Debbie Childs RDMS, RVT Sonographer Murphy Medical Center Murphy, NC

Debbie Childs RDMS, RVT Sonographer Murphy Medical Center Murphy, NC

Worked at Murphy Medical Center as a sonographer for 18 years Registered in Abdomen, OB/GYN, Breast, & Vascular Ultrasound ACR Accredited for 16 years

Why establish your own QC program? New ACR Requirements QC Notebook Phantoms Testing Transducers Recommended images Record keeping/ worksheets Image Optimization Ultrasound Gel Joint Commission Surveying

QC ensures that ultrasound equipment is operating consistently at it s expected level of performance QC testing ensures distance measurements are accurate and the image is of the best possible quality from the image scanner

Provide patients with high quality exams Earlier detection of malfunctions and defects Your safety & your patients Establishes records Valuable tool for prospective employers ACR recommends it.

Considered the GOLD Standard Since 1987 the ACR has accredited more than 35,000 facilities in 10 different imaging modalities Ultrasound Breast Ultrasound Nuclear Medicine Stereotactic Breast Biopsy Radiation Oncology MRI Breast MRI Mammography CT PET There are over 6,000 facilities accredited in ultrasound nationwide

Acquisition of clinical images with corresponding physician reports Quality Control Documentation Physician Peer-Review Program

Personnel qualifications (Physicians and Technologists) Time requirements on the submission of exams 45 days to complete the testing portion of the accreditation process Exams cannot predate the application date by more than 6 months

Initial Accreditation Certified or eligible for certification by ARDMS or ARRT (S) Renewal Accreditation Registered as RDMS (OB or AB), RVT, RT (S), RT (VS), or RVS Sites applying for Vascular Ultrasound Accreditation must an RVT, RT (VS), or RVS on site

New ACR QC Requirements revised June 1, 2014 Annual Survey Strongly recommend QC be done by a medical physicist. Preventative Maintenance reports by service engineers will be accepted. QC testing must be performed on all machines and transducers in clinical use annually.

QC testing be performed semiannually The QC program should include: System sensitivity/ Penetration Vertical and horizontal distance Image uniformity Axial/ lateral resolution Assurance of electrical and mechanical safety and cleanliness Acceptance Testing

Letter stating who the program director is Goals and responsibilities Phantom measurement worksheets Image uniformity worksheet PM reports Any other appropriate policies/procedures

Provide our patients with high-quality ultrasound exams Detect malfunctions/ defects sooner Establish quality control records

Test and record measurements of all transducers in clinical use at least 2-3 times a year Visually inspect the ultrasound system daily Clean the ultrasound system and transducers after each exam Adhere to all infection control policies

Include the following: Date and name of person performing testing Type and serial number of ultrasound system Phantom model and serial number Model and serial number of the probe Monitor settings brightness/contrast

Scanner vs. Primary Interpretation

All cords and cables intact? Any transducer cracks? Are the transducers clean? Are the air filters clean?

Wheel locks working? Wheels rotate easily? Are all accessories fastened securely to US system? Image monitors clean?

Have sonographic features similar to soft tissue Contain nylon strings along with structures that mimic cysts and solid masses Make sure the phantom is capable testing grayscale uniformity

System Settings: Abdomen preset Harmonics turned off Crossbeam turned off TGC pods at 50% Virtual convex turned off (linear probe)

Vertical Calibration ** Horizontal Calibration ** Sensitivity/ Penetration ** Axial / Lateral Resolution ** Focal Zone Focal Width Dead Zone Uniformity ** **Required in ACR annual report

Vertical distance measurement obtained along the axis of the sound beam

Horizontal measurement that is obtained perpendicular to the axis of the sound beam.

The ability of an imaging system to detect and display weak echoes from small objects located at specified depths

Dead Zone- distance from the front face of the transducer to the first identifiable echo at the phantom/ patient interface

Measures minimal reflector separation between objects located one beneath the other

Measures the minimal reflector separation between two objects that are side by side

The measurement from the surface of the transducer to the focal point in which the intensity and lateral resolution is the greatest

Measures the width of the pin at the focal zone

Vertical or radially oriented streaks? Dropouts? Reduction of brightness near edges of the scan? Brightness transitions between focal zones?

Change your angle Reposition your patient Try a different preset Adjust your focus Switch transducers

Cone in / Decrease your sector size/width Add/ take away Harmonics, Crossbeam, SRI Pause before freezing the image PRF & color box = better color fill-in

Abdomen Renal

4 MHZ 5 MHZ, adding focus

5 MHZ Curved array 9 MHZ Linear Array Virtual convex, Harmonics off

5 MHZ curved 8 MHZ linear, virtual convex, harmonics off

Abdomen preset, 5MHZ Decrease sector width, zoomed in

Abdomen preset Decrease PRF

How do you disinfect your transvaginal probes? How long do you soak your probe? What do you use to time how long you soak the probe? What do you do after you have soaked your probe?

Where do you store your transvaginal probe? Do you test your Cidex every day? Where is your eye wash station? How do you test the temperature of the Cidex?

Where you store your Cidex Cidex testing log sheets Test strips testing log sheets Expiration dates Wet/ kill times on Sani-cloths

RELAX BE TRUTHFUL KEEP IT SIMPLE

Latest Recommendations from FDA, SHEA, & COCA: PURPOSE- To minimize the risk of infection

Invasive procedures Mucous membranes Neonates Sterile body sites and non-intact skin

Low risk procedures/patients with intact skin Single use 8oz bottles are recommended Discard single use bottles after 30 days

Use single dose packets on precaution patients Tips of the bottles or dispensing nozzles must NOT come in direct with anything Wipe down gel warmers daily with Sani-Cloths

Warm the ultrasound gel only when needed. Do not store the bottles of ultrasound gel in the warmer throughout the day. Clean ultrasound gel warmers daily.

Recently FDA approved Extremely concentrated, sprays on thin More than 100 scans per bottle. Decreased risk of contamination

dchilds@frontier.com

Oleszkowicz, S, et al (2012). Infections associated with use of ultrasound transmission gel: Proposed guidelines to minimize risk. Infection Control & Hospital Epidemiology. 2012;33(12) Zagzebski, James & James Kofler Ultrasound Equipment Quality Assurance 1235-1237 Quality-Safety/Accreditation Ultrasound. (2014, June 1). Retrieved September 28, 2014, from www.acr.org. Medical devices/safety/alerts and notices. (2012 June 8) Retreived September 28 2014 from U.S. Food and Drug Administration www.fda.gov

Safety Communication: Bacteria Found in Other Sonic Generic Ultrasound Transmission Gel Poses Risk of Infection. (2012, April 12). Retrieved September 28, 2014, from Centers For Disease Control: www.emergency.cdc.gov/coca/reminders/2012/220.asp BB Medical Surgical. (n.d.). Retrieved October 12, 2014, from BB Medical Sugical: http://www.bbmedicalsurgical.com/