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Dosimetric Indication Value Test
A(IV)-1 Dosimetric Indication Value Test
Test Group
Test Checkpoint
kV
Loading Factors
mA
Measured Value
Displayed Value
AKR (mGy/min)
Deviation
Pass/Fail
Calculated Value
Displayed Value
Cumulative AKR
(mGy)
Deviation
Pass/Fail
Calculated Value
Displayed Value
2
DAP (μGy*m
)
Deviation
Pass/Fail
A(IV)-2 Automatic Exposure Control Test
Exposure Mode
Auto Cont. Fluo.
Auto Pulse Fluo.
½ Dose Auto Cont. Fluo.
½ Dose Auto Pulse Fluo.
DR Fluo.
XGB6-12-1026, Rev 1.04
Man.
Auto.
Cont.
Cont.
Criteria (mAs, kV)
2.878-3.962
52.2-
63.8
11.14-14.06
50.4-
61.6
1.42-2.18
53.1-
64.9
7.324-9.396
51.3-
62.7
7.576-9.704
49.5-
60.5
Appendix IV - QC Test Log Form
Man.
Auto.
DR
Pulse
Pulse
Value
Pass?
Time
½
½
Auto.
Auto.
Cont.
Pulse
Sig.
177
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