MONTHLY MRI EQUIPMENT QUALITY CONTROL

MRI Facility Name: MRI Scanner Identifier:

1 Test ramps Test plane cube 1 Test plane cube 2 Test plane cube 3 Test plane cube 4
3 7
Setup & Table
High Contrast Low contrast
Position Scan Slice Geometri Uniformity
Resolution sensitivity
Accuracy note
X Y Distorsi Any present?
OK NO Z (mm) Line pair
Date (mm) (mm) geometric
Action limits: ≤ 1,5 mm 36,1 mm 35,9 mm ≥ 87,5 % (1,5 T) ≥ 82 % (3 T) ≤ 1mm ok Yes/No

Reviewed by: Date of Review:

Qualified Medical Physicist / MRIScientist

MRWeeklyQCForms_6-12-15(2)