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SIREMOBIL Iso-C
SP
Maintenance Protocol
System
SIREMOBIL Iso-C
Customer:
Address:
Department:
Room:
Contact person:
Telephone:
Cust. specific no.:
Cust. no.:
Date.:
The instructions SPR2-230.101.02.06.02 are required for
© Siemens AG 1998
this protocol The reproduction, transmission or use
02829450 of this document or its contents is not
permitted without express written
authority. Offenders will be liable for
damages. All rights, including rights
created by patent grant or registration
of a utility model or design, are
reserved.
Print No.: SPR2-230.105.02.06.02 English
Replaces: SPR2-230.105.02.05.02 Doc. Gen. Date: 07.05
Cust.-No.: Date: Protocol
1Protocol
SIEMENS Office:
Address:
Region:
Country:
Contact person:
Tel.:
CSE in charge:
Tel.:
Remarks Regarding the Protocol:
The protocol is valid as proof of quality for one check that must be performed on the sys-
tem / component in one year.
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 customer number (Cust. No.:) and the date of the check in the header of each
page so that each page can be allocated to a customer and to a check date.
• If there are complaints, the IVKs for the component about which a complaint has been
made as well as the type of complaint must be entered in the “Open Points“ table pro-
vided for this. Correction of these open points also must be documented in this table
with the date and a signature. If there are no open points, check “No“ and document this
with the date and a signature.
• If movable components (also test phantoms that are part of the system) that can be
used in different systems are used for the check, they must be entered in the “Movable
Components“ table provided for this.
• 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 3 of this protocol must be filled out and signed.
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 2 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
Protocol Date: Cust.-No.:
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. If needed, a
copy can be handed to the customer.
System:
Serial No.:
Software Version:
Number of the Service Contract:
Type of Maintenance:
Evaluating the Condition of the System / Component
The system 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 differences from
required reference values.
The system / component has serious deficiencies. For
safety reasons, continued operation of the system is per-
mitted only after successfully correcting the deficiencies.
After completing all work steps, an evaluation was performed.
Signature:
Date: Name:
The operator or a person assigned for this has taken note of this evaluation.
(if national regulations require this)
Signature:
Date: Name:
Siemens AG SPR2-230.105.02.06.02 Page 3 of 12 SIREMOBIL Iso-C
Medical Solutions 07.05 CS PS 24
Cust.-No.: Date: Protocol
Explanation of Abbreviations in the Protocol
Abbrev. Explanation Abbrev. Explanation
SI Safety Inspection PMF Preventive Maintenance, Operat-
ing 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
Additional activities performed
Only activities that are not described in the instructions for the system / component need
to be listed.
Date:
Additional activities performed: OK not n.a.
OK
Open Points:
Yes: No: Signature:
Date: Name:
If “Yes“, enter the component with the IVK and the open point (only the number) in the
table. After completing maintenance, record this in the table.
IVK Component Open Points Completed
Date Signature
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 4 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
Protocol Date: Cust.-No.:
Measuring Devices queried electronically:
Yes: No: Signature:
Date: Name:
If the measurement devices are queried electronically, for example with a Scout Mobile
Device, entry of the measuring devices in the table can be skipped.
Measuring Devices Type Serial No. Date Used Next Cali-
bration
Due
Movable Components:
Yes: No: Signature:
Date: Name:
If “Yes“, enter the movable component with which the check was performed along with the
with the Serial No. in the table.
Movable components (also test phantoms that are part of the system) are parts that can
be used on different systems).
Component Serial No.
Siemens AG SPR2-230.105.02.06.02 Page 5 of 12 SIREMOBIL Iso-C
Medical Solutions 07.05 CS PS 24
Cust.-No.: Date: Protocol
OK not n.a.
OK
1 General Information
2 Inspection of Exterior and Surroundings
2.1 Visual inspection of exterior
PMP Damage to the system
PMP Damage to the mains connection
2.2 Inspection of environment
2.2.1 Power outlets
SIE Damage
SIE Mains voltage
SIE Internal line impedance
3 Safety Inspection
3.1 Mechanical safety
SIM Cover panels
SIM Cable deflectors
SIM Foot brake
SIM Brakes
SIM C-arm
SIM Wheels
SIM Lifting column
SIM Emergency Stop switch
3.1.1 I.I. laser light localizer
Option present: Yes: No:
Signature:
Date: Name:
SIM Mechanical system
SIM Function
3.1.2 Laser light localizer
Option present: Yes: No:
Signature:
Date: Name:
SIM Mechanical system
SIM Function
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 6 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
Protocol Date: Cust.-No.:
OK not n.a.
OK
3.1.3 DICOM bridge
Option present: Yes: No:
Signature:
Date: Name:
SIM Mounting
3.1.4 Codonics printer
Option present: Yes: No:
Signature:
Date: Name:
SIM Mounting
SIM Guide rails
3.1.5 Navigation system
Option present: Yes: No:
Signature:
Date: Name:
SIM Navigation system
3.1.6 Monitor(s)/displays
Present: Yes: Material No.:
No: Serial No.:
Signature:
Date: Name:
SIM Monitor(s)/displays
3.1.6 Monitor(s)/displays
Present: Yes: Material No.:
No: Serial No.:
Signature:
Date: Name:
Siemens AG SPR2-230.105.02.06.02 Page 7 of 12 SIREMOBIL Iso-C
Medical Solutions 07.05 CS PS 24
Cust.-No.: Date: Protocol
OK not n.a.
OK
SIM Monitor(s)/displays
3.1.7 Labels
SIM Warning signs
SIM ID labels
3.2 Electrical safety
SIE Cables and plugs
SIE Fluoroscopic timer
SIE Audible warning signal
SIE Radiation indicators
SIE Radiation release switch
SIE Compulsory radiation switch off
SIE Dose rate
SIE Iris collimator
SIE Area-dose product measuring device
Option present: Yes: No:
Signature:
Date: Name:
SIE Codonics printer cable break
Option present: Yes: No:
Signature:
Date: Name:
3.2.1 Monitor(s)/displays
Present: Yes: Material No.:
No: Serial No.:
Signature:
Date: Name:
SIE Monitor(s)/displays
3.2.1 Monitor(s)/displays
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 8 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
Protocol Date: Cust.-No.:
OK not n.a.
OK
Present: Yes: Material No.:
No: Serial No.:
Signature:
Date: Name:
SIE Monitor(s)/displays
3.3 Operation
SIE Check the operating functions
3.4 3D reconstruction
Option present: Yes: No:
Signature:
Date: Name:
SIE 3D reconstruction
SIE 3D reconstruction with navigation system
3.5 Conductive rubber
SIE SIREMOBIL stand voltage discharge rubber
SIE Monitor trolley voltage discharge rubber
3.6 Measurements
SIE Protective conductor test (performed under "Final Work Steps")
SIE Leakage current test (performed under "Final Work Steps")
4 Maintenance, Operating Value / Functional Inspection
4.1 Maintenance
PMP Cleaning the system
PMP System ventilation
PMP Memoskop ventilation
4.1.1 DICOM bridge
Option present: Yes: No:
Signature:
Date: Name:
Siemens AG SPR2-230.105.02.06.02 Page 9 of 12 SIREMOBIL Iso-C
Medical Solutions 07.05 CS PS 24
Cust.-No.: Date: Protocol
OK not n.a.
OK
PMP Ventilation
4.1.2 Codonics printer
Option present: Yes: No:
Signature:
Date: Name:
PMP Ventilation
PMP Cleaning
4.2 Operating value inspection
PMF Error memory
4.3 Functional inspection
PMF Video printer
Option present: Yes: No:
Signature:
Date: Name:
PMF Video recorder
Option present: Yes: No:
Signature:
Date: Name:
PMF Laser camera system "Sneaker Net"
Option present: Yes: No:
Signature:
Date: Name:
PMF DICOM bridge
Option present: Yes: No:
Signature:
Date: Name:
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 10 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
P ro to c o l Date: Cust.-No.:
OK not n.a.
OK
PMF DICOM Connect
Option present: Yes: No:
Signature:
Date: Name:
PMF Codonics printer manual control panel
Option present: Yes: No:
Signature:
Date: Name:
PMF 4 View
Option present: Yes: No:
Signature:
Date: Name:
PMF Laser camera connection
Option present: Yes: No:
Signature:
Date: Name:
PMF Image rotation
PMF Slot diaphragm
PMF Monitor display of the iris collimator aperture
PMF Monitor display of the slot diaphragm positions
5 Final Result / Quality Inspection and General Mainte-
nance
SIE Image quality (IQ) quick test
SIE DICOM bridge IQ test
SIE Codonics printer IQ test
PMP Maintenance
5.1 Final Work Steps
SIE Protective conductor test
SIE Protective conductor resistance
Siemens AG SPR2-230.105.02.06.02 Page 11 of 12 SIREMOBIL Iso-C
Medical Solutions 07.05 CS PS 24
Cust.-No.: Date: Protocol
OK not n.a.
OK
Test circuit per VDE 0751-1:
Test point 1: Measurement value 1:
Test point 2: Measurement value 2:
Test point 3: Measurement value 3:
Test point 4: Measurement value 4:
Test point 5: Measurement value 5:
Test point 6: Measurement value 6:
Test point 7: Measurement value 7:
Test point 8: Measurement value 8:
SIE Leakage current
Messkreis gemäß VDE 0751-1:
Measured value: mA
Power line voltage: V
Corrected value: mA
SIREMOBIL Iso-C SPR2-230.105.02.06.02 Page 12 of 12 Siemens AG
07.05 CS PS 24 Medical Solutions
