SPECT Quality Control and Assurance Online Training

Welcome to the SPECT Quality Control and Assurance Online Training. This online training provides a basic overview of the SPECT quality control procedures using the syngo MI Applications software.     Upon successful completion of this course, you will be able to: Understand the SPECT Quality Control, or QC, schedule Learn about Quality Control Techniques & Accessories Perform daily, weekly, and monthly QC tasks Complete Intrinsic and Extrinsic QC procedures Perform Automatic QC tasks using the AutoQC feature Configure the AutoQC scheduler Congratulations. You have completed the SPECT Quality Control and Assurance Online Training. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. SPECT/CT main components Patient Positioning Monitor  Patient bed SPECT gantry Detectors CT gantry SPECT quality control schedule Daily:  Intrinsic Verification: 35 µCi of Tc99m ​-or-  Extrinsic Verification or Extrinsic Sweep: Co-57 sheet source or AutoQC source  Weekly: Intrinsic Verification with Tune:35 µCi of Tc99m or AutoQC source Monthly: Intrinsic Calibration with Tune Multiple Head Registration (MHR) - 180°: 35 µCi of Tc99m or AutoQC  - or -  Head Alignment Calibration: 1-2 mCi of Tc99m per source (match sources within 20% of each other for Tc99m only) or AutoQC Quality Control Techniques and Accessories Preparation of a point source Position the extrinsic sheet source holder Setup a phantom for mHR When performing manual quality control, it is important to use proper technique in order to be consistent.  Configuring the AutoQC scheduler  The AutoQC option allows unattended automated floods for detector quality control checks. You can schedule the AutoQC (settings need to be verified).   SPECT/CT main components 1. Patient Positioning Monitor (PPM) 2. Patient bed 3. SPECT gantry 4. Detectors 5. CT gantry The SPECT QC schedule is divided into daily, weekly, and monthly procedures. Please note: Local regulations may require additional checks as well.  Quality control procedures can be performed manually or using Auto QC.  AutoQC automatically starts the specific QC tasks so they are finished before the first scheduled patient arrives the next day. Click below to view the SPECT QC schedule. Learn more about the SPECT QC schedule Learn more about the SPECT QC schedule. Element HTMLDaily ​Intrinsic Verification: 35 µCi of Tc99m - or -   Extrinsic Verification or Extrinsic Sweep: Co-57 sheet source or AutoQC source Weekly Intrinsic Verification with Tune: 35 µCi of Tc99m or AutoQC source Monthly Intrinsic Calibration with Tune   Multiple Head Registration (MHR) 180°: 35 µCi of Tc99m or AutoQC - or -  Head Alignment Calibration: 1-2 mCi of Tc99m per source (match sources within 20% of each other for Tc99m only) or AutoQC Sound File Audio ScriptDaily QC for SPECT is either an intrinsic or extrinsic verification.  The intrinsic verification can be performed using a Tc99m point source or AutoQC. The extrinsic verification flood can be performed with a Co-57 sheet source or by completing an extrinsic sweep with AutoQC. Weekly SPECT Procedures include an intrinsic verification with an additional system Tune procedure using a Tc99m point source or AutoQC. There are several procedures that need to be completed for a SPECT system on a monthly basis. This starts with the Intrinsic calibration using a Tc99m point source or AutoQC. This test can take up to 2hrs depending on the source strength. Upon completion of the intrinsic calibration, an intrinsic verification is performed.  In addition to the flood procedures a series of Multiple Head Registrations, or MHRs, will need to be performed for each collimator and detector configuration used clinically. For example the LEHR collimators could potentially be tested using the 180 and 90 degree positions due to the use of this collimator in the 180 degree SPECT studies as well as its use in Cardiac procedures performed in 90 degrees.  The head alignment calibration can also be performed on a monthly basis in place of the MHR's using the AutoQC feature.  When performing manual quality control, it is important to use proper technique in order to be consistent.  Click below to learn more about:  Preparation of a point source Setup of Extrinsic Sheet Source holder Setup of MHR Phantom Preparation of a Point Source Learn how to prepare a point source. To prepare a point source:  Place a small piece of cotton into the cone portion of the vial. Drop the recommended amount of Tc99m onto the cotton  Intrinsic Verification: 35µCi Intrinsic Calibration: 35µCi MHR/COR Template: 1-2mCi per source (match within 20%).       3. The point source is now ready for            use. Please note: When preparing a point source, do not over saturate the cotton. Do not overfill the vial or splash activity on the side.  The integrated source holder is a retractable rod built into the foot end of the patient bed. It is manually pulled out of the patient bed to perform quality control procedures, and then pushed back in to the foot of the patient bed when procedures are complete. A point source vial is inserted into the end of the integrated source holder, enabling source positioning for peaking, tuning, and intrinsic verifications and calibration procedures. Position the Extrinsic Sheet Source holder Learn how to position the extrinsic sheet source holder. The sheet source holder is placed on the patient bed near the pallet handle for extrinsic flood verification and calibrations.   A Co-57 sheet source is used with the system for calibrations. Attaching the Sheet Source Holder:  Home the system, then remove the patient pad from the pallet.   Align the sheet source holder’s base with hook and loop fasteners to the pallet’s shorter set of hook and loop fasteners. Pins on the sheet source holder’s base fit into tracks on both sides of the pallet to provide stability.   Center the sheet source within the sheet source holder’s defined source area.   (1) Locations where the pins sit within the patient bed track.  (2) Hook and loop fasteners run the length of the patient bed  Multiple Head Registration - Phantom Setup Learn how to setup a phantom for MHR. Slide NumberText BlocksCalloutsAudio ScriptImage File1Multiple Head Registration - Phantom Setup The MHR phantom has seven holes cut into the surface for holding point source vials.  A screen on the phantom indicates the point source configuration for the different collimator types.  Setup of the sources on the MHR phantom depends on the collimator to be tested. Three point sources are used for the following collimators: Medium Energy Low Penetration (ME) High Energy (HE) Five point sources are used for the following collimators: High Resolution (LEHR) Ultra High Resolution (UHR) Low Energy All Purpose (LEAP) Fanbeam (FB) SMARTZOOM Low Penetration High Resolution (LPHR) Note: For SMARTZOOM collimators, the configuration of the five point sources is different than the other collimator types with five point sources.The MHR phantom has seven holes cut into the surface for holding point source vials. A screen on the MHR/COR Phantom indicates the point source configuration for the different collimator types. The setup of the sources on the MHR phantom depends on the collimator being tested. Three point sources are for the following collimators: Medium Energy Low Penetration (ME) High Energy (HE) Five point sources are used for the following collimators: High Resolution (LEHR) Ultra High Resolution (UHR) Low Energy All Purpose (LEAP) Fanbeam (FB) SMARTZOOM Low Penetration High Resolution (LPHR) Note: For SMARTZOOM collimators, the configuration of the five point sources is different than the other collimator types with five point sources.2Multiple Head Registration - Phantom Setup Setup to use the MHR Phantom: Fully retract the pallet and remove the pallet pad. Mount the MHR phantom on top of the pallet using the hook and loop fasteners. Insert the appropriate number of vials in the correct configuration depending on the collimator type to be calibrated. CalloutsAlign MHR phantom on the short set of hook and loop fastenerMHR phantom attaches near the patient bed's pallet handleTo setup the MHR phantom, fully retract the pallet and remove the pallet pad. Mount the MHR phantom on top of the pallet using the hook and loop fasteners. Align the phantom’s rear with the rear of the short strip of hook and loop fasteners on the pallet. Insert the appropriate number of vials in the correct configuration depending on the collimator type to be calibrated. 3Multiple Head Registration - Phantom Setup for Fanbeam Fanbeam collimators require a special metal bracket to perform the MHR procedure. The metal bracket connects the MHR/COR phantom to the patient bed.  The bracket attaches to the end of the patient bed’s pallet.  The screen on the MHR Phantom indicates the point source configuration for the fanbeam collimator.  CalloutsMHR fanbeam bracket being attached to the MHR phantomMHR phantom attached to the patient bed's palletFanbeam collimators require a special metal bracket to perform the MHR procedure. The metal bracket connects the MHR phantom to the end of the patient bed. The bracket attaches to the MHR phantom using two thumb screws and then attaches to the end of the patient bed’s pallet by sliding it under the pallet and by means of a screw which clamps the bracket to the pallet’s top. The bracket may remain attached to the phantom during calibration of parallel hole collimators for convenience. The screen on the MHR Phantom indicates the point source configuration for the fanbeam collimator. On a daily basis, a verification should be run to ensure the uniformity corrections are still valid for the system. This can be completed in one of the following ways:  Intrinsic verification (manual or AutoQC) Extrinsic verification (manual or AutoQC) Extrinsic sweep verification (AutoQC only) Click below to learn more about these quality control procedures.  Intrinsic Verification Learn how to perform intrinsic verification. Tab TitleTextIntrinsic Verification Manual Intrinsic Verification AutoQC  Extrinsic Verification Learn how to perform extrinsic verification. Tab TitleTextExtrinsic Verification Manual Extrinsic Verification Sweep - AutoQC  The recommended weekly QC for SPECT is an intrinsic verification with a tuning procedure.  This can be completed manually or using the AutoQC features.  The first step is to Tune the system and then perform an intrinsic verification as previously described in this training.  Click below to learn more about tuning the system. Tuning & Peaking Learn more about tuning & peaking.   Monthly quality control for SPECT systems include: Intrinsic Calibration with a Tuning Procedure followed by in Intrinsic Verification Multiple Head Registration (MHR) at 180° Head Alignment Calibration Intrinsic Calibration Learn how to perform intrinsic calibration. Tab TitleTextIntrinsic Calibration Manual Intrinsic Calibration AutoQC  Multiple head registration Learn more about multiple head registration. Tab TitleTextMHR - General InformationMHR/COR calibrations are performed for each collimator and configuration used clinically.  The calibration aligns the detector to the gantry's center of rotation and to one another. After the initial calibrations are completed, the user may acquire the MHR/COR calibration only at 180° for the most commonly used low energy collimator.  As long as the values from that calibration are within the following acceptable ranges to the last full calibration of the 180° configuration for that collimator, than the remaining collimators and configurations can be skipped: Deviates less than 0.5 pixels (2mm) in the x-shift/center of rotation Deviates less than 0.5 pixels (2mm) in the y-shift/axial shift Deviates less than 0.1° in the back projection angle ​If deviations are greater than specified above, the MHR/COR for all collimators and detector configurations should be performedMHR - Workflow Head Alignment Verification - AutoQCHead alignment verification is automatically performed on the most commonly used low energy collimator. The verification checks the detectors’ alignment with clinical corrections applied to the gantry's center of rotation and to one another. Automatic head alignment calibrations are not supported for SMARTZOOM collimators.  Steps to perform the Head Alignment Verification: Home the system.  Depending on the collimator type, the collimators may be installed automatically if they are stored in the ACC, or be required to be installed manually if stored on a collimator cart. If collimators are installed manually, follow the instructions on the PPM.  The system performs pre-positioning if the Use AutoQC Device check box was selected.  Verify that the background count display on the PPM is less than 0.4 kcts/sec.  Register a new patient, or select a previously registered patient and double click the Head Alignment Verification workflow template.  The AutoQCStart activity is displayed.  Check that the collimators have been installed before pressing the Start button.  Click the Start button.  The system homes itself, aligning the detectors and patient bed.  The Tomo Acquisition activity is displayed.  The system images the line source shielded to be 5 points.  After the acquisition has run, review the results in the Head Alignment processing activity.  The head alignment verification results should be ≤ 2 mm in the center of rotation and axial area, and the backprojection angle should be ≤ 0.2°.  If the results of the verification are acceptable, click the Accept These Verifications button. If the results are not acceptable, click the Reject these verifications button. The workflow proceeds to the next activity. If a save screen or hard copy is needed, select the Hard Copy activity and make the appropriate selections.  Click the Complete button to complete the workflow. After reading the disclaimer, please proceed to the final quiz to complete the online training. Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. The information in this material contains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases. Certain products, product related claims or functionalities described in the material (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH, 2019 The AutoQC option allows unattended automated floods for detector quality control checks.  Click below to learn how to schedule AutoQC.    AutoQC scheduler Learn how to configure the AutoQC scheduler. Tab TitleTextScheduling AutoQC To schedule AutoQC, perform the following steps: From the Command Module, select the Options menu and then click the Configuration menu item.  The Configuration Panel window will open. Scroll to the syngo MI Acquisition Settings icon and double click it.  The Completion Time Setup window will open. Click the Days of Operation check box(es) for the days on which AutoQC is to run. Click the Completion Time arrows to set the time by which AutoQC is to be completed. Click OK.  AutoQC completion day and time are now scheduled. Verifying AutoQC settings To verify AutoQC, perform the following steps: From the command module, select a patient and double click the desired AutoQC template.  This will launch the workflow template. Click the AutoQCStart activity. If this is a verification workflow, verify that the Verify Calibration Data checkbox is selected (contains a checkmark).  If this is a calibration workflow, verify that both the Back Up Calibration Data and the Verify Calibration Data check boxes are selected. From the Workflow Navigator, click the Static Acquisition activity. From the Acquisition tab, select the Camera Parameters tab. Change Completion Day and Completion Time using the pull-down menu and increment arrows if necessary.