On November 6, 2008, a Notice of Violation was issued for a SL III violation that involved the failure to develop, implement, and maintain written procedures to provide high confidence that each medical administration will be done in accordance with the written directive, for administrations requiring a written directive. Specifically, changes in procedures for inputting geometric information into the treatment planning system were not performed in accordance with the current version of the vendor's operator manual. An incorrect magnification factor was used in treatment dose calculations and the licensee's calculation double-checks did not include validation of geometric accuracy. As a result, the patients were administered doses that ranged from 45% to 62% less than the prescribed dose set forth in the written directive.