STATUS: Passed Service Required Preventable problem Adverse event

likely

Ultrasound Scanners

Procedure No. 474-20081015-01 ( Major )

Facility: Dept:
WO No.: Date: Inspector:
Mfr: Model: SN:
CTRL No: Loc: IPM Time:

SPECIAL PRECAUTIONS

TEST APPARATUS
Control/Serial No.
Multipurpose ultrasound phantom
Doppler ultrasound phantom
Blood flow simulator
ECG simulator

QUALITATIVE TASKS
Pass Fail
Chassis/Housing
Mount/Fasteners
Casters/Brakes
AC Plug/Receptacles
Line Cord
Strain Reliefs
Cables
Transducers
Filters
Controls/Switches
Fans
Indicators/Displays
Self-Test
Time/Date Settings

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 Network/Wireless Interfaces
User Calibration
Audible Signals
Labeling
System Performance
ECG
Accessories

QUANTITATIVE TASKS
Criteria Set/Indicated Measured Pass Fail
Grounding Resistance ≤0.5 Ω
Transducer Identification and Scanner
Settings for Tests with the Multipurpose
Ultrasound Phantom
Dead Zone baseline image
values
Axial Resolution baseline image
values
Lateral Resolution baseline image
values
Vertical Distance ±2% of actual
distance
Horizontal Distance ±5% of actual
distance
Doppler Calibration baseline display
values

PREVENTIVE MAINTENANCE
Done
Clean
Lubricate
Refill
Clean

NOTES

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