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Frequently Asked Questions
(Click on a category to expand)
Accreditation
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We
want to become accredited. What is our first step?
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The short answer is:
Call your NPC consultant! For nuclear medicine or PET accreditation,
contact
Dave Close or
Sharon Long. For CT, MRI, breast MRI, mammography ultrasound,
breast ultrasound, or stereotactic breast biopsy accreditation, contact
Bob Kobistek.
You should also visit the
website of the accrediting body, the American
College of Radiology, The
Joint Commission, or the
Intersocietal
Accreditation Commission. For ACR accreditations, you should
download the program requirements documents and read them over. There
are also clinical imaging guides which you should eventually also read.
Be sure to contact your NPC representative early in the process. We
need to schedule visits for phantom imaging, and we can help answer your
questions along the way.
Direct links to the ACR
Program Requirements Documents are as follows:
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The new Medicare Improvements for Patients and Providers Act (MIPPA)
requires imaging centers who offer certain advanced imaging modalities (CT,
MRI, PET, Nuclear) to be accredited by January 1, 2012 in order to be
reimbursed under Medicare Part B. Does this apply to hospitals?
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No. The requirements apply only to freestanding imaging centers.
Off site hospital-based imaging centers are also exempt if they bill through the
hospital for the technical component of the exam. For more detailed
information, visit the ACR website FAQ's at
www.acr.org/accreditation/10-CMS-Accreditation-Requirements.aspx
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We
use a mobile service for PET, MRI, and/or CT. Who has to be
accredited, the mobile company or us?
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For starters, the
accreditation programs involve not just the equipment and image quality, but
also personnel qualifications, policies and procedures, quality assurance,
etc. Taken together these requirements involve not only the equipment,
but the radiologists and the facility as well. So unless the mobile
company provides complete turnkey service, including image reading, billing,
quality assurance, etc., the responsibility for accreditation falls on the
facility. In addition, the accreditation requirements of the MIPPA
fall on the entity who bills Medicare, which in most cases would be the
facility, not the mobile company.
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Mammography
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Should mammography patients be given thyroid shields?
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No. In the fall of
2010, the popular TV doc, Mehmet Oz, aired a program in which he recommended
to his viewers that they request thyroid shields be provided during
screening mammography examinations. This is an erroneous
recommendation and not based on scientific fact. The radiation dose to
the thyroid from scatter and tube leakage during a mammography exam is less
than 0.005 mGy. The presence of a thyroid shield could also cause
image artifacts. In April 2011, the ACR and the SBI published a joint
statement on the use of thyroid shields during mammography, which you can
access with
this link.
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We
are installing our first full field digital mammography unit. What
should we know about getting ready for the physicist acceptance test?
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The most common oversights
in the installation of new FFDM units relate to the hard-copy printer.
Since the radiologists read mammograms on the soft copy workstations, it's
common for facilities to consider of the printer as an afterthought. (See
FAQ on this subject). Other items to remember:
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As in all mammography
installations, everything has to pass before the physicist can provide a
report to the ACR. Unlike the annual physicist survey, the testing
performed after installation (called a Mammography Equipment Evaluation
or MEE) does not allow for the 30 day margin in correcting deficiencies.
All deficiencies must be corrected before the unit may be used
clinically.
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Be sure all
connectivity is enabled. The physicist must not only test the FFDM
unit but also the radiologist viewing stations and the printer.
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If remote viewing
stations are being installed, be sure arrangements can be made to have
the physicist visit the various sites.
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Be sure the physicist
has access to all pertinent QC manuals -- from the FFDM manufacturer,
the soft copy workstation manufacturer and also from the printer
manufacturer. Your physicist may request copies of these manuals
in advance of the acceptance test in the event he is not familiar with
the particular model.
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Computed Tomography
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What
are the requirements of the new Ohio Department of Health regulations
relating to controlling patient radiation exposure?
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Effective April 15,
2009, new ODH regulations require any facility who provides CT
services to develop an ALARA program for CT patients. The program
must be developed in cooperation with a radiation expert (medical
physicist) and must be reviewed annually. That's about all the
regulation says; there is not much detail, and they have not released
any regulatory guidance. At this time, NPC is assisting all our CT
clients with developing and maintaining the ALARA program and performing
annual reviews. As our CT facilities experience ODH inspections
and we gather comments from inspectors, we will continue to relay what
we've learned about ODH's expectations to our clients.
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Are
bismuth shields, for eyes, breasts, and/or thyroid, a good idea?
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The flexible, disposable,
commercially available shields are placed over the breasts, thyroid, or eyes
to reduce the organ dose to the specific region. Whether or not they
are effective vs. simply reducing the mAs per rotation is still being
debated. Of course there is a degradation in image quality, as will
always be the case when radiation dose is reduced. Some researchers
claim that the image quality degradation is acceptable and a worthwhile
tradeoff when dose reduction is considered. Other researchers point
out that although the shields attenuate the primary beam when the tube is in
the anterior position, when the tube is in the posterior position, the
shields attenuate radiation that has already contributed to patient dose and
contains useful image information. Therefore it might be better and
less expensive to reduce dose by reducing the technique or using tube
current modulation. The AAPM is currently working on a position
statement on the use of these shields, and NPC will post it as soon as it
becomes available.
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MRI
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My ACR
phantom has an air bubble in it. What should I do?
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A small air bubble
isn't a problem. The most obvious drawback of a bubble is that
once the bubble becomes large enough, you can no longer see the top of
the phantom. This prevents you from measuring the phantom diameter
on slice # 5 from the top to the bottom. However, unless the
bubble is huge, you can do what the ACR reviewers do. You just
measure the diameter of the phantom slightly to left or the right of top
dead center. Start drawing the line on the edge of the
water-filled part of the phantom, avoiding the bubble. Finish the
measurement on the opposite side of the phantom making sure the
measurement line passes through the center of the grid. However,
if the bubble becomes very large, we recommend you have the phantom
refilled or topped off.
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How can
I have my phantom refilled?
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Can I
top off the phantom myself?
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Yes. It is very
easy to top of the phantom using a syringe and distilled water.
There is a commercially available refill kit. NPC does not
recommend purchasing this kit. The kit costs over $200 and
consists of nothing more than a few ml of distilled water and two
syringes. We are currently working on written instructions on how
you can top off the phantom using distilled water and a syringe.
As soon as we finish these instructions they will be posted on this
website. Meanwhile, if you are an NPC customer, you can call Bob
Kobistek at 888-456-5255 if you need assistance with topping off your
phantom. But if you'd like to give it a try, here's what you do:
Set the phantom on the table with the inferior end up. Use a 5/16"
nutdriver and remove the nylon plug. There are two plugs.
One opens up the captive cylinder inside the phantom, which contains
solution with a higher concentration of nickel ions. Do not remove
that plug -- remove the other one. Tilt the phantom so the air
bubble comes up to the fill opening. Use a syringe filled with
distilled water to top off the phantom. I find that using a
syringe with a hypodermic needle works great because you can inject the
water below the surface and avoid having it bubble up and out of the
phantom. When you are finished filling the phantom replace the
plug and tighten gently. Over tightening will cause the
plug threads to strip.
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Physics Consultants, Ltd.
