Mammography quality assurance from A to Z.

Quality assurance (QA) refers to all planned, systematic activities that instill confidence that quality mammography is being performed. Quality control (QC) refers only to the technical aspects of the examination. Standardized labeling of mammograms and the format for mammographic reports are important parts of a QA program; recommendations for both have been published by the American College of Radiology. Minimum staff for a mammography service consists of a scheduler, technologist(s), medical physicist, and radiologist. The scheduler asks the patient questions to ensure that the appropriate examination is performed, gives the patient instructions, and asks the patient to complete a history questionnaire including a release form to obtain earlier mammograms. One certified, licensed technologist is designated to perform QC, which includes maintaining darkroom, screen, and view box cleanliness; reviewing processor performance, checked with sensitometer, densitometer, and phantom images; repeat analysis; analysis of fixative retained in film, darkroom fog, screen-film contact, and adequacy of compression; and visual inspection of equipment. A certified medical physicist performs equipment acceptance testing and annual QC visits thereafter. The radiologist oversees all aspects of the QA program, including selecting and regularly observing the technologists, selecting and meeting with the physicist, communicating results, ensuring patient follow-up, and assessing patient outcome data. The radiologist is ultimately responsible for image quality and the standard of patient care.