Advisory DI21/07: Standard 3.2: Optimised Radiation Technique Charts - evidence requirements | Australian Commission on Safety and Quality in Health Care

Diagnostic Imaging Accreditation Scheme Standards: Advisory details

Item	Details
Advisory number	DI21/07
Version number	1.0
Trim number	D21-45373
Publication date	7 December 2021
Replaces	Advisory Statement A19/01 version 2.0 published May 2020
Compliance with this advisory	Mandatory for Diagnostic Imaging Accreditation Scheme (DIAS) accrediting agencies and diagnostic imaging practices.
Information in this advisory applies to	All DIAS accrediting agencies Diagnostic imaging practices
Key relationship	2016 DIAS Standard 1.5: Equipment Servicing Standard
Attachment	Nil
Notes	Additional Resources: ARPANSA Website Advisory DI21/03 – Requirements for comparison with national diagnostic reference levels
Responsible officer	Margaret Banks Director, National Standards Phone: 1800 304 056 Email: AdviceCentre@safetyandquality.gov.au
To be reviewed	December 2023

Purpose

Issue

The purpose of Standard 3.2 is to ensure that diagnostic imaging practices adopt a consistent approach to imaging procedures that:

Delivers images of diagnostic quality
Adheres to the principle of keeping radiation doses As Low as Reasonably Achievable (ALARA).

There has been confusion about the evidence required to demonstrate compliance with Standard 3.2 Optimised Radiation Technique Charts for:

Various ionising radiation equipment
Ionising radiation equipment with programmed and embedded settings.
Ionising radiation equipment with manual settings

The evidence an imaging practice provides is dependent on the ionising radiation equipment used for imaging procedures.

Requirements

Diagnostic imaging practices must provide, as a minimum, the following evidence for:

Angiography, computed tomography (CT)^[1] , fluoroscopy, mammography, orthopantomography (OPG) and X-ray equipment

For each piece of equipment, provide evidence that demonstrates:

An annual review of ionising radiation settings
The review outcomes
The actions following the review
Which qualified person^[2] authorised the conduct of the review
Who is responsible for the outcomes and progressing the actions.

Mammography, OPG and X-ray equipment with manual settings

For each piece of equipment with manual settings, also provide a technique chart that

Is consistent with the ALARA principle
Contains a table of recommended settings (mA, time, kVp) that is referred to when selecting exposure factors for different procedures

Angiography and Fluoroscopy Equipment

For each piece of equipment, also provide a log demonstrating:

The procedure’s name
The procedure screening times or system-generated radiation dose metrics for each procedure
An annual review of the log
The review outcomes
The actions to optimise equipment settings
Which qualified person^[2] authorised the conduct of the review
Who is responsible for the outcomes and progressing the actions.

A log of procedure screening times is only acceptable for equipment that does not generate dose metrics.

The information provided in this advisory is summarised below in the section Required evidence for Standard 3.2 – Optimised Radiation Technique Chart.

^[1]This includes CT in conjunction with PET and SPECT.

^[2]A qualified person can be a radiologist, medical physicist, or senior radiographer and other personnel who have direct authority and responsibility for the imaging performed and can authorise the doses delivered to patients at the practice. It is not an equipment service provider.

Required evidence for Standard 3.2 – Optimised Radiation Technique Chart

Evidence	Angiography	Computed tomography	Fluoroscopy	Mammography
A review of settings authorised by a qualified person for each piece of equipment	Required	Required	Required	Required
A log of screening times or dose metrics authorised by a qualified person.	Required	N/A	Required	N/A
A technique chart consistent with ALARA for each piece of equipment with manual settings	N/A	N/A	N/A	Required where settings are manual

Evidence	Nuclear medicine	OPG	X-ray
A review of settings authorised by a qualified person for each piece of equipment	Required for CT in conjunction with PET and SPECT	Required	Required
A log of screening times or dose metrics authorised by a qualified person.	N/A	N/A	N/A
A technique chart consistent with ALARA for each piece of equipment with manual settings	N/A	Required where settings are manual	Required where settings are manual

ALARA = As Low as Reasonably Achievable, CT – Computed Tomography, DRL = diagnostic reference levels, N/A – not applicable, OPG = orthopantomography, PET - Positron Emission Tomography, SPECT - single photon emission computed tomography

For more information

For guidance on the evidence for Standard 3.2, see the User Guide for Diagnostic Imaging Practices Applying for Accreditation. Relevant appendices in the user guide includes Appendix 2: Example safety and quality manual and Appendix 11: Fluoroscopy screening log.

Australian national DRLS are located on the ARPANSA website.

For guidance on diagnostic reference levels see Advisory DI21/03: Requirements for comparison with national diagnostic reference levels.