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| July 10 2019 | July 10 2019 | T140_ClinicalUG.book slatinn Acrobat Distiller 19.0 (Windows) |
| various | User Manual Part 1 | Users Manual | 3.97 MiB | July 10 2019 |
Proton Therapy System Clinical Users Guide Inova Schar Cancer Institute, Falls Church Document 82358 A - September 2019 Volume 1 Treatment Session Copyright Notice 2019 Ion Beam Applications S.A. All rights reserved. All product and company names are the trademarks or registered trademarks of their respective owners. This document contains proprietary information that is protected by copyright. All rights reserved. No part of this document may be reproduced, translated, or transmitted without prior and express written permission of Ion Beam Applications S.A. Abstract The Proton Therapy System Clinical User's Guide contains one volume and provides reference information and instructions for using the IBA Proton Therapy System
(PTS) - Proteus 235 (brand name: Proteus PLUS) from a Clinical point of view. The Clinical User's Guide deals specifically with routine operations in the Treatment Rooms (TRs) and Treatment Control Rooms (TCRs). WARNING The Safety and Emergency Recommendations Document shall be read and understood by any personnel operating, testing, maintaining or repairing the system. Technical Support If you cannot find the information you require in this manual, please contact your Site Manager, Site Technical Leader, or Operations Manager. Alternatively, you can call the IBA main switch board at +32 10 47 58 11. Notice The information contained in this document has been checked for agreement with the hardware and/or software described. Users of the IBA Proton Therapy System must receive adequate training on safe and effective use of the equipment and software before attempting to work with it. Training requirements may vary from country to country. Users must make sure that training is received in accordance with local laws or regulations that have the force of law. Clinical Users Guide Volume 1 - Treatment Session IBA | iii|
Only appropriately qualified personnel may operate the equipment or work in its vicinity. Qualified personnel are persons familiar with the installation, assembly, startup, operation, and maintenance of this product, and who possess the relevant qualifications for their work in accordance with current standards in safety technology. CAUTION United States Federal law restricts this device to sale by or on the order of a physician. Intended Use The Proteus PLUS is a medical device designed to produce and deliver a proton beam for the treatment of patients with localized tumors and other conditions susceptible to treatment by radiation. The PTS may include a Fixed Small Beam Treatment Room dedicated to treatment of patients with localized tumors and other conditions susceptible to treatment by radiation localized in the head and neck. Indications for Use The Proteus PLUS is indicated, according to published data, for the following indications:
Pediatric tumors Medulloblastoma Ependymoma, craniopharyngioma Rhabdomyosarcoma Central Nervous System (CNS) germ cell tumor Atypical teratoid rhabdoid Glioma Skull base chordoma and chondrosarcoma Soft tissue sarcoma, osteosarcoma, Ewings sarcoma Lymphoma (Hodgkin and non-Hodgkin) Ocular tumors IBA | iv |
Clinical Users Guide Volume 1 - Treatment Session Skull base and spine chordoma and chondrosarcoma Primary liver cancer HepatoCellular Carcinoma Lymphoma Hodgkin lymphoma Non-Hodgkin lymphoma Brain tumors Meningioma Pituitary adenoma Acoustic Neuroma Arteriovenous Malformation Glioma Medulloblastoma Head and Neck tumors Paranasal sinus and nasal cavity tumors NasoPharyngeal Carcinoma (NPC) Oropharyngeal cancer Hypopharyngeal cancer Laryngeal cancer Lung cancer Early stage Non-Small-Cell Lung Carcinoma (NSCLC) Locally advanced NSCLC Reirradiation Post-Operative Radiotherapy Gastrointestinal malignancies Pancreatic cancer Esophageal cancer Breast cancer Prostate cancer Clinical Users Guide Volume 1 - Treatment Session IBA | v|
Contra-indications and Precautions There have been numerous reports published indicating that radiotherapy increased risks of both acute and late toxicities in cancer patients with Collagen Vascular Diseases (CVDs).1,2,3,4,5 Most clinicians would likely consider CVDs such as systemic lupus erythematosus, dermatomyositis, scleroderma, rheumatic arthritis and mixed connective tissue disease absolute or relative contraindications to radiotherapy.6 Although there are also studies suggesting that the increased risk in toxicity was not statistically significant7,8,9 the outcomes from cancer patients with CVDs can be varied and therefore great caution should be taken when treating with radiation therapy. Another contraindication to receiving radiation therapy is the presence of genetic abnormalities in DNA repair enzymes, such as in the case of Ataxia-Telangiectasia and its related polymorphisms. These mutations place patients at higher risk for acute side effects during radiation treatment.10 Protons, like photons, are an ionizing radiation with a low Linear Energy Transfer
(LET). The Relative Biological Effectiveness (RBE) of 1.1 has been adopted in current clinical practice, assuming that protons and photons have similar and predictable effect on both tumor and normal tissues. However, increased experimental and clinical evidences have indicated that RBE can vary.11,12,13 RBE variations may lead to the creation of suboptimal proton treatment plans with lower than expected effect in the tumor and higher than expected effect in normal tissue.14 Extra caution should be taken when applying proton therapy for patients with diseases that are reported as high-risk to photon-based radiotherapy. Proton therapy is used to treat a wide range of conditions. To mitigate errors in treatment delivery and minimize operating risks, it is imperative to have quality assurance measures in place and follow guidelines and protocols in practice. Proton therapy is subject to the same safety guidelines and requirements in terms of risk management as those existing for photon-based radiotherapy. When performing the benefit-risk ratio analysis of the therapy the medical professionals need to take caution with the following conditions that may increase the risks:
Pregnancy Active and passive implants and devices Combination of Chemotherapy and Immunotherapy that may increase the sensibility to radiation Proton therapy treatments using Proteus 235 system should only be delivered by radiation oncologists, medical physicists, dosimetrists and other related medical staff who have received adequate proton therapy training. Following the instructions for use, the radiation oncologist performs analysis on the risk/ benefit for the patient before delivering the treatment, taking into account all the side effects and risks resulting from the exposure to ionizing radiation. The radiation oncologist also defines the different volumes and dose constraints that the treatment needs to IBA | vi |
Clinical Users Guide Volume 1 - Treatment Session achieve. The medical physicist assists the radiation oncologist in the decision making process to identify the best treatment technique and performs all the necessary tasks to assure that the equipment delivers the treatment plan as expected. The Proteus 235 must be operated according to the information contained in the Clinical Users Guide and the Safety and Emergency Recommendations. Dose prescription shall be done in agreement with international and national guidelines taking into account acceptable dose to be delivered in healthy tissues (e.g. guidelines are NCCN
(https://www.nccn.org/professionals/physician_gls/f_guidelines.asp). organizations published medical such by as
(For references, see List of Published Literature.) Software Updates Any updates of PTS or Off The Shelf (OTS) software may only be performed by authorized IBA personnel. Clinical Users Guide Volume 1 - Treatment Session IBA | vii|
IBA | viii |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Essential Performances The Essential Performances (EP) applicable to the Proteus PLUS for Pencil Beam Scanning (PBS) are given below. Terminology Range: The Range (d90), or open beam range, is defined as the depth along the beam central axis in water to the distal 90% point of the maximum dose value, achieved without Beam Modifying Accessories (Range Compensator, Range Shifter). Distal fall-off: The Distal Dose Fall-off is defined as the distance (in g/cm2) in which the dose, measured in water along the beam central axis, decreases from 80 to 20%
of the maximum dose value. Field Size: The Field Size is defined as the distance (in mm) between the 50% points of the maximum dose value, measured along the line perpendicular to the beam central axis, on the isocenter in air. Spot size (beam sigma): The Beam Sigma is defined as one standard deviation of the fluence distribution along a line orthogonal to the beam axis, on the isocenter in air. Monitor Units: Monitor Unit is defined as an arbitrary unit in which a quantity is displayed and from which absorbed dose can be calculated. EP Name Limit allowed for EP value Dimensions of the Radiation Field Field Size Depth Min Range (open beam range, without accessories) 30.0 cm * 40.0 cm or larger Max depth: 32 g/cm2 Dedicated Nozzle: =3.1 g/cm2
(extended minimum range option) OR 4.1 g/cm2 (without extended minimum range option). Universal Nozzle: =7.7 g/cm2 (PBS) Irradiation Time/Dose Rate Irradiation Time/Dose Rate 2 min for 2 Gy in 1L or faster Dose Gradient on the Edges of the Radiation Field Spot size (sigma) Distal Dose Fall-Off 2.7 to 8.5 mm 1 mm 20%-80% (on top of monoE beam) or smaller (ICRU) Reproducibility of 2D (Lateral) Dose Distribution in PBS Spot Position Accuracy 1 mm or 10% of beam sigma or smaller Clinical Users Guide Volume 1 - Treatment Session IBA | ix|
EP Name Limit allowed for EP value MU to Dose Accuracy Of Proportionality 1% or smaller Dose Reproducibility Over Time, Fixed Conditions 0,5% 15 min, 1,0% 1 day, 3,0% 1 week or smaller Dose Reproducibility vs Gantry Angle 2% or smaller Delivered MU vs Prescribed MU Error 1% or 0.5 MU or smaller Spot Shape Size Variation Over Time 10% or 0.5 mm or smaller Spot Shape Size Variation Over Gantry Angle Spot Shape Size Variation Over Lateral Position in the Isocenter Plane 10% or 0.5 mm or smaller 10% or 0.5 mm or smaller Reproducibility of Depth Dose Distribution in PBS Range Accuracy for Deepest Layer 1 mm or smaller Pull-Back Accuracy for Shallower Layers 1 mm or smaller Gantry Positioning Gantry angle accuracy for PBS 0.5 degrees or smaller Gantry Isocenter Displacement for PBS 1 mm or smaller Reproducibility of Patient vs Beam Alignment Proton vs X-Ray Colinearity
<1mm + 0.25 X-ray Image Registration accuracy 1mm, 1 or smaller Gating delays Delay from Beam ON request to beam being turned on Delay from Beam OFF request to being being turned off 250 ms 250 ms IBA | x |
Clinical Users Guide Volume 1 - Treatment Session Side Effects Ionizing radiation can be harmful for living organisms. In the case of Radiation Oncology, ionizing radiation is used to treat patients with localized tumors or other conditions susceptible to treatment by radiation. The benefit/risk of the treatment is evaluated by the Radiation Oncologist who determines the amount of radiation that healthy tissues can safely receive with acceptable side effects. The Radiation Oncologist and the clinical team are to define the best treatment plan (technique and dose) that will allow achieving the best risk (i.e., limitation of the undesirable side effects due to irradiation) / benefit (i.e., eradication of the tumors) ratio. The following table summarizes the proton radiation treatment side effects published in literature.
(For references, see List of Published Literature.) Pediatric Dry eye15 Otitis15 Cataract15 Eye CNS and Spine Head and Neck Nausea vomiting33 Neovascular glaucoma/
rubeosis28 Maculopathy29 Dermatitis33 Secondary glaucoma30 Hearing loss, Hypoacusis 33 Dermatitis45 Mucositis45 Nausea45 Retinopathy15 Dry eye symdrome31 Anemia, leukopenia, cytopenia, thrombocyto-
penia33 Vomiting45 Anorexia50 Adult Lung Dermatitis50 Gastrointestinal Fatigue55 Fatigue50 Erythema55 Hyper-
pigmentation50 Inflammation or ulceration within the GI tract55 GI bleeding55 Breast Prostate Radiation dermatitis59 Telangiectasia59 Fat necrosis59 Urinary frequency or urgency63 Dysuria63 Urinary incontinence63 Comesis score60 Obstructive symptoms63 Clinical Users Guide Volume 1 - Treatment Session IBA | xi |
Pediatric Dermatitis15, erythema15, alopecia15 Mucositis15 Odynophagia15 Bowl dysfunction15 Epistaxis16 Cavernoma16 Hearing loss16 Eye CNS and Spine Head and Neck Adult Lung retinal detachment32 Esophagitis, Dysphagia34 Xerostomia43 Nausea50 Anorexia weight loss34 Temporary hair loss, focal alopecia35 Deficit in concentration35 Speech errors, impairment in language35 Visual deficits, hemianopsia 35 Seizure36, epilepsy36 Dysphagia43 Vomiting50 Dysgeusia43 Esophagitis50 Hoarseness43 Dysphagia50 Fatigue43 Dyspnea50 Weight loss44 Atelectasis50 Elevation of bilirubin level56 Elevation of transaminase level56 Anemia56 Feeding tube dependence44 Coughing50 Leuko-
cytopenia56 Facial dimorphism, bone asymmetry17 Central nerve palsy36 Opioid pain requirement44 Pulmonary/
pleural fistula50 Thrombocyto-
penia56 Gastrointestinal Breast Prostate Radiation-
induced liver disease55 Fibrotic stenosis of bile duct56 Biloma56 Fibrosis60 Retentive symptoms63 Skin atrophy60 Prostatitis63 Rib pain60 Proctitis63 Rib fracture60 Breast pain61 Rectal bleeding63 Rectal incontinence63 Breast edema61 Abdominal cramping63 Erythema /
Hyperpigmentati on61 Wet desquamation, Induration61 Urethral stricture64 Hip pain65 IBA | xii |
Clinical Users Guide Volume 1 - Treatment Session Gastrointestinal Nausea57 Breast Fatigue62 Prostate Hip fracture65 Vomiting57 Skin pain62 Hematuria66 Weight loss57 Chest wall pain62 Cystitis66 Epigastralgia57 Esophagitis62 Anorexia57 Lymphedema62 Urgency of defecation67 Anal discomfort67 Pediatric nausea anorexia weight loss18 Diarrhea19 Bladder dysfuntion20 Fatigue, emesis21 Hemianopsia, vasculopathy21 Eye CNS and Spine Head and Neck Adult Lung Peripheral neurologic deficits36 Hemorrhage36 Brain stem toxicity45 Radiation pneumonitis50 Temporal lobe injury45 Tracheo-
esophageal fistula51 Hemoptysis51 Vertebral growth retardation
(Peds) 37 Neurological injury45 Narrowed aorta37 Endocrine dysfunction45 Esophageal stricture52 Osteoradio-
necrosis46 Hematologic toxicity (anemia, thrombocytopen ia, neutropenia leukopenia)53 Baseline neurocognitive impairment, incl. memory and processing speed, intellectual, language, attention, executive function38 Clinical Users Guide Volume 1 - Treatment Session IBA | xiii |
Eye CNS and Spine Head and Neck Adult Lung Nasal congestion46 Subcutaneous induration53 Gastrointestinal Dysphagia58 Breast Prostate Pain at defecation67 Pediatric Cognitive disturbance, Decline in neurocognitive functions22 Endocrinopathy23 Endocrine abnormalities23 Skeletal or muscle defect, scoliosis/
kyphosis24 Neutropenia, pancytopenia, thrombocytopenia, anemia (concurrent chemo)25 Hypertension
(concurrent chemo)25 Endocrine dysfunction Hypopituitarism3 8 Late radiation necrosis38 Leukoencephalo pathy, Anemia Thrombocytope nia, Leucopenia39 Ischemic brain stroke, brain edema, brain necrosis41 Chronic pain, motor paraplegia, hypoesthesia, paraplegia42 Epistaxis46 Myositis53 Esophagitis58 Middle ear inflammation46 Rib fracture54 Esophageal stenosis58 Cerebrospinal fluid leakage40 Vocal cord paralysis47 Epiglottitis47 Hypo-
albuminemia58 Hypocalcemia58 Secondary tooth decay47 Hyponatremia58 Proctalgia67 EPIC sexual score decline68 Erectile dysfunction68 IBA | xiv |
Clinical Users Guide Volume 1 - Treatment Session Pediatric Sepsis (concurrent chemo)25 Ataxia, quadriplegia, bulbar palsies, hemiparesis, seizure26 Imaging changes in brainstem as radiation reaction or necrosis26 Anxiety/depression Pulmonary toxicity Esophagitis27 Chest pain Xerostomia27 Eye CNS and Spine Head and Neck Adult Lung Gastrointestinal Breast Prostate Scoliosis, ataxia42 Urinary and bowel sphincter dysfunction42 Nasolacrimal duct stenosis48 Dry-eye syndrome48 Hypophosphate mia58 Hypoxia Infection58 Ectropion48 Cough58 Conjunctivitis48 Blepharitis48 Cataract48 Sinonasal cutaneous fistulas48 Facial cellulitis48 Clinical Users Guide Volume 1 - Treatment Session IBA | xv |
Pediatric Eye CNS and Spine Head and Neck Adult Lung Gastrointestinal Breast Prostate Ocular/visual toxicity (vascular retinopathy, optic neuropathy)48 Neurologic toxicities48 Auditory toxicities48 Thyroid cartilage necrosis49 Trismus49 Fibrosis49 Esophagitis49 Carotid rupture49 Nasopharyngeal 49 Parapharyngeal bleeding49 IBA | xvi |
Clinical Users Guide Volume 1 - Treatment Session Limitation and Exclusion of Scope The scope of this Clinical Users Guide is to describe the operations, features, and functions of the Proteus PLUS. The Proteus PLUS is capable of interfacing with certain third party products. Where applicable or necessary, these interfaces are described in this Clinical Users Guide. IBA does not assume any responsibility for third party products nor third party product documentation. This Clinical Users Guide in no way aims to replace the relevant documentation of the third party vendor. The third party vendors at all times remain fully responsible for their product and product documentation. Modification of the IBA System or IBA Accessories Users are requested not to make any unauthorized modification to the IBA System or IBA accessories. Unless approved in writing and in advance by IBA, any modification to the IBA System or to IBA accessories by the user may cause the loss of the regulatory approval and will void the warranty, and/or be classified as an abnormal failure under the uptime commitment. Integration or Use of Third Party Equipment or non-
IBA Accessories Users are advised to integrate or use in conjunction with IBA medical devices only authorized third-party equipment or non-IBA accessories that are qualified by IBA as compatible with the IBA System (like proprietary software installation such as the Oncology Information System (OIS)). Users are further advised to analyse the collisions or other hazards induced by the use of immobilization devices. Restriction of Use of OIS The IBA PTS interfaced with an Oncology Information System (OIS) shall only be used in combination with an OIS that is appropriately certified for the country where the Proton Therapy System is deployed. Restriction of Use of TPS and Gating System The IBA PTS interfaced with a Treatment Planning System (TPS) and a gating system shall only be used in combination with a TPS and a gating system that are appropriately certified for the country where the Proton Therapy System is deployed. Clinical Users Guide Volume 1 - Treatment Session IBA | xvii|
Wireless Hand-Pendant Generic:
Safe and effective use of the wireless device:
The wireless hand-pendant subsystem contains:
A Bluetooth radio with the following characteristics:
Bluetooth Low Energy (BLE) version 4.1 operating in the 2.400 GHz-
2.4835 GHz ISM band using F.H.S.S. modulation. Effective Isotropic Radiated Power (EIRP): 0 dBm 1 mW Class 1. A Smartphone using an IEEE 802.11 Wi-Fi link. Other wireless links in the smartphone are factory disabled to avoid interferences. Wi-Fi operating in the 2.400 GHz-2.4835 GHz ISM band using F.H.S.S. modulation; maximum power 100 mW (20 dBm). Wireless Quality of Service (QoS): the subsystem has been designed to be fail safe (to stop movements) in case of loss of communication or significant degradation. Only IBA authorized devices can connect to the hand-pendant wireless access points in treatment room. The battery of the wireless hand-pendant must be replaced by authorized IBA personnel only. Wireless security measure: The subsystem will only accept a connection from a single IBA Hand-Pendant at a time in a given room with IBA Universally Unique Identification protocol. The UUID is factory set and can not be changed by the user. The IEEE 802.11 Wi-Fi link uses WPA2 for authentication. Cross talk between devices in the same vicinity: Due to the unique ID mechanism, it is not possible to operate two devices in the same treatment room. Due to treatment room neutron shielding and low power Bluetooth usage, crosstalk between equipments from outside treatment rooms is very unlikely. However we recommend to keep the wireless hand-pendant in the docking station when not in use. USA:
FCC PART 15 Information to user. FCC ID: 2AHZSHP-MOB FCC ID: 2AHZSHPV3C-MOB FCC ID: 2AHZSHP-FIX IBA | xviii |
Clinical Users Guide Volume 1 - Treatment Session Pursuant to part 15.21 of the Federal Communications Commission (FCC) Rules, you are cautioned that changes or modifications not expressly approved by IBA could void your authority to operate the device. This device complies with part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Europe:
The wireless hand-pendant harmonization legislation: Directive 2014/53/EU (RED). is in conformity with the relevant Union Clinical Users Guide Volume 1 - Treatment Session IBA | xix|
IBA | xx |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank List of Published Literature 1. Exaggerated radiation-induced fibrosis in patients with systemic sclerosis. Varga, J, et al. 24, Philadelphia : s.n., 1991, JAMA, Vol. 265, pp. 3292-3295. 2. Consequences of breast irradiation in patients with pre-existing collagen vascular diseases. Fleck, R, et al. 4, Houston : s.n., 1989, Int J Radiat Oncol Biol Phys, Vol. 17, pp. 829-833. 3. Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Ross, JG, et al. 11, Iowa City : s.n., 1993, Cancer, Vol. 71, pp. 3744-
3752. 4. 5. Irradiation of the setting of collagen vascular disease: Acute and late complications. Morris, MM et Powell, SN. 7, Boston : s.n., 1997, Journal of Clinical Oncology, Vol. 15, pp. 2728-2735. Severe acute toxicity from whole breast radiotherapy in the setting of collagen vascular disease. Hernandez, S, Evans, SB et Wazer, DE. 6, Boston : s.n., 2006, American Journal of Clinical Oncology, Vol. 29, pp. 647-648. 6. Radiotherapy in setting of collagen vascular disease. Wo, J et Taghian, A. 5, Boston : s.n., 2007, Int J Radiat Oncol Biol Phys, Vol. 69, pp. 1347-1353. 7. Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy. Phan, C, et al. Louisville : s.n., 2003, Cancer. 8. Role of radiation therapy in patients with a diagnosis of both systemic lupus erythematosus and cancer. Benk, V, et al. 1, Toronto : s.n., 2005, Arthritis &
Rheumatism, Vol. 53, pp. 67-72. 9. Systemic lupus erythematosus, radiotherapy, and the risk of acute and chronic toxicity: The Mayo Clinic Experience. Pinn, ME, et al. 2, Rochester : s.n., 2008, Int J Radiat Oncol Biol Phys, Vol. 71, pp. 498-506. 10. Ataxia Telangiectasiae - Mutated gene polymorphisms and acute normal tissue injuries in cancer patients after RT. Dong, L, et al. 5, Changchun : s.n., 2014, Int J Radiat Oncol Biol Phys, Vol. 91, pp. 1090-1098. 11. Relative biological effectiveness values for proton beam therapy. Variations as a function of biological endpoint, dose, and linear energy transfer. Paganetti, H, et al. 22, Boston : s.n., 2014, Physics in Medicine & Biology, Vol. 59, pp. 420-473. 12. Towards achieving the full clinical potential of proton therapy by inclusion of LET and RBE models. Jones, B. Oxford : s.n., 2015, Cancers, Vol. 7, pp. 460-480. 13. Clinical evidence of variable proton biological effectiveness in pediatric patients treated for ependymoma. Peeler, CR, et al. Houston : s.n., 2016, Radiotherapy and Oncology, pp. 395-401. 14. Disregarding RBE variation in treatment plan comparison may lead to bias in favor of proton plans. Wedenberg, M et Toma-Dasu, I. 9, Stockholm : s.n., 2014, Medical Physics, Vol. 41. Clinical Users Guide Volume 1 - Treatment Session IBA | xxi|
15. Preliminary results of a phase II trial of proton radiotherapy for pediatric rhabdomyosarcoma. Ladra, MM, et al. 33, Boston : s.n., 2014, Journal of Clinical Oncology, Vol. 32. 16. Proton radiotherapy for pediatric central nervous system ependymoma: clinical outcomes for 70 patients. MacDonald, SM, et al. Boston : s.n., 2013, Neuro-
Oncology, Vol. 15, pp. 1552-1559. 17. Proton radiotherapy for pediatric tumors: review of first clinical results. Rombi, B, et al. Trento : s.n., 2014, Italian Journal of Pediatrics, Vol. 40. 18. Proton radiotherapy for pediatric Ewing's sarcoma: Initial clinical outcomes. Rombi, B, et al. 3, Trento : s.n., 2012, Int J Radiat Oncol Biol Phys, Vol. 82, pp. 1142-1148. 19. Proton therapy for spinal ependymomas: Planning, acute toxicities, and preliminary outcomes. Amsbaugh, MJ, et al. 5, Houston : s.n., 2012, Int J Radiat Oncol Biol Phys, Vol. 83, pp. 1419-1424. 20. Proton radiotherapy for pediatric bladder/prostate rhabdomyosarcoma: clinical outcomes and dosimetry compared to intensity modulated radiation therapy. Cotter, SE, et al. 5, Boston : s.n., 2011, Int J Radiat Oncol Biol Phys, Vol. 81, pp. 1367-1373. 21. Craniopharyngioma and Proton Therapy. Bradley, JA et Indelicato, DJ. Jacksonville : s.n., 2014, International Journal of Particle Therapy, pp. 386-398. 22. Early cognitive outcomes following proton radiation in pediatric patients with brain and central nervous system tumors. Pulsifer, MB, et al. 2, Boston : s.n., 2015, Int J Radiat Oncol Biol Phys, Vol. 93, pp. 400-407. 23. Proton beam therapy versus conformal photon radiation therapy for childhood craniopharyngioma: multi-institutional analysis of outcomes, cyst dynamics, and toxicity. Bishop, AJ, et al. 2, Houston : s.n., 2014, Int J Radiat Oncol Biol Phys, Vol. 90, pp. 354-361. 24. Proton radiotherapy for pediatric sarcoma. Ladra, MM et Yock, TI. Boston : s.n., 2014, Cancer, Vol. 6, pp. 112-127. 25. Outcomes and acute toxicities of proton therapy for pediatric atypical teratoid/rhabdoid tumor of the CNS. McGovern, SL, et al. 5, Houston : s.n., 2014, Int. J. Radiat. Oncol. Biol. Phys., Vol. 90, pp. 1143-1152. 26. 27. 28. Incidence of CNS injury for a cohort of 111 patients treated with proton therapy for medulloblastoma: LET and RBE associations for areas of injury. Giantsoudi, D, et al. 1, Boston : s.n., 2016, Int J Radiat Oncol Biol Phys, Vol. 95, pp. 287-296. Involved-node proton therapy in combined modality therapy for Hodgkin lymphoma: results of a phase 2 study. Hoppe, BS, et al. 5, Jacksonville : s.n., 2014, Int J Radiat Oncol Biol Phys, Vol. 89, pp. 1053-1059. Intravitreal bevacizumab for neovascular glaucoma in uveal melanoma treated by proton beam therapy. Mahdjoubi, A, et al. Paris : s.n., 2018, Graefes Arch Clio Exp Ophthalmol, pp. 411-420. IBA | xxii |
Clinical Users Guide Volume 1 - Treatment Session 29. Radiation maculopathy after proton beam therapy for uveal melanoma: Optical coherence tomography angiography alterations influencing visual acuity. Matet, A, Daruich, A et Zografos, L. Lausanne : s.n., 2017, Investigative Ophtalmology and Visual Science, Vol. 58, pp. 3851-3861. 30. Proton therapy of iris melanoma with 50 CGE. Riechardt, AI, et al. Berlin : s.n., 2017, Strahlenther Onkol, pp. 943-950. 31. Dry eye syndrome after proton therapy of ocular melanomas. Thariat, J, et al. 1, Nice : s.n., 2017, Int J Radiat Oncol Biol Phys, Vol. 98, pp. 142-151. 32. lntravitreal dexamethasone implant (Ozurdex) for exudative retinal detachment after proton beam therapy for choroidal melanoma. Malcls, A, et al. Lyon : s.n., 2017, European Journal of Ophtalmology, Vol. 27, pp. 596-600. 33. Technique, outcomes, and acute toxicities in adults treated with proton beam craniospinal irradiation. Barney, CL, et al. Houston : s.n., 2014, Neuro-Oncology, Vol. 16, pp. 303-309. 34. Proton beam craniospinal irradiation reduces acute toxicity for adults with medulloblastoma. Brown, AP, et al. 2, Houston : s.n., 2013, Int J Radiat Oncol Biol Phys, Vol. 86, pp. 277-284. 35. First experiences in treatment of low-grade glioma grade I and II with proton therapy. Hauswald, H, et al. Heidelberg : s.n., 2012, Radiation Oncology. 36. Stereotactic proton beam therapy for intracranial arteriovenous malformations. Vernimmen, FJ, et al. 1, Tygerberg : s.n., 2005, Int J Radiat Oncol Biol Phys, Vol. 62, pp. 44-52. 37. Clinical results of proton beam therapy for advanced neuroblastoma. Oshiro, Y, et al. Tsukuba : s.n., 2013, Radiation Oncology. 38. Proton therapy for low-grade gliomas: Results from a prospective trial. Shih, HA, et al. 2015, Cancer, pp. 1712-1719. 39. Phase I/II trial of hyperfractionated concomitant boost proton radiotherapy for supratentorial glioblastoma multiforme. Mizumoto, M, et al. 1, Tsukuba : s.n., 2010, Int J Radiat Oncol Biol Phys, Vol. 77, pp. 98-105. 40. Proton beam radiation therapy for skull base adenoid cystic carcinoma. Pommier, P, et al. Boston : s.n., 2006, Arch Otolaryngol Head Neck Surg, Vol. 132, pp. 1242-
1249. 41. Spot scanning-based proton therapy for intracranial meningioma: Long-term results from the Paul Scherrer Institute. Weber, DC, et al. 3, Geneva : s.n., 2011, Int J Radiat Oncol Biol Phys, Vol. 83, pp. 865-871. 42. Long-term outcome of patients with spinal myxopapillary ependymoma:
treatment results from the MD Anderson Cancer Center and institutions from the Rare Cancer Network. Weber, DC, et al. Villigen : s.n., 2015, Neuro-
Oncology, Vol. 17, pp. 588-595. 43. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Romesser, PB, et al. New York : s.n., 2016, Radiotherapy and Oncology, Vol. 118, pp. 286-292. Clinical Users Guide Volume 1 - Treatment Session IBA | xxiii|
44. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. McDonald, MW, et al. Atlanta : s.n., 2016, Radiation Oncology. 45. Proton therapy for head and neck cancer: expanding the therapeutic window. Leeman, JE, et al. New-York : s.n., 2017, The Lancet Oncology, Vol. 18, pp. 254-
265. 46. High-dose proton beam therapy for sinonasal mucosal malignant melanoma. Fuji, H, et al. Nagaizumi : s.n., 2014, Radiation Oncology. 47. Proton radiation for treatment of cancer of the oropharynx: Early experience at Loma Linda University medical centre using a concomitant boost technique. Slater, JD, et al. 2, Loma Linda : s.n., 2005, Int J Radiat Oncol Biol Phys, Vol. 62, pp. 494-500. 48. Long-term outcomes after proton beam therapy for sinonasal squamous cell carcinoma. Russo, AL, et al. 1, Boston : s.n., 2016, Int J Radiat Oncol Biol Phys, Vol. 95, pp. 368-376. 49. Proton beam reirradiation for recurrent head and neck cancer: Multi-institutional report on feasibility and early outcomes. Romesser, PB, et al. 1, New York : s.n., 2016, Int J Radiat Oncol Biol Phys, Vol. 95, pp. 386-395. 50. Phase II study of high-dose proton therapy with concurrent chemotherapy for unresectable stage III non-small cell lung cancer. Chang, JY, et al. Houston : s.n., 2011, Cancer, pp. 4707-4713. 51. Phase 1 study of dose escalation in hypofractionated proton beam therapy for non-small cell lung cancer. Gomez, DR, et al. 4, Houston : s.n., 2013, Int J Radiat Oncol Biol Phys, Vol. 86, pp. 665-670. 52. Long-term outcomes after proton therapy, with concurrent chemotherapy, for stage IIIII inoperable non-small cell lung cancer. Nguyen, QN, et al. Houston :
s.n., 2015, Radiotherapy and Oncology, Vol. 115, pp. 367-372. 53. Hypofractionated high-dose proton beam therapy for stage I non-small cell lung cancer: Preliminary results of a phase I/II clinical study. Hata, M, et al. 3, Tsukuba : s.n., 2007, Int J Radiat Oncol Biol Phys, Vol. 68, pp. 786-793. 54. Proton beam therapy for patients with medically inoperable stage I non-small cell lung cancer at the University of Tsukuba. Nakayama, H, et al. 2, Tsukuba : s.n., 2010, Int J Radiat Oncol Biol Phys, Vol. 78, pp. 467-471. 55. The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: A phase 2 prospective trial. Bush, DA, et al. Loma Linda : s.n., 2011, Cancer, pp. 3053-3059. 56. Proton beam therapy for hepatocellular carcinoma: A retrospective review of 162 Patients. Chiba, T, et al. Tsukuba : s.n., 2005, Clinical Cancer Research, pp. 3799-
3805. 57. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Terashima, K, et al. Hyogo : s.n., 2012, Radiotherapy and Oncology, Vol. 103, pp. 25-31. IBA | xxiv |
Clinical Users Guide Volume 1 - Treatment Session 58. A prospective study of proton beam reirradiation for esophageal cancer. Fernandes, A, et al. 1, Philadelphia : s.n., 2016, Int J Radiat Oncol Biol Phys, Vol. 95, pp. 483-487. 59. Partial breast radiation therapy with proton beam: 5-year results with cosmetic outcomes. Bush, DA, et al. 3, Loma Linda : s.n., 2014, Int J Radiat Oncol Biol Phys, Vol. 90, pp. 501-505. 60. Long-term cosmetic outcomes and toxicities of proton beam therapy compared with photon based 3-Dimensional conformal accelerated partial-breast irradiation: A phase 1 trial. Galland-Girodet, S, et al. 3, Boston : s.n., 2014, Int J Radiat Oncol Biol Phys, Vol. 90, pp. 493-500. 61. Phase II trial of proton beam accelerated partial breast irradiation in breast cancer. Chang, JH, et al. Goyang : s.n., 2013, Radiotherapy and Oncology, Vol. 108, pp. 209-214. 62. Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Cuaron, JJ, et al. 2, New York : s.n., 2015, Int J Radiat Oncol Biol Phys, Vol. 92, pp. 284-291. 63. Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer. Mendenhall, NP, et al. 1, Jacksonville : s.n., 2012, Int J Radiat Oncol Biol Phys, Vol. 82, pp. 213-221. 64. Outcomes in men with large prostates (>60 cm 3) treated with defi nitive proton therapy for prostate cancer. McGee, L, et al. Gainesville : s.n., 2013, Acta Oncologica, Vol. 52, pp. 470-476. 65. Hip fractures and pain following proton therapy for management of prostate cancer. Valery , R, et al. Jacksonville : s.n., 2013, Acta Oncologica, Vol. 52, pp. 486-491. 66. Conformal proton therapy for prostate carcinoma. Slater, JD, et al. 2, Loma Linda : s.n., 1998, Int J Radiat Oncol Biol Phys, Vol. 42, pp. 299-304. 67. Phase II feasibility study of high-dose radiotherapy for prostate cancer using proton boost therapy: First clinical trial of proton beam therapy for prostate cancer in Japan. Nihei, K, et al. Chiba : s.n., 2005, Japanese Journal of Clinical Oncology, pp. 745-752. 68. Erectile function, incontinence, and other quality of life outcomes following proton therapy for prostate cancer in men 60 years old and younger. Hoppe, BS, et al. Jacksonville : s.n., 2012, Cancer, pp. 4619-4626. Clinical Users Guide Volume 1 - Treatment Session IBA | xxv|
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Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Amendment records Version Date of Issue Details of Amendments A September 2019 This is the first version of the System Description for the Inova Schar Cancer Institute, Falls Church. Major Changes in... Not applicable Written by Checked by Approved by Shaunak Khandekar Technical Writer Philippe Hauglustaine PT Project Manager Max Murphy PT Site Manager Savanna Green QA Product Release Associate Navid Radnia PT Site Technical Leader Clinical Users Guide Volume 1 - Treatment Session IBA | xxvii |
IBA | xxviii |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Contents Copyright Notice .............................................................. iii Abstract ............................................................................ iii Technical Support ............................................................. iii Notice ............................................................................... iii Intended Use ....................................................................iv Indications for Use ...........................................................iv Contra-indications and Precautions ..................................vi Software Updates ........................................................... vii Essential Performances ...................................................ix Terminology .....................................................................ix Side Effects ......................................................................xi Limitation and Exclusion of Scope ................................ xvii Modification of the IBA System or IBA Accessories ..... xvii Integration or Use of Third Party Equipment or non-IBA Accessories ..................................................... xvii Restriction of Use of OIS .............................................. xvii Restriction of Use of TPS and Gating System .............. xvii Wireless Hand-Pendant ................................................ xviii List of Published Literature ............................................ xxi Amendment records ................................................... xxvii Contents Figures Tables About this Manual Scope and Contents ............................................................... lxv Referenced Documentation .................................................. lxvi Coordinates and Movements ........................................ lxvi IBA Dosimetry Water Phantoms ................................... lxvi AdaPTinsight Patient Position Verification System ....... lxvi CIVCO Couchtop .......................................................... lxvii What to Expect? ...................................................................lxviii Conventions .......................................................................... lxxii Warnings .......................................................................... lxxii Clinical Users Guide Volume 1 - Treatment Session IBA | xxix|
Cautions ........................................................................... lxxii Important Notes ............................................................... lxxii Typographic Conventions .................................................lxxiii Illustrations .......................................................................lxxiii Troubleshooting Information ............................................lxxiii Visual Cues .......................................................................lxxiii Chapter 1 Introduction Overview ............................................................................... 1-1 Treatment Modes Available at the PT Center ................... 1-2 Therapy Center and Proton Therapy System Building Blocks ...................................................................... 1-2 Treatment Planning System (TPS) ..................................... 1-2 Oncology Information System (OIS) .................................. 1-3 Proton Therapy System (PTS) Software ............................ 1-5 Usage With an OIS ........................................................ 1-5 Usage Without an OIS .................................................. 1-5 Patient Positioning Verification System (PPVS) ................. 1-5 PPVS Process ................................................................ 1-5 Treatment Workflow Options ................................................ 1-7 Workflow Option Criteria .............................................. 1-7 Workflow Options ......................................................... 1-8 Treatment Mode Aspects ............................................. 1-9 Frequency Aspect ....................................................... 1-10 Reading Sequence of This Manual .............................. 1-11 Option A: Using the Batch Importer and Standalone Delivery ......................................................... 1-11 Option B: Full Standalone Mode ..................................... 1-12 Option C: Using the OIS .................................................. 1-12 Patient Related Parameters ................................................. 1-12 Prescribed Parameters ........................................................ 1-12 Received versus Delivered Parameters ............................... 1-13 Operating adaPTdeliver in Clinical Mode or in Physics Mode ...................................................................... 1-13 Using Information From the OIS ..................................... 1-14 Using QA Features of adaPTprescribe ................................ 1-15 Chapter 2 Starting Up Applications in the adaPT Treatment Suite Startup Operations ................................................................ 2-1 Clinical and Non-clinical Environment .................................... 2-1 IBA | xxx |
Clinical Users Guide Volume 1 - Treatment Session Beginning Clinical Operations ............................................ 2-2 Verifying the Global Checksum ..................................... 2-2 The Clinical Environment ................................................... 2-3 Characteristics of the Clinical Environment ....................... 2-4 PART I EXPLAINING ESSENTIAL SAFETY ASPECTS Chapter 3 Emergency Procedures in Case of Irradiation Hazard A Patient is in the Treatment Room and the Beam Fails to Stop when Requested .............................................. 3-2 The Preset Dose Has Been Reached and the Beam Fails to Shut off Automatically ........................................... 3-2 A Radiation Therapy Technologist (RTT) Requests the Beam to Pause (or Stop) and the Beam Fails to Pause
(or Stop) ............................................................................. 3-2 Irradiation Emergency Procedure .................................. 3-2 Staff are Present in a Secured Area ...................................... 3-3 Irradiation Emergency Procedure .................................. 3-4 To be Present in a Location Susceptible to Irradiation While Beam is On or Room is Secured ................................. 3-5 Irradiation Emergency Procedure .................................. 3-5 Chapter 4 Miscellaneous Safety Hazards Cleaning, a Basic Safety Requirement .................................. 4-1 Precautionary Measures .................................................... 4-2 Keyboard and Mouse Requirements ..................................... 4-2 Usage of Tools or Parts in a Treatment Room ....................... 4-2 Dealing With an Emergency Situation ................................... 4-3 Gantry Rolling Floor Precautions ........................................... 4-3 Pinching Hazard ................................................................. 4-4 General Pinching Hazards ...................................................... 4-5 Magnetic Field Hazard ....................................................... 4-7 Functions of the Beam Intensity Redundant Electronic Unit ....................................................................... 4-9 BIREU Startup or Connection Failure ............................ 4-9 Clinical Users Guide Volume 1 - Treatment Session IBA | xxxi|
PART II USING TREATMENT ROOM EQUIPMENT Chapter 5 Introducing Treatment Room Equipment Effects of Temperature and/or Pressure Changes in the Treatment Room ......................................................... 5-2 Safety Aspects ...................................................................... 5-2 Chapter 6 Elementary Notions on Patient Positioning Supported Coordinate Systems ............................................. 6-3 IEC Fixed Reference System (f) ........................................ 6-3 IEC Gantry Coordinate System (g) ..................................... 6-5 IEC Table Top Coordinate System (t) ................................ 6-5 Types of Patient Positioning Device (PPD) Motion ................ 6-8 Using Auto Motions .......................................................... 6-9 Target Positions in a GTR ............................................ 6-10 Using Manual Motions .................................................... 6-11 Manual Motions in a GTR ............................................ 6-12 Using Trajectory Motions ................................................ 6-13 Patient Positioning Devices ................................................. 6-13 Chapter 7 Moving the Patient Positioning Devices Patient Positioning Devices ................................................... 7-3 Patient Positioning System (PPS) ...................................... 7-3 Allowed Maximum Weight on the Couch ..................... 7-4 Patient Positioning System Overload ............................ 7-5 Constant Weight on the Couch ..................................... 7-6 Couch Modifications ..................................................... 7-6 Extended Treatment Volume (ETV) ............................... 7-6 Using the Couch ............................................................ 7-8 Moving the couch beams (for X-ray imaging) for the kVue couch ............................................................. 7-9 Enhanced Safety Through Various Software Limits .... 7-10 GoTo Motions in a GTR ................................................... 7-10 Snout Holder ................................................................... 7-13 Accessory Drawer ....................................................... 7-13 Gantry .............................................................................. 7-14 IBA | xxxii |
Clinical Users Guide Volume 1 - Treatment Session Solving Collisions ................................................................. 7-14 If a collision occurs .......................................................... 7-15 Managing Proximity ............................................................. 7-16 Chapter 8 Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls Wireless Hand-Pendant Screens ........................................... 8-2 Remote Positioning Controls Panel ....................................... 8-3 App Bar (Wireless Hand-Pendant) and Remote Positioning Controls Bar Icons ............................................... 8-5 Understanding Colors in the Wireless Hand-Pendant GUI and Remote Positioning Controls Panel ......................... 8-6 Understanding Auditive Signals ........................................... 8-10 Understanding Vibration Signals of the Wireless Hand-Pendant ...................................................................... 8-11 Switching Command From the Wireless Hand-Pendant to the Remote Positioning Controls .................................... 8-11 Switching Command From the Remote Positioning Controls to the Wireless Hand-Pendant .............................. 8-13 Chapter 9 Using the Wireless Hand-Pendant Safety Measures Specific to the Use of the Wireless Hand-Pendant ......................................................... 9-3 Registering the Wireless Hand-Pendant ................................ 9-4 Registration Procedure ...................................................... 9-5 Registration Consequences .............................................. 9-8 Unlocking the Wireless Hand-Pendant .................................. 9-8 Controlling Speed .................................................................. 9-8 Stopping Movements .......................................................... 9-10 Release the Move Device Button ................................... 9-10 Release the Motion Enable Buttons ................................ 9-11 Press an Emergency Stop Button ................................... 9-11 Operating Modes: Auto and Manual ................................... 9-12 Prerequisite: Selecting a Device ...................................... 9-12 Using the GUI in Auto Mode ............................................... 9-13 Auto Mode Target Positions ............................................ 9-13 Selecting a Target Position .............................................. 9-13 Selecting and Moving a Patient Positioning Device ........ 9-15 PPS Screen ................................................................. 9-16 Gantry, Snout, and Drawer Screen ............................. 9-17 Clinical Users Guide Volume 1 - Treatment Session IBA | xxxiii|
Selecting and Moving a Device ................................... 9-17 Creating User-Defined Positions ..................................... 9-18 Managing Prescribed and User-Defined Positions .......... 9-21 Using the GUI in Manual Mode ........................................... 9-23 Using Manual Mode to Move the Gantry, the Accessory Drawer and the Snout .................................... 9-24 Moving the Gantry ...................................................... 9-25 Moving the Accessory Drawer .................................... 9-26 Moving the Snout holder ............................................. 9-26 Using Manual Mode to Move the PPS (Patient Positioning System) ......................................................... 9-27 Moving the PPS along the X Axis ................................ 9-28 Moving the PPS along the Y Axis ................................ 9-29 Moving the PPS along the Z Axis ................................ 9-29 Rotating the PPS Around the Isocenter ...................... 9-29 Pitching the PPS .......................................................... 9-29 Rolling the PPS ............................................................ 9-31 Moving the Digital Imaging Devices .................................... 9-31 Preparing Equipment for a CBCT Acquisition .................. 9-32 Using Advanced Options From the Menu ........................... 9-39 Recovering Devices after an Error ....................................... 9-40 Colorblind Users: Negative Colors ....................................... 9-40 Chapter 10 Wireless Hand-Pendant Daily Checks and Troubleshooting Checking the Good State of the Hand-Pendants Casing .... 10-1 Checking the Motion Enable Buttons .................................. 10-2 Checking Sound and Vibration Feedbacks ........................... 10-2 Monitoring Wireless Hand-Pendant Connections ................ 10-3 Solving Battery and Autonomy Issues ................................. 10-3 Chapter 11 Using the Remote Positioning Controls Safety Measures Specific to the Use of the Remote Positioning Controls ............................................... 11-2 Performing a Motion Dry Run ......................................... 11-3 Remote Positioning Hardware Console ............................... 11-3 Controlling Speed ................................................................ 11-4 Stopping Movements .......................................................... 11-6 Release the MOVE Button .............................................. 11-6 Release the Motion Enable Button ................................. 11-6 IBA | xxxiv |
Clinical Users Guide Volume 1 - Treatment Session Press an Emergency Stop Button ................................... 11-6 Using Tool Tips .................................................................... 11-7 Operating Modes: Auto and Manual ................................... 11-8 Using the Remote Positioning Controls in Auto Mode ........ 11-8 Auto Mode Target Positions ............................................ 11-9 Selecting a Target Position ............................................ 11-10 Target Position Device Feedback .................................. 11-12 Moving Devices to a Target Position ............................. 11-13 Moving the Snout holder ........................................... 11-14 Moving the Accessory Drawer .................................. 11-14 Moving the Gantry .................................................... 11-17 Moving the PPS ........................................................ 11-17 Using Auto Mode to Move the Imaging Devices .......... 11-18 Preparing Equipment for a CBCT Acquisition ............ 11-18 Using Auto Mode to Move to a User Preset ................. 11-22 Using Auto Mode to Create and Edit User Presets ....... 11-23 Creating a User Preset .............................................. 11-23 Editing a User Preset ................................................ 11-25 Managing User Presets ............................................. 11-26 Using the Remote Positioning Controls in Manual Mode ................................................................................. 11-30 Using Manual Mode to Move the Accessory Drawer and the Snout ................................................... 11-31 Moving the Accessory Drawer .................................. 11-32 Moving the Snout ...................................................... 11-33 Using Manual Mode to Move the Gantry ...................... 11-34 Using Manual Mode to Move the PPS (Patient Positioning System) ....................................................... 11-35 Moving the PPS Along the X Axis ............................. 11-36 Moving the PPS Along the Y Axis ............................. 11-36 Moving the PPS Along the Z Axis ............................. 11-37 Rotating the PPS Around the Isocenter .................... 11-37 Pitching the PPS ........................................................ 11-38 Rolling the PPS .......................................................... 11-38 Using Advanced Settings .................................................. 11-39 Chapter 12 Alignment Tools and Devices Alignment Correction Calculation Tool: adaPTinsight ...........12-3 Relationship between Imaging equipment and treatment geometries ................................................. 12-5 Alignment .................................................................... 12-5 Patient Alignment Devices .................................................. 12-7 Working With Laser Devices ............................................... 12-9 Clinical Users Guide Volume 1 - Treatment Session IBA | xxxv|
Location of Lasers in a GTR ............................................ 12-9 Laser Locations for PBS Dedicated Nozzle ................. 12-9 Turning Lasers On and Off ................................................ 12-12 Working with X-ray Images in a GTR, for Use With adaPTinsight ...................................................................... 12-13 Setting up for Orthogonal X-ray Images in a GTR ......... 12-14 Setting up for Portal View X-ray Images in a GTR ......... 12-16 Setting up for Single-source (Rad-A) Stereoscopic X-ray Image Acquisition in the GTR ............................... 12-17 Setting up for Acquiring Stereo X-ray Images Using Rad-A .............................................................. 12-19 Setting up for Acquiring CBCT Images .......................... 12-21 Chapter 13 Attaching/Removing a Patient Support Device to/from the PPS Preliminary: Gantry Rolling Floor Precautions ................. 13-1 Couch Identification ......................................................... 13-1 The Docking Principle .......................................................... 13-2 Docking Modes ................................................................... 13-5 Manual Docking and Undocking .......................................... 13-7 Manually Docking a PPS Support Device ........................ 13-7 Manually Undocking a PPS Support Device .................... 13-9 Automatic Docking and Undocking ................................... 13-11 Overview: Automatic Docking ....................................... 13-11 Overview: Automatic Undocking ................................... 13-11 Positions and Areas ....................................................... 13-12 Docking Instructions ...................................................... 13-13 Automatically Docking a Docking Device ...................... 13-15 Automatically Undocking a Docking Device .................. 13-19 Interrupting, Resuming, or Cancelling an Automatic Docking or Undocking Operation .................................. 13-21 Interrupting an Automatic Docking or Undocking Operation .................................................................. 13-21 Resuming an Automatic Docking or Undocking Operation .................................................................. 13-21 Canceling an Automatic Docking or Undocking Operation .................................................................. 13-21 IBA | xxxvi |
Clinical Users Guide Volume 1 - Treatment Session Chapter 14 Installing and Removing Accessories into/from the Accessory Drawer or PBS Dedicated Snout Accessories ......................................................................... 14-1 Preliminary Precautions ....................................................... 14-3 Preliminary: Gantry Rolling Floor Precautions ................. 14-3 Accessory Precautions ................................................. 14-3 Accessory Holder Operations .............................................. 14-5 Installing an Accessory or Snout onto the Accessory Drawer ............................................................................. 14-5 Removing an Accessory or Snout from the Accessory Drawer ............................................................................. 14-6 Snout Types ......................................................................... 14-7 Type DN_S (Dedicated Nozzle - Small) Snout Operations ... 14-9 Installing Accessories onto a DN_S Type Snout ........... 14-11 Removing Accessories from a DN_S Type Snout ......... 14-13 Type DN_M (Dedicated Nozzle - Medium) Snout Operations ......................................................................... 14-15 Installing Accessories onto a DN_M Type Snout .......... 14-17 Removing Accessories from a DN_M Type Snout ........ 14-18 Type DN_XL (Dedicated Nozzle - Extra Large) Snout Operations ......................................................................... 14-19 Installing Accessories onto a DN_XL Type Snout ......... 14-22 Removing Accessories from a DN_XL Type Snout ....... 14-22 Chapter 15 Resetting a Dose Counter Electronic Unit DCEU Types ........................................................................ 15-4 DCEU With Actual Preset MU Value ............................... 15-4 DCEU With Preset MU Value to be Multiplied by 10 ...... 15-4 Effects of Temperature and/or Pressure Changes in the Treatment Room ................................................................. 15-5 Chapter 16 Operating the Patient Positioning System Manually
(Emergency Release Mode) Using the Emergency Hand-Pendant .................................. 16-4 Performing a Coplanar Movement, Joints 1-2 ................. 16-4 Performing a Vertical Motion, Joint 3 .............................. 16-5 Clinical Users Guide Volume 1 - Treatment Session IBA | xxxvii|
Chapter 17 Performing QA Checks and Verifying Beams With a Water Phantom Locating the Water Phantom on the PPS ............................ 17-3 Verifying Beams .................................................................. 17-5 Chapter 18 Troubleshooting Treatment Room Equipment PART III THE PENCIL BEAM SCANNING (PBS) SUITE Chapter 19 Guiding You Through the Pencil Beam Scanning Documentation Chapter 20 Pencil Beam Scanning Principles Introduction ......................................................................... 20-1 Clinical Advantages ..................................................... 20-2 Longitudinal and Transversal Dose Distribution in PBS ....... 20-3 Longitudinal Distribution .................................................. 20-3 Layers .......................................................................... 20-3 Transversal Distribution ................................................... 20-4 Beam Delivery Characteristics in PBS ................................. 20-4 Spot Scanning ................................................................. 20-4 Repainting Modes ........................................................... 20-5 In-Layers Repainting .................................................... 20-6 Decrease in Energy ..................................................... 20-6 Back and Forward ....................................................... 20-6 None (no layer repainting) ........................................... 20-6 Mixed Repainting ........................................................ 20-6 Chapter 21 Introducing PBS Beam Delivery System Equipment The PBS Treatment Mode ................................................... 21-1 PBS Capable Nozzle Types .............................................. 21-2 IBA | xxxviii |
Clinical Users Guide Volume 1 - Treatment Session Role of the Scanning Magnets ........................................ 21-2 Low Ranges .................................................................... 21-2 The Scanning Controller .................................................. 21-2 Chapter 22 PBS Multiple Repainting Multiple Repainting Types ................................................... 22-1 None ................................................................................ 22-2 Identification ................................................................ 22-2 Representation ............................................................ 22-2 Graph ........................................................................... 22-2 In-Layers Repainting ........................................................ 22-3 Identification ................................................................ 22-3 Representation ............................................................ 22-3 Graph ........................................................................... 22-4 Decrease in Energy ......................................................... 22-4 Identification ................................................................ 22-4 Representation ............................................................ 22-5 Graph ........................................................................... 22-5 Back and Forward ............................................................ 22-5 Identification ................................................................ 22-6 Representation ............................................................ 22-6 Graph ........................................................................... 22-6 Mixed Repainting ............................................................ 22-7 Identification ................................................................ 22-7 Representation ............................................................ 22-7 Graph ........................................................................... 22-7 PART IV USING adaPTprescribe Chapter 23 TPS-PTS Communication in Standalone Mode Using the Batch Importer .................................................... 23-2 Using the adaPTprescribe Import Feature ......................... 23-4 Clinical Users Guide Volume 1 - Treatment Session IBA | xxxix|
Chapter 24 Getting Started With adaPTprescribe Starting an adaPTprescribe Session .................................... 24-2 Exiting an adaPTprescribe Session ...................................... 24-2 Logging into adaPTprescribe ............................................... 24-3 Logging out From adaPTprescribe ....................................... 24-4 adaPTprescribe Screen Layout ............................................ 24-5 Chapter 25 How adaPTprescribe is Organized Chapter 26 Managing Patients Viewing a Patient ................................................................. 26-2 Searching for a Patient ........................................................ 26-3 Performing a Simple Search ............................................ 26-3 Performing an Advanced Search ..................................... 26-4 Arranging Patients ............................................................... 26-7 Selecting a Patient ............................................................... 26-7 Importing a Patient Using DICOM ....................................... 26-9 Editing a Patient ................................................................... 26-9 Impact of Editing Activities on an External Plan ............ 26-10 Activating or Deactivating a Patient ................................... 26-12 Deactivating a Patient .................................................... 26-12 Activating a Patient ........................................................ 26-12 Unlocking a Patient ............................................................ 26-12 Creating a Study ................................................................ 26-15 Obtaining Irradiation History Reports ................................. 26-16 Saving the Irradiation History Report ............................. 26-17 Exporting the Irradiation History of a Plan in DICOM Format .............................................................. 26-18 Displaying the Irradiation History of a Beam ................. 26-19 Chapter 27 Managing Studies Searching for a Study .......................................................... 27-2 Viewing a Study ................................................................... 27-3 Activating or Deactivating a Study ....................................... 27-3 Deactivating a Study ........................................................ 27-4 Activating a Study ............................................................ 27-4 IBA | xl |
Clinical Users Guide Volume 1 - Treatment Session Chapter 28 Managing Plans Searching for a Plan ............................................................. 28-2 Viewing a Plan ..................................................................... 28-4 Baselining a Plan .................................................................. 28-5 Confirming Baselining in PBS .......................................... 28-7 Receiving the Baseline Notification ................................. 28-7 Copying and Pasting a Plan ................................................. 28-7 Copying a Plan ................................................................. 28-8 Pasting a Plan .................................................................. 28-8 Activating or Deactivating a Plan ......................................... 28-9 Deactivating a Plan .......................................................... 28-9 Activating a Plan .............................................................. 28-9 Chapter 29 Managing Beams Viewing a Setup Beam ........................................................ 29-3 Viewing the Tolerance Table ........................................... 29-4 Viewing a Treatment Beam ................................................. 29-5 Copying and Pasting a Treatment Beam ............................. 29-6 Copying a Beam .............................................................. 29-7 Pasting a Beam ............................................................... 29-7 Saving a PBS Beam ............................................................. 29-7 Accessing Layer Details ...................................................... 29-8 Viewing Layer Details ...................................................... 29-8 Baselining a Beam ............................................................. 29-11 Confirming Baselining in PBS ........................................ 29-12 Confirming Excessive MUs ........................................... 29-12 Receiving the Baseline Notification ............................... 29-13 Chapter 30 Using QA Features of adaPTprescribe Managing QA patients ......................................................... 30-2 Managing MACHINE_QA plans ........................................... 30-2 Modifying the Treatment Machine .................................. 30-3 Creating a New PBS Beam from Scratch ........................ 30-4 Managing Beams Belonging to MACHINE_QA Plans ......... 30-5 Editing Layer and Spot Details On the Layer Editing Screen ............................................................................. 30-6 Editing Layer Details Using the Layer Editing Menu ....... 30-9 Using Keyboard Shortcuts to Edit Layers .................. 30-10 Clinical Users Guide Volume 1 - Treatment Session IBA | xli|
Adding Layers ........................................................... 30-10 Deleting a Layer ........................................................ 30-11 Editing a Layer ........................................................... 30-11 Copying a Layer ......................................................... 30-12 Pasting a Layer .......................................................... 30-12 Editing Spot Details Using the Spot Editing Menu ........ 30-12 Using Keyboard Shortcuts to Edit Spots ................... 30-13 Adding Spots ............................................................. 30-13 Deleting a Spot .......................................................... 30-14 Editing a Spot ............................................................ 30-14 Copying a Spot .......................................................... 30-15 Pasting a Spot ........................................................... 30-15 Importing a PLD (PBS Layer Definition) File .................. 30-16 Understanding PLD files ........................................... 30-16 PART V USING adaPTdeliver Chapter 31 Introducing adaPTdeliver Introduction ......................................................................... 31-1 Using adaPTdeliver in Standalone Mode ......................... 31-1 Using adaPTdeliver in Worklist Mode ............................. 31-3 Starting adaPTdeliver ........................................................... 31-5 Stopping adaPTdeliver ......................................................... 31-6 Logging into adaPTdeliver .................................................... 31-7 Logging Out From adaPTdeliver .......................................... 31-8 Operation Mode: Clinical ..................................................... 31-8 Screen Layout ...................................................................... 31-9 Dealing With Error Messages ....................................... 31-11 Standalone Mode Specific: Selecting a Patient, Study, Plan, or Beam ......................................................... 31-11 Finding a Patient ............................................................ 31-13 Working With Patients, Studies, Plans, or Beams in the List .......................................................... 31-14 Expanding or Collapsing an Instance ......................... 31-15 IBA | xlii |
Clinical Users Guide Volume 1 - Treatment Session PART VI USING ADAPTdeliver IN STANDALONE MODE Chapter 32 Introducing adaPTdeliver Operating in Standalone Mode Introduction ......................................................................... 32-2 In Case an Error Message Appears ... ................................. 32-4 Chapter 33 Including One or More Beams into a Session Introduction ......................................................................... 33-1 Performing General Activities on Screen ............................. 33-1 Selecting an Individual Beam .......................................... 33-1 Selecting Some or All Beams .......................................... 33-3 Displaying Information in the Information Area ............... 33-3 Reviewing Patient, Study, and Plan Information .................. 33-5 Reviewing Clinical Prescriptions - for PBS ........................... 33-7 Displaying Layer Information ............................................. 33-10 Visualizing Layers .......................................................... 33-13 Chapter 34 Proceeding to Beam Selection Introduction ......................................................................... 34-1 Proceeding With an Incomplete Plan .................................. 34-2 Reporting Functions ............................................................ 34-2 Selecting a Beam ................................................................. 34-2 Chapter 35 Preparing the Equipment for Irradiation Getting Started With Equipment Preparation ...................... 35-1 Process ............................................................................ 35-1 Equipment Preparation for a Setup Beam ........................... 35-2 Interpreting Positioning Values ........................................ 35-4 Entering Corrections ........................................................ 35-6 Validating the Positioning Parameters ............................. 35-6 Clinical Users Guide Volume 1 - Treatment Session IBA | xliii|
Equipment Preparation for a Treatment Beam .................... 35-8 Preparing the Treatment Room ....................................... 35-8 Preparing the Equipment for Treatment - PBS Dedicated Nozzle ................................................................. 35-9 Verifying the PBS Dedicated Nozzle .................................. 35-11 Overview ....................................................................... 35-11 Nozzle Devices Details .................................................. 35-14 Verifying the Position of Devices ....................................... 35-17 Influence of Setup Position Corrections on a Subsequent Treatment Beam ....................................... 35-19 An Adjusted Setup Beam followed by multiple Treatment Beams ..................................................... 35-19 An Adjusted Setup Beam followed by multiple sets of Treatment Beams ......................................... 35-20 Entering Corrections ...................................................... 35-20 Validating the Positioning Parameters ........................... 35-21 Requesting Beam .............................................................. 35-22 Obtaining Authorizations ............................................... 35-23 Making a Beam Request ............................................... 35-23 Verifying the Room Interlocks ....................................... 35-25 Proceeding to Treatment .......................................... 35-27 Chapter 36 Monitoring and Controlling the Treatment Proceeding to the Treatment Step ...................................... 36-1 Performing Functions From the Actions Panel .................... 36-3 Working With the Dosimetry Panel ..................................... 36-4 Performing Functions From the Monitor Panel ................... 36-6 Monitor Panel GUI Conventions .................................. 36-7 Viewing Operator Logs .................................................... 36-8 Monitoring System Start/Resume Conditions ................. 36-8 Monitoring Beam Line Checks ........................................ 36-8 Monitoring Nozzle Cyclic Checks .................................. 36-10 Monitoring TSS Interlocks ............................................. 36-11 Monitoring the Positioning System Status .................... 36-12 Resuming Irradiation After a Positioning Check Manager Halt ............................................................. 36-13 IBA | xliv |
Clinical Users Guide Volume 1 - Treatment Session Chapter 37 Starting Irradiation Process ................................................................................ 37-1 Partially Delivered Prescribed Dose ..................................... 37-3 Error Message Delivered MU of layer should be less than prescribed MU ................................................... 37-3 Chapter 38 Pausing and Stopping an Irradiation Introduction ......................................................................... 38-2 Gating the Beam ............................................................. 38-2 Pausing Irradiation ............................................................... 38-3 Resuming Irradiation After a Pause ..................................... 38-4 Stopping Irradiation .............................................................. 38-5 Chapter 39 Resuming after a Partial Irradiation Summary of the steps for Resuming from a Partial treatment ............................................................................. 39-3 Termination by the Therapist: No Recovery needed ........... 39-6 Specific warnings ........................................................ 39-6 Termination by the Proton Therapy System ........................ 39-8 Online recovery - adaPTdeliver session maintained ............ 39-8 Automatic recovery ......................................................... 39-8 Retry and Troubleshoot ............................................... 39-9 Manual recovery from File ............................................. 39-11 Manual Recovery from DCEU values ............................ 39-13 Resuming Irradiation ..................................................... 39-14 Offline recovery - adaPTdeliver session crashes ............... 39-15 Automatic recovery ....................................................... 39-16 Manual recovery from File ............................................. 39-18 Manual Recovery from DCEU values ............................ 39-20 Resuming Irradiation ..................................................... 39-20 Resuming Irradiation in the Same Session ........................ 39-22 Resuming irradiation ...................................................... 39-23 Resuming Irradiation in a New Session ............................. 39-23 Using the Standalone mode .......................................... 39-23 Partial treatment record found .................................. 39-24 Multiple partial treatment records found ................... 39-26 Clinical Users Guide Volume 1 - Treatment Session IBA | xlv|
No partial records found ............................................ 39-27 Using an OIS ................................................................. 39-27 DEV-Centric mode ..................................................... 39-27 PART VII USING adaPTdeliver IN WORKLIST MODE Chapter 40 Operating in Worklist Mode Selecting an Appointment ................................................... 40-1 Appointment Selection: Dose Limits Check .................... 40-3 Grayed Out Appointments .............................................. 40-3 When no Appointments Appear ...................................... 40-4 Procedure ........................................................................ 40-4 Selecting a Beam ................................................................. 40-4 How to Proceed From Here? ............................................... 40-6 Chapter 41 Resuming after a Partial Irradiation Summary of the steps for Resuming from a Partial treatment ............................................................................. 41-2 Termination by the Therapist: No Recovery needed ........... 41-5 Termination by the Proton Therapy System ........................ 41-6 Online recovery - adaPTdeliver session maintained ............ 41-6 Automatic recovery ......................................................... 41-6 Retry and Troubleshoot ............................................... 41-7 Manual recovery from File ............................................... 41-9 Manual Recovery from DCEU values ............................ 41-11 Resuming Irradiation ..................................................... 41-12 Offline recovery - adaPTdeliver session crashes ............... 41-13 Automatic recovery ....................................................... 41-14 Manual recovery from File ............................................. 41-16 Manual Recovery from DCEU values ............................ 41-18 Resuming Irradiation ..................................................... 41-18 Resuming Irradiation in the Same Session ........................ 41-20 Resuming irradiation ...................................................... 41-21 Resuming Irradiation in a New Session ............................. 41-21 Using an OIS ................................................................. 41-21 IBA | xlvi |
Clinical Users Guide Volume 1 - Treatment Session DEV-Centric mode ..................................................... 41-21 End of an Irradiation ...................................................... 41-25 Disconnection of the OIS-adaPTdeliver Link ................. 41-25 PART VIII BROWSING adaPTdeliver REPORTS Chapter 42 Browsing Reports Using Reports ...................................................................... 42-1 Session Report Entry Characteristics .............................. 42-2 Beam Report Entry Characteristics ................................. 42-3 Display an Irradiation Report ....................................... 42-3 Exporting a Session Report to DICOM ....................... 42-4 PART IX ADAPTdeliver IN PHYSICS MODE Chapter 43 Using adaPTdeliver in Physics Mode Session Definition ........................................................... 43-4 Baselining Aspects in Clinical and Physics Mode ....... 43-6 Using the Pristine Beam Tool .............................................. 43-7 Beam Selection ............................................................. 43-11 Preparation .................................................................... 43-11 Verifying the Position of Devices .............................. 43-12 Verifying the Room Interlocks ................................... 43-14 Treatment ...................................................................... 43-15 Clinical Users Guide Volume 1 - Treatment Session IBA | xlvii|
PART X PREPARING FOR TREATMENT Chapter 44 Beam Scheduling Principles ABS Automatic Mode .......................................................... 44-1 ABS Manual Mode .............................................................. 44-1 Switching ABS Modes ......................................................... 44-2 Chapter 45 Preparing a Treatment Room Verifying Removable Patient Supports ................................ 45-1 Preparing a Gantry Treatment Room ................................... 45-1 Preliminary: GRF Precautions .......................................... 45-1 GTR Preparation .............................................................. 45-2 Procedure .................................................................... 45-2 PART XI PATIENT POSITIONING AND ALIGNMENT Chapter 46 Introducing Patient Positioning and Alignment Various Positions Involved ................................................... 46-2 Setup Position ................................................................. 46-3 Prescribed and Corrected Setup Position ................... 46-5 Treatment Position .......................................................... 46-5 Taring the PPS ..................................................................... 46-9 What is the tare, and why should it be done? ................. 46-9 When the tare must be done? ........................................ 46-9 Prerequisites for performing a tare ................................. 46-9 If tare is performed with an incorrect prerequisite... .... 46-10 Procedure to perform the tare ....................................... 46-10 Using the wireless hand-pendant. ............................ 46-10 Automatic Weight Check ................................................... 46-13 The Typical Alignment Correction Process ........................ 46-19 Recovering From an Equipment Error ............................... 46-25 IBA | xlviii |
Clinical Users Guide Volume 1 - Treatment Session Chapter 47 Calculating Corrections Using adaPTinsight Preliminary adaPTinsight Activities ...................................... 47-2 Starting up adaPTinsight .................................................. 47-2 Logging Into adaPTinsight ............................................... 47-2 Logging Out From adaPTinsight ...................................... 47-3 Starting the X-ray Generators .......................................... 47-3 Calculating Corrections ........................................................ 47-5 Selecting the Patient, Plan and Beam ............................. 47-5 Pre-aligning the Patient ................................................... 47-5 Acquiring Images ............................................................. 47-6 3D Acquisition: kV CBCT ............................................. 47-8 Registering Images ......................................................... 47-9 2D-3D Image Registration ......................................... 47-10 3D-3D Image Registration ......................................... 47-10 Generating the Correction ............................................. 47-10 Correction Feedback .......................................................... 47-11 How to Interpret adaPTinsight Corrections ................... 47-11 How to Apply and Implement the Calculated Corrections .................................................................... 47-12 Chapter 48 Using the Universal Beam Triggering Interface Introducing Triggering .......................................................... 48-1 Why Use Triggering With the Proton Beam? .................. 48-1 Why Use Triggering With the Patient Positioning Verification System (PPVS)? ............................................ 48-1 The Triggering Solution ................................................... 48-2 Triggering Requirements ............................................. 48-2 UBTI Details .................................................................... 48-4 Explaining the Universal Beam Triggering Interface ............ 48-4 Location ........................................................................... 48-4 Operating the UTEU ............................................................ 48-6 Two Modes of Operation: Manual or Automatic ............. 48-6 Automatic Triggering ................................................... 48-6 Manual Triggering ....................................................... 48-6 UTEU Controls ................................................................. 48-7 Gating Prescription .......................................................... 48-8 Specify the prescription at TPS/OIS level .................... 48-8 Relationship between prescription and source selected on the triggering rack .................................... 48-8 Prescription display ..................................................... 48-9 Clinical Users Guide Volume 1 - Treatment Session IBA | xlix|
Prescription mismatch ................................................ 48-9 Triggering Procedure ..................................................... 48-16 How the UBTI Affects the Irradiation Process ................... 48-18 Using UBTI in the Pencil Beam Scanning Treatment Mode ........................................................... 48-18 Beam Enabling/Disabling ........................................... 48-19 Chapter 49 Aligning a Patient in the GTR Moving Equipment to the Setup Position ............................ 49-2 Verifying Patient Alignment in Setup Position ..................... 49-3 Correcting the Setup Position .............................................. 49-5 Inputting the Setup Corrections ...................................... 49-6 Implementing the Corrections ......................................... 49-6 Confirming the Setup Position ............................................. 49-8 Working With the Treatment Session Manager .............. 49-8 Moving Equipment to Treatment Position ........................... 49-8 Verifying Patient Alignment in Treatment Position .............. 49-9 Correcting the Treatment Position ...................................... 49-9 Inputting the Treatment Position Corrections ............... 49-10 Implementing the Position Corrections ......................... 49-11 Confirming the Treatment Position ................................... 49-12 PART XII MONITORING AN IRRADIATION Chapter 50 Monitoring an Irradiation Appendix A Nozzle Types and Components Nozzle Position ...................................................................... A-1 Nozzle Types ......................................................................... A-1 Pencil Beam Scanning (PBS) Dedicated Nozzle ................ A-1 Nozzle Types and Components PBS Dedicated Nozzle Structure .................................................................... A-3 The Scanning Controller .................................................... A-3 PBS Dedicated Nozzle Layout ........................................... A-5 PBS Dedicated Nozzle Components ..................................... A-6 IBA | l |
Clinical Users Guide Volume 1 - Treatment Session Nozzle Frame ..................................................................... A-6
(Low Pressure) Ionization Chamber No. 1 - (LP)IC1 .......... A-6 PBS Dedicated Quadrupole Magnets ................................ A-7 Scanning Magnets ............................................................. A-7 PBS Dedicated Nozzle Pre-assembly ................................ A-7 Retractable X-ray Tube ...................................................... A-7 Range Verifier .................................................................... A-7 Beam Stop Assembly ........................................................ A-7 Ionization Chambers No. 2 & No. 3 (IC2 & IC3) ................. A-8 Snout Holder ..................................................................... A-9 Appendix A Using the Dosimetry Manager Starting the Dosimetry Manager ........................................... A-2 Entering Temperature and Pressure Values .......................... A-3 Handling Errors .................................................................. A-4 Entering Dose Correction Factor ........................................... A-5 Determining the Minimum Allowed MU ............................... A-6 Viewing the History Log ........................................................ A-7 Appendix B Managing PTS Users Creating a New User ......................................................... B-3 Editing a User and Changing the Password ...................... B-4 Managing Overrides .......................................................... B-4 Non-Clinical Mode ............................................................. B-5 Appendix C Managing adaPTprescribe Settings Managing Tolerance Tables ................................................... C-2 Performing Functions With Tolerance Tables ................... C-3 Internal Tolerance Tables .............................................. C-3 External Tolerance Tables ............................................. C-4 Managing MU Clinical Ranges ............................................... C-5 Managing Accessories .......................................................... C-6 Appendix D Emergency Stop Button Locations Motion Stop Buttons .............................................................D-4 Clinical Users Guide Volume 1 - Treatment Session IBA | li|
Appendix E System Messages Appendix F PTS Acronyms & Abbreviations Appendix G Glossary of Terms Index Safety Decisions Issue Tracking System Problem Reports and Engineering Change Requests ........ ITS-1 IBA | lii |
Clinical Users Guide Volume 1 - Treatment Session Figures Figure 1-1. Figure 1-2. Figure 2-1. Figure 2-2. Figure 2-3. Figure 4-1. Figure 4-2. Figure 6-1. Figure 6-2. Figure 6-3. Figure 6-4. Figure 6-5. Figure 6-6. Figure 7-1. Figure 7-2. Figure 7-3. Figure 7-4. Figure 7-5. Figure 8-1. Figure 8-2. Figure 8-3. Figure 8-4. Figure 8-5. Figure 9-1. Figure 9-2. Figure 9-3. Figure 9-4. Figure 9-5. Figure 9-6. Figure 9-7. Figure 9-8. Figure 9-9. Figure 9-10. Figure 9-11. Figure 9-12. Treatment Workflow Options............................................................. 1-8 Treatment Workflow Options - Frequency Aspect........................... 1-10 About TCS Icon Content................................................................... 2-3 adaPTprescribe in Clinical Mode......................................................... 2-5 adaPTprescribe in a non-clinical Mode................................................ 2-6 Pinching Hazards on Gantry Rolling Floor Panels ............................... 4-4 BireuServiceStartedCheck Message ................................................ 4-9 IEC Fixed Coordinate System............................................................. 6-4 IEC Gantry Coordinate System........................................................... 6-5 Table Top Coordinate System (TTCS)................................................. 6-6 Zero position of the TTCS................................................................... 6-7 Remote Positioning Controls Panel - Auto and Manual Modes.......... 6-8 Wireless Hand-Pendant GUI Screen - Auto and Manual Modes ........ 6-9 PPS Structural Parts............................................................................ 7-4 Treatment Volume.............................................................................. 7-7 Treatment Volume When Using the (kVueOne) Couch...................... 7-9 Tool for moving the kVue couch beams ........................................... 7-10 Gantry Angles in Treatment Session (viewed from the Treatment Room) .......................................................................... 7-14 Remote Positioning Hardware Console.............................................. 8-2 Wireless Hand-Pendant GUI Screen................................................... 8-3 Remote Positioning Controls Panel in adaPTdeliver Screen............... 8-4 Remote Positioning Controls Panel - Main Features .......................... 8-5 Remote Positioning Controls Panel - Disabled ................................. 8-12 Wireless Hand-Pendant ...................................................................... 9-1 Wireless Hand-Pendant Docking Station............................................ 9-2 Wireless Hand-Pendant Connected - Not Registered......................... 9-6 Registration Procedure Screen........................................................... 9-7 Movement Speed Icons ..................................................................... 9-9 Device Selection Bar......................................................................... 9-12 Menu Icon ........................................................................................ 9-14 Menu ................................................................................................ 9-15 Treatment Position - Auto Mode (PPS screen)................................. 9-16 Treatment Position - Auto Mode (Gantry, Snout, Drawer screen).... 9-17 Creating a User-Defined Position...................................................... 9-19 New Position Screen ........................................................................ 9-20 Clinical Users Guide Volume 1 - Treatment Session IBA | liii |
Figure 9-13. Figure 9-14. Figure 9-15. Figure 9-16. Figure 9-17. Figure 9-18. Figure 9-19. Figure 9-20. Figure 9-21. Figure 9-22. Figure 9-23. Figure 9-24. Figure 9-25. Figure 9-26. Figure 9-27. Figure 9-28. Figure 9-29. Figure 9-30. Figure 9-31. Figure 9-32. Figure 11-1. Figure 11-2. Figure 11-3. Figure 11-4. Figure 11-5. Figure 11-6. Figure 11-7. Figure 11-8. Figure 11-9. Figure 11-10. Figure 11-11. Figure 11-12. Figure 11-13. Figure 11-14. Figure 11-15. Figure 11-16. Figure 11-17. Figure 11-18. Figure 11-19. Figure 11-20. Figure 11-21. Figure 11-22. Figure 11-23. Figure 11-24. Figure 11-25. IBA | liv |
Arranging User-Defined Positions..................................................... 9-22 Gantry, Snout and Accessory Holder - Manual Mode....................... 9-25 Move Accessory Drawer Into the Beam Path Icon .......................... 9-26 Move Accessory Drawer Out of the Beam Path Icon ...................... 9-26 Insert Snout Icon .............................................................................. 9-27 Retract Snout Icon............................................................................ 9-27 PPS - Manual Mode.......................................................................... 9-28 PPS Pitch/Roll Widget....................................................................... 9-30 PPS - Pitch Icon (above) and PPS + Pitch Icon (below) .................... 9-30 PPS + Roll Icon (above) and PPS - Roll Icon (below) ........................ 9-31 Digital Imaging Devices Screen........................................................ 9-32 CBCT Preparation Button.................................................................. 9-33 Snout and Accessory Drawer - CBCT Preparation Screen................ 9-34 Retract Snout Icon............................................................................ 9-34 Move Accessory Drawer Into the Beam Path Icon .......................... 9-35 PPS - CBCT Preparation Screen........................................................ 9-36 Digital Imaging Devices - CBCT Preparation Screen......................... 9-37 CBCT Dry Run Screen ...................................................................... 9-38 Menu - Advanced Options................................................................ 9-39 Wireless Hand-Pendant GUI - Inverted Colors.................................. 9-40 Remote Positioning Hardware Console............................................ 11-4 Movement Speed Icons ................................................................... 11-4 Tool Tip ............................................................................................. 11-7 Error Tool Tip .................................................................................... 11-8 Remote Positioning Controls Panel - Auto Mode ............................. 11-9 Target Positions Commands........................................................... 11-10 User Presets Menu......................................................................... 11-11 Preset Selected as Target Position................................................. 11-12 Target Position Device Feedback ................................................... 11-13 Snout Options................................................................................. 11-14 Accessory Drawer Options............................................................. 11-15 Status Panel - Accessory Drawer Position Feedback ..................... 11-16 Gantry Options................................................................................ 11-17 Gantry Options................................................................................ 11-17 CBCT Preparation Panel (equipment not ready) ............................. 11-19 Remote Positioning Controls Panel - CBCT Preparation Icon......... 11-20 CBCT Preparation Panel - Equipment Ready .................................. 11-22 Remote Positioning Controls Panel - User Presets ........................ 11-23 New User Preset Icon .................................................................... 11-23 User Preset Edition Menu .............................................................. 11-24 List of User Presets........................................................................ 11-25 Edit User Preset Icon...................................................................... 11-25 Manage Presets Icon...................................................................... 11-26 Manage Presets Menu ................................................................... 11-27 Edit Preset Icon .............................................................................. 11-28 Clinical Users Guide Volume 1 - Treatment Session Figure 11-26. Figure 11-27. Figure 11-28. Figure 11-29. Figure 11-30. Figure 11-31. Figure 11-32. Figure 11-33. Figure 11-34. Figure 11-35. Figure 11-36. Figure 11-37. Figure 11-38. Figure 11-39. Figure 11-40. Figure 11-41. Figure 11-42. Figure 11-43. Figure 11-44. Figure 11-45. Figure 11-46. Figure 12-1. Figure 12-2. Figure 12-3. Figure 12-4. Figure 13-1. Figure 13-2. Figure 13-3. Figure 13-4. Figure 13-5. Figure 13-6. Figure 13-7. Figure 13-8. Figure 13-9. Figure 13-10. Figure 13-11. Figure 13-12. Figure 13-13. Figure 13-14. Figure 13-15. Figure 14-1. Figure 14-2. Figure 14-3. Figure 14-4. Figure 14-5. Clone Preset Icon ........................................................................... 11-29 Delete Preset Icon.......................................................................... 11-30 Remote Positioning Controls - Manual Mode................................. 11-31 Accessory Drawer and Snout Commands...................................... 11-32 Move Accessory Drawer Into the Beam Path Icon ........................ 11-32 Move Accessory Drawer Out of the Beam Path Icon .................... 11-32 Insert Snout Icon ............................................................................ 11-33 Retract Snout Icon.......................................................................... 11-33 Insert or Retract Snout Icon............................................................ 11-34 Gantry Commands.......................................................................... 11-34 Gantry Commands - Target Angle Selected ................................... 11-35 PPS Commands.............................................................................. 11-36 X and Y PPS Axes Icon ................................................................... 11-36 X and Y PPS Axes Icon ................................................................... 11-37 Z PPS Axis Icon............................................................................... 11-37 PPS + Rot Arrow (above) and PPS - Rot Arrow (below) ................. 11-38 PPS +Pitch Icon (above) and PPS - Pitch Icon (below) ................... 11-38 PPS + Roll Icon (above) and PPS - Roll Icon (below) ...................... 11-39 Options Menu Icon......................................................................... 11-39 Advanced Settings Menu ............................................................... 11-40 Reset SRCU Warning ..................................................................... 11-41 GTR Imaging Geometry.................................................................... 12-4 adaPTinsight Integration With the TCS............................................. 12-5 Laser Locations for PBS Dedicated Nozzle in GTR......................... 12-11 CBCT Commands on the X-ray Console......................................... 12-22 Tool ID system for couch identification ............................................ 13-2 PPS - Major Moving Parts................................................................. 13-3 Coupling System............................................................................... 13-3 Lock/Unlock Button .......................................................................... 13-4 Air Locking Coupler on the Wrist...................................................... 13-5 Positioner Menu ............................................................................... 13-8 Positioner Menu ............................................................................... 13-9 Automatic Docking Areas and Positions......................................... 13-12 Automatic Docking Areas and Positions......................................... 13-13 Automatic Docking - Sequence of Operations................................ 13-14 Advanced Menu.............................................................................. 13-16 Automatic Docking Screen ............................................................. 13-17 Lock/Unlock Button ........................................................................ 13-18 Automatic Docking Screen ............................................................. 13-19 Back Button .................................................................................... 13-22 PBS Dedicated Snout Holder............................................................ 14-5 Type DN_S Snout Components........................................................ 14-9 LEDs on the Snouts Tray............................................................... 14-10 Type DN_S Snout (lateral cut)......................................................... 14-12 Type DN_M Snout Components..................................................... 14-15 Clinical Users Guide Volume 1 - Treatment Session IBA | lv |
Figure 14-6. Figure 14-7. Figure 14-8. Figure 14-9. Figure 14-10. Figure 15-1. Figure 15-2. Figure 16-1. Figure 16-2. Figure 16-3. Figure 16-4. Figure 17-1. Figure 20-1. Figure 20-2. Figure 20-3. Figure 21-1. Figure 22-1. Figure 22-2. Figure 22-3. Figure 22-4. Figure 22-5. Figure 22-6. Figure 22-7. Figure 22-8. Figure 22-9. Figure 22-10. Figure 23-1. Figure 24-1. Figure 24-2. Figure 24-3. Figure 25-1. Figure 26-1. Figure 26-2. Figure 26-3. Figure 26-4. Figure 26-5. Figure 26-6. Figure 26-7. Figure 26-8. Figure 26-9. Figure 26-10. Figure 26-11. Figure 26-12. Figure 26-13. Figure 26-14. IBA | lvi |
LEDs on the Snouts Tray............................................................... 14-16 Type DN_M Snout (lateral cut)........................................................ 14-18 Type DN_XL Snout Components.................................................... 14-19 Type DN_XL Snout Components - continued................................. 14-20 LEDs on the Snout.......................................................................... 14-21 Dose Counter Electronic Unit (DCEU) .............................................. 15-4 Dose Counter Electronic Unit (DCEU) - detail................................... 15-5 Emergency Hand-Pendant................................................................ 16-1 Joints 1 and 2 Motions ..................................................................... 16-4 Joint 3 Motion................................................................................... 16-5 Emergency Hand-Pendant Details.................................................... 16-6 Position of Water Phantom on PPS (typical)..................................... 17-3 Pencil Beam Scanning (PBS) Delivery Technique............................. 20-2 Organization of the Prescription Data............................................... 20-4 Scaling Sample: 3 Paintings.............................................................. 20-5 BDS Equipment Usage in PBS Treatment Mode - Schematic.......... 21-1 None (No Multiple Repainting) Icon.................................................. 22-2 None (No Multiple Repainting) Energy/Layer Graph......................... 22-2 In-Layers Icon ................................................................................... 22-3 In-Layers Energy/Layer Graph........................................................... 22-4 Decrease in Energy Icon................................................................... 22-5 Decrease in Energy Energy/Layer Graph.......................................... 22-5 Back and Forward Icon ..................................................................... 22-6 Back and Forward Energy/Layer Graph (typical) ............................... 22-6 PBS Mixed Icon ................................................................................ 22-7 PBS Mixed Energy/Layer Graph ....................................................... 22-7 Communication Mode: Using the Batch Importer............................ 23-3 Start adaPTprescribe Icon................................................................. 24-2 adaPTprescribe Login Screen ........................................................... 24-3 adaPTprescribe Screen..................................................................... 24-5 Treatment Data Organization............................................................ 25-2 Prescription Screen........................................................................... 26-2 Search Area ...................................................................................... 26-3 Advanced Search Panel .................................................................... 26-4 adaPTprescribe Arrange Options...................................................... 26-7 Patient Panel (typical)........................................................................ 26-8 Patient Data File Selection................................................................ 26-9 Patient Edit Screen ......................................................................... 26-10 Locked Patient................................................................................ 26-13 Unlock Confirmation Prompt .......................................................... 26-14 Create Study Screen....................................................................... 26-15 Irradiation History............................................................................ 26-16 Save Screen.................................................................................... 26-17 Irradiation History - Plan Selected................................................... 26-18 Save Screen (DICOM format)......................................................... 26-19 Clinical Users Guide Volume 1 - Treatment Session Figure 26-15. Figure 26-16. Figure 26-17. Figure 26-18. Figure 27-1. Figure 27-2. Figure 27-3. Figure 28-1. Figure 28-2. Figure 28-3. Figure 28-4. Figure 28-5. Figure 28-6. Figure 29-1. Figure 29-2. Figure 29-3. Figure 29-4. Figure 29-5. Figure 29-6. Figure 29-7. Figure 29-8. Figure 29-9. Figure 29-10. Figure 30-1. Figure 30-2. Figure 30-3. Figure 30-4. Figure 30-5. Figure 30-6. Figure 30-7. Figure 30-8. Figure 30-9. Figure 30-10. Figure 30-11. Figure 30-12. Figure 31-1. Figure 31-2. Figure 31-3. Figure 31-4. Figure 31-5. Figure 31-6. Figure 31-7. Figure 31-8. Figure 31-9. Figure 31-10. Irradiation History - Beam Selected ................................................ 26-19 Irradiation Report ............................................................................ 26-20 Irradiation Report ............................................................................ 26-21 Irradiation Report ............................................................................ 26-22 Study List.......................................................................................... 27-1 Study Search Results........................................................................ 27-2 Study Panel....................................................................................... 27-3 Plan List ............................................................................................ 28-1 Plan Search Results.......................................................................... 28-3 Plan Panel ......................................................................................... 28-4 Unbaselined Plan .............................................................................. 28-5 Consistency Check Pitch/Roll PPS Positions.................................... 28-6 Couch Positions Check - Pop-Up Message ...................................... 28-7 Beam List Screen ............................................................................. 29-1 Setup Beam Display Screen ............................................................. 29-3 Tolerance Table Pop-up .................................................................... 29-4 Treatment Beam Display Screen...................................................... 29-5 Layer List Screen.............................................................................. 29-8 Layer Details Screen......................................................................... 29-9 Unbaselined Beams........................................................................ 29-11 Beam Baseline Confirmation .......................................................... 29-12 MU Override Confirmation ............................................................. 29-12 Beam Baseline Notification............................................................. 29-13 Treatment Machine Field.................................................................. 30-4 Plan Display Screen .......................................................................... 30-5 Notification Message........................................................................ 30-6 Layer Editing Screen......................................................................... 30-7 Layer Edit Menu ............................................................................... 30-9 Input Layer Information Dialogue ................................................... 30-10 Input Layer Information Dialogue ................................................... 30-11 Spot Edit Menu............................................................................... 30-12 Input Spot Information Dialogue..................................................... 30-14 Input Spot Information Dialogue..................................................... 30-15 Import PLD File............................................................................... 30-16 PLD File .......................................................................................... 30-17 Treatment Flow - Standalone Mode ................................................. 31-2 adaPTdeliver Activities...................................................................... 31-4 Start adaPTdeliver Icon..................................................................... 31-5 adaPTdeliver Logo Screen ................................................................ 31-5 adaPTdeliver Login Screen ............................................................... 31-7 adaPTdeliver - Login Error................................................................. 31-8 Typical adaPTdeliver Screen ............................................................. 31-9 adaPTdeliver - Typical Error Message............................................. 31-11 Session Definition Screen............................................................... 31-12 Find Criteria and Patient List........................................................... 31-13 Clinical Users Guide Volume 1 - Treatment Session IBA | lvii |
Figure 31-11. Figure 32-1. Figure 32-2. Figure 33-1. Figure 33-2. Figure 33-3. Figure 33-4. Figure 33-5. Figure 33-6. Figure 34-1. Figure 34-2. Figure 35-1. Figure 35-2. Figure 35-3. Figure 35-4. Figure 35-5. Figure 35-6. Figure 35-7. Figure 35-8. Figure 35-9. Figure 35-10. Figure 35-11. Figure 35-12. Figure 35-13. Figure 35-14. Figure 35-15. Figure 35-16. Figure 35-17. Figure 35-18. Figure 35-19. Figure 36-1. Figure 36-2. Figure 36-3. Figure 36-4. Figure 36-5. Figure 36-6. Figure 36-7. Figure 36-8. Figure 36-9. Figure 36-10. Figure 36-11. Figure 37-1. Figure 37-2. Figure 38-1. Figure 39-1. IBA | lviii |
List Area.......................................................................................... 31-14 Mode Indication (OIS/Standalone) on adaPTdeliver Screens............ 32-1 Treatment Flow - Standalone Mode ................................................. 32-3 Quick Selection Options ................................................................... 33-3 Patient, Study, and Plan Information ................................................ 33-5 Beam Information - Pencil Beam Scanning ...................................... 33-7 Maximum Field Size ......................................................................... 33-8 Layer Information............................................................................ 33-11 Layer Information - details .............................................................. 33-13 Beam Selection Confirmation Prompt .............................................. 34-2 Beam Selection Screen .................................................................... 34-3 Equipment Preparation Screen......................................................... 35-2 PMS Interface Panel......................................................................... 35-5 Beam Correction Screen................................................................... 35-6 Equipment Preparation Screen......................................................... 35-7 Setup Beam - Completed indication ................................................. 35-7 Equipment Preparation Screen......................................................... 35-9 PBS Dedicated Nozzle Panel .......................................................... 35-11 Nozzle Panel ................................................................................... 35-13 PBS Dedicated Nozzle Panel .......................................................... 35-14 PBS Dedicated Nozzle Panel .......................................................... 35-15 PMS Interface Panel....................................................................... 35-17 Beam Correction Screen................................................................. 35-21 PMS Interface Panel....................................................................... 35-22 Beam Panel..................................................................................... 35-22 Beam Preparation Failure Message................................................ 35-24 Beam Panel..................................................................................... 35-25 Room Interlocks Panel - Not Ready................................................ 35-26 Room Interlocks Panel - Ready....................................................... 35-27 Equipment Preparation Screen....................................................... 35-27 Treatment Screen............................................................................. 36-2 Treatment Screen - Actions Panel .................................................... 36-3 Treatment Screen - Dosimetry Panel (typical) .................................. 36-4 Treatment Screen - Dosimetry Panel - Irradiating screen (typical).... 36-5 Treatment Screen - Monitor Panel.................................................... 36-7 Monitor Panel - Operator Logs ......................................................... 36-8 System Start/Resume Tab................................................................ 36-8 Beam Line Checks Tab..................................................................... 36-9 Nozzle Cyclic Checks Tab ............................................................... 36-11 TSS Interlocks Tab.......................................................................... 36-12 Positioning System Status Tab....................................................... 36-13 Irradiation Screen: Irradiating ........................................................... 37-2 Partial Delivery - System Message................................................... 37-3 Mode Indication (OIS/Standalone) on adaPTdeliver Screens............ 38-1 Resuming from Partial Treatments................................................... 39-5 Clinical Users Guide Volume 1 - Treatment Session Figure 39-2. Figure 39-3. Figure 39-4. Figure 39-5. Figure 39-6. Figure 39-7. Figure 39-8. Figure 39-9. Figure 39-10. Figure 39-11. Figure 39-12. Figure 39-13. Figure 39-14. Figure 39-15. Figure 39-16. Figure 39-17. Figure 39-18. Figure 39-19. Figure 39-20. Figure 39-21. Figure 39-22. Figure 39-23. Figure 39-24. Figure 39-25. Figure 39-26. Figure 39-27. Figure 40-1. Figure 40-2. Figure 40-3. Recovery after Termination by Therapist - Warning message.......... 39-6 Resuming irradiation - Standalone mode: Warning messages ......... 39-7 Recovery after termination by PTS - Warning message................... 39-8 Recovery after termination by PTS - Automatic recovery process (online) ............................................................................. 39-9 Recovery after termination by PTS - Automatic data recovery information (online)...................................................................... 39-10 Recovery after termination by PTS - Retrying automatic recovery process (online) ............................................................ 39-11 Recovery after termination by PTS - Manual data recovery information (online)...................................................................... 39-12 Recovery after termination by PTS - Manual recovery process (online) ........................................................................... 39-13 Recovery after termination by PTS - Recovery from DCEU values ............................................................................... 39-14 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 39-14 Recovery after termination by PTS - Offline recovery .................... 39-16 Recovery after termination by PTS - Automatic data recovery information (offline) ...................................................... 39-17 Recovery after termination by adaPTdeliver - Manual data recovery message (offline) .................................................. 39-18 Recovery after termination by PTS - Manual data recovery information (offline) ..................................................................... 39-18 Recovery after termination by PTS - Manual recovery process (offline)........................................................................... 39-19 Recovery after termination by PTS - Recovery from DCEU values ............................................................................... 39-20 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 39-21 Resuming irradiation after partial treatment ................................... 39-22 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 39-23 Resuming irradiation after partial treatment in Standalone mode .. 39-24 Resuming irradiation....................................................................... 39-25 Resuming irradiation after partial treatment ................................... 39-25 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 39-26 Resuming irradiation - Partial treatment records found .................. 39-27 Resuming irradiation after partial treatment ................................... 39-28 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 39-29 Appointment Selection Screen......................................................... 40-1 Consistency Check Pitch/Roll PPS Positions.................................... 40-2 Couch Positions Check - Pop-Up Message ...................................... 40-3 Clinical Users Guide Volume 1 - Treatment Session IBA | lix |
Figure 40-4. Figure 41-1. Figure 41-2. Figure 41-3. Figure 41-4. Figure 41-5. Figure 41-6. Figure 41-7. Figure 41-8. Figure 41-9. Figure 41-10. Figure 41-11. Figure 41-12. Figure 41-13. Figure 41-14. Figure 41-15. Figure 41-16. Figure 41-17. Figure 41-18. Figure 41-19. Figure 41-20. Figure 41-21. Figure 41-22. Figure 42-1. Figure 42-2. Figure 42-3. Figure 42-4. Figure 43-1. Figure 43-2. Figure 43-3. IBA | lx |
Beam Selection Screen .................................................................... 40-4 Resuming from Partial Treatments................................................... 41-4 Recovery after Termination by Therapist - Warning message.......... 41-5 Recovery after termination by PTS - Warning message................... 41-6 Recovery after termination by PTS - Automatic recovery process (online) ............................................................................. 41-7 Recovery after termination by PTS - Automatic data recovery information (online)........................................................................ 41-8 Recovery after termination by PTS - Retrying automatic recovery process (online) .............................................................. 41-9 Recovery after termination by PTS - Manual data recovery information (online)...................................................................... 41-10 Recovery after termination by PTS - Manual recovery process
(online)......................................................................................... 41-11 Recovery after termination by PTS - Recovery from DCEU values .......................................................................................... 41-12 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 41-12 Recovery after termination by PTS - Offline recovery .................... 41-14 Recovery after termination by PTS - Automatic data recovery information (offline) ..................................................................... 41-15 Recovery after termination by adaPTdeliver - Manual data recovery message (offline) .......................................................... 41-16 Recovery after termination by PTS - Manual data recovery information (offline) ..................................................................... 41-16 Recovery after termination by PTS - Manual recovery process (offline)........................................................................... 41-17 Recovery after termination by PTS - Recovery from DCEU values ............................................................................... 41-18 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 41-19 Resuming irradiation after partial treatment ................................... 41-20 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 41-21 Resuming irradiation after partial treatment ................................... 41-22 Confirmation to the use of simulated data for resuming irradiation..................................................................................... 41-23 Irradiation Screen: Irradiation Complete (typical) ............................ 41-25 Report List Screen............................................................................ 42-2 Irradiation Report Screen.................................................................. 42-4 DICOM Export Screen...................................................................... 42-5 DICOM File List ................................................................................ 42-5 adaPTdeliver Login Screen ............................................................... 43-2 adaPTdeliver in Physics Mode .......................................................... 43-3 Physics Mode Acknowledgment Message ...................................... 43-4 Clinical Users Guide Volume 1 - Treatment Session Figure 43-4. Figure 43-5. Figure 43-6. Figure 43-7. Figure 43-8. Figure 43-9. Figure 43-10. Figure 43-11. Figure 43-12. Figure 43-13. Figure 43-14. Figure 43-15. Figure 46-1. Figure 46-2. Figure 46-3. Figure 46-4. Figure 46-5. Figure 46-6. Figure 46-7. Figure 46-8. Figure 46-9. Figure 46-10. Figure 46-11. Figure 47-1. Figure 47-2. Figure 47-3. Figure 47-4. Figure 47-5. Figure 47-6. Figure 47-7. Figure 48-1. Figure 48-2. Figure 48-3. Figure 48-4. Figure 48-5. Figure 48-6. Figure 48-7. Figure 48-8. Figure 48-9. Figure 48-10. Figure A-1. Figure A-2. Session Definition Screen - Physics Mode....................................... 43-5 Pristine Beam Tool - Beam Settings................................................. 43-7 Pristine Beam Tool - BEAM SETTINGS SCREEN .................................................... 43-8 Pristine Beam Tool - Preparation Screen .......................................... 43-9 Pristine Beam Tool - Irradiation Screen........................................... 43-10 Beam Selection Screen .................................................................. 43-11 Equipment Preparation Screen....................................................... 43-12 PMS Interface Panel....................................................................... 43-13 PMS Interface Panel, with Blocking Selection................................ 43-14 Room Interlocks Panel.................................................................... 43-14 Treatment Screen........................................................................... 43-16 Treatment Screen........................................................................... 43-17 Setup Position (GTR, lateral view) .................................................... 46-3 Setup Position (GTR, top view)......................................................... 46-4 Treatment Position (GTR, lateral view) ............................................. 46-6 Treatment Position (GTR, top view).................................................. 46-7 PPS icon of the wireless hand-pendant GUI screen....................... 46-10 Tare section of the wireless hand-pendant GUI screen.................. 46-11 Automatic weight check - Positioner screen .................................. 46-14 Automatic weight check - Retract imager ...................................... 46-15 Automatic weight check - Move Gantry ......................................... 46-16 Automatic weight check - Move PPS ............................................. 46-17 Automatic weight check - Perform weight check........................... 46-18 AdaPTinsight Login........................................................................... 47-2 AdaPTinsight WORKFLOW SELECTION SCREEN ....................................................... 47-3 Power Switch for X-ray Generators .................................................. 47-4 X-ray Console.................................................................................... 47-4 kV/kV Single Source Workflow ......................................................... 47-7 X-ray Console Hand-switch............................................................... 47-7 Correction ....................................................................................... 47-11 UTEU Rack........................................................................................ 48-4 Universal Triggering Electronic Unit (UTEU) Module........................ 48-8 Gating Prescription - No gating input selected ............................... 48-10 Gating Prescription - Gating input selected for setup beam........... 48-11 Gating Prescription - Gating input selected for treatment beam .... 48-12 Gating Prescription - User override for Gating YES and no input selected for treatment beam.............................................. 48-13 Gating Prescription - Gating YES and no input selected for treatment beam........................................................................... 48-14 Gating Prescription in Physics mode - Gating YES and no input selected for treatment beam....................................................... 48-15 Gating Interface Visual Checks....................................................... 48-18 UBTI, in Pencil Beam Scanning Treatment Mode .......................... 48-20 PBS Dedicated Nozzle ........................................................................ A-5 PBS Dedicated Snout Holder.............................................................. A-9 Clinical Users Guide Volume 1 - Treatment Session IBA | lxi |
Figure A-1. Figure A-2. Figure A-3. Figure A-4. Figure A-5. Figure A-6. Figure A-7. Figure B-1. Figure B-2. Figure B-3. Figure B-4. Figure B-5. Figure C-1. Figure C-2. Figure C-3. Figure C-4. Figure C-5. Figure C-6. Figure D-1. adaPTdeliver: Dosimetry Manager Button.......................................... A-2 Dosimetry Manager Main Display ...................................................... A-3 Dosimetry Manager: Entering credentials for confirmation................ A-4 Dosimetry Manager: Entering Temperature and Pressure Values ..... A-4 Dosimetry Manager: Entering Dose Correction Factor....................... A-5 Dosimetry Manager: Determining the Minimum Allowed MU........... A-6 Dosimetry Manager: Viewing the History Log.................................... A-7 User Manager Login Screen............................................................... B-1 User Manager Main Screen................................................................ B-2 New User Screen ............................................................................... B-3 User Update Screen ........................................................................... B-4 User Manager in a non-clinical Mode ................................................. B-5 adaPTprescribe Login Screen - Administration................................... C-2 Tolerance Table Management Screen................................................ C-4 Tolerance Table Management Screen - with External Tables............. C-5 Monitor Unit (MU) Clinical Range Definition Screen........................... C-6 Accessories Management Screen...................................................... C-7 Snout Type Legend ............................................................................ C-8 Location of Safety and Emergency Devices...................................... D-3 IBA | lxii |
Clinical Users Guide Volume 1 - Treatment Session Tables Table 1-1. Table 1-2. Table 1-3. Table 6-1. Table 6-2. Table 7-1. Table 8-1. Table 8-2. Table 8-3. Table 8-4. Table 8-5. Table 8-6. Table 9-1. Table 11-1. Table 11-2. Table 11-3. Table 12-1. Table 14-1. Table 26-1. Table 30-1. Table 30-2. Table 30-3. Table 36-1. Table 43-1. Table 43-2. Table 48-1. Table D-1. Table E-1. Treatment Mode by Treatment Room................................................ 1-2 Treatment Mode Aspects................................................................... 1-9 Reading Sequence by Workflow Option........................................... 1-11 Target Positions for a GTR................................................................ 6-10 Manual Motions in a GTR ................................................................. 6-12 Labeled Positions for a GTR ............................................................. 7-11 Wireless Hand-Pendant App Bar and Remote Positioning Controls Bar: Common Icons........................................ 8-6 Wireless Hand-Pendant GUI and Remote Positioning Controls Panel- Color Legend.......................................................... 8-7 Wireless Hand-Pendant - GUI Color Legend....................................... 8-9 Remote Positioning Controls - Color Legend.................................... 8-10 Wireless Hand-Pendant and Remote Positioning Controls - Auditive Signals............................................................. 8-10 Wireless Hand-Pendant - Vibration Signals....................................... 8-11 Movement Speeds ........................................................................... 9-10 Movement Speeds ........................................................................... 11-5 Imaging Devices Movement Options............................................. 11-18 CBCT Preparation - Devices Movement Options ........................... 11-21 Wireless Hand-Pendant App Bar and Remote Positioning Controls Bar: Lasers ON/OFF Icon ........................... 12-12 PBS Accessories............................................................................... 14-2 Internal/External Plans (for PBS)..................................................... 26-11 Types of Patients, Plans, and Plan Intents........................................ 30-1 Keyboard Shortcuts - Edit Layer Details ......................................... 30-10 Keyboard Shortcuts - Edit Spot Details........................................... 30-13 Monitor Panel Icons and Colors Legend........................................... 36-7 Patient and Plan Availability .............................................................. 43-3 Baselining Aspects in Clinical and Physics Mode............................. 43-6 Triggering in Pencil Beam Scanning ............................................... 48-19 Emergency Stop Button Data............................................................ D-1 System messages .............................................................................. E-2 Clinical Users Guide Volume 1 - Treatment Session IBA | lxiii |
IBA | lxiv |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank About this Manual Scope and Contents This Clinical User's Guide describes and gives instructions to clinical staff for operating the Proton Therapy System (PTS). The Clinical User's Guide includes one volume. Clinical staff have to deal with the Treatment session only of the PTS software version 12. Treatment sessions are fully accessible at the Treatment Control Room (TCR) workstation and Treatment Room (TR) terminal. Limited functions are also available through the Treatment Planning Room (TPR) terminal. Important This guide is intended for properly qualified personnel who are authorized to operate the Proton Therapy System. Clinical Users Guide Volume 1 - Treatment Session IBA | lxv |
Referenced Documentation Coordinates and Movements Coordinates and movements described throughout this manual are based on:
International Standard IEC 61217:2011,Radiotherapy Equipment Coordinates, Movement, and Scales. Note: Throughout the manual, International Standard IEC 61217:2011 is referred to as IEC 61217. IBA Dosimetry Water Phantoms For a description of and operation instructions for the IBA Dosimetry water phantoms, refer to any of the following documents relevant at your site:
IBA Dosimetry WP1D User's Guide (PW-01-001-510-001 01) IBA Dosimetry RFA-300 with MCU User's Guide (DAA000 90015 03) IBA Dosimetry Blue Phantom with CU500E User's Guide (DWA000 90001 04) IBA Dosimetry OmniPro-Accept 6.6 User's Guide (P-07-001-510-001 04) IBA Dosimetry RFA-300 with CCU User's Guide (PW-04-002-510-001 03) IBA Dosimetry Blue Phantom with CCU User's Guide (PW-04-002-510-002 02) IBA Dosimetry Blue Phantom2 User's Guide (PW-04-002-510-003 01) IBA Dosimetry OmniPro-Accept 7.1 User's Guide (P-08-010-510-001 02) Leoni Orion Patient Positioning System For technical information on the Leoni Orion Patient Positioning System, refer to the following documentation set:
Leoni Orion System - User Manual (UMN_Orion_EN) AdaPTinsight Patient Position Verification System For instructions on how to operate the IBA adaPTinsight hardware and software for patient position verification, refer to:
adaPTinsight System Description manual adaPTinsight Clinical Users Guide IBA | lxvi |
Clinical Users Guide Volume 1 - Treatment Session adaPTinsight Safety and Emergency Recommendations adaPTinsight Labels CIVCO Couchtop For information on how to use the CIVCO Couch Top, refer to any of the following document(s) relevant for your site:
CIVCO Couchtop Extensions - Reference Guide Universal Couchtop Long Extension - CIVCO Technical Data Sheet ProForm Head & Neck Extension - Technical Details - Extensions Clinical Users Guide Volume 1 - Treatment Session IBA | lxvii |
What to Expect?
This chapter ... Describes ... Chapter 1 Chapter 2 A general overview of the Proton Therapy System from a clinical point of view, and an introduction of some essential notions on coordinate systems and types of parameters. Some strict rules to obey when starting up applications in the adaPT Treatment Suite, and outlines guidelines on how to verify that the PTS is operated in a Clinical environment. Part I - Explaining Essential Safety Aspects Chapter 3 List of some basic emergency procedures that must be performed in case of an irradiation hazard. Chapter 4 List of miscellaneous safety hazards. Part II - Using Treatment Room Equipment Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 An introduction to the Treatment Room equipment. Some elementary notions on patient positioning. General information on the movement of the patient positioning devices. Information on how to control equipment movement using the wireless hand-pendant and the remote positioning controls. Detailed information on how to use the wireless hand-pendant to perform movements with the patient positioning devices. Information on wireless hand-pendant troubleshooting. Detailed information on how to use the remote positioning controls to perform movements with the patient positioning devices. An overview of the alignment tools and devices, with instructions on how to manipulate the Patient Alignment Devices. An explanation on how to attach/remove a docking device to/from the PPS. Information about how to install and remove accessories onto/from the accessory drawer or PBS dedicated snout. Information on how to reset a Dose Counter Electronic Unit. A brief explanation about the manual operation of the PPS. Reference to information about how to perform energy checks using a water phantom. Chapter 18 A list with troubleshooting information for the treatment room equipment. IBA | lxviii |
Clinical Users Guide Volume 1 - Treatment Session This chapter ... Describes ... Part III - The Pencil Beam Scanning (PBS) Suite Chapter 19 Chapter 20 Chapter 21 Chapter 22 A list of all parts and chapters of the current manual that together comprise the Pencil Beam Scanning (PBS) documentation. An overview of principles that have been applied in developing the current Pencil Beam Scanning implementation. An introduction to the Pencil Beam Scanning (PBS) Beam Delivery System
(BDS) equipment. Detailed information on how the different PBS repainting types are identified and represented on screens. Part IV - Using adaPTprescribe Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 A description of the communication between the Treatment Planning System (TPS) and the Proton Therapy System (PTS) in Batch mode. An explanation on how to launch an adaPTprescribe session and how to logon. A brief explanation of how adaPTprescribe is organized. An explanation on how to manage patients. An explanation on how to manage studies. An explanation on how to manage plans. An explanation on how to manage setup and treatment beams and how to access layer details. Chapter 30 Specific information on how to use the QA features of adaPTprescribe. Part V - Using adaPTdeliver Chapter 31 An introduction on how to get started with adaPTdeliver, including an explanation of the screen layout and how to retrieve a patient, study, plan, or beam. Part VI - Using adaPTdeliver in Standalone Mode Chapter 32 Chapter 33 Chapter 34 Chapter 35 Chapter 36 Chapter 37 An introduction on what it means to use adaPTdeliver in Standalone mode. An explanation on how to include one or more beams into a session. A brief explanation of how to proceed to beam selection, how to proceed with an incomplete plan, and how to select a beam. An explanation of how to prepare the PTS equipment for irradiation. An explanation on how to monitor and control a treatment. An explanation of how to start an irradiation and how to deal with an partially delivered prescribed dose. Chapter 38 An explanation on what to do to pause, or stop an irradiation. Clinical Users Guide Volume 1 - Treatment Session IBA | lxix |
This chapter ... Describes ... Chapter 39 An explanation on resuming after a partial irradiation. Part VII - Using adaPTdeliver in Worklist Mode Chapter 40 Chapter 41 An introduction on what it means to use adaPTdeliver in OIS (DEVC mode). An explanation on resuming after a partial irradiation. Part VIII - Browsing adaPTdeliver Reports Chapter 42 An explanation on how to use the reporting function in adaPTdeliver. Part IX - adaPTdeliver in Physics Mode Chapter 43 A description of the difference in usage of adaPTdeliver in Physics mode, as compared with its usage in Clinical mode. Part X - Preparing for Treatment Chapter 44 Chapter 45 A summary of beam scheduling principles. A description of some procedures on how to prepare the treatment room. Part XI - Patient Positioning and Alignment Chapter 46 Chapter 47 Chapter 48 An introduction of what patient positioning entails and a description of the different positions involved. An outline of the procedure to calculate alignment corrections using the adaPTinsight Patient Position Verification System (PPVS) application. A description of how to use the Universal Beam Triggering Interface (UBTI) when taking X-ray images or during treatment. Chapter 49 A detailed description of the alignment procedure in the GTR. Part XII - Monitoring an Irradiation Chapter 50 Here you find out how you can monitor an irradiation. This appendix ... Describes ... Appendix A The nozzle components. Appendix B How to use the Dosimetry Manager. Appendix C Information on how to configure and manage PTS roles. Appendix D How to manage adaPTprescribe settings (tolerance tables, MU clinical ranges, and accessories). Appendix E An overview of the emergency stop button locations. Appendix F A list of the different system, error and fault messages intended for the clinical operator IBA | lxx |
Clinical Users Guide Volume 1 - Treatment Session This appendix ... Describes ... Appendix G A list of acronyms and abbreviations. Appendix H Glossary of Terms Index Safety Decisions A list of keywords used throughout this manual, in alphabetical order. A list of all safety decisions used throughout this manual, along with the relevant page numbers. Issue Tracking System A list of all bug solutions documented throughout this manual, along with the relevant page numbers. Clinical Users Guide Volume 1 - Treatment Session IBA | lxxi |
Conventions The following typographic conventions and visual cues are used in this guide. Warnings WARNING A Warning is provided when:
A procedure, practice, etc., may result in personal injury or loss of life if not followed properly. The personnel may be exposed to hazards when carrying out a task on the system. Cautions CAUTION A Caution is provided when a procedure, practice, etc., may result in damage to the equipment if not followed properly. Important Notes Important An Important Note is provided where a task or procedure requires emphasis or additional information essential to completion. IBA | lxxii |
Clinical Users Guide Volume 1 - Treatment Session Typographic Conventions Typeset Button SCREEN
< entry >
Label Message Refers to The name of a command button to be clicked with the mouse The name of a user interface screen Information to be entered from the keyboard appears inside angle brackets The label of a field appearing on a screen A message (warning, error, acknowledgment, or request) from the system appearing on a screen Illustrations Photos, drawings, and User Interface (UI) screen representations are provided for reference purposes only and do not necessarily reflect the actual appearance of system hardware or software. Troubleshooting Information Error messages and system warnings are presented in tables throughout this guide as in the example below:
Pop-up Message Patient ID previously defined String of maximum length (nn) expected Description A patient with the same Patient Identifier already exists in the database. Use a different ID. Too many characters have been entered into this field. Visual Cues The table below lists the symbols that identify the location where a task may be performed. Symbol Identification Identifies paragraphs or steps performed in the Treatment Planning Room (TPR) or on the Treatment Planning Room terminal. Clinical Users Guide Volume 1 - Treatment Session IBA | lxxiii |
Symbol Identification Identifies paragraphs or steps performed in the Treatment Control Room (TCR) or on the Treatment Control Room workstation. Identifies paragraphs or steps performed in the Treatment Room (TR) or on the Treatment Room terminal. Identifies paragraphs or steps performed with the hand-
pendant (HP) in the Treatment Room (TR). Identifies paragraphs or steps performed by the Accelerator Operator. IBA | lxxiv |
Clinical Users Guide Volume 1 - Treatment Session Chapter 1 Introduction Overview IBA Proton Therapy System (PTS) Proteus 235 is a medical proton beam irradiation system designed to:
Create and deliver a proton beam with an adequate energy, shape and intensity to the patient treatment location Deliver the designated dose to the patients treatment site with the dose distribution defined in the patients treatment plan. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-1 |
Treatment Modes Available at the PT Center The following treatment modes are available in the TRs:
Introduction |
Table 1-1. Treatment Mode by Treatment Room TR Treatment Modes GTR1 PBS GTR2 PBS Note: Gantry Treatment Room (GTR). Therapy Center and Proton Therapy System Building Blocks The PTS consists of a large number of hardware elements such as the cyclotron, the beam line, the nozzle, to name but a few. The physical structure of the PTS is described in detail in PTS System Description. In addition to the physical structure, it is important for you as a user of the PTS to have an understanding of the logical structure of the PTS. Major logical components of the PTS, or interfaced with the PTS, are:
Treatment Planning System (TPS) (interfaced) Oncology Information System (OIS - DEVC) (interfaced) Proton Therapy System (PTS) Software Patient Positioning Verification System (PPVS) Figure 1-1 illustrates the therapy center and PTS building blocks from a clinical point of view. Treatment Planning System (TPS) The Treatment Planning System (TPS) enables users to prepare and store all prescription data. Before starting a treatment, staff of the treatment center takes images using various imaging techniques such as X-ray imaging, CT scans, MRI, PET, etc. of that region of the patient's body where irradiation is needed. Based on these images and scans, staff of the treatment center uses the TPS to select the beam delivery technique, determine dose distribution, and design potential patient specific devices such as blocks or range compensators. IBA | 1-2 |
Clinical Users Guide Volume 1 - Treatment Session Introduction |
For many tumor types, CT scans are instrumental in enabling the PPVS (e.g., adaPTinsight) to perform the correction vector calculation at the time of treatment. With such input material the PPVS will be able to perform an automatic image registration. Certain tumor types, e.g., prostate tumors, require patient specific landmarks to be established as fiducial points. In these cases, a number of implants will identify specific locations on the tumor on the CT scan. At the time of treatment these locations need to be selected in the PPVS (e.g., adaPTinsight). The CT scans will be instrumental in computing proper patient alignment corrections at the time of treatment. The Treatment Planning System (TPS) is connected to the OIS via a DICOM 1 connection, which renders the data interchangeable. The DICOM protocol is the de facto standard communications protocol for medical applications. Oncology Information System (OIS) One very efficient way of entering prescription data into the PTS software is by using an OIS. The OIS is capable of managing and communicating all patient and treatment related data, potentially coming from various systems offering diverse treatment types, such as conventional radiation therapy, proton therapy, and others. The OIS is the central repository for prescription data of all treatment types. Various systems offering diverse treatment types, such as conventional radiation therapy, proton therapy, and others, can communicate patient and treatment related data with the OIS. Important It is recommended to use an Oncology Information System (OIS) to manage all patient and treatment related data. Once completed in TPS, the treatment plan data is transmitted through the Dicom protocol from the TPS to the OIS. At treatment time, the plan is transmitted from the OIS into PTS software, each time via the DICOM interface. At the end of the treatment, a treatment record is sent back from the PTS software to the OIS; this information is recorded in the OIS. The OIS cooperates with the PTS working in DevC mode (Device Centric mode), whereby the PTS is in command of the communication with the OIS. 1. DICOM is the registered trademark of the National Electrical Manufacturers As-
sociation for its standards publications relating to digital communications of medical information. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-3|
Introduction |
Treatment Planning System
(TPS) D I C O M Oncology Information System
(OIS) D I C O M PTS adaPTdeliver adaPTinsight For each patient that will be treated by the PTS, patient data is received from the OIS and stored in the PTS software database. To enable proton therapy treatment, specific study and treatment plan data is also stored. Data resident in the OIS is not only communicated to the PTS software but also to the (optional) milling machine that is used to make patient specific blocks and range compensators to be used in snouts, and to the PPVS, e.g., adaPTinsight. IBA | 1-4 |
Clinical Users Guide Volume 1 - Treatment Session Proton Therapy System (PTS) Software Introduction |
The PTS is controlled by a package called the PTS Software. It is mainly composed of software components. Depending on their function in the treatment center various users have access to different options of the PTS software;
some are clinical, others are administrative or more hardware oriented. It is obvious that, as a clinical user of the system, you have access to the full clinical functionality of the PTS software. Usage With an OIS With respect to the proton therapy treatment provided by the PTS, the PTS software stores and retrieves all clinical data into the dedicated software database. The PTS software is the central repository of all key information of the PTS. Communication between the OIS and the PTS happens via a DICOM1 interface. Figure 1-1 illustrates the communication between the OIS and the PTS. Usage Without an OIS The PTS software can store all clinical data into and retrieve that data from the dedicated database, which is the central repository of all key information of the PTS. For each patient that will be treated by the PTS, patient data is stored in the PTS software database. To enable proton therapy treatment, specific treatment plan data is also stored. This patient and treatment plan data typically is created in a planning system. For PBS, the treatment plan, which requires large amount of data, is transmitted from TPS into PTS software via the DICOM interface. Patient Positioning Verification System (PPVS) Data resident in TPS is communicated, with or without the use of the OIS, to the PPVS. PPVS Process At the time of treatment, the Patient Position Verification System (PPVS) (e.g., Verisuite, adaPTinsight) requests the Oncology Information System (OIS) for the required information (e.g., CT scans, DRRs, etc). 1. DICOM is the registered trademark of the National Electrical Manufacturers As-
sociation for its standards publications relating to digital communications of medical information. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-5|
Introduction |
The PPVS transforms the CTs into DRRs and those DRRs are automatically compared to the DRs; adaPTinsight, for instance, calculates the corrections using a grey level comparison algorithm. The computed corrections must be manually entered (or electronically exchanged and confirmed) and applied from a PTS software monitor in the TR. These applied corrections subsequently must be implemented using the hand-pendant. IBA | 1-6 |
Clinical Users Guide Volume 1 - Treatment Session Treatment Workflow Options Introduction |
Note: This section Treatment Workflow Options lists all workflow options that are possible using the PTS. Depending on criteria listed below, not all options may be available at your treatment center. You can choose among different workflow options to process treatments. Workflow Option Criteria The options available in any given Treatment Control Room (TCR) and TR depend on:
the chosen beam delivery technique (refer to section Overview on page 1-1). the availability (or absence) of an OIS the operational mode of the PTS: EMRC or DEVC Note: Depending on the selections made at your treatment center, only a subset of all listed workflow options may be available. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-7|
Introduction |
Workflow Options As a result, the following options can be distinguished (see Figure 1-1):
Option A: Using the Batch Importer and Standalone Delivery (refer to page 1-11) Option B: Full Standalone Mode (not supported from PTS release 12.0.) Option C: Using the OIS, also called Worklist mode (refer to page 1-12) A B C Standalone mode using Batch Importer PBS Full standalone mode Treatment mode not supported Workflow Option (mode) Workflow Stage Create Plan Store in PTS Batch Baseline Select Patient/Plan Select Beam Prepare & Treat Create Record Store Record TPS adaPTprescribe adaPTdeliver OIS mode PBS OIS N/A OIS Figure 1-1. Treatment Workflow Options Figure 1-1 illustrates the different stages of a treatment workflow, from the creation of a plan (top) up to storage of the record after irradiation (bottom), as seen by the user. All processes such as the OIS, the batch importer, etc., continually keep on running during the entire workflow. IBA | 1-8 |
Clinical Users Guide Volume 1 - Treatment Session Introduction |
Treatment Mode Aspects Table 1-2 lists the preferred workflow option that can be used for each of the treatment modes, and its possible alternatives. Note: The workflows that are validated for your treatment center are listed in the Site Delivery Note. Table 1-2. Treatment Mode Aspects Option A Standalone mode using Batch Importer Alternative Option B Full Standalone mode Option C OIS mode Preferred Pencil Beam Scanning
(PBS) Clinical Users Guide Volume 1 - Treatment Session IBA | 1-9|
Introduction |
Frequency Aspect From a different perspective, all activities can be categorized in two groups:
to be performed once for the entire treatment: boxed in green in Figure 1-2 . to be performed every day of the treatment: boxed in red in Figure 1-2 . A B C Workflow Option (mode) Standalone mode using Batch Importer Full standalone mode OIS mode PBS Treatment mode not supported PBS Workflow Stage Create Plan Store in PTS Batch Baseline Select Patient/Plan Select Beam Prepare & Treat Create Record Store Record TPS adaPTdeliver adaPTdeliver OIS N/A OIS Figure 1-2. Treatment Workflow Options - Frequency Aspect Note: Option B is not supported from PTS release 12.0. IBA | 1-10 |
Clinical Users Guide Volume 1 - Treatment Session Introduction |
Reading Sequence of This Manual Your choice of treatment workflow option also decides on the chapters to read in this manual. This manual contains generic information that is not related to any specific workflow option on the one hand, and some chapters that are workflow option specific on the other. This implies that, depending on the workflow option that you wish to use, those chapters on workflow options that you do wish not to use, are not relevant to you. Table 1-3 lists the reading sequence of the chapters, by workflow option. Table 1-3. Reading Sequence by Workflow Option Workflow option A Workflow option B Workflow option C 1 through 22 23 N/A N/A 40-41 24-32 33-39 N/A 42 through 50 App A through H Index Safety Decisions Issue Tracking System Note: Generic information has been highlighted in yellow. Option A: Using the Batch Importer and Standalone Delivery This workflow option can be used for the SS, DS, US, and PBS treatment modes. The treatment plan is created using the Treatment Planning System (TPS) and then imported into the PTS using the Batch Importer. Baselining is performed using adaPTprescribe. All subsequent activities, i.e., patient and plan selection, selection of the beam, preparation and treatment of the patient, creation of the irradiation record, and local storage of that record in the PTS software database are performed using adaPTdeliver. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-11|
Option B: Full Standalone Mode Introduction |
Note: This option is not supported from PTS release 12.0. The treatment plan data is created using a Treatment Planning System (TPS). For eye treatment, this must be an eye Treatment Planning System (TPS) such as the Eclipse Ocular Proton Planning application (from Varian). Subsequently, and this is the meaning of Full standalone, the user manually encodes the patient, plan, and beam data into the PTS: definition of the plan;
baselining in PTS is performed using adaPTprescribe. All subsequent activities, i.e., patient and plan selection, selection of the beam, preparation and treatment of the patient, creation of the irradiation record, and local storage of that record in the PTS software database are performed using adaPTdeliver. Option C: Using the OIS This workflow option can be used for the SS, DS, US, and PBS treatment modes. The treatment plan is created using the Treatment Planning System (TPS) and then communicated to the OIS. The plan is stored in the OIS. Patient and plan selection, selection of the beam, and preparation and treatment of the patient is performed using adaPTdeliver. The session record is created by adaPTdeliver and then communicated to the OIS for storage. Patient Related Parameters Patient related parameters within the PTS allow for the configuration of an entire course of treatment for a particular patient. This section gives a brief description of the different types of parameters associated with a patient:
Prescribed parameters Received parameters Delivered parameters Prescribed Parameters Prescribed parameters are a selected set of values needed by the PTS equipment to deliver an irradiation and are prescribed by the Radiation Oncologist. IBA | 1-12 |
Clinical Users Guide Volume 1 - Treatment Session Prescribed parameters are expressed both as Prescribed Clinical parameters and Prescribed Equipment Settings. The clinical staff enters the clinical parameters. The prescribed equipment settings are the result of translation algorithms on the prescribed clinical parameters. Introduction |
Received versus Delivered Parameters When beam starts, the system begins logging parameters. Logged parameters fall into two categories, received and delivered. The difference is the way that they are stored:
Received parameters are recorded along the irradiation and include relevant equipment feedbacks. Delivered parameters are stored in the database at the end of irradiation and include:
Dose counts Patient Positioning Device (PPD) settings Date, time at beginning and end of beam, and user logged on to the TCR. Operating adaPTdeliver in Clinical Mode or in Physics Mode You can use adaPTdeliver in two modes:
Clinical mode: purpose of Clinical mode is to perform clinical operations aimed at irradiating patients. Almost all the information in this manual is focused on Clinical mode. Physics mode: Purpose of Physics mode is to perform Quality Assurance (QA) and calibration activities. No actual patient irradiations are involved at all. WARNING In Physics mode, patient treatment is absolutely forbidden at all times. Note: Make sure that you have obtained the right to use Physics mode. For detailed information on the User Manager, refer to Appendix B, Managing PTS Users. Because no actual patients are involved in this mode, Physics mode is available in Standalone mode only, not in OIS mode. You can, however, make use of information that resides in the OIS. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-13|
Introduction |
For detailed information on the use of adaPTdeliver that is generic to both Clinical mode and Physics mode, refer to Part V, Using adaPTdeliver. For detailed information on the use of adaPTdeliver specifically in Physics mode, refer to Part IX, adaPTdeliver in Physics Mode. Using Information From the OIS You can select a patient, study, plan, or beam using an OIS connection but the OIS is not informed about any such retrieval, nor does the PTS send any Physics mode related information to the OIS. When the OIS sends a plan in Physics mode, the PTS issues an error message to the OIS that the plan is erroneous. In this way, the OIS is prevented from storing any subsequent data. The plan, however, is used in PTS. The steps to transfer a plan from the OIS to the PTS are identical in Physics mode and Clinical mode. No special or extra actions are required. IBA | 1-14 |
Clinical Users Guide Volume 1 - Treatment Session Using QA Features of adaPTprescribe Introduction |
Login in adaPTprescribe is either using Prescription or Administration. For detailed information on the use of adaPTprescribe, refer to Part IV, Using adaPTprescribe. For detailed information on the use of the QA features of adaPTprescribe, refer to Chapter 30, Using QA Features of adaPTprescribe. Clinical Users Guide Volume 1 - Treatment Session IBA | 1-15|
Introduction |
IBA | 1-16 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Chapter 2 Starting Up Applications in the adaPT Treatment Suite Startup Operations At startup in the Main Control Room (MCR) and TCR, the PTS performs automated checks on the versions of critical software running in Control Units (CU) and Electronic Units (EU) inside the system against the expected versions of these software packages. In case of a mismatch a pop-up message appears and the PTS blocks startup. WARNING In case you opt to bypass the software version checks, i.e., you click OK to acknowledge that you want to continue, knowing that such version discrepancies exist, be aware that any formal activity (e.g., treatment, patient Quality Assurance (QA), clinical acceptance, etc.) is forbidden. Clinical and Non-clinical Environment WARNING Any formal activity (e.g., treatment, patient Quality Assurance (QA), clinical acceptance, etc.) performed out of the Clinical environment is forbidden. The Proton Therapy System cannot be guaranteed to satisfy safety and performance criteria needed for such activities out of the Clinical environment. Clinical Users Guide Volume 1 - Treatment Session IBA | 2-1 |
Starting Up Applications in the adaPT Treatment Suite |
It is imperative that all clinically related activities are performed within the Clinical environment. Therefore, this chapter provides some strict rules to obey, and outlines guidelines on how to verify that the PTS is operated in a Clinical environment, or to detect otherwise. Important If, for any reason, you encounter a system message that reads 'Not using clinical database', do not proceed with any clinical workflow. Stop using the system and contact IBA. Beginning Clinical Operations Make sure to comply with the warning messages in this section whenever clinical operations get started. WARNING Before starting daily clinically related activities, the Proton Therapy System must be restarted completely through the startup procedure. WARNING When starting up the Proton Therapy System, and before starting clinically related operations, do check and log the software versions running on the computer at startup. In case of unexpected change, checksum issue, or warning of the system's runtime, you must suspend all clinically related activities and contact IBA personnel as the Proton Therapy System cannot be guaranteed to satisfy safety and performance characteristics. Verifying the Global Checksum A checksum mechanism is in place to detect possible changes or corruptions of software configuration files and/or runtime executables. The Global Checksum enables users to easily monitor unexpected changes in the software. The Global Checksum should only change in case of a new installation of a PTS version or configuration. IBA | 2-2 |
Clinical Users Guide Volume 1 - Treatment Session Starting Up Applications in the adaPT Treatment Suite |
Each morning, and before beginning clinically related operations, it is recommended to verify that the content of the About TCS icon stored in the MCR log book by IBA operators is not unexpectedly modified compared to the previous day of clinical use. Global Checksum Figure 2-1. About TCS Icon Content WARNING In case of any unexpected change of the Global Checksum line compared to the line present in the About TCS content of the previous day of clinical use, you must suspend all clinically related activities. The safety and essential performances of the Proton Therapy System cannot be guaranteed. In this case, you must contact IBA immediately for support. The Clinical Environment WARNING The Clinical environment is the only suitable environment for clinically related activities. Clinical Users Guide Volume 1 - Treatment Session IBA | 2-3|
Starting Up Applications in the adaPT Treatment Suite |
WARNING Any formal activity (e.g., treatment, patient Quality Assurance (QA), clinical acceptance, etc.) performed out of the Clinical environment is forbidden. The Proton Therapy System cannot be guaranteed to satisfy safety and performance criteria needed for such activities out of the Clinical environment. Characteristics of the Clinical Environment Each of the applications in the adaPTsuite, i.e., adaPTprescribe, adaPTinsight, and adaPTdeliver, requires you to perform a dedicated login. When the applications in the adaPTsuite have been validated for clinical use, the background color of the header is black. This is indicative of a Clinical environment. Whenever the applications in the adaPTsuite have not been validated for clinical use, the background color of the header is red. This is indicative of a non-Clinical environment. In these circumstances, the applications are NOT for clinical use. The applications must not be used for treating patients. Note: Within the Clinical environment, the different adaPTsuite applications offer different log-in modes. AdaPTdeliver in particular offers a Clinical and a Physics mode. AdaPTdeliver's Physics mode is to be used for QA purposes, calibration and research activities only. IBA | 2-4 |
Clinical Users Guide Volume 1 - Treatment Session Starting Up Applications in the adaPT Treatment Suite |
header, background color: black Figure 2-2. adaPTprescribe in Clinical Mode Clinical Users Guide Volume 1 - Treatment Session IBA | 2-5|
Starting Up Applications in the adaPT Treatment Suite |
header, background color: red non-clinical indication Figure 2-3. adaPTprescribe in a non-clinical Mode For information regarding adaPTdeliver, refer to Chapter 31. IBA | 2-6 |
Clinical Users Guide Volume 1 - Treatment Session Part I Explaining Essential Safety Aspects Clinical Users Guide Volume 1 - Treatment Session Chapter 3 Emergency Procedures in Case of Irradiation Hazard WARNING In case the system does not behave as expected when trying to stop an operation (if releasing the motion enable button does not stop a movement or if the beam pause function does not stop the beam as requested), push an emergency stop button. IBA has taken precautions to make the PTS as failsafe as possible. However, conditions may exist that cannot be foreseen, either due to human error or because of equipment failure. Any such condition may lead to irradiation incidents or near irradiation incidents. IBA wants all staff on site to be informed about such incidents as well as be prepared and trained to face such incidents. Therefore, the following irradiation emergency procedures have been developed. We strongly advise you to communicate these procedures to all members of your staff, and provide training on these procedures regularly. Emergency procedures have been developed for the following situations:
A Patient is in the Treatment Room and the Beam Fails to Stop when Requested Staff are Present in a Secured Area To be Present in a Location Susceptible to Irradiation While Beam is On or Room is Secured Clinical Users Guide Volume 1 - Treatment Session IBA | 3-1 |
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard |
A Patient is in the Treatment Room and the Beam Fails to Stop when Requested The following situations can be distinguished whereby a patient can be subjected to a dose higher than requested:
The preset dose has been reached and the beam fails to shut off automatically A Radiation Therapy Technologist (RTT) requests the beam to pause and the beam fails to pause A RTT requests the beam to stop and the beam fails to stop The Preset Dose Has Been Reached and the Beam Fails to Shut off Automatically The normal end to a treatment is triggered by the dose count from ionization chamber 2 (IC2) to the Therapy Control System (TCS). The irradiation normally stops when the dose read by IC2 equals the required dose. In the PBS beam delivery technique the setpoint of each magnet is progressively modified for each map (i.e., each layer) to reach the setpoint of the first spot to irradiate; that setpoint is kept constant until the spot is fully irradiated and then it is adapted to reach the setpoint for the next spot, until the last spot is irradiated. All the setpoints are calculated by Scanalgo and are then applied by the scanning controller. If treatment is not intended to be resumed, a RTT also has the option to stop an irradiation by clicking Pause followed by Stop from the IRRADIATION SCREEN. A Radiation Therapy Technologist (RTT) Requests the Beam to Pause (or Stop) and the Beam Fails to Pause (or Stop) A pause interrupts the beam and prevents it from entering the TR. If, as a RTT, you interrupt the irradiation from the TCR by clicking Pause from the IRRADIATION SCREEN and the irradiation does not pause, immediately perform the procedure that follows. Irradiation Emergency Procedure If the beam does not pause (or stop):
when the preset dose count has been reached when the user requires it IBA | 3-2 |
Clinical Users Guide Volume 1 - Treatment Session
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard |
when paused Immediately perform the following procedure:
Press the emergency stop button in the TCR. 1. Note: The emergency stop button can be a global or local emergency stop, depending on the configuration of your PT center. 2. Turn the TCR master key switch off. 3. Open the doors of the TR. If this procedure fails to stop the irradiation, contact the MCR immediately and request the accelerator operator to shut off the RF. Important In any case, immediately contact the local radiation safety department and inform them with full details of the radiation incident. The TR must not be used for treatments until the cause of the incident has been fully established and remedied. The irradiation should only be resumed after the cause of the incident has been fully investigated and remedied. Staff are Present in a Secured Area Beam should only be On when the securable areas (i.e., all locations where irradiation hazards are present: cyclotron vault, beam transportation vault, GTR pit, TRs and technical rooms adjacent to TRs) have been properly searched and secured. The securable areas are listed in Appendix D Emergency Stop Button Locations. This is applicable to all securable areas required for sending beam to a given TR. Note: The MCR and TCRs are not securable areas. WARNING Closure of a door of a securable area is part of a search procedure. Whenever you close a door of a securable area, make sure that no other person is performing the search procedure for the same securable area. Clinical Users Guide Volume 1 - Treatment Session IBA | 3-3|
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard |
In the event that anyone is detected (using video monitors or any other detection system) to be present in a secured area when beam is On, or when you are about to produce beam, perform the procedure that follows. Irradiation Emergency Procedure Immediately perform the following procedure:
1. 2. Turn the MCR master key switch off. Verify that beam is Off and cannot be restarted: confirm RF is Off, and remove and take possession of the master key. 3. Go to that secured area. 4. Break the search. 5. Contact that person. 6. 7. Evacuate that person from the area. Inform your supervisor of the incident. Important If there is any possibility that a person was exposed to ionizing radiation, contact the local radiation safety department and inform them with full details of the radiation incident. 8. If required, update your local safety procedure. IBA | 3-4 |
Clinical Users Guide Volume 1 - Treatment Session
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard |
To be Present in a Location Susceptible to Irradiation While Beam is On or Room is Secured In the unlikely event that you find yourself in a secured area before beam is On, or while beam is On, perform the procedure that follows. Irradiation Emergency Procedure Immediately perform the following procedure:
1. 2. 3. Press the emergency stop button nearest to you (see Appendix D Emergency Stop Button Locations). Proceed to the nearest exit in the secured area. Inform the MCR operator immediately. Important Contact the local radiation safety department and inform them with full details of the radiation incident. 4. 5. Investigate the cause of the incident. If required, update your local safety procedure. Clinical Users Guide Volume 1 - Treatment Session IBA | 3-5|
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard |
IBA | 3-6 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Chapter 4 Miscellaneous Safety Hazards Cleaning, a Basic Safety Requirement CAUTION The Proton Therapy System (PTS) parts which are not in direct contact with the patient can be cleaned with the following products:
* Isopropyl Alcohol - Concentration up to 70 %
* Ethyl Alcohol - Concentration up to 90 %
* Bleach solution - up to 100 ppm active Chlorine
* Formaldehyde - up to 35 %
* Didecyldimethylammonium chloride - up to 3 mg/g The following exclusions apply:
* Couch: you must refer strictly to the user instructions of the couch.
* Robot Patient Positioning System (PPS): you should avoid bleach and other chlorine solutions for Robot PPS cleaning. During the cleaning process please ensure to:
* Avoid water to penetrate inside equipment parts.
* Avoid using sprays such as the cleaning product penetrates parts. Clinical Users Guide Volume 1 - Treatment Session IBA | 4-1 |
|Part I - Explaining Essential Safety Aspects Miscellaneous Safety Hazards |
Precautionary Measures Avoid all infiltration of liquids that are likely to cause operating problems, especially on the hand-pendant, PPS, snout. During cleaning and disinfection, use protective gloves. Keyboard and Mouse Requirements WARNING Do not modify the keyboard or mouse of the Proton Therapy System
(PTS). The application of wireless or battery powered devices is not allowed. Usage of Tools or Parts in a Treatment Room WARNING It is strictly forbidden to ever place any objects (tools, parts, etc) on top or inside moving devices such as the nozzle, or the gantry. Falling tools or parts can injure patients or staff. Take inventory of the tools or parts after using them in a treatment room. WARNING Make sure that all tools and maintenance equipment have been properly removed from moving parts and safely stored prior to the operation of the system. IBA | 4-2 |
Clinical Users Guide Volume 1 - Treatment Session
|Part I - Explaining Essential Safety Aspects Miscellaneous Safety Hazards |
Dealing With an Emergency Situation WARNING In case the system does not behave as expected when trying to stop an operation (if releasing the motion enable button does not stop a movement or if the beam pause function does not stop the beam as requested), push an emergency stop button. WARNING In case of an emergency situation (e.g., fire, earthquake, flooding, etc.) or before an emergency response, push emergency stop button from a safe position. Gantry Rolling Floor Precautions Gantry treatment rooms that are equipped with the Gantry Rolling Floor enable you to enter the patient enclosure. Whenever you consider entering the patient enclosure, be aware of the warning texts below. WARNING Do not stand or move into the patient enclosure or the gantry rolling floorwhen the gantry is rotating. WARNING Do remove any objects from the patient enclosure before rotating the gantry. Check that no objects are present on the Gantry Rolling Floor before gantry rotation. Clinical Users Guide Volume 1 - Treatment Session IBA | 4-3|
|Part I - Explaining Essential Safety Aspects Miscellaneous Safety Hazards |
WARNING Watch your step when entering the patient enclosure. When the nozzle is positioned between approximately 135 and 225, there is a slight height difference between the treatment room floor and the gantry rolling floor. Pinching Hazard WARNING Do not touch any of the panels of the Gantry Rolling Floor when the gantry is rotating. Fingers may get pinched when you touch the space between the panels while the gantry is rotating. pinch points Figure 4-1. Pinching Hazards on Gantry Rolling Floor Panels IBA | 4-4 |
Clinical Users Guide Volume 1 - Treatment Session
|Part I - Explaining Essential Safety Aspects Miscellaneous Safety Hazards |
General Pinching Hazards WARNING Do not touch any of the components of devices such as the Gantry Rolling Floor, the Patient Positioning System (PPS), the Accessory Drawer, the snout. Fingers may get pinched. Clinical Users Guide Volume 1 - Treatment Session IBA | 4-5|
|Part I - Explaining Essential Safety Aspects Miscellaneous Safety Hazards |
IBA | 4-6 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank |Part I - Explaining Essential Safety Aspects Starting Up Applications in the adaPT Treatment Suite |
Magnetic Field Hazard The indicative values of electromagnetic fields around the nozzle are defined according to tests established against ICNIRP #74:1998, IEEE C95.1:2005 and IEEE C93.3:2002 series). These values are of importance to evaluate the impact on implantable medical devices for patients and anyone else carrying such device. The tests state values for fixed or low frequency (<= 100 kHz) / high frequency
(> 100 kHz) fields by type of TR, treatment mode, and nozzle type, as follows:
FBTR, PBS, Dedicated Nozzle at isocenter: < 2.5 T* / < 1 V/m*
at nozzle contact: < 2.5 T* / < 1 V/m*
IBTR, PBS, Full Universal Nozzle at isocenter: < 2.5 T* / < 1 V/m*
at nozzle contact: < 2.5 T* / < 1 V/m*
IBTR, US, Universal Nozzle at isocenter: < 2.5 T* / < 1 V/m*
at nozzle contact: < 2.5 T* / < 1 V/m*
GTR, PBS, Dedicated Nozzle at isocenter: < 2.5 T* / < 1 V/m*
at nozzle contact: < 2.5 T* / < 1 V/m*
GTR, PBS, Full Universal Nozzle at isocenter: < 30.52 T / < 1 V/m*
at nozzle contact: < 20.25 T / < 1 V/m*
GTR, DS, Universal Nozzle at isocenter: < 2.5 T* / < 1 V/m*
at nozzle contact: < 2.5 T* / < 1 V/m*
*: the values measured have been identified below the levels of 2.5 T or 1 V/m. Note: It is possible that one or more type of TR, treatment mode and/or nozzle type from the above list are not available at your PT center. Clinical Users Guide Volume 1 - Treatment Session IBA | 4-7|
|Part I - Explaining Essential Safety Aspects Starting Up Applications in the adaPT Treatment Suite |
IBA | 4-8 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank |Part I - Explaining Essential Safety Aspects Starting Up Applications in the adaPT Treatment Suite |
Functions of the Beam Intensity Redundant Electronic Unit Throughout the PTS a number of electrometers are installed. Electrometers are connected to Beam Profile Monitors (BPMs) and Beam Current Monitors (BCMs). An electrometer reads out very small currents and performs some basic calculation on the acquired data that it transmits to the Beam Operation Manager (BOM). One of the electrometers is called the Beam Intensity Redundant Electronic Unit
(BIREU), which is connected to the ionization chamber of the cyclotron (IC cyclo). Note: If the BIREU is not (yet) installed at your center, the cyclo IC chamber is connected to the Beam Current Comparator Electronic Unit (BCCEU). The BIREU performs the following functions:
Perform a Max Current Check Provide a Dosimetry Counter Electronic Unit (DCEU) output to enable measurement of the overall dose delivered by the cyclotron BIREU Startup or Connection Failure In case the BIREU cannot start or fails to connect, the following error message appears:
Figure 4-2. BireuServiceStartedCheck Message Clinical Users Guide Volume 1 - Treatment Session IBA | 4-9|
|Part I - Explaining Essential Safety Aspects Starting Up Applications in the adaPT Treatment Suite |
IBA | 4-10 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Part II Using Treatment Room Equipment Clinical Users Guide Volume 1 - Treatment Session Chapter 5 Introducing Treatment Room Equipment The purpose of this part is to describe each piece of equipment in the TR that may be used during a Treatment session. The PTS at your treatment center features the following types of TR:
Gantry Treatment Room (GTR) For those pieces of equipment that can be controlled from the hand pendant (i.e., the device used to move patient positioning devices and imaging equipment from within the TR) or the remote positioning controls (i.e., the controls displayed on adaPTdeliver screens that allow you to move patient positioning devices and imaging equipment from the TCR), the most common actions are described. Otherwise, generic descriptions of the hand pendant controls are provided. The chapters in this part describe the following activities:
Elementary Notions on Patient Positioning Moving the Patient Positioning Devices Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls Using the Wireless Hand-Pendant Wireless Hand-Pendant Daily Checks and Troubleshooting Using the Remote Positioning Controls Alignment Tools and Devices (Using the devices of the (PPVS) Attaching/Removing a Patient Support Device to/from the PPS Installing and Removing Accessories into/from the Accessory Drawer or PBS Dedicated Snout. Resetting a Dose Counter Electronic Unit Clinical Users Guide Volume 1 - Treatment Session IBA | 5-1 |
|Part II - Using Treatment Room Equipment Introducing Treatment Room Equipment |
Operating the Patient Positioning System Manually (Emergency Release Mode) Performing QA Checks and Verifying Beams With a Water Phantom Troubleshooting Treatment Room Equipment. Effects of Temperature and/or Pressure Changes in the Treatment Room Fluctuations in temperature and/or pressure have an impact on beam measurement performed by Ionization Chamber 2/3 (IC2/3), which is located in the nozzle. To ensure correct IC2/3 measurement, the ambient TR temperature and pressure is measured and recorded every morning. If, in the course of the day, temperature and/or pressure is observed to be deviating from the values measured in the morning, these new values must be recorded using the Dosimetry Manager. For detailed information on the Dosimetry Manager, refer to Appendix C Using the Dosimetry Manager. WARNING Whenever the temperature and pressure deviate beyond the treatment center quality management plan threshold, the temperature and pressure have to be updated manually using the Dosimetry Manager. Note: An acceptable deviation will depend on the your PT center's requirement for dose reproducibility Safety Aspects WARNING It is strictly forbidden to ever place any objects (tools, parts, etc) on top or inside moving devices such as the nozzle, or the gantry. Falling tools or parts can injure patients or staff. Take inventory of the tools or parts after using them in a treatment room. IBA | 5-2 |
Clinical Users Guide Volume 1 - Treatment Session Chapter 6 Elementary Notions on Patient Positioning Positioning and alignment of a patient happen before every fraction. As treatment progresses, it may become necessary to gradually modify an initially defined position. Or because of a patient's condition it may become necessary to deviate from the originally planned position. It is therefore important that a coherent and clear coordinate system is used, leaving no room for misinterpretation and ensure the exact recording of positioning data. This chapter contains the following information:
Supported Coordinate Systems Types of Patient Positioning Device (PPD) Motion Patient Positioning Devices Clinical Users Guide Volume 1 - Treatment Session IBA | 6-1 |
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Supported Coordinate Systems A coordinate system is a system that defines the position of a point in space. A coordinate system is defined by its origin and axes X, Y, and Z. All coordinate systems used by the Treatment Control System (TRCS) are Cartesian right-handed (axis X is the thumb, Y is the index, and Z is the middle finger). Positioning and alignment data are stored in the PTS database according to the IEC61217 standard. All PPDs positions are represented according to IEC61217 standard both on screen and in the database. The IEC61217 defines a unique way to display the table, snout and gantry positions. Note: Imager and Focus coordinate systems defined in IEC61217 are not used. Within the TRCS the following IEC 61217 compliant Coordinate Systems are used:
Fixed Reference System (FRS): for detailed information, refer to section "IEC Fixed Reference System (f)" on page 6-3. Gantry Coordinate System (GCS): for detailed information, refer to section
"IEC Fixed Coordinate System" on page 6-4. Table Top Coordinate System (TTCS): for detailed information, refer to section
"IEC Table Top Coordinate System (t)" on page 6-5. IEC Fixed Reference System (f) The IEC61217 Fixed Reference System (FRS) is defined on the basis of the radiation beam axis, the gantry axis and the isocenter. In the GTR there is a rotating radiation beam axis that orthogonally crosses a fixed gantry axis through a common isocenter. The FRS is defined as follows:
the origin is at isocenter Xf is aligned with the beam axis and directed towards the beam source when the gantry is at 901 Yf is aligned with the gantry axis and directed to the left of a viewer facing the beam source when the gantry is at 902 Zf is vertical and directed upwards 1. 2. By convention, the gantry angle is 90 when the radiation beam axis is horizon-
tal, at 90 from Zf and directed in the opposite direction of Xf. When the radiation beam axis is horizontal, Yf is the horizontal axis passing through the FRS origin, and orthogonal to the beam axis. Clinical Users Guide Volume 1 - Treatment Session IBA | 6-3|
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Z FRS positive rotation positive pitch positive roll Y X Figure 6-1. IEC Fixed Coordinate System IBA | 6-4 |
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IEC Gantry Coordinate System (g) The IEC 61217 gantry coordinate system is stationary with respect to the gantry. It is defined as a daughter of the FRS, as follows:
the origin is the origin of the FRS Xg is orthogonal to the beam axis, directed downwards when the gantry angle is 90 Yg is coincident with Yf Zg is aligned with the beam axis, directed towards the beam source Zg Xg Figure 6-2. IEC Gantry Coordinate System IEC Table Top Coordinate System (t) The IEC 61217 table top coordinate system (TTCS) is stationary with respect to the table. In case of a couch (which presents a rectangular planar surface):
Xt is parallel to the table small side and directed on the left of a patient in head-
first supine position on the table Yt is parallel to the table longitudinal axis (long side) and directed towards the head of a patient lying head-first on the table Zt is normal to the table surface and directed upwards Clinical Users Guide Volume 1 - Treatment Session IBA | 6-5|
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the origin is the center of the treatment volume (see page 7-6), 10 cm above the table top in the Z direction (this distance may vary depending on the table used), on the median of the table that is parallel to its long axis in the X direction, and 85 cm to the front of the physical rotation axis of joint 6 in the Y direction. As a result, the origin of the TTCS is defined in such a way that, when the center of the treatment volume of the table top is placed at the origin of the FRS, then the origin of the TTCS is overlaid with the origin of the FRS. Zt 85 cm Yt 10 cm Xt Figure 6-3. Table Top Coordinate System (TTCS) Note: TTCS does not comply with IEC 61217 for following points:
Zero position is not the one defined in IC61217 for Y and Z axis. Zero position of TTCS is defined so that the TCP (as shown in Figure 6-4) is at isocenter. Pitch and roll are between [-180;180] instead of [0;360]
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Height: 400 mm Width: 500 mm TCP=ETV Center 250 mm PPS Couplers side 100 mm 500 mm Length: 1200 mm Figure 6-4. Zero position of the TTCS Note: PPS positions are always displayed according to the TTCS. Note: Auto PPS motions are managed in such a way that movement along all involved axes is synchronized. As such, the PPS trajectory is not defined in TTCS terms. Note: PPS Manual movements follow the HTTCS1 for translations along the X, Y and Z axes as well as for top rotation. 1. The Horizontal Table Top Coordinate System (HTTCS) is equivalent to the IEC 61217 patient support coordinate system and as its name indicates, it always remains horizontal. In the Proton Therapy System, it is used instead of the TTCS for the execution of Manual PPS motions. This enables lateral (X) and longitudinal (Y) motions to be horizontal displacements of the table top even if there is a pitch or roll of the table. If the TTCS was used instead, as it is stationary with respect to the table, lateral (X) motions would be executed on the plane of the current roll angle and longitudinal (Y) motions on the plane of the current pitch angle. Clinical Users Guide Volume 1 - Treatment Session IBA | 6-7|
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Types of Patient Positioning Device (PPD) Motion Using the hand-pendant or the remote positioning controls, the user can perform any of the following types of motion:
Auto motions Manual motions Note: For the purpose of this manual, the Manual operating mode of the remote positioning controls is fully explained and illustrated. This operating mode may or may not be available at your treatment center. Manual/Auto mode selection bar. Auto motions are available using the Auto operating mode of the remote positioning controls. Manual motions are available using the Manual operating mode of the remote positioning controls. Figure 6-5. Remote Positioning Controls Panel - Auto and Manual Modes
(typical) IBA | 6-8 |
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Manual/Auto mode selection bar. Auto motions are available using the Auto operating mode of the hand-pendant. Manual motions are available using the Manual operating mode of the hand-pendant. Figure 6-6. Wireless Hand-Pendant GUI Screen - Auto and Manual Modes
(typical) Besides Auto and Manual motions, Trajectory motions are predefined gantry trajectories that enable the acquisition of CBCT. Using Auto Motions Auto motions are available using the Auto operating mode of the hand-pendant or of the remote positioning controls. This type of motion is used to move several PPDs to a predefined programmed position (also called target position), which may either be a prescribed position or a user-defined position. Prescribed positions are patient-specific (i.e., they depend on the patient-
specific data from the treatment plan that may be loaded in the system at a given time). Clinical Users Guide Volume 1 - Treatment Session IBA | 6-9|
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User-defined positions are non patient-specific (i.e., they do not depend on the loaded patient-specific data). These positions may be stored and used across treatment sessions in the same treatment room. For example, a user-defined Load position may be used to load patients onto the couch. Prescribed or user-defined positions may require more than one PPD to be positioned in a certain way. These positions are computed in advance, so you may use the hand-pendant or the remote positioning controls to execute Auto motions that take the different devices to target. Motions of the different devices take place sequentially. Each device involved in a predefined programmed position needs to be individually selected and moved to its target position. The settings of all target positions are displayed according to IEC61217 (refer to
"Supported Coordinate Systems" on page 7-3). Target Positions in a GTR This section features a list of the target positions that may be available in the different types of treatment rooms when using Auto mode. Note: For further information on how to perform Auto motions using the wireless hand-pendant, refer to Chapter 9. For further information on how to perform Auto motions using the remote positioning controls, refer to Chapter 11. Table 6-1. Target Positions for a GTR Position name Coordinate system in which it is expressed SETUP IEC PPD Settings for target position Obtained from the patients selected treatment plan. Gantry PPS PBS ded. snout TREATMENT IEC Gantry PPS PBS ded. snout Obtained from the patient's plan, with application of the correction from the setup beam. c i f i c e p s
-
t n e i t a P
/
d e b i r c s e r P IBA | 6-10 |
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Table 6-1. Target Positions for a GTR (Contd) PPD Settings for target position Position name Coordinate system in which it is expressed CORRECTED IEC PPS Gantry Snout Obtained from the setup or treatment correction data manually entered by a user or received from a patient position verification system such as adaPTinsight. It means that you want to execute the corrections that have been manually entered or received from adaPTinsight. You may define and save the equipment position(s) that you deem useful.
/
d e n i f e d
-
r e s U c User presets i f i c e p s
-
t n e i t a p n o N IEC PPS Gantry Snout
(Optional) Using Manual Motions Note: For the purpose of this manual, the Manual operating mode of the remote positioning controls is fully explained and illustrated. This operating mode may or may not be available at your treatment center. WARNING Manual motions do not ensure an accurate positioning of the patient. If a treatment with the beam has to be done after a manual motion, it is necessary to check the tumor position with the imaging systems. Manual motions are available using the Manual operating mode of the hand-
pendant or of the remote positioning controls. This type of motion is used to move a single piece of equipment along an axis/direction either without a specific target or with a target defined on the go. Manual motions allow the user to execute the refinements that ensure proper patient positioning according to the circumstances. Manual motions may follow an Auto motion. Clinical Users Guide Volume 1 - Treatment Session IBA | 6-11|
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The settings of all Manual motions are displayed according to IEC61217 (refer to
"Supported Coordinate Systems" on page 7-3). Manual Motions in a GTR This section features a list of the Manual motions available in the different types of treatment rooms when using Manual mode. Note: For further information on how to perform Manual motions using the wireless hand-pendant, refer to Chapter 9. For further information on how to perform Manual motions using the remote positioning controls, refer to Chapter 11. Table 6-2. Manual Motions in a GTR Device Axis/ Direction of Movement PPS
+X
-X
+Y
-Y
+Z
-Z Rotation CW/CCW Pitch CW/CCW Roll CW/CCW Gantry CW CCW Snout
(PBS ded.) Drawer Insertion/
Retraction Coordinate System IEC HTTCSa Movement Couch movement along the X-axis of the HTTCS. IEC HTTCS Couch movement along the Y-axis of the HTTCS. IEC HTTCS Couch movement along the Z-axis of the HTTCS. IEC HTTCS Clockwise and counterclockwise couch rotation IEC TTCS IEC TTCS IEC IEC Gantry rotation (0 360) Snout extension a. The Horizontal Table Top Coordinate System (HTTCS) is equivalent to the IEC 61217 patient support coordinate system and as its name indicates, it always remains horizontal. In the Proton Therapy System, it is used instead of the TTCS for the execution of Manual PPS motions. This enables lateral
(X) and longitudinal (Y) motions to be horizontal displacements of the table top even if there is a pitch or roll of the table. If the TTCS was used instead, as it is stationary with respect to the table, lateral (X) motions would be ex-
ecuted on the plane of the current roll angle and longitudinal (Y) motions on the plane of the current pitch angle. IBA | 6-12 |
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Using Trajectory Motions Trajectory motions are applicable to the gantry when the full trajectory of its movement is predefined. This type of motion enables volumetric image acquisition using adaPTinsight. The parameters of the gantrys trajectory are set by the user
(e.g., start and stop gantry angles and gantry rotation speed) and a dry-run is performed before treatment. Motion is initiated by pressing both the software and the hardware start buttons (respectively on adaPTinsight and on the Cone-Beam Computed Tomography - CBCT console), and does not require continuous activation from the user. Motion stops when the trajectory is complete or when the user presses a motion stop button. WARNING As a Radiation Therapy Technologist (RTT), you should visually check the absence of collision before initiating a Cone-Beam Computed Tomography (CBCT) acquisition. In case of doubt, you shall perform a dry-run of the CBCT trajectory to confirm that there is no collision. As a RTT, you shall be vigilant regarding positioning changes; if the patient position or the position of immobilization devices changes during different fractions, this verification shall be re-done. As a RTT, you shall also be vigilant regarding collision with other equipment such as anesthesia or respiratory equipment which have a direct impact on the patient's safety. Note: The trajectory motion mode is closely related to CBCT image acquisition. For further information on CBCT acquisition refer to adaPTinsight user documentation. Patient Positioning Devices Proper positioning and alignment of a patient entails the proper positioning of the patient positioning devices involved: gantry, PBS Dedicated snout, and Patient Positioning System (PPS). Depending on the case, one or more of these devices may need to be properly positioned. Note: For further information on Patient Positioning Devices, refer to Chapter 7. Different PPDs exist in each type of treatment room, as follows:
Gantry Treatment Room (GTR):
Patient Positioning System (PPS) Gantry PBS Dedicated snout and accessory drawer Clinical Users Guide Volume 1 - Treatment Session IBA | 6-13|
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Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Chapter 7 Moving the Patient Positioning Devices This chapter contains some general information on the movement of the different Patient Positioning Devices in the treatment room:
Patient Positioning Devices Solving Collisions Managing Proximity Use the hand-pendant described in Chapter 9 or the remote positioning controls described in Chapter 11 to move the gantry, snout, PBS Dedicated snout, the PPS or the imaging devices. CAUTION Improper patient restraint on the Patient Positioning System (PPS) can cause the patient to fall from the PPS when in motion. Furthermore, releasing the pressure sensitive button on the back of the hand pendant stops the PPS abruptly and can cause the patient to fall off if not suitably restrained. Only press the Motion Enable Button when the patient is safely restrained on the couch or outside the moving equipment operating range. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-1 |
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WARNING The Leoni Orion maintenance hand pendant is a service hand pendant only. As a service hand pendant, the Leoni Orion maintenance hand pendant is capable of overriding safety checks. It is strictly forbidden to use the Leoni Orion maintenance hand pendant after an initial beam request has been completed, and for any clinical operation in general. Do NOT use the Leoni Orion maintenance hand pendant while the patient is loaded. WARNING It is strictly forbidden to ever place any objects (tools, parts, etc) on top or inside moving devices such as the nozzle, or the gantry. Falling tools or parts can injure patients or staff. Take inventory of the tools or parts after using them in a treatment room. CAUTION In order to avoid Patient Positioning System (PPS) damage, do not use the PPS robot as a lifting tool. CAUTION Take caution for flat panel arm and gantry movement in GTR as they do not respect the rotation and linear movement stopping distances. IBA | 7-2 |
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Patient Positioning Devices The Patient Positioning Devices in the treatment room allow you to position the patient for treatment. You may control them using the wireless hand-pendant or the remote positioning controls. Note: For details on how to move the PPDs with Manual and Auto motions using the wireless hand-pendant, refer to Chapter 9. For details on how to move the PPDs with Manual and Auto motions using the remote positioning controls, refer to Chapter 11. The Patient Positioning Devices in the GTR are:
Patient Positioning System (PPS): the PPS is the mechanical arm that serves to position the patient laying on the couch. Dedicated Nozzle Snout Holder (DNSH): the DNSH is the device that holds the accessory drawer and is capable of bringing it closer or further from the patient skin for treatment. Accessory Drawer: the device capable of putting the accessory fully in or out of the beam path depending on whether or not the accessory is used in the prescription. Gantry: the device capable of rotating the nozzle to deliver the proton beam from different angles. Patient Positioning System (PPS) Note: For information on how to manually operate the PPS (in case of emergency), refer to Chapter 16, Operating the Patient Positioning System Manually (Emergency Release Mode). The Patient Positioning System (PPS) has six axes of movement that can be controlled using the hand-pendant or the remote positioning controls. Note: PPS positions are always displayed according to the TTCS in the FRS. Note: Auto PPS motions are managed in such a way that movement along all involved axes is synchronized. As such, the PPS trajectory is not defined in TTCS terms. Note: PPS Manual movements follow the TTCS for translations along the X, Y and Z axes as well as for top rotation. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-3|
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Couch Coupling interface Front arm Joint 3 Joint 2 Joint 6 Joint 5 Turret Joint 4 Joint 1 Figure 7-1. PPS Structural Parts CAUTION Before moving the Patient Positioning System (PPS) robot, the user shall ensure area around the joint 1 and the turret has to be clear. Allowed Maximum Weight on the Couch The PPS is a high-precision tool. The precision is guaranteed for total weights on the couch within certain weight limits; this total weight may be comprised of the patient and/or equipment. Beyond those guaranteed limits, absolute weight limits exist. IBA | 7-4 |
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WARNING The maximum load allowed on the Patient Positioning System (PPS) robot is 215 kg. This maximum load includes the patient and any accessory placed on the couch with the patient or any other equipment. Between the maximum load of the PPS robot and the maximum load of the couch being used, one must consider the lowest load as your maximum load allowed, no matter if the couch labeling suggests a higher load.
* Couch supporting 250 kg: Maximum load is 215 kg
* Couch supporting 150 kg: Maximum load is 150 kg Failure to comply could induce a loss of accuracy or precision which impairs safety and performances of the PPS robot. Patient Positioning System Overload CAUTION When loading, unloading or positioning the patient, the patient mass must be spread homogeneously and adequately centered on the couch at all times to avoid excessive stress on a part of the couch or on the robot. As the patient mass on the couch creates deflection, one must ensure the patient mass is placed such as you do not exceed a mass of 100 kg beyond the center of the Extended Treatment volume (85 cm from the Patient Positioning System Joint 6). Pay particular attention to other loads related to clinical application which can have inadapted load characteristics (ex.: a fully filled water phantom, heavy metallic parts,..). Failure to comply could lead to damages and / or loss of accuracy or performance of the PPS Robot. CAUTION If the robot has undergone an overload or a collision, the essential performances of the Patient Positioning System are not guaranteed anymore. Contact IBA immediately before resuming clinical use of the robot. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-5|
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Constant Weight on the Couch CAUTION The same clinical devices must be put on the Patient Positioning System (PPS) for every treatment day in order to maintain a constant weight on the couch. Couch Modifications To ensure good accuracy and collision detection, it is required to identify the mass installed above the PPS coupling System, and the position of the center of gravity of this mass. Each couch is identified by a unique couch ID and the mass properties of each couch are configured in the IBA system according to the couch ID. The patient mass properties are measured and updated automatically by the PPS before each motion, except for the patient Z-coordinate which is based on an assumption. WARNING Define a new couch ID and related couch properties when mass properties of the couch are changed significantly. Failure to do so may result in an incorrect couch properties assumption. Examples of significant changes are an unknown couch, a modified couch, or a couch loaded with clinical equipment above 15 kg. Extended Treatment Volume (ETV) The extended treatment volume, in the case of a PPS with a couch, is a box-shaped virtual volume attached to the table top. Its inferior surface is merged with the horizontal top surface of the couch. The longitudinal axis of the ETV is parallel to the longitudinal axis of the couch and intercepts orthogonally rotation axis of joint 6 of the PPS. This volume includes all the points that can be physically brought to the isocenter with:
a PPS top rotation within the interval [-95; +95]
a PPS pitch value between -5 and 5 and a PPS roll value between 5 and -5 IBA | 7-6 |
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the defined absolute accuracy The dimensions of the extended treatment volume are:
50 cm parallel to the table tops short axis 100 cm parallel to the table tops long axis 40 cm perpendicular to the table top The extended treatment volume contains the origin of the TTCS (Table Top Coordinate System), also named Tool Center Point (TCP), as the origin. This point is centered with respect to the length and width of the extended treatment volume and 10 cm above its inferior internal surface. This point is located 850 mm away from PPS axis joint 6 along the longitudinal direction of the couch. The origin of the TTCS (also known as the Tool Center Point) is centered with respect to the length and width of the extended treatment volume and 10 cm above its inferior internal surface. It is located 85 cm away from PPS axis 6. 85 cm 50 cm Refer to section Using the Couch for details. 40 cm Yt 10 cm 100 cm Zt Xt Extended Treatment Volume: Virtual box-shaped volume attached to the table top which includes all points that can be brought to isocenter to be irradiated by the proton beam with a PPS Top Rotation of -185/5. Its dimensions are 50 cm x 100 cm x 40 cm. Figure 7-2. Treatment Volume
(drawing not to scale) Clinical Users Guide Volume 1 - Treatment Session IBA | 7-7|
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Note: Positioning accuracy is only validated for points within the treatment volume. Note: For a long table-top offering uniformity1, WET (Water Equivalent Thickness) uniformity is only guaranteed for a position within the ranges of the treatment volume. This is relevant only for those positions where the beam passes through the table in the RT Ion plan beams geometry definition. The PPS is capable to move and place a zone of interest outside the treatment volume. However, positioning the PPS outside the treatment volume requires you to exercise specific care for patient positioning verification. The accuracy in the treatment volume is valid for left and right elbow configurations. Note: The Patient Positioning System (PPS) is capable of positioning a point of the treatment volume at isocenter within the required accuracy and repeatability values. These values are valid for both small correction movements and large absolute PPS movements. WARNING Due to existing interferences, it may not be possible to acquire images of certain points of the treatment volume in all hardware configurations. You must select the proper arm configuration (right or left) such that the oblique imager X-ray beams will not be obstructed by the robotic arms. Whenever you confirm a position outside the treatment volume, the following message appears on the hand-pendant:
Position outside treatment volume. Position verifications are mandatory. Press OK to validate your selection. Using the Couch Note: The following information is valid for the kVue, kVueOne and CIVCO couch. Figure 7-3 shows a detailed view of the treatment volume displayed by Figure 7-2. When using the couch, the section represented in red (see Figure 7-3) is not part of the treatment volume. The dimensions of the rectangular sides of the triangle are as follows:
+/- 0 pitch: 5 cm by 5 cm
+/- 5 pitch: 10 cm by 10 cm 1. To establish whether or not the table-top offers uniformity, refer to the OEM documentation. IBA | 7-8 |
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Figure 7-3 represents the most restricted situation. 10 cm 10 cm Figure 7-3. Treatment Volume When Using the (kVueOne) Couch Longitudinal Cross Section CAUTION Specific attenuation tests should be conducted by physics department. The support beams (arms) can be moved laterally with or without the patient on the kVue. The clinical user shall, whenever possible, make sure that the support beams are not in the treatment beam path. Moving the couch beams (for X-ray imaging) for the kVue couch The automatic load cell check needs to block the beams of the kVue couch. Hence, a tool is fixed on the beams (see Figure 7-4) In some cases, the user might need to move beam of the kVue couch for X-ray imaging or when they are in interference with gantry. In this case, the user must squeeze or press the handle of this tool to move the beams (see Figure 7-4). Clinical Users Guide Volume 1 - Treatment Session IBA | 7-9|
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Press the handle to move the beam Figure 7-4. Tool for moving the kVue couch beams Enhanced Safety Through Various Software Limits Safe operation of the PPS is guaranteed by a set of configurable software limits and low level non-configurable software limits for each axis, protecting the patient from being injured and the equipment from being damaged. To be sufficiently accurate, these software limits depend on the load that is exerted on the PPS; these limits reside in the TCS configuration database. The operation of the software limits is fully transparent to you as a user. GoTo Motions in a GTR Commands sent from the hand-pendant to move the Patient Positioning System
(PPS) and gantry and PBS Dedicated snout to a target position are received and managed by the Therapy Control System (TCS). Note: Only those Labeled positions for which the conditions are currently met appear in the GOTO menu. IBA | 7-10 |
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Table 7-1. Labeled Positions for a GTR PPD Settings for target position c i f i c e p s t n e i t a P Position name Coordinate system in which it is expressed SETUP Isocentric TREATMENT Isocentric MEMORY FRS, Isocentric Gantry PPS PBS ded. snout Gantry PPS PBS ded. snout Gantry PPS PBS ded. snout CORRECTED FRS, Isocentric PPS CBCT menu -
Pre-start Isocentric Gantry CBCT menu -
Dry-run Isocentric Gantry Obtained from the patients plan. Obtained from the patient's plan, with application of the correction from the setup beam. This position is only available if previously defined and saved when the PPD settings were saved during a Save Position request. The saved MEMORY position is deleted following a fraction. Obtained from the setup or treatment correction data entered by a user. It means that you want to execute the corrections that have been entered. This position is only available when the PPVS is in the CBCT acquisition step. After selecting the start angle in the CBCT Acquisition menu of adaPTinsight, Prestart moves the gantry to a start position, ready for a CBCT scan. This position is only available when the PPVS is in the CBCT acquisition step. Performs a CBCT dry-run to verify that the trajectory will be collision free. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-11|
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Table 7-1. Labeled Positions for a GTR (Contd) Position name Coordinate system in which it is expressed PPD Settings for target position CBCT menu -
Safe Isocentric PPS LOAD FRS, Isocentric USER FRS c i f i c e p s t n e i t a p
-
n o N GANTRY 90 GANTRY 180 GANTRY 270 FRS, Isocentric FRS, Isocentric FRS, Isocentric Gantry PPS PBS ded. snout Gantry PPS PBS ded. snout Gantry Gantry Gantry Defines a target position for the PPS. This position is only available when the PPS is not in a safe position for CBCT; this position is used when the current PPS position will lead to a collision trajectory during a CBCT scan. Moving the PPS after choosing the CBCT Safe position will move the PPS to a position where no collision occurs with the table. Position used to load/unload a patient onto/from the couch. This position is only available if in Service session and previously defined and saved in the TR when the PPD settings were saved during a Save Position request. Position used to move the gantry to a frequently required position. Position used to move the gantry to a frequently required position. Position used to move the gantry to a frequently required position. IBA | 7-12 |
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Snout Holder Note: For details on how to move the PBS dedicated snout with Manual and Auto motions using the wireless hand-pendant, refer to Chapter 9. For details on how to move the PBS dedicated snout with Manual and Auto motions using the remote positioning controls, refer to Chapter 11. The Snout Holder is the structure on which the accessory drawer is mounted. The snout holder has one direction (axis) of movement:
Movement along the beam axis (Zg axis of the Gantry Coordinate System) to position the accessory drawer closer to the patients skin in preparation of irradiation or to retract it away from the patients skin following irradiation. Accessory Drawer Note: For details on how to move the accessory drawer with Manual and Auto motions using the wireless hand-pendant, refer to Chapter 9. For details on how to move the accessory drawer with Manual and Auto motions using the remote positioning controls, refer to Chapter 11. Note: Due to safety reasons, moving the accessory drawer using the hand-pendant is only possible when the snout holder is at a position far from isocenter (i.e, retracted position). At the end of the nozzle, an accessory drawer can support an optional range shifter, ridge filter or snout (and a block and/or range compensator onto the snout). This accessory drawer can be put fully in (inserted) or out (retracted) of the beam path depending on whether or not the accessory is used in the prescription. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-13|
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Gantry Note: For details on how to move the gantry with Manual and Auto motions using the wireless hand-pendant, refer to Chapter 9. For details on how to move the gantry with Manual and Auto motions using the remote positioning controls, refer to Chapter 11. Note: The rotating gantry is only available in a Gantry Treatment Room (GTR). The gantry is capable of rotating 360 around its center (horizontal) axis with respect to the nozzle (vertical beam) positioned vertically and pointed in a downward direction, as illustrated by Figure 7-5. The gantry may be rotated clockwise from 0
(12:00 oclock) to 180 (6:00 oclock) and counterclockwise from 0 (12:00 oclock) to 180 (6:00 oclock). In Treatment session, the gantry angle scale is in the range of 0 (12:00 oclock) to 360 (12:00 oclock). Throughout this guide, reference to the various positions of the gantry are made in terms of both degrees and clock positions. 0 (12:00 oclock) 270 (9:00 oclock) 90 (3:00 oclock) Figure 7-5. Gantry Angles in Treatment Session (viewed from the Treatment Room) 180 (6:00 oclock) Solving Collisions CAUTION If the robot has undergone an overload or a collision, the essential performances of the Patient Positioning System are not guaranteed anymore. Contact IBA immediately before resuming clinical use of the robot. IBA | 7-14 |
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CAUTION In case of collision of the Patient Positioning System (PPS) with a device or person, suspend all clinically related activities and contact IBA personnel as the Proton Therapy System (PTS) cannot be guaranteed to satisfy safety and performance characteristics. Collision of the PPS with a device or person can affect the calibration of the PPS, leading to reduction of positioning accuracy. Any collision between a device and the PPS is automatically detected. CAUTION Be careful when handling the system in this mode because the collision detection will be automatically disabled (upon acknowledgement of the collision detection) at the start of a collision recovery phase in order to allow to move equipment(s) out of collision. In case of collision, the PPS shifts into Recovery mode and the Collision detected message appears. Pressing OK will start a recovery phase. During this phase, you can move the equipments at a very slow speed. When the PPS has been moved out of the collision situation, the Out of collision. Next move will re-enable detection message appears. When you move an equipment, collision detection will be enabled again. If a collision occurs If a collision occurs between the PPS and a person or another equipment, proceed as follows:
1. 2. The Collision detected message appears. Press OK. If a collision is no longer present, a. The Out of collision. Next move will re-enable collision message immediately appears. b. When you move an equipment, collision detection will be enabled. 3. If a collision is still present, c. The Please move out of collision. Be careful: collision detection will be disabled during next movement message appears. Clinical Users Guide Volume 1 - Treatment Session IBA | 7-15|
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d. Press OK e. Move the equipment causing the collision. During this movement, collision detection is disabled and equipement movements can be performed at low speed only. f. If this movement brings the system into a state in which the collision is no longer present, see Step 2. g. If you interrupt the movement while the collision is still present, see Step 3. Managing Proximity When a proximity situation is detected:
Patient Positioning Devices (PPDs) move at medium speed. The wireless hand-pendant or the remote positioning controls make(s) a beeping sound during equipment motion to alert you that the devices are getting close to each other. Note: If the PPDs are close but the motion is such that one is getting away of the other, there is no proximity situation. IBA | 7-16 |
Clinical Users Guide Volume 1 - Treatment Session Chapter 8 Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls The wireless hand-pendant is the device used to move patient positioning devices and imaging equipment from within the Treatment Room (TR). Note: For detailed information on using the wireless hand-pendant, refer to Chapter 9. Most motion control functions can also be used from the Treatment Control Room
(TCR) using the remote positioning controls, which are displayed on adaPTdeliver screens. The remote positioning controls are used in combination with the remote positioning hardware console. To execute the motions selected using the remote positioning controls, you must use the Motion Enable Button (MEB) and Move buttons on the remote positioning hardware console. Note: For detailed information on using the remote positioning controls, refer to Chapter 11. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-1 |
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Motion Enable Button
(MEB) Emergency stop button Move button Figure 8-1. Remote Positioning Hardware Console Note: When the Cone-Beam Computed Tomography (CBCT) option is active, it is also possible to move equipment from the CBCT controls on the X-ray generator hardware console. For further details, refer to the adaPTinsight user documentation. The wireless hand-pendant and remote positioning controls share a number of similar features. This chapter provides you with an overview of those features. Wireless Hand-Pendant Screens All wireless hand-pendant screens (both in Manual and Auto modes) share a series of main features (see Figure 8-2). IBA | 8-2 |
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Motion Enable Button (MEB) status
(pressed/released) Light field ON/OFF Dim room lights ON/OFF Room ID Lasers ON/OFF App bar Manual/Auto mode selection bar The central dial displays various Move buttons, depending on the currently selected device. Movement speed Imaging system Menu icon: this icon provides access to a set of actions that are performed less often than those available via the main screens. Status of the Move buttons (Move button pushed/Move button not pushed) Gantry, snout and accessory holder. Device selection bar PPS Figure 8-2. Wireless Hand-Pendant GUI Screen
(typical) Remote Positioning Controls Panel The remote positioning controls panel appears on the right of all the adaPTdeliver screens. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-3|
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Remote positioning controls panel Figure 8-3. Remote Positioning Controls Panel in adaPTdeliver Screen
(typical) The remote positioning controls panel, both in Manual and Auto modes, has a series of main features (see Figure 8-4). IBA | 8-4 |
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Manual/Auto mode selection bar Remote positioning controls bar Dim room lights ON/OFF Lasers ON/OFF Light field ON/OFF Device speed selection Motion Enable Button (MEB) status (pressed/released) Menu icon: provides access to the ADVANCED SETTINGS PANEL. The rest of the features in the remote positioning controls panel depends on the selected mode
(Manual/Auto). These particular features are described in Chapter 11. Figure 8-4. Remote Positioning Controls Panel - Main Features
(typical) App Bar (Wireless Hand-Pendant) and Remote Positioning Controls Bar Icons The wireless hand-pendant App bar and the remote positioning controls bar feature a series of common icons. These icons are described in Table 8-1. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-5|
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Table 8-1. Wireless Hand-Pendant App Bar and Remote Positioning Controls Bar: Common Icons Icon Meaning Menu Indicates the status of the Motion Enable Button (Pressed/Not Pressed) Switches the light field ON/OFF Switches the lasers ON/OFF Dims/undims room lights Confirms position Understanding Colors in the Wireless Hand-
Pendant GUI and Remote Positioning Controls Panel The color legend detailed in Table 8-2 applies to all of the wireless hand-pendant GUI screens as well as to the remote positioning controls panel. IBA | 8-6 |
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Table 8-2. Wireless Hand-Pendant GUI and Remote Positioning Controls Panel-
Color Legend Feature General Color Meaning Explanation Light gray Function disabled/not selectable When due to the current circumstances a particular option or set of options is disabled (e.g., high speed is not selectable when a proximity situation is detected, remote positioning controls are disabled when the wireless hand-pendant is being used, etc.), the corresponding icon(s) or button(s) appear(s) in light gray and are not selectable (see Figure 8-5). When a mode is selected, it becomes underlined by a blue trait. When a mode is not selected, the word Manual or Auto appears on a gray background. Mode selection bar Blue Mode selected Gray Mode not selected Green App bar (wireless hand-
pendant)/Remote positioning controls bar Feature is active Depending on the icon in the remote positioning controls bar: MEB pressed/ light field on/ laser crosswire on/ lights dimming on. Gray Feature is not active Depending on the icon in the remote positioning controls bar: MEB not pressed/ light field off/ laser crosswire off/
lights dimming off. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-7|
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Table 8-2. Wireless Hand-Pendant GUI and Remote Positioning Controls Panel-
Color Legend (Contd) Feature Movement speed selection Color Blue Meaning Explanation Speed selected When a speed is selected, the dot next to the corresponding icon (turtle for low speed, hare for high speed) or the medium speed dot turns blue. Gray Speed not selected Light gray Speed not selectable Device selection Blue Device selected and ready for movement Orange Device selected and not ready for movement Red Device selected and in error When a speed is not selected, the dot next to the corresponding icon (turtle for low speed, hare for high speed) or the medium speed dot is gray. When a speed is not selectable in the current circumstances (e.g., high speed is not selectable when a proximity situation is detected), the dot next to the corresponding icon
(turtle for low speed, hare for high speed) or the medium speed dot is light gray. When a device is selected and ready for movement, the corresponding icon becomes highlighted with some blue traits. When a device is selected but not ready for movement
(e.g., the gantry needs to be homed), the corresponding icon becomes highlighted with some orange traits. When a device is selected but in error, the corresponding icon becomes highlighted with some red traits. The color legend detailed in Table 8-3 applies to all of the wireless hand-pendant GUI screens. IBA | 8-8 |
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Table 8-3. Wireless Hand-Pendant - GUI Color Legend Feature Central dial Color Gray Meaning Explanation No proximity or collision situation detected Yellow Red Proximity situation detected Collision situation detected Move buttons Dark Blue Button is not pressed. Light Blue Button is pressed and movement is authorized. When neither a proximity nor a collision situation is detected, the circle surrounding the central dial is gray. When a proximity situation is detected, the circle surrounding the central dial turns yellow, as is the case in Figure 8-2. When a collision situation is detected, the circle surrounding the central dial turns red. When a Move button in the central dial is not being pressed, its border at the center of the central wheel is highlighted by a dark blue line. When a Move button in the central dial is being pressed and movement is authorized, its border at the center of the central wheel is highlighted by a light blue line. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-9|
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The color legend detailed in Table 8-4 applies to the remote positioning controls. Table 8-4. Remote Positioning Controls - Color Legend Feature Target position selection (Auto mode)/
Movement selection
(Manual mode) Color Blue White Meaning Explanation Target selected/Move ment selected Target not selected/Move ment not selected When a target position (Auto mode) or a movement
(Manual mode) is selected, the dot corresponding to the selected target or the arrow or label corresponding to the selected movement becomes highlighted in blue. When a target position (Auto mode) or a movement
(Manual mode) is not selected, the dot corresponding to the target or the arrow or label corresponding to the movement is displayed in gray. Understanding Auditive Signals The remote positioning controls and wireless hand-pendant produce the following auditive signals. Table 8-5. Wireless Hand-Pendant and Remote Positioning Controls - Auditive Signals Signal Meaning Single short beep Target position reached by a PPD. Double short beep Target position reached by all PPDs. Single long beep Error. Explanation A given PPD has reached its target position. All PPDs have reached the target positions required. There is a device or system error or a warning message. IBA | 8-10 |
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Understanding Vibration Signals of the Wireless Hand-Pendant The remote wireless hand-pendant produces the following vibration signals. Table 8-6. Wireless Hand-Pendant - Vibration Signals Signal Meaning Explanation Short vibration Movement starts. Target position reached by a PPD. Long vibration Error. The Move and Motion Enable Buttons are pressed and PPD movement starts. A given PPD has reached its target position. There is a device or system error or a warning message. Switching Command From the Wireless Hand-
Pendant to the Remote Positioning Controls When you are using the wireless hand-pendant, all of the options in the remote positioning controls panel are grayed out. You are hence unable to use the remote positioning controls. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-11|
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Figure 8-5. Remote Positioning Controls Panel - Disabled
(typical) To switch command to the remote positioning controls, press and release the Motion Enable Button (MEB) on the remote positioning hardware console. As a result:
the remote positioning controls are enabled the wireless hand-pendant is disabled IBA | 8-12 |
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the Locked - TCR hand-pendant in use. message appears on the wireless hand-pendant display Note: It is impossible to take over command when the Motion Enable Button
(MEB) is pressed on the active hand-pendant. Note: It is impossible to take over command when the Move button on the X-ray generator hardware console is being pressed. In cases where the Cone-Beam Computed Tomography (CBCT) controls on the X-ray generator hardware console are locking the control, press the Reset button on the console. Switching Command From the Remote Positioning Controls to the Wireless Hand-
Pendant When you are using the remote positioning controls, the Locked - TCR hand-
pendant in use message appears on the wireless hand-pendant display. To switch command to the wireless hand-pendant, squeeze and release the Motion Enable Button (MEB) on the sides of the wireless hand-pendant:
the wireless hand-pendant is enabled the remote positioning controls are disabled the Locked - TR hand-pendant in use. message appears on the remote positioning controls. Note: It is impossible to take over command when the Motion Enable Button
(MEB) is being pressed on the remote positioning hardware console. Clinical Users Guide Volume 1 - Treatment Session IBA | 8-13|
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IBA | 8-14 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Chapter 9 Using the Wireless Hand-Pendant Note: Figures of the wireless hand-pendant GUI across this manual show a typical configuration (Gantry Treatment Room with snout and accessory drawer as well as with stereoscopic, portal and orthogonal imagery system). Some details may differ from the GUI displayed by the wireless hand-pendant in other room configurations. However, the principles explained apply to all GUI configurations. The wireless hand-pendant is the device used to move the patient positioning devices and imaging equipment inside the Treatment Room (TR). It features a Graphical User Interface application and two buttons, one on each side. These are the Motion Enable Buttons (MEB). The MEB enable you to confirm and enable, as a user, the execution of the movements commanded via the Graphical User Interface. Figure 9-1. Wireless Hand-Pendant
(typical) The wireless hand-pendant can be docked for charging onto a docking station. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-1 |
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Figure 9-2. Wireless Hand-Pendant Docking Station
(typical) This chapter provides instructions on how to use the wireless hand-pendant, covering the following topics:
Safety Measures Specific to the Use of the Wireless Hand-Pendant Registering the Wireless Hand-Pendant Unlocking the Wireless Hand-Pendant Controlling Speed Stopping Movements Operating Modes: Auto and Manual Using the GUI in Auto Mode Using the GUI in Manual Mode Using Advanced Options From the Menu Colorblind Users: Negative Colors Note: Most motion control functions can also be used from the Treatment Control Room (TCR) using the remote positioning controls, which are displayed on adaPTdeliver screens. For more details on how to use the remote positioning controls, refer to Chapter 11. For detailed information on adaPTdeliver refer to Part V, Using adaPTdeliver. Note: Throughout this chapter, the color legend, auditive signals, and vibration signals described in Chapter 8 apply. IBA | 9-2 |
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Safety Measures Specific to the Use of the Wireless Hand-Pendant Make sure you read and understand the following warning and important messages before using the wireless hand-pendant. WARNING It is not allowed to activate movements with the wireless hand pendant when there is no visibility on the moving devices (e.g., it is not allowed to move the patient positioning devices from the maze). WARNING Stop using the wireless hand pendant and inform IBA personnel in case any unusual defect is observed on the wireless hand pendant. Defects can be (but are not limited to) unusual overheating of the device, leakage of substances, emission of fumes or gas, cracks in the hand pendant case. Important Other wireless devices could interfere with the wireless hand-pendant and are therefore proscribed in the treatment room. Interferences could lead to untimely and unexpected motion interruptions. While remaining safe, such situation could impede the normal use of the Proteus 235 system. If you experience loss of effectiveness or an unexpected stop of movements with the wireless hand-pendant, please move away emitters like mobile phones, laptops, etc. Important Do not use the wireless hand-pendant for another purpose than controlling Proteus 235 system. Do not connect the wireless hand-
pendant manually to any Wi-Fi network. Do not connect the wireless hand-pendant to another Wi-Fi network than a Proteus PLUS treatment room. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-3|
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Important When leaving the treatment room, you must always put the wireless hand-pendant back on its docking station. This ensures that the wireless hand-pendant remains protected from irradiation during treatment. Important The wireless hand-pendant is a failsafe device. In case of interruption of the communication between the wireless hand-pendant and the rest of the Proton Therapy System, any ongoing movement will be stopped. The loss of communication of the wireless hand-pendant is considered as a release of any currently pressed or tapped button. More specifically, if the system looses the communication with the wireless Motion Enable Button during a movement, it will stop and disable all motion in the treatment room. WARNING Use the wireless hand pendant always with the delivered IBA necklace or with an alternative reliable means to prevent the device falling down accidentally Falling of the wireless hand pendant can cause severe damages, including
- Damage to the battery
- Degradation inducing hazardous faulty behaviour. Registering the Wireless Hand-Pendant In order to use the wireless hand-pendant in a given treatment room, it is necessary to register it to that treatment room. When as part of the registration process the application connects via Wi-Fi to the Proton Therapy System, it retrieves the room configuration of the room to which it is currently registered. The room configuration includes the list of the installed devices and their type. Based on this information, the application adapts itself to provide IBA | 9-4 |
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controls that match the current room configuration. For this reason, there are as many possible GUI configurations as there are room configurations. The same wireless hand-pendant can be used in any treatment room as long as it has been successfully registered to that treatment room. The registration process guarantees that only one wireless hand-pendant is allowed to send commands in a given treatment room. The registration of a wireless hand-pendant to a given room is not possible if another user is pressing the motion enable buttons on an already registered wireless hand-
pendant, irradiation is ongoing or the registration of another wireless hand-pendant is ongoing. This rule guarantees that it is not possible to interfere with a user sending commands to the Proton Therapy System. When you enter a Treatment Room with a wireless hand-pendant that is not registered, the wireless hand-pendant automatically prompts you to register it by displaying the Register button, which enables you to start the registration procedure. Although several wireless hand-pendants may be present in a given treatment room and they may all be connected to the wireless network, only one wireless hand-
pendant can be registered to a single treatment room at any given time. The registered wireless hand-pendant is the only one authorized and able to move treatment room equipment. Registration Procedure In order to register a wireless hand-pendant to a given treatment room, proceed as follows:
1. Once the wireless hand-pendant is in the treatment room, it automatically connects to the treatment room Wi-Fi network. The following screen appears:
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Figure 9-3. Wireless Hand-Pendant Connected - Not Registered 2. Touch the REGISTER button. The REGISTRATION PROCEDURE SCREEN appears. This screen features some animated instructions that illustrate the sequence of operations that needs to be performed in order to complete the registration. IBA | 9-6 |
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Figure 9-4. Registration Procedure Screen
(typical) 3. Follow the animated instructions on the REGISTRATION PROCEDURE SCREEN:
a. Press and hold both side buttons. b. Release one of the side buttons. c. Press and hold both side buttons. d. Release the side button that was not released in Step b. 4. After 5 seconds, the REGISTRATION PROCEDURE SCREEN is closed and the locked screen appears:
If the registration was performed successfully, you are able to unlock and use the device. To unlock the device, proceed as detailed in section Unlocking the Wireless Hand-Pendant. If the registration was not performed successfully, you can execute the registration procedure again by touching the REGISTER button (see Figure 9-3). Clinical Users Guide Volume 1 - Treatment Session IBA | 9-7|
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Registration Consequences Only one wireless hand-pendant can be registered to a single treatment room at any given time. The successful registration of a wireless hand-pendant to a given treatment room has the following consequences:
The wireless hand-pendant that was previously registered in this treatment room is automatically unregistered. The newly registered wireless hand-pendant is automatically unregistered from any other treatment room it was previously registered to. Note: It is not possible to register a wireless hand-pendant to a treatment room if a user is currently pressing the motion enable buttons of the wireless hand-pendant currently registered to that same treatment room. Unlocking the Wireless Hand-Pendant In order to unlock the wireless hand-pendant, swipe as indicated on the locked screen. Note: Once a wireless hand-pendant is registered to a given treatment room and unlocked, it is automatically locked after 5 minutes of inactivity. Controlling Speed Each patient positioning device (PPD) may be moved at the following speeds:
low speed: always possible. medium: not possible during homing. high: not possible when a device is in a situation of proximity. In case high speed cannot be selected, it could be due to the following:
Device must be homed A retractable device is positioned between the inserted and retracted position (DID panel, drawer, etc.) A device may be moving too close to another device Note: Certain activities like homing the gantry or taring the PPS cannot be performed at all speeds. IBA | 9-8 |
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Movement speed Figure 9-5. Movement Speed Icons To choose the high speed option, touch the dot next to the hare icon. Alternatively, to choose the low speed option, touch the dot next to the tortoise icon. Alternatively, to choose the medium speed option, touch the dot between the high and low speed options. The dot corresponding to the currently selected speed is highlighted in blue. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-9|
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Table 9-1. Movement Speeds Icon Speed High speed (hare icon) Medium speed Low speed (tortoise icon) Note: The speed of the device remains set to the last speed used until a different speed is selected. Note: The proximity control software may automatically switch the speed of a device from high speed to medium speed in certain circumstances. Stopping Movements The following methods are available to stop movements of the Proton Therapy System (PTS) equipment when using the wireless hand-pendant:
Release the Move button that is currently being pressed on the wireless hand-
pendant. Release the Motion Enable Buttons on the wireless hand-pendant. Press an emergency stop button. WARNING If a patient is not safely secured to the PPS, the patient may fall off. Each patient shall be safely secured before moving the PPS. Release the Move Device Button If the currently pressed Move button is released during Patient Positioning Device
(PPD) movement, the PPD performs a normal stop. IBA | 9-10 |
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Release the Motion Enable Buttons If the Motion Enable Buttons are released during Patient Positioning Device (PPD) movement, the PPD performs an emergency stop. If you release these buttons before releasing the currently pressed Move button, the motion stops abruptly. Only press the Motion Enable Button when the patient is safely restrained on the couch or outside the moving equipment operating range. The movement can be resumed by pressing the Motion Enable Buttons, followed by the chosen Move button. Press an Emergency Stop Button Note: Emergency stop buttons and TSS interlocks exist on a level local to your treatment room and system-wide. The description in this section pertains to the local level only. WARNING Emergency stop buttons shut off energy to most components in the Proton Therapy System (PTS). However, the electrical power to some components will not be interrupted, so be aware that electrical hazards and faults (faulty parts made live or induced fire) may still be present. If an emergency stop button local to your treatment room is pressed during Patient Positioning Device (PPD) movement, motion stops immediately. After using an emergency stop button local to your treatment room to stop the PPDs, the emergency stop button and the Therapy Safety System (TSS) must be reset. After the emergency stop button and TSS are reset, the following may also be required:
Recovery enabling beam production Recovery of gantry movement (for GTR only) Recovery of PBS Dedicated snout and PPS movements Recovery enabling beam in TR Recovery enabling X-ray high-voltage Verification of proper operation Successful daily calibrations (e.g., variable collimators) Clinical Users Guide Volume 1 - Treatment Session IBA | 9-11|
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Operating Modes: Auto and Manual The wireless hand-pendant can be used in two different operation modes:
Auto mode: using Auto mode, you may perform Auto motions to prescribed or user-defined target positions. For detailed information on Auto motions, refer to Chapter 6. Note: Only those target positions for which conditions are currently met are available using Auto mode. Manual mode: using Manual mode, you may perform Manual motions to positions that are not predefined. For detailed information on Manual motions, refer to Chapter 6. Both Auto and Manual modes give you access to the motion of the imaging devices. Note: The digital imaging devices screen is identical in Auto and Manual mode. The Auto and Manual operating modes may also be available in the remote positioning controls (Manual mode available upon request). For more details on how to use the remote positioning controls, refer to Chapter 11. Prerequisite: Selecting a Device Before selecting an operating mode, select your device from the device selection bar at the bottom of the WIRELESS HAND-PENDANT GUI SCREEN (see Figure 8-2). Gantry, snout, and drawer PPS (or Positioner) Imaging device Figure 9-6. Device Selection Bar A selected device appears in blue on the screen. For example, in Figure 9-6 the gantry, snout, and drawer are selected. IBA | 9-12 |
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Using the GUI in Auto Mode Auto mode enables you to perform Auto motions to patient-specific and non patient-
specific target positions. To select Auto mode, proceed as follows:
1. Touch the Auto option on the hand-pendant mode selection bar. Auto option becomes highlighted by a blue line and the default Auto mode screen appears. Auto Mode Target Positions A target position may be one of the following:
User preset: a user preset is a target position defined by the user. The label of a user preset is the name of the preset as defined by the user. Setup position: setup positions are defined in the Treatment Plan and associated to setup beams. As such, a setup position is only available as a target position when a setup beam is selected and the preparation for the setup beam has started. Treatment position: treatment positions are associated to treatment beams. As such, a treatment position is only available as a target position when a treatment beam is selected and the preparation for the treatment beam has started. Corrected position: a corrected position becomes available once a given treatment or setup position has been corrected using the Patient Position Verification System (PPVS), adaPTinsight. As such, a corrected position is only available as a labeled target position when a treatment or setup beam is selected and after the alignment process is complete. Depending on the stage of the workflow, you may choose among the available target positions. Selecting a Target Position All prescribed and user-defined target positions are available in the menu accessible via the Menu icon located at the top left of the screen. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-13|
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Menu icon Figure 9-7. Menu Icon
(typical) To select a target position from the menu, proceed as follows:
1. 2. Touch the Menu icon on the top left of the screen. Touch the prescribed or user-defined target position that you want to select. The selected prescribed or user-defined target position is highlighted in blue. IBA | 9-14 |
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Figure 9-8. Menu
(typical) Once you choose a prescribed or user-defined target position, you are able to move the patient positioning devices that need to be moved in order to reach the selected position, one by one, using the different device screens in Auto mode. Selecting and Moving a Patient Positioning Device In Auto mode, the only movement possible for every device is the one required for it to reach the selected target position. At the bottom left of every device screen, the GUI displays the icons of all the devices that need to be moved in order to reach the selected target position. The icons of those devices that have not been moved to the target position yet are displayed in gray. Those that have already been moved to the target position are displayed with a green check mark overlaid. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-15|
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PPS Screen Devices that need to be moved in order to reach the treatment position. In this example, the gantry has already reached its target position. Figure 9-9. Treatment Position - Auto Mode (PPS screen) Figure 9-9 shows the PPS screen in Auto mode, with a treatment position selected. The GUI application always enables the user to switch back and forth between Manual and Auto modes. IBA | 9-16 |
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Gantry, Snout, and Drawer Screen retract snout snout in position Rad-A gantry insert drawer Figure 9-10. Treatment Position - Auto Mode (Gantry, Snout, Drawer screen) Figure 9-10 shows the Gantry, Snout, and Drawer screen in Auto mode, with a treatment position selected. Selecting and Moving a Device In order to select the patient positioning device that you want to move, proceed as follows:
1. Touch the icon corresponding to the device that you want to move on the device selection bar at the bottom of the screen. The screen corresponding to that particular patient positioning device appears. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-17|
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In order to move the selected patient positioning device to the selected target position, proceed as follows:
1. Touch and hold the Move button. 2. While holding the Move button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. Creating User-Defined Positions User-defined positions enable you to define new positions to fit your user needs. Using the menu, it is possible to create new user-defined positions, arrange the list of existing user-defined positions and delete, copy or modify existing user-defined positions. In order to create a new user-defined position, proceed as follows:
1. 2. Touch the Menu icon at the top left of the screen in order to display the menu. Touch the New icon in order to access the NEW POSITION SCREEN. IBA | 9-18 |
Clinical Users Guide Volume 1 - Treatment Session
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Create new user-defined position Figure 9-11. Creating a User-Defined Position
(typical) Figure 9-12 shows the NEW POSITION SCREEN, the interface that enables you to create a new user-defined position or to modify an existing one. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-19|
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Figure 9-12. New Position Screen
(typical) 3. 4. Fill in the required fields. Note: The fields in the NEW POSITION SCREEN are automatically filled with the current position of the equipment. You may modify this information, as necessary. To select the devices that you require to be included in a new user-defined position (i.e., the devices that shall have an assigned target when the user-
defined position is selected), proceed as follows:
a. Touch the section corresponding to the device(s) that you wish to include in the new position. The background color toggles between blue and white. Device section(s) with a blue background are included in the new user-defined position. Device section(s) with a white background are not included in the new user-
defined position. IBA | 9-20 |
Clinical Users Guide Volume 1 - Treatment Session
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b. Enter the required position for each selected device. Note: When a user-defined target position is selected, you are only able to select for movement those devices that are included in the target position (i.e., the devices that have an assigned target for the selected user-defined position). 5. Touch the position.
(Tick) icon at the right of the app bar to save the newly created You may also save the new position by touching the arrow at the left of the app bar or the return arrow at the bottom right of the screen. 6. You are prompted to enter a name for the newly created position. Enter an appropriate name and the new position is saved. Managing Prescribed and User-Defined Positions Using the menu, it is possible to create a new user-defined position, arrange the list of existing user-defined positions and delete, copy or modify an existing user-defined position. In order to arrange the list of user-defined positions, proceed as follows:
1. To display the menu, touch the Menu icon at the top left of the screen. Note: Once the menu is open, the Menu icon is replaced by an arrow pointing to the left (see Figure 9-13). You may touch this arrow to close the menu. 2. To be able to arrange the existing positions, touch the Arrange icon. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-21|
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Arrange user-defined positions Figure 9-13. Arranging User-Defined Positions
(typical) 3. To arrange the existing positions, drag each position to the order that suits your preferences. In order to delete an existing user-defined position, proceed as follows:
1. 2. To display the menu, touch the Menu icon at the top left of the screen. To be able to delete a particular position, touch the arrow located to the right of the user-defined position that you want to delete. 3. To delete the user-defined position, touch the Delete icon. A pop-up message prompts you to confirm your action. In order to copy an existing user-defined position, proceed as follows:
1. 2. To display the menu, touch the Menu icon at the top left of the screen. To be able to copy a particular position, touch the arrow located to the right of the user-defined position that you want to copy. IBA | 9-22 |
Clinical Users Guide Volume 1 - Treatment Session
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant |
3. To copy the user-defined position, touch the Copy icon. You are now able to create a new user-defined position using the NEW POSITION SCREEN. All the fields in this screen are automatically filled out with the values corresponding to the copied user-defined position. You may modify these values as you consider appropriate. 4. Touch the
(Tick) icon at the right of the app bar to save the new user-position. You may also save the changes by touching the arrow at the left of the app bar or the return arrow at the bottom right of the screen. In these cases, you are prompted to confirm whether or not you want to save the changes before leaving the NEW POSITION SCREEN. In order to edit an existing user-defined position, proceed as follows:
1. 2. To display the menu, touch the Menu icon at the top left of the screen. To be able to edit a particular position, touch the arrow located to the right of the user-defined position that you want to edit. 3. To edit the user-defined position, touch the Edit icon. You are now able to modify the user-defined position using the USER-DEFINED POSITION EDITING SCREEN. 4. Touch the user-position.
(Tick) icon at the right of the app bar to save the changes to the You may also save the changes by touching the arrow at the left of the app bar or the return arrow at the bottom right of the screen. In these cases, you are prompted to confirm whether or not you want to save the changes before leaving the USER-DEFINED POSITION EDITING SCREEN. Using the GUI in Manual Mode Manual mode enables you to perform equipment movements that do not require any particular patient information or user presets. This covers Manual motions as well as certain Auto motions (the insertion/retraction of various pieces of equipment, gantry Auto angle motions, etc.). Note: All positions appear displayed according to IEC61217 (refer to "Supported Coordinate Systems" on page 7-3). To select Manual mode, proceed as follows:
1. Touch the Manual option on the hand-pendant mode selection bar. Manual option becomes highlighted by a blue line and the default Manual mode screen appears. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-23|
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Using Manual Mode to Move the Gantry, the Accessory Drawer and the Snout 1. Touch the Gantry, Accessory Drawer and Snout icon on the device selection bar at the bottom of the screen. Once the gantry, snout and accessory holder subsystem is selected, the interface displays four Move buttons in the central dial:
The top and bottom buttons enable you to insert and retract the snout (Insert Snout button and Retract Snout button). The left and right buttons enable you to put the accessory drawer in or out of the beam path (Move Accessory Drawer Into the Beam Path button and Move Accessory Drawer Out of the Beam Path button). The ROT slider controls gantry rotation, which may be performed either clockwise or counter clockwise. A target gantry position may be specified using the field above the central dial, on the right of the screen. Note: The GUI is designed to provide quick access to often used actions. Other actions are accessible using the Nav icon (top left of the screen). IBA | 9-24 |
Clinical Users Guide Volume 1 - Treatment Session
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Figure 9-14. Gantry, Snout and Accessory Holder - Manual Mode
(typical) Moving the Gantry The Gantry, Accessory Drawer and Snout commands enable you to move the gantry in several ways. To move the gantry to a particular angle, proceed as follows:
1. 2. Touch the field on the top right of the screen and enter a target gantry angle. Touch and hold the central Move button. 3. While holding the central Move button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. To move the gantry clockwise or counterclockwise, proceed as follows:
1. Touch and hold the ROT tab on the ROT slider and slide it clockwise or counterclockwise, as necessary. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-25|
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2. Hold the ROT tab until the device reaches the required position. 3. While holding the ROT tab, press and hold the MEB buttons on the wireless hand-pendant until the device reaches required position. Moving the Accessory Drawer Note: The system only enables you to move the accessory drawer when the snout is in a completely retracted position (the furthest possible from the isocenter). To move the accessory drawer into the beam path, proceed as follows:
1. Touch and hold the Move Accessory Drawer Into the Beam Path button. Figure 9-15. Move Accessory Drawer Into the Beam Path Icon 2. While holding the Move Accessory Drawer Into the Beam Path button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. To move the accessory drawer out of the beam path, proceed as follows:
1. Touch and hold the Move Accessory Drawer Out of the Beam Path button. Figure 9-16. Move Accessory Drawer Out of the Beam Path Icon 2. While holding the Move Accessory Drawer Out of the Beam Path button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. Moving the Snout holder To insert the snout, proceed as follows:
1. Touch and hold the Insert Snout button. IBA | 9-26 |
Clinical Users Guide Volume 1 - Treatment Session
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Figure 9-17. Insert Snout Icon 2. While holding the Insert Snout button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the position that you consider appropriate or motion is stopped by the software motion limits. To retract the snout, proceed as follows:
1. Touch and hold the Retract Snout button. Figure 9-18. Retract Snout Icon 2. While holding the Retract Snout button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the position that you consider appropriate or motion is stopped by the software motion limits. Using Manual Mode to Move the PPS (Patient Positioning System) Note: Manual PPS motions are executed along the Horizontal Table Top Coordinate System (HTTCS) axes. 1. Touch the PPS icon on the device selection bar at the bottom of the screen. Once the PPS subsystem is selected, the interface displays four Move buttons in the central dial:
The top and bottom buttons enable you to move the PPS along the Y axis (Y+
button and Y- button). The left and right buttons enable you to move the PPS along the X axis (X+
button and X- button). The Z slider controls PPS movement along the Z axis (positive movement if the slider is slid clockwise, negative movement if the slider is slid counterclockwise). Clinical Users Guide Volume 1 - Treatment Session IBA | 9-27|
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The ROT slider controls PPS top rotation. Note: By default, the GUI application displays the X, Y, Z and top rotation controls. You may access the pitch and roll view using the widget located above the central dial, on the left of the screen. PPS X, Y, Z and top rotation controls widget Figure 9-19. PPS - Manual Mode
(typical) Moving the PPS along the X Axis To move the PPS along the X axis, proceed as follows:
1. To move the PPS in the + direction along the X axis, touch and hold the X+
button. Alternatively, to move the PPS in the - direction along the X axis, touch and hold the X- button. 2. While holding the X+ or X- button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. IBA | 9-28 |
Clinical Users Guide Volume 1 - Treatment Session
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Moving the PPS along the Y Axis To move the PPS along the Y axis, proceed as follows:
1. To move the PPS in the + direction along the Y axis, touch and hold the Y+
button. Alternatively, to move the PPS in the - direction along the Y axis, touch and hold the Y- button. 2. While holding the Y+ or Y- button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. Moving the PPS along the Z Axis To move the PPS along the Z axis, proceed as follows:
1. Touch and hold the Z tab on the PPS Z slider and slide it in the desired direction
(positive movement along the Z axis if the slider is moved clockwise, negative movement along the Z axis if the slider is moved counterclockwise). 2. While holding the Z tab, press and hold the MEB buttons on the wireless hand-
pendant until the device reaches the required position. Rotating the PPS Around the Isocenter To rotate the PPS around the isocenter, proceed as follows:
1. Touch and hold the ROT tab on the PPS ROT slider and slide it in the desired direction (clockwise PPS rotation when looking at the couch from above if the slider is moved to the left, counterclockwise PPS rotation when looking at the couch from above if the slider is moved to the right). 2. While holding the ROT tab, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. Pitching the PPS To pitch the PPS, proceed as follows:
1. To access the PPS pitch and roll commands, touch the widget located above the central dial, on the left of the screen. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-29|
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PPS pitch/roll controls widget Figure 9-20. PPS Pitch/Roll Widget
(typical) 2. Touch and hold the PPS + Pitch button to pitch the PPS in the positive direction. Alternatively, touch and hold the PPS - Pitch button to pitch the PPS in the negative direction. pitch axis Figure 9-21. PPS - Pitch Icon (above) and PPS + Pitch Icon (below) Note: The arrows indicate the rotation around the pitch axis. IBA | 9-30 |
Clinical Users Guide Volume 1 - Treatment Session
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3. While holding the PPS + Pitch or PPS - Pitch button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. Rolling the PPS To roll the PPS, proceed as follows:
1. To access the PPS pitch and roll commands, touch the widget located above the central dial, on the left of the screen. 2. Touch and hold the PPS + Roll button to roll the PPS in the positive direction. Alternatively, touch and hold the PPS - Roll button to roll the PPS in the negative direction. roll axis Figure 9-22. PPS + Roll Icon (above) and PPS - Roll Icon (below) Note: The arrows indicate the rotation around the roll axis. 3. While holding the PPS + Roll or PPS - Roll button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the required position. Moving the Digital Imaging Devices Digital imaging devices options may be accessed either from the Auto or Manual mode screen. The options available in both modes are identical. 1. Touch the Digital Imaging Devices icon on the device selection bar at the bottom of the screen. Once the digital imaging devices subsystem is selected, the interface displays four Move buttons in the central dial:
The top button enables you to insert the devices needed for performing stereoscopic image acquisition. The left button enables you to insert the devices needed for performing orthogonal image acquisition. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-31|
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The right button enables you to insert the devices needed for performing portal image acquisition. The bottom button enables you to retract all digital imaging devices. Figure 9-23. Digital Imaging Devices Screen
(typical) 2. Touch and hold the button corresponding to the image acquisition mode that you want to perform. 3. While holding the button, press and hold the MEB buttons on the wireless hand-
pendant until the device reaches the target position. Preparing Equipment for a CBCT Acquisition When a Cone-Beam Computed Tomography (CBCT) preparation is requested using adaPTinsight, the CBCT Preparation button appears above the central dial of the DIGITAL IMAGING DEVICES SCREEN. IBA | 9-32 |
Clinical Users Guide Volume 1 - Treatment Session
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CBCT Preparation button Figure 9-24. CBCT Preparation Button
(typical) 1. To access the CBCT Preparation workflow, touch the CBCT Preparation button. The CBCT Preparation workflow consists of several screens which enable you to move the patient positioning and imaging devices to the position required for adaPTinsight to be able to perform a CBCT scan. Note: Only the devices available in the treatment room are shown on the screens of the CBCT Preparation workflow. Note: The CBCT Preparation workflow has a predetermined order and the screens progress automatically after each step is complete. However, you may choose to modify the order of the steps of the CBCT preparation workflow by selecting the device that you want to prepare next, using the Device Selection bar at the bottom of the screen. In this case, the screens in the workflow do not progress automatically. After touching the CBCT Preparation button, the SNOUT AND ACCESSORY DRAWER - CBCT PREPARATION SCREEN appears. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-33|
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Figure 9-25. Snout and Accessory Drawer - CBCT Preparation Screen
(typical) 2. Use the Move buttons on the SNOUT AND ACCESSORY DRAWER - CBCT PREPARATION SCREEN to retract the snout and put the accessory drawer in the beam path. To retract the snout, proceed as follows:
a. Touch and hold the Retract Snout button. Figure 9-26. Retract Snout Icon b. While holding the Retract Snout button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. IBA | 9-34 |
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A green check mark overlays the Move button once the device has reached the target position. To move the accessory drawer into the beam path, proceed as follows:
a. Touch and hold the Move Accessory Drawer Into the Beam Path button. Figure 9-27. Move Accessory Drawer Into the Beam Path Icon b. While holding the Move Accessory Drawer Into the Beam Path button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. A green check mark overlays the Move button once the device has reached the target position. Once both Move buttons are overlaid by a green check mark, the workflow progresses automatically onto the next screen. The PPS - CBCT PREPARATION SCREEN appears. The device icon in the Device Selection bar at the bottom of the screen is also overlaid by a green check mark once all required movements are complete. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-35|
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Figure 9-28. PPS - CBCT Preparation Screen
(typical) 3. Use the Move button on the PPS - CBCT PREPARATION SCREEN to put the PPS in a safe position for CBCT acquisition. a. Touch and hold the Move button. b. While holding the Move button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. A green check mark overlays the Move button once the device has reached the target position and the workflow progresses automatically onto the next screen. The DIGITAL IMAGING DEVICES - CBCT PREPARATION SCREEN appears. The device icon in the Device Selection bar at the bottom of the screen is also overlaid by a green check mark once all required movements are complete. IBA | 9-36 |
Clinical Users Guide Volume 1 - Treatment Session
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Figure 9-29. Digital Imaging Devices - CBCT Preparation Screen
(typical) 4. Use the Move button on the DIGITAL IMAGING DEVICES - CBCT PREPARATION SCREEN to put the digital imaging devices in place for CBCT acquisition
(orthogonal imager). a. Touch and hold the Move button. b. While holding the Move button, press and hold the MEB buttons on the wireless hand-pendant until the device reaches the target position. A green check mark overlays the Move button once the device has reached the target position and the workflow progresses automatically onto the next screen. The CBCT DRY RUN SCREEN appears. The device icon in the Device Selection bar at the bottom of the screen is also overlaid by a green check mark once all required movements are complete. Note: You may at this point continue the CBCT acquisition procedure using adaPTinsight, without completing the dry run. Clinical Users Guide Volume 1 - Treatment Session IBA | 9-37|
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Move Gantry to Prestart Position button Move Gantry to Postend Position button Figure 9-30. CBCT Dry Run Screen
(typical) 5. Use the Move buttons on the CBCT DRY RUN SCREEN to perform a CBCT dry run before proceeding to CBCT acquisition using adaPTinsight. Note: You may perform the following actions in the order you consider appropriate considering the current circumstances. The order explained here is a suggestion. a. Use the Move Gantry to Postend Position button to move the gantry to the position reached at the end of a CBCT acquisition. b. Use the Move Gantry to Prestart Position button to move the gantry to the position required to start a CBCT acquisition. The gantry is now in position to proceed to CBCT acquisition using adaPTinsight. Note: For further details on CBCT acquisition, refer to the adaPTinsight user documentation listed in the Delivery Note. IBA | 9-38 |
Clinical Users Guide Volume 1 - Treatment Session
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Using Advanced Options From the Menu Figure 9-31 shows the functions present in the Advanced section of the menu. These functions include:
Select all devices: this function enables you yo select all positioning devices so that they are all reset in a single push of the SRCU Restart button. This action is necessary after an emergency stop has occurred. Note: For further details on how to recover the system after an emergency stop refer to the Safety and Emergency Recommendations document. Reset checks: this function resets internal Positioning Management System communications. You may need to reset checks after a particular error occurs. This is recommended in the relevant error messages. These functions are used less often than those directly available via the manual and auto modes screens. Figure 9-31. Menu - Advanced Options
(typical) Clinical Users Guide Volume 1 - Treatment Session IBA | 9-39|
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Recovering Devices after an Error When an error occurs, the icon in the Device Selection bar which corresponds to the device in error becomes red. Long press the red icon to select recover mode and be able to move the device back to a normal working position using the available commands. Colorblind Users: Negative Colors In order to ease the user experience of the GUI for colorblind users, the interface can be displayed in negative colors. Figure 9-32 shows a sample screen of the GUI accessible for colorblind users. To use the GUI in negative colors, contact IBA personnel. Figure 9-32. Wireless Hand-Pendant GUI - Inverted Colors
(typical) IBA | 9-40 |
Clinical Users Guide Volume 1 - Treatment Session Chapter 10 Wireless Hand-Pendant Daily Checks and Troubleshooting This chapter describes the following tasks:
Checking the Good State of the Hand-Pendants Casing Checking the Motion Enable Buttons Checking Sound and Vibration Feedbacks The checks listed above need to be performed daily in order to ensure correct hand-
pendant operation. Besides, this chapter describes the following:
Monitoring Wireless Hand-Pendant Connections Solving Battery and Autonomy Issues Checking the Good State of the Hand-
Pendants Casing It is important that the hand-pendants casing remains in a good state for the device to operate safely. Please inspect the casing every day to check that:
There are no visible cracks. Both Motion Enable Buttons work properly (e.g., they do not jam). If the check is successful, you may proceed to use the wireless hand-pendant. If the check is not successful, the hand-pendant must be serviced. Clinical Users Guide Volume 1 - Treatment Session IBA | 10-1 |
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Checking the Motion Enable Buttons The Motion Enable Button is a safety component of the wireless hand-pendant that regularly performs self-tests automatically. If the wireless hand-pendant is not used for a period of time longer than 24 hours, in order to unlock it, you need to perform a Motion Enable Buttons check. In order to perform a Motion Enable Buttons check, proceed as follows:
1. Follow the instructions detailed in the wireless hand-pendant screen:
a. Push and hold both side buttons. b. Release one of the side buttons. c. Press and hold both side buttons. d. Release the side button that was not released in Step b. 2. You may be prompted to repeat this procedure until the check is completed. If the check is successful, you may proceed to use the wireless hand-pendant. If the check is not successful, the hand-pendant must be serviced. Checking Sound and Vibration Feedbacks The wireless hand-pendant provides sound and vibration feedback to the user. This feedback is important to perform movement commands in a safe way. It is therefore important to regularly check that these functions remain operational. For this purpose, the wireless hand-pendant requests you to check these functions, as follows:
1. 2. Every 24 hours, before you are able to unlock the graphical interface, the wireless hand-pendant displays a message stating that a sound and a vibration are about to be produced for the sound and vibration check procedure. The wireless hand-pendant then prompts you to confirm whether both have been observed. 3. You are then prompted to acknowledge that:
the sound check is correct by touching the OK button on the screen. the vibration check is correct by touching the OK button on the screen. If the check is successful, you may proceed to use the wireless hand-pendant. If the check is not successful, the hand-pendant must be serviced. IBA | 10-2 |
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Monitoring Wireless Hand-Pendant Connections The wireless hand-pendant is connected via Wi-Fi to the rest of the PTS. The status of this connection can be monitored via the Wi-Fi icon in the welcome screen:
1. 2. Long press the Wi-Fi icon. The Wi-Fi, Notification Server and PMS Controller statuses appear. Solving Battery and Autonomy Issues If the wireless hand-pendant faces autonomy issues, contact IBA to service the wireless hand-pendant. Important The battery of the wireless hand pendant must be replaced by IBA authorized personnel only. Clinical Users Guide Volume 1 - Treatment Session IBA | 10-3|
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IBA | 10-4 |
Clinical Users Guide Volume 1 - Treatment Session Intentionally left blank Chapter 11 Using the Remote Positioning Controls Note: Figures of the remote positioning controls panel across this manual show a typical configuration (Gantry Treatment Room with snout and accessory drawer as well as with stereoscopic, portal and orthogonal imagery system). Some details may differ from the remote positioning controls displayed in other room configurations. However, the principles explained apply to all remote positioning controls panel configurations. Most motion control functions can also be used from the Treatment Control Room
(TCR) using the remote positioning controls, which are displayed on adaPTdeliver screens. The remote positioning controls are used in combination with the remote positioning hardware console. To execute the motions selected using the remote positioning controls, you must use the Motion Enable Button (MEB) and Move buttons on the remote positioning hardware console. This chapter provides instructions on how to use the remote positioning controls, covering the following topics:
Safety Measures Specific to the Use of the Remote Positioning Controls Remote Positioning Hardware Console Controlling Speed Stopping Movements Operating Modes: Auto and Manual Using the Remote Positioning Controls in Auto Mode Using the Remote Positioning Controls in Manual Mode Using Advanced Settings Clinical Users Guide Volume 1 - Treatment Session IBA | 11-1 |
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Safety Measures Specific to the Use of the Remote Positioning Controls Make sure you read and understand the following warning messages before using the remote positioning controls. Use of the remote positioning controls from the Treatment Control Room (TCR) means that the Radiation Therapy Technologist (RTT) is not in the near vicinity of the patient and therefore may have less visibility on the exact position of the patient and potential collisions. Therefore, two cameras in the Treatment Room capture images that are displayed on two video screens in the Treatment Control Room. WARNING When motion is performed from the Treatment Control Room (TCR) during the treatment session, visually check to see on the video screens in the TCR that no collision with the patient is imminent before initiating motion. Also, continuously check the absence of collision during motion. Interrupt motion immediately in case of patient movement or insufficient visibility on the video screens during motion. WARNING Be careful to avoid collisions of the Patient Positioning System. Collisions may damage the PPS. It may also deteriorate the robot accuracy and performance. In case of a collision, the robot must be calibrated. CAUTION When performing actions from the Treatment Control Room, as a Radiation Therapy Technologist, make sure that the means for audio and video communication with the patient are available during treatment positioning and delivery. IBA | 11-2 |
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Performing a Motion Dry Run WARNING When it is planned to perform motion from the Treatment Control Room (TCR), perform a motion dry run from the Treatment Room to evaluate the risk of collision before performing motion from the TCR. In case the motion dry run reveals that the risks of collision remain high, motion must be performed from the Treatment Room. The motion dry run is to reproduce the motions to be performed in the treatment session as faithfully as possible. The purpose of performing a motion dry run is a follows:
Test all motions. Test these motions in the order as foreseen in the Treatment Room. Consider the fact that:
a different setup correction may be applied to the patient support in each treatment session the patient might move during motion The motion dry run can be performed either on the first day of treatment or during a simulation session. It is recommended to record all points of attention in the patient chart. Remote Positioning Hardware Console Each Treatment Control Room (TCR) is equipped with a remote positioning hardware console featuring the following buttons:
Motion Enable Button (MEB) Move button Emergency stop button To execute the motions selected using the remote positioning controls, you must use the MEB and Move buttons on the remote positioning hardware console. Clinical Users Guide Volume 1 - Treatment Session IBA | 11-3|
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Motion Enable Button
(MEB) Emergency stop button Move button Figure 11-1. Remote Positioning Hardware Console Important Throughout this manual, whenever you are instructed to press the Motion Enable Button (MEB) or the Move button on the hand-pendant, this means either on the wireless hand-pendant or on the remote positioning hardware console. Controlling Speed Each patient positioning device (PPD) may be operated at high, medium or low speed. Movement speed Figure 11-2. Movement Speed Icons Remote Positioning Controls Bar (typical) 1. To chose the high speed option, click the dot next to the hare icon. IBA | 11-4 |
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Alternatively, to choose the low speed option, click the dot next to the tortoise icon. Alternatively, to choose the medium speed option, click the dot between the high and low speed options. The dot corresponding to the currently selected speed is highlighted in blue. Table 11-1. Movement Speeds Icon Speed High speed (hare icon) Medium speed Low speed (tortoise icon) Note: The speed of the device remains set to the last speed used until a different speed is selected. Note: The proximity control software may automatically switch the speed of a device from high speed to medium speed in certain circumstances. Note: The high speed option is not selectable when a device is in a situation of proximity. Clinical Users Guide Volume 1 - Treatment Session IBA | 11-5|
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Stopping Movements The following methods are available to stop movements of the Proton Therapy System (PTS) equipment when using the remote positioning controls:
Release the MOVE button on the remote positioning hardware console. Release the Motion Enable Button on the remote positioning hardware console. Press an emergency stop button. WARNING If a patient is not safely secured to the PPS, the patient may fall off. Each patient shall be safely secured before moving the PPS. Release the MOVE Button If the MOVE button is released during Patient Positioning Device (PPD) movement, the PPD stops smoothly. Release the Motion Enable Button If the Motion Enable Button is released during Patient Positioning Device (PPD) movement, the PPD stops immediately. If you release this button before releasing the MOVE button, the motion stops abruptly. The movement can be resumed by pressing the Motion Enable Button, followed by the MOVE button. Press an Emergency Stop Button Note: Emergency stop buttons and TSS interlocks exist on a level local to your treatment room and system-wide. The description in this section pertains to the local level only. WARNING Emergency stop buttons shut off energy to most components in the Proton Therapy System (PTS). However, the electrical power to some components will not be interrupted, so be aware that electrical hazards and faults (faulty parts made live or induced fire) may still be present. IBA | 11-6 |
Clinical Users Guide Volume 1 - Treatment Session
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls |
If an emergency stop button local to your treatment room is pressed during Patient Positioning Device (PPD) movement, the motion stops immediately. After using an emergency stop button local to your treatment room to stop the PPDs, the emergency stop button and the Therapy Safety System (TSS) must be reset. After the emergency stop button and TSS are reset, the following may also be required:
Recovery enabling beam production Recovery of gantry movement (for GTR only) Recovery of PBS Dedicated snout and PPS movements Recovery enabling beam in TR Recovery enabling X-ray high-voltage Verification of proper operation Successful daily calibrations (e.g., variable collimators) Using Tool Tips The remote positioning controls panel consists of tool tips. Place the mouse pointer over any given icon to see a tool tip with some details regarding what that particular icon or button can enable you to do, the meaning of its current state, etc. Figure 11-3. Tool Tip
(example) Tool tips also exist for error messages. Place the mouse pointer over an error sign to see a tool tip with some details regarding the occurring error. Clinical Users Guide Volume 1 - Treatment Session IBA | 11-7|
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls |
Figure 11-4. Error Tool Tip
(example) Operating Modes: Auto and Manual The remote positioning controls can be used, by default, in a single operating mode in adaPTdeliver clinical sessions:
Auto mode: using Auto mode, you may perform Auto motions to prescribed or user-defined target positions. For detailed information on Auto motions, refer to Chapter 6. Note: Only those target positions for which conditions are currently met are available using Auto mode. Auto mode also gives you access to the motion of the imaging devices. The Manual operating mode may be available in the remote positioning controls of adaPTdeliver clinical sessions at your site upon explicit request to IBA:
Manual mode: using Manual mode, you may perform Manual motions to positions that are not predefined. For detailed information on Manual motions, refer to Chapter 6. Note: For the purpose of this manual, the Manual operating mode of the remote positioning controls is fully explained and illustrated. This operating mode may or may not be available at your site. Both Manual and Auto operating modes are available in adaPTdeliver physics mode sessions. Manual and Auto operating modes are available by default in the wireless hand-
pendant GUI. For more details on how to use the wireless hand-pendant, refer to Chapter 9. Using the Remote Positioning Controls in Auto Mode Auto mode enables you to perform Auto motions to patient-specific and non patient-
specific target positions. IBA | 11-8 |
Clinical Users Guide Volume 1 - Treatment Session
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls |
Target positions commands Imaging system commands User presets menu Figure 11-5. Remote Positioning Controls Panel - Auto Mode
(typical) Auto Mode Target Positions A target position may be one of the following:
User preset: a user preset is a target position defined by the user. The label of a user preset is the name of the preset as defined by the user. Setup position: setup positions are defined in the Treatment Plan and associated to setup beams. As such, a setup position is only available as a target position when a setup beam is selected and the preparation for the setup beam has started. Treatment position: treatment positions are associated to treatment beams. As such, a treatment position is only available as a target position when a treatment beam is selected and the preparation for the treatment beam has started. Clinical Users Guide Volume 1 - Treatment Session IBA | 11-9|
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls |
Corrected position: a corrected position becomes available once a given treatment or setup position has been corrected using the Patient Position Verification System (PPVS), adaPTinsight. As such, a corrected position is only available as a labeled target position when a treatment or setup beam is selected and after the alignment process is complete. Depending on the stage of the workflow, you may choose among the available target positions. Selecting a Target Position To make a selection among the available target positions, click the dot next to the required target position in the Target Positions part of the remote positioning controls panel. The dot becomes blue. Target positions commands Figure 11-6. Target Positions Commands
(typical) The User Preset target position, which appears on the left side of the Target Positions commands, is not selectable. To select a user preset as a target position, use the USER PRESETS MENU at the bottom of the remote positioning controls panel. IBA | 11-10 |
Clinical Users Guide Volume 1 - Treatment Session
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls |
Figure 11-7. User Presets Menu
(typical) Click the dot next to the user preset that you want to set as the target position. The dot next to the preset becomes blue. The User Preset position that appeared on the left side of the Target Positions commands now echoes the USER PRESETS MENU selection. Clinical Users Guide Volume 1 - Treatment Session IBA | 11-11|
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