MONTHLY MRI EQUIPMENT QUALITY CONTROL
MRI Facility Name:                                                                                 MRI Scanner Identifier:
    1         Test ramps                       Test plane cube 1                   Test plane cube 2        Test plane cube 3               Test plane cube 4
                   3                                   7
             Setup & Table
                                                                                                                         High Contrast         Low contrast
               Position                      Scan Slice Geometri                        Uniformity
                                                                                                                         Resolution            sensitivity
               Accuracy                                                                                                                                         note
                                                          X           Y                                                          Distorsi       Any present?
                     OK            NO     Z (mm)                                                                    Line pair
   Date                                                  (mm)        (mm)                                                       geometric
Action limits:                          ≤ 1,5 mm      36,1 mm      35,9 mm       ≥ 87,5 % (1,5 T)    ≥ 82 % (3 T)   ≤ 1mm            ok           Yes/No
         Reviewed by:                                                                                                                         Date of Review:
                                                        Qualified Medical Physicist / MRIScientist
      MRWeeklyQCForms_6-12-15(2)