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					National Non-Drug List                                                                    MRI                                                                             1st Edition, 2012




                                                                            ANNUAL INDENT: 2013-2014

Name of the Health Centre:                                                                                                                                 Date:

Note: Fill in the quantity required only against those rows which has "√" marks against the level of your Health Centre. You are strictly advised to follow this standard format
only
                                                                                                               Qty.      Qty.     Current Average            Qty.
                                                                                               BHU BHU
    S/No                     Particular Specification              P/Size NRH RRH DH                        Indented Received       stock      monthly Required Remarks
                                                                                                 I      II
                                                                                                              12-13      12-13     Balance       use       for 13-14
                                                                                 EQUIPMENTS

                              MRI Equipment
             MRI friendly Suction machine 1/2 HP, mobile fibre
             casting pressure tube with pressure regulator tube.
             Twin suction bottle of 2-3 Ltrs capacity. Display of
 MRI/E-101                                                           Set     √
             vacuum from 100 to 700mm HG. (MRI compatible)
             Power supply: AC 220V- 230V, 50HZ Power cord
             with round 3 pin top
 MRI/E-102   CO2 cylinder for MRI 'A' type (Re-filling)             Piece    √
 MRI/E-103   MRI compatible wheel chair                             Piece    √
 MRI/E-104   MRI compatible Patient trolley                         Piece    √
 MRI/E-105   MRI compatible IV Stand                                Piece    √
             MRI compatible Anaesthesia machinePower supply:                                                                                                        BES/Anaesthesia
 MRI/E-106   AC 220V- 230V, 50HZ Power cord with round 3 pin         Set     √                                                                                      to be provide
             top and suitable voltage stabilizer                                                                                                                    Specs
                                                                                                                                                                    BES/anaesthesia
             MRI compatible Pulse Oximeter,Power supply: AC
 MRI/E-107                                                           Set     √                                                                                      to be provide
             220V- 230V, 50HZ Power cord with round 3 pin top
                                                                                                                                                                    Specs
           Dry view camera, Power supply: AC 220V- 230V,                                                                                                            BES to be
 MRI/E-108                                                          Piece    √
           50HZ Power cord with round 3 pin top.                                                                                                                    provide Specs
 MRI/E-109 Patient Positioning straps (Belts)                        Set     √
                                                                                                                                                                    BES to provide
 MRI/E-110 MRI UPS                                                   Set     √
                                                                                                                                                                    Specs
                                                                                                                                                                    BES to be
 MRI/E-111 MRI Machine with automatic injector                       Set     √
                                                                                                                                                                    provide Specs




                                                       Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                     MRI                                         1st Edition, 2012




           MRI machine 1.5 Tesla specifications: ADW CPU,
           ADW monitor, mouse and mouse pad, metal detectors,
           Kodak dry view 8900 camera, report card CPU,
           Monitor, key board, CCTV, newmatic slimline head
           sets, microphone, Onkyo music system with speakers,
           AM/FM antenna, GOC computer, Monitor, PAC
           monitor, spectris solaris pressure injector 2 batteries
           and charger, SCSI tower, keypad, mouse and pad,
           gradient chiller, 1.5T sumitomo compressor, Cryo
           chiller, Quad knee coil, 8 channel brain coil, 1.5T split
           head coil, 8 channel body array, 8 channel Neuro
 MRI/E-112 Vascular array, 8 channel CTL coil, 8 channel anterior      Set    √
           bridge, general purpose flex coil, phased array
           shoulder coil, 8 channel breast coil, QD plug coil
           adaptor extremity, coil ID connector, 1.5T peripheral
           Vascular coil, 1.5T 5 inch round coil, 1.5T 3 inch
           round coil, Dual array adaptor, MR compatible
           adaptor, MR compatible anaesthesia m/c, phantom cart
           with LV shim phantom, DQA phantom with loader,
           TLT head sphere, ball phantom, upper anular
           phantom, CTL phantom, SNR phantom head SNR
           phantom, ball phantom with base, 8 channel NV array
           phantom, loading phantom, service ladder, newmatic
           slimline head sets, invivo pulse oxymeter, ERU,




                                                         Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                     MRI                                         1st Edition, 2012




             CT Machine 16/64 slice Specification: Brilliance CT
             16 slice: Infant cradle, Extended Brilliance
             Workspace, Bone mineral analysis package PC: HP dx
             2000PC, Color laser printer HP 3800n, Kodak Dry
             view laser camera 8900, Stabilizer, UPS with 30
             minutes backup – 125KVA, Pressure injector:
             MEDRAD Stellant, Defibrillator: Heart start XL,
             Separate PC for conferencing and teaching aids,
             Anesthetic machine with pediatric and adult ventilator.
             Cardiac monitor with stand and Pulse oximeter
             compatible to the machine. Scan tools Pro, RRCV
             tools kit, Functional CT/MR image fusion, CV pro
             analysis package, Virtual colonoscopy, Dental
             planning package, Lung disease quantification
             package, Bone mineral analysis, (Installed in
             Computer).



 MRI/E-113                                                             Set    √




                                                         Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                   MRI                                         1st Edition, 2012




           Operator’s Manuals/ Documentations: Bone
           mineral analysis program (Q-MAP II) CT operator’s
           manual, Brilliance CT – Instruction for use – English
 MRI/E-113 Volume -1, Brilliance CT – Review – Volume – 2,          Set     √
           Brilliance CT – Basic analysis – English – Volume –
           3, Brilliance CT – Advanced analysis – English –
           Volume – 4, Extended Brilliance Workspace –
           Instruction for use – Volume – 1, Extended Brilliance
           Workspace – Viewing modes – Volume – 2, Extended
           Brilliance Workspace – Analysis – Volume – 3,
           Extended Brilliance Workspace – View forum –
           Volume – 4, Extended Brilliance Workspace -
           Supplement version 2.1 Instruction for use, Extended
           Brilliance Workspace – Cardiac application guide,
           Brilliance CT – 16 power configuration: Cardiac
           applications, CT patient log, Kodak Dry view 8900
           laser imager – Release 3: User guide, Stellant CT
           injection system: operation manual, M3/M4 Monitors
           (M3046A) Measurement server: Instruction for use,
           Heart start XL - Instruction for use, Heart start XL –
           User training workbook, Oxywave pulse oximeter:
           Operation manual, Drager Anesthesia Ventilator,
           Model Fabius-CE: Operation manual, Drager
           Anesthesia Ventilator, Model Fabius-CE: Medibus for
           CDs/MODs: Brilliance_ Host_ OS_2.0.0.10,
           Brilliance CT- Host 2.0.2.13005, Brilliance CT-
           incremental 2.0.2.13006, Brilliance CT- versions
           2.0.2. 13011, CIRS – 4.1.19.5, CIRS- Service-
           4.1.19.5, Brilliance CT- Firmware-2.0.2.13001, A
           plane collimator calibration files: S/N 1758, Systems
           Diagnostic utilities: Revision:014, Dell Precision
           Workstation resource CD.




                                                       Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                 MRI                                               1st Edition, 2012




            Extended Brilliance Workspace V2.1.1 –Software
            CD set: P/N 4550 122 02131: Unattended V1.25 –
            EBW-V2.01: Disk: 1of 6, Environmental creator
            –EBW-V2.0.1: Disk: 2 of 6, COTS (3rd party) V2.0.1-
            EBW-V2.0.1: Disk: 3 of 6, Application software –
            EBW-V2.0.1: Disk: 4 of 6, View forum – EBW-
            V2.0.1: Disk: 5 of 6, Mandatory Add-on – EBW –
            V2.0.1: Disk: 6 of 6, Update version –V2.0.11- EBW,
            EBW-V2.1.0, EBW-V2.1.1, Brilliance Hot fix,
            NVIDIA FX540 Drivers CD For Dell 670-EBW.
           Drivers & Utilities – Dell Precision Workstation
           Resource CD, Q-MAP II Version 3.15, Q-MAP II
           Instructional CD: Rev. A, Merge DSP 1.0.2 Dicom
           storage provider, Microsoft Windows XP Professional
           Service Pack2: Operating system CD – For HP PC,
           Microsoft Windows XP Professional Service Pack2:
           Version 2002 – Compaq PC, HP/Compaq DX 2000
           MT drivers, HP restore Plus: For HP dx 2000 MT PC,
 MRI/E-114                                                        Set     √                                                        Accessories
           HP Business Desktop documentation library CD:
           dx2000 model, HP color LaserJet 3800, Norton
           Antivirus, LCD monitor – Electronics user’s manual:
           Version – H6195, Kodak Dry view 8900 laser imager
           – Version 1.0, Default grid voltage file: Tube No.
           105702 MRC 600, Heart start XL: User training CD
           ROM, Sony magneto optical Disk – 9.1GB: Model
           EDM 9100C.




                                                     Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                     MRI                                         1st Edition, 2012




            Cables and Hardware accessories/spares: Spike
            buster/Extension box with six outlets, Computer
            power cables, RJ 45 straight network – long, RJ 45
            straight network – short, RJ 45 cross straight network
            cables – short, DVI Video cable for Philips LCD
            monitor, VGA cable for Philips LCD monitor, USB
            cable, Audio cable, Examination table lifting service
            bracket, Kodak dry view laser camera connector, C7
            PCB for consul servo voltage stabilizer, C7 trip PCB
            for consul servo voltage stabilizer, Transformer CC10
            for consul servo voltage stabilizer, Transformer CC11
            for consul servo voltage stabilizer, 12 teeth pinion for
            consul servo voltage stabilizer, Carbon brush for servo
            voltage stabilizer, Packing sims-1mm, Packing sims-
            2mm, CT tube repairing kit, Laser aperture tool, Cable
            for QMAP PC, Parallel cable, Earth cables for ECG
            Monitor, Binder, Dongle for QMAP PC, VGA adaptor
            HD15/DB15.
            MR Pulse oximeter: Invivo 4500 MRI pulse oximeter
            with pediatric sensor, Monitors blood oxygenation,
MRI/E-115   pulse and waveform in MR environment. Includes              Set     √
            oximeter, fiberoptic pediatric sensor, Power supply:
            AC 220V- 230V, 50HZ Power cord with round 3 pin
            top.
MRI/E-116   UPS 80KVA                                                   Set     √
            MR compatible Laryngoscope for adult and
MRI/E-117                                                               Set     √
            children
            MR compatible anesthesia machine for adult and
MRI/E-118                                                               Set     √
            paediatrics
                                                                                    CONSUMABLES
                             MRI Consumables
                                                                       Packet
            Film - dry view laser imaging film: Size 14 x 17 inch
MRI/C-201                                                              of 125   √
            (compatible with the machine)
                                                                       sheets
MRI/C-202 Ear Plugs (spongy foam)                                      Piece    √
MRI/C-203 MRI compatible ECG leads                                     Piece    √
                                                                                    ACCESSORIES




                                                         Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                   MRI                                         1st Edition, 2012




          MRI UPS Battery: Highlit, 12xLB420, 12v
          416w/cell/15 min to 1.67v/cell at 25 degree C (77
MRI/A-301 degree F), Float voltage 13.62v at 20 degree C (68        Set     √
          degree F), 13.56v at 25 degree C (77 degree F),
          connection torque 8-9Nm/70-80 mlb.
          Hand Held Meta Detector: Hand held super scan
MRI/A-302                                                           Set     √
          metal detector weighing 10 oz.
          1.5T 8 Channel Brain Coil: This eight element head
          coil for the use with 8 channel EXCITE 1.5T MR
          system provides unprecedented high SNR. Critically
          important for high throughput, the coil is optimized
          for ASSET parallel imaging with a speedup factor of
MRI/A-303 two. With a 24 cm diameter and S/I coverage of 30         Set     √
          cm, the coil features an open, patient friendly design
          with a lookout mirror to let patients view the world
          outside the system. This coil will change your
          expectations for clinical brain imaging intracranial
          MRA and paediatric imaging (8-ch option is
          mandatory)




                                                       Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                  MRI                                         1st Edition, 2012




          1.5T Channel CTL Array: This 12 element, multi-
          station array for use with 8-channel EXCITE 1.5 T
          MR system delivers extraordinarily high SNR, spatial
          resolution and coverage over the full range of spine,
          soft tissue neck and carotid studies. It’s packaged to
          conform to the spin’s normal curvature and includes a
          patients comfort pad and restraint. Patients can be
          positioned head first or feet first and the coil’s
          extensive coverage 75 cm in the S/I direction-
          accommodates imaging of the entire spine, making it a
MRI/A-304 truly high productivity solution for your site. This      Set    √
          coil’s unique split top design extends its clinical
          flexibility. The removable top facilities routine neck
          imaging, including the anterior cervical spine and neck
          and eliminates the need to switch to a dedicated neck
          coil. Coil markers make accurate positioning at
          imaging isocenter surprisingly quick and easy. The
          result improved productivity and patient throughput.
          This package includes applications manuals, operating
          instructions, SNR testing phantoms and formfitting
          patients comfort pads.

          1.5 T Open Neurovascular Array: With a four-
          channel, quadrature phased array design and extended,
          48 cm S/I coverage, this receive only coil is specially
MRI/A-305 suited to high-SNR imaging of the neck, head, brain       Set    √
          and vascular system. It features a two piece removable
          top with many openings and an adjustable mirror
          system to reduce claustrophobia.




                                                      Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                   MRI                                         1st Edition, 2012




          1.5T 8 Channel body Array: This is a 12 element
          coil designed for use in creating extraordinary images
          of the chest, abdomen and pelvis on 8 channel
          EXCITE 1.5T MR system. This coil offers such
          extensive coverage that repositioning of the coil for
MRI/A-306 combined abdomen-pelvis exams typically is not         Set       √
          necessary. It provides higher sensitivity than anybody
          coil offered previously by GE, to enable the highest
          possible signal-to-noise ratio. And particularly
          important for body imaging, the coil was optimized for
          the use of ASSET98 ch option is mandatory
          USAI 1.5T Phased Array shoulder coil: The USAI 1.5
          T shoulder array coil offers the increased signal of the
          phased array coil along with a unique sleeve design
          that gives the user exceptional joint imaging
          capabilities. Added benefits of teh coil include. This
          shoulder coil is able to image the shoulder region
          providing images with clear definition of the shoulder
          joint, specifically the head of the humerus, clavical,
          acromion bone, supraspinatus muscle and ligaments.
          This shoulder coil is able to image the shoulder region
          providing images with clear definition of the shoulder
MRI/A-307                                                            Set       √
          joint, specifically the head of the humerus, clavical,
          acromion bone, supraspinatus muscle and ligaments.
          This shoulder coil is able to image the shoulder region
          providing images with clear definition of the shoulder
          joint, specifically the head of the humerus, clavical,
          acromion bone, supraspinatus muscle and ligaments.
          The shoulder coil is able to image both shoulders (not
          at the same time). The shoulder coil provides patients
          comfort for patient imaging of up to 40 minutes
          procedures. The shoulder coil is ASSET compatible
          and delivers optimum FATSAT imaging.




                                                       Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                    MRI                                         1st Edition, 2012




          Peripheral Vascular phased Array Coil: Coil is a
          specially designed 12 elements phased array coil with
          1.26 meter extended coverage for peripheral vascular
          run-offs from renal to dorsal digital arteries with
          smartstep2000. The other applications include
          visualization of lower abdomen and lower extremities.
          High signal uniformity. 1.26 meter coverage in S/I
          direction (3 x 44 cm steps with 3 cm overlap).
MRI/A-308 Physical dimension 1.37 m long and 74 cm wide.              Set    √
          Flexible and 2 part coil structure for close proximity to
          patient. Received only phased array design. Wide
          positioning strips with Velcro captures is provided
          with the coil to hold the coil closely to the peripheral
          leg vessels into a common plane. Must ensure that
          M1087CY pre amp kit also ordered with the system.
          Includes signal to noise test scanning phantom for
          image quality assurance procedures.

MRI/A-309 MAI QUAD EXTREME COIL W ID                                  Set    √
          Open breast phased Array coil: Coil is specially
          designed for imaging and visualization of the female
MRI/A-310 breast and auxiliary tissue. It is possible to perform      Set    √
          either unilateral imaging of the either left or right
          breast or bilateral imaging of the both breast.

          3 Inch circular general purpose coil: This is a 3”
          circular general purpose coil for applications in orbits,
          IAC, ankle and wrist. Can be combined with another 3
MRI/A-311                                                             Set    √
          inch GP coil for simultaneous high resolution dual
          imaging of TMJ, Orbits and IAC (Dual array adapter
          is mandatory for such applications).

          1.5T GP flex coil: Coil is designed to optimize
MRI/A-312 imaging of irregular anatomy such as the branchial          Set    √
          plexus, hip, thigh, elbow, large knees, ankle and foot.




                                                        Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                                                   MRI                                         1st Edition, 2012




          5 inch circular general purpose coil: This coil is
          useful for a wide range of small parts applications-
MRI/A-313 including the orbits, IAC, ankles and wrist. And with     Set     √
          the help of a dual array adaptor, two of the coils can
          be used concurrently for simultaneous high-resolution
          of TMJ, orbits or IAC.
          Dual Array Adapter: Allows for combining two
MRI/A-314 receive only non phased array coils. This helps in high   Set     √
          SNR imaging of symmetrical anatomy such as TMJ

Prepared by (Name & Sign):


Controlling Officer (Name & Sign of CMO/MO):


Supervised by (Name & Sign of DHO):




                                                       Quality Assurance and Standardization Division, Ministry of Health, Thimphu
National Non-Drug List                                     MRI                                         1st Edition, 2012




                         Quality Assurance and Standardization Division, Ministry of Health, Thimphu

				
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