Therapy Remarketing Group
 

Linear Accelerator Questionnaire

Please supply the following information about your Facility and Linear Accelerator.

Facility Information ( Required fields are denoted by )
 
 Your name:
Title:
Organization:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Email:

Linear Accelerator Information
 
Manufacturer:
Model:
Serial Number:
Manufacturer date:
Installation date: — mm/dd/yy
Estimated removal date: — mm/dd/yy
Is it still installed?
Is it still operational?
Photon energies: MV
Electron energies: MeV
Beam hours: hrs.
Filament hours: hrs.
Klystron/Magnetron ever replaced? Yes No
Klystron/magnetron replacement date: — mm/dd/yy
Waveguide ever replaced?: Yes No
Waveguide replacement date: — mm/dd/yy
What other major component have been replaced (and when)?
Does it have a beamstopper or counterweight?

Does the system have Independent (asymetric) Jaws? Dual    Single    None
Couch Type:
MLC Type (If any)
Software revision:
Does it have a complete spare parts kit? Yes No
If "no", what is missing?
Additional system information?

Technical Contact (for more information about the linear accelerator)
 
Name:
Phone:

Service Contact (who has been maintaining the linear accelerator)
 
Name:
Phone:
How many years?