DXA Quality Control Survey Form
Please complete this form to evaluate and document the DXA quality control checks. Your feedback helps ensure accurate and reliable results.
Date of Quality Control Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility or Department Name
*
Operator Name
*
DXA Machine Model
*
Please Select
GE Lunar
Hologic
Norland
Other
Was the daily calibration performed successfully?
*
Yes
No
Phantom Scan Results
*
Rows
Pass
Fail
BMD within acceptable range
1
2
Image quality acceptable
3
4
No artifacts observed
5
6
How would you rate the overall condition of the DXA machine?
*
1
2
3
4
5
How confident are you in the accuracy of today's QC results?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Were all QC logs and documentation completed?
*
Yes
No
Additional Comments or Observations
Submit Survey
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