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TrueBeam 2.5 Administration and Physics

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100% found this document useful (8 votes)

15K views937 pages

TrueBeam 2.5 Administration and Physics

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Sandeep Hunjan

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TrueBeam 2.

5 Administration and
Physics
TB201
TrueBeam 2.5 Administration and Physics

Abstract
This TrueBeam 2.5 Administration and Physics manual is an educational aid for Varian TrueBeam machine.

Notice
Information within this document is subject to change without notice and does not represent a commitment on the part of Varian.
Varian is not liable for errors contained in this document or for incidental or consequential damages in connection with furnishing or
use of this material. This document contains proprietary information protected by copyright. No part of this document may be
reproduced, translated, or transmitted without the express written permission of Varian Medical Systems, Inc.

HIPAA
Varian’s products and services are specifically designed to include features that help our customers comply with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA). The ARIA and VARiS Vision systems use a secure login process,
requiring a user name and password that supports role-based access. Users are assigned to groups, each with certain access
rights, which may include the ability to edit and add data or may limit access to data. When a user adds or modifies data within the
database, a record is maintained of the data that was changed, the users ID and the date and time the changes were made. This
establishes an audit trail that can be examined by authorized system administrators.

Trademarks
Argus Software®, ARIA®, Clinac®, Exact® Arm, On-Board Imager®, SonArray®, Trilogy® and VARiS® are registered trademarks
of Varian Medical Systems, Inc. 4D Integrated Treatment Console™, Acuity™, Eclipse™, Enhanced Dynamic Wedge™,
FastPlan™, Millennium™ MLC, PortalVision™, Real-Time Position Management™, SmartBeam™, and TrueBeam™ are
trademarks of Varian Medical Systems, Inc.

All other trademarks or registered trademarks are the property of their respective owners.

© 2015 Varian Medical Systems, Inc.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
© Varian purposes
Medical Systems, only
Inc. All rights reserved.
pg 2 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Contacting Support
Support services are available without charge during the initial warranty period. If you seek information
not included in this publication, contact Varian Medical Systems:

 The most up-to-date contact information can be found at MyVarian.com

Ordering Additional Documents

To order additional documents, contact Varian Medical Systems:

 The most up-to-date contact information can be found at MyVarian.com

Communicating Using the World Wide Web

If you have access to the Internet, you will find Varian Medical Systems support at the following location:
Oncology Systems: https://www.varian.com/oncology
Select Service & Education for more information on various help resources

Sending E-Mail
Support is available via e-mail, contact Varian Medical Systems:

 The most up-to-date contact information can be found at MyVarian.com

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
© Varian purposes
Medical Systems, only
Inc. All rights reserved.
pg 3 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Document Conventions
This workbook contains several icons that alert you to important or supplemental information.

Icon Name Description

Note Details supplemental information.

Important Note Details critical supplemental information.

Tip Details alternative methods or helpful hints.

Caution Describes actions or conditions that could result in injury or damage to

equipment, software, or data.

Warning Describes actions or conditions that could result in serious injury or death.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
© Varian purposes
Medical Systems, only
Inc. All rights reserved.
pg 4 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Table of Contents
Documentation and Help Resources TAB 1

Documentation and Help Resources

System Overview TAB 2

System Overview

Software Overview

Beam Production and Shaping Components, Dosimetry System

Administration TAB 3

OSP, Users and Rights

Creation of an OSP User Account

TrueBeam System Administration

Service Mode for Physicists TAB 4

Service Mode Overview

Plan Delivery and Imaging in Service Mode

Absolute Dose Calibration

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

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pg 5 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Imaging & Geometry Calibrations TAB 5

Imaging & Geometry System Calibrations Overview

PVA Calibration Administration

PVA Calibration Overview

Imaging Mode Calibrations

Imaging Calibrations Exercise

Geometry Calibrations

CBCT Calibrations

Optical Camera Calibration

Power Up, Shut Down, Recovery, Power-Cycle TAB 6

Power Up, Shut Down

Recovery after Emergency Stop

Daily, Weekly Power-Cycle

Power Up from a Complete Power Off

CTB-GE-791 (TrueBeam Power Up Instructions)

Treatment and Imaging Applications TAB 7

Treatment Application Overview

Imaging Procedures Overview

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
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pg 6 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Clinical Applications TAB 8

Plan QA in Treatment Mode

Dry Run

2D-2D Match

Marker Match

3D-3D Match

2D-3D Match

Treatment with Automation

Interrupted Treatment

Treatment with Clearance Override

Treatment with Auto Beam Hold

Electron Plan Delivery, Custom Coding

Unplanned Treatment

Treatment with Respiratory Gating

Advanced Reconstruction

Daily Machine Checks TAB 9

Machine Performance Check Overview

Using Machine Performance Check

Machine QA Plans

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
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Inc. All rights reserved.
pg 7 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Appendix TAB 10

High-Intensity Beams Overview

Imaging Application Overview

Service Console Rights

Optimizing Image Quality

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
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Inc. All rights reserved.
pg 8 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Documentation and Help Resources TAB 1

Documentation and Help Resources

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
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Medical Systems, only
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pg 9 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Documentation and Help Resources

1 1

Procedure
2 2
Objectives:
After completing this module the student will have performed the following tasks using the TrueBeam
Administration and Physics manual as a resource:

1. Identified the major HW components of the TrueBeam system, their placement, role in the system
and basic parameters.

2. Understood TrueBeam control system.

3. Reviewed TrueBeam safety components.

Procedure Content:
Control Room Components:

1. Alphanumeric keyboard and mouse

2. Workstation control console

3. Console electronics cabinet

4. Console imaging cabinet

5. CCTV monitors

6. Workstation monitors

Treatment Room Components:

7. Clinac stand

8. Clinac gantry

a. kVS

b. kVD

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

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System Overview

c. MVD

9. Clinac couch

a. Side panels

b. Hand pendants

10. Respiratory Gating camera

11. CCTV camera(s)

12. Live view camera

2
TrueBeam Control System Components

Main TrueBeam Safety Features

References:
P1005923-002-B – TrueBeam Technical Reference Guide – Volume 1; chapters 2, 5, 7, 9, 10, 12, 13,
appendix B.

P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging; chapters 2, 3, 4, 5, 6,

12, appendix B.

P1005922-001-A – TrueBeam Instructions for Use – chapter 6, appendix G.

P1005927-001-A – TrueBeam Quick Reference Guide.

RAD 10094L – TrueBeam™ System Specifications.

P1007370-001-A – TrueBeam™ IEC Accompanying Documents Functional Performance Characteristics,

appendix E.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

System Overview 2
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pg 29 DCID:
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System Overview

A. Control Room Components

1. Typical Control Room layout. Control Room consists of Control Console Area (A) and Electronics
Cabinets (B), see Figure 1.

2 2

A
B

Figure 1: General Control Console Area, A – Control Console Area; B – Electronics Cabinets

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2. Control Console Area, see Figure 2, includes the following system components:

Workstation monitors

2
‘Treatment ‘Imaging’

CCTV monitor CCTV monitor

Control console

Alphanumeric KBD Mouse

Figure 2: Control Console Area

a) Workstation monitors are both connected to TrueBeam workstation and provide a visual
interface which allows interaction with software installed and running on TrueBeam workstation.
‘Treatment’ monitor shows main user-facing application, ‘imaging’ monitor shows imaging related
information with respect to main running application,

b) CCTV monitors enable therapist to monitor treatment room from control console area. They
have button controls for camera zoom, camera navigation, navigation and zoom reset, ON/OFF,
brightness and contrast. They also have adjustable tilt,

c) Mouse can be smoothly dragged between both monitors,

d) Alphanumeric keyboard (KBD) is used if user input is needed,

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e) and Control Console, see Figure 3:

Lock & Key

Emergency stop Imager selection

2 2
Backup MU display
Intercom system

Beam controls
Motion controls

Figure 3: Control Console

 Control Console controls are separated into several logical sections – see Figure 3. The
controls allow remote motions, kV and MV beams, communication with patient inside in the
treatment room and basic safety operations:

Lock and key - If key is in locked position ( ) motions from the console as well as
treatment and imaging are not available.

Emergency stop button stops any beam and motion and shuts off high voltage power.
Console area workstations remain powered on.

Backup MU counter shows delivered MU even if there is no electrical power (at least 30
minutes after power was lost).

Imager Selection - allows to select imaging arm to be controlled from control console.
Cycles through 3 options: kV (kVS and kVD arms selected), MV (MVD arm selected) and MV
+ kV (MV and kV imaging arms selected).

Motion Selection buttons allow selecting axes to be controlled remotely from control
console.
Orange color of the button indicates that the actual axis position differs from the axis position
in the plan more than is allowed for the axis by the tolerance table.
Green flashing label over the button indicates that the axis has been selected to be moved
from the console and will move when Motion Enable buttons are pressed and held down.

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Motion Enable – both buttons need to be pressed and held down to move selected axis (or
more axes) to planned position(s). Motion Enable buttons are lit up when active.

Clearance Override – in conjunction with one or both Motion Enable buttons it can be used
to override ‘low clearance’ treatments for which Machine Protection and/or Patient
Protection systems would report a collision disallowing continuation of the treatment.

Tip: Clearance Override functionality has to be enabled in Treatment mode

each session it is to be used and for each of the protection systems to be
2
overridden. Successful authorization requires Override Patient Protection
user right.

 Table 1 and Table 2 describe roles of Beam Controls and Motion Selection buttons.

Beam Control Button Function:

Preview Plan/Field preview mode, ‘No Mode Up’

Transfers selected field parameters to the machine (previously called ‘Mode

Up’)
Prepare
MLC and jaws move to planned positions if not there yet without need to
press and hold Motion Enable

Indicates that MV beam preparation was successful, no active interlocks.

Stays lit for several second waiting for confirmation from user. If MV beam
is not confirmed by pressing and holding this button down, the system
MV Ready
returns to Prepare
To confirm MV beam, press and hold this button until it goes dark and MV
Beam On button becomes lit

Turns on the MV beam for treatment and/or imaging

MV Beam On If held down the MV beam is temporarily paused for the time the button is
held down

Beam Off Shuts off the active beam (MV and/or kV)

kV Beam On Prepares and turns on the kV beam for imaging

Table 1: Beam Controls

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Motion Selection Function:

Selects planned position or in the absence of a plan to the default extended

position to be applied to selected imaging arms when Motion Enable are pressed
and held down

To Plan

Selects a preset midway position which avoids exposure to imaging panels during
2 treatment to be applied to selected imaging arms when Motion Enable are
pressed and held down
2
Mid

Selects fully retracted position to be applied to selected imaging arm(s) when

Motion Enable are pressed and held down

Retract

Select couch linear axes (Vrt, Lng, Lat) to be moved when Motion Enable buttons
are pressed and held down. If PerfectPitch 6DOF couch available this button also
applies to Roll, Pitch
Couch Linear

Selects gantry and collimator ( including jaws ) axes to be moved to planned

position(s) by pressing Motion Enable

Gantry

Selects couch rotation to be applied by Motion Enable

Couch Rtn
Table 2: Motion Selection Controls

Note: Gantry and couch cannot be moved at the same time from outside of
the vault.

If only one button is orange, the axes it represents are automatically selected
to be moved by Motion Enable ( label over the button is flashing in green ).

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System Overview 7
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3. Electronics Cabinets – Control and Imaging Cabinets:

• Control Cabinet, see Figure 4, holds the following components:

a) TrueBeam workstation – runs user-facing software applications, provides access to R&V

system and patient data,

b) In-Room Monitor (IRM) workstation – hosts ‘in-room’ monitors that show plan relevant machine
and patient information inside in the treatment room,

c) Service workstation – runs remote access and machine monitoring software,

2
d) Node Electronics Assembly – contains control system nodes including Supervisor, power
supply and network switch for nodes communications,

e) UPS and external batteries, firewall, ethernet switch (Imaging and Workstation networks),
Live View Camera control unit and service connectors.

Service connectors

Firewall,
Node Electronics Assembly
Ethernet
Switch,

Live View
Camera control
unit Service WS

IRM WS

TrueBeam WS

UPS

Extended batteries

Figure 4: Control Cabinet

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• Imaging Cabinet, see Figure 5, holds the following components:

a) CBCT Reconstructor – reconstructs CBCT from kV projections acquired during gantry rotation,

b) XI (X-ray Imaging) – part of the control system responsible for kV imaging, MV imaging,
Respiratory Gating; controls X-ray generator,

c) Power supply for XI.

2 2

XI power supply

CBCT
Reconstructor

Figure 5: Imaging Cabinet

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System Overview 9
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System Overview

B. Treatment Room Components

1. Figure 6 shows typical component deployment in Treatment Room.

Live View Respiratory Gating

camera camera

Gantry
stand

Gantry 2
In-room monitors with
imaging
arms

CCTV cameras
Treatment couch

Modulator

Figure 6: Treatment Room Components

2. CCTV cameras – capture view of the treatment room which is then displayed on CCTV monitors in
the control console area. View angle and zoom can be adjusted using the controls on the monitors.
System is configurable for up to 6 CCTV monitoring devices.

3. Live view camera – captures treatment room view which is then displayed in real time in treatment
application. Machine motions and/or collisions detected by Protection systems are displayed as color
overlays on this view. See Figure 7.

a) Orange arrows – motions to be done to move to planned position for active field.

b) Blue arrows – indication of motions done during treatment ( for example gantry motion during arc
treatment ).

c) Red overlay displayed over couch/collimator/imaging panel(s) – indication of collision detected by

one of Protection systems.

d) Yellow overlay displayed over couch/collimator/imaging panel(s) – warning that indicated

machine parts are about to collide.

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2 2

Figure 7: Live View Display in Treatment Application

4. Respiratory Gating Camera, see Figure 8 – Polaris Spectra camera from NDI used to track patient
respiratory motion by tracking passive marker block placed on the patient:

Status LEDs, laser and laser activation button

Position sensors and illuminators

Reflective markers

Figure 8: Respiratory Gating Camera (top) and Marker Block (bottom)

a) Camera directly produces stream containing marker block position and its orientation (x, y, z, roll,
pitch, yaw ) which is received by the XI.

b) Permanently connected to XI power supply to avoid long warm-up times which can be, from cold
start, anywhere between 10 minutes and 2 hours.

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c) Camera has a bump sensor built-in. Detected impact is indicated by LEDs on the camera.
Possible system states are explained in Table 3.

1) Laser aperture
2) Error LED (amber)
3) Laser Activation Button
4) Power LED (green) 2
5) Status LED (green)

Power LED Status LED Error LED State

Flashing Any Any Warm up

Solid Solid Off Ready for use, no faults

Solid Solid Flashing Minor recoverable fault (for example bump

detected). Does not prevent system operation

Solid or Off Solid Solid Major recoverable fault. System will not
operate until fixed

Solid Off Solid Non-recoverable fault. Service required

Table 3: Position Sensor States

d) Marker block is made of a lightweight plastic material ABS 757.

e) Marker block white cross lines are used to align marker block with isocenter for camera
calibration.

Note: Intercom microphones inside in the treatment room are typically close
to Live View and Gating cameras.

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5. In-room monitors – system includes 2 in-room monitors that display relevant patient and machine
information for operator inside in the treatment room. They are mounted side-by-side where operator
can easily observe the data while still watching the patient.
Machine monitor displays machine parameter information and Patient monitor shows patient
information and treatment plan setup data. See Figure 9 and Figure 10.

a) Patient monitor screen is divided into 4 quadrants. Upper right and lower left show setup
pictures attached to the active field in R&V/TPS. Lower right shows patient picture. Patient first
name, last name, patient ID, plan ID and patient orientation are displayed in bottom right corner of
these views.
2 Upper left quadrant can display Setup Notes, Activity notes or Fields. Selection can be made 2
using navigation buttons on the hand pendant. Selecting Fields automatically starts Dry Run.
Dry Run can be finished by selecting Setup Notes tab or pressing Done button in Treatment
Application.

Important Note: Dry Run is a practice run of a treatment plan. Performing a

Dry Run lets you check machine movement for possible collision and other
problems before the patient is treated. Varian strongly recommends that Dry
Run is performed each time treatment includes movement of imaging arms
and/or gantry to avoid patient injury and/or equipment damage.

Figure 9: Patient Monitor Example

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b) Machine monitor – shows planned and actual positions of machine axes. Blue bar on the right
side shows machine status messages ( upper half ) and routine interlocks ( lower half ). Blue bar
on the top includes patient and selected/active field information.
Orange background for actual machine axis position value indicates that the actual axis position
differs from the planned axis position more than is allowed for the axis by the tolerance table.
See Figure 10.

Status messages
2

Routine interlocks

Figure 10: Machine Monitor Example

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6. Modulator - contains components that transform AC electricity into the required high voltage and
distribute it to primary and support systems of the clinac. It contains main power controls, system
circuit breakers and other controls and indicators. Can be also located in a dedicated room separate
from treatment.

7. Clinac stand – support structure for the Gantry. TrueBeam platform features 2 different stand
installation versions – standard (not in production with TrueBeam 2.5, still available on upgraded
machine) and small vault configuration, see Figure 11.
Small vault configuration stand is about 40cm ( 15.6” ) shorter than standard and does not require
access from the back ( can be installed directly against back wall ) which makes it suitable for smaller
2 treatment rooms. Because of significant reduction in volume inside, most of the stand components 2
and some gantry components have been re-packaged/re-designed in order to fit reduced space.
Stand contains following vital and supporting clinac components (see also Figure 12 and Figure 13):

a) Water cooling components:

 Water tank – contains up to 12 gallons of distilled water mixed corrosion inhibitors and
biocides (included with TrueBeam as additive kit).

 Water pump – provides adjustable water flow-rate and pressure.

 Heat exchanger – component where internal water and facility water flow past each other
and exchange heat, cools down internal water.

 Strainer – removes large debris.

 3-way valve – controls rate of facility water flowing in TrueBeam cooling system, which
affects internal water cooling rate.

 Flow, temperature and water level sensors.

 The cooling system keeps the water temperature between 38.2 °C and 41.8 °C. If the
temperature reaches 45 °C for more than 5 minutes, minor fault would prevent the machine
from beaming on. If water overheats to 48 °C major fault cause power to be shut down and
de-energize major heat-producing components.

b) Fans – interior of the stand is cooled by air.

c) Klystron – linear vacuum tube microwave amplifier.

d) X-ray generator and X-ray tube voltage transformer.

e) SF6 system – waveguide between klystron and clinac accelerator structure is filled with dielectric
SF6 gas to suppress arcing inside the waveguide.
System consists of gas tank, filter, pressure sensor and relief and solenoid valves. If pressure
is below 30.5 psig the control system opens the solenoid valve to increase the pressure. Valve is
then closed when pressure rises above 33.5 psig.

f) Power supplies – accelerator solenoid, klystron solenoid, bending magnet, RF driver.

g) Control system PCBs.

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h) Backup motion controller – allows gantry and couch motions when machine is without external
power. For service use only.

Figure 11: Stand Options, Standard (left) and Small Vault Configuration (right)

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kV generator
voltage
transformer

2 2
Waveguide

SF6 dryer

Backup SF6 solenoid valve

motion
controller

Water flow sensors

SF6 pressure
gauge

Emergency Off button

SF6 pressure monitor

Klystron
Shut off valve

SF6 tank

Figure 12: Stand Components (Gantry Right)

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kV generator

2
Acc. solenoid PS Klystron solenoid PS

Bending magnet PS

RF driver PS

Cooling system
funnel Sliding panels
with control
system PCBs

Emergency Off button

Water pressure gauge

Figure 13: Stand Components (Gantry Left)

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kV generator

2 2
Water funnel on
a swing arm

Emergency Off button

Water flow
sensors

Klystron

SF6 tank

Water cooled pulse tank

Figure 14: ‘Slim’ Stand Components (Gantry Right)

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kV generator

RF driver 2
3-in-1 power supply
(KSOL, ASOL, BMAG)

Swing panel with

controller PBCs

Emergency Off button

Pump stand with pump

Figure 15: ‘Slim’ Stand Components (Gantry Left)

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8. Clinac couch – patient positioning platform which provides a travel range to accommodate a wide
variety of treatment techniques. Consists of a couch top and a pedestal.

a) Inside in the treatment room couch can be operated from Side Panels and/or Hand Pendants.

b) In addition to standard 4DoF couch, TrueBeam 2.0 (and higher) platform also offers 6DoF couch
as an option. Varian PerfectPitch™, see Figure 16, adds 2DoF (roll – lateral tilt, pitch –
longitudinal tilt ) to 4DoF couch pedestal. PerfectPitch requires new couch pedestal and supports
several different couch tops – Varian IGRT, kVue, Calypso kVue.

Pitch and roll values are not in treatment plan, they are considered axes that can correct for
2 deviations in patient setup and can only be applied from control console or hand pendant in the
2
treatment room as a result of patient setup verification process. Custom roll and pitch can also be
applied in Service mode; either using the hand pendants or control console.

Roll and pitch applied for the session may be saved to the treatment database but will not be
imported for subsequent session.

Roll and pitch zero automatically when couch is lowered 40cm below isocenter.
Maximum pitch and roll angular rotations are ±3°.

2DoF Roll and Pitch

mechanism

Figure 16: PerfectPitch™

c) Operating limits in IEC 61217 Scale:

 Lateral limits – -24.5 cm to +24.5 cm.

 Longitudinal limits - +15.5 cm to +160.5 cm.

 Rotation - +95° to +265°.

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 Vertical Limits – depend on couch top. See Table 4.

Couch top Robotics (Roll and Pitch) Vertical Range

IGRT None -66.5 to +40.5 cm

IGRT Varian -58.0 to +40.5 cm

3rd party : kVue None -66.5 to +40.5 cm

3rd party : kVue Varian -53.5 to +40.5 cm

2
3rd party : BrainLab 3rd party : BrainLab -56.3 to +40.5 cm
Table 4: Vertical Travel Range

4DoF 6DoF

Max patient load 227 kg ( IGRT, kVue, 200 kg ( IGRT)

Calypso kVue )
155 kg (kVue, Calypso kVue )

Min. patient load height ~ 63 cm ~ 72 cm

Vertical travel range ~ 106 cm ~ 98 cm

Table 5: 4DoF vs 6DoF Comparison

d) TrueBeam couch includes a feature called Couch Compensation. Couch Compensation takes
account of small deflections in the couch structure itself – as couch longitudinal and lateral axes (
and/or roll and pitch if applicable) are moved small elastic deflections of couch top occur which
have small but measurable influence on position of couch top with respect to isocenter, see
Figure 17. Couch compensation converts couch top actual position into precise motor position
and adjusts couch vertical to keep target at isocenter which can be visible as small amount of
vertical motion when longitudinal, lateral (and/or roll and pitch if applicable ) are changing.
In float mode the compensation function calculates the effective vertical axis position for actual
longitudinal, lateral (and/or roll and pitch if applicable ) positions of the couch top which appears
as a change in the vertical axis position displayed during float mode motion.

Figure 17: Couch Compensation

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e) Hand pendants – there are two identical hand pendants connected to couch pedestal, one on
each side of couch. They are used to move the machine axes.

 Display on top of the pendant shows Gantry position and currently selected imaging arms.

Pendant display

Button Description
2 2
Selected imager(s) motions Turns treatment room lights on/off.

Automatic motions

Turns field light on/off

Turns the Optical Distance Indicator (ODI)

on/off

Turns the room lasers on/off

Thumbwheels function selectors

Turns the pendant flashlight on/off. The

flashlight is located on the back of pendant
Thumbwheels for manual motions

Toggles the radiation field aperture between

plan and open. For dynamic MLC fields the
button toggles between Complete Irradiated
Area Outline (CIAO) and open.

Moves the selected imager(s) to planned

position or default extended position if there is
no plan

Moves the selected imager(s) to midway

position to provide clearance for motions and

minimize imaging panel exposure

Moves the selected imager(s) to fully retracted

position

Motion Enable

Figure 18: Hand Pendant

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Button Description

Service button allows pendant test and calibrations of the pendant thumbwheels.
Requires additional steps to be done in Service application.

Navigation buttons – cycle through tabs and panels on the Patient Monitor – can be used
to start/stop Dry Run.

Expands the selected view on the Patient Monitor. 2

Restarts the Dry Run or allows cancelling the Dry Run with automation.

Moves the couch longitudinally, laterally and vertically to the planned position. Motion
needs to be allowed by pressing Motion Enable bars.

Moves gantry and collimator axes to plan.

Rotates the couch to the planned position.

Enables the thumbwheels to move the collimator, gantry and couch manually. Also, can
be used to enable the thumbwheels to apply custom roll and pitch when Service Mode or
Select Major Mode is opened at the console.

Selects the imager(s) to move with imaging arm positioning buttons and enables
thumbwheels to move the selected MV or kV imaging arm. The selected arm(s) appears
on pendant display. Imager selection is specific to each pendant.

Enables the thumbwheels to move collimator jaws manually. Pressing the button
repeatedly cycles through different asymmetry motion modes.

Table 6: Hand Pendant Buttons

Important Note: Automatic Motion buttons, when backlit in orange color, can
be used to move the machine to plan positions.
For the Automatic Motion buttons on the paddle, the system uses very tight
internal tolerances which may be different from plan. Thus these buttons still
can be backlit in orange color, even when control console buttons are not
orange ( difference between actual and plan is less than plan tolerance ).

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f) Couch side panels – buttons with same symbols as on the hand pendant have same functionality.

2 2

Figure 19: Couch Side Panel

Note: TrueBeam v2.0 (and higher) new installs have additional new buttons
on the side panel whether the couch is 6DOF or not.

Button Function

Level couch top ( zero roll and pitch )

Future development, not yet functional buttons.

Table 7: TrueBeam 2.0 (and Higher) New Couch Side Panel Buttons

Note: EMO Vertical allows lowering the couch only.

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9. Clinac gantry – contains parts that generate and shape the beam for treatment. Supports the
imaging arms which provide kV and MV imaging. Gantry is connected to the stand and is rotated as a
unit. See Figure 20.

Figure 20: Gantry

Gantry Specifications Specifications

Rotational accuracy ≤ 0.3 degrees

Rotation range ±185° from the vertical

Rotation speed Variable from 0 to 1 RPM

Gantry and collimator isocenter accuracy ≤ 0.5 degrees

Gantry, collimator and couch isocenter accuracy ≤ 0.75 degrees

Target to gantry axis distance 100 ± 0.2 cm

Table 8: Gantry Specification

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a) Collimator – contains important beam shaping components such as X and Y jaws and MLC. X
and Y jaws are independent, X jaws move in same direction as MLC leaves along linear path, Y
jaws move along arc trajectory. The collimator has attachments that accept wedge filters, shadow
block trays, compensating filters, electron applicators and other accessories to modify the
treatment beam further, see Figure 21. Custom coding is available for selected accessories - the
collimator electronics reads the codes placed on trays of patient specific, beam modifying
accessories (e.g. electron cut-out ), see Figure 22.

2 2

Figure 21: Collimator and its Accessories

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Figure 22: Custom Coding

Collimator Performance Specifications Specifications

Rotational accuracy ≤ 0.5 degrees

Rotational reproducibility ≤ 0.3 degrees

Rotation range ±175°

Coincidence of light field and radiation field (50% isodensity line) 1.5 mm

Cross hair intersection alignment to collimator ±0.5 mm

Rotational speed, no accessories Variable from 0 to 2.5 RPM

Rotational speed, with accessories Variable from 0 to 1 RPM

Optical range finder 70 - 156 cm range, 0.5 cm resolution,

accurate to ±0.1 cm at 100 cm

Mechanical front pointer 70 - 110 cm range, 0.2 cm resolution,

accurate to ±0.1 cm, at 100 cm
Table 9: Collimator Specifications

Independent Upper and Lower Jaws Specifications

Upper jaw positional accuracy ±2 mm for static fields

Lower jaw positional accuracy ±1 mm for static fields

Travel range – lower jaws -2 cm to +20 cm

Travel range – upper jaws -10 cm to +20 cm

Jaw speed Variable, 0 cm/s to a maximum speed of 2.5 cm/s

Table 10: Jaw Specifications

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MLC Specification Specification

Maximum leaf retract position 20.1 cm from centerline

Maximum leaf extend position -20.1 cm over beam centerline

Maximum displacement between adjacent leaf ends at a single carriage 15 cm

position

Average leaf transmission < 2.0%

2 Maximum interleaf leakage < 3.0% 2

Maximum carriage speed Variable from 0 to 1.2 cm/sec

Maximum leaf speed Variable from 0 to 2.5 cm/sec

Minimum static leaf gap (end to end) 0.0 mm

Minimum dynamic leaf gap (end to end) 0.5 mm

Leaf interdigitation Yes

Independent leaf and carriage motion Yes

Table 11: MLC General Specifications

NDS120 MLC specifics:

Number of leaves 120

Central high resolution leaf width (central 20 cm, leaf width projected at 5 mm
isocenter, 40 leaves)

Outboard leaf width (outer 10 cm on each side of MLC carriage, leaf 10 mm

width projected at isocenter, 20 leaves)

Maximum static field size 40 cm x 40 cm

NDS120HD MLC specifics:

Number of leaves 120

Central high resolution leaf width (central 8 cm, leaf width projected at 2.5 mm
isocenter, 32 leaves)

Outboard leaf width (outer 7 cm on each side of MLC carriage, leaf width 5 mm
projected at isocenter, 28 leaves)

Maximum static field size 40 cm x 22 cm

Table 12: MLC 120 and HD 120 Specifications

Note: Leakage is specified as percentage of total dose per field or dose

segment, measured with jaws fully retracted.

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b) Imaging arms :

 System features 3 robotic arms – kV Source (kVS) arm, kV Detector (kVD) arm and MV
Detector (MVD) arm responsible for positioning kV and MV imaging components. For high
positioning accuracy all three arm are mounted on a frame attached to gantry. See Figure 23.

Anti-collision plates
kVS arm

2
kVD arm

MVD arm

Figure 23: Imaging Arms

 kVS arm has 3 rotation axes – shoulder, elbow, wrist which define Lng and Vrt source
position with respect to isocenter; see Figure 25.
kVD and MVD arms have 3 rotation axes and 1 linear – shoulder, elbow, wrist, hand (lateral
panel motion), which define Lng, Vrt and Lat panel position, see Figure 24.

Shoulder

Hand Elbow

Wrist

Figure 24: MVD, kVD Arms

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Shoulder

Elbow

Wrist

2 2

Figure 25: kVS Arm

Characteristic kVS Arm kVD Arm MVD Arm

Maximum payload 45 kg 20 kg 20 kg

Absolute positioning X,Y radial 1.5 mm, Z ± 2 X,Y radial 1.5 mm, Z ± 2 X,Y radial 1.5 mm, Z ±
accuracy mm mm 2 mm

Positioning X,Y radial 0.5 mm, Z ± X,Y radial 0.5 mm, Z ± 1 X,Y radial 0.5 mm, Z ±
Repeatibility 0.5 mm mm 1 mm

Dynamic stability X,Y radial 0.4 mm, Z ± 1 X,Y radial 0.8 mm, Z ± 1 X,Y radial 0.8 mm, Z ±
mm mm 1 mm

Positioning Speed 1 mm/s up to 35 mm/s for 1 mm/s up to 35 mm/s 1 mm/s up to 35 mm/s

clinical axes for clinical axes for clinical axes

Stopping Distance Below 25 mm/s within Below 25 mm/s within Below 25 mm/s within
3mm 3mm 3mm
Above 25 mm/s within 10 Above 25 mm/s within 10 Above 25 mm/s within
mm. mm. 10 mm.

Time to retract or (0,0,-100) (0,0,-80) (0,0,-80)

extend
Park (Mid) Extend: 17 s Extend: 14 s Extend: 13 s
Park (Mid) Retract: 7 s Retract:15 s Retract: 5 s
Table 13: Imaging Arms Mechanical Characteristics

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 Figure 26 shows clinical zones for all 3 imaging arms – possible positions of the center of the
MV and kV imaging panel(s) with respect to isocenter and position of kV beam source with
respect to isocenter.

Figure 26: Clinical Zones, kVS (top) and MVD, kVD (bottom)

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c) kV source and imaging panels:

 kVS arm carries the source of X-ray radiation, X-ray tube GS – 1542, see Figure 27. The
X-ray tube consists of the cathode and rotating anode that are small distance (1 to 2 cm)
apart in a vacuum closure made of metal and glass. The tube housing provides protection
from radiation leakage and encapsulates the cooling oil. High voltage and current necessary
to produce the X-rays are provided by kV X-ray generator in the clinac stand.

Characteristics Specification

2 X-ray Generator: 2
Voltage 40 kV to 140 kV in 1kV steps

Exposure time 1 ms to 6300 ms in 1 ms steps

Current range 10 mA to 630 mA in 1 mA steps

Current-time product 0.1 mAs to 1000 mAs

Maximum pulse rate 30 pps

X-ray tube GS 1542:

2 focal spots Small 0.4 mm

Large 1 mm

Target angle 14 deg

Target diameter 133 mm

Maximum anode heat units 1.5 MHU

Weight (including housing) 30.4 kg

Inherent filtration 2.7 mm on the exit window of X-ray tube

Table 14: X-ray Tube Characteristics

Note: X-ray tube is cooled by oil which is then cooled in oil-water heat
exchanger as part of clinac water cooling system. Oil pump and oil-water heat
exchanger are located on kV source side of the gantry. Oil pressure is
constantly monitored and kV generator stops functioning if pressure is
outside of normal range. If kV tube temperature reaches approximately 80°C
(176 °F), the Over Temperature Switch located in the tube and hard-wired to
X-ray generator opens and immediately stops any X-ray generation.

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Cathode

Filaments for 2 focal spots

kV beam exit window

Anode

Figure 27: X-ray Tube GS 1542

 kV source is equipped with beam shaping and hardening filters and beam collimating blades,
see Figure 28.

Exit window inherent filtration

Norm chamber

Blades

Half-fan Full-fan Titanium

hardening filter

Bow-tie filters

Figure 28: Filters and Norm Chamber

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 Norm chamber – single photo-diode device measuring secondary radiation of the kV beam
during CBCT scanning. Reading is included in acquired projections and is used by CBCT
reconstructor to compensate for pulse-to-pulse beam intensity variation – CBCT
reconstructor uses the value to normalize projections relative to each other.

 Blades – fully independent blades which shape the beam in symmetric or asymmetric
radiation field in X-Y plane. System provides a function such that the blades track the active
area of the kV imager automatically. If this function is turned off user can set positions of the
blades also manually.

2 Characteristic Value 2
Minimum symmetric : 2 x 2 mm
Maximum symmetric : 50 x 50 cm
kV radiation field size at isocenter
X1, Y1 asymetric : -25 to +3.5 cm
X2, Y2 asymetric : -3.5 to +25 cm

± 2mm for fields ≤ 20 cm x 20 cm

Absolute positioning accuracy:
± 1% for fields ≥ 20 cm x 20 cm

Repeatability ≤ ± 0.5 mm

Speed Up to 35 mm/s

Dynamic stability ± 0.5 mm during gantry rotation

Table 15: Blades characteristics

 Bowtie filters – mounted in front of tube on the filter deck equipped with motor-driven filter
changer. It takes about 10 seconds to change bow-tie filters. Made of aluminum and they
improve image quality of the CBCT projections: allow use of larger X-ray techniques without
saturating imager, reduce charge trapping in the detector, reduce X-ray scatter and patient
skin dose. Bow-tie filter is part of CBCT scanning mode – Half-fan is used to scan larger
volumes (pelvis), Full-fan is used for smaller volumes (head).
See Figure 29 and Figure 30.

 Beam hardening foil filter – provides optional additional beam hardening by absorbing low-
energy photons in the beam. The filter is 0.89 mm thick foil made of Titanium.

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Figure 29: Use of Half-Fan Bowtie Filter with kV Imager at 150 cm Distance from kV Source; Maximum Axial
Length and Scan Diameter Values Are Only Approximate

Figure 30: Use of Full-Fan Bowtie Filter with kV Imager at 150 cm Distance from kV Source; Maximum Axial
Length and Scan Diameter Values Are Only Approximate

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 kVD arm carries the detector of X-ray radiation – imager Paxscan 4030CB.

Characteristics Value

Scatter Grid Parallel 10:1; 150 cm focus

Maximum imaging area 39.7 x 29.8 cm2

Pixel matrix size 2048 x 1536

2 2
A/D conversion, bit depth 14 bits

Imaging modes:

Dynamic Gain Dynamic Gain, 1024 x 768, 15 fps max

High Quality Single Gain, 2048 x 1536

Low Dose Single Gain, 1024 x 768, 15 fps max

Table 16: kV Detector Basic Characteristics

 MVD arm carries the detector of MV radiation – MV IDU 20 or DMI (Digital Megavolt
Imager). DMI is available with Small Vault Configuration stand or as a purchasable upgrade
for machines with Standard stand.

Characteristics MV IDU 20 DMI

Maximum imaging area 40.1 x 30.1 cm2 43 x 43 cm2

Pixel matrix size 1024 x 768 1280 x 1280

A/D conversion, bit depth 14 bits 16 bits

Max. frame rate @ full resolution 10 25

Imaging modes (resolutions as for IDU 20):

High Quality Single MV radshot @ 1024 x 768. MV beam is on hold while reading entire
panel

Low Dose Single MV radshot @ 512 x 384. MV beam is on hold while reading entire
panel

Continuous Synchronized MV @ 1024 x 768. Imager is read out between MV beam

pulses, used for cine

Dosimetry Unsynchronized MV @ 1024 x 768. Imager is continuously read out whether

or not the MV beam is in pulse or on hold. All frames acquired between
BEAM ON and BEAM OFF are summated, used for dosimetry purposes
Table 17: MV Detectors Basic Characteristics

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 All Varian image detectors are indirect converters. The detector first converts an incident
photon to electrons which is then absorbed in scintillator. Electron absorption releases energy
in form of light which generates an electron-hole pair. Negatively charged electrons move
toward the cathode and holes move toward the anode and photocurrent is produced.
Integrated current, charge accumulated by photodiode can be read-out for each photodiode
and is converted to digital value also known as pixel value. See Figure 31.

Figure 31: Image Generation, Indirect Radiation Detection

 Pixel consists of a light sensitive photodiode and a Thin Film Transistor (TFT). Photodiode
acts as a capacitor – the received light is integrated and captured as an electric charge. By
enabling the gate line, the TFT is switched on and the charge held in the photodiode is read
out over the data line. To acquire an image the pixels are arranged in a matrix. Gate driver
electronics enable the row – all TFT of the entire pixel row are switched on. The charges held
in all photodiodes in this row are then transferred to the readout electronics. As soon as one
row is read out, the system switches to next row and continues until the entire image is
generated. See Figure 32 and Figure 33.

Figure 32: IDU 20 (left) and DMI (right) - 1) Readout Electronics, 2) Photodiode Array, 3) Gate Driver
Electronics

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2 2

Figure 33: Imager Schema

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C. TrueBeam Control System

1. TrueBeam is controlled by a sophisticated network of control boards (modules) coordinated by a
Supervisor module, providing integrated control of the entire system.

2. The control system is divided into subsystems, each responsible for controlling a portion of the
machine. The subsystems are linked and coordinated through Supervisor (SPV), the central node.
Subsystems can be further sub divided into sub-subsystems (AKA sub-nodes), see Figure 34.

Figure 34: Schematic Architecture of TrueBeam Control System, Networks

a) Supervisor (SPV) – central node in the system, coordinates and monitors the other nodes.

b) X-ray Imaging (XI) – provides kV and MV image data; provides real-time image data access for
gating and tracking.

c) Stand node (STN) – controls and monitors cooling and SF6 systems, power distribution including
emergency stop, controls and monitors gantry position, interfaces with control console.

d) Couch upper node (CCHU) – controls and monitors couch longitudinal and lateral axes (also roll
and pitch if PerfectPitch installed), interfaces with hand pendants and couch side control panels.

e) Couch lower node (CCHL) – controls and monitors couch vertical and rotation axes.

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f) Positioning unit MVD (PU-MVD) – controls and monitors position of MVD arm.

g) Positioning unit kVD (PU-KVD) – controls and monitors position of kVD arm.

h) Positioning unit kVS (PU-KVS) – controls and monitors position of kVS arm.

 kV collimator subnode (kV-COLL) – controls and monitors kV source blade, hardening and
shaping filters.

i) Collimator (COLL) – controls and monitors collimator rotation, upper and lower jaws, MLC;
monitors accessories attached to collimator.
2 2
j) Beam Generation and Monitoring (BGM):

 Electron Gun (EGN) – controls electron gun driver.

 Modulator (MOD) – interfaces with modulator and klystron, controls and monitors their
voltages and currents.

 RF source and power supply (RFSPS) – controls RF driver and power supplies to the bend
magnet, accelerator and klystron solenoids.

 Position (POS) – controls and monitors positions of the following motion axes : energy
switch, target, all carrousel axes, ion chambers/ light bulbs.

 Pulse-width modulator (PWM) – controls the coils that steer the beam.

3. TrueBeam networks:

 All control system nodes are connected through Real-time Ethernet network for cyclical
(10ms, UDP – universal datagram network protocol used; is similar to TCP/IP but faster as it
does not require ‘hand-shake’ communication prior and/or after the message is
communicated) message exchange, status update and command flow.

 Sub-nodes are typically connected with their nodes using the controller area network
(CAN). CAN provides quick (about 1ms) peer-to-peer communication to exchange small
packets of information.

 TrueBeam workstation is connected with hospital Record and Verify system through Hospital
network (TCP/IP).

 Imaging systems components – XI, TrueBeam workstation, Reconstructor - are connected

through Imaging network (TCP/IP).

 Workstation Ethernet (TCP/IP) connects the TrueBeam workstation, in-room monitor

workstation and supervisor for non-real-time information exchange (plan data, actual axes
positions, etc.).

b) Each subsystem of control system ( with exception of XI and SPV) consists of an ETX
(Embedded Technology eXtended – highly integrated and compact single-board computer
including CPU, memory, and common I/O like USB, audio, graphics and network), Node Carrier
PCB (printed circuit board), Mezzanine PCB and Controller PCB, see Figure 35 to Figure 36.

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 Control system Node is represented by an ETX, Compact Flash and Node Carrier board.
Nodes are located in Control Console area in Node Electronics Assembly.

 Node Carrier and Mezzanine are support boards allowing communication between ETX and
Controller. Each ETX is mounted on its own Node Carrier board; the Mezzanine boards are
mounted on Controller PCBs.

 Controller PCB represents an interface with the controlled hardware. Controller PCBs are
located on the machine, see Figure 37 to Figure 41.

 The communications are provides through High-Speed Serial Bus (HSSB) data link.
2

Figure 35: Control System Components

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2 Carrier boards’ troubleshoot LEDs 2

Node electronics assembly

Node carrier board

Compact flash

ETX

Power supply

SPV

Network
switch
(UDP)

Figure 36: Node Electronics Assembly – Cover (top) and Contents (bottom)

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 Controller PCB locations:

BGM – MOD
sub-node
2
Stand controller
PCB

Couch lower
controller PCB
Power distribution
PCB

BGM – RFSPS
sub-node

Figure 37: Stand – Sliding Panels with Controller PCBs

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2 2
Couch upper
controller PCB

Figure 38: Couch

PU – MVD

PU – KVD

PU – KVS

Figure 39: Gantry Front

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Mezzanine
board Collimator
BGM controller controller
PCB PCB

BGM – POS BGM – PWM

sub-node sub-node

Figure 40: Gantry Left – ‘Medicine’ Cabinet Content

BGM – EGN
sub-node

Figure 41: Gantry Top, Near Electron Gun

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4. Supervisor control sequence – control system communicates every 10ms, on the system sync
pulse. The system sync pulse is maintained by STN node.
At each system sync pulse, the Supervisor issues instructions, and each node provides status
information about its axis to Supervisor.
The supervisor determines the required position of each of the axes and the dose to be delivered,
based on the treatment plan.

a) When plan is loaded the supervisor calculates trajectory for each moving axis. It also calculates
the amount of dose to be delivered at each point in the sequence of movements (trajectory
sequence).
2 b) After calculating the trajectory for each node, it creates appropriate instructions for each node that
2
will realize the treatment.

c) When treatment begins, the Supervisor sends appropriate instructions to each motion axis and
beam delivery system every 10ms. Each instruction tells the node where its axis must be in 10ms
and in 20ms (2 pulses ahead).

d) When node receives a trajectory instruction for its axis, it carries out the orders. During the 10ms
interval between sync pulses, each node receives and evaluates position information from
sensors on its axis. If the axis position deviates from trajectory calculated by Supervisor (outside
of the specified range), the node issues a motion fault and treatment stops.

e) When Supervisor receives back information from the node, it verifies axis positions (or delivered
dose) reported in the status message, and calculates two new positions (P1 and P2) to be
reached at following two sync signals.

Figure 42: Supervisor Control Sequence

Tip: Information about expected and actual positions during the treatment is
saved into a file (*.bin), so called trajectory log file, in user accessible folder.
Due to file length concerns information in the file is saved at 20ms sampling
frequency. Information in the file can be used to assess the accuracy of plan
delivery on the TrueBeam system.

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D. Main TrueBeam Safety Features

1. TrueBeam system features numerous safety components:

a) Intercom.

b) Emergency Off Buttons - Control Console, Treatment room walls, selected machine components
inside in treatment room, see Figure 43.

Figure 43: Emergency Stop Buttons on the Machine

c) Mechanical collision detection plates on all imaging arms, see Figure 44.

d) Mechanical collision detection covers on kV and MV imaging panels and kV source,

see Figure 44.

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Collision
detection plates

2 2

Collision
detection covers

Figure 44: Collision Detection Plates and Covers on kVD and MVD Arms

e) CCDS (Capacitive Collision Detection System) on kV Source:

In addition to the mechanical collision detection a capacitive collision detection sensor (CCDS) is
located on kVS, see Figure 45. If a person comes into contact with the kV source cover or
approaches the sensor active area, a signal is
triggered to stop the motion of the arm. The
sensor active area (AKA proximity range) is a
space of 1-2cm around the kV source cover;
proximity range is variable depending on the
obstacle itself and the speed in which it is
approaching. A finger will trip collision signal at
a shorter distance than a hand. Moreover,
obstacles moving slowly will trigger collision
later (will almost make a contact) than objects
moving quickly.

The capacitive sensor measures a baseline

and slowly adjusts the baseline according to
environment. Thus the CCDS is independent of
minor environmental changes (temperature)
and enables adaptive collision detection.
Figure 45: CCDS Sensor on kVS, Green Is
CCDS interfaces with kVS collimator controller. Sensor PCB

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f) Laser Guard II (Patient Protection System):

It is a protection-protection system which uses an infrared laser sensor to detect any object that
enters its protection zone. The sensor is safe for eyes, exposure for any length of time does not
cause injury.

The laser sensor provides an infrared shield which covers the collimator face. When an object
enters this active area (AKA protection zone), the system asserts a collision interlock.

The protection zone is inclined by 3 degrees and is V-shaped. The open area in the center is
called a conformal notch – system does NOT asset an interlock when object is within the 2
conformal notch area. The purpose of the tilt and notch is to maximize patient clearance as gantry
rotates. The patient zone is the cylindrical zone, coaxial with gantry rotation axis which must
contain the patient and couch to permit uninterrupted gantry rotation; diameter of the patient zone
is around 75 cm, see Figure 46.

3° tilt 75 cm

Patient zone

Conformal notch

Figure 46: LaserGuard II

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Note: LaserGuard II is automatically disabled when an accessory is mounted

on the collimator; the only exception is upper wedge which does not disable
LaserGuard II.
LaserGuard II is also deactivated (detected collision does not stop motions)
when the vault door is open, except during a Dry Run.
LaserGuard II can be overridden by operator for remote motions during
treatment. Dry Run is highly recommended in such situations, to check the
clearance.

g) Machine Motion Model (Machine Protection System, AKA collision model):

2 2
Machine motion model is a software model of the machine. It tracks the locations of all parts of
the machine in 3D. Asserts a collision interlock if any part approaches within a predefined
distance of any other part. Non-Varian equipment (such as third-party couch top) is not included
in the collision model, Varian recommends installing and using Laser Guard II when using non-
Varian equipment.

Machine Motion Model uses two tolerance level distances – proximity warning and collision.
When the affected machine parts enter the proximity warning distances they continue moving at
lower speed, when the collision distances are reached all motions stop. Proximity warnings and
collisions are indicated on Live View in Treatment Application, see Figure 47.

Note: Machine Motion Model can be overridden by operator for remote

motions during treatment. Dry Run is highly recommended in such situations
to check the clearance.
Machine Motion Model is enabled when door to treatment room is opened.
When collision occurs it can be cleared using collision reset button on couch
or collimator, highlighted in red.

Figure 47: Live View Proximity Warning (left) and Collision (right) Overlays

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h) Zone Rules:

Are patient protection rules affecting remote motions from control console, during setup only.
There are 10 rules for mutual positions of gantry and couch which prevent the gantry from
approaching too close to the treatment couch if the couch is unusually high or low, or offset
laterally or rotated and couch from approaching too close to gantry depending on gantry position.

Note: Zone Rules can be reviewed and configured in Service. If the machine
has the LaserGuard II enabled, most of the Zone Rules are ignored by the
system.
2

i) Safety Enable Loops – allow subsystem controller boards to inhibit power, beam generation, or
motion if a subsystem is not ready. Enable loops are routed through the subsystem and local
networks. Each controller in the safety loop can open the loop and monitor the state of the loop.
Safety loops are current-type loops; power is provided by Stand controller. Current flows out of
the Stand controller; if any board has its loop switch open, the current is inhibited and a certain
machine function is disabled. There are 4 different Safety Enable Loops:

 Beam Enable Loop (BEL) – if open, problem with MV beam generation has been detected,
MV beam not available.

 Power Enable Loop (PEL) – if open, power is removed of all major system AC loads; only if
PEL is closed it is possible to switch the system to On state.

 Motion Enable Loop (MEL) – MEL depends on Motion Enable buttons – if Motion Enable
buttons are pressed, MEL is closed if other boards in MEL allow it; boards can open a MEL
switch if an error is detected that indicates it is not safe to move an external axis.

 kV Beam Enable Loop (kVBEL) – if open, problem with kV beam generation detected, kV
beam not available.

Figure 48: PEL Example

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Software Overview
Procedure
2 2
Objectives
After completing this lesson, the student will have identified TrueBeam software modules, reviewed plan
delivery options on TrueBeam system and understood mapped network I: drive structure and its purpose.

References:
P1005922-001-A – TrueBeam Instructions for Use – chapter 3, appendix A.

P1005925-001-A – TrueBeam Administrators Guide, chapters 7, 10, appendix B.

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Software Overview

A. TrueBeam Software modules

1. TrueBeam software consists of several different software modules, each covering specific area of
treatment delivery process – treatment, QA, system administration, calibrations and service.

The software runs under Microsoft Windows operating system (OS) and all user-facing applications
are accessible through Major Mode screen.

The OS on TrueBeam workstation is configured for automatic logon to Varian account and Select
Major Mode is launched automatically. A typical user has no access to functions and services
provided by operating system such as accessing files on local drives. 2

Machine power state icon

Figure 1: Select Major Mode Screen

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2. The Initialization mode is used to initialize machine axes like Collimator, Jaws, MLC, Imager arms,
etc. which are currently uninitialized, it does not allow initialization of axis which is currently initialized.
Axis initialization may be required after machine stops unexpectedly – Emergency OFF is pressed,
power outage, etc. – or when node is rebooted.

Initialization is a sequence of motions for an axis, to establish the reference frame and the clinical
position based on calibrated values. The reference is typically found by the process called
‘mechanical end stop homing’ – The system moves the axis and monitors the current of drive motors.
When the axes contact their respective mechanical end stops, the motor currents rise; at the
predefined current threshold the control node recognizes that the axes have reached their references.
2 This procedure ensures very high absolute axes positions. 2
Initialization application does not require any specific Varian rights, no need to login at start up.

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11. Tools menu:

a) Utilities – Opens System Administration with Synchronization tab only. The Synchronization tab
controls enable the operator to export selected configuration data to *.xml files and to
backup/restore configuration of selected control system nodes or workstation settings to/from
*.wox files. Requires authorization using OSP user account credentials.

b) PMI – service tool that can automatically capture and then analyze and export information such
as control system configuration, Initialization frequency, Calibration frequency, Board
temperatures, Clinical Faults and more, for PMI (periodic maintenance inspection) purposes.
Requires authorization using OSP user account credentials.
2
c) Event Viewer – troubleshooting tool that provides access to information in Event Log files and
System Log files maintained by TrueBeam system. The tool requires authorization using OSP
user account to start. See Figure 11.

Figure 11: Event Viewer

d) User Rights – Opens Platform Portal and allows users to configure/review OSP (Oncology
System Platform) system configuration settings, OSP user accounts, OSP user groups and OSP
rights.

e) Restart CMS – restarts Varian Clinac Model Service (Varian CMS). The CMS is Windows service
connecting TrueBeam workstation software with Supervisor.

f) Services – Opens Windows Services and allows starting, stopping and restarting background
services if needed.

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g) Control System Installer – Allows maintenance of software installed on control system boards.
Can be used by service personnel to get information on software installed on control system
PCB, allows backup and/or update of PCB firmware. Requires password authorization.

h) Log Off – logs the current user off their windows account. Requires password authorization.

i) Restart – reboots the TrueBeam workstation. Requires password authorization.

2 2

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B. Plan delivery options on TrueBeam

Major Mode

Plan format: Treatment Machine QA Service Developer

(in File mode)

DICOM file containing Treatment YES YES YES YES

plan

DICOM file containing NO YES YES YES

2
Verification plan

MLC Shaper plan NO NO YES YES

TrueBeam XML plan NO NO NO YES

Table 1: DICOM Plan Delivery Options

1. Only Treatment application can load plans from connected Record and Verify System, when it
operates in Record and Verify mode. In this mode patient is first selected from patient list (Queue
application) and then plan(s) scheduled for the selected patient for the day can be opened to be
delivered in QA or Treat mode. Verification plans can only be delivered in QA mode, see Figure 12.

QUEUE application

Figure 12: Treatment in Record and Verify Mode, Queue, Treat / QA buttons

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Software Overview

C. Mapped network drive – I:

1. To protect patient and software integrity, regular users cannot access the files on TrueBeam
workstation. Files produced by TrueBeam workstation software for users are automatically transferred
onto a mapped network drive. This network drive is typically mapped under letter ‘I’ on TrueBeam
workstation and it represents a folder shared out from the server ( \\myserver ) as “va_transfer”.

2. Files are replicated and synchronized by 3rd party software installed and configured on TrueBeam
workstation. The replication software support real-time as well as scheduled synchronization, which
allows the desired files to be quickly and safely replicated between TrueBeam workstation and
2 desired server. 2
3. The share \\myserver\va_transfer can be accessed from client computers on the same network to
access user data generated by TrueBeam or to upload data to be later used on the TrueBeam, e.g.
plans to be delivered in Machine QA. In ARIA environment, this share is located on ARIA Server.

4. Network locations of the replicated folders are as follows:

Important Note: Configuration of the synchronization software is as-is and

cannot be changed.

Source folder Target folder Content

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi
\Output\Backup neID>\Backup

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Treatment data (Images, Match,

\Output\DailyQA neID>\DailyQA Gating data) acquired for plans
delivered from DailyQA input folder

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi *.png files, acquired screen

\Output\PrintScreen neID>\PrintScreen captures

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Trajectory log files acquired in

\Output\TrajectoryLog neID>\TrajectoryLog Machine QA, Treatment mode

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Treatment record files and other

\Output\Treatment neID>\Treatment treatment data for plans delivered
from Treatment input folder.
Treatment record files for plans
delivered from I:drive or treatments
that could not be saved back to
database

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Machine QA plans supplied with

\Input neID>\Input the machine

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D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Machine Performance Check

\Output\MPC neID>\MPC output folder

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi
\Output\Service\SavedCo neID>\Service\SavedConfigParameter
nfigParametersXML sXML

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Advanced Reconstruction output

\Output\AR neID>\AR folder

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Default export folder for images

\Output\IPS neID>\IPS from Service mode → IPS tab 2
D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi
\Output\TRK neID>\TRK

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi
\Output\CBCT neID>\CBCT

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Session data (images, movies,

Service\XI\SessionExport neID>\XI\SessionExport related data) when session
exported from XI tab in Service
mode

D:\VMSOS\AppData\MPC \\<myserver>\va_transfer\TDS\<machi Contains Machine Performance

\Checks neID>\MPCChecks Check checks data

D:\VMSOS\AppData\TDS \\<myserver>\va_transfer\TDS\<machi Images acquired and saved in PVA

\Output\Imaging\ neID>\Imaging Calibration
Table 2: Synchronized Folders and Content

Note: Do not place any files in any of I:\TDS subfolders. This location is
designed for data files from the TrueBeam machine. Create your own folder
on I: drive (not inside of TDS) for the plans to be delivered from the I: drive.

Important Note: The contents of each TDS subfolder is periodically archived

into a zip file, typically every 30 days. After additional time, typically another
30 days, the archived data is deleted. If a data file from the machine is
needed for a longer time, move it from the I:\TDS to a different storage.

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D. Keyboard shortcuts:
1. CTRL+SHIFT+ALT+R – can be used to terminate an unresponsive application mode. This keyboard
combination closes all current mode applications and displays the Select Major Mode screen.

2 2

Figure 13: CTRL+SHIFT+ALT+R

Important Note: Always read the message and use with caution as patient
data may be lost.

2. CTRL+SHIFT+ALT+Z – opens Clinac Model Service status window. The window must be closed
by hitting the minimize button from system menu. The window can be used to identify the
problematic control system component and reveal source of the problems.

Can accept commands SPV Reports connected

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Beam Production, Steering and Shaping,
Dosimetry system

 The energy ports are located on a robotic system that drives the filters or port cover into
position on a rotating carousel to within 0.005 degrees and the carousel center to position within
0.5 mm

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Beam Production, Steering and Shaping,
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2 2

 Target Motion Axis – Based on the selected energy mode target moves to position along the
electron beam axis
 Rotation Axis – Based on selected energy mode carousel plate rotates and positions flattening
filter or electron foil into electron beam path
 Y Stage Axis – Based on selected energy mode offsets rotation axis longitudinally and position
flattening filter or electron foil along the electron beam axis and adjusts the field light mirror for
proper focus. For electron treatment modes moves the target and primary colimator out of the
electron beam.
 Ion Chamber Axis – this axis is shared with field light bulbs. Positions/retracts ionization
chambers in/from the beam respectively, retracts/positions light bulbs for light field

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Beam Production, Steering and Shaping,
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 Target Motion Axis – Based on the selected energy mode target moves to position along the
electron beam axis
 Rotation Axis – Based on selected energy mode carousel plate rotates and positions flattening
filter or electron foil into electron beam path
 Y Stage Axis – Based on selected energy mode offsets rotation axis longitudinally and position
flattening filter or electron foil along the electron beam axis and adjusts the field light mirror for
proper focus. For electron treatment modes moves the target and primary collimator out of the
electron beam.
 Ion Chamber Axis – this axis is shared with field light bulbs. Positions/retracts ionization
chambers in/from the beam respectively, retracts/positions light bulbs for light field

© Varian Medical Systems

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Beam Production, Steering and Shaping,
Dosimetry system

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Beam Production, Steering and Shaping,
Dosimetry system

2 2

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Beam Production, Steering and Shaping,
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2 2

 Combination of Tungsten and Lead shielding part is used to shield the accelerator head
 More information on leakage can be found in TrueBeam 2.0 IEC accompanying documents –
Site Tests and Type Tests

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Administration TAB 3

OSP, Users and Rights

Creation of an OSP User Account

TrueBeam System Administration

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OSP, Users and Rights

3 3

© Varian Medical Systems

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OSP, Users and Rights

© Varian Medical Systems

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OSP, Users and Rights

Columns with checkboxes can be moved by dragging the column title.

LMC on column title sorts the list in an ascending/descending order
‘Export’ can be used to export the rights to ‘VARightsExport.xml’.
‘Import’ can be used to restore user rights by importing previously exported ‘VARightsExport.xml’.

Click Privilege Description link to display “Oncology System Platform User Rights Reference
Guide”.

Note: The application software has to be re-started to apply new user rights.

© Varian Medical Systems

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OSP, Users and Rights

Stricter password policy – letters as well numbers would have to be used in a password
Only the last one applies to TrueBeam
First two would affect Eclipse and ARIA applications

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OSP, Users and Rights

3 3

OSP account/user gives a person the ability to open and use Varian application(s)
With Patient Data Security enabled, if a person is to be able to open a patient for some
department in Eclipse/ARIA ( TrueBeam applications are not affected ) application(s) a link needs
to be created between OSP account and the department. This is done by creating a human
resource for a person in Data Administration and assigning the OSP account (‘user’) to it. Such a
human resource with an OSP account assigned then can be assigned to selected department

Assignments highlighted using red arrows can be done in Data Administration only

© Varian Medical Systems

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OSP, Users and Rights

© Varian Medical Systems

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OSP, Users and Rights

3 3

User right permission assignment is sole responsibility of the site/department

© Varian Medical Systems

3 3

© Varian Medical Systems

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OSP, Users and Rights

 References
 P1010002-001-A – Oncology System Platform (OSP) Administration Reference Guide,
chapters 2, 3, 6
 P/N 100016562-06 – Data Administration Reference Guide, chapter 4
 P1011289-001-A – Oncology Systems Platform (OSP) User Rights Reference Guide,
chapter 2
 P1005925-001-A – TrueBeam Administrators Guide, chapter 10
 P1008852-001-A – Machine Performance Check Reference Guide, chapter 4

© Varian Medical Systems

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Creation of an OSP User Account

Creation of an OSP User Account

Procedure

Objectives

3 After completing this procedure the student will have performed following tasks: 3
1. Create new OSP user account.

2. Manage user rights.

References:
P1010002-001-A – Oncology System Platform (OSP) Administration Reference Guide, chapter 3.

A. Platform Portal settings for TrueBeam

1. Open Platform Portal:

a) ARIA/Eclipse WS:

 Start > All Programs > Varian Tools > Platform Portal.

b) TrueBeam WS:

 Major Mode > Tools > User Rights.

Note: New user account in ARIA environment can be created also in Data
Administration application. If user is to have access to ARIA/Eclipse
applications this would be the preferred path since Data administration
application allows assigning new user account to the staff member within the
OIS and then to departments to be able to access patient data with Patient
Data Security feature enabled.

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2. Sign in to Platform Portal. See Figure 1.

Figure 1: Platform Portal – Sign In

3. In the Platform Portal select Security > Users. See Figure 2.

Figure 2: Security > Users

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4. Click Add User to add a new user. See Figure 3.

3 3

Figure 3: Add User

5. Define User ID, User Name, and Password. Assign the user to appropriate Group, select
Language and set password and account policy by checking appropriate boxes. Click OK when
done. See Figure 4.

Figure 4: Add User Dialog

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6. Select Security > Rights. See Figure 5.

Figure 5: Security > Rights

7. Expand Groups menu and selected groups to be displayed. Click Apply when done and close
Groups menu. See Figure 6.

Figure 6: Groups

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8. If multiple groups are displayed the columns can be re-arranged. Click and drag the column title to
the desired location. See Figure 7.

3 3

Figure 7: Moving Group Columns

9. If desired, the rights can be filtered by Categories or Applications. See Figure 8.

Figure 8: Filters – Category, Applications

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10. Select/verify the desired rights for the displayed groups and click Save when done. See Figure 9.

List can be sorted by

3
clicking column title

Right name filter; empty the box

and press Enter to clear this filter

Rights list scroll bar

Figure 9: Select Rights

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TrueBeam System Administration

TrueBeam System Administration

Procedure

Objectives

3 After completing this procedure the student will have identified and reviewed administrative settings in 3
TrueBeam System Administration.

Abbreviations
Left mouse click denoted as LMC.

Right mouse click denoted as RMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 6.

P1007694-005-E – TrueBeam Customer Release Note.

A. Introduction
1. Provides access to machine configuration and machine administration settings.

2. If a site has multiple TrueBeam machines each has its own separate System Administration.

3. The screens may contain editable as well as read-only information depending on the user rights.

4. Some configuration elements are controlled by Varian and can only be changed by Varian personnel.

5. The System Administration access is controlled by the user rights listed in Table 1.

Note: If a user does not have any of the rights listed in Table 1, they still have
( mostly read-only ) access to System Administration. Controls on CBCT
Reconstructor tab of System Administration are available and allow CBCT
Reconstructor management.

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OSP right Description

Access Treatment Allows modifying user settings in the following tabs:

Admin Treatment, DICOM Stream Service, PVA

Edit External Beam Allows modifying user settings in Configuration → Installation tab with
Configuration exception of Default dose rate. Allows changing machine Scale. Allows
changing couch operating limits in Configuration → General

Edit External Beam Allows changing Machine ID and Linac Operation Status. Allows modifying
General Preferences user settings in Configuration → General (except couch limits) and
Synchronization. Allows to change Default dose rate in Configuration →
Installation

Edit External Beam Allows changing the Custom User Settings in Service Preferences tab
Service Preferences 3
Table 1: System Administration User Rights

6. Changes made in System Administration must be saved (or discarded) as you move from tab to tab.
Short explanation of the changes needs to be provided when saving the changes. This record is
saved on OSP and can be accessed using Platform Portal → Security → Security Viewer, see
Figure 1.

Figure 1: Saving Changes in System Administration (top) and Security Viewer (bottom)

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TrueBeam System Administration

B. System Administration
1. Launch the System Administration application at TrueBeam workstation - click System
Administration and log in when prompted. See Figure 2.

3 3

Figure 2: Major Mode Selection → Login

2. Wait until the application launches. The System Administration has several sections, see Figure 3.

Machine and user information

Tabs
Sub-tabs

Configuration area

Taskbar

Figure 3: System Administration

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3. Machine and user information includes:

a) Machine ID – string identifying the machine. If a plan with fields planned for machine of different
ID is opened in Treatment application, it cannot be delivered until successful Machine Override
is performed. Machine Override requires Override Machine OSP right.

b) Serial Number – numeric machine identifier, not editable.

c) Linac Operation Status – Active or Inactive. Inactive disallows opening a plan in Treatment
application (File mode as well as R&V mode). Service mode is not affected.

d) User Name – user name of the person who has logged in.

e) Force English Language – Select to force English everywhere on in the TrueBeam system.
Useful when screenshots need to be sent to Varian for troubleshooting.
3
4. Select Configuration and then Installation tab. See Figure 4.
This tab contains setting for dose rates for listed machine energies, MLC, Laser Guard II, Motion
Management Devices, Backpointer Laser and DKB Motion Continuation. List of machine
energies is given in selected BJR code; choices are BJR-11 and BJR-17. Checkboxes on the screen
indicate available treatment techniques for listed energies and are not user-configurable.

Figure 4: Configuration → Installation

a) Default dose rate – dose rate for MV imaging in Treatment mode and MV Test Images in PVA
Calibration.

b) Service Default Dose Rate – default dose rate for beams run in Service mode ( Service
Manager Console - SMC ).

c) Clinical Max Dose Rate – maximum dose rate, for each listed energy, allowed to be used on the
machine. Also applies to Service mode ( SMC ).

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Important Note: 6X energy and 600 MU/min doserate is used for mandatory
Isocenter Calibration (IsoCal). Changing the Clinical Max Dose Rate for 6X
energy to dose rate lower than 600MU / min will results in inability to perform
Isocenter Calibration ( IsoCal ).

d) Motion Management Devices – allows configuring devices for managing patient motion and
respiratory gating. Enabled devices can be selected for a treatment session when opening plan in
Treatment application, see Figure 5.

 Device Type –can be Respiratory Gating or Patient Position Monitoring or Both.

 Status – can be Enabled or Disabled.

3 3
e) Default Respiratory Gating Device – Of the installed and enabled devices, select the device
you want to appear as default when opening a plan. The operator, opening the plan, can change
the device.

f) Default Patient Position Monitoring Device – Of the installed and enabled devices, select the
device you want to appear as default when opening a plan. The operator, opening the plan, can
change the device.

Default selected

Figure 5: Selecting Motion Management Devices for Patient and Plan in Treatment

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g) MLC table displays the MLC model, operational status, number of the leaves and the ID. The
MLC ID is an alphanumeric that matches the MLC ID in the RadOnc Management system.

h) Laser Guard II table shows, if the device is installed and can be used to Enable or Disable the
Laser Guard II.

i) Allow DKB Motion Continuation of External Axes when door open – allows motions initiated
at the control console ( also called DKB – dedicated keyboard ) to continue when the treatment
door room opens.

j) Backpointer Laser Active – can be used to Enable or Disable the backpointer lasers.

Important Note: Enabling or Disabling hardware devices (such as Varian

Respiratory Gating, Laser Guard II, etc.), or otherwise changing machine
configuration, requires further actions in Service mode (and System
Administration - 3rd party ADI devices), see Figure 6.
3
Changing device configuration in System Administration modifies the copy of
configuration file of the control system node that controls the device, which
resides on the workstation. Configuration file residing on the affected control
system node has to be updated/synchronized in SMC, Network -> Conn
Status tab and further actions may be necessary (node reboot, initialization).

Figure 6: Syncing the Configuration Files - System Administration Message (top), Service Mode (bottom)

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5. Select Configuration and then General tab. See Figure 7.

This tab allows setting motion permissions, motions limits for couch and couch robotics.

a) Couch Top - identifies the installed couch top.

b) Couch robotics – identifies the pitch and roll stage (PRS) configuration. The PerfectPitch couch
2DoF pitch and roll mechanism is called Varian Robotics. It can be enabled or disabled. If
disabled, no roll and pitch are applicable on the system.

c) Couch Axis Range Settings – this section determines the allowable range of couch movement.
Set Default button resets user-made changes to default (maximum) range.

3 3

GoTo for couch linear
axes is available in QA
modes only (Plan QA,
Machine QA)

Figure 7: Configuration → General

d) Auto Goto – Treatment application includes GoTo button, which can be used to move the
machine to a specific position other than defined in plan; when pressed, the operator can define
machine positions using edit boxes enabled in Treatment application. This setting determines
how the machine can be moved to user-defined position. The options for this setting are listed in
Table 2.

Note: Setting Auto Goto to None allows the operator to use hand pendant
and the thumbwheels only, to move the machine. If this option is used, the
edit box for the axis set to None will not be displayed in Treatment application
after pressing GoTo button.

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e) Auto Setup – when a plan is opened in Treatment application, the target positions for all machine
axes are read from the plan and can be forwarded to devices, such as control console, hand
pendants and couch side panels, which can be used to move the machine to plan target values.
This setting determines what devices can be used to move the machine axes to plan target
values. The options for this setting are listed in Table 2.

Important Note: In case of Gantry Rtn, Coll Rtn and Couch Rtn axes, the
system also looks at the field tolerance table to decide where the machine
axis can be moved from (for Auto Setup). The most restrictive option from
Tolerance table and System Administration Auto Setup is then used for the
axis. See tolerance table example below:

= InRoom

= None

= Remote

Note: Auto Setup for couch linear axes is set to InRoom and cannot be
changed. The ability to apply couch shifts remotely after image guided setup
verification can be configured in Treatment tab of System Administration.

Permission level Description

Instant The operator does not have to use hand pendant, side panels or control console

Most permissive level – Axes can be moved from control console or treatment
Remote
room ( automatic or manual motions )

Axes can be moved inside the treatment room only – automatically using Auto
InRoom Motion buttons on hand pendants and /or side panels or manually using
thumbwheels on hand pendants

Least permissive level – moving axes requires using thumbwheels on the hand
None
pendants
Table 2: Auto Goto and Auto Setup Permission Levels

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6. Select Configuration and then Accessories tab. See Figure 8.

This tab displays information about Slots and jaw settings for available Electron application and SRS
cones, Wedges and other accessories. Most information in these tabs is read-only.

3 3

Figure 8: Configuration → Accessories → Wedges

a) Select Applicators sub-tab, any of the conical conical cones and verify/modify Max Field Size
for conical cones. See Figure 9.

Select a conical cone to see

Max Field Size for SRS cones

Figure 9: Configuration → Accessories → Applicators

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7. Select Configuration and then Energy Configuration tab. See Figure 10.
Energy configuration controls and settings are for use only by Varian service personnel.

Figure 10: Configuration → Energy Configuration

8. Select Configuration and then Imager Deactivation tab. See Figure 11.
This tab can be used to deactivate a malfunctioning imaging component in an effort to allow treatment
beam delivery without using the problematic component. Making changes on the screen may not be
enough; changes to cabling or other hardware changes may be required. 3

Figure 11: Configuration → Imager Deactivation

Important Note: Always contact Varian service before making changes to

the imaging system. Disabling an inoperable imaging arm may require
specific knowledge and specialized tools.

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9. Select Synchronization tab. See Figure 12.

The Synchronization tab has 3 sub-tabs which can be used for backing up, exporting and restoring
configuration files for the system.

3 3

Figure 12: Synchronization → Backup

a) Backup – can be used to back up selected machine configuration and calibration data. Select the
information to back up, define the backup path and click Backup. Selected data can be saved as
a single zip file or as a set of files of different formats. See Figure 12.

b) Restore – can be used restore selected machine configuration / calibrations from the backup.
Select the information to be restored, define the path to backup file(s), select the backup format
and click Restore. See Figure 13.

Figure 13: Synchronization → Restore

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Important Note: Restoring node configuration requires configuration file

synchronization in Service mode, see Figure 6, and may require further
actions.

c) Export – can be used to export selected information in form of an xml file. Select the information
to export, define the export path and click Export. See Figure 14.

Shows backup, restore or export status

Figure 14: Synchronization → Export

Tip: ARIA RadOnc 11.0 or higher version checkbox can be used to export
machine definition xml file for Eclipse / ARIA. The file can be imported in
ARIA RT Administration workspace to create an abstract machine for ARIA /
Eclipse.

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10. Select Service Preferences tab. See Figure 15.

a) Custom User Settings – allows setting default number of node records retrieved in Service
mode → General tab → Node Records. Also, allows setting date and time formats for the time
and date included in the filename, if node records are exported into a file. Set default button re-
sets user-made changes to default values. Configured by Service personnel.

b) Auto Start Time – can be used to specify the time and days for the TrueBeam system to
automatically transition from StandBy to On.

Tip: The machine starts only if the treatment room door is closed. The
operator can override the automatic start by leaving the treatment room door
open.
3 3

Figure 15: Service Preferences

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11. Select Tools tab. See Figure 16.

The Tools tab has 6 sub-tabs - Flash Tools, Services, General, Node Config, Compatibility
Matrix, Cones Data Synchronization – which provide troubleshooting and configuration tools
primarily used by Varian service personnel.

Figure 16: Tools Tab

3
a) Flash Tools – controls on this tab are available and used by Varian service technicians only.

b) Services – includes controls that allow starting, stopping and restarting windows services such
as Axeda Desktop Server and Varian Clinac Model Service.

 Axeda Desktop Server – allows remote access to TrueBeam system, enables remote
customer support.

 Varian Clinac Model Service – provides communication between TrueBeam workstation

software and Supervisor node.

c) General – includes controls which allow the following:

 Time Sync Server - allows setting the time synchronization server, to synchronize the time in
the TrueBeam workstation with the time in the synchronization server.

 Duplicate Access in Treatment Room – The InRoom Monitor (IRM) can be set to duplicate
workstation access. When enabled, on the startup the system launches the VNC viewer and
the IRM computer can then perform all functions as if done at the console workstation. This
allows the operator to control Service mode inside in the Treatment room. IRM computer and
TrueBeam workstation have to be rebooted for the change to take effect.

 Reboot IRM now button – reboots in-room monitor computer.

 Developer Mode, Advanced Reconstruction, Machine Performance Check – these

modes can now be enabled or disabled for the Major Mode screen. Varian HASP is required.

d) Node Configuration – enables user to see configuration file for selected control system node in
xml format.

e) Compatibility Matrix – allows viewing of hardware and firmware combinations. Matrix is

displayed by Node.

f) Cones Data Synchronization – enables Varian service personnel to synchronize TrueBeam

machine configuration with machine definition exported from ARIA.

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12. Select Treatment and then Clinical tab. See Figure 17.
Allows configuring preferences for Treatment and Imaging (PVA) applications.

3 3

Figure 17: Treatment → Clinical

a) Table 3 describes parameters configurable in General Preferences section.

General Preference Description

Yes – allow field grouping for treatment automation. Operator also must have appropriate
right to add automation for a treatment session.
Allow Automation No – do not allow field grouping for treatment automation. Service mode still allows
automation.

Yes – requires the therapist to sign off before closing a session, after a patient has been
treated. Operator also must have appropriate right to be allowed to signoff a treatment
Close Patient
session.
Signoff NO – does not require the therapist to sign off before closing a session, after a patient has
been treated.

Yes – indicates that Enhanced Dynamic Wedge (EDW) functionality has been
commissioned and enables EDW treatments.
EDW Commissioned No – disables EDW treatments in the TrueBeam System. Service mode still allows EDW
fields.

Set tolerance for photon energy override ( 0 – 3 MV ); affects machine override capability
Photon Energy when a plan is transferred from one machine to another.
Override Tolerance For example, if the plan has been written for 6X energy, and this machine offers 8X
(MV) instead, setting this tolerance to 2 or more will allow the energy to be overridden at
machine override if user also has appropriate override user rights.

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General Preference Description

Set tolerance for electron energy override ( 0 – 3 MV ); affects machine override capability
Electron Energy when a plan is transferred from one machine to another.
Override Tolerance For example, if the plan has been written for 6e energy, and this machine offers 9e
(MeV) instead, setting this tolerance to 3 will allow the energy to be overridden at machine
override if user also has appropriate override user rights.

Yes – requires operator sign-off to deactivate a treatment field. Operator also must have
Field Deactivation
appropriate right to be allowed to sign off the field deactivation.
Signoff No – operator sign-off is not required to deactivate the field.

Yes – allows the operator to create an ad hoc treatment plan in treatment application, for
Allow Unplanned a patient opened from Queue. Operator also must have appropriate right to be allowed to
Treatment perform an unplanned treatment.
No – Unplanned treatment is disabled. 3
Yes – plan integrity will be checked against plan signature in the plan, when a plan is
being opened. If the plan does not have plan signature, loading the plan has to be signed-
Second Channel
off by operator. For more information, refer to Treatment Plan Data Integrity Check
Plan Integrity Check white paper available on my.varian.com.
No – plan integrity is not checked.

Yes - allows the operator to load an unapproved plan from file mode. Operator also must
Allow Unapproved
have right allowing use of the file mode.
Plan No – does not allow loading an unapproved plan from file mode.

Allow manual Yes – allows the operators to with appropriate user rights to manually verify a custom
coded accessory, overriding the accessory interlock. Applies to electron insert frames,
verification of block trays and compensator trays.
custom accessory No – does not allow operators to override accessory interlock.

Alert MU level in Set the alert MU level for an open field. For treatment field that does not have accessories
or an MLC, a “High Dose Warning” is displayed, after preparing the beam (Prepare
case Tx filed has no button), if the field has more MU that the Alert MU level. The message needs to be signed
accessories (MU) off if the field is to be delivered.

Yes – instructs the system to validate the MLC plan when plan is loaded. Prevents invalid
plans from being loaded, based on the machine limits that may not have been respected
Perform dynamic in the plan. The validation does not restrict limitations that the Supervisor can control,
MLC shape such as max leaf speed. For example a plan which calls for faster-than-possible MLC
validation movement can be treated because the Supervisor can modulate the gantry movement
and/or dose rate during treatment.
No – the above MLC validation is not performed.

Enforce electronic Yes – enables the Integrated Conical Collimator Verification and Interlock system (ICVI). If
a site is using Barcode Conical Collimator Verification (BCCV) system, this setting has no
verification of effect.
conical collimator No – disables ICVI.

Verify Manufacturer Yes – checks if the DICOM tag “Manufacturer Name” for the plan field machine contains
‘Varian’. If not, the field is marked as invalid with error message “Manufacturer Name
Name to allow does not match” and is not treatable.
treatment No – the system allows treating a field planned for a non-Varian machine.

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General Preference Description

Yes – allows non-safety faults to be automatically acknowledged after a few second

Auto-Acknowledge display.
faults No – does not allows non-safety faults to be automatically acknowledged, all faults must
be acknowledged by qualified user.

Auto Acknowledge Number of seconds to display a non-safety fault before it is automatically acknowledged
Interval (sec) by the system.

Auto Field Yes – next field is automatically selected in QA mode after the current beam is completely
treated. This setting can be temporarily overridden in QA mode.
Sequencing in QA No – next field has to be selected manually in QA mode, when the current field is
Mode completely treated.

Enables a new item in Tools menu of the Treatment Application that opens a dialog which
3 Override Couch can be used to override internal couch tolerance and allow the user to continue treatment
3
Tolerance with heavy patient on Perfect Pitch where IPSN interlock is asserted and cannot be
cleared. ‘Override Setup Correction Threshold’ right is needed to sign off the override.
Table 3: Treatment → Clinical, General Preferences

b) Couch Correction – Remote Motion Thresholds

 Allow Remote Motion – setting determines if couch shifts calculated as a results of image-
guided patient setup verification can be applied remotely from control console, if within
defined limits and allowed by Auto Setup Level for couch parameter(s) of field tolerance
table.

 Limits – allows setting limits for remote motions if those are allowed. Shifts larger then limits
can only be applied to couch inside in the treatment room.

Important Note: If calculated shifts are smaller than Limits it may be

necessary to sign them off. The sign-off behavior for couch shifts has
changed in TrueBeam 2.0 compared to earlier versions. It is required to sign-
off the couch shifts, if they are larger than plan tolerance = tightest of plan
fields tolerance tables. ( Tolerance values are compared to difference
between image acquisition couch position and target couch position).
‘Override Setup Correction Threshold’ right is needed for sign-off.

c) Film Imaging Preferences – allows setting preferences for port films, such as energy, MU and
dose rate.

d) Setup Notes – enables the administrators to create setup notes templates. These templates then
appear on a list available to an operator when adding a setup note to a field in a patient plan.

 Setup Note Size – can be used to control number of characters for setup notes.

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13. Select Treatment and then Advanced tab. See Figure 18.
Setting on this tab are configured during machine installation, they include Auxiliary Devices (ADI)
preferences and DICOM settings.

Figure 18: Treatment → Advanced

a) ADI Preferences – ADI devices are devices that communicate with the system using the ADI
protocol, for example BCCV, PAVS or 3rd party Motion Management Devices such as Exact
Track, Calypso. This section shows list of configured ADI devices, Enable checkbox can be used
to enable / disable selected device.

Important Note: Enabling or disabling ADI device may require further steps.

b) DICOM Preferences – this section contains DICOM settings for communication with DICOM
Treatment Daemon.

 Test Connection button can be used to test if DICOM daemon is connected and responding.

 Save Pitch and Roll in Treatment Records – if roll and pitch settings are saved back to
R&V system (capable of storing roll and pitch) connected with the TrueBeam. ARIA V11 and
higher support 6DoF and saved roll and pitch are displayed in Offline Review and Treatment
Field History.

c) Clear Recovery Session – if treatment is unexpectedly interrupted and treatment application is

closed abnormally (power outage, for example), the recovery data is automatically loaded when
treatment application is re-started and allows to continue with the treatment. If it is desired not to
continue with the interrupted treatment but start new treatment, recovery data can be deleted with
this button.

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14. Select Treatment and then MU Limits tab. See Figure 19.
This tab provides a list of treatment techniques and allows the administrators to set maximum MU for
the listed techniques. Entered MU cannot exceed the system limits; see TrueBeam Administrators
Guide for default MU limits and the system limits.

Note: For TrueBeam 2.5 the system limit MU

have been increased to closer match C-Series
3 MU limits. The screenshot shows TrueBeam 3
system limits for TrueBeam 2.5 MR1.

Figure 19: Treatment → MU Limits

Tip: If a plan is loaded that calls for higher MU than is set in the MU Limit
table, the plan is invalid and cannot be treated. If possible, the Treatment
planning system used with the TrueBeam should be updated with the MU
limits so it yields treatable plans. In Eclipse TPS this can be done in RT
Administration, Radiation and Imaging Devices workspace and Technique tab
for the TrueBeam machine. See picture below:

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TrueBeam System Administration

15. Select CBCT Reconstructor tab. See Figure 20.

This tab can be used to adjust settings for the CBCT Reconstructor workstation. It provides the same
settings and options as CBCT Reconstructor tab in Service mode.

Scan list

Figure 20: CBCT Reconstructor

a) Reconstructor Service – a windows service running on CBCT Reconstructor providing

communication with CBCT Reconstructor workstation. Can be restarted with Stop / Start controls
if needed ( for example, when Reconstructor Service Status light is not green ).

b) Reconstructor Workstation – Restart and ShutDown controls can be used to restart or shut
down the CBCT Reconstructor workstation if needed (for example when Reconstructor
Workstation Status light is not green).

c) Configuration and Calibration – controls in this section can be used to Backup or Restore
CBCT Reconstructor configuration and calibration data.

Note: CBCT backup done in CBCT Reconstructor tab backs up the same
information as backup in Synchronization tab, when CBCT Configuration /
Calibration is selected. However, backup done in CBCT Reconstructor tab
can only be used to restore CBCT calibrations and configurations in CBCT
Reconstructor tab.

d) Scan list – shows available scans stored on the Reconstructor. These are not CBCT but
projections acquired for CBCT and can be used to reconstruct CBCT using different
reconstruction parameters in Advanced Reconstructor. The scans can also be deleted ( Delete )
or exported ( Export ) for use outside of TrueBeam system.

e) Information – shows uptime (running time) for the Reconstructor Service and the Reconstructor
Workstation and workstation memory usage.

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f) Settings – this section can be used to define the amount of information in log files – Logging
Level – and to set Disk Quota – space on Reconstructor workstation disk reserved for scans; as
the space taken by the scans approaches to quota, older scans will be deleted when new scans
are acquired so that the space occupied by the scans is <= set quota.

16. Select DICOM Stream Service tab. See Figure 21.

This tab contains configuration settings of DICOM Stream Service (DSS). It also includes controls
allowing troubleshooting. Varian DSS is a windows service transferring data between PVA (Imaging)
application and Varian Image Daemon.

Caution: Before making any changes to these configuration settings, Varian

recommends that you consult with an experienced Varian representative.
3 Errors in these settings can interrupt delivery of patient information.
P1005925-001-A – TrueBeam Administrators Guide, page 69.
3

Figure 21: DICOM Stream Service

a) Start / Stop buttons can be used to restart the service

b) Run Test button can be used to test connection to Image Daemon.

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TrueBeam System Administration

17. Select PVA and then Acquisition tab. See Figure 22.
Settings on the PVA tab allow you to configure imaging function of the TrueBeam system. The
Acquisition sub-tab provides settings to control imaging devices and to configure other acquisition
parameters.

Figure 22: PVA → Acquisition

a) Unused Imager Position – this setting defines behavior of an imager arm which is not being
used by a treatment plan – for instance, MV imager arm is not used during kV-only imaging
session.

 Send Target – if enabled, selected target position will be sent to unused imager arm,
operator has to move the unused imager to its target position to clear interlock; if deselected,
no target defined for unused imager arm so it can remain at current position without asserting
an interlock

 Mid – target for the unused arm is Mid position

 Retract – target for the unused arm is Retract position

 Based on Actuals – target for the unused arm is determined by its current (actual) position :
target will be either Mid or Retract, whichever is closest to actual position.

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b) MV acquisition – this setting defines maximum number of MU to acquire Before and After MV
images. Default value is 12. Actual MU used to acquire an MV image depend on the acquisition
technique used, good image quality is obtained with 1.5 – 3 MU.

c) Default Field Outline Visibility – this section can be used to instruct the system to display an
overlay of the treatment field outline on selected types of acquired images. For dynamic MLC
plans, the field outline is the CIAO (complete irradiated area outline).

d) CBCT Reconstructor – this setting, when checked, instructs the system to CBCT Reconstructor.
This checkbox has the same meaning as ‘CBCT Enabled’ in PVA Calibration Administration; they
have always the same state.

e) Continuous Acquisition – (configured by Service personnel)

 Max Movie Size – maximum size, in MB, of the MPEG video generated for continuous kV or
3 MV acquisitions. If the encoded movie exceeds the configured maximum movie size, the
3
MPEG encoding stops, no more information is recorded. Stopping the MPEG encoding does
not impact the acquisition.

 Max Number of Triggered Frames – maximum number of frames stored in case of a

continuous triggered kV acquisition. If the effective number of acquired frames exceeds the
configured number, the system discards some of the frames such that the frames stored are
evenly spaced over the entire acquisition. If some of the frames are discarded, the first and
the last of the acquired frames are always stored.

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18. Select PVA and then Workflow tab. See Figure 23.
This sub-tab contains options to automate selection of imaging and matching workspaces and to save
changes made during imaging for the following sessions.

Figure 23: PVA → Workflow

a) Automatic Workflow Management – this section can be used to activate imaging/matching

workspace or next field/image after an image has been acquired.

 Paired Acquisition – after an image has been acquired, automatically select next image of
the pair to be acquired. Affects paired acquisition only (kV-kV, MV-kV or MV-MV pair).

 Topogram Acquisition – after a topogram (scout) has been acquired, automatically opens
CBCT acquisition workspace.

 3D – 3D Match – after a CBCT has been acquired, automatically activates 3D-3D match
workspace.

 Paired Match – after an image pair has been acquired, automatically selects most suitable
matching workspace – 2D - 2D or 2D - 3D (if reference images do not exist in plan and the
reference CT is available).

 2D Match – after an image has been acquired, automatically activates 2D Match workspace.

b) General

 Use Object Related Settings – selecting this option instructs the system to store acquisition
settings as persistent parameters. Storing settings can streamline subsequent treatment
sessions. For more information refer to TrueBeam Technical Reference Guide – Volume 2:
Imaging.

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19. Select PVA and then Gating and Motion Management tab. See Figure 24.
This sub-tab can be used to adjust settings for respiratory gating and intrafraction motion
management.

3 3

Figure 24: PVA → Gating and Motion Management

a) Waveform Recording section:

 Recording Length – is the maximum recording period for respiratory gating waveforms.
Should be set to longest expected beam delivery time with respiratory gating.

 Waveform Lead / Trailer – define how many seconds a waveform is recorded before and
after beam on.

b) Image Processing Service – if enabled, images acquired in PVA are stored on the computer
with the given IP address. These images do not contain any patient information and can be
accessed and exported in Service → IPS tab. The setting also controls Auto Beam Hold (ABH).
The checkbox does not affect the status (running, stopped) of the service.

Note: This setting has no effect on CBCT. Projection acquired for CBCT or
reconstructed CBCT are not available in SMC → IPS tab.

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c) Intrafraction Motion Management – this section contains options for Intrafraction Motion
Review (IMR) and Auto Beam Hold (ABH) imaging features. When a patient has reference
markers implanted and those have been located on the reference CT for the plan, the reference
markers will be projected on top of acquired triggered kV images as circle overlays (kV imaging
during is used for a treatment field). This allows the operator to monitor the accuracy of the
treatment by observing position deviations between actual markers visible on the acquired
images and markers projected from reference CT (as green circle overlays). This technique is
called Intrafraction Motion Review, when kV acquisition is triggered by RPM.
For Auto Beam Hold, the kV acquisition trigger is specified by user (MU or Gantry or Time),
system will detect (using operator-defined options) the reference markers on the acquired kV
images and beam will be automatically paused if the detected actual markers are not inside of
circle overlays.

 Overlay Diameter – Defines the default value for the diameter of circular overlay
superimposed on triggered kV images during IMR/ABH session. The size of the circular 3
overlay can also be changed on-the-fly in PVA application.

 Image Processing – enables Auto Beam Hold.

Important Note: Both Image Processing and Image Processing Service

have to be enabled to allow ABH. Patient Position Monitoring Device in
Motion Management Devices in Configuration → Installation tab, must be
available to allow ABH during treatment session, see Figure 4 and Figure 5.
Auto Beam-Hold is available by separate license.

 Image Processing Timeout – an ABH parameter. Determines how long the system waits for
a response from image processing system before stopping the beam – lack of response
indicates that the image processing system has stopped working or is otherwise busy.

d) RPM Import – this option identifies the location for importing RPM data for respiratory gating
plans. Typically this is set during installation and subsequently not changed.

Note: RPM Converter utility is used to convert information from RPM system
- *.dat files – into DICOM files. These DICOM files then need to be imported
on the TrueBeam for respiratory gating plans.
The folder where RPM Converter saves converted DICOM files must be the
same as the RPM import folder, where the DICOM files can be imported to
gating plans from.

e) Patient Breathing Pattern – the system automatically re-learns the breathing trace, when couch
motion is detected (e.g. couch shifts applied).

Important Note: If the shift is less than 2mm, the respiratory gating system
will not relearn the patient’s breathing pattern. If this behavior is a concern,
manually initiate the respiratory gating system by pressing the Start Tracking
button on the toolbar.

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20. Select PVA and then Analysis tab. See Figure 25.
This sub-tab allows adjustments to parameters that affect matching.

3 3

Figure 25: PVA → Analysis

a) Color Blending – allows defining colors when color blending is active. The colors should be
complementary.

 Fixed Frame – define color for the fixed image.

 Moving Frame – define color for the moving image.

b) Match Settings section:

 Use 6DoF for Matching – if enabled, the matching workspace display 6 DoF – Vrt, Lng, Lat,
Rtn, Pitch and Roll. The match algorithm defaults to using 6DoF values even though system
only has 4DoF couch. This setting affects 4DoF couches only.

 Pitch / Roll Tolerance [deg] – sets the threshold for an alert that appears on the status bar.
The setting affects 4DoF couches only, when display is set to show roll/pitch (the above
setting is enabled).

 Sign-off when Couch Corrections differ from Match – displays a dialog box for an
operator to sign-off when shift values different from what the match yielded were applied – it
was necessary to limit the shift, because the match yielded shifts exceeding couch
mechanical limits or some of the axes were excluded (e.g. couch rotation deselected). If the
match calls for a shift which exceeds physical limits of the couch ( e.g. >3 deg pitch) the Limit
Shift button appears on the screen and can be clicked to apply the physical limits of the
couch. The truncated shift can then be applied to the treatment couch. Override Setup
Correction Threshold right is needed for successful sign-off.

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 Include Rtn Correction with 4DoF Couch – if selected, couch rotation is by default included
in match calculations and shifts.

c) CBCT Reconstruction section:

 Max. Number of CBCT Re-reconstructions - number of re-reconstructions, calculated in

CBCT Review workspace, kept in the memory ( and saved back to connected R&V system )
after the CBCT Review workspace has been closed.

Note: Setting the Max Number of CBCT Re-reconstructions value too high
may cause memory problems.

Select PVA and then System Features tab. See Figure 26.
This sub-tab allows selecting the oncology information system (OIS) connected to TrueBeam system
3
and can allow selecting supported features for the selected OIS.

Figure 26: PVA → System Features

d) Profiles – allows selecting the OIS.

e) Features – allows selecting the features the selected OIS supports. Feature list is not editable for
ARIA OIS. For detailed explanation of all features, refer to TrueBeam Administrators Guide.

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21. Select PVA and then Advanced tab. See Figure 27.
This tab provides debugging and troubleshooting tools for Varian service and product support
specialists. Information saved in the debug files is typically of no interest to clinical users.

3 Figure 27: PVA → Advanced 3

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Service Mode for Physicists TAB 4

Service Mode Overview

Plan Delivery and Imaging in Service Mode

Absolute Dose Calibration

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FOR TRAINING PURPOSES ONLY
Service Mode Overview

Service Mode Overview for physicists

Procedure

Objectives
After completing this procedure the students will have reviewed the following:

1. Service Mode (SMC) graphical user interface.

4 2. Settings and options available in Service Mode intended and designed for physicists (system 4
administrators).

Abbreviation
Left mouse click denoted as LMC.

Right mouse click denoted as RMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapters 4, 5, 6, 7, 8, 9, 10, 11, appendix A.

P1005924-001-A – TrueBeam Technical Reference Guide – Volume2: Imaging, chapter 4.

A. Introduction
1. Service Mode allows all the tasks required for the system maintenance and service that include:

a) monitor, record and view information handled by the control system.

b) configure, tune, calibrate and service the TrueBeam system.

c) diagnose and troubleshoot the TrueBeam system.

2. The screens may contain editable as well as read-only information depending on the user rights.
Screen content, available controls and menu options may vary depending on user rights.

3. Some configuration elements are controlled by Varian and can only be changed by Varian personnel.

4. The Service Mode (SMC) is controlled by user rights listed in Table 1. See appendix for more details.

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Service Mode Overview

OSP right Description

Service External Only allows basic tasks such as delivering the beam, plan, template plan,
Beam Basic initializing the machine axes, acknowledging interlocks, rebooting some control
system nodes.

Service External Allows additional tasks such as absolute dose calibration, overriding interlocks /
Beam Intermediate faults, some beam tuning tasks.

Service External The most permissive user right (exception: does not allow absolute dose
Beam Advanced calibration), allows mechanical axes calibrations and additional beam tuning
tasks.

Service External User right intended for personnel remotely connected to machine using Smart
Beam Remote Connect, allows less than Advanced.
Table 1: Service Mode User Rights
4
Note: If a user does not have any of the rights in Table 1, they are unable to
open and access Service Mode.

5. Table 2 shows default user rights in the OSP as assigned to groups.

Group\Right Service External Service External Service External Service External

Beam Basic Beam Intermediate Beam Advanced Beam Remote

AdvTherapist Yes Yes No No

ChargesAdmin No No No No

Nurse No No No No

Oncologist No No No No

Physicist Yes Yes Yes No

Secretary No No No No

Service Yes Yes Yes No

SysAdmin No No No No

Therapist Yes No No No
Table 2: Default User Rights in OSP

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Service Mode Overview

B. Opening Service Mode (SMC)

1. At the TrueBeam workstation, launch the SMC application. Select the Service major mode, log in
when prompted. See Figure 1.

4 4

Figure 1: Major Mode Selection → Login

2. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 2.

Figure 2: Select User Privileges for the Session

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Service Mode Overview

3. Verify the state of the system and then click Continue when done. See Figure 3.

Figure 3: Service Startup - System Status Summary

a) Node Connection Status – whether the control systems are connected. If other then
Connected, View Details button can be used to see what nodes are not connected.

b) CRC Match – the comparison of cyclic redundancy check (CRC) between configuration files
residing on the control system nodes and on the TrueBeam workstation. If other than Match,
View Details button can be used to see for what node the comparison yielded mismatch.

c) Motion Axis State – whether motion axes have been initialized. If other than Initialized, View
Details button can be clicked to see which axes are not initialized.

d) System Compatibility – if system components are compatible.

e) EventLog Faults Settings – compares the number of faults and interlocks that are configured to
be logged (in Settings → Event Log) to the number logged by default.

f) DIP Switch Settings – compares the configuration of DIP switches (DIP = Dual In-line Switch;
manual electric switch) to the actual switches states. DIP switches are used to configure
conditions for Safety Enable Loops, such as when / if neutron door has to be closed to allow MV
beam.

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Service Mode Overview

g) OSP Connection status – shows status of connection to OSP.

h) Servo Initial Settings – allows selecting servo(s) that will be enabled / disabled when the service
application opens. The checkboxes for some servos may be disabled if the logged-in user does
not have enough rights to change the status of those servos.

Note: The Service Startup – System Status Summary – dialog remains open
for 5 minutes. If Continue is not clicked within this period of time, the service
mode closes and system returns to Select Major Mode screen.

4. Service mode must not be used to treat human beings or animals. Click Continue to acknowledge
you understand and proceed to Service mode. See Figure 4.

4 4

Figure 4: Service Mode Warning

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Service Mode Overview

C. Service Mode – graphical user interface

1. Service mode includes 3 applications running concurrently on TrueBeam workstation: Service
Manager Console (SMC), XI Service Image Viewer and PVA Calibration. SMC uses the monitor
on left hand side.

2. The SMC screen consists of three main sections – Faults and Routine interlocks, Machine controls
and Tabs. It also includes Utilities bar and Taskbar. See Figure 5.

Utilities bar
Machine Controls
Faults and Routine interlocks

Tabs

Taskbar

Figure 5: SMC

3. XI Service Image Viewer and PVA Calibration use the monitor on right hand side, one of them at a
time. PVA Calibration can be made active (brought to front) by clicking PVA Calibration tab in SMC,
selecting XI tab activates XI Service Image Viewer.

4. Faults and Routine Interlocks section allows clearing, overriding and un-overriding fault interlocks
and routine interlocks. It also includes controls to see interlock details.

a) An interlock prevents the system from operating until a particular condition is resolved. The
system asserts two kinds of interlocks:

 A fault interlock – is triggered whenever the machine is not operating correctly together with
a message that identifies the issue. Fault interlock must be cleared, before the machine will
function. Interlock can be cleared when the issue has been resolved and the fault condition
does not exist. Acknowledging the interlock clears the interlock, if the interlock is not active.

 A routine interlock – is designed to be triggered when machine is not ready to operate

because a particular precondition required to perform a certain function has not been met; for
instance beam cannot be initiated while the door is open.

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b) Fault interlocks generated by the machine fall, depending on the interlock severity, into one of the
following three categories: Warning, Minor fault, Major fault.

 Warning – condition does not require immediate attention, motions, beam delivery and
power are not affected.

 Minor – may not cause the system to stop operating, motions or beam delivery may be
impacted.

 Major – fault puts the system to Standby state, beam delivery not possible, machine motion
or power may be affected.

c) Fault interlocks are organized into interlocks groups, each of which is represented by Fault
Group button, see Figure 6. Fault Group buttons are color-coded to simplify user navigation,
‘highlight the problematic area’ and indicate seriousness of the problem. Button color indicates
severity of active interlock(s) in the interlock group, text color indicates whether some interlocks
have been overridden, see Table 3. RMC on the Fault Group button opens a context menu that
can be used to acknowledge, override and un-override all interlocks in the group, see Figure 6.
4 4
Fault Group Description / Meaning
button example

Cyan button color, white text – there are no

active interlocks, no overridden interlocks

Cyan button color, black text – there are no

active interlocks, at least one overridden
RMC menu interlock

Orange button color, white text – there are

active fault warnings, no overridden faults

Orange button color, black text – there are

active fault warnings, at least one overridden
fault

Red button color, white flashing text – there

are active minor and/or major faults, no
overridden faults

Red button color, black text – there are

Fault Group buttons active minor and/or major faults, at least one
overridden fault
Table 3: Fault Group Button Background and Text Colors

Figure 6: Fault and Routine

Interlocks Window

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d) LMC a Fault Group button opens Fault Interlock Details window for that particular group. The
window provides detailed information about the interlocks of the selected group. RMC a line with
a particular interlock provides context menu that allows acknowledging, overriding or un-
overriding that particular interlock (or a selection). Buttons on the top of the window allow
additional filtering by interlock status, enable loop or control system node, see Figure 7.

Filtering by control Interlock status

system nodes filter buttons

Filtering by
enable loops
Multiple interlocks can be selected
with CTRL key and mouse 4

Figure 7: Fault Interlock Details for COMM Group Example, with RMC Menu

e) The Fault Interlock Details window provide the following information for any interlock:

Key – interlock identifier showing reporting node, interlock group, hardware or software;
ID – numerical fault identifier;
Overridable – whether the fault can be overridden;
Severity – fault interlock severity – warning, minor, major;
Time – time and date when interlock occurred;
ACT – active (yes) or inactive (no);
OVR – whether the interlock is currently overridden;
PEL, BEL, MEL, kVBEL – whether and what enable loops are affected by the fault;
Description, Eng Description – interlock description;
ACK – whether the fault has been acknowledged;
Suggestion – possible way(s) to resolve the problem;
Cause – Likely reason;
Notes – additional notes;
Debug Data 1,2 – data captured when the fault was asserted.

f) Diagnostics Log – can be used to capture system information that is then saved in several
different files on a local disk. Information can be used by service personnel to diagnose the
system.

g) Activate Label Tooltips checkbox - if enabled, a tooltip window will popup when mouse cursor is
parked over a windows control (button, edit box, etc.). Tooltip window can provide more
information on the button functionality.

h) Clear All button – lets you quickly acknowledge all faults; inactive faults are cleared, faults that
have not been resolved, remain active. Then, Interlock Details windows for fault interlocks and
routine interlocks are opened.

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i) Fault Interlocks button – opens the Fault Interlock Details window for all fault interlocks;
see Figure 8.

Figure 8: Fault Interlocks Details for All Fault Interlocks

j) Routine Interlocks button – opens Interlock Details window for routine interlocks. Button text is
flashing if there are active routine interlocks. See Figure 9.

4 Filter buttons 4

Figure 9: Interlock Details for Routine Interlocks

Important Note: Some interlocks require a signoff before they can be

overridden. Proceed with caution and override only if consulted with a
qualified service representative:

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5. Machine Controls section is separated into the following areas, see Figure 10.

Machine Status – shows machine and beam states, actual water temperature and expected
water temperature range, logged-in user. Allows selecting a machine scale for current service
session. LMC the button in upper right corner changes machine power state Standby ↔ On

Machine Parameters Selection buttons

Utilities bar

Beam – contains controls to define Machine Parameters – shows Meter Readouts or

beam parameters such as energy, displays and allows to set positions of machine mechanical
MU, dose rate, time, displays the
actual beam parameters during
Axes or displays and allows to choose Accessories. What
is displayed in this area is controlled by selection buttons
4
delivery on the top.

Figure 10: Machine Controls

a) Machine Parameters - shows Meter Readouts, Axis or Accessories. When Axis or

Accessories is selected there are additional controls to set and apply positions of the machine
axes or to choose accessories. See Figure 12 and Figure 11.

Choose the accessories

Figure 11: Machine Parameters → Accessories

Note: Couch ISO checkbox determines whether couch is moved up/down to

keep the couch top in the treatment area at isocenter, when applying
roll/pitch. The setting is only used when applying a specific user defined
‘program’ roll/pitch (even using ‘to plan’ on a hand pendant); does not apply
to manual roll/pitch from a hand pendant. See Figure 12.

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Cancel motion
request

Request motion

Figure 12: Machine Parameters → Axis

Tip: The values in Program columns represent target values for the beam
4 delivery. If the axes target values differ from actual axes positions and/or 4
selected accessories do not match currently inserted accessories, the beam
will be interlocked with routine interlock(s). Target values can be left blank (or
cleared if loaded from plan), if the beam is to be delivered at current machine
position.

 Go To button – sends a request to move the axes which have their target values defined.
Requested motions are indicated on the screen by green arrows and on the control console
as buttons in Motion Selection area highlighted in orange. Press the Motion Selection
buttons on the console for the axes to be moved. Then, press both highlighted Motion
Enable buttons and keep holding them until all selected axes reach their target positions.

Figure 13: Go To and Control Console, Gantry and Arms Selected

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Note: Instant axes, such as jaws, will move automatically after clicking GoTo
button.

ToPlan button for imaging arms is not highlighted in orange when target
position is defined and GoTo is clicked. It still is active and can be pressed to
select the arms with target position to be moved. After pressing Motion
Enable the arms with target position defined will move to target.

Gantry and couch axes cannot be moved at the same time from control
console. An attempt to do so will fail with an Alert - orange Alert button.

 Cancel button– cancels a motion request, orange Motion Selection buttons are turned off, as
well as Motion Enable buttons.

4
Note: If user is logged in with Service External Beam Advanced privilege
there are three additional controls in upper right of Machine Parameters area.
An axis can be selected from the drop down and the slider bar can be used to
move the selected axis dynamically during the beam delivery in desired
direction and at desired speed. Reset button sets the slider to 0.
Carefully watch the motions if using this option.

b) Utilities bar consists of the following buttons:

 Preview – just like Preview on the control console, puts the system into Preview mode – no
beam loaded, allows selecting / modifying beam / plan parameters.

 Prepare – just like Prepare on the control console, prepares the active beam to be delivered.
Prepare command includes request to move axes to defined Plan / Program values; it is not
necessary to press GoTo button separately to move axes.

 Default Beam – Resets all beam delivery parameters – no axis target values, no
accessories, no energy selected.

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 Utilities dropdown – Provides a menu of choices, the list of choices depends on user rights.
See an example on Figure 14.

4 4

Figure 14: Utilities

Event Log – captures system state that is saved on local disk in form of several files of
different format; can be used by experienced technician to troubleshoot the system.

Axes Information – displays extended information about positions of all mechanical axes.

Enable/Disable Motion Axes – allows the operator to disable motions for selected axes. The
affected axes cannot be moved using any motion controller (console, hand pendant, etc.).

Cycle Axes – can be used to instruct the system to move selected axis between specified
positions. The number of cycles can be defined.

Cycle MLC – can be used to instruct the system to move the MLC through its planned
positions in a set of MLC plans. MLC plans are defined in form of xml files. Number of cycles
can be defined. This option can be used to set an MLC shape for a beam using an xml file.

Dry Run – allows Dry Run for dynamic MLC plan, just like in Treatment mode.

Radiation Safe Mode – enables technician to beam on without any beam being generated.

Encoder display – provides raw counts of primary and secondary encoders.

Raw Scale Move – enables axis control without sensor feedback to allow moving an axis
with a malfunctioning sensor or when it is not initialized. The axis has to be moved from hand
pendant.

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 Alert – Opens a window that displays current alerts in the system. If the button is orange
there are some new – not reviewed yet - alerts. Alerts remain listed in the window even when
the trigger condition does not exist, until they are cleared; orange color disappears when alert
window is closed (alerts have been reviewed).

Figure 15: Alerts

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D. SMC – tabs overview

1. Tabs – provide controls that enable the operator to perform beam, imaging and mechanical axes
calibrations, mechanical axes initializations, backup, maintenance, monitoring, diagnostics and
configurations.

Note: On some tab screens it is necessary to click padlock icon next to a

button to enable the button and allow the task it controls.

2. Network – the tab has following sub-tabs:

a) Conn Status – provides controls for rebooting, power-cycling the nodes and verify SPV and XI
connection status. This tab also allows synchronizing node configuration file(s) after making
changes to machine configuration. See Figure 16.
4 4
Important Note: Rebooting / power-cycling a node may require further steps,
such as mechanical axes initialization.

b) Comm Statistics – can be used to retrieve selected node communication statistics.

c) Comp Simulation – shows component simulation status, if a particular machine components is

simulated by software.

d) HSSB – enables the operator to see states of high-speed-serial-bus (HSSB) links. The HSSB
connects node carrier boards to their respective controller boards in the machine.

e) Node Config – enables the operator to review node configuration in xml format. Provides the
same information as Tools → Node Config in System Administration.

Figure 16: Network → Conn Status

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3. Beam Tuning – contains controls that allow beam tuning, calibrations and beam performance
monitoring. Dose Cal is the sub-tab of primary physicist interest – it allows absolute dose calibration
for the available photon and electron energies. See Figure 17.

Important Note: Controls on the Dose Cal sub-tab are available if and only if
user is logged in the SMC with Service External Beam Intermediate right.

Figure 17: Beam Tuning → Dose Cal

4. MLC – enables the operator to see position data for leaves and carriages, motors currents and pulse
with (driving force) to the leaves. Allows MLC initialization, calibration and diagnostics / testing. MLC
display can be also enabled in this tab. See Figure 18.

Displayed information
selection buttons
Carriage
information display

MLC leaves
information display

Figure 18: MLC

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a) Initialization – opens Initialization and Calibration interface, see Figure 19.

4 Figure 19: MLC → Initialize and Calibrate Interface.

4
b) Diagnostics menu allows the following tests:

MLC difference test – enables the operator to test Primary vs Secondary or Expected vs
Actual position differences for the MLC. MLC records are captured between selected user
defined events. See Figure 20.
MLC PWM Test – moves the carriage to its retracted position and then moves the leaves to
sample the minimum driving force needed to move each leaf 1mm/sec.
MLC Velocity Test – moves the carriage to its retracted position, then moves the leaves at a
constant force (pulse width) and samples the speed of each MLC leaf.
Leaf Difference Test – provides same test options as MLC Difference Test; mainly for use with
template MLC plans.

Figure 20: MLC Difference Test

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5. General – allows retrieving node records with detailed motion, beam, cooling and power data. For
Varian service personnel mainly. See Figure 21.

4
Figure 21: General

6. Power – provides information about power distribution. See Figure 22.

Figure 22: Power, Gantry

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7. Cooling – provides readings regarding cooling system – water temperature, flow, pump speed and
water level. Also displays SF6 gas pressure. See Figure 23.

4
4
Figure 23: Cooling, Low Water Level, Pump Not Running Example

8. Carrousel – provides status of foils and filters, allows carousel axes manual motions, calibrations and
initializations, provides access to field light options. Provides carrousel axes Diagnostics tools,
see Figure 24.

Shows / hides initialization,

calibration and other controls
on carrousel sub-tabs

Figure 24: Carrousel → Init Axis

a) Diagnostics tools include:

Carrousel Axes Calibration Repeatability Test – axes are moved between two limit switches
as many times as set in the screen. The resolver values at the limits are checked against saved
values. The results are displayed on a graph so that results from several runs can be compared.

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Carrousel Axes Energy Position Repeatability Test – axes are being evaluated as machine
moves from one energy to another and back. The results show errors due to energy transition
and can be displayed on a graph.

Carrousel Axes Backlash Repeatability Test – the axes are driven in one direction, stopped
and reversed as many times as set in the screen. The results show the amount of play in the axis
gears that drive it.

b) Field Light sub-tab and its controls can be used to see the status of the Field Light bulbs, turn
the specific light bulb on and choose behavior of carrousel when using Field Light. See Figure 25.

Turn the light on

4
Select the bulb

Figure 25: Carrousel → Field Light

 Mimic Treatment Room Field Light – if enabled (default), the Field Light in service mode
will mimic the way it operates when treatment door is open – automatically switch to energy
mode (move the mirror away from the beam path) when beam is programmed.

Important Note: With Mimic Treatment Room Field Light disabled, it is

necessary to change the carrousel mode manually (e.g. to energy mode after
having used the field light in the treatment room). It can be done by selecting
or leaving the Field Light tab, and choosing appropriate button on the
displayed message box; see Figure 26.

Displayed when carrousel in

energy mode and Field Light
sub-tab selected
Displayed when carrousel in
light mode and leaving the
Field Light sub-tab

Figure 26: Move to Field Light Position (top) and Move to Energy Position (bottom) Messages

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9. Safety Loops – displays the state of the selected Safety Enable Loop, see Figure 27.

4 Figure 27: Safety Loops
4
10. Axis – allows calibrations of gantry, collimator, jaws and couch axes; initializations of collimator, jaws
and couch axes, shows couch and pitch and roll stage (PRS, Varian 2DoF Robotics) PCB readings.
See Figure 28.

Figure 28: Axis → Jaws

Note: (Internal) Calibration is an automated process that establishes a

relationship between position sensor readouts (which are relative) and
positions which are permanently affixed to a system structure – end-of-travel
switches, hard stops, collision sensors.
Initialization is a process of verifying an axis travel range. An axis is driven
to its home position (a verifiable reference point for the axis); results are
compared to calibration results for the home position.

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Note: System Calibration establishes position of the axis with respect to an

external reference and in physical units. For instance, system calibration of
the jaws is done using external measuring devices and field light to determine
position of the jaw with respect to collimator center in centimeters.

11. Accessories – can be used to view status and information for the accessories inserted in available
machine slots. See Figure 29.

Figure 29: Accessories

12. Input Devices – can be used to enable / disable hand pendants and to test controls on the input
devices. Bypass button enables test mode – no action results from pressing the button as signal is
prevented from reaching the SPV. See Figure 30.

Test mode

Device control
test success

Device connection status

Figure 30: Input Devices → Control Console

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13. Versions – contains information about installed components – HW, SW, PCB, firmware. Compatibility
Matrix allows viewing of compatible hardware and firmware combinations, matrix is displayed by
node. PCBs have compatibility number which defines which HW items are compatible with specific
SW release. Compatibility Matrix can also be reviewed in System Administration, Tools →
Compatibility Matrix. See Figure 31.

4 4

Figure 31: Versions

14. Settings – allows additional system configuration. Some settings can be modified by Varian service
personnel only.

Figure 32: Settings → System Status

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a) System Status provides the following options:

Enable DKB Motion of Targeted Axes when door open: if enabled, control console is allowed
to send external axes to target positions when the treatment door is open. The setting can only be
modified by Varian service personnel.
Allow DKB Motion Continuation of Targeted Axes when door open: allows axes that are
moving to keep moving when treatment door opens. This setting can be configured in System
Administration, Configuration → Installation.
Sticky collision override: if enabled, Collision Reset button remains active after pressed so that
the operator does not have to hold down the button while moving an axis through collision zone.
Repeated press of the Collision Reset button reactivates the collision safety function.
Clearance Override for Collision Model: allows the operator to use Clearance Override button
on the control console to override collision detected by machine motion model (machine
protection system) and perform low clearance motion using control console.
Clearance Override for Laser Guard: allows the operator to use Clearance Override button on
the control console to override collision detected by Laser Guard II (patient protection system)
and perform low clearance motion using control console.
Collision Model: enables or disables the machine protection system for the active service 4
session (if disabled, the model will be enabled automatically when Service mode has been
closed). Machine protection system ( a.k.a machine motion model ) is software which keeps track
of the physical locations of all machine equipment and stops motions even before actual collision
occurs, protecting the machine equipment. Non-Varian equipment, such as 3rd party couch top, is
not included in the collision model.
Couch Compensation: enables or disables couch compensation. Couch compensation makes
adjustments to couch vertical axis during longitudinal or roll and pitch motions so that the
treatment target remains at the isocenter even when couch top is deflected by the weight of the
patient. This setting can be changed by Varian service personnel only.

b) Zone Rules – can be used to view and change zone rules. The zone rules define a patient
protection zone – the minimum distance that must be maintained between the couch and the
gantry so that the patient is never in danger. See Figure 33.

Figure 33: Settings → Zone Rules

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Zone rules are additional machine safety system independent of Machine Protection System
(Machine Motion Model) and / or Patient Protection System (Laser Guard II). However, if Laser
Guard II is installed and active on the system, zone rules are disabled (except for the upper zone
rule, which is always active).

Zone rules are only checked when motions are applied using control console (remote motions)
when beam parameters are being applied (between treatment fields; automation and arcs are not
affected by zone rules). If the requested motion violates the zone rules a message pops up in the
treatment application and the necessary motion can be done inside in the treatment room or the
zone rules can be overridden, by pressing and holding Motion Enable and Clearance Override
buttons on the console, to continue moving the machine to target positions from outside of
treatment room.

Example Name Description

1) Gantry Restricted When couch is above the preset value (+16 cm,
(red) By Couch Vertical IEC61217), the gantry cannot enter or move within (if it
4 High (blue) is already inside) the user-defined gantry restricted
zone. The restricted zone is defined in CCW direction.
4
The default zone start and end values can be changed
by +/- 5 deg.

2) Gantry Restricted When couch is above the preset value (+16 cm,
(red) By Couch Vertical IEC61217), the gantry cannot enter or move within (if it
Low (blue) is already inside) the user-defined gantry restricted
zone. The restricted zone is defined in CCW direction.
The default zone start and end values can be changed
by +/- 5 deg.

3) Gantry Restricted When couch is rotated more than the preset value (+15
(red) By Couch deg., IEC61217), the gantry cannot enter or move within
Rotational (blue) (if it is already inside) the user-defined gantry restricted
zone. The restricted zone is defined in CCW direction.
The default zone start and end values can be changed
by +/- 5 deg.

4) Gantry (red) When couch is rotated more than the preset value (345
Restricted By Couch deg., IEC61217), the gantry cannot enter or move within
Rotational (blue) (if it is already inside) the user-defined gantry restricted
zone. The restricted zone is defined in CCW direction.
The default zone start and end values can be changed
by +/- 5 deg.

5) Gantry Restricted When couch is laterally shifted more than the preset
(red) By Couch Lateral value (-10 cm, IEC61217), the gantry cannot enter or
(blue) move within (if it is already inside) the user-defined
gantry restricted zone. The restricted zone is defined in
CCW direction. The default zone start and end values
can be changed by +/- 5 deg.

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Example Name Description

6) Gantry Restricted When couch is laterally shifted more than the preset
(red) By Couch Lateral value (+10 cm, IEC61217), the gantry cannot enter or
(blue) move within (if it is already inside) the user-defined
gantry restricted zone. The restricted zone is defined in
CCW direction. The default zone start and end values
can be changed by +/- 5 deg.

7) Couch Vertical High When gantry is in the upper zone defined by preset
Restricted (red) By values, 90 to 270 deg. (IEC61217) CCW, the couch
Gantry (blue) cannot be moved higher than the user-defined couch
vertical value. The default couch vertical value can be
changed by +/- 2cm.

8) Couch Vertical Low When gantry is in the lower zone defined by preset
Restricted (red) By values, 270 to 90 deg. (IEC61217) CCW, the couch
Gantry (blue) cannot be moved lower than the user-defined couch
vertical value. The default couch vertical value can be
changed by +/- 5cm. 4

9) Gantry Restricted When couch is rotated more than the preset value (+15
(red) By Couch Rotation deg., IEC61217) and couch longitudinal is greater than
and Couch Longitudinal the preset value (+95cm, IEC61217), the gantry cannot
(blue) enter or move within (if it is already inside) the user-
defined gantry restricted zone. The restricted zone is
defined in CCW direction. The default zone start and
end values can be changed by +/- 5 deg.

10) Gantry Restricted When couch is rotated more than the preset value
(red) By Couch Rotation (+345 deg., IEC61217) and couch longitudinal is greater
and Couch Longitudinal than the preset value (+95cm, IEC61217), the gantry
(blue) cannot enter or move within (if it is already inside) the
user-defined gantry restricted zone. The restricted zone
is defined in CCW direction. The default zone start and
end values can be changed by +/- 5 deg.
Table 4: Zone Rules: Red Arrows Represent User Definable Restricted Zones, Blue Arrows Represent Preset
Conditions Triggering Restrictions

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c) Laser Guard II – displays zone and status information. If Mimic Clinical Behavior is active the
Laser Guard II operates as it were in treatment mode – it is active when the door is closed and in
Dry Run mode with the door open, otherwise it is inactive (Collision Reset button flashes when
intrusion detected but motions are not stopped) when the door is opened and when accessories
are mounted. If Mimic Clinical Behavior is disabled, the Laser Guard II can be manually
activated or deactivated with additional activate controls – if active, then the system operates
even when the door is opened (motions stop when intrusion is detected). See Figure 34.

Green, if no intrusion detected;

Red, if the zone intruded

4 4

Figure 34: Settings → Laser Guard II

d) General Settings – can be used to start, stop or restart the Axeda Desktop Server service. When
started, this allows the remote service engineer to see and control your Service mode.

Figure 35: Settings → General Settings

Note: Axeda Desktop Server is a remote desktop sharing application; if

running, machine desktop can be accessed remotely. The service can also
be started / stopped in System Administration. However, the Axeda Desktop
Server service is automatically stopped when Service mode is launched, to
disable remote access. If remote assistance is desired / necessary while in
Service mode, the service can be started with Start button on this tab.

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e) Audio Settings – allows setting the volume of speakers and sensitivity of microphones and
volume of the various sound inputs available on the control console. Sounds coming from
treatment room to control area can be muted for the active service session –the audio will be
automatically unmuted when Service application is closed. Reset button sets the default values
for the tab controls. See Figure 36 and Figure 37.

Show / hide this tab’s controls

Figure 36: Audio Settings → Treatment Room Audio

Show / hide this tab’s controls

Figure 37: Audio Settings → Console Audio

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f) Event Log – can be used to configure WindView and Event Log generation parameters such as
what interlocks / faults trigger an event and are recorded in Event Log. These settings can be
configured by Varian service personnel only.

15. CBCT Reconstructor – can be used to adjust settings for the CBCT Reconstructor workstation. See
Figure 38. This tab is equivalent to CBCT Reconstructor tab in System Administration.

Scan list

4 4

Figure 38: CBCT Reconstructor

a) Reconstructor Service – a windows service running on CBCT Reconstructor providing

communication with CBCT Reconstructor workstation. Can be restarted with Stop / Start controls
if needed ( for example, when Reconstructor Service Status light is not green ).

c) Configuration and Calibration – controls in this section can be used to Backup or Restore
CBCT Reconstructor configuration and calibration data.

d) Scan list – shows available scans stored on the Reconstructor. These are projections acquired
for CBCT and can be used to reconstruct CBCT using different reconstruction parameters in
Advanced Reconstructor. The scans can also be deleted ( Delete ) or exported ( Export ) for use
outside of TrueBeam system.

e) Information – shows uptime (running time) for the Reconstructor Service and the Reconstructor
Workstation and workstation memory usage.

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f) Settings – this section can be used to define the amount of information in log files – Logging
Level – and to set Disk Quota – space on the Reconstructor workstation disk reserved for scans;
as the space taken by the scans approaches to quota, older scans will be deleted when new
scans are acquired so that the space occupied by the scans is <= set quota.

16. XI – provides service and maintenance interface for the XI system.

Its Status sub-tab shows state of the XI system.

Its Acquisition sub-tab can be used to acquire kV or MV images for quick analysis, research and test
purposes. Images acquired in the XI tab are automatically stored on the TrueBeam workstation local
disk and they can be accessed through XI Service Image Viewer application, see Figure 39 and
Figure 40. The acquired images can also be exported out in various file formats, including DICOM.

The Tasks sub-tab allows performing MV, kV and generic tasks such as configuration files backup for
service purposes, configuration files review (Retrieve XI calibration images - brings selected
calibration files into gallery window for a review).
4
The Readouts sub-tab can be used to display XI node performance information such as CPU and
Memory utilization charts and others.

Format and destination folder selection

Import
Image
Export
Delete

Figure 39 : XI Service Image Viewer

Tip: CBCT cannot be acquired in XI tab. If it is desired / necessary to acquire

CBCT without using Treatment or Machine QA modes it can be done so in
PVA Calibration application which is part of the Service mode.

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Imaging mode selection

Imaging parameters

Figure 40: XI → Acquisition

4 17. PVA Calibration – there are no controls on this tab. Selecting this tab activates PVA Calibration 4
application on the Imaging monitor (right hand side). PVA Calibration allows imaging modes
calibrations and imaging related geometric calibrations ( kV collimator, IsoCal ). It allows image
acquisition, among others also CBCT. Images acquired in PVA Calibration can be saved as DICOM
files.

18. Tracking – this tab allows marker tracking with MLC. This feature requires a license and is currently
available for specific research centers only.

19. CBCT Mode Editor – this tab can be used to create new custom CBCT modes. The system comes
with several pre-installed, the default, CBCT modes. See Figure 41.

Drag the arrows with mouse to set

manually start and end point of the scan.

Figure 41: CBCT Mode Editor

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a) The default CBCT modes are used as template when creating new CBCT mode. The default
CBCT modes cannot be deleted, the only editable parameter for the default modes is Mode Type
that can be set to non-clinical if it is desired not to use the mode clinically.

Note: Mode Type of any CBCT mode can be either clinical or non-clinical.
Any non-clinical mode cannot be selected for CBCT acquisition in Treatment
mode. In addition non-clinical modes cannot be calibrated and cannot be
used for CBCT acquisition in PVA Calibration.

b) In order to create new CBCT mode, follow the following steps, see also Figure 41:

 Select a pre-existing CBCT mode (dropdown in upper left corner).

 Click Copy button below the mode selection dropdown.

 Provide a unique name for the new mode, define the Mode Type, the acquisition and
reconstruction parameters.
4
 Click Save.

c) New CBCT mode has the following user-definable / editable acquisition parameters:

Parameter Description

X-ray Voltage Beam Energy, choice of 80,100,125 and 140 kV.

X-ray Current Tube Current, beam intensity, between 10 and 600 mA.

X-ray Pulse Length Pulse Duration, integer between 10 and 100 ms.

Frame Rate Number of CBCT projections acquired per second, choice of 3,7,11,15.

Gantry Speed Gantry Speed in deg/s, between 1 and 6 in steps of 0.5.

Dose Factor Ratio between dose [mGy] and exposure [100mAs] calculated from several
(CTDIw,norm) point dose measurements carried out on a specific phantom. Used to calculate
CTDIw value displayed in Treatment mode, when CBCT is acquired using the
mode. For more information on CTDI measurement, refer to TrueBeam
Technical Reference Guide – Volume 2: Imaging.

CTDI Phantom Phantom type used to measure the Dose Factor.

Prescan Dark Field If selected, a dark field calibration will be done prior to each CBCT scan. This
may result in better image quality ( mainly because dark field is affected by
actual imager temperature ) but will add a delay of approximately 15 sec,
which is the time necessary to acquire the dark field. Affects Treatment mode
only, dark field is always acquired prior to any imaging CBCT calibration, such
as Air Norm and HU.

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Parameter Description

Trajectory For full fan modes (half fan modes require full gantry rotation) it is possible to
choose the gantry trajectory – half (200 deg.) or full (360 deg.). If trajectory is
set to half then starting gantry angle can be selected to be determined
automatically or manually - Start Angle dropdown. If Start Angle is set to
manual the visual icon showing the gantry trajectory can be used to set the
exact starting point for all CBCT for the mode. See Figure 41.

Yellow arrow is gantry trajectory, white arrow is kV Source trajectory, green

dots indicate starting points, red dots are the end points of the scan.

Manually set trajectory may be of interest, when it is necessary to move gantry

between 2 exact points to either avoid collision or dose to patient organ.
Table 5: Configurable CBCT Mode Acquisition Parameters

4 Note: If Start Angle is set to automatic, starting point is determined based 4

on the actual gantry position – the CBCT scan will start at the point closest to
actual gantry angle from which it is possible to make uninterrupted 200 deg
(half trajectory) gantry rotation. This is same as default behavior for half
trajectory CBCT scans in older TrueBeam systems.

d) Reconstruction parameters:

 Algorithm – Default or 4D Basic or 4D Advanced. 4D reconstruction algorithms are available

for 4D modes only. 4D modes are only available when acquiring CBCT with gating. New 4D
modes can be created from default 4D modes only.

 Default 3D/4D checkbox – what algorithm is automatically, by default, selected when adding
4D reconstruction in Advanced Reconstructor for the scan acquired with the 4D mode. The
reconstruction in PVA is always with default 3D algorithm.

 Filter - convolution filter applied in the filtered backprojection, sharp filters tend to increase
spatial resolution (enhanced structure edges), smooth filters reduce the noise for the cost of
losing the image details.

 Matrix Size - slice pixel matrix size – 128,256,384,512 pixels.

 Slice Thickness - distance between every two neighboring slices, in mm.

 Ring Suppression – strength of the post processing stage correcting for ring artifacts due to
variation in detector pixel response.

Note: CBCT modes that use the same bowtie filter and X-ray voltage use
same calibration data. If kV parameter remains unchanged, the new mode
will use parent calibration data.

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20. IPS – this tab provides access to images acquired in Treatment mode (PVA application). Images do
not contain any patient information and can be exported out of the TrueBeam system in DICOM or
XIM formats. Refresh button has to be clicked first, to see the list of the available images.

Click Refresh to see the list

4

Figure 42: IPS

a) Image Processing Service – windows service typically running on CBCT Reconstructor. It

processes (removes patient information) and saves images acquired in Treatment mode on the
CBCT Reconstructor; it also supports Auto Beam Hold. Start / Stop button can be used to stop
and then start the service.

b) Apply – can be used to set the amount of disk space (the Disk Space Quota) on CBCT
Reconstructor reserved for acquired and saved images.

c) Export – allows exporting the images in DICOM or XI format in the specified location. Exported
images are compressed and saved as a zip file.

d) Delete – Images can be deleted manually, if necessary.

Note: Image Processing Service checkbox in System Administration, PVA

→ Gating and Motion Management has to be enabled, in order to have
images acquired in PVA saved. The images acquired for CBCT are not
available through this tab. They are available in CBCT Reconstructor tab
instead. Reconstructed CBCT are also not available in IPS tab.

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21. External Interface – shows the status of DIP switches for kVBEL, BEL and MEL, allows their
configuration, see Figure 43.
The DIP switches determine conditions when the individual Enable Loops can be closed. For
instance, when using energies higher than 10MV, the neutron door has to be closed to enable MV
beam (to close the BEL). The DIP switches are located on the stand controller board. Mismatch
between actual DIP switch settings and expected / configured DIP switch settings are marked on the
display with exclamation points within red circles. Any switch configuration change on this screen
requires that the physical switches on the stand controller board are flipped to same positions.

4 4

Figure 43: External Interface

22. Positioning Units – displays information about positioning units (imaging arms) and kV source
collimator and their calibration status, see Figure 44. Allows calibrations and initializations;
see Figure 45.

Figure 44: Positions Units → PU Status.

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Figure 45: Positioning Unit → KVD

a) Installation calibration – measures the distance from a fixed reference position to the
mechanical end stops. This calibration needs to be performed during the original installation of 4
the PU arms and again only when a readout sensor is replaced.

b) Axes calibration – finds the offset between the mechanical end stops and the axis home
position, which is used to re-establish the arm geometry whenever the PU motion control nodes
lose power. Following axes calibration, the PU arms must be initialized.

c) Initialization – a sequence of motions for each axis to verify axis calibration data - the offset
between the fixed reference frame and the home position.

d) Teach Drive – provides an additional verification mechanism for arm motion. During calibration
the tertiary readout of the PU arm’s elbow and wrist axes is measured at a virtual index pulse ( a
defined APRO (Axis Primary Read-Out) position) when extending the arm from the retracted to
the extended position. This value is saved to arm configuration and compared against the tertiary
readout whenever the virtual index pulse is passed again during arm motion. The arm will be
interlocked if the actual readout is outside a defined tolerance band. The Teach drive calibration
does not invalidate System Calibration or ISO Calibration.

e) System Calibration – aligns the arm to the machine coordinate system; the operator moves the
imaging panel until the panel center is at the machine isocenter. This position then becomes
[0,0,0] for the imaging arm. For KVS the calibration position is 100 cm Vertical, 0cm Longitudinal.
Performed by qualified service personnel. System Calibration invalidates the IsoCal calibration.

f) ISO Calibration ( IsoCal, Isocenter calibration ) – using images and calibration phantoms it
calibrates MVD and kVD to the radiation isocenter. It calculates gantry angle dependent
correction vectors required to shift imaging panels laterally and longitudinally so that the isocenter
is projected onto panel center for any gantry position. This calibration is end-user responsibility
and can be performed in PVA Calibration.

Important Note: Image acquisition in Treatment mode is not possible without

valid IsoCal.

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23. Plans – allows delivering DICOM, MLC plans (revisions H or J) and pre-installed template plans, see
Figure 46. MLC plans are files containing static / dynamic MLC shapes in Varian Shaper format; and
can be created in Shaper. For more information refer to Shaper Instructions for Use, available on
my.varian.com. Alternatively, mlc shapes can be exported from Eclipse TPS into files compatible with
Varian Shaper.

4 4

Figure 46: Plans

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Plan Delivery and Imaging in SM

Plan Delivery and Imaging in Service

Mode
Procedure

Objectives
Lead by instructor, the students will have learned how to perform the following tasks in Service mode:

1. Deliver an open field.

4
2. Deliver a DICOM plan.

3. Deliver an MLC plan.

4. Deliver a template plan.

5. Acquire an image in XI tab.

6. Acquire an image (or CBCT scan) in PVA Calibration.

Abbreviations
Left mouse click denoted as LMC.

Right mouse click denoted as RMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapters 4, 10, 11.

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A. Overview
1. Service mode includes pre-installed plans that can be delivered. The plan parameters can be
modified before the plan is delivered. Geometry parameter (e.g. collimator angle) can also be cleared
to leave the target position for the axis undefined and deliver the plan with the actual geometry
parameter value. Plan templates are not editable / modified parameters cannot be saved.

Tip: There is an EDW (enhanced dynamic wedge) plan available among the
template plans if it is necessary to delivery an EDW on the machine without
loading an external plan.

2. Service mode does not create trajectory log files. Hence plan delivery accuracy cannot be evaluated
in Offline QA application for plans delivered in Service.

3. It is not possible to take digital images for custom plans loaded in Service mode → Plans tab.
4 4
4. Images can be acquired in the XI tab or in PVA Calibration, after having selected PVA Calibration
tab. Image acquisition in XI tab provides higher level of control and more options, allowing testing and
research, acquisition in PVA Calibration is more ‘clinical’. PVA Calibration allows CBCT acquisition,
unlike XI tab.

5. A user that has External Beam Service Basic OSP right, can perform any of the tasks described in
this procedure.

Tip: If the system is in ‘prepared’ state (Prepared button has been pressed
but the beam has not been finished), another plan cannot be loaded, beam
parameters cannot be changed. Press Preview button on the console or on
the screen to unlock the system.

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B. Delivering an open MV beam

1. Launch the Service mode. Login with appropriate OSP rights.

2. Click Accessories button in Machine Controls section, if it is desired to choose accessories for the
beam delivery. Actual accessory inserted on the machine in the selected slot then has to match the
defined accessory for the same slot, otherwise beam will be interlocked.

3. Click Axis button and define machine geometry for the beam delivery. See Figure 1.

4. In Beam section, choose the energy, type in the MU and select the dose rate. See Figure 1.

Note: Treatment time does not have to be entered. If the treatment time is
defined, the beam will be stopped when the actual beam-on time reaches the
entered value.

5. Click MLC tab and then MLC Display. Check the MLC shape in the opened BEV. If the MLC needs
to be opened click Retract button on the MLC tab. See Figure 1. 4

Define beam
parameters

Define machine
geometry parameters

Figure 1: SMC

Tip: MLC view can also be displayed in a separate floating window

(Detached MLC Display checkbox) if MLC is to be visible when other than
MLC tab is selected.

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6. When all delivery parameter have been defined, click GoTo and then Prepare button. (clicking
Prepare on the screen is equivalent to pressing Prepare on the control console). See Figure 2.

Figure 2: GoTo and Prepare Buttons

7. Axes with target positions defined and different from their actual positions will have their buttons
highlighted in orange color on the control console. Press the buttons for the axes to be moved. Then
press the Motion Enable buttons and keep holding them until all selected axes have reached their
target positions. See Figure 3.

4 4

Figure 3: Control Console, Gantry, Collimator and Arms Selected

Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time from outside of the vault (from control console).

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Important Note: Check the Alert button; if it is orange click it and inspect the
alerts. Service mode will only alert you in situation when imaging arms are
out and may be irradiated. Using Imager Selection and Retract (Mid) button
on the control console the arms not in use can be retracted (or put to Mid).

8. When all axes have reached their target positions and all interlocks have been cleared, MV Ready
button on the control console illuminates. Press and hold MV Ready button until MV Beam On
illuminates. Then, press MV Beam On button to initiate the beam. See Figure 4.

Tip: if MV Ready button does not illuminate check the interlocks. If there are
active routine interlocks, preventing the beam, the Routine Interlocks button
in Faults and Routine Interlock section is flashing.

Figure 4: MV Ready, MV Beam On

9. Beam can be stopped at any time with Beam Off button on the console. Step B.8 can be repeated to
resume the beam. If it is desired not to resume but change beam delivery parameters, press Preview
button on the control console to unlock beam controls on the screen.

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C. Delivering a DICOM plan

1. Launch the Service mode. Login with appropriate OSP rights.

2. Select the MLC tab, click MLC Display and then check Detached MLC Display to open BEV with
MLC display in a separate floating window. See Figure 5.

Figure 5: MLC → MLC Display, Detached MLC Display

3. Select Plans tab and click File Open. See Figure 6.

4 4

Figure 6: Plans

4. Browse for the DICOM plan file to be delivered. The dialog box allows selecting a file from I:\ drive;
see Figure 7.

Figure 7: Open File Dialog

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5. The SMC application does not read / use some information in DICOM files. Read the displayed
information and click Continue if the plan is to be delivered. See Figure 8.

Figure 8: DICOM RT Plan Load Warning

6. When the plan loads, the plan ID, file name and plan type are populated on the screen. Plan fields will
4
be listed in plan display section, see Figure 9.

Plan display section

Figure 9: Plan Opened

Note: If there is a problem with a field it is indicated by symbol before the

field name. Tooltip can display additional information about the problem. Click
the padlock icon and then select the Fix the invalid field(s) and allow to
load checkbox to attempt to fix the problem with a plan.
Mismatch in the MLC type cannot be fixed - MLC type in the plan has to
match the type of the MLC actually installed on the machine.

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7. Plan can be delivered using the automation, just like in Treatment mode. Press and hold down the
CRTL key and select the fields with mouse. Then click Group Fields, see Figure 10.

4 4

Figure 10: Adding Automation

8. Confirm the following Grouping Warning, see Figure 11:

Figure 11: DICOM Field Grouping Warning

9. Click Axis in Machine Controls section and review the field parameters. If necessary, beam and
geometry parameters can be modified. Geometry parameters can also be cleared if the actual
parameter value is acceptable for the plan delivery – e.g. couch values can be cleared if it is not
desired to move the couch.

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10. Click GoTo and then Prepare buttons. (clicking Prepare on the screen is equivalent to pressing
Prepare on the control console). See Figure 12.

Figure 12: GoTo and Prepare Buttons

11. Axes with target positions defined and different from their actual positions will have their buttons
highlighted in orange color on the control console. Press the buttons for the axes to be moved. Then
press the Motion Enable buttons and keep holding them until all selected axes have reached their
target positions. See Figure 13.

Figure 13: Control Console, Gantry, Collimator and Arms Selected

Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time from outside of the vault (from control console).

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Important Note: Check the Alert button; if it is orange click it and inspect the
alerts. Service mode will only alert you in situation when imaging arms are
out and may be irradiated. Use Imager Selection button to select the arm(s)
to retract, then press Retract button and finally press and hold Motion Enable
buttons until the arms have been retracted.

12. When all axes have reached their target positions and all interlocks have been cleared, MV Ready
button on the control console illuminates. Press and hold MV Ready button until MV Beam On
illuminates. Then, press MV Beam On button to initiate the beam. See Figure 14.

4 4

Figure 14: MV Ready, MV Beam On

13. MLC shape and positions of the jaws can be observed during the beam delivery on the detached BEV
window with MLC display.

14. Beam can be stopped at any time with Beam Off button on the console. Step C.12 can be repeated
to resume the beam. If it is desired not to resume but change beam delivery parameters, press
Preview button on the control console to unlock beam controls on the screen.

15. LMC the remaining field(s) and follow steps C.9 to C.14 to deliver them.

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D. Delivering an MLC plan

1. Launch the Service mode. Login with appropriate OSP rights.

2. Select the MLC tab, click MLC Display and then check Detached MLC Display to open BEV with
MLC display in a separate floating window. See Figure 15.

Figure 15: MLC → MLC Display, Detached MLC Display

3. Select Plans tab and click File Open. See Figure 16.

Figure 16: Plans

4. Browse for the MLC plan file to be delivered. The dialog box allows selecting a file from I:\ drive,
see Figure 17.

Figure 17: Open File Dialog

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Important Note: MLC plan files are plain text files. The file integrity and
content are protected by CRC at the end of the file. When loading the MLC
plan file, the SMC application calculates the CRC from contents of the
file and if it does not match the CRC value in the file, the plan will not be
loaded

5. When plan loads, file name and plan type are populated on the screen. Plan fields will be listed in
plan display section. LMC the field to be delivered, see Figure 18.

Plan display section

4 Figure 18: Plan Opened 4
6. MLC plan files do not contain beam parameters such as beam energy, MU, dose rate etc. Define the
beam parameters for the selected field. Select the energy. See Figure 19.

7. If the loaded MLC plan contains dynamic leaf motions, enter the field MU in MU (Planned) box
and click Update MU (Planned) button. That updates also MU1 box, the dose to be delivered. Then
define the remaining beam parameters. See Figure 19.

Figure 19: Defining Beam Parameters for Dynamic MLC Plan

8. If the loaded MLC plan contains static MLC field(s), define the MU in MU1 box and then select the
dose rate. MU (planned) and Update MU (Planned) controls are unavailable for MLC plan with static
MLC shapes. If an MLC plan contains multiple static MLC fields, the fields cannot be grouped /
automated as the beam parameters are not included in the file and have to be defined for each field
separately.

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Important Note: MLC plan file includes the MLC type. MLC plans made for
NDS120HD MLC cannot be delivered on a system equipped with NDS120
MLC and vice versa.

9. Click Axis in Machine Controls section and review the field parameters. Define / update the
geometry for the beam delivery.

Important Note: Pay extra attention to position of the jaws as this information
is not included in the MLC plan file. The only geometry parameter included in
the MLC plan file is collimator angle.

10. Click GoTo and then Prepare button. (clicking Prepare on the screen is equivalent to pressing
Prepare on the control console). See Figure 20.

Figure 20: GoTo and Prepare Buttons

Figure 21: Control Console, Gantry, Collimator and Arms Selected

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Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time from outside of the vault (from control console).

Important Note: Check the Alert button; if it is orange click it and inspect the
alerts. Service mode will only alert you in situation when imaging arms are
out and may be irradiated. Use Imager Selection button to select the arm(s)
to retract, then press Retract button and finally press and hold Motion Enable
buttons until the arms have been retracted.

Tip: if MV Ready button does not illuminate check the interlocks. If there are
4 active routine interlocks, preventing the beam, the Routine Interlocks button 4
in Faults and Routine Interlock section is flashing.

Figure 22: MV Ready, MV Beam On

13. MLC shape and positions of the jaws can be observed during the beam delivery on the detached BEV
window with MLC display.

14. Beam can be stopped at any time with Beam Off button on the console. Step D.12 can be repeated
to resume the beam. If it is desired not to resume but change beam delivery parameters, press
Preview button on the control console to unlock beam controls on the screen.

15. If the plan has more static mlc fields, LMC the remaining field(s) and follow steps D.8 to D.14 to
deliver them.

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E. Delivering a template plan

1. Launch the Service mode. Login with appropriate OSP rights.

2. Select the MLC tab, click MLC Display and then check Detached MLC Display to open BEV with
MLC display in a separate floating window. See Figure 23.

Figure 23: MLC tab, MLC Display, Detached MLC Display

3. Select Plans tab and click Standard Templates. See Figure 24.

Figure 24: Standard Templates, EDW Plan Selected

4. LMC a plan to be delivered. Click Axis in Machine Controls section and review the field parameters.
Define / update the geometry for the beam delivery. See Figure 25.

Figure 25: Axis, Machine Geometry

5. Click GoTo and then Prepare button (clicking Prepare on the screen is equivalent to pressing
Prepare on the control console). See Figure 25.

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6. Axes with target positions defined and different from their actual positions will have their buttons
highlighted in orange color on the control console. Press the buttons for the axes to be moved. Then
press the Motion Enable buttons and keep holding them until all selected axes have reached their
target positions. See Figure 26.

4 4

Figure 26: Control Console, Gantry, Collimator and Arms Selected

Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time from outside of the vault (from control console).

Important Note: Check the Alert button; if it is orange click it and inspect the
alerts. Service mode will only alert you in situation when imaging arms are
out and may be irradiated. Use Imager Selection button to select the arm(s)
to retract, then press Retract button and finally press and hold Motion Enable
buttons until the arms have been retracted.

7. When all axes have reached their target positions and all interlocks have been cleared, MV Ready
button on the control console illuminates. Press and hold MV Ready button until MV Beam On
illuminates. Then, press MV Beam On button to initiate the beam. See Figure 27.

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Figure 27: MV Ready, MV Beam On

8. MLC shape and positions of the jaws can be observed during the beam delivery on the detached BEV
window with MLC display.

9. Beam can be stopped at any time with Beam Off button on the console. Step E.7 can be repeated to
resume the beam. If it is desired not to resume but change beam delivery parameters, press Preview
button on the control console to unlock beam controls on the screen.

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F. Acquiring an image in XI tab

1. Launch the Service mode. Login with appropriate OSP rights.

Tip: The XI tab allows acquiring an MV image with custom shaped mlc – load
a plan (DICOM, MLC plan) in Plans tab, LMC the field with desired MLC
shape. Then select the MLC tab and click Go to Plan button on the bottom of
the screen. If the selected field contains dynamic mlc, the mlc will take shape
of the first control point. MLC display can be enabled and detached.

2. Select the XI and then Acquisition tab. Then select kV or MV tab. LMC the imaging mode to be used
to acquire an image. Selected mode name will then be displayed beside the list, on the right-hand
side. See Figure 28.

4 4
selected mode
Selected mode

Figure 28: XI, Acquisition, kV, High Quality Selected Example

Tip: The list included ‘full’ imaging modes as well as partial steps the ‘full’
modes consist of – Dark Field (DF), Flood Field (FF), Analog Offset (AO).
The ‘full’ modes are displayed using bold letters.

3. Review the imaging parameters and modify if necessary. Available imaging parameters depend on
the selected imaging mode. See examples on Figure 29, Figure 30 and Figure 31.

DF used Y / N

FF used Y / N

Pixel correction map, Y / N

Figure 29: High Quality kV Mode Parameters Example

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Figure 30: kV Fluoro Imaging Mode Parameters Example

Figure 31: MV High Resolution Imaging Mode Parameters

4. If acquiring an MV image, select the energy in Beam Parameters section. If using MV Continuous
(a.k.a. cine) or Dosimetry imaging mode, define the MU and select the dose rate. See Figure 32.

Note: In case of kV imaging the energy will be automatically set to Idle kV.

Figure 32: Beam and Machine Parameters, MV Continuous Selected

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5. Click Axis in Machine Controls section and review the field parameters. Define / update the
geometry for the beam delivery. See Figure 32.

Important Note: The default target position for the imaging arms is
automatically populated when imaging mode has been selected. Make sure
the position is appropriate and the arm(s) will not collide as moving to target
position. The default position for Dosimetry mode is [0,0,0] at which the
panel center is at isocenter, make sure the couch is fully retracted
before you move the MV panel to isocenter.

Tip: If acquiring an MV image, pay attention to positions of the jaws, make

sure only the imaging area of panel is irradiated. Select the MLC tab to check
the MLC shape or check the MLC shape on the detached MLC display
kV Collimator blades can be positioned in Positioning Unit → KVS Collimator
→ Clinical Axes tab, if it is desired to customize field size for kV imaging.

4 6. Click GoTo in Machine Controls section and then Prepare button. (clicking Prepare on the screen is 4
equivalent to pressing Prepare on the control console).

Figure 33: Control Console, Gantry, Collimator and Arms Selected

Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time from outside of the vault (from control console).

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Important Note: Check the Alert button; if it is orange click it and inspect the
alerts. Service mode will only alert you in situation when imaging arms are
out and may be irradiated. Use Imager Selection button to select the arm(s)
to retract, then press Retract button and finally press and hold Motion Enable
buttons until the arms have been retracted.

8. If acquiring an MV image, the MV Ready button on the control console illuminates once all axes have
reached their target positions and all interlocks have been cleared. Press and hold MV Ready button
until MV Beam On illuminates. Then, press MV Beam On button to initiate the beam. See Figure 34.

9. If acquiring a kV image, the kV Beam On illuminates once all axes have reached their target
positions and all interlocks have been cleared. Press and hold the kV Beam On button until the kV
beam is initiated.

Tip: If MV Ready or kV Beam On buttons do not illuminate check the

4
interlocks. If there are active routine interlocks, preventing the beam, the
Routine Interlocks button in Faults and Routine Interlock section is flashing.

MV Beam

Figure 34: Beam Controls

10. Beam can be stopped at any time with Beam Off button on the console. kV Fluoro acquisition does
not require that the operator holds kV Beam On button and must be ended with Beam Off button.

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11. Acquired image is automatically displayed in XI Service Image Viewer, in the gallery window on the
bottom of the screen. The application provides image statistical information automatically and there
are additional tools available in the toolbar. Image can be exported out of the TrueBeam system in
several different formats and in user defined location. See Figure 35.

Toolbar

Export window
Import, export, delete

Image statistics

4 4
Active image

Image gallery window

Figure 35: XI Service Image Viewer

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G. Acquiring an image in PVA Calibration

1. Launch the Service mode. Login with appropriate OSP rights.

2. Select the PVA Calibration tab. The PVA Calibration will be activated and displayed in the Imaging
Monitor on the right-hand side. See Figure 36.

4

Figure 36: PVA Calibration

3. Select the imaging modality by LMC the imaging mode to be used. Then click Details button on the
top, see Figure 37.

Figure 37: MV Modes selected, Details Button

4. Click the Test Image ( or Test Scan in case of CBCT ) hyperlink for the mode to be used for imaging.
MV modes are also listed by energies and dose rates. See Figure 38.

Acquires test images for

Low Dose and 6X energy

Figure 38: PVA Calibration, MV Details

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5. The acquisition workspace will be launched.

Follow instructions on the Status Bar (the PVA Calibration application automatically sends Prepare
and GoTo commands, there is no need to press GoTo or Prepare buttons). Check the geometry
parameters on the Dashboard and modify if necessary. See Figure 39.

4 4

Status Bar Dashboard

Figure 39: Acquisition Workspace, MV Low Dose Imaging Mode Example

Tip: Include Couch allows the operator to define couch plan position and move
couch to this position from console. Manual button allows setting the positions of
jaws (for MV) or blades (for kV). Any modifications made on the Dashboard must
be confirmed with OK button on the Status Bar:

Note: PVA application automatically opens the MLC when acquiring an MV image.

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6. Select the axes to be moved using Motion Selection buttons on the control console. Then press both
Motion Enable buttons and hold them until all axes have reached their target positions.

Note: Door to the treatment room has to be closed in order to be able to

move the machine from console. Gantry and couch axes cannot be moved at
the same time outside of the vault (from control console).

7. When all interlocks have been cleared and all axes have reached their plan (target) positions the
beam control illuminate:

a) if acquiring an MV image – press and hold MV Ready until MV Beam On illuminates. Then press
MV Beam On to initiate the MV beam.

b) if acquiring a kV image – press and hold kV Beam On button until kV beam is initiated (or kV
Beam On button gets dark).

8. Acquired image will be displayed for a review. Tools on the toolbar can be used to evaluate and
4
analyze the images. Acquired image can also be saved with in the toolbar. The application does
not provide an option to choose the destination folder; Instead, the images are saved on the local disk
and then they are mirrored by PeerSync into \\myserver\va_transfer\TDS\<machineID>\Imaging
\ExportedImages automatically. The images are saved in DICOM format. See Figure 40.

Figure 40: Acquistion Workspace, MV Dosimetry Image, Line Profile Tool

9. LMC Next button on the Status Bar to close the acquisition workspace.

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Absolute Dose Calibration

Procedure

Objectives
After completing this procedure the student will have learned how to perform absolute dose calibration for
photon and electron energy.

4 Abbreviations 4
Left mouse click denoted as LMC.

Right mouse click denoted as RMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, appendix A.

CTB-GE-228 – Dosimetry Monitoring System Calibration.

P/N IPA-HT-2X-B – TrueBeam Installation Product Acceptance, chapter 10.

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A. Overview
1. An operator has to be logged in with External Beam Service Intermediate OSP right in order to be
able to perform Absolute Dose Calibrations.

2. Each TrueBeam machine is calibrated in the factory. However, the final absolute dosimetry
calibration is ultimately responsibility of the hospital and should be performed by the
customer after completion of the acceptance testing.

Important Note: When calibrating the absolute dose, the dosimetry system
should be adjusted so that 1MU corresponds to the delivery of 1cGy of the
dose at the depth of dose maximum on the beam central axis, in water, at
100cm TSD - target to surface distance ( = Machine Calibration Point ), for a
10x10 field (for X-rays) or 15x15 field (for electrons).

3. Calibration of the imaging 2.5 MV imaging-only energy follows the same steps and Dose / MU 4
recommendation.

4. Follow the adopted dosimetry protocol regarding measurement geometry and equipment.
Measurement Point can be different from Machine Calibration Point.

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B. Absolute dose calibration of a photon energy

1. Enter the treatment room. Set up the machine and the measurement equipment for absolute
calibration measurement following the recommendations of the adopted dosimetry protocol.

2. At the TrueBeam workstation, launch the SMC application. Select the Service major mode, log in
when prompted. See Figure 1.

4 4

Figure 1: Major Mode Selection → Login

3. If you have more than one Service External Beam right, the following screen is displayed. Select
Service Intermediate and click Continue to proceed. See Figure 2.

Figure 2: Select User Privileges for the Session

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4. Verify the state of the system and then click Continue when done. See Figure 3.

Figure 3: Service Startup - System Status Summary

5. Service mode must not be used to treat human beings or animals. Click Continue to acknowledge
you understand and proceed to Service mode. See Figure 4.

Figure 4: Service Mode Warning

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6. Click the Axis and verify the machine geometry. If the field size for the calibration has not been set
yet, deselect the Asym checkbox, set the field size and click GoTo button, see Figure 5.

Figure 5: Axis

Note: The procedure assumes that the other geometry parameters had been
set before the measurement equipment in the treatment room was set up.
4 4
7. Verify the MLC position. Select the MLC tab, then click MLC Display. If MLC needs to be opened,
click Retract button on the bottom of the screen. See Figure 6.

Figure 6: MLC Tab, Retract

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8. Select the BeamTuning tab and then click Dose Cal sub-tab. See Figure 7.

Figure 7: BeamTuning → Dose Cal

Note: If the measurement device needs to be warmed up, program the SMC
for some energy, MU and dose rate and deliver the warm-up beam. Steps
B.9 to B.10 can be followed to do so.

9. In the Beam area, select the energy mode to calibrate, type in calibration MU (e.g 100), and select
the dose rate. See Figure 8.

Figure 8: Setting Beam Parameters

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10. Press Prepare on the control console or on the screen. Wait until the beam is prepared and
MV Ready button on the console illuminates. Then press MV Ready button and hold it until MV
Beam ON button illuminates.
Start the measurement device and then press MV Beam On to initiate the beam See Figure 9.

Console MU display

4 4

Figure 9: Control Console

Tip: If MV Ready button does not light up after Prepare there are some
active interlocks preventing beam. Active faults can be acknowledged with
Clear All button. Routine interlocks can be checked in routine interlocks
detail window opened with Routine Interlocks – the button flashes if there
are active routine interlocks.

11. When the beam stops, stop the dose measurement. Make sure that the programmed dose was
delivered completely. The delivered MU can be checked on the screen or on the backup MU display
on the control console (Figure 9). See Figure 10.

Primary chamber feedback

Secondary chamber measurement

Figure 10: Beam Section After Calibration Beam Has Been Delivered

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12. If the beam delivery was incomplete repeat the delivery – follow steps B.9 to B.11.

13. Repeat steps B.9 to B.11 to measure the dose several times.

14. Average the measured values and using the adopted dosimetry protocol, calculate the dose at the
Measurement Point.

Caution: Make sure all necessary corrections are applied according to

national protocol. While calibrating High Intensity modes make sure that the
ionization chamber is appropriate size and properly corrected for charge
collection efficiency.

15. Convert the measured dose value to corresponding dose value at the Machine Calibration Point, for
instance TSD = 100cm, dmax on CAX. Let us denote this dose at Machine Calibration Point as Dact.

Dact
16. If Dexp is the desired dose at the Machine Calibration Point, calculate Standard = MU1, where
Dexp 4
MU1 is the actual MU recorded by primary dosimetry channel.

17. Type the Standard value calculated in previous step in Standard box on Dose Cal tab and then click
Calibrate button. See Figure 11.

Current MU gains

Figure 11: Dose Cal, Standard and Calibrate Controls

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18. The system will use the Standard value to calculate new MU1 and MU2 gains. The updated MU
gains will be displayed in the information message. Click Yes to update the MU gains, see Figure 12.

Figure 12: New MU Gains
4 4
Important Note: The MU gains are calculated using the following formula:
Standard
MU1gainnew MU1gainold and
MU1 delivered
Standard
MU2gainnew MU2gainold ,where MU delivered is the actual MU
MU2 delivered
recorded by each dosimetry channel (MU1, MU2). As the Standard value
includes beam nominal MU, the calibration automatically synchronizes both
MU channel in case they have slightly diverged over the time.

19. By selecting Yes in the previous step, the new MU gains have been accepted and will be used for MU
calculation until Service mode is closed. Repeat steps B.9 to B.11 to verify that the new MU gains
yield desired measured dose.

20. Once it has been confirmed that the new MU gains are correct, they need to be saved in machine
configuration files. Click Save Configuration button in lower right corner of Service console. See
Figure 13.

Figure 13: Save Configuration Button

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21. Confirm the changes in the displayed dialog box by clicking Apply button. See Figure 14.

Figure 14: Updating BGM (Beam Generation Module) Configuration
4
22. After the data has been successfully saved, click OK to close the dialog box, see Figure 15.

Figure 15: Configuration Files Updated Successfully, Click OK to Close

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Absolute Dose Calibration

C. Absolute dose calibration of an electron energy

1. Enter the treatment room. Set up the machine and the measurement equipment for absolute
calibration measurement following the recommendations of the adopted dosimetry protocol. Insert the
electron applicator to be used and verify that the standard square electron cut-out is inserted in the
electron cut-out slot.

2. At the TrueBeam workstation, launch the SMC application. Select the Service major mode, log in
when prompted. See Figure 16.

4 4

Figure 16: Major Mode Selection → Login

3. If the logged-in user has more than one Service External Beam rights, it needs to be selected on the
following screen, which of the granted service rights is to be used for the session. Select Service
Intermediate and click Continue. See Figure 17.

Figure 17: Select User Privileges for the Session

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4. Verify the state of the system and then click Continue when done. See Figure 18.

Figure 18: Service Startup - System Status Summary

5. Service mode must not be used to treat human beings or animals. Click Continue to acknowledge
you understand and proceed to Service mode. See Figure 19.

Figure 19: Service Mode Warning

6. Select the BeamTuning tab and then click Dose Cal sub-tab. See Figure 20.

Figure 20: BeamTuning → Dose Cal

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7. In the Beam area, select the energy mode to calibrate, type in calibration MU (e.g 100), and select
the dose rate. See Figure 21.

Figure 21: Setting Beam Parameters

4 8. Press Prepare on the control console or on the screen, see Figure 21. 4
9. Click the Accessories; verify the electron applicator and then the e-aperture (electron cut-out).
See Figure 22.

Figure 22: Accessories

Caution: For electrons, the accessory information will be read from the machine and
displayed for operator review. If there is no electron applicator installed, 25x25
applicator will be selected and beam will be interlocked:

Jaws automatically move depending on energy selected and applicator inserted.

Do not change the field size from console

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10. Wait until the beam is prepared and MV Ready button on the console illuminates. Then press MV
Ready button and hold it until MV Beam ON button illuminates.
Start the measurement device and then press MV Beam On to initiate the beam See Figure 23.

Console MU display 4

Figure 23: Control Console

Note: If the measurement device requires a warm up, repeat steps C.7 to
C.10.

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Primary chamber feedback

Secondary chamber measurement

Figure 24: Beam Section After Calibration Beam Has Been Delivered

12. If the beam delivery was incomplete repeat the delivery – follow steps C.7 to C.11.
4 4
13. Repeat steps C.7 to C.11 to measure the dose several times.

14. Average the measured values and using the adopted dosimetry protocol, calculate the dose at the
Measurement Point.

15. Convert the measured dose value to corresponding dose value at the Machine Calibration Point, for
instance TSD = 100cm, dmax on CAX. Let us denote this dose at Machine Calibration Point as Dact.

Dact
16. If Dexp is the desired dose at the Machine Calibration Point, calculate Standard = MU1, where
Dexp
MU1 is the actual MU recorded by primary dosimetry channel.

17. Type the Standard value calculated in previous step in Standard box on Dose Cal tab and then click
Calibrate button. See Figure 25.

Current MU gains

Figure 25: Dose Cal, Standard and Calibrate Controls

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18. The system will use the Standard value to calculate new MU1 and MU2 gains. The updated MU
gains will be displayed in the information message. Click Yes to update the MU gains, see Figure 26.

Figure 26: New MU Gains
4
Important Note: The MU gains are calculated using the following formula:

Standard
MU1gainnew MU1gainold and
MU1 delivered
Standard
MU2gainnew MU2gainold ,
MU2 delivered

where MU delivered is the actual MU recorded by each dosimetry channel

(MU1, MU2). As the Standard value includes beam nominal MU, the
calibration automatically synchronizes both MU channel in case they have
slightly diverged over the time.

19. By selecting Yes in the previous step, the new MU gains have been accepted and will be used for MU
calculation until Service mode is closed. Repeat steps C.7 to C.11 to verify that the new MU gains
yield desired measured dose.

Figure 27: Save Configuration Button

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21. Confirm the changes in the displayed dialog box by clicking Apply button. See Figure 28.

4 4

Figure 28: Updating BGM (Beam Generation Module) Configuration

22. After the data has been successfully saved, click OK to close the dialog box, see Figure 29.

Figure 29: Configuration Files Updated Successfully, Click OK to Close

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Imaging and Geometry Calibrations TAB 5

Imaging & Geometry System Calibrations Overview

PVA Calibration Administration

PVA Calibration Overview

Imaging Mode Calibrations

Imaging Calibrations Exercise

Geometry Calibrations

CBCT Calibrations

Optical Camera Calibration

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 Imaging system user calibrations consist of 4 calibrations

- PU Calibrations – calibration of kV and MV imaging arms, kV tube, kV colimator system
calibration
- acquisition techniques calibrations
- Geometry calibrations - IsoCal calibration and verification, kV Collimator calibration
- Calibration of Respiratory Gating Camera
 PU calibrations are done by service personnel

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 PU calibrations are done by service personnel.

- Installation Calibration – determines the reference position (hard stop) for all rotational
axes.
- Axis Calibration – process that establishes the offset between the fixed reference position
(hard stop) and the axis home position.
- Axis Initialization – calibration verification procedure that compares baseline calibration
values (hard stop and home) against actual values.
- Teach Drive Calibration – during calibration the tertiary readout of the PU’s elbow and wrist
is measured at defined primary readout position. This value is saved and compared against
the tertiary readout whenever the axis passes the defined primary readout position.
- System Calibration – calibration of the robotic arms with respect to machine isocenter.
 IsoCal calibration has to be repeated after System Calibration
 These calibrations are carried out in Service Manager Console (SMC, Service mode)
application, PU and XI tabs, not in PVA Calibration.

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 Image calibration application is utilized

 The main view shows by default the Summary of the calibration state and calibrations are
grouped into MV, kV, CBCT and Geometry calibrations
 Calibration status is color coded
- Gray – Not calibrated – This imaging mode has not been calibrated
- Red – Expired – means at least one of the calibration step is out of date
- Green – Valid Calibration
 PVA Calibration is also en entry point to imaging related Administration
 RMC on a mode invokes context menu with additional information/options

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 ‘Select Modality’ drop-down allows to select another calibration group without need to go to
Summary View.
 All calibrations in PVA calibration application are user-guided wizard-driven, very user-friendly

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 Low Dose and High Quality are image acquisition modes synchronized with beam hold – after
prescribed dose/frame (MU) has been delivered to MV imager, beam is paused and entire
imager will be read out. This can repeat several times until desired number of frames is
acquired. Final image is then produced as an average of acquired frames to reduce the noise.
Low Dose is half resolution (512x384) and High Quality is full resolution (1024x768), Low Dose
requires less dose / frame to be delivered as 2x2 neigboring pixels form (summation) one
superpixel.
 Continuous is full resolution mode synchronized with beam pulses – information from imager
(max number of lines it can) is read out between MV beam pulses. Continuous acquisition
(a.k.a cine) results in series of images which can be saved back to Record and Verify System
as MPEG video if supported by the Record and Verify System.
 Dosimetry (a.k.a integrated) is full resulution mode, unsychronized – information from panel is
read out independently of beam pulses, all acquired frames during BEAM ON are summated to
produce final image which represents a dose captured by panel during BEAM ON

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 The imaging panel Varian 4030CB is capable of switching readout gains automatically. This is
achieved by using additional capacitor on readout line once the switch threshold has been
reached. Dynamic Gain mode increases dynamic range of the panel and allows higher
quantization resolution the CBCT can benefit from.
 The switch thresholds are determined for all pixels during dynamic gain calibration. The system
acquires many Flood Field images at increasing ms and automatically determines at what
charge level each and every pixel saturates.
 When taking a clinical image with the Dynamic Gain mode, the system starts with high gain
(purple line) using only one capacitor. When the gain switch threshold is reached an additional
capacitor will be turned on and the read-out will be finished using the low gain (red line). Lastly
high gain (high sensitivity) pixel value and low gain (low sensitivity) value are scaled by gain
ratio (~ 8:1) and summated. This results in pixel value higher than the A/D converter on the
panel allows, thus increasing pixel depth (depth resolution) of the panel (18 bit vs single gain
14bit). This image is further processed by XI where especially Flood Field correction can further
increase the pixel value. To avoid pixel value overflow due to image processing, the system
uses 20 bits to encode dynamic gain image pixel values.
 Dynamic Gain mode is used by all CBCT modes thus Dynamic Gain calibration is prerequisite
for CBCT modes calibration.

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 All imaging modes have at least 3 calibration steps:

- Dark field calibration
- Flood field calibration
- Pixel Correction map generated based on last Flood Field calibration
 The MV Dosimetry mode, requires two additional steps:
- Beam Profile Correction
- Normalization (absolute calibration in terms of Calibrated Units - CU)
 Calibration data is saved on XI node; Image processing is done by XI node – applies DF and
FF correction, pixel correction map, averages frames if needed, compresses image sequences
to MPEG (kV fluoro, MV cine)

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 Photodiodes have some leakage current (PixelOffset) – when panel is read out with no
radiation present the acquired frame is not completely empty (zero value for all pixels). This
leakage is accounted for by Dark Field frame acquired without irradiating the panel.
 Pixel value is further proportional to delivered dose until panel saturates at too high dose per
frame. Pixel sensitivity can be different for different pixels. This variation, if left uncorrected,
would result in noisier images with more fluctuating pixel values. Flood Field correction adjusts
individual pixel sensitivities and makes the image more homogeneous (flat).

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 OffsetPixeli – pixel i value on DF

 Pixel Gaini – pixel i value on FF
 Mean Pixel Gain – average of FF image pixel values.
 DF and FF calibration images are displayed for user review and they need to be either
accepted or declined before moving to next calibration step.

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 Pixel correction defects are determined by statistical analysis of the Flood-Field calibration and
during the dynamic gain calibration
 Corrects for outlier pixels (aka defects). Some pixels behave clearly different than their
neighbors. Outliers’ readouts are replaced by the average of neighboring pixels.
 PVA Calibration also offers tools in the toolbar that allow manual modification of the Correction
Map of necessary.

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 Diagonal profile must be provided in the w2cad format and these parameters
- One curve in the file
- Measured for the largest field size (40x40cm)
- Shallow depth (ideally 8mm, dmax is sufficient)
- Point separation is 2.5mm
- Distance increases in the x-axis (positive half of the profile)
 File content is black, comments are in red
 For more information about w2cad file format see Eclipse Algorithms Reference Guide.
 Alternatively beam profile correction can also be provided in form of *.dxf file (Dose Exchange
Format). *.dxf file is an ascii file containing 2D beam profile image / matrix. Portal Dosimetry
application can export images to *.dxf files.

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 The file format is recognized by its extension – w2CAD files must have cdp extension, DXF files
must have dxf extension, otherwise the application will consider the profile file invalid.

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 Dose normalization links the imager response to the desired CU value

 Normalization is performed by delivering 10x10cm field with 100MU to the imager at a 100 SID
(source-to-imager distance) imager position.
- Afterwards, the imager readout is displayed and the desired number can be entered
 The principle of Portal Dosimetry System is to compare ‘predicted dose’ images, calculated by
‘Portal Dose Image Prediction’ (PDIP) Eclipse algorithm from IMRT fields fluences, to
‘measured dose’ images captured by MV imager, operating in Dosimetry imaging mode, when
the IMRT fields are delivered onto it. Thus the imager calibration must be linked to the
prediction algorithm (PDIP) calibration in Eclipse.

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 For PVA application, the isocenter is represented by panel central pixel. There are unavoidable
circumstances ( gravity, machanical flex ) due to which treatment isocenter does not have to
project exactly on central pixel of the panel, moreover distance and direction of the isocenter
projection from panel center pixel is gantry angle dependant. Purpose of the IsoCal calibration
is to improve correlation between the panel central pixel and treatment isocenter projection and
make it less gantry angle dependant.
 IsoCal calibration uses several different MV and kV imaging modes to take images which are
used to determine the corrections, necessary to have the imager center pixel aligned with the
isocenter for any gantry position. 6X High Quality and 6X Continuous (at 600MU/min) MV
imaging modes and Dynamic Gain kV imaging mode are used to take images for IsoCal
calibration.
 Image acquisition in Treatment modes is disabled if Isocenter calibration has not been
performed on the system. Image acquisition in Service mode is unaffected by Isocenter
Calibration (IsoCal) status.

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 The Isocal phantom consists of 16 tungsten carbide BBs arranged in a special pattern with
each BB being 4 mm in diameter and all BBs embedded in a polyoxymethylene ((POM)
(Delrin)) cylinder. The manufacturing tolerances are ±0.5mm
 The BB pattern has been selected and this means:
- The BB pattern is unique for each gantry angle so an independent check of relative gantry
angles can be estimated using the phantom.
- The BB pattern covers the entire area of the imager to reduce sensitivity to manufacturing
uncertainties and to maximize sensitivity to changes in magnification of the imaging system.
- A gap in BBs occurs in the center of the imaging field of view, to avoid overlap between the
BBs and the shadow projected by the partial transmission plate.
- The BB pattern has few BBs projecting at any time at the edge of the phantom, where
changes in intensity because of phantom attenuation make BB tracking more difficult.

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 The plate is made from 3 mm aluminum and is designed to lock into the accessory interface
mount. A locking handle as well as a lock pin ensure reliable positioning of the plate and ensure
that it does not move during gantry rotation. A 6 mm diameter, 8 mm thick, stainless steel pin is
pressed into the plate to form the partial transmission structure. At 6 MV, the transmission of
the pin is 85%.

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 The IsoCal phantom does not need to be located absolutely accurately at the MV isocenter, but
there are checks that the miss-alignment is not greater than 5mm.

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 The isocenter calibration algorithm makes the following assumptions:

- There is no spatial distortion in the images caused by the imager.
- The phantom is manufactured precisely and the phantom is not moved at all during isocal
calibration.
- The focal spots are point sources. Both kV focal spots (for example, small, large) are
coincident so that only one kV isocenter exists.
- All MV focal spots (for example, 6 MV, 15 MV) are coincident so that only one MV isocenter
exists (and so the calibration process only needs to use the low -X treatment beam).
- The piercing line (that is, the line between the focal spot, center of rotation and imager) is
perpendicular to the imager.
- Rotation center is a single point.
- Inaccuracies in source and imager movements are all corrected by the physical imager
position (kV and MV).

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 DOF = degrees of freedom

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 Offset of collimator rotation axis from pin projection is calculated from 4 collimator MV images
acquired at 4 different collimator angles at the beginning of the process

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 Shift vectors are saved in the Supervisor configuration file. Press ‘Save Configuration’ button in
lower left corner of Service Console to save results permanently on Supervisor and confirm the
changes in the displayed dialog box.
 System will physically move imaging panel (apply IsoCal - calculated correction vectors) so that
isocenter is projected onto panel center at any gantry angle
 NOTE: IsoCal correction is calculated for imager at SID=150cm. The correction is the
same regardless of the vertical position of the arm. Therefore, when the arm is used for
Portal Dosimetry, where the arm is at SID=100cm, the corrections may not be completely
accurate. Suggestion: portal dosimetry images can be aligned in Portal Dosimetry
application

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 Reference : Geometric Accuracy of Imaging Systems on TrueBeam™ using an

Automated Geometric Test Tool
 Authors: Andrew Jeung, Andres Graf, Roland Suri and Peter Munro
 Ginzton Technology Center, Varian Medical Systems, Mountain View, CA, Varian Medical
Systems iLab GmbH, Baden-Dättwil, Switzerland

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 During the isocal calibration process, positions of imaging panels are not actively corrected.
After calibration the corrections are enabled. By repeating the calibration process without
moving the phantom, but with the corrections enabled, it is possible to estimate the errors in the
calibration. If existing calibration data is good, only very small displacement of the isocenter
from the panel central pixel should be calculated by the Verification process.

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 3 images taken:
- 20x14 no bowtie
- 4x4 no bowtie
- Full fan bowtie
 The edge detection algorithm is used to identify field edge and calculate distances of blades
and bowtie filter from isocenter – purple lines are SPV reported positions; blue lines are
positions detected by the edge detection algorithm on the acquired images.
 Results are displayed for review and can be Accepted or Declined.
 Use ‘Save Configuration’ button in lower left corner of Service Mode and confirm changes on
the displayed dialog box to save the calibration data permanently.

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 The predefined modes cannot be edited nor deleted, but can be hidden (not possible to use nor
calibrate) by setting their Mode Type to ‘non-clinical’
 When new mode is created, the calibration data from the source mode is copied to it.

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 The Reconstructor software is shipped with default settings for all of the user calibration steps.
Thus, CBCT scans can be acquired and reconstructed before user calibrations on-site are
completed, permitting basic system testing immediately after machine installation. It is possible
to ‘revert the calibration to factory default’ -> RMC on CBCT user calibration in Detail View ->
from displayed context menu, select ‘Revert to Factory Default’.
 There are also some internal calibration data (factory calibrations), the CBCT Reconstructor
uses to improve image quality, which cannot be done onsite:
 Spectrum correction
 Scatter correction
 It is highly recommended that kV Collimator and Isocenter calibrations are done prior to CBCT
calibrations

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 Crescent artifact example

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Imaging & Geometry System Calibrations Overview

 The reason for crescent artifact is a motion that appears as an apparent bowtie filter motion but
includes other motions such as kVS wrist, tube filament, etc.

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5 5

 Hardening and shaping filters are in place. For half trajectory modes (full fan) the data is
collected for full gantry rotation.
 All modes that use the same bowtie filter, share the crescent calibration.

 The crescent calibration measures the horizontal shift of the bowtie shape in the projections as
a function of the gantry position. A polynomial function is then fit to measured data points and
the coefficients of the polynomial are saved as calibration results. Each rotation results in a
separate polynomial describing bowtie filter motion.
 The average of CW and CCW curves is used as the correction.

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 The air norm calibration is formed by averaging a large number of projections with no patient
object or couch in the beam path.
 Air norm is an open-beam measurement representing the (un-attenuated) intensity of the
incident beam, used to calculate the attenuation for each pixel in a projection.
 Titanium filter is used to filter low energy X-Rays and the bowtie filter will prevent the detector
from saturation at the edges of body.

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5 5

 The linear mapping is given by the equation: H(p) = k . R(p) + m, where H(p) is HU value for
pixel p, R(p) is raw pixel intensity for pixel p; k and m are slope and offset coefficients of linear
scaling which are determined as the result of the HU calibration.

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 Red boxes represent reconstruction steps which use CBCT user calibration data, if calibration done on site. Air Norm
is used at Scatter correction step

 Crescent correction – corrects for geometrical instabilities of the kV source by applying subtle air norm shifts
tangential to the scan trajectory
- improves accuracy of CT numbers, slice uniformity; reduces scatter induced streaks (correction for angle
dependent normalization errors)
 Scatter correction – deconvolves the scatter contribution from acquired projections
- greatly reduces streaks due to scatter
 Normalization – signal from norm chamber is used to normalize projections relative to each other, air norm data is
used to account for non-uniformity of the kV beam
- beam flatness correction, avoidance of ring artifacts
 Beam Hardening & Spectrum Correction - analytical model to calculate the spectral effects of various materials
(beam hardening filter, bowtie filters, patient …) in the X-ray beam path
- improves slice uniformity and accuracy of CT numbers

 Filtering and Binning – noise reduction and downsampling (projection spatial resolution is higher than required for
CBCT reconstructions) to reduce noise and reconstruction time
 Convolution – transaxial filtering, part of image preparation for backprojection

 HU Mapping – scaling pixel values to HU : H(p) = k . R(p) + m, as explained on previous slide

 Ring Suppression – algorithm locates ring artifacts and replaces them with replacement information estimated to
suppress the artifact.

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5 5

 The camera system installation—including its mechanical orientation and lighting is set up by
the Varian Service, and requires no adjustment by the user.
 The purpose of the calibration is to check and re-adjust the camera using the TrueBeam
software, to ensure that the coordinate system transformation between the camera and the
fixed-room coordinate system is correct.

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5 5

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 References
 P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2 : Imaging, chapter 5
 B504596R01B – TrueBeam Technical Reference Guide – Volume 2 : Imaging, chapter 13
 P1005925-001-A – TrueBeam Administrators Guide, chapter 10, appendix D
 P1008611-003-C – Eclipse Photon and Electron Algorithms Reference Guide, chapter 12,
appendix C

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PVA Calibration Administration

PVA Calibration Administration

Procedure

Objectives
After completing this procedure the student will have reviewed the administrative settings in PVA
Calibration application.

Abbreviations
Left mouse click denoted as LMC.

5 Right mouse click denoted as RMC. 5

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 6.

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A. PVA Calibration Administration

1. At the TrueBeam workstation, launch the PVA Calibration application. Select the Imager Calibration,
log in when prompted. See Figure 1.

Figure 1: Major Mode Selection → Login

Note: In order to modify settings in PVA Calibration Administration, the user

must have at least Service External Beam Advanced user right.

2. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 2.

Figure 2: Select User Privileges for the Session

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3. Verify the state of the system and then click Continue when done. See Figure 3.

5 5

Figure 3: System Status Summary

4. Confirm the following warning by clicking Continue. See Figure 4.

Figure 4: Service Mode Warning

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5. PVA Calibration application will be displayed on the imaging monitor (right hand side). The application
will be in Summary view showing the available calibrations, see Figure 5.

Figure 5: PVA Calibration Application, Summary View, Calibration Groups

6. LMC the Administration button in the upper right corner of PVA Calibration application, see Figure 5.

7. PVA Calibration Administration settings are organized into 7 tabs displayed on the top of the
application. The Communication tab will be selected. The settings on this tab are configured by
Varian Service representative. See Figure 6.
5

Figure 6: Communication Tab

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Note: CBCT Enabled checkbox can be used to disable / enable CBCT acquisition ( in any
major mode which normally allows CBCT acquisition ) and CBCT modes calibrations on the
machine. It has same meaning as CBCT Reconstructor Enabled checkbox in System
Administration → PVA → Acquisition, see the picture below.
Enabling / disabling one of the checkboxes, enables / disables the other automatically.

8. Select Tube Warmup tab. If desired, enable the kV tube warmup by checking the Enable Tube
5 Warmup and define Duration, Min. Anode Heat Unit and kV Exposure Settings. LMC Save button
5
when done. See Figure 7.

Figure 7: Tube Warmup Tab

Note: This setting applies to PVA Calibration application only. There is no

tube warmup prompt for the Treatment mode.

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9. Select Validity Periods tab. Configure the validity periods of MV Modes, kV Modes, CBCT Modes
calibration steps and Geometric Calibrations. Confirm the changes by clicking Save. See Figure 8.

Figure 8: Validity Periods Tab, Shows Default Expiration Periods

Note: The calibration (step) expires if it has not been performed longer that
the expiration period.
Expiration does not prevent user from using the the imaging mode for
imaging, no warning is displayed in Treatment mode. Expired calibrations
(calibration steps) have their statuses displayed on red background in Status
column in PVA Calibration application.

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10. Select kV Templates tab. Review existing templates. Existing templates can be modified or deleted;
new templates can be added, if needed. (Upgrade can be used by service personnel to migrate
custom templates during an upgrade to TrueBeam v2.0). See Figure 9.

5 5

Figure 9: kV Templates

Note: kV templates can be used in the Imaging Application. The operator can
choose the Anatomy and Size to bring up kV exposure settings from the
template given by selected anatomy and size. The populated kV exposure
settings can be modified, if necessary, prior to acquiring an image. See below
the screenshot from Imaging Application:

template selection,
anatomy and size

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11. In order to create new template, LMC New Anatomy button. Then define the anatomy name, size
name, select the kV imaging mode in Image Mode column and define the exposure settings – kV,
mAs, focal spot size. See Figure 10.

If it is desired to add additional sizes for the anatomy template, LMC New Size and define the rest of
parameters for the new size. New Settings can be used to insert Triggered Image Mode Type for
the template. Parameters defined for Triggered image mode type would be used when taking
triggered image with the template. Validate hyperlink can be used to check if parameters entered for
the template are valid. If there are invalid parameters the hyperlink background turns red
and templates cannot be saved. Click Save to save the new template.
See Figure 10.

Figure 10: New kV Template

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12. Select MV Imaging Mode tab. This tab allows enabling / disabling calibrations of Continuous imaging
mode for selected energies and dose rates. It also allows selecting default energy for MV imaging
(before and after) in Treatment mode. Click Save after making desired changes, see Figure 11.

If checkbox for some energy and dose rate is cleared, that combination of energy and doserate is not
available among Continuous modes in PVA Calibration in Details view, therefore Continuous mode
for that combination of energy and dose rate cannot be calibrated. See Figure 11 and Figure 12.

5 5

Figure 11: MV Imaging Mode Tab

Figure 12: PVA Calibration, Detail View for MV Modes.

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Note: Imaging with the hidden modes in Treatment mode is still possible if
the hidden modes have been calibrated before hiding them.
Checkboxes on blue background are not editable, those modes cannot be
hidden.

13. Select Dumps tab. Settings in this tab are mainly for service personnel. This tab can be used to
configure whether images and / or configuration and / or communication data is be automatically
saved on the TrueBeam workstation. See Figure 13.

a) Save Images As – if enabled, images taken during calibrations and Test Images acquired in PVA
Calibration are automatically saved in DICOM and / or XIM formats.

b) Machine Configuration, Supervisor Status, Last Imaging Settings can also be chosen to be
saved as xml files automatically.

c) Export Directory for Movies – a folder where Test Images acquired for MV continuous modes
and kV fluoro can be exported as a movie with MPEG compression.

Figure 13: Dumps Tab

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Note: If saving of the images and configuration files is enabled in the Dumps
tab, the files will be written on TrueBeam workstation local disk only.

Note: Settings in the Dumps tab, if enabled, are for PVA Calibration only.
Imaging for patients in Treatment mode(s) is not affected by these settings.

14. Select Log Levels. Settings in this tab are for service personnel only. It allows configuring the file
format for system log files.

15. LMC Calibrate button in upper right corner to close the Administration, then LMC Close button in
lower right corner of Service Manager Console (SMC) application to get back to Major Mode
Selection screen.

5 5

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PVA Calibration Overview

PVA Calibration Overview

Procedure

Objectives
After completing this procedure, the student will have reviewed PVA Calibration application and its
graphical user interface (GUI).

Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC. 5

Left mouse button denoted as LMB.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 10.

A. Introduction
1. PVA Calibration application allows to carry out TrueBeam imaging calibrations.

2. PVA Calibration application provides to access PVA Calibration Administration.

3. PVA Calibration application allows to perform miscellaneous imaging related user calibrations /
procedures – Isocenter Calibration (IsoCal), Isocenter Verification, kV Collimator, Optical Camera.

4. Imager Calibration or Service major mode can be used to open PVA Calibration application.

a) Imager Calibration major mode is limited version of Service Mode ( Service Manager Console
application, SMC ) with most of the service tasks / settings disabled; the PVA Calibration is
automatically launched as part of the service mode and made active.

b) Service major mode is full version of Service Mode; the PVA Calibration is automatically
launched as part of the service mode, but it is necessary to select the PVA Calibration tab in
SMC to activate the application. See Figure 5.

5. PVA Calibration application user interface is displayed on the imaging ( right hand side ) monitor.

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6. User rights determine what tasks the user can perform in the PVA Calibration application. The
following table lists and explains user rights and calibrations, see Table 1.

Service External Service External Service External Service External

Task \ OSP user right
Beam Basic Beam Intermediate Beam Advanced Beam Remote

IsoCal Calibration No Yes Yes No**

IsoCal Verification Yes Yes Yes Yes

kV Collimator Calibration No No Yes No**

Test images or scans Yes Yes Yes Yes

Disable IsoCal No Yes Yes No

Optical Camera No Yes Yes Yes

Tube Warmup Yes Yes Yes Yes

MV mode Dark Field,
Flood Field Yes Yes Yes Yes

kV mode Dark Field,

Flood Field Yes Yes Yes Yes
5 5
MV mode Pixel Correction No No Yes Yes

kV mode Pixel Correction No No Yes Yes

MV mode Beam Profile No No Yes Yes

MV mode Dose
Normalization No No Yes Yes

CBCT Crescent No No Yes Yes

CBCT Air Norm No No Yes Yes

CBCT HU No No Yes Yes

Administration – set
validity periods No* No* Yes Yes

Administration – edit kV
templates No* No* Yes Yes

Administration – enable /
disable tube warmup No* No* Yes Yes

Table 1: Calibrations and User Rights

* Basic and Intermediate users have read-only access to PVA Calibration

Administration.
** The task can be performed with the right but results cannot be saved
permanently.

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B. PVA Calibration
1. At the TrueBeam workstation, launch the PVA Calibration application. Select the Imager Calibration
or Service major mode, log in when prompted. See Figure 1.

Figure 1: Major Mode Selection → Login

2. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 2.

Figure 2: Select User Privileges for the Session

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Note: Service Manager Console (SMC) application uses same ( Service

External Beam … ) rights as PVA Calibration. The selection in Figure 2 will
affect the SMC application.
The PVA Calibration will permit calibrations allowed by most permissive right
if user has more than one Service External Beam rights, regardless of
selection in Figure 2.

3. Verify the state of the system and then click Continue when done. See Figure 3.

5 5

Figure 3: System Status Summary

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4. Confirm the following warning by clicking Continue. See Figure 4.

Figure 4: Service Mode Warning

5. If Service major mode was used to launch PVA Calibration, select PVA Calibration tab in SMC in
order to see PV Calibration application, see Figure 5.

Figure 5: Service Manager Console (SMC), PVA Calibration Tab

6. PVA Calibration application will be displayed on the imaging monitor (right hand side). The application
will be in Summary view showing the available calibrations, see Figure 6.

Figure 6: PVA Calibration Application, Summary View, Calibration Groups

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7. There are 4 control buttons on the top of the PVA Calibration application – Summary, Details,
Calibrate and Administration, see Figure 7.

Control buttons

Calibration groups

Figure 7: Summary View, Geometry Calibration Group Selected

a) The Summary and Details buttons on the top of the application allow switching between two
application display modes:

 Summary – Shows all 4 calibration groups (MV modes, kV modes, CBCT modes,
Geometry), lists calibrations / imaging modes for each group and their calibration statuses,
5 see example on Figure 7. 5
 Details – Shows all calibration steps for all calibrations in selected calibration group, their
calibration statuses, allows selecting calibration steps to be carried out for the imaging mode
in selected calibration group, allows taking a test image; see Figure 12 as an example.

Note: In order to switch to Details view for a calibration group, a calibration or

imaging mode which is part of the group has to be clicked first.

b) Calibrate button can be used to initiate selected calibration / calibration step.

Note: If the application is in Summary view and the calibration status for the selected
calibration is OK (green, not expired), the following dialog box is opened and the user
can choose whether to go to Details view. No calibration would start.

c) Administration button provides access to PVA Calibration Administration.

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8. The Status column shows actual shows actual calibration date and informs about possible expiration.
Expiration time periods can be set in PVA Calibration Administration.

Note: In Summary view, the Status box shows the status of the calibration
step which has the ‘worst’ status of all calibration steps for selected
calibration / imaging mode – not calibrated or expired longest time ago or will
expire in shortest time.

a) There are 3 possible fill colors for the calibration status, see Table 2.

Color Example Description

Gray For CBCT modes only, the factory calibration is in use, calibration
has not been done on site yet

In Summary view – at least one step of selected calibration /

Gray imaging mode is not calibrated
In Details view – the step is not calibrated 5
In Summary view – all calibration steps for the selected calibration
/ imaging mode are OK
Green
In Details view – the calibration step is OK (within expiration time
period set for the step in Imaging Administration)

In Summary view – at least one step of the selected

Red calibration/imaging mode has expired
In Details view – the calibration step has expired
Table 2: Calibration Statuses

Note: Expired calibrations are allowed to be used clinically in Treatment

mode.

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9. RMC on a calibration / imaging mode in the Summary view provides the following menu,
see Figure 8.

Figure 8: RMC Context Menu in Summary View

a) Show Details for … - goes to Details view for selected calibration group.

b) Calibrate Selected Steps – equivalent to Calibrate button or double LMC; starts calibrations if
there are expired or not calibrated steps for the selected calibration.
5 5
c) Acquire Test Image – allows the user to take a test image with selected imaging mode. This
menu is available for ‘MV modes’ and ‘KV modes’ calibration groups only.

d) Show Image Mode Parameter – displays additional information about selected calibration /
imaging mode. See Figure 9.

Figure 9: Show Image Mode Parameters

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10. RMC on a calibration / imaging mode in Details view provides the following context menu,
see Figure 10.

Figure 10: RMC Context Menu in Details View

a) Show Summary – to go back to Summary view.

b) Calibrate Selected Steps – opens calibration interface and allows all necessary calibrations to
be carried out for the selected imaging mode. 5
c) Show Image Mode Parameters – shows additional information about selected calibration /
imaging mode, see Figure 9.

d) Disable Isocenter Correction – available in RMC context menu of Isocenter Calibration only,
disables IsoCal calibration.

e) Revert to Factory Default – available in RMC context menu of CBCT user calibrations only,
resets calibration to factory default, see Figure 11.

Figure 11: RMC Context Menu for CBCT Calibrations

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Note: In Details view for CBCT calibrations, only individual CBCT calibration
steps have RMC context menu.
For CBCT calibrations, it is possible to select and perform only one
calibration step for one of the CBCT modes at a time.

11. In Details view, it is possible to switch to another calibration group using the Select Modality
dropdown. See Figure 12.

Changing calibration group in

5 Details view 5

Figure 12: PVA Calibration Application, Details View for MV Modes Calibration Group

12. Calibration data may be shared by multiple imaging modes, for instance all ‘Low Dose’ modes for all
different MV energies share Dark Field and Pixel Correction data. See Figure 13.

Only one rectangle for all energies

Figure 13: Sharing Calibration Files

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13. In the Details view, multiple calibration steps can be selected ( with exception of CBCT calibrations ):

a) By clicking the imaging mode, all of its calibration step become selected, see Figure 14.

b) By clicking the column title, all steps in the column become selected, see Figure 15.

c) By holding CTRL key and left mouse clicking on individual calibration steps, see Figure 16.

d) By clicking and dragging the mouse while keeping the left mouse button pressed, see Figure 16.

LMC

Figure 14: LMC the Imaging Mode Selects All of its Calibration Steps
5

LMC

Figure 15: LMC the Dark Field Column Title Selects Dark Field Calibration Steps for All Available Imaging
Modes

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LMC

Release
LMB

CTRL +
LMC

5 Figure 16: Multiple Calibration Steps Selected Example

5
14. Calibration process can then be started from context menu - Calibrate Selected Steps - displayed
after RMC on selection or by clicking Calibrate button. See Figure 17.

15. Alternatively, double-click on the calibration / imaging mode or calibration step can be used to open
calibration wizard workspace and start calibration process of the selected calibration / imaging mode
or single calibration step.

Figure 17: Starting the Calibration Process

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16. PVA Calibration also allows taking test images or test CBCT scans for quick evaluation and analysis
after calibration. Test image/scan acquisition can be initiated:

a) By selecting Acquire Test Image from context menu displayed after RMC on imaging mode in
Summary view (not for CBCT modes), see Figure 8.

b) By clicking Test Image ( or Test Scan for CBCT imaging modes) hyperlink for the imaging mode
in Details view, see Figure 18 and Figure 19.

Figure 18: Test Image

Figure 19: Test Scan

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17. Re-Reconstruction hyperlink in Details view for CBCT calibration group, see Figure 19, allows re-
reconstructing scans available on the CBCT Reconstructor. See Figure 20.

5 5

Figure 20: CBCT Re-reconstruction

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C. PVA Calibration – calibration wizard workspace

1. Calibrations and Test Image / Test Scan acquisitions are performed in calibration wizard workspace.

2. The workspace screen is divided into 5 sections, see Figure 21.

a) Toolbar – contains tools available in calibration wizard workspace, see Table 3 for more details.

b) Workflow List – shows calibration steps and calibration progress.

c) Image view – displays acquired image(s).

d) Dashboard – displays plan and actual machine axes, allows user input when necessary.

e) Status Bar – informs the operator what to do and allows going to next calibration step once the
previous step has been completed.

Toolbar

5
Image view

Workflow list

Dashboard

Status Bar

Figure 21: Calibration Wizard Workspace with RMC Context Menu for Workflow List

Icon Description

Back to calibration selection (Details or Summary, whichever was used to start the calibration
process)

Manual adjust Window Width / Window Level

Automatic Window Width / Window Level

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Icon Description

Zoom In

Zoom Out

Pan

Reset View

Measure Distance

Measure Angle

Digital Graticule

Display Grid

Measure Pixel Value – see example on Figure 22

Line Profile – see example on Figure 23

5 5
Area Profile - see example on Figure 24

Area Histogram - see example on Figure 25

Hide / Show Dashboard

Save selected acquired image (or CBCT scan slices) on disk

Acquire cine – acquires and saves a movie (mpeg); available when taking a Test Image for MV
continuous modes or kV fluoro only

Export a movie – saves acquired data as mpeg movie in a folder defined in PVA Calibration
Administration; available when taking a Test Image for MV continuous modes or kV fluoro only

Image filter selection

Enables arc (in lower right corner of calibration wizard); available when taking a Test Image for
MV continuous modes or kV fluoro only
Table 3: Tools in Calibration Workspace

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Figure 22: Pixel Value Tool with RMC Context Menu

Figure 23: Line Profile Tool with RMC Context Menu

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5 5

Figure 24: Area Profile Tool with RMC Context Menu

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5

Figure 25: Area Histogram Tool with RMC Context Menu

3. When calibrating kV imaging modes or CBCT modes there is the Dynamic Window above the
Dashboard providing additional information about kV imaging system and CBCT Reconstructor. The
window opacity changes dynamically depending if the mouse cursor is in the window or outside of the

window. If desired, the window can be hidden and then restored by clicking and buttons on
the top of the Dashboard respectively. See Figure 26.

Dynamic Window

Figure 26: Dynamic Window

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Imaging Modes Calibrations

Imaging Modes Calibrations

Procedure

Objectives
After completing this procedure, the student will have reviewed the following TrueBeam kV and MV
imaging modes calibrations:

1. Tube Warmup – ( kV modes only ).

2. Dark Field.

3. Flood Field.
5 5
4. Pixel Correction.

5. Beam Profile ( Dosimetry imaging mode only ).

6. Dose Normalization ( Dosimetry imaging mode only ).

Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 10.

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A. Prerequisites
1. The TrueBeam machine is ON.

2. All PU calibrations have been completed; the imaging arms have been initialized.

3. Imaging modes calibrations should be done in the sequence listed in PVA Calibration: Dark Field →
Flood Field → Pixel Correction ( → Beam Profile → Dose Normalization; Dosimetry mode only ).

Note: Isocenter Calibration – IsoCal - is not a prerequisite for imaging modes

calibrations and Test Image acquisition.

B. Overview
1. The TrueBeam imaging modes calibrations can be performed in PVA Calibration application. The
PVA Calibration application can be launched using one of the following Major Modes:

a) Imager Calibration,

b) Service.
5
2. If Service major mode is used it is then necessary to select PVA Calibration tab in order to see PVA
Calibration on the imaging monitor (right hand side). See Figure 1.

Figure 1: Service Manager Console, PVA Calibration

3. PVA Calibration allows selecting multiple calibration steps for multiple imaging modes ( of the same
modality ). See PVA Calibration Overview procedure for more information about how to create
workflow list ( to select calibration steps ) for the calibration wizard.

4. The default positions of all machine axes for the calibration are defined by the calibration wizard. The
interface may allow the user to change some of the machine geometry parameters prior to calibration
(e.g. couch position, gantry). Beam can only be enabled when machine axes have been moved to
defined (‘plan’ column on the Dashboard). Actual positions not matching the plan positions will be
displayed on orange background, see Figure 2.

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Figure 2: Include Couch

5. Operator can choose whether and where the treatment couch should be moved.
Include Couch checkbox should be by default checked for calibrations which require that the couch
is not in the beam (e.g. Flood Field). Include Couch checkbox should be by default deselected for
calibrations which require use of calibration phantom that is placed on the couch. Make sure the
appropriate is selected and if couch is to be moved, make sure it is safe to move the couch to defined
couch target position. See Figure 2.
5 5
6. The Dashboard may also allow changing other beam parameters before the actual calibration –
Gantry angle, positions of jaws (for MV) of blades (for kV). The change(s) have to be applied by the
OK button on the Dashboard. See Figure 3.

a) Manual – allows setting the jaws / blades manually,

b) Automatic,

 for MV, jaws are open to track the active area of MV imager,

 for kV, blades are fully open ( 50x50 cm2 ).

Figure 3: Collimator Manual

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Note: The default field parameters populated for the calibration by the
calibration wizard are appropriate.

7. The machine can be moved to plan:

a) Inside in the treatment room, using the hand pendant,

b) or more conveniently, outside of the treatment room, in control room, using the control console.

8. Before moving the machine, verify plan / target positions for all machine axes on the Dashboard.
If the machine is to be moved from outside, using the control console, select the axes to be moved on
the control console using the Motion Selection buttons. The axes not at plan will have their buttons
highlighted in orange. After pressing the button, the green axis name above the button will start
flashing indicating that the axis has been selected to be moved, see Figure 4.

a) if only one button is orange its axis is automatically selected to be moved – axis name above the
button is flashing in green.

b) multiple axes can be selected to be moved at the same time, with exception of couch and gantry
which cannot be moved simultaneously from control console.
5

Figure 4: Control Console, Gantry & Collimator Selected To Be Moved, Motion Enable Buttons Active

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Important Note: Make sure that all kV and MV imaging arms are selected
using Imager Selection button – both kV and MV labels are illuminated.
Arms that are not selected cannot be moved to plan remotely, as To Plan
button would not turn orange for them thus disallowing the user to select
them to be moved when Motion Enable buttons on the console are pressed.

9. Selecting some axes to be moved will cause the Motion Enable buttons to illuminate. Press both
Motion Enable buttons to move the selected axes and hold them until the axes have reached their
plan positions. Carefully watch as the selected machine axes move on available CCTV monitors and
if motions need to be interrupted, release Motion Enable buttons. See Figure 4.

10. When all machine axes are at plan and there are no additional interlocks, appropriate beam can be
turned on.

a) If MV beam is needed, press and hold MV Ready button until MV Beam On button lights up. (and
MV Ready button gets dark). Then press MV Beam On to turn on the MV beam. See Figure 4.

5 Note: Pressing the MV Beam On button when MV beam is on causes the 5

beam to be paused / held off. Thus keeping the MV Beam On button pressed
for a longer time can interrupt the calibration process

b) If kV beam is needed, press and hold kV Beam On button until the button gets dark and the kV
beam turns on. Then release the button. See Figure 4.

Tip: The buttons enabling beams illuminate automatically when all machines
are at plan positions and all system components are ready for the beam
If beam enabling buttons are dark, the beam is interlocked and the interlock
section in Service Manager Console (SMC) application can provide more
information. Use the buttons on the bottom of the interlock panel in SMC to
clear active faults , see active faults
or routine interlocks .

11. Calibration steps which do not require any beam will be done by wizard automatically; user may be
prompted to review the acquired / calculated data.

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C. X-ray Tube Warm-up – kV modes only

1. At the TrueBeam workstation, launch the PVA Calibration application. Select the Imager Calibration
major mode, log in when prompted. See Figure 5.

Figure 5: Major Mode Selection → Login

2. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 6.

Figure 6: Select User Privileges for the Session

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3. Verify the state of the system and then click Continue when done. See Figure 7.

5 5

Figure 7: System Status Summary

4. Confirm the following warning by clicking Continue. See Figure 8.

Figure 8: Service Mode Warning

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5. PVA Calibration application will be displayed on the imaging monitor (right hand side). The application
will be in Summary View showing the available calibrations. LMC the Tube Warmup calibration in
Geometry column, see Figure 9.

Figure 9: PVA Calibration Application, Summary View

Note: Tube Warmup is listed in Geometry column only if enabled in PVA

Calibration Administration.

Also, the user will be automatically prompted to carry out the tube warmup 5
prior to performing kV modes calibrations if the actual anode heat units are
lower than the Min. Anode Heat Units [%] set in Imaging Administration as
threshold for kV tube warmup.

6. Click Details button on the top of PVA Calibration application. See Figure 10.

Figure 10: Details Button

7. In Details View, LMC the Status box for the Tube Warmup, then click the Calibrate button.
Alternatively, you can double-click the Status box for the Tube Warmup to open the calibration
wizard and start the calibration process. See Figure 11.

Figure 11: Details View, Tube Warmup Selected, Calibrate Button

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8. The calibration wizard workspace opens with Tube Warmup selected in the workflow list. The Next
button on the Status Bar can be used to skip the tube warm up if desired. See Figure 12.

5 5

Figure 12: Move to Targets, Tube Warmup

9. Axes currently not at plan positions will be highlighted in orange on the Dashboard. Use Motion
Selection buttons on control console to select the axes to be moved. Make sure it is safe to move all
selected axes and then press Motion Enable buttons on control console to move the selected axes.
Carefully watch as the selected axes move on available CCTV monitors and if motions need to be
interrupted, release Motion Enable buttons. Keep holding Motion Enable button until all axes have
reached the plan positions.

Note: For the warm-up procedure the kV imaging panel will not be deployed
and irradiated.

10. Once all axes have reached the plan positions, the kV Beam On button illuminates. Turn on the kV
beam by pressing the kV Beam On button and hold it until the kV Beam On button gets dark and
beam turns on. Then it can be released.

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11. Wait until the warm up has finished. The kV beam will be ON for the time period set for the warm up
in Imaging Administration. See Figure 13.

5

Figure 13: Tube Warm-up in Progress

12. When the process has completed the system will proceed automatically to next calibration step in the
workflow list.

If there are no other calibration steps listed in workflow list then the calibration wizard workspace is
closed.

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D. Dark Field, Flood Field and Pixel Correction Map calibrations

1. Follow steps C.1 to C.5 to launch PVA Calibration application.

2. Then LMC the kV or MV imaging mode to calibrate in kV Modes or MV Modes column respectively.
See Figure 14 and Figure 15.

5 5

Figure 14: Summary View, High Quality kV Mode Selected Example

Figure 15: Summary View, Low Dose MV Mode Selected Example

3. Then click Details button on the top of PVA Calibration application. See Figure 16.

Figure 16: Details Button

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4. In Details View, LMC the imaging mode to be calibrated. Then click Calibrate button on the top of
PVA Calibration application to open the calibration wizard and start the calibration process.
See Figure 17 and Figure 18.

Figure 17: Calibrate Button, Dynamic Gain kV Imaging Mode Example

Figure 18: Calibrate Button, Low Dose MV Imaging Mode Example

5. The calibration wizard opens with all calibration steps for the selected mode in the workflow list. See
example on Figure 19.

Figure 19: Workflow List Example, Low Dose MV Mode Example

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Note: If Tube Warmup is enabled in Imaging Administration and the tube is

too cold then the Tube Warmup would be first in the list if kV mode is
calibrated.

6. Dark Field acquisition is automatic. Once the Dark Field has been acquired the system automatically
moves to next calibration in the workflow list - Flood Field.

Note: If Dark Field was selected in PVA Calibration as the only calibration to
be done, it will be displayed for a review and needs to be Accepted or
Decline after it is acquired.

7. Axes currently not at plan positions will be highlighted in orange on the Dashboard. Use Motion
Selection buttons on control console to select the axes to be moved. Make sure it is safe to move all
selected axes and then press Motion Enable buttons on control console to move the selected axes.
Carefully watch as the selected axes move on available CCTV monitors and if motions need to be
interrupted, release Motion Enable buttons. Keep holding Motion Enable button until all axes have
reached the plan positions.
5 5
Note: Include Couch should be automatically checked for the Flood Field
calibration. Make sure the couch values are appropriate and couch will not be
in the field when moved to this position.

Figure 20: Moving Selected Axes to Plan, Couch Included – kV Mode Example

Figure 21: Moving Selected Axes to Plan, Couch Included – MV Mode Example

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8. When all axes have reached their target positions enable the appropriate beam ( kV or MV ) as
prompted on the Status Bar.

9. Wait until the system has acquired the Flood Field data. Depending on the calibrated mode, time
needed to acquire all necessary data can differ.

10. The acquired Dark Field, Flood Field and Test image will then be displayed for a review. Select
Accept or Decline. See examples on Figure 22 and Figure 23.

Figure 22: Review Acquired DF and FF Data Example, Accept / Decline – kV Mode Example

Figure 23: Review Acquired DF and FF Data Example, Accept / Decline – MV Mode Example

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Note: The Test Image (in lower right corner) may not be automatically
acquired for some imaging modes ( e.g. Dynamic Gain ).

11. After accepting or declining the previously acquired Dark Field and Flood Field data, the calibration
wizard will to next step in workflow list – Pixel Correction.

12. Pixel Correction map will be calculated automatically, wait until the calculation is complete.

13. Then the Pixel Correction map is displayed for a review. Results are displayed using colorful layers
which can be enabled / disabled using the toolbar buttons described in Table 1. Red and blue layers
are enabled by default – blue pixels are the new automatically detected defective pixels. See example
on Figure 24.

Button Description

Red layer shows current defective pixels already included in Pixel Correction Map

5 Blue layer is for current and new automatically detected defective pixels, this layer is ‘on the
bottom’
5
Green layer is for manually edited, this layer is ‘on the top’

Table 1: Layer Tools

Figure 24: Pixel Correction Map Example

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14. Pixel Correction map can be manually edited if needed, using the Pixel Editing tools on the toolbar,

described in Table 2. An image can be loaded in the background using button in the toolbar.

Button Description

Insert / erase single pixel

Insert / erase entire horizontal line of defective pixels

Insert / erase entire vertical line of defective pixels

Changes selected pencil tool into an eraser

Table 2: Tools for Manual Corrections

Note: If the display resolution is less than 1:1, the tools allowing manual
modification of Pixel Correction Map are disabled.
5

15. Review the Pixel Correction map and the displayed statistics. Then choose a correction to be applied
to Pixel Correction map, see Figure 24.

16. If there are no more steps listed in calibration workflow the calibration wizard will now close.

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E. Beam Profile and Dose Normalization for MV Dosimetry modes

1. Follow steps D.1 to D.15 to select MV Dosimetry for desired energy and perform Dark Field, Flood
Field and Pixel Correction calibrations for the Dosimetry mode.

2. Make sure Dosimetry mode for desired energy is selected in step D.4, see example on Figure 25.

Figure 25: Dosimetry Imaging Mode for 6X Energy Selected Example

3. Beam Profile calibration step will follow after Pixel Correction. The system automatically searches for
available beam profile correction files in folder displayed on the top of the application. If there are no
5 suitable beam profile correction files, a message will be displayed, see Figure 26. LMC the message 5
and then OK to close the message box.

Figure 26: No Beam Profile Files Found

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4. In the Beam Profiles Directory textbox type the full path to a folder containing appropriate beam
profile correction files. See Figure 27.

Important Note: The software supports two file formats – w2cad and DXF
(Dose Exchange Format). w2cad files must have *.cdp extension and files in
DXF format must have *.dxf extension.

5. All files detected will then be listed in Beam Profile Selection window. When a file is selected its
contents are displayed in window below Beam Profile Selection. Select the appropriate beam profile
correction file and click Use Selected, see Figure 27.

Selected file contents

Figure 27: Beam Profile Correction Selection

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6. The calibration wizard will then move to next calibration listed in workflow list – Dose Normalization.

7. Axes currently not at plan positions will be highlighted in orange on the Dashboard. Make sure all
geometry parameters are correct and couch will not be included in the field. Use Motion Selection
buttons on control console to select the axes to be moved. Make sure it is safe to move all selected
axes and then press Motion Enable buttons to move the selected axes. Carefully watch as the
selected axes move on available CCTV monitors and if motions need to be interrupted, release
Motion Enable buttons. Keep holding Motion Enable buttons until all axes have reached target
positions.

8. Define the desired Reference Dose in CU for displayed Target MU. Then click OK on the Status Bar
to confirm the change. See Figure 28.

5 5

Figure 28: Define Reference Dose in CU for the Target MU

9. When prompted on the Status Bar, enable the MV beam using control console. Press and hold MV
Ready button until MV Beam On button lights up. Then press MV Beam On button on the control
console.

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10. Once the beam has been delivered, the acquired dosimetric image will be displayed for a review and
the old and new dose conversion factors will be displayed on the Dashboard. Finish the calibration
by clicking Accept or Decline. See Figure 29.

Figure 29: Dose Normalization Results

Important Note: Always make sure that all target MU have been delivered
and beam was not prematurely interrupted.
Review old and new dose conversion factors and if large differences are
observed, make sure the result is desired.

Important Note: All previous calibration steps of the dosimetry imaging mode
may affect Dose Normalization. A test image can be acquired to ensure that
Dose Normalization still yields desired results after the previous steps have
been re-done.

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Imaging Calibrations - Exercise

Exercise

Objectives
Lead by the course instructor and using the course manuals, the students will have calibrated selected
Imaging Modes.

A. Instructions
1. Using the course manual ‘Imaging Modes Calibrations’ procedure calibrate the following kV imaging
modes:
5 a) Dynamic Gain kV imaging mode
5
b) High Quality kV imaging mode

c) Low Dose kV imaging mode

2. Using the course manual ‘Imaging Modes Calibrations’ procedure calibrate the following MV imaging
modes:

a) Continuous MV imaging mode for energy and dose rate of student’s choice

b) Low Dose MV imaging mode for energy of student’s choice

c) High Quality MV imaging mode for energy of student’s choice

d) Dosimetry MV imaging mode for energy of student’s choice

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Geometry Calibrations
Procedure

Objectives
After completing this procedure, the students will have reviewed and performed the following TrueBeam
geometry imaging – related user calibrations

1. Isocenter Calibration (IsoCal Calibration).

2. Isocenter Verification (IsoCal Verification).

3. kV Collimator calibration.
5
Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 10.

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A. Prerequisites
1. TrueBeam machine is ON.

2. Imaging arms have been calibrated and initialized.

3. kV Dynamic Gain imaging mode has been calibrated.

4. MV Continuous imaging mode for 6X energy and 600 MU/min dose rate has been calibrated.

5. MV High Quality for 6X energy has been calibrated.

6. Isocenter Calibration must have been completed before performing kV Collimator calibration.

Note: Isocenter calibration has to be repeated if kV or MV imager arm is

recalibrated.

Caution: When performing IsoCal calibration, make sure that the filter plate
is correctly seated. After obtaining the IsoCal result, check for alerts that
5 show the new IsoCal parameters exceed the predefined tolerances. After
5
accepting the IsoCal calibration result, always perform a verification scan.
Make sure that the IsoCal calibration is verified on a regular basis.
P1005925-001-A – TrueBeam Administrators Guide, page 148.

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B. Overview
1. The TrueBeam Geometry calibrations can be performed in PVA Calibration application. The PVA
Calibration application can be launched using one of the following Major Modes:

a) Imager Calibration,

b) Service.

2. If Service major mode is used it is then necessary to select PVA Calibration tab in order to see PVA
Calibration on the imaging monitor (right hand side). See Figure 1.

5
Figure 1: Service Manager Console, PVA Calibration

3. Isocenter Calibration and Verification procedures require that IsoCal phantom is mounted on the
treatment couch and properly aligned with isocenter.

4. The default positions of all machine axes for the calibration are defined by the calibration wizard. The
interface may allow the user to change some of the machine geometry parameters prior to calibration
(e.g. couch position, gantry). Beam can only be enabled when machine axes have been moved to
defined (‘plan’ column on the dashboard). Actual positions not matching the plan positions will be
displayed on orange background, see Figure 2.

Figure 2: Include Couch

5. Operator can choose whether and where the treatment couch should be moved.
Include Couch checkbox should be by default checked for calibrations which require that the couch

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is not in the beam (e.g. kV Collimator). Include Couch checkbox should be by default deselected for
calibrations which require use of calibration phantom that is placed on the couch (e.g Isocenter
Calibration). Make sure the appropriate is selected and if couch is to be moved, make sure it is safe
to move the couch to defined couch target position. See Figure 2.

6. The machine can be moved to plan:

a) Inside in the treatment room, using the hand pendant,

b) or more conveniently, outside of the treatment room, in control room, using the control console.

7. Before moving the machine, verify plan / target positions for all machine axes on the dashboard.
If the machine is to be moved from outside, using the control console, select the axes to be moved on
the control console using the Motion Selection buttons. The axes not at plan will have their buttons
highlighted in orange. After pressing the button, the green axis name above the button will start
flashing indicating that the axis has been selected to be moved, see Figure 3.

a) if only one button is orange its axis is automatically selected to be moved – axis name above the
button is flashing in green.

b) multiple axes can be selected to be moved at the same time, with exception of couch and gantry
which cannot be moved simultaneously from outside of the vault (control console).
5 5

Figure 3: Control Console, Gantry & Collimator Selected To Be Moved, Motion Enable Buttons Active

8. Selecting some axes to be moved will cause the Motion Enable buttons to illuminate. Press both
Motion Enable buttons to move the selected axes and hold them until the axes have reached their
plan positions. Carefully watch as the selected machine axes move on available CCTV monitors and
if motions need to be interrupted, release Motion Enable buttons. See Figure 3.

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9. When all machine axes are at plan and there are no additional interlocks, appropriate beam can be
turned on.

a) If MV beam is needed, press and hold MV Ready button until MV Beam On button lights up. (and
MV Ready button gets dark). Then press MV Beam On to turn on the MV beam. See Figure 3.

Note: Pressing the MV Beam On button when MV beam is on causes the

beam to be paused / held off. Thus keeping the MV Beam On button pressed
for a longer time can interrupt the calibration process.

b) If kV beam is needed, press and hold kV Beam On button until the button gets dark and the kV 5
beam turns on. Then release the button. See Figure 3.

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C. Isocenter Calibration
1. Enter the treatment room. Mount the IsoCal phantom adaptor at the end of the treatment couch. Lock
the adaptor in H4 couch index position and fix it to the couch with the latch on the bottom of the
adaptor. See Figure 4.

5 5

Side Top Couch View Side Bottom Couch View

Figure 4: IsoCal Phantom Adaptor

2. Hang the IsoCal phantom on the adaptor on the front end of the couch. Then position the phantom at
the isocenter. Use the cuts on the phantom surface to align the phantom with collimator crosshair
and/or room lasers. See Figure 5.

Figure 5: IsoCal Phantom on the Adaptor at Isocenter

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Note: The phantom does not need to be located precisely at the MV

isocenter, but the misalignment may not be greater than 5 mm.

3. Insert the partial transmission plate into interface mount on the collimator. See Figure 6.

Top View
Bottom View, installation

5
Figure 6: Partial Transmission Plate, Installation

4. At the TrueBeam workstation, launch the PVA Calibration application. Select the Imager Calibration
major mode, log in when prompted. See Figure 7.

Figure 7: Major Mode Selection → Login

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5. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 8.

Figure 8: Select User Privileges for the Session

6. Verify the state of the system and then click Continue when done. See Figure 9.

5 5

Figure 9: System Status Summary

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7. Confirm the following warning by clicking Continue. See Figure 10.

Figure 10: Service Mode Warning

8. PVA Calibration application will be displayed on the imaging monitor (right hand side). The application
will be in Summary View showing the available calibrations, see Figure 11.

Figure 11: PVA Calibration Application, Summary View

9. LMC the Isocenter Calibration box in Geometry column to select Isocenter Calibration / Geometry
calibration group. See Figure 11.

10. Then click Details button on the top, see Figure 12.

Figure 12: Details Button

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11. In Details View, LMC the Status box for the Isocenter Calibration, then click the Calibrate button.
Alternatively, you can double-click the Status box for the Isocenter Calibration to open the
calibration wizard and start the calibration process. See Figure 13.

Figure 13: Details View, Isocenter Calibration Selected, Calibrate Button

12. The calibration wizard opens with all steps listed in workflow list.
First step is to acquire collimator shots using High Quality 6X with collimator at 4 different angles.
5 See Figure 14. 5

Figure 14: MV Collimator Shots

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13. Follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
position. Select the axes to be moved using Motion Selection buttons on control console and then
press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is deselected as the IsoCal phantom has already been set up. See Figure 15.

Figure 15: Select the Axes To Be Moved and Press Motion Enable To Move Them.

14. When all required machine axes are at target positions enable the MV beam. Press MV Ready button
on the control console and hold it until MV Beam On button illuminates. Then press MV Beam On
button to turn on the MV beam.

15. Wait until all necessary images have been acquired. The collimator will rotate automatically when
needed. When the step is complete, click Next button on the Status Bar as prompted on the Status
Bar. See Figure 16.
5

Figure 16: Collimator Shots Have Been Acquired, Click Next

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16. The second step is to acquire set of MV images with MV Continuous imaging mode for 6X and 600
MU / min dose rate while gantry makes full rotation around the IsoCal phantom.
Follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
position. If needed, select the axes to be moved using Motion Selection buttons on control console.
Press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is deselected as the IsoCal phantom has already been set up. See Figure 17.

Figure 17: Select the Axes To Be Moved and Press Motion Enable To Move Them.

17. When all required machine axes are at target positions enable the MV beam as prompted. Press MV
Ready button on the control console and hold it until MV Beam On button illuminates. Then press MV
Beam On button to turn on the MV beam.

5 18. Wait until all necessary images have been acquired. The gantry will rotate around the IsoCal 5
phantom. When the step is complete, click Next button on the Status Bar as prompted.
See Figure 18.

Figure 18: MV Arc Complete, Click Next

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19. The third step is to acquire set of kV images with kV Dynamic Gain imaging mode while gantry makes
full rotation around the IsoCal phantom.
Follow the instructions on the status bar. If it is required to move the machine axes to wizard-defined
plan position, select the axes to be moved using Motion Selection buttons on control console and
then press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is deselected as the IsoCal phantom has already been set up.

20. When all required machine axes are at target positions enable the kV beam as prompted,
see Figure 19. Press kV Beam On button on the control console and hold it until the kV beam turns
on and the button gets dark.

Figure 19: Press kV Beam On Button To Turn On the kV Beam

21. Wait until all necessary images have been acquired. The gantry will rotate around the IsoCal
phantom. When the step is complete, click Next button on the Status Bar as prompted. 5
See Figure 20.

Figure 20: kV Arc Complete, Click Next

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22. At the last step the system processes the acquired data and displays for a review.

23. First, the application detects the pin from partial transmission plate on all 4 collimator shots (blue
circle) and calculates the collimator axis (green cross). Review the results and click Next button.
See Figure 21.

5 5

Figure 21: Pin and Collimator Axis on Acquired Collimator Shots

24. Now the software processes the MV images acquired while gantry was rotating around the IsoCal
phantom. On every acquired projection it identifies the IsoCal phantom BBs and partial transmission
plate pin. Found objects are outlined with blue circles. The rectangles (so called gates) indicate areas
where the software is searching for the image objects, green color indicates successful detection, red
color of the rectangle indicates that BB detection for the gate failed. Wait until identification is
complete. See Figure 22.

Figure 22: MV Image Processing

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25. When the software has processed all previously acquired MV Arc images, review the results and click
Next button. Images can be reviewed using the scrollbar on the bottom of image display.
See Figure 23.

Scrollbar, image number

/ image count

Figure 23: Review the Results and Click Next

26. Now the software processes the kV images acquired while gantry was rotating around the IsoCal
phantom. On every acquired projection it identifies the IsoCal phantom BBs. Found objects are
outlined with blue circles. The rectangles (so called gates) indicate areas where the software is
searching for the image objects, green color indicates successful detection, red color of the rectangle
indicates that BB was not identified in the gate. Wait until identification is complete. See Figure 24.

Figure 24: kV Image Processing

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27. When the software has processed all previously acquired kV Arc images, review the results and click
Next button. Images can be reviewed using the scrollbar on the bottom of image display.
See Figure 25.

Scrollbar, image number

/ image count

5 5

Figure 25: Review the Results and Click Next

28. Final results are displayed for user review. See Figure 26. Review results and then make appropriate
selection (Accept, Decline, Do not use). Show Details button opens window with additional
calibration parameters, their actual values and tolerances for a review.

The result bar on the top indicates whether the results are within normal limits or not. If its color is
Green, the results are within normal limits. Yellow or red color indicates that some parameters are
not within normal limits. In such case Show Details will be selected and suspicious parameters will
be highlighted.

Review the MV and kV imager correction plots. The plots show where the MV isocenter projects onto
MV and kV imagers, center of the graph being the imager center. Review the magnitude of calculated
corrections for both MV and kV imaging arms displayed on the graphs. Black curve shows newly
calculated corrections, gray curve shows calibration data currently in use. The black circle shows the
maximum shift tolerance distance.

Additional parameters displayed:

a) Max deviation from central beam : the radius of region defined by intersections of the central
axis of the treatment beam over a 360 degress gantry rotation.

b) Inplane imager rotation MV / kV : in-plane rotation of MV / kV imager in degrees.

c) Max imager shift MV / kV : the maximum correction vector for MV / kV imager.

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d) Phantom position : the position of the center of IsoCal phantom with respect to MV isocenter
(which is at origin [0,0,0]).

Result Bar

5

Figure 26: IsoCal Results

29. Click the Save Configuration button in lower right corner of Service Manager Console (SMC) to save
the Isocenter Calibration results permanently in the TrueBeam Supervisor (SPV) node configuration
files. See Figure 27.

Figure 27: Save Configuration

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30. Review the changes and decide what to do with changes – Save / Undo – in the displayed dialog
box. Then apply your decision by clicking Apply button. See Figure 28.

5
5
Figure 28: Modified Configuration Parameters Dialog, Apply

31. Finally, click Close button to close the dialog box, see Figure 29.

Figure 29: Modified Configuration Parameters Dialog, Close

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D. Isocenter Verification
1. Follow steps C.1 to C.8. to setup the IsoCal phantom and open PVA Calibration application.

2. Then LMC Isocenter Verification box to select Isocenter Verification / Geometry calibration group.
See Figure 30

Figure 30: PVA Calibration Application, Summary View 5
3. Then click Details button on the top, see Figure 31.

Figure 31: Details button

4. In Details View, LMC the Status box for the Isocenter Verification, then click the Calibrate button.
Alternatively, you can double-click the the Status box for the Isocenter Verification to open the
calibration wizard and start the calibration process. See Figure 32.

Figure 32: Details View, Isocenter Verification Selected, Calibrate Button

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5. Then follow steps C.12 to C.27. Isocenter Verification procedure follows the same steps as Isocenter
Calibration but during the verification the correction vectors determined during Isocenter Calibration
are being applied.

6. Final results are displayed at the end for a user review. Displayed parameters have the same
meaning as the parameters displayed at the end of Isocenter Calibration. Small correction vectors
prove that the previous Isocenter Calibration yielded correct results which, when applied to imaging
arms, cause that MV isocenter is projected onto imaging panel center.
Click OK button when done to close the results window. See Figure 33.

5 5

Figure 33: IsoCal Verification Results

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E. kV Collimator Calibration
1. Enter the treatment room and make sure there are no phantoms mounted at the front end of the
treatment couch; remove partial transmission plate from collimator.

2. Follow steps C.4 to C.8 to launch PVA Calibration application.

3. LMC kV Collimator box in Geometry calibration group. See Figure 34.

Figure 34: PVA Calibration Application, Summary View
5
4. Then click Details button on the top, see Figure 35.

Figure 35: Detail Button

5. In Details View, LMC the Status box for kV Collimator, then click the Calibrate button. Alternatively,
you can double-click the Status box for the kV Collimator to open the calibration wizard and start the
calibration process. See Figure 36.

Figure 36: Details View, kV Collimator Calibration Selected, Calibrate Button

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6. Follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
position. Select the axes to be moved using Motion Selection buttons on control console and then
press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Include
Couch is, by default, selected as couch may not be in the field. If couch is already far away from
beam and it is desired not to move it remotely, Include couch can be deselected. If moving couch,
make sure couch target values are appropriate and safe. See Figure 37.

5 5

Figure 37: Move the Machine Axes to Target Positions

7. When all required machine axes are at target positions enable the kV beam as prompted,
see Figure 38. Press kV Beam On button on the control console and hold it until the kV beam turns
on and the button gets dark.

Figure 38: Enable kV Beam

8. With gantry at 90° the software automatically acquires 3 kV images with the following parameters:

a) rectangular opening 20x14 cm2, no bowtie filter,

b) small square opening 4x4 cm2, no bowtie filter,

c) maximum square opening and full fan bowtie filter in place.

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9. Using edge detection algorithm, the software detects positions of the blades and bowtie filter on
acquired images. Results are displayed for a user review, see Figure 39. Purple lines indicate
expected positions, blue lines are calculated/detected actual positions. Show Details button can be
used to see more details, see Figure 40. Click Accept or Decline when done.

Figure 39: kV Collimator Calibration Results

Figure 40: kV Collimator Calibration Results, Show Details

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10. Click Save Configuration button in lower right corner of Service Manager Console (SMC) to save the
kV Collimator calibration results permanently. See Figure 41.

Figure 41: Save Configuration

11. Review the changes and decide what to do with changes – Keep / Save / Undo – in the displayed
5 dialog box. Then apply your decision by clicking Apply button. See Figure 42. 5

Figure 42: Modified Configuration Parameters Dialog Box

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12. Finally, click OK button to close the dialog box. See Figure 43.

Figure 43: Click OK to Close the Dialog Box

Note: Repeating the kV Collimator calibration may result in a display very

similar to what was displayed during previous kV Collimator calibration. This
is because the calibration always starts with same default values without
using the results of previous calibration.
Hence, the calibration cannot be checked by repeating it. One can move the
blades to a desired position and take a test image instead, to verify whether
blades are positioned properly after the calibration or not.

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CBCT Calibrations

CBCT Calibrations
Objectives
After completing this procedure, the students will have reviewed and performed the following TrueBeam
CBCT calibrations:

1. Crescent calibration.

2. Air Norm calibration.

3. HU calibration.

Abbreviations
5 5
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 10.

A. Prerequisites
1. TrueBeam machine is ON.

2. Imaging arms have been calibrated and initialized.

3. kV Dynamic Gain imaging mode has been calibrated.

4. It is highly recommended to perform kV Collimator Calibration and Isocenter Calibration prior to any
CBCT calibration.

5. CBCT calibrations should be carried out in the following sequence: Crescent → Air Norm → HU.

Note: Each CBCT calibration comes with a factory calibration out of the box.
It is possible to acquire CBCT scan with factory calibration.
Also, each CBCT calibration can be reverted to factory calibration – RMC the
calibration to be reverted in Details View and select Revert to Factory
Default.

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B. Overview
1. The TrueBeam CBCT calibrations can be performed in PVA Calibration application. The PVA
Calibration application can be launched using one of the following Major Modes:

a) Imager Calibration,

b) Service.

2. If Service major mode is used it is then necessary to select PVA Calibration tab in order to see PVA
Calibration on the imaging monitor (right hand side). See Figure 1.

5
Figure 1: Service Manager Console, PVA Calibration

3. CBCT HU calibration procedure requires use of Catphan 504 phantom.

4. The default positions of all machine axes for the calibration are defined by the calibration wizard. The
interface may allow the user to change some of the machine geometry parameters prior to calibration
(e.g. couch position). Beam can only be enabled when machine axes have been moved to defined
(‘plan’ column on the dashboard). Actual positions not matching the plan positions will be displayed
on orange background, see Figure 2.

Figure 2: Include Couch

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5. Operator can choose whether and where the treatment couch should be moved.
Include Couch checkbox should be by default checked for calibrations which require that the couch
is not in the beam (e.g. Air Norm). Include Couch checkbox should be by default deselected for
calibrations which require use of calibration phantom that is placed on the couch (e.g. HU calibration).
Make sure the appropriate is selected and if couch is to be moved, make sure it is safe to move the
couch to defined couch target position. See Figure 2.

6. The machine can be moved to plan:

a) Inside in the treatment room, using the hand pendant,

b) or more conveniently, outside of the treatment room, in control room, using the control console.

a) if only one button is orange its axis is automatically selected to be moved – axis name above the
button is flashing in green.

5 b) multiple axes can be selected to be moved at the same time, with exception of couch and gantry 5
which cannot be moved simultaneously from outside of the vault (control console).

Figure 3: Control Console, Gantry & Collimator Selected To Be Moved, Motion Enable Buttons Active

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9. When all machine axes are at plan and there are no additional interlocks, appropriate beam can be
turned on.

To turn on the kV beam, press and hold kV Beam On button until the button gets dark and the kV
beam turns on. Then release the button. See Figure 3.

Tip: The buttons enabling beams illuminate automatically when all machines 5
are at plan positions and all system components are ready for the beam
If beam enabling buttons are dark, the beam is interlocked and the interlock
section in Service Manager Console (SMC) application can provide more
information. Use the buttons on the bottom of the interlock panel in SMC to
clear active faults , see active faults
or routine interlocks .

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C. Crescent Calibration
1. At the TrueBeam workstation, launch the PVA Calibration application. Select Imager Calibration
major mode, log in when prompted. See Figure 4.

5 5

Figure 4: Major Mode Selection → Login

2. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 5.

Figure 5: Select User Privileges for the Session

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3. Verify the state of the system and then click Continue when done. See Figure 6.

Figure 6: System Status Summary

4. Confirm the following warning by clicking Continue. See Figure 7.

Figure 7: Service Mode Warning

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5. PVA Calibration application will be displayed on the imaging monitor, on the right hand side. The
application will be in Summary View showing all available calibrations. See Figure 8.

Figure 8: PVA Calibration Application, Summary View

6. LMC the CBCT mode to be calibrated in the CBCT Modes column and click Details button on the top
of PVA Calibration application. See Figure 9.

5 5

Figure 9: Select CBCT Mode To Calibrate, then Click Details

7. Then LMC the Crescent Calibration box for the mode to be calibrated and click Calibrate to initiate
the calibration. Alternatively, the calibration can be initiated by double-clicking the Crescent
Calibration box. See Figure 10.

Figure 10: Crescent Calibration Selected, Head CBCT Mode Example

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8. Follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
position. Select the axes to be moved using Motion Selection buttons on control console and then
press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is selected as couch may not be in the beam, make sure the couch target
position is appropriate and safe and then move the couch away from the beam. See Figure 11.

Figure 11: Select the Machine Axes and Press Motion Enable To Move to Target

9. When all required machine axes are at target positions enable the kV beam as prompted on the
Status Bar.
Press and hold kV Beam On button on the control console until the button gets dark and the kV
beam turns on.

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10. Gantry will make one full revolution. Acquisition progress is shown on the display. See Figure 12 and
Figure 13.

5 5

Figure 12: Acquisition in Progress, Full Fan Mode Example

Figure 13: Acquisition in Progress, Half Fan Mode Example

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11. Wait until the data acquisition is complete.

12. When prompted on the Status Bar, turn on the kV beam again. Press and hold kV Beam On button
on the control console until the button gets dark and the kV beam turns on. Gantry will perform one
full rotation in the opposite direction. Progress is displayed on the screen.
See Figure 12 and Figure 13.

13. Wait until the data acquisition is complete. The wizard automatically accepts the acquired data and
closes.

Note: Half fan bow tie filter will be in place for half fan modes, imager will be
shifted; full fan bow tie filter will be in place for full fan modes, imager
centered. Regardless of the mode, gantry will perform two full rotations, one
in CW, the other in CCW direction.

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D. Air Norm Calibration

1. Follow steps C.1 to C.6 to launch PVA Calibration application, select CBCT mode and display
Details for CBCT modes.

2. Then LMC the Air Norm box for the mode to be calibrated and click Calibrate to initiate the
calibration. Alternatively, the calibration can be initiated by double-clicking the Air Norm box.
See Figure 14.

Figure 14: Selecting Air Norm Calibration, Head CBCT Mode Example

3. Dark Field image will be taken automatically.

4. Then follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
5 position. Select the axes to be moved using Motion Selection buttons on control console and then
5
press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is selected as couch may not be in the beam, make sure the couch target
position is appropriate and safe and then move the couch away from the beam. See Figure 15.

Figure 15: Select the Machine Axes and Press Motion Enable To Move to Target

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5. When all required machine axes are at target positions enable the kV beam as prompted on the
Status Bar. Press and hold kV Beam On button on the control console until the button gets dark and
the kV beam turns on. Gantry will not move during data acquisition, data will be acquired with kV
beam going straight down ( Gantry is at 90 deg ). No bowtie filter is used. Acquisition progress is
shown on the display. See Figure 16 and Figure 17.

Figure 16: Air Norm Calibration Phase 1 (No Bowtie Filter) in Progress, Full Fan Example

Figure 17: Air Norm Calibration Phase 1 (No Bowtie Filter) in Progress, Half Fan Example

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6. Wait until the data acquisition is complete. When prompted on the Status Bar, turn on the kV beam
again to acquire image with bow tie filter in place. Press and hold kV Beam On button on the control
console until the button gets dark and the kV beam turns on. Gantry will not move during data
acquisition, data will be acquired with kV beam going straight down ( Gantry is at 90 deg ). Bowtie
filter is in place. Acquisition progress is shown on the display. See Figure 18 and Figure 19.

5 5

Figure 18: Air Norm Calibration Phase 2 (with Bowtie Filter) in Progress, Full Fan Example

Figure 19: Air Norm Calibration Phase 2 (with Bowtie Filter) in Progress, Half Fan Example

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7. Wait until the data acquisition is complete. Both acquired images will be displayed for user review.
Click Accept or Decline. See Figure 20 and Figure 21.

5

Figure 20: Air Norm Calibration Final Review, Full Fan Example

Figure 21: Air Norm Calibration Final Review, Half Fan Example

8. After accepting or declining the results, the calibration wizard will close.

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E. HU Calibration
1. Enter the treatment room and setup the Catphan 504 phantom. Position the phantom container at the
front of the couch, leaving the lid open as a counterweight to the rear. Remove the phantom and hook
the two rear lugs over the front end of the empty box. Use the two thumbscrews on the rear of the
phantom to level the phantom.

2. Then align the phantom to the isocenter using the wall lasers and/or collimator crosshair. The vertical
laser ( indicating couch longitudinal ) should align with the center of CTP404 module of the phantom,
which is approximately 9 cm from the unsupported end of the phantom. See Figure 22.

5 5

CTP 404 insert

Figure 22: Catphan Phantom Setup

3. Follow steps C.1 to C.6 to launch PVA Calibration application, select CBCT mode and display
Details for CBCT modes.

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4. Then LMC the HU Calibration box for the mode to be calibrated and click Calibrate to initiate the
calibration. Alternatively, the calibration can be initiated by double-clicking the HU Calibration box.
See Figure 23.

Figure 23: Selecting the HU Calibration, Head CBCT Mode Example

5. Dark Field image will be taken automatically.

6. Then follow the instructions on the status bar. Move all required machine axes to wizard-defined plan
position. Select the axes to be moved using Motion Selection buttons on control console and then
5
press the Motion Enable on control console to move the selected axes. Carefully watch as the
machine moves and if motions need to be interrupted release the Motion Enable buttons. Make sure
that Include Couch is deselected as the phantom has already been set up and it is not desired to
move the couch. See Figure 24.

Figure 24: Select the Machine Axes and Press Motion Enable To Move to Target

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7. When all required machine axes are at target positions enable the kV beam as prompted on the
Status Bar. Press and hold kV Beam On button on the control console until the button gets dark and
the kV beam turns on.

8. The system acquires a CBCT scan of the Catphan phantom. Wait until the scan is complete.
Progress will be displayed on the screen, see Figure 25.

5 5

Figure 25: Scan in Progress, Full Fan Example

Figure 26: Scan in Progress, Half Fan Example

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9. Then the system automatically identifies all materials of the CTP 404 insert and displays the
calibration curve for a user review. Evaluate the quality of the result and decide whether to Accept or
Decline. See Figure 27.

Figure 27: HU Calibration Final Results, Accept or Decline

10. After accepting or declining the results, the calibration wizard will close.

Note: The system will use full trajectory (360° rotation) for any CBCT mode
for HU calibration.

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Optical Camera Calibration

Optical Camera Calibration

Procedure

Objectives
After completing this procedure, the student will have reviewed and performed the TrueBeam Optical
Camera Calibration.

Abbreviations
Right mouse click denoted as RMC.

5 Left mouse click denoted as LMC. 5

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 10.

A. Prerequisites
1. Camera is turned on, warmed up and ready.

2. Marker block is available, set up on the treatment couch and properly aligned with isocenter.

B. Overview
1. The purpose of the optical camera calibration is to ensure that the coordinate system transformation
between the camera and the fixed-room coordinate system (IEC) is correct.

2. Optical Camera Calibration does not require any beam or remote machine motions.

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Optical Camera Calibration

C. Optical Camera Calibration

1. Enter the treatment room. Locate the marker block, position it on the treatment couch. Move the
couch and/or marker block until the white lines on the marker block are aligned with wall lasers and/or
collimator crosshair. See Figure 1.

Figure 1: Align the Marker Block with Isocenter

2. Before you leave the treatment room, check the status LEDs on the Optical Camera to make sure
that it is warmed up and ready. The Camera is ready when first two LED from your left ( when facing
the camera ) are lit up in green and solid, like on the picture below:

Figure 2: Optical Camera, in Ready State

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Optical Camera Calibration

3. Exit the treatment room and launch the PVA Calibration at the TrueBeam workstation. Select Imager
Calibration major mode, log in when prompted. See Figure 3.

5 5

Figure 3: Major Mode Selection → Login

4. If you have more than one Service External Beam right, the following screen is displayed. Select the
service right to be used for the session and click Continue to proceed. See Figure 4.

Figure 4: Select User Privileges for the Session

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5. Verify the state of the system and then click Continue when done. See Figure 5.

Figure 5: System Status Summary

6. Confirm the following warning by clicking Continue. See Figure 6.

Figure 6: Service Mode Warning

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7. PVA Calibration application will be displayed on the imaging monitor, on the right hand side. The
application will be in Summary View showing all available calibrations. See Figure 7.

Figure 7: PVA Calibration Application, Summary View

8. LMC the Optical Camera Calibration box in Geometry column. Then click Details button on the top
of PVA Calibration application. See Figure 8.

5 5

Figure 8: Optical Camera Calibration Selected in Summary View

9. Then select the Status box for Optical Camera Calibration and click Calibrate button to initiate the
calibration. Alternatively, you can double-click the Status box for the Optical Camera Calibration to
open the calibration wizard and start the calibration process. See Figure 9.

Figure 9: Details View, Optical Camera Calibration Selected, Calibrate Button

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10. Calibration wizard opens and the marker position will be displayed on the dashboard. Decide whether
to Accept or Decline. See Figure 10.

5

Figure 10: Optical Camera Calibration Final Results, Accept or Decline

11. After accepting or declining the results, the calibration wizard will close.

Tip: If the camera is unable to detect the marker block, the Accept button is
disabled and the marker block position will be displayed in red color:

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5 5

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Power Up, Shut Down, Recovery, Power-Cycle TAB 6

Power Up, Shut Down

Daily, Weekly Power-Cycle

Recovery after Emergency Stop

Power Up from a Complete Power Off

CTB-GE-791 (TrueBeam Power Up Instructions)

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FOR TRAINING PURPOSES ONLY
Power Up / Shut Down

Morning Power Up / Evening Shut Down

Procedure

Objectives
After completing this procedure the student will have learned how to:

1. power up the machine from Standby state in the morning.

2. shut down the machine to Standby state at the end of the work day.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 3.

P1005922-001-A – TrueBeam Instructions for Use, chapters 3, 13.

6 6

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Power Up / Shut Down

A. Power up the machine from Standby state

1. Turn on the monitors in the treatment room and in the console area, if turned off for night.

2. At the control console insert the key to unlock it. See Figure 1.

6

Figure 1: Unlocking the Control Console

Note: The machine can be configured to automatically transition to ON on

selected days and time in System Administration → Service Preferences
tab. If that is the case, the machine already may be ON and further steps of
this start-up procedure can be skipped.
If auto power on is enabled, an audible alarm sounds once a minute for
several minutes leading up to the power actually coming on to warn people in
the area. If the treatment door is open, auto power on is disabled and
machine has to be powered on using MPC, Treatment, Machine QA or
Service mode.

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Power Up / Shut Down

3. Check the machine power state on the Select Major Mode screen. See Figure 2.

Standby state

Figure 2: Select Major Mode Screen

4. If MPC mode is going to be used first to check the machine performance, choose MPC and login
when prompted. If Treatment application is going to be used, choose Treatment, login when
prompted. See Figure 2.

6 5. When the selected major mode opens, the current machine power state is clearly indicated on 6
machine state panel. See Figure 3 and Figure 4.

Figure 3: MPC Application in Power Saver (Standby) Mode

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Power Up / Shut Down

Figure 4: Treatment Application in Standby Mode

6. Click Tools button in lower left corner and then choose Power Saver / Standby option.
See Figure 5 and Figure 6.
6

Figure 5: MPC Power Saver Menu in Tools

Figure 6: Treatment Power Saver Menu in Tools

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Power Up / Shut Down

7. System will require confirmation that you have been granted ‘Turn ON Treatment Machine’ right.
Enter your user name and password, and then click OK. See Figure 7.

Figure 7: Confirm Transition to Power On, Treatment Application (top), MPC (bottom)

8. Wait until the machine is ready. Longest time required to wait is 12 minutes. It may be shorter ( 2
minutes shortest ) if the machine has been is standby mode less than 10 minutes.

6 6

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Power Up / Shut Down

B. Shut down the machine to Standby state

1. Enter the Treatment room and use the hand pendant to:

a) move the MV detector arm to the completely Retracted position.

b) move both kV arms to the Mid (Park) position. This position allows service personnel to access
items in the gantry, if necessary.

c) rotate the gantry to 120º (IEC61217). This position places the water flow sensors at a low point
on the gantry, and the MLC at a higher point which protects it from potential water damage.

d) rotate the collimator to 90º (IEC61217). In this position the MLC power supply is at high point,
protected from potential water damage and the MLC leaves are not pulled by gravity from or to
carriages.

2. Turn off the In-Room Monitors (optional) and then return to the console.

Important Note: Do not forget to close the door to the treatment room if the
system is configured for automatic transition to ON.

3. At the console, close the patient plan if open.

4. Close the active Major mode to return back to Select Major Mode screen - if Treatment mode is open,
click Change Mode button in the upper left corner of Treatment application; see Figure 8. 6

Alternatively, the machine can be

put to Standby state in the
Treatment application by clicking
Tools button and then choosing
Standby

Figure 8: Closing Treatment Mode, Change Mode Button

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Power Up / Shut Down

5. Click the green Power On button in the upper right corner of Select Major Mode screen, see Figure 9.
The button then changes to orange icon indicating that the system is in Standby state.

Power On state

Standby state

Figure 9: Select Major Mode, Power State Button
6 6
6. Turn off the CCTV and workstation monitors. (Optional)

7. If required by site security protocol, lock up the system to prevent un-authorized use:

a) lock the control console by turning the key to the vertical position (locked). Then remove the key
and place it in its designated location for overnight storage. See Figure 10.

Note: When the console is locked some functions such Emergency Stop
button and intercom controls still work. Beams and motions from the console
are not available. Machine can be moved inside using the hand pendant, if
necessary.

b) lock the console cabinets. Turn the key to the locked position. Then remove the key and place it
in its designated location for overnight storage.

c) if required, lock the gantry stand. Turn the key to the locked position. Then remove the key and
place it in its designated location for overnight storage.

d) lock the modulator cabinet. Turn the key to the locked position. Then remove the key and place it
in its designated location for overnight storage.

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Power Up / Shut Down

Note: The Modulator may or may not be inside the treatment room.

6

Figure 10: Locking the Control Console

Cabinet lock and key

Figure 11: Console Cabinet

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Power Up / Shut Down 8
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Standards and Content
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Power Up / Shut Down

Gantry stand lock and key

6 Figure 12: Gantry Stand

Modulator lock and key

Figure 13: Modulator

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Power Up / Shut Down 9
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Standards and Content
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Daily / Weekly Power-Cycle

Daily / Weekly Power-Cycle

Procedure

Objectives
After completing this procedure the student will have reviewed Varian recommended daily and weekly
power cycle procedures:

References:
P1007694-005-E – TrueBeam Customer Release Note, appendix A.

A. Overview
1. To ensure maximum performance, Varian recommends to power-cycle the TrueBeam workstations 6
as part of your daily and/or weekly routine.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Daily / Weekly Power-Cycle 1
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Standards and Content
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Daily / Weekly Power-Cycle

B. Treatment Workstation power-cycle

1. It is recommended to re-boot the TrueBeam treatment workstation daily at the end of the
treatment day.

2. Select Tools menu on the Select Major Mode screen and then click Restart. See Figure 1.

6 Figure 1: Tools → Restart

6
3. Enter the password ‘varian’ and then click OK. See Figure 2.

Figure 2: Enter Password

4. The workstation will restart and after several minutes the Select Major Mode screen will be available.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Daily / Weekly Power-Cycle 2
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Standards and Content
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Daily / Weekly Power-Cycle

C. IRM and CBCT Reconstructor workstations power-cycle

1. It is recommended to re-boot the IRM (In-Room Monitor) and CBCT Reconstructor
workstations once per week at the end of the treatment day.

2. Launch System Administration, log in (Edit External Beam General Preferences right is necessary).

3. Navigate to Tools → General. Then click Reboot IRM Now button. See Figure 3.

Check the reboot status here

Figure 3: System Administration → Tools → General

4. Select CBCT Reconstructor tab, then click Restart button. See Figure 4.

Green light indicates that the workstation is back on

Figure 4: CBCT Reconstructor

Tip: IRM workstation can be also restarted from inside the treatment room.
Use the mouse in the treatment room to navigate to Windows Start menu and
then select Restart.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Daily / Weekly Power-Cycle 3
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Recovery after Emergency Stop

Recovery after Emergency Stop

Procedure

Objectives
After completing this procedure the student will learned how to:

1. start up the machine after Emergency Stop in Treatment mode.

2. move the couch after Emergency Stop in Treatment mode.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 11.

P1005925-001-A – TrueBeam Administrators Guide, chapter 2.

6 6
A. Overview
1. Emergency Stop Buttons are located on these TrueBeam components:

a) Control Console.

b) Stand.

c) Couch.

d) Modulator Cabinet.

e) Owner-supplied Emergency Stop buttons and switches on the walls inside and outside the
treatment room.

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Recovery after Emergency Stop 1
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Standards and Content
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Recovery after Emergency Stop

2. Operation of Emergency Stop differs, depending on whether the TrueBeam is in Treatment mode or
not. See Table 1 for details. Main difference is whether the 24V power supply for the control system
remains on.

Power off to Power remains on to

Treatment mode

High-voltage input power to the modulator which 24 V power supply. Operates multiple PCB
stops any motion or beam including node electronics and SPV

Most AC power to the treatment room Control Console

AC fans Console area computers

Closed-circuit television (CCTV) system

Intercom system

In-Room monitors

Control power throughout the system ( for

example to couch emergency controls )

kV detector

CBCT and XI nodes 6

Some fans

Not in Treatment mode

Most components including the 24V power Control Console

supplies. That includes power to control system
PCBs including node electronics and SPV

Cooling fans Console area workstation computers

Closed-circuit television (CCTV) system

In-Room monitors

Emergency Stop power supply

kV detector

CBCT and XI nodes

Table 1: Results of Pressing Emergency Stop in Treatment and Service Modes

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 2
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pg 445 DCID:
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Recovery after Emergency Stop

Warning: The Emergency Disconnect Switch (or button), located on the main
circuit breaker panel on a wall inside or outside the treatment room, shuts off
all the power to the TrueBeam system. Use the switch only during an
emergency, such as fire, smoke or any catastrophic situation. The switch
shuts off power to UPS and all incoming power to the system including main
circuit breaker, all components including console area computers. DO NOT
test the Emergency Disconnect Switch when computers are on to prevent
data corruption and damage to the computer operating system.
P1005925-001-A – TrueBeam Administrators Guide, page 23.

6 6

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Recovery after Emergency Stop 3
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Recovery after Emergency Stop

B. Startup after Emergency Stop in the Treatment mode

1. When an Emergency Stop button is pressed any motion and beam stop immediately.

2. Enter the treatment room and evacuate the patient. Emergency controls on couch side panels should
be illuminated. See Figure 1. Use the Motion Enable and Emergency Down buttons to lower the
couch. Use Emergency Float and couch handles to move couch laterally and longitudinally.

Emergency Float, releases the

brakes on both the lateral and
longitudinal axes.

Motion Enable Emergency Down

6

Figure 1: Couch Emergency Controls

Tip: The emergency controls use an Uninterruptible Power Supply (UPS) that
supplies emergency power to the couch for 10 minutes only. To ensure
patient safety you must lower the couch within 10 minutes.

In the event of a combination of circumstances that renders the couch

emergency controls inoperative, you can use a hand crank to lower the couch
so that you can evacuate the patient.

Caution: Move the couch slowly and carefully to avoid jolting the patient or
damaging the couch. The Emergency Float button releases both the lateral
and longitudinal axes at the same time; do not lean on the lateral couch to
avoid pushing the couch unexpectedly into the collimator or imagers and
injuring the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 255.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 4
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Recovery after Emergency Stop

3. Depending upon which Emergency Stop button was pressed, either press the Emergency Stop button
again or pull the button out.

4. If the Emergency Stop was pressed accidentally, EMO status LEDs in control cabinet can be used to
identify the Emergency Stop button pressed. See Figure 2 and explanation below.

Emergency Stop on the

console pressed example

Figure 2: EMO Status LED
6 6
a) EMO PS ON - Emergency Off Power Supply On, this will be illuminated when the emergency
controls on the couch side panel are available.

b) Live 24V – EMO 24V source, protected by a 0.9A polyfuse.

c) EMO CONTROL CONSOLE, EMO STAND, EMO CCH, EMO ROOM LEDs indicate which
Emergency Stop button is pressed. Because Emergency Off buttons are connected in series the
first LED off indicates which button is depressed.

 EMO CONTROL CONSOLE - not illuminated if the Emergency Stop button is pressed on the
control console.

 EMO STAND - not illuminated if the Emergency Stop button is pressed on the gantry stand of
the machine.

 EMO CCH - not illuminated if the Emergency Stop button is pressed on the couch.

 EMO ROOM - not illuminated if the Emergency Stop button is pressed on the walls of the
room.

d) EMO GOOD - Emergency Off Good, will become illuminated once the green Start button in
modulator has been pressed.

e) 24V IN - Indicates if 24V power supply for the control system electronics is available. Should stay
on, if Emergency Stop is pressed in Treatment mode.

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Recovery after Emergency Stop 5
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Standards and Content
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Recovery after Emergency Stop

5. Record the delivered dose from the Backup MU Counter on the control console in case power is lost
and partial treatment cannot be saved or the system is not able to recover using recovery session.

6. Close the plan and patient at the console. Click Close Patient button. See Figure 3.

6
Figure 3: Emergency Stop Pressed

7. Sign-off the partial treatment. See Figure 4. Click OK once you have entered your user name and
password.

Figure 4: Incomplete Treatment Session Sign-off

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 6
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Standards and Content
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Recovery after Emergency Stop

8. Choose the appropriate locking option if required, see Figure 5. Click OK when done.

Figure 5: Locking Options

9. Press the green Start button in the modulator. The modulator for the machine may or may not be in
the treatment room. See Figure 6.

6 6

Start button

Figure 6: Start Button in the Modulator

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 7
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Standards and Content
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Recovery after Emergency Stop

10. Check the EMO Status LEDs in the control cabinet. Before you proceed to next step, make sure
all the LEDs are illuminated. See Figure 7.

Important Note: If EMO GOOD LED is not on and Treatment application is

closed, 24V IN power supply for the control system electronics will be
switched off. In such a case all machine axes will need to be re-initialized.

6

Figure 7: Power State Good

11. Check the main circuit breaker. If the breaker has been tripped, reset the switch.

12. Click Change Mode button on top of the Treatment application. See Figure 8.

Figure 8: Change Mode Button

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Recovery after Emergency Stop 8
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pg 451 DCID:
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Standards and Content
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Recovery after Emergency Stop

13. Select Initialize mode on Select Major Mode screen. See Figure 9.

Figure 9: Select Major Mode → Initialize

Note: The system power state may be Power Off or Standby depending on
how much time has passed since the Start button was pressed. The system
automatically transitions from Power Off to Standby.

14. Click Acknowledge button to clear all faults. It may be necessary to click the Acknowledge button
several times to successfully clear all faults. See Figure 10.
6 6

Figure 10: Initialization Wizard → Acknowledge Button

15. Click Start Initialization button to initialize the MLC. See Figure 11.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 9
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pg 452 DCID:
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Standards and Content
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Recovery after Emergency Stop

Figure 11: Start Initialization

16. Sign-off transition to ON. Enter your user name and password and then click OK. See Figure 12.

Figure 12: Sign-off Transition to ON

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 10
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Recovery after Emergency Stop

Note: If the gantry is not at the position required for initialization the following
message appears, see Figure 13. Click OK to close the message. Enter the
treatment room, press one of Collision Reset buttons and move gantry to requested
position. Then click Start Initialization in Initialize mode again.

6 6

Figure 13: Gantry not at the Required Position.

17. Wait until the initialization is complete. Do not close the Initialize mode while initialization is in
progress. If necessary, initialization can be restarted by clicking Cancel Initialization and then Start
Initialization button. See Figure 14.

Figure 14: Initialization in Progress

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Recovery after Emergency Stop 11
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Recovery after Emergency Stop

18. Click Change Mode button to close the Initialize mode and return to Select Major Mode screen. The
system has just recovered from emergency stop. See Figure 15.

Time Delay

Figure 15: Initialize Mode → Change Mode Button
6
19. Treatment mode can be opened and the partial treatment can be now completed. The machine still
may need some time to warm up (Time Delay).

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Recovery after Emergency Stop 12
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Standards and Content
Document Version 1.0 Revised [01/01/2001]
Power Up from a Complete Power Off

Power Up from a Complete Power Off

Procedure

Objectives
Inform the student that a Customer Technical Bulletin exists for the TrueBeam system with instructions
how to power up the TrueBeam system from a complete power off state.

References:
CTB-GE-791-C - Power On Instructions for TrueBeam™, TrueBeam™ STx, Edge™ and VitalBeam™
Linear Accelerators.

A. Overview
6 6
1. Customer Technical Bulletin CTB-GE-791 is available to TrueBeam users. The CTB describes the
steps to power up the TrueBeam from a complete power off state.

2. There may be a newer version of the CTB available at MyVarian.com.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

Power Up from a Complete Power Off 1
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pg 456 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Customer
Technical Bulletin
CTB Information
TM TM TM TM
Title Power On Instructions for TrueBeam , TrueBeam STx, Edge , and VitalBeam
Linear Accelerators
DWG Number 100052134 CTB GE-791
Complaint No. N/A Est. Labor Hrs 30 minutes
TM TM TM
Purpose This CTB describes the steps to power on TrueBeam , TrueBeam STx, Edge
TM
Radiosurgery System, and VitalBeam linear accelerators from a complete power off state.
Product Product Code: H19 Product Name: TrueBeam, TrueBeam STx, Edge, VitalBeam
Code(s)
Affected
Prerequisites NA
AN UPDATE TO THIS CTB MAY BE AVAILABLE ON MY.VARIAN.COM

Tools Information

Tools and NA
Equip
Reference TrueBeam Instructions for Use (TrueBeam, TrueBeam STx, Edge Radiosurgery System);
Documents VitalBeam Instructions for Use
Modification • Powering on the TrueBeam platform and VitalBeam platform consoles
Overview •
TM
Initial TrueBeam™, Truebeam STx, edge™, and VitalBeam™ Powerup
• Performance/ System Verification

Order Kit Information

Order Number Description 6

100052134 NA
Order From: CSS Logistics MY.VARIAN.COM Not Applicable

Revision Information

REV DATE AUTHOR NAME DESCRIPTION OF CHANGE FILE NAME

A December 10, 2010 Ruth Connolly Initial Release CTB-GE-791-A.pdf

B December 17, 2010 Ruth Connolly Clarification of Instructions CTB-GE-791-B.pdf

TM TM
Inclusion of Edge and VitalBeam ; Inclusion of additional
C August 15, 2015 Ruth Connolly CTB-GE-791-C.pdf
screenshots

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no representation to the qualifications of any service technicians other than its own employees. Improper or
uninformed maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including but not limited to one or more of the following: mechanical collision, electrical shock, and radiation.
Any of these hazards could cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved.
SHEET

1 OF 13
100052134 C
DWG NO. REVISION

Format TMP-GE-CTB Rev S

© Varian Medical Systems TrueBeam 2.5 Administration and Physics
For education purposes only pg 457 DCID: TB2.5-CEM-02-B
Customer Technical Bulletin

GENERAL INFORMATION

Read this entire document, carefully reviewing all instructions. If there are tasks identified in this document
that you are unable to complete, please contact Varian Service for assistance.

PERFORMANCE CHECK

Complete a thorough performance verification before disassembling and modifying any system. Make a
note of any operational discrepancies.

SAFETY PROCEDURES

Become familiar with Customer Support Service’s safety policies before working on Oncology Systems
Products. Ensure compliance with CSS’s safety practices and procedures while performing this
modification. Refer to the Product Users’ Manual for safety instructions.

CONTACT INFORMATION

If there are any questions, issues, or concerns contact Varian at 1.888.VARIAN.5 (1.888.827.4265) or go
to http://my.varian.com and click on Contact Us.

6 6

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
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of 13
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 458 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

1. INTRODUCTION

The following procedures are outlined in this Customer Technical Bulletin and should be provided
to all TrueBeamTM, TrueBeamTM STx, EdgeTM, and VitalBeamTM customers.
• Powering on the TrueBeam platform and VitalBeam platform consoles
• Initial linear accelerator power on.

CAUTION If this procedure is being performed for demonstration or test purposes, the
TM
following steps must be taken to ensure safety of the TrueBeam platform and
TM
VitalBeam platform equipment.
1. Turn off the following computers by momentarily pressing the power
button on each of them.
a. Treatment/TrueBeam Workstation
b. In Room Monitor (IRM) Workstation
c. QA/ OSP/ Service Workstation
d. CBCT Workstation
2. If the computer is a Dell R200, you will notice a flashing blue light on the
computer power button when it is powered off.
3. It is now safe to press the Emergency Disconnect Button on the main
breaker panel
a. If this is a TrueBeam or VitalBeam GE breaker panel, the
Emergency Disconnect Button will be a large red button in the 6
center of the panel.
4. Once the Emergency Disconnect button has been pressed, please wait 40
seconds before releasing the button (the switch should latch in the off
position). The Uninterruptible Power Supply (UPS) needs to be powered
down completely before releasing the Emergency Disconnect Button on
the Main breaker panel.
5. Confirm the UPS has been completely powered off by observing that there
are no indicator lights on the front of the UPS. Once this has been
confirmed you may safely proceed to step 2.1 in the procedure outlined
below.

2. POWERING UP TRUEBEAMTM, TRUEBEAMTM STX, EDGETM, AND VITALBEAMTM CONSOLES

AFTER EMERGENCY DISCONNECT

2.1. Release the Emergency Disconnect switch on the Main Circuit Breaker Panel or other site
specific disconnect device if not using the Varian recommended Main Circuit Breaker
Panel.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
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of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 459 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

TM
Note The Emergency Disconnect switch is commonly a red button. On a TrueBeam or
M
VitalBeamT GE Breaker Panel, this red button must be turned a quarter turn clockwise
to release.

2.2. This should turn on one or more green lights (LEDs) on the UPS if power is available. This
may take up to 10 seconds.

Note There are two brands of UPS in use with TrueBeam and VitalBeam platform linear
accelerators: IBM and Eaton. Figures are provided for both of these brands.

2.3. Turn on the UPS by pressing the power button for several seconds until the UPS powers
on.

2.3.1. For the IBM UPS, use the power button in the upper right corner of the UPS front
panel to power on the UPS.

6 6

Figure 1- IBM UPS Power On Button

2.3.2. For the Eaton UPS, model 5130, the power button is the large middle button.

Figure 2 – Eaton UPS Model 5130 Power On Button

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
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of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 460 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

2.3.3. For the Eaton UPS, model 5PX, the power button is located on the lower right side.

Figure 3 – Eaton 5PX 3000 UPS Power on Button

2.4. Confirm that the following computers are automatically turned on. (Blue LEDs will illuminate
on the corresponding workstations in the console cabinets).

1. Treatment/ TrueBeam Workstation

2. In Room Monitor (IRM) Workstation

3. QA/OSP/ Service Workstation

4. CBCT Workstation
6

Figure 4 – Workstations in the Two Cabinet Configuration

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
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of 13
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 461 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

6 6

Figure 5 – Workstations in the Tall Cabinet Console

Note If the procedure is being performed as part of the demonstration or test, and you have
manually turned off the above computers, you will need to turn them back on by using
their individual power buttons located on the front of each computer.

Note You may have a power ware message display on either the Treatment or Imaging
monitor. It is OK to clear this message and continue.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
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of 13
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 462 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

3. INITIAL TRUEBEAM™, TRUEBEAMTM STX, EDGE™, AND VITALBEAM™ POWERUP

3.1. Check the EMO LEDs on the front of the Console Cabinet.

Figure 6 – Console Cabinet LEDs before the Modulator Start Button is Pressed.

3.2. All the EMO switch LEDs should be lit if the EMO line is closed. "EMO good" and "24V IN"
will not light at this point.
6
3.3. Open the front right door of the modulator and press the green start button. The square
green start button on the TrueBeam Main Circuit Panel will illuminate.

Note In some installations, the system may have been configured to start using the green
start button on the TrueBeam or VitalBeam Main Circuit panel. If this is the case, you
will not press the green start button on the Modulator.

3.4. Check the "EMO Good" LEDs on the front of the Console Treatment Cabinet are lit. If the
"EMO Good" LED does not light, check that the EMOs on the Modulator are all pulled out.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
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DWG NO.
Rev C
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of 13
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 463 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

Figure 7– Console Cabinet LEDs after Modulator Start Button is pressed.

3.5. Verify the "24 Volts In" LED is lit.

3.6. The system may take a few minutes to reset. The Major Mode screen will display a blue
question mark in the upper right corner indicating that the Supervisor has not yet re-
established communication with the treatment workstation.

6 6

Figure 8 – Power On System State

(Note: Figure may not be exact and is used as a reference)

3.7. Once the supervisor has re-established communication with the treatment workstation, a
white circle with a dark blue background will display in the upper right corner of the Major
Mode Screen.

3.8. As the system powers on, the user may briefly hear the noise of the control system booting
at the treatment console intercom. This is expected as the intercom is active during the
power up.

Note It may take up to 5 minutes for the system to fully power on. During this time, do not
rotate the gantry or select anything on the Major Mode screen. If the system hasn't
powered on after 5 minutes, please contact your Varian Service Representative for
assistance.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and8Physics
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 464 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

3.9. Choose Initialize from the Major Mode Screen.

Figure 9 - Major Mode Selection

(Note: Figure may not be exact and is used as a reference)

3.10. When the initialization screen appears, press Acknowledge.

Figure 10 - Initialization Mode

(Note: Figure may not be exact and is used as a reference)

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and9Physics
of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 465 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

3.11. Acknowledging and clearing faults requires appropriate user rights.

Figure 11 – Initialization Mode with Fault Sign Off.

6 6
3.12. The machine will transition from a power off state to Standby state.

Figure 12 – Initialization Mode – Standby

3.13. Wait 15 seconds and then press Acknowledge again to clear remaining faults. It may
require more than two acknowledgements to clear all faults if you do not wait 15 seconds
between acknowledging faults.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and10Physics
of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 466 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

Figure 13– Initialization Mode 6

Note If any major faults are present at this point and cannot be cleared, please contact your
Varian Service Representative for assistance.

3.14. In the treatment room, push the collision reset button on the couch side panel or on the
gantry head.

3.15. Ensure that the Gantry is at 0 degrees (IEC Scale)

3.16. When all the faults are clear, click Start Initialization. The machine will transition to the On
state and axis initialization will begin.

Figure 14 – Start Initialization

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and11Physics
of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 467 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

Figure 15– Initialization Mode

Note Minor faults may display during the initialization process. These will only affect the
6 initialization process if they impact motion. If you have motion failures during
initialization, please contact your Varian Service Representative.
6

3.17. Follow the prompts within the Initialization wizard to complete initialization of all axes. Refer
to the TrueBeamTM System and VitalBeamTM Instructions for Use manuals for further
details.

If you need help performing these instructions, please contact your Varian Service Representative
and they will be able to assist you.

4. PERFORMANCE/ SYSTEM VERIFICATION

Verification of beam accuracy is a customer responsibility. Please adhere to your departmental
guidelines for beam quality checks and routine Quality Assurance procedures.

5. CUSTOMER DOCUMENTATION
This document and the latest version of the instructions for use are available for download at
https://my.varian.com.

This CTB includes new information not available in other Varian documents. Please advise the
appropriate personnel working in your radiotherapy department of the content of this CTB and
place a copy of this CTB with the user manuals for the affected Varian Product.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and12Physics
of 13
For education purposes only
cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 468 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
Customer Technical Bulletin

Bill Of Materials

-01 Part Number Description

- N/A -

Drawing or
Other Documents Included
Document Number
1 100052134 CTB-GE-791 TrueBeamTM System Power On Instructions.

ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100052134
© Varian Medical Systems
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
GE-791
TrueBeam
DWG NO.
Rev C
2.5 Administration and13Physics
of 13
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cause serious injury and even death. Copyright © 2015, Varian Medical Systems, Inc. All rights reserved. pg 469 DCID: TB2.5-CEM-02-B
Format TMP-GE-CTB Rev S
6 6

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education purposes only pg 470 DCID: TB2.5-CEM-02-B
Treatment and Imaging Applications TAB 7

Treatment Application Overview

Imaging Procedures Overview

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

For education
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Medical Systems, only
Inc. All rights reserved.
pg 471 DCID: TB2.5-CEM-02-B
FOR TRAINING PURPOSES ONLY
Treatment Application Overview

Treatment Application Overview

Procedure

Objectives
After completing this procedure the student will have reviewed

1. Treatment application GUI and settings.

2. Similarities and differences among various Treatment application modes.

Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

7 7
References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 5.

© Varian Medical Systems TrueBeam 2.5 Administration and Physics

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Treatment Application Overview

A. Treatment application
1. The Treatment application consists of the following sections, see Figure 1.

Mode and Submode Routine Interlocks Live View Status Messages

Operator prompt &

Beam state indicator

Session Area

Field buttons

7
Taskbar Beam Parameters & Geometry Parameters & Beam’s Eye View &
Accessories Tolerances MLC controls

Figure 1: Treatment Application Screen

2. Session area: shows patient and dose information, lists treatment and imaging (setup) fields in the
order in which they are to be delivered; includes Field buttons to perform operations on the fields.

a) Patient and dose information can be shown or hidden as needed, see Figure 2.

Patient picture

Figure 2: Patient and Dose Information

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Treatment Application Overview

b) The Field list includes the following information, see Figure 3 and Table 1 for more details.

Plan ID Fraction

Actual / Plan MU
Treatment field
Active Field

Imaging icons

Setup note

Setup field

Field ID - name

7 7
Field buttons

Figure 3: Session Area, Field List

Icon Description

Treatment field; depicts gantry position rounded to multiples

of 45°

Setup field; depicts imaging source position rounded to

multiples of 45°

Imaging icons – single MV, single kV, MV film, CBCT,

MV/MV pair, MV/kV pair, kV/kV pair

Machine override performed, Invalid field parameter, Field

delivered, Setup note, Automation, Deactivated field
Table 1: Icons in Session Area

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Treatment Application Overview

c) Session area also provides Reorder, Deactivate, Add, Remove buttons:

 Reorder – provides a dialog box that allows changing the field order. The fields can be
reordered using the buttons on the dialog box or by dragging and dropping the fields with
mouse. Operation requires a sign-off with ‘Update Plan Parameters’ user right. See Figure 4.

drag & drop the

selected field(s)

Figure 4: Reordering the Fields

 Deactivate – allows the operator to deactivate the selected field. Field deactivation may 7
require sign-off with ‘Deactivate/Activate Treatment Field’ right, if enabled in System
Administration. See Figure 5.

Deactivated field

Figure 5: Deactivating the Field, Deactivated Field

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 Add – provides the options to add Imaging to selected field or plan, Automation to plan. Add
New Field can be used to create and ad-hoc plan. See Figure 6 and Figure 7.

Figure 6: Adding Automation, Automation Added

Note: Automation can only be used with fields that have the same couch
positions, energy mode and nominal dose rate. Fields with imaging cannot be
automated. Maximum number of the fields that can be grouped is variable –
All grouped / automated fields must have less than the maximum of 5000
control points together.

7 7

Figure 7: Adding MV Film

Tip: See Imaging procedures overview and Unplanned treatment in this

training manual for more information on Add Imaging and Add New Field
options.

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 Remove – provides the options to remove what has been previously added to field / plan.
See Figure 8.

Figure 8: Remove Menu

Tip: Imaging procedures can be removed from the fields after all necessary
imaging has been done, to allow automated plan delivery.

d) Any faults preventing the system from functioning are displayed below the session area. Use the
tooltip to see more information. Acknowledge button can be used to clear inactive faults. Sign-off
with appropriate rights may be required. See Figure 9 and Table 2.

Severity indicator

Tooltip
7

Figure 9: Faults in Treatment Application

Icon Description

Minor Fault; Inactive and Active

Major fault; Inactive and Active

Table 2: Fault Icons

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Treatment Application Overview

3. Taskbar: provides control buttons to carry out various tasks. Tools button provides multiple options
and is available even if there is no patient / plan opened to allow some more generic tasks.

a) Tools button provides the following options, see Figure 10:

Machine is ON Machine in Standby

Figure 10: Tools Menu, with Plan Opened (left), no Plan Opened (right)

 File Mode – Treatment application mode that allows the operator to load a DICOM plan file.
Plans to be delivered in file mode should be placed on the shared network drive, typically
\\<myserver>\va_transfer\RTPlans. File mode is useful when the information system is not
available for some reason, or when the patient cannot be opened the normal way.

 Record and Verify Mode – default Treatment application operation mode. It provides an
access to Queue application; operator can then select a patient and plan(s) to be delivered.
Plan information is then loaded from hospital’s Record & Verify system.
7 7
 Standby – this menu allows the operation to change the machine power state from Standby
to On or from On to Standby. See Figure 11. Transition from Standby to On requires a sign-
off with ‘Turn ON Treatment Machine’ right. Checkmark indicates the current power state, see
Figure 10.

Standby → ON

ON → Standby

Figure 11: Changing Machine Power State in Treatment Mode

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Treatment Application Overview

 Live View Calibration – a step-by-step wizard used to calibrate the live view. It ensures that
the live overlays showing motions and collisions are of proper size and position.

 Enable Disable Axes Motion - provides a dialog box that the operator can use to disable /
enable motions for some of the machine axes. Disabled axes cannot be moved from any
controller that normally would allow motions; a lock will be displayed next to the disabled
axes. The setting stays in effect even when Treatment mode is closed. See Figure 12.

Disabled axes

Figure 12: Enable / Disable Axes Motion Dialog (left), Disabled Axes with Lock (right)

 Motion Management Devices – provides a dialog box that the operator can use to select
Patient Position Monitoring and Respiratory Gating Devices for the plan. The settings
can be applied permanently or for the active session only. Gating devices can be selected for
Gating Enabled plans only. See Figure 13.
The dialog opens automatically on the first day of treatment for any plan if a Patient Position
Monitoring Device has been enabled in System Administration, otherwise for gating –
enabled plans only. It will also open on subsequent session if the devices have been 7
previously applies for session only.

Figure 13: Motion Management Devices Dialog

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Treatment Application Overview

 Sign Off Primary User – signs-off the user that has logged-in when opening Treatment
mode; allows someone else to log-in without closing and re-opening the Treatment mode.

 Allow Clearance Override – provides a dialog box that the operator can use to override
machine and patient protection systems for the currently opened plan. See Figure 14.
Overriding the protection systems requires ‘Override Patient Protection’ user right.

Figure 14: Allow Clearance Override Dialog

 Override Couch Tolerance – provides a dialog box that the operator can use to override
internal couch tolerance and allow continuation of a treatment with heavy patient on Perfect
Pitch where IPSN interlock is asserted and cannot be cleared. See Figure 15.
‘Override Setup Correction Threshold’ right is needed to sign off the override. This menu is
7 only available in Tools if ‘Override Couch Tolerance’ in System Administration → Treatment 7
→ Clinical is set to Yes.

Figure 15: Override Couch Tolerance

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Treatment Application Overview

 Reconnect nodes – allows an attempt the re-connect the control system node that got
momentarily disconnected.

 Auto Field Sequencing – whether next field is automatically selected after the previous field
has been delivered. This menu is inactive in Treatment mode and the auto field sequencing is
always on. Menu is only active in Machine QA / Plan QA modes.

b) Notes: provides access to field, plan, appointment and setup notes, field photos and actual SSD.
‘Update Plan Parameters’ right is required to make changes. The dialog has two tabs – Setup
Notes and Photos and Treatment Notes and SSD. See Figure 16 and Figure 17.

Figure 16: Setup Notes and Field Photos

Figure 17: Treatment Notes and SSD

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Treatment Application Overview

c) Open Patient or Open Plan or Close Plan: The caption of the button varies depending on
Treatment application mode and if plan has been opened:

 The button reads Open Patient when Treatment application is in Record and Verify Mode
and no plan has been loaded. It opens Queue. Plan can be opened for Treatment (Treat
button) or QA (QA button, Plan QA mode), see Figure 18.

7 7
Patient preview

Selected patient

Available courses
and plans
Patient List

Figure 18: Open Patient → Queue

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 The button reads Open Plan when in File Mode; it opens a dialog that allows the operator to
choose a DICOM RT Plan file to load. See Figure 19.

Access to network shared

drive mapped as I: on the
TrueBeam workstation
7

Figure 19: Open DICOM RT Plan File

 The button reads Close Plan when plan has been loaded and it allows the operator to close
the opened plan. Sign-off may be required if enabled in System Administration.

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Treatment Application Overview

4. Geometry Parameters: shows actual and plan positions for machine mechanical axes. Orange
background means that difference between actual and planned value is greater than allowed by the
tolerance table. Hover over the next tolerance table to see the tolerance values. See Figure 20.

Tolerance values

Out of tolerance
parameters

Figure 20: Geometry Parameters

a) Acquire – can be used to acquire actual couch position values from the machine. Click Acquire,
check the parameters to acquire and click Apply. Sign-off the action with ‘Update Plan
Parameter’s right and then decide what fields the acquired parameter will be applied to.
See Figure 21.
7 7

Figure 21: Acquiring Couch Values

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b) Edit – can be used to manually edit couch values. Availability depends on OSP couch locking
setting. See Figure 22.

Figure 22: Editing Couch Values

c) GoTo – allows the operator to move the machine axes to position other than required by the plan.
Click GoTo, set the new position(s) and click Apply. Use Motion Selection buttons highlighted in
orange on the control console to select the axes to be moved. Then press Motion Enable
buttons and hold them down until all selected axes have reached the entered positions. Click
Done when done. See Figure 23.

Green arrow indicates that the Apply

button has already been pressed and
the request to move (gantry) has
been sent to console

Figure 23: Using GoTo

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Treatment Application Overview 14
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Treatment Application Overview

d) Override / Machine Override – Machine Override may appear right after a plan has been loaded
in case that the machine ID in the plan is different from the actual machine ID, defined in System
Administration. Machine Override has to be clicked to allow plan delivery. See Figure 24.

Figure 24: Machine Override

Override – the button appears after the Prepare button on the console has been pressed in case
that some of the geometry values are out of the tolerance. It allows overriding this mismatch
(IPSN interlock) and treating the plan with parameters different than in the plan. Click the
7 Override button and check the parameters to be overridden. Then sign-off with appropriate rights 7
(may need to be done several times as different parameters may require different override right)
Couch values may be overridden for multiple fields. See Figure 25.

Figure 25: Overriding Plan Parameters

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Treatment Application Overview 15
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Treatment Application Overview

5. Beam’s Eye View: shows the MLC shape preview, positions of the jaws and CIAO. The preview can
be displayed using one of the magnifications (Normal, Zoom). The section also includes buttons to
manipulate the MLC and it shows the MLC delivery technique. See Figure 26.

Complete irradiated
area outline (CIAO)

Move to CIAO Retract MLC

Go to plan

Figure 26: Beam’s Eye View

a) View – opens Graphical Field Editor in the Imaging application in read-only mode. It allows
playing leaf motions. Click Done on the bottom of the screen to close the view. See Figure 27.

b) Edit – opens Graphical Field Editor in the Imaging application. It contains tools to modify the MLC
shapes; allows moving the leaves manually with the mouse. Edit (MLC) button is only active for
ad-hoc plans created in the Treatment application on-the-fly. 7

Display options

Animation player

Figure 27: Field View and Editor

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Treatment Application Overview

6. Routine Interlocks: shows active routine interlocks. See Table 3 for more details.

Tip: Mouse over the interlock picture gives a quick tooltip:

Icon Meaning Action

Accessory – There is a problem Make sure that all required accessories have been
with accessory inserted and correctly.

Beam – The system is not ready Check using the tooltip. If no beam has been loaded,
for MV beam load one now by selecting a field and pressing Prepare
button.

Collimator – The MLC, jaws or Check using the tooltip. Initialize the collimator
collimator not initialized components that need to be initialized.

Collision – The system software Check using the tooltip.

has detected that a collision
occurred or is possible
7 7
Couch – The couch has been left Return to the treatment room and deactivate the Float
in Float mode mode.

Busy – The machine is performing Wait. Check the tooltip to see what machine is doing.
an internal function that requires a
longer time

Door – The door to the treatment Verify that the door is shut securely and that the door
room is open shut indicator is working.

Imager – One of the imaging arms Check using the tooltip. Initialize the imaging arm that
has not been initialized needs to be initialized.

IPSN, Actual ≠ Plan – The Move the couch, gantry, collimator or imagers until the
planned and actual values are not values are within treatment tolerance. Mismatch can be
in tolerance overridden if operator has the appropriate rights.

Lock – The key in the control Turn the key to unlocked position.
console is in the locked position

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Treatment Application Overview

Icon Meaning Action

Pendant – One of the hand Verify that both pendants have been returned to their
pendants has not been hung up hooks.
properly.

Workstation – Workstation is Check using the tooltip, task may require confirmation /
busy with another task additional action from user.
Table 3: Routine Interlocks

7. Live View Window: used to monitor the patient and machine during the treatment. The view includes
live animated overlays showing axes moving to plan (orange arrows) and axes moving dynamically
during the treatment (blue arrows). It also shows collision warnings and imminent collisions detected
by one of the protection systems. See Figure 28 and Figure 29.

Roll & Pitch indicators

7
Figure 28: Orange Arrows for Motions to Plan, Blue Arrows for Motions During

Figure 29: Collision Warning (left), Imminent Collision (right)

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Treatment Application Overview

8. Status Messages: this section shows the messages informing the operator about the system state.
See Table 4 for more details.

Tip: Mouse over the status message gives a quick tooltip:

Icon Description

System is in Standby state. Choose Tools → Standby to start up the

machine. Requires sign-off with Turn ON Treatment machine right.

The system does not have the power, for instance Emergency Stop
button has been pressed. Follow Start up after Emergency Stop
procedure.

The Live View video feed is not available, or the view has not been
calibrated. Live View can be calibrated by choosing Tools → Live
View Calibration.
7 One of the required external subsystems is not connected. View the 7
tooltip for more information.

The machine is warming up. The display shows the approximate time
until the machine will be ready.

One of the communication channels between the machine and the

Treatment application is disconnected or otherwise affected. View the
tooltip for more information.

One of the machine protection systems is being overridden from the

console.

The system does not have power or some other condition needs
attention.

Patient protection system is not active.

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Treatment Application Overview

Icon Description

Machine protection system is not active.

Both machine and patient protection systems are inactive.

The system has not yet authorized a subsystem that is required for the
Treatment application to progress. View the tooltip for more
information.

Respiratory gating system has been overridden at the console for the
patient plan.

Collision triggered by touch guard.

Collision triggered by imaging arms.

Collision detected by machine protection system (3D machine motion

model).

Collision triggered by PRS (Pitch-Roll Stage).

7
Collision detected by patient protection system (Laser Guard II).

Table 4: System Status Messages

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Treatment Application Overview

B. Bolus verification
1. The operator at the treatment console may now manually verify the presence of a planned bolus.
When a bolus is included in the plan for a specific treatment field, the operator may now confirm, by
clicking a button and sign off, that the bolus was placed on the patient for the required treatment field
prior to beam on.

2. The manual bolus verification requires that

a) Bolus is added to a treatment plan field during the planning process.

b) Bolus Verification Device is to None in System Administration → Treatment → Advanced.

See Figure 30.

7 7

Figure 30: System Administration → Treatment → Advanced

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3. ‘Required’ appears in Bolus textbox when a plan is opened and the field with a bolus is selected.

Make sure the correct bolus has been placed on the patient and click . See Figure 31.

Treatment is interlocked
until the bolus is verified

Figure 31: Bolus Required 7
4. Enter your user name and password to confirm that the bolus has been placed on the patient and
click OK. ‘Override Accessory Verification’ right is required. See Figure 32.

Figure 32: Confirm Bolus Placement

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5. After a successful sign-off, the bolus is verified and the field can be delivered. See Figure 33.

7 7

Figure 33: Bolus Verified

Important Note: For fields that do not have a bolus, bolus removal has to be

confirmed. Click and then confirm that the bolus has been removed:

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Treatment Application Overview

C. Treatment application modes

1. There are several different Treatment application modes:

a) Treatment application in Record and Verify Mode, plan opened in Treat mode (R&V Mode).

b) Treatment application in Record and Verify Mode, plan opened in QA mode (Plan QA Mode).

c) Treatment application in File Mode (File Mode).

d) Machine QA mode = Treatment application in File Mode and QA mode (Machine QA).

2. The following Table 5 summarizes differences and similarities among the various treatment modes.
VP = Verification plan, TP = Treatment plan:

Feature \ Mode R&V Mode Plan QA Mode File Mode Machine QA

Opens plans from Yes Yes No No

Record & Verify

Opens DICOM RT No No Yes Yes

Plan file

Can treat treatment Yes Yes Yes Yes

plan

Can treat No Yes No Yes

verification plan

Acquire couch OSP couch Yes, when plan is OSP couch No – for TP, OSP
locking dependent being opened. locking dependent couch locking
7
Then: No – for dependent for VP
TP, OSP couch
dependent locking
for VP

Acquire gantry / No Yes, when plan is No No

collimator being opened

Add / Remove field Yes, I: drive No Yes, I: drive No

photos

Edit couch values OSP couch No – for TP, OSP OSP couch No – for TP, OSP
locking dependent couch locking locking dependent couch locking
dependent for VP dependent for VP

Auto field Yes, always on Selectable ad- Yes, always on Selectable ad-
sequencing hoc, default set in hoc, default set in
System Admin. System Admin.

Automation (also Yes Yes Yes Yes

for gated plans)

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Dry Run Yes Yes Yes Yes

Gating Yes Yes Yes Yes

Imaging & Yes, assuming all Yes, assuming all Yes, assuming all Yes, assuming all
matching * data required for data required for data required for data required for
the match is the match is the match is the match is
available* available* available* available*

Override couch for Yes Yes Yes Yes

multiple fields

Re-order fields Yes Yes – for VP Yes Yes – for VP

No – for TP No – for TP

Setup notes access Yes No Yes No

at console

Setup notes access Yes Yes Yes Yes

inside vault

GoTo for couch, No Yes No Yes

(Vrt, Lng, Lat, Rtn)

Unplanned Yes No No No
treatment

Repeat field No Yes No Yes

delivery
Table 5: Treatment Application Modes
7 7
Note: Gating is only available for plans that include set of DICOM tags that
enable gating. The DICOM tags are included in the plan when ‘Use Gated’
checkbox is enabled in Eclipse TPS, in plan properties dialog.

3. The modes that open plan(s) from the Record and Verify system database, save treatment
information back in the database. Plan QA mode does not record the delivered dose, hence the
treatment session delivered in Plan QA mode is not recorded in patient treatment record in Record
and Verify system.

4. The modes that open DICOM RT Plan file, save the treatment information including acquired images,
match (spatial registration) and gating data on the disk in DICOM format. If the plan is opened from
the I:drive, the data acquired during the session is saved in the folder where the opened plan resides,
in a subfolder named YY-MM-DD_HH-MM-SS. In addition, the File Mode also records the delivered
dose, hence the fields’ Treatment Record DICOM files are saved for sessions delivered in File Mode
and can be found in \\<myserver>\va_transfer\TDS\<machineID>\Treatment folder. These files are
named RT_PatientFirstName_PatientLastName_UID.dcm.

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Imaging Procedures Overview

Imaging Procedures Overview

Procedure

Objectives
After completing this procedure the student will have reviewed imaging procedures available on
TrueBeam.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapter 7.

A. Adding / Removing Imaging procedures

1. In order to take an image for a field an Imaging Procedure has to be attached to that field.

2. There are two ways of scheduling Imaging Procedures to fields: 7

a) On-the-fly in Treatment Application after plans has been opened:
Select the field and then click Add button below the field list. Select Add Imaging from the menu,
see Figure 1.

Figure 1: Add Button Menu – Add Imaging

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Imaging Procedures Overview

b) In Record & Verify system (e.g. ARIA Plan Scheduling workspace). These Imaging Procedures
are then transferred to Treatment Application together with other plan data.

Tip: When imaging procedures are attached to setup fields in Record &
Verify system, the setup fields will be automatically paired if they are
orthogonal and next to each other in the plan by field order. If there are more
than 2 setup fields, only the first two that are eligible to be paired will be
paired.

Tip: It is not possible to have multiple fields selected at the same time.
Imaging Procedure added on-the-fly to a treatment field can be applied to all
treatment fields in Modify Imaging dialog box, see Figure 7 as an example.

For subsequent sessions it is possible to restore Imaging Procedures from

previous session, see Figure 5, Figure 7.

3. Imaging Procedure(s) can also be deleted from fields in Treatment Application. Deleting Imaging
Procedure from field is possible even when images have already been taken for the field. Removing
an Imaging Procedure from the field does not delete images taken for it during the session. In order to
delete Imaging Procedure from field select the field, click Remove button below the field list and then
select Delete Imaging Procedure, see Figure 2.

7 7

Figure 2: Remove Button Menu – Delete Imaging Procedure

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Imaging Procedures Overview

4. Imaging Procedures of the same type (before, during or after) can be deleted from multiple treatment
fields at the same time:

a) select the Imaging Procedure for one of the treatment fields (or the field for imaging during). Click
Remove button and then select Delete All imaging Procedures. See Figure 3.

Figure 3: Remove Button Menu – Delete All Imaging Procedures

b) Then confirm removing all Imaging Procedures, see Figure 4.

Figure 4: Delete All Imaging Procedures Confirmation Dialog

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Imaging Procedures Overview

B. Imaging Procedures schedulable to setup fields in Treatment

application

Note: TrueBeam imaging features are licenses controlled. This procedure

shows all TrueBeam v2 imaging features available.

1. Add → Add Imaging allows selecting the following imaging options for setup fields, see Figure 5.

a) kV → single kV image taken from setup field gantry position direction – kV source is at ‘gantry
position’ angle from the plan.

b) MV → single MV image taken from setup field gantry position direction.

c) CBCT → allows CBCT acquisition for the selected setup field.

d) kV – kV → allows acquiring orthogonal kV/kV image pair.

e) MV – kV → allows acquiring orthogonal MV/kV image pair.

f) MV – MV → allows acquiring orthogonal MV/MV image pair.

7 7

Figure 5: Imaging Options for Setup Field

Tip: Restore imaging definitions from last session can be checked to

schedule Imaging Procedures to all fields in the plan exactly as they were
scheduled the previous session.

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Tip: Paired imaging is available for orthogonal setup fields only. Orthogonal
setup field have to be next to each other in the field list and paired imaging
has to be added to the first one in the list to pair them, see Figure 6.

(When adding imaging to setup fields the Treatment Application looks at the
next field in the plan to see if it can be paired with selected setup field which
is being added the an Imaging Procedure. If the next setup field is not
suitable to be paired with the selected setup field then paired Imaging
Procedures will be disabled.)

Figure 6: Pairing Two Orthogonal Setup Fields, kV/kV Pair Example

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C. Imaging Procedures schedulable to treatment fields in Treatment

application
1. Add → Add Imaging allows selecting the following imaging options for treatment fields, see Table 1.

Modality Phase Source Direction Modality specifics

Planned

Before Beam’s Eye View Single kV image or fluoro

On Demand

Single kV image at selected % of

treatment field MU

N/A (+90° from treatment field Triggered (at regular MU, gantry
kV During
angle) angle <for VMAT only> or time
intervals)

Continuous - fluoro

Planned

After Beam’s Eye View Single kV image or fluoro

On Demand

Planned
Single MV image – Open Port,
7 Before
Treatment Port or Double Exposure 7
On Demand

Single MV at selected % of treatment

field MU
MV During Field gantry angle
Continuous MV

Dosimetry

Planned
Single MV image – Open Port,
After
Treatment Port or Double Exposure
On Demand

Rotation range, start, stop

Before angles depends on selected N/A
CBCT mode
CBCT
Rotation range, start, stop
After angles depends on selected N/A
CBCT mode

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Imaging Procedures Overview

Before
kV – kV Planned or On Demand CW or CCW gantry rotation
After

Before
MV – kV Planned or On Demand No gantry rotation
After

Before
MV - MV Planned or On Demand CW or CCW gantry rotation
After
Table 1: Imaging Procedures Available for Treatment Fields

2. Source direction parameter selectable for some of the Imaging Procedures has the following
meaning:

a) Beam’s Eye View – kV image will be taken with kVS at planned gantry angle. (actual gantry
angle = 90° + planned gantry angle)

b) Planned - image will be taken with gantry at planned gantry position. If this option is selected for
paired acquisition then one of the images (both in case of MV/kV image pair) will be taken at
planned gantry position. The other image will be acquired 90° from planned gantry angle in
selected gantry rotation direction ( gantry does not need to move in case of MV/kV paired
acquisition) – CW or CCW. If gantry cannot move 90° in user-selected direction, it will move in the
other direction.

c) On Demand – current/actual gantry position is the acquisition position for the image acquisition. If
this option is selected for paired acquisition then the current gantry angle becomes the acquisition
positions for of the images (both in case of MV/kV image pair). The other image will be acquired
7
90° from first image gantry position in selected gantry rotation direction ( gantry does not need to
move in case of MV/kV paired acquisition) – CW or CCW. If gantry cannot move 90° in user-
selected direction, it will move in the other direction.

Tip: After the Imaging Procedure has been scheduled and selected for
imaging, the further imaging details can be set in the Imaging application.
They include imaging energy, detector position, kV focal spot, time when an
image is acquired or trigger for acquisition during, etc.

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Imaging Procedures Overview

3. The following pictures show examples of Imaging Procedures applicable to treatment fields:

Figure 7: Scheduling MV Image Before to a Treatment Field

7 7

Figure 8: Scheduling MV Imaging During to a Treatment Field

Figure 9: Scheduling kV Imaging Before to a Treatment Field

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Single or fluoro or triggered can be

chosen in Imaging application

Figure 10: Scheduling kV Imaging During to a Treatment Field

Figure 11: Scheduling CBCT Acquisition to a Treatment Field

Figure 12: Scheduling Orthogonal kV/kV Imaging to a Treatment Field

Figure 13: Scheduling Orthogonal MV/kV Imaging to a Treatment Field

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4. Imaging parameters can be defined for selected Imaging Procedure in Imaging Systems panel of
Imaging application if applicable. See following examples:

a) kV imaging before or after:

7 7

Figure 14: Imaging Options for kV Imaging Before or After

Note: kV imaging mode (‘HighQuality’ on example Figure 14) is part of the

Anatomy template and cannot be changed on-the-fly in Imaging Application.
Anatomy templates can be customized in Imaging Administration.

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b) kV imaging during – single image at given % of field MU, fluoro or triggered:

Fraction of MU in % when the

single image is to be acquired

Single or Fluoro

Trigger selection

Figure 15: Imaging Options for kV Imaging During

Note: Gantry Rtn trigger is only available for arc fields.

Minimum interval for Time triggering is 3 sec. Minimum interval for MU
depends on field nominal dose rate and cannot be smaller than time
equivalent of 3 sec. Minimum gantry rotation trigger interval is 10 degrees.

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c) kV imaging during, triggered at defined MU intervals:

PVA shows the valid range for

trigger interval if the user input
not within the valid range

Figure 16: Gantry Triggered kV Imaging During

7 d) MV imaging during – Single and Cine buttons allow toggling between single image taken at given 7
% of field MU and continuous acquisition (cine). Treatment field energy is used:

Figure 17: Imaging Options for MV Imaging During – Single / Cine (left) , Dosimetry (right)

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e) MV imaging before, energy and MV imaging mode – Exposure / imaging mode can be selected:

Figure 18: Imaging Options for MV Imaging Before or After
7
Tip: TrueBeam v2 features 2.5 MV imaging energy for more contrast and
less noise. This energy is selectable either from Energy dropdown in MV
Acquisition Parameters section of Imaging Systems window of Imaging
Application (see Figure 18) or it is selected automatically if the MV imaging
procedure comes from ARIA (is attached to field in Treatment Preparation
workspace) and the procedure is configured for ‘Low’ energy in RT
Administration.

Note: Triggered MV imaging is available with Respiratory Gating only.

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7 7

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For education purposes only pg 510 DCID: TB2.5-CEM-02-B
Clinical Applications TAB 8

Plan QA in Treatment Mode

Dry Run

2D-2D Match

Marker Match

3D-3D Match

2D-3D Match

Treatment with Automation

Interrupted Treatment

Treatment with Clearance Override

Treatment with Auto Beam Hold

Electron Plan Delivery, Custom Coding

Unplanned Treatment

Treatment with Respiratory Gating

Advanced Reconstruction 8

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FOR TRAINING PURPOSES ONLY
Plan QA in Treatment Mode

Plan QA in Treatment Mode

Procedure

Objectives
After completing this procedure, the student will have learned how to deliver a plan in Plan QA mode in
Treatment mode for the purpose of pre-treatment QA.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 4.

A. Overview / Prerequisites
1. Plan QA is a Treatment mode plan delivery option intended to deliver a patient plan for the purpose of
the plan pre-treatment QA.

2. Using Plan QA mode, you perform quality assurance on a patient plan by delivering the plan fields to
a measurement device or to the MV imager, without the patient being present.

Warning: Never attempt to deliver treatments using Plan QA mode. Dose is

8 not recorded in Plan QA mode and fields can be delivered multiple times. 8
P1005922-001-A – TrueBeam Instructions for Use, page 62.

3. The plan status has to be Planning Approved at least. Plan does not have to have the fractions
scheduled but the patient must have an appointment with the machine scheduled in order to be able
to open the patient from Queue.

4. The operator must have the ‘Access Plan QA Mode’ right to be allowed to work with the Plan QA
mode.

5. Verification plans, such as for Portal Dosimetry, can be delivered in Plan QA mode ( or offline in
Machine QA mode ) only.

6. Images acquired in Plan QA are saved to Record and Verify system.

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Plan QA in Treatment Mode

B. Treatment plan in Plan QA

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom. See Figure 1.

Figure 1: Treatment Application

3. Login to Queue, if prompted. See Figure 2. ( Required only once per Treatment mode session ).

Figure 2: Login to Queue

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Plan QA in Treatment Mode

4. Locate and select the patient and the treatment plan for pre-treatment QA in the schedule for your
machine. Then click QA in lower right corner. See Figure 3.

Figure 3: Select Patient and Plan from Queue

5. Acknowledge the Queue confirmation message, saying that the plans will be loaded for QA, by
clicking OK button. See Figure 4.
8 8

Figure 4: Plans Will Be Loaded for QA

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Plan QA in Treatment Mode

6. In Plan QA mode, the operator has the option to set the preferred values for the following geometric
parameters for all field in the opened plan.

a) Selecting the checkbox acquires the actual axis position. Then the value can be modified.
The parameters with the checkboxes enabled will be applied to all fields in the plan after
clicking the Apply button. See Figure 5.

Figure 5: Plan QA Setup

7. You may be prompted to choose Motion Management Devices for the QA session; choose None and
click Apply. See Figure 6.

Figure 6: Patient Position Monitoring Device Selection

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Plan QA in Treatment Mode

8. The plan parameters are then displayed in Treatment application. There are three indications that the
application is in Plan QA mode: yellow background in session area, warning message through Live
View and ‘QA mode’ message and orange color for text in upper left corner. See Figure 7.

Application and mode

Live View warning

Yellow background

Figure 7: Treatment Plan Loaded for Plan QA

Tip: Acquire and Edit are not available as this is treatment plan. GoTo button offers
extended option to move the couch to position of user’s choice from the console, if
necessary, see Figure 8.

8 8

Figure 8: Extended GoTo Option

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Plan QA in Treatment Mode

Note: Any field can be delivered multiple times, if necessary. Automation

can be added in Plan QA mode ( if the fields meet all criteria to allow
automation ). Imaging can be added to fields on the fly, if necessary, imaging
arm position can be set. Auto Field Sequencing can be enabled / disabled
as needed, default is set in System Administration → Treatment → Clinical.
See Figure 9.

Figure 9: Options in Plan QA, Tools (left), Add (right)

9. Move to plan, if needed. Press the orange Motion Selection buttons on the control console to select
the axes to move, then press the Motion Enable buttons and hold them until all selected axes have
reached their planned positions. See Figure 10.

Figure 10: Control Console, Motion Selection and Motion Enable

10. Press Prepare on the control console to prepare the beam. See Figure 10.

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Plan QA in Treatment Mode

11. If there is still a mismatch between planned and actual positions that is desired to keep, (couch
values not acquired at step B.6.a)), click Override button. See Figure 11. Override button is only
available if there is an actual mismatch to override.

Figure 11: Override Available

12. Check the parameters to be overridden and then click Apply. See Figure 12.

Figure 12: Overriding Couch Values

13. Confirm that you have the appropriate override right. Enter your user name and password, click OK
when done. See Figure 13.

8 8

Figure 13: Confirm Override Right

14. Step B.13 may need to be repeated for different override groups - if parameters requiring different
override rights were selected to be overridden.

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Plan QA in Treatment Mode

15. Decide whether the selected parameters will be overridden for all fields or for current field only. Click
the appropriate button on the bottom of the dialog. See Figure 14.

Figure 14: Override All or Current Only ?

16. Press MV Ready button when it lights up and hold it until MV Beam On illuminates. Then press MV
Beam On to initiate the beam. See Figure 15.

Figure 15: Control Console, MV Beam Controls

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Plan QA in Treatment Mode

17. If Auto Field Sequencing is on, next field is automatically selected after the previous field has been
delivered. With Auto Field Sequencing off, click the field in the Session area to select it.
See Figure 16.

Click next field

to deliver it

Figure 16: Session Area, Auto Sequencing Off

18. Deliver the remaining fields. Close the patient when done ( ).

8 8

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Plan QA in Treatment Mode

C. (PD) Verification plan in Plan QA

1. Repeat steps B.1 to B.3 to launch the treatment mode and open Queue.

2. Locate and select the patient and the verification plan for pre-treatment QA in the schedule for your
machine. Then click QA in lower right corner. See Figure 17.

Figure 17: Selecting Verification Plan

8
3. Acknowledge the Queue confirmation message, saying that the plans will be loaded for QA, by
clicking OK button. See Figure 18.

Figure 18: Plans Will Be Loaded for QA

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Plan QA in Treatment Mode

4. In Plan QA mode, the operator has the option to set the preferred values for the following geometric
parameters for all field in the opened plan.

Figure 19: Plan QA Setup

5. You may be prompted to choose Patient Position Monitoring Device; choose None and click Apply.
See Figure 20.

8 8

Figure 20: Patient Position Monitoring Device Selection

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Plan QA in Treatment Mode

6. Plan is then loaded and its parameters are displayed in Treatment application. See Figure 21.

Figure 21: Verification Plan Loaded for Plan QA

7. If the imaging was not scheduled in Record & Verify system, schedule the imaging. Click Add and
then select Add Imaging. See Figure 22.

Figure 22: Adding Imaging

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Plan QA in Treatment Mode

8. Choose the appropriate imaging in the PVA application, Dosimetry for Portal Dosimetry verification.
Click OK when done. See Figure 23.

Figure 23: Dosimetry Imaging for Portal Dosimetry Verification

9. Apply to all treatment beams options can be used to schedule the selected imaging to all treatment
fields in the plan. If the option is not available, repeat steps C.7 to C.8 to schedule the appropriate
imaging to all treatment fields to be imaged.

10. In PVA application, check the planned position for MV panel for the selected field. Type in the desired
position and click OK to apply. Repeat for each field. See Figure 24.

Predicted image
8 8

Figure 24: Modifying MV Imaging Panel Position

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Plan QA in Treatment Mode

Tip: If the imaging is scheduled in Record & Verify system, the default
planned position for MV imager is equal to value of Imager Vrt field parameter
or -50 if Imager Vrt is not defined for the field.
If imaging is scheduled on-the-fly, the default planned position for MV imager
is -50 (50 cm away from the isocenter in beam direction).

Note: As the fields will be imaged, it is not possible to use automation. An

attempt to add automation would result in the following message:

11. Move to plan if needed. Press the orange Motion Selection buttons on the control console to select
the axes to move, then press the Motion Enable buttons and hold them until all selected axes have
reached their planned positions. See Figure 25.

Figure 25: Control Console, Motion Selection and Motion Enable

12. Press Prepare on the control console to prepare the beam. See Figure 25.

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Plan QA in Treatment Mode

13. If there is still a mismatch between planned and actual positions and it is desired to keep it, it can be
overridden (couch values not acquired at step C.4.a)). Click Override button. It only is available if
there is actual mismatch to override. See Figure 26.

Note: It is also possible to Acquire or Edit couch values as this is verification

plan.

Figure 26: Override Available

14. Check the parameters to be overridden and then click Apply. See Figure 27.

Figure 27: Overriding Couch Values

15. Confirm that you have the appropriate override right. Enter your user name and password, click OK
8 when done. See Figure 28. 8

Figure 28: Confirm Override Rights

16. Step C.15 may need to be repeated for different override groups - if parameters requiring different
override rights were selected to be overridden.

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Plan QA in Treatment Mode

17. Decide whether the selected parameters will be overridden for all fields or for current field only. Click
the appropriate button on the bottom of the dialog. See Figure 29.

Figure 29: Override All or Current Only ?

18. Press MV Ready button when it lights up and hold it until MV Beam On illuminates. Then press MV
Beam On to initiate the beam. See Figure 30.

Figure 30: Control Console, MV Beam Controls

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Plan QA in Treatment Mode

19. If Auto Field Sequencing is on, next field is automatically selected after the previous field has been
delivered. With Auto Field Sequencing off, click the field in the Session area to select it.
See Figure 31.

Click next field

to deliver it

Figure 31: Session Area, Auto Sequencing Off

20. Deliver the remaining fields. Close the patient when done ( ).

8 8

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Dry Run

Dry Run
Procedure

Objectives
After completing the procedure, the students will have learned how to:

1. Perform a Dry Run on a plan without automation.

2. Perform a Dry Run on a plan with automation.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 6.

A. Overview
1. Dry Run is a practice run of a treatment plan with the patient setup on the couch. Performing a dry
run lets you check machine movements for possible collisions or other problems before the patient is
treated, and resolve any potential collision hazards.

2. Varian strongly recommends that you perform a dry run each time you set up a treatment that
includes movement of imager arms or the gantry. Varian also strongly recommends that you perform
a dry run before any arc or other automated treatment in which any part of the machine or 8
accessories are required by the plan to come into close proximity to the patient.

3. Dry Run is also available in Machine QA or Plan QA modes and can be used to check for potential
collisions with measurement equipment and cables.

Warning: To avoid the risk of an unforeseen collision hazard that could injure
the patient or you, or damage equipment, Varian strongly recommends that
you perform a dry run:
 Before setting up a treatment that includes movement of imager arms
or the gantry and/or couch rotation.
 Before any arc or other automated treatment in which the plan
requires any part of the machine or accessories to closely approach
the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 128.

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Dry Run

Note: Dry Run only includes treatment fields, not the setup fields.

Note: Dry Run requires that the couch is moved to plan position. Hence it
may be necessary to acquire couch values for the plan before executing Dry
Run if plan contains just generic couch values.

8 8

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Dry Run

B. Dry Run with no automation

1. Launch the treatment mode, login when prompted.

2. In Treatment application, click Open Patient button at the bottom. See Figure 1.

Figure 1: Treatment Application

3. Login to Queue, if prompted. See Figure 2. ( Required only once per Treatment mode session ).

Figure 2: Login to Queue

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Dry Run

4. Locate and select the patient and the plan to be treated. Then click Treat in lower right corner.
See Figure 3.

Figure 3: Select Patient and Plan from Queue

5. Select the appropriate Patient Position Monitoring Device, if prompted. See Figure 4.

8 8

Figure 4: Choose Patient Position Monitoring Device

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Dry Run

6. Wait until the plan loads. Then enter the treatment room.

7. Use the navigation buttons on one of the hand pendants to select the Fields tab on the in-
room patient monitor. That starts the Dry Run. See Figure 5.

Figure 5: In-room Patient Monitor, Fields Tab

8. Follow the instructions on the bottom of the screen. Use hand pendant to move axes to initial position
– press and hold Motion Enable and then press the Automatic Motion buttons highlighted in 8
orange. See Figure 6.

Navigation Buttons Automatic Motions Motion Enable

Figure 6: Hand Pendant Controls

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Dry Run

Tip: For dynamic MLC fields, the MLC initially takes the shape of the first

control point. Jaws / MLC button on the hand pendant can be used to
fully open the MLC. Pressing the button again shapes the MLC to CIAO.
Repeatedly pressing the button then, changes the MLC shape between fully
open and CIAO. In case of RapidArc field, the MLC does not move as gantry
rotates during the Dry Run.

9. Press Enter on the hand pendant to move to the next field. Alternatively, the navigation

buttons on the hand pendant can be used to select next field. In case of an arc field, pressing
Enter performs gantry rotation planned for the field, next field is selected then.

10. Repeat steps B.8 to B.9 to check all fields in the plan.

Caution: Machine Protection and Patient Protection systems are always

active during the Dry Run. They can be overridden by holding down the
Collision Override button and manually moving the machine with
thumbwheels. Proceed with extreme caution to check if the plan can be
treated as-is with protection systems overridden for treatment at the console.

11. When done, the Dry Run can be finished by selecting Setup Notes or Activity Notes tab on the in-
room patient monitor using the hand pendant navigation buttons. Alternatively, the Dry Run can be
finished at the console by clicking Done button, see Figure 7. If the Dry Run is to be finished while arc

field check is in progress, it needs to be cancelled using button on the hand pendant first.

8 8

Figure 7: Done Button Can Be Used at the Console to Regain Control and Exit Dry Run Mode

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Dry Run

C. Dry Run with automation

1. Repeat steps B.1 to B.5 to launch the Treatment mode and open the desired patient plan.

2. Click Add and select Add Automation. See Figure 8.

Figure 8: Add → Add Automation

3. Enter the treatment room. Use the navigation buttons on one of the hand pendants to select
the Fields tab on the in-room patient monitor. That starts the Dry Run. See Figure 9.

Figure 9: In-room Patient Monitor, Fields Tab

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Dry Run

4. Follow the instructions on the bottom of the screen. Use hand pendant to move axes to initial position
– press and hold Motion Enable and then press the Automatic Motion buttons highlighted in
orange. See Figure 10.

Navigation buttons Automatic Motions Motion Enable

Figure 10: Hand Pendant Controls

5. Press Enter on the hand pendant to start the Dry Run. The system will automatically
advance to next field and move to plan for each field.

Note: In case of dynamic MLC field, the MLC takes shape of the first MLC
control point. In case of RapidArc field, the MLC does not move as gantry
rotates during the Dry Run.

6. Keep holding Motion Enable bars and wait until the system has gone through all plan fields.
8 8

Tip: Press the on the hand pendant if the Dry Run is to be restarted /
finished prematurely. Only then the Dry Run can be finished by selecting tab
other than Fields on IRM or at the console by pressing Done button.

7. Then select the Setup Notes or Activity Notes tab on in-room patient monitor, using hand pendant
navigation buttons. Alternatively, the Dry Run can be finished at the console by clicking Done button.
See Figure 11.

Figure 11: Done Button To Exit the Dry Run Mode

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2D-2D Match

2D-2D Match
Procedure

Objectives
After completing this procedure the student will have reviewed 2D-2D Match procedure.

Abbreviations
Right mouse click denoted as RMC.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapters 8, 9, 10.

P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

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2D-2D Match

A. Procedure notables
1. 2D-2D Match is a process of matching a paired set of treatment images with their reference images.
The 2D-2D match establishes a geometrical relation (spatial registration) between the paired
treatment images and the reference images.

2. In order to be able to perform the 2D-2D Match, the plan must have 2 setup fields that are orthogonal
and next to each other in the plan.

Tip: Field order can be changed in Treatment application, if user has enough
rights, using the Reorder button in lower left corner.

3. Each of the setup fields must have the primary reference image.

4. The reference image and its setup field must have same gantry rotation, couch rotation and patient
orientation. In addition, if the reference image is a DRR, the setup field and the reference image must
have the same isocenter and frame of reference (FOR).

5. The setup fields must be paired for kV-kV, MV-kV or MV-MV acquisition. The setup fields can be
paired in the Treatment application once the plan has been opened or they would be paired
automatically if appropriate imaging procedures have been attached to them in Record & Verify
system and the fields meet the other requirements for pairing – orthogonal, next to each other in field
order.

Note: In case of kV acquisition, the gantry angle of the setup field(s) will be
the position of kV source. In case of MV-kV pair, the fields will be paired so
that the gantry does not move - as the fields have to be orthogonal, the MV
acquisition will occur from direction that corresponds to gantry angle of that
8 setup field whose gantry angle is 90deg in CW direction from the other setup 8
field.

6. Both acquired images must have the same FOR (frame of reference) and couch positions.

Caution: Before administering a treatment, verify that the treatment plan

belongs to the correct patient. You can use patient identifiers such as patient
photo, patient name, patient ID, or date of birth for verification. Do not rely
solely on the barcode scanner for this process.
P1005922-001-A – TrueBeam Instructions for Use, page 118.

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2D-2D Match

Warning: Before and while moving the imagers and the equipment, observe
the Live View and Motion View monitors to make sure that the patient is safe
and that there is no collision risk.
P1005922-001-A – TrueBeam Instructions for Use, page 156.

Warning: If matches are performed incorrectly and imagers or markers are

Warning: To avoid collision when making couch corrections, carefully

observe the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 191.

Warning: Always take another image to verify the patient position after a
couch shift because the patient may have moved during the matching
process. The final patient position must be verified to prevent mistreatment.
P1005922-001-A – TrueBeam Instructions for Use, page 192.

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2D-2D Match

B. Acquiring kV-kV image pair for paired setup fields

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 1.

Figure 1: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8 8

Figure 2: Motion Management Devices Example

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2D-2D Match

6. Locate the setup fields to be paired for kV-kV acquisition, then select the first of them in plan order.
See Figure 3.

Figure 3: Plan Loaded, Setup Field with no Imaging Procedures

7. Click Add and then select Add Imaging. Select the appropriate imaging procedure (e.g. kV-kV) in
Modify Imaging dialog box displayed in PVA and click OK. See Figure 4.
This step can be skipped if the fields are already paired for kV-kV acquisition.

Figure 4: Adding kV-kV Imaging

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2D-2D Match

8. The setup fields will then be paired for kV-kV acquisition. PVA displays the fields’ reference images.
Blank views on the right are for the images to be acquired, green box indicates currently active
acquisition direction. See Figure 5 and Figure 6.

Figure 5: Setup Fields for kV-kV Paired Imaging

Lat. reference Lat. acquired (active)

8 8

AP reference AP acquired

Figure 6: PVA Application with Reference Images Displayed

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2D-2D Match

9. If necessary, the direction to be imaged can be selected by clicking the view for the image to be
acquired. Otherwise, the system automatically selects the direction that requires less gantry motion.

10. Press Prepare button on the control console to make the kV beam ready. See Figure 7.

11. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange, then press both Motion Enable buttons and hold them down until all
selected axes are at imaging position for the selected imaging direction. See Figure 7.

Figure 7: Control Console

12. Review the acquisition parameters and modify them if necessary. kV or mAs can be set manually or
by choosing appropriate Anatomy and Size template. See Figure 8.

Figure 8: Setting the Acquisition Parameters

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2D-2D Match

Note: If the system is configured, in System Administration, to store and then

reuse Object Related Settings (also known as Persistent Parameters), the
operator-adjusted imaging and matching parameters, such as Anatomy and
Size selections, kV, mAs etc. are saved and then reused on subsequent
treatment days. Refer to TrueBeam Technical Reference Guide, Volume 2:
Imaging, for more details.

13. When the kV Beam On button illuminates press and hold it until the button gets dark. See Figure 9.

Figure 9: Control Console, Prepare

14. Make sure the image was acquired; review the image quality. See Figure 10. If the acquired image is
of insufficient quality, select the image and repeat steps B.12 to B.13 to re-acquire the image.

8 8
Acquired image

The next is already selected

Figure 10: First Image Acquired

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2D-2D Match

15. When the first image has been acquired, the second imaging direction may be selected automatically
if the system has been configured for automatic field selection (PVA → Workflow → Paired
Acquisition checkbox) in System Administration. If that is not the case, click the image view for the
second image to select it for imaging.

16. Repeat steps B.11 to B.14 to acquire an image for the second direction.

Note: If acquiring an MV image, the system needs to be in Preview state (Preview

button on the console has been pressed) to be able to change the MV acquisition
parameters. Click OK on the PVA taskbar to accept the modified parameters and then,
press Prepare button on the console to re-program the BGM for the new settings.

17. If automatic workspace selection has been enabled in System Administration (PVA → Workflow →
Paired Match checkbox) the PVA automatically launches 2D-2D Match workspace once both images
have been acquired. If image acquisition is to be repeated, the matching workspace can be closed
using the Cancel button on the Taskbar. If the 2D-2D Match workspace does not open automatically,
click the Match and Review workspace button and select 2D-2D Match, see Figure 11.

Active matching workspace

Figure 11: Closing (left) and Opening (right) the 2D-2D Match Workspace

Tip: If the acquired images are not of satisfactory quality, the acquisition can be repeated.
The images that will not be used for the match can be deleted if desired. If an image is
acquired and it is even worse than what has been previously taken, it is possible to select 8
the previous one for matching. Select the image (click the view), then click Images dynamic
tab, RMC the image and make appropriate selection. See picture below:

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2D-2D Match

C. 2D-2D Match using kV-kV image pair (a.k.a. kV-kV match)

1. When the 2D-2D Match workspace is opened, the acquired and the reference images will be
superimposed in the upper views. The lower views show the individual reference and acquired
images. The Dashboard shows the couch shifts. See Figure 12.

Couch shifts
Superimposed / blended views

Individual images

Figure 12: 2D-2D Match Workspace

2. The Manual Match and the Blend Images tools will be by default enabled, the Blend

Images slider will be positioned to show 100% acquired image to allow for
8 acquired image quality assessment prior to matching. 8

3. Use Window / Level and adjust the Blend Image slider to achieve
optimal viewing.

a) The blend ratio is the same for both superimposed views – moving the blend slider for one of the
views changes the blending for the other view.

b) For the blended views, the window / level bar that allows setting the window width and level is on
the left hand side for the reference image, and on the right hand side for the acquired image.

Note: Blend Image slider is connected to Window / Level tool – when

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2D-2D Match

4. Use the Manual Match or the Automatic Match tools or both, to align the overlaid
reference and the acquired (setup) images.

5. Manual Matching:

a) Reference images can be moved by the operator in order to align the visible patient anatomy, the
acquired images are fixed.

b) Image translations and rotations are translated into available couch motion axes - Vrt, Lat, Long,
Rtn, Roll, Pitch.

Tip: Roll can be applied using SHIFT key and moving the mouse with LMB
pressed outside of red dotted rotation circle; it cannot be applied just by
moving and rotating the images in 2D-2D match.

c) The images are linked – if one is moved in patient longitudinal direction the other moves same
amount in the same direction.

d) When Manual Match is enabled, the mouse cursor is red and the cursor icon indicates what
operation can be performed on the images when mouse button is clicked and mouse is moved -
Inside of the dotted red circle, the mouse allows image translations; outside of the dotted red
circle, the mouse allows image rotation. See Figure 13.

Rotation cursor

Red dotted image rotation

circle
Translation cursor

Figure 13: Mouse Cursor Indicating Manual Match, Translations (left), Rotations (right)

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2D-2D Match

6. Automatic Matching:

a) The automatic match starts immediately after clicking the Automatic Match button . If the
match is not found the dialog box with the settings is opened. Alternatively, the dialog box with
the settings will be opened, if the CTRL button on the keyboard is held down when the Automatic
Match button in PVA is clicked. See Figure 14.

b) Select the Parameter Set for the matching, axes allowed to move and decide whether to use
Intensity Range. Then select the interval of values that will define the matching domain on the
acquired images if the Intensity Range is enabled. Synchronize ranges can be checked to make
the intensity range the same for both views. Last step only can be checked if intensity range is
to be used at last algorithm step only. Click Start to run the auto-match algorithm, see Figure 14.

Figure 14: Auto Match Parameters

c) The Automatic Match tool also automatically enables ROI – adjust the size and position of the
ROI by dragging the small red squares on its sides / corners. See Figure 15.

8 8
Adjust the ROI

Figure 15: Setting the ROI for the Automatic Match, Pink Area Are the Pixel Within the Intensity Range

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2D-2D Match

Tip: The Parameter Set settings (matching algorithm settings) can be set by
clicking arrow down next to Automatic Match button in the toolbar and
choosing Change Settings:

Changing the Auto-Match settings requires Administer System right.

7. Utilize the Split Window , Moving Window and / or Color Blend tools to evaluate match
results. See Figure 16. Manual Match can be deselected prior to match evaluation to avoid
inadvertent shift. However, the matching workspace has the Undo/Redo functionalities, that can be
invoked with CTRL+Z and CTRL+Y keyboard keys.

8

Figure 16: Match Evaluation Tools: Color Blend, Moving Window, Split Window

8. RMC the blend slider provides the option to enable flickering, see Figure 17. CTRL+A keyboard keys
can be used to flip the blend slider around 50% manually.

Figure 17: Flicker

9. Use the arrow keys on the keyboard to make fine adjustments in desired directions. CTRL + arrow left
and right keys can be used to introduce small image rotations.

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2D-2D Match

10. When done with the matching and the image alignment has been verified, decide whether the shift
will be applied permanently or for the session only and whether all calculated rotations will be
included and applied to couch. See Figure 18.

Figure 18: Applying the Shift

11. Click Apply button on the Taskbar to transfer the calculated shift to treatment application.
See Figure 18.

8 8
Tip: The Approve button in the toolbar can also be used to apply the
shifts and approve and save the acquired images back to R & V system. This
requires an optional license that may not be available on the system.

12. After applying the shifts, an additional sign-off with appropriate rights will be required, if:

a) the match and images were approved (shift was applied with Approve button).

b) the couch shift is different from match results (some axes were excluded or shift was truncated to
meet physical limitations of couch with Limit Shift button) and PVA → Analysis → Sign-off when
Couch Corrections differ from Match checkbox has been enabled in System Administration.

c) the applied couch shift was selected to be applied permanently.

d) the applied couch shift is larger than allowed by plan tolerance (least permissive tolerance table).

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2D-2D Match

Note: If there are multiple reasons for the shift approval, one sign-off only is
required, with the right indicated in the Apply Shift Parameters dialog.

13. If it is required to approve the match using the Apply Shift Parameters dialog, read the message,
review the shifts and then sign-off with the indicated right, see Figure 19.

Figure 19: Example of Apply Shift Parameters Dialog

Important Note: The User Right indicated in the Apply Shift Parameters
window may not exactly match the OSP right as it is available in the Platform
Portal:
Update Plan Parameters in dialog corresponds to ‘Update Plan Parameters’
in OSP. Approve Images in dialog corresponds to ‘Change Treatment Image
Status to Approved’ right in OSP. And Setup Correction Approval
corresponds to ‘Override Setup Correction Threshold’ right in OSP.

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2D-2D Match

14. After successful sign-off, the applied shifts are translated into new couch position. See Figure 20.

Green arrows indicate the

possibility to move the couch
remotely, from the console

Figure 20: New Couch Positions

15. Apply the couch shifts. If the remote couch corrections are allowed and within tolerances as set in
System Administration → Treatment → Clinical, then the couch can be moved from the console. If
that is not the case, enter the treatment room and apply the shifts from one of the hand pendants.

16. To move the couch from the console, press the Motion Selection buttons on the console highlighted
in orange (couch linear and couch rotation if rotations applied; if only one button is orange it would be
selected automatically). Then press both Motion Enable buttons and hold them down until couch has
8 reached the new position. See Figure 21.
8

Translations applied as selected,

for session on the example

Rotations applied for session only

Figure 21: Couch Has Been Moved to the New Position

Note: Couch Rtn, Roll, Pitch cannot be applied permanently.

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Marker Match

Marker Match
Procedure

Objectives
After completing this procedure the student will have reviewed the Marker Match procedure.

Abbreviations
Right mouse click denoted as RMC.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapters 8, 9.

P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

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Marker Match

A. Procedure notables
1. Marker Match is a process of matching projections of the markers from the volume image (planning
CT) with markers visible on the acquired images.

2. The Marker Match requires that the planning CT is available and has been successfully loaded. At
least 3 Markers must have been identified in the planning CT. The Markers can be pre-detected in
Record & Verify / TPS, if supported or they can be detected at the TrueBeam console in PVA →
Marker Detection workspace once the plan has been opened.

3. The Marker Match requires that an orthogonal image pair (kV-kV, MV-kV or MV-MV) is acquired. The
image pair can be acquired:

a) for paired orthogonal setup fields,

b) or ‘on demand’ for one of the treatment fields. This requires that an optional, on demand imaging
, license is available on the system.

Note: If the plan has an orthogonal pair of setup fields that have reference
images and an image pair is acquired for the paired setup fields, the operator
can choose between 2D-2D, 2D-3D match if the system is equipped with 2D-
3D match license and Marker Match (assuming that the planning CT is
available and markers have been detected in the planning CT).

4. Both acquired images must have the same FOR (frame of reference) and couch positions.

5. The ‘on demand’ paired imaging for the treatment fields requires selecting additional parameters:

a) Execution Phase – Before or After – whether the imaging procedure is scheduled before or
after the selected treatment field.
8 b) Source Direction – Planned or On Demand: 8
 Planned – one of the images will be acquired with gantry at planned gantry position for the
selected field,

 On-Demand – one of the images will be acquired with gantry at the actual / (current at the
time of attaching the procedure to field) gantry position.

c) Modality Specifics (not for MV-kV) – Clockwise or Counterclockwise – determines the gantry
rotation direction when gantry moves from Planned or On Demand (Actual) imaging direction to
next imaging direction (90° offset in the selected rotation direction). If gantry cannot move 90° to
next imaging direction in user-selected direction, it will move in the other direction.

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Marker Match

Caution: Before administering a treatment, verify that the treatment plan

Warning: If matches are performed incorrectly and imagers or markers are

Warning: To avoid collision when making couch corrections, carefully

observe the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 191.

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Marker Match

B. Marker Match using MV-kV image pair acquired for setup fields
1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 1

Figure 1: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8 8

Figure 2: Motion Management Devices Example

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Marker Match

6. Locate the setup fields to be paired for MV-kV acquisition, then select the first of them in plan order.
See Figure 3.

Setup fields have to be orthogonal

and next to each other in the plan
to be able to pair them

Figure 3: Plan Loaded, Setup Field with no Imaging Procedures

7. Click Add and then select Add Imaging, see Figure 3. Then select the appropriate imaging
procedure (e.g. MV-kV) in Modify Imaging dialog box displayed in PVA and click OK. See Figure 4.
Skip this step if the setup fields are already paired for MV-kV acquisition.

Figure 4: Modify Imaging, Selecting MV-kV Paired Imaging

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Marker Match

8. The setup fields will then be paired for MV-kV acquisition and selected. See Figure 5.

Figure 5: Setup Fields Paired for MV-kV Acquisition

9. Use control console to move required machine axes to imaging position – press the Motion Selection
buttons highlighted in orange to select the axes to move, then press both Motion Enable buttons and
hold them down until all the selected machine axes have reached the plan position. See Figure 6.

Both kV and MV should be

selected as all three imaging arms
must be deployed out for MV-kV

Figure 6: Control Console, Moving to Plan Position for Imaging

10. In the PVA, select the direction to be imaged by clicking the view for the image to be acquired. Set
the acquisition parameters on the Dashboard and click OK.

8 8

Direction and modality

Active direction

Figure 7: PVA, Selecting the Direction, Setting Acquisition Parameters

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Marker Match

Note: If the system is configured, in System Administration, to store and then

reuse Object Related Settings (also known as Persistent Parameters), the
operator-adjusted imaging and matching parameters, such as Anatomy, Size
selections, kV, mAs and MV energy and exposure mode are saved and then
reused on subsequent treatment days. Refer to TrueBeam Technical
Reference Guide, Volume 2: Imaging, for more details.

11. Then press Prepare on the control console to prepare the beam (either kV or MV).

12. Acquire an image using the control console.

a) for MV: press and the illuminated MV Ready button and hold it down until MV Beam On
illuminates. Then press MV Beam On.

b) for kV: press the illuminated kV Beam On button and hold it down until the image is acquired.

13. When the first image has been acquired, the second imaging direction may be selected automatically,
if the system has been configured in System Administration for automatic field selection (PVA →
Workflow → Paired Acquisition checkbox). If that is not the case, click the image view for the second
image to select it for imaging.

Note: In case of MV-kV imaging it is not necessary to move the gantry.

However in case of kV-kV or MV-MV imaging gantry needs to move between
image acquisitions – press and hold Motion Enable buttons on the console to
move the gantry to second imaging position once the first image has been
acquired and the second image has been selected for imaging.

14. Review and modify the image acquisition parameters, if necessary, in PVA. See Figure 8.

The system must be in Preview

state in order to be able to change
MV imaging settings. Changes must
be confirmed by clicking OK

Figure 8: Acquiring the Second Image

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Important Note: If acquiring an MV image, the system needs to be in Preview

state (Preview button on the console has been pressed) to be able to change
the MV acquisition parameters. Click OK on the PVA taskbar to accept the
modified parameters and then press Prepare button to re-program the BGM for
the new settings.

15. Then repeat step B.12 to acquire the second image using the control console.

16. Once both images have been acquired, the PVA may automatically launch some matching
workspace, depending on what automatic workspace selection options have been enabled in System
Administration (PVA → Workflow checkboxes) and data for what matching procedures is available.
Click Cancel button on the Taskbar if

a) wrong workspace has been automatically opened. The desired workspace can then be selected
using Match and Review workspace button. See Figure 9.

b) the acquired image(s) are of poor quality, not suitable for the matching process. Re-acquire the
images by following steps B.10 to B.12.

Active workspace

Figure 9: Closing (left) and Opening (right) Matching Workspaces

8 8

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Marker Match

C. Marker Detection
1. Select Marker Detection workspace to detect markers at the TrueBeam console. See Figure 10.

Marker Detection is
only available if the
planning CT has
already been loaded

Figure 10: Selecting Marker Detection

Note: The marker detection can be skipped if the markers have been pre-
detected in Record & Verify system / TPS.

2. The Marker Detection workspace provides three orthogonal views – Transversal, Sagittal and Frontal.
Click the icon to have the desired view displayed in the main window.

View legend Cycle through views View legend

8
View defining sliders

View legend

Main Window - Transversal

Figure 11: Marker Detection Workspace

3. Mouse wheel, and / or Page Up, Page Down keys can be used to scroll through CT slices. View
defining slides can be used to define contents of the views. Use CRTL + mouse wheel to zoom in and
zoom out, alternatively Zoom In / Zoom Out tools are available on the toolbar.

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Marker Match

4. Marker Detection workspace provides tools for Automatic as well as Manual marker
detection.

5. Automatic detection:

a) Use the ROI tool in the toolbar to define the volume of interest for searching.

b) Click button on the toolbar. Define the Marker Length, Marker Diameter and Expected
Number of Markers (3 to 20). Click Start to run the automatic detection. See Figure 12.

Figure 12: Automatic Marker Detection

c) Scroll through the CT slices to review results. If the results are not satisfactory, all markers can be
removed by pressing Delete all markers button and search can be repeated with different
parameters.

Tip: Auto Marker Detection is a modeless window that allows users to

operate / interact with the other windows, i.e. results can be reviewed and
ROI can be modified for another search without closing the dialog.

6. Manual detection:
8 8
a) Click button on the toolbar, inspect the tooltip for this tool. Now it is possible to move, add or
delete existing markers with the mouse.

b) Hold down the SHIFT or CTRL key and click the marker on the CT to add new marker object. The
markers are represented by yellow X symbol on the planning CT. See Figure 13.

Important Note: With SHIFT key held down to add a marker algorithm
searches the 3D volume in the vicinity of the clicked position for marker-like
structure. Position of the new marker is automatically adjusted to match the
algorithm-detected marker-like structure; therefore the marker may not
appear exactly where the mouse was clicked.
With CTRL key held down, no detection / adjustment is done and the new
marker is placed exactly where the mouse was clicked.

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Marker Match

c) Click the marker (X) to be deleted and press Delete key on the keyboard to remove the marker.
Selected marker is represented by larger red X with green outline. See Figure 13.

d) Find the marker to be repositioned, the X indicating marker position will be larger, click and drag
the marker to move it. See Figure 13.

Marker is on the slice and

can be selected and moved

Marker has been selected

with the mouse

Figure 13: Marker on the Slice (left), Marker Selected (right)

7. Click OK button on the taskbar when done detecting the markers. See Figure 14.

Figure 14: Closing Marker Detection

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Marker Match

D. Marker Match
1. Use the Match and Review workspace selection button to select Marker Match if it does not launch
automatically. See Figure 15.

Figure 15: Selecting Marker Match

2. The markers previously detected on the planning CT are projected onto the acquired setup images.
See Figure 16.

Previously detected markers

projected onto acquired images

8 8

Figure 16: Marker Match

Note: Notice that if the setup fields with reference images are used to acquire
the necessary pair of setup images, the reference images are not used
therefore they are not needed for Marker Match. However if the reference
images are available, one can also use 2D-2D match for anatomy verification
after Marker Match or vice versa, if desired.

3. Match the projected markers (the X’s) to markers visible on the acquired images. Marker Match

workspace allows Automatic or Manual matching.

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Marker Match

4. Automatic Match:

a) Click button in the toolbar. The detection is fully automatic, no parameters can be defined. If
the match is not entirely successful the user is notified, see Figure 17.

Figure 17: Not All Markers Found

5. Manual Match:

a) Click to allow manual matching (selected by default).

b) Click one of the markers to move the markers; by default all markers move as group. Hold down
the CTRL key to move individual marker, if necessary. After being moved, the marker color
changes to green, markers are blue while being moved. (markers are red if they have not been
moved yet).

c) Repeat the process for both of the acquired images. The marker groups in both views are not
linked – when one group moves, the markers in the other view do not move. The PVA provides
blue dashed lines to indicate where the markers from the other view project to help matching the
markers. See Figure 18.

Projections of markers at AP
view through lateral view

Matched view Markers being matched

Figure 18: Matching the Markers

d) Markers can be re-projected by clicking tool in the toolbar if it is necessary to re-start the
matching process from the beginning.

e) Mean Error after Match displayed on the Dashboard is a measure of how large the patient setup
correction is and is calculated as square root of the sum of squares of individual marker shifts
divided by total number of markers.

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Marker Match

6. When done with the matching and the marker alignment has been verified, decide whether the shift
will be applied permanently or for the session only and whether all calculated rotations will be
included and applied to couch. See Figure 19.

Figure 19: Match Done, Apply Button Has Been Clicked

7. Click Apply button on the Taskbar to transfer the calculated shift to treatment application.
See Figure 19.

Tip: The Approve button in the toolbar can also be used to apply the
shifts and approve and save the acquired images back to R & V system. This
requires an optional license that may not be available on the system.
8 8
8. After applying the shifts, an additional sign-off with appropriate rights will be required, if:

a) the match and images were approved (shift was applied with Approve button).

c) the applied couch shift was selected to be applied permanently.

d) the applied couch shift is larger than allowed by plan tolerance (least permissive tolerance table).

Note: If there are multiple reasons for the shift approval, one sign-off only is
required, with the right indicated in the Apply Shift Parameters dialog.

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9. If it is required to approve the match using the Apply Shift Parameters dialog, read the message,
review the shifts and then sign-off with the indicated right, see Figure 20.

Figure 20: Example of Apply Shift Parameters Dialog

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10. After successful sign-off, the applied shifts are translated into new couch position. See Figure 21.

Green arrows indicate the

possibility to move the couch
remotely, from the console

Figure 21: New Couch Positions

11. Apply the couch shifts. If the remote couch corrections are allowed and within tolerances as set in
System Administration → Treatment → Clinical, then the couch can be moved from the console. If
that is not the case, enter the treatment room and apply the shifts from one of the hand pendants.

12. To move the couch from the console, press the Motion Selection buttons on the console highlighted
in orange (couch linear and couch rotation if rotations applied; if only one button is orange it would be
selected automatically). Then press both Motion Enable buttons and hold them down until couch has
8 reached the new position. See Figure 22.
8

Translations applied as selected,

for session on the example

Rotations applied for session only

Figure 22: Couch Has Been Moved to the New Position

Note: Couch Rtn, Roll, Pitch cannot be applied permanently.

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3D-3D Match

3D-3D Match
Procedure

Objectives
After completing this procedure the student will have reviewed the 3D-3D Match.

Abbreviations
Right mouse click denoted as RMC.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapters 8, 9, 10.

P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

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3D-3D Match

A. Procedure notables
1. 3D-3D Match is a process of matching an acquired CBCT to the plan reference volume image
(planning CT).

2. The CBCT can be acquired

a) for one of the setup fields in the plan that has been attached the CBCT imaging procedure. The
CBCT imaging procedure can be attached to setup field on-the-fly in Treatment application or in
the Record & Verify system, if supported.

b) for one of the treatment fields that has been attached the CBCT imaging procedure on-the-fly in
Treatment application.

3. The 3D-3D Match is available if:

a) The planning CT and its structure set are available and have been loaded.

b) CBCT has been acquired.

c) The loaded plan must have a valid isocenter.

4. CBCT acquisition features so called ‘scan zone’ to protect patient and the machine. See Figure 1.

8 8

Figure 1: CBCT Scan Zone, Values are in mm

5. If the couch is positioned within the polygon, inside of the scan zone, no couch centering is required
(green points). When couch coordinates are outside of the polygon, the operator is suggested to
center the couch. Operator can decide to center the couch or to override the couch centering (if they
know there is enough space to safely move the gantry around couch with patient). If the operator
decides to center the couch the behavior of the couch depends on its exact location:

a) In all cases the couch lateral value is set to 0.

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3D-3D Match

b) couch vertical will either not change (yellow points) or will move to closest allowed vertical couch
value at a couch lateral value of 0 (red points move to blue points).

c) if couch rotation is more than 2.5°, then couch rotation will change to 0° and the couch will also
move laterally to 0 even if the couch lateral value is less than 5cm.

6. When couch has been moved for CBCT acquisition it will be required to restore the couch (undo
couch movement). Couch can be restored after CBCT has been acquired, before matching or after
matching, including shifts resulting from the matching process. Plan cannot be closed without
restoring the couch or a sign-off with Override Couch Restore right is required.

Caution: Before administering a treatment, verify that the treatment plan

Warning: If matches are performed incorrectly and imagers or markers are

misaligned, the wrong area will be irradiated during treatment. Be sure to
follow your department mandatory clinical procedures for quality assurance
for image guidance systems.
P1005922-001-A – TrueBeam Instructions for Use, page 190.
8
Warning: To avoid collision when making couch corrections, carefully
observe the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 191.

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B. CBCT on demand acquisition with couch centering

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 2.

Figure 2: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 3.
8 8

Figure 3: Motion Management Devices Example

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6. Select the treatment field that is to be attached the CBCT imaging procedure. See Figure 4. (Similarly
the CBCT imaging procedure can be scheduled to setup field if the plan has one).

Figure 4: Plan Loaded, Setup Field with no Imaging Procedures

7. Click Add and then select Add Imaging. Select the CBCT imaging procedure in Modify Imaging
dialog box displayed in PVA, choose the Execution Phase and click OK. See Figure 5.

Figure 5: Adding CBCT Imaging

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8. The treatment field will be attached CBCT imaging procedure, which should be automatically
selected. PVA displays the CBCT acquisition parameters. If the couch is outside of the scan zone, the
Couch tab opens to show the warning. See Figure 6 and Figure 7.

Figure 6: kV CBCT Imaging Before

Outside of scan zone warning

8 8
Perform couch centering

Override couch centering

CBCT acquisition
parameters

Perform couch centering suggestion

Figure 7: PVA Application

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9. The operator can choose either to center the couch as suggested or to override couch centering and
acquire the CBCT with couch at actual position. The Treatment Application will block the beam with

Workstation routine interlock until one or the other option has been selected.

Warning: You must perform a dry run before selecting Override Center
Couch to ensure that patient and machine clearances are adequate and safe.
P1005922-001-A – TrueBeam Instructions for Use, page 182.

10. Click Center Couch button in PVA → Couch tab, see Figure 8.

Allows restoring the couch. If not done explicitly

before applying shifts resulting from the image
matching, the couch movements necessary to
restore the couch will be included in the final
shift after images have been matched

8

Figure 8: Center Couch Clicked

Note: One can decide to perform the couch centering even when the couch
is within the scan zone.

Note: Couch Restore button can be used to restore the couch or ‘undo’
couch centering if the centering was selected by accident. Always verify the
clearance when moving the couch. Failure to do so can result in injury or
death.

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11. Move couch to the new position. Press the Motion Selection buttons for couch movements ( Couch
Linear and Couch Rtn ) highlighted in orange, then press both Motion Enable buttons and hold them
down until the couch has reached the new couch position for acquisition. See Figure 9.

Note: Couch and Gantry cannot be moved at the same time. Gantry needs to
be deselected in order to be able to move the couch.

Couch axes selected

Couch is at the new

New couch position position
requested

Figure 9: Centering the Couch

12. Select the CBCT Mode. Then click the CBCT tab and review / set the CBCT reconstruction
parameters. See Figure 10.

8 8

Figure 10: CBCT Acquisition and Reconstruction Parameters

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a) CBCT Mode – one of the modes available on the system; calibrated and enabled for clinical use.
There is no default CBCT Mode for first time use.

b) Trajectory – Full (360°) or Half (200°). It can only be selected for Full Fan Modes. If the mode is
Half Fan, full rotation is always required.

c) Diameter and Range – define the diameter of reconstructed volume and the axial length of the
scan.

d) Reconstruction parameters are part of the CBCT Mode. Default reconstruction parameters for
new CBCT Modes created in Service → CBCT Mode Editor can be set in CBCT Mode Editor.

 Matrix – size of each reconstructed CT slice in pixels.

 Thickness – slice thickness in mm.

 Filter – convolution filter applied in backprojection. Sharp filters increase spatial resolution,
smooth filters reduce noise ( at the cost of blurring the image ).

 Ring Suppression – strength of ring artifact suppression.

Note: mAs for the scan can also be changed. Changing the CBCT Mode,
mAs and Trajectory affects the CTDIw (CT dose index weighted).

Note: If the system is configured, in System Administration, to store and then

reuse Object Related Settings (also known as Persistent Parameters), the
operator-adjusted CBCT acquisition and reconstruction parameters such as
CBCT Mode, Trajectory, mAs, Scan Range, Scan Diameter and Blade
positions are saved and then reused on subsequent treatment days. Refer to
TrueBeam Technical Reference Guide, Volume 2: Imaging for more details.

13. Confirm the changes with OK button on the PVA Taskbar. See Figure 11 8

Figure 11: Confirming CBCT Acquisition Parameters

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14. Move to plan – press the Motion Selection buttons highlighted in orange color to select the axes to
move; then press both Motion Enable buttons and hold them down until all selected axes have
reached the planned position. See Figure 12.

Figure 12: Moving to Plan from the Console

Note: Start and Stop gantry for CBCT Mode can be automatic or manual (for full fan
modes, half trajectory only).
For modes that have gantry start and stop angles set manually, the acquisition is
always done between those two directions.
Modes that have the start and stop gantry angles set to automatic, the start angle and
direction is determined right before scan – acquisition will start at the gantry angle
closest to actual gantry from where gantry can rotate the required 200 degrees. One
can move the gantry manually (for instance using GoTo button, from the console) prior
to moving to plan, to change gantry actual position hence re-defining the gantry start
8 position and rotation direction for the following CBCT acquisition. 8

15. Press Prepare on the control console. When kV Beam On button illuminates press it and hold down
until the acquisition starts. See Figure 12. Then the button can be released.

16. When the CBCT has been acquired, the 3D-3D

Match workspace will launch automatically if the
automatic workspace selection has been enabled in
System Administration (PVA → Workflow → 3D-3D
Match checkbox). If that is not the case, use the
Match and Workspace selection button to launch
the 3D-3D Match workspace. See Figure 13.

Figure 13: Selecting 3D-3D Match

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C. 3D-3D Match
1. The 3D-3D Match workspace provides 3 orthogonal views (transversal, frontal and sagittal) with
acquired CBCT and the planning CT overlaid. Any / all of the views can be used to align the acquired
CBCT with the planning CT. Alternatively, a 4 view layout is also available with the 4th view showing
the planning CT only. See Figure 14 and Figure 15.

Transversal view 3 or 4 views Sagittal view

Viewing planes defining sliders

Frontal view

Figure 14: 3-view Layout

Planning CT view

Figure 15: 4-view Layout

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2. Blend Images and Manual Match tools are by default enabled, blending slider is initially
set to 50%.

3. Use the Blend Images and Window / Level to achieve optimal viewing. RMC the W/L bar
provides also anatomy based W/L presets. If the planning CT contains too many contours, some of

them can be hidden using Show / Hide Structures tool, see Figure 16.

Figure 16: W/L Anatomy Presets (left) and Show / Hide Structures Tool (right)

Note: If the Blend Images slider is adjusted to show the acquired CBCT only
(100%), the structures from the planning are still displayed and can be used
to align the image sets or assess how well the image sets are aligned.

4. Use the viewing plane defining sliders to see the desired area of the volumes in the image views. The
red slider defines contents of the sagittal view, the blue is to set the contents of the transversal view
8 and green defines the frontal view. Mouse wheel can also be used to scroll through planes of the
8
active view.

5. Use the Manual Match and / or the Automatic Match tools to align the image sets:

6. Manual Matching:

a) The acquired CBCT image can be moved by the operator in order to align the visible patient
anatomy, the planning CT is fixed.

b) Image translations and rotations are translated into available couch motion axes - Vrt, Lat, Long,
Rtn, Roll, Pitch.

c) The image views are linked – if a CBCT is moved in one of the views, the content of the other two
views will also change.

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d) When Manual Match is enabled, the mouse cursor is red and the cursor icon indicates
what operation can be performed on the images when mouse button is clicked and mouse is
moved - Inside of the dotted red circle, the mouse allows image translations; outside of the dotted
red circle, the mouse allows image rotation. See Figure 17.

Red dotted rotation circle

Rotation cursor

Translation cursor

Figure 17: Mouse Cursor Indicating Manual Match, Translations (bottom) and Rotations (top)

e) The following keyboard shortcuts can be used while matching images:

 Arrow keys ( →←↑↓ ) (+ ALT) can be used to apply small (large) image translations.
8
 CTRL + arrow left and right ( ←→ ) can be used to apply small image rotations.

 CTRL + Z or Y can be used as UNDO or REDO.

 CTRL + A can be used to flip Blend Images slider around 50% - manual flicker. Automatic
flicker can be enabled by RMC the Blend Images slider, see Figure 18.

Figure 18: Flicker Tool

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7. Automatic Matching – is treated as an iterative optimization problem with the goal to find the
geometric transformation that minimizes the ‘differences’ (defined by similarity measure function)
between the moving and fixed images.

a) Auto matching starts immediately after clicking the Auto Match button in the toolbar. Hold
down the CTRL key and click the Auto Match button to open the Auto Matching dialog. Then
choose the Parameter Set, set the Intensity Range and decide whether to use Structure VOI
for matching. See Figure 19. Bones and Soft Tissue are pre-defined HU ranges; Intensity Range
can also be defined using Window / Level bar.

b) The ROI (region of interest) would be automatically enabled, set the ROI. See Figure 19.

c) Click Start to initiate the auto matching process, see Figure 19.

Adjust the ROI

Figure 19: Auto Matching, 3D-3D Matching Workspace
8 8
Note: The Auto Matching window is a modeless window and allows setting
the ROI or otherwise interacting with other visible controls while it is open.

Tip: Both the Structure VOI and Intensity Range are (together with
rectangular ROI) mechanisms that allow the operator to set a region on the
reference image (planning CT) that will be used by 3D-3D auto matching
algorithm.
Structure VOI allows defining the match VOI using plan structures, the
Intensity Range allows defining the voxels that will be used by the auto match
algorithm by setting the HU range; all other voxels will be ignored.

The 3D-3D match algorithm uses logical AND between all ROI / VOI defining
mechanisms – only voxels meeting all criteria will be included in the matching
process, all voxels outside of rectangular ROI are ignored.

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8. Use the Moving Window , Split Window and/or Color Blending match verification
/ assistant tools to verify that the image sets have been aligned correctly. See Figure 20.

Tip: Manual Match can be deselected prior to using the evaluation tools in
order to avoid inadvertent image shifts.

Figure 20: Match Evaluation Tools, Split Window (top left), Color Blend (bottom) and
Moving Window (top right)

Note: In 3D-3D Match workspace, the acquired CBCT is displayed through

the ‘moving window’ and upper left and lower right quadrants of the split
window.

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9. When you have verified the match, decide whether the shift will be applied permanently or for the
session only and whether all calculated rotations will be included and applied to couch, see Figure 21.

10. Click Apply button on the Taskbar to transfer the calculated shift to treatment application.
See Figure 21.

The Couch shifts displayed

do not include couch
movement needed to undo
the couch centering.

Figure 21: Applying the Shifts
8 8
Tip: The Approve button in the toolbar can also be used to apply the
shifts and approve and save the acquired images back to R & V system. This
requires an optional license that may not be available on the system.

11. After applying the shifts, an additional sign-off with appropriate rights will be required, if:

a) the match and images were approved (shift was applied with Approve button).

c) the applied couch shift was selected to be applied permanently.

d) the applied couch shift is larger than allowed by plan tolerance (least permissive tolerance table).

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Note: If there are multiple reasons for the shift approval, one sign-off only is
required, with the right indicated in the Apply Shift Parameters dialog.

12. If it is required to approve the match using the Apply Shift Parameters dialog, read the message,
review the shifts and then sign-off with the indicated right, see Figure 22.

New couch position includes

the couch motions necessary
to restore the couch (undo
couch centering)

Figure 22: Example of Apply Shift Parameters Dialog

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13. After successful sign-off, the applied shifts are translated into new couch position. See Figure 23.

Green arrows indicate the

possibility to move the couch
remotely, from the console

Figure 23: New Couch Positions

14. Apply the couch shifts. When the couch shift includes the couch motions necessary to undo the
couch centering, the shift can be larger than Couch Correction - Remote Motion Thresholds
set in System Administration → Treatment → Clinical. However, it is still possible to move the
couch from the console. Verify the clearance before restoring the couch ! The couch shifts can
also be applied inside in the treatment room using one of the hand pendants.

15. To move the couch from the console, press the Motion Selection buttons on the console highlighted
8 in orange (couch linear and couch rotation if rotations applied; if only one button is orange it would be 8
selected automatically). Then press both Motion Enable buttons and hold them down until couch has
reached the new position. See Figure 24.

Translations applied as selected,

permanently on the example

Rotations applied for session only

Figure 24: Couch Has Been Moved to the New Position

Note: Couch Rtn, Roll, Pitch cannot be applied permanently.

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2D-3D Match
Procedure

Objectives
After completing this procedure the student will have reviewed 2D-3D Match procedure.

Abbreviations
Right mouse click denoted as RMC.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapters 8, 9, 10.

P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

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A. Procedure notables
1. 2D-3D Match is a process of matching a paired set of treatment images (or just one single treatment
image) with dynamically created projections (or just one dynamic projection) from the volume image
(planning CT). The 2D-3D match establishes a geometrical relation (spatial registration) between the
paired treatment images and the reference image volume.

2. The appearance of the projections can be adjusted by selecting appropriate projection (DRR)
template from RMC context menu and it can be done at any time during the matching process at the
console. The available projection templates are the same as default DRR templates in Eclipse and
the list or individual templates cannot be modified.

3. The 2D-3D match requires that the planning CT is available and has been successfully loaded.

4. The 2D-3D match also requires that an optional 2D-3D match license is available on the system.

5. An image pair (kV-kV, MV-kV or MV-MV) is typically acquired for 2D-3D match. This image pair is
always orthogonal. However, it is possible to perform the 2D-3D match with only one image acquired.

6. If an image pair is to be used for the 2D-3D match then

a) it can be acquired for paired orthogonal setup fields,

b) or the image pair can be acquired ‘on demand’ for one of the treatment fields, what requires that
the optional, on demand imaging, license is available on the system. This would be the intended
workflow as the idea behind the 2D-3D match is to relieve the user from the need to create setup
fields / DRR for the plan.

Note: If the plan has an orthogonal pair of setup fields that have reference
images and an image pair is acquired for the paired setup fields, the operator
can choose between 2D-2D and 2D-3D match if the system is equipped with
2D-3D match license (and planning CT is available).
8 8
7. Both acquired images must have the same FOR (frame of reference) and couch positions.

8. The ‘on demand’ paired imaging for the treatment fields requires selecting additional parameters:

a) Execution Phase – Before or After – whether the imaging procedure is scheduled before or
after the selected treatment field.

b) Source Direction – Planned or On Demand:

 Planned – one of the images will be acquired with gantry at planned gantry position for the
selected field.

 On-Demand – one of the images will be acquired with gantry at the actual / (current at the
time of attaching the procedure to field) gantry position.

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c) Modality Specifics (not for MV-kV) – Clockwise or Counterclockwise – determines the gantry
rotation direction when gantry moves from Planned or On Demand (Actual) imaging direction to
next imaging direction (90° offset in selected rotation direction). If gantry cannot move 90° to next
imaging direction in user-selected direction, it will move in the other direction.

Caution: Before administering a treatment, verify that the treatment plan

Warning: If matches are performed incorrectly and imagers or markers are

Warning: To avoid collision when making couch corrections, carefully

observe the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 191.
8
Warning: Always take another image to verify the patient position after a
couch shift because the patient may have moved during the matching
process. The final patient position must be verified to prevent mistreatment.
P1005922-001-A – TrueBeam Instructions for Use, page 192.

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B. Acquiring kV-kV image pair on demand

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 1.

Figure 1: Select the Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8 8

Figure 2: Motion Management Devices Example

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6. Wait until the plan loads. The ‘on-demand’ imaging can be done from planned or on-demand
directions. If the imaging is to be done from ‘on-demand’ direction, make sure the gantry is at desired
position.

7. GoTo button can be used to move the gantry to desired position. Click GoTo button, see Figure 3.

Figure 3: GoTo

8. Type the desired gantry position in Gantry Rtn edit box, then click the Apply button. See Figure 4.

Figure 4: Moving Gantry Ad-hoc Example

9. Use Motion Selection buttons on the console to select gantry to be moved. Press the buttons 8
highlighted in orange color until green ‘Gantry’ flashes above the Gantry button. Then press both
Motion Enable buttons and hold them down until gantry has reached the position. See Figure 5.

Gantry selected to be moved

Figure 5: Control Console, Gantry Selected To Be Moved

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10. Click Done button once the gantry has been moved to desired imaging position. See Figure 6.

Figure 6: Gantry at Position

11. Select any treatment field; click Add and then Add Imaging. Select the appropriate imaging
procedure (e.g. kV-kV) in Modify Imaging dialog box displayed in PVA and click OK. See Figure 7.

8 8

Figure 7: Adding kV-kV Imaging

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12. A paired imaging will then be attached to the selected field and selected. PVA displays the reference
projections calculated from the volume image. Blank views on the right are for the images to be
acquired, green box indicates currently active acquisition direction. See Figure 8 and Figure 9.

Figure 8: On-Demand kV-kV Pair

AP projection
AP to be acquired

Projected images include

8
overlays with structures
projected from planning CT

Lt. lat projection Lt lat. to be acquired

(selected)

Figure 9: PVA Application with Reference Images Displayed

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13. If necessary, the direction to be imaged can be selected by clicking one of the views for the acquired
images. Otherwise, the system automatically selects the direction that requires less gantry motion.

14. Press Prepare button on the control console to make the kV beam ready. See Figure 10.

15. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange, then press both Motion Enable button and hold them down until all
selected axes are at imaging position for the selected imaging direction. See Figure 10.

Figure 10: Control Console

16. Review the acquisition parameters and modify them if necessary. kV or mAs can be set manually or
by choosing appropriate Anatomy and Size template. See Figure 11.

8 8

Figure 11: Setting the Acquisition Parameters

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Note: If the system is configured, in System Administration, to store and then

17. When the kV Beam On button illuminates press and hold it until the button gets dark. See Figure 12.

Figure 12: Control Console, Prepare

18. Make sure the image was acquired; review the image quality. See Figure 13. If the image quality is
not satisfactory, select the image and repeat the steps B.16 to B.17 with different acquisition settings.

8
The next is already selected

Acquired image

Figure 13: First Image Acquired

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2D-3D Match

19. When the first image has been acquired the second imaging direction is selected automatically if the
system has been configured for automatic field selection (PVA → Workflow → Paired Acquisition
checkbox) in System Administration. If that is not the case, click the image view for the second image
to select it for imaging.

20. Repeat steps B.15 to B.18 to acquire an image for the second direction.

Note: If acquiring an MV image, the system needs to be in Preview state

(Preview button on the console has been pressed) to be able to change the MV
acquisition parameters. Click OK on the PVA taskbar to accept the modified
parameters and then press Prepare button on the console to re-program the
BGM for the new settings.

21. If automatic workspace selection has been enabled in System Administration (PVA → Workflow →
Paired Match checkbox) the PVA automatically launches 2D-3D Match workspace once both images
have been acquired. If image acquisition is to be repeated, the matching workspace can be closed
using the Cancel button on the Taskbar. If the 2D-3D Match workspace does not open automatically,
click the Match and Review workspace button and select 2D-3D Match, see Figure 14.

Active matching workspace

Figure 14: Closing (left) and Opening (right) the 2D-3D Match Workspace

Tip: If the acquired images are not of satisfactory quality, the acquisition can be repeated.
8 The images that will not be used for the match can be deleted if desired. If an image is
8
acquired and it is even worse than what has been previously taken, it is possible to select
the previous one for matching. Select the image (click the view), then click Images dynamic
tab, RMC the image and make appropriate selection. See picture below:

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2D-3D Match

C. 2D-3D Match using on demand acquired kV-kV pair

1. When the 2D-3D Match workspace is opened, the acquired and the reference images will be
superimposed in the upper views. The lower views show the individual projections and acquired
images. The Dashboard shows the couch shifts. See Figure 15.

Couch shifts
Superimposed / blended views

Acquired images and projections

RMC the projection

allows customizing its
appearance

Figure 15: 2D-3D Match Workspace

2. The Manual Match and the Blend Images tools will be by default enabled, the Blend
Images slider will be positioned to show 100% acquired image
8
3. Use Window / Level and adjust the Blend Image slider to achieve
optimal viewing. The blend ratio is the same for both superimposed views.

4. For the blended views, the window / level bar that allows setting the
window width and level is on the left hand side for the projection,
and on the right hand side for the acquired image. Blend Image
slider is connected to Window / Level tool – when adjusting window
and / or level for the image the blend slider will automatically
change to show only that image.

5. Structure projections displayed on the top of projected images can

also be used to align the images or to help assess the quality of the
match. They all can be enabled / disabled with Show / Hide
Structures button that also provides a drop-down selection that allows Figure 16: Show /
selecting individual structures to be displayed or hidden. See Figure 16. Hide Structures

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2D-3D Match

6. Use the Manual Match or the Automatic Match tools or both, to align the overlaid
projections and the acquired (setup) images.

7. Manual Matching:

a) The projections can be moved by the operator in order to align the visible patient anatomy, the
acquired images are fixed. The PVA automatically recalculates / updates the projections as they
are moved by the operator.

b) Image translations and rotations are translated into available couch motion axes - Vrt, Lat, Long,
Rtn, Roll, Pitch.

Tip: Roll can be applied using SHIFT key and moving the mouse with LMB
pressed outside of red dotted rotation circl; it cannot be applied just by
moving and rotating the images in 2D-3D match.

c) The images are linked – if one is moved in patient longitudinal direction the other moves same
amount in the same direction.

Translation cursor

Rotation cursor
8 8

Red dotted image rotation

circle

Figure 17: Mouse Cursor Indicating Manual Match, Translations (left), Rotations (right)

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2D-3D Match

8. Automatic Matching:

b) Select the Parameter Set for the matching, axes allowed to move Click Start to run the auto-
match algorithm, see Figure 18.

Figure 18: Auto Match parameters

Note: Unlike 2D-2D Auto Match, the 2D-3D Auto Match does not allow
selecting the Intensity Range, The Intensity Range is hard-coded for the
individual Parameter Sets, (e.g. `Bones` only uses Intensity Range for bones)

c) The Automatic Match tool also automatically enables ROI – adjust the size and position of the
ROI by dragging the small red squares on its sides / corners. See Figure 19.
8

Adjust the ROI

Figure 19: Setting the ROI for the Automatic Match

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2D-3D Match

Tip: The Parameter Set settings (matching algorithm settings) can be set by
clicking arrow down next to Automatic Match button in the toolbar and
choosing Change Settings:

Changing the Auto-Match settings requires Administer System right.

9. Utilize the Split Window , Moving Window and / or Color Blend tools to evaluate match
results. See Figure 20. Manual Match can be deselected prior to match evaluation to avoid
inadvertent shift. However, the matching workspace has the Undo/Redo functionalities, that can be
invoked with CTRL+Z and CTRL+Y keyboard keys.

8 8

Figure 20: Match Evaluation Tools: Color Blend, Moving Window, Split Window

10. RMC the blend slider provides the option to enable flickering, see Figure 21. CTRL+A keyboard keys
can be used to flip the blend slider around 50% manually.

Figure 21: Flicker

11. Use the arrow keys on the keyboard to make fine adjustments in desired directions. CTRL + arrow left
and right keys can be used to introduce small image rotations.

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2D-3D Match

12. When done with the matching and the image alignment has been verified, decide whether the shift
will be applied permanently or for the session only and whether all calculated rotations will be
included and applied to couch. See Figure 22.

Figure 22: Applying the Shift

13. Click Apply button on the Taskbar to transfer the calculated shift to treatment application.
See Figure 22.
8
Tip: The Approve button in the toolbar can also be used to apply the
shifts and approve and save the acquired images back to R & V system. This
requires an optional license that may not be available on the system.

14. After applying the shifts, an additional sign-off with appropriate rights will be required, if:

a) the match and images were approved (shift was applied with Approve button).

c) the applied couch shift was selected to be applied permanently.

d) the applied couch shift is larger than allowed by plan tolerance (least permissive tolerance table).

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Note: If there are multiple reasons for the shift approval, one sign-off only is
required, with the right indicated in the Apply Shift Parameters dialog.

15. If it is required to approve the match using the Apply Shift Parameters dialog, read the message,
review the shifts and then sign-off with the indicated right, see Figure 23.

8 8

Figure 23: Example of Apply Shift Parameters Dialog

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2D-3D Match

16. After successful sign-off, the applied shifts are translated into new couch position. See Figure 24.

Green arrows indicate the

possibility to move the couch
remotely, from the console

Figure 24: New Couch Positions

17. Apply the couch shifts. If the remote couch corrections are allowed and within tolerances as set in
System Administration → Treatment → Clinical, then the couch can be moved from the console. If
that is not the case, enter the treatment room and apply the shifts from one of the hand pendants.

18. To move the couch from the console, press the Motion Selection buttons on the console highlighted
in orange (couch linear and couch rotation if rotations applied; if only one button is orange it would be
selected automatically). Then press both Motion Enable buttons and hold them down until couch has
reached the new position. See Figure 25.
8

Translations applied as selected,

for session only on the example

Rotations applied for session only

Figure 25: Couch Has Been Moved to the New Position

Note: Couch Rtn, Roll, Pitch cannot be applied permanently.

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Treatment with Automation

Treatment with Automation

Procedure

Objectives
After completing this procedure the student will have learned how to treat a plan with automation.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 5.

8 8

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Treatment with Automation

A. Automation
1. Automation is a TrueBeam feature that allows the operator to group fields in the plan and the
machine delivers the group as if it was just one single field – the machine automatically moves gantry,
collimator, jaws, MLC between the original fields with radiation held off.

2. In order to be able to use automation, the following prerequisites have to be met:

a) Allow Automation is set to Yes, in System Administration → Treatment → Clinical tab.

b) The operator has the Automate Treatment right.

c) The plan has to have a group of the fields that

 have the same energy mode parameters – energy, mode (photon, electron), nominal dose
rate, etc.,

 have the same couch values,

 have no imaging procedures attached,

 have no different physical accessories.

Caution: An automated (multi-field) treatment delivery may increase the risk

of a collision between the patient and the machine. You should perform a dry
run before this kind of treatment.
P1005922-001-A – TrueBeam Instructions for Use, page 96.

Note: The maximum number of fields that can be automated is determined

by the number of control points. The group of the fields to be delivered with
automation can have up to 5000 control points. 8

Note: Adding automation affects the current session only. It does not change
the plan that is stored in the hospital information system.

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Treatment with Automation

B. Treating an IMRT plan with automation

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 1.

Figure 1: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8 8

Figure 2: Motion Management Devices Example

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Treatment with Automation

6. Wait until the plan loads. Then perform all the imaging necessary to make sure the patient has been
properly set up, make corrections if necessary.

7. When the patient position has been verified, the treatment can start. Select one of the fields that are
to be grouped. Click Add and then choose Add Automation, see Figure 3.

Important Note: If imaging (image-based patient setup, couch position,

correction process) has not been done for the plan, it may be necessary to
resolve the mismatch between the actual and plan couch values. It needs to be
resolved prior to adding Automation either by acquiring couch values with the
Acquire button or by editing couch position for each field with Edit button, if
couch values modification is permitted by OSP couch locking setting. Acquiring
or editing couch values requires Update Plan Parameters right.

Alternatively, the mismatch can be overridden for all fields using Override button
that becomes available after pressing Prepare on the console. Overriding the
couch values removes the automation; hence the system needs to be switched
back to Preview to add automation again. After adding automation and pressing
Prepare the couch position mismatch is still overridden.

Figure 3: Adding Automation

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Treatment with Automation

8. The automation will then be added to eligible fields. See Figure 4.

Figure 4: Automation Added

Note: The fields will be delivered in the exact order they are listed on the
screen and they will be delivered without user intervention. The field order
can be changed before adding the automation using Reorder button if
desired. Reordering requires Update Plan Parameters right.

Tip: If the Automation was added accidentally, it can be deleted from plan
using Remove button and then choosing Delete Automation:

9. Press Prepare on the Control Console. See Figure 7.

8 8

Figure 5: Control Console, Prepare

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Treatment with Automation

10. The following Clearance Caution message is displayed. See Figure 6. Read the message and decide
if it safe to proceed with the treatment. Acknowledge the message with OK button.

Figure 6: Clearance Caution Message

11. Move the remaining machine axes to plan – press the Motion Selection buttons on the console that
are highlighted in orange to select the axes to be moved (if only one button is orange, it will be
selected automatically). Press both Motion Enable buttons and hold them down until the selected
axes have reached their plan positions. See Figure 7.

Figure 7: Control Console, Motion Selection, Motion Enable

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Treatment with Automation

12. When all axes have reached the plan positions (and all other interlocks have been cleared), the MV
Ready button on the console illuminates. Press the MV Ready button and hold it down until MV
Beam On button illuminates. Then press MV Beam On to start the treatment. See Figure 8.

Figure 8: Control Console, MV Ready → MV Beam On

13. Watch the treatment progress on the screen and wait until all grouped fields have been delivered.
See Figure 9.

Moving to Field 4

8 8

MU are grouped

Figure 9: Treatment with Automation in Progress, Moving to Field 4 Example

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Treatment with Automation

14. Click Close Patient when all plan fields have been delivered. See Figure 10.

Figure 10: Close Patient

15. It may be required to sign-off the treatment; if configured in System Administration → Treatment →
Clinical. Enter your user name and password, then click OK, see Figure 11.

Figure 11: Close Patient Sign-off

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Interrupted Treatment

Interrupted Treatment
Procedure

Objectives
After completing this procedure the student will have reviewed interrupted treatment.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 8.

8 8

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Interrupted Treatment

A. RapidArc treatment with interruption

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 1.

Figure 1: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8

Figure 2: Motion Management Devices Example

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Interrupted Treatment

6. Wait until the plan loads. Then perform all the imaging necessary to make sure the patient has been
properly set up, make corrections if necessary.

Note: If imaging (image-based patient setup, couch position, correction

process) has not been done for the plan, it may be necessary to resolve the
mismatch between the actual and plan couch values. It can be done either by
acquiring couch values with the Acquire button or by editing couch position for
each field with Edit button, if couch values modification is permitted by OSP
couch locking setting. Acquiring or editing couch values requires Update Plan
Parameters right.

Alternatively, the mismatch can be overridden for all fields using Override
button that becomes available after pressing Prepare on the console.

7. Select the first of the fields to be delivered. See Figure 3.

8 8

The arrow indicates

gantry rotation direction

Figure 3: Plan Loaded, Patient Setup Correction Done, the First Treatment Field Selected

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Interrupted Treatment

8. Press Prepare on the Control Console. See Figure 4.

Figure 4: Control Console, Prepare, Motion Selection, Motion Enable

9. The following Clearance Caution message may be displayed in case that the gantry is going to move
automatically during the treatment without the operator intervention (automation, arc treatments).
Read the message and decide if it safe to proceed with the treatment. Acknowledge the message
with OK button. See Figure 5.

Figure 5: Clearance Caution Message

10. Move the remaining machine axes to plan – press the Motion Selection buttons on the console that
are highlighted in orange to select the axes to be moved (if only one button is orange, it will be
selected automatically). Press both Motion Enable buttons and hold them down until the selected
axes have reached their plan positions. See Figure 4.

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Interrupted Treatment

11. When all axes have reached the plan positions (and all other interlocks have been cleared), the MV
Ready button on the console illuminates. Press the MV Ready button and hold it down until MV
Beam On button illuminates. Then press MV Beam On to start the treatment. See Figure 6.

Figure 6: Control Console, MV Ready → MV Beam On

12. After a while, interrupt the treatment by pressing Beam Off button on the console. See Figure 6.

13. The radiation and the gantry stop. As the gantry is too heavy to stop immediately when the Beam Off
button is pressed, it is necessary to move gantry backwards a little bit. This is only needed for arc
treatments. See Figure 7.

8 8

Figure 7: Move Gantry Back, ‘Resume at’

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Interrupted Treatment

14. Press both Motion Enable buttons on console to move gantry back to ‘Resume at’ position and hold
them down until the gantry reaches the position. See Figure 8.

Gantry will be selected

automatically as one
button only is orange

Figure 8: Moving Gantry Back to ‘Resume at’ Position

15. When gantry is back at ‘Resume at’ position, see Figure 9, MV Ready button on the console
illuminates. Press and hold it until MV Beam On button illuminates. Then press MV Beam On to
resume the treatment. See Figure 10.

8

Figure 9: Gantry Is Back at ‘Resume at’ Angle, Treatment Can Be Now Resumed

Figure 10: Control Console, MV Ready → MV Beam On

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Interrupted Treatment

16. After a while, interrupt the treatment by pressing Beam Off button on the console again.

17. Close the plan and the patient. Press Preview button on the console, see Figure 11, and then click
Close Patient button on the screen, see Figure 12.

Figure 11: Control Console, Preview Button

8 8

Figure 12: Close Patient Button

Note: The Close Patient button is available on the screen immediately after
pressing Beam Off button. However when the button is clicked it shows the
following message, and it is necessary to press Preview on the console to be
able to close the plan.

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Interrupted Treatment

18. Sign-off the incomplete treatment session warning. See Figure 13.

Figure 13: Incomplete Treatment Sign-off

19. Decide whether the plan can be resumed or the plan will be locked. If the plan is locked, the partial
treatment session can be made available in Plan Scheduling workspace of ARIA, to finish the
treatment.

Figure 14: Partial Treatment Status

Note: Partial Treatment Status options depend on QUEUE preferences for

the partial treatment that are set in Data Administration → Setup → System
→ Department Details → Preferences → Edit button → Queue tab. The
system may be configured not to display any options at the treatment console
for partial treatments; situation must be then resolved in Plan Scheduling.

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Interrupted Treatment

B. Resuming the interrupted treatment

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and the partially treated plan. Click Treat in lower right corner. See Figure 15.

Partially treated

Figure 15: Select Partially Treated Plan

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 2.
8 8

Figure 16: Motion Management Devices Example

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Interrupted Treatment

6. Wait until the plan loads. Then perform all the imaging necessary to make sure the patient has been
properly set up, make corrections if necessary.

Important Note: If imaging (image-based patient setup, couch position,

correction process) has not been done for the plan, it may be necessary to
resolve the mismatch between the actual and plan couch values. It can be
done either by acquiring couch values with the Acquire button or by editing
couch position for each field with Edit button, if couch values modification is
permitted by OSP couch locking setting. Acquiring or editing couch values
requires Update Plan Parameters right.

Alternatively, the mismatch can be overridden for all fields using Override
button that becomes available after pressing Prepare on the console.

7. Select the partially delivered field. See Figure 3.

8
MU delivered / MU planned

The field will be resumed

exactly, where the treatment
was previously interrupted

Figure 17: Plan Loaded, Patient Setup Correction Done, the Partially Delivered Field Selected

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8. Press Prepare on the Control Console. See Figure 18.

Figure 18: Control Console, Prepare, Motion Selection and Motion Enable

8 8

Figure 19: Clearance Caution Message

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Interrupted Treatment

Figure 20: Control Console, MV Ready → MV Beam On

12. Deliver the remaining fields in the plan.

13. Click Close Patient when all plan fields have been delivered. See Figure 21.

Figure 21: Close Patient

14. It may be required to sign-off the treatment; if configured in System Administration → Treatment →
Clinical. Enter your user name and password, then click OK, see Figure 22.

Figure 22: Close Patient Sign-off

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Treatment with Clearance Override

Treatment with Clearance Override

Procedure

Objectives
After completing this procedure the student will have reviewed low-clearance treatment with Machine
Motion Model and Laser Guard II systems overridden.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

Warning: Use extreme caution when moving the couch, gantry, or imaging
equipment with the Clearance Override button engaged, to prevent
equipment colliding with the patient.
P1005922-001-A – TrueBeam Instructions for Use, page 41.

References:
8 P1005922-001-A – TrueBeam Instructions for Use, chapter 2, appendix G. 8

A. Overview
1. The TrueBeam system features (in addition to the hardware collision detectors) three primary motion
safety systems:

a) Machine Motion Model (AKA collision model, AKA Machine Protection System): Software model
of the machine. It provides machine protection by tracking the locations of all parts of the machine
in three dimensions and stops all motions if any two parts are so close that a collision is very
likely to occur.

b) LaserGuard II (AKA Patient Protection System): A device that uses an infrared laser sensor to
detect objects that enter its protection zone which is a V-shaped area below the collimator. All
motions stop if an intrusion is detected.

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Treatment with Clearance Override

c) Zone Rules: 10 rules for mutual positions of gantry and couch preventing collisions between
them. When the LaserGuard II is active, the upper zone rule remains in force, but the other zone
rules are inactive. Zone Rules only apply to couch and gantry motions initiated from the control
console.

Warning: To avoid the risk of collision and injury to the patient or equipment,
always perform a dry run to verify treatment motion is safe before using
Clearance Override.
P1005922-001-A – TrueBeam Instructions for Use, page 355.

Caution: Always observe the patient and machine closely when moving
axes, to ensure that the motion is safe.
P1005922-001-A – TrueBeam Instructions for Use, page 356.

2. Any or all of the above safety features can be overridden using Clearance Override button on the
control console to allow remote motions that would normally trigger collision interlocks. One or both
Motion Enable buttons would have to be pressed and held down together with Clearance Override
to allow the remote motions. See Figure 1.

Figure 1: Clearance Override and Motion Enable

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Treatment with Clearance Override

a) Overriding the Zone Rules requires that the Zone Protection is checked in Tools → Allow
Clearance Override dialog; authorization with username and password is not necessary. The
checkbox is only active if Zone Rules are active (LaserGuard II not installed / disabled) and is
enabled by default. See Figure 2.

Figure 2: Allow Clearance Override when LaserGuard II not Installed / Disabled

b) Overriding collision interlocks triggered by Machine Motion Model (Machine Protection System)
and / or LaserGuard II (Patient Protection System) requires that the protection system is selected
in Tools → Allow Clearance Override dialog and the override is authorized by user that has
Override Patient Protection right. Authorization is (only) valid for the duration of current
treatment session. See Figure 3.

8 8

Figure 3: Allow Clearance Override when LaserGuard II Enabled

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Treatment with Clearance Override

Note: The Clearance Override button on the console never illuminates

whether it has been authorized / enabled (in Allow Clearance Override dialog
) to override some of the protection systems or not. If the button is pressed
when it has not been enabled for use the following User Message is
displayed:

3. One or both of the Motion Enable buttons must be pressed together with Clearance Override to
allow remote motions through ‘collision zone’ or beam, while the machine is in ‘collision zone’.

a) One of Motion Enable buttons is enough for arc fields, CBCT or treatment with automation to
move through the ‘collision zone’ or to beam on while in ‘collision zone’; generally during the
treatment.

b) Both Motion Enable buttons would have to be used during patient setup (moving to plan from
console), to move an axis in general before treatment.

4. Clearance Override message appears on the system status messages

panel when one or more protection systems have been overridden. Tooltip can be used to see what
protection systems have been overridden. See Figure 4.
8
Red overlay for collimator and
couch indicates that machine is
in ‘collision zone’

Figure 4: Clearance Override Message, Machine in ‘Collision Zone’

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Treatment with Clearance Override

5. Status messages panel also provides information what protection system has triggered the collision.
See Figure 4.

a) - collision triggered by Machine Motion Model.

b) - collision triggered by Laser Guard II.

8 8

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Treatment with Clearance Override

B. Exercise
1. Instructor(s) will demonstrate Clearance Override functionality using a plan of their choice.

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Treatment with Auto Beam Hold

Treatment with Auto Beam Hold

Procedure

Objectives
After completing this procedure the student will have reviewed treatment with Auto Beam Hold (ABH).

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 6.

P1005922-001-A – TrueBeam Instructions for Use, chapter 8.

8 8

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Treatment with Auto Beam Hold

A. Overview
1. Auto Beam Hold (ABH) feature utilizes triggered kV imaging - the images are acquired as the
treatment field is being treated at a rate given by the selected trigger. Markers inside of the patient
are detected on the acquired images and compared to positions of the markers in the planning CT or
plan structures. The beam is automatically held-off if detected markers are too far from markers in the
plan or out of projected user-selected plan structure.

2. Auto Beam Hold requires that:

a) “Both” Varian Motion Management Devices (Gating and ABH) have been enabled in System
Administration → Configuration → Installation. Device ID must be 4. See Figure 1.

ABH is Patient Position

Monitoring Device
8

Figure 1: System Administration → Configuration → Installation

Note: Selecting ‘Both’ from the Device Type requires elevated access to
System Administration with Varian HASP key.

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Treatment with Auto Beam Hold

b) both Image Processing Service and Image Processing have been enabled in System
Administration → PVA → Gating and Motion Management. See Figure 2.

Figure 2: System Administration → PVA → Gating and Motion Management

c) Varian Motion Management Device enabled in System Administration has been selected for the
plan as Patient Position Monitoring Device in Motion Management Devices dialog, see Figure 3.

8 8

Figure 3: Selecting Varian Motion Management Device as Patient Position Monitoring Device

d) the system is equipped with the Auto Beam Hold and Triggered Imaging licenses. Trigger can be
specified in terms of Time interval, MU interval or Gantry angle interval (for arc fields only).
Alternatively, Respiratory Gating can be used as a trigger (acquisition triggered when patient’s
breathing trace crosses a gating threshold).

e) patient has markers implanted.

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Treatment with Auto Beam Hold

f) markers have been detected in the planning CT prior to treatment,

 either in the available Treatment Planning / Record & Verify Systems, if supported,

 or on the TrueBeam system itself, in Marker Detection workspace.

3. User has the option to select the marker to be detected; therefore number of implanted markers can
be greater than the number of markers being detected. Currently, the system uses ‘relaxed’ marker
detection. It means that one marker can go undetected and the beam still may stay on if there is
sufficient number of other markers detected:

a) 1 marker selected to be detected – 0 undetected markers allowed.

b) 2 markers selected to be detected – 0 undetected markers allowed. This is because with only one
marker detected there is not enough spatial information to evaluate validity of detection.

c) 3 or more markers selected to be detected – 1 undetected marker allowed. This is because there
is enough spatial information ( geometric relation between detected markers) to evaluate validity
of detection.

Important Note: In addition, the system also internally evaluates confidence

of detection. If the markers are detected but the overall detection confidence
is low, the beam will be held off.
Hence situations can occur when there are two detected markers (green
overlay) and one undetected (projection shown using orange overlay) with
different beam outcome – once the beam is held off because confidence of
detection is too low and some other time the beam would stay on as
confidence of detection is high enough.
The detection confidence is a general concept always used, not only when
one marker was not found.

8
4. The detected marker has to be ‘within’ its (user-defined) Search Region to mark it as green and
possibly allow radiation depending on positions of the other detected markers and detection
confidence. ‘Within’ in this context means that the center of the detected marker has to be inside of
the defined Search Region, where the center of detected marker is the center of area of all marker
pixels. The center of the marker is indicated using + (plus) symbol on the acquired images, if
detected.

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Treatment with Auto Beam Hold

B. RapidArc™ plan treatment with ABH

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 4.

8 8

Figure 4: Select Patient Example

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Treatment with Auto Beam Hold

5. When the Motion Management Devices dialog opens, select Varian Motion Management Device as
the Patient Position Monitoring Device and decide if it is to be used for the session only or
permanently. See Figure 5.

Figure 5: Motion Management Devices Example

Tip: If necessary, the Motion Management Devices dialog can be accessed

using the Tools button any time the plan is opened to enable or disable ABH:

6. Wait until the plan loads. Then perform all the imaging necessary to make sure the patient has been
properly set up, make corrections if necessary.

Note: If imaging (image-based patient setup, couch position, correction

Alternatively, the mismatch can be overridden for all fields using Override
button that becomes available after pressing Prepare on the console.

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Treatment with Auto Beam Hold

7. Select the first of the fields to be delivered. Click Add and choose Add Imaging. See Figure 6.

Figure 6: Adding Imaging to the First of the Treatment Fields

8. Select kV imaging during. Apply to all treatment beams can be selected, if desired. See Figure 7.

8 8

Figure 7: Scheduling kV Imaging During

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Treatment with Auto Beam Hold

9. In PVA, click the Trigger button and select the appropriate kV beam triggering option. See Figure 8.

Figure 8: kV Trigger Options

10. Define the trigger Interval. Set the remaining imaging parameters such as kV and mAs ( manually or
by selecting appropriate Anatomy and Size ) and then click OK. See Figure 9.

8
Time trigger selected

Figure 9: Setting Trigger Interval and Other Imaging Parameters

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Treatment with Auto Beam Hold

Note: When using ABH with arc fields make sure that kV imaging settings are
appropriate for all directions that the gantry will go through. Bad image quality
may result in failure to detect the markers in the patient.

Note: Gantry Rtn trigger is only available for arc fields.

Minimum interval for Time triggering is 3 sec. Minimum interval for MU
depends on field nominal dose rate and cannot be smaller than time
equivalent of 3 sec. Minimum gantry angle trigger interval is 10 degrees.

11. The Beam Hold dynamic tab should automatically pop up. Select the markers to be detected and
define the Search Region for each of them, set the Diameter for the Default search region. Choose
the appropriate Marker Detection Method. Finally, select the Structures to be projected onto
acquired kV images during the treatment. See Figure 10.

8 8

All ABH prerequisites for

the plan have been met

Selecting Overlay Structures

may be useful for visual
inspection by the operator

Marker Detection can be used to identify

the markers in planning CT if necessary

Figure 10: Beam Hold Settings

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Treatment with Auto Beam Hold

Note: The system recognizes several different ABH states as displayed in PVA:

ABH is fully engaged

ABH inactive as Varian Motion

Management Device has not been
selected for the plan and session as
Patient Positioning Management Device
in Motion Management Devices dialog. If
continued, marker are still detected but
the beam is not gated based on the
results of marker detection

ABH does not apply as no marker has

been selected, structures can still be
selected and would be overlaid on the
acquired images for visual guidance

Note: When ABH has been disabled in System Administration, for instance by
unchecking System Administration → PVA → Gating and Motion Management
→ Image Processing checkbox, the PVA shows Overlay tab instead of the
Beam Hold tab. One can use the Overlay tab to choose markers and structures
to be projected onto the triggered kV images acquired during the treatment as
visual guidance providing live treatment accuracy feedback. See Overlay tab
example below:

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Treatment with Auto Beam Hold

a) Search Region – defines where the detected markers have to be in order to allow the beam. If
any one of the detected markers is outside out the Search Region selected for that particular
marker, the beam will be held-off. The Search Region can be Default (circular region) or any of
the planning CT structures. See Figure 11. If a structure is selected then the detected marker
needs to be within the projection of the selected structure on the acquired image. If the Default is
selected, then the detected marker needs to be within a circle of the selected Diameter to allow
the beam, where the center of the circle is given by projection of the marker in the planning CT.

Figure 11: Search Region Options

Note: The algorithms actually search in volume larger than selected /

defined. The scanning volume is roughly double the size of the marker + the
control margin (the tolerance circle size or the selected structure size). This is
to avoid searching in the areas that are not relevant for motion control, as the
detection has to be fast, while still making sure that no possible marker
information will be missed.

b) The Marker Detection Method – defines the marker type to look for on the acquired images.
Marker Detection Method name is defined as “Marker Type”_”Width (in mm)”x”Length (in mm)”.
See the options on the Figure 12.

8 8
For instance, this option is for
Gold seed marker with width of
1.0mm and length of 3.0 mm

Figure 12: Marker Detection Methods

Important Note: Marker detection methods are named after marker type and
dimensions. For accurate detection it is important to choose the detection
method as close as possible to the actual marker dimension even though
detection method has some tolerance embedded in it to compensate for
projection and size variation.

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Treatment with Auto Beam Hold

12. When all the Beam Hold options have been defined click Confirm Setting button on the Beam Hold

dynamic tab. See Figure 13. That releases the workstation interlock .

Figure 13: Confirm Settings

13. Move the machine axes to plan. Press the Motion Selection buttons, on the control console, that are
illuminated in orange color to select the axes to be moved, if needed. Press both Motion Enable
buttons and hold them down until the selected axes have reached the plan position. See Figure 14.

MV Beam On only needs to

be pressed to initiate the
treatment, kV beam will be
fired during the treatment
when triggered.
8

Figure 14: Control Console, Motion Selection, Motion Enable

14. Press Prepare button on the console when all machine axes are at plan positions. Wait until MV
Ready button illuminates. Then press the MV Ready button and hold it down until MV Beam On
button illuminates. Finally, press the MV Beam On button to initiate the treatment. See Figure 14.

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Treatment with Auto Beam Hold

Note: Treatment is initiated using MV Beam controls but kV imaging during

has been scheduled for the field hence the kV will also be enabled when
required by the trigger option.

15. kV images will be acquired at the rate given by selected trigger option and interval. Observe the
images taken during the treatment, the detected markers, selected structure overlays and search
regions. The view can be maximized if necessary. See Figure 15, Figure 16 and Figure 17.

Search region (the circle = nominal

marker position from plan projected onto
image with defined Diameter) and
detected marker (the plus symbol)

Structure Overlay (Body)

8 8

Figure 15: Beam Is On, Circles Are Search Regions and Crosses Are Detected Markers; Green Color of All
Markers Indicates Beam State – On

a) green overlay color - marker has been found to be inside of its search region.

b) red overlay color – marker has been found to be outside if its search region, radiation held off.

c) orange overlay color – marker has not been found on the image.

d) gray overlay color – PVA is waiting for results (image is being processed).

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Treatment with Auto Beam Hold

Marker detected outside of its

search region, radiation held-off

Figure 16: One Marker Is Outside of its Search Region – Radiation Is Held Off

One of the markers could not be

found, radiation was on in this case

Figure 17: One Marker Could Not Be Found, Radiation May Be On or On Hold

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Treatment with Auto Beam Hold

Important Note: If MU or Gantry angle are selected as the triggers and the
radiation is put on hold during the treatment, it would never be released as no
more MU are being delivered and gantry stops. It is then necessary to
interrupt the treatment with Beam Off button and re-start the treatment; first
image is acquired after the beam has been on for a while.

16. Repeat the procedure for the remaining plan fields.

17. Click Close Patient when all plan fields have been delivered. See Figure 18.

8 Figure 18: Close Patient 8
18. It may be required to sign-off the treatment; if configured in System Administration → Treatment →
Clinical. Enter your user name and password, then click OK, see Figure 19.

Figure 19: Close Patient Sign-off

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Treatment with Auto Beam Hold

Note: Before closing the plan or even after delivering each particular field, the
images can be reviewed in Image Playback workspace. Select the treatment
field and then choose Image Playback using Match and Review selection
button in PVA. See Figure 20.

Figure 20: Image Playback After ABH

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Electron Plan Delivery, Custom Coding

Electron Plan Delivery, Custom Coding

Procedure

Objectives
After completing this procedure, the student will have reviewed the following:

1. Custom Coded Accessories on TrueBeam.

2. Delivery of an electron plan with custom FFDA (electron cut-out).

References:
P1005925-001-A – TrueBeam Administrators Guide, chapter 9.

P1005922-001-A – TrueBeam Instructions for Use, chapter 8, 12.

8 8

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Electron Plan Delivery, Custom Coding

A. Custom Coded Accessories

1. The TrueBeam system is designed for collimator accessory verification and performs most efficiently
when custom codes are used for patient-specific accessories. Custom coding permits the system to
verify that the accessory in place is the one called for in the treatment plan.

2. Custom coding allows the operators to easily configure custom accessories for a patient by uniquely
identifying the accessories with special adhesive labels called custom coding labels. The custom
coding labels are placed on the trays that hold the patient specific accessories such as blocks,
electron cut-outs in place. See Figure 1.

Figure 1: Custom Coding Labels Example, E-Aperture (top), Photon Block (bottom)

3. The system verifies custom-coded accessories. The treatment screen displays the numerical code
and any patient plan-based ID in the accessory data boxes. The numerical code for planned
accessory as well as for the accessory inserted in a particular machine slot is also displayed on In-
Room Monitor (Machine Monitor).

4. To verify that the correct accessory is installed, the system compares the numerical code it detected
(by reading the code on the accessory custom coding label) with that in the patient plan. If the two do
not match, the system asserts an accessory interlock and prevents treatment delivery until the correct
accessory is installed.

5. Treatment planning and delivery with custom coding includes the following steps:

a) Treatment plan is generated including use of an accessory that may be uniquely identified for that 8
given patient.

b) The custom accessory (block and its tray, electron insert) is prepared in accordance with the
treatment plan.

c) An appropriate custom code label is applied to the accessory tray. See Figure 2.

Figure 2: Custom Coding Labels on the Accessory Trays Example, Photon Block (top), E-Apertures (bottom)

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Electron Plan Delivery, Custom Coding

d) The code of the accessory tray is entered for the appropriate treatment field in the Treatment
Planning System or Record & Verify system. See Figure 3, Figure 4 and Figure 5.

Figure 3: Custom Code for Photon Block Tray in Eclipse, Plan Is Planning Approved

8 8

Figure 4: Custom Code for Electron Insert in Eclipse, Plan Is Planning Approved

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Electron Plan Delivery, Custom Coding

Figure 5: Custom Code for Photon Block Tray (top) and Electron Insert (bottom) in Treatment Preparation,
Plans are Planning Approved

 The following Table 1 shows the types of supported custom accessories, where these
accessories are installed and range of valid code numbers for these accessories.

Accessory Position in Slot Label Name Range of Coded

collimator Labels in Binder
8
Custom Photon Block Tray Accessory Mount Slot 2 Photon Blocks 1 - 104

Custom Compensator Tray Interface Mount, Slot 1 & 4 Comp 1 - 52

Compensator Mount

Custom Electron Arc Tray Accessory Mount Slot 2 Electron Arc 3329 - 3358

6x6 Electron FFDA Trays Electron Aperture Slot 3 E-Aperture 1 - 84

Custom Electron FFDA Trays Electron Aperture Slot 3 E-Aperture 3328 - 3707
(10x6, 10x10 and larger)

6x6 Standard FFDA Electron Aperture Slot 3 E-Aperture 126

10x6, 10x10 and larger Electron Aperture Slot 3 E-Aperture 4094

Standard FFDA
Table 1: Supported Custom Accessory Codes

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Electron Plan Delivery, Custom Coding

Important Note: Always verify the patient identity and make sure that the
tray codes are assigned to the correct patient. Custom code for trays defined
in Eclipse is not printed on Eclipse plan report. Include the code in block ID in
order to have the code in plan report from Eclipse.

Note: If the accessory code has not been identified in the treatment plan, the
field with such accessory will be read as invalid and the treatment cannot
proceed until a valid internal code is assigned.

e) Department personnel perform treatment plan QA and approval processes.

f) The treatment delivery operator opens the treatment plan. When a field with custom accessories
is selected, the custom accessory code is displayed for the corresponding accessory slot.

g) The treatment delivery operator inserts the appropriate required tray into the correct slot at the
treatment machine.

h) The system reads the code on the label of the inserted tray and compares this with the code
identified for that accessory in the treatment plan:

 if the code identified by the system does not match the code in the treatment plan, the system

asserts an interlock preventing beam on, see Figure 6 and Figure 7.

8 8

Figure 6: Code Mismatch

No checkbox to allow manual

verification / override

Figure 7: No Option to Override the Mismatch

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 if the code in the treatment plan is not within the valid range of codes for the given accessory
type or there is no code for the accessory tray in the plan, the system identifies the accessory
(and the field) as invalid and treatment is not permitted. See Figure 8.

Invalid field

Figure 8: Wrong Code

 if the code on the label of the inserted tray matches the code identified for that tray in the

plan, the system releases the Accessory interlock and the treatment may proceed.

 if the accessory cannot be identified as it does not have the custom coding label, the system
asserts an interlock preventing treatment. Manual accessory verification may be allowed, see
step A.6.

6. The system allows manual verification of accessories, see Figure 9 and Figure 10, if:
8
a) The user has the Override Accessory Verification right and,

b) ‘Allow manual verification of custom accessory’ setting in System Administration → Treatment →

Clinical has been set to YES and,

c) the installed accessory does not have the custom coding label (all holes open) and,

d) the plan has a valid accessory with a code valid for the planned accessory slot (field is valid).

Figure 9: Unknown Accessory, Press Override to Manually Verify

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Manually verified

Figure 10: Overriding / Verifying the Unknown Accessory, Sign-off with Override Accessory Verification
Right is Required after Clicking Apply

8 8

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Electron Plan Delivery, Custom Coding

B. Delivery of an electron plan

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 11.

Figure 11: Select Patient Example

5. If the Motion Management Devices dialog opens, make the appropriate selection and decide if the
settings are to be used for the session only or permanently. See Figure 12.
8

Figure 12: Motion Management Devices Example

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6. Wait until the plan loads and then enter the treatment room.

7. Move gantry to plan using one the hand pendants, install the accessories as indicated on In-Room
Monitors (on the Machine Monitor); see Figure 13.

Figure 13: Machine Monitor, Accessory Mismatch

Important Note: When installing the accessories make sure they all have
been properly locked in their slots.

8. When the accessories have been inserted, verify on the Machine Monitor, that they have been
properly detected and identified by the machine and they agree with plan. See Figure 14.

8 8

Figure 14: Machine Monitor, Planned and Actual Accessories Match

9. Carefully setup the patient on the treatment couch and move the couch with patient to the treatment
position. Then return to the console area and close the door to the treatment room.

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Important Note: It is important to move gantry and collimator to planned

positions inside in the treatment room. It is not possible to move gantry and /
or collimator from the console if there are accessories, other than an
accessory installed in the interface mount (upper wedge, compensator),
installed on the collimator. An attempt to move gantry and / or collimator from
the console would result in the following user messages displayed in the
Treatment application:

10. Verify the planned and actual field parameters in the Treatment application. Make sure again that
planned and actual accessories match. See Figure 15.

Laser Guard is inactive as

accessory mount and electron
applicator are present

Figure 15: Treatment Application, Plan Loaded

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11. Prior to treatment it may be necessary to resolve actual and planned couch values mismatch. The
plan couch values can be acquired (see Figure 16) or edited (see Figure 17), if the OSP ‘couch
locking’ setting allows couch modifications, or the mismatch may still be overridden later just for the
session.

Figure 16: Acquiring Actual Couch Values

Figure 17: Editing Plan Couch Values

12. A sign off with Update Plan Parameter right will be required if couch values were manually edited or
acquired. See Figure 18.

8 8

Figure 18: Confirm Plan Couch Values Change

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13. Press Prepare on the control console. See Figure 19.

Figure 19: Control Console, Prepare Button

14. If the mismatch between planned and actual couch values has not been resolved yet, it can be
overridden now, see Figure 20, Figure 21 and Figure 22.

8

Figure 20: Override Button

Figure 21: Overriding Mismatch Between Plan and Actual Values

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Figure 22: Confirm Couch Values Mismatch Override

15. Press MV Ready button on the console when it illuminates and hold it down until MV Beam On
button illuminates. The press MV Beam On button to initiate the MV beam. See Figure 23.

8 8
Figure 23: Control Console, MV Ready Button

16. Wait until the field MU are delivered. Watch the treatment progress on the screen. See Figure 24.

Figure 24: Treatment in Progress

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17. If the plan has more fields, deliver the remaining fields.

18. Close the patient when the plan has been delivered, see Figure 25.

Figure 25: Closing the Patient

19. It may be required to sign-off the treatment; if configured in System Administration → Treatment →
Clinical. Enter your username and password, then click OK, see Figure 26.

Figure 26: Close Patient Sign-off

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Unplanned Treatment

Unplanned Treatment
Procedure

Objectives
After completing this procedure the student will have learned how to:

1. create an unplanned treatment in Treatment mode,

2. acquire a kV image from treatment beam’s eye view, draw field aperture and set the acquired
image as the reference image for the treatment field,

3. shape the MLC for the treatment field for the Unplanned treatment,

4. acquire a multi-scan CBCT for the patient.

Note: Multi-Scan CBCTs are acquired in PVA application. The multiple

acquired CBCT scans can be merged into a volume of extended length in
Advanced Reconstruction application only.

Note: This procedure is written to demonstrate TrueBeam system treatment

8 features above and is not to be followed exactly. 8

References:
P1012177-001-A – ARIA OIS for RO Instructions for Use, chapter 6.

P1005922-001-A – TrueBeam Instructions for Use, chapters 7, 10.

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Unplanned Treatment

A. Overview / Prerequisites
1. Unplanned Treatment allows the operator to create a plan with treatment and setup fields ad hoc in
the Treatment application. Does not allow MU calculation.

2. Unplanned treatment requires the following:

a) Allow Unplanned Treatment has to be set to Yes in System Administration → Treatment

→ Clinical tab, General Preferences section.

b) The operator must have been granted the Unplanned Treatment OSP right.

c) Patient has been created in Record and Verify system and must have an appointment with
the machine scheduled.

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B. Create a patient and an appointment (ARIA)

1. At the ARIA workstation, double click the Home icon ( ). Login when prompted. See Figure 1.

Figure 1: Login

2. In the User Home, select QuickLinks and navigate to EMR → Appointment Scheduling.
See Figure 2.

8 8

Figure 2: QuickLinks → EMR → Appointment Scheduling

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3. Select the appropriate machine or create a new machine agenda view if necessary. See Figure 3.

Figure 3: Machine Agenda View

Tip: A new machine agenda view can be created using the View menu if necessary:

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4. Double click on the appropriate date / time slot to schedule an appointment. See Figure 4.

Double-click appropriate date / time

slot to open Appointment Dialog

Figure 4: Scheduling Appointment

5. In the Appointment Dialog select Emergency Treatment (or other appropriate option) from Activity
drop-down. Then click New Patient. See Figure 5. Alternatively, Search controls can be used to
select an existing, previously created patient for emergency treatment.

8 8

Figure 5: Appointment Dialog

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6. Fill out the necessary patient information (at least ID1 and Last Name are required). Then click OK.
See Figure 6.

8

Figure 6: Patient Explorer, New Patient

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7. The new patient is automatically selected for the active date / time slot. Click OK to close the
Appointment Dialog. See Figure 7.

8 8

Figure 7: Patient Selected, Close Appointment Dialog

8. RMC the date/time slot with the patient and check-in the patient, see Figure 8.

Figure 8: Check-in

9. Close Appointment Scheduling workspace and then User Home.

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C. Emergency Treatment
1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom. See Figure 9.

Figure 9: Treatment Application

3. Login to Queue, if prompted. See Figure 10. (Required only once per Treatment mode session.)

Figure 10: Login to Queue

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4. Locate and select the patient for emergency treatment in the schedule for your machine. Then click
Treat in lower right corner. See Figure 11.

Figure 11: Select Patient

5. As there are no plans for the patient, the following message is displayed. Read the message. Then
click the message and acknowledge by clicking OK. See Figure 12.

8 8

Figure 12: No Plans Message

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6. Click Add button. Then select Add New Field. See Figure 13.

Figure 13: Add → Add New field

Tip: Add New Field is also available when a plan is loaded from Record and
8
Verify system. It is allowed to create an ad-hoc plan on-the-fly even if the
patient already has plan(s).

7. System will require a confirmation that you have the ‘Unplanned Treatment’ right. Login with your
credentials. See Figure 14.

Figure 14: Login

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8. Define plan and the first field properties. Click OK when done. See Figure 15.

Figure 15: Define Plan and Field Parameters

a) Beam Type can be one of the following – STATIC = gantry static field; DYNAMIC = arc field;
SETUP = setup field.

b) Gantry Direction – allows selecting gantry direction for DYNAMIC fields (CW or CCW).

c) Use open MLC – if checked, the field will have a fully open MLC initially; MLC shape can be
changed before the field is delivered. If unchecked, the created field will have no MLC.

8 8

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9. The plan is created and the field is selected. Review / modify the field parameters. Define the missing
information (MU, Dose rate, Time). Click Apply when done. See Figure 16.

Figure 16: Treatment Application

10. Click Add and then select Add Imaging. See Figure 17.

Figure 17: Adding Imaging

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11. Select the appropriate imaging options. For instance kV, before, from beam’s eye view; click Ok when
done. See Figure 18.

Figure 18: kV, Before, Beam’s Eye View

12. Verify that the imaging has been added and is selected. See Figure 19.

8 8

Figure 19: Imaging Before

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13. In PVA application, set the kV acquisition parameters to appropriate values. See Figure 20.

Figure 20: kV Acquisition Parameters

14. Use Motion Selection buttons on the console to select the axes to move, then press Motion Enable
buttons and hold them until all axes have reached plan positions. See Figure 21.

15. Press Prepare on the control console. Then press kV Beam On button and hold it until the image is
acquired. See Figure 21.

Figure 21: Control Console

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16. Use the drawing tools available in PVA to outline the MLC shape on the acquired image.
See Figure 22. Make sure layers are enabled, otherwise the MLC outline is not being displayed as it
is being drawn on the acquired image.

Show / hide layers

Figure 22: Draw the Field Aperture / MLC Outline

17. When finished, RMC the image and select from the options. See Figure 23.

Freehand tool active

8 8

Figure 23: Finishing the Outline

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Tip: If the contour needs to be modified use Modify Points tool. If it is desired to
delete the contour, select the Select tool, RMC the contour and select Delete:

Select / Modify tool

18. Click button in the toolbar to set the acquired image as the reference image for the imaged
treatment field.

19. In the Treatment application click the treatment field to make it active. Then click Edit button below
MLC preview to shape the MLC. See Figure 24.

Figure 24: Edit MLC

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20. In the PVA application, shape the MLC for the field. Click Apply when done. See Figure 25.

Display options

Setting collimator
manually
Shaping tools

Setting jaws
manually

Figure 25: Fitting the MLC

a) Use to set the position for closed leaf pairs (Bank A side , Bank B side, Middle)

8 b) Use to set leaf edge ↔ contour meeting point (how the MLC leaves touch the 8
drawn outline; from inside, leaf edge center, from outside). The shaping tools automatically
conforms the MLC to a drawing on the image layer called ‘User Annotation’.

c) Use to set recommended jaw positions.

Note: The MLC can be shaped also manually. Multiple leaves can be
selected with CTRL or SHIFT keys. Selected leaves turn green and can be
moved with the mouse.
Collimator angle and jaws can also be set by dragging red squares on the
field outline (yellow rectangle). See Figure 25.

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21. Deliver the field. Use Motion Selection buttons on the console to select the axes to move, then press
Motion Enable buttons and hold them until all axes have reached plan positions. See Figure 26.

22. Press Prepare on the control console. Wait until MV Ready illuminates.

Note: If MV Ready does not illuminate some axes may not be at plan position
or there are some other faults. If couch values were not acquired, they can be
overridden, edited after clicking Edit or acquired after clicking Acquire.

23. Then press and hold MV Ready button until MV Beam On illuminates. Then press MV Beam On.
See Figure 26.

8

Figure 26: Control Console

24. Repeat steps C.6 to C.23 if more fields is to be added to the plan.

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D. Acquiring Multi-Scan CBCT

1. Click Add and then select Add New Field. See Figure 27.

Figure 27: Add New Field

2. Define field parameters. Choose SETUP as Beam Type. See Figure 28.

8 8

Figure 28: New Setup Field

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3. When the field is created, review / modify its parameters and then click Apply. See Figure 29.

Figure 29: Apply Field Parameters

4. Then click Add and select Add Imaging. See Figure 30.

Figure 30: Add Imaging

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5. In PVA application select CBCT imaging for the field. Click OK when done. See Figure 31.

Figure 31: CBCT Imaging

6. The following message will be displayed as the patient does not have reference CT. Read the
message, click it and acknowledge by clicking OK. See Figure 32.

8 8

Figure 32: No Reference CT Message, no 3D-3D Match

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7. Select the appropriate CBCT mode for the patient and click OK. See Figure 33.

Figure 33: Selecting CBCT Mode

8. Select Couch tab and click Enable Multi-Scan button to enable multi scan. See Figure 34.

Figure 34: Enabling Multi-Scan

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9. Acquire the first CBCT scan. Use Motion Selection buttons on the console to select the axes to
move, then press Motion Enable buttons and hold them until all axes have reached plan positions.
See Figure 35.

10. Press Prepare on the control console. Then press kV Beam On button and hold it until CBCT
acquisition start. Wait until the CBCT acquisition is finished. See Figure 35.

Figure 35: Control Console

11. Use Extend Volume buttons to select the area for the next scan. The scan can be moved UP or
DOWN along patient longitudinal axis, the couch will move in opposite direction. See Figure 36.

8 8

Figure 36: Extend the Volume

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12. Couch Linear Motion Selection button on the console should highlight in orange color. Press
Motion Enable to move couch to selected scanning position.

13. Then press kV Beam On button on the console and hold it down until CBCT acquisition starts. Wait
until the CBCT acquisition is complete.

14. Repeat steps D.11 to D.13 to acquire more scans, to extend the scanned volume even more.

15. Click Restore Couch button when all multi-scans have been taken. See Figure 37. This sets the
couch position back to where the couch was for the first CBCT scan.

Figure 37: Restoring Couch

16. Couch Linear Motion Selection button on the console should highlight in orange color. Press
Motion Enable on the console to move couch back to original position.

8
Important Note: Restoring the couch must always be done. Other fields
cannot be treated or imaged if couch has not been restored. Closing the plan
would also result in the following error:

17. Close the patient with button on the bottom of the screen, sign-off may be required.

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Treatment with Respiratory Gating

Treatment with Respiratory Gating

Procedure

Objectives
After completing this procedure the student will have reviewed

1. Using the RPM Data Converter and creating Gating Protocol by importing RPM data.

2. 2D-2D Match using kV-kV image pair with Respiratory Gating enabled.

3. Pre-treatment fluoroscopic verification.

4. Treatment with intra-fraction motion review.

5. CBCT acquisition for 4D reconstruction.

Note: This procedure is written to demonstrate TrueBeam system treatment

features above and may not be followed exactly.

8 References: 8
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapter 12.

P1005922-001-A – TrueBeam Instructions for Use, chapter 9, appendix H.

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Treatment with Respiratory Gating

A. Using the Respiratory Gating

1. The optical imaging system tracks patient respiration motion using a stereo-view video camera (also
called optical camera) installed above the couch. The camera tracks reflectors attached to the
reflector block (see Figure 1), which is placed on the patient’s chest or abdomen and it moves in
response to patient breathing.

Figure 1: Marker Block with Reflectors

2. Marker block motion is converted into a chart that is often called patient breathing trace. The operator
defines so called Gating Thresholds that determine when the radiation will be on and when on hold.
Gating Thresholds are individual for each patient and plan treated with Respiratory Gating.

3. The system may also be setup up to monitor periodicity of the patient’s breathing and if the breathing
trace is not ‘periodic enough’ the radiation will be held-off even when the breathing trace is within
gating thresholds. The parameter is called Predictive Filter and it is a measure of how sensitive the
system is to changes in the periodic nature of the patient’s breathing. The higher the value, the more
sensitive the system is to irregular breathing; the lower the value, the less sensitive.

4. Respiratory Gating thresholds and predictive filter are part of Gating Protocol that includes all gating
settings. Any plan that is to be treated with Respiratory Gating must have a gating protocol defined.
The system recognizes three basic types of Gating Protocols:
8
a) Amplitude Gating – the thresholds (upper and lower) are defined by selecting two amplitude
values – the radiation is on when the displayed breathing trace is between the two given
thresholds; between the lower and upper thresholds. On the breathing trace chart the lower
threshold is represented by orange horizontal line and the upper by blue horizontal line. Yellow
areas on the chart indicate when beam in on. See Figure 2.

Thresholds Beam is On

Figure 2: Amplitude Gating Example

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b) Phase Gating– the thresholds (upper and lower) are defined by selecting two phase values –
radiation is on when the displayed breathing trace is between the two given phase values;
between the lower and upper thresholds. On the phase dial next to breathing trace display the
lower threshold is represented by orange mark, the upper by blue mark. Yellow areas on the
chart indicate when beam in on. See Figure 3.

Beam is On

Thresholds too irregular

Figure 3: Phase Gating Example

Note: Parts of the breathing trace that are plotted using red color indicate
when the breathing trace was too irregular.

c) Breath-hold Gating - the thresholds (upper and lower) are defined by selecting two amplitude
values – the radiation is on when the displayed breathing trace is between the two given
thresholds; between the lower and upper thresholds. On the breathing trace chart the lower
threshold is represented by orange horizontal line, the upper by blue horizontal line. The Breath-
hold gating has the predictive filter disabled as the breathing trace is expected to be non-periodic.
See Figure 4.

8 8
No periodicity monitoring

Figure 4: Breath-hold Gating Example

Note: The Visual Couching display shows thin yellow bar that represents the
amplitude of the breathing trace. It moves up and down copying the
amplitude of the displayed breathing trace. The blue static bar represents the
area between the amplitude thresholds where the treatment occurs.

Tip: When the Respiratory Gating system has been enabled for a plan, MV
beam can only be enabled between given thresholds whether it is for imaging
or treatment purpose. The kV beam is allowed to be on when the breathing
trace is outside of the thresholds (is not gated) for the fluoroscopic acquisition
and CBCT.

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5. The Respiratory Gating protocol for a plan can be created:

a) In ARIA/Eclipse (v13 and higher) by importing gating data in DICOM format or by creating a
gating protocol from available templates:

 Open your patient and plan in Treatment Preparation workspace. If the plan has ‘Use
Gated’ checkbox enabled, Go to Gating Parameters button is available to access gating
data for the plan. See Figure 5.

Figure 5: Go to Gating Parameters

 In Gating Parameters view, click Import… to import gating data in DICOM format.
See Figure 6

Create from template

Figure 6: Import

Note: If the gating data (protocol and trace) have already been imported in
Eclipse/ARIA with the 4D CT used for planning, the protocol can be selected
for the plan from Select Protocol.

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 Use DICOM Import Export workspace to import gating data. Notice that gating data in
DICOM format are two separate files – the gating protocol (Motion Management Protocol,
filename starts with ‘MP’) and the breathing trace (Motion Management Waveform, filenames
starts with ‘MW’). They both have to be imported and linked to the plan. See Figure 7.

Figure 7: Importing Gating Data

 Return back to Treatment Preparation, Gating Parameters view for the plan and select the
imported protocol from Select Protocol. See Figure 8.

8 8

Figure 8: Select Protocol

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 Finally, review and/or modify gating parameters, click Save Patient when done and
click Back to Field Parameters to return to field parameter display. See Figure 9.

Figure 9: Imported Gating Protocol Preview

b) on the TrueBeam using a built-in wizard. A new gating protocol can be created on-the-fly,
protocol can be copied from predecessor plan or the protocol can be created by importing data
from RPM system. Creating or modifying the Gating Protocol requires Modify Gating Parameters
right. Adjusting gating thresholds requires additional Adjust Gating Threshold right. If Record
&Verify system supports storing the Gating Protocol, the protocol needs to be created only once
(on the first day of treatment) for each plan. See Figure 10.

Figure 10: Gating Protocol Creation Options

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6. If Gating Protocol is to be created based on data from RPM system, the patient’s data in the RPM
system has to be converted into DICOM format. The gating data from the DICOM file can later be
imported to plan on the machine using Gating Protocol creation wizard or in Treatment Preparation
workspace of Eclipse/ARIA.

a) RPM data is converted into DICOM file using RPM Data Converter. The RPM Data Converter is
not available on the TrueBeam workstation; it is installed on a computer determined by the
facility. The RPM Data Converter must have access to RPM system database and TrueBeam
RPM Data Exchange Path configured in System Administration → PVA → Gating and
Motion Management. See Figure 11 and Figure 12.

8 8
Figure 11: System Administration - RPM Exchange Directory

Figure 12: RPM Data Converter – Options

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b) When the RPM Data Converter is launched it shows list of the patients available in the RPM
database. Upon selecting the patient and their reference RPM session the information will be
converted into DICOM file that is placed in the RPM Data Exchange Path. When the option to
import RPM data is selected in Gating Protocol creation wizard, it scans DICOM files in the RPM
Data Exchange Path and allows selecting previously converted RPM patient data to be imported.
See Figure 13.

Figure 13: Patient selection in Protocol creation wizard

c) Figure 14 schematically shows the process of importing data from the RPM system to a ‘gated’
plan loaded on TrueBeam workstation.

*.dat files DICOM files

RPM Data Converter

RPM Database RPM Exchange Directory 8

Gating Protocol
creation wizard

TrueBeam Workstation

Figure 14: Importing Data from RPM System to Patient’s Plan on the TrueBeam

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7. Use of the Respiratory Gating requires that it has been enabled in System Administration →
Configuration → Installation, see Figure 15, and the system is equipped with Respiratory Gating
license.

Figure 15: System Administration → Configuration → Installation

Note: The Device Type can read ‘Both’ if Auto Beam Hold (ABH) is enabled
on the system. ‘Both’ includes Respiratory Gating and ABH. Status must be
set to ‘Enable’.

8. If a plan is to be treated with Respiratory Gating, it must have Varian Motion Management Device
selected as Respiratory Gating Device. This is done using Motion Management Devices dialog.
See Figure 16.

8 8

Figure 16: Selecting a Gating Device for a Plan

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a) Gating Devices are available in Motion

Management Devices dialog only for plans
that have been enabled for gating in
Record & Verify or Treatment planning
system. For such plans the Motion
Management Devices dialog opens
automatically if the device has not been
defined for the actual session. Gating is
enabled for a plan by checking Use Gated
checkbox in Plan Properties dialog. See
Figure 17.

b) If a plan has been enabled for gating by

checking Use Gated and it is desired to
deliver the plan without using the
Respiratory Gating system, None can be
selected as the Respiratory Gating
Device for the plan in the Motion
Management Device dialog. A sign-off with
Bypass Gating right is required.

c) If the Record & Verify system used with the

TrueBeam does not support Use Gated
flag, the Respiratory Gating Device can be
added to the plan using Motion
Management Devices dialog.
Figure 17: Plan Properties in Eclipse

Note: Respiratory Gating is not supported for electron fields.

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B. Using RPM Data Converter

1. Launch the RPM Data Converter at the workstation it has been installed on.

2. When the RPM Data Converter opens it automatically shows a list of patients that are currently
available in the RPM database. Click your patient in the list and then click Select. See Figure 18.

Figure 18: Selecting a Patient

3. Then select the session to be converted and exported and click Select. See Figure 19.

8 8

Figure 19: Selecting a Session to Be Exported

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4. The software will display a confirmation that the session was successfully exported. Choose whether
to Exit or go back to patient selection (Next Patient). See Figure 20.

Figure 20: Export Successful

Note: If the same patient data has already been exported, the following
message is displayed:

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C. Creating Gating Protocol by importing RPM data

1. At the TrueBeam console, open the Treatment mode, if not open. Login when prompted.

2. In Treatment application, click Open Patient button at the bottom.

3. Login to Queue, if prompted. (Required only once per Treatment mode session.)

4. Locate the patient and select the plan to be treated. Click Treat in lower right corner. See Figure 21.

8 8

Figure 21: Select Patient Example

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5. When the Motion Management Devices dialog opens, make sure that Varian Motion Management
Device is selected as the Respiratory Gating Device, choose Permanently or For Session, click
Apply when done. See Figure 22.

Figure 22: Motion Management Devices Example

Tip: The Motion Management Devices dialog opens automatically when a

plan with ‘Use Gated’ enabled is opened for treatment for the very first time or
even on subsequent sessions if Respiratory Gating Device was previously
applied to a session only.
If the settings had been applied permanently and it is necessary to disable
gating for a certain session, the Motion Management Devices dialog can be
accessed using the Tools button any time the plan is opened.

Selecting ‘None’ as Respiratory Gating Device disables the gating for the
current session and requires a sign-off with Bypass Gating right.

Note: Permanently / For session option only determines when Motion

Management Devices Dialog is automatically opened when loading a plan.
Gating Protocol needs to be created only once if connected Record & Verify
system supports saving it (such as ARIA).

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6. Wait until the plan loads. The PVA will display applicable options that can be selected to create the
Gating Protocol for the plan. Select the desired option (e.g. ‘Create a new Gating Protocol by
importing RPM data’) and click Next. See Figure 23.

Figure 23: Gating Protocol Options

7. The system then scans the files in Reference Session Directory and fills the Patient dropdown in
Patient Selection section with the available patients. Choose your patient using the dropdown in
Patient Selection section. The selected patient is compared with the patient currently opened and
discrepancies will be highlighted in orange color. Click Accept Patient Data to use the selected
patient to create the Reference Gating Protocol for the plan currently opened.
8 See Figure 24. 8

Figure 24: Patient Selection

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Important Note: Make sure that the correct patient data is selected to create
the Gating Protocol for the plan currently opened. Failure to select the correct
patient can result in a mistreatment.

Caution: If you import data from RPM 1.7, review the resulting behavior
carefully. In some cases, imported data may be inaccurate, depending on the
format in which the information was originally recorded. If the data has been
created by an RPM 1.7 device and stored in the RPM 1.7 dedicated
database, some missing parameters may be filled in by the TrueBeam
system default values.
P1005922-001-A – TrueBeam Instructions for Use, page 224.

Note: If multiple sessions have been converted for the patient into DICOM
format using the RPM Data Converter, there will be one more dropdown
menu in Patient Selection section to choose a session for the patient:

8. When the patient selection has been confirmed with Accept Patient Data button, click Next on the
bottom of the screen. See Figure 25.

Accept Patient Data has

already been pressed

Figure 25: Next

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9. Review the parameters imported and make changes if necessary. Click Next when done.
See Figure 26.

Figure 26: Gating Protocol Parameters

a) The window has 5 sections

 Gating Technique – allows selecting Phase Gating, Amplitude Gating or Breath-hold.

 Visual Couching Instructions – allows the operator to configure settings pertaining to

Visual Couching. However, visual instructions are currently not displayed on the In-Room
Monitors.
8 8
 Audio Couching Instructions – allows the operator to select language of the audio
couching and define the speed for audio “Breath-In” and “Breath-Out” instructions.

 Periodic Breathing Settings (disabled for breath-hold gating protocol):

Breathing Predictive Filter – (between 0 and 100) is the value of periodicity where the
beam will turn off. The lower the value the more forgiving the Respiratory Gating System is to
irregular breathing before turning off.

Enable Visual Patient Motion Monitoring – changes the display of the “Patient Motion”
indicator so that changes from the learned motion are indicated with color changes.

 Default Settings – allows the operator to set or restore the default settings.

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10. Review the imported reference breathing trace and the gating thresholds. Click OK when done.
See Figure 27.

Restart button can be used to

start tracking and acquire the
actual patient breathing trace
for visual comparison with the
Phase dial Review the reference breathing trace reference

Figure 27: Review the Reference Breathing Trace

a) This window allows the operator to review the reference breathing trace and the thresholds
imported from the RPM system. Alternatively a new reference breathing trace for the patient can
be acquired here.

b) The gating thresholds can be set by typing values in edit boxes for Upper Threshold and Lower
Threshold. Alternatively, amplitude thresholds can be modified by dragging orange and blue
lines indicating thresholds on the breathing trace chart, the phase thresholds can be modified by
dragging orange and blue marks indicating phase thresholds on the phase dial.
8
c) Original gating thresholds from reference curve – displays the original thresholds from
imported RRM reference session.

d) Planned gating thresholds – shows the thresholds that will be used for the plan treatment when
the Gating Protocol is accepted with OK button.

Note: Switching between Original and Planned gating thresholds allows

visual comparison of the duty cycle on beam-on periods in the graphic trace.
This provides a visual means of adjusting gating thresholds when using
amplitude gating while phase gating was originally used on the RPM system;
generally it provides visual guidance for changing the thresholds when gating
technique needs to be changed.

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Warning: Using reference and verification images not belonging to the same
breathing phase for patient setup can lead to inaccurate corrections. Always
verify that the respiratory gating thresholds selected during treatment and
imaging match the thresholds set during planning.
P1005922-001-A – TrueBeam Instructions for Use, page 228.

11. System returns back to PVA. Click Restart button to start respiration monitoring. See Figure 28.

Figure 28: PVA, Monitoring / Tracking Has Already Started
8 8
a) Settings button provides access to Respiratory Gating Protocol wizard and allows
modifying the protocol parameters.

b) Audio couching button allows the operator to enable or disable audio couching during
the session.

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D. Gated 2D-2D Match using kV-kV image pair

1. Locate the setup fields to be paired for kV-kV acquisition, then select the first of them in plan order.
See Figure 29.

Figure 29: Plan Loaded, Setup Field with no Imaging Procedures

2. Click Add and then select Add Imaging. Select the appropriate imaging procedure (e.g. kV-kV) in
Modify Imaging dialog box displayed in PVA and click OK. See Figure 30.
Skip this step if the fields are already paired for kV-kV acquisition.
8

Figure 30: Adding kV-kV Imaging

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3. The setup fields will then be paired for kV-kV acquisition. PVA displays the fields’ reference images.
Blank views on the right are for the images to be acquired, green box indicates currently active
acquisition direction. Patient breathing trace is being monitored and results are displayed on the
bottom of PVA, below the images views. See Figure 31 and Figure 32.

Figure 31: Setup Fields for kV-kV Paired Imaging

Lat. reference Lat. acquired (active)

8 8

AP reference AP acquired

Figure 32: PVA Application with Reference Images Displayed

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4. If necessary, the direction to be imaged can be selected by clicking the view for the image to be
acquired. Otherwise, the system automatically selects the direction that requires less gantry motion.

5. Press Prepare button on the control console to make the kV beam ready. See Figure 33.

6. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange if needed, then press both Motion Enable buttons and hold them down
until all selected axes are at imaging position for the selected imaging direction. See Figure 33.

Figure 33: Control Console

7. Review the acquisition parameters and modify them if necessary. kV or mAs can be set manually or
by choosing appropriate Anatomy and Size template. Make sure the trigger is set to Once at Beam
On (default). See Figure 34.

Figure 34: Setting the Acquisition Parameters

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Note: If the system is configured, in System Administration, to store and then

8. When the kV Beam On button illuminates press and hold it until the button gets dark. See Figure 35.
The image will be acquired when the breathing trace crosses the lower threshold.

Figure 35: Control Console, Prepare

9. Wait until the image has been acquired; review the image quality. See Figure 36. If the acquired
image is of insufficient quality, select the image and repeat steps D.7 to D.8 to re-acquire the image.

8 8
Acquired image

The next is already selected

Figure 36: First Image Acquired

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10. When the first image has been acquired, the second imaging direction may be selected automatically
if the system has been configured for automatic field selection (PVA → Workflow → Paired
Acquisition checkbox) in System Administration. If that is not the case, click the image view for the
second image to select it for imaging.

11. Repeat steps D.6 to D.9 to acquire an image for the second direction.

Note: If acquiring an MV image, the system needs to be in Preview state (Preview

button on the console has been pressed) to be able to change the MV acquisition
parameters. Press OK on the PVA taskbar to accept the modified parameters and
then, press Prepare button to re-program the BGM for the new settings.

12. If automatic workspace selection has been enabled in System Administration (PVA → Workflow →
Paired Match checkbox) the PVA automatically launches 2D-2D Match workspace once both images
have been acquired. If image acquisition is to be repeated, the matching workspace can be closed
using the Cancel button on the Taskbar. If the 2D-2D Match workspace does not open automatically,
click the Match and Review workspace button and select 2D-2D Match, see Figure 37.

Active matching workspace

Figure 37: Closing (left) and Opening (right) the 2D-2D Match Workspace

1. When the 2D-2D Match workspace launches, the acquired images can be aligned to the reference
images. Patient breathing trace is not displayed in matching workspace. See Figure 38.

Overlaid views

Figure 38: 2D-2D Match Workspace

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2. The Manual Match and the Blend Images tools will be by default enabled, the Blend

Images slider will be positioned to show 100% acquired image to allow for
acquired image quality assessment prior to matching.

3. Use Window / Level and adjust the Blend Image slider to achieve
optimal viewing.

4. Use the Manual Match or the Automatic Match tools or both, to align the overlaid
reference and the acquired (setup) images.

5. Utilize the Split Window , Moving Window and / or Color Blend tools to evaluate match
results. See Figure 39. Manual Match can be deselected prior to match evaluation to avoid
inadvertent shift. Matching workspace also has the Undo/Redo functionalities, that can be invoked
with CTRL+Z and CTRL+Y keyboard keys.

8 8

Figure 39: Match Evaluation Tools: Color Blend, Moving Window, Split Window

Important Note: Always carefully verify that the images have been properly
aligned prior to applying shifts.

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6. When done with the matching and the image alignment has been verified, decide whether the shift
will be applied permanently or for the session only and whether all calculated rotations will be
included and applied to couch. See Figure 40.

Figure 40: Applying the Shift

7. Press Apply button on the Taskbar to transfer the calculated shift to treatment application.
See Figure 40.

8
Tip: The Approve button in the toolbar can also be used to apply the
shifts and approve and save the acquired images back to R & V system. This
requires an optional license that may not be available on the system.

8. After applying the shifts, an additional sign-off with appropriate rights will be required, if:

a) the match and images were approved (shift was applied with Approve button).

c) the applied couch shift was selected to be applied permanently.

d) the applied couch shift is larger than allowed by plan tolerance (least permissive tolerance table).

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Note: If there are multiple reasons for the shift approval, one sign-off only is
required, with the right indicated in the Apply Shift Parameters dialog.

9. If it is required to approve the match using the Apply Shift Parameters dialog, read the message,
review the shifts and then sign-off with the indicated right, see Figure 41.

8 8

Figure 41: Example of Apply Shift Parameters Dialog

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10. After successful sign-off, the applied shifts are translated into new couch position. See Figure 42.

No green arrows = shifts are

larger than remote couch
correction tolerances set in
System Administration, no
remote couch motions available

Figure 42: New Couch Positions, Shifts Too Large Example

Figure 43: Couch Has Been Moved to the New Position

Note: Couch Rtn, Roll, Pitch cannot be applied permanently.

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13. After moving the couch to new position, the system automatically restarts the breathing monitoring.
Wait until the system has learned the patient breathing trace. See Figure 44.

Figure 44: The Monitoring Has Been Restarted; System Is Learning the Patient Breathing Pattern

8 8

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E. Pre-treatment fluoroscopic verification

Note: When acquiring a fluoroscopic image, the contour overlays or structure

overlays change their colors reflecting gated beam status. This provides a
visual aid to assess whether the area of interest is inside of the desired overlay
when the beam will be on during the treatment or not.

Tip: The fluoroscopic image can be acquired for a setup field or a ‘kV from
beam’s eye view’ imaging procedure attached to a treament field (Add → Add
Imaging). If a setup field is to be used, it may be useful to create a dedicated
setup field that would have the same gantry angle as one of the plan’s
treatment fields, create a DRR for it and copy field aperture contour from the
treatment field to this setup field in ARIA / Eclipse.

1. Select a treatment field of a direction to be imaged from.

2. Click Add and then Add Imaging. Select kV, Before from Beam’s Eye View imaging in the Modify
Imaging dialog. See Figure 45.

Figure 45: Selecting kV, Before, Beam’s Eye View for Pre-treatment Verification

3. Make sure that the new kV from Beam’s Eye View procedure is selected. See Figure 46.

Figure 46: kV Beam’s Eye View Selected

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4. Click Fluoro button to enable the fluoroscopic acquisition for the field. Review / modify the remaining
fluoroscopic parameters and click OK to confirm the selection. See Figure 47.

Figure 47: Enabling Fluoroscopic Acquisition

5. Press Prepare button on the control console to make the kV beam ready. See Figure 48.

6. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange if necessary, then press both Motion Enable buttons and hold them
down until all selected axes are at imaging position for the selected imaging direction. See Figure 48.

8 8

Figure 48: Control Console

7. When the kV Beam On button illuminates press and hold it down for the duration of the pre-treatment
visual verification. See Figure 48.

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Treatment with Respiratory Gating

8. Use the Show/Hide Structures tool to select contours to be displayed during the verification on top
of the acquired fluoroscopic image. All available contours are enabled by default. See Figure 49.

9. The fluoroscopic acquisition itself will be continuous, not gated. The selected contours will be
displayed on top of the acquired image and their color will reflect the state of the gated beam: yellow
– when beam would be on, blue/green (Field Edge type contours are blue, the others are green) -
when beam would be on hold. See Figure 49 and Figure 50.

Show / Hide Structures

Field Edge (Field 1)

CIAO

Figure 49: Blue Color – Outside of the Gating Thresholds 8

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Field Edge (Field 1)

CIAO, beam would be on

Figure 50: Yellow Color – Beam Would Be On

8 8

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F. Treatment with Intra-fraction Motion Review (Overlays)

1. Select the first treatment field in the plan. Then click Add and choose Add Imaging. See Figure 51.

Figure 51: Adding Imaging to Treatment Fields

2. Select kV imaging during in Modify Imaging dialog; enable Apply to all treatment beams, if
available. See Figure 52.

Figure 52: Modify Imaging Dialog, Scheduling kV Imaging During

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3. Review / modify kV acquisition parameters. kV and mAs can be defined by selecting appropriate
Anatomy and Size options; click Trigger and choose Continuous at Beam On. See Figure 53.

Figure 53: Defining kV Imaging Parameters and Trigger

4. Confirm selection by clicking OK on the PVA Taskbar. See Figure 54.

8 8

Figure 54: Confirm kV Imaging Parameters and Trigger

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Treatment with Respiratory Gating

5. The dynamic tabs will open with Overlay tab selected. Select the markers and the plan structures to
be projected onto the acquired images. Define the diameter of circles that will represent markers
projected from the planning CT. See Figure 55.

Selected structures
and markers (green)

Figure 55: Overlay Tab Settings

Note: If the system is equipped with Auto Beam Hold that has been enabled in
8
System Administration, Beam Hold tab is displayed instead of Overlay tab.
Markers would not only be projected but also detected in the acquired images.
Whether or not the beam will be held-off when markers are detected to be
outside of their search region depends on if ABH has been enabled for plan and
session by selecting Varian Motion Management Device as Patient Position
Monitoring Device in Motion Management Devices dialog. ABH state is
indicated in PVA:

Patient Position Monitoring Device Patient Position Monitoring Device

set to None set to Varian Motion Management
Device

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6. Press Prepare button on the control console to make the MV and kV beams ready. See Figure 56.

7. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange if necessary, then press both Motion Enable buttons and hold them
down until all selected axes are at imaging position for the selected imaging direction. See Figure 56.

Figure 56: Control Console

8. When the MV Ready button illuminates, press it and hold it down until MV Beam On button
illuminates. Then press MV Beam On. See Figure 57.

8 8

Figure 57: MV Ready → MV Beam On

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9. The system acquires a kV image every time at the defined trigger (e.g. Continuous at Beam On
trigger). Previously selected markers and structures are projected onto the acquired images and
provide visual aid for the operator to assess whether the patient is treated correctly or not.
See Figure 58.

Selected structures and

markers (green) projected
during the treatment onto
acquired kV images

Figure 58: Acquired Image with Selected Markers and Structure Overlays

Tip: Intra-fraction Motion Review using Overlays can be used also in case
that the system is not equipped with ABH and patient does not have markers
implanted. Any well-defined anatomical structure clearly visible on acquired
8
kV images can be projected during the treatment onto them.

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G. 4D CBCT Acquisition
1. Select the setup field that is to be scheduled CBCT imaging. Then click Add and choose Add
Imaging. See Figure 59.

Note: The CBCT imaging can be scheduled to a particular setup field in

Record & Verify system already, if supported. Alternatively, CBCT can also
be acquired by scheduling CBCT imaging procedure to any of the treatment
fields using Add → Add Imaging → Modify Imaging dialog.

8 8

Figure 59: Adding Imaging to a Setup Field

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2. Select CBCT from Modify Imaging dialog and then click OK. See Figure 60.

Figure 60: Adding CBCT Imaging to a Setup Field

3. In PVA, select an appropriate 4D CBCT mode for the acquisition. Click OK when done.
See Figure 61.

Figure 61: Selecting 4D CBCT Mode

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Important Note: It is important to select one of the available 4D modes for

the acquisition. 4D modes can be selected for CBCT acquisition only for
plans with gating enabled. CBCT acquisition using a 4D mode allows 4D
reconstruction later in Advanced Reconstruction. Reconstruction in PVA is
always done using the default 3D reconstruction algorithm.

4. Press Prepare button on the control console to make the kV beams ready. See Figure 62.

5. Use the control console to move gantry and imaging arms to position. Press the Motion Selection
buttons highlighted in orange if necessary, then press both Motion Enable buttons and hold them
down until all selected axes are at imaging position for the selected imaging direction. See Figure 62.

8 8

Figure 62: Control Console

6. When the kV Beam On button illuminates, press it and hold it down until the CBCT acquisition starts.
See Figure 62.

Note: 4D CBCT acquisition takes longer than regular 3D acquisition. For the
4D CBCT mode the gantry speed has been reduced so that sufficient number
of projections is collected for each phase of the patient breathing trace. That
allows a set of 3D CBCT to be reconstructed each CBCT corresponding to a
selected interval of phases.

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7. Close the plan when the acquisition has finished. Click Close Patient button. See Figure 63.

Figure 63: Closing the Plan

8. It may be required to sign-off the treatment; if configured in System Administration → Treatment →

Clinical. Enter your user name and password, then click OK, see Figure 64.

Figure 64: Close Patient Sign-off

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Advanced Reconstruction

Advanced Reconstruction
Procedure

Objectives
After completing this procedure the student will have learned how to:

1. merge multi-scan CBCTs in an extended length CBCT scan.

2. reconstruct 4D CBCT.

References:
P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapter 14.

8 8

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Advanced Reconstruction

A. Overview
1. The Advanced Reconstruction (AR) is a standalone application, one of the major modes.

2. The CBCT data ( projections used to reconstruct CBCT ) is acquired using PVA (imaging) application
during routine clinical operations and stored in the CBCT Reconstructor. Advanced Reconstruction
application can be used to access this data and re-reconstruct CBCT.

Tip: CBCT scans are only available to AR for limited time span. Deletion of
scans occurs when the disk quota dedicated to storing scans on the
TrueBeam CBCT Reconstructor is used up; oldest scans are deleted first.
The size of the disk quota can be modified in the CBCT Reconstructor tab
of the System Administration or Service Manager Console (Service Mode).

3. Re-reconstructed CBCT slices can be saved back to Record and Verify database or on the
TrueBeam workstation disk (available on I: drive, \\<myserver>\va_transfer\TDS\<machineID>\AR
\Reconstructions). AR also creates structure set.

4. Advanced Reconstruction is an interface to TrueBeam CBCT Reconstructor which also enabled

access to advanced reconstruction algorithms not available in PVA (imaging) application. These
include 4D CBCT and multi-scan (extended length) reconstructions.

a) 4D CBCT reconstructions are only available for scans acquired using 4D CBCT acquisition
modes. 4D acquisition modes are only available with gated treatments. Gantry speed is
reduced for 4D CBCT modes. In this way, the gantry makes less progress from one breathing
cycle to next (more projections for each breathing cycle) and the angles of projections
belonging to the same time bin are more evenly distributed. Respiratory gating data is
needed to sort projections for 4D CBCT reconstructions. Refer to TrueBeam Technical
Reference Guide, Volume 2, regarding the general guidelines for all scanning techniques.

b) Extended length scan can be reconstructed from CBCT acquisitions that have the same 8
irradiation event UID (DICOM tag). This tag is only added to CBCT acquisitions that have
been acquired sequentially and have been linked by the operator by selecting Enable Multi-
Scan button in PVA (imaging) application. Couch moves longitudinally by predefined distance
between the scans, the geometric relationship between the acquisitions is known and an
extended length scan can be reconstructed.

5. Advanced Reconstruction can also be used as a viewer – it can open reconstructed CBCT from a
disk for a preview.

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Advanced Reconstruction

B. Multi-scan reconstruction
1. Select Advanced Reconstruction on Select Major Mode screen; then login. See Figure 1.

Figure 1: Advanced Reconstruction → Login

2. Click Open Raw Data to access scans available on CBCT Reconstructor. See Figure 2.

8 8

Figure 2: Advanced Reconstruction, Open Raw Data

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Advanced Reconstruction

3. Locate the patient and the scans. Use CTRL or SHIFT key to select all the scans to merge. Click
Open when done. See Figure 3.

Patient filter options

Scan filter options

Figure 3: AR Patient Explorer

4. Opened scans are visible on the left panel. Scans that share the same Irradiation Event UID are
grouped within same gray box. Click the green triangle pointing down to merge scans. See Figure 4.

Merge scans

Figure 4: Grouped Scans

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Advanced Reconstruction

5. Now the selection represents the entire volume to be merged and the reconstruction will stitch these
scans together. Click Add 3D Reconstruction button. See Figure 5.

Figure 5: Collapsed Multi-scan, Extended Length Volume Reconstruction

6. Review / modify reconstruction parameters. Click Start when done. See Figure 6.

8 8

Small ‘+’ in the corner of the

reconstruction icon indicates stitching

Extended length

Figure 6: Reconstruction Added, Reconstruction Parameters

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Advanced Reconstruction

Note: The name of the reconstruction can be changed by double-clicking the

green box representing the reconstruction. The name of the reconstruction
defines the name of 3D CT image and structure set when the data is saved
back to database. The system adds ‘AR_’ in front of the user defined name:

7. Wait until reconstruction has finished. See Figure 7.

The reconstruction has

Figure 7: Reconstruction Complete

8. Click the arrow down button on the save button and decide whether to save the data on the disk or to
the database. Then click the save button. See Figure 8.

Figure 8: Save Options

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Advanced Reconstruction

9. When the reconstruction has been saved, click Change Mode button to close Advanced
Reconstruction. See Figure 9.

The reconstruction has

been saved to DB

Figure 9: Reconstruction Saved to DB

Note: If the reconstruction has not been saved to the database, the following
message appears after pressing Change Mode:

8 8

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Advanced Reconstruction

C. 4D scan reconstruction
1. Follow steps A.1 to A.2 to launch Advanced Reconstruction and open Patient Explorer.

2. Locate the patient and the scan. Click Open when done. See Figure 10.

Figure 10: AR Patient Explorer

3. Opened scan is visible on the left panel. If the scan was taken using 4D CBCT acquisition mode, it is
possible to select 4D Reconstruction using arrow down on Add Reconstruction button.
See Figure 11.

Figure 11: 4D Reconstruction

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4. Click Add 4D Reconstruction button. See Figure 12.

Figure 12: Add 4D Reconstruction

5. Review / modify reconstruction and binning options. Then click Start. See Figure 13.

8 8

Figure 13: Reconstruction and Binning Options

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Advanced Reconstruction

6. In 4D reconstruction, additional parameters for the time binning can be specified:

a) reconstruction algorithm can be Basic 4D or Advanced 4D. For more information on 4D

reconstruction, refer to TrueBeam Technical Reference Guide, Volume 2.

b) Number of Phases – number of bins in which the projections will be grouped. Phases
implicitly defines the number of datasets, or respiratory phases which will be reconstructed.

c) Phase Bin Width – the width, in percentage, of each phase bin. It does not necessarily have
to be equal to 100% / number of phases. There can be an overlap, or a gap, between
reconstructed phases.

d) Initial Phase Offset – this parameters introduces a phase shift, or offset, to the position of
the first time bin.

Note: At present, only Phase-Correlated gating method / binning is available.

7. Wait until the reconstruction has finished. The animation player (4D Player) provides the functionality
to display sequentially the different respiratory phases. See Figure 14.

8
The reconstruction has finished

Figure 14: 4D Reconstruction Has Finished, 4D Player

 Offline mode, unlike the Console mode, allows administering MPC data for different TrueBeam
machines.

 Offline mode looks just like Review Workspace of the console mode with additional ‘Select
Machine’ menu that allows the operator to choose a machine unit to review.
9 9

For education purposes only pg 746 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 Checks or the pass/fail thresholds cannot be modified.

 MPC application does not allow creating custom tests.

 Geometry Check is considered mandatory and is scheduled automatically to be done every

day.

 MPC uses the High Quality mode for acquisition, thus it is assumed that this imaging mode is
calibrated, otherwise an error message is displayed. For the beam constancy check, MPC 9
acquires a dark field and retrieves the pixel defect map, both are applied to the raw MV image.

For education purposes only pg 747 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 Beam constancy checks are available also for electron energies and/or FFF beams; Images
for electron energies are acquired without electron applicator.

9 9

For education purposes only pg 748 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

For education purposes only pg 749 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 Output Change: Average percentage of change in detector response in the central area of
the images. As the EPID produces a stable output even over an extended period of time, this
value is influenced primarily by changes in the beam.

 Uniformity Change: Total percentage of change in detector response in the central area of
the imager. It captures the worst-case, the variation between the two imager pixels with the
lowest and highest ratio. High frequency noise is filtered. This value can indicate changes in
the target and filter system as well as in the steering of the beam.
9 9
 Center Shift: Describes relative shift of the field center, defined by a jaw-collimated field, with
respect to the baseline. Field center is established through detection of the jaw edges in the
beam image.

For education purposes only pg 750 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 6X MV energy is used to acquire MV images for geometry checks.

For education purposes only pg 751 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 Size: Maximum distance of a beam’s central axis from idealized isocenter.

 MV and kV Imager Offset: Maximum distance of the imager center from the projection of the
treatment isocenter. It is a measure of the correctness of IsoCal calibration.

 Note: The Gantry angle in the legend of kV images is the actual gantry angle, not kV source
position.
9 9

For education purposes only pg 752 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 MLC (Maximal Offset, Mean Offset, Individual Offset, Leaves A/B): Determined using a
static comb pattern with alternating leaves; leaf positions measured as distance of MLC leaf tip
from MLC’s center line that is defined as the line going through the center of rotation of the
MLC and is perpendicular to the edges of the leaves.

 Jaws (Offset X1,X2,Y1,Y2): Detected on a symmetric 18x18 field; jaw position measured as
the distance of the jaw edge from the center of rotation of the MLC.

 Rotation Offset: An MLC comb pattern is acquired at 5 different collimator angles. Rotation 9
offset is the maximum deviation of the nominal versus the actual collimator rotation angle
observable through the edges of the MLC leaves.

 MV images acquired at 5 different collimator angles are also used to determine the beam
central axis for isocenter checks. Position of the beam axis is represented by a virtual pin that
replaces the physical pin on partial transmission plate used for the IsoCal calibration. Position
of the virtual pin is calculated as an intersection of leaf pair edges (leaf edge instead of leaf tip
is used as it is considered more rigid). The virtual pin is then inserted in MV images acquired
at different gantry angles and collimators of 0 and 90 deg for the isocenter checks.

For education purposes only pg 753 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 When couch moves up the BBs in the phantom project to different positions on the panel. If
couch vertical axis is exactly parallel with beam direction then vector defined by a BB and the
beam center will only change its size, not direction.

9 9

For education purposes only pg 754 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 The reference position for the couch can be established using Acquire Couch Reference
option in the software (Acquisition Workspace -> Tools -> Acquire Couch Reference)

 Lateral: describes the positioning accuracy of couch lateral axis on a 5cm travel range (IEC
61217, positive direction, to the right)
 Longitudinal: describes the positioning accuracy of couch longitudinal axis on a 5cm travel
range (IEC 61217, negative direction, away from gantry)
 Vertical: describes the positioning accuracy of couch vertical axis on a 15cm travel range
(IEC 61217 positive direction, upward) 9
 Rotation: describes the positioning accuracy of couch rotation axis on a 10°travel range (IEC
61217, positive direction, CCW in source view)

 Note: Couch will move without operator intervention (MEB do not need to be held)

For education purposes only pg 755 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

9 9

For education purposes only pg 756 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

Note: If the available actual disk space drops below 5.5GB on the disk drive, no new checks can
be acquired

For education purposes only pg 757 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

9 9

For education purposes only pg 758 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 I:\ = \\myserver\va_transfer\

For education purposes only pg 759 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 Offline Mode is not connected to OSP hence user rights do not apply.

 Console mode also features elevated access for Service personnel with HASP. Service
access allows additional tests and maintenance options.

9 9

For education purposes only pg 760 DCID: TB2.5-CEM-02-B
Machine Performance Check Overview

 References
 P1008852-001-A – Machine Performance Check Reference Guide, chapters 3, 4, 5, 6, 7,
appendices A, B
 P1005922-001-A – TrueBeam Instructions for Use, appendix E

For education purposes only pg 761 DCID: TB2.5-CEM-02-B
Using Machine Performance Check

Using Machine Performance Check

Procedure

Objectives
After completing this procedure the student will have:

1. learned how to schedule beam checks,

2. collected MPC data for the geometry test and selected beam tests,

3. learned how to appoint the baseline and delete checks,

4. exported the performed checks and created reports,

5. used MPC Offline Mode.

Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

References:
P1008852-001-A – Machine Performance Check Reference Guide, chapters 5, 6, appendices A, B.

9 P1005922-001-A – TrueBeam Instructions for Use, appendix E. 9

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Using Machine Performance Check

A. Scheduling beam tests

1. If the operator has Administer QA Application right, they can schedule beam tests to be done every
day.

2. Launch the MPC application at the TrueBeam workstation by clicking MPC button on the Select
Major Mode screen; login when prompted. See Figure 1.

Figure 1: Launching the MPC Application

3. When the application launches, click Options in the MPC Review Workspace and then select
Configuration. See Figure 2.

Figure 2: Review Workspace → Options → Configuration

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Using Machine Performance Check

4. Select the combinations of energies and week days for the beam tests. Click Save when done.
See Figure 3.

Figure 3: Scheduling Beams Tests for Week Days and Energies

Note: 6X energy is not in the list because beam test for 6X energy is included
in the mandatory and automatically scheduled ‘beam and geometry test’ that
uses 6X MV energy.
9 9
Note: Tests scheduled for the day can be removed by the operator collecting
the MPC data, if they have Administer QA Application right.

5. The MPC application can be closed, if desired, using Change Mode button on the top of the MPC
Acquisition Workspace. See Figure 4.

Figure 4: Change Mode Button

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Using Machine Performance Check

B. Setting up the IsoCal phantom

1. Enter the treatment room. Place the MPC bracket on the couch at the reference position indicated on
the bracket label (H2 in case of Varian IGRT couch top, H4 in case of QFIX kVue standard insert).
Make sure the MPC bracket is exactly at the notches, firmly attached to the couch, see Figure 5.

Slit for front plate of

the IsoCal phantom

Figure 5: MPC Bracket Holder on the Couch

Important Note: In some cases it may be necessary to firmly press the

phantom down to ensure that it is positioned correctly. Otherwise,
discrepancies or false data will result.

2. Then place the IsoCal phantom on the MPC mount. See Figure 6.

Figure 6: IsoCal Phantom in the MPC Bracket Holder

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Note: The treatment couch will move as the MPC will collect the machine
data. Make sure the IsoCal firmly sits on the MPC holder and it will not shift
relative to couch during data collection.

3. Carefully align the IsoCal Phantom to the isocenter using the room lasers. This step can be skipped if
the couch reference position has already been acquired. See Figure 7.

Figure 7: Aligning the IsoCal Phantom to the Isocenter

Important Note: MPC requires couch reference position for the testing
procedure. The couch reference position is a couch position where the IsoCal
9 Phantom is aligned to the isocenter. The reference position can be 9
established / acquired in the MPC application.
If the MPC bracket holder is positioned every day to the same notches on the
couch top, the reference position must be acquired on the first day of use
only, on the subsequent days the MPC will use the same couch position as
the reference and the IsoCal phantom will still be aligned with isocenter.
Alternatively, the user may choose to align the IsoCal phantom to the
isocenter regardless of its position on the couch and then acquire couch
reference for each session independently.

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C. Collecting MPC data

1. Launch the MPC application at the TrueBeam workstation. Click MPC button on the Select Major
Mode screen and then login when prompted. See Figure 8.

Figure 8: Launching MPC Major Mode

2. When MPC launches, the tests scheduled for the day will be listed in the session area. See Figure 9

Tests scheduled for the day

Figure 9: MPC Launched

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3. If it is desired to acquire new couch reference position, click Tools and choose Acquire Couch
Reference. Then click OK to acknowledge the confirmation message. See Figure 10.

Figure 10: Acquire Couch Reference → Confirmation Message

Note: If the actual couch position differs from the previously saved couch
reference position by more than 2cm, the following message appears. Verify
the phantom position and decide whether to acquire the current couch
position as reference for the phantom or cancel.
9 9

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4. If it is desired to add more beam tests, for other machine energies, click Tools, choose Add Energy
and then select the other energies to test. See Figure 11.

Figure 11: Adding Beam Tests for Other Energies

Tip: Notice that the operator is always able to add more beam tests ad hoc,
but the operator may not have enough rights to remove the scheduled
checks. Removing scheduled checks requires Administer QA Application
right.
With sufficient privileges the scheduled checks can also be removed by 9
clicking ‘minus in red box’ button on the test in the session area:

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5. Press Prepare on the control console. Use the Motion Selections buttons that are highlighted in
orange color to select the machine axes to move. Then press both Motion Enable buttons on the
console and hold them down until all machine axes have reached the plan position. See Figure 12.

Figure 12: Control Console

6. When MV Ready button illuminates, press and hold it until MV Beam On illuminates. Then press the
MV Beam On to initiate the treatment. See Figure 12. Both MV and kV beams will be on for the
geometry tests.

Note: During the geometry test the treatment couch will move. This will
happen without the operator intervention. In MPC mode, the couch can be
moved to plan from outside of the vault (from console)
9 9
7. Wait until all data for the active test has been collected. The images will be quickly displayed for
review as acquired. See Figure 13.

8. Every test in the list is handled as if it was a separate treatment field. Auto-sequencing is always on.
When the data for previous has been collected, next test will be selected automatically. When MV
Ready button illuminates, press and hold it until MV Beam On illuminates, then press MV Beam On
to start data collection for the selected test. Results for the completed tests are already available.

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Pass / Fail

Test in Progress

Figure 13: Acquiring Test Data

9. The finished tests are immediately available for analysis and review in the MPC Review Workspace.
See Figure 14.

Figure 14: Review Workspace, Finished Tests Are Available Immediately

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D. Data and results review

1. In the MPC Review Workspace, click the test to review on the MPC History timeline. Alternatively,
arrow down button in the MPC Acquisition Workspace can be used to review results for a
particular test that the data was acquired for, during the session. See Figure 15.

Figure 15: Selecting a Test for a Review

a) MPC Review Workspace includes a legend (on the bottom of the window) that explains colors
and symbols available on the workspace’s timeline:

Show / Hide legend

Symbol Meaning

Check passed – all evaluated parameters for the check are within thresholds.

9 Check passed close to thresholds – at least one of the checked parameters is within the 9
threshold but only 10% of being out of specification (outside of the threshold).

Check failed – at least one of the evaluated parameters is outside of its threshold or
evaluation not possible because of failed processing.

The check was set as the beam check baseline.

A note has been created for the check.

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b) MPC Acquisition Workspace shows the check status using one of the following symbols:

Symbol Meaning

Check passed – all evaluated parameters for the check are within thresholds

Check passed close to thresholds – at least one of the checked parameters is within the
threshold but only 10% of being out of specification (outside of the threshold)

Check failed – at least one of the evaluated parameters is outside of its threshold or
evaluation not possible because of failed processing

The check was set as baseline

2. Upon selecting a check, the MPC Review Workspace displays the check details in Details View.
MPC Acquisition Workspace shows checks’ overall statuses. See Figure 16.

Figure 16: 6X Beam & Geometry Check Selected, Acquisition WS (left), Review WS (right)

a) Repeat button can be used to repeat a particular check; alternatively a particular check can be
scheduled again using Tools → Add Energy menu.

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3. The Details View of the MPC Review Workspace consists of three main sections: Title and Menu,
Check results area, Image review area. See Figure 17.

Title & Menu

Check results area

Check Notes
Image review area

Figure 17: Review Workspace, Details View

4. Review the evaluated parameters. Use / icons to expand / collapse the results list.
See Figure 18.

9 9

Figure 18: Result List

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Important Note: Beam Check evaluated parameters are not displayed in the
list until the baseline is appointed. If energy other than 6X is selected the list
will be empty.

5. A note can be defined for a check on the bottom of the Check results area. See Figure 19.

Show/ Hide note

Figure 19: Check Note

6. For an image review, click a thumbnail of the image to be reviewed. The image is then displayed in
the image view on the right hand side for a quick analysis. See Figure 20.

Image thumbnail
9

Figure 20: Image Review Area

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a) The MPC Review Workspace provides similar image evaluation tools as the PVA workspace:

Icon Meaning

Pan

Zoom In, Zoom Out

Reset View

Manual Window / Level, Automatic Window / Level

Measure Distance / Ruler

Measure pixel value

7. The Details View of the MPC Review Workspace also provides trend chart. Bring the mouse cursor

next to name of the parameter of the interest and click the button. See Figure 21.

Click to show the trend chart

9 9

Figure 21: Displaying the Trend Chart

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a) The trend chart will be displayed in a separate window. See Figure 22.

Close the trend window

Figure 22: Trend Window

b) It is possible to see more evaluated parameters in one trend window. Bring the mouse cursor
over the name of the displayed parameter. Click the that appears and choose parameter(s)
to be displayed. See Figure 23.

Figure 23: Displaying More Parameters in the Trend Chart

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c) Bring the mouse over the parameters to be removed from the chart and click to remove the
parameter from the trend chart. See Figure 24.

Checkboxes can be
used to show / hide the
parameter trend chart

Figure 24: Removing Parameter from Chart

d) RMC the chart area provides the menu with following options – See Figure 25.

Copy to clipboard as image

9 9

Figure 25: RMC Context Menu

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8. If the beam data is to be used as the baseline, click Options in the Details View of the MPC Review
Workspace for the selected check and then choose Appoint Baseline. See Figure 26.

Figure 26: Appointing Baseline

a) Sign-off with Administer QA Application right is required. See Figure 27.

Figure 27: Appoint Baseline Sign-off

Important Note: Historical data cannot be appointed as baseline. Only the

beam data acquired during the current MPC session.
Check can only be appointed as baseline if it was successful (Beam Delivery,
Processing).

9. If the check is to be deleted, click Options in the Details View of the MPC Review Workspace for
the check and then choose Delete Check. See Figure 28. 9

Figure 28: Deleting Check

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a) Sign-off with Administer QA Application right is required. See Figure 29.

Figure 29: Check Deletion Sign-off

Important Note: Actual baseline checks cannot be deleted. ‘Delete Check’

menu will be inactive.

9 9

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E. Reports and data export

1. A particular check data can be exported in Details View of the MPC Review Workspace.

a) Click the check to be exported on the MPC Review Workspace timeline. See Figure 30.

Figure 30: MPC Review Workspace Timeline

b) In Check Details View, click Options and then choose Export Check. See Figure 31.

Figure 31: Exporting Check

c) Wait until the MPC exports the selected check data. Then acknowledge the export confirmation
message by clicking OK. See Figure 32.

Figure 32: MPC Check Export Confirmation

d) The data is exported in form of a *zip file. The filename is <computer name>-<YYYY>-<MM>-
<DD>-<HH>-<MM>-<SS>-<daily timeline order>-<energy>-<check name>_<export number>,

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where check name can be “Geometry” or “Beam” and <export number> is included if the same
check was exported several times.

e) The file is saved in TrueBeam workstation local folder that is synchronized to a user-server to the
following directory: \\myserver\va_transfer\TDS\<machineID>\MPC\Checks.

f) The file contains images (*.xim), check results (Results.csv) and other data. The exported file can
be extracted and reviewed in MPC Offline Mode. The Results.csv file can be used in Excel. See
Machine Performance Check Reference Guide for more information about CSV file content.

2. MPC Check Report for a particular check can be created in Details View of the MPC Review
Workspace.

a) Click the check of the interest on the MPC Review Workspace timeline to open the Details View
for the check. Then click Options and choose Create Report. See Figure 33.

Figure 33: Create Check Report

b) The report will be created and displayed for a preview. Click Accept to keep the report on the
disk. See Figure 34.

9 9

Figure 34: MPC Check Report

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c) The MPC Reports are saved on the local disk in TDS\Output\MPC\Reports. This folder is
synchronized to a user-server in the following directory: \\myserver\va_transfer\TDS\<machineID>
\MPC\Reports. MPC Reports are PDF documents.

3. MPC Session Report can be created by clicking Create Session Report button on the bottom of the
MPC Acquisition Workspace. See Figure 35.

Figure 35: Create Session Report

a) The report will be created and displayed for user review. It includes all checks done during the
MPC session. Click Accept to keep the report on the disk. See Figure 36.

Figure 36: MPC Session Report
9
b) The MPC Session Reports are saved on the local disk in TDS\Output\MPC\Reports. This folder is
synchronized to a user-server in the following directory: \\myserver\va_transfer\TDS\<machineID>
\MPC\Reports. MPC Session Reports are PDF documents.

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4. Results for all checks available in the MPC History can be exported in the MPC Review Workspace.

a) Click Options and then choose Export MPC History to CSV Files. See Figure 37.

Figure 37: Export MPC History to CSV

b) Wait until the data has been exported. Acknowledge the successful export by clicking OK on the
MPC export confirmation message. See Figure 38.

Figure 38: Results Exported

c) The MPC History is exported on local disk. The directory is synchronized to a user-server in the
following directory: \\myserver\va_transfer\TDS\<machineID>\MPC\Results. MPC History file is a
text file in CSV format that contains results for all tests in the MPC history for a particular energy.
The file name is <YYYY>-<MM>-<DD>-<HH>-<MM>-<SS>-<energy>.csv.

9 9

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F. Using MPC Offline Mode

1. Launch the MPC Offline Mode on the computer the Offline Mode has been installed. The MPC
Application can be launched from Windows Start Menu: All Programs → Varian →Performance
Check. See Figure 39.

Figure 39: Launching MPC from Windows Start Menu

2. Wait until the MPC launches. The MPC Offline Mode is basically MPC Review Workspace with the
option to review data for different machines (Select Machine menu). If no machines have been
added yet, the MPC History timeline will be empty with title (No Machine Selected). See Figure 40.

Figure 40: MPC Offline Mode, no Machine Selected

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3. If it is necessary to add a new machine, click Select Machine and then choose Add a Machine.
Otherwise this step can be skipped. See Figure 41.

Figure 41: Adding a Machine

a) Use the file explorer to navigate into a folder that contains the MPC Checks. See Figure 42.

Figure 42: Select the Folder with MPC Checks
9 9

Tip: The MPC checks are automatically synchronized to the following

directory on a user-server: \\<myserver>\va_transfer\TDS\<machineID>\
MPCChecks. This would be preferable source of data for MPC Offline Mode.
Alternatively Exported Checks can also be extracted and reviewed in the
MPC Offline Mode.

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b) Define the Machine Name in the displayed dialog. See Figure 43.

Figure 43: Define Name

c) The MPC History timeline is then refreshed and shows the MPC checks available in the selected
folder. See Figure 44.

Figure 44: MPC History Timeline Showing Available Check

d) Click the check of the interest to switch to Details View for detailed analyses, trends and reports.
See Figure 45.

Figure 45: Details View for a Check in MPC Offline Mode

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4. Repeat step F.3 if it is desired to add more machines in the MPC Offline Mode.

5. If multiple machines have been added to MPC Offline Mode, Select Machine menu can be used to
switch between the machines. See Figure 46.

Figure 46: Switching Between the Machines

Tip: button can be used to delete a machine from the machine list.
See Figure 46. Deleting a machine does not remove its check data from the
disk.

9 9

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Machine QA Plans

Machine QA Plans
Procedure

Objectives
After completing this procedure, the student will have reviewed contents and use of the Machine QA
plans supplied with TrueBeam.

Abbreviations
Left mouse click denoted as LMC.

Right mouse click denoted as RMC.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 4, appendices C, D.

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A. Overview
1. Machine QA test plans supplied with the TrueBeam system are designed to evaluate constancy of
system performance. These tests are representative of modern daily and weekly quality assurance
checks recommended by international guidelines.

Note: All the files are provided with a generic machine ID, default couch
position values. Varian encourages you to customize these tests to meet your
local QA protocols and accommodate the operating conditions of your testing
and output measurement devices.

2. The plans can be run as-is in file mode or they can be modified in hospital TPS / R&V system for the
site’s needs. After having modified the plan in TPS / R&V the plan can be exported. The plans are
located at \\myserver\va_transfer\TDS\<machineID>\Input\DailyQA.

Tip: In System Administration → Treatment there is a setting Allow

Unapproved Plan that determines if unapproved plans can be loaded in
Treatment / Machine QA application in file mode.

Tip: DICOM Media File Import Filter in ARIA / Eclipse configuration may
require an update to allow importing the QA plans in the system. The plan
being imported has to be linked to a machine configured in the system; if the
plan contains machine ID that does not match the machine ID of any machine
configured in the system, import fails. In such case, import filter has to be
configured to convert machine ID in the plan to the ID of a particular machine
existing in the system to import and connect the plan with that particular
machine. See Eclipse / ARIA manuals for more information.

9 3. There are 7 Machine QA tests: 9

a) Safety Tests - provides tests appropriate for evaluation functionality of detector touch systems,
motion enable buttons and bars, emergency stop, latching and verification of accessories, patient
monitoring systems and stereotactic motion disable feature. See section B.

b) Alignment Tests – provides tests appropriate for evaluating the functionality of Optical Distance
Indicator, jaw positions accuracy and laser alignment. See section C.

c) Imager Tests – provides tests for evaluating geometric alignment of imager systems to isocenter,
couch shift accuracy, check of door interlock, beam on indicator check, and beam on/off button
check. See section D.

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d) Beam Tests – provides tests for evaluating the constancy of photon and electron beam output,
check of door interlock, beam on indicator check, beam on/off button check, and functionality of
electron applicator verification system and touch guards. See section E.

e) Treatment Test – provides set of representative treatment fields for evaluating the constancy of
system output under clinical operation. See section F.

f) Gated IGRT Tests – provides fields to evaluate constancy of respiratory gated imaging and
treatment delivery. See section G.

g) PerfectPitch Tests – provides fields to verify that the system maintains the correct isocenter
when roll and pitch is used. See section H.

Note: Safety, Alignment, Imager, Gated IGRT and PerfectPitch test groups
are run in Treatment Mode. Beam and Treatment test groups may be run in
Machine QA Mode. Machine QA mode does not record the dose and allows
that the field is delivered multiple times. Machine QA mode does not display
Setup Notes at the console but allows Dry Run if necessary.

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B. Safety Tests
1. Safety Tests is a single DICOM plan, RP.Daily QA_SafetyTest.dcm.

2. Fields in the plan contain Setup Notes that can provide additional guidance. The plan contains
following fields:

a) Set up safety – used to test touch detectors on the imaging arms.

b) Motion Enable – used to test motion enable buttons and Stereotactic Motion Enable/Disable
function.

c) Interface – used to test the read out system of the interface mount.

d) Compensator – used to test the read out system of the compensator mount.

e) Accessory - used to test the read out system of the accessory mount.

f) Audio/Video – used to test the intercom system, cameras, volume and mute controls.

Note: The procedure demonstrates the plan as-is and is run in Treatment
mode in file mode.

3. Launch the Treatment mode at the console. Login with appropriate rights. See Figure 1.

9 9

Figure 1: Major Mode Selection → Login

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4. Select Tools → File Mode. See Figure 2.

Figure 2: Tools → File Mode

5. Click Open Plan. See Figure 3.

Figure 3: Open Plan

6. Navigate to I:\ drive and then TDS\<machineID>Input\DailyQA\Safety Tests. Select RP.Daily

QA_SafetyTest.dcm file. Click Open to continue. See Figure 4.

Figure 4: File Selection

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7. When the plan loads, the imaging application displays a warning that the plan contains different
couch positions. Click the message and then click OK. See Figure 5.

Figure 5: Imaging Application Warning Message

8. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 6.

9 9

Figure 6: Machine Override

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9. Authorize the machine override (Override Machine right is required). See Figure 7.

Figure 7: Machine Override Authorization

10. Select all the fields by clicking Select All. Click Next to continue. See Figure 8.

9

Figure 8: Override Machine – Field Selection

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11. Click Convert to override the machine. See Figure 9.

Figure 9: Machine Override, Convert the Selected Fields

12. On the machine override summary dialog, check the status and click Done. See Figure 10.

9 9

Figure 10: Machine Override Summary

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13. Select Set up safety field and enter the treatment room. See Figure 11.

Figure 11: Set Up Safety

14. In the treatment room, use the hand pendant to move gantry and couch to plan
position. Gantry and couch have to be moved one at a time.

15. If the arms are not fully retracted, select all the arms with imager selection button and use

Retract button on the hand pendant to retract them.

16. Select the MV imager using imager selection button on the pendant and move the MV imager

to mid-position using the Mid button on the pendant.

17. While the MV imager is moving to plan, touch the MV detector cover with your hand.

18. Make sure that all motions cease, an audible collision alert tone sounds, and the red Collision Reset
buttons on the collimator and couch side panels light up.

19. Press Motion Enable and confirm that motion is not possible after collision has been detected.

20. Move your hand away from the MV detector cover and press one of the Collision Reset buttons. 9
21. Confirm that motion is now allowed.

22. Repeat steps B.16 to B.21 with the kV Source and kV Detector.

Note: kV Source and kV Detector always move together in Treatment mode.

It is not possible to move only one of them.

23. Leave the imaging arms at their current positions. Return to the console.

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24. Select the Motion Enable field. See Figure 12.

Figure 12: Motion Enable

25. Access Stereotactic Motion Enable/Disable feature - Select Tools → Enable/Disable Axes Motion.
See Figure 13.

Figure 13: Tools → Enable/Disable Axes Motion

26. Click Disable All and then click Apply. Click Close to continue. See Figure 14.

9 9

Figure 14: Disable Axes Motion

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27. Enter the treatment room.

28. Using the pendant, side panel and control console motion controls, attempt to move the system to the
planned position. No axis should move and the disabled motion axes should be displayed with a
padlock icon ( ) on the in room monitor and on the treatment screen. Each attempt to move the axes
will result in a User Message at the console, see Figure 15.

Figure 15: Motion Prevented User Message

29. Access the Stereotactic Motion Enable/Disable at the console. Select Tools → Enable/Disable Axes
Motion. See Figure 13.

30. Click Enable All and then click Apply. Click Close to continue. See Figure 16.

9
Figure 16: Enable Axes Motion

31. Return to the treatment room.

32. Using one pendant, move the gantry to plan ( ). Once motion has started, release the motion
enable bars. Confirm that gantry stops.

33. Repeat step B.32 for the second pendant.

34. Using one of the side panels press Motion Enable and Retract button to begin retracting the
imager. Once the motion has started, release the Motion Enable and confirm that all motions stop.

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35. Repeat step B.34 for the other side panel. Alternatively couch manual motions thumbwheels with
Motion Enable buttons can be used to check Motion Enable buttons.

Important Note: The Motion Enable field is also designed to test Emergency
Stop button(s). This test requires that you engage the Emergency Stop
system and then you initiate the recovery procedure to power on the system.
Because this test takes a longer time, Varian recommends that you test only
one Emergency Stop button per day. Emergency controls on couch side
panels should be tested at least once a month.

36. Press the selected Emergency Stop button.

37. Confirm that beam and motion interlocks are asserted, power to the treatment system is turned off
with exception of the workstations and digital control system. The backlights on the side panel control
buttons should dim and the Emergency Operations control buttons should illuminate. See Figure 17.

Figure 17: Couch EMO Controls

38. Press or pull out the activated Emergency Stop button immediately after confirming proper system
performance and initiate transition to Power On using the applicable procedure from this manual.

39. At the console, change to Service mode to check the status of Emergency Operations control battery.
In Service mode, select the Power tab, then choose Stand and check the 24V Battery Monitoring
level at far right of the screen. The battery charge level must be greater than or equal to 24 V. The
TrueBeam small vault configuration does not use the emergency battery, so this step does not apply.

9 9

Figure 18: Service Mode, 24V Battery Monitoring

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40. Enter the treatment room. Using the hand pendant, enter the Dry Run by selecting Fields tab on the

patient monitor with hand pendant navigation buttons . Then select the Interface field with the
pendant navigation buttons. See Figure 19.

Figure 19: Patient and Machine Monitors → Fields Tab (Dry Run)

41. Using the automatic motion controls on the pendant, move the system to the planned position.

42. Insert the accessory into the mount according to the plan (15° upper wedge right, W15R30U).

43. Confirm that when the accessory is installed correctly, the accessory status indicator light is green.

44. Confirm that when the accessory is installed correctly the accessory status indicator light is green and
the wedge is verified as correctly installed according to the plan.

45. Confirm that once the accessory is moved out of the correct position, the accessory status on the
machine monitor reads Partial, the collimator status indicator light is red, and an accessory interlock
is asserted. Then remove the accessory and store it.

46. Use the navigation buttons on the hand pendant to select next field.

47. Repeat steps 41 - 46 for Compensator and Accessory fields. The Accessory field does not have
planned accessory and it is to check that when clean blank block tray is installed in the accessory
mount correctly, the accessory status indicator light is green and the accessory will be identified on
machine monitor as UnkAcc2 and an accessory interlock will be asserted when tray is inserted as
there is no accessory in the plan.

48. Return to the console, cancel the Dry Run, see Figure 20, and then select the Audio/Video field.
9

Click Done to finish Dry Run

Figure 20: Finish Dry Run

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49. View the display of the treatment room in the treatment application (Live View), visually assess the
image quality.

50. Confirm that the machine motion model arrows overlay the video display and correctly indicate the
expected motion and the direction of that motion.

51. Start to move the system to the plan positions using the control console. Confirm that the machine
motion model arrows overlay the video display and correctly indicate the activated motion and the
direction of that motion. Stop the motion before reaching the plan values by releasing Motion Enable
button, confirm that all motion stops.

52. Inspect the Motion View monitors (CCTV camera monitors), confirm the operation of the pan-tilt-zoom
controls, setting of the home position and assess the image quality for clarity and clear view of couch
edges.

53. Test the aural system. If a MP3 music source is available on your system, turn this on.

54. In the treatment room, confirm that the side panel volume controls ( ) are operational.
Confirm that the music can be muted by pressing the mute button.

55. Confirm that the side panel volume and mute controls do not cause the intercom to be muted.

56. Confirm that a therapist at the treatment console can hear you as you speak in the treatment room.

57. At the treatment console, confirm that pressing the intercom button, see Figure 21, on the control
console interrupts the music.

9 9

Figure 21: Control Console

58. Close the plan with Close Plan button at the bottom of the screen.

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C. Alignment Tests
1. Alignment Tests is a single DICOM plan, RP.Daily QA_AlignmentTest.dcm.

2. Fields in the plan contain Setup Notes that can provide additional guidance. The plan contains
following fields:

a) ODI 1, ODI 2, ODI 3 – these fields are used to verify the Optical Distance Indicator (ODI)
operation.

b) Lasers – used to verify the functionality and alignment of the room lasers.

Note: The procedure demonstrates the plan as-is and is run in Treatment
mode in file mode.

3. Launch the Treatment mode at the console. Login with appropriate rights. See Figure 22.

Figure 22: Major Mode Selection → Login

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4. Select Tools → File Mode. See Figure 23.

Figure 23: Tools → File Mode

5. Click Open Plan. See Figure 24.

Figure 24: Open Plan

6. Navigate to I:\ drive and then TDS\<machineID>Input\DailyQA\Alignment Tests. Select RP.Daily

QA_AlignmentTest.dcm file. Click Open to continue. See Figure 25.

9 9

Figure 25: File Selection

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7. When the plan loads, the imaging application displays a warning that the plan contains different
couch positions. Click the message and then click OK. See Figure 26.

Figure 26: Imaging Application Warning Message

8. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 27.

Figure 27: Machine Override

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9. Authorize the machine override (Override Machine right is required). See Figure 28.

Figure 28: Machine Override Authorization

10. Select all the fields by clicking Select All. Click Next to continue. See Figure 29.

9 9

Figure 29: Override Machine – Field Selection

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11. Click Convert to override the machine. See Figure 30.

Figure 30: Machine Override, Convert the Selected Fields

12. On the machine override summary dialog, check the status and click Done. See Figure 31.

Figure 31: Machine Override Summary

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13. Enter the treatment room. Using the hand pendant, enter the Dry Run by selecting Fields tab on the

patient monitor with hand pendant navigation buttons . Then select the ODI 1 field.
See Figure 32.

Figure 32: Patient Monitor, Enable Dry Run

14. Turn the room lights off and then turn on the field light .

15. Use Auto Motion buttons on the hand pendant, highlighted in orange color, to
move to plan.

16. Turn on the Optical Distance Indicator . Confirm that the ODI reads 100 - the couch top
surface is at isocenter.

17. Use the hand pendant navigation buttons to select next field – ODI 2 and then use Auto Motion
buttons highlighted in orange to move to plan.

18. Confirm the ODI reads 110 - the couch top surface is 10 cm below isocenter.

19. Use the hand pendant navigation buttons to select next field – ODI 3 and then use Auto Motion
buttons highlighted in orange to move to plan.

9 20. Confirm the ODI reads 90 - the couch top surface is 10 cm above isocenter. 9

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21. Turn on the room light and install the Imager Cube phantom at H4 position on the treatment couch.
See Figure 33.

Figure 33: Imager Cube Phantom Installed on the Couch at H4

22. Use the hand pendant navigation buttons to select the last field – Lasers and then use Auto
Motion buttons highlighted in orange to move to plan.

23. Turn the room lights off and then turn on the lasers .

24. If necessary, move the couch manually using the thumbwheels, until the red crosses on the Imager
Cube are aligned with lasers.

9
Tip: Update the couch positions in the provided plan with the new positions
appropriate for this test to facilitate couch setup.

25. Confirm that the alignment of both lateral lasers, the sagittal laser, and the ceiling laser to the cube
phantom cross hairs is appropriate and acceptable.

26. Turn on the backpointer lasers on the side panel; visually inspect and confirm that the
backpointer lasers intersect the cross hairs on the imaging cube.

27. Close the plan with Close Plan button at the bottom of the screen.

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D. Imager Tests
1. Imager Tests is a DICOM plan, RP.Daily QA_Imager Tests.dcm accompanied by 5 reference images
(file names start with RI).

2. Fields in the plan contain Setup Notes that can provide additional guidance and they have the
appropriate imaging procedures already scheduled. The plan contains following fields:

a) kV Fluoro – used to test acquisition of fluoroscopic image, kV beam on visual indicators, door
interlock for kV beam, kV beam on button operation.

b) kV AP – see below.

c) kV Lat – kV AP and kV Lat are paired for kV-kV acquisition and used to test geometric alignment
of kV imaging system to isocenter and accuracy of remote couch shifts.

d) kV-MV LAT – see below.

e) kV-MV AP – these fields are used to check the geometric alignment of MV imaging system to
isocenter.

Important Note: When the plan is loaded, different field names will appear
on the display as the fields already have imaging procedures attached.

Warning: The Machine QA Imager Test suite contains a plan to test image-
guided couch positioning repeatability. A reference image for the geometric
cube phantom is provided as a space-holder—this reference image must be
replaced with an equivalent reference image acquired using the site’s
geometric cube phantom. There is known variation in the manufacture of
such phantoms that prevents image matching on-site to the Varian-provided
reference image.
P1005922-001-A – TrueBeam Instructions for Use, page 57.

9 Warning: Couch performance, including couch shifts, must be tested every

9
day to ensure correct patient positioning.
P1005922-001-A – TrueBeam Instructions for Use, page 321.

Note: The procedure demonstrates the plan as-is and is run in Treatment
mode in file mode.

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3. Launch the Treatment mode at the console. Login with appropriate rights. See Figure 22.

Figure 34: Major Mode Selection → Login

4. Select Tools → File Mode. See Figure 23.

Figure 35: Tools → File Mode

5. Click Open Plan. See Figure 24.

Figure 36: Open Plan

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6. Navigate to I:\ drive and then TDS\<machineID>Input\DailyQA\Imager Tests. Select RP.Daily

QA_Imager Tests.dcm file. Click Open to continue. See Figure 25.

Figure 37: File Selection

7. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 27.

9 9

Figure 38: Machine Override

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8. Authorize the machine override (Override Machine right is required). See Figure 28.

Figure 39: Machine Override Authorization

9. Select all the fields by clicking Select All. Click Next to continue. See Figure 29.

9

Figure 40: Override Machine – Field Selection

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10. Click Convert to override the machine. See Figure 30.

Figure 41: Machine Override, Convert the Selected Fields

11. On the machine override summary dialog, check the status and click Done. See Figure 31.

9 9

Figure 42: Machine Override Summary

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12. Enter the treatment room and install the Imager Cube phantom at H4 position on the treatment couch.
See Figure 43. Align the red crosses on the phantom roughly with lasers.

Figure 43: Imager Cube Phantom Installed on the Couch at H4

13. Use the hand pendant to move the machine axes to plan. Check the Setup Notes on the Patient
monitor for more information on this test. Leave the treatment room and do not close the door.

14. At the console, select the first field in the plan, see Figure 44.

Figure 44: 1st Field Selected

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15. Set up the PVA application for a fluoroscopic acquisition, click the Fluoro button and then OK.
See Figure 45.

Figure 45: PVA, Selecting Fluoro

16. Press Prepare on the control console to prepare the beam. Confirm that the kV beam is interlocked
when the treatment room door is open and the beam cannot be initiated. See Figure 46.

9 9

Figure 46: Control Console

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17. Close the door to the treatment room. Acquire a fluoroscopic image by pressing and holding the
illuminated kV Beam On button on the console.

18. Confirm that images are being displayed, kV Beam On indicator in the console area is on and console
emits an audible tone when beam is on.

19. Release the kV Beam On button and confirm that image acquisition ceases immediately and audio
and visual beam on indicators are turned off when beam is off.

20. Click Cancel on the bottom of PVA application if 2D Match workspace was entered automatically.

21. Select the kV image pair, see Figure 47.

Figure 47: kV Pair Selected

22. Check the acquisition parameters and modify them if necessary, see Figure 48. Press and hold kV
Beam On button on the console to acquire a kV image.

Click the image to select the

field / acquisition direction,
green border is the active field

Figure 48: Acquisition Parameters

23. Once the first image has been acquired, the system may automatically select the second field of the
kV pair if PVA has been configured in System Administration to do so. If the second field is not
selected automatically LMC the space for the second image in PVA application, see Figure 48.

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24. When the second field has been selected, press Motion Enable on the control console to move the
gantry to plan position for the second field.

25. When the gantry has reached the plan position for the second image (and kV Beam On has
illuminated), make sure the acquisition parameters are appropriate and press the kV Beam On button
to acquire the second image of the pair.

26. The 2D-2D match workspace may open automatically if PVA has been configured in System
Administration to do so. If the 2D-2D match does not open automatically, click 2D-2D Match button
on the bottom of PVA application, see Figure 49.

Figure 49: 2D-2D Match Button

27. Acknowledge the following message that is displayed when matching workspace is opened; click the
message and then OK, see Figure 50.

9 9

Figure 50: No Undelivered Treatment Fields Message

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28. Match the newly acquired kV images to the plan reference images, or align the digital graticule with
the center of the cube phantom. See Figure 51.
Figure 52 shows graticules – reference image graticule in the center of the acquired cube phantom
when acquired image only is displayed (100% blending level).

Note: Graticules are color coded. Reference graticule is blue and acquired
image is red.

Calculated shifts

Graticule

Blending level

Apply shifts when done

Figure 51: Images Matched

Figure 52: Graticules

29. Click Apply button to apply the calculated couch shifts, see Figure 51.

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30. If the shifts are larger than allowed by the plan tolerance tables, an authorization is required. Enter
your credentials and click Apply to continue (‘Override Setup Correction Threshold’ right required for
successful sign-off). See Figure 53.

Figure 53: Shift Larger Than Plan Tolerance Authorization
9 31. Apply the couch shifts – select the couch motions to be applied (rotation and / or linear) on the 9
console, press and hold Motion Enable button until all couch axes have reached the new position.

32. Repeat steps D.22 to D.26 to acquire another image pair for the new couch / phantom position and
open the 2D-2D match workspace.

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33. Do not match acquired and reference images. Zoom in and measure the difference between digital
graticule and the center of the BB in the phantom using the ruler tool. The difference should be less
than or equal to 0.5mm. See Figure 54.

Graticule and ruler

Figure 54: Agreement After the Couch Shift

34. Click Cancel to close the matching workspace, see Figure 54. Then press Preview on the console to
allow plan edits.

35. Remove the imaging procedures from remaining two fields – click the field, then click Remove and
select Delete Imaging Procedure, see Figure 55.

Figure 55: Deleting Imaging Procedure

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36. Add MV-kV image pair to last two fields – select the first one of the two in the list, click Add and then
select Add Imaging. See Figure 56.

Figure 56: Adding Imaging

37. From the available imaging procedures choose MV-kV and click OK. See Figure 57.

9 9

Figure 57: Select Imaging Procedure

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38. Select the MV-KV Setup Pair, see Figure 58.

Figure 58: MV-kV Setup Pair

39. Move to plan position – select the axes to be moved on the control console, then press and hold
Motion Enable buttons until axes have reached their plan positions. See Figure 59.

Figure 59: Move to Plan Using the Console, Beam Controls
9
40. Press Prepare on the console, see Figure 59. Then initiate the kV or MV beam depending on what
image has been selected to be acquired, see Figure 60. Click the image to be acquired in PVA, if the
application does not select the second image automatically.

a) for MV image – press and hold MV Ready until MV Beam On illuminates, then press MV Beam
On to turn the MV beam on. See Figure 59.

b) for kV image – press kV Beam On and hold until kV beam turns on. See Figure 59.

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Note: If MV image acquisition parameters need to be modified, press

Preview on the console, update acquisition parameters and then press
Prepare.

MV image

kV image,
currently active

Figure 60: Acquiring MV and kV Images for MV-kV Match

41. The 2D-2D match workspace may open automatically if PVA has been configured in System
Administration to do so. If the 2D-2D match does not open automatically, click 2D-2D Match button
on the bottom of PVA application.

42. Do not match acquired and reference images. Zoom in and measure the difference between digital
graticule and the center of the BB in the phantom using the ruler tool. The difference should be less
than or equal to 0.5mm. See Figure 54.
9 9
43. Click Cancel to close the matching workspace.

44. Close the plan.

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E. Beam Tests
1. Beam Tests is a single DICOM plan, RP.Daily QA_Beam Tests.dcm.

2. Most of the fields in the plan contain Setup Notes that can provide additional guidance. The plan
contains fields for all energy modes to check the beam output, flatness, symmetry and energy. In
addition, there are fields to check beam safety, jaw positioning accuracy and electron applicator cut-
out tray read-out system and touch guard:

a) Beam Safety – used to test beam interlock, Beam Off button, Beam On indicators.

b) Jaws Open, Asym Jaw1, Asym Jaw2, Asym Jaw3, Asym Jaw4 – used to check the jaws using
the field light.

c) ApplicatorCheck – used to test the applicator cut-out tray read-out system and touch guard
(collision detector at the end of applicator).

Note: The procedure demonstrates the plan as-is and is run in Machine QA
mode.

3. Launch the Machine QA mode at the console. Login with appropriate rights. See Figure 61.

Figure 61: Major Mode Selection → Login

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4. Click Open Plan. See Figure 62.

Figure 62: Open Plan

5. Open Beam Tests folder and select RP.Daily QA_Beam Tests.dcm file. Click Open to continue.
See Figure 63.

Figure 63: File Selection

6. When the plan loads, the imaging application displays a warning that the plan contains different
couch positions. Click the message and then click OK. See Figure 64.

9 9

Figure 64: Imaging Application Warning Message

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7. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 65.

Figure 65: Machine Override

8. Authorize the machine override (Override Machine right is required). See Figure 66.

Figure 66: Machine Override Authorization

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9. Select all the fields by pressing Select All. Click Next to continue. See Figure 67.

Figure 67: Override Machine – Field Selection

Note: Exclamation mark in red circle indicates energies not available on your
machine. If enabled in System Administration and user has appropriate rights
(Override External Energy), energy can be changed on the next screen of the
machine override wizard.

9 9

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10. Click Convert to override the machine. See Figure 68.

Figure 68: Machine Override, Convert the Selected Fields

11. On the machine override summary dialog, check the status and click Done. See Figure 69.

Figure 69: Machine Override Summary

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12. Enter the treatment room and set up the daily QA device. Align the surface of the measurement
device to isocenter.

13. Turn off the room light, turn on the field light using hand pendant or side panel controls.

14. Using the hand pendant, enter the Dry Run by selecting Fields tab on the patient monitor with hand

pendant navigation buttons .

15. Then use navigation buttons to select the Jaws Open field, see Figure 70. Jaws should
automatically move to plan, verify the actual jaw position on the machine monitor.

Figure 70: IRMs

16. Confirm that the field size indicated on IRM is equal to field light area measured on the measurement
device.

17. Repeat steps E.15 to E.16 with Asym Jaw 1 - Asym Jaw 4 fields.

18. Select the Beam Safety field and move to plan (except couch) using the hand pendant.

19. Cancel the DryRun by selecting Setup Notes tab on patient monitor using the hand pendant

navigation buttons .

20. Leave the door to the treatment room open and press Prepare on the console.

21. If it is necessary to override the plan couch position values, click Override on the bottom of
Treatment application, see Figure 71.
9 9

Figure 71: Overriding Couch Position Values

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22. Select the parameters to override and click Apply, see Figure 72.

Figure 72: Selecting Parameters To Be Overriden

23. Enter your credentials in the displayed window to confirm you have the rights to override couch.
See Figure 73.

Figure 73: Confirm Override

24. Then select the fields the override is to be applied to. See Figure 74

Figure 74: Copy Override to Fields

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25. Confirm that the beam is interlocked when the treatment door is open and that the beam cannot be
initiated.

26. Close the door to treatment room and confirm that the door interlock is removed and the beam can
now be initiated.

27. Deliver the field, press MV Ready and then MV Beam On buttons on the console, when it illuminates.

28. Confirm that visual and audio beam on indicators are on when the beam is on.

29. Press Beam Off on the console and confirm that beam is stopped and visual and audio beam on
indicators are off the beam is off.

30. Press MV Ready and then MV Beam On buttons on the console, when it illuminates and confirm that
the delivery is resumed.

31. Select the photon energy field to be tested, initiate the measurement and then treatment delivery.

32. Deliver beam to the measurement device, make sure treatment was not prematurely interrupted and
the plan MU was delivered completely. Otherwise repeat the measurement and beam delivery.

33. Assess the central axis beam output, beam flatness and symmetry, energy (beam quality) and record
the values.

34. Repeat steps E.31 to E.33 for all applicable / available photon energies.

35. At the console, select the ApplicatorCheck field and enter the treatment room.

36. Install the electron applicator and the cut-out (FFDA). Confirm that both applicator size and cut out
were properly detected and are displayed on IRM. Confirm that the accessory status indicator light is
green when applicator is installed correctly. Cycle through all available electron applicators, testing
one applicator each day.

37. Touch the face of the electron applicator (touch guard). Confirm that collision is detected and collision
reset buttons illuminate red.

38. Confirm that the motion interlock is asserted and machine cannot be moved.

9 39. Press one of the Collision Reset buttons. Confirm that the interlock has been removed and the 9
machine can now move.

40. Replace the applicator and the FFDA by the ones used for beam characteristics measurements.

41. Using the hand pendant, enter the Dry Run by selecting Fields tab on the patient monitor with hand

pendant navigation buttons , select the first electron energy to be tested. Move the machine to
plan using the hand pendant. Then select Setup Notes tab to cancel the Dry Run.

42. Set up the measurement device for measuring the electron beams according to device manual and
adopted QA protocol.

43. Leave the treatment room and close the door.

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44. Press Prepare on the console.

45. If it is necessary to override the plan couch position values, repeat steps E.21 to E.24.

46. Initiate the measurement and then the treatment delivery for the selected electron energy.

47. Deliver beam to the measurement device, make sure treatment was not prematurely interrupted and
the plan MU was delivered completely. Otherwise repeat the measurement and beam delivery.

48. Assess the central axis beam output, beam flatness and symmetry, energy (beam quality) and record
the values.

49. Repeat steps E.46 to E.48 for all applicable / available electron energies.

50. Once all the photons and electron energies have been tested, close the plan.

Figure 75: Closing the Plan

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F. Treatment Tests
1. Beam Tests are three DICOM plans, RP.Daily QA_Tx Test120MLC.dcm, RP.Daily QA_Tx
TestsHDMLC.dcm and RP.Daily QA_Tx Tests80MLC.dcm. RP.Daily QA_Tx Test120MLC.dcm is for
machines equipped with NDS120 MLC, RP.Daily QA_Tx Tests80MLC.dcm is for machines equipped
with 80 leaves MLC and RP.Daily QA_Tx TestsHDMLC.dcm is for machines with NDS120HD MLC.

2. The plans contain fields to test commonly used dynamic treatment techniques, such as EDW, IMRT,
Conformal Arc and others, see Table 1:

NDS120 NDS120HD MLC80 Description

EDWXXIN or EDWXXIN or EDWXXIN or used to test EDW (Enhanced Dynamic Wedge)

EDWXXOUT EDWXXOUT EDWXXOUT of different angles and orientations

LFIMRT 120 LFIMRT HD LFIMRT 80MLC used to test Large-Field IMRT delivery
technique

IMRT 6FFF IMRT 6FFF IMRT 6FFF used to test IMRT for 6X FFF beam
120 HD 80MLC

N/A IMRT 10FFF N/A used to test IMRT for 6X FFF beam
HD

VMAT 120 VMAT HD N/A used to test VMAT delivery

VMAT 6FFF VMAT 6FFF N/A used to test VMAT delivery for 6X FFF beam
120 HD

N/A VMAT 10FFF N/A used to test VMAT delivery for 10X FFF beam
HD

Photon ARC Photon ARC Photon ARC used to test photon arc delivery

Conf ARC 120 Conf ARC HD Conf ARC 80MLC used to test conformal photon arc
Table 1: Field Description

9 9
Note: The procedure demonstrates the plan as-is and is run in Machine QA
mode.

Tip: EDW fields cannot be delivered if EDW technique is disabled in System

Administration.

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3. Launch the Machine QA mode at the console. Login with appropriate rights. See Figure 76.

Figure 76: Major Mode Selection → Login

4. Click Open Plan. See Figure 77.

Figure 77: Open Plan

5. Open Treatment Tests folder and select the file appropriate for the machine MLC. Click Open to
continue. See Figure 78.

Figure 78: File Selection

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6. When the plan loads, the imaging application displays a warning that the plan contains different
couch positions. Click the message and then click OK. See Figure 79.

Figure 79: Imaging Application Warning Message

7. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 80.

9 9

Figure 80: Machine Override

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8. Authorize the machine override (Override Machine right is required). See Figure 81.

Figure 81: Machine Override Authorization

9. Select all the fields by clicking Select All. Click Next to continue. See Figure 82.

Figure 82: Override Machine – Field Selection

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10. Click Convert to override the machine. See Figure 83.

Figure 83: Machine Override, Convert the Selected Fields

11. On the machine override summary dialog, check the status and click Done. See Figure 84.

9 9

Figure 84: Machine Override Summary

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12. Enter the treatment room and set up the QA device.

13. Select the field to be tested at the console. Move to plan – select the machine axes to be moved by
pressing Motion Selection buttons on the console illuminated in orange color. Then press Motion
Enable buttons on the control console and hold them down until the selected machine axes have
reached their positions. See Figure 85.

Figure 85: Control Console

14. Deliver the selected field to measurement device - Press Prepare on the console. Wait until all
interlocks are cleared and MV Ready button on the console illuminates.

15. If couch position values need to be overridden click Override button on the bottom of the application
and then follow instructions on the screen.

16. Initiate the measurement. Then press and hold MV Ready until MV Beam On button illuminates. 9
Finally, press MV Beam On to initiate the beam.

17. Make sure that all field MU were delivered, stop the measurement and record the measured data.

18. Repeat steps F.13 - F.17 with the rest of the fields in the plan.

19. Close the plan.

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G. Gated IGRT Tests

1. Gated IGRT Tests are two DICOM plans, RP.Daily QA_Gating120MLC.dcm and RP.Daily
QA_GatingHDMLC.dcm accompanied by gating data file. RP.Daily QA_Gating120MLC.dcm is for
machines equipped with NDS120 MLC, RP.Daily QA_GatingHDMLC.dcm is for machines with
NDS120HD MLC. Both plans provide fields to test the same respiratory gating features.

2. The plans contain fields to test commonly used gating features, see Table 1:

NDS120 NDS120HD Description

Fluro 120 Fluoro HD used to test kV imaging with gating

IMRT 120 Gated IMRT HD Gated used to compare gated vs ungated delivery

MV image MV image Used to test MV imaging with gating

Table 2: Field Description

Note: The procedure demonstrates the plan as-is and is run in Treatment
mode in file mode.

3. Launch the Treatment mode at the console. Login with appropriate rights. See Figure 86.

9 9

Figure 86: Major Mode Selection → Login

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4. Select Tools → File Mode. See Figure 87.

Figure 87: Tools → File Mode

5. Click Open Plan. See Figure 88.

Figure 88: Open Plan

6. Navigate to I:\ drive and then TDS\<machineID>Input\DailyQA\Gated IGRT Tests. Then select the
plan file appropriate for machine’s mlc. Click Open to continue. See Figure 89.

Figure 89: File Selection

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7. Motion Management Devices window will pop-up. Select the gating device for the session and click
Apply. See Figure 90.

Figure 90: Motion Management Devices

8. If there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 91.

9 9

Figure 91: Machine Override

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9. Authorize the machine override (Override Machine right is required). See Figure 92.

Figure 92: Machine Override Authorization

10. Select all the fields by clicking Select All. Click Next to continue. See Figure 93.

Figure 93: Override Machine – Field Selection

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11. Click Convert to override the machine. See Figure 94.

Figure 94: Machine Override, Convert the Selected Fields

12. On the machine override summary dialog, check the status and click Done. See Figure 95.

9 9

Figure 95: Machine Override Summary

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13. Enter the treatment room and place the Varian-provided gating motion phantom with the gating
marker block on the treatment couch, where the gating camera can see it. See Figure 96. Set up a
measurement device appropriate to measure output for gated MV beam and align it to isocenter.

Figure 96: Gating Motion Phantom with Gating Marker Block on the Couch

14. Turn on the motion phantom and confirm that marker block moves primarily up and down and is not
sliding on the moving bar. Leave the treatment room open and do not close the door.

15. At the console setup the gating protocol in PVA application. Click Next when done. See Figure 97.

Figure 97: Select Gating Protocol

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16. Define the gating parameters, leave the audio couching on. Click Next when done. See Figure 98.

Figure 98: Gating Parameters

17. Record the reference breathing pattern. Click Start button. See Figure 99.

9 9

Figure 99: Record the Reference Breathing Trace

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18. When you have recorded several full cycles, click Stop. Then set the gating thresholds and finally
click OK. See Figure 100.

Amplitude thresholds can also

be set by moving the orange
and blue lines with mouse

Phase thresholds can also be set

by moving orange and blue lines
on the dial, with the mouse

Figure 100: Finalizing Gating Protocol

19. Select the first field in the plan and activate audio couching on the dashboard of the PVA application.
See Figure 101.

9

Figure 101: Activate Audio Couching (Shows Disabled Button when Audio Couching HW not Available)

20. Confirm that pressing Push to Talk button on the console mutes the audio couching, volume controls
on the couch side panels can manage the volume of the audio couching and that the audio couching
can be muted inside with the Mute button on couch side panel.

21. Return to the console and close the door to the treatment room.

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22. At the console, select the Fluoro field. Click Add and then select Add imaging, see Figure 102.

Figure 102: Add Imaging

23. Then select kV and click OK. See Figure 103.

9 9

Figure 103: Modify Imaging Dialog

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24. Repeat steps G.22,G.23 for MV image field to enable MV image acquisition with this field.

25. Select the Fluoro field. Configure PVA application for kV radiographic acquisition; set kV Acquisition
parameters and the appropriate trigger; accept settings with OK on dashboard. See Figure 104.

Figure 104: kV Acquisition Parameters, Trigger Options (right)

26. Move to plan from the console, press the Motion Selection buttons on the console illuminated in
orange. Then press Motion Enable and hold them down until all selected axes have reached their
plan positions. Then press Prepare on the console. See Figure 105.

Figure 105: Control Console

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27. When kV Beam On button illuminates, press and hold it to acquire an image. Confirm that image is
acquired within gating thresholds.

28. Configure PVA application for kV fluoro acquisition, accept setting with OK button on the dashboard,
see Figure 106.

Figure 106: Fluoro

29. Press kV Beam On and acquire a fluoroscopic image. Verify that the fields contour is blue when the
beam is gated off and yellow, when the beam is gated on.

30. Select the MV image field, move to plan from the console; press the Motion Selection buttons on
the console illuminated in orange to select the axes to be moved. Then press Motion Enable and
hold them down until all selected axes have reached their plan positions. Then press Prepare on the
9 console. See Figure 105. 9
31. Once the MV Ready button on the console has illuminated; press and hold it down until MV Beam
On button on the console illuminates. Then press MV Beam On button to initiate the MV beam.

32. Confirm that image acquisition occurs within the gating thresholds.

33. Select the IMRT Gated field and deliver it - press the Motion Selection buttons on the console
illuminated in orange to select the axes to be moved. Then press Motion Enable and hold them
down until all selected axes have reached their plan positions.

34. Then press Prepare, make the necessary overrides to allow beam.

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35. When MV Ready button on the console illuminates, start the beam output measurement. Then press
the MV Ready button and hold it until MV Beam On illuminates. Then press MV Beam On button to
start the beam delivery.

36. During the delivery confirm that the beam is delivered under respiratory gating conditions – beam is
on when breathing trace is within gating thresholds and held off when breathing trace is outside of
gating thresholds.

37. Stop the measurement when beam delivery is complete. Make sure all plan MU have been delivered
and then record the measured data.

38. Close the plan. Sign off of the partial treatment may be required, if enabled in System Administration.
Then decide whether to save the plan with updated gating parameters or not. See Figure 107.

Figure 107: Sign-off Closing the Plan, Save Plan Dialogs

39. Repeat steps G.3 to G.6 to re-open the plan again. Select None from Respiratory Gating Devices,
then click Apply. See Figure 108.

Figure 108: Motion Management Devices

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40. Confirm bypass gating (Bypass Gating right required). See Figure 109.

Figure 109: Confirm Bypass Gating

41. Then repeat steps G.8 to G.12 to perform the machine override.

42. Select the IMRT Gated field and deliver it – all axes should still be at plan positions.

43. Then press Prepare, make the necessary overrides to allow beam.

44. When MV Ready button on the console illuminates, start the beam output measurement.

45. Then press the MV Ready button and hold it until MV Beam On illuminates. Then press MV Beam
On button to start the beam delivery.

46. During the delivery confirm that the beam is delivered with no gating.

47. Stop the measurement when beam delivery is complete. Make sure all plan MU have been delivered
and then record the measured data.

48. Compare the results of gated treatment with non-gated treatment. Confirm that the compared
performance of the gated and non-gated plans meet your local standards.

49. Close the plan.

Tip: Similarly this test can also be performed in Machine QA mode. IMRT
Gated field needs to be delivered two times which can be done in Machine
QA without re-opening the plan. The Motion Management Devices dialog can
be opened from Tools menu to bypass/enable gating for the plan:

9 9

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H. PerfectPitch Tests
1. PerfectPitch Tests is a DICOM plan, RP.Daily QA_PerfectPitch.dcm accompanied by 3 reference
images (file names start with RI).

2. The plan contains following fields:

a) initial_kV_0, initial_kV_270 – two orthogonal setup fields to be paired for kV-kV acquisition and
2D-2D Match. Used to evaluate accuracy of the couch isocenter when roll / pitch are applied.
These setup fields have kV imaging procedures attached and will be paired for kV-kV acquisition
automatically when the plan is opened.

b) initial – plan treatment field. The field has ‘treatment port before’ imaging procedure attached for
MV imaging, if desired.

3. Prerequisites:

a) PerfectPitch 6DoF couch is calibrated.

b) kV imaging system is fully calibrated (including IsoCal).

c) kV-kV Image Pair Acquisition test is completed.

d) Couch shift test is completed.

Note: The procedure demonstrates the plan as-is and is run in Treatment
mode in file mode.

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4. Position the couch with 0° rotation.

5. To ensure that pitch and roll are both zero, press and hold down Motion Enable and the Pitch and

Roll Reset buttons on the couch side panel.

6. Ensure that the kV detector is able to rotate safely around the couch top (gantry rotation 0-90°).

7. Place the OBI Cube Phantom on the couch, on the anti-slip mat, toward the end of the couch, closest
to the throat of the gantry.

Tip: The phantom can be placed anywhere on the couch top. However, the
further away from the couch base, the more sensitive the check will be. The
anti-slip mat ensures that the phantom does not move during pitch and roll
motions.

8. Using in-room lasers, position the phantom in the isocenter. See Figure 110.

9 9

Figure 110: Align the OBI Cube Phantom at the Isocenter

Important Note: For the procedure, it is important to align the phantom as

accurately as visually possible.

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9. Launch the Treatment mode at the console. Login with appropriate rights. See Figure 111.

Figure 111: Major Mode Selection → Login

10. Select Tools → File Mode. See Figure 112.

Figure 112: Tools → File Mode

11. Click Open Plan. See Figure 113.

Figure 113: Open Plan

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12. Navigate to I:\ drive and then TDS\<machineID>Input\DailyQA\PerfectPitch Tests. Then select the
RP.Daily QA_PerfectPitch.dcm. Click Open to continue. See Figure 114.

Figure 114: File Selection

13. Motion Management Devices window may pop-up. Choose None and click Apply. See Figure 115.

9 9

Figure 115: Motion Management Devices

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14. When there is a mismatch between machine ID in the plan and the actual machine ID, the Machine
Override is necessary. Click Machine Override button, see Figure 116.

Figure 116: Machine Override

15. Authorize the machine override (Override Machine right is required). See Figure 117.

Figure 117: Machine Override Authorization

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16. Select all the fields by clicking Select All. Click Next to continue. See Figure 118.

Figure 118: Override Machine – Field Selection

17. Click Convert to override the machine. See Figure 119.

9 9

Figure 119: Machine Override, Convert the Selected Fields

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Machine QA Plans

18. On the machine override summary dialog, check the status and click Done. See Figure 120.

Figure 120: Machine Override Summary

19. Click the KV-KV Setup Pair to initiate kV-kV acquisition. See Figure 121.

Figure 121: Selecting KV-KV Setup Pair for Paired kV-kV Acquisition

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20. Acquire a kV-kV image pair. Press Prepare on the control console. See Figure 122.

Figure 122: Control Console, Prepare

21. In PVA, set appropriate kV imaging parameters. See Figure 123.

9 9

Figure 123: Setting Parameters for kV Imaging

22. Move to plan. On the console press the Motion Selection buttons that are highlighted in orange to
select the machine axes to move, if needed. Then press both Motion Enable buttons and hold them
down until the selected machine axes reach the plan position. See Figure 122.

23. When all machine axes have reached the imaging position, the kV Beam On button illuminates –
press kV Beam On button and hold it down until an image is acquired. See Figure 122.

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24. Once the first image has been acquired, the system may automatically select the second field of the
kV pair if PVA has been configured in System Administration to do so. If the second field is not
selected automatically LMC the space for the second image in PVA application, see Figure 124.

Second image selected

Figure 124: Selecting the second image of the kV-kV pair

25. Set the kV acquisition parameters for the second image in PVA. See Figure 124.

26. Move the machine axes to plan. Press both Motion Enable buttons on the control console and hold
them down until gantry has reached the imaging position for the second image. See Figure 125.

27. When gantry has reached the imaging position for the second image kV Beam On button illuminates.
Press and hold it down until the second image has been acquired. See Figure 125.

Figure 125: Control Console

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28. The 2D-2D match workspace may open automatically if PVA has been configured in System
Administration to do so. If the 2D-2D Match does not open automatically, select 2D-2D Match using
Match and Review Workspace selection button on the bottom of PVA application. See Figure 126.

Figure 126: Selecting 2D-2D Match Workspace

29. Within 2D-2D match workspace match the acquired images to the reference images. Make sure that
only translational values (Lng, Lat, Vrt) are used to match the images.

30. Zoom in, enable Window/Level bars and adjust the images’ Window/Level until the BB in the phantom
is clearly visible. Enable Manual Match and use the arrow keys on the keyboard to match the green
circle representing the phantom BB on the reference images to the phantom BB on the acquired
images. Apply the match using Apply button when done. See Figure 127.

Adjust W/L

9 9

Figure 127: Align the Images

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31. Press both Motion Enable buttons on the control console to move the couch to new position.

32. Having re-positioned the couch, follow steps H.20 to H.28 to re-acquire new image pair and launch
2D-2D Match workspace.

33. Check the alignment of the phantom center BB against reference images from the plan. If the
phantom ball is not exactly aligned at the isocenter apply the necessary shift again and repeat the
centering procedure until the phantom ball is exactly at the isocenter. Move to step H.34 when you
are sure that the acquired images are perfectly aligned with the reference images with no matching.

Note: The phantom ball must be exactly aligned at isocenter as the

remainder of this test depends on this positioning.

34. Select the roll and pitch combination to test, from the following table, Table 3:

Test Pitch [°] Roll [°]

Position 1 1.5 1.5

Position 2 -3.0 -3.0

Position 3 3.0 0.0

Position 4 0.0 3.0

Table 3: Proposed Pitch and Roll Test Combinations

35. Apply the selected Pitch and Roll combination to acquired images:

a) Pitch – click outside of the red dotted circle on the lateral image and drag the mouse cursor until
Pitch is close to selected Pitch value. Press CTRL key and use the left and right arrow keys on
the alphanumeric keyboard to change pitch by 0.1° steps to achieve the exact selected pitch
value.
9
b) Roll – press SHIFT key, click outside of the dotted circle on the lateral image and drag the mouse
until roll is close to selected Roll value. Press Shift + CTRL and use the left and right arrow keys
on the alphanumeric keyboard to change the roll by 0.1° steps to achieve the exact selected roll
value.

Important Note: When changing roll and pitch, make sure that no other
couch shifts (Vrt, Lng, Lat, Rtn) are introduced.

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36. Click Apply button once the selected pitch / roll combination has been introduced. See Figure 128.

Figure 128: Selected Roll/Pitch Combination Applied

37. Press and hold both Motion Enable buttons on the control console to move the couch to new
position with selected Roll/Pitch combination (Couch Linear button in Motion Selection section will
be orange and selected). See Figure 129.

9 9

Figure 129: Repositioning the Couch to Applied Roll/Pitch Combination

38. Having re-positioned the couch, follow steps H.20 to H.28 to re-acquire another image pair and
launch 2D-2D Match workspace.

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39. Zoom in, adjust Window/Level and check the position of phantom ball against reference images. The
phantom ball should not have moved (is allowed to move only slightly). Match the acquired images to
reference images using translational couch motions (Lng, Lat, Vrt). See Figure 130.

BB shift for the

applied Roll/Pitch

Figure 130: Matching Images After the Couch Has Been Moved to Selected Roll/Pitch Combination

40. The following Table 4 shows the maximum allowable offset of the ball after applying selected pitch
and roll. Evaluate your test against values in the table.

Direction Pitch and Roll from 0 to 1.5 degrees Pitch and Roll from 1.5 to 3.0 degrees

Longitudinal ≤ 0.5 mm ≤ 1 mm
9
Lateral ≤ 0.5 mm ≤ 1 mm

Vertical ≤ 0.5 mm ≤ 1 mm
Table 4: Maximum Allowed Translation After Pitch and Roll

41. Click Cancel (see Figure 130) to close the 2D-2D Match workspace; then click Close Plan to close
the plan when done. See Figure 131.

Figure 131: Close Plan

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Tip: Alternatively, the test can be carried out by acquiring MV-kV imaging
pair. Use 2.5MV energy to get good resolution of the very small steel ball
inside the phantom. As the gantry does not move during MV-kV acquisition,
this excludes any effects of residual imager arm motion that might result from
gantry movement.

Note: Some sites may wish to place weights on the couch top to imitate
patient weight. Evaluating test results should take into consideration the
following:
Case1: weight up to 135kg – tolerances as when roll and pitch motions are
between 0 to 1.5° are valid.
Case2: weight of more than 135kg – tolerances as when roll and pitch are
between 1.5° to 3.0° are valid.

9 9

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Appendix TAB 10

High-Intensity Beams Overview

Imaging Application Overview

Service Console Rights

Optimizing Image Quality

© Varian©Medical
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High-Intensity Modes Overview

 More information on collection inefficiency of different chambers can be found in: “Ion-
recombination correction for different ionization chambers in high dose rate flattening-filter-free
photon beams”, Stephanie Lang et al, Phys. Med. Biol. 57 (2012) 2819–2827
 For more information on Eclipse beam data requirements please refer to current Eclipse
Algorithm reference guide.

10 10

© Varian©Medical
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High-Intensity Modes Overview

 Figures from: Kry et al, Out-of-field photon dose following removal of the flattening filter from a
medical accelerator; Phys. Med. Biol. 55, 2155-2166
 Figure on the left shows the ratio of FFF/FF dose as a function of distance from the edge of a
4x4cm2 open field at 6MV. The ratio is shown at both 5 cm depth and 15 cm depth.
 Comparison of a 10x10cm2 field at 6MV with the flattening filter (FF; solid line) and without it
(FFF; dashed line). Total out of field dose (T) is divided into patient scatter (P), collimator
scatter (C) and head leakage (L) components

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High-Intensity Modes Overview

 Figure above describes: Out of field dose from a complete course of IMRT to prostate using
6MV beams with flattening filter (FF) and without the flattening filter
 Figure from: Kry et al, Out-of-field photon dose following removal of the flattening filter from a
medical accelerator; Phys. Med. Biol. 55, 2155-2166

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© Varian©Medical
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For training purposes only! pg 886 DCID: TB2.5-CEM-02-B
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High-Intensity Modes Overview

 In this study 18MV energy was used

 Figure description: Neutron fluence for accelerator operated in flattening filter (FF) and
flattening filter free (FFF) modes with closed field. Measurements made in patient plane (100cm
from X-ray target)
- on central axis (CAX)
- 30cm toward gantry (30 G)
- 60cm toward gantry (60 G)
- 30cm away from gantry (-30 G)
- 100cm to the patient left of central axis (100 Lf)
 Figure and table from: Kry et al, Reduced neutron production through use of a flattening-filter-
fee accelerator; Int. J. Radiation Oncology Biol. Phys. Vol. 68, No. 4., 1260-1264 10

© Varian©Medical
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High-Intensity Modes Overview

 Typical DVH for 6-MV treatment plans with a flattening filter (solid lines, closed symbols) and
without one (dashed lines, open symbols).
 Figure taken from : O. Vassiliev et al, Treatment-Planning study of prostate cancer intensity-
modulated radiotherapy with a Varian clinac operated without flattening filter; Int. J. Radiation
Oncology Biol. Phys. Vol. 68, No. 5., 1567-1571

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High-Intensity Modes Overview

 Figure: S. Stathakis et al, Treatment planning and delivery of IMRT using 6 and 18 MV photon
beams without flattening filter; Applied Radiation and Isotopes, 67, 1629-1637

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High-Intensity Modes Overview

 Figure: S. Stathakis et al, Treatment planning and delivery of IMRT using 6 and 18 MV photon
beams without flattening filter; Applied Radiation and Isotopes, 67, 1629-1637

10 10

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High-Intensity Modes Overview

 Figure 13: S. Stathakis et al, Treatment planning and delivery of IMRT using 6 and 18 MV
photon beams without flattening filter; Applied Radiation and Isotopes, 67, 1629-1637

© Varian©Medical
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High-Intensity Modes Overview

 Table 3: W. Fu et al, Delivery time comparison for intensity-modulated radiation therapy

with/without flattening filter: a planning study; Phys. Med. Biol. 49, 1535-1547
 (1) O. Vassiliev et al, Stereotactic radiotherapy for lung cancer using flattening filter free clinac;
Journal of Applied Clinical Medical Physics, Vol. 10, No. 1., 14-21
 (2) P.F. O’Brien et al, Radiosurgery with unflattened 6-MV photon beams; Med. Phys. 18, 519-
521
 (3) J. E. Bayouth et al, Image Guided Stereotactic Radiosurgery using a specially designed high
dose rate linac; Medical Dosimetry, Vol. 32, No. 2, 134-141

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High-Intensity Modes Overview

 Comparison of measured and Calculated depth dose curves and profiles at 5cm depth
 Figure 2: L. Tillikainen, Multi-source modeling of flattening filter free photon beams;
Proceedings of the XVth International Conference on the Use of Computers in Radiation
Therapy (ICCR 2007). Toronto, Canada 4-7 June 2007, volume II, pages 408-412

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High-Intensity Modes Overview

 Source:
 COMMISSIONING OF PHOTON BEAMS OF A FLATTENING FILTER-FREE LINEAR
ACCELERATOR AND THE ACCURACY OF BEAM MODELING USING AN ANISOTROPIC
ANALYTICAL ALGORITHM
JAN HRBACEK, M.SC., STEPHANIE LANG, M.SC., AND STEPHAN KLÖCK, DR
Int. J. Radiation Oncology Biol. Phys., Vol. 80, No. 4, pp. 1228–1237, 2011

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© Varian©Medical
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Medical Systems TrueBeam 2.5 Administration and Physics
For training purposes only! pg 894 DCID: TB2.5-CEM-02-B
For education purposes only
High-Intensity Modes Overview

© Varian©Medical
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High-Intensity Modes Overview

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High-Intensity Modes Overview

 References
 100053355-01 – TrueBeam High-Intensity Energy Configurations, Performance and
Operational Characteristics; chapters 3, 4, 8
 RAD 10093H - TrueBeam™ STx System Specifications
 Other referenced publications are in the notes to the corresponding referencing slide

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Imaging Application Overview

Imaging Application Overview

Procedure

Objectives
After completing this procedure the student will have reviewed the Imaging Application GUI and its
workspaces.

Abbreviations
Right mouse click denoted as RMC.

Left mouse click denoted as LMC.

References:
P1005922-001-A – TrueBeam Instructions for Use, chapter 7.

P1005924-001-A – TrueBeam Technical Reference Guide – Volume 2: Imaging, chapter 7.

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Imaging Application Overview

A. Imaging Application
1. Imaging application, also known as PVA (Patient Verification Application), performs two main
functions in its corresponding workspaces:

a) Image acquisition,

b) Image review and matching.

2. Appropriate Imaging workspace is automatically selected based on Imaging Procedure attached to

field being imaged. If Automatic workflow is enabled in System Administration, appropriate Matching
workspace will also be opened automatically once the image(s) have been acquired.

3. The appearance of the PVA depends upon the workspace selected, the specific task being performed
(such as 2D-2D match, 3D-3D match etc.) and the specific layout selected by user.

4. The screen is divided into 4 logical sections – Dashboard, Taskbar, Toolbar and Image View.
Figure 1 shows an example of typical acquisition workspace.

Toolbar

Source direction &

modality indicator
(red = kV)
Dashboard

Image View

Source direction &

modality indicator
(yellow = MV)

kV Status bar
Taskbar

Figure 1: Acquisition Workspace Layout – MV-kV (2D-2D) Acquisition Example 10

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5. Taskbar – includes Acquisition and Match and Review selection buttons, see Figure 2. The other
content of the Taskbar depends on the active workspace.

a) The PVA provides 4 Acquisition workspaces and 9 Matching and Review workspaces.
Workspace availability depends on the field selected ( or Imaging Procedure selected) and the
plan data available. See example on Figure 2.

Figure 2: Acquisition (left) and Match and Review (right) Workspaces

b) Optimize, OK and Cancel buttons may be present on the Taskbar, if an Acquisition workspace is
active and a change to acquisition parameters has been made. OK, Cancel are used to confirm
or cancel the changes, Optimize button can be used to optimize the position of the imaging panel
or jaws / blades when changes have been made to field size using the Collimator Tool.
See Figure 3.

Figure 3: Taskbar in Acquisition Workspace

Note: When in acquisition mode, the Taskbar also includes kV Status bar
that provides information about kV Dose, Fluoro Timer, kV tube anode and
housing heat units (in % as a fraction of maximum heat units).

c) When a Matching workspace is active, the Taskbar includes Reset, Cancel and Apply buttons.
See Figure 4.
10 Reset button reverts all the matching back to zero shifts; Cancel button closes the matching 10
workspace and allows the setup images to be re-acquired or other matching workspace to be
selected and Apply button transfers the calculated shift back to treatment application that
calculates new position for the couch. Couch is then typically moved from the control console.

Figure 4: Taskbar in Matching Workspace.

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Imaging Application Overview

d) Acquisition workspaces include:

MV Imaging – used to acquire an MV image. Dashboard displays and allows setting parameters
relevant to MV imaging.

kV Imaging – used to acquire a kV image, triggered kV image set or kV fluoro. Dashboard

displays and allows setting parameters relevant to kV imaging.

kV CBCT – used to acquire a CBCT. Dashboard displays and allows setting parameters relevant
to CBCT acquisition such as CBCT mode, reconstruction parameters and others.

kV Topogram – used to acquire a topogram before CBCT. This allows the operator to set length
and width for the following CBCT scan as well as move the couch in case when topogram reveals
that the area / volume of interest would not be included in the CBCT scan with couch at actual
position.

e) Match and Review workspaces include:

2D or 2D-2D: used to match the acquired image (kV or MV) or an image pair (kV-kV or MV-kV or
MV-MV) with the reference image or reference image pair.

2D-3D: used to match the acquired image pair (kV-kV or MV-kV or MV-MV) or single image (kV,
MV) with dynamically created projections (DRRs) from the volume image (planning CT).

Marker Detection: allows detecting markers on the volume image (planning CT) for the Marker
Match on-the-fly. It is useful in case that the patient markers have not been detected on TPS or
Record & Verify system does not support storing and transferring marker objects.

Marker Match: used to match the markers projected from the volume image (planning CT) to the
actual markers visible on the acquired image pair (kV-kV or MV-kV or MV-MV).

3D-3D: used to match the CBCT to the reference volume image (planning CT) when a CBCT has
been acquired.

Review CBCT: can be used to re-reconstruct the CBCT taken during the actual treatment
session (only, no access to historical data). The new CBCT can then be used for 3D-3D match.

Image Playback: allows review of cine, fluoro or kV triggered images.

Gating Review: allows review of images acquired for Gated plans, displays patient breathing
trace as well.
10
Tip: A particular workspace is only available when all data required for the
workspace use is available. For instance MV and kV acquisition workspaces
are available when MV-kV setup pair is active, kV Topogram and kV CBCT
workspaces are available for CBCT Imaging Procedures. Similarly, Marker
Match is only available if planning CT has markers identified and an
orthogonal image pair has been acquired; 3D-3D Match is only available if
planning CT with structure set and isocenter information and CBCT are
available, etc.

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Imaging Application Overview

6. Dashboard – provides access to data and parameters relevant to opened workspace.

Dashboard for the Acquisition workspaces includes positions or the imaging arms and provides
access to acquisition parameters. See examples on Figure 5 and Figure 6.

Dynamic Tabs

Imaging panels, at
Imaging panels, not plan position already
at plan position yet

kV Exposure
settings
MV energy and
imaging mode
Single image
or fluoro

Figure 5: Dashboard for kV Imaging (left) and MV Imaging (right) Workspaces

CBCT scanning
mode selection

Selecting Anatomy
10 and Size populates
kV and mAs
10

projection direction

Figure 6: Dashboard for kV Topogram (left) and kV CBCT (right) Acquisitions

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Imaging Application Overview

a) Positions of the imaging panels can be set on the Dashboard or the Collimator Tool can be
used to set ( Lat., Long. ) position of the panel for imaging, if necessary.

Tip: Anatomy and Size dropdowns can be used to select pre-defined

anatomy template and size to populate kV exposure settings (kV, mAs).
Anatomy templates can be configured in PVA Calibration Administration.

Tip: When a topogram is acquired before CBCT, it allows the operator to

visually set the width, length and center of the CBCT scan. If the area of
interest is not in the scanning volume the operator can choose to move the
center of the scan graphically which will result in couch longitudinal motion.

b) The Dynamic Tabs on the Dashboard provide additional acquisition options, see Figure 7.

Advanced acquisition and

reconstruction parameters

Advanced couch options

Bowtie filters and/or titanium
hardening filter can be
selected as desired 10
Figure 7: Dynamic Tabs Examples

Tip: There may be more dynamic tabs available for ‘special’ imaging and
treatment cases, such as IMR, Gating, etc. They provide access to settings
specific to those individual techniques.

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Imaging Application Overview

Note: Images Tab can be used to save, delete or set the active image (if
more images available) for the field. CBCT images or projections are not
available through Images tab.

c) The buttons can be clicked to see details about imaging panels and or blades / kV filters. This
information is read-only. See Figure 8.

Figure 8: Imaging Arms (left) and kV Filter / Blades (right) Details

Dashboard for the Matching workspaces shows the actual shifts. The checkboxes next to individual
shifts axes can be used to choose, whether that individual shift is to be applied to couch or not.

a) If the match calls for a shift that exceeds the physical limits of the couch, the Limit Shift button
can be used to truncate the match results to values applicable to couch; sign-off may be required,
if requested in System Administration, to apply truncated or excluded shifts. See Figure 9.

Truncate the shift to

couch mechanical limits

Included in the shift ?

Shift exceeds couch

10 mechanical limits 10

Apply permanently or just

for the actual session ?

Figure 9: Dashboard in Matching Workspace

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Imaging Application Overview

7. Image View – used to display the reference and the acquired images. The actual layout also
depends on the active workspace. See Figure 10.

Image ID, creation date and time, source angle green outline indicates
the active image

Lateral reference image (DRR) Lateral acquired image

AP reference image (DRR) AP acquired image

Figure 10: Paired Image Acquisition Workspace Example

Note: Reference image volume (planning CT) is not displayed in kV CBCT

acquisition workspace.

a) Each view includes patient orientation icon in lower left corner as well as letters (H =
head, F = feet, R = right, L = left, A = anterior, P = posterior) indicating patient orientation.

b) When the reference image has been calculated on-the-fly from the reference volume image, its
appearance can be changed from RMC context menu. See Figure 11.
10

Figure 11: RMC on DRR Calculated on TrueBeam

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Imaging Application Overview

Note: The DRR appearance options are the same as default DRR templates
in Eclipse. The DRR appearance options available on TrueBeam are not
configurable.

Note: Structures from the planning CT will be automatically projected onto

the on-the-fly calculated DRRs. They will have same colors as in TPS. If
there too many, the individual structures can be hidden using tool.

c) In 2D-2D (or 2D-3D) Matching workspace, individual images are displayed on the bottom and
overlaid views (reference and acquired superimposed) are on the top. See Figure 12.

Image IDs, date, time source angle

‘Pitch’ circle

RMC Window / Level

‘Rotation’ circle

Blending level; 0% = DRR

only, 100% = Acquired only

Figure 12: Matching Workspace Image Layout, 2D-2D Match

d) icons in upper right corner can be used to hide the individual images in lower part of the
10 10
window and then show them again. They are equivalent to tool.

e) icon in each view can be used to maximize the view and then restore it back.

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f) In 3D-3D Matching workspace, there are three orthogonal view (transversal, frontal and sagittal)
that show the planning reference CT and the acquired CBCT overlaid. See Figure 13.

g) button in the toolbar can be used to switch to 4 views mode that shows one more image
view with the planning CT only.

View legend Cycle through views

Laser Isocenter

View defining sliders

Match Isocenter

Main View

Figure 13: 3D-3D Match Workspace Example

h) button in the corner of the main view can be used to cycle through the available views
(Transversal, Sagittal, Frontal) and have any of them displayed in the main view. Keyboard
shortcut – CTRL + R.

i) Window / Level bars can be enabled using tool to improve image brightness and contrast.
RMC between the slides allows the operator to expand or shrink the range between the sliders. In
3D-3D match workspace the W/L context menu also includes pre-defined W/L presets for several 10
different anatomies. See Figure 13.

j) View defining sliders can be used to set the CT planes displayed in individual views – blue
defines transversal plane, red defines sagittal plane and green sets the frontal plane. Color of the
slider corresponds to the color of rectangle around the view that the slider defines the contents of.

k) There are 4 different isocenters displayed, see Figure 13: P-planning isocenter, M – init match
isocenter ( isocenter location when matching started ), A – acquisition isocenter ( isocenter
location where the CBCT acquisition occurred ) and L – initial laser isocenter ( isocenter location

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Imaging Application Overview

when CBCT acquisition process was initiated ). Some of these isocenters may be the same,
however because couch can move during the process they may as well be different.

l) The views with the superimposed images include Blend Image slider on the bottom. It provides
the operator with the option to adjust the relative weights of the overlaid images for optimal
viewing. RMC the slider allows the operator to enable flickering and set the rate. See Figure 14.

m) Blend Image slider position is automatically same for all views – adjusting one slider changes the
second slider automatically.

Figure 14: Flicker

Note: Blend Image slider is connected to Window / Level tool – when

adjusting window and / or level for the image the blend slider will
automatically change to show only that image. When the window / level tool
is deselected the blend settings will return to original state.
W/L bar for reference images is always located on the left hand side, and for
acquired setup images on the right hand side. It corresponds with Blend
Image slider sides. When slider is being moved it shows a tooltip:

Tip: CTRL+A keyboard keys can be used to flip the blend slider around 50%
manually.

10 10
Important Note: In 2D-2D and 2D-3D workspaces the Blend Image slider
defaults to 100% acquired image. Manual Match is also enabled by default.
As the reference image is the one that can be moved by the operator,
adjusting the image blending needs to be done always prior to matching.

n) Blend Image slider can be displayed or hidden as needed with the tool in the toolbar.

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8. Toolbar – contains tools that can be used to manipulate the images, evaluate and analyze the
images and the match. Available tools depend on the active workspace.

Icon Description

Save image(s) and match

Manual Window / Level and Automatic W/L

Image filter selection

Zoom In, Zoom Out, Pan and Reset View. Zoom In/Out
, , , can also be done with CTRL key and mouse wheel

Measure Distance, Measure Angle

Show / Hide Digital Graticule, Show / Hide Grid

Show / Hide Structures

Image Analysis tools - Pixel Info, Line Profile, Area Profile,

Area Histogram

Show Image Properties

Show / Hide Reference Images

3 or 4 view display. In 3D-3D match workspace only.

Show / Hide Dashboard

Collimator Grid Tool, Collimator Tool

10
Drawing and annotation tools (for acquired image only) –
Select / Modify, Free hand, Point, Image Annotation,
Rectangle, Ellipse, Correction, Modify points

Gating audio couching ON/ OFF. Click the tool to set the
, volume for audio couching
Table 1: Toolbar Tools in Acquisition Workspace

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a) Image Analysis tools can be used to quantitatively evaluate the images. The tools can also be
applied to the Dosimetry images and the statistics will be in Calibrated Units.

Pixel Info – allows the user to measure pixel value. RMC the blue flag with the reading
provides additional options. See Figure 15.

Figure 15: Pixel Info Tool

Line Profile – allows the user to measure pixel values along arbitrary line – select the tool,
click the image and drag the mouse with LMB pressed to draw a line in a direction in interest.
Results are displayed in a separate window. RMC the chart provides additional options.
See Figure 16.

10 Line of interest 10

Figure 16: Line Profile Tool

Tip: Profile and Histogram tools provide the option to save image or export
chart data on the disk. Upon selecting the corresponding menu, the operator
is prompted to enter filename, the file will be saved in
\\<myserver>\va_transfer\TDS\<machineID>\Imaging\Charts.

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Area Profile – allows the user to measure and evaluate image values in a selected area of
interest. Select the tool and draw a region on the interest. Results are displayed in a new window.
RMC the displayed chart provides additional options. See Figure 17.

ROI

Figure 17: Area Profile Tool

Area Histogram – allows the user to obtain a pixel value histogram for pixels included in
defined area of interest. Select the tool and draw a region on the interest. Results are displayed in
a new window. RMC the displayed chart provides additional options. See Figure 18.

ROI

Figure 18: Area Histogram Tool

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b) Collimator Tool - provides the option to customize positions of the blades / jaws and or
position of the imaging panel. System has to be in Preview state to allow changes to be made to
blades / jaw / panel positions. Blade Tracking has to be deselected in order to make changes to
blades positions. See Figure 19.

Blades – purple lines

Click & drag to move

the imager

Figure 19: Collimator Tool

Optimize button is active when blades / jaws are beyond the imaging panel; when pressed the
field will be centered within the panel, jaws / blades would be truncated, aligned with panel edges,
if necessary, to make sure that the field is not larger than the active area of panel.

Collimator Grid Tool can be used for the same purpose as Collimator Tool, when moving
blades, jaws or panel they would move by 5mm steps, independently of image magnification.

10 10
Note: If field size and / or panel position is to be adjusted before the image is
acquired, a view with the reference image has to be selected in order for this
tool to be available on the toolbar.

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c) There are additional tools available in Marker Detection and Marker Match workspaces,
see Table 2

Icon Description

Open a dialog box that allows automatic marker detection

Manually Add (Shift key), Delete (Del key) or Move markers during marker detection

Remove all markers

Set ROI / VOI for marker detection

Re-project markers – resets the marker match by re-projecting markers from the 3D
reference volume onto the acquired image pair

Allows moving the markers manually, selected by default when Marker Match workspace is
opened
Table 2: Marker Tools

d) There are additional tools available in all Matching workspaces, see Table 3.

Icon Description

Manual Matching – allows manual alignment of the images with mouse or arrow keys

Automatic Matching – opens a dialog box that allows auto match

Blend Images – enables blending slider at the bottom of the overlaid view which controls the
blend ratio of the reference and acquired image.

Split Window – divides the overlaid views into 4 quadrants: upper left and lower right
showing the reference and the upper right and lower left showing the acquired image. The
split window can be moved by dragging the origin or one of the axes with the mouse.

Moving Window – shows the reference image through rectangular window. Windows can be
moved with the mouse, size can be adjusted by dragging the corners with the mouse. Used 10
to assess quality of the match

Color Blending – reference and acquired images are displayed using complimentary colors,
bony anatomy will appear white when matched properly

Match Approval – Approves the images used for match, applies the shift. Images will be
saved back to Record & Verify system with approval status ‘Approved’. The approval status
of the match, spatial registration object, will be Unapproved. Requires an optional license.
Table 3: Matching Tools

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e) All matching workspaces provide Manual and Automatic Match tools:

f) Manual Match – if enabled, the operator can align the images using the mouse or
alternatively with the keyboard.

When Manual Match is enabled, the mouse cursor is red when the image can be moved and the
cursor icon indicates what operation would be performed on the images when mouse button is
clicked and mouse is moved: Inside of the dotted red circle, the mouse allows image translations;
outside of the dotted red circle, the mouse allows image rotation. See Figure 20.

Image rotation cursor

Red dotted image rotation

circle

Image translation cursor

Figure 20: Mouse Cursor Indicating Manual Match, Translations (left), Rotations (right)

In 2D-2D and 2D-3D matching workspaces the reference image is the one that can be moved by
operator. In 3D-3D workspace, the acquired CBCT is the volume image that can be moved by the
operator.

The following keyboard shortcuts can be used while matching images:

10 10
 Arrow keys ( →←↑↓ ) can be used to apply small image translations, or large translations if
ALT key is held down.

 CTRL + arrow left and right ( ←→ ) can be used to apply small image rotations.

 SHIFT + image rotations with mouse - applies Roll in 2D-2D (3D) matching workspaces. In
3D-3D match the roll can be applied ‘natively’ by rotating transversal image.

 CTRL + Z or Y can be used as UNDO or REDO.

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g) Automatic Match – is treated as an iterative optimization problem with the goal of finding
the geometric transformation such that the ‘differences’ (defined by similarity measure function)
between the moving image and fixed are minimized.

Auto match parameters are organized into Parameter Set, each of which consists of selection of
optimizer, similarity measure, preprocessors, interpolators, search range, tolerance values and
others. Different workspaces may have different Parameter Sets. See Figure 21.

Figure 21: Auto Matching, 2D-2D Matching Workspace

Auto matching starts immediately after pressing the Auto Match button in the toolbar. Hold down
the CTRL key and click the Auto Match button if it is desired to open the Auto Matching dialog
and choose parameter set for matching. The Auto Matching window is a modeless window and
allows setting the ROI or otherwise interacting with other visible controls while it is open.

Click the arrow down button next to Auto Match button in the toolbar and then choose Change
Settings to customize the Parameter Sets. Login with Administer System right when prompted
and then the Auto Match Detailed Settings dialog is opened, see Figure 22.

Figure 22: Parameter Set Configuration

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h) All matching workspaces also provide same match assistant tools – Moving Window, Split
Window and Color Blending.

i) Moving Window - the reference image is displayed through a window. Size of the window
can be adjusted by dragging its corners, position can be adjusted by clicking inside of the window
and then moving the mouse with LMB pressed down. If Manual Match tool is enabled, clicking
outside of the window and moving the mouse with LMB pressed results in image translations or
rotations if outside of red dotted circle. Blending defaults to 0%. See example on Figure 23.

Adjusts the size

Figure 23: Moving Window

j) Split Window - the tool divides the view into 4 quadrants. The reference image is displayed
in upper left and lower right quadrant, the acquired setup image is displayed in upper right and
lower left quadrant. One can click and drag the + in the origin to adjust the quadrants, or the
quadrants can be adjusted by dragging the interface lines between them. If Manual Match tool is
enabled, the reference image can be moved or rotated by clicking and dragging inside of any of
the quadrants. Blending defaults to 0% when the tool is selected. See example on Figure 24.

Adjusts the origin Drag the interface line to

adjust the quadrants
10 10

Figure 24: Split Window

Note: In 3D-3D matching workspace the images are reverted for Moving and
Split Window tools – the acquired CBCT is displayed through the ‘moving
window’ and in upper left and lower right corner of split window. Blending
defaults to 100%.

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k) Color Blending - reference and acquired images are displayed using complimentary
colors, bony anatomy will appear white when matched properly. The colors for color blending can
be customized in System Administration → PVA → Analysis. Blending defaults to 50% for the
tool. The Color Blending is best to be used without the Moving Window or Split Window. See
Color Blending example on Figure 25.

Well matched bones

Figure 25: Color Blending

9. PVA also supports gating applications. For gating enabled plans the patient breathing trace is
displayed in lower half of the screen. See Figure 26.

Figure 26: Patient Breathing Trace

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Service Console Rights

Service Console Rights

Parameter/ Control/ Service Service Service Service

Operation External Beam External Beam External Beam External Beam
Remote Basic Intermediate Advanced

Faults and Interlocks

Acknowledge Faults

Override Faults N.A.

Override Interlocks N.A.

Node/Sub Node Reboot

SPV Reboot

STN Reboot

XI Reboot

EGN Reboot

PWM Reboot

RFSPS Reboot

MOD Reboot

SPV Hard Reboot (Power N.A. N.A.

cycle)

CCHU Hard Reboot (Power N.A. N.A.

10 cycle) 10
CCHL Hard Reboot (Power N.A. N.A.
cycle)

COLL Hard Reboot (Power N.A. N.A.

cycle)

KVS Hard Reboot (Power N.A. N.A.

cycle)

cycle)

PRS Reboot

EXIO Reboot

Node Simulation

BGM Simulation N.A. N.A.

COLL Simulation N.A. N.A.

CCHU Simulation N.A. N.A.

CCHL Simulation N.A. N.A.

XI Simulation N.A. N.A.

KVS Simulation N.A. N.A.

KVD Simulation N.A. N.A. 10

MVD Simulation N.A. N.A.

Limp Along Mode N.A. N.A.

(Deactivation)

Component Simulation N.A.

Configuration Sync

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Configuration Synchronization N.A.

Records

Node Records Fetch

# Entries Records

Retrieve Records

Export Records

Beam Delivery

Power Button

Default Plan Button

Meter Readouts / Axis

Positions

GoTo

Cancel Button

Motion Axis Slider Control N.A. N.A.

(Manual Motion Control)

Alerts Button

Event log Button N.A. N.A.

Direct Axes Move (under Goto N.A. N.A. N.A. N.A.

button)

Auto Cycle MLC Axis N.A. N.A.

New (In MLC Axis AutoCycle N.A. N.A.

screen)

Add Plan Files (In MLC Axis N.A. N.A.

AutoCycle screen)
10 10
Save (In MLC Axis AutoCycle N.A. N.A.
screen)

Delete (In MLC Axis N.A. N.A.

AutoCycle screen)

Auto Cycle Axes N.A. N.A.

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Include charting (In Axes N.A. N.A. N.A. N.A.

AutoCycle screen)

Radiation Safe Mode N.A. N.A.

Enable Motion Axes N.A.

Dry Run N.A. N.A.

Encoder Display

MLC

MLC Goto Plan (button)

MLC Current (button)

MLC PRO/SPRO (button)

MLC PRO/SPRO (menu item

under the button)

MLC LED Calibration N.A. N.A.

Show MLC LED Receiver ADC

Value

MLC Plan Play (in Positions

View)

Show Plan Positions (check

button in Plan Actual Positions
View)

Show Hw PROs (check button

in PRO, SPRO, Hw Positions
View)

Leaf Values As Offset (check

button in PRO, SPRO, Hw
Positions View)

Show Values At Leaf Plane 10

(check button in PRO, SPRO,
Hw Positions View)

Detach MLC Display (check

button in Plan Actual Positions
View)

MLC Pattern Test N.A.

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Retract MLC

Retract Carriages to Limit

Switch

Retract MLC Leaves

Extend MLC Leaves

MLC Close

MLC Tests N.A.

MLC Tests (Charting Access N.A. N.A. N.A. N.A.

and charting capabilities)

One Click MLC Motion

Records

MLC Auto Initialization

MLC Calibrate/ Retrieve/Save N.A.

Edit MLC Diagnostics Test N.A. N.A. N.A. N.A.

Parameters

MLC Direct move N.A.

Edit MLC Centerline Offset N.A.

Edit MLC Gap N.A N.A.

MLC Verification

Carousel

Change Assigned Energy N.A. N.A. N.A.

Save Assigned Energy N.A. N.A. N.A. N.A.

Changes

Calibrate Beam Axes N.A. N.A. N.A.

10 10
Acquire Calibration Data N.A. N.A. N.A.

Initialize Beam Axes

Manual Mode N.A. N.A. N.A.

Mimic Clinical Behavior N.A.

Field Light Switching N.A. N.A.

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Change Beam Rotation Axis N.A. N.A. N.A. N.A.

Belt type

Axes

Initialize Geometric Axes

Calibrate/Acquire Geometric N.A. N.A. N.A.

Axes

Recycle the power to CCHU N.A. N.A. N.A.

and CCHL sensors.

Select/Unselect Calibration of N.A. N.A. N.A. N.A.

COL X1, X2, Y1, Y2 and
ColRtn; BGM carrousel Linear,
carrousel Rotational, Energy
switch, Ion chamber, and
Target axes Resolver Offset

Select/Unselect Calibration of N.A. N.A. N.A. N.A.

Couch Lat, Lng, and Rtn, Pit
and Roll axes Resolver Offset

Beam Tuning

AFC Sweep N.A. N.A.

Dosimetry Calibration N.A. N.A. N.A.

Saturate Bend Magnet N.A. N.A.

Retrieve Ion Charge Capacity N.A.

Calculate Ion Charge Offset N.A.

Calculate Nominal Beam Data N.A. N.A.

Flatness Calibration N.A. N.A. N.A.

Calculate AR Sensitivity N.A. N.A. N.A. N.A.

Calculate AT Sensitivity N.A. N.A. N.A. N.A. 10

Calculate PR Sensitivity N.A. N.A. N.A. N.A.

Calculate PT Sensitivity N.A. N.A. N.A. N.A.

Calibrate AR Balance Gain N.A. N.A.

Calibrate AT Balance Gain N.A. N.A.

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Service Console Rights

Calibrate PR Balance Gain N.A. N.A. N.A.

Calibrate PT Balance Gain N.A. N.A. N.A.

Generate Local MOD Trigger N.A. N.A.

Generate Local RF Trigger N.A. N.A.

Generate Local Gun Trigger N.A. N.A.

Peak RF N.A.

Generate AFC Triangular N.A. N.A.

Wave

Calibrate AR Symmetry N.A. N.A. N.A.

Calibrate AT Symmetry N.A. N.A. N.A.

Calibrate PR Symmetry N.A. N.A. N.A.

Calibrate PT Symmetry N.A. N.A. N.A.

Select All Servo Settings N.A. N.A.

Calcheck Normal Test Capture N.A. N.A.

AFC Coefficient Tuning N.A. N.A. N.A.

BGM Diagnostics

Dose rate output vs. gantry N.A. N.A. N.A. N.A.

rotation

BGM record parameter N.A. N.A. N.A. N.A.

Enable/Disable

BGM POS Diagnostics: N.A. N.A. N.A.

Calibration Repeatability Test

BGM POS Diagnostics: N.A. N.A. N.A.

Energy Position Repeatability
10 Test 10
BGM POS Diagnostics: N.A. N.A. N.A.
BacklashTest

Diagnostics

Execute Node Diagnostic N.A. N.A. N.A. N.A.

Commands

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Service Console Rights

On Demand Diagnostic Log

Cooling

Gas Valve Manual Control N.A. N.A. N.A. N.A.

Water Valve Manual Control N.A. N.A. N.A. N.A.

Calibrate Flow Sensors N.A. N.A.

Cooling Servo Configuration N.A. N.A. N.A. N.A.

setting

Input Devices

Put device into ByPass mode

and back to Run mode

Enable / Disable Left pendant N.A.

Enable / Disable Right N.A.

pendant

Configuration

Edit Configuration N.A. N.A. N.A. N.A.

Edit Defaults N.A. N.A. N.A. N.A.

View Configuration

View Defaults

Modified Configuration Parameter Display

Select/Unselect modified N.A. N.A. N.A. N.A.

parameters to Save

Select/Unselect modified N.A. N.A.

parameters Group/Node to
save

Fault Eventlog Configuration 10

Edit Fault Eventlog N.A. N.A. N.A. N.A.
configuration

Add default event log fault into N.A. N.A. N.A. N.A.
configuration

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Service Console Rights

Remove default fault from N.A. N.A. N.A. N.A.

configured event log/windview
log id list

Reset node fault configuration N.A. N.A. N.A. N.A.

to default settings

View Fault Configuration

Customer Input Device Settings – including Neutron Door

Edit/Save Customer Input N.A. N.A. N.A.

Devices settings

EXGI Device Settings

Loopback diagnostics N.A. N.A.

Select device for Beam

EXGI Simulator N.A. N.A. N.A. N.A.

Settings

Zone Rules N.A. N.A.

Sticky Collision Override N.A. N.A. N.A. N.A.

LaserGuard Mimic Clinical

Behavior

LaserGuard
Activate/Deactivate

Start Stop Axeda service

Configure DKB Clearance

Override button

Enable/Disable Collision N.A. N.A. N.A.

Model

10 Enable/Disable Couch N.A. N.A. N.A. N.A. 10

Compensation

Enable DKB motion when door N.A. N.A. N.A. N.A.

open

Versions

Hardware Information N.A. N.A. N.A. N.A.

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Service Console Rights

Network

Communication Statistics N.A.

Sound Management

Change and save the audio N.A. N.A. N.A.

volume level setting

Reset N.A. N.A. N.A.

Mute Treatment Room volume N.A.

Configuring min/max audio N.A. N.A. N.A. N.A.

level values for the Console
Speaker

Configuring min/max audio N.A. N.A. N.A. N.A.

level values for the Treatment
Room Speaker

Plan Snapin

Open Custom Beam N.A. N.A. N.A. N.A.

Open Standard Template

Rev H Plan Load

DICOM Plan Load

Save as SetBeam XML N.A. N.A. N.A. N.A.

Load dynamic couch and N.A. N.A. N.A. N.A.

collimator plans

Raw Scale Move

Raw Scale Moves N.A. N.A. N.A.

HSSB Diagnostics

View HSSB communication 10

status

Hardware Change Support

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Service Console Rights 10
For education
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Inc. All rights reserved.
pg 927 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

Optimizing Image Quality

Procedure

Objectives
The students will have learned how to improve image quality.

References:
B505009R01B – On-Board Imager (OBI) Advanced Imaging Reference Guide, chapter 6.

A. Overview
1. There are a number of factors that influence image quality. This section focuses on how to
manipulate clinical factors to optimize patient images.

2. Default X-ray imaging techniques are provided with TrueBeam for several different patient anatomies.
While these X-ray techniques have been selected to produce high quality images, due to differences
between patients, there will be times when it is necessary to adjust the technique factors used.

3. When selecting the technique factors, remember the

a) kV setting controls the penetrating power of the beam;

b) mA setting controls the quantity of X-rays produced;

c) ms setting determines the duration of the exposure.

4. An image will be of poor quality if it is under- or overexposed. A noisy or grainy image results from a
poor signal-to-noise ratio due to underexposure. An image that is lacking in contrast detail may not
10 provide the detail needed for patient verification.
10
5. This section seeks to provide indications of what steps can be taken to improve upon image quality.

Optimizing Image Quality 1
For education
© [2013] purposes
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Inc. All rights reserved.
pg 928 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

B. Underexposed Images
1. An image is underexposed if an insufficient quantity of X-rays is recorded by the detector.
See Figure 1.

Figure 1: Underexposed Image

2. There may be several causes of this. Firstly, if the mA (or mAs) setting is too low, not enough X-rays
will reach the detector resulting in underexposure.

3. Image exposure is also affected by the kV setting. The penetrating power of the beam increases with
increase in kV. Selecting too low a kV setting will also result in an underexposed image.

4. An image may be underexposed in particular areas or throughout the image.

10
5. The mA (or mAs) setting will need to be increased as the X-ray path through the patient increases
(that is, a larger patient will require a higher mA (or mAs) setting than a smaller patient for the same
anatomy).

6. The kV setting will need to be increased with increase in electron density in the X-ray path. So a
tangential breast image will require a lower kV than a lateral pelvis image. There are other
considerations to be made before determining the kV setting required (see section F – Image
Contrast).

Optimizing Image Quality 2
For education
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Varian Medical Systems,only
Inc. All rights reserved.
pg 929 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

C. Grainy Images
1. If an image is grainy, it is an indication that there was insufficient X-Ray intensity at the imaging
panel. See Figure 2.

Figure 2: Grainy Image (‘Invert’ Filter Applied)

2. This can be addressed by increasing the mAs and/or the kV, see Figure 3. When increasing mAs,
you may increase the mA, the ms or both. When deciding whether or not you wish to increase the kV
and the mAs to address graininess, you should also consider the contrast in the image (see section F
– Image Contrast). If the image has the desired contrast, you should increase mAs rather than kV.

10 10

Figure 3: Image after mAs Increased (‘Invert’ Filter Applied)

Optimizing Image Quality 3
For education
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Inc. All rights reserved.
pg 930 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

D. Overexposed images
1. The causes of overexposure are the opposite of underexposure - too high an mA (or mAs) setting or
kV setting. See Figure 4.

Figure 4: Overexposed Image

2. Overexposure can be avoided by lowering mA or mAs or kV setting. See Figure 5.

Figure 5: Image with Appropriate Exposure

Optimizing Image Quality 4
For education
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Inc. All rights reserved.
pg 931 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

E. Saturated Images
1. If an image is saturated, it may be possible to see the Asics display of the imager within the image.
Oversaturation of the panel indicates that the intensity of the X-Rays at the imager is too high.
Intensity of the X-Ray beam is related to both mAs and kV, therefore reducing either of these will
reduce the saturation. The same considerations should be given as for overexposed images as
saturation is a form of overexposure. See Figure 6.

10 10

Figure 6: Oversaturated Image

2. Reducing kV will reduce saturation faster than reducing the mA, however, if a higher kV is required
for penetration, the mA should be reduced.

Optimizing Image Quality 5
For education
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Inc. All rights reserved.
pg 932 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

F. Image Contrast
1. Does the image have sufficient contrast between bone and soft tissue?

2. The ability to distinguish between different tissues (for example, bone and soft tissue) is governed by
the image contrast. The primary factor affecting image contrast is the kV setting. As the kV is
increased, the difference in attenuation though different tissues is decreased, reducing the contrast.
Contrast is also affected by scatter radiation, so irradiation of thick body parts can result in a
decreased contrast.

3. If the contrast detail in an image is insufficient (and the image exposure is correctly set), the kV
should be decreased (and the mAs increased to compensate for the reduction in exposure).

Optimizing Image Quality 6
For education
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Varian Medical Systems,only
Inc. All rights reserved.
pg 933 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

G. Factors to improve upon clinical image quality

1. In addition to manipulation of the X-Ray imaging technique, there are other measures you may take
to improve upon clinical image quality.

2. Blade Collimation

a) To minimize scatter radiation, collimation of the blades to the imaging region of interest should be
performed. Selecting Blade Tracking will ensure that the blades are collimated to the
imaging detector, however additional collimation to the imaging region of interest will further
reduce scatter and improve image quality. See Figure 7 and Figure 8.

Tip: Positions on the blades can be adjusted on the TrueBeam with mouse
when the Collimation Tool is enabled:

10 10

Figure 7: Anterior Pelvis Image with Blades Collimation (10x10)

Optimizing Image Quality 7
For education
© [2013] purposes
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Inc. All rights reserved.
pg 934 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

Figure 8: Lateral Pelvis Image with Blades Collimation (10x10)

Optimizing Image Quality 8
For education
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Inc. All rights reserved.
pg 935 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

3. Imaging Filters

a) Once the images have been acquired, imaging filters may be used to further enhance the quality
of the images. There are a number of filters available within TrueBeam. Additional information
about the variety of filters available with TrueBeam can be found in TrueBeam Instructions for
Use manual. See Figure 9 and Figure 10 to compare differences between image display with and
without filter.

Figure 9: Acquired Image without Image Filter Applied

10 10

Figure 10: Acquired Image with ‘Optimized’ Image Filter Applied

Optimizing Image Quality 9
For education
© [2013] purposes
Varian Medical Systems,only
Inc. All rights reserved.
pg 936 DCID:
Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]
Optimizing Image Quality

Tip: A filter can be applied from filter drop-down in the toolbar. Filters are
cumulative - multiple filters can be applied to an image.

Optimizing Image Quality 10
For education
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Inc. All rights reserved.
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Produced by Global TB2.5-CEM-02-B
Standards and Content
Document Version 1.0 Revised [01/01/2001]

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