Professional and Technical Aspects of Serving FFDM Facilities Robert J. Pizzutiello, Jr., FACMP
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Professional and Technical Aspects of Serving FFDM Facilities Robert J. Pizzutiello, Jr., FACMP Upstate Medical Physics, Inc. Overview • What’s different about FFDM facilities? Technology Regulatory Accreditation Educational Practical Your first experience The client calls • We just ordered a new FFDM unit • What do we do now? •Get educated! University of Oklahoma Digital Mammography Productivity Study From GE web site: http://www.gemedicalsystems.com/rad/xr/mammo/index.html Be Prepared • Professional symposia (AAPM, RSNA, ACR Breast Cancer Conference, etc.) • Manufacturer’s training • Learn the software • Tips on testing the machine • Work with the service engineer during installation • Be an expert or… • ………………….just wing it My personal experience • Attended several FFDM lectures < 1999 • Attended 8 hour ACR BCC FFDM course 1999 • Learned that first client ordered GE 2000D, with delivery in 3 months (4/01) • Trained with Ed Hendrick and Eric Berns 8 hours (6 hours hands-on) Learned sequence of testing Learned tips on testing the unit Learned tips on working with GE and the facility Hands-on Manufacturer’s Training • Tuition + Travel ~ $2 - 3,000 • Your time = 1.5 - 2 days (with travel) • Was it worth it? …Absolutely! Professional Confidence Advertise as having been trained Admit to my own limited experience • My advice – invest the time and money. Your expertise is your best asset. Negotiate for manufacturer to include your training with cost of system Before you start - Regulatory • Remind the facility that they cannot begin clinical work (including applications) until Medical Physics Equipment Evaluation is complete and all items acceptable Submit materials to DMQRP Receive OK from DMQRP Latest estimate ~ 10 days after receipt of materials Before you start - Accreditation • At present, ACR does not have an accreditation program for FFDM facilities • Facilities must have a functioning, accredited SFM unit • Stay tuned for ACR updates Technologist’s QC • Required under MQSA • Manufacturers claim they cover RT QC • Often, RT’s cannot assimilate everything during applications, and QC is not clearly understood • QC tests are quite different from SFM, and heavily computer oriented • Consider a second visit to review QC. Include in price quote • Remind facility to allow time for weekly QC How long will the MP survey take? • Very little film processing (saves time) • Software learning curve (adds time) • MP QC learning curve (adds time) • GE Senographe 2000D – 7 hours for the first survey 3-4 hours for a “smooth” survey • What’s a “smooth survey”? Our experience with 2000D • Facility A Unit #1 Acceptance 4/01 Unit #2 Acceptance 11/01 Unit #2 Second survey 4/02 • Facility B Unit #1 Acceptance 11/01 Unit #1 First MEE (Onyx upgrade) 4/02 Unit #1 Second MEE (new IR) 6/02 What we learned - QC • Before the new unit is installed, QC is not high on the list • GE covers QC, but there is so much other new information covered during applications.. • After installation, technologists really appreciate some extra one-on-one review • QC technologists have some questions in the first few months, then do fine on their own What we learned – Physics • The most common installation problems have been with the CRT monitors Reading room sub-optimally configured Dome light meter not connected CRT not calibrated or incorrectly calibrated Calibration changes over time 8 Security of monitor settings 8 Calibration difficult w/o using laptop Take Home Message • Talk to the FSE during installation • Ask for FSE to be present or available during Acceptance Testing If there are apparent problems, it is in everyone’s best interests for the FSE to be there and participate in finding a solution Cannot use machine until all problems are resolved Your schedule may not permit waiting for the FSE to arrive or respond by phone • If the unit is not acceptable and you have to come back or delay the process, everyone loses! What we learned • The grid is very delicate • Should be stored in GE-designed slot • It is easily damaged, causing artifacts Medical Physics QC • Manufacturer’s QC Manual • Hendrick-Berns Manual • Hendrick-Berns Excel spreadsheets • Then GE changed the manual • Check out revision 3! Medical Physics QC • Consider the optimal sequence of tests IR uniformity and artifacts first! Cover IR with lead for generator tests Consider impact of broad area AEC • Group tests requiring film processing Collimation Focal spot performance • Plan for best time to test both the x-ray unit and CRT monitors. We have had some difficulty with CRT access. What we learned • Get to know the FSE’s • Exchange phone numbers • Buy bagels and coffee • Promote communication between FSE + MP + RT • Discuss how you will handle “major changes” that may require MEE Take Home Message • Be prepared • Discuss FFDM with potential users now! • Advise facility to include in contract Mfr training to include the MP Mfr reimburses for re-calibrations + additional medical physics work (MEE, consultations) until new installation is satisfactorily completed
