Inspection

Site:

Site ID:

Survey date:

Email to send the report to:

Employer:

RPS:

RPS Training: within last 5 years and since IRR17 came into force:

Designation of controlled/supervised areas

Occupancy concerns?

Please note them here:

MPE:

Is the RPA Shahed Khan?

Name of RPA:

Perform Chargeable Risk Assessment for client:

Sources of Radiation
Select the source of radiation

Number of units

Radon: Evidence of previous Radon monitoring / assessment

Equipment Details

Generator

Tube stand

Tube

Control panel

Bucky stand

LBD

Tank

Bucky trays

Processor

Battery pack

Last Svc:

CE Marked?

1.0 Radiation Protection

1.1 The X-Ray unit is used in a:

Measuring approximately m x m

1.2 The walls are

Approximate Pb equiv (mm)

Approximate thickness (cm)

1.3 The entrance door has a functioning locking mechanism

Indicating bolt advised?

Door / Glazing shielded?

Note the Pb Equ in mm

Access controlled by operator

1.4 Exposure switch has multiple controls

Location of exposure button (s)

Prevents Door Closure?

>3 long?

Operator is in a Protected area

1.5 Primary Method of Shielding:

How far (m)?

How thick (mm Pb)?

How thick (mm Pb)?

1.6 Lead rubber was provided?

1.7 Is personal monitoring performed?

Who?

Past Doses

1.8 Is leaded PPE provided?

Apron

Quantity

Thickness (mm Pb Equ)

Storage

Serviceable

Screening records

Gloves/mitts

Quantity

Thickness (mm Pb Equ)

Storage

Serviceable

Screening records

Thyroid shield

Quantity

Thickness (mm Pb Equ)

Storage

Serviceable

Screening records

Sleeves

Quantity

Thickness (mm Pb Equ)

Storage

Serviceable

Screening records

1.9 Local Rules Condition

Location

Up to date

Officers details

1.10 Warning Lights Present

Appropriate?

Controlled by separate switch?

Functional?

Notice present?

Appropriate?

Send a new sign?

Pregnancy warning?

Needs relocating?

1.11 Scatter Survey performed?

Exposure factors used?

2 Electro-Mechanical Condition

2.1 All major mechanical parts were found to be in a serviceable order:

2.2 Movement of the various parts were smooth:

2.3 Covers in good condition:

Securely attached:

2.4 Tube stand / mount / ceiling track secure / height adjustment functional / movements smooth

2.5 X-ray tube (stand) stationary following positioning and release

2.6 Counterweighting: X-ray tube

Verticle Bucky

2.7 Tube stand electro-mechanical brakes

2.8 Bucky stand electro-mechanical brakes

2.9 The x-ray tube apparently perpendicular to the table top.

2.10 The x-ray table:

2.11 Tube – grid/bucky alignment:

2.12 The cassette tray

2.13 Collimator

2.14 The visible suspension components were seen to be:

2.15 Grids:

Grid size

Ratio

Frequency

Interspace

Focal length

condition

2.16 Mains connection via:

2.17 Safe disconnect in emergency?

2.18 Phases

2.19 All controls and displays functioned correctly

Strain reliefs OK

2.20 All visible cables were sound

2.21 The earth wiring present?

Under tension?

2.22 The locking retaining rings for the HT cables are:

3. Image Processing

3.1 Ventilation adequate.

3.2 Image processing/capture was provided by the use of:

3.3 This was sitting on an appropriate:

3.4 Developer temperature °C

3.5 The films were adequately fixed

Washed

3.6 The rollers were in a reasonable condition

3.7 House keeping: send darkroom chart

Processor cleaning dates

Roller cleaning dates

Cassette cleaning dates

Chemicals changed dates

Sensitometry dates

Chemistry stored appropriately

3.8 The chemical waste is:

3.9 A drip tray is advisable to protect film

Film type

Colour

Stored upright

Screen ISO

Screen Colour

Cleanliness OK

Cassette lightproof

Safelight

Appropriate

Housing leaking?

Light-proofing

3.10 Safe handling time

3.11 Optical density on the test film was reasonable

3.3 This was sitting on an appropriate:

3.12 Exposure index unit (DDI)

Details

3.13 Cassette storage

3.14 Range of appropriate processing algorithms

3.15 Cassette artefacts

50 kV, 0.5 mAs @75cm (or aim for 20 µGy)

Small (18 x 24) sensitivity

Date started

DI @ centre

Medium (24 x 30) sensitivity

Date started

DI @ centre

Large (35 x 43) / ( 30/40/) sensitivity

Date started

DI @ centre

3.16 Any image artefacts due to objects in the beam path

Pleate damage?

Reader?

Dust/dirt?

Scratches/Pickoff

Scum?

Screens?

4. Radiographic Practice

4.1 Operators appropriately trained

4.2 Holding procedures performed?

Holders documented?

PPE from holding procedures seen on images?

4.3 Record keeping uses:

Give details

Time period audited: Has been kept up tp date

Full details of every radiograph

# Exposures in logbook

Patient measurement/weight

Exposure grading

# Exposure recorded on computer

4.4 The estimated average exposure (kV, mAs & cm)

4.5 Exposure chart:

4.6 L & R indicators available?

Demonstrated appropriately

4.7 Are the following available
4.8 Patient identity:

4.9 The reviewed images displayed consistently diagnostic densities

4.10 Optimal exposure determinations Y/N

Extremes of range displayed

Most in the range

4.11 Techniques were determined to be consistent

4.12 Artefacts demonstrated on the reviewed images

4.13 Split films

4.14 Collimation and positioning: Consistent?

Appropriate?

Positioning

Centring

Demonstrated 3 or 4 borders

Add comments

5. Equipment performance

Distance tape accurate to within 1cm?

Timer

Controls operating correctly

Early release Terminates?

Displays operating correctly

Continue or restart exposure

Focal spot position marked

Measured?

Early release: Alarm

HVL Recorded

Value?

Repeatability

measurements taken

AV indication of exposure

Set vs measured kV

operating as expected

mA Linearity

mAs Linearity

kV and DR waveforms obtained setting

Radiation - light film taken

Erasure Efficiency+ EI

Calliper check 5cm / 18cm

Limiting resolution (lp/mm)

Plate transport check

TO.20 exposure

Dental: Beam circular?

Dental: Beam central to cone?

LAT lumbar spine: The current UK national Diagnostic Reference Level (DRL) is 10mGy (2.5Gy.cm2)

Measured dose (mGy)

Measured distance (cm)

Pt. Thickness (cm)

Clinical FFD (m)

Screenshot 2020-03-30 at 16.50.52.png

Therefore entrance skin dose = (mGy)

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.