Radiation Therapy VB20 Improvements - USA

Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue Untitled Scene Master Template HILS2218 | Effective Date: 25 Mar 2022 ? Radiation Therapy VB20 Improvements Online Training In this training, we will introduce the VB20 software improvements for Radiation Therapy to you. Describe the principle of Oncology Exchange 1 Reconstruct images with extended HD Field of View (HD FoV 5.0) Operate ZeeFree RT to reduce stack artifacts Reconstruct relative stopping power with DirectDensity Perform the new RT lasers workflow to define isocenters Apply DirectSetup Notes improve- ments 2 4 5 3 6 Welcome [welcome.mp3] Welcome to the Radiation Therapy VB20 improvements online training. In this training, we will introduce the VB20 software improvements for Radiation Therapy to you. The main learning objectives of this training are numbered below. Table with 2 columns and 5 rows Not all pages contain audio. Some pages invite you to read for yourself or watch a video. All pages show a ? button in the lower-right corner. Select the ? button to get a quick guide through the navigation elements. Select the button on the top left corner to display or hide the menu. You can magnify an image with this icon placed in the bottom left corner of the image. Select the image to enlarge. Select the image again to return to its normal size. ? Navigation hints Before you start, we would like to give you a few tips on how to navigate: Enjoy the course! ? Navigation hints ? Overview VB20 improvements for Radiation Therapy With the VB20 software version, there are various improvements available, intended to even further facilitate your daily clinical routine and workflows in Radiation Therapy: Introducing Oncology Exchange (optional) and its workflow myExam Compass VB20 improvements DirectSetup Notes VB20 improvements Define isocenters with RT lasers Introducing the ceiling-mounted FAST 3D Camera (optional) New RTP scan protocols DirectDensity VB20 improvements (optional) Introducing ZeeFree RT in Direct i4D scans (optional) AI-supported extended HD Field of View (HD FoV 5.0) Sim&GO and RT Image Suite* improvements *Optional. This RT post-processing application is a standalone medical device. Overview VB20 improvements for Radiation Therapy [overview_vb20_improv_rt.mp3] With the VB20 software version, there are various improvements available, intended to even further facilitate your daily clinical routine and workflows in Radiation Therapy: Introducing Oncology Exchange (optional) and its workflow myExam Compass VB20 improvements DirectSetup Notes VB20 improvements Define isocenters with RT lasers Introducing the ceiling-mounted FAST 3D Camera (optional) New RTP scan protocols DirectDensity VB20 improvements (optional) Introducing ZeeFree RT in Direct i4D scans (optional), and AI-supported extended HD Field of View (HD FoV 5.0) Sim&GO and RT Image Suite improvements. ? Course review Congratulations. You have completed the Radiation Therapy VB20 Improvements Online Training. Select the numbered buttons below to review the material before proceeding to the final assessment. Perform the new RT lasers workflow to define isocenters Apply DirectSetup Notes improvements Describe the principle of Oncology Exchange 1 1 1 3 3 3 2 2 2 5 5 5 6 6 6 Operate ZeeFree RT to reduce stack artifacts Reconstruct images with extended HD Field of View (HD FoV 5.0) 4 4 4 Reconstruct relative stopping power with DirectDensity Course review Reconstruct images with extended HD FoV (HD FoV 5.0) With the VB20 software version, the extended HD Field of View reconstruction HD FoV 5.0 is available as an option. It is supported by AI to extend the SFoV by a circular area up to the bore size. Please note: The extended circular area outside the SFoV has reduced image quality. For diagnosis, do not use the image area outside the regular field of view. It has reduced quality and may contain artifacts. Scan Field of View (SFoV)* HD FoV 4.0 reconstruction AI-supported HD FoV 5.0 reconstruction Extended HD FoV* *Sizes of SFoV and extended HD FoV are scanner model dependent. Clinical case images courtesy of University Hospital Würzburg, Würzburg, Germany. Operate ZeeFree RT to reduce stack artifacts ZeeFree RT is a reconstruction algorithm. You can apply it for scans that you have acquired with the Direct i4D scan mode. Please note: Direct i4D is an optional feature. With the VB20 software version, ZeeFree RT is contained in the Direct i4D license. The scanner system performs Direct i4D scans in stacks with an overlap of about 10% of the detector height. Motion artifacts can occur, when breathing is irregular and Direct i4D cannot fully compensate for it. With ZeeFree RT, the overlapping data is used to reduce stack artifacts by applying deformable image registration, which brings data in the overlap regions to agreement. You can apply ZeeFree RT by adjusting the recon parameters of the recon job that you want to start: Physio Recon tab Æ StackRecon drop-down Æ Select ZeeFree. Warning: ZeeFree RT reconstructions are modified images. You can only use them as supplemental information. You need a second reconstruction with the StackRecon Æ Standard setting to check consistency. Standard setting ZeeFree setting DirectDensity overview and new VB20 features DirectDensity reconstructs CT images of material properties needed for RT treatment planning from single-energy CT acquisitions, that would otherwise only be available from spectral imaging. Please note: If you use the VB20 version of DirectDensity, you must re-measure your calibration curve in the TPS, since we have changed the algorithm. Detailed algorithmic improvements For VB20, we have made detailed algorithmic improvements to more accurately represent all material properties and reduce the remaining kVp dependence across the entire range of CT values. Enabling use of CARE kV The resulting DirectDensity reconstructions are mostly independent of the kVp setting used during the scan. This enables you to use CARE kV, our automatic patient-specific tube voltage selection, without the need of using multiple calibration curves in your Treatment Planning System. Additional material property: Relative stopping power The resulting CT values can be interpreted as relative electron density or relative mass density - hence as the direct elemental properties needed for treatment planning. New with VB20: DirectDensity now also supports relative stopping power as an additional material property. Perform the new RT lasers workflow to define isocenters You can use this new workflow to manually move the RT lasers and the table position, so that they are aligned with the mark on the patient's body that indicates the isocenter coordinates. Using Scan&GO on your tablet, you can mark the patient in the examination room and afterwards send the isocenter coordinates to CT Sim&GO at your Acquisition Workplace. In CT Sim&GO, import your POI, view it in the Anatomy & Targets Navigator, and, if displayed, check the Import POI Report for the deviation between what the software saved to the data set and what the CT scanner received (and where you have drawn on the patient‘s skin). This workflow is useful for palliative cases, re-sims or cases where you need to modify the POI from CT Sim&GO. Apply DirectSetup Notes improvements ARIA CORE 18.1 MR2 can now extract patient setup information and photos directly from the Direct Setup Notes report with the new functionality Direct import of setup information. In its dialog, you can Filter by Prescription. Then, simply select and copy the relevant photos and setup notes to the correct fields in ARIA CORE. On your CT scanner, you can now configure if a measurement or accessory should be available for automatic copy into the setup note field in ARIA CORE. After configuration, simply select the Allow Direct Import to Setup Note checkbox in the dialog of the item you want to add. Starting from ARIA CORE 18.1 MR2, your CT scanner can now retrieve the setup information from the ARIA CORE server when a patient comes back for a re-sim. A Load Data tab appears on your tablet then and indicates previous Patient Setup Reports are available for the current anatomic area. Your system administrator can now also configure the Document Photos step for DirectSetup Notes in the Administration Portal. Document Photos are detached from patient setup photos. They document things not related to the patient setup. Document Photos is available as a separate item in the ARIA CORE Documents workspace. If you have Document Photos configured, you can easily move a photo by dragging and dropping it with your index finger in either direction between Patient Setup Photos and Document Photos on your tablet. During the examination, you can now edit and change the accessories that are available in the template on the Patient Setup dialog of your tablet. On the Patient Setup dialog of your tablet, you can now also add another Anatomic Area to the template. In the Administration Portal, your system administrator can now configure the layout of the Patient Setup Report and download a layout document. You can then edit it in Microsoft Word according to your needs. The admin can then upload it back to the CT system. Describe the principle of Oncology Exchange Oncology Exchange is an optional feature. The principle of Oncology Exchange is to transfer prescription information from the ARIA CORE oncology information system to your CT software. Please note: You will need the SEMANTIC_INFO_INTEROP license to be able to use this feature. Oncology Exchange displays some of the attributes and values from the prescription workspace in ARIA CORE on the CT user interface. You can use this information for automation. The prescription information helps you at the scanner to know how to proceed with the CT scan. For example, it helps you to know What the motion management technique is. If a bolus is needed. If contrast medium is needed. Please remember: The more correctly you fill in your prescription information in ARIA CORE, the better will be the scan protocol selection of the CT scanner software. Disclaimer 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 Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please 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. All trademarks are the property of their respective owners. Unrestricted | Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2025 Siemens Healthineers HQ | Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com ? Disclaimer Assessment Start ? This assessment will test your retention of the presented content. A passing score of 80% or higher is required. You will have 3 attempts to complete the course and earn your certificate . Assessment questions must be answered completely to receive full credit. Partial credit will not be given for assessment questions that require multiple answers. Assessment ? Select two (2) answers. Question 1 of 10 The principle of Oncology Exchange is… …to display unified display names between your CT software and ARIA CORE. …to transfer prescription information from ARIA CORE to your CT software. …to make patient setup reports and setup photos from your CT software available in ARIA CORE. …to transfer recon parameters from your CT software to ARIA CORE. Multiple Answer Select the best answer to complete the statement. ? …time-saving automatic answering of clinical decision tree questions. Question 2 of 10 Linking myExam Companion to ARIA CORE now enables… …efficient deletion of clinical decision tree questions. …improved scan protocol change in clinical decision trees. …improved radiation therapy scheduling in ARIA CORE. Fill in Blank ? Select three (3) answers. Question 3 of 10 With the VB20 software version, the following DirectSetup Notes improvements are now available: Starting from ARIA CORE 18.1 MR2, your CT scanner can now retrieve the setup information from the ARIA CORE server when a patient comes back for a re-sim. You can now change the look and feel of the DirectSetup Notes UI according to your needs. ARIA CORE 18.1 MR2 can now extract patient setup information and photos directly from the DirectSetup Notes report. Your system administrator can now configure the layout of the Patient Setup Report and download an editable layout document. Multiple Answer Before starting with the actual workflow,… …make sure the RTP basic license and the RTP Direct Laser Steering license are available. Select the Mark Patient button in Scan&GO to… …create a new POI at the current table and laser position. As your last step in Scan&GO on your tablet,… …confirm that you have marked the patient by selecting the Marking Completed button. In CT Sim&GO at your syngo acquisition workplace,… …import your POI, view it in the Anatomy & Targets Navigator, and check the Import POI Report, if displayed. Drag each response from the right column to its corresponding item in the left column. Match the correct statements about the new workflow to define isocenters with RT lasers. ? Question 4 of 10 Matching Drag each response from the right column to its corresponding item in the left column. Assign the correct hardware compenents of the FAST 3D Camera to the corresponding numbers of the image. x x x 2 1 3 ? Question 5 of 10 Ceiling flange Ceiling extension Ceiling-mounted FAST 3D Camera Matching Select the best answer. ? SOMATOM Pro.Pulse SOMATOM X.cite and SOMATOM X.ceed Question 6 of 10 With the VB20 software version, RTP scan protocols are introduced on which CT scanners? NAEOTOM Alpha.Peak, NAEOTOM Alpha.Pro and NAEOTOM Alpha.Prime SOMATOM On.site Multiple Choice Select the best answer. ? Hr – High resolution Sd – Electron Density Question 7 of 10 Which new kernel is now available with the optional DirectDensity reconstruction algorithm? St – Stopping Power Ratio (SPR) Sm – Mass Density Multiple Choice ? Select three (3) answers. Question 8 of 10 Which statements about the optional ZeeFree RT feature are correct? You should use ZeeFree RT results only as supplemental information. ZeeFree RT reduces stack artifacts. ZeeFree RT is a reconstruction algorithm. ZeeFree RT separates stacks created during Direct i4D scans. Multiple Answer Select the best answer. ? The circle in orange. Question 9 of 10 Which dotted circle represents the maximal extended FoV by using HD FoV? The circle in black. The circle in petrol. Multiple Choice Select the best answer. ? In tools other than Patient Marking and Beam Placement, you can now select View in Scanned Position. When you scan images with the Patient Marking tool in FFP position, the system automatically displays them in HFS position. Question 10 of 10 Which statement about the display of acquired images in the RT Image Suite* is correct? The menu item View in Scanned Position is available in the bottom right corner menu of an image segment. There is no corner menu item View in Scanned Position available in tools other than Patient Marking and Beam Placement. *Optional. This RT post-processing application is a standalone medical device. Multiple Choice Retry Assessment Results %Results.ScorePercent%% %Results.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results You have exceeded your number of assessment attempts. Exit You did not pass the course. Select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Certificates tab from the learning activity overview page. You can also access the certificate from your Siemens Healthineers Academy transcript. ? You have completed the Radiation Therapy VB20 Improvements Online Training. Completion details, certificates tab Navigation Help Select the icon above to open the table of contents. Click Next to continue. Next Welcome Slide The timeline displays the slide progression. Slide the orange bar backwards to rewind the timeline. Click Next to continue. Next Tmeline Select the buttons to learn more about a topic. Be sure to review all topics before navigating to the next slide. Click Next to continue. Next Tab Arrow Slide Select the X to close the pop-up. Click Next to continue. Next Layer Slide Some images may have a magnifier icon. Select the image to see an enlarged view. Select it again to return to the normal view. Click Next to continue. Next Zoom Slide Some images have a magnifier icon in the bottom-left corner. Select these image to see an enlarged view of the image. Select the image again to return to the normal view. Select Submit to record your response. Click the X in the upper right corner to exit the navigation help. Assessment Slide Introducing Oncology Exchange Oncology Exchange (optional) Chapter 1 ? Oncology Exchange (optional) ? Introducing Oncology Exchange The principle of the optional feature Oncology Exchange is to transfer prescription information from the ARIA CORE oncology information system to your CT software. Please note: You will need the SEMANTIC_INFO_INTEROP license to be able to use this feature. Oncology Exchange displays some of the attributes and values from the prescription workspace in ARIA CORE on the CT user interface. You can use this information for automation. The prescription information helps you at the scanner to know how to proceed with the CT scan. For example, it helps you to know What the motion management technique is. If a bolus is needed. If contrast medium is needed. Please remember: The more correctly you fill in your prescription information in ARIA CORE, the better will be the scan protocol selection of the CT scanner software. Introducing Oncology Exchange [oncol_exchange_01.mp3] The principle of the optional feature Oncology Exchange is to transfer prescription information from the ARIA CORE oncology information system to your CT software. Please note: You will need the SEMANTIC_INFO_INTEROP license to be able to use this feature. Oncology Exchange displays some of the attributes and values from the prescription workspace in ARIA CORE on the CT user interface. You can use this information for automation. The prescription information helps you at the scanner to know how to proceed with the CT scan. For example, it helps you to know What the motion management technique is. If a bolus is needed. If contrast medium is needed. Please remember: The more correctly you fill in your prescription information in ARIA CORE, the better will be the scan protocol selection of the CT scanner software. ? Oncology Exchange Workflow Now we would like to introduce the Oncology Exchange workflow to you in more detail. Select the numbered steps below to learn more about this workflow. 1 1 1 2 2 2 3 3 3 4 4 4 Oncology Exchange Workflow [oncol_exchange_04.mp3] Now we’d like to introduce the Oncology Exchange workflow to you in more detail. Select the numbered steps below to learn more about this workflow. Use case: Multiple prescriptions If there are multiple prescriptions available for your patient, you need to select / activate at least one prescription for automatic scan parameter adaption. You can either do so at your workplace or on your tablet. The system will automatically synchronize. Please note: You can select no more than 10 prescriptions at a time. Proceed with your clinical workflow as usual. 4 Acquisition Workplace Tablet Use prescription information at CT scanner software When you select the patient in the CT scanner soft-ware, the system automatically queries the corres-ponding prescription information from ARIA CORE. Please note: The system displays prescriptions from the past six months. Scroll down on the Patient Registration tab of your selected patient to see the Radiotherapy Prescription section. You can use the prescription information to know, for example, Which motion management technique to use. If you need to use a bolus. If you should use contrast medium for the CT examination. 2 Use case: Single prescription If you select your patient from the tablet, the system displays the prescription information directly on the tablet. If there is only one prescription available, it is automatically activated. Proceed with your clinical workflow as usual. Tablet 3 Fill in prescription workspace in ARIA CORE In ARIA CORE, the medical doctor needs to fill in the prescription workspace. The prescription does not have to be approved. Please remember: Fill in the prescription information in ARIA CORE as correctly and completely as possible. This will improve the scan protocol selection of the CT scanner software. You can use the Notes field in the Treatment Prescription section to provide useful hints, for example, if contrast medium should be used for the CT examination. 1 Data Element Value Data Element Value Prescription Name* - Prescription Name - Site - Treatment Site - Bolus - Bolus - Mode* - Modality - Technique - Technique - Notes - Notes - Course - Course - Course Intent - Course Intent - Prescription Status - Status - Gating* Amplitude Based Motion Management Respiratory 4D Phase Based Respiratory 4D Breath Hold Breathhold None None Primary/Boost None Primary/Boost None Boost Boost Primary Primary ? Prescription information displayed at the CT scanner The following table lists display names from the ARIA CORE prescription workspace versus display names at your CT scanner. To fit better to the CT naming convention, some display names are different at the CT scanner compared to ARIA CORE. We have highlighted them in blue and orange. * Used for automation ARIA CORE display name CT VB20 display name Prescription information displayed at the CT scanner [oncol_exchange_05.mp3] The following table lists display names from the ARIA CORE prescription workspace versus display names at your CT scanner. To fit better to the CT naming convention, some display names are different at the CT scanner compared to ARIA CORE. We’ve highlighted them in blue and orange. ? Scan protocol mapping according to treatment site With the VB20 software, scan protocol mapping is now also possible with the Treatment Site provided by ARIA CORE as part of Oncology Exchange. Scan protocol mapping works in the same way as before, except the system can now also use the treatment site instead of the requested procedure. The treatment sites are displayed in the Browse Protocols dialog instead of the requested procedure. Please note: The first time you use a treatment site, you need to select the desired scan protocol manually. The second time you use the same treatment site, the system will automatically load the scan protocol that you previously mapped. Just like in scan protocol mapping via requested procedure, you can remove the checkmark, if you do not want to use scan protocol mapping. Scan protocol mapping according to treatment site [oncol_exchange_06.mp3] With the VB20 software, scan protocol mapping is now also possible with the Treatment Site provided by ARIA CORE as part of Oncology Exchange. Scan protocol mapping works in the same way as before, except the system can now also use the treatment site instead of the requested procedure. The treatment sites are displayed in the Browse Protocols dialog instead of the requested procedure. Please note: The first time you use a treatment site, you need to select the desired scan protocol manually. The second time you use the same treatment site, the system will automatically load the scan protocol that you previously mapped. Just like in scan protocol mapping via requested procedure, you can remove the checkmark, if you do not want to use scan protocol mapping. ? Mapping more than one protocol to a treatment site If you have mapped more than one scan protocol to a particular treatment site or requested procedure, the linked scan protocols are shown in a filtered list. With the VB20 software, the system now also displays the linked protocols on the tablet. Mapping more than one protocol to a treatment site [oncol_exchange_07.mp3] If you have mapped more than one scan protocol to a particular Treatment Site or requested procedure, the linked scan protocols are shown in a filtered list. With the VB20 software, the system now also displays the linked protocols on the tablet. ? Mapping when patient has more than one prescription Let us say you have a patient with more than one prescription fetched from ARIA CORE, for example prostate cancer and bone metastases. In analogy to protocol mapping for treatment sites, the first time you work with these prescriptions you need to select the desired scan protocols manually. The second time you deal with the same patient and prescriptions, the system will automatically load the scan protocols that you previously mapped. Mapping when patient has more than one prescription [oncol_exchange_08.mp3] Let’s say you have a patient with more than one prescription fetched from ARIA CORE, for example prostate cancer and bone metastases. In analogy to protocol mapping for treatment sites, the first time you work with these prescriptions you need to select the desired scan protocols manually. The second time you deal with the same patient and prescriptions, the system will automatically load the scan protocols that you previously mapped. ? RT structure template selection depending on treatment site With the VB20 software, the CT system can now automatically select the corresponding RT structure template for contouring depending on the treatment sites fetched from ARIA CORE. Please note: To use this feature, you need to select the Auto structure template selection mode in your scan protocol. Under Configuration Panel Æ Advanced Visualization Æ Contouring Configuration, the system lists all treatment sites fetched from ARIA CORE. You can select several treatment sites for a specific structure template here. When the CT system receives the ARIA CORE treatment site for your exam, it automatically chooses the structure template matching the required treatment site. RT structure template selection depending on treatment site [oncol_exchange_09.mp3] With the VB20 software, the CT system can now automatically select the corresponding RT structure template for contouring depending on the treatment sites fetched from ARIA CORE. Please note: To use this feature, you need to select the Auto structure template selection mode in your scan protocol. Under Configuration Panel Æ Advanced Visualization Æ Contouring Configuration, the system lists all treatment sites fetched from ARIA CORE. You can select several treatment sites for a specific structure template here. When the CT system receives the ARIA CORE treatment site for your exam, it automatically chooses the structure template matching the required treatment site. myExam Compass VB20 improvements myExam Compass VB20 improvements Chapter 2 ? myExam Compass VB20 improvements ? Introduction Please note: All myExam Compass VB20 improvements are related to the optional feature Oncology Exchange. Linking myExam Companion to ARIA CORE now enables time-saving automatic answering of clinical decision tree questions. You will need the SEMANTIC_INFO_INTEROP license to be able to use the myExam Compass VB20 improvements we present in the following. Introduction [myexam_comp_01.mp3] Please note: All myExamCompass VB20 improvements are related to the optional feature Oncology Exchange. Linking myExam Companion to ARIA CORE now enables time-saving automatic answering of clinical decision tree questions. You will need the SEMANTIC underscore INFO underscore INTEROP license to be able to use the myExam Compass VB20 improvements we present in the following. Data Element Value Data Element Value Gating Motion Management Amplitude Based Respiratory 4D Phase Based Respiratory 4D Breath Hold Breathhold None None ? Automatic answers for RT Motion Management decision tree The Radiotherapy Motion Management clinical decision tree is part of the RTP Respiratory Motion Management Protocol. With the VB20 software update, the system now answers this decision tree automatically, if you select the Gating option in ARIA CORE. The table below shows which ARIA CORE values get mapped and what their equivalents and names are in VB20. ARIA CORE display name CT VB20 display name mapped to Automatic answers for RT Motion Management decision tree [myexam_comp_02.mp3] The Radiotherapy Motion Management clinical decision tree is part of the RTP Respiratory Motion Management Protocol. With the VB20 software update, the system now answers this decision tree automatically, if you select the Gating option in ARIA CORE. The table below shows which ARIA CORE values get mapped and what their equivalents and names are in VB20. ? Automatic answers for RT Motion Management decision tree If you have selected more than one prescription, the situation is as follows: In order to make the system answer the Radiotherapy Motion Management decision tree automatically, the Motion Management values need to be the same for each prescription. Clinical example: You have a patient with two different prescriptions for the RTP Respiratory Motion Management Protocol. Prescription #1 has the Motion Management value Breathhold. Only if prescription #2 has the same value Breathhold, the system will automatically answer the decision tree. If it is, for example, None for prescription #2, the system will not answer the decision tree automatically. Select the Illustration button below to see an illustration of this clinical example. Illustration Automatic answers for RT Motion Management decision tree 2 [myexam_comp_03.mp3] If you have selected more than one prescription, the situation is as follows: In order to make the system answer the Radiotherapy Motion Management decision tree automatically, the Motion Management values need to be the same for each prescription. Clinical example: You have a patient with two different prescriptions for the RTP Respiratory Motion Management Protocol. Prescription #1 has the Motion Management value Breathhold. Only if prescription #2 has the same value Breathhold, the system will automatically answer the decision tree. If it is, for example, None for prescription #2, the system will not answer the decision tree automatically. Select the Illustration button below to see an illustration of this clinical example. ARIA CORE workplace (Hover over screen items to magnify) syngo CT VB20 acquisition workplace Illustration of clinical example Patient with two different prescriptions which have the same Gating values Patient with two different prescriptions which have different Gating values System automatically answers the RT Motion Management decision tree question You have to manually answer the RT Motion Management decision tree question ? Automatic answers for RT Modality decision tree The RTP Modality clinical decision tree is available, but not linked to a scan protocol. You can use this decision tree, if there are differences in the scan protocol depending on which treament Modality you use (ARIA CORE name Mode). For example, Rho vs. Stopping Power Ratio recon (SPR) for a Photon vs. a Proton treatment. Clinical example: If your site provides Proton Therapy and you are connected to ARIA CORE, first you have to assign a Proton Therapy-specific scan protocol to your CT exam. In the following, myExam Compass will automatically answer all Proton Therapy- and SPR-related RTP Modality decision tree questions depending on the ARIA CORE input, for example whether you should perform a Rho or an SPR recon. Stopping Power Ratio (SPR) The stopping power is a measure of how much energy a particle loses as it travels through a material. Accurate SPR values are essential for predicting the range of particles, such as protons, within the body, which in turn helps in targeting tumors more precisely while minimizing damage to surrounding healthy tissues. Rho In radiation therapy, the term Rho refers to the electron density of a material, which is defined as the number of electrons in one unit of volume, normalized by the electron density of water. This value is crucial in radiation therapy because it is linear with the "equivalent stopping power" of the material. Automatic answers for RT Modality decision tree [myexam_comp_04.mp3] The RTP Modality clinical decision tree is available, but not linked to a scan protocol. You can use this decision tree, if there are differences in the scan protocol depending on which treament Modality you use (ARIA CORE name Mode). For example, Rho versus Stopping Power Ratio recon (SPR) for a Photon versus a Proton treatment. Clinical example: If your site provides Proton Therapy and you are connected to ARIA CORE, first you have to assign a Proton Therapy-specific scan protocol to your CT exam. In the following, myExam Compass will automatically answer all Proton Therapy- and SPR-related RTP Modality decision tree questions depending on the ARIA CORE input, for example whether you should perform a Rho or an SPR recon. Plus marker texts: Rho: In radiation therapy, the term Rho refers to the electron density of a material, which is defined as the number of electrons in one unit of volume, normalized by the electron density of water. This value is crucial in radiation therapy because it is linear with the "equivalent stopping power" of the material. Stopping Power Ratio (SPR): The stopping power is a measure of how much energy a particle loses as it travels through a material. Accurate SPR values are essential for predicting the range of particles, such as protons, within the body, which in turn helps in targeting tumors more precisely while minimizing damage to surrounding healthy tissues. DirectSetup Notes VB20 improvements DirectSetup Notes VB20 improvements Chapter 3 ? DirectSetup Notes VB20 improvements ? Direct import of setup information in ARIA CORE ARIA CORE 18.1 MR2 has a new functionality in the Treatment Preparation workspace called Direct import of setup information. It directly extracts the setup photos and setup information from the DirectSetup Notes report. Once you have created the therapy plan in ARIA CORE, you can select Direct import of setup information to copy the setup photos and setup information to the appropriate fields. The setup photos and information now get automatically assigned to the correct fields on the ARIA CORE user interface. Direct import of setup information in ARIA CORE [directsetup_notes_vb20_improv_01.mp3] ARIA CORE 18.1 MR2 has a new functionality in the Treatment Preparation workspace called Direct import of setup information. It directly extracts the setup photos and setup information from the DirectSetup Notes report. Once you’ve created the therapy plan in ARIA CORE, you can select Direct import of setup information to copy the setup photos and setup information to the appropriate fields. The setup photos and information now get automatically assigned to the correct fields on the ARIA CORE user interface. ? The Direct import of setup information dialog – 1 In the top left corner of the Direct import of setup information dialog, you can Filter by Prescription. ARIA CORE associates the setup photos and setup information to the prescription that was available at the CT scanner during the patient setup documentation procedure. Please note: You will need the SEMANTIC_INFO_INTEROP license to be able to use this feature. If the prescription was not available during the CT procedure, ARIA CORE sets the Filter by Prescription drop-down to None. Then it will show all setup photos and setup information that are available for that patient. To proceed, you can select and copy the relevant photos and setup notes to the correct fields in ARIA CORE. The Direct import of setup information dialog [directsetup_notes_vb20_improv_02.mp3] In the top left corner of the Direct import of setup information dialog, you can Filter by Prescription. ARIA CORE associates the setup photos and setup information to the prescription that was available at the CT scanner during the patient setup documentation procedure. Please note: You will need the SEMANTIC underscore INFO underscore INTEROP license to be able to use this feature. If the prescription was not available during the CT procedure, ARIA CORE sets the Filter by Prescription drop-down to None. Then it will show all setup photos and setup information that are available for that patient. To proceed, you can select and copy the relevant photos and setup notes to the correct fields in ARIA CORE. ? The Direct import of setup information dialog – 2 When creating accessories and measurements in the Patient Setup Configuration of your CT scanner software, you can now configure if the measurement or accessory should be available for automatic copy into the setup note field in ARIA CORE. Simply select the Allow Direct Import to Setup Note checkbox in the dialog of the item you want to add. The Direct import of setup information dialog - 2 [directsetup_notes_vb20_improv_03.mp3] When creating accessories and measurements in the Patient Setup Configuration of your CT scanner software, you can now configure if the measurement or accessory should be available for automatic copy into the setup note field in ARIA CORE. Simply select the Allow Direct Import to Setup Note checkbox in the dialog of the item you want to add. ? Prescription information Radiotherapy Prescription information as configured for your CT scanner software is available in DirectSetup Notes, if your CT scanner software has the SEMANTIC_INFO_INTEROP license installed. Please note: Prescription information is displayed on both your acquisition workplace monitor and on the tablet when performing the mobile workflow with DirectSetup Notes. On the tablet, it is displayed in the Patient Setup dialog. If you have selected more than one prescription at the start of the CT examination, you have to assign a prescription to the setup information here. No assignment is available when there has been a mistake with the prescription in ARIA CORE or when you do not want to assign a prescription to the setup information. Prescription information [directsetup_notes_vb20_improv_04.mp3] Radiotherapy Prescription information as configured for your CT scanner software is available in DirectSetup Notes, if your CT scanner software has the SEMANTIC underscore INFO underscore INTEROP license installed. Please note: Prescription information is displayed on both your acquisition workplace monitor and on the tablet when performing the mobile workflow with DirectSetup Notes. On the tablet, it is displayed in the Patient Setup dialog. If you have selected more than one prescription at the start of the CT examination, you have to assign a prescription to the setup information here. No assignment is available when there has been a mistake with the prescription in ARIA CORE or when you do not want to assign a prescription to the setup information. ? Re-sim workflow Starting from ARIA CORE 18.1 MR2, you can retrieve the setup information from the ARIA CORE server when a patient comes back for a re-sim. Whenever previous Patient Setup Reports are available for the current anatomic area, the Load Data tab is available on your tablet screen. These reports can be available either local in your CT scanner software or in ARIA CORE. Please note: Any changes you have made in ARIA CORE in the meantime until the re-sim will not be available on your CT scanner software. If you do not have ARIA CORE 18.1 MR2, only local data is available to you. On the Load Data tab, two different icons indicate from where an existing report loads: The system has not sent the existing report to ARIA CORE yet and opens it from local CT storage. ARIA CORE has retrieved the existing report. Re-sim workflow [directsetup_notes_vb20_improv_05.mp3] Starting from ARIA CORE 18 point 1 MR2, you can retrieve the setup information from the ARIA CORE server when a patient comes back for a re-sim. Whenever previous Patient Setup Reports are available for the current anatomic area, the Load Data tab is available on your tablet screen. These reports can be available either local at your CT scanner software or in ARIA CORE. Please note: Any changes you have made in ARIA CORE in the meantime until the re-sim will not be available on your CT scanner software. If you don’t have ARIA CORE 18 point 1 MR2, only local data is available to you. On the Load Data tab, two different icons indicate from where an existing report loads: The system has not sent the existing report to ARIA CORE yet and opens it from local CT storage. ARIA CORE has retrieved the existing report. ? Document Photos You can now also configure the Document Photos step for DirectSetup Notes. Document Photos are detached from patient setup photos. They document things not related to the patient setup, such as scars, skin rashes, or wounds of the patient. Document Photos is available as a separate item in the ARIA CORE Documents workspace. They are not available to be directly associated to the setup fields in ARIA CORE. Document Photos [directsetup_notes_vb20_improv_06.mp3] You can now also configure the Document Photos step for DirectSetup Notes. Document Photos are detached from patient setup photos. They document things not related to the patient setup, such as scars, skin rashes, or wounds of the patient. Document Photos is available as separate item in the ARIA CORE Documents workspace. They are not available to be directly associated to the setup fields in ARIA CORE. ? Document Photos configuration To configure Document Photos to be available, your system administrator needs to perform the following three steps in the Administration Portal. Select the numbered steps below to learn more. 1 1 1 2 2 2 3 3 3 Document Photos configuration [directsetup_notes_vb20_improv_07.mp3] To configure Document Photos to be available, your system administrator needs to perform the following three steps in the Administration Portal. Select the numbered steps below to learn more. Document Photos configuration – Step 3 Stay in Patient Setup Configuration Æ System. Then select Destinations and look for the FHIR (Fast Healthcare Interoperability Resources) configuration item. Under step 3 Select Document Type of the dialog popping up, select Document Photo from the Document Photo Type drop-down. Please note: In addition, a document photo type Document Photo needs to be configured in ARIA CORE. 3 Document Photos configuration – Step 2 Stay in Patient Setup Configuration Æ System. Then select Report and look for the Patient Setup Photos and Document Photos item. Select its entry Save the patient setup photos and document photos in the report and as separate image files. 2 Document Photos configuration – Step 1 Under Patient Setup Configuration Æ System Æ General Æ Document Photos, activate Enable Document Photos entry in every template. Here, you can also define the Photo Display Order for the tablet: Either select Newest photos on top or Oldest photos on top. 1 ? Move Document Photos via drag and drop If you have Document Photos enabled in your configuration, you can easily move a photo in either direction between Patient Setup Photos and Document Photos on your tablet. Proceed as follows like in our example, where we move a Setup Photo to Document Photos: Activate the Patient Setup dialog. Select the Anatomic Area tab. Then Setup Photos. Simply press the photo with your index finger. Then drag it to and drop it at the Document Photos section. You can also easily move multiple photos between the two photo sections: Select the Multiselect icon. Then select the photos you would like to move. Afterwards, select the More icon (three vertical dots). Then select Move to Document Photos. Select a single photo Select multiple photos Move Document Photos via drag and drop [directsetup_notes_vb20_improv_08.mp3] If you have Document Photos enabled in your configuration, you can easily move a photo in either direction between Patient Setup Photos and Document Photos on your tablet. Proceed as follows like in our example, where we move a Setup Photo to Document Photos: Activate the Patient Setup dialog. Select the Anatomic Area tab. Then Setup Photos. Simply press the photo with your index finger. Then drag it to and drop it at the Document Photos section. You can also easily move multiple photos between the two photo sections: Select the Multiselect icon. Then select the photos you would like to move. Afterwards, select the More icon (three vertical dots). Then select Move to Document Photos. ? Edit accessories During the examination, you can now edit and change the accessories that are available in the template. On the Patient Setup dialog, select the Edit pencil in the bottom left corner. The Edit Accessory dialog will open where you can delete and add any already configured accessories. You can change the accessory order by selecting, dragging and dropping the multiple dots icon on the left of every accessory name to the position you desire. Please note: Edits you perform here the system only applies to the current patient and will not save them to the template database. Edit accessories [directsetup_notes_vb20_improv_09.mp3] During the examination, you can now edit and change the accessories that are available in the template. On the Patient Setup dialog, select the Edit pencil in the bottom left corner. The Edit Accessory dialog will open where you can delete and add any already configured accessories. You can change the accessory order by selecting, dragging and dropping the multiple dots icon on the left of every accessory name to the position you desire. Please note: Edits you perform here the system only applies to the current patient and will not save them to the template database. ? Add Anatomic Area You can also copy the setup information (excluding photos) from the current to the added template. Furthermore, you can delete manually added anatomic areas. Please note: It is not possible to delete Anatomic Areas coming from the CT scanner. For these, only editing is possible. You can now also add another Anatomic Area to the template. This means you scan the patient with one scan, but you have multiple isocenters for this patient. This is practical when you want separate setup documents for each isocenter, for example one spine scan with several spinal metastases. Select the + icon on the top right of the Patient Setup dialog to open the list of anatomic areas that have templates associated. You can change the name of the anatomic area. Add Anatomic Area [directsetup_notes_vb20_improv_10.mp3] You can now also add another Anatomic Area to the template. This means you scan the patient with one scan, but you have multiple isocenters for this patient. This is practical when you want separate setup documents for each isocenter, for example one spine scan with several spinal metastases. Select the plus icon on the top right of the Patient Setup dialog to open the list of anatomic areas that have templates associated. You can change the name of the anatomic area. You can also copy the setup information (excluding photos) from the current to the added template. Furthermore, you can delete manually added anatomic areas. Please note: It is not possible to delete Anatomic Areas coming from the CT scanner. For these, only editing is possible. ? Configurable Patient Setup Report layout In the Administration Portal Æ Clinical Configuration Æ Patient Setup Æ tab Report Layout, your system administrator can now configure the layout of the Patient Setup Report. Several factory layouts are available for selection, for example in portrait format, landscape format or with different numbers of columns. Your system admin can download a layout document, so that you can edit it in Microsoft Word according to your needs. The admin can then upload it back to the system. There is a preview available showing the selected layout. On the Report layout tab, your admin can also configure how accessories, measurements and attributes should be ordered. Configurable Patient Setup Report layout [directsetup_notes_vb20_improv_11.mp3] In the Administration Portal, Clinical Configuration, Patient Setup, tab Report Layout, your system administrator can now configure the layout of the Patient Setup Report. Several factory layouts are available for selection, for example in portrait format, landscape format or with different numbers of columns. Your system admin can download a layout document, so that you can edit it in Microsoft Word according to your needs. The system admin can then upload the edited template to the system and select it to apply. There is a preview available showing the selected layout. On the Report layout tab, your admin can also configure how accessories, measurements and attributes should be ordered. ? Edit Patient Setup Report layout in Word In Microsoft Word, you can, for example, Change the font size or color Increase or decrease the number of columns Change margins to achieve the desired Patient Setup Report layout. The downloaded document contains placeholder terms enclosed in two asterisks, for example *BIRTHDATE*. They represent the UI-related name of a content element. The document also contains placeholder terms enclosed in two hashtags, for example #BIRTHDATE#. They represent the value of a content element. The system will fill them with input data when generating the Patient Setup Report. Please note: To change the format of content elements, you need to select placeholder names AND the pair of asterisks or hashtags that enclose them. Once edited, rename and save the layout document. Your system admin can then upload the edited template back to the system and select it to apply. Edit Patient Setup Report layout in Word [directsetup_notes_vb20_improv_12.mp3] In Microsoft Word, you can, for example, Change the font size or color Increase or decrease the number of columns Change margins to achieve the desired Patient Setup Report layout. The downloaded document contains placeholder terms enclosed in two asterisks, for example asterisk BIRTHDATE asterisk. They represent the User Interface-related name of a content element. The document also contains placeholder terms enclosed in two hashtags, for example hashtag BIRTHDATE hashtag. They represent the value of a content element. The system will fill them with input data when generating the Patient Setup Report. Please note: To change the format of content elements, you need to select placeholder names AND the pair of asterisks or hashtags that enclose them. Once edited, rename and save the layout document. Your system admin can then upload the edited template back to the system and select it to apply. Define isocenters with RT lasers Define isocenters with RT lasers Chapter 4 ? Define isocenters with RT lasers ? Workflow in CT Scan&GO You can use this new workflow to manually move the RT lasers and the table position, so that they are aligned with the position on the patient‘s body that indicates the isocenter position. Using Scan&GO on your tablet, you can mark the patient in the examination room and afterwards send the isocenter coordinates to CT Sim&GO (see next workflow). This workflow is useful for palliative cases, re-sims or cases where you need to modify the POI from Sim&GO. Select the numbered steps below to learn more about this workflow. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 Workflow in CT Scan&GO [def_isocenters_rt_lasers_01.mp3] You can use this new workflow to manually move the RT lasers and the table position, so that they are aligned with the position on the patient‘s body that indicates the isocenter position. Using Scan&GO on your tablet, you can mark the patient in the examination room and afterwards send the isocenter coordinates to CT Sim&GO (see next workflow). This workflow is useful for palliative cases, re-sims or cases where you need to modify the point of interest from Sim&GO. Select the numbered steps below to learn more about this workflow. Workflow in CT Scan&GO – Further Option 2 Delete existing POI / Create new POI You have created a POI in Sim&GO, but when entering the examination room, you see this POI is not an ideal place for marking the patient. Then you can delete the existing POI by selecting the Delete icon in the Patient Marking: Target Position dialog of Scan&GO. The system will then delete the POI from the Patient Marking list in Scan&GO and from the dataset in Sim&GO. Afterwards, select Create New POI in Scan&GO to navigate to the manual laser control page and create a new POI to be sent to the RT software. Proceed to the next workflow of this training that you perform in Sim&GO. 6 Workflow in CT Scan&GO – Further Option 1 Abort marking If the lasers move due to unforeseen circumstances or you move the table during the marking procedure, Scan&GO displays the Abort Marking button. Select the Abort Marking button in order to return to the initial state. Afterwards, Sim&GO will show a message that you have aborted marking and that the system has deleted any already imported isocenters. 5 Workflow in CT Scan&GO – Patient Marking with Scan&GO Back in Scan&GO on your tablet, select the Patient Marking icon to open the Patient Marking: Target Position popover. In the examination room, move the table and the laser crosshair to the isocenter position at which you want to mark the isocenter on your patient’s body. Select Create New POI to create a new POI (point-of-interest) at the current table and laser position, then select the Mark Patient button. The system will send the coordinates over to Sim&GO then. Please note: During the patient marking process, The system locks the RT laser position, so you cannot move them. This prevents you from a mismatch of what you have drawn on the patient‘s skin and what you have in the dataset. The Mark Patient button in Sim&GO is dimmed. Your last step in Scan&GO: To confirm that you have marked the patient, select the Marking Completed button. Select the short video on the right to watch how to proceed with steps 9 to 12 (no audio). 4 Workflow in CT Scan&GO – Open CT Sim&GO At your syngo Acquisition Workplace, switch to CT View&GO. In the Tool Gallery, select the Sim&GO icon to open Sim&GO. 3 Workflow in CT Scan&GO – Initial steps From the RTP protocol folder on the Protocol Selection tab, select and apply an RTP scan protocol. Confirm the patient position. Acquire the topogram. Acquire the tomogram. Check the quality of the images and reconstruct the images. After the reconstruction, the system automatically loads the reconstructed series into CT View&GO. 2 Workflow in CT Scan&GO – Prerequisites Before starting with the actual workflow, check the following prerequisites: The RTP basic license and the RTP Direct Laser Steering license are available. The Direct Laser system is available. Please note: This workflow is only possible with a Direct Laser system, not with an LAP laser system. The laser system is configured in the Administration Portal and in CT Sim&GO. You have prepared the RTP examination. 1 ? Workflow in CT Sim&GO The workflow in CT Sim&GO at your Acquisition Workplace seamlessly follows the one in CT Scan&GO on your tablet. Select the tab arrows on the right to learn more about this workflow. Import your POI After the POI import Check the Import POI Report Workflow in CT Sim&GO [def_isocenters_rt_lasers_02.mp3] The workflow in CT Sim&GO at your Acquisition Workplace seamlessly follows the one in CT Scan&GO on your tablet. Select the tab arrows on the right to learn more about this workflow. Check the Import POI Report Depending on your POI configuration, there might be a difference of your outside marking position and the marking position on the actual slice. If your POI configuration is set to Snap to original, it can happen that the POI will be placed on the closest real slice, which may not match the table position (IEC Y position) that the scanner sent to the software. In this case, you will see the Import POI Report dialog which indicates the deviation between what the software saved to the data set and what the CT scanner received (and where you have drawn on the patient‘s skin). This dialog also informs you to change your POI configuration to Free placement, if you want the POI to be saved in the data set at the exact place that was received from the scanner. After the POI import After checking the Import POI dialog entries and selecting the desired isocenters, select the Import button to import them. The system will display the POI in the Anatomy & Targets navigator. The isocenters are now part of the data set for further treatment planning. At the same time, the system updates the image display to show the POI on all of the image segments. Import your POI In Sim&GO, the Import POI dialog is shown as soon as you have selected Mark Patient in Scan&GO: The system displays the isocenter Name, the co-ordinates X, Y, Z and the Table Position and Height. The isocenter name and color follows the same naming rules as when you create a POI in Sim&GO. You can select the Name field and change the isocenter name and the color of the POI. The system will save the POI to the dataset that is currently loaded in the segment: If you would like to save the POI to a different dataset, then select the drop-down menu to choose a different series. All series that are part of the current study are displayed in the drop-down. If you have marked mutiple isocenters, they will all appear in the dialog. The system will update the image segment to the first isocenter in this list. FAST 3D Camera FAST 3D Camera (optional) Chapter 5 ? FAST 3D Camera (optional) ? Introducing the ceiling-mounted FAST 3D Camera (optional) The optional ceiling-mounted FAST 3D Camera captures data of the patient structure and produces a three-dimensional live image. This image helps you with correct patient positioning, topogram planning, and collision indication. The camera system is equipped with an infrared light source and sensor, and an RGB (Red-Green-Blue) camera. It is positioned above the patient table. On your tablet, you can see the live image captured with the camera. Introducing the ceiling-mounted FAST 3D Camera [fast_3d_cam_01.mp3] The optional ceiling-mounted FAST 3D Camera captures data of the patient structure and produces a three-dimensional live image. This image helps you with correct patient positioning, topogram planning, and collision indication. The camera system is equipped with an infrared light source and sensor, and an RGB (Red-Green-Blue) camera. It is positioned above the patient table. On your tablet, you can see the live image captured with the camera. ? Hardware components The ceiling-mounted FAST 3D Camera consists of the following components: Ceiling flange: Covers the fixation to the concrete or suspended ceiling. Ceiling extension: The length of the ceiling extension is variable to allow an installation of the camera at different room heights. Ceiling-mounted FAST 3D Camera: Produces a three-dimensional live image of the patient to help you with patient positioning and topogram planning. 1 2 3 Hardware components [fast_3d_cam_02.mp3] The ceiling-mounted FAST 3D Camera consists of the following components: Ceiling flange: Covers the fixation to the concrete or suspended ceiling. Ceiling extension: The length of the ceiling extension is variable to allow an installation of the camera at different room heights. Ceiling-mounted FAST 3D Camera: Produces a three-dimensional live image of the patient to help you with patient positioning and topogram planning. ? Software on your tablet For the optional FAST 3D Camera, there are software features available that you control in the Scan&GO application on your tablet. Select the tab arrows to learn more about these features. Grid Overlay Collision Indication Radiotherapy Mode Special RT use case Software on your tablet [fast_3d_cam_03.mp3] For the optional FAST 3D Camera, there are software features available that you control in the Scan&GO application on your tablet. Select the tab arrows to learn more about these features. FAST 3D Camera – Special RT use case In RT workflows where you need to move the table to the CT laser first in order to zero the table there, you need to disable the automatic table movement to the topogram start position. Otherwise the Move to CT Laser button would not be active. To disable the Automatic Patient Positioning mode, select the General Scan parameters group, then set the parameter FAST Topo Region to None at your Acquisition Workplace. The system will also display the selected FAST Topo Region None on the bottom of your tablet screen. Afterwards, only Collision Indication will still be available. FAST 3D Camera – Radiotherapy Mode For radiotherapy examinations with the FAST 3D Camera, there is an optional, license-depending Radiotherapy Mode available for Collision Indication. You can activate this mode in the Settings dialog Æ Radiotherapy tab of Scan&GO on your tablet. Just like before, if the system displays a potential collision, you can correct the position of the patient, accessories, or the table height before you move the patient table into the gantry. But in addition, when you press the Move button, the table automatically moves to the topogram target position in a horizontal direction only. The table height remains at the previously set values. FAST 3D Camera – Collision Indication The feature Collision Indication displays visual indicators for potential collisions between the patient and the gantry or an accessory before you move the patient table into the gantry. Like this, you can correct the position of the patient or accessories or the table height before you move the patient table into the gantry. Please note: In order to be able to use Collision Indication, You need the optional COLLISION_INDICATION_3D license. You first need to turn on the FAST 3D Camera in the Settings dialog of your tablet. Then turn on Collision Indication. The software will indicate potential collisions as yellow hatched areas and display a warning message on your tablet screen. FAST 3D Camera – Grid Overlay The feature Grid Overlay shows a grid on the live image of the Automatic Patient Positioning screen on your tablet. This overlay provides visual feedback for correct patient positioning. Please note: In order to be able to use Grid Overlay, You need the optional GRID_POSITIONING_3D license. You first need to turn on the FAST 3D Camera in the Settings dialog of your tablet. Then turn on Grid Overlay. To check correct patient positioning, the software will overlay the image of the patient with a grid that is aligned with the table. New scan protocols New RTP scan protocols Chapter 6 ? New RTP scan protocols ? RTP Respiratory Motion Management protocol The RTP Respiratory Motion Management scan protocol now contains a clinical decision tree that allows you to switch among Respiratory 4D, Breathhold and routine thorax scans (None). For automatic answering of the decision tree questions in connection with ARIA CORE, please see the myExam Compass VB20 improvements chapter in this online training. RTP Respiratory Motion Management protocol [new_rtp_scan_prots_01.mp3] The RTP Respiratory Motion Management scan protocol now contains a clinical decision tree that allows you to switch among Respiratory 4D, Breathhold and routine thorax scans (None). For automatic answering of the decision tree questions in connection with ARIA CORE, please see the myExam Compass VB20 improvements chapter in this online training. ? NAEOTOM Alpha class With the VB20 software version, new RTP scan protocols are available for the photon-counting technology scanners NAEOTOM Alpha.Peak, NAEOTOM Alpha.Pro and NAEOTOM Alpha.Prime. They are available for the treatment sites listed on the right. For details about these protocols, please see the RTP Scan Protocols VB20 Update Job Aid on Siemens Healthineers Academy. Table with 1 columns and 13 rows Treatment site Head Head & Neck Brain & Whole Spine Thorax Respiratory 4D Respiratory Motion Management Breast Abdomen Pelvis Spine Extremity Commissioning NAEOTOM Alpha class [new_rtp_scan_prots_02.mp3] With the VB20 software version, new RTP scan protocols are available for the photon-counting technology scanners NAEOTOM Alpha.Peak, NAEOTOM Alpha.Pro and NAEOTOM Alpha.Prime. They are available for the treatment sites listed on the right. For details about these protocols, please see the RTP Scan Protocols VB20 Update Job Aid on Siemens Healthineers Academy. ? Somaris 10 scanners With the VB20 software version, new RTP scan protocols are available for all Somaris 10 scanners (except for SOMATOM On.site). The table on the right gives you an overview of the different RTP scan protocol options. For details about these protocols, please also see the RTP Scan Protocols VB20 Update Job Aid on Siemens Healthineers Academy. Table with 1 columns and 13 rows Treatment site Head Head & Neck Brain & Whole Spine Thorax Respiratory 4D Respiratory Motion Management Breast Abdomen Pelvis Spine Extremity Commissioning Table with 1 columns and 13 rows RTP X X X X X X X X X X X - Table with 1 columns and 13 rows RTP+ * X X X X X X X X X X X X Table with 1 columns and 13 rows RTP+ DE ** X X - - - - - X X X X X * Only with DirectDensity license ** Only with TwinSpiral DE license Somaris 10 scanners [new_rtp_scan_prots_03.mp3] With the VB20 software version, new RTP scan protocols are available for all Somaris 10 scanners (except for SOMATOM On.site). The table on the right gives you an overview of the different RTP scan protocol options. For details about these protocols, please also see the RTP Scan Protocols VB20 Update Job Aid on Siemens Healthineers Academy. DirectDensity VB20 improvements DirectDensity VB20 improvements (optional) Chapter 7 ? DirectDensity VB20 improvements (optional) ? DirectDensity VB20 improvements The optional feature DirectDensity is a reconstruction algorithm used in CT imaging. You can use the images produced by DirectDensity reconstruction for Radiation Therapy Planning. They are not intended for diagnostic imaging. DirectDensity is available for all energy-integrating CT scanners with a Somaris 10 operating system (except SOMATOM On.site) and with conventional energy-integrating detector technology. Select the tab arrows on the right to learn more about the VB20 improvements of DirectDensity. DirectDensity overview and new VB20 features New kernel St (Stopping Power Ratio) Changes of image type in DICOM header DirectDensity VB20 improvements [directdens_vb20_improv_01.mp3] The optional feature DirectDensity is a reconstruction algorithm used in CT imaging. You can use the images produced by DirectDensity reconstruction for Radiation Therapy Planning. They are not intended for diagnostic imaging. DirectDensity is available for all energy-integrating CT scanners with a Somaris 10 operating system (except SOMATOM On.site) and with conventional energy-integrating detector technology. Select the tab arrows on the right to learn more about the VB20 improvements of DirectDensity. Changes in DICOM header For better interoperability with your TPS, we have improved DICOM tags to clearly identify the material property reconstructed in the DirectDensity image*: Image type Previously: All ORIGINAL\PRIMARY\AXIAL\CT_SOM5 SPI New: Sd ORIGINAL\PRIMARY\AXIAL\CT_SOM5 SPI\ELECTRON_DENSITY Sm ORIGINAL\PRIMARY\AXIAL\CT_SOM5 SPI\MASS_DENSITY St ORIGINAL\PRIMARY\AXIAL\CT_SOM5 SPI\SPR * Changes apply only for ORIGINAL\PRIMARY and not for DERIVED\SECONDARY images as generated by Inline Results (for example Parallel Ranges) DirectDensity – New kernel St (Stopping Power Ratio) For Single Energy Stopping Power Ratio (SE SPR) reconstructions within proton therapy, there is the new St kernel available for Single Energy scans now. The stopping power is a measure of how much energy a particle loses as it travels through a material. Accurate SPR values are essential for predicting the range of particles, such as protons, within the body, which in turn helps in targeting tumors more precisely while minimizing damage to surrounding healthy tissues. At your Acquisition Workplace, you can select the St kernel in the Recon Parameters Æ Recon Favorites tab Æ Kernel column Æ StoppingPowerRatio drop-down menu item. DirectDensity overview and new VB20 features DirectDensity reconstructs CT images of material properties needed for RT treatment planning from single-energy CT acquisitions, that would otherwise only be available from spectral imaging. Enabling use of CARE kV The resulting DirectDensity reconstructions are mostly independent of the kVp setting used during the scan. This enables you to use CARE kV, our automatic patient-specific tube voltage selection, without the need of using multiple calibration curves in your Treatment Planning System. Please note: If you use the VB20 version of DirectDensity, you must re-measure your calibration curve in the TPS, since we have changed the algorithm. Detailed algorithmic improvements For VB20, we have made detailed algorithmic improvements to more accurately represent all material properties and reduce the remaining kVp dependence across the entire range of CT values. Additional material property: Relative stopping power The resulting CT values can be interpreted as relative electron density or relative mass density - hence as the direct elemental properties needed for treatment planning. New with VB20: DirectDensity now also supports relative stopping power as an additional material property. ZeeFree RT ZeeFree RT in Direct i4D scans (optional) Chapter 8 ? ZeeFree RT in Direct i4D scans (optional) ? Challenges of irregular breathing and motion 75% of patients breathe irregularly, which leads to motion artifacts in imaging1,2. Motion artifacts reduce the confidence in tumor delineation and treatment planning, potentially leading to larger safety margins3. Therefore, a high image quality is crucial to limit dose to normal tissue and improve the therapeutic window. ZeeFree RT addresses these challenges and reduces stack artifacts for Direct i4D scans. How Direct i4D and ZeeFree RT interact: While Direct i4D addresses the artifacts at the source by means of a real-time acquisition that adapts to patient breathing, ZeeFree RT addresses and reduces only the remaining motion artifacts during reconstruction. Image courtesy of University Clinic Hamburg Eppendorf, Hamburg, Germany 1 Werner R et al. Reduction of breathing irregularity related motion artifacts in low-pitch spiral 4D CT by optimized projection binning. Radiation Oncology 2017. 2 Wulfhekel et al. Compilation of a database for illustration and automated detection of 4D CT motion artifacts. Radiother Oncol. 2014. 3 Jan E, Lorenz C (eds). 4D Modeling and Estimation of Respiratory Motion for Radiation Therapy. Springer-Verlag Berlin Heidelberg; 2013. Challenges of irregular breathing and motion [zeefree_rt_01.mp3] 75% of patients breathe irregularly, which leads to motion artifacts in imaging. Motion artifacts reduce the confidence in tumor delineation and treatment planning, potentially leading to larger safety margins. Therefore, a high image quality is crucial to limit dose to normal tissue and improve the therapeutic window. ZeeFree RT addresses these challenges and reduces stack artifacts for Direct i4D scans. How Direct i4D and ZeeFree RT interact: While Direct i4D addresses the artifacts at the source by means of a real-time acquisition that adapts to patient breathing, ZeeFree RT addresses and reduces only the remaining motion artifacts during reconstruction. ? ZeeFree RT – Stack artifact reduction for Direct i4D ZeeFree RT is a reconstruction algorithm. You can apply it for scans that you have acquired with the Direct i4D scan mode. Please note: Direct i4D is an optional feature. With the VB20 software version, ZeeFree RT is contained in the Direct i4D license for newly installed systems. For upgrades from VB10, you must order ZeeFree RT separately, even if Direct i4D is available on your system. The scanner system performs Direct i4D scans in stacks with an overlap of about 10% of the detector height. Motion artifacts can occur, when breathing is irregular and Direct i4D cannot fully compensate for it. With ZeeFree RT, the overlapping data is used to reduce stack artifacts by applying deformable image registration, which brings data in the overlap regions to agreement. Without ZeeFree RT With ZeeFree RT ZeeFree RT – Stack artifact reduction for Direct i4D [zeefree_rt_02.mp3] ZeeFree RT is a reconstruction algorithm. You can apply it for scans that you have acquired with the Direct i4D scan mode. Please note: Direct i4D is an optional feature. With the VB20 software version, ZeeFree RT is contained in the Direct i4D license for newly installed systems. For upgrades from VB10, you must order ZeeFree RT separately, even if Direct i4D is available on your system. The scanner system performs Direct i4D scans in stacks with an overlap of about 10% of the detector height. Motion artifacts can occur, when breathing is irregular and Direct i4D cannot fully compensate for it. With ZeeFree RT, the overlapping data is used to reduce stack artifacts by applying deformable image registration, which brings data in the overlap regions to agreement. ? Apply ZeeFree RT You can apply ZeeFree RT by adjusting the recon parameters. Open the parameter panel for the recon job that you want to start. Select the Physio Recon tab. From the StackRecon drop-down, select Standard, TrueStack or ZeeFree. Standard means an unchanged behavior. This setting delivers reconstructions without stack artifact reduction and blended overlap regions. TrueStack delivers reconstructions without stack artifact reduction and sharp overlap regions. You can use this setting for investigating the presence of stack alignment artifacts. ZeeFree delivers reconstructions with stack artifact reduction and sharp overlap regions. Repeat the steps above for other recon jobs. Then start the selected recon jobs as usual. Apply ZeeFree RT [zeefree_rt_03.mp3] You can apply ZeeFree RT by adjusting the recon parameters. Open the parameter panel for the recon job that you want to start. Select the Physio Recon tab. From the StackRecon drop-down, select Standard, TrueStack or ZeeFree. Standard means an unchanged behavior. This setting delivers reconstructions without stack artifact reduction and blended overlap regions. TrueStack delivers reconstructions without stack artifact reduction and sharp overlap regions. You can use this setting for investigating the presence of stack alignment artifacts. ZeeFree delivers reconstructions with stack artifact reduction and sharp overlap regions. Repeat the steps above for other recon jobs. Then start the selected recon jobs as usual. ? ZeeFree RT limitations Please consider the following limitations of ZeeFree RT: Warning: ZeeFree RT reconstructions are modified images. You can only use them as supplemental information. You need a second reconstruction with the StackRecon Æ Standard setting to check consistency. You cannot combine ZeeFree RT with HD Field of View (HD FoV). ZeeFree RT cannot stack-reduce Average CT / TMaxIP / TMinIP images. Instead, for dose calculation use Average CT without ZeeFree RT where stack artifacts are implicitly reduced due to the temporal averaging. ZeeFree RT limitations [zeefree_rt_04.mp3] Please consider the following limitations of ZeeFree RT: Warning: ZeeFree RT reconstructions are modified images. You can only use them as supplemental information. You need a second reconstruction with the StackRecon “Standard” setting to check consistency. You cannot combine ZeeFree RT with HD Field of View (HD f-o-v). ZeeFree RT cannot stack-reduce Average CT, tee-maxip or tee-minip images. Instead, for dose calculation use Average CT without ZeeFree RT where stack artifacts are implicitly reduced due to the temporal averaging. ? How to work with ZeeFree RT How to evaluate if I can trust images reconstructed with ZeeFree RT? For each image, create two reconstructions: One with the StackRecon Æ Standard setting and one with the StackRecon Æ ZeeFree setting. If there are no relevant artifacts close to the tumor volume, then you can use the standard image for treatment planning. If there are artifacts in the standard image, overlay both images to verify that the anatomy in the ZeeFree RT reconstruction is more correct compared to the standard image. How to perform QA with ZeeFree RT? Use anthropomorphic phantoms for QA, since ZeeFree is optimized for patient scans. Check with static phantom scans that there are no relevant distortions. Check performance to reduce stack artifacts on patient data retrospectively (How could the image have looked?). Images courtesy of University Clinic Erlangen, Erlangen, Germany Standard setting ZeeFree setting Difference image in RT Image Suite How to work with ZeeFree RT [zeefree_rt_05.mp3] How to evaluate if I can trust images reconstructed with ZeeFree RT? For each image, create two reconstructions: One with the StackRecon “Standard” setting and one with the StackRecon “ZeeFree” setting. If there are no relevant artifacts close to the tumor volume, then you can use the standard image for treatment planning. If there are artifacts in the standard image, overlay both images to verify that the anatomy in the ZeeFree RT reconstruction is more correct compared to the standard image. How to perform QA with ZeeFree RT? Use anthropomorphic phantoms for QA, since ZeeFree is optimized for patient scans. Check with static phantom scans that there are no relevant distortions. Check performance to reduce stack artifacts on patient data retrospectively (How could the image have looked?). Extended HD Field of View (FoV) Extended HD Field of View (HD FoV 5.0) Chapter 9 ? Extended HD Field of View (HD FoV 5.0) ? Reconstructions with previous HD Field of View (HD FoV) You can only reconstruct full quality images in the Scan Field of View (SFoV). Outside the SFoV, some image data is missing. Especially in radiation therapy planning, parts of the patient are often located outside the SFoV. Reasons for this can be obese patients or special positioning requirements. Therefore, we need a specific algorithm that can estimate the image even outside the SFoV. Scan Field of View (SFoV)* *Size of SFoV is scanner model dependent. Reconstructions with previous HD Field of View (HD FoV) [extended_hd_fov_01.mp3] You can only reconstruct full quality images in the Scan Field of View (s-f-o-v). Outside the s-f-o-v, some image data is missing. Especially in radiation therapy planning, parts of the patient are often located outside the s-f-o-v. Reasons for this can be obese patients or special positioning requirements. Therefore, we need a specific algorithm that can estimate the image even outside the s-f-o-v. ? Reconstructions with extended HD FoV With the VB20 software version, the extended HD Field of View reconstruction HD FoV 5.0 is available as an option. It is supported by AI to extend the SFoV by a circular area up to the bore size. Please note: The extended circular area outside the SFoV has reduced image quality. For diagnosis, do not use the image area outside the regular field of view. It has reduced quality and may contain artifacts. Scan Field of View (SFoV)* HD FoV 4.0 reconstruction AI-supported HD FoV 5.0 reconstruction Extended HD FoV* *Sizes of SFoV and extended HD FoV are scanner model dependent. Clinical case images courtesy of University Hospital Würzburg, Würzburg, Germany. Reconstructions with extended HD FoV [extended_hd_fov_02.mp3] With the VB20 software version, the extended HD Field of View reconstruction HD f-o-v 5.0 is available as an option. It’s supported by AI to extend the s-f-o-v by a circular area up to the bore size. Please note: The extended circular area outside the s-f-o-v has reduced image quality. For diagnosis, do not use the image area outside the regular field of view. It has reduced quality and may contain artifacts. Sim&GO and RT Image Suite Improvements Sim&GO and RT Image Suite improvements Chapter 10 ? Sim&GO and RT Image Suite improvements ? Display of images in Sim&GO and the RT Image Suite In Sim&GO and when you use the Tools Patient Marking and Beam Placement in the RT Image Suite*, you can now view the acquired images in scanned position. Example: If you scanned the images in Feet First-Prone position (FFP), then the system displays them in FFP. In RT Image Suite Tools other than Patient Marking and Beam Placement you can now change how the system displays the acquired images. In the top left corner menu of any image segment, there is the new menu item View in Scanned Position. When you select this menu item from the drop-down, you can switch between viewing the images in scanned position or in Head First-Supine position (HFS). *Optional. This RT post-processing application is a standalone medical device. Display of images in Sim&GO and the RT Image Suite [sim_go_rtis_01.mp3] In Sim&GO and when you use the Tools Patient Marking and Beam Placement in the RT Image Suite, you can now view the acquired images in scanned position. Example: If you scanned the images in Feet First-Prone position (FFP), then the system displays them in FFP. In RT Image Suite Tools other than Patient Marking and Beam Placement you can now change how the system displays the acquired images. In the top left corner menu of any image segment, there is the new menu item View in Scanned Position. When you select this menu item from the drop-down, you can switch between viewing the images in scanned position or in Head First-Supine position (HFS). Question Bank 1 Radiation Therapy VB20 Improvements - USA QR700029929 Siemens Healthineers Here are some useful links and documents: 1.1 Welcome 1.2 Navigation hints 1.3 Overview VB20 improvements for Radiation Therapy 3.1 Oncology Exchange (optional) 3.2 Introducing Oncology Exchange 3.3 Oncology Exchange Workflow 3.4 Prescription information displayed at the CT scanner 3.5 Scan protocol mapping according to treatment site 3.6 Mapping more than one protocol to a treatment site 3.7 Mapping when patient has more than one prescription 3.8 RT structure template selection depending on treatment site 4.1 myExam Compass VB20 improvements 4.2 Introduction 4.3 Automatic answers for RT Motion Management decision tree 4.5 Automatic answers for RT Modality decision tree 5.1 DirectSetup Notes VB20 improvements 5.2 Direct import of setup information in ARIA CORE 5.3 The Direct import of setup information dialog 5.5 Prescription information 5.6 Re-sim workflow 5.7 Document Photos 5.8 Document Photos configuration 5.9 Move Document Photos via drag and drop 5.10 Edit accessories 5.11 Add Anatomic Area 5.12 Configurable Patient Setup Report layout 5.13 Edit Patient Setup Report layout in Word 6.1 Define isocenters with RT lasers 6.2 Workflow in CT Scan&GO 6.3 Workflow in CT Sim&GO 7.1 FAST 3D Camera (optional) 7.2 Introducing the ceiling-mounted FAST 3D Camera 7.3 Hardware components 7.4 Software on your tablet 8.1 New RTP scan protocols 8.2 RTP Respiratory Motion Management protocol 8.3 NAEOTOM Alpha class 8.4 Somaris 10 scanners 9.1 DirectDensity VB20 improvements (optional) 9.2 DirectDensity VB20 improvements 10.1 ZeeFree RT in Direct i4D scans (optional) 10.2 Challenges of irregular breathing and motion 10.3 ZeeFree RT – Stack artifact reduction for Direct i4D 10.4 Apply ZeeFree RT 10.5 ZeeFree RT limitations 10.6 How to work with ZeeFree RT 11.1 Extended HD Field of View (HD FoV 5.0) 11.2 Reconstructions with previous HD Field of View (HD FoV) 11.3 Reconstructions with extended HD FoV 12.1 Sim&GO and RT Image Suite improvements 12.2 Display of images in Sim&GO and the RT Image Suite 1.4 Course review 1.5 Disclaimer 1.6 Assessment