Dosimetrist/Physicist Training Guide - UCSF Radiation Oncology

MOSAIQ 

Dosimetrist/Physicist 

Training Guide 

Version 1.60 

Module I: Care Plan and Prescription 

Information

Dosimetrist/Physicist 

Training Guide 

MOSAIQ 

Oncology Management System 

Version 1.60 

Module I: Care Plan and Prescription Information 

Copyright 2009 

All Rights Reserved 

IMPAC Medical Systems

PUBLISHED BY: 

IMPAC Medical Systems, Inc. 

100 Mathilda Place, Fifth Floor 

Sunnyvale, CA 94086 

COPYRIGHT 2009 by IMPAC Medical Systems 

All Rights Reserved 

Instructional Designer/Writer: Robin Bonke 

LTGRAD0005A – 2.0 – 2/26/2009 

This manual contains proprietary information to be used exclusively 

by customers of IMPAC Medical Systems. All rights reserved. 

No part of the contents of this book may be reproduced or transmitted 

in any form or by any means without the written permission 

of IMPAC Medical Systems.

Table of Contents 


Table of Contents...........................................................................................................................................................................................i 

Introduction ................................................................................................................................................................. 1 

What’s In This Course ................................................................................................................................................................................ 1 

SupportPlus Online ...................................................................................................................................................................................... 2 

Document Conventions.............................................................................................................................................................................. 3 

Text Conventions...............................................................................................................................................................................................................3 

Mouse Conventions...........................................................................................................................................................................................................4 

Keyboard Conventions .....................................................................................................................................................................................................5 

Lesson1 Reviewing Treatment Information ....................................................................................................... 7 

Objectives....................................................................................................................................................................................................... 7 

Using the Home View.................................................................................................................................................................................. 8 

Opening the Chart View........................................................................................................................................................................... 12 

Opening the eCHART Navigator Views................................................................................................................................................ 13 

Opening the Diagnoses and Interventions Window........................................................................................................................... 17 

Opening the Dose Site Summary and Dose Action Points Windows ............................................................................................ 23 

Opening the Treatment Chart Window ............................................................................................................................................... 26 

Opening the Dosimetry Configuration Dialog Box............................................................................................................................. 32 

What’s Next ................................................................................................................................................................................................ 34 

Quick Version.............................................................................................................................................................................................. 35 

Using the Home View................................................................................................................................................................................................... 35 

Opening the Chart View............................................................................................................................................................................................... 35 

Opening All of the eCHART Navigator Views ........................................................................................................................................................ 35 

Opening the Diagnoses and Interventions Window ............................................................................................................................................. 35 

Opening the Dose Site Summary and Dose Action Points Windows............................................................................................................... 35 

Opening the Treatment Chart Window................................................................................................................................................................... 36 

Opening the Dosimetry Configuration Dialog Box ................................................................................................................................................ 36 

Lesson 2 Adding Diagnoses, Care Plans, and Prescriptions............................................................................. 37 

Objectives..................................................................................................................................................................................................... 37 

Adding Diagnosis and Staging Information ............................................................................................................................................ 38 

Opening the Diagnosis and Staging Window......................................................................................................................................................... 38 

Adding Diagnosis Information..................................................................................................................................................................................... 40 

Affirming a Diagnosis .................................................................................................................................................................................................... 42 

Assigning Care Plans .................................................................................................................................................................................. 46 

Adding Prescriptions.................................................................................................................................................................................. 48 

Using Radiation Prescription Sequencing .............................................................................................................................................. 56 

Adding Dose Limit Dose Action Points................................................................................................................................................. 58 

Changing Prescriptions.............................................................................................................................................................................. 60 

Appending Fractionation Phases.............................................................................................................................................................. 64 

Showing Historical Prescription Data .................................................................................................................................................... 69 

What’s Next ................................................................................................................................................................................................ 71 

Copyright 2009, IMPAC Medical Systems i 

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MOSAIQ Dosimetrist/Physicist Training Guide Module I 

Quick Version.............................................................................................................................................................................................. 72 

Opening the Diagnosis and Staging Window ......................................................................................................................................................... 72 

Adding Diagnosis Information..................................................................................................................................................................................... 72 

Affirming a Diagnosis .................................................................................................................................................................................................... 73 

Assigning Care Plans...................................................................................................................................................................................................... 73 

Adding Prescriptions....................................................................................................................................................................................................... 73 

Using Radiation Prescription Sequencing................................................................................................................................................................. 74 

Adding Dose Limit Dose Action Points...................................................................................................................................................................... 74 

Changing Prescriptions.................................................................................................................................................................................................. 74 

Appending Fractionation Phases................................................................................................................................................................................. 74 

Showing Historical Prescription Data........................................................................................................................................................................ 74 

Lesson 3 Adding Simulation and Treatment Fields...........................................................................................74 

Objectives..................................................................................................................................................................................................... 74 

Adding Simulation Fields............................................................................................................................................................................ 74 

Adding Header Information......................................................................................................................................................................................... 74 

Adding Measurement Settings.................................................................................................................................................................................... 74 

Adding Geometric Settings........................................................................................................................................................................................... 74 

Adding Radiography Settings....................................................................................................................................................................................... 74 

Copying Simulation Fields............................................................................................................................................................................................. 74 

Adding Site Simulations ............................................................................................................................................................................. 74 

Adding Positioning Devices........................................................................................................................................................................................... 74 

Adding Site Simulations................................................................................................................................................................................................. 74 

Adding a Site Setup..................................................................................................................................................................................... 74 

Copying Simulation Field into Treatment Fields .................................................................................................................................. 74 

Copying Simulation Fields and Adding Treatment Field Data............................................................................................................................ 74 

Adding Accessory and Geometric Settings............................................................................................................................................................... 74 

Applying a Tolerance Table......................................................................................................................................................................................... 74 

Adding Treatment Field Notes.................................................................................................................................................................................... 74 

Using the Apply Limits Option .................................................................................................................................................................................... 74 

Copying Treatment Fields......................................................................................................................................................................... 74 

Manually Adding a Treatment Field ........................................................................................................................................................ 74 

Manually Adding Treatment Fields............................................................................................................................................................................ 74 

Manually Adding Geometric Settings........................................................................................................................................................................ 74 

Manually Adding Accessory Information.................................................................................................................................................................. 74 

Manually Adding Portal Image Information ............................................................................................................................................................ 74 

Adding Field Setup Information .................................................................................................................................................................................. 74 

Setting Up Accessory Verification........................................................................................................................................................... 74 

Specifying Accessory Verification................................................................................................................................................................................ 74 

Printing Accessory Barcode Labels............................................................................................................................................................................. 74 

Approving Treatment Fields..................................................................................................................................................................... 74 

Changing Approved Treatment Fields.................................................................................................................................................... 74 

Copying Couch Parameters and Changing Field Notes ..................................................................................................................... 74 

Reviewing Diagnoses and Interventions Options for Treatment Fields ......................................................................................... 74 

What's Next ................................................................................................................................................................................................ 74 

Quick Version.............................................................................................................................................................................................. 74 

Adding Simulation Fields – Header Information.................................................................................................................................................... 74 

ii Copyright 2009, IMPAC Medical Systems 

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Adding Simulation Fields – Measurement Settings............................................................................................................................................... 74 

Adding Simulation Fields – Geometric Settings...................................................................................................................................................... 74 

Adding Simulation Fields – Radiography Settings.................................................................................................................................................. 74 

Copying a Simulation Field........................................................................................................................................................................................... 74 

Adding Positioning Devices........................................................................................................................................................................................... 74 

Adding Site Simulations ................................................................................................................................................................................................ 74 

Adding a Site Setup ....................................................................................................................................................................................................... 74 

Copying Simulation Fields and Adding Treatment Field Data............................................................................................................................ 74 

Adding Accessory and Geometric Settings............................................................................................................................................................... 74 

Applying a Tolerance Table......................................................................................................................................................................................... 74 

Adding Treatment Field Notes.................................................................................................................................................................................... 74 

Using the Apply Limits Option.................................................................................................................................................................................... 74 

Copying Treatment Fields ............................................................................................................................................................................................ 74 

Manually Adding Treatment Fields............................................................................................................................................................................ 74 

Manually Adding Geometric Settings........................................................................................................................................................................ 74 

Manually Adding Accessory Information.................................................................................................................................................................. 74 

Manually Adding Portal Image Information ............................................................................................................................................................ 74 

Adding Field Setup Information.................................................................................................................................................................................. 74 

Specifying Accessory Verification................................................................................................................................................................................ 74 

Printing Accessory Barcode Labels............................................................................................................................................................................. 74 

Approving Treatment Fields......................................................................................................................................................................................... 74 

Changing Approved Treatment Fields....................................................................................................................................................................... 74 

Copying Couch Parameters and Changing Field Notes........................................................................................................................................ 74 

Moving Treatment Fields to a Different Radiation Prescription ........................................................................................................................ 74 

Hiding Treatment Fields............................................................................................................................................................................................... 74 

Changing the Treatment Order of Treatment Fields............................................................................................................................................ 74 

Opening the Treatment Calendar ............................................................................................................................................................................. 74 

Adding Simulation and Treatment Fields with No Prescription ......................................................................................................................... 74 

Course Evaluation: Dosimetrist/Physicist Module I .............................................................................................. 74 

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iv Copyright 2009, IMPAC Medical Systems 

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Notes 


Copyright 2009, IMPAC Medical Systems 1 

LTGRAD0005A/2.0/26-Feb-2009 

Introduction 

Welcome to MOSAIQ Dosimetrist/Physicist Training Module I. This book is your 

guide to unlocking the possibilities of MOSAIQ 1.60 application software, hereafter 

referred to as MOSAIQ. It is designed to be used during your instructor-led training, 

and as a handy desk reference any time you need a quick reminder how to do 

something in MOSAIQ. We recommend that you keep this book near your 

workstation so you can find it easily when needed. 

This training guide is not intended to replace the MOSAIQ radiation oncology 

documentation, which is contained in the MOSAIQ Help system. The MOSAIQ Help 

system provides in-depth information on all available MOSAIQ features. 

Dosimetrist/Physicist Training Module I is an Intermediate course that, with 

Dosimetrist/Physicist Training Modules II and III, covers how to review and add treatment 

information that your facility will use to safely treat the patient. This course assumes 

that you have basic Windows skills and have taken, and are familiar with, the 

concepts presented in MOSAIQ General Introduction training. Topics presented in 

this course build upon the concepts learned in the General Introduction. 

What’s In This Course 

In this course, you will review treatment information, define prescriptions, define 

treatment fields, change MLC files, import and export RTP files, review IMRT 

options, and set up dose tracking. You will also manually record treatments, change 

dose, use the Treatment Calendar, and run the eCHART Chart Check. 

In this module, you will review treatment information and define prescriptions, 

simulation fields, and treatment fields. 

This course will not teach you basics on using MOSAIQ, which are covered in the 

General Introduction. 

Note that when you are working in the practice database, all activities are enabled for 

the practice ID. In your clinical database, you may or may not have security rights to 

do all the activities that you will do in this course.


Notes 

SupportPlus Online 

SupportPlus is IMPAC’s dedicated online support system, which gives you the most 

from your IMPAC oncology management system. SupportPlus contains valuable 

support information including installation and troubleshooting documents, training 

manuals, upgrade checklists, downloadable software tools, and much more. 

Access may be restricted based on your IMPAC service 

agreement. 

You can find this document under the Oncology Management tab in the Training 

Resources folder. 

Turn to SupportPlus for resources on implementation, training, support, and upgrades 

for all IMPAC products. 

For more information, contact support@impac.com, or call 800.488.4672. 

Log in to SupportPlus every week or two to check for new 

announcements, new document postings, and new training 

events. Please take a moment to send us a Product 

Suggestion. 

2 Copyright 2009, IMPAC Medical Systems 

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Notes 

Introduction 


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Document Conventions 

This document uses specific conventions, or rules, in the instructions to help you 

perform the exercises correctly. This section explains the text, mouse, and keyboard 

conventions used in this document. 

Text Conventions 

The instructions in this guide are formatted to make them easy to read and to 

recognize when you should perform a particular task. The following text conventions 

are used in the instructions: 

Bold Print Indicates menu or list items that you select. 

Example: Click File | Register New Patient…. 

Example: In the Select Patient window, click Lamb, Mary. 

Italics Indicates words or phrases that appear on the computer 

screen, references to text or a number as itself, or new terms 

that are being defined. 

Highlighted 

Print 

Example: Position the insertion point to the left of p in 

patient. 

Example: Annotation is the process of adding customized 

notes to a Help topic. 

Indicates something you type. 

Example: Type 3000. 

Explanations Located directly below the step. 

Menus Menu commands that are executed one directly after the other 

are separated by a vertical line. 

Buttons and 

Icons 

Example: Click File | System Utilities | Supplies… 

means from the menu bar, click File, from the File 

menu, point to the System Utilities command, 

and from the System Utilities menu, click the 

Supplies… command. 

Indicate items on which you click. 

Example: Click . 

Example: Click .


Notes 

Notes, Hints, 

and Warnings 

Note example: 

Hint example: 

Warning example: 

Mouse Conventions 

Notes, hints and warnings are preceded by unique symbols 

and are presented in a shaded box. Notes provide ancillary 

information, hints provide tips to help you use the system, 

and warnings provide important information on the 

consequences of performing a particular action. 

You can also open the eCHART Navigator window if you 

press F5. 

You may find it helpful to print out illustrations from the 

Help reference tools to include with patient education 

materials. 

Once you change the status of an order to Voided, you 

cannot change the status again. 

The following terms are used to describe actions you perform with the mouse: 

Click Press and release the left mouse button. 

Double-click Click the left mouse button twice in rapid succession. 

Right-click Press and release the right mouse button. 

Drag Move the mouse while holding down the left mouse button. 

Highlight Drag the mouse pointer across data, causing the information 

to appear in reverse video. 


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Introduction 


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Notes Keyboard Conventions 

Keys that do not produce a character appear in all upper case bold print. These keys 

include: 

Function Keys F1, F2, F3, F4, F5, F6, F7, F8, F9, F10, F11, and F12. 

Booster Keys ALT, CTRL, and SHIFT. 

Pointer 

Movement 

Keys 

HOME, PAGE UP, PAGE DOWN, END, TAB, and the 

arrow keys. 

Other Keys BACKSPACE, DELETE, INSERT, CAPS LOCK, ESC, 

ENTER, SPACEBAR, PRINT SCRN, SCROLL LOCK, 

PAUSE, and NUM LOCK. 

Two or more keys that should be pressed simultaneously are separated by a plus sign. 

Example: Press CTRL+F4. 

Example: Press ALT+N.


Notes 


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Notes 



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Lesson1 Reviewing 

Treatment 

Information 

Objectives 

You will learn how to: 

• Use the Home View 

• Open the Chart View 

• Open the eCHART Navigator, then see its different views 

• Open the Diagnoses and Interventions window 

• Open the Dose Site Summary and Dose Action Points windows 

• Open the Treatment Chart window and the Treatment Calendar 

• Open the Dosimetry Configuration dialog box 

eCHART is a multi-functional electronic treatment chart that organizes and maintains 

critical treatment information required throughout the course of radiation therapy. 

Looking at treatment information provides you with a wealth of information about 

your patients and how they are being treated in your facility. 

For this lesson, we recommend that you use an existing patient with radiation 

treatments already recorded or planned. For the remainder of the course, you must 

quick-admit a fictitious patient with minimal information, but make sure you assign an 

attending physician and a patient ID. 

The steps in each exercise are provided at the end of the lesson. These short 

procedures are called the Quick Version. Refer to the Quick Version when you need a 

quick reminder of the steps to complete any task in MOSAIQ that was covered in the 

lesson. 

In this lesson, you will use the Home view, open the Chart View, open the eCHART 

Navigator window and view its three different views. You will open the Diagnoses and 

Interventions window, the Dose Site Summary and Dose Action Points windows, the 

Treatment Chart window, and the Treatment Calendar. You will also open the 

Dosimetry Configuration dialog box.


Notes 

To select an existing patient, you must have Administrative | 

General | View security rights. 

To open the eCHART Navigator, Diagnoses and Interventions 

window, and the Treatment Chart window, you must have 

Clinical | General | View security rights. 

To open the Treatment Calendar, you must also have 

Clinical | Care Plans | View security rights. 

To open the Dose Site Summary window, you must also have 

Clinical | Action Points | View and Clinical | Tx Status | View 

security rights. 

To open the Dose Action Points window and Dose Action 

Point dialog box, you must also have Clinical | Action Points | 

View security rights. 

Using the Home View 

The MOSAIQ user interface has the Home view and the Chart view. The Home and 

Chart views let you quickly access the information that you use most frequently, such 

as schedules, appointments, and the Quality Checklist. Refer to the subsequent 

exercise for information on the Chart view. In the Home view, the My Work List pane 

includes work list items from across MOSAIQ. It shows the items in one view and lets 

you do assigned tasks without navigating to other areas. In this exercise, we will 

explore the MOSAIQ Home and Chart views. 

1. If necessary, start MOSAIQ and use the impac user name and impac password to 

log on to the Practice database. 

Logs you on to the MOSAIQ system and opens the MOSAIQ Home view, 

shown in Figure 1. 

The MOSAIQ Home View appears if your system administrator 

configured your workstation to use the MOSAIQ user interface. 


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Notes 

Lesson 1: Reviewing Treatment Information 


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Title Bar Menu Bar 

Status Bar Application Workspace 

Figure 1: MOSAIQ Main Application Window 

The MOSAIQ window contains all application components, such as the Home 

view. The Home view shows the data that you use most frequently and is the first 

screen you see after you log on to MOSAIQ. 

For information on how to configure the MOSAIQ user 

interface, refer to LPNMSQ0031, MOSAIQ 1.50 Homepage 

Configuration Quick Reference. 

2. In the My Work List pane, click adjacent to the Schedule work list. 

Shows your scheduled appointments in Figure 2. 

Toolbar Window Control Buttons 

Logged in User Initials 

Open Patient Chart Button 

MOSAIQ User Interface Pane


Notes 

Figure 2: My Work List Pane Showing Scheduled Appointments 

Your screen can look different if your configuration is different. The Schedule work 

list can show the scheduled appointments for different time frames, such as the 

current day or week. You also can configure each one of the other work lists. 

3. Click the Patient column in the Schedule work list. 

Sorts the Schedule work list by patient. You can sort ascending or descending with 

an arrow button on the right side of the column as shown in Figure 3. 

Figure 3: Schedule Work List Sorted by Patient 


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Notes 4. Click one of the appointments in the Schedule work list. 

Shows the appointment in the Work List Detail pane in Figure 4. 

Figure 4: Selected Appointment Displayed in the Work List Detail Pane 

The Work List Detail pane shows the applicable information on a selected work 

list item. Click to move down to show more information. Most work lists let you 

open the work list item in the applicable dialog box or window and do other tasks. 

For example, for the Schedule work list, you can show the appointment in the 

Appointment Slip dialog box, queue the patient, and capture a charge for the 

appointment. 

5. In the Work List Detail pane, click , then close the dialog box. 

Opens the Appointment Slip for the selected appointment, then closes it. From 

the Appointment Slip dialog box, you can make changes to the appointment. You 

do not have to open the Staff Schedule and then open the appointment.


Notes 

Opening the Chart View 

The Chart view lets you view information about the patient at a glance and shows the 

chart of the most recently selected patient. Rather than open multiple windows, you 

can view all of the information in a patient EMR on one screen. In this exercise, you 

will open the Chart view. 

1. Click , then double-click Kirk, James T.. 

Opens the patient chart of James T. Kirk and makes him the current patient. 

2. In the toolbar, click . 

If the Photo ID Display dialog box appears, close it. You can 

right-click or press F4 in the Select Patient window, then 

click Photo ID Display to disable this option. 

Opens the Chart view, shown in Figure 5. 

Figure 5: Chart View 

From the Chart view, you can view the patient diagnosis, orders, other 

medications, notes, and appointments. The MOSAIQ user interface lets you add 

tabs and panes, so you can customize the view to your needs 


Opens the Home view. 


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Notes Opening the eCHART Navigator Views 

The eCHART Navigator shows recent information from the patient chart and 

contains features and buttons to view and add patient and treatment information. It 

also lets you view and go to most areas of the electronic patient chart from one 

window. In this exercise, you will open the eCHART Navigator and view its three 

different views. 


Opens the eCHART Navigator window, shown in Figure 6. 

You can also click eChart | Navigator… from the menu bar 

or press F5 to open the eCHART Navigator window. 

Summary Note tabs 

Current clinical note tab 

Summary Writer box 

Figure 6: eCHART Navigator Window – General View 

Patient information 

header 

Summary information from the Diagnoses 

and Interventions window 

You do NOT have to close the eCHART Navigator window if 

you open the chart of a new patient.


Notes The eCHART Navigator window contains the information and fields below: 

Patient 

Information 

Header 

Summary 

Tabs 

Patient 

Clinical 

Summary Box 

Summary 

Writer Box 

Diagnoses 

and 

Interventions 

Box 

Shows basic patient information, such as patient name, 

referring physician, medical record number, and date of birth. 

If the patient has multiple attending or referring physicians, an 

arrowhead appears on the right side of the Attending MD and 

Referring MD fields. Move the mouse pointer to to show 

the names of the other physicians. 

Changes the category of notes shown in the Patient Clinical 

Summary box. You can configure the tab names (on a global 

basis) if you have the applicable security rights. Right-click or 

press F4 in the eCHART Navigator, then click 

Configuration…. 

Shows short notes added from the Summary Writer box. 

When you click a Summary tab, the contents change. 

Adds a note to the currently shown Summary tab. The button 

above the Summary Writer box shows the currently selected 

tab. 

Opens the Flowsheet window, from which you can add, 

change, and view vital signs, laboratory results, and patient 

assessments for the selected patient. 

Opens the Assessments tab of the Flowsheet window, from 

which you can use add, change, and view patient assessment 

information. 

Opens the Image List window, from which you can view 

online patient images and add, change, or remove information 

about each image. 

Opens the Quality Checklist window in the Patient view, from 

which you can view, add, change, or remove Quality 

Checklists for the selected patient. 

Opens the Patient Schedule window, from which you can 

view, add, change, or remove appointments for the selected 

patient. 

Shows the information added for the patient in the Diagnoses 

and Interventions window. 

Opens the Diagnoses and Interventions window, from which 

you can view and assign diagnoses, Care Plans, radiation 

prescriptions, and treatment fields. 


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Notes Orders Box Shows the most recent orders generated for the patient. 

Documents 

Header Box 

Labs and 

Vitals Box 

Other 

Medications 

Box 

Allergies and 

Alerts Box 

Opens the Orders dialog box, from which you can add, 

change, remove, view, and approve orders. This also applies to 

orders not generated from approved Care Plans. 

Shows a list of all of your documents. 

Opens the Documents window, from which you can view, 

add, or change patient documents. 

Shows the most recent laboratory and vital sign information 

and assessments. 

Opens the Laboratory tab of the Flowsheet window, from 

which you can view and add laboratory information. 

Shows other medications the patient may be taking that you 

may or may not be prescribing. 

Opens the Other Current Medications window, from which 

you can add, change, remove, and view other medications the 

patient may be taking. 

Shows recent allergy and alert information for the selected 

patient. 

Opens the Allergies dialog box, from which you can add, 

change, remove, and view patient allergy information. You can 

also configure alerts particular to your facility. 

Your system administrator can configure one of three different views of the 

eCHART Navigator to agree with your departmental requirements. The view 

usually used at Radiation Oncology facilities is shown in Figure 7.


Notes 

This is the only pane that changes in the Radiation Oncology view. 

Figure 7: eCHART Navigator Window – Radiation Oncology View 

The Dose Site Summary pane replaces the Other Medications pane shown in the 

General view. The Dose Site Summary pane shows a summary of the prescribed 

and current doses for each dose tracking site and all of the specified dose action 

points. A third view of the eCHART Navigator window is shown in Figure 7. 

Figure 8: eCHART Navigator Window – Additional Radiation Oncology View 


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Notes 



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You can also use a fourth view of the eCHART Navigator. See 

online help for configuration information and settings. 

The Orders, Documents, and Allergies and Alerts panes are replaced by expanded 

views of the Dose Site Summary and Treatment Field panes. The expanded Dose 

Site Summary pane shows the start and last treatment dates, actual and prescribed 

fractions, and other summary information on the dose tracking sites. The 

Treatment Fields pane shows an overview of the treatment fields for the patient. 

It shows the MU, dose, energy, modality, and blocking/beam modifiers for each 

treatment field. 

2. Click . 

Closes the eCHART Navigator window. 

Opening the Diagnoses and Interventions 

Window 

The Diagnoses and Interventions window shows diagnosis, course, prescription, field, 

and calendar information added for the selected patient. You can add, change, and 

view treatment fields from the Diagnoses and Interventions window. In this exercise, 

you will open the Diagnoses and Interventions window. 

1. In the menu bar, click eChart. 

Opens the eChart menu, shown in Figure 9. 

Figure 9: eChart Menu


Notes The eChart menu contains the commands below: 

Navigator… Opens the eCHART Navigator window, from which 

you can view and add patient and treatment 

information. You can also click the toolbar icon 

shown to the left or press F5. 

Diagnoses and 

Interventions… 

Opens the Diagnoses and Interventions window, 

from which you can view and assign diagnoses, ad 

hoc care plans, order sets, and prescriptions. You can 

also click the toolbar icon shown to the left. 

Orders… Opens the Orders dialog box, from which you can 

add, change, remove, view, and approve pharmacy, 

observational, and text orders. 

Flowsheet… Opens the Flowsheet window, which shows vital 

signs, laboratory results, and patient assessments for 

the selected patient. You can also click the toolbar 

icon shown to the left. 

Radiotherapy 

Treatment… 

Opens the Treatment Chart window, from which you 

can give treatments and view historical treatment 


shown to the left. 

Vital Signs… Opens the Flowsheet window with the Vital Signs 

tab active. You can view and add patient vital sign 

information. 

Laboratory… Opens the Flowsheet window with the Laboratory 

tab active. You can view and add laboratory 



Assessments… Opens the Flowsheet window with the Assessments 

tab active. You can view and add patient assessment 

information. 

Allergies and 

Alerts… 

Medication 

List… 

Opens the Allergies dialog box, from which you can 

add, change, remove, and view patient allergy and 

alert information. You can also click the toolbar icon 


Opens the Medication List window, from which you 

can add, change, remove, and view other medications 

the patient may be taking. 

Notes… Opens the Patient Notes window, from which you 

can add, change, remove, and view patient notes. 

You can also click the toolbar icon shown to the left. 


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Notes Documents… Opens the Documents window, from which you can 

view imported patient transcriptions. If your facility 

purchased eSCRIBE, PhAST Note, and/or eSCAN, 

you can add and change eSCRIBE documents and 

PhAST Notes, and import eSCAN documents. You 

can also click the toolbar icon shown to the left. 

Images… Opens the Image List window, from which you can 

view the patient ID image, field setup photos, and 

diagram images if your facility purchased the Photos 

and Diagrams module. You can see patient medical 

images if your facility purchased the ViewStation 

module. You can also click the toolbar icon shown to 

the left. 

Follow-Up… Opens the Follow-Up Status Summary window, 

from which you can add, change, remove, and view 

patient follow-up status information. 

Chart Check… Opens the Chart Check Options dialog box, from 

which you can do chart checks. You can also click 

the toolbar icon shown to the left. 

2. Click Diagnoses and Interventions…. 

You can also click in the toolbar. 

Opens the Radiation tab of the Diagnoses and Interventions window, shown in 

Figure 10.


Notes 

Figure 10: Diagnoses and Interventions Window – Radiation Tab 

The Diagnoses and Interventions window shows all of the diagnoses for the 

selected patient and courses, prescriptions, simulation fields, and treatment fields. 

If your department is identified as a Radiation Oncology department in System 

Utilities, the Radiation tab is the default tab in the Diagnoses and Interventions 

window. The Order Set level of detail is also the default. 

The Diagnoses and Interventions window contains the information and fields 

below: 

Diagnosis 

and Care 

Plan 

Information 

Buttons to add diagnosis, Care Plan, order sets, prescriptions, 

treatment fields, simulation fields, and site setup information. 

Expanded item Divisional tabs Display level options 

Diagnosis 

Treatment fields 

Course of treatment with care plan 

Simulation 

Radiation prescription 

Buttons to change, remove, or change status of existing diagnoses, Care 

Plans, prescriptions, and order sets; for dosimetry setup; and to refresh data. 

Shows the name of each diagnosis added and each 

intervention planned or completed. (This column is not 

labeled.) 

Start Shows the date of the diagnosis, the start date of the first 

instance of the care plan and the start date of the prescription. 

It can also show the due date or the approval date of an item. 


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Notes Status Shows the status of the care plan, course, or prescription. If 

the item status is Pending, this column is blank. Other statuses 

for an item have one of the indicators below: 

A Approved 

C Completed 

H Hidden for treatment fields 

P Partial treatment of a radiation treatment field 

V Voided 

X Closed 

O Associated orders (as in AO or CO) 

The date the status was last changed also appears to the right 

of the status indicator, along with the initials of the user who 

last changed the status. 

Level Sets the level of detail shown in the Diagnoses and 

Interventions window. 

Opens a blank Diagnosis and Problem List dialog box, from 

which you can select or add diagnoses to the Diagnoses and 

Interventions window. If the patient has no diagnosis added, a 

blank Diagnosis and Staging window opens. 

Opens the Patient Care Plan dialog box, from which you can 

assign a treatment course to the patient and add pre-defined 

radiation oncology Care Plans. 

Opens the Order Sets window, from which you can add an 

individual order set to a Care Plan. 

Opens the Radiation Prescriptions dialog box, from which you 

can add prescriptions and manage a related set of prescription 

sites in the same course of treatment. If you add a second 

prescription, the Radiation Prescription Sequencing dialog box 

opens first. It lets you identify the start day of a prescription 

site relative to a different prescription site in the same course. 

Opens the Treatment Field Definition dialog box when you 

click a Rad Rx folder and lets you add a treatment field. If you 

selected a simulation or treatment field, a message box 

appears. It asks you if you want to copy the information for 

selected simulation or treatment field into the Treatment Field 

Definition dialog box. 

Opens the Simulation Field dialog box, from which you can 

add a simulation field.


Notes 

Opens the Site Setup dialog box, from which you can select 

the patient orientation. This is only available if you selected a 

prescription site, simulation, or treatment field. If not, a 

message box prompts you to click a Radiation Prescription 

folder. 

Opens the applicable window/dialog box for the selected item 

so you can change it. 

Removes the selected item. You cannot remove approved 

items. 

Refreshes the data in the Diagnoses and Interventions 

window. 

Opens the Record Status dialog box, from which you can 

approve planned or scheduled radiation treatment sessions, 

and radiation oncology order sets. 

Opens the Dosimetry Setup window, from which you can 

configure dose tracking and view, add, change, or remove 

dosimetry information. 

Opens the Archived Objects window. Active only if your 

facility purchased MOSAIQ Oncology PACS. 

Opens the Couch Copy window, from which you can select 

the treatment fields from which to copy couch parameters. 

You can copy couch parameters (vertical, longitudinal, or 

lateral) from one treatment, setup, kV setup, or CT field to a 

different prescribed field. 

To move between tabs, click the tab you want to view. Different tabs show 

different information. Some information applies to specified tabs on the 

Diagnoses and Interventions window. For example, the Radiation Oncology care 

plan folder appears in the Medical tab, but the radiation prescriptions, simulation 

fields, and treatment fields that make up the care plan do not. 


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Notes Opening the Dose Site Summary and Dose 

Action Points Windows 

The Dose Site Summary window shows information about the amount of dose already 

delivered to each treatment site identified as a dose tracking site. In this exercise, you 

will open the Dose Site Summary and Dose Action Points windows. 

1. Right-click in the Diagnoses and Interventions window or press F4. 

Opens the Diagnoses and Interventions Options menu, shown in Figure 11. 

Figure 11: Diagnoses and Interventions Options Menu 

2. Click Dose Site Summary…. 

Opens the Dose Site Summary window, shown in Figure 12. 

Figure 12: Dose Site Summary Window


Notes The Dose Site Summary window contains the information and fields below: 

Site Shows all primary and secondary dose tracking sites. 

Start Tx Shows the date on which treatment to the site began. 

Last Tx Shows the date the site was last treated. 

Days Shows the number of days between the first and most recent 

treatments. 

Frac Shows the number of fractions administered to date, as well as 

the total number of fractions planned. 

Dose Shows the radiation dose delivered to date, as well as the total 

dose planned for this course of treatment. 

Prior Shows any dose previously delivered to this site as noted in 

the Primary Dose Tracking Site or the Secondary Dose 

Tracking Site dialog boxes. 

Total Shows the dose delivered to date, dose administered to the 

dose tracking site before the electronic medical record, and the 

total prescribed dose. 

Frac Dose Shows the dose to be delivered in each fraction. 

Technique Shows the radiation therapy technique used to administer dose 

to the site. 

3. Click . 

Shows the Dose Action Points window, from which you can 

add, view, or change Dose Action Points. 

Opens the Dose Action Points window, shown in Figure 13. 

You can also open the Dose Action Points window from the 

Diagnoses and Interventions window. Right-click or press F4 

to open the Options menu, then click Dose Action Points…. 


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Notes 



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Figure 13: Dose Action Points Window 

The Dose Action Points window shows: 

• The dose tracking site name. 

• Whether or not the dose action point was acknowledged. 

• By whom the dose action point was acknowledged. 

• Dose at which you must complete a task. 

• The type of dose action point (Standard, Mandatory, or Dose Limit) as 

defined in the Dose Action Point dialog box. 

• A description of the dose action point. 

4. Click . 

Refer to Lesson 6, Setting up Dose Tracking, in Module II of 

this guide for more information. 

Closes the Dose Action Points window. 

5. Click . 

Closes the Dose Site Summary window. 

6. Click . 

Closes the Diagnoses and Interventions window.


Notes 

Opening the Treatment Chart Window 

The Treatment Chart window has two views. The first is the Treatment Chart to 

review historic and planned treatments and initiate treatment delivery or QA Mode 

sessions. It also helps you monitor patient progress throughout the course of 

treatment. The second is the Treatment Calendar to plan radiation therapy treatments. 

Critical information is available in the Treatment Chart view, such as treatments given, 

accumulated dose, treatment fields, portal images recorded, MU, recording therapists, 

and doses. The Treatment Calendar manages treatment session schedules that you can 

refer to when you treat fields and take portal images. For information on how to use 

the Treatment Calendar, see Lesson 8 in Module II of this guide. In this exercise, you 

will open both views of the Treatment Chart window. 

1. Click eChart | Radiotherapy Treatment… or click . 

Opens the Treatment Chart window, shown in Figure 14. 

Click these icons to open the source window or dialog box 

associated with the info in the corresponding group. 

Diagnosis Group – Shows 

diagnosis and course info for the 

treatment event. 

Historic and Planned Treatment 

List – Shows a listing of daily 

treatments for the patient. 

Prescription Group – Shows 

radiation prescription info for the 

treatment event. 

Treatment Detail Group – 

Shows field detail information 

for the treatment event. 

Figure 14: Treatment Chart Window 


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Notes 



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If you have more treatments recorded or scheduled than fit 

in the Historic and Planned Treatment list, a scroll bar 

appears vertically on the right. Use this scroll bar to move 

up and down the list. 

Only the dose site columns scroll when you use the scroll box 

to show the fields hidden to the right. The dose site column 

heading shows the name of the dose site preceded by Rx: for 

prescribed treatment sites, RxCum: for Cumulative Primary 

Dose Tracking Sites, or Sec: for Secondary Dose Tracking 

Sites. Examples are Rx:Brain, or Sec:Cord. 

You can use the Treatment Chart to review previous and planned treatments. You 

can also use it to start treatment delivery. The Treatment Chart window contains 

the information and fields below: 

Diagnosis 

Group 

Prescription 

Group 

Treatment 

Detail Group 

Shows diagnosis and course information for the treatment 

session selected in the Historic and Planned Treatments List. 

Click to the left of the left-most to open the Diagnosis and 

Staging window. The lets you click in the group to open 

the Patient Care Plan dialog box. 

Shows radiation prescription information for the treatment 

session selected in the Historic and Planned Treatments List. 

The lets you click in the group to open the Radiation 

Prescriptions dialog box. 

Shows field detail information for the treatment session 

selected in the Historic and Planned Treatments List. The 

lets you click in the group to open the Historic Treatment 

dialog box. 

Historic and Planned Treatments List 

Session Shows basic information about the treatment session: 

No Shows the treatment session number for the summary 

treatment session only. Click to show the individual 

treatment field records. 

Date Shows the date of pending/administered treatment for 

the summary treatment session only. 

Time Shows the time of the administered/pending 

treatment.


Notes Field Shows information on treated or planned fields and delivered 

or planned portal imaging: 

ID Shows the number of treated or planned fields for 

the summary treatment session. For individual 

treatment fields, shows the field ID. 

Tx Shows the number of times the treatment field 

was or will be recorded. 

ED Shows the number of days that have elapsed or 

will elapse between the first treatment and the 

current treatment. 

Seq Shows field sequencing, if applicable. 

PI In the main treatment session, shows the number 

of fields with portal images. In the individual 

treatment fields, shows the number of portal 

image monitor units recorded for treated fields 

and the planned portal image(s) for planned fields. 

MU In the individual treatment fields, shows the 

number of monitor units delivered or scheduled 

for the field. 

Dose Shows the calculated field dose delivered or 

planned. 

Machine Shows the machine used or scheduled. 

Notes Shows the notes type indicator as applicable for both 

treatment sessions and individual treatment fields: 

T Historic Treatment Note 

S Field Setup Note 

P Prescription Site Note 

F Fraction Specific Note 

D Dose Action Point 

C Treatment Calendar Session Note 

Sts Shows the treatment status for delivered treatment or planned 

treatment: 

m Manually recorded treatment 

H Hidden fields for a planned treatment 

A Approved treatment field or session 

p Partial treatment of a planned treatment 

^ First actual or planned treatment with a new or updated 

treatment field definition or prescription 

* Overrides were recorded 

+ Includes data from multiple treatments and/or portal 

image records for a field in the same session 

By Shows the initials of the user(s) logged in at the time of 

treatment or who approved the planned treatment session. 


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Notes Rx: Shows as many as 20 dose site columns, but all dose sites are 

tracked even if they do not appear. Each dose site column 

contains sub-columns that give recorded or planned treatment 

information for the specified dose site. The dose site column 

heading identifies the dose site type: 

Rx: Prescribed Treatment Sites 

Sec: Secondary Sites 

RxCum: Cumulative Primary Dose Tracking Sites 

Cum: Secondary Cumulative Dose Tracking Sites 

The dose site type is followed by the dose site; for example, 

Rx:Left Central Breast or Cum:Lung. 

The columns in this section are shown below: 

Fx Shows the calculated number of fractions treated or 

planned for the prescription dose site or summary 

treatment sessions. 

Ses Non-Rx sites only. Shows the number of dose sitespecific 

treatment sessions delivered or planned for 

summary treatment sessions. 

ED Shows the number of days that have elapsed or are 

projected to elapse since the first treatment of the dose 

site for summary treatment sessions. 

Dly Shows the calculated daily dose actually delivered, or 

planned to be delivered, to the dose site during the 

session. 

Cum Shows the actual or planned cumulative dose to be 

delivered to the dose site. 

Shows the Treatment Calendar window, from which you can 

add, change, and remove treatment sessions. You can also 

schedule or change fields to treat and add portal imaging 

within sessions. 

Shows the Dose Site Summary window, from which you can 

view the radiation dose administered to each treatment site 

with a dose tracking site. 

Shows the Treatment Chart Notes window, from which you 

can view notes on patient radiation treatments. 

Shows the Treatment Delivery Table dialog box, from which 

you can deliver actual or manual treatments. 

Shows the Treatment Delivery Table dialog box in QA 

(Quality Assurance) mode, from which you can do a treatment 

field quality check. QA mode treatment sessions do not add to 

dose or fractions in the patient chart.


Notes 2. Click in the horizontal scroll bar to the right of the scroll box. 

Shows the hidden columns to the right. Only the dose site columns scroll. 

3. Click . 

Opens the Treatment Calendar view of the Treatment Chart window, shown in 

Figure 15. 

Tabs – Lets you insert and 

manage sessions or schedule 

Calendar View – Shows weeks of 

treatment and session(s) scheduled. 

Planned treatment session Dose action point reached 

Recorded individual treatment 

Recorded treatment session 

Portal Image – Schedules the type of 

portal image planned for the treatment. 

Figure 15: Treatment Calendar in the Treatment Chart Window 

You can also open the Treatment Calendar window from the 

Diagnoses and Interventions window. Click a radiation 

prescription, right-click or press F4 to open the Options 

menu, then click Treatment Calendar…. 


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Notes The Treatment Calendar has three tabs: Insert Sessions, Select Sessions, and 

Schedule Fields. The Treatment Calendar has a calendar (Calendar View) and a list 

of all sessions (Historic and Planned Treatment List). The Historic and Planned 

Treatments List at the bottom of the window is the same as the one that appears 

in the Treatment Chart window. For information on the Treatment Calendar, 

refer to Lesson 8 in Module II of this guide. 

The Treatment Calendar window has the information and fields below: 

Calendar 

View 

Shows scheduled treatment sessions in a calendar format. The 

format includes a week number (start of treatment is Week 1), 

the dates for each week, and the days of the week (starts with 

Sunday). When you select one day of the week, the date 

appears above the Calendar View. To select a treatment 

session in the History and Planned Treatment List, click a day 

of the week (cell) in the Calendar view. 

Portal Image Schedules portal images for the selected planned field. You 

can schedule a field for a maximum of one treatment for each 

session and as many portal images as necessary. 

Pre Schedules portal imaging to occur before you treat 

the planned treatment field. 

During Schedules portal imaging to occur during treatment 

of the planned treatment field. 

Post Schedules portal imaging to occur after you treat the 

planned treatment field. 

Only Schedules portal imaging only (no treatment) for the 

planned treatment field. 

Adds a portal image-only instance of the selected planned 

treatment field to the same treatment session. This lets you 

schedule a portal image and keep the scheduled field separate. 

Opens the main Treatment Chart window. 

Opens the Dose Site Summary window. 

Shows any notes associated with the treatment session for the 

patient. 

Opens the Treatment Calendar Session dialog box for a new 

treatment session. 

Opens the Treatment Calendar Session dialog box for the 

selected treatment session. 

Removes the selected treatment session(s).


Notes 

Opens the Record Status dialog box, which lets you change 

the status of a treatment session. 

Opening the Dosimetry Configuration Dialog 

Box 

In the Dosimetry Configuration dialog box, you can configure the dose unit for all 

MOSAIQ dialog boxes. You can also configure the defaults for the minimum time 

between treatment sessions and the dose required to count a partial treatment as a 

fraction. In this exercise, you will open the Dosimetry Configuration dialog box. 

1. Click File | System Utilities | Department Setup…, then click . 

Opens the Clinical (RO) tab of the Department Setup dialog box, shown in 

Figure 16. 

Figure 16: Department Setup Dialog Box – Clinical (RO) Tab 

2. Click . 

Opens the Dosimetry Configuration dialog box, shown in Figure 17. 


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Notes 



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IMPAC recommends you communicate all changes in this 

dialog box with the radiation oncologist(s) at your facility. 

Changes in this dialog box change how recorded treatments 

appear department-wide. 

Figure 17: Dosimetry Configuration Dialog Box 

MOSAIQ uses the global parameters in the Fractions 

Calculated group to calculate the number of fractions. You 

can override the parameters for a specified patient if 

necessary. 

The Dosimetry Configuration dialog box contains the information and fields 

below: 

Dose Units Sets MOSAIQ to use cGray (cGy) or Gray (Gy) for all of 

the windows that show dose units. The default is cGray. 

Fractions Calculation 

Minimum Interval Sets the amount of time (in hours and minutes) during 

which multiple treatment records are counted and 

appear as 1 fraction.. For example, a patient received 200 

cGy at 9 AM, but only received 20 cGy because the 

treatment session was interrupted. You must deliver the 

remaining 180 cGy within the Minimum Interval time for 

MOSAIQ to count the two sessions as 1 fraction.


Notes % of the 

Prescribed 

Fractional Dose 

Sets the relative minimum dose threshold as a 

percentage of the prescribed fractional dose. You must 

deliver this percentage during a treatment session for it 

to count as a fraction. For example, if you type 20% in 

this field and the patient only receives 40 cGy out of the 

prescribed fractional dose of 200 cGy, the treatment 

session counts as a fraction. Less than that does not. The 

default is 10%. 

And / Or Sets the dose threshold with a relative and/or an 

absolute dose: 

• Minimum relative dose in percentage. 

• Minimum absolute dose as a whole number. 

Select And if the dose must meet both criteria. 

Select Or if the dose must meet the lesser of the criteria. 

What’s Next 

Changes the configurations back to their defaults. 

In this lesson, you learned how to open and review the Home and Chart views, and 

the eCHART Navigator window and its four different views. You learned how to 

open the Diagnoses and Interventions window, the Dose Site Summary window, the 

Dose Action Points window, and the Treatment Chart window. You also learned how 

to open the Dosimetry Configuration window. Use the Quick Version as a concise, 

step-by-step guide when you must quickly apply any of the skills you have learned in 

this lesson or if you simply want to reinforce what you have learned. 

In the next lesson, you will learn how to add and affirm diagnosis and staging 

information, add prescriptions, and use Radiation Prescription Sequencing. You will 

also learn how to change prescriptions, append fractionation phases, add a Dose Limit 

dose action point, and view historical prescription data. 


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Notes Quick Version 

Using the Home View 

1. In the My Work List pane, click adjacent to the work list you want to view. 

2. In the shown work list, click the column by which you want to sort the work list. 

3. Click a work list item to show it in the Work List Detail pane. 

4. In the Work List Detail pane for the selected item, click a button, such as 

, to open the applicable dialog box or window. 

Opening the Chart View 

1. In the toolbar, click to open the Chart view. 

2. In the toolbar, click to open the Home view. 

Opening All of the eCHART Navigator Views 

1. If necessary, start MOSAIQ and log on to the Practice database using the impac user 

name and impac password. 

2. Click , then double-click a patient. 


4. Click . 

Opening the Diagnoses and Interventions Window 

1. In the menu bar, click eChart. 

2. Click Diagnoses and Interventions…, or click in the toolbar. 

Opening the Dose Site Summary and Dose Action Points 

Windows 


2. Click Dose Site Summary… to open the Dose Site Summary window. 

3. Click 

to open the Dose Action Points window. 

4. Click three times to close the open windows.


Notes Opening the Treatment Chart Window 

1. Click eChart | Radiotherapy Treatment…, or click to open the 

Treatment Chart window. 

2. Click in the horizontal scroll bar to the right of the scroll box to show the hidden 

columns to the right. 

3. Click to open the Treatment Calendar. 

4. Click . 

Opening the Dosimetry Configuration Dialog Box 


2. In the Department Setup dialog box, click . 


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Notes 



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Lesson 2 Adding Diagnoses, 

Care Plans, and 

Prescriptions 

Objectives 


• Add and affirm diagnosis and staging information 

• Assign Care Plans 

• Add radiation prescriptions 

• Use Radiation Prescription Sequencing 

• Add a Dose Limit dose action point 

• Change radiation prescriptions 

• Append fractionation phases 

• Show historical prescription data 

Radiation prescriptions are a basic part of the clinical chart in MOSAIQ. In this 

lesson, you will add and affirm diagnosis and staging information, assign care plans, 

add prescriptions, and use Radiation Prescription Sequencing. You will add a Dose 

Limit dose action point and change prescriptions. You will also append fractionation 

phases, and show historical prescription data. 

IMPAC realizes that your facility usage of the term “course” 

can differ from ours. Make sure you add your data in a way 

that is consistent with your usage of the term “course.” 

The figures in this manual are provided as a marker to make sure that you are at the 

correct place when doing the exercises. The figures can differ from what you see 

because of the patient you registered or changes you make to the practice database 

during other classes. 

Your screen can also vary from the examples shown in this 

guide if your current date and window dimensions are 

different.


Notes 

To admit a new patient, you must have Administrative | New 

Patient | Modify security rights. 

To open the Diagnoses and Interventions window, you must 

have Clinical | General | View security rights. 

To add a diagnosis, you must have Clinical | Diag/Staging | 

Modify security rights. 

To affirm a diagnosis, you must have Clinical | Diag/Staging 

| Approve security rights. 

To add a basic course/care plan, you must have Clinical | 

Care Plans | Modify security rights. 

To add or change a basic radiation prescription, you must 

have Clinical | Prescription | Modify security rights. 

To add dose action points, you must have Clinical | Action 

Points | Modify security rights. 

Adding Diagnosis and Staging Information 

eCHART has the Diagnosis and Staging window, which lets you add diagnosis and 

staging information as recommended by the AJCC. The information in the window 

includes the data set recommended by JCAHO for accreditation of a cancer program. 

It also includes the patient diagnosis (ICD-O code set) and the tumor stage by AJCC 

standards. It is also important to record the consult date, diagnosis category (also, the 

specific diagnosis if you know it), and treatment objective for reporting purposes. In 

the following exercises, you will open the Diagnosis and Staging window, add 

diagnosis information, and affirm a diagnosis. 

Refer to Using Diagnosis and Staging, LPNMED0010, for 

more information on how to stage a cancer diagnosis or add 

tumor information. 

Opening the Diagnosis and Staging Window 

You can open the Diagnosis and Staging window from the Diagnosis and Problem 

List dialog box through the Diagnoses and Interventions window. You can also open 

it from the Diagnosis and Problem List pane in the Chart view. In this exercise, you 

will open the Diagnosis and Staging window from the Diagnoses and Interventions 

window. 

1. Quick-register a new patient and add a patient ID and an attending physician. 

2. Open the chart for your lesson patient, if necessary. 


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Notes 

Lesson 2: Adding Diagnoses, Care Plans, and Prescriptions 


LTGRAD0005A/2.0/26-Feb-2009 

3. Click eChart | Diagnoses and Interventions… or click in the toolbar. 

Opens the Radiation tab of the Diagnoses and Interventions window for your 

patient. The window is blank because the patient has no diagnosis added or care 

plan assigned. 

4. Click in the Add group. 

Opens the Diagnosis and Problem List dialog box briefly, then opens the 

Diagnosis and Staging window, shown in Figure 18. 

To open the Diagnosis and Problem List dialog box from the 

Chart view, click in the top right corner of the Diagnosis 

and Problem List pane. Click Go To. Click to 

open the Diagnosis and Staging window. 

Diagnosis category and type 

Can use ICD-9, ICD-10, 

or ICD-O-3 code sets. 

Add more information 

Shows the Diagnosis folder in 

Diagnoses and Interventions as closed. 

Configures Diagnosis and Staging window. 

Inactivates diagnosis; date 

appears in field to right. 

Adds tumor marker results 

directly from Flowsheet. 

Shows existing tumor markers. 

Adds tumor marker(s) from 

Diagnosis and Staging. 

Figure 18: Diagnosis and Staging Window 

Initial diagnosis 

and consult dates. 

Age calculated automatically.


Notes The Diagnosis and Staging window has multiple tabs. The Staging tab has two 

major sections, Clinical and Pathologic, that let you stage the cancer for clinical and 

pathology findings. The N/A field applies only to some diagnoses. Also, the 

Staged By and Edition fields for the sections automatically show your initials and the 

staging method respectively. 

The Tumor tab lets you add multiple tumor measurements and tumor 

information, such as positive nodes. The Details tab lets you add or change 

information such as the basis of the staging or diagnosis and shows a history of 

changes to the diagnosis. The Additional Classifiers tab lets you apply additional 

staging classifiers that apply to the patient diagnosis. The Collaborative Staging tab 

has fields that you can use to describe how far a cancer has spread at the time of 

diagnosis. 

Adding Diagnosis Information 

When you add diagnosis and staging information, the only required information is the 

diagnosis. In this exercise, you will add diagnosis information. 

The diagnosis you select changes the available options for 

many of the fields. Make sure you select the diagnosis first so 

that the applicable options appear. 

1. In the Diagnosis and Staging window, click adjacent to the Initial Diagnosis field. 

Opens the Calendar dialog box, shown in Figure 19. 

Figure 19: Calendar Dialog Box 

The Initial Diagnosis specifies when the diagnosis was made (defaults to blank). 

You can use the arrow buttons to show current or previous months, then click the 

date. An error message appears if you select a future month or day. 

2. Click a date from the previous week. 

Closes the Calendar dialog box and adds the initial diagnosis date to the Initial 

Diagnosis field. After you choose a date, you can type the new date in the 

MM/DD/YYYY format. 

3. Click adjacent to the Diagnosis field. 

Opens the Diagnosis field list tabs, shown in Figure 20. 


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Notes 



LTGRAD0005A/2.0/26-Feb-2009 

Figure 20: Diagnosis Field List Tabs 

You can select from different diagnosis coding systems, such as ICD-9, ICD-10, 

and ICD-O-3. The tab that first appears is the default diagnosis coding system for 

your facility, but you can click a diagnosis from a different coding system. If a tab 

has no diagnoses configured for that coding system, No results found appears. 

You can type a diagnosis category in the Diagnosis field to 

show the desired code group(s). You can also type a partial 

diagnosis description (such as bre), a partial diagnosis code 

(such as 11), or a diagnosis group number (such as 174). If 

you keep the field blank, the Diagnosis field list shows all the 

diagnosis codes in the system for the selected tab. 

4. Type 162.3 in the Diagnosis field, then click . 

Adds the diagnosis for your patient, shown in Figure 21. 

Figure 21: Diagnosis and Staging with Diagnosis Selected 

The diagnosis category LUNG appears in the Category field. If the selected 

diagnosis has an applicable diagnosis category, it appears in the Category field. 

5. Click Left from the Laterality field. 

The cancer diagnosis applies to the left lung. 

6. Type 8070/3 00 in the Morphology field. 

Adds the morphology code for the disease, shown in Figure 22.


Notes 

Figure 22: Diagnosis and Staging Showing Morphology 

The Age at Dx field shows the age of the patient. MOSAIQ uses the date you 

added in the Initial Diagnosis to calculate the age. Keep the Tumor Markers field 

blank. 

7. Type other necessary information about the diagnosis in the Notes field. 

Specifies any information about the diagnosis, such as lab results or the name of 

the physician who made the diagnosis. 

Affirming a Diagnosis 

You must affirm the diagnosis for it to appear in the Diagnoses and Intervention 

window. You also cannot assign a Care Plan or add a radiation prescription without an 

affirmed diagnosis. In this exercise, you will affirm and save the diagnosis. 

IMPAC recommends that the radiation oncologists affirm the 

diagnosis in a clinical setting. For this exercise, you must 

affirm the diagnosis so that you can add the Care Plan and 

other treatment information in Lesson 3 of this module. 

1. In the Diagnosis and Staging window, click . 

Changes the state of the diagnosis to Affirmed. is no longer 

active. The message This diagnosis has been affirmed appears adjacent to the inactive 

button, shown in Figure 23. 


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Notes 



LTGRAD0005A/2.0/26-Feb-2009 

Figure 23: Diagnosis and Staging with Affirmed Diagnosis 

2. Click . 

Saves the diagnosis information. The diagnosis appears in the Diagnosis and 

Problem List dialog box as shown in Figure 24. 

Figure 24: Diagnosis and Problem List with New Diagnosis


Notes The Diagnosis and Problem List dialog box shows all of the patient diagnoses and 

contains the information and fields below: 

Show Code 

Capture 

Sequence 

If selected, shows a list of the patient diagnoses at the bottom 

of the dialog box. The diagnoses are prioritized by the most 

current diagnosis treated and billed for procedures and 

supplies. 

Dx Date Shows the initial date of the diagnosis. 

Dx Shows the diagnosis code. 

Description Shows a description of the diagnosis for the patient. 

Inactive Date Shows the date the diagnosis became inactive. 

State Shows Imported if the diagnosis was imported from an HL7 or 

ESI interface. Shows Entered if the diagnosis was manually 

added in Diagnoses and Interventions, Patient Demographic 

Data, NEW Patient Registration, Code Capture, or Multi- 

Code Capture. Shows Affirmed if the diagnosis was affirmed by 

a clinician with Clinical/Diag Staging | Approve security rights. 

MOSAIQ highlights a diagnosis in gray if it was added from 

the Code Capture or Multi-Code Capture dialog boxes. When 

a clinician affirms this particular diagnosis, the background 

turns to white. 

Source Shows the source from which the diagnosis is saved: External 

Interface, D&I (for Diagnoses and Interventions), Code Capture, 

or Administrative. 

List Order 

Opens the Diagnosis and Staging window to add a new 

diagnosis. 

Opens the Diagnosis and Staging window for the diagnosis 

code of the diagnosis selected in the Diagnosis and Problem 

List dialog box. 

Removes the selected diagnosis. You can remove a diagnosis 

only if the diagnosis has no assigned Care Plan(s) or related 

diagnoses. 

When there is more than one diagnosis in the list, you can 

change the sequence of the diagnosis information. Click one 

of the buttons to move a diagnosis up or down. 

The up/down arrow buttons put the diagnoses in the required 

billing order as they appear in the Code Capture dialog box. 


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Notes 3. Click . 

Closes the Diagnosis and Problem List dialog box. The diagnosis you added 

appears in the Diagnoses and Interventions window. 

Figure 25: Diagnoses and Interventions with New Diagnosis


Notes 

Assigning Care Plans 

Before you can add a prescription, simulation fields, and treatment fields, you must 

assign a Care Plan to add the course of treatment. In this exercise, you will assign a 

Care Plan. 

If a patient has multiple diagnoses, you must click the 

diagnosis with which you want to associate the Care Plan 

before you click . 

1. In the Diagnoses and Interventions window, click in the Add group. 

Opens the Patient Care Plan dialog box, shown in Figure 26. 

Figure 26: Patient Care Plan Dialog Box 

The Patient Care Plan dialog box shows the course number, start date and time, 

assigning physician, treatment intent, and modality indicators. The Regimen field 

shows Radiation Care Plan because the care plan is an Ad Hoc care plan rather than 

a Care Plan template approved by your facility. 

2. Click adjacent to the Care Plan field. 

Opens the Care Plans window, shown in Figure 27. 


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Notes 



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Figure 27: Care Plans Window 

The Care Plans window shows the approved Care Plans used by your facility. The 

header of the window can show information about the primary disease that the 

Care Plan is intended to treat if your system administrator configured this 

information. The top pane includes the category, name, regimen, cycle days, cost, 

and status of the Care Plans. The bottom pane shows detailed activities from the 

Care Plan selected in the top pane. Order sets are the building blocks of Care 

Plans. Order sets are made up of activities, such as immobilization devices, beam 

modifiers, laboratory tests, nursing activities, radiology orders, medications, and 

supplies. 

In this exercise, you will not add a specific Care Plan to the course of treatment, 

but will add an Ad Hoc care plan. 

3. Click . 

For information on how to configure Care Plans, refer to the 

MOSAIQ System Configuration Guide for Radiation Oncology 

and the Radiation Oncology Care Plans document, 

LPN15008. 

Closes the Care Plans window and shows the Patient Care Plan dialog box. 

4. Click Curative (primary) from the Intent field. 

Specifies the treatment intent. 

5. Click Yes from the External Beam field. 

Specifies the treatment modality.



Adds the course to the diagnosis as shown in Figure 28. 

Figure 28: Diagnoses and Interventions Window with Diagnosis and Course 

The course is related to the diagnosis, as identified by the indentation and 

connecting line. 

Adding Prescriptions 

When adding prescriptions, you must add the required information for each 

prescription site. You can add and change information for each site in the same 

treatment course from the Radiation Prescriptions dialog box. In this exercise, you will 

add prescription information. 

The Radiation Oncology Physician Training Guide Module II 

(LTGRAD0003B) includes instructions on how to approve a 

radiation prescription. 

1. In the Diagnoses and Interventions window, click Radiation Oncology Course: 

1, then click in the Add group. 

Opens the Radiation Prescriptions dialog box. 


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Shows the Radiation Prescriptions dialog box in edit mode, shown in Figure 29. 

Displays diagnosis 

and course 

Fraction and dose 

information 

Figure 29: Radiation Prescriptions Dialog Box in Edit Mode 

Use the Radiation Prescriptions dialog box to add or change information about 

patient prescriptions and to manage a set of prescription sites in the same course 

of treatment. The top part of the dialog box shows the diagnosis for the selected 

course. It also has a table that shows a summary of all the prescription sites for 

this course. The bottom part has three different views to add a prescription for a 

new site in an existing or new course. You can also change or view the 

prescription for each site in the course. 

3. Type Lung in the Rx Site field, then press TAB. 

Adds the prescription site, then moves the insertion point to the Technique field. 

4. Click AP/PA from the Technique field. 

Specifies the technique. 

5. Click x06 from the Modality field. 

Specifies the treatment modality. 

Conventional prescription 

information 

Calendar view of 

prescribed fractions 

6. Click Isodose from the Dose Spec field, then press TAB. 

Summary of existing 

prescriptions, if any 

Adds the dose specification, then moves the insertion point to the second box.


Notes 7. Type 90, press TAB, select % from the second Dose Spec field. 

Specifies an Rx to the 90 percent isodose line. 

8. Type 5000 in the Rx Dose field. 

Specifies the total dose for the radiation prescription. This is the first field of the 

table that is directly below the Dose Spec field. The fields in this table apply to 

fractionation details. 

MOSAIQ uses the information you type in the Rx Dose and 

Fractional Dose fields to calculate the number of fractions. 

This information is also used to make sure the dose in other 

areas of the system is correct. 

9. Type 200 in the Fractional Dose field. 

Specifies the dose to deliver for each treatment fraction, shown in Figure 30. 

Figure 30: Partially Completed Radiation Prescriptions Dialog Box 

The Number of Fractions field shows 25. This is the number of fractions with which 

to treat this site and is calculated from the total dose and fractional dose you 

typed. The calendar view on the right side of the fractionation phase field shows 

25FxPattern? because the radiation prescription does not have a fractionation 

pattern. 

10. Click adjacent to the Fractionation Pattern field. 

Opens the Wave Setup Form dialog box, shown in Figure 31. 


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Notes 



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Figure 31: Wave Setup Form Dialog Box 

The Wave Setup Form dialog box lets you add multiple instances of 

appointments, medications, Care Plan order sets, and orders with a variety of 

patterns. You can also use it to add the fractionation pattern with which to deliver 

the treatment. The Wave Setup Form dialog box contains the information and 

fields shown below: 

Start Specifies when to start the recurring appointment or 

fractionation pattern. TBD is the default setting and identifies 

that the day on which to start treatments is unknown. This is 

the default setting. Click On a certain day of the week to show the 

Day of week field. Type or click the day to start treatment of the 

first fraction in the Day of week field. 

End Shows the number in the Number of Fractions field on the 

Radiation Prescriptions dialog box and specifies to end the 

treatment after the last fraction. This is the default setting. 

Click or type a new number in the Times field. 

Times Per Day 

Once Specifies to deliver only one fraction per day. This is the 

default setting. 

BID Shows a 2 in the Times field and specifies to deliver two 

fractions each day. Type the number of hours before you 

deliver the second fraction in the Interval field.


Notes TID Shows a 3 in the Times field and specifies to deliver three 

fractions each day. Type the number of hours between each 

treatment in the Interval field. 

Pattern 

Daily Specifies to repeat the fractions on daily intervals. Every Day is 

the default setting. You can also click Every other day or Every n 

Days. To add weekends or holidays, click the applicable Include 

checkboxes: Saturday, Sunday, and Holidays. 

Weekly Specifies to repeat the fractions weekly: Every week or Every n 

Weeks. Click Mon, Tue, Wed, Thur, and Fri to specify the days of 

the week. To add weekends or holidays, click the applicable 

Include checkboxes: Saturday, Sunday, and Holidays. 

Bi-Weekly Specifies to repeat the fractions on a bi-weekly basis. Click 

Mon, Tue, Wed, Thur, and Fri to specify the days of each week. 

To add weekends or holidays, click the applicable Include 

checkboxes: Saturday, Sunday, and Holidays. 

11. Click . 

Accepts the default settings, then closes the Wave Setup Form dialog box. Daily 

appears in the Fractionation Pattern field as shown in Figure 32. 

Calendar view shows the fractionation pattern for the 25 fractions. 

Fractions are automatically calculated. These are the number of 

treatment sessions necessary to deliver the prescribed dose. 

Figure 32: Radiation Prescriptions Dialog Box Showing Calendar View 


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Notes The Treatment Calendar uses the information in the Fractionation Pattern field to 

add treatment sessions. Refer to Lesson 8 in Module II of this guide. The calendar 

view in Radiation Prescriptions shows the sequence in which treatment sessions in 

the same course are treated relative to one another. 

If you know the text string of the temporal fractionation 

pattern, such as Daily, Every Other Day, BID (for twice daily), 

or MWF (for weekly on Mondays, Wednesdays, and Fridays), 

you can type it in the Fractionation Pattern field. 

Click to open the Dose Limits window. You will use the Dose Limits 

window to add a Dose Limit dose action point in a future exercise. Close the 

Dose Limits window. 

12. Type CBC weekly in the Comment field. 

Specifies a prescription note that appears in several locations within MOSAIQ. 

13. Click . 

Opens the Radiation Prescriptions note window, shown in Figure 33. 

Figure 33: Radiation Prescriptions Note Window 

14. Type Dr requested CBC Weekly in the Subject field, then press TAB. 

Adds a subject for the prescription note, then moves the insertion point to the 

body of the note. 

15. Type Dr requested that patient have a weekly CBC done after receiving 

the last fraction for the week, then click . 

Adds the note text, then closes the Radiation Prescriptions note window. A green 

checkmark appears adjacent to if the radiation prescription has an 

attached note as shown in Figure 34.


Notes 

Figure 34: Radiations Prescriptions Dialog Box with Note 

Click to open the Fraction Specific Note window. It lets you add notes 

for the fractions. You will add a fraction note in the 


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Notes Appending Fractionation Phases exercise in this lesson. 

16. Click . 

Completes the prescription for this treatment site, then closes the Radiation 

Prescriptions dialog box. A summary of the new prescription appears in the top 

section of the Radiation Prescriptions dialog box. 

17. Click . 

Closes the Radiation Prescriptions dialog box. The new prescription appears in 

the Diagnoses and Interventions window as shown in Figure 35. 

Figure 35: Diagnoses and Interventions Window with New Prescription


Notes The new prescription is associated with Radiation Oncology Course: 1, identified by 

the indentation and connecting line. The Status column is blank because the 

prescription is not approved. 

If you make an error or must add new information, you can 

change a prescription before you approve it. 

Using Radiation Prescription Sequencing 

Use Radiation Prescription Sequencing to set up the start date of a new prescription 

site in relation to other sites in the same treatment course. Radiation Prescription 

Sequencing is also known as site sequencing. In this exercise, you will add site 

sequencing for a second prescription site, then add prescription data for the site. 

1. In the Diagnoses and Interventions window, click Radiation Oncology 

Course: 1, then click in the Add group. 

Opens the Radiation Prescription Sequencing dialog box, shown in Figure 36. 

Figure 36: Radiation Prescription Sequencing Dialog Box 

The Radiation Prescription Sequencing dialog box only opens if you add 

prescription sites to the same course. If you click , Sequencing? appears in 

the second column of the calendar view in the Radiation Prescriptions dialog box. 

It appears when there is no site sequencing for the second radiation prescription. 

The Radiation Prescription Sequencing dialog box contains the information and 

fields below: 

Treat this Rx Site 

Concurrent 

with 

beginning of 

Overlapping 

with 

Specifies to deliver the first fraction for the prescription site 

in the same treatment session as the first fraction of the 

selected prescription site. 

Specifies to deliver the first fraction for the prescription site 

after a prior site is started but before it is completed. The 

overlap is identified in the Treat the first fraction of this Rx Site 

at least group. 


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Notes After Specifies to deliver the first fraction for the prescription site 

after you complete the selected prescription site in the Site 

field. This is the default setting. 

Site Specifies the prescription site to use in site sequencing. The 

list only shows prescription sites in the same course that 

come before the prescription site for which you are 

identifying site sequencing. 

Treat the first fraction of this Rx Site at least 

Number of 

days or hours 

Specifies the number of hours or days to start the first 

fraction for the prescription site after the specified fraction 

for the selected prescription site. You select the prescription 

site from the Site field. 

Days or hours Specifies days or hours as the unit of time to start the first 

fraction of the prescription site in relation to the specified 

fraction for the selected prescription site in the Site field. 

You must add the number of hours between sessions for 

concurrent sites you will treat in different BID sessions. 

After Fraction Specifies one of the fractions for the selected prescription 

site in the Site field. This is the last fraction delivered when 

you start treatment of the first fraction of the prescription 

site for which you identify site sequencing. This field 

defaults to the number of fractions in the prescription 

selected in the Site field. 

Of Site Shows the prescription site selected in the Site field. 

2. Click . 

Accepts the default settings in the Radiation Prescription Sequencing dialog box, 

then shows the Radiation Prescriptions dialog box. 

3. Fill in the Radiation Prescriptions dialog box as shown below: 

Field Data 

Rx Site Lung Boost 

Technique Obliques 

Modality x15 

Dose Spec Plan 

Rx Dose 900 

Fractional Dose 150 

Total Cum 5900


Notes The Total Cum field is the maximum total dose that you intend to administer to 

this site from all prescriptions. 

4. Click . 

Saves the changes and shows the prescription in view-only mode. A summary line 

about site sequencing appears above the calendar view, shown in Figure 37. 

Site sequencing for 2 nd prescription site. 

Figure 37: Radiation Prescriptions Dialog Box with Site Sequencing 

Adding Dose Limit Dose Action Points 

Dose Limit dose action points let you make a recurring alert for a dose related 

task. For example, you must change the field shape to avoid critical structures 

such as the spinal cord. In this exercise, you will add a Dose Limit dose action 

point. 

For Dose Action Points to operate correctly, you must set up 

dosimetry for the applicable dose tracking site. To do so, 

add the dose site coefficients that calculate the dose 

contributions from each applicable prescription site. Refer 

to Lesson 6 in Module II of this guide. 

1. In the Radiation Prescriptions dialog box, double-click the Lung Boost prescription, 

then click . 

Opens the Dose Limits window, shown in Figure 38. 


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Notes 



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Figure 38: Dose Limits Window 

The Dose Limits window shows all Dose Limit dose action points for the selected 

patient. You can also add, change, or remove Dose Limit dose action points. You 

can also manage Dose Limit dose action points from the Dose Action Points 

window. 

There are three types of Dose Action Points: Standard, Mandatory, and Dose 

Limit. Dose Limit dose action points are Mandatory dose action points that make 

a duplicate dose action point each time you acknowledge them. This makes sure 

therapists see the alert each time they treat the patient. To close a Dose Limit dose 

action point and stop the alert, you must change it to a Standard or Mandatory 

dose action point, then acknowledge it. Mandatory dose action points do not 

appear after you acknowledge them. You do not have to acknowledge a Standard 

dose action point. 

2. Click . 

Opens the Dose Limit dialog box, shown in Figure 39. 

Figure 39: Dose Limit Dialog Box 

3. Type Heart in the Dose Tracking Site field. 

Adds a new dose tracking site to which the Dose Limit dose action point applies. 

You can also select an existing dose tracking site. 

4. Type 6000 in the Dose Limit field. 

Specifies a maximum dose for the dose tracking site.


Notes 5. Type Do not exceed the dose limit for this critical structure in the Comment 

field. 

Specifies a mandatory comment for the dose tracking site. 

6. Click . 

Saves the Dose Limit dose action point, then closes the Dose Limit dialog box. 

The new Dose Action Point is shown in Figure 40. 

Figure 40: Dose Limits Window with New Dose Limit Dose Action Point 

7. Click , then click . 

Closes the Dose Limits window. 

Changing Prescriptions 

You can change a prescription before or after it is approved by the radiation 

oncologist. When you change an approved prescription, the approval is removed. The 

radiation oncologist must approve again each prescription that you change. Make sure 

you set up site sequencing again if your edits also change the fractions. In this exercise, 

you will change a prescription. 

1. Click the Lung prescription in the top part of the Radiation Prescriptions dialog 

box, then click . 

Highlights the prescription in the table at the top of the Radiation Prescriptions 

dialog box, then shows the prescription in edit mode. 

2. Type 4320 in the Rx Dose field, then type 180 in the Fractional Dose field. 

Changes the total prescribed and fractional dose. The number of fractions changes 

to 24. 

3. Click . 

Accepts and saves the change, then opens the Radiation Prescriptions dialog box 

in view-only mode as shown in Figure 41. 


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Notes 



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Figure 41: Radiation Prescriptions Showing Change 

Sequencing? appears in the calendar, which tells you that you must do the site 

sequencing of the second prescription again. 

4. Click the Lung Boost prescription at the top of the Radiation Prescriptions dialog 

box. 

Highlights the second treatment site in the course. A message above the calendar 

view tells you that the site sequencing is not correct as shown in Figure 42. 

Site sequencing was removed. 

Figure 42: Radiation Prescriptions Dialog Box – Site Sequencing Not Valid


Notes 

5. Click . 

You can put your cursor above a fraction in the calendar 

view. This shows a pop-up information box about the 

scheduled fraction(s) for that day. If a plus sign (+) appears 

with the fraction number, there are overlapping fractions. 

Opens the prescription in edit mode for the selected prescription site. 

6. Right-click or press F4. 

Opens the Radiation Prescriptions Options menu, shown in Figure 43. 

7. Click Site Sequencing…. 

Figure 43: Radiation Prescriptions Options Menu 

Opens the Radiation Prescription Sequencing dialog box, shown in Figure 44. 

Figure 44: Radiation Prescription Sequencing – Setting the Sequencing 

Again 

8. Click After in the Treat Rx Site group. 

Specifies to start treatment of the first fraction of the second prescription site after 

the last fraction of the first prescription site. The After Fraction field automatically 

changes to 24 because of the new prescription information for the first 

prescription site, shown in Figure 45. 


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Notes 



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Figure 45: Radiation Prescription Sequencing – Automatic Change in 

Fractions 


Accepts the new site sequencing and closes the Radiation Prescription Sequencing 

dialog box. The prescription appears in view-only mode, shown in Figure 46. 

Figure 46: Radiation Prescriptions with New Site Sequencing


Notes 

Appending Fractionation Phases 

With fractionation phases, you can append a prescription to add fractions with 

different properties. When you use fractionation phases, you can change the fractional 

dose or the fractionation pattern, add treatment breaks, or remove full fractionation 

phases. You cannot remove information that applies to treated fractions. In this 

exercise, you will append the prescription for the second site, add a fraction note, 

change a fractionation phase, and remove a fractionation phase. 

1. In the Radiation Prescriptions dialog box, click the Lung Boost prescription site, 

click , then click . 

Opens the Radiation Prescription Phase Start dialog box, shown in Figure 47. 

Figure 47: Radiation Prescription Phase Start Dialog Box 

Use the Radiation Prescription Phase Start dialog box to set the time interval of 

fractions between fractionation phases in the same prescription. 

2. Type 2 in the first text field, then click . 

Specifies a 2-day interval, then closes the Radiation Prescription Phase Start dialog 

box. The radiation prescription has a second line, shown in Figure 48. 

Figure 48: Radiation Prescription with Phase Sequencing 


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Notes 3. Type 180 in the second Rx Dose field, then press TAB. 

Adds the total prescribed dose for the new fractionation phase, then moves the 

insertion point to the Fractional Dose field. 

4. Type 90 in the second Fractional Dose field then press TAB. 

Adds the fractional dose and the number of fractions, then moves the insertion 

point to the Fractionation Pattern field. 2 appears in the Number of Fractions field. 

5. Click adjacent to the Fractionation Pattern field, click Every Other Day in the 

Pattern group, then click . 

Opens the Wave Setup Form dialog box, specifies to treat the new fractions every 

other day, then closes the dialog box. New fractions, 31 and 32, appear in the 

calendar view as shown in Figure 49. 

Figure 49: Radiation Prescription with Fractions Appended 

6. Click . 

Opens the Fraction Specific Notes window, shown in Figure 50.


Notes 

Figure 50: Fraction Specific Notes Window 

Use Fraction Specific Notes to record changes to the 

prescription; for example, to change the fractional dose 

from 200 to 180. If you add a Fraction Specific Note in the 

prescription, an F appears in the Notes column of the 

Treatment Calendar. To open these notes in the Treatment 

Calendar, click or right-click, then click Notes…. 

There are no other alerts or note messages in the system 

for Fraction Specific Notes. 

7. Double-click 7 in the Fraction column. 

Opens the Rx Site: Lung Boost, Fraction 7 Note window, shown in Figure 51. 

Figure 51: Rx Site: Lung Boost, Fraction 7 Note Window 

8. Type Adding two fractions, then press TAB. 

Specifies the subject line of the fraction note, then moves the insertion point to 

the body of the note. 


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Notes 9. Type The patient can tolerate the dose, so adding two more fractions, 

then click . 

Adds the fraction note, then closes the Rx Site: Lung Boost, Fraction 7 Note 

window. The note appears for Fraction 7, shown in Figure 52. 

Figure 52: Fraction Specific Notes Window with New Note 


Saves the changes and shows the Radiation Prescriptions dialog box in view-only 

mode, shown in Figure 53. 

Shows the sum of 

both fractionation 

phases. 

Variable fractional dose. 

New fractions. 

Figure 53: Radiation Prescriptions Dialog Box – 2 nd Fractionation Phase 

A green checkmark appears adjacent the button. 

Identifies a 

fraction note.


Notes 11. Double-click the second fractionation phase. 

Opens the selected fractionation phase in edit mode. 

12. Type 200 in the Rx Dose field for the second fractionation phase, then press TAB. 

Adds the new total prescribed dose, then opens an error message, shown in 

Figure 54. 

Figure 54: Error Message – Changing Total Prescribed Dose 

This error message tells you to add the applicable fractional dose for the new total 

dose. The total dose must divide equally into the fractional dose so that the system 

can calculate the number of fractions. 

13. Click . 

Closes the error message. 

14. Type 100 in the Fractional Dose field, then click . 

Adds the new fractional dose and automatically adds the number of fractions, 

then opens the prescription in view-only mode. 

If all of the fractions are treated and you clicked that fractionation phase, then 

clicked , the Change Not Allowed message box appears, shown in 

Figure 55. 

Figure 55: Change Not Allowed Message Box 

If only some of the fractions were treated in the first fractionation phase, the 

remaining fractions that were not treated appear in their own fractionation phase. 

You can click to change the total prescribed dose, fractional dose, and 

fractionation pattern for the untreated fractions. 

15. Make sure the Lung Boost prescription is still selected, then click . 

Opens the Lung Boost prescription in edit mode. 

16. Click the second fractionation phase that you added in this exercise. 

Selects the second fractionation phase. 


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Removes the second fractionation phase. 

18. Click . 

You cannot remove a fractionation phase if you have 

treated some of the fractions. 

Saves the changes, then shows the Lung Boost prescription in view-only mode. 

19. Click . 

Closes the Radiation Prescriptions dialog box. 

Showing Historical Prescription Data 

eCHART keeps a historical record of all approved prescriptions for each patient. By 

default, only the most recent version of the prescription, approved or unapproved, 

appears in the Diagnoses and Interventions window. But, you can review a list of all 

prior approved prescriptions. In this exercise, you will review historical prescription 

data. 

1. Open the chart of a patient with previously approved prescriptions, then open the 

Diagnoses and Interventions window. 

Opens the Diagnoses and Interventions window. 

2. Right-click in the window or press F4, then click Historical View. 

Opens the Diagnoses and Interventions window in Historical view as shown in 

Figure 56.


Notes 

Figure 56: Diagnoses and Interventions Window – Historical View 

You can also press CTRL+I to show the Historical view. 

A historical approved prescription appears above the current prescription and is 

“grayed out” or dimmed. The course and prescription site are not repeated for 

historical versions of a prescription. Dimmed or grayed out text always identifies 

historical or voided items. 

You cannot change or remove historical prescriptions; they 

are view-only. 


Opens the Diagnoses and Interventions Options menu. The Historical View 

option has a checkmark that appears on the left. This identifies the option as a 

toggle command and that it is active. 

4. Click Historical View. 

Shows the Diagnoses and Interventions window in normal view. 

5. Close the Diagnoses and Interventions window. 

6. Close the patient chart. 


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Notes What’s Next 

In this lesson, you learned how to add and affirm diagnosis information, assign a care 

plan and prescriptions, apply site sequencing, change prescriptions, and view historical 

prescription data. You also learned how to append prescriptions and view historical 

prescription data. Use the Quick Version as a concise, step-by-step guide when you 

must quickly apply any of the skills you have learned in this lesson or if you simply 

want to reinforce what you have learned. 

In the next lesson, you will learn how to add simulation fields, positioning devices, site 

simulations, and a site setup. You will learn how to copy simulation fields into 

treatment fields and add field/MU dose specifications, accessory, geometric settings. 

You will add treatment field notes, apply tolerance tables, copy treatment fields, set up 

accessory verification, and manually add treatment fields. You will also change 

treatment fields, approve treatment fields, and review Diagnoses and Interventions 

options for treatment fields.


Notes 

Quick Version 

Opening the Diagnosis and Staging Window 

1. Open the chart of the patient. 

2. Click eChart | Diagnoses and Interventions… to open the Diagnoses and 


3. Click in the Add group to open the Diagnosis and Problem List dialog 

box. 

4. Click to open the Diagnosis and Staging window. 

Adding Diagnosis Information 

1. In the Diagnosis and Staging window, click adjacent to the Initial Diagnosis field 

to open the Calendar dialog box. 

2. Click the current date or a prior date to fill in the Initial Diagnosis field with the 

date. 

3. Change the Consultation date if it is not the current date. Change the Type field if 

the diagnosis is not the primary diagnosis for the patient. 

4. Click adjacent to the Diagnosis field to open the Diagnosis field list tabs. 

5. Type a diagnosis category, such as lung in the Diagnosis field, then click . You 

can also type a partial of a diagnosis description, partial diagnosis code, or 

diagnosis group number. 

6. Scroll through the diagnosis groups, then click adjacent to one of the diagnosis 

groups, then click a diagnosis. 

7. Select the Laterality field of the diagnosis, if necessary. 

8. Type a partial description or code in the Morphology field, then click to show the 

Morphology field list. 

9. Scroll through the morphology groups, then click adjacent to one of the groups, 

then click the applicable morphology code. 

10. Add tumor marker information in the Tumor Markers field(s) or type more 

information about the diagnosis in the Notes field. 


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Notes Affirming a Diagnosis 

1. In the Diagnosis and Staging window, click . 

2. Click to save the diagnosis and close the Diagnosis and Staging 

window. 

3. Click to close the Diagnosis and Problem List dialog box. 

Assigning Care Plans 

1. In the Diagnoses and Interventions window, click in the Add group to 

open the Patient Care Plan dialog box. 

2. Click adjacent to the Care Plan field to open the Care Plans window. 

3. Click . 

4. In the Patient Care Plan dialog box, click the treatment intent from the Intent field, 

such as Curative (primary). 

5. In the Treatment Modality group, select the treatment modality, such as External 

Beam field. 

6. Click to add the course of treatment to the patient chart. 

Adding Prescriptions 

1. In the Diagnoses and Interventions window, click the course of treatment, then 

click in the Add group. 

2. In the Radiation Prescriptions dialog box, click to open the Radiation 

Prescriptions dialog box in edit mode. 

3. Type the name of the prescription site in the Rx Site field. 

4. Click the technique, such as AP/PA, from the Technique field. 

5. Click the treatment modality, such as x06, from the Modality field. 

6. Click adjacent to the Dose Spec field, then select the dose specification name, 

such as Isodose. 

7. Type the isodose percentage in the second field (text field to the right of the Dose 

Spec field), then select % in the adjacent field. 

8. Type the total dose in the Rx Dose field. 

9. Type the dose to deliver for each treatment fraction in the Fractional Dose field. 

10. Click adjacent to the Fractionation Pattern field to open the Wave Setup Form 

dialog box.


Notes 11. Click to accept the default (Daily) and close the Wave Setup Form 

dialog box. 

12. Type a brief prescription note in the Comment field. 

13. Click to open the Radiation Prescriptions note window. 

14. Type the Subject of the prescription note, then press TAB. 

15. Type the content of the note, then click to close the Radiation 

Prescriptions Note window. 

16. In the Radiation Prescriptions dialog box, click to save the radiation 

prescription. 

17. Click to close the Radiation Prescriptions dialog box and open the 


Using Radiation Prescription Sequencing 

1. In the Diagnoses and Interventions window, click the course of treatment, then 

click in the Add group to open the Radiation Prescription Sequencing 

dialog box. 

2. Click to accept the default radiation prescription sequencing and to 

open the Radiation Prescriptions dialog box. 

3. Complete the radiation prescription information, including the Total Cum. 

4. Click to save the prescription. 

Adding Dose Limit Dose Action Points 

1. In the Radiation Prescriptions dialog box, double-click the radiation prescription 

with the total cumulative dose (Total Cum), then click . 

2. In the Dose Limits window, click to open the Dose Limit dialog box. 

3. Type or select the name of the Dose Tracking Site to which the Dose Limit dose 

action point applies. 

4. Type the dose limit in the Dose Limit field, such as 6000. 

5. Type a comment or an action to perform in the Comment field, such as Do not 

exceed the dose limit for this critical structure. 

6. Click to save Dose Limit dose action point. 

7. Click to close the Dose Limits window, then click . 


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Notes Changing Prescriptions 

1. In the top part of the Radiation Prescriptions dialog box, click the first 

prescription, then click . 

2. Make your changes, such as a new Rx Dose field. 

3. Click to save the changes. 

4. Click the second prescription in the table at the top of the Radiation Prescriptions 

dialog box. 

5. Click . 

6. Right-click or press F4 to open the Radiation Prescriptions Options menu. 

7. Click Site Sequencing… to open the Radiation Prescription Sequencing dialog 

box. 

8. Click After in the Treat Rx Site group. 

9. Click to save the new site sequencing and close the Radiation 

Prescription Sequencing dialog box. 

10. In the Radiation Prescriptions dialog box, click to save the change. 

Appending Fractionation Phases 

1. In the Radiation Prescriptions dialog box, click the prescription site, click 

, then click . 

2. In the Radiation Prescription Phase Start dialog box, type the number of hours or 

days in the first text field. Then, select Hours or Days. 

3. Click to close the Radiation Prescription Phase Start dialog box. 

4. In the Radiation Prescriptions dialog box, type the Rx Dose for the appended 

prescription, then press TAB. 

5. Type the Fractional Dose field for appended radiation prescription, then press TAB. 

6. Click adjacent to the Fractionation Pattern field, use the Wave Setup Form dialog 

box to select the fractionation pattern, then click . 

7. Click to open the Fraction Specific Notes window. 

8. Double-click the fraction in the Fraction column to open the Fraction Note 

window. 

9. Type the Subject of the note, then press TAB. 

10. Type the content of the fraction note, then click .


Notes 11. Click , then click to save the change. 

12. Double-click the second fractionation phase. 

13. Type a new dose in the Rx Dose field for the second fractionation phase, then 

press TAB. 

14. In the Changing Total Prescribed Dose message box, click . 

15. In the Radiation Prescriptions dialog box, type the new fractional dose in the 

Fractional Dose field, then click to save the change. 

16. Make sure the prescription is selected, then click . 

17. Click the fractionation phase that you added. 

18. Click to remove the fractionation phase. 

19. Click to save the change. 

20. Click . 

Showing Historical Prescription Data 

1. Open the chart of a patient with prior approved prescriptions, then open the 


2. Right-click in the window or press F4, then click Historical View to open the 

Diagnoses and Interventions window in Historical view. 


4. Click Historical View to open the Diagnoses and Interventions window in 

normal view. 

5. Close the Diagnoses and Interventions window. 

6. Close the patient chart. 


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Notes 



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Lesson 3 Adding 

Simulation and 

Treatment Fields 

Objectives 


• Add simulation fields 

• Add positioning devices 

• Add site simulations 

• Add a site setup 

• Copy simulation fields into treatment fields 

• Copy treatment fields 

• Set up accessory verification 

• Manually add treatment fields 

• Approve treatment fields 

• Change treatment fields 

• Copy couch parameters and change field notes 

• Review Diagnoses and Interventions Options for Treatment Fields 

The Treatment Field Definition feature lets you add patient treatment field 

information used during external beam therapy. To add treatment field definitions, 

you can: 

• Manually create them 

• Copy simulation fields 

• Copy other treatment fields 

• Automatically capture treatment unit settings 

• Import them from your treatment planning system 

In this lesson, you will add simulation fields, positioning devices, site simulations, and 

a site setup. You will also copy simulation fields into treatment fields, copy treatment 

fields, and set up accessory verification. You will manually add treatment fields, add 

field/MU dose specifications, add accessory and geometric settings, add treatment 

field notes, and apply tolerance tables. Finally, you will approve treatment fields, 

change treatment fields, copy couch parameters, change field notes, and review 

Diagnoses and Interventions Options for treatment fields.


Notes 

To open the Diagnoses and Interventions window, you must 

have Clinical | General | View security rights. 

To add, change, or copy a treatment field, add a site setup, 

and capture geometric settings from the linear accelerator, 

you must have Clinical | Field Defs | Modify security rights. 

To add or modify dose coefficient/MU information from the 

Portal Image group of the Treatment Field Definitions dialog 

box, you must have Clinical | Field Defs | Modify and Clinical 

| Coefficients | Modify security rights. 

To approve a treatment field, you must have Clinical | Field 

Defs | Approve security rights. 

To add/change simulation fields or site simulations, you 

must have Clinical | General | View and Clinical | Simulation | 

Modify security rights. 

To add positioning devices, you must have Admin | System 

Utilities | Clinical | Modify security rights. 

To change approved field notes, you must have Clinical | 

Field Note Edit | Approve security rights. 

To copy couch parameters, you must have Clinical | Couch 

Copy | Approve rights. If you have Clinical | Field Defs | 

Approve rights, you also get Field Note Edit and Couch Copy 

rights by default. 


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Notes 

Lesson 3: Adding Simulation and Treatment Fields 


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Adding Simulation Fields 

You can add and view simulation field information in the Simulation Field dialog box. 

You can add as many Simulation Field definitions as necessary during the course of 

therapy for the patient. Although you can capture simulation fields directly from your 

simulator, you will manually add a simulation field for your patient so you know the 

required data. In the following exercises, you will add header information, add 

measurement settings, add geometric settings, add radiography settings, and copy 

simulation fields. 

Adding Header Information 

The simulation field header information identifies the course, prescription site, 

simulation field, and accelerator used in actual treatments. In this exercise, you will add 

header information. 

1. Open the chart for your lesson patient, then open the Radiation tab of the 


2. Click the Lung prescription, then click . 

Opens the Simulation Options Menu, shown in Figure 57. 

Figure 57: Simulation Options Menu 

The Options menu lets you add a simulation field or a site simulation. Site 

simulations are included in this lesson. Refer to Adding Site Simulations for more 

information 

3. Click Field. 

Opens the General tab of the Simulation Field dialog box, shown in Figure 58.


Notes 

Figure 58: Simulation Field Dialog Box – General Tab 

Use the Simulation Field dialog box to add information about the simulation setup 

for the field. It contains basic header information, measurement, and geometric 

setting fields. 

4. Type 1 in the first Sim Field, then press TAB. 

Specifies the simulation field number. 

5. Type Lt. AP Lung in the second Sim Field. 

Specifies the simulation field description. 

6. Click adjacent to the Machine field. 

Opens the Location Directory window, shown in Figure 59. 


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Notes 



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Figure 59: Location Directory Window 

7. Double-click a treatment machine, such as Clinac MLC (80). 

Specifies the accelerator in the Machine field. 

Adding Measurement Settings 

Measurement settings include SSD (Source to Skin Distance), SFD (Source to Film 

Distance), and the SAD (Source to Axis Distance). In this exercise, you will add 

measurement settings. 

1. In the Simulation Field dialog box, type 92.5 in the SSD measurement field. 

Specifies the Source to Skin Distance. 

2. Type 145 in the SFD measurement field, then press TAB. 

Specifies the Source to Film Distance, then moves the insertion point to the SAD 

measurement field. 

3. Type 100 in the SAD measurement field, then press ALT+G. 

Specifies the Source to Axis Distance, then moves the insertion point to the 

Gantry field in the Geometric group.


Notes Adding Geometric Settings 

Geometric settings include gantry angle, collimator angle, field size, and couch 

settings. In this exercise, you will add geometric settings. 

1. In the Simulation Field dialog box, type 12 in the Field X geometric field. 

Specifies the size of the X jaws for the simulation. 

2. Type 15 the Field Y geometric field. 

Specifies the dimensions of the Y jaws for the simulation. Fields are automatically 

symmetrical unless you click the X Jaws Asy and/or the Y Jaws Asy checkboxes. 

You can then add individual measurements for each jaw. 

3. Type 111.2 in the Couch Vrt geometric field. 

Specifies the couch vertical setting. 

4. Type 97.1 in the Couch Lat geometric field. 

Specifies the couch lateral setting. 

5. Type 125 in the Couch Lng geometric field. 

Specifies the couch longitudinal setting. Keep the Couch Ang and Couch Ped fields at 

their defaults. Replace the parameters above with the correct parameters for your 

simulator if necessary, shown in Figure 60. 

Figure 60: Completed Simulation Field Dialog Box 


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Notes Adding Radiography Settings 

Radiography settings let you add radiographic settings for a simulation film. You can 

add the kVp and mA values, the number of seconds to expose the field, and the blade 

positions during exposure. In this exercise, you will add radiography settings. 

1. In the Simulation Field dialog box, click . 

Opens the Radiography tab of the Simulation Field dialog box, shown in 

Figure 61. 

Figure 61: Simulation Field Dialog Box – Radiography Tab 

2. Type 50 in the kVp field of the Exposure group. 

Specifies the kVp value. 

3. Type 200 in the mA field. 

Specifies the mA value. 

4. Type .25 in the Secs field. 

Specifies the duration of the exposure in fractions of a second.


Notes 5. Type the settings below in the Blades group: 

Field Data 

X1 15 

X2 15 

Y1 15 

Y2 15 

Specifies the X and Y plane blade settings. 

6. Click . 

Saves the simulation field, closes the Simulation Field dialog box. The new 

simulation field appears in the Diagnoses and Interventions window as shown in 

Figure 62. 

Figure 62: Diagnoses and Interventions Window with New Simulation Field 

The simulation field is related to the prescription as identified by the indentation 

and connecting line. 


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Notes Copying Simulation Fields 

You copy an existing simulation field, then change only those parameters that are 

different between the two fields to add a new field. In this exercise, you will copy a 

simulation field. 

1. In the Diagnoses and Interventions window, click the 1 - Lt. AP Lung simulation 

field. 

Specifies the simulation field to copy. 

2. Click , then click Field. 

Opens the Confirm Field Copy message box, shown in Figure 63. 

3. Click . 

Figure 63: Confirm Field Copy Message Box 

Opens the copied simulation in the Simulation Field dialog box. 

4. Type 2 in the first Sim Field, then press TAB. 

Specifies the simulation field number, then moves the insertion point to the next 

text box in the Sim Field. 

5. Type Lt. PA Lung in the second Sim Field. 

Specifies a description of the new simulation field. 

6. Press ALT+G. 

Moves the insertion point to the Gantry geometric field. You bypassed the fields 

below the Separations and Other groups and went directly to the Gantry field in the 

Geometric group. 

7. Type 180 in the Gantry field, then click . 

Changes the gantry angle, then saves your changes to the simulation field as 

shown in Figure 64.


Notes 

Figure 64: Diagnoses and Interventions Window with Two Simulation Fields 

Adding Site Simulations 

You can use the Site Simulation dialog box to record patient setup information at the 

Site level when you do a virtual simulation. A site simulation (virtual simulation) is the 

first phase of the treatment planning process. The setup information collected for a 

radiation prescription site during a virtual simulation is used in Site Setup. You can 

also add positioning device information in the Positioning Devices Library. In the 

following exercises, you will add positioning devices, then add a site simulation. 

Adding Positioning Devices 

You can use the Positioning Devices window to view, add, change, or remove 

positioning devices used in patient treatment. In this exercise, you will add positioning 

devices. 

1. Click File | Libraries | Positioning Devices…. 

Opens the Positioning Devices window, shown in Figure 65. 


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Notes 



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2. Click . 

Figure 65: Positioning Devices Window 

Opens the Positioning Device dialog box, shown in Figure 66. 

Figure 66: Positioning Device Dialog Box 

The Positioning Device dialog box lets you add or change positioning devices. 

You can type a unique device ID, description, and select the type of positioning 

device. You can also set the current status of the device to active or inactive. 

3. Type Bellyboard in the Name field. 

Specifies the name of the device, with a maximum of 16 characters. Keep the Class 

as Global for positioning devices that all patients can shared. Select Patient for 

devices that are custom built for a patient. Patient Support applies only to certain 

treatment machines. 

4. Click BODY_FRAME from the Type field. 

Specifies the type of positioning device.



Saves the new positioning device, then closes the Positioning Device dialog box. 

The new positioning device appears in the Positioning Devices window, shown in 

Figure 67. 

Figure 67: Positioning Devices with New Positioning Device 

6. Click . 

Closes the Positioning Devices window. 


Once you add positioning devices for all or the currently selected patient, you can add 

the site simulation. In this exercise, you will add a site simulation. 

1. In the Diagnoses and Interventions window, click the Lung radiation prescription. 

Specifies the radiation prescription to associate with the new site simulation. 

2. In the Add group, click , then click Site. 

Opens the Site Simulation dialog box, shown in Figure 68. 


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Notes 



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Figure 68: Site Simulation Dialog Box 

3. Click adjacent to the Patient Orientation field, then click Head In, Supine. 

Specifies the patient orientation. 

4. In the Accessories group, click adjacent to the Pt Support field, then click the 

method of patient support. 

Specifies the method of patient support. 

5. Click the positioning device(s) from the Positioning Device 1-4 fields. 

Specifies the positioning device(s), such as a mask or cast. 

6. Add a patient note or view simulation images, if necessary. 

The Simulation Image List pane shows all non-portal medical images associated with 

the selected treatment site. To view an image, click the image in the Simulation 

Image List pane, then click to open the image. 

The Site Setup Note box shows setup instructions added to the site simulation. To 

add setup instructions, you can click in the Site Setup Note box, then type your 

setup instructions. You can also add an extended note with the button. 

7. Click . 

Saves the site simulation, then closes the Site Simulation dialog box. The new site 

simulation appears in the Simulations folder of the Diagnoses and Interventions 

window, shown in Figure 69.


Notes 

Figure 69: Diagnoses and Interventions with Site Simulation 

Adding a Site Setup 

You can use the Site Setup dialog box to add patient positioning data into a treatment 

site. This site setup record applies to all fields in a treatment site (prescription) folder. 

Patient orientation is necessary to perform image registration, communicate 

shifts/offsets in patient coordinates and change isocenter data from patient 

coordinates to machine coordinates for couch calculations. In this exercise, you will 

add a site setup. 

1. In the Diagnoses and Interventions window, click . 

Opens the Site Setup dialog box, shown in Figure 70. 

Figure 70: Site Setup Dialog Box 


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Notes 2. In the Orientation group, click Head In, Supine from the Patient Orientation field. 

Specifies the patient orientation. The Couch Movement Threshold/Maximum group 

applies if your facility has Elekta Automated Table Movement (ATM). This group 

lets you select the applicable couch offset thresholds/maximums for a given 

prescription site from a list of defined thresholds/maximums. Make sure your 

treatment machine is correctly characterized for automated table movement. 

MOSAIQ tells you if your site setup is incorrect, thresholds/maximums are 

undefined, or your treatment machine is not correctly characterized. Keep the 

Couch Threshold and Couch Maximum fields at their defaults. 

3. In the Setup Correction group, click the Prescribed Offsets, then type any changes 

between the simulation isocenter position and the planned isocenter position in 

centimeters. 

Specifies the prescribed offsets for the site setup. The Setup Correction group lets 

you view setup shifts from surface localization landmarks (tattoos). The prescribed 

relative offsets are determined during treatment planning. Localization offsets 

correct systematic setup changes. This group is available only if your facility has 

Setup Intelligence. 

4. In the Structure Set group, select the Structure Set for this site setup, if any. 

Specifies the structure set that applies to the site setup. The Structure Set group 

selects the structure set to associate with the prescription site that identifies the 

reference CT. 

5. Click . 

Saves the site setup, then closes the Site Setup dialog box. The new site setup 

appears above the Simulations folder of the Diagnoses and Interventions window, 


Figure 71: Diagnoses and Interventions with Site Setup


Notes 

Copying Simulation Field into Treatment Fields 

You copy simulation field to add new treatment fields directly. When you copy the 

simulation field, you can: 

• Add field data and treatment field notes 

• Add parameters for accessories such as wedges, compensators, and blocks 

• Change any geometric settings copied from the simulation field 

In the following exercises, you will copy a simulation field and add treatment field 

data, add geometric and accessory settings, add a treatment field note, and apply the 

tolerance table. 

Copying Simulation Fields and Adding Treatment Field Data 

In this exercise, you will copy a simulation field and add header, beam, and portal 

image information. 

1. In the Diagnoses and Interventions window, click the 1 - Lt. AP Lung simulation 

field, then click . 

Opens the Confirm Field Copy message box. 

2. Click . 

Opens the Machine Characterization warning message box, shown in Figure 72. 

Figure 72: Machine Characterization Warning Message Box 

3. Click . 

The Machine Characterization warning does not appear 

each time before the Treatment Field Definition dialog box 

opens. 

Opens the Treatment Field Definition dialog box, shown in Figure 73. 

If your default settings cause the Field Setup view to appear, 

click to open the Tx Field view. 


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Notes 



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Beam settings not available 

to a Simulation field 

Accessories settings not 

available to a Simulation field 

Figure 73: Treatment Field Definition Dialog Box 

The Treatment Field Definition dialog box contains the header information and 

geometric parameters from the copied simulation field. It also has fields to 

configure the dose. You must, at minimum, complete the Type and Modality fields 

and apply a tolerance table. 

4. Click Static from the Type field. 

Specifies the type of beam. 

Geometric settings 

5. Click Xrays from the Modality field. 

Field setup note or 

field graphic 

Couch settings Portal Image settings not 

available to a Simulation field 

Opens the Beam Configurations dialog box, shown in Figure 74. 

Figure 74: Beam Configurations Dialog Box


Notes Xrays is automatically highlighted, but you can change your selection. If you 

change the Modality in Beam Configurations, the Modality field in Treatment Field 

Definition also changes. 

6. Click 15 in the Energy column. 

Specifies the energy level of the beam, then shows the applicable doserates for the 

beam in the Doserate column. 

7. Click 400 in the Doserate column, then click . 

Specifies the treatment modality, energy, and doserate to use to treat with the 

field, then closes the Beam Configurations dialog box. The Energy and Doserate 

fields show the values you selected in the Beam Configurations dialog box. 

8. Type 120 in the MU field. 

Specifies the MU field, adds the monitor units for the field. The Energy field shows 

the energy you added in the Beam Configurations dialog box. 

The Wedge MU field only applies to facilities with Elekta or 

GE linear accelerators. If you have a Varian or Siemens 

linear accelerator, do not use the Wedge MU field. If you 

have an Elekta or GE linear accelerator, speak with your 

instructor to make clear its use in MOSAIQ. 

9. Type .50 in the Time field. 

Specifies the treatment delivery time, in fractions of a minute, such as 0.50 for 30 

seconds. 

10. Type 90 in the Dose field. 

Specifies the dose for the treatment field. The yellow highlighting does not appear 

after you add the dose. 

11. In the Portal Image Planned group, type 2 in the Planned MU field. 

Specifies the planned portal image monitor units value. 

12. Type 2 in the Open MU field. 

Specifies the open field portal image monitor units. For this exercise, keep the 

Dose Coeff fields for open and planned portal images at their defaults. 

You have to only add a dose coefficient if your facility 

figures portal images as part of the total dose. 

13. Type 8 in the Open Delta field. 

Specifies the change in jaw settings necessary between the planned and open 

portal image exposures, shown in Figure 75. 


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Notes 



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Figure 75: Treatment Field Definition Dialog Box with Treatment Field Data 

In this exercise keep the EPID and SID checkboxes at their defaults. When 

selected, the EPID checkbox specifies to use an EPID (Electronic Portal Imaging 

Device) to get the portal image rather than film. The SID checkbox specifies the 

Source-Image-Distance for the portal image in centimeters (cm). 

The EPID and SID checkboxes are required fields for the 

Varian 4D and Siemens Coherence machines. Refer to 

Siemens Therapists Workspace, LPN19004, and Varian 

4D/OBI MOSAIQ Sequencer Reference Manual, Version 8.30, 

LRM19011. 

Adding Accessory and Geometric Settings 

You can add parameters for accessories such as wedges, compensators, and blocks, 

and change geometric settings copied from the simulation field. In this exercise, you 

will add accessory settings. 

1. In the Accessories/Slots group of the Treatment Field Definition dialog box, click or 

type None in the Wedge field. 

Specifies no wedge. 

2. Type None in the Compensator field. 

Specifies no compensator.


Notes 3. Type Cerro in the Block field. 

Specifies the type of block necessary for treatment. 

4. Type None in the Bolus field. 

Specifies no bolus. 

5. Change geometric or other settings if necessary. 

Your entries should look similar to those shown in Figure 76. 

Figure 76: Treatment Field Definition Completed 

Applying a Tolerance Table 

Before you save the treatment field definition, you must apply a tolerance table to the 

field. Tolerance tables are configured in the System Utilities. In this exercise, you will 

apply a tolerance table. 

1. In the Treatment Field Definition dialog box, click adjacent to the Tolerance 

field. 

Opens the Tolerance Table list, shown in Figure 77. 

Figure 77: Tolerance Table List 


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Notes Tolerance tables are set up by your system administrator and are specific to your 

facility. 

2. Click 5 Lung. 

Specifies the tolerance table for the treatment field. 

You must apply a tolerance table before you can save a 

treatment field definition. 

Adding Treatment Field Notes 

You can add notes when you add simulation fields or treatment fields. Notes that you 

add when you add a simulation field automatically appear in the Treatment Field 

Definition dialog box where you can change them. Treatment field notes appear when 

you treat the field. In this exercise, you will add a treatment field note. 

1. In the Treatment Field Definition dialog box, click . 

Opens the Field Setup view of the Treatment Field Definition dialog box, shown 

in Figure 78. 

Field header information 

Prescription information 

Shows imported 

photos and diagrams 

Field setup note. Simulation or 

treatment field notes appear here. 

Note added in the Radiation Prescription 

dialog box. You cannot change it from here. 

Figure 78: Treatment Field Definition Dialog Box – Field Setup View


Notes Use the Field Setup text box in the Treatment Field Definition dialog box to type 

your note text. If your note is an alert, click the Display Field Setup First when 

Treating this Field checkbox. When this box is selected, the Field Setup view 

automatically appears when the therapist selects the field for treatment. If it is not 

an alert, the default view appears. 

2. Click in the Field Setup text box, then type SUPINE, AQUAPLAST, SPONGE 

UNDER KNEES. 

Specifies the note text. 

3. Click . 

Press ENTER in the Setup Note field to move the insertion 

point to a new line. This does NOT save the note and close 

the Treatment Field Definition dialog box. 

Saves the treatment field, then closes the Treatment Field Definition dialog box. 

The new treatment field appears in the Diagnoses and Interventions window as 


Figure 79: Diagnoses and Interventions Window with New Treatment Field 


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Notes Using the Apply Limits Option 

The Apply Limits option lets you correct out-of-bounds parameters for the Gantry 

angle, Collimator angle, MLC, Field size X/Y, and Jaws X1, X2, Y1, and Y2. If one or 

more of these field parameters exceeds the machine limits as defined in the Machine 

Characterization in MOSAIQ, the Positional Limits Exceeded message opens. In this 

exercise, you will apply the Apply Limits option. 

The Positional Limit Exceeded message shows different 

messages based on the task you are doing when you exceed 

the positional limits. 

If you use the Apply Limits option, make sure that your 

clinical staff verifies all changes. 

1. In the Diagnoses and Interventions window, double-click 1 - Lt. AP Lung. 

Opens the Treatment Field Definition dialog box for the selected treatment field. 

2. Change one or two geometric settings so that they are out of bounds. 

Makes sure that the message box appears. 

3. Right-click in the Treatment Field Definition dialog box or press F4. 

Opens the Treatment Field Definition Options menu, shown in Figure 80. 

4. Click Apply Limits. 

Figure 80: Treatment Field Definition Options Menu 

Closes the Treatment Field Definition Options menu and opens the Positional 

Limit Exceeded message box, shown in Figure 81.


Notes 

5. Click . 

Figure 81: Positional Limit Exceeded Message Box 

Applies the new parameters. If your machine can accept the values for the out-ofbound 

parameters, you can change your machine characterization and not use the 

Apply Limits option. 

6. Save your changes. 

Copying Treatment Fields 

You can copy the second treatment field from the second simulation field, the same as 

you did with the first treatment field. If you have added all the MU/dose parameters 

for the first treatment field, you can copy that treatment field, then change only those 

parameters necessary for the second treatment field. In this exercise, you will copy 

treatment fields. 

1. In the Diagnoses and Interventions window, click the 1 - Lt. AP Lung treatment 


Specifies the treatment field to copy, then opens the Confirm Field Copy message 

box. 

2. Click . 

Opens the Treatment Field Definition dialog box with the settings from the 

copied treatment field. 

3. Type 2 in the first Field text box, then press TAB. 

Specifies that this is the second treatment field. 

4. Type Lt. PA Lung in the second Field text box. 

Specifies that this is the posterior treatment field. 

5. Right-click or press F4. 

Opens the Treatment Field Definition options menu. 

6. Click Flip. 

Opens the Flip Confirmation message box, shown in Figure 82. 


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Notes 



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7. Click . 

Figure 82: Flip Confirmation Message Box 

Opens the Question message box, shown in Figure 83. 

8. Click . 

Figure 83: Question Message Box 

Inverts the geometric settings, shown in Figure 84. 

Figure 84: Treatment Field with “Flipped” Geometric Settings 

9. Click . 

Saves your changes to the treatment field, then closes the Treatment Field 

Definition dialog box. The new treatment field appears in the Diagnoses and 

Interventions window as shown in Figure 85.


Notes 

Figure 85: Diagnoses and Interventions Window with Two Treatment Fields 

Manually Adding a Treatment Field 

In most cases, you will copy simulation fields or other treatment fields to add 

treatment fields. You can add a treatment field “from scratch” if the patient treatment 

does not come over from your treatment planning system through DICOM. This 

could occur if the patient was not planned out, or if you do not transfer plans from a 

treatment planning system into MOSAIQ. In the following exercises, you will 

manually add a treatment field and manually add geometric and other information. 

Manually Adding Treatment Fields 

In this exercise, you will manually add a treatment field. 

1. In the Diagnoses and Interventions window, click the Lung Boost radiation 

prescription. 

Specifies the radiation prescription to which to manually add the field. 

2. Click . 

Opens the Treatment Field Definition dialog box. 

3. Type 3 in the first Field text box, then press TAB. 

Specifies the Treatment Field ID, which identifies the treatment field. 

4. Type LAO LUNG in the second Field text box. 

Specifies a more detailed description of the treatment field. 

5. Click adjacent to the Machine field, then double-click a linear accelerator. 

Specifies the linear accelerator used to treat the patient. When you select the linear 

accelerator, you can also click the BEV radio button to open the Beam’s Eye 

View. It shows the dimensions of the treatment field. 


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Notes 6. Click 5 Lung from the Tolerance field. 

Specifies the tolerance table for the treatment field. This sets the degree of 

tolerance within which the treatment unit parameters must remain when you set 

up the patient and treatment is allowed. 

7. Type 75 in the Dose field. 

Specifies the dose for this treatment field. The radiation prescription was 

configured for 150 cGy for each treatment. Also, there are (or will be) two 

treatment fields for this prescription, so the dose must be between 1 and 150 cGy. 

When you type a dose, the yellow highlighting does not appear. 

8. In the Beam group, click Static from the Type field. 

Specifies whether the beam is static (fixed), dynamic (variable), or arc. 

9. Click Xrays from the Modality field. 

Specifies the treatment modality, then opens the Beam Configurations dialog box. 

10. Click or type 15 in the Energy column, click or type 400 in the Doserate column, 

then click . 

Specifies the treatment modality energy, and doserate to use, then closes the Beam 

Configurations dialog box. The Energy and Doserate fields show the values selected 

in the Beam Configurations dialog box. 

The machine characterization of your linear accelerator can 

cause different energies and doserates to appear. 

11. Type 120 in the MU field, then press TAB twice. 

Specifies the MU field, then adds the monitor units for the field, then moves the 

insertion point to the Time field. The Energy field shows the energy you selected in 

the Beam Configurations dialog box. 

12. Type .50 in the Time field. 

Specifies the treatment delivery time, in fractions of a minute, such as 0.50 for 30 

seconds, shown in Figure 86.


Notes 

Figure 86: Treatment Field Definition with Beam Information 

Manually Adding Geometric Settings 

Most of the time, you will get treatment field geometric settings from the treatment 

planning system that you use. Sometimes you may have to add the geometric settings 

manually. In this exercise, you will manually add geometric settings such as the beam, 

gantry, collimator, and couch settings for your new treatment field. 

1. In the Treatment Field Definition dialog box, type 345 in the Gantry Angle field. 

Specifies the gantry angle. 

2 Type 10 in the Field Size X field. 

Specifies the size of the X jaws, width, and length. 

3. Type 12 in the Field Size Y field. 

Specifies the size of the Y jaws. For this exercise, the X and Y jaws are the same 

dimensions, so keep the two Asy checkboxes at their defaults. The Asy 

checkboxes specify that the jaw sizes are asymmetrical. If you clicked one or both 

of the checkboxes, the jaw size fields for that jaw become active. You then add 

the individual jaw values. 

4. In the Couch group, type 125 in the Longitudinal field. 

Specifies the longitudinal couch angle, which is necessary for EXCI Varian linear 

accelerators, shown in Figure 87. 


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Notes 



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Figure 87: Treatment Field with Geometric Settings 

5. Use the right-click Apply Limits option if necessary. 

Makes sure the treatment field parameter sessions are correct for your machine. 

Manually Adding Accessory Information 

You can specify parameters for accessories such as wedges, compensators, and blocks. 

In this exercise, you will manually add information on accessories. 

1. In the Treatment Field Definition dialog box, type or click None from the Wedge 

field. 

Specifies that the treatment field does not use a wedge. For this exercise, keep the 

Compensator field blank. The Compensator field identifies the type of compensator 

required for treatment. 

If you select electrons for the treatment modality, the 

Applicator field appears rather than the Wedge field. The 

drop-down list shows cones for the selected machine. 

2. Type Cerro in the Block field. 

Specifies the type of block required for treatment. For this exercise, you will also 

keep the Bolus field blank. The Bolus field specifies the type of bolus required for 

treatment.


Notes Manually Adding Portal Image Information 

You can specify MU and other parameters specifically for portal images. In this 

exercise, you will add portal image information. 

1. In the Treatment Field Definition dialog box, type 2 in the Planned MU field of 

the Portal Image group. 

Specifies the planned portal image acquisition monitor units. 


Specifies the open field portal image monitor units. For this exercise, keep the 

Dose Coeff fields for open and planned portal images at their defaults. 

You must type a dose coefficient only if your facility includes 

portal images when you calculate the total dose. 

3. Type 8 in the Open Delta field. 

Specifies the change in field size for open portal images. Also, for this exercise, 

keep the EPID and SID fields at their defaults, shown in Figure 88. 

Figure 88: Treatment Field with Portal Image Settings 


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Notes Adding Field Setup Information 

You can use the Field Setup view of the Treatment Field Definition dialog box to add 

information necessary when you set the patient up for treatment. For example, you 

can add patient positioning devices or accessories not shown in the Accessories group, 

such as angle cushions or breast boards. In this exercise, you will add field setup 

information. 

1. In the Treatment Field Definition dialog box, click . 

Shows the Field Setup view of the Treatment Field Definition dialog box. 

2. Click in the Field Setup text field (below the SSD field), then type SUPINE, BHH, 

WING BOARD, ANGLE CUSHION UNDER KNEES. 

Specifies information about setting up the treatment field and patient positioning. 

3. Click . 

Saves the treatment field information, then closes the Treatment Field Definition 

dialog box. The new treatment field appears in the Diagnoses and Interventions 

window, shown in Figure 89. 

Figure 89: Diagnoses and Interventions with Third Treatment Field


Notes 

Setting Up Accessory Verification 

If your facility has SEQUENCER, you can use the Accessory Verification feature to 

track accessory use. To track accessories, you type Custom in the field for the accessory, 

print a barcode label, then attach it to the accessory. When the field is treated, you 

must swipe the accessory with a barcode wand before beam-on. In the following 

exercises, you will specify accessory verification and print accessory barcode labels. 

You must activate Accessory Verification in Department 

Setup to use it. Click File | System Utilities | Department 

Setup…, then click the Clinical (RO) tab. Select the 

Accessory Barcode Verification checkbox in the Treatment 

Options group. 

Specifying Accessory Verification 

Before you can print barcode labels, you must change the treatment field(s) to use 

accessory verification. In this exercise, you will specify accessory verification. 

1. In the Diagnoses and Interventions window, double-click the 1 - Lt. AP Lung 


Opens the field for editing in the Treatment Field Definition dialog box. 

2. Type Custom in the Block field. 

Specifies accessory verification for the Block field. 

3. Click . 

Saves your changes to the field. 

4. In the Diagnoses and Interventions window, double-click the 2 - Lt. PA Lung 


Opens the field for editing in the Treatment Field Definition dialog box. 

5. Type Custom in the Block field. 

Specifies accessory verification for the Block field. 

6. Click . 

Saves your changes to the field. 


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Notes Printing Accessory Barcode Labels 

To print barcode labels, the workstation you print from must have a barcode label 

printer attached. If your workstation does not have a barcode label printer, log on to 

the Practice database on a workstation that does before you do this exercise. In this 

exercise, you will print accessory barcode labels. 

1. Click File, then point to Print Barcodes. 

Opens the Print Barcodes menu, shown in Figure 90. 

2. Click Accessory…. 

Figure 90: Print Barcodes Menu 

Opens the Treatment Field Definitions window, shown in Figure 91. 

Figure 91: Treatment Field Definitions Window 

Some fields have a » adjacent to them. This identifies that the fields have accessory 

verification items. The fields were automatically selected when you typed Custom in 

the Accessory group fields. 

3. Click 1 in the Field column. 

Specifies only Field 1. 

To select more than one field, click a field, then press 

SHIFT. Repeat as necessary.



Prints the barcode label for the selected field. 

Once you print the barcode labels, you must attach the 

applicable label to the applicable block/accessory. When you 

treat a field, swipe the block/accessory with a barcode wand 

before beam on. This makes sure that you use the correct 

block/accessory for the field. 

Approving Treatment Fields 

When you have set up the treatment fields how you want them, you can approve the 

treatment fields before you treat the patient. In fact, your facility can require you to 

approve a treatment field before you can treat a patient. When you approve a field, 

you cannot remove it, but you can make changes to the field. If you change an 

approved field, the status of the field automatically changes to Unapproved. You must 

have the correct approval privileges to approve treatment fields. In this exercise, you 

will approve the treatment field you manually added in this lesson. 

1. In the Diagnoses and Interventions window, double-click the 03 LAO Lung 



2. Right-click in the Treatment Field Definition dialog box or press F4. 

Opens the Treatment Field Definition Options menu. 

3. Click Approve…. 

Opens the Approve Treatment Field Definition dialog box, shown in Figure 92. 

Figure 92: Approve Treatment Field Definition Dialog Box 

You can also press CTRL+A to open the Approve Treatment 

Field Definition dialog box. 

4. Type your Password, then press ENTER. 

Adds your user initials and the approval date in the Approved field, shown in 

Figure 93. 


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Notes 



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You can also approve treatment fields when you first add 

them. 

Figure 93: Treatment Field Definition Dialog Box – Approved Treatment Field 

5. Click . 

Approval signature and date. 

Saves the approved treatment field information, then closes the Treatment Field 

Definition dialog box. The approval appears in the Status column of the 

Diagnoses and Interventions window as shown in Figure 94. 

Figure 94: Diagnoses and Interventions Dialog Box with Approved Field


Notes 

Changing Approved Treatment Fields 

If the machine characterization of the treatment machine or patient treatment plan 

changes, you may have to change an approved treatment field definition. If you 

change an approved field, the status of the field automatically changes to Unapproved. 

You have to re-approve the field before treatment, unless you configure MOSAIQ to 

let you copy couch parameters and change field notes without changing the status. 

Both are included in the exercise that follows. When you have re-approved the 

treatment field, you can open the Field Delta View dialog box to show all versions of 

the treatment field. In this exercise, you will change an approved treatment field, reapprove 

it, then open the Field Delta View dialog box. 

1. In the Diagnoses and Interventions window, double-click the 3 LAO Lung 



2. Type 90 in the Collimator Angle field. 

Specifies the collimator angle for the treatment field. 


Specifies the MU for the open portal image. 

4. Type NONE in the Bolus field. 

Specifies that no bolus for this treatment field, shown in Figure 95. 

Figure 95: Approved Treatment Field with Changes 


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Notes 5. Right-click or press F4, then click Approve…. 

Opens the Treatment Field Definition Options menu, then opens the Approve 

Treatment Field Definition dialog box. 

6. Type your Password, then press ENTER. 

Adds your user initials and the approval date in the Approved field. 

7. Right-click or press F4, then click Field Delta. 

Opens the Field Delta View dialog box, shown in Figure 96. 

Figure 96: Field Delta View Dialog Box 

Changes between versions are highlighted yellow. Click to revert to a 

previous version of the field. You cannot use the Rollback option if the most 

recent version of the field was approved or treated. You cannot change fields in 

the Field Delta View dialog box. 

8. Click . 

Closes the Field Delta View dialog box.



Saves the changes to the treatment field, then closes the Treatment Field 

Definition dialog box. The Status field in the Diagnoses and Intervention window 

still shows your user initials, the approval date, and the approval status. 

Copying Couch Parameters and Changing Field 

Notes 

You can copy couch parameters and change field notes for approved fields and not 

change the status to Unapproved if your system administrator configured MOSAIQ to 

do so. You can find the settings in the Field Edit Rules group on the Clinical (RO) tab 

of the Department Setup. In this exercise, you will copy couch parameters and change 

the field note of an approved treatment field. 


Opens the Clinical (RO) tab of the Department Setup dialog box, shown in 

Figure 97. 

Figure 97: Department Setup Dialog Box – Clinical (RO) Tab 


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Notes 2. Click On Couch Copy Retain Field Approval Status. 

Opens the Warning message box as shown in Figure 98. 

3. Click . 

Closes the Warning message box. 

Figure 98: Warning Message Box 

4. Click On Note Edit Retain Field Approval Status, then click . 

Specifies that you can change a field note without changing the approval status of 

a treatment field, then closes the Warning message box. 

5. Click . 

Saves your changes, then closes the Department Setup dialog box. 

6. In the Diagnoses and Interventions window, click the 1 - LT AP Lung treatment 


Specifies the treatment field from which to copy the couch parameters, then 

opens the Couch Copy window, shown in Figure 99. 

Figure 99: Couch Copy Window


Notes From the Couch Copy window, you can copy vertical, longitudinal, and latitudinal 

couch parameters from one treatment, setup, kV setup, or CT field to a different 

prescribed field. MOSAIQ copies the couch values from the initially selected field 

to the field(s) selected in this window. Fields to which you want to copy couch 

values must be geometrically equivalent to the source field. 

7. Click adjacent to the Rad Rx: Lung Boost prescription in the Select Fields to Copy 

Rx Couch Values To group. 

Shows the treatment fields for the selected prescription. 

8. Click the 3 - LAO LUNG treatment field. 

Specifies the treatment to which to copy the couch parameters from the treatment 

field in the Copy Rx Couch Values From group as shown in Figure 100. 

Figure 100: Couch Copy with To Field Selected 

9. Type your password in the Password field, then click . 

Copies the couch parameters to the selected field as shown in Figure 101. 

Figure 101: Couch Copy with Couch Parameters Copied 


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Saves the copied couch parameters, then closes the Couch Copy window. In the 

Diagnoses and Interventions window, the 3 - LAO LUNG treatment field has a 

status of Approved. 

11. Double-click the 3 - LAO LUNG treatment field, then click . 

Opens the Field Setup view of the Treatment Field Definition dialog box. 

12. Change the note in the Field Setup text box, then click . 

Saves the change, then closes the Treatment Field Definition dialog box. In the 

Diagnoses and Interventions window, the treatment field still has a status of 

Approved as shown in Figure 102. 

Figure 102: Diagnoses and Interventions with Treatment Field Still Approved 

Reviewing Diagnoses and Interventions Options 

for Treatment Fields 

The Diagnoses and Interventions window has options to view, organize, and continue 

treatment planning for treatment fields. In this exercise, you will review the Diagnoses 

and Interventions options for treatment fields. 

1. In the Diagnoses and Interventions window, click and hold the left mouse button 

down over 3 - LAO LUNG. 

Changes the mouse pointer to and indicates drag and drop mode. 

2. Drag the mouse pointer down until the outline appears over the radiation 

prescription, then release the left mouse button. 

Opens the Warning message box, shown in Figure 103.


Notes 

Figure 103: Warning Message Box – Moving a Treatment Field 

3. Click . 

Closes the message box, then moves the new treatment field from the old 

prescription to the new prescription. 

4. Drag and drop 3 - LAO LUNG over the 2 - Lt. PA Lung treatment field in the 

original prescription following steps 2 and 3. 

Moves the treatment field back to its original position. 

You can use the Drag-and-Drop technique to change the 

treatment field sequence in the same prescription. You can 

also use it to move the treatment fields to a different 

prescription. 

5. Click 3 - LAO LUNG, then right-click in the Diagnoses and Interventions window 

or press F4. 

Opens the Diagnoses and Interventions Options menu, shown in Figure 104. 

Figure 104: Diagnoses and Interventions Options Menu 

6. Click Hidden Tx Field. 

Marks the treatment field as hidden in the Diagnoses and Interventions window, 



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Notes 



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H indicates for Hidden field 

Figure 105: Diagnoses and Interventions Window with Hidden Treatment 

Fields 

7. Right-click or press F4, then click Hide Tx Fields marked as Hidden. 

Hides the treatment field marked Hidden in the Diagnoses and Interventions 

window in this view of the window only. If you close the Diagnoses and 

Interventions window, then open it again, all hidden treatment fields appear until 

you select Hide Tx Fields marked as Hidden again. 

8. Right-click or press F4, then click Treatment Calendar…. 

Opens the Treatment Calendar view of the Treatment Chart window, shown in 

Figure 106. 

Figure 106: Treatment Chart Window


Notes 

The Treatment Chart window has two views: the Treatment Calendar and 

Treatment Chart. Use the Treatment Calendar to plan radiation therapy 

treatments, and the Treatment Chart to review historic and planned treatments 

and start treatment delivery or QA Mode sessions. 

9. Right-click or press F4, then click Add Simulation without Rad Rx…. 

Opens the Simulation Field dialog box. This option lets you add a simulation field 

that is not associated with a radiation prescription. (adding simulation fields is 

covered in this lesson.) 

10. Right-click or press F4, then click Add Tx Field without Rad Rx…. 

Opens the Treatment Field Definition dialog box. This option lets you add a 

treatment field that is not associated with a radiation prescription. (Manually 

adding a treatment field is covered in this lesson.) 

11. Click and hold the left mouse button down over a treatment field you wish to 

move to a new radiation prescription, then drag the field to another radiation 

prescription. 

Moves the treatment field. 

12. In the warning message box, click . 

You can also right-click or press F4, then click Treatment Order… and use the 

Treatment Order window to change the sequence of the treatment fields. Use the 

and in the Treatment Order window to specify the sequence to 

treat the first 15 fields defined for the patient. If you must set a treatment order 

for more than 15 fields, use the Treatment Calendar. 

13. Move the treatment field back to its original position. 

What's Next 

Congratulations! You have completed Module I of the Dosimetrist/Physicist training 

guide. In this lesson, you learned how to add simulation fields, positioning devices, site 

simulations, and site setups. You learned how to copy simulation fields into treatment 

fields, add field/MU dose specifications, and add accessory/geometric settings. You 

also learned how to add treatment field notes, apply tolerance tables, copy treatment 

fields, set up accessory verification, and manually add treatment fields. Finally, you 

learned how to change treatment fields, approve treatment fields, and use Diagnoses 

and Interventions options for treatment fields. Use the Quick Version as a concise, 

step-by-step guide when you must quickly apply any of the skills you have learned in 

this lesson or if you simply want to reinforce what you have learned. 


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Notes Quick Version 

Adding Simulation Fields – Header Information 

1. Open the chart for your patient, then open the Radiation tab of the Diagnoses and 


2. Click the radiation prescription, then click to open the Simulation 

Options Menu. 

3. Click Field to open the General tab of the Simulation Field dialog box. 

4. Type the number of the simulation field, such as 1, in the first Sim Field, then 

press TAB. 

5. Type the name of the simulation field, such as Lt. AP Lung, in the second Sim 

Field. 

6. Click adjacent to the Machine field to open the Location Directory window. 

7. Double-click a treatment machine, such as Clinac MLC (80). 

Adding Simulation Fields – Measurement Settings 

1. In the Simulation Field dialog box, type the Source to Skin Distance in the SSD 

measurement field. 

2. Type the Source to Film Distance in the SFD measurement field. 

3. Type the Source to Axis Distance in the SAD measurement field. 

Adding Simulation Fields – Geometric Settings 

1. In the Simulation Field dialog box, type the size of the X jaws in the Field X 

geometric field. 

2. Type the size of the Y jaws in the Field Y geometric field. 

3. Type the couch vertical setting in the Couch Vrt geometric field. 

4. Type couch lateral setting in the Couch Lat geometric field. 

5. Type the couch longitudinal setting in the Couch Lng geometric field. 

Adding Simulation Fields – Radiography Settings 

1. In the Simulation Field dialog box, click to open the Radiography tab. 

2. Type the kVp value in the kVp field in the Exposure group. 

3. Type the mA value in the mA field.


Notes 4. Type the duration of the exposure in the Secs field. 

5. Type the X and Y plane settings (X1, X2, Y1, Y2) in the Blades group. 

6. Click to save the simulation field. 

Copying a Simulation Field 

1. In the Diagnoses and Interventions window, click a simulation field, click 

, then click Field. 

2. In the Confirm Field Copy message box, click to open the 

Simulation Field dialog box. 

3. Type the simulation field number in the first Sim Field. 

4. Type the name of the simulation in the second Sim Field. 

5. Change the Measurements, Separations, Other, and Geometric group fields if necessary. 

6. Click to save the new simulation field. 

Adding Positioning Devices 

1. Click File | Libraries | Positioning Devices… to open the Positioning Devices 

window. 

2. Click to open the Positioning Device dialog box. 

3. Type the Name of the positioning device, to a maximum of 16 characters. 

4. Click the Class of the positioning device: Global, Patient, or Patient 

Positioning. 

5. Click the Type of positioning device. 



1. In the Diagnoses and Interventions window, click the radiation prescription. 

2. Click in the Add group, then click Site to open the Site Simulation 

dialog box. 

3. Click adjacent to the Patient Orientation field, then click the patient orientation, 

such as Head In, Supine. 

4. In the Accessories group, click adjacent to the Pt Support field, then click the 

method of patient support. 

5. Click the positioning device(s) from the Positioning Device 1-4 fields. 


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Notes 6. Add a patient note or view simulation images, if necessary. 

7. Click to save the site simulation. 

Adding a Site Setup 

1. In the Diagnoses and Interventions window, click to open the Site 

Setup dialog box. 

2. Click adjacent to the Patient Orientation field, then click the patient orientation, 

such as Head In, Supine. 

3. Click the appropriate couch offset thresholds/maximums for the prescription site 

from a list of defined thresholds/maximums. The Couch Movement 

Threshold/Maximum group is available only if your facility has Elekta Automated 

Table Movement (ATM). 

4. In the Setup Correction group, click the Prescribed Offsets, then type the offset in 

centimeters. 

5. In the Structure Set group, click the Structure Set for this site setup. 

6. Click . 

Copying Simulation Fields and Adding Treatment Field Data 

1. In the Diagnoses and Interventions window, click a simulation field, then click 

to open the Confirm Field Copy message box. 

2. Click . 

3. Click if the Machine Characterization warning message box appears. 

4. In the Treatment Field Definition dialog box, click the type of beam from the Type 

field. 

5. Click the treatment modality from the Modality field to open the Beam 

Configurations dialog box. 

6. Click the energy level of the beam in the Energy column. 

7. Click the doserate in the Doserate column, then click to close the Beam 


8. In the Treatment Field Definition dialog box, type the monitor units in the MU 

field. 

9. Type treatment delivery time in the Time field. 

10. Type dose for the treatment field in the Dose field. 

11. In the Portal Image Planned group, type planned portal image monitor units in the 

Planned MU field.


Notes 12. Type open field portal image monitor units in the Open MU field. 

13. Type the portal image delta setting in the Open Delta field. 

Adding Accessory and Geometric Settings 

1. In the Accessories/Slots group of the Treatment Field Definition dialog box, click 

the type of wedge from the Wedge field. 

2. Type the compensator in the Compensator field. 

3. Type the block needed for treatment in the Block field. 

4. Type the bolus in the Bolus field. 

5. Change any geometric settings if necessary. 

Applying a Tolerance Table 

1. In the Treatment Field Definition dialog box, click adjacent to the Tolerance 

field to open the Tolerance Table list. 

2. Click the tolerance table for the treatment field. 

Adding Treatment Field Notes 

1. In the Treatment Field Definition dialog box, click to show the Field 

Setup view. 

2. Click in the Field Setup text box, then type the field note content. 

3. Click to save the note and the treatment field. 

Using the Apply Limits Option 

1. Double-click the treatment field to open the Treatment Field Definition dialog 

box. 

2. Change one or two geometric settings so that they are out of bounds. 

3. Right-click or press F4 to open the Treatment Field Definition Options menu. 

4. Click Apply Limits…. 

5. Click if the Positional Limit Exceeded message box appears. 


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Notes Copying Treatment Fields 

1. In the Diagnoses and Interventions window, click a treatment field to copy, then 

click to open the Confirm Field Copy message box. 

2. Click to open the Treatment Field Definition dialog box. 

3. Type the treatment field number in the first Field text box, then press TAB. 

4. Type the name of the treatment field in the second Field text box. 

5. Right-click or press F4 to open the Treatment Field Definition options menu. 

6. Click Flip to open the Flip Confirmation message box. 

7. Click to open the Question message box. 

8. Click to invert the geometric settings. 

9. Click to save the new treatment field. 

Manually Adding Treatment Fields 

1. From the Diagnoses and Interventions window, click the radiation prescription. 

2. Click to open the Treatment Field Definition dialog box. 

3. Type treatment field ID in the first Field text box, then press TAB. 

4. Type a description of the treatment field in the second Field text box. 

5. Click adjacent to the Machine field, then double-click a linear accelerator. 

6. Click the tolerance table from the Tolerance field. 

7. Type the dose for the treatment field in the Dose field. 

8. In the Beam group, click the type of beam from the Type field. 

9. Click the treatment modality from the Modality field to open the Beam 


10. Click energy in the Energy column, click the doserate in the Doserate column, then 

click . 

11. Type the monitor units for the field in the MU field, then press TAB twice. 

12. Type the treatment delivery time in the Time field.


Notes 

Manually Adding Geometric Settings 

1. In the Treatment Field Definition dialog box, type the gantry angle in the Gantry 

Angle field. 

2 Type the size of the X jaws, width, and length in the Field Size X field. 

3. Type the size of the Y jaws in the Field Size Y field. 

4. In the Couch group, type the longitudinal couch angle in the Longitudinal field. 

Manually Adding Accessory Information 

1. In the Treatment Field Definition dialog box, click or type the wedge in the Wedge 

field. 

2. Type the compensator in the Compensator field. 

3. Type the block in the Block field. 

4. Type the bolus in the Bolus field 

Manually Adding Portal Image Information 

1. In the Treatment Field Definition dialog box, type the planned portal image 

acquisition monitor units in the Planned MU field of the Portal Image group. 

2. Type the open field portal image monitor units in the Open MU field. 

3. Type the change in field size for open portal images in the Open Delta field. 

Adding Field Setup Information 

1. In the Treatment Field Definition dialog box, click to show the Field 

Setup view. 

2. Click in the Field Setup text field (below the SSD field), then type the field setup 

and patient positioning information. 

3. Click to save the treatment field. 

Specifying Accessory Verification 

1. Double-click a treatment field to open the Treatment Field Definition dialog box. 

2. Type Custom in the Block or other accessory field. 

3. Click to save the changes. 

4. Repeat with other treatment fields if necessary. 


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Notes Printing Accessory Barcode Labels 

1. Click File, then point to Print Barcodes to open the Print Barcodes menu. 

2. Click Accessory… to open the Treatment Field Definitions window. 

3. Click the field(s) in the Field column. 

4. Click to print the barcode labels. 

Approving Treatment Fields 

1. In the Diagnoses and Interventions window, double-click the treatment field to 

approve. 

2. Right-click in the Treatment Field Definition dialog box or press F4 to open the 

Treatment Field Definition Options menu. 

3. Click Approve… to open the Approve Treatment Field Definition dialog box. 

4. Type your Password, then press ENTER to approve the treatment field. 

5. In the Treatment Field Definition dialog box, click to save the 

change. 

Changing Approved Treatment Fields 

1. In the Diagnoses and Interventions window, double-click a treatment field to 

open the Treatment Field Definition dialog box. 

2. Change any geometric, accessory, or other parameter setting. 

3. Right-click in the Treatment Field Definition dialog box, or press F4 to open the 

Treatment Field Definition Options menu. 

4. Click Approve… to open the Approve Treatment Field Definition dialog box. 

5. Type your Password, then press ENTER to re-approve the treatment field. 

6. Right-click or press F4 to open the Treatment Field Definition Options menu. 

7. Click Field Delta to open the Field Delta View dialog box. 

8. Click to close the Field Delta View dialog box. 

9. Click to save the change(s) to the treatment field.


Notes 

Copying Couch Parameters and Changing Field Notes 

1. Click File | System Utilities | Department Setup…, then click to 

open the Clinical (RO) tab of the Department Setup dialog box. 

2. Click On Couch Copy Retain Field Approval Status to open the Warning message box. 

3. Click to close the Warning message box. 

4. Check On Note Edit Retain Field Approval Status, then click . 

5. Click to close the Department Setup dialog box. 

6. In the Diagnoses and Interventions window, click the treatment field from which 

to copy, then click to open the Couch Copy window. 

7. Click adjacent to the prescription in the Select Fields to Copy Rx Couch Values To 

group. 

8. Click the treatment field to which to copy the couch parameters. 

9. Type your Password, then click . 

10. Click to close the Couch Copy window and show the Diagnoses 

and Interventions window. 

11. Double-click the treatment field, then click to open the Field Setup 

view of the Treatment Field Definition dialog box. 

12. Change the note in the Field Setup text box, then click . 

Moving Treatment Fields to a Different Radiation Prescription 

1. In the Diagnoses and Interventions window, click and hold the left mouse button 

down over a treatment field you wish to move to a new radiation prescription. 

2. Drag the mouse pointer down until the outline shows over the radiation 

prescription to which you want to move the treatment field, then release the left 

mouse button. 

3. In the warning message box, click . 

Hiding Treatment Fields 

1. In the Diagnoses and Interventions window, click a treatment field, then rightclick 

in the Diagnoses and Interventions window or press F4. 

2. Click Hidden Tx Field to mark the treatment field as hidden. 


LTGRAD0005A/2.0/26-Feb-2009



LTGRAD0005A/2.0/26-Feb-2009 

Notes 3. Right-click or press F4, then click Hide Tx Fields marked as Hidden to hide 

the treatment field marked Hidden in the Diagnoses and Interventions window in 

this view of the window only. 

Changing the Treatment Order of Treatment Fields 

1. Right-click or press F4, then click Treatment Order…. 

2. Click and/or in the Treatment Order window to specify the 

order to treat the first 15 fields defined for the patient. 

Opening the Treatment Calendar 

1. Right-click or press F4, then click Treatment Calendar… to open the 

Treatment Calendar view of the Treatment Chart window. 

Adding Simulation and Treatment Fields with No Prescription 

1. Right-click or press F4, then click Add Simulation without Rad Rx… to open 

the Simulation Field dialog box. This option lets you add a simulation field that is 

not associated with a radiation prescription. 

2. Right-click or press F4, then click Add Tx Field without Rad Rx… to open the 

Treatment Field Definition dialog box. This option lets you add a treatment field 

that is not associated with a radiation prescription.


Notes 


LTGRAD0005A/2.0/26-Feb-2009

Course Evaluation: Dosimetrist/Physicist 

Module I 

Now that you have completed Dosimetrist/Physicist Module I Training, please answer the following by placing a 

checkmark in the appropriate box. Mark the tasks that were covered in class on the left, then indicate your “comfort” 

level with each task that was covered in class. Each task is followed by a lesson reference. If you answer “Cannot do” 

for any of the tasks, you can refer to the appropriate lesson in the Training Guide to review the course information. 

Check tasks 

covered 


LTGRAD0005A/2.0/26-Feb-2009 

Can you do the following tasks? 

Can do 

Can do 

with help 

Cannot 

do 

Opening the Home View (Lesson 1) 

Opening the Chart View (Lesson 1) 

Opening the eCHART Navigator Views (Lesson 1) 

 

Opening the Diagnoses and Interventions Window 

(Lesson 1) 

 

Opening the Dose Site Summary and Dose Action Points 

Windows (Lesson 1) 

Opening the Treatment Chart Window (Lesson 1) 

 

Opening the Dosimetry Configuration Dialog Box 

(Lesson 1) 

Opening the Diagnosis and Staging Window (Lesson 2) 

Adding Diagnosis Information (Lesson 2) 

Affirming a Diagnosis (Lesson 2) 

Assigning Care Plans (Lesson 2) 

Adding Prescriptions (Lesson 2) 

Using Radiation Prescription Sequencing (Lesson 2) 

Adding a Dose Limit Dose Action Point (Lesson 2) 

Changing Prescriptions (Lesson 2) 

Appending Fractionation Phases (Lesson 2) 

Showing Historical Prescription Data (Lesson 2) 

Adding a Simulation Field (Lesson 3) 

Copying a Simulation Field (Lesson 3) 

Adding a Positioning Device (Lesson 3) 

Adding a Site Simulation (Lesson 3) 

Adding a Site Setup (Lesson 3)

Check tasks 

covered 

Can you do the following tasks? 

Can do 

Can do 

with help 

Cannot 

do 

 

Copying the Simulation Field and Adding Treatment Field 

Data (Lesson 3) 

Adding Accessory and Geometric Settings (Lesson 3) 

Applying a Tolerance Table (Lesson 3) 

Adding a Treatment Field Note (Lesson 3) 

Using the Apply Limits Option (Lesson 3) 

Copying a Treatment Field (Lesson 3) 

Manually Adding the Treatment Field (Lesson 3) 

 

Manually Adding Geometric Settings, Accessories, Portal 

Image, and Field Setup Information (Lesson 3) 

Specifying Accessory Verification (Lesson 3) 

Printing Accessory Barcode Labels (Lesson 3) 

Approving a Treatment Field (Lesson 3) 

Changing an Approved Treatment Field (Lesson 3) 

 

Copying Couch Parameters and Changing Field Notes 

(Lesson 3) 

 

Moving Treatment Fields to a Different Radiation 

Prescription (Lesson 3) 

Hiding Treatment Fields (Lesson 3) 

 

Changing the Treatment Order of Treatment Fields 

(Lesson 3) 

 

Adding Simulation and Treatment Fields with No 

Prescription (Lesson 3) 

Name: Date: 

Facility: 


LTGRAD0005A/2.0/26-Feb-2009

100 Mathilda Place, Fifth Floor, Sunnyvale, CA 94086

Dosimetrist/Physicist Training Guide - UCSF Radiation Oncology

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