The IAC is pleased to include sample documents to assist facilities in providing quality care to their patients. These documents meet or exceed the requirements of the Standards, and they may be used to develop facility policies and reporting forms, whether your facility is seeking accreditation or simply working to standardize or improve current practices.

PLEASE NOTE: The following documents are SAMPLES only. Protocols submitted with the application must be customized to reflect current practices of the facility. Click on the name of the file to download the document.

CHECKLISTS:

• IAC CT Accreditation Checklist (1.9MB) NEW!
• CT Multiple Site Checklist (95KB)

SAMPLE POLICIES:

• Contrast and Medication Administration Policy (47KB) NEW!
• CT Reporting Policy (50KB) NEW!
• Incident/Adverse Events Policy (41KB) NEW!
• Patient Complaint Policy (27KB)
• Patient Confidentiality Policy (61KB) NEW!
• Patient Identification Policy (43KB) NEW!
  
• Primary Source Verification Policy (37KB)
• Preliminary Reports Policy (43KB) NEW!
• Radiation Safety (Conventional CT Scanners) Policy (51KB) NEW!
• Radiation Safety (Volume Cone Beam Scanners) Policy (49KB) NEW!

SAMPLE CT REPORTS:

• Sample CT Report (40KB) NEW!

QUALITY IMPROVEMENT:

• Facility CT Dose Tracker (19KB)
• Interpretive Quality Assessment Policy for CT (47KB)
• Technical Quality Assessment Policy for CT (59KB)
• Sample CT Technical Quality Assessment Worksheet (26KB) NEW!

GUIDANCE DOCUMENTS:

• Guidance for Radiation Protection Survey & Dose Assessment (10KB)
• Medical Physicist or Qualified Expert Report (104KB)

SITE VISIT DOCUMENTS:

• Site Visitor Agenda (15KB)

REFERENCE DOCUMENTS:

• FDA Information Regarding Cone-Beam Computed Tomography
  On this webpage, the FDA is providing: information about the use of cone-beam computed tomography in dentistry particularly in the pediatric population; information for patients, parents and health care providers to help reduce unnecessary radiation exposure from dental cone-beam computed tomography; and, resources for manufacturers of dental cone-beam computed tomography devices.
  
• Clinical Practice Guideline: Adult Sinusitis
  A report from the American Academy of Otolaryngology - Head and Neck Surgery. (414kb)
• Alliance for Radiation Safety in Pediatric Imaging
  The Alliance for Radiation Safety in Pediatric Imaging – the Image Gently Alliance -is a coalition of health care organizations dedicated to providing safe, high quality pediatric imaging nationwide. The primary objective of the Alliance is to raise awareness in the imaging community of the need to adjust radiation dose when imaging children.
• ACCF/AHA Clinical Competence Statement on Cardiac CT and MR
  A report of the American College of Cardiology Foundation/ American Heart Association/American College of Physicians Task Force on Clinical Competence and Training.
• ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging — A report of the American College of Cardiology Foundation Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions and Society of Interventional Radiology.

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