MM Radiation Therapy Image Suite (RTiS) - 4D Workflow

4D Workflow in RTiS MM Radiation Therapy Image Suite (RTiS) VA40 Sim&GO VA40 (limited functions available) and syngo.via VB60 Internal structures, predominately in the chest and abdomen, move during respiration. Evaluating this movement at the time of the simulation scan can aid in determining the treatment strategy. Available evaluation tools include: • Cine Movie • Manual distance calculation • Image Grid • Contouring • Propagation of Structures or POI’s (Points of Interest) • Show Movement (system calculation of movement if contoured) and • ITV (Internal Tumor Volume) Creation Functionality is limited to purchased licenses. Note: This example below uses phase-based reconstructions, series already split, and the RTiS application. 1. After acquiring a 4D scan, load the series into the RTiS workflow. 2. In the Navigator Panel, select the Contouring tab. SIEMENS. Healthineers MM RT mage Suite Q + RT Imat Suite O:: Pati rking Regist ion Contouring Series 1 Planning CT 2.0 831f Q. Dose Evaluation RT Navigator Findings Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers 3. In the Series panel, press the caret symbol next to the phase series (usually indicated by a 10 in the upper corner) to expand the list to show individual phase folders. 4. Left mouse click and hold and drag any of the individual phase folders into the pane. The program will automatically load all phases. Series Add study Current - C1. 5/20/2020 RO_Thor_Lung_4D Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 2 of 11 5. After loading the images, the Movie toolbar is available. Scroll through the series as needed to locate the desired structure. Left mouse click and hold and drag the crosshairs and center on the structure to evaluate (tumor). 2IMAn a. FRM n.a. SP R47.4 2IMA ~119 SP H36.0 60Thorax 2 00 0140 85 0- 9 4DThorax 2.00 Qr40 S5 0 - 90 50 In TPS_SORT 6% 04/22/2020 2:13:15 PM Structure Set_1 UNAPPROVED CD H 2 IMAn.a. FRM n.a. SP A245.9 4DThorax 2.00 Q:40 $5 0 - 90 50 In TPS SORT 6% 10cm 04/22/2020 213:15 PM - 8 O 400 2D 21 3D Nuoge Freehand Contour Sagment FaniScale by Value Rotate Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 3 of 11 6. Hover over the Movie toolbar icons to see the function of each. If only basic evaluation is applicable, press the Start button, and the system will cine continuously through the phases. In the upper right corner menu, a Distance Line is available if needed. Note: Corner Menus are available in all layout panes. A Distance Line Measure straight distance [D 2 IMA ~119 SP H36.0 Pixel Lens 4DThorax 2.00 Qr40 S5 0 - 90 70 In TPS_SORT 8% 04/22/2020 Arrow 2:13:16 PM Angle 4 Structure Set 1 UNAPPROVED Text T Image Grid R 10cm Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 4 of 11 7. An Image Grid is also available in the upper right corner menu. The Image Grid is centered on the layout pane. A tip for centering the tumor on the Image Grid is to move the crosshairs to the center of the tumor, then pan the image until the crosshairs align with the orientation alphabet (as the alphabet is centered on the pane). Perform this function in all layout boxes if necessary. 2 IMAn.a. FRM n.a. SP R47.4 2 IMA ~119 4DThorax 2.00 Qr40 85 0 - 90 70 In TPS_SORT 8% SP H36.0 04/22/2020 4DThorax 2.00 Qr40 S5 0 - 90 70 In TPS_SORT 8% 2:13:16 PM 04/22/2020 2:13:16 PM - 8 Structure Set_1 UNAPPROVED LI 400 R 2 IMAn.a. FRM n.a. SP A245.9 4DThorax 2.00 Qr40 85 0 - 90 70 In TPS/ SORT 8% 10cm 04/22/2020 2:13:16 PM O F LA 21 400 2D 3D L+ Draw Nudge Segment Pan/Scale Freehand Contour by Value Rotate Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 5 of 11 8. When playing the cine, the Image Grid can be used to evaluate the tumor distance movement. Using the Zoom function, the grid increments will automatically adjust to the magnification. 2 IMAn.a. FRM n.a. SP-R47.4 20 2 IMA-119 4DThorax 2.00 Q:40 85 0- 90 70 In TPS SORT 8% SP H36.0 04/22/2020 4DThorax 2.00 Qr40 S5 0 - 90 70 In TPS_SORT 8% 2:13:16 PM 04/22/2020 2:13:16 PM Structure Set_1 UNAPPROVED 10cm 20 SPA245.9 4DThorax 2 00 Q:40 55 0 . 90 70 In TF'S/ SORT 8% 10cm 04/22/2020 2:13:16 PM O F 20 3D Draw Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 6 of 11 9. If time is taken to Contour a structure (tumor), it is possible to propagate the contour to the other phases. Right mouse click on the structure name and select Propagate to. A popup box will appear and select which phases to propagate. Select Copy. MM RT Inoge Suite --- -- looks -- ===- 10.Once the function is complete, evaluate each phase to ensure the propagation is accurate. You can then play the cine and evaluate the motion of the contours in every phase. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 7 of 11 11.The system can also measure the movement of the contours across the phases. Right-mouse-click on the structure name and select Show Movement. A popup box will appear. The program can display movement in Tumor Trajectory or Distance to Midposition. Note: It is not possible to snapshot this box. MM RT Image Suite Contouring Tumor Curve ? X Series 4DThorax 2.00 .. TPS_SORT 10% Structure/POI : tumor Preview Head-Feet Amplitude : 0.1 cm Left-Right Amplitude : 0 cm dagin structure Caudal Adapt Anterior-Posterior Amplitude : 0.3 cm .... Phase Closest to Midposition : 30 In . Tumor Trajectory Distance to Midposition 0.35 RT Navigator Findings 0.3 0.25 Structures POI 0.2 O Name Type tumor Rename 0.15 Distance (cm) Change Type 0.1 Erase Contours ................ Delete 0.05 Duplicate Merge o in 10 In 20 In 30 In 40 In 50 In Phase 60 In 70 In 80 In 90 In Lock Show as defined in Propagate to use 4D data that is binned equidistant in time to identify midventilation phasel Tools Show Movement Create ITV OK Overwrite HU Full Text Hide Hide Lines Roces Graphics Timcpol .. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 8 of 11 12.The program can also create an ITV from the propagated contours. Right mouse click on the structure name and Select Create ITV. A popup box will appear. Select the phases desired to create the ITV and which phase to display the ITV. .. IOC_CART 1.004 Create ITV ? X RT Navigator Findings Select phases to include in ITV Structures POI Name Type tumor Rename 4DThorax 2.00 Qr40 55 0 - 90 0 In TPS_ SORT Change Type Erase Contours 4DThorax 2.00 Or40 55 0 - 90 10 In TPS SORT 4DThorax 2.00 Qr40 55 0 - 90 20 In TPS SORT Delete 4DThorax 2.00 Qr40 55 0 - 90 30 In TPS_SORT Duplicate Merge 4DThorax 2.00 Qr40 55 0 - 90 40 In TPS SORT Lock 4DThorax 2.00 Qr40 55 0 - 90 50 In TPS_SORT Show as defined in 4DThorax 2.00 Qr40 55 0 - 90 60 In TPS SORT Propagate to 4DThorax 2.00 Qr40 55 0 - 90 70 In TPS_SORT Tools Show Movement 4DThorax 2.00 Qr40 55 0 - 90 80 In TPS_SORT Create IT 4DThorax 2.00 Qr40 55 0 - 90 90 In TPS_SORT Full Text Overwrite HU HiGe Hide Linea REZ Associate ITV to 4DThorax 2.00 Qr OK Cancel 13.Select OK. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 9 of 11 14.A popup box will appear asking if you want to create a new structure or overwrite your original contour. Select Create New. ITV Confirmation AF X ? Do you want to create a new structure or overwrite the existing structure based on the ITV result? IMAn PA18 DThe Create New Overwrite Cancel 4/220 13:13 15.The ITV will now appear on the phase it was associated with. MM RT Image Suite 2 MMAn a Contouring 2 IMAn a SP R36.3 4DThorax 2 00 Qr40 95/01-9 Series 40Thorax 2.00 ., TPS_SORT 10% SP H102.0 04/22/2020 4DThorax 2.00 Qr40 S5 0 - 90 90 In TPS_SORT 10% 2:13:17 PM 04/22/2020 2:13:17 PM Contour Structure Set_1 Previow UNAPPROVED Create Cut Margin Zructure tumor tumor ITV VI RT Navigator Findings Structures POI Name Type mor_ITV Tools Lunch Full Text Hide Graphics Hide Lines Timepoi .. SL min Ecit Snapshot Print Export Unde Redo . 20 Layout . 30 27 You can use the Copy Structures and POI’s function to copy these structures to another scan such as the Free Breathing, Average or MIP (Maximum/Minimum Intensity Projection). Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 10 of 11 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2023 Siemens Healthineers Headquarters Local Contact Information Legal Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Siemens Shanghai Healthcare Sector Henkestr. 127 40 Liberty Blvd. Medical Equipment Ltd. 91052 Erlangen Malvern, PA 19355-9998 USA 278 Zhou Shu Road Germany Telephone: +1-888-826-9702 Shanghai 201318 Phone: +49 9131 84-0 Customer Care Telephone: P.R. China https://www.siemens-healthineers.com +1-800-888-7436 Telephone: +1 847 304 7700 Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 06 October 2023 | QR700001522 Healthineers Page 11 of 11