|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Preset selected Figure 11-8. Preset Selected as Target Position (typical) Target Position Device Feedback Next to the ‘Target Positions’ title in the remote positioning controls panel, three icons represent the three patient positioning devices that may need to be moved in order to reach the target position.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Reached: a green ‘check’ appears on top of the device icon. Not reached: no green ‘check’ on top of the device icon. ‘Target position reached’ feedback Figure 11-9. Target Position Device Feedback (typical) Moving Devices to a Target Position Once a target position is selected, you are able to move the devices that need to be moved in order to reach it.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | In order to move the different patient positioning devices to the target position, proceed as follows: Note: It is your responsibility as a Radiation Therapy Technologist (RTT) to decide in which order you move the different devices that need to be moved in order to reach a target position. This procedure describes a ‘typical’ procedure in which it may be necessary to move the snout, gantry and PPS.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Accessory drawer options Figure 11-11. Accessory Drawer Options (typical) The ‘In’ and ‘Out’ options refer to accessory drawer positions. The position of the accessory drawer (In/Out of the beam path) may be part of the prescribed position. Make sure you select the ‘In’ option to put the accessory drawer in the beam path or the ‘Out’ option to put the accessory drawer out of the beam path, as prescribed.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | The orange background indicates that the accessory drawer is not at the prescribed position. The gray background indicates that the accessory drawer is at the prescribed position. Figure 11-12. Status Panel - Accessory Drawer Position Feedback In order to move the accessories holder, proceed as follows: 1. To move the accessory drawer in the beam path, select the ‘In’ option. 2.
|Part II - Using Treatment Room Equipment 2. Using the Remote Positioning Controls | Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the target position. Moving the Gantry Figure 11-13. Gantry Options (typical) In order to move the gantry, proceed as follows: 1. 2. Click on the gantry icon and the ‘⊚’ option is automatically selected.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Using Auto Mode to Move the Imaging Devices In order to move the imaging devices, proceed as follows: 1. Click on the desired option, as follows: Table 11-2. Imaging Devices Movement Options Icon Meaning Put both imagers in position for image acquisition. Put the portal imager in position for image acquisition. Put the orthogonal imager in position for image acquisition. Retract all imagers. 2.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Close CBCT preparation panel Figure 11-15. CBCT Preparation Panel (equipment not ready) (typical) This panel enables 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 in the CBCT PREPARATION PANEL (EQUIPMENT NOT READY).
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | CBCT preparation icon Figure 11-16. Remote Positioning Controls Panel - CBCT Preparation Icon (typical) Once in the CBCT PREPARATION PANEL (EQUIPMENT NOT READY), proceed as follows in order to move the devices to the required position: 1. IBA | 11-20 | Click on the icon corresponding to the device and the movement that you want to request.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Table 11-3. CBCT Preparation - Devices Movement Options Icon Meaning Retract the snout. Move accessory drawer into the beam path. PPS move to Safe position. Put the orthogonal imager in position for image acquisition (only available in Gantry Treatment Rooms). 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the target position. 3.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-17. CBCT Preparation Panel - Equipment Ready (typical) 4. You may now continue the CBCT acquisition procedure using adaPTinsight. Note: For further details on CBCT acquisition, refer to the adaPTinsight user documentation listed in the Delivery Note. Using Auto Mode to Move to a User Preset In order to move the patient positioning devices to a user preset, proceed as follows: 1.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-18. Remote Positioning Controls Panel - User Presets (typical) 2. Proceed as described in section Moving Devices to a Target Position. Using Auto Mode to Create and Edit User Presets Creating a User Preset In order to create a new user preset, proceed as follows: 1. In order to access the USER PRESET EDITION MENU, click the New User Preset icon in the ‘User Presets’ part of the Remote Positioning Controls panel.
|Part II - Using Treatment Room Equipment 2. Using the Remote Positioning Controls | Fill in the fields in the USER PRESET EDITION MENU as necessary. Note: The fields in the USER PRESET EDITION MENU are automatically filled with the current position of the equipment. You may modify this information, as necessary. 3. In order to select the devices that need to be included in the new user preset, tick the boxes next to the gantry, snout and table icons as necessary.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Alternatively, to cancel the modifications done to the values of the new user preset click the Revert button at the bottom left of the USER PRESET EDITION MENU. Note: When the value input in a field is not valid (e.g., gantry angle 500°), a red cross is displayed next to the field in question. Hover over the red cross and a tooltip explaining the reason of the error appears.
|Part II - Using Treatment Room Equipment 3. Using the Remote Positioning Controls | Modify the fields in the USER PRESET EDITION MENU as necessary. Note: The ‘name’ field of the USER PRESET EDITION MENU is not editable when you are modifying an existing user preset. 4. In order to save the changes, click the Save button at the bottom right of the USER PRESET EDITION MENU.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-24. Manage Presets Menu (typical) In order to arrange the list of user presets, proceed as follows: 1. Drag and drop each user preset to the chosen position in the list. Note: The first 5 user presets in the list (a.k.a. favorite user presets, which appear in the MANAGE PRESETS MENU next to slots 1 to 5) appear in the list in the Remote Positioning Controls panel.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Edit preset Figure 11-25. Edit Preset Icon 2. You are now able to modify the user preset using the USER PRESET EDITION MENU. Proceed as described in section Editing a User Preset. In order to clone an existing user preset, proceed as follows: 1. IBA | 11-28 | Click the Clone Preset icon next to the user preset that you want to clone.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Clone preset Figure 11-26. Clone Preset Icon In order to delete an existing user preset, proceed as follows: 1. Clinical User’s Guide Volume 1 - Treatment Session Click the Delete Preset icon next to the user preset that you want to delete.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Delete preset Figure 11-27. Delete Preset Icon Using the Remote Positioning Controls in Manual Mode Note: For the purpose of this manual, the Manual mode of the remote positioning controls is fully explained and illustrated. This operating mode may or may not be available at your site. Manual mode enables you to perform equipment movements that do not require any particular patient information or user presets.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Snout and Accessory Drawer commands Gantry commands Patient Positioning System Figure 11-28. Remote Positioning Controls - Manual Mode (typical) Using Manual Mode to Move the Accessory Drawer and the Snout The commands to move the accessory drawer and the snout are grouped at the top of the Remote Positioning Controls panel.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-29. Accessory Drawer and Snout Commands (typical) Moving the Accessory Drawer Note: The system only enables you to move the accessory drawer when the snout is at a completely retracted position (the furthest possible from the isocenter). To move the accessory drawer into the beam path, proceed as follows: 1. Click on the Move Accessory Drawer Into the Beam Path icon. Figure 11-30.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Moving the Snout To insert the snout, proceed as follows: 1. Click on the Insert Snout icon. Figure 11-32. Insert Snout Icon 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the required position. To retract the snout, proceed as follows: 1. Click on the Retract Snout icon. Figure 11-33. Retract Snout Icon 2.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-34. Insert or Retract Snout Icon 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the required position. Using Manual Mode to Move the Gantry The commands to move the gantry appear in the middle of the Remote Positioning Controls panel. Figure 11-35. Gantry Commands (typical) These commands enable you to move the gantry in several ways.
|Part II - Using Treatment Room Equipment 1. Using the Remote Positioning Controls | Click on the line corresponding to the angle to which you want to move the gantry. Alternatively, click any point of the circle of the gantry dial. The angle corresponding to the line that you clicked or to the line that is closest to the point of the circle that you clicked appears in the angle field in the center of the gantry dial. The dot below the angle field becomes blue. Figure 11-36.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-37. PPS Commands (typical) Moving the PPS Along the X Axis Proceed as follows: 1. To move the PPS in the + direction along the X axis, click on the +X on the right of the X and Y PPS Axes icon. Alternatively, to move the PPS in the - direction along the X axis, click on the -X on the left of the X and Y PPS Axes icon. Figure 11-38. X and Y PPS Axes Icon 2.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-39. X and Y PPS Axes Icon 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the target position. Moving the PPS Along the Z Axis Proceed as follows: 1. To move the PPS in the + direction along the Z axis, click on the +Z on top of the Z PPS Axis icon.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | horizontal rotation axis Figure 11-41. PPS + Rot Arrow (above) and PPS - Rot Arrow (below) 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the target position. Pitching the PPS Proceed as follows: 1. Click the PPS + Pitch icon to pitch the PPS in the positive direction. Alternatively, click the PPS - Pitch icon to pitch the PPS in the negative direction.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | roll axis Figure 11-43. PPS + Roll Icon (above) and PPS - Roll Icon (below) 2. Press and hold the MEB and Move buttons on the remote positioning hardware console until the device reaches the required position. Using Advanced Settings 1. To access the ADVANCED SETTINGS MENU while working in Auto or Manual mode, click on the Options Menu icon in the remote positioning controls bar. Figure 11-44.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-45 shows the options present in the ADVANCED SETTINGS MENU: Figure 11-45. Advanced Settings Menu (typical) Reset motion controller: this function resets internal Positioning Management System communications. You may need to reset the motion controller after a particular error occurs. This is recommended in the relevant error messages.
|Part II - Using Treatment Room Equipment Using the Remote Positioning Controls | Figure 11-46. Reset SRCU Warning b. Clinical User’s Guide Volume 1 - Treatment Session Click the OK button and reset the SRCU within the following 60 seconds.
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Chapter 12 Alignment Tools and Devices •••••• Proper alignment requires the following: Precise alignment devices to record the actual alignment using adaPTinsight: in case adaPTinsight is used for computing the initial corrections, the initial position of the tumor is indicated on the CT scan in the TPS. Next the treatment plan and the CT scan are transferred to adaPTinsight.
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|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Alignment Correction Calculation Tool: adaPTinsight The adaPTinsight software enables you to calculate the alignment corrections that must be applied to the PPS to ensure a correct alignment of the patient in respect to the isocenter. The adaPTinsight application calculates corrections for the GTR.
|Part II - Using Treatment Room Equipment Important Alignment Tools and Devices | If the administration of your center has established any such procedure, make sure that a regular backup is taken of the adaPTinsight log files containing the information on the dose delivered to each patient by means of X-rays or fluoroscopy.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | systems a look-up-table is computed containing the deviations of the proton position relative to the X-ray isocenter for different gantry angles and snout extensions. Such deviations – whose typical values are of the order of 1mm and never exceed 5mm – are obtained by positioning an ionization chamber detector or a radiographic film at X-ray isocenter and measuring the relative distance to the center of the proton field.
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|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Patient Alignment Devices The Patient Alignment Devices are used to verify the correct position of the patient prior to an irradiation. These devices are: Lasers X-ray tubes and associated Digital Imaging Devices (DID): each X-ray tube works in combination with a DID flat panel to record an X-ray image. Note: Use the lasers for initial positioning of the patient, use the X-ray tubes next.
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|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Working With Laser Devices Laser devices may be used to align the patient on the couch. CAUTION The nozzle lasers have been calibrated at 270° only. Lasers therefore should be used for rough alignment only. Important As radiation therapy technologist (RTT), pre-position the patient using the lasers.
|Part II - Using Treatment Room Equipment IBA | 12-10 | Alignment Tools and Devices | Laser 8 (mounted on the ceiling, above the PPS) emits a vertical laser beam. Laser 9 (on the nozzle edge) emits a horizontal laser beam.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | . Laser 1 Laser 9 Laser 2 Laser 9 Laser 3 Laser 7 Laser 6 Laser 4 Laser 8 Laser 5 Figure 12-3.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Turning Lasers On and Off To turn the lasers on using the wireless hand-pendant or the remote positioning controls, proceed as follows: 1. Touch or click the Lasers ON/OFF icon located in the App bar (wireless handpendant) or in the Remote Positioning Controls bar. The Lasers ON/OFF icon becomes green and the lasers are turned on.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Working with X-ray Images in a GTR, for Use With adaPTinsight Images can be taken either 2D (one image) or 2D stereoscopic (two images that will be combined). The adaPTinsight application supports the acquisition of the following kinds of X-ray images depending on the TR hardware configuration: Orthogonal X-ray images are taken in the direction orthogonal to the proton treatment beam.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Setting up for Orthogonal X-ray Images in a GTR This procedure is for the retractable X-ray tube inside the nozzle and both associated flat panel holder systems. To set up the equipment for the acquisition of orthogonal X-ray images, proceed as follows using the wireless hand-pendant or the remote positioning controls: Note: For further information on how to use the wireless hand-pendant, refer to Chapter 9.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | The background becomes highlighted if the setting is not compatible with the irradiation. Note: The desired DID flat panel must be in place before attempting to acquire an X-ray image. 4. The system is now ready for X-ray images to be taken. CAUTION No Digital Imaging Device (DID) flat panel must be plugged or unplugged from the associated power supply while the power supply is powered on.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Setting up for Portal View X-ray Images in a GTR This procedure is for the retractable X-ray tube inside the nozzle and the associated flat panel holder system. To set up the equipment for the acquisition of portal view X-ray images, proceed as follows using the wireless hand-pendant or the remote positioning controls: Note: For further information on how to use the wireless hand-pendant, refer to Chapter 9.
|Part II - Using Treatment Room Equipment WARNING Alignment Tools and Devices | Over time, the quality of digital radiographs may become degraded, suffer from an offset or a deterioration of the gain of the flat panels or from defective pixels. Periodic tests must be performed to ensure sufficient X-ray image quality. The frequency shall take into account the foreseeable flat panel deterioration by neutrons.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | The IN (or OUT) status of the DID panels and X-ray tube A appears on the flat panel monitors when the selected device(s) reach(es) the desired position; depending on the device, these positions are: X-ray tube: in the beam path DID A: its inserted (extended) position The background becomes highlighted if the setting is not compatible with the irradiation.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Setting up for Acquiring Stereo X-ray Images Using Rad-A CAUTION No Digital Imaging Device (DID) flat panel must be plugged or unplugged from the associated power supply while the power supply is powered on. If there is a need to connect or disconnect a DID panel, the associated power supply must be switched off first. Else the DID panel may suffer severe damage. 1. Acquire an X-ray image. 2.
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|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Setting up for Acquiring CBCT Images CBCT images are acquired using X-Ray Tube Rad-B. The CBCT acquisition controls provided by the X-ray image guidance system on the CBCT console (i.e., the CBCT buttons on the left hand side of the X-ray console) control the gantry rotation and enable you to acquire CBCT images, as follows: 1. Select one of the preset options (e.g., Head, Thorax, Pelvis, etc.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | Command buttons LEDs Figure 12-4. CBCT Commands on the X-ray Console Check the absence of collision before initiating the CBCT acquisition by performing a dry-run. To perform the dry-run: IBA | 12-22 | 1. Select the CBCT acquisition parameter from the drop-down menu in adaPTinsight (i.e., Clockwise or Counter ClockWise and define start angle). This automatically defines the Prestart and Postend position on the hand-pendant. 2.
|Part II - Using Treatment Room Equipment Alignment Tools and Devices | WARNING As a Radiation Therapy Technologist (RTT), it is your responsibility to verify the absence of collision with the patient or any equipment before initiating a CBCT image acquisition by performing a dry-run. If the patient position or the position of immobilization devices changes between two different fractions, a new verification shall be performed.
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Chapter 13 Attaching/Removing a Patient Support Device to/from the PPS •••••• Preliminary: Gantry Rolling Floor Precautions When you are performing functions in the vicinity of the PPS, bear in mind the Gantry Rolling Floor (GTR) precautions as specified in section “Gantry Rolling Floor Precautions” on page 4-3. Couch Identification When using multiple accessories, it is possible to use the Tool ID system. The system identifies each accessory with a different number.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Pogo pin Tool ID frame Thumbwheel (decade) Thumbwheel (unit) Figure 13-1. Tool ID system for couch identification The Docking Principle Prior to treatment, the patient is placed on a docking device (also called patient support device) such as a bed that is capable of being attached (also called docked) to the PPS.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Shoulder Turret Joint 6 3 int o J Join t 4 Wrist in Jo t5 Joint 1 Joint 2 Front arm Figure 13-2. PPS - Major Moving Parts The Patient Positioning System has one air locking coupler installed on the coupling system (Figure 13-3), facing up. Figure 13-3.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Each docking device also has one air locking coupler installed, facing down. Joining the docking device coupler with the corresponding PPS coupler firmly latches the docking device to the PPS. Lock/Unlock Button Figure 13-4.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Air Locking Coupler Figure 13-5. Air Locking Coupler on the Wrist Docking Modes The docking device can be docked onto the PPS in the following mode: Manually: you manually position the docking device over the wrist of the PPS and you manually line up the docking device coupler with the PPS coupler. For detailed information, refer to section “Manual Docking and Undocking” on page 13-7.
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|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Manual Docking and Undocking WARNING No patient must be present on the docking device while performing a manual docking or undocking procedure. Manually Docking a PPS Support Device To manually attach a docking device to the PPS: 1. CAUTION Manually move the docking device over the coupling system of the PPS.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Figure 13-6. Positioner Menu Ready to Dock 4. Long touch Mode. Ready to Dock appears. 5. Press the lock/unlock button on the coupling system. The docking device is now pneumatically locked onto the coupling system. Note: There is a lock/unlock button on either side of the coupling system. You can use any of these two buttons.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | 7. Long touch the PPS icon on the WIRELESS HAND-PENDANT GUI SCREEN (see Figure 8-2). The POSITIONER MENU appears (see Figure 13-6). 8. Press and hold the Motion Enable Button on the hand-pendant. 9. Long touch Mode. Ready to Move appears (Figure 13-7). Figure 13-7. Positioner Menu Ready to Move Manually Undocking a PPS Support Device To manually release a docking device from the PPS: 1.
|Part II - Using Treatment Room Equipment CAUTION Attaching/Removing a Patient Support Device to/from the PPS | Make sure to sufficiently support the docking device before pressing the lock/unlock button on the wrist to unlock the couplers. Failure to do so may result in bodily harm or equipment damage. 4. Keep the lock/unlock button on the coupling system pressed until it starts blinking. 5. Release the button, then press it again. The docking device is now pneumatically unlocked from the wrist. 6.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Automatic Docking and Undocking Overview: Automatic Docking A docking device such as a couch can be automatically docked onto the PPS. The typical automatic docking process is as follows: CAUTION 1. The trolley (also called ‘gurney’), with the docking device mounted on it, is positioned in a dedicated docking position in the treatment room. 2.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Positions and Areas Automatic docking functions can be performed in well defined areas and in specific positions. The docking area is a space that covers those locations where the PPS coupler is capable of attaching to the docking device coupler. The collision avoidance and collision detection systems of the PPS can detect a collision throughout the docking area, with the exception of the coupling area.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | docking reference point, sample docking position coupling area docking area Figure 13-9.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Cancel: to cancel the selected docking operation. Note: Be aware that neither Manual nor Auto motions are possible before termination of an automatic docking or undocking operation when the PPS is in the docking area. If you cannot allow an ongoing docking or undocking operation to terminate orderly, you must select the Cancel option if you want to perform a Manual or Auto motion with the PPS.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Automatically Docking a Docking Device CAUTION A total load on the docking device exceeding 180 kg (397 lbs) will generate a prompt on the hand pendant requesting the Radiation Therapy Technologist (RTT) for an acknowledgment to proceed. Any load on the docking device exceeding 250 kg (551 lbs) will prevent the PPS from moving. To automatically attach a docking device to the PPS: CAUTION 1.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Figure 13-11. Advanced Menu 5. Press and hold the Motion Enable Button on the hand pendant. 6. Click the Fetch icon from the AUTOMATIC DOCKING SCREEN (see Figure 13-12). 7. Touch and hold the relevant Move button till completion of the Fetch sequence. 8. Click OK to acknowledge the message that appears. 9.
|Part II - Using Treatment Room Equipment CAUTION Attaching/Removing a Patient Support Device to/from the PPS | Movement of the Patient Positioning System (PPS) is only possible if the coupler is properly engaged and if the docking device is locked, i.e., the lock/unlock button on the coupling system has been pressed. 10. Visually verify that the lock/unlock button on the wrist is lit. 11. Press and hold the Motion Enable Button on the hand pendant. 12.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Lock/Unlock Button Figure 13-13.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Automatically Undocking a Docking Device To automatically release a docking device from the PPS: 1. Press and hold the Motion Enable Button on the hand pendant. 2. Select the Automatic Docking option from the ADVANCED MENU (see Figure 1311). The AUTOMATIC DOCKING SCREEN appears (see Figure 13-12). 3. Click the Put Back icon from the AUTOMATIC DOCKING SCREEN (see Figure 13-14).
|Part II - Using Treatment Room Equipment 6. Attaching/Removing a Patient Support Device to/from the PPS | Disengage the docking device coupler fails to disengage from the PPS coupler: a. Long press (approximately 3 seconds) the lock/unlock button on the wrist. The button starts blinking. b. Release the lock/unlock button on the wrist. c. Within two seconds, press the lock/unlock button on the wrist until the button goes dark (approximately 1 second). d.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Interrupting, Resuming, or Cancelling an Automatic Docking or Undocking Operation Interrupting an Automatic Docking or Undocking Operation To interrupt an ongoing automatic docking or undocking operation, release the relevant Move button on the hand pendant. Resuming an Automatic Docking or Undocking Operation To resume an interrupted operation: 1. Click OK to acknowledge the message that appears. 2.
|Part II - Using Treatment Room Equipment Attaching/Removing a Patient Support Device to/from the PPS | Back Figure 13-15. Back Button 4. IBA | 13-22 | Click OK to acknowledge that you want to cancel docking.
Chapter 14 Installing and Removing Accessories into/from the Accessory Drawer or PBS Dedicated Snout •••••• In the irradiation preparation phase using adaPTdeliver, it may be required to install one or two accessories onto the accessory holder or the PBS dedicated snout, as outlined in the prescription.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Accessories can be inserted into the accessory drawer or into a snout that may be mounted onto the accessory drawer. Table 14-1 details which accessories or combination of accessories can be used. Table 14-1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Preliminary Precautions Preliminary: Gantry Rolling Floor Precautions When you are performing functions in the vicinity of the PPS, bear in mind the Gantry Rolling Floor (GTR) precautions as specified in section “Gantry Rolling Floor Precautions” on page 4-3.
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|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Accessory Holder Operations The accessory holder need not be in any particular position to enable an accessory or the snout to be inserted or removed. On the other hand, for safety reasons, moving the accessory drawer using the hand pendant is only possible when the snout holder is retracted.
|Part II - Using Treatment Room Equipment 3. Installing and Removing Accessories into/from the Accessory Drawer or PBS Depress the tray toggle switch to the Locked position. Removing an Accessory or Snout from the Accessory Drawer The procedure to remove an accessory or snout from the drawer is as follows: IBA | 14-6 | 1. Pull the tray lock toggle switch up to the Unlocked position (see Figure 14-1). 2. Remove the tray mounted accessory or snout from the drawer. 3.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Snout Types The following snout(s) is (are) available at your center: The following section(s) explain(s) how to install and remove accessories on the snout(s) that is (are) available at your center: Clinical User’s Guide Volume 1 - Treatment Session IBA | 14-7|
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|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Type DN_S (Dedicated Nozzle - Small) Snout Operations The type DN_S snout is a round snout with two slots: one block holder (slot 1) one range compensator, range shifter or ridge filter holder (slot 2) One hinged retainer, including a spring-loaded retaining pin, secures the accessories once installed onto the snout.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS The LEDs turn ON (green light) when the respective presence switches or pressure pins send a signal indicating that (each item corresponding to a LED in the same order as the list above): The snout has been inserted The block has been installed into slot 1 The second accessory has been installed into slot 2 The hinged retainer is closed Two presence switches installed at the
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Installing Accessories onto a DN_S Type Snout Note: The maximum combined weight of all accessories installed in the DN_S type snout must not exceed 10 kg. The procedure to install a block and accessory onto a DN_S type snout is as follows: CAUTION 1. Pull the spring-loaded retaining pin to release the hinged retainer. 2. Open the hinged retainer. 3.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Safety locks keys (2) (on snout) & keyways (on accessory) presence switches (2) Hinged retainer Spring loaded retaining pin Figure 14-4.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Removing Accessories from a DN_S Type Snout The procedure to remove a block and accessory from a DN_S type snout is as follows: CAUTION 1. Pull the spring-loaded retaining pin to release the hinged retainer. 2. Open the hinged retainer. 3. Unlock the safety lock retaining the accessory installed on slot 2. 4. Remove the accessory from slot 2. 5.
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|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Type DN_M (Dedicated Nozzle - Medium) Snout Operations The type DN_M snout is a round snout with three slots: two block holders (slots 1.1 and 1.2) one range compensator, range shifter or ridge filter holder (slot 2) One hinged retainer, including a spring-loaded retaining pin, secures the accessories once installed onto the snout.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS The LEDs turn ON (green light) when the respective presence switches or pressure pins send a signal indicating that (each item corresponding to a LED in the same order as the list above): The snout has been inserted The first block slice has been installed into slot 1.1 The second block slice has been installed into slot 1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Installing Accessories onto a DN_M Type Snout Note: The maximum combined weight of all accessories installed in the DN_M type snout must not exceed 20 kg. The procedure to install a block and accessory onto a DN_M type snout is as follows: CAUTION 1. Pull the spring-loaded retaining pin to release the hinged retainer. 2. Open the hinged retainer. 3.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Safety locks keys (2) (on snout) & keyways (on accessory) presence switches (3) Hinged retainer Spring loaded retaining pin Figure 14-7. Type DN_M Snout (lateral cut) Removing Accessories from a DN_M Type Snout The procedure to remove a block and accessory from a DN_M type snout is as follows: CAUTION IBA | 14-18 | 1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Type DN_XL (Dedicated Nozzle - Extra Large) Snout Operations The type DN_XL snout is a rectangular snout with five slots that cater to two different accessories: four block holders (slots 1.1, 1.2, 1.3, and 1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS snout lock safety locks (4 in total) Figure 14-9. Type DN_XL Snout Components - continued Seven LEDs are installed on the snout’s tray (from bottom to top), in two rows: Rightmost row: SNOUT SLOT 1.1 SNOUT SLOT 1.2 SNOUT SLOT 1.3 SNOUT SLOT 1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS The first block slice has been installed into slot 1.1 The second block slice has been installed into slot 1.2 The third block slice has been installed into slot 1.3 The fourth block slice has been installed into slot 1.
|Part II - Using Treatment Room Equipment Installing and Removing Accessories into/from the Accessory Drawer or PBS Installing Accessories onto a DN_XL Type Snout The procedure to install a block and accessory onto a DN_XL type snout is as follows: 1. Insert the first block slice; the safety lock falls into place and the LED on the snout’s tray indicating ‘Snout Slot 1.1’ turns green. 2. Repeat Step 1 with each block slice. Check to see that the corresponding LED turns green. 3.
Chapter 15 Resetting a Dose Counter Electronic Unit •••••• The Dose Counter Electronic Unit (DCEU) is a redundant dose counter. It is used to: Provide a redundant reading of the dose monitor units received by the patient. Provide a redundant way of stopping the irradiation when the target dose entered on the Therapy Control System (TCS) is reached.
|Part II - Using Treatment Room Equipment WARNING Resetting a Dose Counter Electronic Unit | As a Radiation Therapy Technologist (RTT), when the treatment is interrupted (e.g., the treatment is stopped after a pause, the software crashes, etc.), you have to manually record the value reported by the hardware Monitor Unit (MU) counter, which is located on the front panel of the Dose Counter Electronic Unit (DCEU). If applicable, i.e.
|Part II - Using Treatment Room Equipment Important Resetting a Dose Counter Electronic Unit | Enter the maximum preset Monitor Units (MU) value on the Dosimetry Counter Electronic Unit (DCEU) front panel before irradiation. The maximum preset MU value depends on the treatment mode, as follows: Pencil Beam Scanning: a MU value equal to 105% of the prescribed MU The DCEU also emits beeps while the dose is being delivered.
|Part II - Using Treatment Room Equipment Resetting a Dose Counter Electronic Unit | 3. Use the volume knob to set the volume of the audible signal produced by the DCEU. 4. Use the Beeper Rate knob to match the prescribed dose to the gray/minute1. For example, when set at two gray/min, the audible signal should be heard once per second. DCEU Types Two different types of DCEU exist: one where you set the actual MU value: see section ‘DCEU With Actual Preset MU Value’ on page 15-4.
|Part II - Using Treatment Room Equipment Resetting a Dose Counter Electronic Unit | preset display Reset button Figure 15-2. Dose Counter Electronic Unit (DCEU) - detail x10 Preset Value 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 are located in the nozzle. The impact is irrespective of the type of ionization chamber, be it sealed or open air1.
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Chapter 16 Operating the Patient Positioning System Manually (Emergency Release Mode) •••••• The Patient Positioning System (PPS) is the mechanical arm that serves to position the patient laying on the couch. It has six axes of movement that can be controlled using the hand-pendant or the remote positioning controls. In such a case, all movements are electrically executed. For more information on the PPS, see Chapter 7, “Moving the Patient Positioning Devices”.
|Part II - Using Treatment Room Equipment Operating the Patient Positioning System Manually (Emergency Release Mode) | WARNING The Radiation Therapy Technologist (RTT) shall be trained and exercised to perform efficiently and safely the emergency release mode operations. WARNING The emergency release mode shall be used only if the Patient Positioning System (PPS) or the patient positioning devices do not respond to control or are likely to be unsafe for operation.
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|Part II - Using Treatment Room Equipment Operating the Patient Positioning System Manually (Emergency Release Mode) | Using the Emergency Hand-Pendant Performing a Coplanar Movement, Joints 1-2 To perform a combined coplanar (lateral and longitudinal) motion, it is necessary to release the joints 1 and 2 as described below: Figure 16-2. Joints 1 and 2 Motions Refer to the “Leoni Orion System” User manual for additional information.
|Part II - Using Treatment Room Equipment Operating the Patient Positioning System Manually (Emergency Release Mode) | Performing a Vertical Motion, Joint 3 To perform a vertical motion, it is necessary to release the joint 3 as described below: Figure 16-3. Joint 3 Motion Refer to the “Leoni Orion System” User manual for additional information.
|Part II - Using Treatment Room Equipment Operating the Patient Positioning System Manually (Emergency Release Mode) | Activation key Release confirmation button Motion enable button or Brake release switch button Axis selector switch Activation LED Figure 16-4.
Chapter 17 Performing QA Checks and Verifying Beams With a Water Phantom •••••• WARNING Periodic system recalibration to maintain operational compatibility with clinical needs of the treatment center is not part of the equipment manufacturer’s responsibility. As a physicist you are responsible for the equipment and must perform verifications of the machine output at an established frequency.
|Part II - Using Treatment Room Equipment CAUTION Performing QA Checks and Verifying Beams With a Water Phantom | Be aware that the lifetime of Ionization Chambers may be reduced if exposed to over 10E6 Gray, which corresponds to approximately 450 hours of beam exposure at 5 nA. Ionization Chamber 1 (IC1) can sustain 450 hours of beam exposure at 5 nA. Ionization Chamber 2/3 (IC 2/3) can sustain 450 hours of unscanned beam exposure at 5 nA.
|Part II - Using Treatment Room Equipment Performing QA Checks and Verifying Beams With a Water Phantom | Locating the Water Phantom on the PPS The water phantom has to be positioned above the rotation axis (joint 6) of the PPS to ensure precise measurements and to prevent potential damage to the PPS. water phantom location rotation axis of PPS Figure 17-1.
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|Part II - Using Treatment Room Equipment Performing QA Checks and Verifying Beams With a Water Phantom | Verifying Beams Some beam parameters are validated by making measurements with a water phantom before using a new beam. This validation ensures consistency of the settings between the Treatment Planning System (TPS) and the PTS equipment.
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Chapter 18 Troubleshooting Treatment Room Equipment •••••• The following table describes the error/warning messages displayed on the wireless hand-pendant screen. . Message Description DEVICEa must be homed first. Home the device DEVICE before performing this action. Gantry position too far from prescription. Move the gantry closer to the treatment position before confirming the current position. Position cannot be confirmed. Lock the couch before moving. The couch is not properly locked.
|Part II - Using Treatment Room Equipment Troubleshooting Treatment Room Equipment | Message Description Selected device DEVICE is in unknown state. Probably it has not been configured properly. The software controlling the device DEVICE has not configured it properly. Selected device DEVICE is off! The software controlling the device DEVICE has performed a shutdown. Contact an operator to check its configuration. Contact an operator to restart it.
|Part II - Using Treatment Room Equipment Troubleshooting Treatment Room Equipment | Message Description Snout cannot move. The room configuration prevents the snout holder from moving. Contact an operator to enable snout motion in the room configuration. DEVICE must be tared first. You need to tare the device DEVICE in order to be able to move it. Weight check must be performed first on DEVICE. Perform a weight check sequence on the device DEVICE. Jog request is not valid for this device.
|Part II - Using Treatment Room Equipment Troubleshooting Treatment Room Equipment | b. During normal equipment operation, the word ‘ORIGIN’ present in several of the messages in this table is replaced by the name of the relevant device, check or check manager according to the circumstances.
Part III The Pencil Beam Scanning (PBS) Suite Clinical User’s Guide Volume 1 - Treatment Session
Chapter 19 Guiding You Through the Pencil Beam Scanning Documentation •••••• The purpose of this part is to describe the major PBS principles and to provide an overview of the equipment that is used to deliver PBS treatments.
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Chapter 20 Pencil Beam Scanning Principles •••••• Introduction Pencil Beam Scanning (PBS) is the beam delivery technique that delivers the dose by scanning a narrow proton beam over the target by adjusting the transverse trajectory of a mono-energetic pencil beam. The scanning operation is performed by two scanning magnets that are located in the nozzle.
|Part III - The Pencil Beam Scanning (PBS) Suite Pencil Beam Scanning Principles | Beam delivery in the treatment volume is achieved: Longitudinally, by varying the proton beam energy Transversally, by magnetic scanning Scanning magnets Yg Scanning magnets Xg layers already treated Scanning beam Proton beam 2-D dose distribution on the actually scanned layer Bragg peak Figure 20-1.
|Part III - The Pencil Beam Scanning (PBS) Suite Pencil Beam Scanning Principles | Longitudinal and Transversal Dose Distribution in PBS A very precise dose distribution can be obtained both longitudinally (in depth) and transversally (on the plane perpendicular to the beam direction) using PBS. Longitudinal Distribution In order to spread the dose delivery along the longitudinal axis (that is to say, in depth), the dose is delivered in successive single energy layers.
|Part III - The Pencil Beam Scanning (PBS) Suite Pencil Beam Scanning Principles | Patient Study 1 Plan 1 Beam 1 Layer 1 Layer n Plan n Study n Beam 1 Beam n Figure 20-2.
|Part III - The Pencil Beam Scanning (PBS) Suite Pencil Beam Scanning Principles | This combination of longitudinal and transversal dose distribution lies at the core of the PBS delivery technique. Repainting Modes When a given layer is scanned by the proton beam more than once (or repainted), the total dose to be delivered at each layer in the target is divided by the number of scans or paintings that is to be achieved.
|Part III - The Pencil Beam Scanning (PBS) Suite Pencil Beam Scanning Principles | In-Layers Repainting From the distal to the proximal edge of the target volume, each defined layer is scanned by the proton beam (or painted) as many times as prescribed until the total dose prescribed for that layer is delivered. Only when a given layer has received its full dose, the scanning process progresses on to the next layer.
Chapter 21 Introducing PBS Beam Delivery System Equipment •••••• The PBS Treatment Mode Following is a schematic representation of how Beam Delivery System (BDS) equipment is used in the PBS treatment mode. scanning magnets, horizontal focussing quadrupole magnets snout holder nozzle optional range shifter, ridge filter, or snout IC 2/3 Y beam tube Z X IC1 scanning magnets, vertical vacuum chamber Figure 21-1.
|Part III - The Pencil Beam Scanning (PBS) Suite Introducing PBS Beam Delivery System Equipment | PBS Capable Nozzle Types At your center, PBS can be delivered using the following: PBS Dedicated Nozzle: for detailed information, refer to section “Nozzle Types and Components PBS Dedicated Nozzle Structure” on page A-3. Role of the Scanning Magnets The two scanning magnets located in the nozzle deflect the beam and continually paint the treatment field with a small beam area.
|Part III - The Pencil Beam Scanning (PBS) Suite Introducing PBS Beam Delivery System Equipment | The Scanning Controller handles most of the functionality required for the pencil beam scanning treatment delivery. The Scanning Controller (SC) is largely responsible for the controls and feedbacks of some elements that affect the beam trajectory and intensity as well as some other aspects of the beam.
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Chapter 22 PBS Multiple Repainting •••••• The PBS delivery mode is capable of delivering beam using the multiple repainting technique. This technique has been introduced in section “Beam Delivery Characteristics in PBS” on page 20-4. Multiple Repainting Types PBS multiple repainting can be performed using different types of repainting, as follows: None (no layer repainting): see section “None” on page 22-2. In-Layers repainting: see section “In-Layers Repainting” on page 22-3.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | None From the distal to the proximal edge of the target volume, each defined layer is scanned by the proton beam (or painted) once. The prescribed dose is delivered completely for each spot in the target in just one scanning operation. This type means that PBS is delivered without any repainting. Identification This repainting type is labelled PBS in the (Delivery) Technique fields on the adaPTprescribe and adaPTdeliver screens.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | In-Layers Repainting From the distal to the proximal edge of the target volume, each defined layer is scanned by the proton beam (or painted) as many times as prescribed until the total dose prescribed for that layer is delivered. A different number of re-paintings may be prescribed for each layer in the plan.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | Graph Figure 22-4 illustrates the energy that is delivered in each layer. A graph similar to this one appears on adaPTdeliver screens. Figure 22-4. In-Layers Energy/Layer Graph (typical) Decrease in Energy From the distal to the proximal edge of the target volume, each defined layer is scanned by the proton beam (or painted) once.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | Representation This repainting type is represented by an icon on adaPTdeliver screens. Figure 22-5. Decrease in Energy Icon Graph Figure 22-6 illustrates the energy that is delivered in each layer. A graph similar to this one appears on adaPTdeliver screens. Figure 22-6.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | Identification This repainting type is labelled PBS-B&F in the (Delivery) Technique fields on the adaPTprescribe and adaPTdeliver screens. Representation This repainting type is represented by an icon on adaPTdeliver screens. Figure 22-7. Back and Forward Icon Graph Figure 22-8 illustrates the energy that is delivered in each layer. A graph similar to this one appears on adaPTdeliver screens. Figure 22-8.
|Part III - The Pencil Beam Scanning (PBS) Suite PBS Multiple Repainting | Mixed Repainting In this mode, different types of repainting are mixed for the same beam. Identification This repainting type is labelled PBS-MIX in the (Delivery) Technique fields on the adaPTprescribe and adaPTdeliver screens. Representation This repainting type is represented by an icon on adaPTdeliver screens. Figure 22-9. PBS Mixed Icon Graph Figure 22-10 illustrates the energy that is delivered in each layer.
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Part IV Using adaPTprescribe Clinical User’s Guide Volume 1 - Treatment Session
Chapter 23 TPS-PTS Communication in Standalone Mode •••••• The standalone mode option can be used when you opt not to use the OIS, or if the OIS is not available. For each patient that will be treated by the PTS, patient data is stored in the PTS database. To enable proton therapy treatment, specific study and treatment plan data are also stored. These patient and treatment plan data are typically created using a Treatment Planning System (TPS) and once created, need to be imported into the PTS.
|Part IV - Using adaPTprescribe TPS-PTS Communication in Standalone Mode | These are the different ways to import deliverable plans into the PTS database: Entering data manually: this possibility only exists for treatment plans to be delivered using the double scattering, uniform scanning or single scattering delivery techniques. Pencil Beam Scanning plans cannot be created manually in adaPTprescribe due to the big amount of data they contain.
|Part IV - Using adaPTprescribe TPS-PTS Communication in Standalone Mode | Workflow Stage Create Plan A TPS Import Plan to PTS Database Batch importer Baseline adaPTprescribe Select Patient/Plan Select Beam Prepare & Treat adaPTdeliver Create Record Store Record Figure 23-1.
|Part IV - Using adaPTprescribe TPS-PTS Communication in Standalone Mode | The batch importer, i.e., the process that manages batch imports, is continually running in the background and waits for incoming DICOM connection requests. For detailed information, refer to the TPS OEM documentation for instructions on how to connect and send a Plan from TPS to the batch importer. To display the exported treatment plan in adaPTprescribe, refresh the screen and select the desired patient and study.
Chapter 24 Getting Started With adaPTprescribe •••••• WARNING Beam algorithms and parameters can be modified both on the TPS and the PTS side. A similar algorithm and a parameter database to compute equipment settings out of clinical parameters exists both on the PTS and the TPS, which means there is a risk of inconsistent results. As a treatment center, it is your responsibility to perform a set of quality assurance measurements to verify the coherence between both algorithms and parameter databases.
|Part IV - Using adaPTprescribe Getting Started With adaPTprescribe | Starting an adaPTprescribe Session Click the adaPTprescribe icon on the desktop in the TCR or in the TR to start up adaPTprescribe. Figure 24-1. Start adaPTprescribe Icon When you start an adaPTprescribe session, the ADAPTprescribe LOGIN SCREEN appears (see Figure 24-2). Exiting an adaPTprescribe Session Whenever you want to exit the adaPTprescribe session: IBA | 24-2 | 1.
|Part IV - Using adaPTprescribe Getting Started With adaPTprescribe | Logging into adaPTprescribe Double-click the adaPTprescribe icon and the ADAPTprescribe LOGIN SCREEN appears. Figure 24-2. adaPTprescribe Login Screen Enter your user name and password, as obtained from your administrator, and select your language and operating mode. User name and password are case sensitive. Should you want to change your password, please contact your administrator.
