Revision History


The intent of the CT Accreditation Program is to use the information obtained from the review of both clinical and phantom images to assess overall image quality. Your facility will need to submit up to four specified phantom scans and corresponding dosimetric data using your facility’s routine clinical adult head, adult abdomen, pediatric head and pediatric abdomen protocols. In order to be accredited with the ACR, a CT unit must pass both the clinical and phantom image quality tests. The phantom will fail (and the unit will fail ACR accreditation) if the dose from the CT unit exceeds the pass/fail criteria. The facility must repeat the entire ACR phantom and dosimetry portion of the accreditation testing, and pass, for the unit to be granted accreditation.


Materials submitted for accreditation review are sent to 2 physicist reviewers in active practice. Phantom images are reviewed for image quality and radiation dosimetry.


An ACR phantom (Gammex 464) must be used to accredit all units used to produce diagnostic clinical images for patients at the facility. A complete set of phantom images—along with dose measurements taken with the appropriate dose phantoms—from every CT unit must be submitted. Using the Gammex 464 phantom and Computed Tomography Dose Index (CTDI) phantoms, your medical physicist will be able to calculate various descriptors of dose for your adult head, adult abdomen, pediatric head (1 y.o.) and pediatric abdomen (5 y.o., approx. 40 lbs) examinations in correlation to your use of the scanner and your application.


When submitting images for the ACR quality phantom, submit one set of contiguous images starting with the BB's in Module 1 through the BB's in Module 4. For the dosimetry phantom, submit all images from a single axial rotation; this must include either the center or 12 o'clock measurement. 


The phantom must be ordered from the manufacturer. The order form for the Gammex 464 phantom is available on the ACR's CT website. Please make sure that you order your phantom as soon as possible after you receive your CTAP number (assigned to you with your initial application) to allow ample time for shipping and completion of all testing materials within the allotted time frame provided by the ACR.


The ACR CT accreditation phantom has been designed to examine a broad range of scanner parameters, including:


Positioning accuracy
CT # accuracy
Low contrast resolution
High contrast (spatial) resolution
CT number uniformity
Image noise


You will not have to assess all of the above measurements as part of your phantom submission for accreditation. You will, however, use all of them for your routine QC.


Please be aware that the requirement for CT accreditation is that facilities use the same protocols for the Gammex 464 phantom that the facility uses for its clinical imaging.


Failure to comply with this requirement could result in failure to achieve accreditation. The only exceptions to this are that automatic mA modulation must be turned off, the scan field of view (SFOV) may be adjusted to a size appropriate to the size of the phantom and a display field of view (DFOV) of 21 cm is to be used.


It is essential that the scan acquisition parameters match your facility’s clinical use in all portions of your phantom submission:

1. Phantom Data Form

2. Gammex 464 phantom images

3. Dose Data Forms

4. CTDI phantom images


If your facility uses dual energy protocols for one or more of the required ACR Phantom Image Quality or CTDI scans, please contact the CT Accreditation program to notify them of your dual energy submission. The online system forms do not accommodate dual energy phantom submissions at this time. Download and complete the CTAP Phantom Data/Dose Forms, fill out all parameters and submit via email, modifying as appropriate. Since there is not an area to upload additional information in the online system, you will need to forward any explanations or additional information by email. This information will be forwarded to reviewers. The online forms must still be completed. The techniques for the higher energy can be entered in the online forms. 

 

ACR Image Quality Phantom Images

Scan the ACR phantom as per the testing instructions using the dual energy protocol.  Submit the dual energy reconstruction used for interpretation. With regard to CT number accuracy, follow the testing instructions: “If you are routinely using other than 120-130 kVp for the adult abdomen protocol and your CT numbers do not meet the criteria listed, please submit an additional scan of module 1 using 120-130 kVp.”   

 

CTDI Images

For the dosimetry, it is recommended at this time to use a dual energy protocol in the axial mode. The dosimetry can be acquired in either a single scan or two scans (add CTDIs for each independent energy) depending on the available energy selection modes for axial scans.


The Phantom Site Scanning Data Form and the Dose Calculation Forms are part of the online testing package that you must submit in the ACR Accreditation database, ACRedit. There are generic blank forms available on the CT Accreditation page under the “Gather Data” heading. These will allow you to gather the data, but you must enter the data into the online testing package and submit the data to the ACR. Please note that the CT Phantom Data/Dose Forms have SE and DE tabs. You only need to complete the tabs relevant to your submission type.


The ACR CT accreditation phantom (Gammex 464) is a solid phantom containing four modules, and is constructed primarily from a water-equivalent material. Each module is 4 cm in depth and 20 cm in diameter. There are external alignment markings scribed and painted white (to reflect alignment lights) on EACH module to allow centering of the phantom in the axial (z-axis, cranial/caudal), coronal (y-axis, anterior/posterior), and sagittal (x-axis, left/right) directions. There are also “HEAD”, “FOOT” and “TOP” markings on the phantom to assist with positioning.



Module 1 is used to assess positioning and alignment, CT number accuracy, and slice thickness. The background material is water equivalent. For positioning, the module has 1-mm diameter steel BBs embedded at the longitudinal (z-axis) center of the module, with the outer surface of the BB at the phantom surface at 3, 6, 9, and 12 o’clock positions within the field of view (19.9cm center to center). To assess CT number accuracy, there are cylinders of different materials: bone-mimicking material (“Bone”), polyethylene, water equivalent material, acrylic and air. Each cylinder, except the water cylinder, has a diameter of 25 mm and a depth of 4 cm. The water cylinder has a diameter of 50 mm and a depth of 4 cm. To assess image width, two ramps are included that consist of a series of wires that are visible in 0.5-mm z-axis increments.




Module 2 is used to assess low contrast resolution. This module consists of a series of cylinders of different diameters, all at 0.6% (6 HU) difference from a background material having a mean CT number of approximately 90 HU. The cylinder-to-background contrast is energy-independent. There are four cylinders for each of the following diameters: 2 mm, 3 mm, 4 mm, 5 mm and 6 mm. The space between each cylinder is equal to the diameter of the cylinder. A 25-mm cylinder is included to verify the cylinder-to-background contrast level and to assess the contrast-to-noise ratio.





Module 3 consists of a uniform, tissue-equivalent material to assess CT number uniformity. Two very small BBs (0.28 mm each) are included for optional use in assessing the accuracy of in-plane distance measurements. They may also be used to assess section sensitivity profiles.






Module 4 is used to assess high contrast (spatial) resolution. It contains eight bar resolution patterns: 4, 5, 6, 7, 8, 9, 10 and 12 lp/cm, each fitting into a 15-mm x 15-mm square region. The z-axis depth of each bar pattern is 3.8 cm, beginning at the Module 3 interface. The aluminum bar patterns provide very high object contrast relative to the background material. Module 4 also has four 1mm steel beads, as described for Module 1.




Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes

3-13-20Dual energyInformation added regarding dual energy protocol submission
11-19-2020
Added image submission instruction box



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