LECTURE 03:

RESOURCES AND REQUIREMENTS FOR

THE IAEA REMOTE QC PROGRAM
 2

NOTE TO READER
• The IAEA publication ‘Diagnostic Radiology Physics: A Handbook for Teachers and Students’ (International
Atomic Energy Agency (IAEA), Diagnostic Radiology Physics, Non-serial Publications, 2014) contains basic
information on radiography and mammography, instrumentation, image quality/image perception, dosimetry etc.
• Additional training material, in the form of PowerPoint presentations, has been developed for each chapter of the
handbook and are uploaded at the IAEA Human Health Campus (
Human Health Campus - Diagnostic Radiology Physics: A Handbook for Teachers and Students (iaea.org). They
are designed, as an additional training tool to assist in the better presentation of the content of information in the
Handbook.
• The current training material is not designed to replace the existing PowerPoints. It builds upon these
presentations in order to deepen knowledge in the specific topics reviewed in the new publication “International
Atomic Energy Agency (IAEA), Implementation of a Remote and Automated Quality Control Programme for
Radiography and Mammography Equipment, Human Health Series No. 39, IAEA, Vienna 2021”.
 3

LEARNING OBJECTIVES
• By the end of this presentation, you should be able to:
• explain the time commitment requirements for the remote QC programme

• identify the human resource, IT, local infrastructure, data protection, centralised data repository requirements

• describe the financial considerations

 4

OUTLINE

• Time commitment requirements for the remote QC program

• Human resources requirements
• IT requirements
• Staff
• Local infrastructure
• Data Protection
• Centralized data repository
• Financial considerations
 5

STAFF AND FACILITY TIME

COMMITMENTS FOR THE PROGRAM
• Key staff in the facility must be assigned formal time to ensure a successful implementation
of the program by
• Adapting and adopting the remote QC protocols to reflect and cover the local needs to develop
the local testing procedures
• Setting up the data and software infrastructure, mainly done by IT experts, for the storage, data
integrity and analysis of the images and the transmission of the results and images
• Training of the corresponding professionals, mainly by the responsible CQMP, to properly
perform the tests and frontline analysis either for the transmission of the required results or the
images
• To periodically and consistently run the program, preventing testing fatigue and program lapsing
 6

HUMAN RESOURCES
REQUIREMENTS
• Institution should have a well-defined quality assurance team that oversees activities for
high quality images using an appropriate patient dose
• The following individuals are key elements of an effective QC/QA program:
• Medical radiation technologist
• Must be located on-site
• Is responsible for
• Acquiring the images of the phantoms
• Recording information on data forms
• Sending the data or images to the processing server, or analysing the images with the ATIA application
• An image artifact evaluation
• As applicable implement corrective actions
 7

HUMAN RESOURCES
REQUIREMENTS
• Medical physicist:
• The physicist may be on-site, but usually remote from the actual imaging rooms in the facility
• Responsible for training all appropriate staff in the facility
• Understands and works with the ATIA application
• Responsible for the establishment of baseline values of the various metrics that will be monitored
over time
• Must be available to review the data from various imaging facilities to provide oversight and
recommend follow-up and corrective measures in a timely manner.
 8

HUMAN RESOURCES
REQUIREMENTS
• Radiologist:
• Responsible for the implementation of radiation protection policies, including the
appropriateness of the examination and optimization of the protocols
• Should be available to discuss image artifacts and seek corrective actions

• Administrative Head of the department:

• Responsible for assigning dedicated time to personnel to perform the necessary QA activities and
• Procuring the funds needed to keep the QA program running
• When appropriate, securing technical service to be provided as soon as possible when corrective
actions are identified by the QC program
 9

HUMAN RESOURCES
REQUIREMENTS
• IT specialist or engineer:
• Responsible for correct installation of the ATIA application, internet access and bandwidth
issues, lossless transmission of data and images, and maintenance of the PACS infrastructure.
• Service engineer:
• Responsible for preventive and corrective maintenance issues
• Required for ensuring access to the required images and needed for assisting in the correct
transmission.
• Help with identifying the cause of problems identified by the QC program
 10

LOCAL IT INFRASTRUCTURE AND

STAFF REQUIREMENTS
• For facilities without image transmission capabilities
• Simplest model for implementing a remote QC program is through the transmission of
numerical data obtained from measurements, without the need to transmit the associated
images
• Access to the “raw” or “for processing” images is indispensable
• Assistance from local service and IT engineers is likely to be required
• Analysis of the images with the ATIA software and the collection of relevant data takes place
locally
• Results obtained are transmitted to the supervising medical physicist in order to analyze the
system performance over time
 11

LOCAL IT INFRASTRUCTURE AND

STAFF REQUIREMENTS
• For facilities without image transmission capabilities
• Installation of the ATIA software on the site to allow image measurements.
• ATIA is an application without special installation requirements that is typically easily
installed on any PC
• Centralized online system for data collection that can be implemented in a Hospital-wide or
even Regional basis is also desirable
• Direct internet access from the remote site for data transmission
• Interim solutions such as e-mails or text messages could be considered but only as
temporary solutions
 12

LOCAL IT INFRASTRUCTURE AND

STAFF REQUIREMENTS
• For facilities without image transmission capabilities
• A unique facility and system identification must be developed for the transmitted data in
order  to ensure consistency and accuracy of data
• Unless local regulations mandate a minimum time for maintaining QC records, images and
associated results should be stored locally for a reasonable time as determined by the facility
and the supervising medical physicist
 13

LOCAL IT INFRASTRUCTURE AND

STAFF REQUIREMENTS
• For facilities with image transmission capabilities
• Actual transmission of the quality control images is certainly preferable as it provide a more
comprehensive and sustainable approach
• This allows access to the images for the supervising medical physicist to perform more
comprehensive analysis and review the DICOM information Facilities with a central PACS
structure in place must establish identification and storage guidelines to prevent confusion
and duplication of images
• Auto-send function to be enabled in the PACS with routing set to transfer the images to a
remote server at the medical physicist’s facility on which the ATIA application exists. The
receipt of the image would trigger the automated analysis.
 14

LOCAL IT INFRASTRUCTURE AND

STAFF REQUIREMENTS
• For facilities with image transmission capabilities
• If a PACS is not available and the imaging systems are not connected to external networks,
then the following should be considered:
• Coordinate, and local IT support, to identify and setup the most convenient and stable way
of exporting the images.
• Address bandwidth issues both at the sending and receiving points, as medical images can be
rather large, making the transmission slow, unreliable and inefficient.
• Interim solutions, such as attaching images to e-mails, could be considered if needed, but
only as temporary solutions
• Organize an external central image repository for image archiving
 15

DATA PROTECTION ISSUES

• As in all applications that involve distribution of digital data, protection of such data
is essential
• Although QC images do not contain sensitive information as patient data, they
should be handled very carefully as they possess information with regard to
performance of radiographic systems in the facility
• The actual concern is the access to the facility digital network through the exchange
of information between the local facility and the remote facility where the medical
physicist is located
 16

DATA PROTECTION ISSUES

• Careful evaluation is required to verify adequate data protection and to ensure that
unauthorized access to the data for outside users is strictly blocked
• Access to detailed test data for each facility should only be granted to the
supervising medical physicist and to staff members designated by the facility
• Even though the supervising medical physicist might have access to the performance
results from equipment in different facilities; each department must only have access
to its own data and not to the detailed data of other departments or facilities.
 17

DATA PROTECTION ISSUES

• When properly generated and documented and if required by the administrative
levels of a facility, summary reports of data can be utilized as evidence of good
practice and can be provided to the regulatory authority for compliance and
licencing purposes.
• Provisions must be made to ensure that the identity of the originating department
and the type or manufacturer of the X ray equipment are protected during this data
sharing
 18

CENTRALIZED DATA REPOSITORY

• Whenever possible, it Is recommended that all data from the Remote QC programme
(images, data analysis and control charts) be stored in a central server setup by the clinical
qualified medical physicist (CQMP)
• This centralized data repository can function at the following levels:
• Small scale: the CQMP can monitor systems performance for one individual hospital with
several X ray rooms, including both radiography and mammography.
• Medium scale: the CQMP can monitor performance at several hospitals simultaneously
• Large scale: with larger adequate medical physics support, this program can run on a national or
regional level (eg. screening programs, multiple countries or regional arrangements)
 19

FINANCIAL CONSIDERATIONS
• A number of financial considerations must be made in order to secure all the resources, both
human and material, listed before.
• In terms of the proper implementation of the QC program, the following must be included in
budgetary plans for the facility
• Fabrication of the phantom, including acquiring the required materials.
• IT costs, which are determined by the complexity of the department and institution and
may include:
• On-site computers
• Data lines / Connections / Internet services
• Hardware for a centralized data repository equipment
• Data storage
• Dedicated time for technologists and cost of QCMP oversight
 20

FINANCIAL CONSIDERATIONS
• Facilities must develop a culture of quality control and quality assurance, understanding that
such programs are designed to detect technical and equipment problems early and that
corrective actions must follow such discoveries
• Based on this, facilities must be open to the possibility of additional costs which may be
incurred from enforcing such corrective action, among others:
• Repairs and replacement of critical components of the radiographic systems
• Cost of maintenance and service
 21

FINANCIAL CONSIDERATIONS
• On the other hand, facilities will benefit financially from implementation of the QC program
with tangible and trackable improvements such as
• Decreased imaging equipment down-time, by timely identifying problems and potential
failures.
• Increased patient and study throughput, by routinely ensuring the clinical availability of the
imaging system
• Improved diagnostic accuracy, by ensuring that the established high levels of image quality
are continuously met
• By identifying immediately any slow deterioration that would otherwise go unnoticed in
between annual tests
 22

FINANCIAL CONSIDERATIONS
• Comply with regulatory requirements that mandate documented regular and frequent testing
• Decreased travel time and expenses for the medical physicist to visit remote areas in order to
keep monitor system performance
• Support to licensing procedures, providing regular and concrete evidence of quality practices
in the department and thus commitment to quality
• Retrospective evaluation for medical-legal defense, in extreme cases of unforeseen events
that might be linked with the performance of the imaging equipment
 23

END OF LECTURE 7
 BIBLIOGRAPHY 24

• International Atomic Energy Agency (IAEA), Implementation of a Remote and Automated

Quality Control Programme for Radiography and Mammography Equipment, Human Health
Series No. 39, IAEA, Vienna (2021).
• International Atomic Energy Agency (IAEA). Worldwide Implementation of Digital Imaging in
Radiology, Human Health Series No. 28, IAEA, Vienna (2015).
• International Atomic Energy Agency (IAEA). Dosimetry in Diagnostic Radiology: An
International Code of Practice, Technical Reports Series No. 457, IAEA, Vienna, 2007.
• International Atomic Energy Agency (IAEA). Roles and Responsibilities, and Education and
Training Requirements for Clinically Qualified Medical Physicists, Human Health Series No. 25,
IAEA, Vienna, 2013.
• International Atomic Energy Agency (IAEA), Radiation Protection of Patients (RPOP). Available
at: https://www.iaea.org/resources/rpop.
• International Atomic Energy Agency (IAEA), Diagnostic Radiology Physics, Non-serial
Publications, 2014