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Ingrid, No - it just says, “PM performed per service instructions. System passed all tests and is functioning per manufacturer specifications to the exception of tube output and dose for all techniques. ” The lead tech at the site told me that</div>
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Ingrid,</div>
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No - it just says, “PM performed per service instructions. System passed all tests and is functioning per manufacturer specifications to the exception of tube output and dose for all techniques.” </div>
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The lead tech at the site told me that she was told that the dose was a little high and that he (the FSE) didn’t think it was too high to stop operations but that they needed me to make that decision.</div>
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Rebecca.</div>
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<b>From: </b>Ingrid Reiser <ireiser@uchicago.edu><br>
<b>Date: </b>Monday, June 1, 2026 at 10:48 AM<br>
<b>To: </b>Milman, Rebecca <REBECCA.MILMAN@CUANSCHUTZ.EDU>; Tao, Ashley T <attao@emplifyhealth.org>; DxMedPhys List
<intl_dxmedphys_wd_osu_list@lists.osu.edu>
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<intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject: </b>RE: MQSA - Manufacturer PM vs ACR DM QC manual<br>
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[External Email - Use Caution]</div>
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<span style="font-size: 11pt;">Does the PM service report state whether the system is compliant with MQSA and can be used for imaging patients, or if these failed tests require repairs within a certain time frame?</span></p>
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<span style="font-size: 11pt;"> </span></p>
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<span style="font-size: 11pt;">Ingrid</span></p>
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<span style="font-size: 11pt;"> </span></p>
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<span style="font-family: Calibri, sans-serif; font-size: 11pt;"><b>From:</b> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu>
<b>On Behalf Of </b>Milman, Rebecca via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Monday, June 1, 2026 11:21 AM<br>
<b>To:</b> Tao, Ashley T <attao@emplifyhealth.org>; DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu> <intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] MQSA - Manufacturer PM vs ACR DM QC manual</span></p>
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<span style="font-size: 1pt; color: white;">Update: I just received a PM service report (from Hologic) that stated that, “System passed all tests…to the exception of tube output and dose for all techniques.</span><span style="font-family: Arial, sans-serif; font-size: 1pt; color: white;"> </span><span style="font-size: 1pt; color: white;">”
This raises a couple of questions, and I’m interested in other people’s experiences.</span><span style="font-family: Arial, sans-serif; font-size: 1pt; color: white;"> </span></p>
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<span style="font-size: 12pt; color: black;">Update: </span></p>
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<span style="font-size: 12pt; color: black;"> </span></p>
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<span style="font-size: 12pt; color: black;">I just received a PM service report (from Hologic) that stated that, “System passed all tests…to the exception of tube output and dose for all techniques.”</span></p>
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<span style="font-size: 12pt; color: black;"> </span></p>
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<span style="font-size: 12pt; color: black;">This raises a couple of questions, and I’m interested in other people’s experiences.</span></p>
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<span style="font-size: 12pt; color: black;">As a physicist, I don’t really know what it means if the “tube output and dose for all techniques” doesn’t pass during a PM. Without more information - including their internal pass/fail criteria - I’m not sure how
to interpret this service report.</span></p>
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<span style="font-size: 12pt; color: black;"> </span></p>
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<span style="font-size: 12pt; color: black;">The other issue is related to Ashley’s original post. If the manufacturer’s tolerance for HVL is 0.01 mm Al, then it is problematic when you’re measuring HVL with a device with a measurement error > 0.01 mm Al. My
experience has been that Hologic FSEs use the Raysafe X2 systems, which have a measurement error of 5% (below 25 kV) or 10% (above 25 kV). For a system with an HVL ~ 0.5 mm Al at 28 kV, then the measurement error is well above 0.01 mm Al. </span></p>
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<span style="font-size: 12pt; color: black;">So how do we (QMPs) address the situation where a manufacturer cites an issue based on a problematic performance criterion? For any other modality I would make a note of why the manufacturer’s criteria are problematic,
but with the added regulatory requirements of mammography and the authority that MQSA wields over us all, what is a reasonable approach? </span></p>
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<span style="font-size: 12pt; color: black;">Should we start reporting measured values as a range of values to represent errors in the measurement equipment? There are regulations saying that manufacturers need to provide the facility with a service report,
but how much information are they required to provide? It seems reasonable that they would need to provide a description of the test that failed and what their measurements were, but does anyone get that in their service reports?</span></p>
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<span style="font-size: 12pt; color: black;">Rebecca.</span></p>
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<span style="font-size: 12pt; color: black;"> </span></p>
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<span style="font-size: 11pt; color: black;"><b>Rebecca Milman, Ph.D., DABR</b></span></p>
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<span style="color: black;">Division Chief, Radiological Sciences | Associate Professor</span></p>
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<span style="color: black;">Department of Radiology</span></p>
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<span style="color: black;">University of Colorado Anschutz</span></p>
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<span style="color: black;">720.848.6625</span></p>
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<span style="font-size: 12pt;"> </span></p>
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<span style="font-size: 12pt; color: black;"><b>From: </b>Intl_dxmedphys_wd_osu_list <</span><span style="font-size: 12pt; color: rgb(70, 120, 134);"><a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu" data-outlook-id="8f549899-165c-4b9c-9921-ebcdc912857c" style="color: rgb(70, 120, 134); margin-top: 0px; margin-bottom: 0px;"><u>intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</u></a></span><span style="font-size: 12pt; color: black;">>
on behalf of Tao, Ashley T via Intl_dxmedphys_wd_osu_list <</span><span style="font-size: 12pt; color: rgb(70, 120, 134);"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" data-outlook-id="ecc08231-b090-47a1-ba6f-be9f8567ca70" style="color: rgb(70, 120, 134); margin-top: 0px; margin-bottom: 0px;"><u>intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span><span style="font-size: 12pt; color: black;">><br>
<b>Date: </b>Tuesday, May 19, 2026 at 2:27</span><span style="font-family: Arial, sans-serif; font-size: 12pt; color: black;"> </span><span style="font-size: 12pt; color: black;">PM<br>
<b>To: </b>DxMedPhys List </span></p>
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<span style="font-size: 12pt; color: black;"><</span><span style="font-size: 12pt; color: rgb(70, 120, 134);"><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" data-outlook-id="540ec295-e778-4ba1-b780-1d325aa8887e" style="color: rgb(70, 120, 134); margin-top: 0px; margin-bottom: 0px;"><u>intl_dxmedphys_wd_osu_list@lists.osu.edu</u></a></span><span style="font-size: 12pt; color: black;">><br>
<b>Subject: </b>[Intl_DxMedPhys] MQSA - Manufacturer PM vs ACR DM QC manual</span></p>
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<span style="font-size: 12pt; color: rgb(34, 34, 34);">[External Email - Use Caution]</span></p>
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<span style="font-size: 11pt; color: black;">Dear DxMedPhys Listerv,</span></p>
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<span style="font-size: 11pt; color: black;"> </span></p>
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<span style="font-size: 11pt; color: black;"> I am wondering if anyone who is using the ACR DM QC manual has had any experience with MQSA inspectors giving citations for not following up with PM specifications.</span></p>
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<span style="font-size: 11pt; color: black;"> </span></p>
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<span style="font-size: 11pt; color: black;">Let me set the scene:</span></p>
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<span style="font-size: 11pt;" role="presentation">Our biomed engineer performed service on our unit and determined HVL to be outside of Hologic specs of +/-0.01 mm Al from their baseline/reference value. At 28kV, hologic baseline was 0.513 mm Al, and biomed
measured 0.517. We were due for annual testing about a month and a half from the discovery. biomed asked if they could schedule PM for the day before physics testing. Since we were well above the minimum HVL requirement of 0.28 mm Al, we agreed. </span></li></ol>
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<span style="font-size: 11pt; color: black;">MQSA inspectors said that ACR DM QC Test summary (mee report), Beam quality (HVL) assessment failures must be corrected before clinical use. Our HVL passes the ACR DM QC manual, but because biomed failed it, they
said we needed to correct before clinical use and have an MEE. </span></p>
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<span style="font-size: 11pt;" role="presentation">Our biomed engineer performed service on our unit and determined AEC performance to be outside Hologic's specifications @ 2cm. Hologic references a range of EI values, whereas ACR DM QC manual specifies the
SNR needs to be within +/-15% of the MEE. These two metrics are not comparable. We did perform a partial MEE because we were not certain whether or not we needed to. It turns out the MEE SNR was 22.34 and after AEC calibration, the new MEE SNR was 22.21. The
MEE was completed 34 days after service but we were cited because it needed to be within 30 days. How do you reconcile the metrics used by Hologic vs ACR DM QC manual if they are not comparable? </span></li><li style="font-family: Aptos, sans-serif; font-size: 10pt; color: black; margin: 0in;">
<span style="font-size: 11pt;" role="presentation">Our biomed engineer performed service on our unit and determined target dose to be outside Hologic's specifications of +/-0.1 mGy. The ACR DM QC manual specifies the target dose for a CC view of the ACR DM
QC phantom to be <=3 mGy and that the unit AGD must be within +/-25% of the calculated AGD. Again, Hologics metrics are different than the ACR DM QC manual. We are well within specifications, but because biomed failed it and we did not service it within 30
days, we were cited. </span></li></ol>
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<span style="font-size: 11pt; color: black;">We showed the MQSA inspectors the service report and explained what the results were but they didn't seem to care and said that we would need to provide a corrective action letter before escalating to their next
level inspector. It is my understanding that Hologic PM specs are more stringent for optimal performance. The ACR DM QC manual does not specify a timeline to address deficiencies in PM except for if there is relevant service and a finding were to be out of
compliance with the ACR DM QC manual then you would need appropriate follow-up (e.g. immediately before clinical use versus 30 days). We are writing a response letter addressing these citations, but I would appreciate any input this group may have regarding
their experience w/ inspectors and PMs being out of spec. </span></p>
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<span style="font-size: 11pt; color: black;"> </span></p>
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<span style="font-size: 11pt; color: black;">On a side note, if HVL is out of Hologic spec (but within MQSA requirements), and my biomed engineer needs to recalibrate but it also requires them to recalibrate AEC as part of the process, it seems that there would
need to be on-site physicist testing of the AEC because according to ACR DM QC manual - Table 3 Medical Physicist Involvement in Equipment Adjustments, Changes or Repairs(pg 138) - are any of you basically having to do MEEs every time your PMs are just a
little bit out of spec?</span></p>
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<span style="font-size: 11pt; color: black;">Looking forward to hearing about your experiences.</span></p>
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<span style="font-size: 11pt; color: black;">Thanks</span></p>
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<span style="font-size: 11pt; color: black;">Ashley </span></p>
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