Stephen Hale, Jr., Ph.D.

On occasion when we are visiting with a potential client, we’re asked what benefit a physics inspection of the equipment provides.  One thought commonly expressed is that since preventive maintenance (PM) is done on a regular basis, there should be no reason to have another testing procedure in place.  Another concern on everyone’s mind is the cost, both monetarily and in terms of having a system out of commission for a time during the testing.

For owners of registered x-ray equipment in Missouri, a new program being implemented by the Department of Health and Senior Services (DHSS) effective January 1, 2014, will require that all x-ray machines are inspected by a Qualified Expert (QE) on a regular basis.  All 4 inspectors at Integrated Science Support (ISS) have achieved QE status under the new state program.  The frequency of this inspection depends on the types of equipment present at the facility.  All registered facilities should have received a letter from DHSS by now explaining the new inspection system and informing them of their survey due date.  The QE will perform the machine inspections and then report their findings to the state for each facility before the due date.  Testing results from the previous 12 months can be submitted, so as to avoid rescheduling any previous arrangements between the facilities and the medical physicists.

In Kansas and Iowa, state regulations require annual inspections of x-ray equipment.  The results of these surveys must be available for inspection by the state.

In addition to regulatory reasons for having your machines inspected on a regular basis, there are patient care aspects that are directly impacted by the performance of the x-ray equipment.  Tests that are performed by ISS’s inspectors can find a variety of problems that aren’t immediately apparent to the end user and that can contribute to patient harm.

One test that is performed regularly on all fluoroscopic equipment is the alignment of beam limitation collimators with the image receptor.  The typical requirement is that the x-ray field itself must fall within 3% of the source-to-image distance (SID) of the image receptor.  Automatic collimation of the system should occur when magnification modes are changed, but it is not uncommon for our testing to reveal that when a mag mode is selected, the collimation does not decrease the size of the x-ray field.  On at least one occasion, a mobile C-arm fluoroscopic device was found to be within the 3% limit on the normal mode, but when all magnification modes were chosen, the collimators failed to decrease the radiation field.  Any patient being examined with this device would have excess tissue exposed to radiation without any visible image being created for diagnostic purposes.  A quick note to the biomedical support services at the facility resulted in the problem being fixed.

Integrated Science Support works to provide qualified expert services in Missouri, Kansas, and Iowa.  Contact us today to find out how we can help you maintain regulatory compliance as well as achieve excellent patient care in the diagnostic field.