Proton Therapy System Clinical User’s Guide Inova Schar Cancer Institute, Falls Church Document 82358 A - September 2019 Volume Treatment Session 1
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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.
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-
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.
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 User’s Guide and the Safety and Emergency Recommendations.
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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).
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 10% or 0.
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.
Adult Pediatric Eye CNS and Spine Head and Neck Esophagitis, Dysphagia34 Xerostomia43 Nausea50 Radiationinduced liver disease55 Fibrosis60 Retentive symptoms63 Mucositis15 Anorexia weight loss34 Dysphagia43 Vomiting50 Fibrotic stenosis of bile duct56 Skin atrophy60 Prostatitis63 Odynophagia15 Temporary hair loss, focal alopecia35 Dysgeusia43 Esophagitis50 Biloma56 Rib pain60 Proctitis63 Bowl dysfunction15 Deficit in concentration35 Hoarseness43 Dysphagia50 Elevation of bilirubin l
Adult Pediatric Eye CNS and Spine Head and Neck nausea anorexia weight loss18 Peripheral neurologic deficits36 Brain stem toxicity45 Radiation pneumonitis50 Nausea57 Fatigue62 Hip fracture65 Diarrhea19 Hemorrhage36 Temporal lobe injury45 Tracheoesophageal fistula51 Vomiting57 Skin pain62 Hematuria66 Bladder dysfuntion20 Vertebral growth retardation (Peds) 37 Neurological injury45 Hemoptysis51 Weight loss57 Chest wall pain62 Cystitis66 Fatigue, emesis21 Narrowed aorta37 Endocrine dy
Adult Pediatric Eye CNS and Spine Head and Neck Cognitive disturbance, Decline in neurocognitive functions22 Endocrine dysfunction Hypopituitarism3 Nasal congestion46 Subcutaneous Endocrinopathy23 Late radiation necrosis38 Epistaxis46 Endocrine abnormalities23 Leukoencephalo pathy, Anemia Thrombocytope nia, Leucopenia39 Middle ear inflammation46 Skeletal or muscle defect, scoliosis/ kyphosis24 Cerebrospinal fluid leakage40 Neutropenia, pancytopenia, thrombocytopenia, anemia (concurrent chemo)
Adult Pediatric Eye CNS and Spine Head and Neck Lung Gastrointestinal Sepsis (concurrent chemo)25 Scoliosis, ataxia42 Nasolacrimal duct stenosis48 Hypophosphate mia58 Ataxia, quadriplegia, bulbar palsies, hemiparesis, seizure26 Urinary and bowel sphincter dysfunction42 Dry-eye syndrome48 Hypoxia Infection58 Imaging changes in brainstem as radiation reaction or necrosis26 Ectropion48 Cough58 Anxiety/depression Pulmonary toxicity Esophagitis27 Conjunctivitis48 Chest pain Xerostomia27 Blepha
Adult Pediatric Eye CNS and Spine Head and Neck 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 User’s Guide Volume 1 - Treatment Session
Limitation and Exclusion of Scope The scope of this Clinical User’s 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 User’s Guide. IBA does not assume any responsibility for third party products nor third party product documentation.
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 GHz2.4835 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.
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.
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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.
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, NeuroOncology, Vol. 15, pp. 1552-1559. 17. Proton radiotherapy for pediatric tumors: review of first clinical results. Rombi, B, et al. Trento : s.n.
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.
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. 254265. 46. High-dose proton beam therapy for sinonasal mucosal malignant melanoma.
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.
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Amendment records Version A Date of Issue September 2019 Written by Shaunak Khandekar Technical Writer Clinical User’s Guide Volume 1 - Treatment Session Details of Amendments Major Changes in... This is the first version of the System Description for the Inova Schar Cancer Institute, Falls Church.
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Contents Copyright Notice .............................................................. iii Abstract ............................................................................ iii Technical Support ............................................................. iii Notice ............................................................................... iii Intended Use ....................................................................iv Indications for Use ..................................................
Cautions ........................................................................... lxxii Important Notes ............................................................... lxxii Typographic Conventions .................................................lxxiii Illustrations .......................................................................lxxiii Troubleshooting Information ............................................lxxiii Visual Cues .......................................................................
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 ..........................
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) ........................................
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 .......................................
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 ....
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 .......................
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 .........
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 ..............................................
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 .....................................................
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 ...............................................
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 ............................................
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 .......................................
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 ......
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 .............................
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 ..................................................
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 ......................
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 .................
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 ...................
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 ...................................
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 ..........................................
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 .........
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 .......................................
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 ........
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 .....................................................
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 11-26. 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 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 26-15. 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 31-11. 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 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..........
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 ....................................................................
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 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. IBA | lxii | adaPTdeliver: Dosimetry Manager Button.......................................... A-2 Dosimetry Manager Main Display ...................................................... A-3 Dosimetry Manager: Entering credentials for confirmation................
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...................................................................
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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.
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.
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 User’s Guide Volume 1 - Treatment Session IBA | lxvii |
What to Expect? This chapter ... Describes ... Chapter 1 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. Chapter 2 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.
This chapter ... Describes ... Part III - The Pencil Beam Scanning (PBS) Suite Chapter 19 A list of all parts and chapters of the current manual that together comprise the Pencil Beam Scanning (PBS) documentation. Chapter 20 An overview of principles that have been applied in developing the current Pencil Beam Scanning implementation. Chapter 21 An introduction to the Pencil Beam Scanning (PBS) Beam Delivery System (BDS) equipment.
This chapter ... Describes ... Chapter 39 An explanation on resuming after a partial irradiation. Part VII - Using adaPTdeliver in Worklist Mode Chapter 40 An introduction on what it means to use adaPTdeliver in OIS (DEVC mode). Chapter 41 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.
This appendix ... Describes ... Appendix G A list of acronyms and abbreviations. Appendix H Glossary of Terms Index A list of keywords used throughout this manual, in alphabetical order. Safety Decisions 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.
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.
Typographic Conventions Typeset Refers to Button The name of a command button to be clicked with the mouse SCREEN The name of a user interface screen < entry > Information to be entered from the keyboard appears inside angle brackets Label The label of a field appearing on a screen Message 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 o
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 handpendant (HP) in the Treatment Room (TR). Identifies paragraphs or steps performed by the Accelerator Operator.
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 patient’s treatment site with the dose distribution defined in the patient’s treatment plan.
Introduction | Treatment Modes Available at the PT Center The following treatment modes are available in the TRs: 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.
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.
Introduction | D I Treatment Planning System (TPS) D I C O M Oncology Information System (OIS) PTS adaPTdeliver C O M 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.
Introduction | Proton Therapy System (PTS) Software 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.
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.
Introduction | Treatment Workflow Options 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).
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.
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.
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 .
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.
Introduction | Option B: Full Standalone Mode 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®).
Introduction | 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. Received versus Delivered Parameters When beam starts, the system begins logging parameters. Logged parameters fall into two categories, received and delivered.
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”.
Introduction | Using QA Features of adaPTprescribe 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”.
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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.
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.
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.
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.
Starting Up Applications in the adaPT Treatment Suite | header, background color: black Figure 2-2.
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.
Part I Explaining Essential Safety Aspects Clinical User’s 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.
|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 t
|Part I - Explaining Essential Safety Aspects Emergency Procedures in Case of Irradiation Hazard | when paused Immediately perform the following procedure: 1. Press the emergency stop button in the TCR. 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.
|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: Important 1. Turn the MCR master key switch off. 2.
|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: Important 1.
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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 t
|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.
|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.
|Part I - Explaining Essential Safety Aspects WARNING Miscellaneous Safety Hazards | 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.
|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.
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|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.
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|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).
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Part II Using Treatment Room Equipment Clinical User’s 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.
|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.
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.
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|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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).
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | Z positive rotation positive pitch Y FRS X positive roll Figure 6-1.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | TCP=ETV Center Height: 400 mm 250 mm 100 mm PPS Couplers side Width: 500 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | Table 6-1. Target Positions for a GTR (Cont’d) Position name Coordinate system in which it is expressed PPD Settings for target position CORRECTED IEC PPS Obtained from the setup or treatment correction data manually entered by a user or received from a patient position verification system such as adaPTinsight.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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.
|Part II - Using Treatment Room Equipment Elementary Notions on Patient Positioning | 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 gantry’s 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.
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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.
|Part II - Using Treatment Room Equipment WARNING Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | Couch Coupling interface Front arm Joint 3 Joint 6 Joint 5 Joint 4 Joint 2 Turret 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.
|Part II - Using Treatment Room Equipment WARNING Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | the defined absolute accuracy The dimensions of the extended treatment volume are: 50 cm parallel to the table top’s short axis 100 cm parallel to the table top’s 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | Patient specific Table 7-1. Labeled Positions for a GTR Position name Coordinate system in which it is expressed PPD Settings for target position SETUP Isocentric Gantry Obtained from the patient’s plan. PPS PBS ded. snout TREATMENT Isocentric Gantry PPS PBS ded. snout MEMORY FRS, Gantry Isocentric PPS PBS ded.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | Non-patient specific Table 7-1. Labeled Positions for a GTR (Cont’d) Position name Coordinate system in which it is expressed PPD Settings for target position CBCT menu Safe Isocentric PPS 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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).
|Part II - Using Treatment Room Equipment CAUTION Moving the Patient Positioning Devices | 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.
|Part II - Using Treatment Room Equipment Moving the Patient Positioning Devices | 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.
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.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Emergency stop button Motion Enable Button (MEB) 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.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Motion Enable Button (MEB) status (pressed/released) Menu icon: this icon provides access to a set of actions that are performed less often than those available via the main screens. Light field ON/OFF Room ID Dim room lights ON/OFF Lasers ON/OFF App bar Manual/Auto mode selection bar The central dial displays various Move buttons, depending on the currently selected device.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | 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).
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | 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).
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Table 8-1.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Table 8-2. Wireless Hand-Pendant GUI and Remote Positioning Controls PanelColor Legend Feature Color Meaning Explanation General Light gray Function disabled/not selectable When due to the current circumstances a particular option or set of options is disabled (e.g.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Table 8-2. Wireless Hand-Pendant GUI and Remote Positioning Controls PanelColor Legend (Cont’d) Feature Color Meaning Explanation Movement speed selection Blue 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.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | Table 8-3. Wireless Hand-Pendant - GUI Color Legend Feature Color Meaning Explanation Central dial Gray No proximity or collision situation detected When neither a proximity nor a collision situation is detected, the circle surrounding the central dial is gray.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | The color legend detailed in Table 8-4 applies to the remote positioning controls. Table 8-4.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | 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. The Move and Motion Enable Buttons are pressed and PPD movement starts. Target position reached by a PPD.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | 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.
|Part II - Using Treatment Room Equipment Controlling Movement: Wireless Hand-Pendant and Remote Positioning Controls | 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.
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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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Figure 9-2.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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).
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Figure 9-3. Wireless Hand-Pendant Connected - Not Registered 2. IBA | 9-6 | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Figure 9-4. Registration Procedure Screen (typical) 3. 4. Clinical User’s Guide Volume 1 - Treatment Session 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Using the GUI in Auto Mode Auto mode enables you to perform Auto motions to patient-specific and non patientspecific 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Menu icon Figure 9-7. Menu Icon (typical) To select a target position from the menu, proceed as follows: 1. Touch the Menu icon on the top left of the screen. 2. 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | Figure 9-12. New Position Screen (typical) 3. 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. 4. To select the devices that you require to be included in a new user-defined position (i.e.
|Part II - Using Treatment Room Equipment b. Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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. To display the menu, touch the Menu icon at the top left of the screen. 2.
|Part II - Using Treatment Room Equipment 3. Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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).
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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. Touch the field on the top right of the screen and enter a target gantry angle. 2. Touch and hold the central Move button. 3.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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).
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment 3. Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
|Part II - Using Treatment Room Equipment Using the Wireless Hand-Pendant | 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.
Chapter 10 Wireless Hand-Pendant Daily Checks and Troubleshooting •••••• This chapter describes the following tasks: Checking the Good State of the Hand-Pendant’s 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 handpendant operation.
|Part II - Using Treatment Room Equipment Wireless Hand-Pendant Daily Checks and Troubleshooting | 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. 2.
|Part II - Using Treatment Room Equipment Wireless Hand-Pendant Daily Checks and Troubleshooting | 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. Long press the Wi-Fi icon. 2. The Wi-Fi, Notification Server and PMS Controller statuses appear.
|Part II - Using Treatment Room Equipment Wireless Hand-Pendant Daily Checks and Troubleshooting | Intentionally left blank IBA | 10-4 | Clinical User’s Guide Volume 1 - Treatment Session
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.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | 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.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | 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.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Emergency stop button Motion Enable Button (MEB) 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.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | 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.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Stopping Movements The following methods are available to stop movements of the Proton Therapy System (PTS) equipment when using the remote positioning controls: WARNING 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.
|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.
|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.
|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.
|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.
|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.
