ACR ACCREDITATION: FAQS FOR MEDICAL PHYSICISTS Priscilla F. Butler, MS, Senior Director and Medical Physicist, ACR Quality and Safety

Does your facility need help on applying for accreditation? In each issue of this newsletter, I'll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR's accreditation web site portal for more FAQs, accreditation application information, and QC forms. Beginning on July 24, 2017, the ACR will implement the 2016 ACR Digital Mammography Quality Control Manual into the accreditation process. Facilities who chose to use the 2016 ACR Digital Mammography Quality Control Manual may submit phantom images obtained with the ACR Digital Mammography Phantom and QC results using the new manual for accreditation of their 2D full-field digital mammography systems. See the American College of Radiology Digital Mammography QC Manual Frequently Asked Questions for more information.

Q.When may our facility start using the 2016 ACR Digital Mammography QC Manual and stop using our manufacturer's manual?
A. You may begin using the 2016 ACR Digital Mammography QC Manual for QC on all applicable digital mammography units and discontinue using the manufacturer's QC manual on July 24, 2017.

Q. When will the ACR start accepting technologist QC and medical physicist reports using the 2016 ACR Digital Mammography QC Manual for accreditation purposes?
A. The ACR will start accepting technologist QC and medical physicist reports using the 2016 ACR Digital Mammography QC Manual for applications submitted on or after July 24, 2017.

Q. When will the ACR start accepting images from the 2016 ACR Digital Mammography Phantom for mammography accreditation?
A. The ACR will start accepting images from the 2016 ACR Digital Mammography Phantom for mammography accreditation for applications submitted on or after July 24, 2017.

Q. If a facility chooses to use the ACR Digital Mammography QC Manual for their digital mammography unit, do they need to notify the ACR?
A. No. They may do so without notifying the ACR. Facilities should submit the appropriate documentation and testing materials using the 2016 QC manual during their normal accreditation cycle.

Q. If a facility chooses to use the ACR Digital Mammography QC Manual for their digital mammography unit, do they need to notify their MQSA inspector?
A. No. However, the facility should document the date they transitioned to the 2016 ACR Digital Mammography QC Manual in their QC records (e.g., their Corrective Action Log).

Q. After July 24, 2017, may our facility begin using the 2016 ACR Digital Mammography QC Manual and stop using our manufacturer's manual?
A. Yes, but please note that before the facility QC technologist may start using the 2016 DMQC Manual on a unit, the medical physicist must first conduct an annual survey of the digital mammography unit and display devices using the 2016 manual and phantom. This is important to provide testing techniques and procedures for the QC technologist to use during routine QC. After this is done, the QC technologist may start performing routine QC using the 2016 manual.

Q. Our facility has several digital mammography units in one location and several radiologist workstations at different locations in several states. We intend to switch to the 2016 ACR Digital Mammography QC Manual for all devices. How long does our facility have to transition QC testing for all devices (units and workstations) to the new manual once we begin this transition with one device?
A. The ACR does not require that all devices within a facility be transitioned to the 2016 ACR Digital Mammography QC Manual within a specific timeframe. However, for ease of QC management, we encourage that this transition take place as soon as possible.

Q. When transitioning from the manufacturer's QC manual to the 2016 ACR Digital Mammography QC Manual, must the medical physicist's annual survey include both the tests in the ACR QC manual AND all the tests in the manufacturer's QC manual?
A. No. The medical physicist is only required to perform the tests that are in the 2016 ACR Digital Mammography QC Manual.

Q. We will be performing a mammography equipment evaluation (MEE) on a new digital mammography unit after July 2017 using the 2016 ACR Mammography QC Manual. Must the medical physicist's MEE include both the tests in the ACR QC manual AND all the tests in the manufacturer's QC manual?
A. No. The medical physicist is only required to perform the tests that are in the 2016 ACR Digital Mammography QC Manual.

Q. What is the biggest change in evaluating the new ACR Digital Mammography Phantom image relative to the old phantom?
A. The biggest change is failing the phantom image for artifacts. QC technologists, medical physicists and ACR phantom reviewers should fail the phantom image if there is a clinically-significant artifact in a location that could impact clinical interpretation, even if all fibers, speck groups and masses pass. This change was made since phantom reviewers noted that phantom images submitted for accreditation would occasionally contain clinically-significant artifacts that would not prompt failure since they did not obscure test objects in the old phantom.

Q. Can my unit fail accreditation if the ACR phantom reviewers fail my ACR Digital Mammography Phantom image submitted for accreditation due to clinically-significant artifacts?
A. Yes.

Q. I am still using the old, small ACR Mammography Phantom for routine QC using the manufacturer's QC manual and am submitting that phantom's image for accreditation. Will the ACR phantom reviewers fail my phantom image if clinically-significant artifacts are present but all fibers, speck groups and masses pass?
A. No. At this time, ACR phantom reviewers will continue to use the scoring protocol outlined in the 1999 ACR Mammography Quality Control Manual. This means they will not fail the old phantom images for artifacts if all fibers, speck groups and masses pass. However, they will note that the artifacts are "unacceptable" and provide possible causes. If this occurs, the facility should work with their medical physicist to further diagnose and eliminate the artifact.