Ultrasound Quality Assurance

Lincoln County Hospital’s Nick Dudley, Physicist and Chair of the BMUS Physics & Safety Group, shares his top tips for QA

1. Ultrasound QA is legally required. 

?The specific legislation for ionising radiation can distract us from more generic legislation; this covers the management of medical equipment and standards in healthcare and also requires equipment QA.  The Health & Social Care Act and the Provision and Use of Work Equipment Regulations require that equipment is suitable for purpose, regularly inspected, properly maintained and that risks are assessed and mitigated; this can’t be achieved without a QA programme. There is also a misconception that maintenance contracts include QA; they rarely do.

2. The literature shows that over 90% of faults may be detected by simple visual inspection and uniformity assessment.

These activities form a key part of the BMUS guidelines for Sonographer QA and take only a few minutes.1  Many Ultrasound departments don’t have the support of Physics or Engineering services. Sonographers are highly trained professionals, capable of following the BMUS guidelines and implementing a QA programme.

3. Use specific settings for uniformity assessment, including a shallow focus to ensure a small transmit aperture; this improves the chances of seeing single element dropout.

Modern controls such as compounding and advanced processing can mask uniformity faults; so turn them off.

4. There is very little guidance on managing faults.

Here, the CQC requirement “exhibiting only minor deterioration” is useful. To comply with this needs a risk assessment, taking account of the use of the equipment, to determine whether the deterioration is minor. For example, a single line of dropout in the periphery of the image may be acceptable, but a large area of dropout anywhere in the image is not. A damaged probe may be an electrical and infection hazard, even if imaging is not affected.

5. Don’t forget that acceptance testing and audit are essential elements of a QA programme.2

Although within the capabilities of Sonographers, these can be more time-consuming and technically demanding so it may be more appropriate to seek the support of a nearby Medical Physics and Clinical Engineering Department or an independent provider.

  1. Dudley N, Russell S, Ward B and Hoskins P; BMUS QA Working Party. BMUS guidelines for the regular quality assurance testing of ultrasound scanners by sonographers. Ultrasound 22, 8-14, 2014
  2. Russell S, Dudley N, Evans, T, Hoskins P, Watson A, Starritt H.  Quality assurance of Ultrasound Imaging Systems.  IPEM Report No 102. IPEM, York 2010