Submitted by ACR

How ACR accreditation impacts equipment maintenance and service

With today’s focus on patient-centered care, accreditation programs for diagnostic imaging have emerged as vital initiatives to enhance quality and safety, especially for modalities that depend on advanced technologies such as CT, MRI, nuclear medicine, and PET.

Now more than ever, patients are informed and discriminating consumers of medical care. And they actively seek out hospitals and imaging centers with equipment, technologists, and physicians that meet the highest standards for quality and safety.

The gold seal of the American College of Radiology (ACR) — ACR accreditation — lets patients know that a hospital, clinic, or imaging center has gone through a rigorous review process to ensure it meets nationally accepted standards. When patients choose an ACR-accredited facility, they also know that the equipment used is appropriate for the test or treatment they will receive, and that the facility meets or exceeds quality assurance and safety guidelines.

In this article, we take a look at the basics of the ACR accreditation programs and discuss how they can impact your equipment service and maintenance.

What Does It Mean for a Facility to Be Accredited by the ACR?

The ACR awards accreditation to facilities for the achievement of high practice standards based on peer-reviewed assessment of clinical and phantom images, as well as radiation dose. Evaluations are conducted by board-certified radiologists and medical physicists who are experts in the field.

The program also evaluates personnel qualifications, performance of facility equipment, quality control procedures, and quality assurance programs. All findings are reported to the facility via a comprehensive report that includes recommendations for improvement.

The ACR accredits facilities in the following modalities:

  • Breast MRI
  • Breast ultrasound
  • CT
  • Mammography
  • MRI
  • Nuclear medicine and PET
  • Radiation oncology
  • Stereotactic breast biopsy
  • Ultrasound

The ACR is the oldest and most widely recognized radiology accrediting body in the United States, and it is the only accrediting process created by and carried out by radiologists and medical physicists. The educationally focused accreditation process is based on the ACR Practice Parameters and Technical Standards, which were developed to ensure appropriate radiologic care for patients.

Why Do Facilities Need to Be Accredited?

Achieving ACR accreditation is not only the right thing to do for patient quality and safety, it also helps your facility meet governmental and third-party payer criteria and protect your reimbursements.

In 2012, the Medicare Improvements for Patients and Providers Act (MIPPA) mandated that providers of CT, MRI, breast MRI, nuclear medicine, and PET exams that bill under Part B of the Medicare Physician Fee Schedule be accredited in order to receive payment for the technical component of these services.

CMS requirements for accreditation include:

  • Personnel qualifications for non-physician medical staff, medical directors, and supervising physicians
  • Image quality
  • Equipment performance
  • Safety standards for staff and patients
  • Quality assurance and quality control

To meet MIPPA standards, sites must have a policy in place for primary source verification of personnel qualifications. That means you must verify the credentials of your employees directly with licensing and certifying bodies:

  • Physician medical license — check with the licensing board for that state.
  • Physician certification — verify with American Board of Medical Specialties.
  • Technologist certification — verify with specific certifying agencies such as ARRT, ARMRIT, and NMTCB.
  • Medical physicist — confirm credentials with CRCPD.

Facilities must also maintain a written policy on patient access to information, including the patient record-retention and retrieval process. Other requirements include maintaining written policies for staff and patient safety and for consumer complaints, including a posted notice about where and how to file a complaint with the provider’s accrediting organization.

Goals of ACR Accreditation

  • Improve the quality of patient care
  • Validate good practice through peer review
  • Establish quality standards for imaging
  • Identify recommendations for improvement
  • Determine if equipment meets quality requirements
  • Evaluate qualifications of personnel to determine if they meet the accreditation program’s requirements
  • Meet criteria of governmental or third-party payers
  • Gain recognition for quality imaging practices

How Does the ACR Accreditation Process Work?

ACR accreditation is an educational process of self-assessment and peer review.

The ACR accreditation process documents that your facility meets accreditation requirements for equipment, medical personnel, and quality assurance. Critical elements of the process include clinical and phantom image quality review, as well as radiation dose assessments.

The ACR’s streamlined application process has cut approval time in half, with accreditation evaluation typically completed within 90 days of image submission. Here’s how it works:

Depending on modality, the evaluation process may include review of the following materials:

  • Clinical images
  • Phantom images
  • Dose measurements
  • Scanning protocols
  • Patient reports
  • Annual system performance evaluations

Materials submitted for accreditation review are sent to volunteer reviewers. For clinical images, the ACR requires evaluation by two radiologist reviewers. For phantom images, one or two medical physicists provide evaluation.

To achieve ACR accreditation:

  • Every unit performing imaging must go through testing for site to be accredited.
  • Every unit must apply for all modules performed on that unit for site to be accredited.
  • All clinical images submitted for review should first be approved by the facility’s supervising physician.
  • All images submitted for each unit must pass for accreditation to be granted.

If you receive a deficiency, you will have a dedicated ACR support team to discuss your options to appeal, withdraw, repeat, reinstate, retest, etc. And, you can contact ACR if you have any questions throughout the accreditation process.

What You Need to Know About Phantoms

ACR phantoms are scanned by a technologist or physicist. If performed by a technologist, a medical physicist should check all images and data forms. Depending on the modality, ACR phantom measurements may include:

  • CT number calibration
  • Low-contrast (CNR)
  • Spatial resolution
  • Uniformity
  • Artifacts

For dose testing on CT units, the dosimetry must be performed by a medical physicist. Dose testing includes:

  • CTDIvol
  • Reference values and pass/fail criteria

Phantom submissions may include:

  • CT ACR phantom (Gammex) and dosimetry phantom images
  • MR phantom (JM Specialty Parts), including:
  • Large phantom for whole body magnets
  • Small phantom for extremity magnets
  • NM and PET ACR-approved phantoms (Data Spectrum)

Here’s an example of a poor-quality image from a nuclear medicine phantom. The site that submitted this planar uniformity image from a gamma camera failed accreditation.

Why Quality Control?

A key aspect of achieving accreditation rests in the proper maintenance and functioning of imaging equipment to ensure quality and safety. Routine quality control (QC) can help ensure that your equipment operates appropriately to achieve the necessary image quality. A continuous QC program is essential to identify problems before the diagnostic utility of the equipment is significantly impacted.

The evaluation of equipment performance as part of an ongoing QC program can also be instrumental in building a business case to justify improved service contracts or the purchase of new equipment. What’s more, documentation of QC—including acceptance testing, annual survey, routine QC tests, and preventive maintenance—is often a governmental regulation.

Most importantly, a routine QC program provides an opportunity for education and practice quality improvement.

As a key component of its accreditation program, the ACR offers several QC manuals to assist facilities in their efforts to ensure top-performing equipment:

  • The ACR MRI Quality Control Manual is designed to assist facilities in testing and maintaining their magnetic resonance imaging equipment as a part of continuous quality control program. The manual describes which personnel are responsible for specific tasks and delineates methods for evaluating equipment performance with many tests using the ACR magnetic resonance imaging phantom.
  • The ACR CT Quality Control Manual helps facilities establish and maintain a quality control program for CT. The manual details the quality control responsibilities of the radiologist, radiologic technologist, and medical physicist for CT. Each section incorporates best practices and includes step-by-step instructions for daily, weekly, monthly, and yearly quality control tests. Based on test results, the manual provides suggestions for corrective action.
  • The ACR Digital Mammography Quality Control Manual provides user-friendly instructions to perform and document QC across all manufacturers and types of digital mammography equipment. The objective of the manual is to ensure high-quality digital mammograms while keeping radiation doses low.

How to Prepare for Accreditation

The ACR has dedicated and readily accessible resources to help sites prepare for accreditation. Start with ACR accreditation website (acraccreditation.org), where you’ll find a wealth of easy-to-access online information that serves as a comprehensive guide to the requirements for each program. For each modality, you can also find all the latest articles, announcements, and frequently asked questions (FAQs) regarding accreditation.

Here are the basic steps to follow when you embark on your accreditation journey:

Step 1: Before applying for accreditation, visit the ACR accreditation website and carefully review modality-specific program requirements and documents about the accreditation process and instructions for submitting images and phantoms.

Step 2: Review the FAQs specific to each modality, as well as general FAQs about the ACR accreditation process.

Step 3: Access the ACR online accreditation application. Log in to ACRedit to apply for, update, or renew your accreditation. The system will step you through the process to enter facility, modality, and CMS information (such as Medicare ID number, national provider identifier, and EIN).

Step 4: Gather images and data. Use the modality-specific guides and forms to help you prepare your materials for submission to the ACR accreditation team. These resources can include: clinical image quality guides, testing instructions, test image data forms, phantom image order forms, dose forms, annual system performance evaluation forms, technologist QC forms, quality assurance questionnaires, and testing materials checklists.

The Quality and Safety section (acr.org/Quality-Safety) of the ACR website also provides access to ACR Practice Parameters and Technical Standards, ACR Appropriateness Criteria®, the ACR National Radiology Data Registry (NRDR®), the Education Catalog, and numerous other resources.

What Happens After Accreditation?

Imaging facilities are accredited for three years. For MIPPA modalities, each accredited facility will go through an unannounced site visit during the three-year accreditation period. Sites can be visited by an ACR representative and/or CMS at any time during the three-year accreditation period.

As an accrediting organization, the ACR conducts validation site surveys on accredited facilities to monitor compliance with accreditation standards and to meet the requirements of MIPPA.

How can you prepare for unannounced site visits? The ACR provides a detailed toolkit designed to assist gathering and maintaining documentation that is required for accreditation. The toolkit can also be used to prepare pre-accreditation and/or post-accreditation onsite surveys.

Expert Help to Guide You

Along the path to accreditation, ACR experts are standing by to guide you every step of the way. ACR has more than 25 years of experience in imaging accreditation and a team of experienced technologists readily accessible by phone or email to guide you throughout the process. With our expert staff and the assistance of more than 250 board-certified radiologists and qualified medical physicists, the ACR has provided successful and timely accreditation for nearly 40,000 facilities nationally.

Contact
American College of Radiology
1891 Preston White Drive
Reston, VA 20191
Accreditation Hotline: 800-770-0145
www.acraccreditation.org