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1965 1965
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M AN AN -
1965 Revision 003,
Ma ua
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Site Uni Manufa Manufactu cturer rer Date of Installation Medical Pass-Fail Evaluation
anua anua
merg mergen ency cy co pres pressi si
Collimatio atio 2. Collim
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ower ower fail failur ur
Assess Assessmen men
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elea elea
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of
Eval Evalua uatio tio
Arti Artifa fact ct were were no appa appare rent nt or no sign signif ific ican an and
4.
ea ured ured ve ag wi hi 5% of indi indi ated ated kV coef coeffi fici cien en of vari variat atlo lo 0.02 Half Half-v -val alue ue laye laye is with within in acce accept ptab able le lowe lowe limi limi at al kV valu values es test tested ed
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Revision 003 1965 Revision
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mu
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1965 Revision 003,
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19
Re isio 00
mu
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1965 Revision 003,
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Site:
Room ID
Date
X-ray uni manufacturer Diagnostic revie workstation DICO
printer
Model Modelf-------------I ~
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Model
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withou obstructions to motion
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1965 Re ision003
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1965 Revision 003,
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height st su an
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1965 Revision 003, only.
91
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1965 Revision 003,
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1965
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1965 Revision 003,
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1965
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1965 Revision 003, only.
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1965 Revisi n00
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1965 Revision 003, only.
101
Qualit
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Manufacturer Model
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1965
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1965 Revision 003, only.
103
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1965
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03
mu
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MA
1965 Revision 003, only
105
Quality Control Manual sfo
AE
Functi
Perf rmance at Different Phanto
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lF
Contact
Phantom Thickness
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kVp
Mode
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wi
P o N um b
MANO 1965 Revision 003, only_
107
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AC IO
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AC IO
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1965 R ev is io n
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distance
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Seria Number
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W
W
Iter
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ACTION LIMIT:
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P a t N u m be r M AN -
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1965 Revision 003, only,
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distance
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correction factor Part
mb
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4.2
Serial Number
Conventional
for
CT ON LI IT se
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PartNu
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N-
19
dose values
evisio
03
mu
Pa
mb
M AN -
1965 Revision 003, only.
13
lity
ourc
nt ol
nu
70 cm
to
67.5 cm
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detector distance
used
correction factor
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mAs
4.5 cm abov
if
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N-
1965
evisio 00
sfo
mu
wi
P a N um b
M AN -
1965 Revision 003, only.
15
lity Co tr
Ma ua
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Phanto
used: Previous Image
Current Image
Comments
ACTIONLIMITS: yb
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96
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Pa
N um b
MA
1965 Revision 003, only.
17
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Ma ua
used: ~
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Comments
ACTION LIMITS score is
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seek
service.
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AN-O 19
Re ision00
mu
wi
mb
MA
1965 Revision 003, only.
19
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Curre
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CN
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Last
rati
difference
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ar Nu be
AN-O
96
Re isio 00
mu
wi
P a N um b
ll
M AN -
ta
1965 Revision 003, only.
121
Qualit
Date: Serial Number Photometer Serial Number
Contro Manual
----------------------------------------------
Comment
Performance AC IO
IM
Th
it
leve
al
di ferent fr Th
la
leve shal no
10
Comments
0%,.
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1965
evisio 00
mu
us
wi
Pa
N um b
MANO 1965 Revision 003, only.
123
lity
mAs
kV
Filter
nt ol
Fl(nn"a
nu
Step
Factor
Date
Comments
mu
wi
N um b
MA
Revision
only.
