ACR Support

Clinical Images

Phantom Images

Nuclear Medicine

• Failure to label for laterality and orientation

• Failure to follow the accreditation instructions

• Incomplete submission of exams

• Submitting CT, MRI, or fused images

• Failure to follow written procedure

• Failure to send quality images

• Data form does not accurately reflect information for images submitted

• Incomplete dataset

• Failure to submit composite of rods

• Center of rotation

• High-count flood

• Phantom mixing and positioning

• Not applying required attenuation correction (if available in the processing software)

• Data form does not accurately reflect information for images submitted

PET

• Failure to label for laterality and orientation

• Failure to follow the accreditation instructions

• Submitting CT, MRI, or fused images

• Failure to follow written procedure

• Failure to send quality images

• Data form does not accurately reflect information for images submitted

• Incomplete dataset

• Failure to include rods

• Failure to remove spheres

• Phantom mixing and positioning

• SUV measurements outside of the ACR acceptable range 

• Not submitting 1cm thick DICOM slices

• Data form does not accurately reflect information for images submitted

CT

• Scanning through orbits/lens on brain CT

• Not submitting required series (i.e. contrast enhanced)

• Not reviewing and following the CT Testing Instructions before choosing exams for submission

• Selecting examinations your site does not usually perform

• Supervising physician not reviewing images before they are sent to the ACR

• Techniques listed in Phantom Site Scanning Data Form do not match techniques used to scan the ACR or dosimetry phantoms

• Parameters given to physicist are not parameters used for clinical exams

• Not checking images for correct protocol

• Not submitting dose images

• Incorrect size chosen for pediatric abdomen phantom in data form

MRI

• Not reviewing testing instructions before choosing exams for submission  

• Not reviewing and following instructions located on the first page of each module in the Testing Instructions  

• Not submitting required sequences

• Not submitting ADC map

• Poor SNR

• Incomplete anatomical coverage                  

• Supervising physician not reviewing images before they are sent to the ACR

• Not following instructions provided in guidance documents

• Physicist not reviewing images/data before sending to the ACR

Mammography

• Positioning

• Compression

• Anonymizing images

• Failure to read instructions

• Phantom images do not meet criteria for fibers, specks and masses

• Failure to read instructions

• Not choosing best tomosynthesis slice for DBT units

• Choosing wrong size phantom in testing package

Breast MR

• Low SNR

• Artifacts

• Parameters for pre- and post-contrast T1 images do not match

Breast Ultrasound

• Correlating mammogram was not performed within 60 days prior to sonogram

• CC and MLO images not submitted

• Sonogram discordant with mammogram

• Distance from nipple to abnormality not measured on images

• Improper technical settings

• Improper scanning technique

• Poor image quality

Stereotactic Breast Biopsy

• Correlating mammogram was not performed within 60 days prior to stereo biopsy

• Calcifications not seen on both stereo pair views

Radiation Oncology

• Insufficient information in consultative note

• Incomplete patient history and physical examination

• Incomplete treatment prescriptions

• Lack of defined goals and requirements of treatment plan by radiation oncologist (i.e., dose constraints)

• No formal treatment planning quality assurance plan

• Lack of dose volume histograms

• Lack of proper treatment quality assurance prior to patient treatment (i.e., no IMRT QA)

• No written directive for brachytherapy procedure(s)

• Insufficient radiation oncologist coverage during patient treatment

• Lack of port film verification

• Lack of documented weekly patient visits

• No documented patient follow-up plan

• No formal quality assurance and improvement program documented (e.g., outcome studies, focus studies)

• No physician or physicist peer-review documented

• End-of-treatment physics check not performed within a week

Ultrasound

• Failure to follow the accreditation instructions

• Submitting studies that do not meet the Exam Requirements

• Failure to meet Exam Requirements with static imaging (cine loops are permissible for some exams; details of which exams allow cine clips are included in the specific Exam Requirements)

• Inadequate documentation of required anatomy 

• Submitting post-surgical studies

• Improper technical settings

• Improper scanning technique

• Poor image quality

Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes

2-3-2020

Ultrasound

Added frequent Ultrasound deficiencies

2-26-20

NMAP

Under phantom added: "Not applying required attenuation correction (if available in the processing software)"

Under clinical added "Submitting only fused images"

5-2-2023

Ultrasound

Updated Ultrasound deficiencies

2-23-2024

MRI

Removed "not submitting entire exam"

8-2-2024

NMAP

Updated reasons for deficiencies for Clinical Images

11-17-2025

Breast Ultrasound

Removed pre-fire or post-fire image labeling common deficiency

11-19-2025

Nuclear Medicine and PET

Updated reasons for deficiencies for Clinical and Phantom Images

11-19-2025

Breast Ultrasound

Updated reasons for deficiencies