CALIBRATION REPORT OF NEWLY INSTALLED STATIONARY

X – RAY EQUIPMENT FOR GENERAL RADIOGRAPHY

a) Calibration or job order number

b) Name of facility
c) Address of facility
d) Name of facility representative
GENERAL e) Condition of equipment upon purchase
INFORMA – f) X – ray equipment installation date
TION g) X – ray equipment calibration date
h) Date of reporting of test results
i) Name of third party service provider
j) Name of service engineer
k) Room/location
a) Manufacturer
b) Model number
TEST
c) Serial number
TOOL A
d) Date of calibration
(kVp Meter)
e) Calibration expiry date
f) Calibration report of test tool A Please provide after the calibration report
a) Manufacturer
b) Model number
TEST
c) Serial number
TOOL B
d) Date of calibration
(Timer)
e) Calibration expiry date
f) Calibration report of test tool B Please provide after the calibration report
a) Manufacturer
TEST b) Model number
TOOL C c) Serial number
(Radiation d) Date of calibration
Dosimeter) e) Calibration expiry date
f) Calibration report of test tool C Please provide after the calibration report

X – RAY a) Manufacturer
CONTROL b) Model number
CONSOLE c) Serial number
a) Manufacturer
X – RAY TUBE
b) Model number
ASSEMBLY
c) Serial number
a) Tube mA range
b) kVp range
X – RAY
c) Exposure time setting range
EQUIPMENT
d) Maximum kW rated output
TECHNICAL
e) Power supply information
SPECIFICATIONS
f) Inherent/total filtration
g) Overload circuit protection

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 MECHANICAL
PARAMETERS TRIAL 1 TRIAL 2 TRIAL 3 MEAN
CHECKS
a) Misalignment in side A (cm, %)
b) Misalignment in side B (cm, %)
1. COLLIMATION
c) Misalignment in side C (cm, %)
ASSESSMENT
(Provide images d) Misalignment in side D (cm, %)
of the test after e) Total misalignment (cm, %)
calibration f) The x – ray beam
report) perpendicularity (degrees)
<<State the source image receptor distance (cm), x –
g) Settings
ray field size (cm2), kVp, mA, and s settings here>>

TRIAL 1 TRIAL 2 TRIAL 3

Misalignment in side A

<<Provide picture here>> <<Provide picture here>>

Misalignment in side B

<<Provide picture here>> <<Provide picture here>> <<Provide picture here>>

Misalignment in side C

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 <<Provide picture here>> <<Provide picture here>> <<Provide picture here>>

Misalignment in side D

<<Provide picture here>> <<Provide picture here>> <<Provide picture here>>

X – ray beam perpendicularity

<<Provide picture here>> <<Provide picture here>> <<Provide picture here>>

2. X – RAY TUBE AND TABLE BUCKY ALIGNMENT

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 <<INSERT PICTURES <<INSERT PICTURES <<INSERT PICTURES
HERE>> HERE>> HERE>>

TRIAL 1 TRIAL 2 TRIAL 3

SETTINGS: <<State the source image receptor distance (cm), x – ray field size (cm2), kVp, mA, and s settings here>>

3. X – RAY TUBE AND VERTICAL CASSETTE/BUCKY ALIGNMENT

<<INSERT PICTURES <<INSERT PICTURES <<INSERT PICTURES

HERE>> HERE>> HERE>>

TRIAL 1 TRIAL 2 TRIAL 3

SETTINGS: <<State the source image receptor distance (cm), x – ray field size (cm2), kVp, mA, and s settings here>>

GENERATOR SET TRIAL TRIAL TRIAL S.

SSDb COVc COLd % REe
CHECKS VALUE 1 2 3 MEAN
a)
b)
c)
2. kVp
ACCURACY d)
e)
<<State the source image receptor distance (cm), x – ray field size (cm2), kVp, mA,
f) Settings
and s settings here>>

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 a)
b)
4. EXPOSURE
c)
TIME
ACCURACY d)
(s) e)
<<State the source image receptor distance (cm), x – ray field size (cm2), kVp, mA,
f) Settings
and s settings here>>
a) mA μGy μGy μGy μGy μGy
b) mA μGy μGy μGy μGy μGy
6. mA
c) mA μGy μGy μGy μGy μGy
LINEARITY
(Xd in μGy d) mA μGy μGy μGy μGy μGy
vs. mA) e) mA μGy μGy μGy μGy μGy
<<State the source image receptor distance (cm), x – ray field size (cm2), kVp, mA,
f) Settings
and s settings here>>
a c
Legends: Radiation dose/exposure Coefficient of variance (COV = SSD / Sample Mean)
b d
Sample standard Coefficient of linearity [COL = (Xmax – Xmin) / (Xmax + Xmin)]
deviation
e
Percent relative error
[% RE = (Set Value – Actual Value)(100 %) / Set Value]
Specifications:
Mechanical Collimation
● Allowable misalignment for each side = ± 1 % of SID
checks assessment
● Allowable total misalignment = ± 2 % of SID

● Allowable x-ray beam perpendicularity = 90° ± 1.5°

X – ray tube and
● The center of x – ray beam and the center of indicator light beam must be at the center
table bucky
alignment of image receptor
X – ray tube and
● The center of x – ray beam and the center of indicator light beam must be at the center
vertical
cassette/bucky of image receptor
alignment
Generator kVp Accuracy
● For < 100 kVp: actual kVp shall be within ± 6 % of the set kVp
checks
● For > 100 kVp: actual kVp shall be within ± 6 % of the set kVp
Exposure time
● For exposure time < 0.1 s, actual time shall be within ± 20 % of the set time
accuracy
● For exposure time > 0.1 s, actual time shall be within ± 10 % of the set time

● The COV shall be within 0.05

mA linearity
● The overall COL shall be ≤ 0.1

Performed by: Checked and attested by: Conformed and accepted by:

<<Name and signature>> <<Name and signature>> <<Name and signature>>

<<Position>> <<Position>> <<Position>>

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