UCSF MEDICAL CENTER - UCSF Radiation Oncology

PURPOSE
UCSF MEDICAL CENTER
DEPARTMENT OF RADIATION ONCOLOGY
PROCEDURE MANUAL TO SET UP 2D/3D IMAGING
BY THE THERAPIST IN MOSAIQ/SYNGO
Initialization, scheduling, tranfer, acquisition and association of Electronic Portal
Imaging (EPI) and Cone Beam CT (CBCT) imaging in Mosaiq/Syngo by therapist. Verify
the plan and chart. Complete a RTT ‘New Start Checklist’.
CRITICAL POINTS
The files have to be received 24 hours prior to the patient’s dry run. If not, an incident
report (IR) has to be filled out.
PROCEDURE
In Mosaiq
I. COMPLETE THE RTT CHECKLIST AFTER APPROVING PLAN IN D&I
II. INITIALIZE AND SCHEDULING EPI AND
CBCT IN MOSAIQ
• Select Patient, click on ‘RO Treat’ and
.
• Choose ‘Insert Sessions’,
• Insert prescription, site and start date,
• Click on ,
Note: Special scheduling (like every other day) might be
required.
• In ‘Insert Sessions’ choose Prescription, Field,
Range, Days (choose from Mon-Fri) and click
‘Schedule Fields to be Treated in These Session’,
this will open up the ‘Schedule Fields’ tab.
• Pick each of the required fields and click on ‘Add’ then ‘OK’. Each field must be selected in the sequence you want
to treat. Always add CB and EPI (orthogonal site set-up) at that time. Click OK.
• Hit Schedule Field Button.
Go to and it’s done.
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II. ACQUISITION OF EPI AND CBCT IN MOSAIQ/SYNGO
PATIENT WITH CBCT FIELDS
Once the prescription is approved by the physician,
• Go to and click on ,
• Click on ‘Continue’ to Acknowledge,
• On the ‘Treatment Delivery Table’, right click
(RC) on the CBCT field and choose ‘Load
Reference Data’ from the menu. This will send the
CT images over to Syngo. This is done only once.
• Click ‘Cancel’ on the verification screen.
• ‘Send Plan’
Note for therapists: This operation takes up to five minutes (5 min.). To be preformed
prior to patient on the table.
Note for physicists: Never ‘Load the reference data’ in QA mode.
Read and Acknowledge (override if needed) in the treatment Readiness Check window
Click . The treatment fields are sent to Syngo.
In Syngo
A will appear next to the MVCBCT field (means can’t be downloaded),
• Click on ,
• RC on the CBCT field and choose ‘Imaging Options’,
• Select the appropriate protocol from the drop down menu (see Appendix
A for details). Could change patient size if needed and click OK.
• Click on to Apply change for treatment.
• Check the box next to CBCT for acquisition,
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• Click on ‘Treat’ in the very bottom LHS (Linac
console needs to be in remote mode. If not press F7).
Operate machine control console as usual.
When the CBCT is acquired, the reference image is
automatically loaded.
• Left click the MPR Image Thickness icon
and right click to set the tickness to 3 mm. Click
OK,
• Click on the blending tool and adjust each
image as you wish (left side is CBCT and right is
Planning CT). Slide the bar to Treatment around
70%.
• Zoom if needed ,
• In the Registration tab , click on the manual registration tool . Align the two images manually
(Tutoring tool on how to align prostate patient with GM and H&N patient at:
http://www.radonc.ucsf.edu/links/Video/ConeBeamTutorial/Prostate.htm and
http://www.radonc.ucsf.edu/links/Video/ConeBeamTutorial/Head%26Neck.htm).
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• Accept the offset .
In Mosaiq
with Treatment Session window open
• RC anywhere and select Record Third Party
Offset,
• In the window select ‘Offset was applied
during treatment’, and select machine’s name (ex: Artist 3D or Artist 2D) in Source.
Use the following table to enter the moves written in the Syngo workstation, right column of the Offset numbers.
In Syngo
• Click on the ‘apply offsets’ button (first button on the RHS),
• Follow instructions on Syngo screen. Wait until flat panel is automatically parked. The table will move lateral and
longitudinal. Only the couch vertical position in yellow is blinking, then hit F12. This will manually move the table
to the offset vertical position. To continue from the control console, press RAD ON.
• Turn the key back and go to the tab
and then, select the following treatment.
After treatment is done, close patient .
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In Mosaiq
If it’s patient’s first day (dry run),
• In Couch Copy window, highlight all the
fields, enter the password and click Copy.
This will copy the table coordinate for now on.
• Click Record and close the two next
windows.
For each CBCT,
• Click and double click the CBCT
just acquired. When open, click on ,
this will bring the Image Information window,
• Click on Site and select the appropriate site. Click
OK,
- Record and complete patient Tx in Mosaiq,
- Use Lantis to capture Chart (Long Hospital),
- Complete Assessment,
- Download the next patient and repeat the same steps.
PATIENT WITH EPI (SET UP) FIELDS
Should be already set-up by dosi.
PATIENT WITH EPI (DOUBLE
EXPOSURE) FIELDS
In Mosaiq
• Go to TX calendar,
• Highlight the field you want to port,
• Click on “Details>>” on the bottom of the far right
panel,
• Select and ,
(this will give you a double exposure)
• Click OK
Then, send plan.
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In Syngo
• Click on option edit ,
• Select the field (now it will have a double exposure port
film icon ), right click and choose Imaging Options…
• Select ,
• Change the delta to a larger field size (click Tab on keyboard),
• Select the “Clipping” option.
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ARCHIVE IMAGES FROM SYNGO
In Syngo
• Open the patient Browser (click on , or Patient | Browser).
• If the patient received Cone Beams, delete all Cone Beam Projections files before archiving.
In the patient’s folder, select Cone Beam Projections, right click, and select Delete.
• Send to the Archive system,
In Patient Database, select the patient’s folder only.
Click , or click Transfer | Send to…
In the new window ‘Send To’, select Achive and
click .
An icon will appear at the right bottom
of the Syngo screen, saying it’s transferring.
If you click on this icon (or click Transfer | Export to Off-line…), a new
window ‘Network Job Status’ will appear and will keep you informed about the transfer process.
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• When the left column ‘Status’ changes from Active to Completed, Delete
the entire patient’s folder.
If for any reason the transfer Failed click the Restart button till it shows
Completed in Status. This will assure that the entire patient’s information is
transferred to the archive system.
Authors Date Version Modifications
Pam Akazawa
Michèle Aubin
Dilini Pinnaduwage
March 30 th 2011 1.0
Original procedure with
Mosaiq 2.0 and Syngo V2.0
Michèle Aubin May 10 th 2011 1.1 Added archiving section
Michèle Aubin
Olivier Morin
Dilini Pinnaduwage
Angela Carlson, Sherman
Lim, Rainier Llejay, Alex
Meraz, Debbie Stott and
Stuart Suen
June 7 th 2011 1.2
Added double exposure
July 15 th 2011 1.3 Critical details
Olivier Morin August 3 rd 2011 1.4 Third party shifts table
REVIEWED BY:
___________________________________ ___________________________________
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