KonicaCR数位乳房影像及X光摄影仪品质保证校验纪录表

附件八之二_KONICAMINOLTAREGIUS(範例)醫院：檢查人員簽名：覆核人員簽名：KonicaCR數位乳房影像及X光攝影儀品質保證校驗紀錄表A.日常性(非年度)品質保證作業每週、每季及每半年實施:1.每日乳房攝影數位影像系統檢查(DailyOperationalChecks)(RTQm-1).………….….22.假體影像品質控制表(PhantomImageQualityChart)(RTQm-2)………….………...…33.影像板片匣檢視與清潔紀錄表(ImageCassetteandPlateCheck)(RTQm-3).…………44.影像顯示器與閱片箱清潔紀錄表(MonitorandViewboxCheckChart)(RTQm-4)…...55.系統設備檢查與清潔品管表(VisualInspectionChart)(RTQm-5)…………………..…66.乳房攝影品管清單(A)(RTQc-1a)、(B)(RTQc-1b)……………………………….…...7、87.重照影像紀錄表、分析表(RepeatAnalysisChart)(RTQm-6a、RTQm-6b)……....…9、108.壓迫力測試表(CompressionForceTestChart)(RTQm-7)………………..…………...119.每季每半年乳房攝影品管清單(RTQc-2)……..…………………………………...…12B.定期性(年度)品質保證作業每年實施:10.房攝影單元組件檢查表(PhysicalInspectionChart)(MPQm-8)………….…….…....1311.暗雜訊評估表(DarkNoiseCheckChart)(MPQm-9)……………………….….….…1412.殘影評估(GhostImageEvaluationChart)(MPQm-10)….…………………….….…..1513.管電壓準確性與再現性評估(kVpAccuracyandReproducibilityEvaluationChart)(MPQm-11)……………………………………………………….….…….....1614.自動曝光控制效能評估表(AECPerformanceCheckChart)(MPQm-12)…........…...1715.系統假影評估表(SystemArtifactEvaluationChart)(MPQm-13)…….…….….…….1816.影像板感光均勻度評估表(ImagePlateResponseUniformityCheckChart)(MPQm-14)……………………………………………………………..……….....…..1917.影像顯示器品質管制表(MonitorQualityControlChart)(MPQm-15)……..………..2018.印像機品質管制表(PrinterQualityControlChart)(MPQm-16)…………….…….…2019.閱片裝置及閱片環境評估表(ViewBoxesandViewingConditionEvaluationChart)(MPQm-17)……………………………………………………...….…………..2020.解析度評估表(SpatialResolutionEvaluationChart)(MPQm-18)…..………….….…2121.假體影像品質評估表(PhantomImageQualityChart)(MPQm-19)……………….…2222.幾何失真測試表(GeometricDistortionCheckChart)(MPQm-20)….…………..…...2323.S值對應顯示測試(S-ValueResponseIndicatorCheckChart)(MPQm-21)…….……2424.準直儀狀況評估(CollimatorAssessmentCheck)(MPQm-22)……………………….2525.射束品質的評估及半值層測定表(BeamQualityEvaluationandHVLMeasurement)(MPQm-23)…………………………………………………...……....2626.乳房入射曝露、自動曝露控制的再現性、平均乳腺劑量和輻射輸出評估(MPQm-24)…………………….……………………………………………...……....27CRmammo醫院：檢查人員簽名：覆核人員簽名：1品質保證校驗紀基本資料一、數位影像系統︰製造廠商︰Konica-Minota型號︰___________________二、X光攝影儀︰製造廠商︰型號︰___________________三、影像顯示器︰製造廠商︰型號︰___________________四、印相機︰製造廠商︰型號︰___________________CRmammo醫院：檢查人員簽名：覆核人員簽名：2每日乳房攝影數位影像系統檢查(DailyOperationalChecks)(RTQm-1)Site:Date:Equipment:X-rayunitmanufacturer/Model:(Frequency:Daily)A.X-rayUnitEvaluationPassFail1Free-standingunitismechanicallystable2Allmovingpartsmovesmoothly,withoutobstructionstomotion3Alllocksanddetentsworkproperly4Imagereceptorholderassemblyisfreefromvibrations5Imagereceptorslidessmoothlyintoholderassembly6ImagereceptorisheldsecurelybyassemblyinanyorientationB.CRControlAreaEvaluationPassFail7CRAcquisitionMonitorisfreeofblemishesand8REGIUSloginscreenisdisplayedandnoerrorsarereported9NoerrorsaredisplayedontheR190Reader10Techniquechartisinplace11ExposureswitchisinplaceC.ImagingCassettesandPlates(PlacetheR190Readerinto“Deep”erasemode)PassFail12InserteachcassetteintotheReaderforerasure13FollowingerasurethecassettesshouldbestoredinaradiationshieldedlocationtopreventfoggingoftheimagingplatefromscatterradiationPerformanceCriteria:Allevaluationitemsaremet.AllCassettearereturned.Comments:CRmammo醫院：檢查人員簽名：覆核人員簽名：3假體影像品質控制表(PhantomImageQualityChart)(RTQm-2)CRmammo醫院：檢查人員簽名：覆核人員簽名：4影像板片匣檢視與清潔紀錄表(ImageCassetteandPlateCheck)(RTQm-3)廠牌︰____________________型號︰_______________________年份___________________年(實施頻率:每週)DateIP#1IP#2IP#3IP#4IP#5IP#6IP#7IP#8PerformanceCriteria:Allevaluationitemsaremet.改善措施:CRmammo醫院：檢查人員簽名：覆核人員簽名：5影像顯示器與閱片箱清潔紀錄表(MonitorandViewboxCheckChart)(RTQm-4)廠牌︰____________________型號︰_______________________年份___________________年(實施頻率:每週)DateRadiologist’sMonitorCRConsoleViewboxＭonitor1Monitor2Monitor3Monitor4MonitorViewbox1Viewbox2PerformanceCriteria:Allcheckitemsaremet.改善措施:CRmammo醫院：檢查人員簽名：覆核人員簽名：6系統設備檢查與清潔品管表(VisualInspectionChart)(RTQm-5)X-rayUnit:CRModel:__Year:_(Frequency:Monthly)Month123456789101112DateInitialsGantry:AngulationIndicatorLocks(all)FieldLightSmoothnessofmotionInspectallpaddlesforcracksControlPanel:Switches/indicatorsDisplayTechniquechartsCleaning:X-rayUnitAllImagePlateMonitorsViewBoxesPass:PFail:FDosenotApply:N/APerformanceCriteria:Allinspectionitemsaremet.Comment:CRmammo醫院：檢查人員簽名：覆核人員簽名：7乳房攝影品管清單（A）每日/每週檢視(RTQc-1a)CRmammo醫院：檢查人員簽名：覆核人員簽名：8乳房攝影品管清單（B）每月檢視(RTQc-1b)CRmammo醫院：檢查人員簽名：覆核人員簽名：9重照影像紀錄表(RepeatAnalysisChart-a)(RTQm-6a)CRmammo醫院：檢查人員簽名：覆核人員簽名：10重照影像分析表(RepeatAnalysisChart-b)(RTQm-6b)CRmammo醫院：檢查人員簽名：覆核人員簽名：11壓迫力測試表(CompressionForceTestChart)(RTQm-7)X-rayUnitBrand/Model：___________________________(Frequency:Semi-Annual)DateAuto(11.4-20.4kg)Manual(11.4-20.4kg)PassFailPassFailRemarksDateActionCRmammo醫院：檢查人員簽名：覆核人員簽名：12每季每半年乳房攝影品管清單(RTQc-2)Quarterly/Semi-AnnualRecordofCheckYearMonthDateInitialsRepeatAnalysisCompressionAutoManualManualRadiologistReviewPhysicistReviewComments:CRmammo醫院：檢查人員簽名：覆核人員簽名：13乳房攝影單元組件檢查表(PhysicalInspectionChart)(MPQm-8)Site:Date:Equipment:X-rayunitmanufacturer/Model:MammographicUnitAssemblyEvaluationPassFail1Free-standingunitismechanicallystable2Allmovingpartsmovesmoothly,withoutobstructionstomotion3Alllocksanddetentsworkproperly4Imagereceptorholderassemblyisfreefromvibrations5Imagereceptorslides