Government of India

Atomic Energy Regulatory Board

Radiological Safety Division
Niyamak Bhavan, Anushaktinagar,
Mumbai-400094
FORMAT FOR QUALITY ASSURANCE TEST FOR DIAGNOSTIC X-RAY EQUIPMENT
(Applicable for Radiography/Radiography&Fluoroscopy/C-Arm/InterventionalRadiology Equipment)
A. DETAILS OF THE DIAGNOSTIC X-RAY EQUIPMENT
1

Name of the Institution and City

2
3
4

Type of Equipment
Model Name
Name of the Manufacturer

Name(s) of Person(s) testing the equipment

and Name of Supplier/Service Agency
Dates and Duration of the Tests

POPULAR MEDICARE
LIMITED,POPULAR HOSPITAL (MOHIT
DIAGNOSTIC NO. 10/60,A-2
KAKARMATTA,VARANASI
RADIOGRAPHY
BRIVO XR 115
M/S WIPRO GE HEALTHCARE PVT
LTD, BANGLORE
NEELU DIXIT, GENWORKS HEALTH
PVT LTD
26.05.2016

B. SUMMARY OF RADIATION SAFETY PERFORMANCE TEST REPORT:

Sr.
No.
1
2

4
5
6

Parameters
Tested
Congruence
of radiation
and optical
field
Central Beam
Alignment
Effective focal
spot
measurement
FFD= 60 cm

Specified
Values
Measurement
at 60 kV

Accuracy of
Operating
Potential (kV)
Accuracy of
Irradiation
Time(sec.)
Total filtration

(last value
maximum kV)

Measured
Values
1.2%
0.8%

Measurement
at 60 kV

Single Focus

1.50
1.8mm X
1.8mm

104
N/A

Measurement
at maximum
kVp 100

4.4 mmAl

Tolerance
Tolerance :
X + X 2% of FFD
Y + Y 2% of FFD
Central Beam Alignment
1.50
Tolerance :
1. + 0.5 f for f 0.8 mm
2. + 0.4 f for 0.8 f 1.5
mm
3. + 0.3 f for f 1.5 mm
5 kV
% Error < 10 %
Tolerance :
1.5 mm Al for kV 70
2.0 mm Al for 70 < kV 100
2.5 mm Al for kV 100

Remarks
PASS
PASS

PASS

PASS
N/A
PASS

8
9

10

11

12

Linearity of
mA/mAs
loading
Stations
Consistency
of radiation
output
Low contrast
resolution

0.023228
0.009108

Measurement
at Maximum
kVp and
corresponding
tube current

PASS

CoV < 0.05

80 KVp

Measurement
shall be done
on each mode
of Image
Intensifier
High contrast
Measurement
resolution
shall be done
on each mode
of Image
Intensifier
Exposure Rate Applicable
at Tabletop
Fluoroscopy
Mode
Radiation
leakage level
at 1m from
tube housing
and
Collimator
(Pl. mention
values
separately)

CoL<0.1

PASS
3.0 mm hole pattern must be
resolved
N/A

N/A
1.5 lp/mm pattern must be
resolved

N/A

N/A

N/A
Tolerance :
1. Exposure Rate without AEC
mode 5 cGy/Min
2. Exposure Rate with AEC
mode 10 cGy/Min
Tube Leakage < 1 mGy in one
hour

N/A

PASS

.26 mR
Or
0.00221
mGy

I hereby undertake that all the information provided above is correct and in accordance with the detailed
Quality Assurance Report enclosed herewith.
Place:Mughal Sarai
Date:27.05.2016

#Signature of Institutions Representative:

Name of Institution:
Seal of the Institution:

Signature:
Name of the Service Engineer: Mr. Neelu Dixit
Name of Supplier/Service Agency: Genworks Health
Pvt Ltd
Seal of Supplier/Service Agency:

1. CONGRUENCE OF RADIATION & OPTICAL FIELD

Operating parameters:
FFD (cm)

100

kV

60

Shift in the edges of the radiation field

Dimensions (cm)
Observed shift
X + X
1.2
Y + Y
0.8

% of FFD
1.2
0.8

mAs

Tolerance
2 % of FFD
2 % of FFD

Remark
PASS
PASS

2. CENTRAL BEAM ALIGNMENT

Operating parameters:
FFD (cm)

100

kV

60

mAs

Observe the images of the two steel balls on the radiograph and evaluate tilt in the central beam.
Observed tilt
PASS
1.50
0
Tolerance: Central Beam Alignment 1.5
3. EFFECTIVE FOCAL SPOT MEASUREMENT

Large focus
Small focus

Stated value of Focal

Spot
Size (mm x mm)
1.8 mm x 1.8 mm
NA

FFD (cm)

60

Measured value of Focal Spot Tolerance:

Size (mm x mm)
1. + 0.5 f for f 0.8 mm
2. + 0.4 f for 0.8 f 1.5 mm
1.8 mm x 1.8 mm
3. + 0.3 f for f 1.5 mm
NA

4. ACCURACY OF OPERATING POTENTIAL

5. ACCURACY OF IRRADIATION TIME
6. TOTAL FILTRATION

FFD (cm)

100

Applied

Set
(s)

Measured values
mA stations
Routinely used
Maximum mA
mA station
station
kVp
Time (s)
kVp Time (s)
60.5
NA
60.4
NA
70.5
NA
70.2
NA
79.2
NA
80.4
NA
98.5
NA
98.4
NA

Minimum mA
station
kVp Time (s)
60.5
NA
70.4
NA
80.5
NA
98.2
NA

Average
kVp

Average
Time (s)

60
NA
60.4667 NA
70
NA
70.37
NA
80
NA
80.03
NA
Max.
NA
98.37
NA
100kVp
Tolerance for kVp : 5 kV
Tolerance for Timer : % Error: 10 %
Total Filtration (measurement at maximum kVp) : 4.5 mm of Al
Tolerance for Total Filtration: 1.5 mm Al for kV 70, 2.0 mm Al for kV 100, 2.5 mm Al for kV 100

Remarks
PASS
PASS
PASS
PASS

7. LINEARITY OF ( mA/mAs) LOADING STATIONS

Operating parameters:
FFD (cm)

100

mA
applied

kV

60

Radiation Output (Gy)

Reading 1 Reading 2
25
42.3
42.6
50
87.3
86.3
100
166.5
166.23
Tolerance: COL 0.1

Average
Output

Reading 3
42.72
87.8
165.561

(Gy)
42.54
87.13
166.097

Time (s)

1 Sec

Gy /mAs
( X)

Coefficient
of Linearity
(CoL)

Remarks

0.023228

PASS

FFD (cm)

100

1.7
1.74
1.661

8. OUTPUT CONSISTANCY
Applied
kV

mAs

Radiation Output (Gy)

70

160

403.23

402.87

80

120

157.3

100

60

253.4

404.12

403.23

403.35

158.2

160.1

160.2

157.3

254.7

253.3

253.1

252.2

Tolerance : CoV 0.05

9.

LOW CONTRAST SENSITIVITY:

Diameter of the smallest size hole clearly resolved on the monitor

N/A

Avera
ge
(X)
403.1
7
158.6
2

Coefficient of Remarks
Variation
(CoV)
0.001144
PASS
0.009108

PASS

253.3
4

0.003537

PASS

Recommended performance standard

10.

3.0 mm hole pattern must be resolved

HIGH CONTRAST SENSITIVITY

Bar strips resolved on the monitor (lp/mm)

Recommended performance standard
11.

N/A
1.5 lp/mm pattern must be resolved

EXPOSURE RATE AT TABLE TOP

Distance from Focus

Applied kV Applied mA Exposure rate at table top (cGy/Min)
to Table top
N/A
Tolerance :
1. Exposure Rate without AEC mode 5 cGy/Min
2. Exposure Rate with AEC mode 10 cGy/Min
Minimum focus to table top distance shall be 30 cm for fluoroscopy

Remarks
N/A

12.TUBE HOUSING LEAKAGE

Operating parameters:
FDD (cm)

100

kVp

(Max)

mA

60

Time(s)

1sec

Location
Exposure level (mR/hr)
Result
(at 1.0 m from
Left
Right
Front
Back
Top
the focus)
Tube
3.7
3.1
1.54
3.87
1.2
PASS
Collimator
5.2
5.7
2.1
2.6
1.4
PASS
Tolerance: Maximum leakage radiation level at 1 meter from the focus should be 1 mGy (114 mR)
in one hour.
Work load 180 mAmin in one hr
Max leakage = 180 mAmin in 1 hr X 5.2mR/hrMax Exposure level (mR/hr)
60 X 60 mA used for measurement
Maximum radiation leakage from tube housing = 0.26 mR in one hour 0.002281 mGy
Maximum radiation leakage from tube collimator = 0.26 mR in one hour
Details of Radiation Protection Survey of the installation
Date of radiation protection survey:
Whether radiation survey meter used for the survey has valid calibration certificate: Yes
Equipment Setting:Applied Current (mA): 60
Applied Voltage (kV): 70
Exposure time(s): 1 Sec

Workload: 3500 mAmin/week

Provide the measured maximum radiation levels (mR/hr) at different locations
Location
Control console(Operator Position)
Outside patient entrance door
Behind Windows (if applicable)
Patient Waiting Area
Maximum Radiation level/week (mR/wk) =
(mR/hr)

Max. Radiation level (mR/hr)

0.187 mR/hr
0.1 mR/hr
N/A
0.023 mR/hr
3500 mAmin/week X 0.187Max. radiation level
60 X 60 mA used for measurement

Maximum Radiation Level/Week (mR/wk)= 0.208 mR/week

Permissible limit
For location of Radiation Worker: 20 mSv in a year (40 mR/week)
For Location of Member of Public: 1 mSv in a year (2mR/week)