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MRIdian System 4.5
VIEWRAY MRIdian System 4.5 User Manual
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Oper
at
or
’
s Manual
fo
r t
he
MRIdian® S
yst
em 4.5
For
So
ft
ware
Rel
ea
s
e 4.
5
November 2016
Document No. L-0009
This document con
tains the confidential and pr
oprietary inf
ormation of ViewRay
, Inc. Neither
this document nor an
y of the information cont
ained is to be reproduced, distributed, used or
disclosed, either in whole or in part, e
xcept
as specifically authoriz
ed by ViewRay
, Inc.
2
Table of Contents
Default Chapter
5
Intended Use
5
Table of Contents
7
Chapter 1: Mridian® System Overview
19
System Overview
19
Mridian® System Training
20
Treatment Planning and Delivery Software
22
System Logging Overview
23
Creating a Support Package of Log Files
23
System Messages
24
Uninterruptible Power Supply
25
System Status Icons
26
Environmental Requirements
27
Imaging System
28
Cooling System
28
Magnetic Shielding
28
Gradient System
29
Patient Handling System
29
Receive Coils
31
Coil Sockets
32
Radiation Therapy Delivery System
32
Radioactive Source and Shielding
33
Multi-Leaf Collimator
33
Patient Communication System
33
Patient Headphones
33
Treatment Room Speakers
34
Treatment Room Microphones
34
Flat-Panel Display Monitor
34
Intercom
34
Video Camera
35
Electronics Cabinets
35
About this Manual
36
Chapter 2:Safety Information and Alerts
39
Safety Introduction
39
Definition of Hazard Levels and Symbols
40
General Mridian® System Safety
41
Product Performance Liability
42
Electrical Safety
43
Guidance and Declaration for Electromagnetic Compatibility
43
Precautions
43
Electromagnetic Compatibility
43
Treatment Room Safety
49
Slipping and Falling Hazards
49
Pinch Points
49
Patient Transport Safety and Communication
50
Patient Transport System Safety
50
Patient Alert for Patient-Initiated Communication
50
Communicating with the Patient
51
Laser Positioning Safety
51
Imaging Safety
52
MR Safety Screening
53
Magnetic Field Emergency Procedures
53
Devices Contraindicated for MRI
53
Patients Typically Contraindicated for MRI
54
Pre-Screening Prior to Imaging or Treatment on the Mridian® System37
55
MR Worker Screening and Reporting Requirements
56
Safety Screening Form, MR Hazard Checklist and Patient Instructions39
57
Supervision of Patients and Equipment
59
Artifacts and Imaging Errors
59
Controlled Access Area
60
Fringe Field Effects on Devices
60
MR Restricted Access Sign
62
Exposure to RF Electromagnetic Fields
62
Warming of Body Tissue
63
Noticeable Effects on the Patient
64
Peripheral Nerve Stimulation (Db/Dt)
64
Operating Modes
64
First Level Controlled Operating Mode
65
Current Loops
66
Effects of Antenna
67
Risks of Non-MR Safe Monitoring and Interventional Devices
68
Hazardous Noise Levels
68
Magnet Quench
69
Half Quenches
70
Gauss Line after a Patient-End Magnet Quench
70
Gauss Line after a Service-End Magnet Quench
73
Fire Safety in the Treatment Room
74
Measurement Phantom Safety
75
Contact with Phantom Fluid Spills
75
Risks Due to Aerosol Formation
76
Radiation Precautions
76
Radiation Safety
76
Exposure Control for Operators
77
Audible Radiation Alert
77
Radiation Safety Interlocks
78
Emergency Response Plans
78
Unintended Radiation (Stuck Source) Exposure
79
Using the E-Stop in an Emergency
80
Emergency Magnet Shutdown
81
Magnet Emergency Discharge Button
81
Emergency Quench Procedure
82
Rescuing the Patient in an Emergency
82
Chapter 3:System Coordinates
85
Mridian® System Coordinates
85
Direction Definitions
85
Gantry Coordinate System
86
Gantry Rotation
87
Beam Limiting Coordinate System
87
Beam's Eye View of Multi-Leaf Collimator (MLC)
88
Orientation of an MLC Relative to the Gantry
89
MLC Orientation
90
Planning and Visualization Using Coordinate System
91
Chapter 4:System And Administrative Tasks
95
Starting up the Planning Consoles
95
Starting up the Delivery System
96
Additional Treatment Delivery Console Checks
99
Shutting down the Planning System
100
Shutting down the Delivery and MRI Systems
100
Logging on to System Administration
102
Adding Users to the System
104
User Group Rights
105
Editing User Settings
105
Resetting a User Password
106
Using Global Structures
107
Editing Structures
109
Managing Templates
109
Renaming Templates
110
Removing Templates
112
Exporting Templates
113
Importing a Template
115
Chapter 5:Prescription And Patient Management
117
Introduction
117
Organization of Patient Management Information
118
Adding New Patients
119
Adding a Patient Photo
120
Using the Patient Information Features
121
Filtering the Patient List
122
Sorting the Patient List
123
Editing Patient Information
124
Editing Patient Notes
125
Adding a Diagnosis
126
Editing a Diagnosis
127
Entering a Prescription
128
Entering TNM Values
130
Using Treatment Options
131
Adding Structure, Dose, and Point Constraints
132
Customizing a Structure
134
Setting Structure Constraints
135
Adding a Point Constraint
136
Adding a Primary Reference
136
Plan Summary
138
Scheduling Treatment
139
Viewing the Delivery Calendar
139
Assigning Treatment Plans to Fractions
140
Locking Treatment Fractions
143
Unlocking Treatment Fractions
143
Discontinuing Fractions
145
Undoing Discontinue Fraction
146
Reviewing Individual Fraction Deliveries
147
Viewing the Delivery Report
151
Viewing the Tracking Points Chart
151
Generating a New Plan after a Fraction Review
152
Completion Plans
156
Setting QA Status
157
Comparing Plans
159
Hiding Patients
162
Patient Archive and Restore System (PARS)
164
Archiving Patient Plan Data
165
Restoring Patients after Purging
167
Exporting Patient Plan Data
168
Importing Mridian Treatment Plan Data
169
PARS Status
170
Status Refresh and Filter Options
172
Deleting Patients
173
Returning to Prescription
174
Screen to PDF Capture
174
Chapter 6: Treatment Planning
177
Treatment Planning Introduction
177
The Mridian System Treatment Planning Process
177
Patient Planning
179
Creating a New Plan
180
Selecting an Existing Patient
181
Loading a Plan
182
Viewing Only
183
Adding Images to a Plan
183
Importing Images and RTDOSE from DICOM
186
Importing Images and RTDOSE from DICOM Files
189
Importing Structures/Contours
193
Importing Points
196
Exporting Mridian Data Via DICOM
197
Removing Slices
199
Interpolating and Editing Image Sets
201
Creating a 4D Series
202
Viewing a 4D Series
205
Image Orientation
206
Viewing Images
208
Ortho MPR and 3D Display
208
Using Multiplanar (MPR) Lines
209
Using Window/Level Settings
209
Using the Zoom Tool
210
Using the Pan Tool
210
Using the Measurement Tools
211
Using the Point Tool
211
Using the Length Tool
211
Image Orientation Reset
212
Using the Display Options
213
Removing Overlays
213
Contouring
214
Adding Structures
214
Expanding Structures
216
Auto-Contouring Skin
217
Using the Draw Contours Tools
217
Interpolating Contours
220
Keyboard Shortcuts and Context Menu Options
220
Using the Clean up Tools
222
Using the Boolean Tool
223
Using Iso-Intensity Contouring
226
Using Rules
229
Saving Auto-Contouring Templates
230
Auto-Contouring Using a Saved Template
231
Approving Contours
232
Image Registration
233
Registration Modes
233
Advanced Registration
237
Aligning Volumes Using Overlays
249
Using Image Masks
251
Points
256
Adding Points
257
Using 3-Point Landing
258
Fine-Tuning Point Placement
258
Setting Points at the Center of a Structure
259
Manually Placing Points
259
Entering Values for Point Placement
260
Deleting Points
261
Renaming a Point
261
Couch and Isocenter Placement
262
Finding Valid Isocenters
263
Beams
264
Beams Types
264
Placing a Beam Group
265
Locking Same-Isocenter Beam Groups
266
Changing a Single Beam Type
267
Adding Pseudo-Arc Beams
267
Manually Adjusting Beam Angles
268
Adjusting Beam Angles Using Beam Values
268
Saving Beam Templates
268
Loading Beams from Templates
268
Deleting Beam Groups
270
Setting Mlcs for Conformal Beams
271
Viewing Structures from the Beam's Eye View
273
Viewing the Complete Irradiated Area Outline
273
Setting Electron Densities
274
Use CT Only
275
Use Structure Densities
276
Dose
277
IMRT Prescription Offset
278
Levels
280
Using IMRT Efficiency
280
Setting the Resolution for the Dose Grid
281
IMRT Interdigitation
282
Mridian® System Algorithms
282
Dose Optimization
283
Optimizing Dose for IMRT and Conformal Beams
287
Advanced Dose Settings
289
Changing Structure Constraints after Optimizing Dose
291
Normalizing the Dose
292
Fixed Conformal Beams
293
Plan Evaluation Tools
295
Isodose Lines
296
Saving Isodose Line Templates
298
Loading a Saved Isodose Line Template
300
Managing Motion Using Isodose Lines
300
Realtarget
302
Numerical Margins and Structure Boundaries
304
Finding Valid Spatial Integrity Region for Realtarget
304
Real-Time Realtarget
305
Realtarget Delay and Wait Time
305
Treatment Plan Evaluation and Approval
305
Calculating Dose
306
Comparing Two Plans
307
Comparing 2 Plans that Have 2 Prescriptions
308
Setting Registration Options
309
Approving a Treatment Plan
311
Remote Connectivity
312
Chapter 7: Imaging
315
Introduction
315
Time-Varying Magnetic Fields (Db/Dt) and Peripheral Nerve Stimula
315
Managing Images
317
Searching for Images
317
Importing Images from PACS
318
Importing DICOM Images from Files
320
Exporting Images
322
Viewing Images
323
Imaging
323
Adding a New Patient
324
Using the Patient Sidebar
325
Searching for Patients
326
Editing Patient Information
326
Filtering the Patient List
327
Sorting the Patient List
328
Acquiring Images
328
Acquiring Low Resolution Images
329
Acquiring a High Resolution Image
330
Field of View Placement
330
Setting Image Display
330
Saving Images
331
Deleting Images
333
Simulating Treatment Delivery
334
Preview Settings
335
Saving a Ciné
335
Realviewer
337
Exporting a Ciné
338
Chapter 8:Patient Set-Up
339
Patient Transport Safety and Communication
339
Pinch Points
339
Slipping and Falling Hazards
339
Monitoring the Patient
339
Intercom
340
Squeeze Bulb
340
Using Patient Headphones
342
Patient Set-Up
342
Displays and Indicators
343
Couch Control Buttons
345
Buttons Available on the In-Room Control Panel Only
347
Understanding the Stored Couch Position
347
Patient Load Position
348
Loading and Positioning the Patient Without a Stored Couch Position
349
Patient Positioning Using Stored Couch Position
350
Chapter 9:Treatment Delivery
353
Introduction
353
Powering up the System
353
Retrieving the Patient
354
Loading the Plan for Delivery
355
Using Daily Images to Position the Patient
356
Acquiring a High-Resolution Image
359
Registering Daily Images
359
Finding the Couch Shift
361
Manually Finding the Couch Shift
362
Automatically Finding the Couch Shift
365
Saving the Patient's Couch Position
366
Set to Center of Option
366
Viewing Beams on the Positioning Screen
367
Editing Contours for Patient Positioning
367
Editing Rule-Based Contours
368
Predicting Dose
369
Normalizing New Plan to Prescription
374
Editing New Plan in Planning Workflow
375
Treating with Re-Optimized Dose
376
New Plan Comparison Export
378
Checking Realtarget Settings
379
Using Tracking Points
381
Realtarget Preview
382
Tracking Result and Decision
384
Beam on and ROI
384
Correlation Graph
385
Applying a 2D Shift
386
Delivering a Treatment Fraction
388
Treatment Control Panel
390
Delivering a Multi-Isocenter Plan
391
Ending Treatment Early
392
Adding Completion Plans to the Delivery Calendar
394
Consolidating Treatment Fractions
398
Monitoring Treatment Delivery
399
Two-Headed Treatment Mode
401
Chapter 10:Quality Assurance
407
Recommended QA Tests and Procedures
407
Recommended Frequencies for QA Tests
408
Accessing the QA Screen
411
Plan QA
412
Creating a QA Plan from a Treatment Plan
412
Exporting Dose
415
Saving a QA Plan
417
Positioning Couch on Points Screen for a QA Plan
418
Localization
422
CT to Relative Electron Density
424
Adding and Removing Look-Up Table Data Points
425
Viewing Delivery Records
429
Snr/Uniformity
432
Source Tracking
433
Calibration Verification
434
Spatial Integrity QA
438
Daily Laser Alignment Calibration Test
443
Sealed Source Leak Testing
444
MLC Speed Test
447
Optional Physics QA Tools
450
Chapter 11:Cleaning
455
Cleaning the LCD Monitor and Video Display
455
Cleaning Plugs and Connectors
455
Cleaning the Patient Table
455
Cleaning System Components
456
Electrical Cabinets
456
Chapter 12:Receive Coils
457
Precautions
458
Description
459
Coil Design
459
Decoupling Method
459
Symbols
460
Cleaning
463
Service
463
Storage
464
4
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VIEWRAY MRIdian System 4.5 Specifications
General
Brand
VIEWRAY
Model
MRIdian System 4.5
Category
Medical Equipment
Language
English
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