During the last decade many European countries have applied and regulated through state legislation quality control (QC) program in diagnostic radiology. Such a program forms an essential part of dose effective radiological practice and should be implemented in every x-ray medical equipment. Implementation of QC tests on diagnostic radiographic equipment can ensure the optimal status of imaging systems, providing in this way high-quality images. QC of radiological medical devices in Albania is applicated since 2015, every three years. QC techniques used to test the components of the radiological system and verify that the equipment is operating satisfactorily are performed from the Institute of Applied Nuclear Physics and all the instruments used for performing these measurements are sponsored by the International Atomic Energy Agency. The aim of this study was to investigate the status of 8 randomly selected X-ray generators used in radiology centers of 6 different cities in Albania during the 2021-2022 period. This study presents only the primary QC parameters: kilovoltage (kVp) accuracy and reproducibility, kVp variation with change of mA, exposure time accuracy and reproducibility, tube output and reproducibility, tube output variation with change in indicated tube current - exposure time product (mAs) and filtration (half value layer). All measurements were performed using Radcal (AGMS-DM+) solid-state multi sensor, plugged into its appropriate (Accu-Gold+) digitizer module. This detector was placed on the radiographic tabletop along with the central axis of the X-ray beam at the focus to detector distance of 100 cm. Based on the findings, this study showed clearly that all the radiographic devices, subject of routine quality control tests were in a very good compliance with the acceptable criteria. Specifically, for the primary QC parameters tests, kVp accuracy was between 1.4 - 5%, kVp reproducibility was between 1-3.1%, kVp variation with change of mA was between 1.4 - 5.4 %, time accuracy and reproducibility was between 0 - 6.6%, tube output value with a total filtration 2.5 mm Al at 100 cm for true 80 kV operation was between 26.1 - 60µGy/mAs, tube output reproducibility was between 0 – 2.5%, tube output variation with change of mAs product was between 1 - 18% and filtration at 70 kV was between 2.6 – 3.9 mm Al. Results of this study showed that, even though radiological devices in Albania are relatively old with high workload, especially during the last years, all the devices met the standard criteria.

1. Dosimetry in Diagnostic Radiology: An International Code of Practice, Technical Report Series No. 457, IAEA, Vienna, Austria, 2007, pp. 1 – 14.
   Retrieved from: http://www.iaea.org/publications/
   Retrieved on: Jun. 12, 2021
2. Medical Electrical Equipment — Part 1-3: General Requirements for Basic Safety and Essential Performance — Collateral Standard: Radiation Protection in Diagnostic X-ray Equipment, IEC 60601-1-3:2008, Jan. 22, 2008.
3. Handbook of Basic Quality Control Tests for Diagnostic Radiology, IAEA Human Health Series No. 47, IAEA, Viena, Austria, 2023, pp. 2 – 16.
   Retrieved from: http://www.iaea.org/Publications/
   Retrieved on: Mar. 10, 2023
4. Instrumentation Requirements of Diagnostic Radiological Physicists (General Listing), Rep. No. 60, AAPM, Alexandria (VA), USA, 1998, pp. 1 – 35.
   Retrieved from: https://doi.org/10.37206/59
   Retrieved on: Oct. 25, 2020
5. The Council of the European Union. (Dec. 5, 2013). Council Directive 2013/59/EURATOM on laying down basic safety standards for protection against the dangers arising from exposure to ionizing radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom.
   Retrieved from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32013L0059
   Retrieved on: Jan. 20, 2022
6. Ministria e Shëndetësisë. (Qershor 18, 2014). Nr 404. Prot për miratimin e rregullores Për rregullat bazë të instalimeve radiologjike në mjekësi.
   (Council of Minister for the approval of the regulation (Jun. 18, 2014). No. 404. On basic rules of radiological installations in medicine.)
   Retrieved from: http://www.ishp.gov.al/rrezatimetjonizuese/
   Retrieved on: Jun. 18, 2020
7. Quality Control in Diagnostic Radiology, Rep. No. 74, AAPM, Alexandria (VA), USA, 2002, pp. 2 – 19.
   DOI: 10.37206/73
8. P.-J. P. Lin, A. R. Goode, “Accuracy of HVL measurements utilizing solid state detectors for radiography and fluoroscopy X-ray systems,” J. Appl. Clin. Med. Phys., vol. 22, no. 9, pp. 339 – 344, Sep. 2021.
   DOI: 10.1002/acm2.13389
   PMid: 34375033
   PMCid: PMC8425946
9. Diagnostic Radiology Physics: A Handbook for Teachers and Students, IAEA, Vienna, Austria, 2014, pp. 93 – 139.
   Retrieved from: http://www.iaea.org/Publications/
   Retrieved on: Sep. 30, 2020
10. Recommended Standards for the Routine Performance Testing of Diagnostic X-ray Imaging Systems in Medicine, IPEM Rep. No. 91, IPEM, York, UK, 2005, pp. 5 – 7.
11. Optimization of the Radiological Protection of Patients Undergoing Radiography, Fluoroscopy and Computed Tomography, IAEA-TECDOC-1423, IAEA, Vienna, Austria, 2004, pp. 4 – 44.
    Retrieved from: http://www-ns.iaea.org/standards/
    Retrieved on: Sep. 30, 2020
12. A. K. Jones et al., “Ongoing quality control in digital radiography: Report of AAPM Imaging Physics Committee Task Group 151,” Med. Phys., vol. 42, no. 11, pp. 6658 – 6670, Nov. 2015.
    DOI: 10.1118/1.4932623
    PMid: 26520756
13. J. Malone et al., “Criteria and suspension levels in diagnostic radiology,” Radiat. Prot. Dosim., vol, 153, no. 2, pp. 185 – 189, Feb. 2013.
    DOI: 10.1093/rpd/ncs295
    PMid: 23173220
14. Criteria for Acceptability of Medical Radiological Equipment Used in Diagnostic Radiology, Nuclear Medicine and Radiotherapy, Radiation Protection
    No. 162, European Commission, Luxembourg, Luxembourg, 2013, pp. 16 – 30.
    Retrieved from: http://op.europa.eu/EUpublication/
    Retrieved on: Oct. 25, 2021