Weekly Reflective Report Grading

Part 1: Instructions

This document serves as both a template and a guide for documenting your weekly
experiences, learning, and challenges throughout your training in the medical physics
program. It includes detailed descriptions and illustrative examples for each section to
help you complete your report effectively.

Each week, you are required to submit a reflective report and subsequently discuss its
content with your academic supervisor. Your performance will be evaluated based on
both the written report and the discussion during the assessment meeting. Specific rubrics
for grading will be provided to you prior to submission and the assessment meeting.

The reports and the assessment meetings will be evaluated, and scores will be assigned
based on the rubrics. You will submit three reports and participate in three assessment
meetings during the training period. The average score from these reports and meetings
will account for 30% of your final course grade.

It is crucial to use all sections of the provided template and adhere to the specified
structure. By following these instructions and the template accurately, you will be able to
document your training experiences effectively and optimize your performance
evaluation.
Part 2: Weekly Reflective Report Template with Examples

Personal and Administrative Information

Name: [ FATEN MOHAMMED ALYOBI ]

Student ID: [2114147]
Date: [9 /9 / 2024]
Week Number: [ week 2 ]
Clinical Supervisor: [Dr. Eid Al-sulami ]
Hospital/Department:
[East Jeddah General Hospital, Radiology Department]
Focus of the Week: [Quality Control Tests on portable X-ray Machines]
Weekly Objectives

Clinical Objectives:

 Conduct comprehensive quality control (QC) tests on portable X-ray machines to

ensure optimal performance.
 Kilovoltage Accuracy & reproducibility
 Exposure timer accuracy and reproducibility
 mAs (Tube Output) Linearity & Reproducibility
 Radiographic Half Value Layers (HVLs)
 Light Field and X-ray field Alignment & Perpendicularity
 Image quality

Personal Objectives:

 Review and thoroughly understand the theoretical aspects of X-ray machine

operations and quality control, including the principles of X-ray generation such
as the production of X-rays through the interaction of high-speed electrons with a
target material (usually tungsten), the function of different components within the
machine such as the X-ray tube, collimators, and image receptors, radiation safety
measures including proper shielding, distance, and exposure time to minimize
radiation exposure, techniques for image quality optimization such as adjusting
exposure factors, image processing, and artifact reduction, and compliance with
 regulatory standards and guidelines such as those set by the FDA, ACR, and
IAEA to ensure safe and effective use of X-ray equipment in medical and
industrial settings.

Ensure that your objectives are clearly articulated and relevant to your training activities
for the week.

Tasks Performed
This week, I conducted daily quality control (QC) tests on portable X-ray
machine ensure optimal performance these tests includes
 Kilovoltage Accuracy & reproducibility test
 Exposure timer accuracy and reproducibility
 mAs (Tube Output) Linearity & Reproducibility test
 Radiographic Half Value Layers (HVLs) test
 Light Field and X-ray field Alignment & Perpendicularity test
 Image quality test

My responsibilities included calibration, alignment checks, and radiation output

measurements. Additionally, I participated in the annual maintenance review with the
lead physicist, assisting in comprehensive equipment evaluations Including solving
complete theoretical equations and verifying their validity with the department's
supervisor.
Ensure that your descriptions are comprehensive and clearly outline your
contributions.

Detailed Description of Tasks

 Methodology for kVp Accuracy & reproducibility test

1- The R/F sensor is maintained on a flexi stand and placed at the center of the
illuminated area.

2- Select a large (or small) focal point and set the SID to 100cm.

3- The accuracy of the kVp was manually assessed for various kVp settings,
commencing with the values 60, 80 (which were repeated thrice), 100 and 125.

4- kVp is recorded by the base unit.

 Data Analysis:

Determine the accuracy, the SD and Compute COV by using

the provided equations

 Methodology for Exposure Timer Accuracy & Reproducibility Test

1- Set up the R/F sensor on flexible stand and placed at center of

illuminated area at 100 cm SID

2. Use 80 kVp and large focal spot (or small focal spot)

3. Test accuracy at 4 different time settings, with 3 reps at 100

ms( Ideal)

4. Record the actual times from the base unit

5. Calculate accuracy, SD, and COV per the provided equations

 Data Analysis:

Calculate accuracy, SD, and COV per the provided equations

 Methodology for mAs Linearity & Reproducibility Test:

1. Set up the R/F sensor on flexible stand and placed at center of

illuminated area at 100 cm SID

2. Use 80 kVp and large focal spot (or small focal spot)

3. Test mAs accuracy at 4 different times settings, with 3 reps at

20 ms( Ideal)

4. Record the Dose (mGy)

 Data Analysis:

Calculate SD, Output, COV, and Linearity Coefficient per the provided equations

 Methodology for Radiographic Half-Value Layers (HVLs) Test

1. Set up the R/F sensor on the flexible stand and place at center of

illuminated area at 100 cm SID

2. Use 60 kVp, 20 mAs and a large focal spot

3. Measure the initial exposure (E0)

4. Calculate E0/2 as the target half-value

5. Add aluminum sheets incrementally until you record

a reading that is:

- Less than E0/2 (Eb)

- Greater than E0/2 (Ea)

Data Analysis:

Calculate the HVL using Equation

 Methodology for Radiographic collimation

1-Ensures the visible light field matches the actual X-ray field.

2- Verifies the X-ray beam is perpendicular to the image receptor.

3-Helps minimize patient radiation exposure and optimize image quality.

Data Analysis:

Focal spot to Champer: 100cm KV:80, mAs :20 Focal spot : Large

 Experimental Findings andResults:

  Conclusion:
The training underscored the critical importance of conducting comprehensive quality
control tests on X-ray equipment to guarantee consistent and precise operation. Adhering
to rigorous quality control protocols is imperative for ensuring the delivery of safe and
high-quality diagnostic imaging services. This meticulous approach not only serves to
minimize radiation exposure for patients but also significantly improves the accuracy of
diagnostic results, thereby contributing to better overall patient care and outcomes.

Theoretical Aspects Related to Practical Tasks

Theoretical Background:

An X-ray machine consists of two main components – an X-ray generator and an image
detection system. An X-ray tube essentially is a high-vacuum diode consisting of a
Cathode and an Anode. X-ray tube operates by generating a stream of electrons by
heating up a cathode (tungsten) filament. (1)

the image quality factors in X-ray: The key factors that influence the sharpness of an
image relate to the size of the source of X-rays (focal spot), the physical characteristics of
the X-ray detector system (area and thickness), and the presence of any motion blur
because of the finite duration of all radiographic exposures. (2)

Parameters of the X-ray image: the x-ray tube voltage (kilovoltage) and the total radiation
intensity (milliampere-second value) used to obtain the image, focus to detector distance.
(3)

diagnostic x-ray beam usually has an HVL in the range of 3 to 5 mm Al or 3 to 6 cm of

soft tissue. (4)

As filtration is increased, so is beam quality, but quantity is decreased. (4)

When I increase tube voltage (Kvp) the patient dose decrease & contrast decrease
When I increase intensity (mAs) patient dose increases & contrast also increases (5)
Radiation Protection and Safety of Radiation Sources: International Basic Safety
Standards (6)
Relevance to Practical Tasks:

When increasing the kilovoltage (kV) in X-ray imaging, it's important to remember that
while it reduces patient dose, it also leads to an increase in scatter within the resulting
image. On the other hand, using lower kV settings results in images with superior contrast
due to reduced scatter levels.

Understanding the concept of the half-value layer (HVL) range is crucial for comparing
calculated results to determine the accuracy of X-ray measurements. This knowledge allows
for a more comprehensive assessment of the correctness of the obtained data.
Moreover, the manipulation of the milliampere-seconds (mAs) setting enables control over
image resolution without escalating the radiation dose. This level of control is essential for
achieving optimal image quality while prioritizing patient safety.
Furthermore, a thorough understanding of the X-ray machine's components is essential for
effectively managing and operating the equipment, ensuring safety and accurate imaging
results.

Clearly articulate the theoretical aspects related to your practical tasks to demonstrate
your understanding of both scientific principles and their applications.

Challenges Encountered
 The main challenge we faced was finding a way to improve the image quality and
clarity without increasing the radiation dose. Initially, the image quality was poor,
which made it difficult to make an accurate diagnosis. This led to additional time
and effort being spent on diagnosing and correcting issues, which ultimately
impacted our workflow and the overall learning experience.

 Additionally, the detector we were using was not providing accurate dose
measurements, leading us to switch to another detector. However, due to
maintenance delays, we experienced a loss of time in the process.

 Furthermore, we encountered a lack of comprehensive protection, as we did not

have a Thermoluminescent Dosimeter (TLD) device to measure our radiation
exposure. This posed a potential risk to our team's safety and well-being.
 Resolution Strategies
1. Optimize Exposure Settings:
Adjust the kilovolt peak (kVp) and milliampere-seconds (mAs) settings based on the
object size and the area being imaged. Using the lowest possible dose that still
provides a diagnostic image can significantly improve quality.

2. Image Processing Algorithms:

Implement advanced image processing techniques such as edge enhancement,

noise reduction, and contrast adjustment. These can improve clarity without
additional radiation.

3. Collaboration with Radiologists:

Work closely with radiologists to understand their needs and preferences, which
can guide adjustments in imaging techniques and protocols.

I invested in reliable detectors by researching and selecting high-quality options known

for their accuracy and reliability. Then, I established a proactive maintenance schedule
for all our equipment, including the detectors. By conducting regular checks, I aimed to
prevent unexpected failures and minimize downtime.
To stay on top of any issues, I implemented real-time monitoring systems for dose
measurements. This approach helps me identify problems early and take prompt
corrective actions. I also collaborated closely with maintenance technicians to ensure
quicker response times for repairs, even setting up a priority system for urgent
maintenance needs.
Additionally, I made it a point to schedule regular calibration of the detectors to maintain
their accuracy. I kept detailed records of detector performance, maintenance history, and
any issues we encountered. This documentation has really helped us identify patterns and
make informed decisions moving forward.

Detail your resolution strategies to demonstrate problem-solving abilities,

resourcefulness, and commitment to continuous learning and improvement.
Safety Procedures
Describe the safety procedures you followed during tests and explain how these
procedures ensured your safety and/or the safety of patients. Show adherence to safety
regulations, ethical standards, and professional responsibilities.
During the quality control tests, I strictly adhered to safety protocols to ensure the well-
being of everyone involved. This involved meticulously inspecting and confirming the
placement of all safety barriers to prevent any potential hazards. I also meticulously
cleared the testing area of any unauthorized personnel to maintain a secure environment.
In addition, I rigorously followed the hospital’s radiation safety guidelines, which
included conducting regular checks of the radiation levels around the machines to prevent
any unnecessary exposure. This entailed using sophisticated equipment to monitor and
analyze radiation levels, ensuring that they remained within safe limits. Furthermore, I
meticulously documented all safety checks and procedures in compliance with stringent
regulatory requirements, maintaining detailed records to guarantee full accountability and
traceability.

Detailing safety procedures underscores your commitment to maintaining a safe work

environment and adherence to professional and ethical standards.

Learning Outcomes
Detail what you have learned this week, focusing on both technical skills and
professional development. Including both types of learning outcomes is essential, as it
will be reflected in your grade according to the rubric.
technical skills:
During my time, I gained a deeper understanding of maintaining X-ray machinery. This
involved learning about the importance of precise calibration for patient safety and
diagnostic accuracy. I also developed practical experience in performing alignment
checks and radiation output measurements, which significantly enhanced my technical
proficiency in managing X-ray equipment.
Use of Advanced Tools:
I didn't use any advanced tools to measure the radiation dose. Instead, I relied on the
equations provided by my supervisor to calculate the radiation dose accurately and
effectively.
Personal Development:
Reflect on personal growth and professional skills developed:
During my training, I significantly enhanced my communication skills by actively
collaborating with a multidisciplinary team that included radiologists and technicians.
This experience enabled me to effectively communicate technical information and work
cohesively within a team setting. Moreover, I honed my time management skills by
meticulously prioritizing tasks and diligently adhering to schedules, resulting in the
timely completion of all quality control tests.Ensure that your learning outcomes clearly
articulate both technical skills and personal development, demonstrating your growth and
commitment to excellence in the field and will contribute to a higher grade based on the
evaluation rubric.

Additional Comments
Use this section to provide any additional comments or observations you wish to share
about your weekly experience.
 References
1. How does an X-Ray machine work? What are the main components of an X-Ray unit? |
Primedeq-Blog [Internet]. [cited 2024 Sep 28]. Available from:
https://www.primedeq.com/blog/how-does-an-x-ray-machine-work-what-are-the-main-
components-of-an-x-ray-unit/

2. Huda W, Brad Abrahams R. X-ray-based medical imaging and resolution. American Journal
of Roentgenology [Internet]. 2015 Apr 1 [cited 2024 Sep 28];204(4):W393–7. Available
from: https://www.ajronline.org/doi/10.2214/AJR.14.13126

3. Huda W, Abrahams RB. Radiographic techniques, contrast, and noise in x-ray imaging. AJR
Am J Roentgenol [Internet]. 2015 Feb 1 [cited 2024 Sep 28];204(2):W126–31. Available
from: https://ajronline.org/doi/10.2214/AJR.14.13116

4. Beam Quality, Beam Quantity (mA, KVp, HVL) For Radiologic Technologist • How Radiology
Works [Internet]. [cited 2024 Sep 28]. Available from:
https://howradiologyworks.com/beamquality/

5. Effect of Changing X-ray Tube Voltage (kV) | Radiology | SUNY Upstate [Internet]. [cited
2024 Sep 28]. Available from:
https://www.upstate.edu/radiology/education/rsna/radiography/kvp.php

6. IAEA Safety Standards for protecting people and the environment. [cited 2024 Sep 28];
Available from:
http://ec.europa.eu/dgs/communication/services/visual_identity/index_en.htm