Therapy Remarketing Group
 

Equipment Available

Linear Accelerator Questionnaire

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

Facility Information (Required Fields )
 

 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?