Quality assurance in ultrasound machines
AhmadSanusiNalado
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39 slides
May 15, 2025
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About This Presentation
Quality assurance in ultrasound
Slide Content
Quality Assurance of Quality Assurance of
UltrasoundUltrasound
UltrasoundUltrasound
IntroductionIntroduction
Ultrasound is principally based Ultrasound is principally based
on reflection of very high sound on reflection of very high sound
frequencies (ultra sound). frequencies (ultra sound).
Acoustic energy is sent into the Acoustic energy is sent into the
body and the reflected energy is body and the reflected energy is
received and evaluated at the received and evaluated at the
point of transmission. point of transmission.
Ultrasound is principally based Ultrasound is principally based
on reflection of very high sound on reflection of very high sound
frequencies (ultra sound). frequencies (ultra sound).
Acoustic energy is sent into the Acoustic energy is sent into the
body and the reflected energy is body and the reflected energy is
received and evaluated at the received and evaluated at the
point of transmission. point of transmission.
Ultrasound (U/S) Ultrasound (U/S)
Physical conceptPhysical concept
Ultrasound is a longitudinal plane Ultrasound is a longitudinal plane
wave.wave.
The wave can be displayed as a The wave can be displayed as a
sinusoid described by sinusoid described by
•AmplitudeAmplitude
•wavelength wavelength
•velocity of propagationvelocity of propagation
Physical conceptPhysical concept
Ultrasound is a longitudinal plane Ultrasound is a longitudinal plane
wave.wave.
The wave can be displayed as a The wave can be displayed as a
sinusoid described by sinusoid described by
•AmplitudeAmplitude
•wavelength wavelength
•velocity of propagationvelocity of propagation
What is quality assurance in
ultrasound?
The purpose of a quality assurance
(QA) program in medical ultrasound
is to ensure that the equipment
and clinical practices of a facility
are safe, and that the
information obtained from a
clinical ultrasound procedure is
as accurate as can be determined
ultrasound?
The purpose of a quality assurance
(QA) program in medical ultrasound
is to ensure that the equipment
and clinical practices of a facility
are safe, and that the
information obtained from a
clinical ultrasound procedure is
as accurate as can be determined
FDAFDA
The FDAThe FDA regulates all ultrasound regulates all ultrasound
equipment energies (for obstetrical equipment energies (for obstetrical
scanning this is below 100 milliwatts scanning this is below 100 milliwatts
per centimeter squared). Therefore, per centimeter squared). Therefore,
the manufactures of the equipment the manufactures of the equipment
are required and have designed their are required and have designed their
equipment in accordance to these equipment in accordance to these
FDA mandated levels.FDA mandated levels.
The FDAThe FDA regulates all ultrasound regulates all ultrasound
equipment energies (for obstetrical equipment energies (for obstetrical
scanning this is below 100 milliwatts scanning this is below 100 milliwatts
per centimeter squared). Therefore, per centimeter squared). Therefore,
the manufactures of the equipment the manufactures of the equipment
are required and have designed their are required and have designed their
equipment in accordance to these equipment in accordance to these
FDA mandated levels.FDA mandated levels.
What are the 3 major
components of ultrasound
machine?
Any ultrasound system has three
basic components: a transducer, or
probe; the processing unit,
including the controls; and the
display
components of ultrasound
machine?
Any ultrasound system has three
basic components: a transducer, or
probe; the processing unit,
including the controls; and the
display
Phantoms used in ultrasound Phantoms used in ultrasound
equipmentequipment
Tissue-mimicking phantomTissue-mimicking phantom
Phantom designPhantom design
Phantom desiccationPhantom desiccation
equipmentequipment
Tissue-mimicking phantomTissue-mimicking phantom
Phantom designPhantom design
Phantom desiccationPhantom desiccation
MaterialsMaterials
The commercial phantom was made The commercial phantom was made
of a material (Zerdine,solid elastic of a material (Zerdine,solid elastic
waterbased polymer) which mimics
‐
waterbased polymer) which mimics
‐
the average acousticproperties of the average acousticproperties of
soft tissue: average speed of sound soft tissue: average speed of sound
(1540 m/s) andattenuation either (1540 m/s) andattenuation either
0.5 or 0.7 dB cm−1MHz−1)0.5 or 0.7 dB cm−1MHz−1)
The commercial phantom was made The commercial phantom was made
of a material (Zerdine,solid elastic of a material (Zerdine,solid elastic
waterbased polymer) which mimics
‐
waterbased polymer) which mimics
‐
the average acousticproperties of the average acousticproperties of
soft tissue: average speed of sound soft tissue: average speed of sound
(1540 m/s) andattenuation either (1540 m/s) andattenuation either
0.5 or 0.7 dB cm−1MHz−1)0.5 or 0.7 dB cm−1MHz−1)
Tissue-Mimicking PhantomTissue-Mimicking Phantom
Is a device that mimics soft tissues Is a device that mimics soft tissues
in its ultrasound transmission in its ultrasound transmission
characteristics, e.g. speed, characteristics, e.g. speed,
attenuation, echogenicity etc.. attenuation, echogenicity etc..
Phantoms have targets in known Phantoms have targets in known
positions for image comparisons positions for image comparisons
e.g. simulated cysts, echogenic e.g. simulated cysts, echogenic
structures and thin targetsstructures and thin targets
Is a device that mimics soft tissues Is a device that mimics soft tissues
in its ultrasound transmission in its ultrasound transmission
characteristics, e.g. speed, characteristics, e.g. speed,
attenuation, echogenicity etc.. attenuation, echogenicity etc..
Phantoms have targets in known Phantoms have targets in known
positions for image comparisons positions for image comparisons
e.g. simulated cysts, echogenic e.g. simulated cysts, echogenic
structures and thin targetsstructures and thin targets
Tissue mimicking phantom
Phantom designPhantom design
The tissue mimicking material consist The tissue mimicking material consist
of a water-based gelatin mixed with of a water-based gelatin mixed with
microscopic graphite particlesmicroscopic graphite particles
Small scatterers are distributed Small scatterers are distributed
throughout the tissue mimicking throughout the tissue mimicking
materialmaterial
Many phantoms have simulated cysts Many phantoms have simulated cysts
and discrete reflectors to measure and discrete reflectors to measure
distancedistance
The tissue mimicking material consist The tissue mimicking material consist
of a water-based gelatin mixed with of a water-based gelatin mixed with
microscopic graphite particlesmicroscopic graphite particles
Small scatterers are distributed Small scatterers are distributed
throughout the tissue mimicking throughout the tissue mimicking
materialmaterial
Many phantoms have simulated cysts Many phantoms have simulated cysts
and discrete reflectors to measure and discrete reflectors to measure
distancedistance
Phantom desiccationPhantom desiccation
Water-based gels loose water and shrinkWater-based gels loose water and shrink
Air might enter thus rendering it Air might enter thus rendering it
ineffective ineffective
Therefore, keep in a humid air-tight Therefore, keep in a humid air-tight
containercontainer
Rubber-based phantom solve the Rubber-based phantom solve the
problem partiallyproblem partially
Can be stored in an open environmentCan be stored in an open environment
Water-based gels loose water and shrinkWater-based gels loose water and shrink
Air might enter thus rendering it Air might enter thus rendering it
ineffective ineffective
Therefore, keep in a humid air-tight Therefore, keep in a humid air-tight
containercontainer
Rubber-based phantom solve the Rubber-based phantom solve the
problem partiallyproblem partially
Can be stored in an open environmentCan be stored in an open environment
..
..
Rubber-based tissue mimicking phantom
..
Rubber-based tissue mimicking phantom
Quality Assurance & Quality Control Quality Assurance & Quality Control
TestsTests
1.1.Transducer choiceTransducer choice
2.2.System sensitivitySystem sensitivity
3.3.Photography and gray-scale hard copyPhotography and gray-scale hard copy
4.4.Routine image checksRoutine image checks
5.5.Scan uniformityScan uniformity
6.6.Distance measurementDistance measurement
7.7.spatial resolutionspatial resolution
8.8.Doppler testingDoppler testing
9.9.Doppler flow phantomDoppler flow phantom
10.10.DocumentationDocumentation
TestsTests
1.1.Transducer choiceTransducer choice
2.2.System sensitivitySystem sensitivity
3.3.Photography and gray-scale hard copyPhotography and gray-scale hard copy
4.4.Routine image checksRoutine image checks
5.5.Scan uniformityScan uniformity
6.6.Distance measurementDistance measurement
7.7.spatial resolutionspatial resolution
8.8.Doppler testingDoppler testing
9.9.Doppler flow phantomDoppler flow phantom
10.10.DocumentationDocumentation
1-Transducer choice1-Transducer choice
Standardized transducer is Standardized transducer is
selected selected
Record its identificationsRecord its identifications
Future tests must be done with Future tests must be done with
the same transducerthe same transducer
Standardized transducer is Standardized transducer is
selected selected
Record its identificationsRecord its identifications
Future tests must be done with Future tests must be done with
the same transducerthe same transducer
2-System sensitivity2-System sensitivity
It refers to echo signal level that can be It refers to echo signal level that can be
detecteddetected
Achieved by controls that vary output and Achieved by controls that vary output and
amplify the received signals (gain)amplify the received signals (gain)
The maximum sensitivity is limited by The maximum sensitivity is limited by
electrical noise (e.g. from computer electrical noise (e.g. from computer
terminals)terminals)
Variations may be due to transducer Variations may be due to transducer
damaged cables or electronic driftdamaged cables or electronic drift
Commonly used in measuring maximum Commonly used in measuring maximum
depth of visualization depth of visualization
Results should be within 1 cmResults should be within 1 cm
It refers to echo signal level that can be It refers to echo signal level that can be
detecteddetected
Achieved by controls that vary output and Achieved by controls that vary output and
amplify the received signals (gain)amplify the received signals (gain)
The maximum sensitivity is limited by The maximum sensitivity is limited by
electrical noise (e.g. from computer electrical noise (e.g. from computer
terminals)terminals)
Variations may be due to transducer Variations may be due to transducer
damaged cables or electronic driftdamaged cables or electronic drift
Commonly used in measuring maximum Commonly used in measuring maximum
depth of visualization depth of visualization
Results should be within 1 cmResults should be within 1 cm
Maximum depth of visualization
A- max. depth is 15.2 cm (4MHz)
B- max. depth is 16.8 cm (3.5 MHz)
C- max. depth cannot be determined
(2.5 MHz) because it is good all the
way down to the bottom of the
phantom
A- max. depth is 15.2 cm (4MHz)
B- max. depth is 16.8 cm (3.5 MHz)
C- max. depth cannot be determined
(2.5 MHz) because it is good all the
way down to the bottom of the
phantom
3-Photography and gray scale hard 3-Photography and gray scale hard
copycopy
A major acceptance testA major acceptance test
The display monitor should be set up The display monitor should be set up
Multiformat camera should be Multiformat camera should be
adjustedadjusted
Image display settings should not be Image display settings should not be
shifted routinelyshifted routinely
To avoid casuals, remove the knobsTo avoid casuals, remove the knobs
copycopy
A major acceptance testA major acceptance test
The display monitor should be set up The display monitor should be set up
Multiformat camera should be Multiformat camera should be
adjustedadjusted
Image display settings should not be Image display settings should not be
shifted routinelyshifted routinely
To avoid casuals, remove the knobsTo avoid casuals, remove the knobs
stepssteps
Set the contrast settings initially to Set the contrast settings initially to
the minimum and adjust the the minimum and adjust the
brightness brightness
Adjust the monitor contrastAdjust the monitor contrast
Adjust the image recording device to Adjust the image recording device to
obtain the same gray scale that obtain the same gray scale that
appear on the monitorappear on the monitor
Compare with the referenceCompare with the reference
Set the contrast settings initially to Set the contrast settings initially to
the minimum and adjust the the minimum and adjust the
brightness brightness
Adjust the monitor contrastAdjust the monitor contrast
Adjust the image recording device to Adjust the image recording device to
obtain the same gray scale that obtain the same gray scale that
appear on the monitorappear on the monitor
Compare with the referenceCompare with the reference
4-Routine image check4-Routine image check
Should be performed weeklyShould be performed weekly
To ascertain that the brightness To ascertain that the brightness
variations are recordedvariations are recorded
The gray bar pattern should appear The gray bar pattern should appear
on the edge on the edge
Verify with the image taken recently Verify with the image taken recently
Should be performed weeklyShould be performed weekly
To ascertain that the brightness To ascertain that the brightness
variations are recordedvariations are recorded
The gray bar pattern should appear The gray bar pattern should appear
on the edge on the edge
Verify with the image taken recently Verify with the image taken recently
5-Scan Image Uniformity5-Scan Image Uniformity
If the unit gain settings are If the unit gain settings are
adjusted properly the image adjusted properly the image
should be uniform should be uniform
Deviation may be due to:Deviation may be due to:
1.1.Bad probe elementsBad probe elements
2.2.Inadequate compensation Inadequate compensation
3.3.Inadequate blending of pixel Inadequate blending of pixel
datadata
If the unit gain settings are If the unit gain settings are
adjusted properly the image adjusted properly the image
should be uniform should be uniform
Deviation may be due to:Deviation may be due to:
1.1.Bad probe elementsBad probe elements
2.2.Inadequate compensation Inadequate compensation
3.3.Inadequate blending of pixel Inadequate blending of pixel
datadata
What is uniformity in
ultrasound?
The image uniformity is defined as
the equipment ability to give
ultrasound echos with the same
amplitude and deepness when
the brightness is fixed. This
quality test is also important to
verify if the transducer crystals have
a well functioning
ultrasound?
The image uniformity is defined as
the equipment ability to give
ultrasound echos with the same
amplitude and deepness when
the brightness is fixed. This
quality test is also important to
verify if the transducer crystals have
a well functioning
....
Image uniformity tests
Good uniformity
Problematic transducer
Image uniformity tests
Good uniformity
Problematic transducer
6-Distance measurement6-Distance measurement
Done periodically Done periodically
Distance indicator include 1-cm Distance indicator include 1-cm
depth markerdepth marker
Two measurements are executed:Two measurements are executed:
vertical and horizontalvertical and horizontal
Done periodically Done periodically
Distance indicator include 1-cm Distance indicator include 1-cm
depth markerdepth marker
Two measurements are executed:Two measurements are executed:
vertical and horizontalvertical and horizontal
Vertical distanceVertical distance
Steps:Steps:
Ensure that the reflectors are clearly Ensure that the reflectors are clearly
imaged imaged
Use the caliper to measure the Use the caliper to measure the
distance between each two distance between each two
reflectorsreflectors
Accuracy must be within 1 mmAccuracy must be within 1 mm
Steps:Steps:
Ensure that the reflectors are clearly Ensure that the reflectors are clearly
imaged imaged
Use the caliper to measure the Use the caliper to measure the
distance between each two distance between each two
reflectorsreflectors
Accuracy must be within 1 mmAccuracy must be within 1 mm
..
..
Vertical distance measurement. The caliper reading 9.9 mm
compare to 10 mm
..
Vertical distance measurement. The caliper reading 9.9 mm
compare to 10 mm
Horizontal DistanceHorizontal Distance
Similar to the vertical accuracy Similar to the vertical accuracy
Should agree with the Should agree with the
manufacturers i.e. within 3 mmmanufacturers i.e. within 3 mm
Similar to the vertical accuracy Similar to the vertical accuracy
Should agree with the Should agree with the
manufacturers i.e. within 3 mmmanufacturers i.e. within 3 mm
..
..
Horizontal distance measurements. The caliper reading is
30.5 mm compare to the actual 30 mm
..
Horizontal distance measurements. The caliper reading is
30.5 mm compare to the actual 30 mm
7-Spatial Resolution Tests:7-Spatial Resolution Tests:
Usually an acceptance testUsually an acceptance test
It allows intercompensations of It allows intercompensations of
scannerscanner
It involve axial resolution, lateral It involve axial resolution, lateral
resolution and focal lesion resolution and focal lesion
resolutionresolution
Usually an acceptance testUsually an acceptance test
It allows intercompensations of It allows intercompensations of
scannerscanner
It involve axial resolution, lateral It involve axial resolution, lateral
resolution and focal lesion resolution and focal lesion
resolutionresolution
Axial resolutionAxial resolution
It is a measure of how close two It is a measure of how close two
reflectors are and still be resolved reflectors are and still be resolved
as separate reflectorsas separate reflectors
The axial resolution in the following The axial resolution in the following
phantom, are 2 mm 1 mm 0.25 mmphantom, are 2 mm 1 mm 0.25 mm
Comparison must be made wit the Comparison must be made wit the
reference reference
It is a measure of how close two It is a measure of how close two
reflectors are and still be resolved reflectors are and still be resolved
as separate reflectorsas separate reflectors
The axial resolution in the following The axial resolution in the following
phantom, are 2 mm 1 mm 0.25 mmphantom, are 2 mm 1 mm 0.25 mm
Comparison must be made wit the Comparison must be made wit the
reference reference
..
..
Axial resolution measurement
..
Axial resolution measurement
Lateral resolution:Lateral resolution:
Is a measure of how close two Is a measure of how close two
reflectors can be to one another reflectors can be to one another
perpendicular to the beam axis perpendicular to the beam axis
and still be distinguished as and still be distinguished as
separate reflectors on an imageseparate reflectors on an image
Just like axial resolution test it Just like axial resolution test it
depends on the power and gaindepends on the power and gain
Is a measure of how close two Is a measure of how close two
reflectors can be to one another reflectors can be to one another
perpendicular to the beam axis perpendicular to the beam axis
and still be distinguished as and still be distinguished as
separate reflectors on an imageseparate reflectors on an image
Just like axial resolution test it Just like axial resolution test it
depends on the power and gaindepends on the power and gain
..
..
Lateral resolution measurements
The horizontal size of the pin target is 1.2 mm
..
Lateral resolution measurements
The horizontal size of the pin target is 1.2 mm
8-Doppler Testing8-Doppler Testing
String testString test::
This is a thin string wound This is a thin string wound
around a pulley and driven by a around a pulley and driven by a
motormotor
The string is echogenicThe string is echogenic
It provides evaluation of velocity It provides evaluation of velocity
measurement of Doppler devicemeasurement of Doppler device
A target of a precise velocity can A target of a precise velocity can
be detected be detected
String testString test::
This is a thin string wound This is a thin string wound
around a pulley and driven by a around a pulley and driven by a
motormotor
The string is echogenicThe string is echogenic
It provides evaluation of velocity It provides evaluation of velocity
measurement of Doppler devicemeasurement of Doppler device
A target of a precise velocity can A target of a precise velocity can
be detected be detected
9-Doppler Flow Phantom9-Doppler Flow Phantom
Consist of one or more hollow Consist of one or more hollow
tube inserted in tissue-mimicking tube inserted in tissue-mimicking
materialmaterial
A blood-mimicking fluid (made of A blood-mimicking fluid (made of
water and glycerol with plastic water and glycerol with plastic
particles ) is pumped inside the particles ) is pumped inside the
tube to simulate blood flowtube to simulate blood flow
The test are:The test are:
Consist of one or more hollow Consist of one or more hollow
tube inserted in tissue-mimicking tube inserted in tissue-mimicking
materialmaterial
A blood-mimicking fluid (made of A blood-mimicking fluid (made of
water and glycerol with plastic water and glycerol with plastic
particles ) is pumped inside the particles ) is pumped inside the
tube to simulate blood flowtube to simulate blood flow
The test are:The test are:
..
The maximum depth at which flow The maximum depth at which flow
waveform can be detectedwaveform can be detected
Alignment of the pulse Doppler Alignment of the pulse Doppler
sample volumesample volume
Volume flow accuracyVolume flow accuracy
Velocity accuracyVelocity accuracy
Color flow indicationColor flow indication
Any changes overtime such as Any changes overtime such as
greater than 1 cm indicate a greater than 1 cm indicate a
change in sensitivity of the change in sensitivity of the
instrument instrument
The maximum depth at which flow The maximum depth at which flow
waveform can be detectedwaveform can be detected
Alignment of the pulse Doppler Alignment of the pulse Doppler
sample volumesample volume
Volume flow accuracyVolume flow accuracy
Velocity accuracyVelocity accuracy
Color flow indicationColor flow indication
Any changes overtime such as Any changes overtime such as
greater than 1 cm indicate a greater than 1 cm indicate a
change in sensitivity of the change in sensitivity of the
instrument instrument
..
. .
Color flow image of a Doppler flow phantom for presentation I color
. .
Color flow image of a Doppler flow phantom for presentation I color
10-Documentation10-Documentation
Results of tests should be kept in a log Results of tests should be kept in a log
bookbook
One transducer is selected to do the job One transducer is selected to do the job
each time (preferably the most used one)each time (preferably the most used one)
Any compensation done must be Any compensation done must be
registeredregistered
Results of tests should be kept in a log Results of tests should be kept in a log
bookbook
One transducer is selected to do the job One transducer is selected to do the job
each time (preferably the most used one)each time (preferably the most used one)
Any compensation done must be Any compensation done must be
registeredregistered
According to industry experts, on According to industry experts, on
average, ultrasound machines should average, ultrasound machines should
be replaced be replaced every 5-7 yearsevery 5-7 years
11
. .
Knowing that an ultrasound system Knowing that an ultrasound system
typically lasts 5-7 years can be typically lasts 5-7 years can be
instrumental when purchasing a new instrumental when purchasing a new
machine.machine.
According to industry experts, on According to industry experts, on
average, ultrasound machines should average, ultrasound machines should
be replaced be replaced every 5-7 yearsevery 5-7 years
11
. .
Knowing that an ultrasound system Knowing that an ultrasound system
typically lasts 5-7 years can be typically lasts 5-7 years can be
instrumental when purchasing a new instrumental when purchasing a new
machine.machine.
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