No.70B, Dr.

Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454

(QA Test protocol is as provided by)

Atomic Energy Regulatory Board
Quality Assurance Test Report for Diagnostic X Ray Equipment

FORMAT FOR QUALITY ASSURANCE TEST FOR DIAGNOSTIC X-RAY EQUIPMENT

(Applicable for Radiography/Radiography&Fluoroscopy/C-Arm/InterventionalRadiology Equipment)
(Periodic Quality Assurance shall be carried out at least once in two years and also after any repairs having radiation safetyimplications)

A. DETAILS OF THE DIAGNOSTIC X-RAY EQUIPMENT

1 Name of the Institution and City New Hope Medical Centre Pvt Ltd,
No 814, Poonamallee High Road,
Kilpauk, Chennai, Tamil Nadu-600010.
2 Type of Equipment C-Arm
3 Model Name Skan C
4 Name of the Manufacturer Skanray Technologies Limited
5 Serial No of the X Ray Equipment MY3422P0170
6 Location of QA test item & QA New Hope Medical Centre Pvt Ltd,
Performed Kilpauk-Chennai.
7 Name(s) of Person(s) testing the N.Sudhakar;
equipment and Name of Advanced QA Services,
Supplier/Service Agency
Chennai.
8 Dates and Duration of the Tests 28/10/2022 - 2 hrs
9 Customer Request Form No: AQAS/CRF-22/0431
10 Report Number: TC945422000000578F
11 Report Type: Original / Correction / Amendment
(Strike out the field not applicable and fill Correction: (original rep No: )Reason for
therelevant information if correction or correction:
amendment) Amendment (Original rep No:
Reason for amendment:

Page 1 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
B. ENVIRONMENTAL CONDITIONS OF RADIOLOGICAL SAFETY PARAMETERS AT CUSTOMER SITE

ENVIRONMENTAL CONDITION
 Radiological Condition Acceptable
 Whether two units are in same room Yes No
 Is there any radiation interference due to other equipment Yes No
presence
 Ambient Temp 280 C
 Unit Operational Condition Operational
Not Operational

C. SUMMARY OF RADIATION SAFETY PERFORMANCE TEST REPORT:

Sr. Parameter Specified Measured Remarks

Tolerance
No. s Tested Values Values (Pass/Fail/NA)
Congruence Tolerance :
1 of radiation NA Ι X Ι + Ι X’ Ι ≤ 2% of FFD NA
and optical Ι Y Ι + Ι Y’ Ι ≤ 2% of FFD
field

Central Beam
2
Alignment NA Central Beam Alignment < 1.50 NA

Tolerance :
3
Effective 1. + 0.5 f for f  0.8 mm
focal spot NA 2. + 0.4 f for 0.8  f  1.5 mm NA
measurement 3. + 0.3 f for f  1.5 mm
4 Accuracy of 50 kV 49.33 kV
Operating 70 kV 69.2 kV ± 5 kV PASS
Potential (kV)
90 kV 90.33 kV
5 Accuracy of
Irradiation NA NA % Error < 10 % NA
Time(s)
6 Tolerance :
Total filtration Measurement 1.5 mm Al for kV  70 PASS
at 90 kV 3.2 mm Al 2.0 mm Al for 70 < kV  100
2.5 mm Al for kV  100

Page 2 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
7 Linearity of
mA/mAs Measured at 0.001 CoL<0.1 PASS
loading 70 kV
Stations
8 Consistency Measured at
of radiation 70 kV 0.00063 CoV 0.05 PASS
output Measured at
0.00047
90 kV
9
Low contrast 2.9 mm hole 3.0 mm hole pattern must
resolution pattern clearly be resolved PASS
Measurement visible
shall be done on
each mode of
10 Image
High contrast Intensifier 1.6 lp/mm 1.5 lp/mm pattern must
resolution pattern be resolved PASS
11 Tolerance :
Exposure Rate Applicable 3.35 cGy/Min 1. Exposure Rate without AEC
at Tabletop Manual Mode mode ≤ 5 cGy/Min PASS
2. Exposure Rate with AEC
mode≤10 cGy/Min
12 Radiation
leakage level Measurement at 0.162 mGy in
at 1m from Maximum 1 hour at tube
tube housing 100 kVp and level Tube Leakage < 1 mGy in PASS
and corresponding one hour
Collimator tube current 0.169 mGy in
(Pl. mention 10 mAs 1 hour at
values Collimator
separately) level

I hereby undertake that all the information provided above is correct and in accordance with the
detailedQuality Assurance Report enclosed herewith.

 Reference Document for test Method - As per AERB prescribed test protocols.
 QA test report does not contain any recommendation on the QA test interval except where
there has been agreed with the customer. However, for customer reference generally two year
QA testing interval mentioned in the report unless otherwise requested by the customer as
prescribed by AERB.

Page 3 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
Note:
1. Tests as mentioned in Sr. No. 1, 2, 3 are not applicable for C-Arm/Interventional Radiology Equipment.
2. Tests as mentioned in Sr. No. 9, 10, 11 are not applicable for only radiography mode of x-ray
equipment.
3. AERB Test Protocol method is used for carrying out QA.
4. Remarks decision Rule: ‘Pass’ indicates parameter results are within tolerance prescribed. ‘Fail’
indicates parameter results are not within tolerance prescribed. ‘NA’ particular test is not
applicable tothat equipment. Acceptance criteria = (Estimated values) ±Meas.Unc <Tolerance
value
5. The reported expanded uncertainty is based on a standard uncertainty multiplied by a coverage
factork=2, which for a normal distribution provides a level of confidence of approximately
95%.
6. Expanded uncertainty for kV is ±2.4%
Expanded uncertainty for Dose is ±6.3%

Place: Chennai Signature:

Date: 31/10/2022 Name of the Service Engineer: N.Sudhakar
Name of Supplier/Service Agency: Advanced QA Services
Seal of Supplier/Service Agency:

#Signature of Institution’s Representative:

Name of Institution: New Hope Medical Centre Pvt Ltd-Kilpauk.
Seal of the Institution:

# Quality Assurance Tests Report shall be signed by Institution’s Representative and duly stamped by the
User’s Institution. The report shall not be reproduced except in full without the written approval of the
agency.
1. CONGRUENCE OF RADIATION & OPTICAL FIELD:

Operating parameters:
-NOT APPLICABLE-
FFD (cm) kV mAs

Shift in the edges of the radiation field

Dimensions (cm) Observed shift % of FFD Tolerance Remark
Ι X Ι + Ι X’ Ι NA NA 2 % of FFD NA
Ι Y Ι + Ι Y’ Ι 2 % of FFD

Page 4 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
2. CENTRAL BEAM ALIGNMENT:

Operating parameters:
-NOT APPLICABLE-
FFD (cm) kV mAs

Observe the images of the two steel balls on the radiograph and evaluate tilt in the central beam.
Observed tilt NA Remark: NA
Tolerance: Central Beam Alignment  1.5 0

3. EFFECTIVE FOCAL SPOT MEASUREMENT:

FFD (cm)
-NOT APPLICABLE-
Stated value of Focal Measured value of Focal Spot Tolerance
Spot Size (mm x mm)
Size (mm x mm)
Focus 1. + 0.5 f for f  0.8 mm
2. + 0.4 f for 0.8  f  1.5 mm
3. + 0.3 f for f  1.5 mm

4. ACCURACY OF OPERATING POTENTIAL

5. ACCURACY OF IRRADIATION TIME
6. TOTAL FILTRATION:
FDD (cm) 100
Applied Set Measured values
kVp time
(s)
8 mAs 10 mAs 16 mAs Average Average Remarks
station station station kVp Time (s)
kVp Time (s) kVp Time (s) kVp Time (s)
50 49.4 49.4 49.2 49.33 PASS
70 69.1 69.2 69.3 69.2 PASS
NA NA NA NA NA
Max. 90.4 90.3 90.3 90.33 PASS
90 kVp
Tolerance for kVp :  5 kV(Reported kV = Avg kV±MU shall be less than Tolerance)
Tolerance for Timer : % Error:  10 %
Total Filtration : ……3.2……..mm of Al (measurement at 90 kVp)
Tolerance for Total Filtration: 1.5 mm Al for kV  70, 2.0 mm Al for kV  100, 2.5 mm Al for kV  100

Page 5 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
7. LINEARITY OF ( mA/mAs) LOADING STATIONS:

Operating parameters:

FDD (cm) 100 kV 70 Time (s)  Sec

mAs Radiation Output (mGy) Average mGy /mAs Coefficien Remarks

applied Output ( X) of
(mGy) Linearity
Reading 1 Reading 2 Reading 3 (CoL)
8 493.9 495.1 494.1 494.367 61.7958
10 616.6 617.4 617.2 617.067 61.7067 0.001 PASS
16 987 985.5 986.4 986.3 61.6438
Tolerance: COL  0.1

8. OUTPUT CONSISTANCY:
FDD (cm) 100

Applied kV mAs Radiation Output (mGy) Average Coefficient Remarks

1 2 3 4 5 (X) of Variation
(CoV)

70 8 0.3633 0.3632 0.3638 0.3635 0.3634 0.36344 0.00063 PASS

90 8 0.6024 0.6028 0.6022 0.6023 0.6028 0.6025 0.00047 PASS
Tolerance : CoV  0.05

9. LOW CONTRAST SENSITIVITY:

Diameter of the smallest size hole clearly resolved on the monitor 2.9 mm hole pattern clearly visible
Recommended performance standard 3.0 mm hole pattern must be resolved

10. HIGH CONTRAST SENSITIVITY:

Bar strips resolved on the monitor (lp/mm) 1.6 1p/mm pattern

Recommended performance standard 1.5 lp/mm pattern must be resolved

Page 6 of 7
 No.70B, Dr. Ambedkar Street, Manali,

Ph : 044-48590158, Mobile : 9444835829

AQAS
E-mail : advancedqas@gmail.com, aqaschennaiofc@gmail.com TC 9454
11. EXPOSURE RATE AT TABLE TOP:

Distance from Focus Mode Applied kV Applied mAs Exposure rate at table top Remarks
to Table top (cGy/Min)
60 Manual 110 5 3.35 cGy/Min PASS
Tolerance :
1. Exposure Rate without AEC mode ≤ 5 cGy/Min
2. Exposure Rate with AEC mode ≤10 cGy/Min
Minimum focus to table top distance shall be 30 cm for fluoroscopy

12. TUBE HOUSING LEAKAGE:

Operating parameters:

FDD (cm) 100 kVp 100 mAs 10 Time(s)  Sec

Location (at Exposure level (mR/hr) Result

1.0 m from Left Right Front Back Top ( mGy in one hour)
the focus)
Tube 0.95 61.62 53.26 1.24 0.032 0.162
Collimator 0.99 64.02 45.36 1.05 - 0.169
Tolerance: Maximum leakage radiation level at 1 meter from the focus should be  1 mGy (114 mR) in
one hour.
Work load = 180 mA min in one hr
Max leakage = 180 mAmin in 1 hr X ---61.62---Max Exposure level (mR/hr)
60 X ---10--mAs used for measurement

Maximum radiation leakage from tube housing = ---------18.49-------- mR in one hour

Maximum radiation leakage from tube collimator = ---------19.21-------- mR in one hour

D. Calibrated QA kit Details:

Type of QA Make Model Type of Date of Whether

Tools/Instrument Detector Calibration Calibration
Valid?
X2 Base Unit mAs Unfors RaySafe X2 Solid State 22/12/2021
RaySafe 14/12/2021
X2 R/F sensor AB, Yes
Sweden
X2 Survey Sensor Ion Chamber 20/12/2021
Radiography Leeds Test TOR IQ 2 NA NA NA
Phantom Objects

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