HomeMy WebLinkAboutUntitled (2) CMP California Medical Physics, Inc. RADIATION PROTECTION SHIELDING RECOMMENDATIONS Sedecal X-Plus LP-Plus, Radiography Room Pacific Orthopedic Associates 289 West Huntington Dr., Suite 206 Arcadia, California July 16, 2014 www.calmp.com Phone (310) 209 8546 Phone (310) 492 5514 SUMMARY EQUIPMENT DATA Equipment data used for calculations are from the Information provided by the Vendor ASSUMPTIONS AND COMMENTS 1. The room to be shielded is located in the side of the 2nd floor of a multi-storey building. 2. There are floors above and below this room. Therefore shielding calculations are needed for the floor and ceiling of this room 3. The primary beam is totally blocked by the U-Arm image receptor at all times. Therefore no primary shielding is needed for the room. All barriers are Secondary. 4. Full occupancy T=1 is used for the calculations of the operator control console area, the two adjacent exam rooms, the other tenant's rooms to the east, and the floors above and below. 5. Other Occupancy factors are according to NCRP Report 147 and are listed in the main calculation table of the report. 6. We assumed and credited 2x 5/8" of gypsum board drywall for the walls and other structural material as per information and construction drawings provided to us by the vendor and/or the facility (Details in the enclosed drawing copies and the calculation table) 7. Calculations are based on a work load of 300 mA.min per week. 8. All calculations performed to maintain radiation exposures ALARA. 9. Shielding criteria based on NCRP#147 and are designed to meet all requirements of the State of California Radiation Control Regulations and by reference 10CFR20 requirements in addition to other Building Codes. SHIELDING RECOMMENDATIONS Sedecal X-Plus LP-Plus, U-Arm, Radiography Room Lead Barrier Description and Location Recommended Total Lead Shielding 04)A: Operator Booth Wall and Window(Pb-Glass) 1/16 inch Pb or 4 lbs/sq ft Pb 05) B: Hallway Entry Door and Wall 1/32 inch Pb or 2 lbs/sq ft Pb 06)C: Exam Room Wall 1/16 inch Pb or 4 lbs/sq ft Pb 07) D: Office Wall 1/16 inch Pb or 4 lbs/sq ft Pb 08) E: 2nd Floor Outside Wall Not Required 09) F: 5'Segment of the Exam Room Wall 1/32 inch Pb or 2 Ibsisq ft Pb 10)G: Ceiling Office Above Not Required 11) H: Floor Office Below Not Required Notes: 1. These are recommended values. These recommendations are based on conservative calculations and reflect considerations for maintaining personnel exposures ALARA,and providing for maximum flexibility of room utilization in the future. 7/16/2014 California Medical Physics,Inc. Pacific_orthopedic._Arcadia_Rad-Rm1_2014-VI (310)209-8546 General Radiation protection recommendations for the construction of new or renovated x-ray rooms appear throughout this report. The required shielding locations and thickness are indicated on the room design drawings, and in the actual Radiation Protection Calculation table. The radiation protection criteria, sources of applicable data and methods of calculation used to derive the recommendations are discussed. General instructions for the construction of the shielded areas are also included. Radiation Protection Criteria The National Council on Radiation Protection and Measurements (NCRP) has recommended maximum permissible dose equivalent (MPD) values for the exposure of radiation workers and the general population to ionizing radiation (1). The NCRP recommendations form the basis of the radiation control regulations adopted by most states, including State of California, and are in accord with the Nuclear Regulatory Commission standards for protection against ionizing radiation. The following criteria, which were used to determine all radiation protection requirements presented in this report, are based on recommendations of the NCRP: ...the Council recommends that the annual occupational effective dose be limited to 5000 millirem (50 mSv) (not including medical and natural background exposure). The NCRP recommends that all new facilities and the introduction of all new practices should be designed to limit annual exposures to individuals to a fraction of the 1000 millirem per year (10 mSv per year) limit implied by the cumulative dose limit. For continuous (or frequent) exposure, it is recommended that the annual effective dose not exceed 100 millirem (1mSv). ... Furthermore, a maximum annual effective dose limit of 500 millirem (5 mSv) is recommended to provide for infrequent annual exposures. Effective February 1994, additional requirements further reduced the permissible radiation exposure in fully-occupied non-controlled areas to 2 millirem/week (0.02 mSv/week). This represents a reduction of permissible radiation levels to one-fifth of their previous values. Radiation Source Parameters The radiation source parameters and estimated workloads you provided were used for shielding calculations and are listed in assumptions above. Sufficient safety factors are incorporated into the recommendations to permit the typical workloads to be moderately exceeded without exceeding the exposure limits. All walls requiring shielding have been outlined in heavy colored lines on a copy of the building plans included with this report. Windows with the same attenuation as calculated for the walls, i.e. same lead equivalency are permitted. 7/16/2014 California Medical Physics,Inc. PacificorthopedjcArcadjaR0dj 12014-j// (310)2094546 Shielding Calculations Methods of shielding calculation as described in the NCRP Handbook Report#147 and the articles referenced were used in all determinations of shielding thickness for the primary and secondary beam, scatter and leakage. The recommended shielding is for the construction of the x-ray room described on the enclosed drawings. Any significant changes in unit's position or room configuration must be reviewed for potential changes in shielding requirements. Radiation Protection Survey and Certification After construction, the room must be surveyed for radiation leakage and radiation safety prior to clinical use. This certifies that the shielding barriers were installed according to the recommendations, and assures the safety of all. Safety Devices A warning sign shall be posted on any entry way to the x-ray room. The sign shall have the Radiation Symbol and the words, "Caution Radiation Area" in yellow and magenta. Standard signs for this purpose are available from several sources. The recommendations for safety devices from the manufacturer shall be followed and the installation shall be according to codes. Miscellaneous BIBLIOGRAPHY 1. Structural Shielding Design for Medical X-Ray Imaging Facilities, NCRP Report# 147. 2004 2. Attenuation properties of diagnostic x-ray shielding materials. Med. Phys. 21 (9), September 1994, pp. 1499-1507. 3. Evaluation of NCRP Report No. 49 assumptions on workloads and use factors in diagnostic radiology facilities. Med. Phys. 23, 577-584. 7/16/2014 California Medical Physics,Inc. 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W a et r i6 n. $ o o a o 0 0 0 0 c� a N CO a 3 m to O 2 E 0 0 0 0 ° 0 0 0 i• a o t4 Z m m 2 c 2• Z 2 o a .= - .°. • m v CO i) c6o a CO to m c m m m CO m E U -0 b -o a -� `0 L m �„ E `o o f 0 co c c c c c c c c c ^r a a a. a a a a p a a a Co IL U) J C' O d3. iL < U) 0) 0) a )) aUi 0 1) )) m a a a m O' U) in, (1) O O CO CO () In Construction Guide for X-ray Areas (Diagnostic-Range) 1. Radiation Shielding Materials and Methods a The additional shielding material specified is Lead, density 709 lbs /cubic foot. b The normal concrete shielding material must be standard weight, density 147 lbs/cubic foot. c Light concrete specified as 115 lbs/cubic foot. Lt Concrete is calculated 4/3 times the thickness of normal concrete to have the same attenuation. d The doors must be a solid core or metal/fire doors with additional Lead lining as specified in the report. e Door frames must be steel with lead lining to provide equivalent shielding to the surrounding walls f There is to be no gaps in the Lead lining. g Lead shielding in walls should be overlapped by approximately 1 inch to eliminate unshielded areas (if required). h Doors need not be interlocked, unless otherwise indicated (e.g. Manufacturer). i All additional lead shielding is to be added to a height of 84 inches (7 feet) as required by State of California Building Codes. The vertical additional shielding must however extend and cover the entire vertical height up to and join the ceiling shielding barrier if and when lead shielding is required in the ceiling and indicated on the plan. J Darkroom walls may also require shielding that extends to a height of 8.5 feet or to the ceiling to protect film stored on shelves above the standard 7 feet height. 1. Barrier Thickness Measurement and units The following table has the thickness of Lead in different units and is partially used in this shielding report: 2/64 inch = 1/32 inch = 0.79 rnm Lead = 2 lbs/sq ft. 3/64 inch = 3/64 inch = 1.19 mm Lead = 3 lbs/sq ft. 4/64 inch= 1/16 inch = 1.58 mm Lead = 4 lbs/sq ft. 5/64 inch = 5/64 inch = 1.98 mm Lead = 5 lbs/sq ft. 6/64 inch = 3/32 inch = 2.38 mm Lead = 6 lbs/sq ft. 7/64 inch = 7/64 inch = 2.77 mm Lead = 7 lbs/sq ft. 2. Penetration of Shielding Materials a Junction and breaker boxes and conduits which penetrate the shielding shall be backed with Lead of the same thickness as is present in the wall. b Nails penetrating lead shielding need not be covered with additional lead. c Door jambs need to be Lead lined. d For floor and ceiling constructed of at least four inch thick concrete, penetrations in the concrete shall be shielded by 2 sheets of 16 gauge steel, such as a junction box. 3. Safety Devices a A warning sign shall be posted on any entry way to the x-ray room. The sign shall have the radiation symbol and the words, "Caution Radiation Area" in yellow and magenta. Standard signs for this purpose are available from several sources. Electric lights indicating x-ray "on" or"in use" may also be used. 7/16/2014 California Medical Physics,Inc. Pacific_orthopedic_Arcadia_Rad-Rml 2014-VI (310)209-8546 i i 4 t t a i __ .ell CD CO L. 4) .i L. CO I I� so X ,. O ce ,< W co I ...J -± V Cr o p t z o J Q 4 W 0 Q x > U o °45 W E U 0 iice- z a CO Cr C OC X on Cm) < El] I I J Fi > -s o.a i - - t CO in b U. il .Z-,Qt .6-.L I ,i-s t ,Z/t £-.£t 1 ,u ......+wu � mow, a�a�w,,,,, ,,,���,.vn.,„., �u,,�,r�uv.,�va�„�vu�,.o.... �t�v�,r,...'nm„. 1� y oa�c t � T-7-1. ttl - .- � o Q(6 4l tr- O 4 Y cc d .}q o'W > v0 Q X aY w w w ?� rY < cx X°a W zaa ■ ± } t^ '1 a = off 'a nm� zt CL zeL— 311 z u ..... to r_rt________,\\,,,± 0 tO la, O z t = O o 04 o � � �i. �o 0 ° ° ®? f 0 0 r s-s ► t ? .L-,9 ,Z-,0Lco C -0-S a, W w = i1 W o IX - 11 .0 0� cn Z = t ID • M- ~ pi\ N r— a U OY X b, Lit V w I w �• � o W"-----i.'1 I QQ tO) 1.-----f,t o ce co CC co Lo W 0 !::, " (..) 2 0 '=' x- W l L U [ 0 0 0 <w = U n EA --- - --- — Medical Physicist's QC Acceptance/Annual Survey Report FOR Pacific Orthopedic Associates 289 West Huntington Dr., Suite 206 Arcadia, CA 91007 Rad Room #1, Universal Rad Stand Sedecal, SHF-525 2014 Submitted by: Mehdi Ramshad, Ph.D. California Medical Physics, Inc. (310)209-8546(Phone) wwww.calmp.com (310)492-5514(Fax) Medical Physicist's Quality Control Test Summary Attn: Karin Martinez,Dir.and Vanessa Ocampo,RT Phone:(626)538-1538 Fax:(626)538-1539 Facility Pacific Orthopedic Associates Survey Date October 29,2014 Site 289 West Huntington Dr.,Suite 206 Report Date October 29,2014 Location Arcadia, CA 91007 Last Surveyed N/A Unit: Mfc-Model Sedecal-SHF-525 Type of Survey Acceptance/Annual Generator S/N H-6137 Overall Score PASS Tube: Mfc-Model Toshiba-E78846 Surveyor Mehdi Ramshad, Ph.D. Tube S/N NN Signature Unit ID: Rad Room#1,Universal Rad Stand Summary Of Medical Physicist's QC Tests And Evaluation Score Lateral Tube: Overtable Pass/Fail/NA Radiographic Collimation assembly Light Field/Radiation Field Coincidence(within 2%of SID) PASS Radiation Field Sizing(within 2%of SID) PASS Field Center Alignment-Table Bucky PASS Source to Image Distance(SID)indicator PASS Radiographic kVp accuracy(within 10%of the Indicated Setting) PASS Radiographic kVp reproducibility(Coefficient of Variation<0.02) PASS Exposure Timer Accuracy(within 10%of the indicated setting) PASS Tube Focal Spot Size Performance(within acceptable range) PASS Radiographic Beam Quality(HVL)in compliance with the minimum limit PASS Radiographic Exposure Accuracy mAs Linearity PASS Exposure Reciprocity PASS Exposure Reproducibility PASS Radiographic Exposure Switch Function PASS Radiographic Unit Assembly Evaluation PASS Identification and calibration information for the detection equipment used for this survey Calibration Agency Calib.Type Calib.Date Next Due Global Calibration Laboratory,Cleveland,Ohio NIST Traceable 3/18/2014 3/17/2015 System Equipment Model/Designation Serial Number Dosimeter 35050A 483 Ion Chamber 96035B 108009 kVp Divider 35080B 108306 kVp Filter Pack 37617C 107447 10/29/2014 California Medical Physics,inc. Pacific Orthopedic Arcadia Sadecal_Rad Rm1_14 i (562)233-1596 California Radiation Control Regulations (Title 17) Unit Assembly/Installation Evaluation: Radiographic Unit Pass/Fail/NA Radiographic Tube Housing & Collimation assembly Tube housing of the diagnostic type. Pass Collimator restricts beam to area of clinical interest. Pass Collimator provides same attenuation as tube housing. Pass Exposure terminates at preset time or exposure. Pass Backup timer terminates exposure properly. Pass Open field phototimer terminates exposure properly. Pass Labeled control settings or meters indicating kVp, mA, exposure time, etc. Pass Dead man switch located in shielded area (at least 6 ft cord for portable). Pass Positive indication of x-ray production. Pass Adequate protective apparel. Pass Mechanical& Electrical Safety conditions (Sharp Edges, cracked or loose cables) Pass Medical Physicist's Recommendations and comments for Quality improvement: This unit is in compliance with all rules and regulations of the California Radiation Control Regulations (Title 17). No recommendations at this time. 10/29/2014 California Medical Physics, Inc. Pacific Orthopedic Arcadia_Sedecal Rad Rm1_14 (562)233-1596 Medical Physicist's Recommendations and comments for Quality Improvement: (continued) 10/29/2014 California Medical Physics, Inc. Pacific Orthopedic ArcadiaSedecal Rad Rml_14 III (562)233-1596 1. Accuracy of Source-to-Image Distance (SID) indicator: Indicated SID Measured Tolerance: Percent of the SID in SID tiny Deviation % I Evaluation 2% 40 40 0.00% 1 Pass ACTION LIMIT: If Measured SID deviates from the indicated SID by more than 2% of the SID, seek service. 2. Radiographic Collimation Assessment - X-Ray to Light Congruence Source to image receptor distance(SID): 40 in 101.6 cm ILeft Edge Right Edge I Top Edge Bottom Edge X-ray to Light Deviation (cm), 0 I 0.2 0.1 0.3 Sum of Left and Right (cm) 02 0 .:,,fr -7 ?x tx: Sum of Top and Bottom (cm) 0.4 Sum as % of SID 0.20% 0.39% Tolerance 2% 2% Evaluation' Pass 1 Pass ACTION LIMIT: If the sum of left and right edge deviations or the sum of the top and bottom edge deviations exceed 2% of the SID, seek service adjustment. 3. Radiographic Collimation Assessment - Light Field Size Accuracy Source to image receptor distance(SID): 40 in 101.6 cm Lateral I Longitudinal Light Field Measured Dimension (in) 9.8 12.1 Light Field Setting Dimension (in) 10 12 Total Difference in Dimensions (in) -0.20 0.10 Size Differences as % of SID -0.50% 0.25% Tolerance 2.00% 2.00% Evaluation' Pass 1 Pass ACTION LIMIT: If deviation between measured field size and indicated setting exceed 2% of the SID, seek service adjustment. 10/29/2014 California Medical Physics, Inc. Pacific Orthopedic_Arcadia_Sedecal Rad Rm1_14 1R (562) 233-1596 4. Radiographic Focal Spot Performance: Large Focal Spot Parallel to Anode-Cathode Axis Perpendicular to Anode-Cathode Axis Nominal Size (mm) 1.2 1.2 Star Pattern Physical Diameter(mm) 45 45 Star Pattern Image Diameter(mm) 82 82 Measured Blur Diameter(mm) 26 28 Magnification 1.82 1.82 Calculated Focal Spot Size (mm) 1.1 1.2 NEMA Specification (mm) 1.7 2.4 Evaluation:I Pass Pass ACTION LIMIT: Fail indicates that the calculated focal spot size exceed twice the nominal focal spot size.X-ray tube should be examined for proper function. Small Focal Spot Parallel to Anode-Cathode Axis Perpendicular to Anode-Cathode Axis Nominal Size (mm) 0.6 0.6 Star Pattern Physical Diameter(mm) 45 45 Star Pattern Image Diameter(mm) 102 102 Measured Blur Diameter(mm) 23 26 Magnification 2.27 2.27 Calculated Focal Spot Size (mm) 0.6 0.7 NEMA Specification (mm) 0.9 1.3 Evaluation: Pass Pass ACTION LIMIT: Fail indicates that the calculated focal spot size exceed twice the nominal focal spot size. X-ray tube should be examined for proper function. 10/29/2014 California Medical Physics,Inc. Pacifrc_Orthopedic Arcadia Sedecal Rad Rm1_14 2R (562)233-1596 5. Radiographic kVp Accuracy Target-lon Chamber-28 in ;Target-TT=37 Machine Setting Measurement kVp Error Evaluation kVp mA FS T(cosec j mAs kVp Abs Error! %Error P/F 55 200 L 50 10 55.41 0.41 0.7% Pass 60 200 L 50 10 60.20 0.20 0.3% Pass 60 200 L 50 10 60.30 0.30 0.5% Pass 70 , 200 L 50 10 70.40 _ 0.40 0.6% Pass 80 200 L 50 10 80.64 0.64 0.8% Pass 80 200 L 50 10 80.64 0.64 0.8% Pass 80 200 L 50 10 80.75 0.75 0.9% Pass 80 200 L 50 10 80.75 0.75 0.9% Pass 90 200 L 50 10 91.54 1.54 1.7% Pass 100 200 L 50 10 102.00 2.00 2.0% Pass 100 200 L 50 10 101.90 1.90 1.9% Pass 110 200 L 50 10 113.30 3.30 3.0% Pass 110 200 L 50 10 113.30 3.30 3.0% Pass ACTION LIMIT: If Measured kVp Readings are not within 10%(from indicated settings) tolerance range,then seek service. The maximum tolerance limit for kVp accuracy in the State of California is+10% For Quality Improvement however,we recommend adjusting the generator to within less than 5%nominal. 6. Exposure Timer Accuracy Target-Ion Chamber=28 in";Target-TT=37 in" Machine Setting/Reading I Measurement !Evaluation kVp mA FS mAs msec msec Error %Error P/F 80 N/A L 2.0 10 9.60 -0.4 -4.00% Pass 80 N/A L 4.0 20 19.60 -0.4 -2.00% Pass 80 N/A L 8.0 40 39.60 -0.4 -1.00% Pass 80 N/A L 16.0 80 79.20 -0.8 -1.00% Pass 80 N/A L 20.0 100 99.70 -0.3 -0.30% Pass 80 N/A L 40.0 200 199.70 -0.3 -0.15% Pass 80 N/A L 100.0 500 499.80 -0.2 -0.04% Pass ACTION LIMIT: The measured exposure time shall not differ from the indicated Machine Setting by more than+10%. 10/29/2014 California Medical Physics.Inc. PacifrcOrthopedic_Arcadia Sedecal Rad Rau 1_14 3R (562)233-1596 7. Radiographic Beam Quality (HVL) • ;;+ 5" ` „�. f y � � � ;. kVp 1 I kVp 2 t kVp 3 I kVp 4 1 kVp 5 Focal Spot L L L kVp Setting 60 80 100 Measured HVL (mm Al) 2.73 3.23 4.03 Minimum required HVL 1.3 2.3 2.7 Evaluation (P/F) Pass Pass Pass Tube kVp 50 60 70 80 90 100 110 120 HVL,,,, 1.2 1.3 2.1 2.3 2.5 2.7 3 3.2 ACTION LIMIT: If Measured HVL is less than the required min HVL seek service: Radiographic Beam Quality HVL 5.0 4.0 • J Q ; O • E 3.0 -J = I 2.0 - I 1.0 . ` : 50 60 70 80 90 100 110 kVp 10/29/2014 California Medical Physics, Inc. Pacific Orthopedic Arcadia Sedecal Rad Rm1_14 4R (562)233-1596 8. Exposure/mAs Linearity Target-inn Chan*'=28 in".Target-T.:37 in Machine Settings Measurement Evaluation kV__ mA FS msec mAs mR mR/mAs Linearity P/F L 80 50 S 50 2.54 32.9 13,16 - _- 80 100 S 50 5 56.4y 11.28, 7.69% Pass 80 200S 50 10• 107.3 10.73 2.50% Pass 80 400 L 50 20 211 10.55 0.85% Pass 80 500 L 50 25 258 10.32 1.10% Pass ACTION LIMIT: The average ratios of exposure to the indicated milliampere-seconds product (mR/mAs)obtained at any two consecutive exposure time settings shall not differ by more than 0.10 times their sum. 9. Exposure Reciprocity Target-ion Chamber=28 in":Target-TT=37 In' Machine Settings Measurement Evaluation p/ imA FS msec mAs mR mR/mAs Linearit+ P/F 80 200 L 10 2 24.2 12.10 - 80 200 L 20 4, 42.5 10.63' 6.49% Pass 80 200 L 40 8 86.1 10.76 0.64% Pass 80 200 L 80 16 172.6 10.79 0.12% Pass 80 200 L 100 20 217 10.85 0.29% Pass 80 200 L 200 40 429 10.73 0.58% Pass 80 200 L 500 100, 1081 10.81 0.39% Pass ACTION LIMIT: The average ratios of exposure to the indicated milliampere-seconds product (mR/mAs)obtained at any two consecutive tube current settings shall not differ by more than 0.10 times their sum. 10. Exposure/kVp Reproducibility: Torget_IonChamber=28 in Target-TT=37 Machine Settings 60 kVp 80 kVp 100 kVp Measurements: kVp Expo(mR) kVp Expo(mR) kVp Expo(mR) Set 1 60.2 65.8 80.64 109.4 102_00 169.6 Set 2 60-3 65.4 80.64 110.7 101.90 167.7 Set 3 _ 80.75 108.1 _ Set 4 80.75 108.1 Average 60.25 65.60 80.69 109.08 101.95 168.65 Standard Deviation 0.0707 0.2828 0.0635 1.2447 0.0707 1,3435 Coefficient of Variation 0.001 0.004 0.001 0.011 0.001 0.008 Evaluation Pass Pass Pass Pass Pass Pass ACTION LIMIT: The coefficient of variation of radiation exposures shall be no greater than 0.05. The kVp coefficient of variation should not exceed 0.02. 10/29/2014 California Medical Physics.Inc. Pacific_Orthopedic Arcadia Sedecal_Rad Rm1_14 `p (562)233-1596 A Radiographic Average Skin Entrance Exposure 25 - 20 15 0 E 4 E ` I 10 - I ( 5 0 b + + 1 + '4 I f 1 I I 40 50 60 70 80 90 100 110 120 kVp "Average Skin Entrance Exposure" is derived from our measurements and calculations for this unit and illustrates the relationship between the entrance skin exposure and the major kVp stations used most frequently in clinical setting. This plot can also be used for calculating various radiation exposure (ESE) and radiation dose after applying additional appropriate factors such as imaging technique and positioning and/or other relevant information. Please call your medical physicist at CMP at (562) 233-1596 for assistance and calculations of radiation dose for an individual specific case. 10/29/2014 California Medical Physics, Inc. Pacific Orthopedic_Arcadia Sedecal Rad Rm 1_14 6R (562) 233-1596 Radiation Protection Survey Report IE FOR Pacific Orthopedic Associates 289 West Huntington Dr., Suite 206 Arcadia, CA 91007 Rad Room #1 Universal Rad Stand, Sedecal, SHF-525 2014 Submitted by: Mehdi Ramshad,Ph.D. California Medical Physics, Inc. II (310)209-8546(Phone) www,calmp.com (310)492-5514(Fax) Pacific Orthopedic Associates 289 West Huntington Dr., Suite 206, Arcadia, CA 91007 Attn: Karin Martinez, Dir. and Vanessa Ocampo, RT Phone: (626) 538-1538 Fax: (626) 538-1539 Unit Manufacturer: Sedecal Unit ID Radiography Model: SHF-525 Survey Date: October 29, 2014 Serial Nr. H-6137 Report Date: October 29, 2014 Location/Room Rad Room#1 Last Surveyed: N/A Software Version N/A Type of Survey: Radiation Protection Survey Date of Manufacture September-14 Overall Score: PASS Installation Date October 28,2014 Medical Physicist: Mehdi Ramshad, Ph.D. Film Processor N/A Signature: Operating Location Rad Room#1,Universal Rad Stand - �""t' I. Summary Of Medical Physicist's QC Tests And Evaluation Radiation Safety Program Review: Operational safety policy and procedures implemented and current PASS Radiation safety training of personell is current PASS Proper use of the system according to the manufacturer guidelines PASS Personell radiation exposure monitoring(Badges) PASS Equipment Integrity and Operational Safety Evaluation All Exposures ALARA PASS Emergency Termination of Acquisition(manually at control console&system housing) PASS Protective Apparel(lead aprons and lead gloves)are available for use as needed. PASS Access door Interlock checked(If installed) NA Cables and other parts have no visible signs of corrosion or defects PASS Accessoray are stored properly PASS Visual inspection of mechanical integrity PASS Direct monitoring or viewing of patient during exposures PASS Proper function of X-ray beam-on indicator lights PASS Adequate posting of proper sinage PASS Identification and calibration information for the detection equipment used for this survey I Calibration Agency Calib.Type Calib.Date Due Date Global Calibration Laboratory,Cleveland,OH NIST Traceable 3/18/2014 3/17/2015 System Equipment Manufacturer/Model Serial Number Survey Meter Fluke V-451P 1754 Pacific Orthopedic_Arcadia RPS Rad Rrn 1_14 California Medical Physics,Inc. 10,29/2014 I (562)233-1596 Medical Physicist's Comments and Recommendations for Quality Improvement: ALL EXPOSURES ALARA according to rules and regulations of the California Radiation Control Regulations(Title 17). 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