TS 41 – APPENDIX A ADDITIONAL X-RAY TUBE rh2006/03

PRACTICE… GENERATOR… ROOM…

Tube Housing Accuracy of Collimation

Manufacturer …. Beam congruency at 1 m = ... mm
Model …. Complies (≤ 10 mm)? q
Serial # …. Light Beam Illuminance
Filtration, mm Al … Illuminance (average) at 1 m =.. lux
Filtration fixed? q Complies (≥ 100 lux)? q
Focal spot position marked? q Voltage Accuracy
Type of mounting Max error … % at .... kVp
C- Arm? q > ± 5.5% and ≤ ± 6.0% (or kVp)? q
Ceiling? q
> ± 6.0% (or kVp)? q
Floor? q
Complies? q
Wall? q
Radiation Output
Insert
Linearity coefficient ....
Manufacturer ….
Complies (≤ 0.1)? q
Model ….
Reproducibility of factors
Serial # ….
Radiation output
Maximum kVp ….
Coefficient of variation ....
Focal spot (s) … mm … mm
Complies (≤ 0.05)? q
Collimator
kVp
Manufacturer ….
Coefficient of variation ....
Model ….
Complies (≤ 0.05)? q
Serial # ….
Exposure times? q
Filtration, mm Al …
Coefficient of variation ....
Multiplane? q
Complies (≤ 0.05)? q
Rotatable? q
Beam Quality
Minimum SID, mm …
HVL = … mm Al at …. kVp

Complies? q

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 Tube Assembly Leakage Complies (≤ 1 mGy)? q
Max measured leakage = … µGy.h-1 at 1m Maximum leakage from:-

using …. kVp …. mA housing assembly? q

mGy in any 1 h at 1 m ... mGy collimator face? q

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This form may be copied provided that the copyright notice is retained.
TS 41 – APPENDIX B ADDITIONAL IMAGE INTENSIFIER rh2006/03

PRACTICE… GENERATOR… ROOM…

Image Intensifier? q DR detector? q Low contrast detectability …... mm

Manufacturer …. Complies (≤ 1 mm at10%)? q
Model …. Limiting resolution ....... lp.mm-1
Field sizes … cm … cm … cm
Complies (See Table 5)? q
Grid? q Maximum Fluoroscopic Dose Rates
Ratio… Focus … Line/cm…
Normal fluoroscopic mode
Image and X-ray Beam Congruency
Max free-in-air .... mGy.min-1
Beam ¨ or ¡? Area ratio (sect 5.2)=…
using …. kVp …. mA
Complies? (Ratio = 1.05) q
Intensifier Input Dose Rates Complies (≤ 100 mGy.min-1 )? q
Field size … cm .... µGy.min-1 Typical with PEP .... mGy.min-1
using … kVp …. mA using …. kVp …. mA
-1
Field size ... cm .... µGy.min Complies (≤ 15 mGy.min-1 )? q
using … kVp …. mA
High dose rate mode? q
Field size … cm .... µGy.min-1
Max free-in-air .... mGy.min-1
using … kVp …. mA
using …. kVp …. mA
Field size … cm .... µGy.min-1
using … kVp …. mA
Complies (≤ 150 mGy.min-1 )? q
Image Quality ( …...... cm field)
Separate audible or visual signal? q
Mode selector uses deadman switch? q
Image distortion visible? q If þ, unit complies.
Low contrast threshold ……. % If ý, mode deselects automatically -
a) after a fixed time if unused? q
Complies (≤ 5% at 10 mm)? q
b) at machine power off? q
Complies? (both a & b þ) q
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© Radiological Council of Western Australia.

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