Ensuring the consistent performance of CT equipment is crucial for accurate diagnostic imaging, which is where the Data CT Equipment Quality Control form comes into play. This tool is designed for daily monitoring, capturing essential variables such as the CT facility name, scanner identifier, and an array of checks on water Hounsfield Unit (HU) limits, water standard deviation (SD) limits, and the presence of axial and helical artifacts. Each parameter is evaluated as 'Yes' or 'No', providing a clear snapshot of the scanner's operational status on a given day. The structured layout facilitates quick reviews while also allowing space for pertinent notes that may affect the interpretation of the data. Additionally, the form is validated by a review from a qualified medical physicist, ensuring that any deviations from normal performance standards are acknowledged and addressed promptly. This comprehensive approach to quality control not only maintains the integrity of diagnostic procedures but also upholds patient safety and the accuracy of results.
| Question | Answer |
|---|---|
| Form Name | Data Form Ct Equipment Quality Control |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | daily ct equipment form template, ct daily form, daily ct quality control form, ct daily quality control |
A. DATA FORM FOR DAILY CT EQUIPMENT QUALITY CONTROL
CT Facility Name:__________________
CT Scanner Identifier:_____________________
|
Date |
|
Water HU |
Limit |
Water SD |
Limit |
|
Axial Artifacts |
Notes |
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
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|
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Helical |
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Y/N |
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Y/N |
|
Y/N |
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|
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Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
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Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
CT |
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
Quality |
|
|
|
|
|
||||
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
Control |
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
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Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
Manual |
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Axial |
|
|
|
|
|
|
|
|
|
Y/N |
|
Y/N |
|
Y/N |
|
||
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
|
|
|
|
|
|
|
|
|
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Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Axial |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
|
Helical |
|
Y/N |
|
Y/N |
|
Y/N |
|
|
Reviewed by: _____________________________ |
|
__________________________________ |
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|
Qualified Medical Physicist |
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Date of Review |
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