Dimensions~ Seleniae Dimensions Maintenance Report iv Installation Report ‘Customer Name HOLOGIC Preventative Maintenance Report Room Identification [Hoan My Thu Duc International General Hospital Page 1 Date of Service System SN System Software Version Detector SN p4r28/2020 fsom131800464 | [1.9.0 /A805192 Contact Name ‘Street Address [_r. Long f241, National Highway 1K, Linh Xuan Ward, T] ivkh@hoanmythudi Email Address & @ thule. com city State Zip Code [Ho Chi Minh Engineer/Title Case # [Mr. Hung System Check Functional Check ] System Cleaning 7] CalToo! Verification 7] Half Value Layer Verification 7] System Lubrication 7] Voltage Verification 7] AEC Performance v] System integrity v7] X-ray Tube Voltage 7] Target Dose “| Xray Tube Current wv] Image Quality Preventative Maintenance _installation Preventative Maintenance Period Pass v] Complete Semiannual AnnualTEST Equipment Digital Multimeter cal batepaz072070 —] Oscilloscope Model# {_____ Cal. Date[___ Compression Gauge Model# LAICA J Gal. Datef03/15/2020_] lon Chamber Model#[____ Cal. Date] High Voltage Tank / Probe Cal. Datefo1/0372020_] Solid State Measurement Device (i.e. Raysafe/Unfors/Piranha/RT!) Serial # Cal. Datep7/2072019_]Hardware Installation Check if a Mobile Unit Gantry [/] Fasten the Gantry in position (/] Verity Read Out Sequence for detector [7] Remove the Grid Assembly Shipping Bracket [7] Install Gantry compliance label [7] install the image Receptor Install Remote X-ray On/Power On lamp connection (optional) | Install Gantry Footswitch Acquisition Workstation [\/] Fasten the Acquisition Workstation in position 7] Install AWS compliance label [7] Install Control Monitor (UAWS only) Install X-ray Footswitch (UAWS only) [7] Install the Preview Display Monitor /] Install the Radiation Shield [\] Install the Acquisition Workstation network cable Mobile Gantry Install Gantry Brake Kit Set vertical height limit Mobile mounting requirements reviewed with the customer Mobile Acquisition Workstation Install mobile mounting arm for Preview Display Review radiation shield requirements 7] Hardware Installation Complete Page 2System Check System Cleaning ] Clean AWS glass 7] Vacuum AWS intake vents (] Vacuum AWS interior ] Vacuum gantry generator exhaust vents (] Vacuum computer fans (] Replace detector filters (ASY-07829) System Lubrication Inspect and lubricate VTA assembly (PN 2-580-0207) Clean and lubricate collimator assembly (PN 2-580-0216) Clean and reapply X-ray tube grease (Dow Corning Silicone 540-0108) C-arm Tomo Gear Rotational Assembly (Lubricate Rotational Gear only PN 2-580-0207) SIRI 2 system Integrity Inspect wiring for safety and integrity Check function of safety interlocks, switches and limit switches Inspect AWS X-Ray Shield for damage and integrity Inspect Vertical Height configuration (Mobile and Low Ceiling) Verify accessory installation and operation (Face Shield, Crosshairs, Paddles, Mag Stand) Verify C-arm function, up, down, clockwise, counter-clockwise rotation Verify Compression function, up, down, release Verify Tomo zero Verify Collimator lamp operation and override (if equipped) Verify Paddle Shifting Verify compression force calibration Verify compression thickness calibration Perform paddle height offset calibration Perform FAST Paddle compression thickness Inspect high voltage cable connections at the Resistor Pack (2) and Multiplier Drawer Verify C-arm and Tomo Arm Functionality Verify C-arm zero angle Verify C-arm Rotational Brake (Biopsy) NINN NSPS Verify Grid configuration (Dip Switch Settings match Grid Rev and Detector) Caltool Verification [¥] X-Ray LFS field alignment [7] X-Ray SFS field alignment [7] Light field alignmentX-ray Tube Current 10mAs 25kV 30kV 35kV 100mAs: 25kV 30kV 35kV 30kV 42kV 200mAs 30kV 35kV 39kV 42kV 400mAs 35kV Large Focal Spot LFS Enter mAs - Range 8 - 12 Small Focal Spot SFS Enter mAs - Range 8 - 12 Enter mAs - Range 384-416 90 [\V] LFS X-ray Tube Current Verification Pass 10mAs. lio 20Kv fio fio aelio lio 30Kv fio 35kv fio Enter mAs - Range 96-104 39kV fi H100 100 40mAs__ Enter mAs - Range 38.4 - 41.6 00 25Kv fio H00 soKv so i100 35Kv fro Enter mAs - Range 196-204 30KV fio 00 boo [| SFS X-ray Tube Current Verification Pass pod 00HVL Verification Rh(28kV) Ag(28kV) Measured mR MeasuredmR 9420 Measured HVL MeasuredHVL so | Tube Output : Tube Output | HVL in File HVL in File | TO in File TO in File | Al(29kV) Measured mR Measured HVL Tube Output HVL in File TO in File Measured value must be within 5% of File value to Pass. [¥] HVL Verification Pass[Hells|fellsllsMleltls SIEIIIEIILIL LUDO DOOOOO00o El Dose mAs Filter kV [¥] AEC Performance Pass AEC Performance ThickSOU iS]Computer Settings (Installation Only) [7] Configure Windows time zone and date 7] Configure network settings [7] Configure computer host name Configure/Verify/Email Hologic Connect settings (optional) 7] Computer Setting Complete Application Settings (Installation Only) Enable AWM (optional) Configure Institution, Address Station and Locale Configure Serial Number Verify Reclaimer System Settings Verify Reclaimer User Settings Verify / Install Licenses SUIS) IS} IS} IS} IS Configure Generated 2D settings (optional) [| Synthesized Method ‘Synthesized2D for CAD (optional) [(/] Auto Mapping (Intelligent2D only) | Set System AE Title S Verify Reorient Tomo, Generated 2D and Projection pixel data settings [V] Configure Procedure RIS Codes (when available) 7] Application Settings Complete Poge 12Interface Configuration (Installation Only) 4 | VY] ir) iv w 4 4 4) O iy] Install Modality Worklist interface(s) Install archive/router devices Install workstation devices (as needed) Install CAD devices (as needed) Install printer devices (as needed) Install Query/Retrieve interfaces Configure installed devices’ info, IP address, AE Title and port data Verify/install optional Image Types for store devices Verify/Install optional Transfer Syntaxes for store devices Verify/install marker burn-in settings for store devices Verify/Configure film sizes for printer devices Set/Verify Retrieve address for query/retieve devices Configure Output Groups Configure optional features as needed (i.e, Dose Reporting, BPO, MPPS) Interface Configuration CompleteInterface Tests (Installation Only) SJ IST IS) (SJ IS) LS ] SJ IS) IS LS} US} (S) IS Verify MWL Query results Verify MWL RIS Code Mapping is set correctly Verify images are stored on PACS Verify images can be viewed from PACS Verify images can be retrieved from PACS (optional) Verify images can be sent to Workstations (optional) Verify images are sent to CAD (optional) Verify that C-View RAW is sent to CAD (optional) Verify images are sent to DICOM printer (optional) Verify that correct TOMO format is sent to PACS and Workstation (3D System) Verify images annotated on SecurView arrive at Dimensions (optional) Verify export settings for removable media Verify paper printer if needed for QC Report, rejected images, etc. (optional) Verify Notices are operational (optional) Reorient pixel data Verify Barcode Reader operation (if equipped) Interface Tests Complete Page 14‘ Cong ty TNH: VGH he va Tang Ahiet by yawAte Hoey