Personnel Qualifications

Interpreting Physician Personnel Qualifications [1]

• Must meet country’s qualification requirements

• Must meet country’s qualification requirement

• Interpret 960 mammographic examinations over a 24-month period

  15 Category I CME in mammography in a 36-month period

• The ACR Practice Guideline for the Performance of Screening and Diagnostic Mammography recommends that diagnostic mammograms be performed under direct supervision. Direct supervision is defined as the physician being present and immediately available to furnish assistance and direction throughout the performance of the procedure. Direct supervision may also be accomplished via telemammography as long as the interpreting physician is immediately available.

Medical Physicist Personnel Qualifications

• Must meet country’s qualification requirements

• Survey 2 mammography facilities and 6 mammography units over a 24-month period

• Obtain15 CME/CEUs in mammography in a 36-month period

Technologist Personnel Qualifications

• Must perform 200 mammographic examinations over a 24-month period

• 15 Category 1 CEUs in mammography in a 36-month period

Mammography Equipment Quality Control (QC)

Documentation of quality control (QC) is required. Detailed instructions for each of the tests listed below are contained in the 

• Film/Screen units: 1999 ACR Mammography Quality Control Manual.

• FFDM/DBT units: 2018 ACR Digital Mammography Quality Control Manual

Mammography Equipment Evaluations (Acceptance Testing)

The medical physicist is required to perform a Mammography Equipment Evaluation when a new unit or processor is installed, a unit/processor is disassembled and reassembled in the same or a new location, or major components of a mammography unit/processor equipment are changed or repaired. This applies to screen-film, FFDM and DBT units and includes previously owned units, recognized units moved from one site to another, and new units replacing previously recgonized units. All problems must be corrected before the new/changed equipment is put into service for examinations or film processing.

Annual Medical Physicist’s Survey

The medical physicist must perform the QC outlined in the 1999 ACR Mammography QC Manual or 2018 ACR Digital Mammography QC Manual at least annually. The medical physicist should provide a written report of the survey’s findings to responsible physician(s) and professional(s) responsible for service of the equipment. 

1999 ACR Mammography QC Manual (Screen-Film Units)

• Mammographic Unit Assembly Evaluation

• Collimation Assessment

• Evaluation of Focal Spot Performance

• Automatic Exposure Control (AEC) System Performance

• Uniformity of Screen Speed    

• Artifact Evaluation                    

• Phantom Image Quality Evaluation    

• kVp Accuracy and Reproducibility       

• Beam Quality (Half-Value Layer) Assessment

• Breast Entrance Exposure, Average Glandular Dose and Radiation Output Rate

• Viewbox Luminance and Room Illuminance

2018 ACR Digital Mammography QC Manual

• ACR DM Phantom Image Quality

• DBT Z Resolution

• Spatial Resolution

• DBT Volume Coverage

• Automatic Exposure Control System Performance

• Average Glandular Dose

• Unit Checklist

• Computed Radiography (if applicable)

• Acquisition Workstation Monitor QC

• Radiologist Workstation Monitor QC

• Film Printer QC (if applicable)

• Evaluation of Site's Technologist QC Program

• Evaluation of Display Device Technologist QC Program

• Manufacturer Calibrations (if applicable)

• Collimation Assessment

Technologist QC Program

A QC program must be implemented for all units and should be established with the assistance of a medical physicist. The radiologic technologist must perform the QC tests listed below at the minimum frequencies specified in the QC Manual being used. The medical physicist should identify the person responsible for performing the tests and may choose to increase the frequency of testing based on the facility and usage. If any QC parameter being monitored falls outside of the control limits, corrective action should be taken. A medical physicist should be available to assist in prescribing corrective actions for unresolved problems.

1999 ACR Mammography QC Manual (Screen-Film Units)

• Darkroom cleanliness 

• Processor QC

• Screen cleaning

• Mammo phantom imaging 

• Film-screen contact test 

• Compression pressure monitored

• Repeat analysis

• Viewboxes and viewing conditions

• Analysis of fixer retention

• Visual checklist

2018 ACR Digital Mammography QC Manual

• ACR DM Phantom Image Quality

• Computed Radiography Cassette Erasure (if applicable)

• Compression Thickness Indicator

• Visual Checklist

• Acquisition Workstation Monitor QC

• Radiologist Workstation Monitor QC

• Film Printer QC (if applicable)

• Viewbox Cleanliness (if applicable)

• Facility QC Review

• Compression Force

• Manufacturer Calibration (if applicable)

• Optional - Repeat Analysis                                                                                                                                  

Record Keeping

• Must follow country’s record keeping requirements and/or ACR record keeping requirements below:

  • Current mammograms and records must be kept by the facility:

  • For at least 5 years, or

  • For at least 10 years if no additional mammograms of the patient are performed at the facility, or

  • For FFDM, either the original or lossless compressed digital data or hard-copy films of final interpretation quality must be maintained.

Preventive Maintenance

Preventive maintenance should be scheduled, performed, and documented by a qualified service engineer on a regular basis. Service performed to correct system deficiencies should also be documented and service records maintained by the facility.

Clinical Image Evaluation and Labeling

Facility’s must review 2 (fatty and dense) typical clinical examinations and attest to meeting the ACR clinical image quality and labeling requirements found below. 

Exam Requirements

• Should evaluate two Clinical images, a fatty case, and a dense case, 2D acquired or 2D synthesized images, as currently allowed.

• Should include CC and MLO images of both breasts

Exam Identification and Labeling

Each image should be clearly and permanently labeled (a permanent sticker label is acceptable for film) with the information below:

• Name of patient (first and last)

• Additional patient identifier (e.g., medical record number or personal identification number; date of birth is less desirable)

• Date of examination

• Standardized view (MLO, CC) and laterality (R/L) markers 

• Facility name and location (must include city, and region)

• Technologist identification, such as unique initials

• Cassette/screen identification (usually an Arabic numeral written or pressed on the screen). This is used to identify screens with artifacts or defects.

• Mammography unit identification number (usually a Roman numeral), if more than one unit in the facility. 

• A patient ID system for hard copy (strongly recommended)

  • More permanent than stick-on labels

  • Information reproduces on copy films

  • ID should fit squarely in its designated space, near the edge of the film

  • Not acceptable if any information is illegible, does not fit, or is lopsided, causing cut-off of information

• Separate date stickers for hard copy (recommended)

  • Allows for the date to be easily read with overhead light

  • May be color-coded by year to facilitate sorting of exams

• Technical factors

  • Include target-filter combination, kVp, mAs, exposure time, compression force, compressed breast thickness and degree of obliquity

Mammography Physician Quality Assurance and Medical Audit

Each facility must establish and maintain a mammography medical outcomes audit program to follow up positive mammography assessments and to correlate pathology results with the interpreting physician’s findings. The ACR strongly recommends that facilities use the ACR Breast Imaging Reporting and Data System (BI-RADS®) final assessment codes and terminology for reporting and tracking of mammography outcomes; however, there is no requirement that the mammography facilities currently recognized by the ACR, nor those applying for recognition in the future, purchase any ACR products in order to obtain or maintain their ACR recognition. The BI-RADS® Atlas also contains guidance on monitoring outcomes and conducting a mammography audit.