syngo RT Therapist 4.3 MR - Software Upgrade Job Aid

SIEMENS Healthineers syngo RT Therapist 4.3 MR3 Software Upgrade Job Aid Template Effective Date: 01/08/2018 | HOOD05162002751995 Job Aid Effective Date: 05/13/2019 | HOOD05162002997200 Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Table of Contents SIEMENS Healthineers Treatment - Updated/New Plan 3 Treatment - Visualization 4 Treatment - Y-Jaw Tracking 5 SIEMENS ARTISTE Treatment - Reporting 6 Treatment - Patient Browser 7 Treatment FPP Retraction 11 Imaging Applying Offsets 12 Imaging Second Portal Image Acquisition 13 Imaging HWF 14 Imaging ConeBeam CT (CBCT) 16 Imaging Virtual 6 DoF (Degrees of Freedom) 18 2 Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Updated/New Plan In the syngo RT Therapist 4.3 MR3 software version the following message will be displayed if an incoming plan is updated or new, which means it does not exist in the local database. OIS Retrieve × An updated / new plan has been loaded from the OIS. ? Please check whether the Workflow has to be manually edited, e.g. in case of Pauses, Gating or Beam Order. OK Treatment 3 Updated/ New plan Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Visualization syngo RT Therapist 4.3 MR3 provides several improvements with regards to Workflow Edit: • Workflow Edit is always available during a treatment session even after the delivery of one beam. • You can always change imaging options for Position Verification (PV) beams, even after delivery. • Re-ordering of the beams (PV and treatment) is always possible even after at least one treatment beam has been delivered. • Imaging options and reference image association are always enabled for non-delivered treatment beams. • To reach the best fit, the beam is not forced to be in the middle anymore (smaller panel travel). • Reference image association is possible from the Plan Browser. • A new icon indicating a user-defined pause will not be applied: o Break before imaging and then imaging is disabled for the beam. o Break before treatment and treatment is converted to port-only. Treatment 4 Visualization Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Y-Jaw Tracking In the syngo RT Therapist 4.3 MR3 software version the Y-Jaws do not need to coincide with the closest leaf of the MLC for all IMRT and mARC treatments. Therapist 4.2 and before: IMRT Therapist 4.3: IMRT and mARC Treatment 5 Y-Jaw Tracking Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Reporting • In syngo RT Therapist 4.3 MR3 you can generate a treatment report in XML Patient Applications_ Calibration Options Help TH ... format for each treatment session with the actual and delivered machine Desktop Common Internet Explorer MS Office TrendMicro OfficeScan Tx Visualization Tx Setup Media Player parameters. Windows Explorer MS Paint • You can see the report and process it automatically with an xml parser. • Reports are stored under C:\coherence\log\Reporting. The report name is formatted as YYYMMDD_HHMMSS_TreatmentReport.xml. Session report • • Reports are automatically compressed according to the calendar week they Report provided as an example only. were created. Start of session: 2012/01/13 09:02:08 Plan name: mARC Gantry Connected machine: MK009A160IEC • The report is automatically displayed formatted upon opening with Internet Explorer. + Beam: 1/ 1/ 6 Beam type: marc • The report provides you automatic processing to determine QA indicators. Radiation type: XRay_Unflattened Energy: 11 MV Doserate: 0 MUmin-1 Beam MUs: 35 MU Midpointerror overview Arclet Nr. pStart pStop mStart |mStop a Start a Stop midpointerror 1 185 185 185 185 185 185 0 2 193 197 193 196.8 193 197.3 0.25 3 203 207 203 206.8 203 206.9 0.05 4 213 217 213 216.8 215 215 0.1 5 223 227 223 226.8 223 227 0.1 Treatment 6 Reporting Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Patient Browser Offline reconstruction button Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help X do auto In previous versions, it used to happen that after delivery of a ConeBeam Reconstruct CT (CBCT) and the start of reconstruction, if the Control Console returned Thorax Breast an error, the ConeBeam error dialog was displayed and the reconstruction was canceled. The offline reconstruction button in the Local Database WJBaacNEW, BB_\ Port 20120419 [1] Cone Beam Projections 1/ 111 /s/ Prot/ Patient Browser stayed disabled and a patient unload was necessary. Scheduler Treatment Not Done AT_SR_STUC [2] ConeBeam CT 111/11 / [3] AT_TreatmentStructureSetSe [4] ConeBeam CT In syngo RT Therapist 4.3 MR3 the offline reconstruction button is now [5] AT_TreatmentStructureSetSe enabled without the need to unload the patient. Treatment 7 Patient Effective Date: 05/13/2019 | HOOD05162002997200 Browser Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Patient Browser Position Verification images Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help In versions 4.1 and 4.2 it was possible to delete Position Verification images rrr during a treatment sequence. Position Verification images are used to calculate offsets, after which the user was able to delete the acquired portal images in the patient browser with the Local Database WIRaacNEW, BB_1 == [4] Vsim_RTStructureSetSeries patient still loaded. WITH ist Prov Thorax Breast R/// / / / / Scheduler Treatment Not [ Open Subtree Close Subtree [3] Breast 3 mm 3.0 B40s R/// / // / Delete Protect In syngo RT Therapist 4.3 MR3 a protection flag will be applied to the Remove Protection Mark patient. This flag is applied on loading and removed on unloading. However, it is also possible to remove the flag manually. Treatment 8 Patient Effective Date: 05/13/2019 | HOOD05162002997200 Browser Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Patient Browser Series Structure Patient Browser Patient Applications Transfer Edit View Filter Sort Private Applications Options Help X XH auto VV ?? • In previous versions, images were stored in series (Verification Image 01ATP RTT Series, PPIS, RPIS) using the series like folders in a file system. Decker, Stephan Local Database . Testpatient, Stephan Port 20120227 [1] 2012-02-27 16:50 Verification Image Series • DICOM requires images that were acquired together to be stored in one Scheduler Testpatient, Stephan2 TXREV SR STUD [2] 2012-02-27 16:51 Verification Image Series series, where all images in the series belong to the same coordinate DVD-CD-RW TestpatientIT4, Free4All [3] Referencelmages system. • A new patient setup on the next day of treatment establishes a different Patient name Testpatient, Stephan Date of birth 8/2/1974 Patient ID HNGBBQ2-SPSW Study description Port 20120227 Study date 2/27/2012 Modality RTIMAGE coordinate system and therefore requires a new series. Instanc ... Instance Date and ... Image Label Instance Comm ... Mark Status Work Status Rad Machine Na 2/27/2012 4:51:27 PM AP:1 TestMLCRedBaron 13 2/27/2012 4:51:27 PM AP:1 TestMLCRedBaron 2/27/2012 4:51:27 PM AP:1 R/// /// TestMLCRedBaron The requirement to support the transfer of the offset from RTT to the OIS Review Comment - / • in a Spatial Registration Object (SRO) enforces the new series structure. Current Filter. Off • The original and all derived image versions reside in one series. Note: SRO is not supported with MOSAIQ, because this is not released for Siemens connectivity. Treatment 9 Patient Effective Date: 05/13/2019 | HOOD05162002997200 Browser Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Patient Browser Patient Transfer In general you can treat an outdated plan by transferring a patient between two geometrically identical machines, when both are connected to the same version of syngo RT Therapist. For example: • You treat a patient on Linac 1 / RTT 1 with a prepared plan (e.g. pauses, imaging options, etc.). • Then you send the patient to Linac 2 / RTT 2 and modify the plan again (e.g. change pause, gating, etc.). Afterwards you send the patient back to Linac 1/ RTT 1. • On Linac 1 / RTT 1 the changes made on Linac 2/ RTT 2 won’t be seen and there is no warning message (like for new Plan UID) for the user. In order to avoid this perform the following steps regardless of which system you are sending the patient data to and/or from: 1. Send the complete patient data. 2. Ensure that the patient data arrived completely on the other side. 3. Delete the complete patient data from the sending system. Treatment 10 Patient Effective Date: 05/13/2019 | HOOD05162002997200 Browser Unrestricted © Siemens Healthcare GmbH, 2019 Treatment SIEMENS Healthineers Flat Panel Positioner (FFP) Retraction • Automatic retraction of Flat Panel Positioner (FFP) before gantry rotates, provided that auto deployment is activated and acknowledged by you. • FPP moves to SID 145 before moving the gantry only if its vertical position is < 145cm, out of the so-called "safe zone”. • The panel won't move during a sequence between 2 gantry positions for taking images if the FPP position >= 145cm. Treatment 11 FFP Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Applying Offsets Apply offsets is only available for Position Verification imaging (0, 90, 270, 180°). If setup beams are acquired and offsets calculated, they can be applied automatically. For identical image angles acquired for treatment beams, offsets can be calculated but not applied automatically. Note: You are unable to apply offsets calculated for two 2D images acquired at 0 and 90 degrees. Imaging 12 Applying Offsets Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Second Portal Image Acquisition Issue: XJA-+4. Pestle 01 1174 +41BE05+ 45.13 The latest acquired portal image is not automatically displayed. 20120 12 IM4 1 The second portal image will not be loaded automatically to the active segment when it is acquired. The RTT still displays the previous image. Solution: R By clicking in the upper right corner you can toggle between the previous and newly acquired images. Complete the first workflow before acquiring new images → review the image, calculate a Dogs Praduel 400 00 the offset, unload the images from the Position Verification application and only after that 0.0 acquire new images. 1D Note: For Position Verification only Setup Image acquisition should be used. Tx Verification images should be used for documentation purposes or field shape verification only. Imaging Second Portal 13 Image Effective Date: 05/13/2019 | HOOD05162002997200 Acquisition Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Home Window & Filter (HWF) • In versions 4.1 and 4.2, filters could be reset until a filtered image was saved. • Afterwards, there was a “Home Presentation State” button, which switched the image back to the original state. • These 2 functionalities are replaced by the HWF button, which uses the acquired image, replacing the pixels in the current image and resetting the windowing values. • View Tab → Home Window and Filter • You can use the HWF button if the image was filtered or windowed as long as the Portal is not yet locked by: offsets applied or ignored for PVG images - reviewed for treatment images - • Only the display of the pixels is affected; overlays like contours, annotations and reticule remain unchanged. Imaging 14 HWF Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Home Window & Filter (HWF) Advanced Filter Filter Properties X Median EdgeEnhance Gaussian CLAHE Advanced Since changes to filter parameters are more likely than before (the default MV Scaling filter applied automatically during image display is sufficient for most cases), a Filter images on loading Window size 200 new Default button was added to the Filter dialog. Preset Head&Neck KV Nominal value 32000 → It resets the filter parameter set of the selected filter presetting to the factory default value. Harmonization Unsharp Mask Kernel Half- width 67 Kernel Half- width 20 Note: Gain 0.20 Gain 7.00 • Double exposure images are still filtered with the older advanced filter Save Apply Cancel Delete Default implementation. This may lead to a conflicting parameter set for single frame and double exposure images. • The presetting always displays Head&Neck_kV; however the correct MV and body part will be used by default. Click View > Filter > Properties Imaging 15 HWF Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers ConeBeam CT (CBCT) CBCT starts 5 degrees before the defined gantry angle as of version RTT version 4.3_SP1 and CC version 13.0. Example: CBCT protocol angle = 260 degrees (CCW) CC start angle = 255 degrees (RTT 254) Reason: With the new CBCT creation process it is necessary for the gantry to move at a particular speed. Therefore a run-up phase is required so that the gantry can reach the necessary speed. Imaging 16 ConeBeam CT (CBCT) Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers ConeBeam CT (CBCT) Reconstruction Offline Reconstruction X 282.00 Slice Size 512 x 512 After acquiring a CBCT, a water-color effect may be observed. This Slice Thickness 0.55 is because the Diffusion Filter that can be applied for CBCT image Kernel Smoothing reconstruction was modified. Anatomy Type Head and Neck Anatomy Size Medium In order to avoid the water-color effect deselect the filter for the Diffusion Ring 282.00 282.00 affected CBCT protocols in the Edit CBCT Protocols dialog. M Scatter Full Scan Reconstruct Cancel Note: Mainly low-contrast objects limited by noise may benefit from the Diffusion Filter, especially when it is used together with the smoothing kernel. Patient Browser -> Offline reconstruction Imaging 17 ConeBeam CT (CBCT) Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Virtual 6 DoF (Degrees of Freedom) • Virtual 6 DoF is a standard feature of syngo RT Therapist as of version 4.3 Acquisition Adjusted available in Adaptive Targeting. 1 Position Position Offset Lat [cm] 10.2 10.0 -0.2 • 6 DoF: 3 translations (LAT, LONG, VERT) + 3 rotations (ISO, PITCH, ROLL). Long [cm] 57.8 57.7 -0.1 • Couch (apply offset) corrects only LAT, LONG and VERT. Vert [cm] -14.2 -14.6 -0.4 Iso [o] +1. Pitch [o] -0.6 1 • Angular values are displayed for information purposes only. Roll [o] +2.9 2 • Display can be toggled ON/OFF from the user interface. Planning Isocenter Iso_1_000_000 3 • Display can be configured to be turned ON/OFF by default – toggle works for both Treatment Isocenter Machinelsocenter configurations: → Registration → Select Registration Options → Check Initially 2 Restrict Display to Translations Re Registration Options X 6DoF Options 3 Initially Restrict Display to Translations ~ Auto-Registration Quality Mode Standard O Precise O OK Cancel Imaging 18 Virtual 6 Effective Date: 05/13/2019 | HOOD05162002997200 DoF Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Virtual 6 DoF (Degrees of Freedom) 6 DoF offset enabled 6 DoF offset disabled Acabore Activar Calibration Load & Save Registration Toch View Structures Bekerence Points Trestmect Beams Options Holo Pebert Applicacons Activate Calibrados Load & Save Registration Tools yjes Structures Beterence Points Treatment Beams Ordons Heb head neck XJBfhm Braaivleis Treatment ID 11111 5/120000 Mal ID 612183 1/7/1965 Atale TxVisualizacon TE Setup Pos Verification TE Delivery Documentation Tx Visualization Tx Setup Pos Verification Tx Delivery Documentation Pts List - Tx RefPts List Dts List & Plan ROIS List Liet & Plan RefPts List List Viewing Iso_1_Field 1 Iso 7 2CBCT Tx Beams List Toces View Reg Tools View Acquanon Adusted Position Petition Offset 56:27 PM Postion Popbon Long [cml 715 718 3 Translational offsets Lat [cm] 02 04 .02 3 Translational offsets Vert [cml .162 .156. .06 Long [cm) 43.2 433 .0.1 Vert Icml .90 .73 +0.5. 3 Rotational offsets 3 Rotational offsets - ROY values are removed Planning isocerter :00_1_CBCTH Treatment locenter Machinetsocerner Planning isocerter Iso__CBCTH Treatment locerter Machineigoconter [A] Restrict to translational Restrict to translational X switched off switched on erapist! Patient dots has been prend su Imaging 19 Virtual 6 Effective Date: 05/13/2019 | HOOD05162002997200 DoF Unrestricted © Siemens Healthcare GmbH, 2019 Imaging SIEMENS Healthineers Virtual 6 DoF (Degrees of Freedom) 6 DoF offset workflow CBCT • Acquisition CBCT → Reference data set loaded → Auto-registration performed. • System displays offsets for all 6 directions (if 6 DoF is enabled by default). • System displays offsets for 3 translational directions only (if restricted mode is enabled by default); rotational values won‘t be displayed (also no zero as this could be a correct value for 6 DoF as well). • 6 DoF means the system will display the rotation in the image display and in the offset values of all 6 directions. It will allow for manual registration to change/correct the rotational angles in all 3 dimensions as well as the general 3 translational directions. • Restricted Mode means the system won’t display the rotation in the image display, the values for the rotational directions are not calculated and therefore not displayed and the labels are greyed out. It won’t allow for manual registration to change/correct the rotational angles. • Switching between 6 DoF and Restricted Mode will always cause a new auto-registration. Imaging 20 Virtual 6 Effective Date: 05/13/2019 | HOOD05162002997200 DoF Unrestricted © Siemens Healthcare GmbH, 2019 SIEMENS Healthineers 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 2019 Global Siemens Healthineers Headquarters Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84 0 siemens.com/healthineers 21 Effective Date: 05/13/2019 | HOOD05162002997200 Unrestricted © Siemens Healthcare GmbH, 2019