By Dr. Georg Stamm, contributing writer

December 19, 2014 -- An updated set of quality assurance guidelines (änderung der Qualitätssicherungsrichtlinie, QS-RL) took effect in Germany on 4 November 2014. Significantly, these guidelines now make reference to the new standard on acceptance and consistency testing of image display systems (DIN 6868, part 157).

  • The following changes have occurred as a result of this fresh approach:

  • Dr. Georg Stamm
    Dr. Georg Stamm is head of experimental radiology and radiation protection in the Institute for Diagnostic and Interventional Radiology at Hannover Medical School.
  • The standard no longer applies to CRT monitors.

  • The existing diagnostic categories A and B will cease to apply. Instead, room categories will be defined on the basis of their uses, and will distinguish between diagnostic and viewing quality (see table below).

  • Daily visual consistency testing should be carried out using test image TG18-OIQ. The interval for metrology tests has changed from quarterly to half yearly.

  • A total of 12 new test images will be used in accordance with DIN EN 62563-1:2014-01 and AAPM TG18. These are available for download at

  • Room categories should also be used for monitors and C-arms first used before 1 May 2015. However, transitional periods apply until 1 January 2025.

  • Acceptance testing of mobile systems such as C-arms and mobile computers must be carried out in accordance with the room category with the highest illumination.

  • The minimum matrix size for monitors is now 1,600 x 1,200 pixels, or 1,024 x 1,024 for CT and fluoroscopy. Devices first used on or before 30 June 2018 may still be acceptance-tested in accordance with DIN 6868-157 using a 1,024 x 1,024-pixel matrix. This transitional period ends on 1 January 2025.

  • Additional minimum requirements apply to mammography, as specified in table five of DIN 6868-157. For example, the matrix size is 2,048 x 2,048 pixels.

  • The person responsible for radiological protection defines the room category and labels diagnostic monitors depending on their intended use (e.g., CT diagnosis or mammography).

  • Acceptance testing is no longer required for viewing-quality monitors. However, a visual inspection should be carried out before the device is first used, and repeated at the user's discretion.

Room category Room Activity Illumination
1 Diagnostic Diagnostic radiography and tomography < 50 lx
2 Examination with immediate diagnosis Making therapy decisions (typically for low-contrast objects, angiography, cardiac catheterization) < 100 lx
3 Examinations Typically for high-contrast objects (e.g., operating room [OR]) < 500 lx
4 Viewing Known diagnosis carried out repeatedly (e.g., repositioning in OR) < 1,000 lx
5 Dental diagnosis   < 100 lx
6 Dental treatment In lighting conditions of treatment locations < 1,000 lx

In the table, displays used to view medical images or make therapy-related decisions such as medication or surgery are not covered by these categories. These include ward-round trolleys and monitors used to show images to the patient.

Editor's note: This is an edited version of a translation of an article published online on 12 December 2014 in German by the German Radiology Society (DRG). Translation by Syntacta Translation & Interpreting.

Dr. Georg Stamm is head of experimental radiology and radiation protection in the Institute for Diagnostic and Interventional Radiology at Hannover Medical School.

Copyright © 2014

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