ECT Service Department of Biological Psychiatry New York State Psychiatric Institute

ECT Device Test and Calibration Form

Mecta spECTrum 5000Q Models

Testing conducted by:

Device Tested:

Name

Manufacturer/Model

Results of Testing (Pass/Fail):

Reason for Failure:

Date

Serial No.

COMMENTS I

Signature of Authorized Individual Assessing Test Results

Form Revision Date: 2/06/01

Date

(Page 1 of 15)

ECT Device Test and Calibration Form

Date Device Type

Serial Number-]

I I I I

Line Isolation Safety

Power Cord Resistance (mOhm)

Case Leakage, External Lead (µA) [<500µAj Power Off Power On -Normal Power On - Reverse Ground Off -Normal_ Ground Off - Reverse Neutral Off - Normal Neutral Off - Reverse

Case Leakage, Ground Conductor (µA) [<58,µA] Power On -Normal Power On - Reverse

0

(Page 3 of 15)

ECT Device Test and Calibration Form

Date

Device Type

Static Impedance Readout

Self-test passes in 150-5,000 ohm range, and fails with resistance below 150 ohm and above 5,000

Documentation of Static Impedance Readout

Serial Number I

Self-Test Range Pass Fail

Known Resistor Device Static I pedance Values

Low Dose #1 High Dose #1 Low Dose #2 High Dose- #2 150 ohm 200 ohm 300 ohm 400 ohm 500 ohm 600 ohm 700 ohm 800 ohm 900 ohm 1000 ohm 1500 ohm 2000 ohm 2500 ohm 3000 ohm 3500 ohm 4000 ohm 4500 ohm 5000 ohm

(Page 4 of 15)

I

ECT Device Test and Calibration Form

Serial Nu

C.

Date Device Type

I

Stimulus Control Parameters

Warning stimulus beeps three times prior to stimulus delivery/ continuous tone during delivery

During continuous tone LCD reads "Stimulus About to Occur", then "Delivering Stimulus." After stimulus reads "Performing Internal Tests"

Following delivery, LCD displays treatment parameters (Dym Impedance, Charge, Energy, Current)

With release of stimulus control during warning, LCD displays "Treatment Terminated. Stimulus control push button released prematurely. Press clear to proceed"

With release of stimulus control during delivery, LCD dispIays "Treatment Terminated. Stimulus control pus button released prematurely. Press clear to proceed"

Following stimulus delivery, the chart recorder engages and monitors the installed amplifier

0

channels

Pressing Off halts chart monitoring, and reports treatment results

Stimulus Warning Pass I Fail

Stimulus Delivery Pass I Fail

LCD Parameters Pass I F a- ail I

Premature Release Pass Fail

Premature Release Pass Fail

Chart Recorder Engage Pass Fail

Treatment Results

Pass Fail

(Page 5 of 15)

ECT Device Test and Calibration Form

Date Device Type Serial Number

Pulse Width Calibration Low Intensity

20 Hz, .5 sec; .5 A, 200 ohm

Independent Obtained Values

Voltage + Voltage - Current + Current - Hz

0.2 ms 0.3 ms 0.4 ms 0.5 MS 0.6 ms 0.7 ms 0.8 Ms 0.9 MS 1.0 MS 1.1 Ms 1.2 ms 1.3 ms 1.4 ms 1.5 Ms 1.6 ms 1.7 ms 1.8 Ms 1.9 Ms 2.0 ms

0

(Page 6 of 15) ECT Device Test and Calibration Form

Date Device Type Serial Number

0.2 ins 0.3 ms 0.4 ms 0.5 ms 0.6 ms 0.7 ms 0.8 ms 0.9 ms 1.0 ms 1.1 ms 1.2 ms 1.3 ins 1.4 ms

1.5 ms 1.6 ms 1.7 ins 1.8 ms 1.9 ms 2.0 ms

I

Pulse Width Calibration Low Intensity (Cont.)

20 Hz, .5 sec, .5 A, 200

I

-1

SPECTRUM Reported Values

current Dynamic Energy Charge Imp

Independent Values

Current Dynamic Energy Charge Imp

(Page 7 of 15) ECT Device Test and Calibration Form

Date :1

I Device Type

Pulse Width Calibration High Intensity

1 120 Hz, 4 sec; .8 A, 300 ohm

I Serial Number I

Independent Obtained Values

Voltage + Voltage - Current + Currant - Hz

0.2 ms 0.3 ms 0.4 ms 0.5 ms 0.6 ms 0.7 ms 0.8 ms 0.9 Ms 1.0 Ms 1.1 MS 1.2 ms 1.3 ms 1.4 ms 1.5 ms 1.6 ms 1.7 ms 1.8 ms 1.9 Ms 2.0 ms

I

(Page 8 of 15)

ECT Device Test and Calibration Form

Date Device Type

2 ms 0.3 ms 0.4 ms 0.5 ms

0.6 ms 0.7 ms 0.8 ms

Serial Number

Pulse Width Calibration High Intensity (Cont.)

120 Hz, 4 sec; .8 A, 300 ohm

SPECTRUM Reported Values Independent Values Current Dynamic Energy Charge Current Dynamic Energy Charge

Imp Imp

1.1 ms 1.2 ms 1.3 ms 1.4 ms 1.5 ms

s

Charge

1.6 ms 1.7 ms

1.8 ms 1.9 ms 2.0 ms

(Page 9 of 15)

ECT Device Test and Calibration Form

Dale Device Type

Pulse Frequency Calibration

Low Intensity Test .3 ms, .5 sec; .5 A, 200 ohm

20 Hz

30 Hz 40 Hz

Serial Number I

Independent Obtained Values

Voltage + Voltage - Current + Current - Hz

50 Hz 60 Hz 70 Hz 80 Hz 90 Hz 100 Hz 110 Hz 120 Hz

SPECTRUM Reported Values

Current

Dynamic Imp

Energy

Charge

Current

Independent Values

Dynamic Imp

I 20 Hz L 30 Hz I

40 Hz 5 0 Hz

60 Hz 70 Hz

80

90 LIZ 100 Hz 110 Hz 120 Hz

Charge

(Page 10 of 15)

ECT Device Test and Calibration Form

Date Device Type

Pulse Frequency Calibration

High Intensity Test 1.5ms, 4 sec; .8A, 300 ohm

I Serial Number

Independent Obtained Values

Voltage + Voltage - Current + Current - Hz

20 Hz 30 Hz 40 Hz 50 Hz 60 Hz

70 Hz

80 Hz 90 Hz 100 Hz 110 Hz 120 Hz

20 Hz 30 Hz 40 Hz 50 Hz

60 Hz 70 Hz 8O Hz

90Hz I 100 Hz 11O Hz I

1 120 Hz

SPECTRUM Reported Values Independent Values

Current Dynamic Energy Charge Current Dynamic Energy Imp Imp

(-.I

Charge

(Page 11 of 15)

ECT Device Test and Calibration Form

Date Device Type Serial Number

Current Intensity Calibration

Low Intensity Test: .3 PW, 20 Hz, .5 sec; 200 ohm

0

A .600 A .700 A .800 A

.900 A_ .500 A .600 A .700 A .800 A .900 A

High Intensity Test 1.5 PW, 120 Hz, 4 sec, 300 ohm

.500 A .600 A .700 A .800 A .900 A .500 A .600 A .700 A .800 A .900 A

Independent Obtained Values

Voltage + Voltage - Current + Current - Hz

SPECTRUM Reported Values Independent Values

Current Dynamic Energy Charge Current Dynamic Energy Imp Imp

L. I

Charge

(Page 12 of 15) ECT Device Test and Calibration Form

Date I Device Type I I

Serial Number]

Train Duration Calibration

Low Settings .3 PW, 20 Hz, .8 A, 200 ohm

0.50 sec 0.75 sec 1 .00 sec 1.25 sec 1.50 sec 1.75 sec 2.00 sec 2.50 sec 3.00 sec 4

Independent Obtained Values

Voltage + Voltage - Current + Current - Cur Duration Hz

0.50 sec 0.75 sec 1.00 sec

2.00 sec 2.50 sec 3.00 sec 4.00 sec

SPECTRUM Reported Values

Current Dynamic Energy Charge

L. I

Independent Values

Current Dynamic Energy Charge Imp

(Page 13 of 15)

I

ECT Device Test and Calibration Form

Date Device Type Serial Number I

Train Duration Calibration

High Settings 1.5 PW, 120 Hz, .8 A, 300 ohm

0.5 sec 0.75 sec 1.00 sec 1.25 sec

1.75 sec 2.00 sec 2.50 sec 3.00

4.00 sec

.00 sec

0.50 sec 0.75 sec 1.00 sec 1.25 sec 1.50 sec 1.75 sec 2.00 sec 2.50 sec

Independent Obtained Values

Voltage + Voltage - Current + Current - Cur Duration Hz

3.00 sec

4.00 sec

SPECTRUM Reported Values Independent Values

Current Dynamic Energy Charge Current Dynamic Energy Charge

IMP 9 Imp

(Page 14 of 15) ECT Device Test and Calibration Form

Date 9 Device Type I Serial Number 150 ohm] 200 ohm 250 ohm 300 ohm] 350 ohm 400 ohm]

450 ohm] 500 ohm] 550 ohm]

150 ohm] 200

250 ohm]

1 300 ohm

350 ohm] 400 ohm] 450 ohm

500 ohm 550 ohm]

Dynamic Impedance Calibration: Low Intensity

20 Hz, .3 msec, .5 sec, .8 A

SPECTRUM Reported Values Independent Values

Current Dynamic Energy Charge Current Dynamic Energy Charge Imp Imp

Dynamic Impedance Calibration: High Intensity

120 Hz, 1.5 msec, 4 sec, .8 A

SPECTRUM Reported Values Independent Values Current Dynamic Energy Charge Current Dynamic Energy Charge Imp Imp

(Page 15 of 15)

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