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Ship To: Start Date: Nov 16, 2020

Test and Verification Report

Work Order: WO-01268452
WORK DETAILS

Engineer Name: Event Type: Predictive / Preventative Maintenance

Service Activity: Visit 3
Device Status: Pass
EQUIPMENT DETAILS
Product Name: Brilliance CT 16 Slice Serial Number: 3407
Product Number: 728246 Installed product: 59490256
UDI:
Min Max UoM Measurement Result Comments
INS: Brilliance CT 64 Install._REV00
Electrical Safety PE (Ground) Checks (IR)
TP2 - "B" Gantry "L" Leg (“APE” SCR) (mOhm) mOhm 0
TP3 - "B" Gantry "R" Leg (rail TB 251) mOhm 0
TP4 - "B" Gantry Stator Frame Area mOhm 0
TP6 - "B" Couch Base Area mOhm 0
TP7 - "B" Couch Top Rear Area mOhm 0
TP8 - "B" CRC Rear GND STUD mOhm 0
TP9 - "B" Host Server Computer Tray mOhm 0
TP10 - "B" Vertical Server Computer mOhm 0

INS: Ingenuity Flex Installation

ES Protective Earth Measurements (IR)
TP2 - "B" Gantry Left Leg 100 0 0
TP3 - "B" Gantry Right Leg 100 0 0
TP4 - "B" Gantry Stator Frame 100 0 0
TP5 - "B" Gantry Rotor (GND Screw) 100 0 0
TP6 - "B" Couch Base (PE 1screw) 100 0 0
TP7 - "B" Couch Top (PE 6 Screw) 100 0 0
TP8 - "B" CRC Rear GND STUD 100 0 0
TP8 - "B" CRC Rear GND STUD 100 0 0
TP9 - "B" Host Rear Computer Tray 100 0 0
TP10 - "B" Server Rear Computer Tray 100 0 0
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Work Order: WO-01268452
Min Max UoM Measurement Result Comments
INS: Ingenuity CT / Core
ES Protective Earth Measurements (IR)
TP2 - "B" Gantry Left Leg 100 0
TP3 - "B" Gantry Right Leg 100 0
TP4 - "B" Gantry Stator Frame 100 0
TP5 - "B" Gantry Rotor (GND Screw) 100 0
TP6 - "B" Couch Base (PE 1screw) 100 0
TP7 - "B" Couch Top (PE 6 Screw) 100 0
TP8 - "B" CRC Rear GND STUD 100 0
TP8 - "B" CRC Rear GND STUD 100 0
TP9 - "B" Host Rear Computer Tray 100 0
TP10 - "B" Server Rear Computer Tray 100 0

PM: CT BR 6-64, BB, Ing Core/ Flex

Documentation
4598 016 29091 Rev. C Ingenuity CT/Core/Core128 /Flex and Brilliance link
6/10/16/16P/40/64/Big BorePM Manual.pdf
Preliminary Checks
Basic Checks Pass
Check Movement From CT Box Pass
Software Version 2.3.9.1316
Scan Seconds 1626264
Revolution Count 36359835
Disk Cleanup Procedures Pass
Collimator Comp. Analyzer Tool (Remote or On-site)
Compensator Analysis Pass
OPT: Collimator Comp. Visual Inspection
Collimator Compensator Visual Inspection Pass
Patient Support External Checks
General Visual Inspection Pass
OPT: Standard foot switch Pass
OPT: Multi-function foot switch N/A Pass
Manual / Horizontal movement (resistance) Pass
Patient Support Interior Inspection
Hardware Inspection Pass
Cables Inspection Pass
Horizontal Tape Switches Pass
Drive Belt Pass
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Work Order: WO-01268452
Min Max UoM Measurement Result Comments
PM: CT BR 6-64, BB, Ing Core/ Flex
Patient Support Interior Inspection
Vertical Encoder O-Ring Belt Pass
Vacuum Patient Support Interior Pass
Patient Support Hor. Drive Linkage Inspection Pass
OPT: Bariatric Patient Support Gas Spring Inspection N/A Pass
Patient Support Lubrication
Ball Screw Lubrication (Vertical Motion) Pass
Check Patient Support Movement Pass
Patient Support External Cleaning Pass
Patient Support Final Checks & Reassembly
Patient Support Cover Reassembly Pass
Checking Patient Support Movement Pass
Patient Support External Cleaning Pass
OPT: Patient Support Paint Touch-up Pass
Console Prel. Cleaning & Preparation
Power Down Host and CIRS Pass
Clean Tabletop, Keyboard, Mouse and CT Box Pass
Host Rack / CIRS Server Exterior Cleaning
Vacuum Host Exterior including Fans Pass
Vacuum CIRS Exterior including Fans Pass
Vacuum CIRS Filters Pass
Erasable Optical Drive Cleaning Not Installed
Host / CIRS Server Interior & GPU Cleaning
Clean and Vacuum Host Interior Pass
Clean and Vacuum CIRS Interior Pass
Optional: Clean GPU Pass
Host & CIRS MB CMOS Battery Replacement
Host Motherboard CMOS Battery Replacement Pass
CIRS Motherboard CMOS Battery Replacement Pass
OPT: Common Console Paint Touch-up
Common Console Paint Touch-up Pass
Console UPS Planned Maintenance
Clean and Inspect UPS Not Installed
Test UPS Not Installed
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Work Order: WO-01268452
Min Max UoM Measurement Result Comments
PM: CT BR 6-64, BB, Ing Core/ Flex
Calibration and IQ Tests
Filament Calibration - Pass 2 Pass
Air calibration (If Needed, See Table) Pass
OPT: Tube Output Calibration (If IMR System) N/A Pass
Dose Modulation Check (DDOM and ZDOM) Pass
Constancy Test Pass
IQ Test Pass
System Backup
System Back-up Pass
Copy to External Medium Pass

Philips Representative Signature:

Engineer Name:
Date: Nov 16, 2020
Work Order: WO-01268452