RFI 33 - ExAblate.pdf

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Site Installation Survey and Report For

VA Palo Alto

VHAPALGargM Text Box

ATTACHMENT C2

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Part I – To be completed by Capital Sales prior to execution by the Installation / Service Team

Site Information

Site Full Name Broward Health SMOC

Address (including city & country)

3801 Miranda Ave.

Palo Alto, CA 94304

Customer/Site Contact Personnel Dr. Payam Massaband

Site Phone Numbers 650-493-5000 Local MR site FE (name, email, phone to be checked via customer)

N/A N/A

Does the MR Suite layout exist?

Is it attached to this document?

Yes _X__ No ___ Yes _X__ No ___

MR Suite layout updated with FUS devices Yes___ No__x__

Additional site info N/A

MR Information & Configuration

MR magnet field 1.5T ____ 3T__X__

MR Type name GE Premier

MR software version (full software detail) Version: RX28.1

Additional info/config N/A

Completed by: Name Signature Date (MM/DD/YYYY)

Jacob Chen 2/18/2022

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Part II – To be completed by the Installation / Service Team Reference Pictures, Floor Plans, Drawings, Measurements

General

General

Loading dock YES Equipment (truck height, lift gate, dollies, etc.) needed to off load equipment onto dock and into storage or room

N/A

Free clearance for FUS equipment’s movement between loading dock to MR suite (corners/elevators/etc.)

N/A

Equipment movement limitations due to floor finish (carpets/etc.)?

N/A

Stocking patient accessory kits? N/A Storage space for the system until installation

N/A

Availability of lower drain source to drain FE/Chiller water container

The lower drain source can be placed anywhere around the MRI suite.

Availability of Deionized water source (Type 2 medical grade water source).

The Front‐End cabinet in the scanning room has a 13‐liter tank (3.25 gallons) on a cart with wheels and needs to be filled with DEIONIZED water before each treatment and be drained on the end of the treatment. The water source can be placed anywhere around the site. The definition of the required water source is in the attached site planning guide, paragraph 7.6, pages 37‐38.

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Reference Pictures, Floor Plans, Drawings, Measurements Equipment Room

Equipment Room: Special items and instructions

Existing equipment and/or cabinetry moved or removed

Following the attached lay out drawings and images A, B all the equipment and the sink with the cabinet must be removed from the area right to the scanning room door entrance. This area will be the HIFU equipment room.

Following the attached layout drawing and Images E, F, all the cartons and stuff by the right side and the back wall of the communication room must be removed to another location.

Equipment cabinet placement Following the attached layout drawing and Images A, B, the equipment cabinet will be installed by the right wall of the space, in parallel to the right wall (107”).

Chiller unit placement Following the attached layout drawing and Images A, B, the chiller will be placed in parallel to the equipment cabinet.

Pen Panel location Following the attached layout drawing and Images E, F, the pen panel will be installed on the back (north) wall of the communication room, close to the corner with the right (east) wall of the room, above the acoustic ceiling. It should be installed so that in the scanning room it’ll come out on the right wall, above the acoustic ceiling, right to the cabinet by the right wall and as close as possible to this cabinet.

Insightec will provide a pen panel frame with a blank panel that will be installed by the shielding company that the site will be in contact with. The blank pen panel installation will be done following paragraph 6.1.4, pages 23‐25 of the attached site planning guide. The area of about 11.5” under the bottom of the pen panel should be without dry wall, only the shielding wall cage, in the equipment room and in the scanning room sides.

System power requirement and location

The site will prepare in the HIFU equipment room space power for the system. The power is 480VAC, 3 phases, 50Amp, 5 wires with a D type Circuit Breaker. The system’s power cord comes out from the electronic cabinet and will be hard wired to the hospital power outlet. Following the attached layout drawing and Image A, the hospital power source with the disconnect should be on the back wall of the HIFU equipment room space, close to the left corner.

Proposed cable routing Following the attached layout drawing and Images A, C, E, the cables from the electronic cabinet and the hoses from the chiller will be routed on the floor along the back wall of the HIFU equipment room space towards the vertical ladder on the back wall and along the vertical ladder to the wall opening. Then through the wall opening to the communication room and from there on the horizontal cable tray above the acoustic ceiling towards the pen panel.

Cables from the chiller to the Equipment cabinet will routed on the floor between the 2 units.

Vertical ladders Following the attached layout drawing and Image A, the site will install on the back wall of the HIFU equipment room space, under the wall opening, close to the left corner, 24” wide vertical ladder from the floor to the wall opening.

VHAPALGargM Text Box (Pen panel cut out is 19" x 17" (+/-).

Shielding Contractor is ETS Lindgren, will know all about the cut out and drywall requirements).

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Cable Trays Following the attached layout drawing and Images A,C,D, the site will install an horizontal cable tray, 24” wide from the wall opening above the acoustic ceiling in the communication room to the pen panel above the acoustic ceiling in the communication room.

Wall openings to route cables Following the attached layout drawing and images A, B, the site will create an opening on the back wall of the HIFU equipment room space (the wall with the communication room), close to the left corner and above the acoustic ceiling. The size of the opening should be 4” height and 8” wide. The opening is for the routed cables and hoses from the equipment cabinet and chiller to the pen panel in the communication room. Images C, D show the wall opening place from the communication room side.

Any additional instructions or guidance for room modification

1. Following the attached layout drawing, the site will install a 3‐inch conduit between the HIFU equipment room space and the control room. In the equipment room it’ll start on the back wall by the top of the 24” vertical ladder and get under the countertop in the control room.

2. The site will make sure that the air condition system in the HIFU equipment room space, will follow the environment requirements described in the attached site preparation guide, paragraph 8.0, page 40.

Scanning / MRI Room

MRI/Scanning Room: Special items and instructions

Existing equipment and/or cabinetry moved or removed

N/A

Front end unit placement Following the attached layout drawing and Images G, H, the Front‐End unit will be placed by the right wall of the room, as close as possible to the MRI emergency switch box.

Pen panel location Following the attached layout drawing and following the placement and installation of the pen panel in the equipment room, it’ll come out on the right wall of the scanning room, above the acoustic ceiling, as close as possible to the cabinet on the right wall (Image H).

Vertical ladders Following the attached layout drawing and images G, H, the site will install on the right wall, right and close to the cabinet, an aluminum vertical ladder, 30 inch wide, from the floor to the pen panel above the acoustic ceiling.

Cable Trays N/A Wall openings to route cables N/A

VHAPALGargM Callout VA's contractor.

VHAPALGargM Line

Line

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Proposed cable routing The cables and water hoses from the pen panel will be routed to the vertical ladder on the right wall and from there on the floor by the right wall to the Front‐End unit.

The length of these cables should be shortened to the minimum standard length which is 6 meters.

Any additional instructions or guidance for room modification

**Note to Customer:

Ensure you have sufficient space to park the HIFU Helmet cart.

Operator / Control Room

Control Room: Special items and instructions

Existing equipment and/or cabinetry moved or removed

N/A

Workstation and monitor placement

The HIFU workstation will be placed in the control room. The HIFU workstation has a tower computer that can be placed on a cart on the floor and a 24‐inch monitor with a small console and a keyboard that must be placed side by side to the MRI monitor in front of the scanning room window.

Power requirement for the workstation computer

The tower computer and the 24‐inch monitor get power from 110VAC power outlet, recommended emergency generator 110vac power outlet.

Data port requirement and placement

The site will prepare an internet data port either in the control room or in the equipment room in order to implement the service remote support VPN tunnel network to the HIFU system.

UPS requirement We recommend that the site will add a UPS unit that will get power from the 110VAC emergency power outlet and will be connected to the workstation tower computer.

Wall/counter openings to route cables

Any additional instructions or guidance for room modification

3‐inch conduit from equipment room to control room location under the counter‐top.

The 3” conduit from the equipment room will get to the control room under the countertop.

Please see more details under the equipment room paragraph.

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IMAGE B IMAGE A

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IMAGE D IMAGE C

VHAPALGargM

NOT ENTERING CABLE RUN THRU TELECOM ROOM

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IMAGE E IMAGE F

VHAPALGargM Line

VHAPALGargM Line

VHAPALGargM

NOT ENTERING CABLE RUN THRU TELECOM ROOM

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IMAGE H IMAGE G

VHAPALGargM

NOT ENTERING CABLES RUN THRU TELECOM ROOM

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