TS 42 MOBILE FLUOROSCOPIC X-RAY EQUIPMENT TEST REPORT rh2006/03

Testers should complete all relevant sections and submit the completed form together with
attachments of all other test results to the Radiological Council.
Note: Boxes should be completed or replaced with þ for ‘yes’ or ý for ‘no’.

Registration Information X-ray Control (cont)

Registration No. RX / , Generator type

Name …. 1-pulse? q
Address ...... 2-pulse? q
...... 6- / 12-pulse? q
...... Medium/high frequency? q
Suburb/Town ... Constant potential? q
Maximum rating (enter mAs if no mA settings)
Postcode 6
Fluoroscopic… kVp mA
Telephone Number ….
Radiographic.. kVp mA mAs
Radiation Safety Officer ….
Exposure warning(s)
Unit location on premises …..
audible signal? q
Date of test …. / /20
or visual signal? q
Exposure switch
Equipment Configuration
Deadman? q
C-Arm q
Handswitch (F)? q
Radiographic mode available? q
Minimum SSD > 200mm q Tube Housing

Manufacturer ….
X-ray Control Model ….
Manufacturer …. Serial # ….
Model …. Filtration, mm Al …
Serial # …. Filtration fixed? q
Year of manufacture …. Focal spot position marked? q

Tube Insert

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This form may be copied provided that the copyright notice is retained.
Manufacturer …. Beam exceeds intensifier diameter? q
Model …. by ... mm

Serial # …. Complies? q
Maximum kVp ….
Voltage Accuracy
Focal spot (s) … mm … mm
Max error …. % at …. kVp

Beam Collimator > ± 5.5% and ≤ ± 6.0% (or kVp)? q

Manufacturer …. > ± 6.0% (or kVp)? q
Model …. Complies? q
Serial # …. Radiation Output
Filtration …. Linearity coefficient (F) .....
Multiplane? q Complies (≤ 0.1)? q
Variable SID? q
Beam Quality
Intensification and Imaging System HVL = … mm Al at …. kVp
Image Intensifier? q DR detector? q Complies? q
Manufacturer ….
Image Quality (Fluoroscopy.......... cm Field)
Model ….
Image distortion visible? q
Field sizes … cm … cm … cm
Low contrast threshold ……. %
Grid? q Complies (≤ 5% at 10 mm)? q
Ratio… Focus … Line/cm… Low contrast detectability …... mm

Imaging System Complies (≤ 1 mm at 10%)? q

Limiting resolution ....... lp.mm-1
Pulsed fluoroscopy? q
Complies (See Table 5)? q
Last image hold? q
Digital acquisition q Intensifier Input Dose Rates
Field size …. cm .... µGy.min-1
using … kVp …. mA
FLUOROSCOPIC MODE TESTS
Field size …. cm .... µGy.min-1
Beam Collimator
using … kVp …. mA
Automatic collimation:- full q partial q Field size …. cm .... µGy.min-1
Beam confined to image receptor? q using … kVp …. mA

Beam Collimation Accuracy Fluoroscopic Timer

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Audible alarm? q 2 sides - beam within 3% SID? q
Adjustable? q 4 sides - beam within 4% SID? q
Maximum time …. Minutes Circular- beam within 1% SID? q
Complies (≤ 5 min)? q Complies? q

Maximum Fluoroscopic Dose Rates Voltage Accuracy

Normal fluoroscopic mode Max error …. % at …. kVp
-1
Maximum free-in-air .... mGy.min
> ± 5.5% and ≤ ± 6.0% (or kVp)? q
using …. kVp …. mA
> ± 6.0% (or kVp)? q
Complies (≤ 100 mGy.min-1 )? q
Complies? q
Typical with PEP .... mGy.min-1
using …. kVp …. mA
Exposure Timer? q
Complies (≤ 15 mGy.min )? -1
q Max error at time > 100 ms …. %
High dose rate mode? q
Complies (≤ ± 10%)? q
Maximum free-in-air .... mGy.min-1
Max error at time ≤ 100 ms (HF etc) … ms
using …. kVp …. mA
Complies (≤ 150 mGy.min-1 )? q Complies (≤ ± (10% + 1) ms)? q
Separate audible or visual signal? q
Radiation Output
Mode selector uses deadman switch? q
If þ, unit complies. Linearity coefficient ....
If ý, mode deselects automatically -
Complies (≤ 0.1)? q
a) after a fixed time if unused? q
b) at machine power off? q
Reproducibility
Complies? (both a & b þ) q
Radiation output
Image and X-ray Beam Congruency
Coefficient of variation ....
Beam ¨ or ¡? Area ratio (sect 5.2)=…
Complies (≤ 0.05)? q
Complies? (Ratio = 1.05) q
kVp
Coefficient of variation ....
RADIOGRAPHIC MODE TESTS
Complies (≤ 0.05)? q
Beam Collimator Exposure times? q
Automatic collimation? q Coefficient of variation ....

Beam confined to image receptor? q Complies (≤ 0.05)? q

Beam Collimation Accuracy Beam Quality

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This form may be copied provided that the copyright notice is retained.
HVL = … mm Al at …. kVp Max measured leakage = … µGy.h-1 at 1m
using …. kVp …. mA
Complies? q
mGy in any 1 h at 1 m ... mGy.
Complies (≤ 1 mGy)? q
Maximum leakage from:-
housing assembly? q
collimator face? q

Tube Assembly Leakage

Comments

Instrument Calibration
Instrument Serial # Date Organisation

Full Compliance Test? q Re-test? q

Compliance Tester (Print / Type) Licence No. LX.. /

Compliance Tester (signature) Date .. / /20

Qualified Expert (Print / Type) Licence No. LX.. /

Qualified Expert (sig nature) Date .. / /20

© Radiological Council of Western Australia.

This form may be copied provided that the copyright notice is retained