IMAGING PRACTICE ACCREDITATION SUBCOMMITTEE REPORT Tyler Fisher, Costa Mesa, CA

Comparison of the Medical Physics Testing Requirements for MRI between the Four CMS- Approved Accreditation Bodies

Currently there are four accreditation bodies approved to provide advanced diagnostic imaging accreditation as required under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). These include the American College of Radiology (ACR), the Joint Commission (JC), the Intersocietal Accreditation Commission (IAC), and RadSite. Accreditation bodies are unique, each bringing a slightly different philosophy to the market. Common areas required for accreditation include quality control of equipment, policies and procedures, personnel qualifications, MRI safety evaluations and phantom images. All accreditation bodies require some form of quality control evaluation of equipment but the number, scope and passing criteria of these tests can vary between organizations. The table below lists the various tests that are discussed within the MRI accreditation programs for each organization.

ACR accreditation testing focuses on phantom image review and evaluation of the technologist QC program. For accreditation submission, phantom images (acquired within the previous six months), using a specific accreditation phantom must be submitted. There are 5 imaging series that must be submitted for accreditation: an ACR-specific Sagittal localizer, ACR-specific T1 & T2 weighted protocols, and site-specific T1 & T2 weighted protocols. The ACR clearly defines the steps for acquiring these images, how to evaluate the images, and what acceptable criteria to use in the 2015 MRI QC Manual. Additional resources on performing many of these tests can be found on the AAPM website from the Working Group on Magnetic Resonance Testing & Quality Control. Information about ACR Accreditation can be found here.

The Joint Commission requirements for equipment quality control closely mirror the ACR requirements. The JC standards allow significant discretion to the physicist in determining how to perform the listed tests and what Pass/Fail standard to use. While the ACR-specified phantom can be used for testing, the Joint Commission does not require it to be used. There is currently no phantom image quality review with the JC. Physics reports are reviewed during the normal course of a JC onsite inspection. Currently, the Joint Commission does not require a qualified medical physicist or MR Scientist to perform these evaluations. Information about JC Accreditation can be found here.

The IAC MRI accreditation program differs from the ACR and Joint Commission programs. IAC requires the submission of phantom images to verify completion of daily QC. The IAC allows the use of any acceptable image quality phantom and, like the Joint Commission, does not require a qualified medical physicist or MR Scientist to perform annual evaluations. Some equipment parameters must be checked and documented as part of preventative maintenance. Information about IAC Accreditation can be found here.

RadSite, approved as an accreditation body in 2013, includes MRI accreditation within their MAP accreditation program. Radsite provides acceptable criteria for their required imaging tests based on the field strength of the MRI. While no specific MRI phantom is required, the phantom must be capable of performing all the required tests and meeting all the pass/fail criteria specified in RadSite standards. Information about RadSite Accreditation can be found here.

All of the accreditation programs include MRI safety as a significant issue that should be evaluated during routine quality control. For example, the ACR has very specific policies and procedures that must be in place regarding patient safety. The Joint Commission includes standards dealing with access, screening, and ferro-magnetic objects being near the entry to the MRI scan room. As physicists, it should be our standard practice to include an evaluation of MRI safety and make strong recommendations to our facilities when deficiencies are found. While there is still much to be determined about the effects of low levels of radiation from medical imaging, there are significant patient injuries and deaths that occur every year within the MRI scan room that we must all be vigilant to prevent.

Standard	ACR	Joint Commission	IAC	RadSite
Alignment Light Accuracy	X	X	X
Artifact Evaluation	X	X	X	X
Center Frequency	X		X
Film Printer QC	X		X
Geometric or Distance Accuracy	X	X	X	X
High-Contrast Resolution	X	X	X	X
Image Unformity	X	X	X	X
Low-Contrast Resolution	X	X		X
Magnetic Field Homogeneity	X	X	X	X
Slice Position Accuracy (Setup and Table Accuracy)	X	X	X	X
Slice Thickness Accuracy	X	X	X	X
Soft-Copy Monitor QC	X	X	X
Transmitter Gain or Attenuation	X		X
Visual Checklist	X
Coil Checks of All Clinically Used Coils
Image Unformity	X	X		X
Signal-to-Noise Ratio	X	X	X	X
Percent Signal Ghosting	X			X

Back to Article List Next Previous