ExacTrac Final Checklist Review Rev 4.0

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

ExacTrac X-Ray Generator

• Space for Dual Generator available? (include photo)

  Yes

  No

  N/A

• Is there a floor pull box underneath x-ray generators (include photo)?

  Yes

  No

  N/A

• Is the pull box less than 16"x16"?

  Yes

  No

  N/A

• Is the location of the pull box such that cables can be pulled and x-ray generator won't tip in?

  Yes

  No

  N/A

• Are the x-ray generators separated?

  Yes

  No

• Is the conduit length from X-Ray Generator #1 to X-Ray Generator #2 less than 15m?

  Yes

  No

  N/A

• 20m X-Ray Generator cable ordered?

  Yes

  No

• Power Supplied: 480V 70A or 208V 100A?

  480V 70A

  208V 100A

• 5 conductors: 3 phase, 1 neutral and 1 ground?

  Yes

  No

  N/A

• Correct circuit breaker / disconnect installed within 6' (include photo)?<br><br>

  Yes

  No

  N/A

Conduits

• 1x5" from floor box 1 to x-ray generator 1

  Yes

  No

  N/A

• 1x5" from floor box 2 to X-Ray Generator 2

  Yes

  No

  N/A

• 1x3" from x-ray generator 1 to computer cabinet

  Yes

  No

  N/A

• 1x3" from x-ray generator 1 to x-ray generator 2

  Yes

  No

  N/A

• Grounding bar and needed conduit in place?

  Yes

  No

  N/A

• Do all conduits meet the cable length limitations?

  Yes

  No

  N/A

ExacTrac Computer Cabinet

• Space for computer cabinet available (include photo)

  Yes

  No

  N/A

• Is computer cabinet located outside the treatment vault? (Only required if treatment energy of 10MV or higher will be used, N/A otherwise.)

  Yes

  No

  N/A

• If No, has this been approved by Happy and additional shielding been ordered?

  Yes

  No

  N/A

• Is there a floor pull box underneath Computer Cabinet (include photo)?

  Yes

  No

  N/A

• Is the pull box less than 16"x16"?

  Yes

  No

  N/A

• Location of the pull box is such a way that cables can be pulled and cabinet won't tip in?

  Yes

  No

  N/A

• Power supplied: 120V 30A single phase

  Yes

  No

  N/A

• Network drop / data connection for computer cabinet in place? (include photo). ***N/A if Elekta integration***

  Yes

  No

  N/A

• Confirmed with IT / customer that this will be live during installation? ***N/A if Elekta integration***

  Yes

  No

  N/A

• Correct circuit breaker / disconnect installed within 6' (include photo)

  Yes

  No

  N/A

Conduits

• 1x3" from computer cabinet to each flat panel detector

  Yes

  No

  N/A

• 1x2" from computer cabinet to IR Camera

  Yes

  No

  N/A

• 1x1" from computer cabinet to warning light 1 and 1x1" from warning light 1 to warning light 2

  Yes

  No

  N/A

• 1x2" for power from computer cabinet to each In Room Distribution Box and Control Room Distribution Box

  Yes

  No

  N/A

• 1x2" for data from computer cabinet to In Room Distribution Box

  Yes

  No

  N/A

• 1x3" for data from computer cabinet to Control Room Distribution Box

  Yes

  No

  N/A

• 1x2" from computer cabinet to baseframe pull box

  Yes

  No

  N/A

• 1x2" from computer cabinet to bluetooth module

  Yes

  No

  N/A

• Pathway is available for network cable to Elekta NSS firewall? ***Elekta integration only***

  Yes

  No

  N/A

• Grounding bar and needed conduit in place (include photo)?

  Yes

  No

  N/A

• Do all conduits meet the cable length limitations?

  Yes

  No

  N/A

Ceiling Mounts

• IR Camera mount installed, free of obstructions, leveled and rigid (include photo)?

  Yes

  No

  N/A

• Both Flat Panel Detector mounts install, free of obstructions, leveled and rigid (include photo)?

  Yes

  No

  N/A

• Is the mount in correct location?

  Yes

  No

  N/A

• Are the mounts in correct location?

  Yes

  No

  N/A

• Touch screen monitor mount installed, free of obstructions, leveled and rigid (include photo)?

  Yes

  No

  N/A

• Is the mount in correct location?

  Yes

  No

  N/A

X-Ray Tube Floor Boxes

• X-Ray Tube Floor boxes are installed and are within specified tolerance (include photo)?

  Yes

  No

  N/A

• For on-floor solution, is routing of on-floor cable raceways planned such that they can access generators and do not interfere with anything vital? (Note that with TrueBeam-Slim cables cannot run immediately to patient-left side of linac.)

  Yes

  No

  N/A

Distribution Boxes

• In Room Distribution Box installed (include photo)?

  Yes

  No

  N/A

• Is it installed in the correct location (withing 9' of touch screen monitor)?

  Yes

  No

  N/A

• 1x2" conduit from In Room Distribution Box to Touch Screen monitor in place?

  Yes

  No

  N/A

• 1x1" conduit from In Room Distribution Box to IR Camera and each Flat Panel Detector in place?

  Yes

  No

  N/A

• 1x2" conduit from In Room Distribution Box to Bluetooth module in place?

  Yes

  No

  N/A

• Control Room Distribution Box installed (include photo)?

  Yes

  No

  N/A

• Is it installed in the correct location?

  Yes

  No

  N/A

Warning Lights and Interlock System

• Are both the warning lights installed (include photo)?

  Yes

  No

  N/A

• Emergency stop interlock in place?

  Yes

  No

  N/A

• Door Interlock in place?

  Yes

  No

  N/A

• Beam on interlock in place?

  Yes

  No

  N/A

Pre-install cables

• Are the pre-install cables pulled? List cables that have not been pulled or issues related to the cables (include photo)?<br>

  Yes

  No

  N/A

Storage Space & Trash Removal

• Main Shipment storage space identified (include photo)?

  Yes

  No

  N/A

• Trash removal discussed with customer?

  Yes

  No

  N/A

Pre-install coordination

• Date by which all pending pre-install work needs to be complete

  Date

Linac specs and coordination

• Is 4DTC version more than 10.2.3? If new linac order then get confirmation from Varian that it will be installed.

  Yes

  No

  N/A

• Is BCCV installed? If new linac order then get confirmation from Varian that it will be installed.

  Yes

  No

  N/A

• Is laser guard installed? If new linac order then get confirmation from Varian that it will be installed.

  Yes

  No

  N/A

• Is ADI/MMI installed? If new linac order then get confirmation from Varian that it will be installed.

  Yes

  No

  N/A

• Couch recalibration services ordered and scheduled?

  Yes

  No

  N/A

• Juniper firewall installed? Add photograph. If new linac order then get confirmation from vendor that it will be installed.

  Yes

  No

  N/A

• Is the R&V system installed?

  Yes

  No

  N/A

• What R&V system does the customer have? (Include version number)

  Aria

  Mosaiq

• Is CITB ET kit installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• Is the ET goal post kit installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• Is XVI 5.0 or higher installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• Is iGuide 2.1 or higher installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• Is NSS installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• For Elekta linac with ETX integration, is MOSAIQ 2.5 or higher installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

• Is the Elekta frameless extension MI part # 10105-414 ordered/delivered?

  Yes

  No

  N/A

• iBeam evo couch adapter for brainlab couch mount ordered/delivered?

  Yes

  No

  N/A

• Integrity 1.2 for Beam Modulator, MLCi, MLCi2 or Integrity 3.2 for Agility installed? If new linac order then get confirmation from Elekta that it will be installed.

  Yes

  No

  N/A

Installation Coordination

• Installation Dates & Installation Team

• Any security clearances, badges, safety courses, immunization etc required by hospital/contractor from installation team?

  Yes

  No

  N/A

• Contractor / Facilities will be assisting with moving the cabinet in place from storage?

  Yes

  No

  N/A

• Select date

  Date

• Electrician will be present during installation to connect the back panel to the wall and connect power

  Yes

  No

  N/A

• Select date

  Date

• Identify who is going to be signing the STATEMENT OF COMPLIANCE FROM HOSPITAL / CONTRACTOR during accetpances

Additional Photographs

• Add media

  Media

Signatures

• Brainlab PM Signature

  Sign

• Customer / Contractor representative signature

  Sign