kVp).  You will also need an x-ray room with relatively low mA stations, a lead apron, and some kind of log to record your results in.  The vendor we purchased our phantom from provided us with a log.  We also took a brand new 14x17 cassette out of circulation and only use it for QC testing to reduce variability (and keep it with your phantom).

Procedure:

1. Erase your test CR cassette before any exposures are made.
2. Raise your x-ray tube to its maximum height and keep it above the floor (not directly over the table).
3. Place a lead apron on the floor directly under your central ray.
4. Place your CR cassette on top of the lead apron (without a grid cap).
5. Place your phantom on top of the cassette - make sure to orient the top of the phantom to the top of the cassette and keep this orientation for all future testing.
6. Center your x-ray beam to the phantom and cassette, leaving about one inch of light field outside the borders and onto the lead apron.
7. Select 80 kVp and 100 mA.  Try also setting 0.10 seconds and make an exposure.
8. Process the image and note the exposure indicator (S#, Exposure Index, or LgM)
9. If needed, adjust the time station so that you achieve an optimum exposure indicator number (*see note for proper levels of exposure indicator numbers)
10. Once you have the disired technical factors, annotate the date, exposure factors, and "baseline image" and send to PACS - your PACS administrator can create a folder for QC images 
11. Create an individual baseline image for each CR reader and log results.

*When attempting to expose your baseline image for optimum exposure indicator, you may need to consult the manufacturer guidelines or your physicist.  As a starting point, you can use the following:  

• S# = 200... if you double your time (or overall mAs), you will half your S#
• Exposure Index (EI) = 1800... if you double your time (or overall mAs), you will add 300 to your EI
• LgM = 2.1... if you double your time (or overall mAs), you will add 0.3 to your LgM

The Baseline exposure log should include the following information that will be referred to for later testing:

• Room number (that the test exposures are made in)
• SID
• Image plate identification number
• kVp
• mA
• time station
• Target exposure indicator number (this is your baseline S#, EI, or LgM)
• CR reader (number your readers if you have not already done so)

Keep your logs, test cassette and phantom/s in a safe place away from your other equipment to minimize risk of circulation with other supplies.  Next, we'll get into some of the monthly tests.

Other posts in this series:

CR Quality Control #1 - Screen Cleaning
CR Quality Control #2 - Creating a Baseline Phantom Image
CR Quality Control #3 - Exposure Indicator Calibration
CR Quality Control #4 - Contrast Evaluation 
CR Quality Control #5 - Sharpness
CR Quality Control #6 - Shading Correction
CR Quality Control #7 - Laser Jitter
CR Quality Control #8 - Image Artifacts and Noise
CR Quality Control #9 - Exposure Linearity
CR Quality Control #10 - Residual Image Testing

Employment Survey Results

Back in October of 2012, I posted a survey about the employment situation across the country and asked six questions relating to the job market aimed at new graduates from radiography school.  With any survey, the more responses received, the more accurate the results.  I received 30 responses to my questions, and here they are:

The results were anonymized, but it seems there are a range of responses across the board.  I know the job market is not as good as when I graduated from x-ray school in 2000, but if these responses are representative of the national average, I have seen worse. 

In my book, Becoming a Radiologic Technologist, I explained the criteria that a radiography program must have 75% of its graduates employed (in any tech job) within 6 months of graduation.  I would be interested in speaking to any of my readers who represent JRCERT to learn more about the re-accreditation process and statistics about radiography program probation due to low employment statistics. 

Until then, it seems that the market is competitive.  Like any field, that's not to say every graduate is guaranteed a job right out of school, or even a full-time day job.  There are positions available, but keep an open mind to the possibility that you may need to relocate, accept undesirable shifts, or have some delays in finding an ideal position.  I wouldn't discourage anyone from seeking an education in radiography, but you need to love what you're doing and be prepared for competition.

CR Quality Control #1 – Screen Cleaning

One of the most important, yet sometimes underperformed activities we can do to keep our image quality high is routine cleaning of image plate phosphor screens.  Each CR system manufacturer will recommend a schedule for routine cleaning of IP’s, but I tend to think that a monthly schedule serves my department well.  This may vary depending on your department’s patient volume and usage. 

How to clean: Remove image plate from cassette holder.  Inspect in good lighting to identify any potential dust, scratches, or flaking off of the phosphor layer (see images below) that may produce artifacts.  Always replace the IP if needed – discuss the need for replacement with a radiologist and/or your department manager if you are uncertain whether or not the plate has enough damage.

Take a non-abrasive cloth or gauze and dampen it with screen cleaner (see manufacturer’s guidelines for type of recommended cleaner).  Wipe in small circular motions until the entire screen has been properly wiped down and inspect for dust.  Make sure that you use something that does not leave a lint residue.  Do not place cleaner directly on image plate. 

Let each screen dry, being careful not to rest the phosphor side of the screen down.  Most cleaners are alcohol-based and should dry rather quickly. Make sure each plate is completely dry before re-inserting into the cassette.

Each IP at my facility (we are using FUJI CR) has a barcode that can be catalogued and records can be kept logging which plates were cleaned, when they were cleaned, and by whom.  It should also be noted when any damage to an image plate is identified, as well as if a plate gets replaced.  I chose a rather worn cassette for the following image because you should also visually inspect the cassette.  Some times the hinges that hold the image plate inside the cassette become loose leaving the plate to fall to the floor and become scratched.  It’s much cheaper to replace hinges on a cassette than to replace the phosphor screen.

Any radiologist will tell you if artifacts are seen on your images, but monthly cleaning of the image plates should keep them to a minimum.  This is one of the easier activities any rad tech or student can perform that can be extremely valuable to image quality in your department.  Normal wear and tear will occur as the image plates are processed, but keeping a log over time should help you predict how often you will need to replace screens and how your department should budget for them.

Other posts in this series:

CR Quality Control #1 - Screen Cleaning
CR Quality Control #2 - Creating a Baseline Phantom Image
CR Quality Control #3 - Exposure Indicator Calibration
CR Quality Control #4 - Contrast Evaluation 
CR Quality Control #5 - Sharpness
CR Quality Control #6 - Shading Correction
CR Quality Control #7 - Laser Jitter
CR Quality Control #8 - Image Artifacts and Noise
CR Quality Control #9 - Exposure Linearity
CR Quality Control #10 - Residual Image Testing

Merry Christmas!

You can download the Kindle version of my book, "Becoming a Radiologic Technologist" for FREE on Christmas Day.  Merry Christmas everyone!

Why is there a Barium Shortage?

For the last few months, our hospital has had trouble acquiring barium for our GI studies.  When I asked our suppliers why there has been such an issue, they told me that all barium was on back-order.  "Yeah right," I thought... when the heck has there ever been a problem getting barium?  I thought they might have forgotten to order some and they didn't want to own up to it.  The problem was that it kept happening!  We got to the point where we had scheduled patients, but not enough barium to complete the studies for the day.  There were several times that we used a courier to deliver supplies from one of our other hospitals within the organization, but eventually, they stopped allowing us to do that after some time because they had also run out.  Why is this happening now, and what is causing it?

Well, yesterday, I was speaking to one of our radiologists, and he informed me that there was a depletion of barite from the world's largest mines... the earth is simply running out!  I thought he was joking at first, but he encouraged me to "google" it.  I found some interesting things:

Most of my first search included headlines from news articles across the world stating things like "hospital forced to stop barium studies."  I guess I'm not the only one experiencing this.  I also ran across this letter from Bracco, the largest supplier of barium sulfate for radiology exam purposes. It goes on to list all of the produces which there is a shortage of, and also explains that they are attempting to fulfill back ordered products as soon as possible.  Among the list of products happens to be every single one my hospital uses for GI studies.  I also ran across a list of current drug shortages from the American Society of Health System Pharmacists which confirms the significance of the shortages.

Then I ran across this article, which explains that due to increased safety regulations in barite mines in China, the volume of barite production has fallen to about 25% of what it once was.  China is responsible for over 51% of the barite mining in the world.  India is the next largest supplier at about 14% The U.S. is responsible for about 9% while Morocco mines about 7%.  The rest of the world together supplies about 19% of the global supply.

The barite reduction is said to mainly be caused by increased safety regulations in China's mines.  There's also the fact that as the mines get deeper and drilling sites expand, there is increased cost for getting the barite to export ports.  If you dig deep (no pun intended) into some of the articles on google, you can find comments from people who claim to be associated with these mining companies (mainly from China and India) who are also stating that the world's supply of barite is being rapidly depleted, and propose that this is another reason for the reduction in barium sulfate production.  It is difficult, however, to find concrete sources for that information with the amount of searching I have done, but it's interesting nonetheless.  Other comments advise the world to begin looking for other materials that can perform the same job that barium sulfate currently does, which would lend some credibility to the notion that it is being depleted.

Could we be entering an era of no barium studies?  It's quite possible, although we will simply have to use another form of contrast media for the current exams we are performing with barium.  There's always water soluble contrast... and there's potentially a lot of money to be made for any manufacturer out there that can come up with a cheap and plentiful alternative to barium (I'll accept a 2% credit on all profits for giving you the idea).  I would love to hear what everyone is using as their barium runs out, along with the pros and cons of each.  Feel free to let me know in the comments!

Radiography Discussion Resources

Have you ever had a burning question about something radiography-related and didn't know where to turn?  You're not alone!  There are others like you who are interested in sharing ideas and providing information.  I have made many connections through discussion forums and websites that are strictly radiography-related, and it's important to have some resources to go to when you need some input, don't have answers to questions, or if you're willing to share your knowledge.  Here are some of the best discussion resources I have found on the web:

Aunt Minnie is a great site for anything from multi-modality news to job boards to discussion forums.  This is by far one of the largest sites with the widest range of contributors that I have come across.  If you're looking for research, a large number of technologists involved, or even CE credits, this is the place to start.

Wiki Radiography is growing, and already has many resources specific to radiography.  I like this one because you will always get a direct answer from a technologist.  There are techs from all over the world participating here including the U.S., U.K. and Australia.  Check out the many great articles and radiographic anatomy resources.

The Radiographer's Alliance is one that I have just recently browsed, but will become more involved in quickly.  With the welcoming description "the place where radiographers can really talk," I'm already feeling welcome.

                                                     

Radiopedia is another large site with literally tons of information.  You will find contributors from radiologists to every modality of imaging.  There are free lessons, tutorials, case studies, and articles posted here among the many discussion boards.  If you have a lot of brain space waiting to be occupied by radiology-specific info, start here!

Radiology Forums is a site that has recently been introduced to me... it's still growing, but I see a lot of promise here.  Any place that is willing to provide a safe environment for discussion is okay in my book.

If you are looking for answers not found on any of these resources, you can always check out Yahoo Answers.  You may run across some opinions that are rather ridiculous and misinformed, but every once in a while you'll strike gold.  I like it because those who are willing to answer questions with any integrity will provide a resource/link to support their answer.

Of course, I always like to hear from my readers and you can get involved here on my blog in the comments, or connect with me on Facebook, Twitter, Linked In, and even Pinterest.  

Radiography Employment Survey

I have spent a lot of time talking about the job market, tips for employment, and even health care politics.  I even published a book that goes into these topics in greater detail based off information and statistics from reputable sources like JRCERT (accredits radiography schools) and the U.S. Department of Labor Statistics.  Since my book has been published, I have received a lot of comments/dialogue about the job market in particular in various regions of the country - even from people who have not read my book and assume that I take a particular stance on whether or not the reader should be jumping into a career in radiography.  The comments are vast and can even be conflicting... in other words, one person would claim there are tons of jobs available if you are willing to travel, take a casual position, work nights, etc.  Others claim that there are next to zero options for them in their situation.

When I wrote my book, my goal was for it to be informative.  I discuss employment from a statistical standpoint with verifiable sources.  I realize there are some elements that quoting national statistics will simply overlook, and I have encouraged anyone purchasing my book to perform their own market research in the region they wish to work as a radiographer due to the competitive nature of jobs in our country today.  That is why I would like to conduct an informal survey.  I want to give YOU a voice as well.    

A large percentage of readers of my blog are students or new grads from the United States.  If this applies to you, I would like to encourage you to participate in this survey.  I can quote statistics until the sun goes down, and many of my readers do not have other sources for information in the health care setting.  So regardless if your experiences finding employment in radiography were positive or negative, I would love to hear about them and share them with my readers.  Below, I have six multiple choice questions and an optional essay response question that I will leave open until January 1 2013.  I wanted to make it short and sweet, but if it's still too time consuming, feel free to leave a comment to this post.  Thank you in advance for those of you who can participate.  Please be respectful of others with your comments. 

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