CT Equipment Forms

Fill out and submit this form if your facility is requesting a change in equipment or adding or replacing a unit to a current accreditation.

STANDARD – Instrumentation

Complete the following table for each CT system:

CT System 1 / CT System 2 / CT System 3
Manufacturer
Model
Year manufactured
Serial number
Date of installation
Date of acceptance testing
Maximum slice capability
Minimum rotation speed
Fixed or mobile
Imaging studies performed (i.e., cardiovascular, whole body, neuro, etc.)
Auto dose or dose reduction technique(s) available

Complete the following table for the CT computer software and reconstruction system components for each CT system in the facility:

CT System 1 / CT System 2 / CT System 3
Manufacturer
Year manufactured
Software version
For all items below, indicate Yes or No if present on the CT system
MIP / Yes No / Yes No / Yes No
VRT / Yes No / Yes No / Yes No
Gating/ECG capability / Yes No / Yes No / Yes No
MPR / Yes No / Yes No / Yes No
Agatston or volume score / Yes No / Yes No / Yes No
Quantification of calcium / Yes No / Yes No / Yes No
ROI capability / Yes No / Yes No / Yes No
Relevant measurements / Yes No / Yes No / Yes No
3-D / Yes No / Yes No / Yes No
Curved planar reformat / Yes No / Yes No / Yes No
3-axis rotational display / Yes No / Yes No / Yes No
List other formats used:

For all CT systems, indicate Yes or No if present on the system(s):

CT System 1 / CT System 2 / CT System 3
1.1.4.1B
Data review in digital
on-screen medium / Yes No / Yes No / Yes No
1.1.4.2B
Ability to maintain resolution of transmitted images / Yes No / Yes No / Yes No
Recommendation
Ability to maintain resolution of images on monitor / Yes No / Yes No / Yes No
1.1.4.3B
Ability to display data in standards contrast settings / Yes No / Yes No / Yes No
1.1.4.4B
Ability to adjust contrast and brightness manually / Yes No / Yes No / Yes No
1.1.4.5B
DICOM compatible for archiving / Yes No / Yes No / Yes No
1.1.4.6B
Ability to adjust FOV based on patient size and protocol / Yes No / Yes No / Yes No

IAC CT Equipment Forms 1

Reviewed 11/2014