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Stationary Lithotripter
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MRI-system specification form
Brand and model
Date of construction
Date of installation
Number of and type of coils
Extra software packages (angio,3D etc)?
Helium level at deinstallation(minimum 70%)
Accessories/options belonging to the system
Language on operating console
Camera type
Format of the film (developping machine included ?)
Generator type
Software version
Documentation / fantoms available?
Maintenance contract
Most recent date of maintenance (dd-mm-jjjj)
Overall impression of the system
De installation route by lift, paces etc.
Will there be a crane needed ?
Yes
No
Is the system on wheels?
Yes
No
No, but the wheels are available
Acces route for trucks or large vehicles by the hospital ?
Yes, in front of the (goods)entrance
No, the closest parking facility is
yards
Expected date of deinstallation (dd-mm-jjjj)
Do you have pictures from the equipment?
You can upload them with the browse button.
Remaining questions / remarks
Details of the proposer
Company Name*
Address*
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City*
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