CALIBRATION REPORT OF NEWLY INSTALLED STATIONARY

X – RAY EQUIPMENT FOR GENERAL RADIOGRAPHY

a) Calibration or job order number

CALAPE MOTHER AND CHILD
b) Name of facility
HOSPITAL
c) Address of facility CALAPE, BOHOL
d) Name of facility representative
GENERAL e) Condition of equipment upon BRAND NEW
INFORMA purchase
– TION f) X – ray equipment installation date APRIL 24, 2022
g) X – ray equipment calibration date APRIL 24, 2022
h) Date of reporting of test results
i) Name of third party service provider
j) Name of service engineer JASPER B. REDOBLE
k) Room/location X-RAY ROOM
a) Manufacturer RaySafe
b) Model number Unfors Raysafe AB
TEST
c) Serial number 296746
TOOL A
d) Date of calibration MARCH 21, 2023
(kVp Meter)
e) Calibration expiry date APRIL 12, 2024
f) Calibration report of test tool A Please provide after the calibration report
a) Manufacturer RaySafe
b) Model number Unfors Raysafe AB
TEST
c) Serial number 296746
TOOL B
d) Date of calibration MARCH 21, 2023
(Timer)
e) Calibration expiry date APRIL 12, 2024
f) Calibration report of test tool B Please provide after the calibration report
a) Manufacturer RaySafe
TEST b) Model number Unfors Raysafe AB
TOOL C c) Serial number 296746
(Radiation d) Date of calibration MARCH 21, 2023
Dosimeter) e) Calibration expiry date APRIL 12, 2024
f) Calibration report of test tool C Please provide after the calibration report

X – RAY a) Manufacturer SHIMADZU

CONTROL b) Model number GSC-2002S
CONSOLE c) Serial number 2492088601
a) Manufacturer SHIMADZU
X – RAY TUBE
b) Model number 0.6/1.2P324DK-85
ASSEMBLY
c) Serial number RM6D88AB2030
a) Tube mA range 100 mA – 500 mA
b) kVp range 40 kV – 150 kV
X – RAY
c) Exposure time setting range .001 – 10 sec
EQUIPMENT
d) Maximum kW rated output 50 kW
TECHNICAL
e) Power supply information 220 V AC Single Phase
SPECIFICATIONS
f) Inherent/total filtration 1.5mm Al equivalent
g) Overload circuit protection 100 A

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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 %)
calibration e) Total misalignment (cm, %)
report) f) The x – ray beam
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>> <<Provide picture here>>

Misalignment in side B

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

Misalignment in side C

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

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 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

<<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

• Page 3 of 5 •
 <<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>>
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
table bucky
alignment center of image receptor
X – ray tube and
● The center of x – ray beam and the center of indicator light beam must be at the
vertical
cassette/bucky center of image receptor

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 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: Conformed and accepted by:

JASPER B. REDOBLE ABITO H. COSENAS JR.

FIELD SERVICE ADMINISTRATIVE
ENGINEER SUPERVISOR

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