<!-- BaNnErBlUrFlE-BoDy-start -->
<!-- Preheader Text : BEGIN -->
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;">
Thanks, Megan. That’s interesting. I would think we could monitor some of these things by looking at the weekly QC phantom images. If the mR/mAs increases, then either the noise should decrease or the AEC-determined mAs should decrease. However,</div>
<!-- Preheader Text : END -->
<!-- Email Banner : BEGIN -->
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;">ZjQcmQRYFpfptBannerStart</div>
<!--[if ((ie)|(mso))]>
<table border="0" cellspacing="0" cellpadding="0" width="100%" style="padding: 0px 0px 10px 0px; direction: ltr" lang="en"><tr><td>
<table border="0" cellspacing="0" cellpadding="0" style="padding: 0px 8px 6px 8px; width: 100%; border-radius:4px; border-top:4px solid #8c8e91;background-color:#cfd3d7;"><tr><td valign="top">
<table align="left" border="0" cellspacing="0" cellpadding="0" style="padding: 0px 8px 4px 8px; font-size: 12px; line-height: 16px">
<tr><td style="color:#000000; font-family: 'Arial', sans-serif; font-weight:bold; font-size:14px; line-height: 20px; direction: ltr">
This Message Is From an External Sender
</td></tr>
<tr><td style="color:#000000; font-weight:normal; font-family: 'Arial', sans-serif; font-size:12px; direction: ltr">
This message came from outside your organization.
</td></tr>
</table>
<![if ie]><br clear="all"><![endif]>
<table align="right" border="0" cellspacing="0" cellpadding="0" style="padding: 0px 0px 4px 0px; font-size: 14px; line-height: 36px"><tr>
<td style="direction: ltr"> <a target="_blank" href="https://us-phishalarm-ewt.proofpoint.com/EWT/v1/KGKeukY!vwQd0oYND6YAxRdx3q-EGRRnxqRs5TqaSCoB7po5W_FNOxeQOpWVSiEad5zkcLFNcAP4aJclRl0MzarlnujNEqZH7auRCiccxAie9bP1ZBursDD8SQyQKozqddo38tj5N1G0XKqcbSn5XkWJcOalPCqN7kohht8ywg$" style="mso-padding-alt: 7px; padding: 7px; border-radius: 2px; border: 1px solid #666666; "><strong style="font-weight: normal; color: #000000; text-decoration: none; font-family: 'Arial', sans-serif; font-size: 14px;"> Report Suspicious </strong></a> </td>
</tr></table>
</td></tr></table>
</td></tr></table>
<![endif]-->
<![if !((ie)|(mso))]>
<div dir="ltr" lang="en" id="pfptBanner3i1m9sh" style="all: revert !important; display:block !important; text-align: left !important; margin: 0 0 10px 0 !important; padding:7px 16px 8px 16px !important; border-radius: 4px !important; min-width: 200px !important; background-color: #cfd3d7 !important; background-color: #cfd3d7; border-top: 4px solid #8c8e91 !important; border-top: 4px solid #8c8e91;">
<div id="pfptBanner3i1m9sh" style="all: unset !important; float:left !important; display:block !important; margin: 1px 0 1px 0 !important; max-width: 600px !important;">
<div id="pfptBanner3i1m9sh" style="all: unset !important; display:block !important; visibility: visible !important; background-color: #cfd3d7 !important; color:#000000 !important; color:#000000; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-weight:bold !important; font-weight:bold; font-size:14px !important; line-height:1.29 !important; line-height:1.29">
This Message Is From an External Sender
</div>
<div id="pfptBanner3i1m9sh" style="all: unset !important; display:block !important; visibility: visible !important; background-color: #cfd3d7 !important; color:#000000 !important; color:#000000; font-weight:normal; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-size:12px !important; line-height:1.5 !important; line-height:1.5; margin-top:2px !important;">
This message came from outside your organization.
</div>
</div>
<div id="pfptBanner3i1m9sh" style="all: unset !important; float: right !important; display: block !important; display: block; margin-left: 16px !important; margin-top: 1px !important; text-align: right !important; width: fit-content !important; font-size: 12px !important">
<a id="pfptBanner3i1m9sh" href="https://us-phishalarm-ewt.proofpoint.com/EWT/v1/KGKeukY!vwQd0oYND6YAxRdx3q-EGRRnxqRs5TqaSCoB7po5W_FNOxeQOpWVSiEad5zkcLFNcAP4aJclRl0MzarlnujNEqZH7auRCiccxAie9bP1ZBursDD8SQyQKozqddo38tj5N1G0XKqcbSn5XkWJcOalPCqN7kohht8ywg$"
style="all: unset !important; display: inline-block !important; text-decoration: none">
<div class="pfptPrimaryButton3i1m9sh" style="display: inline-block !important; display: inline-block; visibility: visible !important; opacity: 1 !important; color: #000000 !important; color: #000000; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-size: 14px !important; font-weight: normal !important; text-decoration: none !important; border-radius: 2px !important; margin-top: 3px !important; margin-bottom: 3px !important; margin-left: 16px !important; padding: 7.5px 16px !important; white-space: nowrap !important; width: fit-content !important;
border: 1px solid #666666">
Report Suspicious
</div>
</a>
</div>
<div style="clear: both !important; display: block !important; visibility: hidden !important; line-height: 0 !important; font-size: 0.01px !important; height: 0px"> </div>
</div>
<![endif]>
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;">ZjQcmQRYFpfptBannerEnd</div>
<!-- Email Banner : END -->
<!-- BaNnErBlUrFlE-BoDy-end -->
<html>
<head><!-- BaNnErBlUrFlE-HeAdEr-start -->
<style>
#pfptBanner3i1m9sh { all: revert !important; display: block !important;
visibility: visible !important; opacity: 1 !important;
background-color: #cfd3d7 !important;
max-width: none !important; max-height: none !important }
.pfptPrimaryButton3i1m9sh:hover, .pfptPrimaryButton3i1m9sh:focus {
background-color: #adb0b4 !important; }
.pfptPrimaryButton3i1m9sh:active {
background-color: #8c8e91 !important; }
html:root, html:root>body { all: revert !important; display: block !important;
visibility: visible !important; opacity: 1 !important; }
</style>
<!-- BaNnErBlUrFlE-HeAdEr-end -->
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
</head>
<body>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Thanks, Megan. That’s interesting. </div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
I would think we could monitor some of these things by looking at the weekly QC phantom images. If the mR/mAs increases, then either the noise should decrease or the AEC-determined mAs should decrease. </div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
However, I will wait for Doug Pfeiffer to point out why I’m wrong about that and for Dustin Gress to point out why that approach is inadequate for accreditation/regulatory purposes. 😉 (Please note that this last sentence is in jest and that I highly respect
both of these physicists!!)</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Rebecca.</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div id="mail-editor-reference-message-container">
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
</div>
<div style="padding: 3pt 0in 0in; border-width: 1pt medium medium; border-style: solid none none; border-color: rgb(181, 196, 223) currentcolor currentcolor;">
<div class="ms-outlook-mobile-reference-message skipProofing" style="text-align: left; font-family: Aptos; font-size: 12pt; color: black;">
<b>From: </b>Megan Brown <megan@centennialmedphys.com><br>
<b>Date: </b>Monday, June 1, 2026 at 11:50 AM<br>
<b>To: </b>Tao, Ashley T <attao@emplifyhealth.org><br>
<b>Cc: </b>Chikezie C. Onyema <onyema.cc@gmail.com>; Milman, Rebecca <REBECCA.MILMAN@cuanschutz.edu>; DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu>
<div class="ms-outlook-mobile-reference-message skipProofing" style="text-align: left;">
<intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject: </b>Re: [Intl_DxMedPhys] MQSA - Manufacturer PM vs ACR DM QC manual<br>
<br>
</div>
</intl_dxmedphys_wd_osu_list@lists.osu.edu></div>
</div>
<table class="ms-outlook-mobile-reference-message skipProofing" align="left" cellspacing="0" cellpadding="0" border="0" style="width: 100%;">
<tbody>
<tr>
<td class="ms-outlook-mobile-reference-message skipProofing" style="padding: 5pt 4pt 5pt 12pt; width: 100%;">
<div class="ms-outlook-mobile-reference-message skipProofing" style="color: rgb(34, 34, 34);">
[External Email - Use Caution]</div>
</td>
</tr>
</tbody>
</table>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
This came up for me recently - Hologic declared the dose was too high and they would have to do adjustments to the tube output. I was sent this if anyone is curious about the vendor spec:</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<img src="cid:ii_mpvhtmo81" alt="IMG_20260601_104856.heic" width="422" height="562" style="width: 422px; height: 562px; max-width: 100%;"></div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<br>
</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
I guess a question to ask is what is meant by "AEC calibration that effects dose" in the ACR QC Manual. Are we adjusting the AEC tables from standard to low dose or contrast screening? In that case yes I think physicist testing is justified. The minor adjustments
that they have been making during PMs are meant to bring it back within their own tight specs for performance. That I don't know requires us to be there to test. The other question is if none of the tech or physicist QC tests fail, then how are we applying
the corrective action timeframe for those tests? IMO if none of the QC tests fail, and no major parts are replaced then physicist oversight should be sufficient. The HVL failures which seem to occur at every PM in particular - I've been doing oversight for
these adjustments and have not had an issue with MQSA.</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<br>
</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<br>
</div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif; font-size: 13px; color: rgb(0, 0, 0);">
Thanks,</div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif; font-size: 18px; color: rgb(0, 0, 255);">
<br>
</div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif; color: rgb(0, 0, 255);">
<span style="font-size: 13px;">Megan Brown, M.S.,</span><span style="font-size: 18px;"> </span><span style="font-size: 13px;">DABR</span></div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif; font-size: 13px;">
Medical Physicist</div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif; font-size: 13px;">
Centennial Medical Physics</div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif;">
<a href="mailto:megan@centennialmedphys.com" target="_blank" data-outlook-id="c61d6f93-4e06-457f-a49c-a18d39b7d8e8">megan@centennialmedphys.com</a></div>
<div class="gmail_signature" style="direction: ltr; font-family: arial, helvetica, sans-serif;">
303.916.5305</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<br>
</div>
<div id="DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2"><br>
<table style="border-top: 1px solid rgb(211, 212, 222);">
<tbody>
<tr>
<td style="padding-top: 13px; width: 55px;"><a href="https://urldefense.com/v3/__https://www.avast.com/sig-email?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!KGKeukY!xcQPCf-xYkReCaACdxAcybQ0J_xFqFXD2labwZRuSzUOdZpXqmQ_LMwqcAqd3l5v8hiCpuRXWSk0i1qTQo70xfVvjxIL0tWZZQdfs0Obq1QA65AHUdh2uA$" target="_blank" originalsrc="https://www.avast.com/sig-email?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail" data-outlook-id="20a17914-a6ec-4b53-aba6-a4edb2d5821b"><img src="https://s-install.avcdn.net/ipm/preview/icons/icon-envelope-tick-round-orange-animated-no-repeat-v1.gif" width="46" height="29" style="width: 46px; height: 29px; max-width: 100%;"></a></td>
<td style="line-height: 18px; padding-top: 12px; color: rgb(65, 66, 78); width: 470px;">
<div style="line-height: 18px; font-family: Arial, Helvetica, sans-serif; font-size: 13px;">
Virus-free.<span style="color: rgb(68, 83, 234);"><a href="https://urldefense.com/v3/__https://www.avast.com/sig-email?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!KGKeukY!xcQPCf-xYkReCaACdxAcybQ0J_xFqFXD2labwZRuSzUOdZpXqmQ_LMwqcAqd3l5v8hiCpuRXWSk0i1qTQo70xfVvjxIL0tWZZQdfs0Obq1QA65AHUdh2uA$" target="_blank" originalsrc="https://www.avast.com/sig-email?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail" data-outlook-id="58f89341-ac99-44f0-9b30-dbff7a97f315" style="color: rgb(68, 83, 234);">www.avast.com</a></span></div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="ms-outlook-mobile-reference-message skipProofing" style="direction: ltr;">
<br>
</div>
<div class="gmail_attr" style="direction: ltr;">On Mon, Jun 1, 2026 at 11:25 AM Tao, Ashley T via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" data-outlook-id="e20ffaba-cee2-43a2-89b5-6bce215eee04">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>
wrote:</div>
<blockquote style="margin: 0px 0px 0px 0.8ex; padding-left: 1ex; border-left: 1px solid rgb(204, 204, 204);">
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
I agree with what you have described Chikezie, however, our MQSA inspectors are holding us to PM failures and citing us for it for not fixing HVL immediately before clinical use. </div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
To complicate matters, when they recalibrate HVL, they technically have to recalibrate AEC. Per the ACR DM QC manual, if there is AEC recalibration that affects dose - technically any recalibration would affect dose and a physicist would need to do on-site
testing post recalibration. </div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<hr style="direction: ltr; display: inline-block; width: 98%;">
<div class="msg8015140392213966909" style="direction: ltr; font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<b>From:</b> Chikezie C. Onyema <<a href="mailto:onyema.cc@gmail.com" target="_blank" data-outlook-id="32eba23a-86b1-4844-9c0d-bba6ea768a4a">onyema.cc@gmail.com</a>><br>
<b>Sent:</b> Monday, June 1, 2026 12:14 PM<br>
<b>To:</b> Milman, Rebecca <<a href="mailto:REBECCA.MILMAN@cuanschutz.edu" target="_blank" data-outlook-id="77f82c0b-3add-477d-bf32-004ceb2c8bf8">REBECCA.MILMAN@cuanschutz.edu</a>><br>
<b>Cc:</b> Tao, Ashley T <<a href="mailto:attao@emplifyhealth.org" target="_blank" data-outlook-id="09861261-eb71-4315-a532-8d433315881b">attao@emplifyhealth.org</a>>; DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" data-outlook-id="a272e08f-ce32-4784-9f4a-721021088376">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>
<<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" data-outlook-id="b0828a53-3cb0-4bc7-8dc2-66abf403009f">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] MQSA - Manufacturer PM vs ACR DM QC manual</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<table class="msg8015140392213966909" align="left" style="direction: ltr; background-color: red;">
<tbody>
<tr>
<td class="msg8015140392213966909" align="left" style="direction: ltr;">
<div class="msg8015140392213966909" style="direction: ltr; color: white;"><b>CAUTION:</b> This email originated from outside of Emplify Health. Do not click on any links or open any attachments unless you recognize the sender and know the contents are safe.<br>
We will NEVER ask you to provide your user name or password in reply to an email.<br>
Questions? Contact the Bellin Service Desk at x258600 / (920) 436-8600 or the Gundersen Help Desk at x53070 / (608) 775-3070.</div>
</td>
</tr>
</tbody>
</table>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
<br>
<br>
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;">Hi,</div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;">My understanding is that the tolerance level set by Hologic and checked by FSE during PMs is tighter than the one specified in the QC manual. The image below shows a snapshot of a tube output measurement
done by FSE during PM. An FSE typically uses a dosimeter (in our case, Raysafe X2) to measure the tube output and HVL at different kV settings, then compares them against set specification values. It is my understanding that if it is out of spec, the FSE can
increase/decrease the X-ray tube output to meet the specification (and pass the tube output tests), which may require a total recalibration of the unit, including dose measurement. It is possible that some measurements may pass per the QC manual, whereas during
PM the same measurement may be out of spec due to tighter tolerances.</div>
<div class="msg8015140392213966909" style="direction: ltr;"><img src="cid:ii_19e843da389eb97e76f1" alt="IMG_1368.jpeg" width="563" height="422" style="width: 563px; height: 422px; max-width: 100%;"></div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;">Thanks</div>
<div class="msg8015140392213966909" style="direction: ltr; color: rgb(32, 33, 36);">
<b>Chikezie Onyema, PhD, DABR</b></div>
<div class="msg8015140392213966909" style="direction: ltr; color: rgb(32, 33, 36);">
Diagnostic Medical Physicist</div>
<div class="msg8015140392213966909" style="direction: ltr; color: rgb(32, 33, 36);">
Department of Radiology</div>
<div class="msg8015140392213966909" style="direction: ltr; color: rgb(32, 33, 36);">
Marshfield Clinic | Sanford Health</div>
<div class="msg8015140392213966909" style="direction: ltr; color: rgb(32, 33, 36);">
Marshfield, WI 54449</div>
<div id="m_8015140392213966909x_m_1331226420470712293m_4621887008957356085DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2">
<div style="direction: ltr;"><br>
</div>
<table style="direction: ltr; border-top: 1px solid rgb(211, 212, 222);">
<tbody>
<tr>
<td style="direction: ltr; padding-top: 13px; width: 55px;"><a href="https://urldefense.com/v3/__http://www.avg.com/email-signature?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!IqJknsWg5-ALmw!QfYFW_Ujhei4YmgkqNDpG2yZw0XUwcoHJzYZ9WeGy8m8PIQMqV3D8xZkBgoRbFuH6q5xRynObaqx0nczGw$" target="_blank" id="m_8015140392213966909OWA09e445c8-0a42-387d-3c3e-483e87f45ed2" originalsrc="https://urldefense.com/v3/__http://www.avg.com/email-signature?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!IqJknsWg5-ALmw!QfYFW_Ujhei4YmgkqNDpG2yZw0XUwcoHJzYZ9WeGy8m8PIQMqV3D8xZkBgoRbFuH6q5xRynObaqx0nczGw$" data-outlook-id="c8312352-3c95-4e05-a178-a690eef6e07d"><img src="https://outlook.office.com/mail/inbox/id/AAkALgAAAAAAHYQDEapmEc2byACqAC%2FEWg0AHTujN5D8V06ELY88DjNfuQAHHG1vTAAA?nativeVersion=1.2026.520.400" width="46" height="29" style="width: 46px; height: 29px; max-width: 100%;"></a></td>
<td style="direction: ltr; line-height: 18px; padding-top: 12px; color: rgb(65, 66, 78); width: 470px;">
<div style="direction: ltr; line-height: 18px; font-family: Arial, Helvetica, sans-serif; font-size: 13px;">
Virus-free.<span style="color: rgb(68, 83, 234);"><a href="https://urldefense.com/v3/__http://www.avg.com/email-signature?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!IqJknsWg5-ALmw!QfYFW_Ujhei4YmgkqNDpG2yZw0XUwcoHJzYZ9WeGy8m8PIQMqV3D8xZkBgoRbFuH6q5xRynObaqx0nczGw$" target="_blank" id="m_8015140392213966909OWA074fa13c-78f8-0129-7739-8dbd3edc30cd" originalsrc="https://urldefense.com/v3/__http://www.avg.com/email-signature?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail__;!!IqJknsWg5-ALmw!QfYFW_Ujhei4YmgkqNDpG2yZw0XUwcoHJzYZ9WeGy8m8PIQMqV3D8xZkBgoRbFuH6q5xRynObaqx0nczGw$" data-outlook-id="1ce7fa17-9117-4278-b520-ff50821ea543" style="color: rgb(68, 83, 234);">www.avg.com</a></span></div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="msg8015140392213966909" style="direction: ltr;"><br>
</div>
<div class="msg8015140392213966909" style="direction: ltr;">On Mon, Jun 1, 2026 at 11:21 AM Milman, Rebecca via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" id="m_8015140392213966909OWA6337f39b-ceb3-522d-c70d-474f1cdcb26c" data-outlook-id="4a152cef-0f15-4b16-bdaa-da3f26800f2f">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>>
wrote:</div>
<blockquote style="margin: 0px 0px 0px 0.8ex; padding-left: 1ex; border-left: 1px solid rgb(204, 204, 204);">
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Update: </div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
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.”</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
This raises a couple of questions, and I’m interested in other people’s experiences.</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
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.</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
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. </div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
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? </div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
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?</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Rebecca.</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class="msg8015140392213966909" style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div id="m_8015140392213966909x_m_1331226420470712293m_4621887008957356085m_-6635549295510210966ms-outlook-mobile-signature">
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<b>Rebecca Milman, Ph.D., DABR</b></div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 10pt; color: rgb(0, 0, 0);">
Division Chief, Radiological Sciences | Associate Professor</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 10pt; color: rgb(0, 0, 0);">
Department of Radiology</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 10pt; color: rgb(0, 0, 0);">
University of Colorado Anschutz</div>
<div style="direction: ltr; font-family: Aptos, Arial, Helvetica, sans-serif; font-size: 10pt; color: rgb(0, 0, 0);">
720.848.6625</div>
<div style="direction: ltr;"><br>
</div>
</div>
<div id="m_8015140392213966909x_m_1331226420470712293m_4621887008957356085m_-6635549295510210966mail-editor-reference-message-container">
<div style="padding: 3pt 0in 0in; border-top: 1pt solid rgb(181, 196, 223);">
<div style="text-align: left; font-family: Aptos; font-size: 12pt; color: black;">
<b>From: </b>Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu" target="_blank" id="m_8015140392213966909OWA979f5f2a-f704-1e6a-ad64-713af35957fe" data-outlook-id="2600a02c-0f07-4e5a-b81b-d1d278bafcc4">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</a>>
on behalf of Tao, Ashley T via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" id="m_8015140392213966909OWAe8502213-1c14-c046-0bd3-b55e9638afc6" data-outlook-id="999b2000-49e8-4100-8576-a10b98559aac">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Date: </b>Tuesday, May 19, 2026 at 2:27 PM<br>
<b>To: </b>DxMedPhys List </div>
<div style="text-align: left; font-family: Aptos; font-size: 12pt; color: black;">
<<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank" id="m_8015140392213966909OWA8b980ed9-5f42-c64f-74d1-af5c7231f767" data-outlook-id="3bee4db0-7748-4ffc-b71e-a2cf60f2b95e">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject: </b>[Intl_DxMedPhys] MQSA - Manufacturer PM vs ACR DM QC manual<br>
<br>
</div>
</div>
<table align="left" cellspacing="0" cellpadding="0" border="0" style="width: 100%;">
<tbody>
<tr>
<td style="padding: 5pt 4pt 5pt 12pt; width: 100%;">
<div style="color: rgb(34, 34, 34);">[External Email - Use Caution]</div>
</td>
</tr>
</tbody>
</table>
<div style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
Dear DxMedPhys Listerv,</div>
<div style="direction: ltr; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
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.</div>
<div style="direction: ltr; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
Let me set the scene:</div>
<ol start="1" style="margin-top: 0px; margin-bottom: 0px; list-style-type: decimal;">
<li style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0); margin-top: 0px; margin-bottom: 0px;">
<div 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. </div>
<div role="presentation">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. </div>
</li><li style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0); margin-top: 0px; margin-bottom: 0px;">
<div 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? </div>
</li><li style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0); margin-top: 0px; margin-bottom: 0px;">
<div 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. </div>
</li></ol>
<div style="direction: ltr; margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
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. </div>
<div style="direction: ltr; margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
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?</div>
<div style="direction: ltr; margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div style="margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
Looking forward to hearing about your experiences.</div>
<div style="direction: ltr; margin-top: 0px; margin-bottom: 0px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
<br>
</div>
<div id="m_8015140392213966909x_m_1331226420470712293m_4621887008957356085m_-6635549295510210966Signature">
<div style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
Thanks</div>
<div style="font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 11pt; color: rgb(0, 0, 0);">
Ashley </div>
</div>
</div>
</blockquote>
</blockquote>
</div>
</body>
</html>