Siemens Sensation Maintenance Protocol
SiemensSchmitt
Sensation
Maintenance Protocol
System
Maintenance Protocol System
Customer:
Address:
CT
Fax / E-Mail:
Fax / E-Mail:
Department: Room:
Material-No.: Serial-No.:
Contract-No.: Expire date:
Order-No.: System - ID:
The instructions CT02-023.831.01.20.02 are required for
this protocol
Print No.:
Replaces: CT02-023.832.01.19.02
073931140754198507543015075431060809895108377520088720170887442710017857101300401035125510351301
CT02-023.832.01.20.02
© Siemens
The reproduction, transmission or use
of this document or its contents is not
permitted without express written
authority. Offenders will be liable for
damages. All rights, including rights
created by patent grant or registration
of a utility model or design, are
reserved.
English
Doc. Gen. Date: 10.09
2005
Protocol Date: Serial-No.:
1Protocol
Evaluating the Condition of the System / Component 0
The system / component has no deficiencies. The image quality
test resulted in no differences from required reference values.
The system / component has slight deficiencies that have no affect
on continued operation of the system. However they should be
corrected preventively. The image quality test resulted in no differences from required reference values.
The system / component has serious deficiencies. For safety reasons, continued operation of the system is permitted only after
successfully correcting the deficiencies.
After completing all work steps, an evaluation was performed.
Signature:
Date: Name:
The customer or a representative has taken note of the assessment of the
system condition (only if required in the country).
Signature:
Date: Name:
Remarks
e.g. Additional activities to be performed, customer wishes
Further Processing and Archiving of the Protocol
The protocol is a document and thus must be archived. After completing the test, it must
be filed in the corresponding register in the “System Owner Manual“ binder.
Sensation CT02-023.832.01.20.02 Siemens
10.09 H WS CS SD CT
Page 2 of 14
Protocol Date: Serial-No.:
Remarks Regarding the Protocol 1.1
The protocol is valid as proof of quality for one check that must be performed on the system
/ component.
The check must be performed in the specified intervals.
The results of the check are entered in this protocol.
The chapter numbers in front of the checkpoints indicate the corresponding chapters in the
particular instructions (see cover page).
The protocol must be completely filled out by the Customer Service Engineer, i.e.:
• All boxes must be filled out. If a box does not apply to the system or if no entry needs to
be made, check the “n.a.“ box.
• Enter the Serial no.: and the date of the check in the header of each page so that each
page can be allocated to a check date.
• The measurement values for the measurements that must be performed during the
check must also be entered in the open spaces / tables provided for them.
• After completing the check, Page 2 of this protocol must be filled out and signed.
Explanation of Abbreviations in the Protocol 0
Abbrev. Explanation Abbrev. Explanation
SI Safety Inspection PMF Preventive Maintenance, Operating
Value Check, Function Check
SIE Electrical Safety Inspection Q System Quality, Image Quality
SIM Mechanical Safety Inspec-
tion
PM Preventive Maintenance QSQ System Quality Check
PMP Periodic Preventive Mainte-
nance
PMA Preventive Maintenance
Adjustments
QIQ Image Quality
SW Software Maintenance
CSE Customer Service Engineer
Siemens CT02-023.832.01.20.02 Sensation
10.09 H WS CS SD CT
Page 3 of 14
Protocol Date: Serial-No.:
Measuring Equipment and Measuring Instruments Used 1.2
Measuring instruments and measuring devices (phantoms, MR coils etc.) may not be
entered in the table if they have already been entered in the mobile device.
Measuring equipment / -instruments Serial No. Date used
Sensation CT02-023.832.01.20.02 Siemens
10.09 H WS CS SD CT
Page 4 of 14
Protocol Date: Serial-No.:
1 General
2 Prerequisites
2.1 Required tools and auxiliary materials
2.2 Evaluating Reports
PM Checking system reports
2.3 Evaluating the logbook
PM Error statistics readout
3 Safety Inspections
3.1 General
3.2 Function Tests
OK not n.a.
OK
3.2.1 Measuring the patient leakage current (DIN VDE 751-1)
SI Patient leakage current checked
3.2.2 Checking the protective ground conductor resistance
3.2.3 Checking the function of the door contact switch
SI Door contact switch checked
3.2.4 System: Checking the radiation preparation indicator
SI Radiation preparation indicators checked
3.2.5 System: Checking the radiation indicator
SI Radiation indicators checked
3.2.6 System: Checking the radiation monitor (108%)
SI Radiation switch-off checked
Measured value:
3.2.7 System: Checking the emergency STOP circuit
SI Emergency STOP circuit checked
3.2.8 Gantry: Checking the tube cooling hoses
SI Tube cooling hoses checked
3.2.9 PHS: Checking the safety switches
SI Safety limit switches checked
3.2.10 PHS: Checking the spindle brake
SI Function of spindle brake checked
3.2.11 PHS: Checking the motor brake
SI Function of motor brake checked
Siemens CT02-023.832.01.20.02 Sensation
10.09 H WS CS SD CT
Page 5 of 14
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