CT Exprès™ Preventative Maintenance and Field Test Report
1.1 Name of Facility: LABORATORIOS FARMACEUT 1.5 Date: 10-feb-2025
Address: Hospital Universitari Sagrat Cor
1.6 Current software version:
1.2 Injector S/N: R0013026-0814 544
Control Panel S/N: 00011078-3014 Only applicable after software update:
Control Panel S/N: 00011079-3014 1.7 Upgraded to:
1.3 Service Order: 17394
1.4 PR / Sales Force #:
What was performed,
■ Preventative Maintenance + Field Test
*Field Test Only (level 2 repair) or software update (not applicable for systems that are ‘End of Service’)
For Level 1 repair, skip the Preventative Maintenance and Field Test sections. (not applicable for systems that are
‘End of Service’)
*When Field Test Only or software update, skip the Preventative Maintenance section.
Note: This section only applicable for US market
Service Date Arrival Time Labor Wait Travel Overtime
Note:
Spare parts used (including lot, serial # and quantity info), Problem Reported and Repair Description fields are
filled out in Salesforce?
Yes ■ No
If yes, it is not mandatory to fill in Spare parts used field and Problem Reported and Repair Description fields.
If Salesforce access is not available, please fill the form completely, sign and submit) to customer services via
[email protected].
17-901906-002 Page 1 of 5 Confidential – Proprietary Information of
FM0923, Rev 04 Bracco Medical Technologies (BMT). This document is
CO-11592 maintained in the document control system. Confirm
current revision prior to use.
CT Exprès™ Preventative Maintenance and Field Test Report
Spare parts used (if applicable):
SKU/Part # Part Description Lot # S/N Quantity
Problem Description:
Preventive maintenance required.
17-901906-002 Page 2 of 5 Confidential – Proprietary Information of
FM0923, Rev 04 Bracco Medical Technologies (BMT). This document is
CO-11592 maintained in the document control system. Confirm
current revision prior to use.
CT Exprès™ Preventative Maintenance and Field Test Report
Repair Description:
Preventive maintenance performed.
Preventative Maintenance
Required Materials: Please follow 901906-002 for detailed instructions on completion of Preventative
Maintenance. This section is only applicable for Preventative Maintenance. For level 1 and 2 field service repairs,
skip this section.
Checklist Description PASS / FAIL / N/A
Step
1. Injector Cleaning ■
2. System Appearance
3. Control and Power On of CT Exprès 2.5T Fuse 1: 2.5T Fuse 2: ■
4. Date and Time ■
5. Standby Test (not applicable for CT Exprès III) ■
6. Touchscreen Calibration ■
7. Display ■
8. Brightness ■
9. Buttons ■
10. Sound ■
11. Connections ■
12. Watchdog ■
13. Motor Shaft Cleaning ■
14. Patient Set Sensor Gap ■
15. “STOP” Buttons ■
16. Perform Field Test. (See step 5 up to and including 9 of the field test section) ■
17. MAVIG Arm Annual Check GD92 and GD92F ■
GD400 Complete FM0854 as well ■
17-901906-002 Page 3 of 5 Confidential – Proprietary Information of
FM0923, Rev 04 Bracco Medical Technologies (BMT). This document is
CO-11592 maintained in the document control system. Confirm
current revision prior to use.
CT Exprès™ Preventative Maintenance and Field Test Report
Field Test
Required Materials: Please follow 901906-002 for detailed instructions on completion of the Field Test.
The Field Test Form should be completed immediately after any level 2 service activity is performed on the CT
Exprès™ system.
Checklist Description PASS / FAIL / N/A
Step
2. Control and Power On of the CT Exprès™ (N/A if PM was performed) ■
3. Hardware Tests and Calibration (N/A if PM was performed) ■
4. Patient Set Sensor Gap (N/A if PM was performed) ■
5. Bottle and Patient Set Air Sensors Verification
Patient set air sensor (channel 1)
Without tube [0 – 15 Dec.]: 2 Dec. ■
Tube empty [0 – 20 Dec.]: 2 Dec. ■
Tube full [225 – 255 Dec.]: 255 Dec. ■
Bottle air sensor left (channel 7)
Without tube [0 – 75 Dec.]: 4 Dec. ■
Tube empty [0 – 75 Dec.]: 4 Dec. ■
Tube full [240 – 255 Dec.]: 252 Dec. ■
Bottle air sensor right (channel 6)
Without tube [0 – 75 Dec.]: 3 Dec. ■
Tube empty [0 – 75 Dec.]: 3 Dec. ■
Tube full [240 – 255 Dec.]: 255 Dec. ■
17-901906-002 Page 4 of 5 Confidential – Proprietary Information of
FM0923, Rev 04 Bracco Medical Technologies (BMT). This document is
CO-11592 maintained in the document control system. Confirm
current revision prior to use.
CT Exprès™ Preventative Maintenance and Field Test Report
Checklist Description PASS / FAIL / N/A
Step
6. Injection
Injection volume precision
If a Patient Set is used for this test:
Injection 1 volume precision (42 +/- 10%): [37.8 – 46.2 mL ]: mL ■
6.1 Injection 2 volume precision (85 +/- 6%): [79.9 – 90.1 mL ]: mL ■
If a Multi Patient Set is used for this test:
Injection 1 volume precision (42 +/- 10%): [37.8 – 46.2 mL ]: 45 mL ■
Injection 2 volume precision (85 +/- 10%): [76.5 – 93.5 mL ]: 91 mL ■
6.2 Patient Set Sensor Pressure (fill in one only) ■
9.22 +/- 1.08 bar: 9.83 bar
134 +/- 15.7 PSI: PSI
0.9222 +/- 0.108 MPa: MPa
6.3 Air Bubble Detection ■
7. Electrical Safety Test ■
8. Field test has been successfully completed in accordance with the
■
instructions and there were no out of specification conditions observed
9. For End of Service systems only:
System did not pass Preventive Maintenance and/or Field Test and does not meet ■
specification*
10. Place PM label onto system and record the Serial Number and the Date that the PM
was performed (Performed if Preventative Maintenance + Field Test was done. N/A ■
if Field Test only was performed)
*''All service and maintenance are subject to ACIST’s Service Terms & Conditions. No repairs will be performed on
systems that are End of Service.''
Comments:
Technicians Name: Technicians Signature: Date:
Firmado digitalmente por CAMPS
VAQUE MIREIA - 45832103A
MCV Fecha: 2025.02.10 10:59:14
+01'00'
10-feb-2025
17-901906-002 Page 5 of 5 Confidential – Proprietary Information of
FM0923, Rev 04 Bracco Medical Technologies (BMT). This document is
CO-11592 maintained in the document control system. Confirm
current revision prior to use.
