|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Remote positioning controls: in Physics mode, the Manual mode of the remote positioning controls is available by default. That is not the case in Clinical mode, where the Manual mode of the remote positioning controls is only available upon explicit request. Figure 43-10.
|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Be aware that the imaging system must be out of the beam path, like in Clinical mode. Figure 43-11. PMS Interface Panel The differences are as follows: Tolerances: if the values are out of tolerance, you do not need to acknowledge any message to confirm that you are aware that the positioning devices are out of tolerance. Drawer: the drawer can be IN or OUT, disregarding the prescription.
|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Figure 43-12. PMS Interface Panel, with Blocking Selection Verifying the Room Interlocks In Physics mode you have the option to insert the TCR Service Mode key in the key switch on the TCR Safety Interface, which is part of the Safety and Triggering Rack. When you then rotate the key switch to proceed to irradiation, the nozzle cyclic checks are disabled.
|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Treatment The TREATMENT SCREEN in Physics mode differs somewhat from the same screen in Clinical mode, as follows: Physics optional actions: this is an additional tab on the Monitor panel of the TREATMENT SCREEN. This tab enables you to select any given layer and to keep track of the monitor units during your operations.
|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Figure 43-14. Treatment Screen During a pause you may want to move any Patient Positioning Device (PPD). To do so, click Unlock at the bottom of the screen. When your preparation is finished, do not forget to click Lock to lock the PPDs again.
|Part IX - adaPTdeliver in Physics Mode Using adaPTdeliver in Physics Mode | Figure 43-15. Treatment Screen From the TREATMENT SCREEN you have the option to pause or stop the beam. When the beam is paused and you do not intend to resume the treatment, click Stop Irradiation from the TREATMENT SCREEN. The PTS terminates the field irradiation. Contrary from Clinical mode, in Physics mode no records are stored in the database.
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Part X Preparing for Treatment Clinical User’s Guide Volume 1 - Treatment Session
Chapter 44 Beam Scheduling Principles •••••• Beam generated by the cyclotron can be allocated to any TR, one TR at a time. Therefore, beam requests coming from different TRs must be scheduled. Once beam usage is no longer needed in a given TR, the beam must be released before it can be allocated to another TR. Beam scheduling can be performed manually by the Accelerator Operator or automatically by the Beam Scheduler. The principle itself is known as Automatic Beam Scheduling (ABS) .
|Part X - Preparing for Treatment Beam Scheduling Principles | When the Accelerator Operator allocates the beam, the RTT in the relevant TR is informed that beam is allocated to the corresponding TR. The subsequent beam tuning can then be performed automatically or manually. Switching ABS Modes Switching between the Manual or Automatic ABS mode is performed by the Accelerator Operator in the MCR. This can be done unless beam is allocated.
Chapter 45 Preparing a Treatment Room •••••• This procedure does not depend on the availability of patient data and may be performed before or simultaneously with the procedure described in Part V, “Using adaPTdeliver”. Verifying Removable Patient Supports At your center you may have different removable patient support types available such as a short couch or a Base of Skull (BoS) frame. Important If the patient support types are different, you will not be able to proceed with treatment.
|Part X - Preparing for Treatment Preparing a Treatment Room | GTR Preparation Important Always check the Treatment Room’s temperature and pressure in the morning Quality Assurance (QA) and enter the data in the Dosimetry Manager. Monitor the temperature and pressure during the day. Whenever the values deviate from the last values known to the system, these new values must be updated in the system via the Dosimetry Manager.
Part XI Patient Positioning and Alignment Clinical User’s Guide Volume 1 - Treatment Session
Chapter 46 Introducing Patient Positioning and Alignment •••••• This part assumes that the Radiation Therapy Technologist (RTT) is familiar with the equipment (refer to Chapter 5, “Introducing Treatment Room Equipment"). At the time of treatment, positioning the patient takes place in the TR using the hand pendant. The Digital Radiographs (DRs) are acquired at the time of preparation.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | WARNING As a Radiation Therapy Technologist (RTT) you should perform motion with the patient on the support (i.e., couch or chair) only after the patient has been securely immobilized on the support. WARNING As a Radiation Therapy Technologist (RTT) it is your responsibility to verify the appropriateness of the corrections generated by the Patient Position Verification System (PPVS).
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Setup Position The Setup position is the position where the center of the treatment site coincides with the isocenter of the system. The setup position is specific to the setup beam. Note: If this is the first beam of the patient’s plan to be delivered, you must move the patient to the baseline Setup position. For all successive beams, the Setup position will be the last saved Setup position.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | gantry axis isocenter, FRS 0,0,0 Xfrs Yfrs TTCS rotational axis of the couch Xttcs Yttcs Figure 46-2.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Prescribed and Corrected Setup Position The relationship between the prescribed Setup position and the required Setup position evolves as follows: With the patient on the couch or chair, the RTT will verify and finely adjust (correct) the Setup position and then save it.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Zfrs FRS TTCS Zttcs gantry axis Yfrs Yttcs rotational axis of the couch isocenter axis Figure 46-3.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Xfrs Yfrs Xttcs rotational axis of the couch Yttcs Figure 46-4.
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|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Taring the PPS What is the tare, and why should it be done? The PPS Leoni is equipped with a force torque sensor, which allows measuring the mass of the payload (couch, patient) carried by the robot. This measure of payload feeds the algorithms ensuring the high accuracy of the PPS.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | If tare is performed with an incorrect prerequisite... Correct the incorrect prerequisite (For example: remove the mass from the couch). Perform a new tare as given in section Procedure to perform the tare. Procedure to perform the tare Using the wireless hand-pendant. 1. Long press the PPS icon from the bottom bar of the hand-pendant menu. Figure 46-5. PPS icon of the wireless hand-pendant GUI screen 2.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Figure 46-6. Tare section of the wireless hand-pendant GUI screen 3. A message informs the user that the tare is performed 4. If the tare was not performed correctly, an error message will appear inside a pop-up.
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|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Automatic Weight Check WARNING Be careful to avoid collisions of the Patient Positioning System. Collisions may damage the PPS. It may also deteriorate the robot accuracy and performance. In case of a collision, the robot must be calibrated. Important Make sure that the area near the PPS robot is clear before starting the automatic weight check. Perform the automatic weight check as follows: 1.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Figure 46-7. Automatic weight check - Positioner screen 2. Long touch on the Weight check Status. 3. Depending on which device is ready for weight check, you might have to perform the following actions: a. IBA | 46-14 | Retract the imager by pressing the Retract Imager ( ) icon (Figure 46-8).
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Figure 46-8. Automatic weight check - Retract imager b. Clinical User’s Guide Volume 1 - Treatment Session Move the gantry in [-20,20] range (already ready in Figure 46-9) and retract the nozzle by pressing the Retract Nozzle ( ) icon (see Figure 46-9).
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Figure 46-9. Automatic weight check - Move Gantry c. IBA | 46-16 | Move the PPS to [0,0,0,0,0,0] position by pressing the Move PPS ( (Figure 46-10).
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Figure 46-10. Automatic weight check - Move PPS 4. Important Verify that there is no patient and no object on the couch. Then, check the box with the message Nothing/Nobody is present on the couch (green box in Figure 46-11). Make sure that the area near the Patient Positioning System robot is clear before starting the automatic weight check. 5.
|Part XI - Patient Positioning and Alignment CAUTION Introducing Patient Positioning and Alignment | Ensure that the area near the PPS is clear as the automatic load cell check function of the PPS performs large pitch and roll motions. Figure 46-11.
|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | The Typical Alignment Correction Process A typical alignment correction procedure is as follows: 1. WARNING In a gantry treatment room equipped with a gantry rolling floor, patient loading should only be performed with the nozzle positioned in the upper part of the gantry, between 90° and 270°. 2. WARNING Position the patient on the couch. Move the PPS into the prescribed Setup position.
|Part XI - Patient Positioning and Alignment b. WARNING WARNING Introducing Patient Positioning and Alignment | Use the PPVS software (e.g., adaPTinsight) to compute a correction vector that orients the patient as planned. The correction vector consists of corrections to one or several PPS axes. As a Radiation Therapy Technologist (RTT) it is your responsibility to verify the appropriateness of the corrections generated by the Patient Position Verification System (PPVS). c.
|Part XI - Patient Positioning and Alignment WARNING Introducing Patient Positioning and Alignment | Be careful to apply the movement sequence of the gantry and the Patient Positioning System (PPS) in the correct order to ensure accurate patient positioning for treatment. Rotating the gantry BEFORE moving the PPS is the only correct order that ensures accurate patient positioning. Moving the PPS before the gantry will introduce an error in patient positioning. 6.
|Part XI - Patient Positioning and Alignment d. WARNING Introducing Patient Positioning and Alignment | Apply the corrections. When all alignment corrections have been applied and recorded by the user, make sure that, according to treatment center procedures, a second Radiation Therapy Technologist (RTT) verifies the entered corrections. e. Use the hand-pendant to implement the correction with the PPS.
|Part XI - Patient Positioning and Alignment CAUTION Introducing Patient Positioning and Alignment | There is risk of misalignment induced by the application of the position correction proposed by the OIS. Application of the correction may induce a misalignment of maximum 0.7mm.
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|Part XI - Patient Positioning and Alignment Introducing Patient Positioning and Alignment | Recovering From an Equipment Error In the unlikely event an equipment failure occurs while performing the patient positioning and alignment procedure, a number of actions must be taken after normal equipment operation has been restored and prior to continue positioning and aligning the patient. In case an equipment error occurs, request for assistance from an operator.
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Chapter 47 Calculating Corrections Using adaPTinsight •••••• The adaPTinsight application enables to perform Image Guided Proton Therapy (IGPT). The required patient setup verifications are performed prior to treatment using either stereoscopic 2D and/or 3D images (depending on the TR hardware configuration). In order to do this, adaPTinsight features the following main functions: It acts as a control interface for X-ray imaging hardware such as X-ray generators and flat panels.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | Preliminary adaPTinsight Activities In the Treatment Planning Room (TPR) the DICOM CT series, the DICOM RT Plan data, and the DICOM RT Structure Set data of the patient are compiled. All this data serves as the input for the Digitally Reconstructed Radiographs (DRRs) that are generated by adaPTinsight prior to computing the correction. The adaPTinsight monitor, keyboard, and mouse are in the shielded area of the TR.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | In addition select the following: your language (currently only one option: English). session mode (currently only one option: Patient Alignment). Press Enter. The adaPTinsight application is then started and the WORKFLOW SELECTION SCREEN appears. Figure 47-2.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | Figure 47-3. Power Switch for X-ray Generators Generator LEDs Hand Switch Figure 47-4. X-ray Console Note: Once a workflow is started on adaPTinsight, communication between the adaPTinsight workstation and the X-ray generator(s) is automatically established.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | Calculating Corrections As a therapist you calculate the necessary corrections in the treatment room, when the patient comes for treatment. The complete correction calculation process comprises the following sequential steps: 1. Start adaPTinsight, if not already started (refer to section "Starting up adaPTinsight" on page 47-2). 2.
|Part XI - Patient Positioning and Alignment Important Calculating Corrections Using adaPTinsight | As a Radiation Therapy Technologist (RTT), pre-position the patient using lasers. During this process, pay attention to the potential large difference between the position of isocenter indicated by the lasers and the position of isocenter indicated by the x-ray image guidance system. Such a large difference would indicate that one of these systems needs to be re-aligned.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | Figure 47-5. kV/kV Single Source Workflow Prepare image (PREPARE) Take image (EXPOSE) Figure 47-6. X-ray Console Hand-switch WARNING As a Radiation Therapy Technologist (RTT) it is your responsibility to verify the appropriateness of the corrections generated by the Patient Position Verification System (PPVS).
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | 3D Acquisition: kV CBCT Note: For more detailed information on how to perform X-ray Image Acquisition, refer to the adaPTinsight documentation listed in chapter “About this Manual”. In the kV CBCT mode, the acquisition of projection radiographs requires the following sequence of operations: 1. Select the tube settings (kVp, mA, ms) by using one of the Presets. 2.
|Part XI - Patient Positioning and Alignment WARNING Calculating Corrections Using adaPTinsight | As a Radiation Therapy Technologist (RTT), always monitor the patient during motion in the CBCT X-ray image acquisition. In case the patient moves, the RTT shall interrupt the acquisition. Registering Images Note: For more detailed information on how to perform Image Registration, refer to the adaPTinsight documentation listed in chapter “About this Manual”.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | 2D-3D Image Registration This step is launched after the 2D stereographic dual source mode acquisition is performed. The two orthogonal radiographs acquired by rad-A and rad-B are compared with numerically generated projections of the planning CT in order to correctly set up the patient for treatment.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | After completing the registration, images are “locked” to enable you to cross check the result but not modify it. Correction Feedback After Image Registration and calculation of the correction, it is necessary to apply these corrections to the Patient Positioning Devices.
|Part XI - Patient Positioning and Alignment Calculating Corrections Using adaPTinsight | How to Apply and Implement the Calculated Corrections Click Validate on the adaPTinsight screen: the corrections supplied by adaPTinsight are transferred to the PMS INTERFACE PANEL of the EQUIPMENT PREPARATION SCREEN that is displayed on the TCS monitor in the treatment room. If the corrections are filled out correctly and you deem them appropriate, click Apply Correction.
|Part XI - Patient Positioning and Alignment WARNING Calculating Corrections Using adaPTinsight | After applying and implementing the corrections calculated by the Patient Position Verification System (PPVS) software (e.g., adaPTinsight), it is recommended to take a new set of X-ray images to verify proper positioning of the patient. If, after taking the final DR pair, the alignment is deemed unsatisfactory, you can reiterate the entire alignment process.
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Chapter 48 Using the Universal Beam Triggering Interface •••••• Introducing Triggering Why Use Triggering With the Proton Beam? When treating patients using particle therapy, it is important to deliver a high dose to a target volume while minimizing the dose to surrounding healthy tissues.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | The Triggering Solution To overcome this problem, the radiation beam, be it the proton beam or X-rays emitted by the X-ray tube, can be subjected to a triggering technique, whereby the beam may be interrupted at given points in time (i.e., beam not authorized), and triggered again when the position of the patient returns to a given state (i.e., beam authorized).
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | For PBS, the maximal time between two requests of beam triggering (Beam Hold request to Beam Resume request) will be greater than 3 sec and shorter than 30 sec.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | UBTI Details Specific types of treatment and tumors may require specific types of gating equipment to monitor physiological motions. The UBTI therefore caters to four distinctive gating devices that can remain connected to the Universal Triggering Electronic Unit (UTEU) rack at any given time.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Once installed and connected, you do not have to interfere with the BGEU.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Operating the UTEU Two Modes of Operation: Manual or Automatic Note: Whether you are using the Universal Triggering Electronic Unit (UTEU) in manual mode or in automatic mode, you are always capable of pausing the irradiation following the procedure described in Chapter “Pausing, Resuming and Stopping an Irradiation”.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | UTEU Controls The UTEU rack features the following controls: A source selector switch: you can set the switch to any of the following positions: No: no gating equipment is currently in use. Ext 1 - Ext 4 (external gating system 1- 4): the system that you intend to use to perform automatic triggering (refer to Section “Automatic Triggering” on page 48-6.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | X-ray triggering toggle button Beam trigger request LED Source selector switch Power LED Manual triggering button Figure 48-2.
|Part XI - Patient Positioning and Alignment Internal Ext 1 Ext 2 Ext 3 Ext 4 Using the Universal Beam Triggering Interface | You will still need to verify which one of this source is appropriate for your patient because this information is not provided by your TPS/OIS. When gating is not required, only “NO” may be selected on the UTEU rack. Prescription display The gating information is displayed in the header part of the screen.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-3. Gating Prescription - No gating input selected If gating is not prescribed, the PTS will also warn you if a gating input is selected (selector in a position other than NO) when the setup beam is selected (Figure 48-4). However in this case, setup beam preparation will not be prevented as an override to a gated prescription is possible at treatment beam level (Figure 48-5).
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-4.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-5. Gating Prescription - Gating input selected for treatment beam In any case, the gating input selector needs to match the prescription (after override, if any) in order to prepare a treatment beam.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-6.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-7. Gating Prescription - Gating YES and no input selected for treatment beam The PTS will also perform a last minute check just before allowing the irradiation to start. Important Any attempt to change your selection of gating source after securing the treatment room will be inhibited by the Therapy Safety System (TSS).
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Figure 48-8.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Note: Optimization of the irradiation time is more complex when using gating. As a consequence, irradiation time will be longer when gating is prescribed than when gating is not prescribed. Triggering Procedure Important Any attempt to change your selection of gating source after securing the treatment room will be inhibited by the Therapy Safety System (TSS).
|Part XI - Patient Positioning and Alignment CAUTION Using the Universal Beam Triggering Interface | As a Radiation Therapy Technologist (RTT), check prior to the actual irradiation that the gating signal displayed on the Universal Triggering Electronic Unit (UTEU) is in line with the triggering device gating signal, and is within appropriate timing specifications. If the above conditions are not met, do NOT start the irradiation and verify the set-up (i.e.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | Gating system screen (e.g. gateRT screen) adaPTdeliver screen Status lamp on gating system hardware (e.g. gateRT gating controller) Status lamp on UBTI console (Beam On Trigger lamp) Status lamp on imaging booth UBTI box Figure 48-9.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | In Pencil Beam Scanning mode, the beam is switched On (i.e. beam is authorized) when all the following conditions are met: The beam has been allocated to the TR and it has not been paused by the RTT. The Beam Triggering signal is On (i.e. beam is authorized). The Scanning Controller has finished calculating the scanning map and the map has been downloaded.
|Part XI - Patient Positioning and Alignment Using the Universal Beam Triggering Interface | gating signal beam triggering signal scanning controller beam allocation Figure 48-10.
Chapter 49 Aligning a Patient in the GTR •••••• Positioning and aligning a patient in the GTR involves the operations that follow. WARNING In a gantry treatment room equipped with a gantry rolling floor, patient loading should only be performed with the nozzle positioned in the upper part of the gantry, between 90° and 270°. WARNING As a Radiation Therapy Technologist (RTT) you should perform motion with the patient on the support (i.e.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | CAUTION The patient may only be loaded onto the couch when the surface of the couch is flat, i.e., when pitch and roll angles are equal to zero. Important Verify the weight of the patient on a day to day basis. If the patient weight changes by more than 10 kg, the correction vector shall be recomputed for the table plate associated to the patient.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | If the remaining device(s) is (are) at the Setup position when the last device reaches the Setup position the hand-pendant beeps two times. Verifying Patient Alignment in Setup Position When the equipment is at the Setup position, the RTT may use the lasers, X-ray tubes, or other patient alignment aids to verify the position of the target site with respect to the isocenter.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Make subsequent corrections to the Setup position (refer to Section "Correcting the Setup Position” on page 49-5. Note: Refer to the treatment center procedure to establish how many X-ray images shall be taken.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Correcting the Setup Position Corrections to the Setup position are computed using adaPTinsight. For detailed information on how to use adaPTinsight, refer to the adaPTinsight documentation listed in the Delivery Note. WARNING As a Radiation Therapy Technologist (RTT) it is your responsibility to verify the appropriateness of the corrections generated by the Patient Position Verification System (PPVS).
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Inputting the Setup Corrections If small corrections to the Setup position are necessary, determined by a review of the X-ray images, prepare the equipment for this Setup beam. For detailed information, refer to Section “Equipment Preparation for a Setup Beam” on page 33-2.
|Part XI - Patient Positioning and Alignment WARNING Aligning a Patient in the GTR | Whenever a pre-programmed motion (e.g., a GoTo motion,) has been used, as a the Radiation Therapy Technologist (RTT), perform a final verification of the position of all moving parts (e.g., Patient Positioning system [PPS], snout, gantry,) in the treatment room before irradiation begins. When a device reaches the Corrected position the hand-pendant or the remote positioning controls beep one time.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Confirming the Setup Position When all devices are in the Corrected position, confirm the Setup position as follows: 1. Touch the green screen. (Tick) icon at the top right of the wireless hand-pendant Note: If the current position is outside the treatment volume, the Position outside treatment volume. Position verifications are mandatory message appears on the hand-pendant.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Verifying Patient Alignment in Treatment Position When the equipment is in the Treatment position, the RTT may choose to perform further verifications according to treatment center procedure by: Taking Portal View X-ray images (using adaPTinsight), following the procedure applicable in the TR type. For detailed information, refer to section "Setting up for Portal View X-ray Images in a GTR" on page 12-16.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Corrections to the Treatment position are computed using adaPTinsight. For detailed information on how to use adaPTinsight, refer to the adaPTinsight documentation listed in the Delivery Note. WARNING As a Radiation Therapy Technologist (RTT) it is your responsibility to verify the appropriateness of the corrections generated by the Patient Position Verification System (PPVS).
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Implementing the Position Corrections WARNING Make sure that the DID flat panel arms are fully retracted before attempting to move Patient Positioning Devices (PPDs) that can collide with the flat panels.
|Part XI - Patient Positioning and Alignment Aligning a Patient in the GTR | Confirming the Treatment Position When you are satisfied that the Treatment position is correct, confirm it as follows: 1. Touch the green screen. (Tick) icon at the top right of the wireless hand-pendant Note: If the current position is outside the treatment volume, the Position outside treatment volume. Position verifications are mandatory message appears on the hand-pendant.
Part XII Monitoring an Irradiation Clinical User’s Guide Volume 1 - Treatment Session
Chapter 50 Monitoring an Irradiation •••••• If the beam is slightly out of specifications, a warning is displayed to the RTT in the TCR but the warning does not interrupt the beam. If the beam is severely out of specifications, the irradiation is interrupted. Monitor the irradiation by: Listening carefully to the regular signals. The beep frequency is determined by the dose delivery. If an irregular beep is heard, there may be a problem. Watching the timer and the two Monitor Unit (MU) counters.
|Part XII - Monitoring an Irradiation WARNING IBA | 50-2 | Monitoring an Irradiation | As a Radiation Therapy Technologist (RTT), during irradiation, you are recommended to check the gating signal (on the gating equipment) against the presence of the triggering request (i.e., the ‘Beam On Trigger requested by source’ LED on the UBTI). In case a mismatch occurs, pause the beam immediately.
Appendices Fixed Small Beam Clinical User’s Guide
IBA | 49-2 | Fixed Small Beam Clinical User’s Guide
Appendix A Nozzle Types and Components •••••• Nozzle Position The nozzle has a different position depending on the type of TR, as follows: GTR: the nozzle is located at the 270º (9:00 o’clock) position on the gantry frame. The weight of the nozzle is significant and is offset on the gantry by the use of a counterweight located at the 90º (3:00 o’clock) position on the gantry frame. Nozzle Types The Pencil Beam Scanning (PBS) Dedicated Nozzle is installed in each TR offering the PBS treatment mode.
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Nozzle Types and Components | Nozzle Types and Components PBS Dedicated Nozzle Structure The PBS Dedicated Nozzle is specifically designed for delivering beam in the Pencil Beam Scanning (PBS) treatment mode. To identify the major components, refer to Figure A-1. Ionization Chamber 1 (IC1) (or Low Pressure Ionization Chamber 1 - LPIC1): to check the alignment of beam at the nozzle entrance. PBS Dedicated Quadrupole Magnets: a set of two quadrupole magnets that focus the beam at isocenter.
Nozzle Types and Components | obtained using both scanning magnets; each of these magnets is driven by a dedicated power amplifier, the so-called Scanning Magnet Power Supply (SMPS). The SMPS is controlled by the Scanning Controller. The Scanning Controller handles most of the functionality required for the pencil beam scanning treatment delivery.
Nozzle Types and Components | PBS Dedicated Nozzle Layout range shifter (or ridge filter, or snout) IC2/3 accessory drawer snout holder PBS dedicated nozzle pre-assembly retractable X-ray tube vacuum chamber slow scanning magnets fast PBS dedicated quadrupole magnets (LP) IC1 135° bending magnet Figure A-1.
Nozzle Types and Components | PBS Dedicated Nozzle Components Nozzle Frame The nozzle frame is the housing used to support and contain all of the nozzle subsystems accessible from a TR. The nozzle frame has a hollow configuration and is almost entirely under vacuum. (Low Pressure) Ionization Chamber No. 1 - (LP)IC1 Ionization Chamber No. 1 (IC1) is the nozzle component where the beam enters the nozzle. (The Low Pressure Ionization Chamber No. 1 is a model of the IC1).
Nozzle Types and Components | PBS Dedicated Quadrupole Magnets Purpose of the PBS dedicated quadrupole magnets is to focus the beam at isocenter so that the size of the beam remains limited. These quadrupole magnets are made of laminated steel to enable a fast current change without overheating the structure of the quadrupole magnets. Scanning Magnets The two scanning magnets located in the nozzle deflect the beam and continuously paint the treatment field with a relatively wide beam area.
Nozzle Types and Components | Ionization Chambers No. 2 & No. 3 (IC2 & IC3) Ionization Chambers No. 2 & No. 3 (IC2 & IC3) consist of two ionization chambers:. The first single-surface collecting electrode along the path of the beam in Ionization Chamber no. 2 (IC2) is divided into 32 parallel strips used to measure the profile and position of the beam in the “X” direction.
Nozzle Types and Components | Snout Holder The snout holder enables the accessory drawer to be moved towards or away from the isocenter. tray (with accessory) accessory drawer snout holder snout lock toggle switch tray lock toggle switch Figure A-2.
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Appendix B Using the Dosimetry Manager •••••• The Dosimetry Manager enables users to: manually enter temperature and pressure measurements into the system: This data is used to correct the dose output factor. manually enter the kIC (Dose Correction Factor): This data is used to finely adjust system behavior to absolute calibration measurements. The Dose Correction Factor is defined based on the morning QA.
Using the Dosimetry Manager | Starting the Dosimetry Manager The Dosimetry Manager is accessible via a button at the bottom of the adaPTdeliver screens. (Once clicked, the button is grayed out; see Figure B-1.) Figure B-1. adaPTdeliver: Dosimetry Manager Button The main display of the Dosimetry Manager is presented in Figure B-2.
Using the Dosimetry Manager | Figure B-2. Dosimetry Manager Main Display Entering Temperature and Pressure Values When the Manual mode is activated (Figure B-4), you may enter: Temperature: expressed in °C (degrees Celsius) Pressure: expressed in kPa (kiloPascal) Optionally, you can add a free text comment. Immediately after entering new values, the system checks that the entered values are within acceptable ranges according to the Dosimetry Manager settings and display an error otherwise.
Using the Dosimetry Manager | Figure B-3. Dosimetry Manager: Entering credentials for confirmation Note: If the system is not able to communicate with the database and store the new values you have entered, an error will be displayed. In this case, you may retry or call an IBA operator Finally, close the Dosimetry Manager. Figure B-4.
Using the Dosimetry Manager | The temperature and pressure values must be updated at least every 24 hours or less if specified differently by the treatment center quality management plan. If the values entered manually are outdated, you will be prevented to proceed with treatment and will be asked to enter new temperature and pressure values manually (see section “Entering Temperature and Pressure Values”). 2.
Using the Dosimetry Manager | Determining the Minimum Allowed MU The Treatment Planning System (TPS) provides a dose setpoint in Monitor Units (MU) to the Proton Therapy System (PTS), that the PTS converts into charge to be collected in the ion chamber. This conversion depends on the temperature, pressure, and the dose correction factor. If the entered temperature or pressure is out of the acceptable range, the TPS may generate treatment plans that will be rejected by the PTS.
Using the Dosimetry Manager | Viewing the History Log The Dosimetry Manager History tab enables you to view the history log of the atmospheric conditions of the treatment room (TR). It contains a line for each automatic acquisition or each manual entry, along with the date, logged user and comment. For an automatic acquisition, the temperature and pressure displayed are the average values, used for kTP computation.
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Appendix C Managing PTS Users •••••• Users of the PTS are managed using the User Manager. Only a limited number of staff in your organization is authorized to manage users of the PT system. If you have such rights, from the USER MANAGER LOGIN SCREEN, login to the User Manager using your user name and password. Figure C-1. User Manager Login Screen The USER MANAGER MAIN SCREEN appears.
