Exactrac Vault Evaluation Rev 3.0

• Audit Title

• Document No.

• Client/Site

• Location
  Address

• Conducted on

  Date

• Customer contact

• Phone

• Email

• Prepared by

• ASM

• Sales

• First contact

Site Information

• What is the number of vaults in the center?

• Does the room/vault being assessed have a specific name?

  Yes

  No

  N/A

• What is the Linac Model? (Include Serial Number & Manufacture Date)

  Varian

  Elekta

  Siemens

• For Varian Truebeam, is laserguard installed?

  Yes

  No

  N/A

• Are as built drawings available?

  D

  H

  Not provided

Equipment Information

• Picture of linac treatment couch.

  Media

• Picture of couch turntable.

  Media

• Is 4DTC version higher than 10.2.3?

  Yes

  No

  N/A

• Portal imaging available?

  Yes

  No

  N/A

• OBI available?

  Yes

  No

  N/A

• What R&V system is used? (Include version)

  ARIA

  Mosaiq

• What treatment planning systems will be used? (Include versions)

Elevation

• Elevation Diagram

  

• Distance From Floor to Isocenter (A)

• Distance From Isocenter to False Ceiling (B)

• Distance From False Ceiling to Concrete (C)

• If Applicable, Distance From Isocenter to False Ceiling at IR camera Post Location (D)

• If Applicable, Distance From False Ceiling to Concrete at IR camera Post Location (E)

Plan

• Plan Diagram

  

• Distance Between Lateral Laser Walls (A)

• Distance From Back Wall to Front Wall (B)

• Distance From Back Wall From Isocenter (C)

• Length of Maze (D)

• Width of Maze (E)

• If Applicable, Service Area Width (F)

• Maze Wall Width

Door

• Door: Width of opening clearance

• Door: Height of opening clearance

Treatment Room and Control Room Information

• What is type of existing flooring?

  Vinyl

  Carpet

  Wood

  Other

• What is type of existing wall covering?

  Paint

  Wallpaper

  Other

• Does the treatment room support ET generator and cabinet?

  Yes

  No

  N/A

• Are flat panel locations free and clear of obstructions?

  Yes

  No

  N/A

• Position 1?

  Yes

  No

  N/A

• Position 2?

  Yes

  No

  N/A

• What is recommended, ceiling mounted monitor arm or wall mount?

  Ceiling Arm

  Wall Mount

• Are considered touch screen locations free and clear of obstructions?

  Yes

  No

  N/A

• Is IR camera location free and clear of obstructions?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Contractor specifics

• Is there existing power available for the ETX generator?

  Yes

  No

  N/A

• What voltage is available?

  480V 70A

  208V 100A

• Is there existing 120V 30A single phase available for the ETX computer cabinet?

  Yes

  No

  N/A

• 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

  N/A

• 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

Additional information

• Will this be a no downtime install?

  Yes

  No

  N/A

• What type of X-Ray Floor Boxes will be installed?

  In floor 12"

  On floor

• Additional Comments

• Additional Photos

  Media