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ARCADIS Avantic
SP

Maintenance Protocol
System
Maintenance Protocol
Customer:

Address:

Fax / E-Mail:
Fax / E-Mail:

Department: Room:
Material-No.: Serial-No.:
Contract-No.: Expire date:
Order-No.: System - ID:
© Siemens, 2005

The instructions SPR2-330.831.01.05.02 are required for © Siemens, 2005

All documents may only be used for rendering
this protocol services on Siemens Healthcare Products. Any
10143408
10048590
document in electronic form may be printed
once. Copy and distribution of electronic docu-
ments and hardcopies is prohibited. Offenders
will be liable for damages. All other rights are re-
served.

Print No.: SPR2-330.832.01.05.02 English

Replaces: SPR2-330.832.01.04.02 Doc. Gen. Date: 08.09
CS SD SP
n.a.

2005
Protocol Date: Serial-No.:

Evaluating the Condition of the System / Component

1Protocol

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 differ-
ences from required reference values.
The system / component has serious deficiencies. For safety rea-
sons, 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.

ARCADIS Avantic SPR2-330.832.01.05.02 Page 2 of 12 © Siemens, 2005

08.09 CS SD SP
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- QIQ Image Quality
tion
PM Preventive Maintenance QSQ System Quality Check
PMP Periodic Preventive Mainte- SW Software Maintenance
nance
PMA Preventive Maintenance CSE Customer Service Engineer
Adjustments

© Siemens, 2005 SPR2-330.832.01.05.02 Page 3 of 12 ARCADIS Avantic

08.09 CS SD SP
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

ARCADIS Avantic SPR2-330.832.01.05.02 Page 4 of 12 © Siemens, 2005

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK
1 General information
1.4 Spare parts which may be needed

1.6 Safety information and protective measures

1.6.1 General safety information (in existing documents)
1.6.2 General electrical safety information
1.6.3 Radiation safety information
1.6.4 Safety information - risk of infection
1.6.5 Mechanical safety information
1.6.6 Systems equipped with an integrated I.I. laser light localizer
1.6.7 Systems equipped with a single tank laser light localizer
1.6.8 Information on the protective conductor resistance test
1.6.9 System leakage current measurement information

2 Inspection of exterior and surroundings

2.1 Inspection of exterior
PMP Damage

2.2 Inspection of surroundings

2.2.1 Power outlets
SIE Damage
SIE Line voltage
SIE Internal line resistance

Maintenance of this section was performed by:

Signature:

Date: Name:

© Siemens, 2005 SPR2-330.832.01.05.02 Page 5 of 12 ARCADIS Avantic

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK
3 Safety inspection
3.1 Mechanical safety
SIM Covers
SIM Cable deflectors
SIM I.I. removable grid - mechanics
SIM I.I. laser light localizer mechanics (if present)
SIM I.I. laser light localizer function (if present)
SIM Laser light localizer, close to tube - mechanics (if present)
SIM Integrated laser light localizer, close to tube - function (if present)
SIM Foot brake
SIM Brakes
SIM C-Arm
SIM Wheels and castors
SIM Lift column
SIM Emergency stop switch
SIM Warning signs
SIM ID labels

ARCADIS Avantic SPR2-330.832.01.05.02 Page 6 of 12 © Siemens, 2005

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK
3.1.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIM TFT monitor(s)

Maintenance of this section was performed by:

Signature:

Date: Name:

3.1.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIM TFT monitor(s)

Maintenance of this section was performed by:

Signature:

Date: Name:

3.1.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIM TFT monitor(s)

© Siemens, 2005 SPR2-330.832.01.05.02 Page 7 of 12 ARCADIS Avantic

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK

Maintenance of this section was performed by:

Signature:

Date: Name:

3.1.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIM TFT monitor(s)

Maintenance of this section was performed by:

Signature:

Date: Name:

3.2 Electrical safety

SIE Cables and plugs
SIE Fluoroscopy timer
SIE Acoustic warning signal
SIE Compulsory radiation switch off
SIE Check the radiation release switch
SIE Dose rate
SIE Radiation indicator
SIE Iris collimator
SIE Voltage discharge rubber
SIE Protective conductor test
SIE System leakage current

Wartung dieses Abschnittes wurde durchgeführt von:

Unterschrift:

Datum: Name:

ARCADIS Avantic SPR2-330.832.01.05.02 Page 8 of 12 © Siemens, 2005

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK
4 Maintenance, operating value/functional inspection
4.1 Maintenance
PMP Cleaning the system
PMP System ventilation

4.2 Operating value inspection

PMF Event log

© Siemens, 2005 SPR2-330.832.01.05.02 Page 9 of 12 ARCADIS Avantic

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK
4.3 Functional inspection
4.3.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIE TFT monitor

Maintenance of this section was performed by:

Signature:

Date: Name:

4.3.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIE TFT monitor

Maintenance of this section was performed by:

Signature:

Date: Name:

4.3.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIE TFT monitor

ARCADIS Avantic SPR2-330.832.01.05.02 Page 10 of 12 © Siemens, 2005

08.09 CS SD SP
Protocol Date: Serial-No.:
OK not n.a.
OK

Maintenance of this section was performed by:

Signature:

Date: Name:

4.3.1 Monitor

Present: Yes: Material No.:

No: Serial no.:

Signature:

Date: Name:

SIE TFT monitor

Maintenance of this section was performed by:

Signature:

Date: Name:

4.3.2 Unit
SIE Air kerma meter (if present)
SIE Dose-area product meter (if present)
PMF Laser camera connection (if present)
PMF Check the operating function.
PMF Monitor display of the iris collimator aperture
PMF PMF Monitor display of the slot diaphragm positions
PMF Battery replacement in the UPS

Wartung dieses Abschnittes wurde durchgeführt von:

Unterschrift:

Datum: Name:

5 Final result/quality inspection and maintenance

SIE Image quality (IQ) quick test
PMP Maintenance

© Siemens, 2005 SPR2-330.832.01.05.02 Page 11 of 12 ARCADIS Avantic

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Protocol Date: Serial-No.:
OK not n.a.
OK
5.1 Final work steps
SIE Protective conductor test

Test circuit per VDE 0751-1, Figure:

TP 1: Ω
TP 2: Ω
TP 3: Ω
TP 4: Ω
TP 5: Ω
TP 6: Ω
TP 7: Ω
TP 8: Ω

SIE Leakage current

Test circuit per VDE 0751-1, Figure:

Measured value: mA
Power line voltage: V
Corrected value: mA

Maintenance of this section was performed by:

Signature:

Date: Name:

6 Changes to previous version

ARCADIS Avantic SPR2-330.832.01.05.02 Page 12 of 12 © Siemens, 2005

08.09 CS SD SP