Free 3068 - Federal

DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION

FIELD TEST SERIAL NO. (1-8)

PEAK KILOVOLTAGE DETERMINATION FIELD TEST RECORD
(Use Form FDA 2782, Field Test Record Continuation, if more space is needed.)

Print Legibly. Use Black Ball Point Pen. Enter One Character per Box. Do Not Write in Shaded Area.

KV
REGIONAL REVIEW (NAME)

Card No.
(9-10)

Test Procedure: 1.

Technique Factors: 2. kVp non-dental: 71 to 90 kVp dental: 70 kVp or lower 3. mA

KV
11 13
4.

14

16

17

20

.
21 24
mAs

sec

OR

pulses

25

27

5.

28

30

30
Copper Transmission Data: MDH (Exposure Mode) 6. at least 100mR mR
dental add 3.5 mm Al

@

31
7.

34

.
35 39 43

mR

@
40

. . . . .

0

0

mm Cu

mm Cu

42

8.

9.

. . .

mR

@
47

mm Cu

46

49

mR

@
54

mm Cu

50
10. less than 2% of Item 6

53

56

mR

@
61

mm Cu

57
REMARKS

60

63

Copper Thicknesses (mm) kVp Dental: 65 70 70 80 90 Item 7 0.46 0.46 0.46 0.54 0.67 Item 8 0.87 0.87 0.87 1.00 1.33 Item 9 1.00 1.00 1.00 1.33 1.67 Item 10 1.26 1.54 1.67 2.13 2.67

Non-Dental:

CHECK IF CONTINUATION SHEET USED
FORM FDA 3068 (8/92)
PSC Media Arts (301) 443-1090

EF