ࡱ> OQNzq` ,bjbjqPqP n::nnnn$Z7Z7Z7P7f8`O8999:CCC[N]N]N]N]N]N]N$LPhR|NC@ CCCNnn9:OKKKKKKCNn9L:[NKKC[NKKKKKK:8 *oZ7UGbKKNL0O0`OKK0SI60SKK0SKKCCKKCCCCCNNJ^CCC`OCCCC/Z7Z7nnnnnn EXAMPLE FORM EQUIPMENT PERFORMANCE EVALUATION DENTAL RADIOGRAPHIC UNIT 25 TAC 289.232(i)(7)(A) Facility Name: _____________________________________ Registration No.:__________________ Date: __________________ Service Company: __________________________________ Service Company Registration No.: _________________________ Survey Instrument Used: ____________________________ % Exposed sensor/detector % Enclosed sensor/detector Instrument Calibration Date: _______________ Technician Signature: _____________________________________________        Rad Insp EPE Dent-1 (July 2006) Page 1 of 5 EQUIPMENT PERFORMANCE EVALUATION - DENTAL UNIT Serial No. _____________________________        Rad Insp EPE Dent-1 (July 2006) Page 2 of 5 EXPOSURE REPRODUCIBILITY CALCULATIONS EXAMPLE  EMBED Equation.3  EMBED Equation.3 Where:  In this example, the exposures are considered to be reproducible. Example: The four (n) exposures (EMBED Equation.3) measured 409 mR, 387 mR, 391 mR, and 410 mR. STEP 1 Determine the mean value (EMBED Equation.3) of the four exposures taken. EMBED Equation.3 STEP 2 Find the difference between each exposure and the mean value (disregard sign). 409.00 mR 387.00 mR 391.00 mR 410.00 mR -399.25 mR -399.25 mR -399.25 mR -399.25 mR 9.75 mR 12.25 mR 8.25 mR 10.75 mR STEP 3 Square each of the differences EMBED Equation.3 EMBED Equation.3 EMBED Equation.3 EMBED Equation.3 Rad Insp EPE Dent-1 (July 2006) Page 3 of 5 STEP 4 Divide each number by 3 (n-1) and add the results 95.06 - 3 = 31.88 150.06 - 3 = 50.02 68.06 - 3 = 22.69 115.56 - 3 = 38.85 143.11 STEP 5 For s, determine the square root of the above number EMBED Equation.3 STEP 6 Divide s by the mean value ( EMBED Equation.3 ) 11.9629 - 399.25 = .0299 = c = the coefficient of variation STEP 7 If c=0.05 or less, the exposures are considered to be reproducible Rad Insp EPE Dent-1 (July 2006) Page 4 of 5 ENTRANCE EXPOSURE (EE) CALCULATIONS EXAMPLE (DENTAL BITE WING) SENSOR/DECTECTOR ENCLOSED WITHIN A HOUSING EMBED Equation.3 Where: EE = entrance exposure mR (MEASURED) = indicated exposure SDD = source (target) to enclosed detector distance SSD = source to surface (skin) distance For this example only: SDD = 24 cm. SSD = 21 cm. Detector = 2cm. below housing surface Measurement = 374 mR (Verify that all units of measurements are the same either inches or centimeters)  STEP 1 Set the control panel with the technique factors (kVp, mA, time) that the facility uses for an average person intraoral bite wing examination. STEP 2 Measure the SSD. To obtain an accurate EE, have the operator position the tube over the detector housing as if they were positioning a patient. Measure from the target to the housing surface. (21 cm.) STEP 3 Measure the SDD. Place the tip of the cone 1.5 cm. or less from the housing surface. Measure from the target to the surface of the housing and add the predetermined distance of the detector below the surface. 22 cm.+2 cm. = 24 cm. STEP 4 Divide the SDD by the answer in Step 2. 24 21 = 1.143 STEP 5 Square the answer in Step 4. 1.143 x 1.143 = 1.307 STEP 6 Multiply the measurement reading in mR by the answer in Step 5. 374 x 1.307 = 489 mR STEP 7 Compare the answer in Step 6 to the regulatory limits of 450 mR when 60 kVp or above is used. Rad Insp EPE Dent-1 (July 2006) Page 5 of 5      EMBED Equation.3  X-RAY UNIT IDENTIFICATION (FROM CONTROL PANEL) Manufacturer: _______________________________________________________________ Location/Room: ______________ Model No.: ________________________________________ Serial No.:____________________________________________ TIMER ACCURACY ( ) Pass ( ) Fail Regulation The accuracy of the timer shall meet the manufacturers specifications. If the manufacturers specifications are not obtainable, the timer accuracy shall be 10 percent of the indicated time with the testing performed at 0.5 second. (See 25 TAC 289.232(i)(6)(H)(i) ) SELECT ONE: % Manufacturer s specifications which are _____________________________________ OR % Intraoral units 10 % tolerance with testing performed at 0.5 second (500 milliseconds) % Panoramic units 10% tolerance with testing performed at ________________seconds Document time used for testing: __________msec; OR __________pulses; OR __________seconds Perform four measurements: 1. _______________ 2. _______________ 3. ______________ 4. _______________ EXPOSURE REPRODUCIBILITY ( ) Pass ( ) Fail Regulation When all technique factors are held constant, the coefficient of variation of exposures for both manual and AEC systems shall not exceed 0.05. (See 25 TAC 289.232(i)(6)(I) ) (See pages 3 and 4 for instructions.) Technique factors selected: _______mA _______kVp _______time Perform four measurements: 1.___________ mR 2. ___________mR 3. ___________mR 4. ___________mR KVP TEST ( ) Pass ( ) Fail Regulation If the registrant possesses the manufacturers kilovolt peak specifications, the radiation machine shall meet those specifications. Otherwise, the measured kVp shall be accurate to within 10 percent of the indicated setting at no less than three points over the usual operating range of the machine. (For units with fewer than three fixed kVp settings, the units shall be checked at those settings.) (See 25 TAC 289.232(i)(6)(J) ) SELECT BELOW: ((Measured kVp  Indicated kVp) Indicated kVp) x 100 = % Deviation % Manufacturer s specifications which are ___________________________________ OR % 10% of the indicated setting used 1. Indicated kVp _________ Measured kVp _________ Deviation _________% 2. Indicated kVp _________ Measured kVp _________ Deviation _________% 3. Indicated kVp _________ Measured kVp _________ Deviation _________% 4. Indicated kVp _________ Measured kVp _________ Deviation _________% TUBE STABILITY ( ) Pass ( ) Fail Regulation The tube shall remain physically stable during exposures. In cases where tubes are designed to move during exposure the registrant shall assure proper and free movement of the unit. (See 25 TAC 289.232(i)(6)(K) ) For intraoral machines only: For panoramic and cephalometric machines only: Tube stable in all orientations? Yes ( ) No ( ) Free movement where designed? Yes ( ) No ( ) COLLIMATION ( ) Pass ( ) Fail Regulation 25 TAC 289.232 (i)(6)(L) Field limitation shall meet the requirements of 25 TAC 289.232(i)(11)(B) and 25 TAC 289.232(i)(12) Intraoral: Minimum source to skin distance (SSD) ___________ cm X-ray field size at tip of cone ___________ cm Field size d" to 7cm if the minimum SSD is 18cm or more; d" to 6cm if the minimum SSD is less than 18 cm Panoramic: Image receptor slit size: (Circle inch or centimeter) Transverse _______in/cm Vertical _______ in/cm X-ray field size: Transverse _______in/cm Vertical _______ in/cm X-ray field misalignment at image receptor slit: Transverse _______in/cm Vertical _______ in/cm (Misalignment cannot exceed 0.0 inches in the transverse axis and 0.5 inches in the vertical axis.) Cephalometric: Source to image distance (SID) __________ in/cm (Misalignment must not exceed 2% of the SID) Image receptor size: __________ in/cm X __________ in/cm Measured x-ray field size: __________ in/cm X __________ in/cm X-ray field misalignment: __________ in/cm X __________ in/cm ENTRANCE EXPOSURE (EE) ( )Pass ( ) Fail Regulation The in-air exposure limits for an average adult intraoral bite wing examination shall not exceed 450 mR for 60 kVp and above; 600 mR for less than 60 kVp. 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