RELIABLE TECHNOCARE PVT. LTD.

'Reliable House', Unit no. 101-104,'Palazzo Greens, Wing-A, Vadgaon, pune-412106

Mobile: 7774055755, 7 7 7 4055855,77 7 4058855, 7 7 7 402Z9OO
Email : reliabletechnocare@gmail.com/reliable1010@gmail.com
Web. : www.reliable,world

QA Test Report For D iagnostic X-Ray Equi pment

A. Name & Address of the lnstitution

Ruby Hall Clinic
40, Sassoon Road, Pune{ 11001.
Report No. : T.21.02.11.001
Date of Received : t7.02.2022
Temperature. (eC) : 24.2 Date of Test : 77.02.2022
Relative Humidity (% RH) : u Due of Test : 16.02.2024
Location of Test : On site Date of lssue : !7.02.2022
Condition of ltem : ok Work lnstruction no RTPL-RWI.O4

B. Details OfThe Dlagnostic X-Ray Equipment

1 Equipment Name : DentalX Ray Machine

2 Name of Manufacturer : Skanray

3 ModelNo. : lntraskan-DC

4 Serial No. : MY351300032

5 Asset Code : 1731

6 Name of the Service Agency : Reliable Technocare Pvt. Ltd.,Pune.

7 AERB Authorisation Number : 17-AFSXE-206685

C. Standards Used for Testlng

Sr,
lnstrument Name Sr. No, Certificate No
No Certified By Validity
1 RF Detector 233596 0749.233596.05072021 RPL 05.07.2022
2 Survey Detector 232s34 07 49.232534.0501202r RPL 05.07.2022
3 lmaging Phantom N.A. N.A. N.A, N.A.

Note :

1) This certificate refers only to the particular item submitted for Test.
2) The Test results reported in the certificate are valid at the time of and under the stated
conditions of measurement.
3) This certificate shall not be reproduced, except in full unless written permission
for the publication of an approved
abstrad has been obtained from the Technical Manager of ,,Reliable
Technocare, pune,, pvt. Ltd.,,.
4) Referred Standard forTesting : AERB Test protocol 2015.
5) Decision Rule : Pass and Fail remark is based on AERB test protocol
and tolerances as mentioned in summary Report.

HIo
Approved By
4o
put/E
:::.'/_,""", g'&"r
Tech#al Manager
R.D. Bodhe
* YaminiBorse

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 Report No.: T.21.02.11.001
D. Summa Of Radiation Performance Test ort
Sr. No, Parameter Used Measurement Conditions Measured Values Tolerance Remarks

7 Congruence Test N.A. N.A. 2% o'f FFD N.A,

2 CentralBeam Alignment N.A. N.A < 1.50 N.A.

Effective focal spot Tolerance:

3 measurement N,A, 1)+0.5 fforf< 0.8 mm
N.A, N,A
FFD = 60 cm 2)+0.4 ffor0.8 < f< 1.5 mm
3)+0.3fforf>1.5mm
Set kvp Measured kVp

Accuracy of Operating 50 47.98

4
Potential rSkv Pass
50 57.87

70 66.93

Set Time (s) Yo Erot

Accuracy of lrradiation 0.1

5 -L.7
Time(sec.) < I (10%) Pass
0.3
-1.3
0.5 ,l 1

Tolerance:
mm of Al
1.5 mm Alfor kvp < 70,
6 Total Filtration
2.0 mm Alfor 70 < kvp < 100 Pass
60 2.734 2.5 mm Al for kvp > 100

7 mAs Linearity 0.00522 Coefficient of Linearity <0.1 Pass

cov
Consistency of radiatlon
8 50 0.0014 CoV < 0,05
output Pass

60 0.0010

Without AECMode : < 5 ccy/min

9 Exposure Rate at tabletop N.A. N.A. N.A
With AEC Mode: < 10ccy/min

10 Low Contrast Resolution N.A. N,A 3.0 mm hole should be visible N.A,

77 HiEh Contrast Resolution N.A. N.A 1.5 lp/mm should be visible N.A.
On - Position Radiation
Leakage level from X-Ray Position mcy in t hr
12
tube housing measured at
< 0.25 mcy in one hour Pass
60 kv Tube Collimator
8 mAs 0.116

Note:

1 Tests as mentioned in Sr. No. 1,2,3 are not applicable for C-Arm/tnterventional Radiology Equipment.

2 Tests as mentioned in Sr. No. 9,10,11 are not applicable for only radiography mode of x-ray equipment

I hereby undertake that all the information provided above is in accordance with the detailed
c o
Quality Assurance Repon enclosed herewith

Pt/,VE 'o
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 Report No. : T.21.02.11.001
I Congruence Of Radiation & Optlcal Field

Not Applicable

2 Central Beam Alitnment

Not Applicable

3 Effective Focal Spot Measurement

Not Applicable

4 Accuracy Of Operating Potential &Total Flltration

I- FFp {.r) I 30

Applied Set Time Measured Values Average Average

kvp (s) kvp time (s) kvp time (s) kvp (s)
50 0.1 47.84 0.097 48.13 0.100 47.98 0.098
60 0.3 57.87 0.297 57.87 0.295 57.87 0.296
70 0.5 67.77 0.499 66.75 0.489 66.93 0.494

Applied Deviation Applied Deviation

kvp kvp kvp %
50 -2.016 0.1 -t.67
60 -2.72A 0.3 -1.33
70 -3.057 0.5 -7.22
Tolerance: For kvp15 kvp
Fortimer ! 10%

Total Filtration measured at 70 kv

TF 2.734 mm of Al

Tolerance For Total Filtration

1.5 mm Alfor kV < 70 The Total Filtration values are Measured
2.0 mm Alfor 70 < kV < 100 directly from Raysafe Xi Platinium System
2.5 mm Al for kV > 100

5 Linearity Of mAs Loading Station

Operating parameters:

FFD (cm) 30
50

Output (mGy) Average mGy/mA

mA Range coL
1 2

4 0.0864 0.0868 0.0866 o.0217

0.0052
6 o.7284 0.t287 0.1286 0.0214

Tolerance in COL : < 0.1

6 Output Consistency

FFD (cm) 30

Output (mGy)
Applied kvp mAs Average cov
7 2 3 4 5

50 0.4 0.088 0.086 _ 0.084 0.086 0.086 0.08586 0.00143

bU 0.4 0.135 o.B7 f 0.135. 0.136 o.137 0.13600 0.00100

Tolerance in COV: < 0.05

\tblr
apded sy

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 Report No. : T.21.02.11.001
7 Low Contrast Sensitivity:
Not Applicable

8 High Contrast Sensltivity

Not Applicable

9 Exposure Rate At Table Top

Not Applicable

10 Radiation leakage levels from X-Ray tube housing at I m from the focus

kVp 60
mAs 8
1.50

Location (at 1.0 m from the Radiation Leakage level {mR/hr)

focus) Cathode Anode Front Back Top
Tube 6.587 5.a77 0.847 4.245 0.134
Collimator

Work load = 180 mA-min in one hour

Maximum Leakage = 180 mA-min in one hour x max mR/hr

60 min x 1.50 mA used for masurement

Maximum radiation leakage mRinthr mcy in t hr Result

Tube housing t3.17 4 0.116 Pass

Collimator

Acceptable Tolerance Limit : Leakage Radiation level at 1 meter from the focus should be
< 114 mR in one hour
or <1 mcy in one hour

App
c

ot ,te

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 Report No.: T.21.02.11.001
11 Radiation Protection Survey Report

Date of radiation protection survey : 17.02.2022

Meter used for survey has valid calibration certificate : Yes

Equipment settings

kvp 60
MA 8
time (s) 1.50

Work Load 5 mA-min/week

Measurement:

Locations Max. Radiation Level mR/week Remark

Operator Position 1.205 mR/hr 0.013 Safe
Doctor Sitting 0.123 mR/hr 0.001 Safe
Entrance Door 0.014 mR/hr 0.000 Safe
Right Side wash Room 0.020 mR/hr 0.000 Safe
Left Side Waiting Area 0.015 mR/hr 0.000 safe
Back Side Office Room 0.164 mR/hr 0.002 Safe

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 2 mR/week

# Signature of lnstitution's Representative:

Name of lnstitution:
Seal of the lnstitution:
s p{/,v6

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