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OptiVantage Dual-Head Contrast Delivery System V-4

Test and Inspection Data

WARNING!

Service on any Injector must be performed by a Qualified Technician who is completely familiar
with its use and operation; trained by the manufacturer in the area of servicing the Injector; and
familiar with the content of the Operator’s and the Installation and Service manual.

Service Ticket Number

Call
Type N/A Service Work Performed Field Service Engineer Information
Preventive Maintenance Date
Installation Name
Repair Signature

Injector Information
Injector Component Serial Number Injector Component Software Version
Console Serial Number Console Software Version
Power-Head Serial Number Power-Head Software Version

POWER - SUPPLY UDI: PLEASE CHECKTHE APPROPRIATE BOX CORRESPONDINGTOTHE MODEL NUMBER AND FILL INTHE SERIAL NUMBER
844001 011074619000269721
844003 011074619000270321
DE844001 011074619000395321 _________________________
DE844003 011074619000398421
DL844001 011074619000397721 Power - Supply Serial Number
DL844003 011074619000400421
DS844001 011074619000396021
DS844003 011074619000399121

_________ ________________

Calibrated Controlled Test Equipment

Used N/A Test Equipment CCN# Calibration Due Date

Torque Wrench (in-lbs)

Pressure Gauge
Digital Volt Meter

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 Test and Inspection Data
The number preceding the heading corresponds to the test procedure
instructions located in the appropriate Service Manual 848003

4.2.2 POWER-SUPPLY CHECK 4.3.1 GROUND CONTINUTY

4.2.3 CONSOLE OPERATIONS

4.4 CEILING SUSPENSION SYSTEM

4.2.5 POWERHEAD OPERATIONS

NO SUSPENSION SYSTEM

4.2.6 REMOTE START OPERATIONS

OEM INTERFACE FEATURE INSTALLED

NO REMOTE START OEM Software Version ____________________

4.2.7 POWERHEAD STOP BUTTON NO OEM INTERFACE FEATURE INSTALLED

4.2.8 FACE PLATE DETECTION

4.2.9 RFID FACE PLATE DETECTION

NO RFID FACE-PLATE

Note: This section of Test and Inspection Data only needs to be completed if
one or more of the following conditions occur during the service event,
Select appropriate Check Box(s);

Installation Request Quality Regulatory Request Software Download

N/A Preventive Maintenance Extension Cables Replaced System Calibration

System Component Covers Removed Major Component Replacement

4.2.10 FLOW RATE CHECK 4.2.11 PRESSURE LIMIT CHECK

ACHIEVED ACHIEVED Programmed Pressure GAUGE READING @ PRESSURE LIMITING = ( +/- 50 PSI)
PROGRAM Injection Values 200ml / RAM A 200ml / RAM B 125ml / RAM A 125ml / RAM B
FACEPLATE RANGE  VALUES A SIDE  VALUES B SIDE 
7.6 m/s @ 250 PSI
275 PSI +/- 50
10 ml/sec ± 0.2 ml/sec ml/ ml/
125ml 5.7 m/s @ 200 PSI
sec sec +/- 50
225 PSI
120 ml ± 2 ml 3.3 m/s @ 100 PSI
ml ml
125 PSI +/- 50
325 PSI < 300 PSI PSI PSI

ml/ ml/
200 ml 10 ml/sec ± 0.2 ml/sec
sec sec
195 ml ± 2 ml
ml ml

325 PSI < 300 PSI PSI PSI

NO ADDITIONAL SERVICE REQUIRED or CUSTOMER DECLINES SERVICE or

ASSOCIATED SERVICE TICKET _____________________

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