CAUSE No. Of Poor Percentage of Poor No.

of Percentage of
Radiographs Radiographs = No. Rejects Rejects = No. of
of Poor/ Total No. of Rejects / Total No.
Poor of Rejects

1. A. No collimation

B. No gonad shielding

2. Optical Density

3. Part Cut-Off

a. Uncooperative patient

b. Excessive collimation

c. Inappropriate film size

d. Others

4. Superimposed images on same film

5. Marker(none or wrong)

6. a. Exhausted Solutions

b. Contaminated Solutions

7. Frilling

8. Fogging

9. Positioning Error

10. Patient Motion

11. Artifact FILM ANALYSIS REPORT FOR
a. Water marks
THE MONTH OF
19
b. Static marks

c. Abrasion marks (scratches)

Total No.of Test Films
d. Crescent marks
Total No. Of Used Films
e. Roller marks
Total No. Of Analyzed Films (A)
f. Foreign body (jewelry, wig, etc.)

g. Stains

h. Dirty screens Total No. Of Good Radiographs (B)

i. Others Total Percentage of Good Radiographs

(B/A x 100%)
12. Choice of exposure factors

13. Others
Total No. Of Poor Radiographs ( C)
Total percentage of Poor Radiographs (C/A x 100%)

Total No. Of Rejects (D)

Total Percentage of Rejects (D/A x 100%)

Report Prepared By:

(Name and Signature)

Noted By:

(Name and Signature)

Date Prepared:
 RHS QADX
Name of Hospital
Form No. 5

QUALITY ASSURANCE PROGRAM - X-RAY SECTION/DEPARTMENT

Address
CASSETTE/INTENSIFYING SCREEN CHECK RECORD

Item Check/Task For Month Ending Task Completed Comments

By: (initials)
Cassette Hinge
Identification No. Fastening
Brand: General Condition
Date of first use: Cleaning
Size:
Intensifying Screen General Condition
Brand: Screen/Film contact
Type: cleaning
Date installed in
cassette
Cassette Hinge
Identification No. fastening
Brand: General condition
Date of first use: cleaning
Size:
Intensifying Screen General Condition
Brand Screen/Film contact
Type: Cleaning
Date installed in
cassette
 RHS QADX

Form No. 5

QUALITY ASSURANCE PROGRAM - X-RAY SECTION/DEPARTMENT

TEST/CHECK PROGRAM
TASK FREQUENCY Person Assigned
D W M 3M NEC (Name and Signature)
X-ray Tube and Cables:

General Condition

Secure Fixing

Beam Limitation

Cones & light beam Delineators:

General Condition

Cone and Cone Coverage

Light Beam Delineator

Coincidence of Light and X-rays

Tables, Stands & Tube Supports:

General Condition

Breaks and Locks

D - Daily W- Weekly M- Monthly 3M- Thrice Monthly NEC- as and when necessary
Note: Check if Satisfactory. Mark with an X if not.
Alignment of Tube and Table

Main Cables & extensions Cables:

General Condition

Secure Terminals

Grids:

General Condition

Uniformity

Bucky Movement

Lead Rubber:

General Condition

QUALITY ASSURANCE PROGRAM - X-RAY SECTION/DEPARTMENT

TEST/CHECK PROGRAM

TASK FREQUENCY Person Assigned

D W M 3M NEC (Name and Signature)
Film Hopper Bin:

General Condition
Electrical Connection

Cassettes:

General Condition

Labelling

Cleaning

Light Leakage Test

Intensifying Screens:

General Condition

Mounting and Marking

Cleaning and Inspecting

Film/Screen Contact

Film:

Storage

Speed

Grids:

Generator:
General Condition

Earthing

Consistent Output
D - Daily W- Weekly M- Monthly 3M- Thrice Monthly NEC- as and when necessary
Same exposure factors
Note: Check if Satisfactory. Mark with an X if not.
Same mAs different mAs

Exposure time