- SITE AND SYSTEM DATA

1. Fill in all necessary fields.

2. Click the 'Print to pdf' button.
Installation Acceptance Test Document Print to pdf 3. Print the pdf on paper.
4. Collect signatures.
5. Scan the print with the signatures.

Field Service
Hospital / site name: Buon Ma Thuot University LE QUANG TRUNG
Engineer:
Hospital / site city and country: Daklak, Vietnam Start date 15-Oct-2021
[dd-mmm-yyyy]:

End date 17-Nov-2021

[dd-mmm-yyyy]:

Description: Prodiva 1.5T CS

(System name and field strength)
Serial. No. (SRN): 82483

System code (6NC): 781069

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System installation MRI IATDs for MRI systems

- IATD 2: SIGN OFF

I declare that the product has been verified according installation instruction.
All requirements in this IATD 1 and IATD 2 have been tested. I am aware that any deviation can have influence on the performance
or safety of the medical product. The document is in accordance with Good Document Practices.

Name Signature
(first and last name of the LE QUANG TRUNG (for IATD 1 and
representative of Philips Service): IATD 2):

Date [dd-mmm-yyyy]: 17-Nov-2021 Print to pdf

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System installation MRI IATDs for MRI systems

- IATD 1

Section C - Magnet installation

Action name Results Unit
Attach label with drains locations pass
Only deliv. HE-vent pip sections used pass
Bend. rad. flex vent pipe >1.5 diam pass
Vent pipe thermal insulation examroom 5 cm
Applied correct drain hole locations pass
HE-vent pipe photos before insulation pass
HE-vent pipe photos after insulation pass
HE-vent pipe photos of pipe outlet pass
Overpress. grid if RF door swings inward Not installed
Insulation magnet and RF enclosure 99999 kOhm
Section D (Ambition: C and F) - Local Mains 400V
Action name Results Unit
Site mains provision lockable in OFF pass
Voltage L1-L2 401 V
Voltage L2-L3 397 V
Voltage L3-L1 396 V
Voltage L1-N 230 V
Voltage L2-N 231 V
Voltage L3-N 228 V
Voltage N-G 1 V
ERDU stickers on ERDU switches Pass
Earth bonding MDU - cryo compressor 23 mOhm
Earth bonding MDU - LCC cabinet 24 mOhm
DACC and LCC4 are mechanically coupled pass
Helium level (first measurement on site) 33 %
Not installed
Cabinets must be installed with earthquake brackets according to local regulations
Cabinets have been installed with earthquake brackets Not installed
Section E - Installation of cabinets
Action name Results Unit
Not installed
Cabinets must be installed with earthquake brackets according to local regulations
Cabinets have been installed with earthquake brackets Not installed
Section H - Signal cables and patient environment
Action name Results Unit
Insulation pat.sup and RF enclosure 99999 kOhm
Section J - Setting to work
Action name Results Unit
Earth bonding MDU - SFB 16 mOhm
Earth bonding MDU - GA cabinet 8 mOhm
Earth bonding MDU - DACC mains 29 mOhm
Earth bonding SFB - Magnet 10 mOhm
Earth bonding magnet - patient support 29 mOhm
Earth bonding OEC - PE MDU not installed mOhm
Earth bonding MDU - ORSR 51 mOhm
Earth bonding MDU to SACU 45 mOhm
Earth bonding MPSO - MDU not installed mOhm
Earth bonding bus bar / MDU - RF enclosure 3 mOhm
Earth bonding MDU - earth bus bar 1 mOhm
Earth bonding MDU - RF amplifier 17 mOhm
Earth bonding SFB/SFP/magnet - PFEI 5 mOhm
Earth bonding SFB/SFP/magnet - MEU 11 mOhm
Earth bonding SFB/SFP/magnet - OEC not installed mOhm
Secondary flow adjustments performed Pass
Gradient cable connections within spec Pass
Leakage current - MDU (not for China) 4 mA
Leakage current - MDU (for China only) n.a. mA
Section J - Setting to work patient support iRF
Action name Results Unit

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System installation MRI IATDs for MRI systems

Distance to the magnet (iRF) 5 mm

Patient support aligned to magnet Pass
Patient support override button test Pass
Section M - Magnet procedures
Action name Results Unit
ERDU test - magnet field OFF pass
Safety marking applied and photos taken pass
Magnetic mat. removed before energizing pass
Area inside 0.5mT line no public access pass
Magnet pressure in control for 2 hours pass
Helium level before energizing (1.5T) 67 %
Helium level before discharge n.a. %
Shimming within the specifications pass
Service port closed and checked on leaks Pass
Static cryo cooler pressure (F50) 1.6 MPa
Dynamic cryo cooler pressure (F50) 2.2 MPa
Magnet height within the specifications Pass
nottoinstalled
Magnet must be installed with earthquake brackets according local regulations
Magnet has been installed with earthquake brackets not installed
Section N - Covers
Action name Results Unit
Pat. vent. inlet beneath false ceiling Pass
Patient ventilation functional Pass
Pressure of system cooling (SACU) 217 Pa
Air pressure sensor connected Pass
Section Authorized Service Provider
Name Authorized Service Provider n.a.

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System installation MRI IATDs for MRI systems

- IATD 2
Section Q - Final procedures
Action name Results Unit
Stop scan function (key-pad) pass
Stop scan function door switch pass
Manual long. function of patient support pass
Table top release function pass
Grad. coil temp. sensor detect circuit pass
Heat exchanger pressure interlock pass
Heat exchanger flow interlock pass
Patient alarm (nurse call) pass
Shutdown function of cold head pass
Emergency stop buttons magnet front pass
Emerg. button audio module func. Pass
Differential Pressure Switch functional Pass
Clean primary strainer LCC Pass
RF spurious test Pass
Maximum spike QPI value 0.00
Section Q - Artifact measurements - all
Action name Results Unit
H01 Echo 1 Head Coil 1.0 %
H01 Echo 2 Head Coil 1.1 %
H01 Echo 3 Head Coil 2.2 %
H01 Echo 4 Head Coil 2.1 %
H02 Echo 1 Head Coil 1.1 %
H02 Echo 2 Head Coil 1.0 %
B01 Echo 1 Body Coil 0.7 %
B01 Echo 2 Body Coil 0.5 %
B01 Echo 3 Body Coil 1.1 %
B01 Echo 4 Body Coil 1.2 %
B02 Echo 1 Body Coil 1.3 %
B02 Echo 2 Body Coil 0.7 %
B02 Echo 3 Body Coil 1.5 %
B02 Echo 4 Body Coil 0.6 %
B03 Echo 1 Body Coil 1.4 %
B03 Echo 2 Body Coil 2.3 %
B03 Echo 3 Body Coil 1.5 %
B03 Echo 4 Body Coil 1.9 %
Section Q - Final procedures (continued)
Action name Results Unit
BODYT transversal scans within spec. pass
BODYC coronal scans performed pass
BODYS sagittal scans performed pass
HEADT transversal scans within spec. pass
PIQT scans performed within spec. pass
Coil IQ for SYSTEM_HEAD within spec. pass
Helium level at technical handover 91 %

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System installation MRI IATDs for MRI systems

- TOOLS AND TEST EQUIPMENT USED FOR INSTALLATION

Tool Serial. No. Manufacturer Model type Calibration

due date: dd-Mmm-yyyy

Current clamp 180604177 HIOKI 3283 24-May-2022

Multimeter 51501819 BENNING MM3 11-Jun-2022

Torque wrench 1218106454 SNAP-ON CTECH2R100A 16-Aug-2022

Magnetic field camera 62444 METROLAB MFC-3045 11-Jun-2022

Earth bonding tester 14932 Schleich 10A/ISO 07-Oct-2022

Magnetic shim kit 59803047 METROLAB MFC-3048 05-Apr-2022

Manometer 1P210693825 KIMO MP-120 13-Aug-2022

Tesla meter N.A. N.A. N.A. N.A.

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