Site Specifications

Site specification

Is this a LGK B/C to PFX/Icon

Old LGK Serial number?

Scraping old system on site?

Is this a LGK PFX to Icon

PFX serial number:

Does the Clearance Check Tool have flex tip or not?
If not a CCT Calibration tool must be sent to site to be used during Phase 2 of the installation.

Is a reload

Hospital Name:

Hospital Address:
Date of inspection:

Reason for inspection:

Customer Representative Signature:
Local Elekta Representative Signature:
Elekta OF Sweden Signature

Pre-Installation Administration

Pre-Installation Administration

Have all parties agreed on the delivery date for the unit?

What is the delivery date?

Has the rigging firm been hired and reviewed the delivery route?

Contact name & phone:

Name of rigging firm:

Have the owner and rigging firm discussed and agreed on the space needed for staging of equipment during deliveries?

Will a lockable area be available for the storage of delivered equipment and tools?

Has the radioactive materials license been received by the user and a copy sent to Elekta Project Manager?

What type of license is on hand?

Is the Radiation Safety Officer, or Authorized person, available to receive the radioactive material on the selected date as per the license conditions?

RSO Name:

RSO Contact #:

Is network information available?

IP address for the Router :

Subnet mask:

Default gateway address:

Broadcast IP address:

Domain name:

DNS Server address:

IP addresses to all known Dicom clients that are to send images to the LGK:

Have the Scanner Interface Forms and Adapter Information been complete and returned to Elekta Project Manager?

FCO

(N/A if the site does not have any Steriotaciall Vantage systems)

YES if all old Vantage Fiducial Boxes AND MRI head coil adapters are replaced with latest versions, No in all other cases.

Is FCO 100-06-301-001 implemented?

Additional comments:

Access to Site / offloading area

Access to site / offloading area

Has the rigger reviewed the area designated for delivery and will that area be clean and unoccupied at delivery time?

Is the off loading area flat and at the same height as the entrance to the hospital building?

If not, who is responsible for preparing the equipment landing area for the off loading?

Name:

Contact number:

Date this will be done:

Has security been notified of the area needed, the timing and extent of the rigging operations of the equipment deliveries and pickup?

Has the radiation safety officer reviewed the delivery route for the cobalt, both outside and inside the building?

Has it been determined that the minimum dimensions of 2 meters width and 2 meter free hight (clear opening) of the delivery route have been met? No passage can be smaller then 1.9 m X 2.0 m.

If not, have arrangements been made to ensure that the minimum dimensions are met throughout th delivery route?

Have pull points been installed (Hilti HKD-SR M20×80 or equivalent) in the rigging route and treatment room?

Has it been determined that the delivery route can support the 18500 KG of the radiation unit, rigging equipment and personnel necessary to move the unit, (floor
load requirement 20 tons / m²).

Is there finished flooring in the delivery route and if so, has the rigger been advised and agreed on flooring protection that will be used?

NOTE: It is recommended that the finished flooring be in place before the delivery of he radiation unit. ( except Terrazzo or Clay Tile)

Has the delivery route for the reminder of the system components been determined and will it be clean and clear of obstructions on the delivery date?

i.e. patient couch, covers, electrical cabinets, etc

Is there a gradient in the delivery route?

Has the rigger reviewed it and made arrangements for equipment necessary to affect delivery?

Has security been informed and have a plan in place if parking/blocking roadways are involved?

NOTE: On new construction sites the entire delivery route must be clean and clear of all obstructions the day before delivery.

NOTE: On existing building sites, hospital personnel must be clear of the delivery route during equipment movements and any obstructions must be removed.

Additional comments:

Treatment Room

Treatment Room

Has the ECU floor box for the radiation unit been checked for correct position?

Has all new concrete work been complete?

Has the floor been checked for levelness?

Does the area require earth quake kit

If earth quake kit is to be installed, has a contractor been contacted regarding the eight 32mm diameter and 180mm deep holes needed for bolts.

Have the door(s) been hung and checked operational with locks to secure the radioactive material once it is on site?

Who will have the keys for access?

Contact number?

Are the final lighting and controls installed and operational?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = +22 to +26 °C (+15 °C to +30 °C during rigging) & humidity = less then 50% (30–75% during rigging) 24/7?

Elekta specify +22 to 26 °C for patient comfort & humidity less then 50% for optimum equipment operation.

Is the ceiling height at 2600 mm (min) to allow loading to occur inside the treatment room?

Are the power outlets operational in the vault?

Is the the site using the Nova Solutions Disconnect Panel?

Has a separate 3 phase and single phase disconnects been installed?

Has a R2 contactor been installed with helper relay (R1) and wiring to ECU floor box been installed?

Is R1 24VDC Relay?

Record the current at 24VDC or the resistance in the coil of R1

Record the single phase voltage

Record the 3 phase voltage:

(PAS) Does the Pause Wall Switch operate correctly? (N.O. mom)

Have all Pause, Emergency, Stop, and Door Switches installed prepared with 2.5 m tails pulled to the ECU box?
Door switch is not included on our delivery.

(ESS) Does the Emergency Stop wall switch operate correctly? (N.C. latching)

(DS1 / 2) Does the door switch/es operate correctly when treatment room doors close? (Doors closed = short)

(RON) Does the Radiation Warning Light operate when control wires are shorted together?

Record the Voltage and Current measured across RON control wires: (24vac, <1.0 amp)

(TRM) Confirm there is an empty 25 mm & 50 mm conduit w/pull strings from Treatment Room Monitor location to control room.

(USI) Confirm there is an empty 50 mm conduit w/ pull string from User Status Indicator location to Floor box under RU.

(CAM1) Confirm there is an empty 50 mm conduit w/ pull string from Camera location on isocenter to control room.

(RM) Confirm a conduit path and outlets at both ends for a customer supplied and customer installed Radiation Monitoring Device.

Are all electrical box covers mounted and all conduits labelled as to destination?

Are the pull strings installed in the conduits for Elekta installed cables?

If in-line pull boxes have been installed, there has to be personnel standing by to assist in the pulling of the Elekta supplied cables.

Has the personnel been advised if applicable?

Contractor name:

Contact number:

Is all the work completed in the treatment room, control room, and planning room to allow installation to take place without interruption?

This includes all flooring, ceiling work, cabinetry, conduits, contractor wiring, user supplied cameras, door switches, e-stops, in-room radiation monitor, data link cabling, and phone lines, etc.

Has the installation been discussed with the site physicist and is he/she available for acceptance testing as needed?

Have final floor finishes (except Terrazzo & Clay tile) been installed?

Additional comments:

Control Area

Control Area

Is all millwork/desks and furniture installed and cable passages drilled in counter tops with grommets installed?

NOTE: the cable passages can be drilled while the installers are on site to determine best location if the contractor will be on site during the installation.

Are the conduits and cable ducts installed?

NOTE: all conduits and cable ducts made of metal (conducting material) must be grounded.

Are the conduits and cable ducts clean and clear?

Do the cable duct covers fit correctly?

Are pull strings installed in the conduits that will be used for Elekta supplied cables?

Are the power outlets operational and in the control room?

Are the final floor finishes installed?

If not, when will this be done?

Are the ceiling grid and all ceiling tiles installed?

Is the control room dust free and cleared of debris?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = +22 to +26 °C (+15 °C to +30 °C during rigging) & humidity = less then 50% (30–75% during rigging) 24/7?

Elekta recommends +22 to + 26 deg for patient comfort and less than 50% humidity for optimum equipment operation.

Are the final lighting and controls installed and operational?

Are the hospital network drops installed and operational? (2 minimum)

If not, when will they be installed?
When will they be operational?

Is there a Wi-Fi or LAN network with internet access that our engineers can use during the installation in the control area?

What is the SSID (name of the network)? : What is the Password? :

Additional Comments:

Treatment Planning Area

Treatment Planning Area

Is this a upgrade from older LGP

Is there also a SPS installation on the same PC

LGP version now:

Database size:

Number of patients:

Is all millwork/desks and furniture installed and cable passages drilled in counter tops with grommets installed?

NOTE: the cable passages can be drilled while the installers are on site to determine best location if the contractor will be on site during the installation.

Are the hospital network drops installed and operational?

If not, when will they be installed?
When will they be operational?

Are the power outlets operational and in the control room?

Are the door(s) installed and lockable?

Who will have the keys for access?

Are the final floor finishes installed?

Are the ceiling grid and all ceiling tiles installed?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = +22 to +26 °C (+15 °C to +30 °C during rigging) & humidity = less then 50% (30–75% during rigging) 24/7?

Elekta recommends +22 to + 26 deg for patient comfort and less than 50% humidity for optimum equipment operation.

Are the final lighting and controls installed and operational?

Is there a Wi-Fi or LAN network with internet access that our engineers can use during the installation in the control area?

What is the SSID (name of the network)? : What is the Password? :

Additional Comments:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.