Exactrac Vault Evaluation rev 1.1a - duplicate

• Client/Site

• Location
  Address

• Conducted on

  Date

• Main contact

• Phone

• Clinical contact

• Phone

• Prepared by

• ASM

• Sales

• First contact

Customer background

• Number of vaults in center

• Total patients for center

• Patients treated per day in vault

• Percent IMRT for vault

• R&V

• Version

• TPS

• Version

• As built provided while on site

  Yes

  No

  N/A

• Digital or hard copy

  D

  H

• 4DITC

  Yes

  No

  N/A

• Version

Equipment background

• Linac model

• Linac serial number

• Linac energies

• Linac software version

• Linac manufacture date

• MLC model

• Couch model

• Couch serial number

• Couch Baseframe

• Portal imaging

  Yes

  No

  N/A

• Model

• Accessories type

Elevations

• Elevation diagram

  

• Distance from floor to isocenter (A)

• Add media

  Media

• Distance from isocenter to false ceiling (B)

• Add media

  Media

• If applicable, @IR camera (C)

• Add media

  Media

• Distance from false ceiling to concrete (D)

• Add media

  Media

• If applicable, @IR camera (E)

• Add media

  Media

Plan

• Plan diagram

  

• Distance between lateral laser walls (A)

• Add media

  Media

• Distance from back wall to front wall (B)

• Add media

  Media

• If applicable, service area (F)

• Add media

  Media

• Distance from back wall from iso (C)

• Add media

  Media

• Length of maze (D)

• Add media

  Media

• Width of maze (E)

• Add media

  Media

• Maze wall width

• Add media

  Media

• Width of opening clearance

• Add media

  Media

• Height of opening clearance

• Add media

  Media

Vault and console characteristics

• Existing flooring

• Existing wall coverings

• Any new items for quote (i.e. Cabinets)

• Does the treatment room support ET generator and cabinet?

  Yes

  No

• Are flat panel locations free and clear of obstructions?

  Yes

  No

• Position 1?

  Yes

  No

• Position 2?

  Yes

  No

  N/A

• Is the Ceiling arm location free and clear of obstructions?

  Yes

  No

  N/A

• IR camera?

  Yes

  No

  N/A

• Is there space to run conduits between the ET cabinets and the in room distribution box?

  Yes

  No

• Are there pre-existing open conduits accessing the treatment room?

  Yes

  No

• Is there access behind the gantry stand of the LINAC?

  Yes

  No

• What is the capacity of the HVAC system?

• Does the console area support additional ExacTrac (ETX) components?

  Yes

  No

Contractor specifics

• Is there existing power available for the ETX generator?

  Yes

  No

• Voltage that is available?

• Is there existing power available for the ETX computer cabinet?

  Yes

  No

• What is the length from the loading/unloading area to the treatment room entrance?

• What is the length from the electrical closet to the treatment room entrance?

• Is the loading area on the same level as the treatment room?

  Yes

  No

• Is there adequate space in the loading/unloading area for Brainlab and construction?

  Yes

  No

  N/A

• Is the parking on the premises available?

  Yes

  No

  N/A

• Can the construction crew easily access the building?

  Yes

  No

  N/A

• Is there STORAGE space available for the ETX pre-installation and installation shipments?

  Yes

  No

  N/A

Comment section

• Comments

• Additional photos

  Media

• Additional drawings

  Drawing