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Use this guide to build that program for CT, X-ray, MRI, ultrasound and other imaging units. It is written for facility managers, clinical engineers, medical physicists, service engineers and imaging staff; hands-on adjustments and service-menu changes belong to trained, authorized professionals.
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What calibration means in medical imaging
In clinical practice, “calibration” usually describes several related activities rather than a single task. Acceptance testing measures a newly installed or substantially modified system against purchase-contract and manufacturer specifications. Routine QC repeats selected measurements to detect drift from an established baseline or an approved action limit. Service calibration adjusts components under the equipment maker’s procedure, after which the responsible team verifies performance before patients are scanned.
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Do not copy a tolerance or test interval from another scanner. A CT dose or image-quality limit, an MRI uniformity test and an ultrasound transducer check use different phantoms, instruments and acceptance criteria. A qualified medical physicist, clinical engineer or authorized service professional must select the procedure for the specific unit.
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Build a documented quality-assurance program
1. Inventory every unit
Create a record for each scanner, generator, workstation and transducer. Include:
- Modality, manufacturer, model, serial number and internal asset identifier.
- Software and firmware versions, accessories and connected dose-monitoring or image-management systems.
- Installation, acceptance and service history, warranty and service-contract terms.
- Applicable license, accreditation and inspection requirements.
- The responsible clinical owner, technologists, medical physicist, engineer and service contact.
The International Atomic Energy Agency (IAEA) recommends arrangements with the manufacturer or installer before operation and ongoing coordination while the unit is in service.
2. Map obligations before setting intervals
Use the current operator and service manuals, the service contract, your regulator’s rules and the professional or accreditation program that applies to the facility. The IAEA’s Safety Standards Series No. SSG-46 states: “All maintenance procedures should be included in the comprehensive programme of quality assurance and should be carried out at the frequency recommended by the manufacturer of the equipment and relevant professional bodies.”
There is no defensible interval that applies to every model. A warranty may specify a preventive-maintenance schedule; an accreditation program may add annual surveys; local law may require inspections or records. Put the most demanding applicable requirement into the unit’s schedule and document who is responsible.
Acceptance testing: establish the baseline before patients
Acceptance testing occurs after installation, relocation or a major upgrade and before clinical imaging. A qualified professional compares quantifiable performance with the purchase specification and the manufacturer’s stated acceptance criteria. Record the measurements as the unit’s baseline; future QC trends are meaningful only when setup, instruments and analysis are repeatable.
CT acceptance
American College of Radiology (ACR) CT accreditation guidance calls for a complete evaluation by a qualified medical physicist before patient imaging. The evaluation uses the phantom, procedure and specifications identified in the purchase contract. Report discrepancies to the service engineer or vendor and retain the results. ACR cautions that tests outside the vendor’s identified methods and acceptance criteria may not be supported by the manufacturer, so distinguish contractual acceptance tests from optional characterization work.
MRI acceptance
An ACR-accredited MRI site completes a qualified evaluation that includes the technologist QC tests and specified annual tests. The baseline should cover the performance measures required for that field strength, coil configuration and software release, as well as the site’s MR safety controls.
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Ultrasound acceptance
ACR guidance recommends initial testing of new or replacement ultrasound equipment before clinical use. Test the system and each transducer that will be used, then preserve baseline images and measurements for later comparison. A transducer can fail while the console still appears normal, so probe-level records matter.
Run routine QC and trend the results
Routine QC is a controlled measurement, not a visual glance at a phantom image. Use the same phantom or test object, positioning, protocol, acquisition settings and analysis method each time. Instruments must be appropriate for the modality and within their own calibration or verification requirements. The IAEA recommends detailed data sheets, calibrated instruments and the correct test phantoms.
Define action limits and escalation
Your approved program should identify an expected range, an action limit, the reviewer and the response for each test. A single outlier may require a repeat measurement; a persistent trend, a failed safety check or an abrupt change after service may require removal from clinical use. Do not invent universal limits from an unrelated device manual. The medical physicist, responsible operator and service professional should approve the limits and escalation path.
Examples of modality-specific schedules
| Modality | Program example | What the schedule does not mean |
|---|---|---|
| CT | ACR-accredited facilities document QC and have a qualified medical physicist perform an annual system-performance evaluation; ACR permits up to 14 months between annual surveys. | This is an ACR accreditation requirement, not a universal legal interval for every CT scanner. |
| MRI | ACR MRI accreditation includes documented QC, weekly technologist QC evaluation in the annual summary, a physicist or MR scientist performance evaluation and an MR safety-program assessment. | Local rules, the scanner’s manual and the site’s risk assessment may require additional checks. |
| Ultrasound | ACR calls for an annual equipment survey of units and transducers in routine clinical use; the survey is more extensive than routine QC. | Routine checks and preventive maintenance still follow the device documentation and facility program. |
| X-ray and other ionizing-radiation systems | QC covers image quality, dose, electrical and mechanical safety, and radiation-protection controls under the applicable regulator and professional guidance. | Requirements vary by jurisdiction, generator type and clinical use. |
Preventive maintenance and qualified service
Schedule preventive maintenance at the frequency specified by the equipment maker, service contract and applicable professional guidance. Work should be performed by the manufacturer, an authorized agent or another demonstrably qualified service organization. The IAEA places electrical and mechanical safety maintenance inside the QA program and says it should be performed by people who understand the equipment specifications.
A maintenance visit should identify the unit, date, scope, findings, parts and adjustments, software changes, safety checks, test results and the person who released the equipment. A “passed service” stamp without measurements is not a useful record.
Control repairs and modifications
Before work begins, define how the unit will be taken out of service, how users will be notified and which tests are required afterward. A repair that changes image formation, dose delivery, timing, gradients, coils, detectors or transducers may need more than the routine QC set.
For CT, ACR treats repair or replacement of an X-ray tube or detector assembly as a major repair. The qualified medical physicist determines the evaluation for the repaired component; ACR guidance calls for that evaluation and technologist QC before clinical use.
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Return-to-use decision after service
- Document the change. Obtain the service report, failed symptom, root cause if known, replaced parts, adjustments, software or protocol changes and any safety implications.
- Identify affected performance. The physicist, engineer and modality lead decide which image-quality, dose, calibration, mechanical, electrical or safety tests could have changed.
- Repeat the appropriate tests. Use the manufacturer’s procedure and the facility’s approved QC protocol. A major repair may require a partial or complete performance evaluation rather than one quick phantom scan.
- Review images and protocols. Confirm that clinical protocols, dose settings, coils or probes, reconstruction options and work-list connections still behave as intended.
- Record disposition. The responsible operator or licensee documents pass, conditional use, further repair or continued hold. No one should return a unit to patients based only on a technician’s verbal assurance.
If a test shows unsafe or unacceptable performance, keep the system out of clinical use until the authorized team documents corrective action and clearance. ACR MRI guidance calls for immediate action to preclude use when a finding poses imminent danger.
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CT and conventional X-ray
Ionizing-radiation systems require two linked controls: diagnostic performance and radiation protection. QC commonly addresses output or dose consistency, image quality, artifacts, display and mechanical operation, but the exact measurements and limits are model-specific. The U.S. Food and Drug Administration (FDA) advises proper maintenance and testing, regular QC, dose optimization and compliance with applicable federal and state requirements.
After tube, detector, generator, collimator or dose-control work, ask the physicist which acceptance or constancy tests apply. Do not assume a stable image means dose and safety systems are also correct.
MRI
MRI does not use X-ray radiation, so its hazards and controls differ from CT. The QA program must sit alongside a documented MR safety program covering screening, access control, projectile prevention, implants, emergency procedures, cryogen or quench risks where applicable, and equipment-specific warnings. Performance QC may include signal, uniformity, geometric accuracy, ghosting, slice or spatial measures and coil operation, but the qualified MR scientist selects the set for the model and field strength.
Ultrasound
Ultrasound QC must include the console and each transducer in clinical use. Look for changes in uniformity, dead elements, penetration, geometric accuracy, display behavior and artifacts using the facility’s approved phantom or test object. FDA states that the United States has no federal radiation-safety performance standards for diagnostic ultrasound; that does not remove medical-device, state, accreditation or professional obligations. ACR’s annual survey is more comprehensive than day-to-day user checks.
Mammography, nuclear medicine and PET
Use the dedicated modality manual and local rules instead of borrowing CT or MRI checks. ACR lists a revised mammography QC manual (2020), a nuclear-medicine QC manual (2024) and a PET QC manual (2025). These editions illustrate why staff should verify the current program and edition that applies to their equipment.
Records that make the program auditable
Maintain a unit-level file, electronic or paper, that can be reconstructed years later. Include:
- User fault and defect logs, including date, symptoms, affected protocol and whether patients were scanned.
- Preventive-maintenance and corrective-service dates, scope and personnel.
- Service reports listing faults, repairs, replaced parts, adjustments, software changes and unresolved conditions.
- Test methods, acquisition settings, instruments, phantom identifiers, instrument verification status, raw results, baseline values and pass/fail or action decisions.
- Trend charts or review notes showing who examined recurring drift and what was done.
- Corrective actions, protocol changes, notifications, downtime and the authorization or rationale for return to clinical use.
The IAEA specifically calls for equipment-level maintenance records containing user-found defects, interim and final repairs and test results before reintroduction into clinical use. Restrict editing rights and retain the original result when a corrected report is issued.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Choosing phantoms, instruments and service arrangements
A phantom or test object is not interchangeable across modalities. The medical physicist and equipment documentation determine the correct design, materials, dimensions, software analysis and protocol. The same principle applies to meters, probes and electrical-safety analyzers: compatibility, traceability and uncertainty matter more than a generic “calibrated” label.
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- Applicability to the exact modality, model, software and accessories.
- Whether the method is required by law, accreditation or only optional characterization.
- Alignment with the manufacturer’s procedure and service contract.
- Qualifications, independence and responsibilities of staff performing and reviewing tests.
- Phantom and instrument compatibility, traceability and repeatability.
- Acceptance criteria, trend analysis, escalation and expected downtime.
- Availability of authorized service and the completeness of service and return-to-use records.
Common failure modes and practical fixes
“We calibrate once a year.”
Why it fails: It confuses an annual survey with all QA activity and may ignore weekly, daily, post-repair or safety checks.
Fix: Maintain a modality-specific calendar containing user QC, physicist evaluations, preventive maintenance, inspections and post-service testing.
“The image looks normal, so the unit is safe.”
Why it fails: Dose, electrical, mechanical, magnetic-field or transducer faults may not be obvious in a single image.
Fix: Require the approved objective tests and documented review before release.
“Any phantom will do.”
Why it fails: A phantom’s geometry and material determine what it measures; an ultrasound object cannot validate CT dose or MRI uniformity.
Fix: Use the model- and modality-specific phantom named by the program or manufacturer.
“The service engineer fixed it, so no further testing is needed.”
Why it fails: Repairs can alter connected systems, protocols or safety controls beyond the replaced part.
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Fix: Obtain the service report, have the responsible professionals define affected tests and record the release decision.
“A spreadsheet is enough without ownership.”
Why it fails: Results without an assigned reviewer and action path become historical data rather than risk control.
Fix: Name the reviewer, due date, action limit, escalation contact and final disposition for every test.
A workable governance checklist
- Every unit has an owner, current manual, service contact and documented risk-based schedule.
- Acceptance testing is complete before patient imaging and its baseline is retained.
- Routine QC uses repeatable methods, compatible phantoms and appropriately verified instruments.
- Preventive maintenance follows the manufacturer, contract, accreditation and regulatory requirements.
- Repairs and modifications trigger a documented decision about affected tests.
- Unsafe or failed equipment is clearly removed from clinical use.
- Return-to-use authorization identifies the reviewer and supporting results.
- Records include faults, parts, adjustments, test data, corrective actions and notifications.
- CT and X-ray programs address dose and radiation protection; MRI programs address MR safety; ultrasound programs include transducers as well as consoles.
- Schedules and manuals are reviewed when software, hardware, accreditation or local rules change.
A strong program therefore treats calibration as a controlled cycle: establish a defensible baseline, measure consistently, trend drift, service through qualified personnel, test after change and document the decision that protects patients and staff.
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