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VERT Workbook

1. EG My Recent Documents E workbook sho Fiename vi Fes of ype Slideshow fs sha C Open as read only gt My Network Creating a new slideshow If you want to create another slideshow file or replace the current slideshow file click the new button on the virtual presenter menu irtual Presenter 3D Slides R structures CT images Slide 1 4 dose visualisation set up error Ed verttest PowerPointslide1 New slideshow The following message appears This will not replace the existing slideshow files it will only make the virtual presenter window ready for new slides The previously created slideshow files will be available when clicking the open folder option Vertual Ltd Nov 2011 Page 58 of 111 Version 1 0 irtual Presenter 3D Slides y structures CT images Virtual Presenter 3D Slides xX Create 3 slides Click the save button and 1 To replace the existing slideshow file save with the same name as before and say yes the following message Vertual Ltd Nov 2011 Page 59 of 111 Version 1 0 Save in B My Recent Documents Save s C Program Files Vertual Shared VERT Plans Brain_Varian_Rapid4RC_PTVISF1_SIB_0072 workbook sho already exists Do you want to replace it My Computer a File name workbook sho v A My Network Saveastype Slideshow files sho v 2 To create
2. create them SAFELY Practice skills again and again Demonstrate techniques new and old Free up clinical resources when teaching Review techniques and learn from peer to peer discussion Bring the Linac into the classroom Enhance understanding a highly visual teaching tool Wertuat VERTUAL 201 The PowerPoint slide will appear in the main VERT window when selected Vertual Ltd Nov 2011 Page 56 of 111 Version 1 0 Saving the slideshow Save the virtual presenter slideshow file all virtual presenter files have the file extension sho using the disk icon irtual Presenter 3D Slides 3 4 structures CT images Slide 1 4 dose visualisation E set Up error Bid verttest PowerPointslide1 Save slideshow file The system automatically chooses the correct directory to save the slideshow file into to make the file available to load easily into the patient during future sessions z Save as type Slideshow files sho ind Give the file a name and click save File name workbook Now exit the patient reload the patient using the file import option and re open the Virtual presenter slideshow file using the open folder option in the virtual presenter menu The following window opens Select the file you wish to open and click the open button Vertual Ltd Nov 2011 Page 57 of 111 Version 1 0 Look in Brain_Varian_ RapidARC_PTVISF1_SIB_0O7 v O P gt m
3. The picture will appear in the bottom of the list PowerPoint slides can also be inserted as JPEG images enabling theory and demonstration of practice to be put together during a session Insert a PowerPoint slide by first saving the PowerPoint slide s needed as JPEGs from within the PowerPoint application Use the save as option and scroll down the list of formats until JPEG Is visible this option is near the end of the list Save As PK Save in O Presentations Oct 2011 v A x Sy oe gt My Recent Banja Luca Oct 27 2011 ppt Documents E beavis _IMRT talk ppt Desktop PEARL ppt T vertualLong ppt YertualShort ppt an Documents i 3 My Computer ew My Network Places File name vertualShort ppt Save as type PowerPoint 97 2003 Presentation ppt Web Page htm html GIF Graphics Interchange Format gif JPEG File Interchange Format jpq PNG Portable Network Graphics Format png TIFF Tag Image File Format tiF Device Independent Bitmap bmp Tools Cancel A Vertual Ltd Nov 2011 Page 54 of 111 Version 1 0 Home Insert Design Animations Slide Show Review View Add Ins i me eet Aw 85 f te he Kat Dicectons N S090 aa Me hape F ah Fiod Sj Reset Align Text ALLOVOGO 2 Shape Outline Si Replace d te side KiDeete PA TeS Sioa A E l Convert to SmartArt 4 NAL ee ee es ai Shape Efed ig Select Clipboard
4. Select the green arrow to choose the slide animation option The slides will run through from the current highlighted slide or from the beginning using the selected timings Vertual Ltd Nov 2011 Page 61 of 111 Version 1 0 The progress is shown in the green circle on the right hand slide of the main VERT screen Creating a slideshow file Creating a slideshow file on a laptop or separate PC from the main VERT one and loading onto the main VERT PC Create a slideshow file on the remote PC and save onto a USB stick jump drive or CDROM This example has the filename workbook2 sho Insert the drive into the VERT PC and open the directory containing the file My Computer led File Edit View Favorites Tools Help ay Q Back amp LP sSearch gt Folders E Address 4 My Computer M gt 05 Ci Sw Removable Disk E a Integrated Webcam gt CJ Shared Documents Cal System Tasks d L DVD RAM Drive D 2 view system information TA Add or remove programs Change a setting Other Places VERT s Documents My Network Places My Documents Shared Documents gt Control Panel Details My Computer System Folder Vertual Ltd Nov 2011 Page 62 of 111 Version 1 0 File Edit View Favorites Tools Help ae Q Bak BF LP Search Folders C Address E VERT v Go File and Folder Tasks c Rename this file Scan selected files with Avira iy Mo
5. oT Examples of the toggle on toggle off tick options also known as check boxes The Control Panel bottom right section The bottom right hand side of the VERT screen is where the controls are located to view aspects of the plan and to change viewed parameters of the machine beams eye view including DRR dose and set up error The patient can also be positioned using the patient position tab The controls are divided into several pages and each tab contains display options related to the tab name Machine CT BEV lt gt i T a Machine CT pevy 4 gt a ae Machine Varian CX vl 7 Visible MLC Port Visualization Beam Transparent Show MLC Leaves Coll Rtn 0 deg M Transverse 110 00 Style Solid v v A _ Rotate MLC Leaves Gantry 0 x deg C Coronal 0 00 Zoom to fit Collimator A Couch Vrt 10 wr C Enable DRR Couch Lng 94 4 m Vi Sagittal pigs v i Preset Couch Lat 0 9 m Te lt Couch Rin a deg Window 0 Window E Field Y 20 0 2 om J Be z 0 Level 40 Level Y2 cm b o a Fieldx 20 0 on X2 gt m F Lasers d SSD Room Field Machine tab CT tab Beams eye view tab Vertual Ltd Nov 2011 Page 8 of 111 Version 1 0 CT BEV Dose 4 gt Dose Setup Error pati Patient Position lt 4 gt Anterior Pos 0 mm C Dose Surface Display Superior Inf 0
6. 111 Version 1 0 Couch Vrt Couch Lng 145 5 Couch Lat 0 6 kaa To choose a different Linac Note Your PC will display only machines included in your license so fewer options may appear than in the illustration above Eim Action Switching treatment machines Any open plans will be dosed The patient must be reloaded if the Linac is changed Vertual Ltd Nov 2011 Page 10 of 111 Version 1 0 Chapter 2 Loading a patient Patient required a patient from your own planning system Alternatively the patient could be a demonstration patient from the Vertual CDROM Time 15 minutes This session will cover the following Data required Anonymisation Loading a patient into VERT Plan type Patient position Remember VERT has no database Plans cannot be altered in VERT only viewed Transfer using a USB stick Messages when opening a patient indicate progress give clues if something goes wrong Data required e To load a patient into VERT the CT images structure set dose and plan should be exported from the treatment planning system This transfer can be completed using a USB stick or network shared drive iia View Favorites Tools Help f P seach Folders gt C demo Released DICOM Plans PUB_CMS_Lung_CMS_081 phase1 Craimsyge_ c magen Cram CF Make a new folder Publish this folder to the c ES Bc va CT_Image_ CT_Image 7 Web x z os z Za G ka Share
7. 111 Version 1 0 e Visualise the axes in the Scene gt Machine menu demonstrate how the lasers coincide on the axes introduce the X Y Z concept of three dimensional movements around the isocentre Visualise how the ODR is at 100cm on the axes Student Exercises o If available hand the students the pendant and virtual couch controls Without using the ODR get the students to position the top of the couch so it is 100cm away from the focal spot o Once they are happy they have achieved this check if the distance is correct using the ODR o Separation exercise explain the concept of patient separation and why this is important Activate the external surface and ask the students to work together to identify what this patient s separation is Demonstration facilitator led Single fields Parallel pair techniques e Visualise both beams on the parallel pair plan implement the dose wash so they can see how the lungs spinal cord skin surface if visualised receives a high dose e Activate the dose surface display and use the dose level slider to demonstrate that the highest dose falls at the entrance and exit points of the two beams Introduce the concept of skin sparing and how opposed beams generate increased dose deposition via their entrance and exit contributions Indicate that MV beams deposit skin dose due to their exit rather than their entrance e Explain to the students that this technique would utilise
8. 2 surfaces GA 1 Patient M Different visualisation options Vertual Ltd Nov 2011 Page 81 of 111 Version 1 0 4 The markers will now be visible on the patients skin Vertual Ltd Nov 2011 Page 82 of 111 Version 1 0 5 Set up to the markers using the lasers the field light and the SSD G The lateral crosses line up with the lasers Vertual Ltd Nov 2011 Page 83 of 111 Version 1 0 The display monitor will show that the couch is not at the planned position The orange inhibit bar shows the incorrect longitudinal position of the couch in this case Monitor D Field Y 20 0 20 0 si EMA Arracenru Field X 20 0 20 0 Saa AG Coll Rtn 0 0 0 0 Gantry Rtn 0 0 0 0 Couch Vrt 9 6 9 6 Couch Lng 149 5 554 Couch Lat 0 8 0 6 Couch Rtn 0 0 0 0 Using the shift measurement from the treatment plan move the couch to set up to the treatment isocentre Vertual Ltd Nov 2011 Page 84 of 111 Version 1 0 The in room monitor display should now show the patient is in the treatment position onitor D Plan Field Y 20 0 Field X 20 0 Coll Rtn 0 0 Gantry Rtn 0 0 Couch Vrt 9 6 Couch Lng 149 5 Couch Lat 0 8 Couch Rtn 0 0 Turn on the skin marks using the view apply skin marks option The lasers should line up with the patient skin marks Vertual Ltd Nov 2011 Page 85 of 111 Version 1 0 J Couch controls The couch can be moved using the hand pendant controls id applica
9. 5 Slides Font Paragraph Drawing Editing Sides Outline E i j gape lt o a aa Dive a dose of ionising Banja Luca Oct 27 2011 ppt sacra smelt MPEARL Bowes Mossun Ri vertualshort ppt Review techniques and learn from peer to peer discussio Bring the Linac into the classroom f O py O ale 5 a5 Slidell of22 Blank Presentation English U S Microsoft Office PowerPoint a j Do you want to export every slide in the presentation or only the current slide Every Slide Current Slide Only The following dialogue box will then appear Select the current slide if only one slide is needed or select the every slide option for all Remember where you save them irtual Presenter 3D Slides X structures CT images Slide 1 dose visualisation set up error verttest Use the insert picture option as before to load the JPEG images of the PowerPoint slides from their saved location Vertual Ltd Nov 2011 Page 55 of 111 Version 1 0 irtual Presenter 3D Slides structures CT images Slide 1 dose visualisation set up error Bd verttest Ed PowerPointslide1 Fe e i The PowerPoint slide is now inserted into the virtual presenter file What can do with VERT Anything you can on a real Linac except give a dose of ionising radiation mport patient from RTPS DICOM Set patient up with lasers light field SSD imaging Explore errors
10. L Room Light Use some of the shortcuts whilst running through a plan for one of the demonstration patients Vertual Ltd Nov 2011 Page 98 of 111 Version 1 0 Section 2 Vertual Ltd Nov 2011 Page 99 of 111 Version 1 0 Chapter 14 Example sessions to use with students Vertual would like to thank the team from Birmingham City University and particularly Mark Holland for the preparation of the student session examples Linear accelerator Machine geometry Session Facilitator Notes Introduction e This session should be timed at around 1 hour e This session should be facilitated subsequent to the linear accelerator visualisation session e Check the students requirements as to whether or not they all are comfortable using the VERT system in stereoscopic 3D mode Revision e Ask the students what the isocentre is Definition of isocentre the isocentre is the point around which everything rotates It is a fixed point inside the room which is 100cm from the focal spot on the target Demonstration facilitator led e Import a 2 field parallel pair bronchus plan ensure all structures and contours are invisible e Click on Beam 1 and reiterate the concept of beam divergence Question the students as to how this phenomenon enables us to generate field sizes greater than 40cm x 40cm Explain how this relates to similar triangles and introduce the concept of inverse square law Vertual Ltd Nov 2011 Page 100 of
11. Wertual VERT Workbook Table of Contents SECTION 1 aye 6 el Ob Hae ate ela en a ca geen none ne ee nn ny ee eee 6 The Main Menu top let Menu ersrersisrirrr n a A ta peu vues E E 6 The Plan Browser top right section ssseesssssessrsersessrrrressrrrressrrrrressrreressertreessrtrressrreresssetrressrteressrrerseseene 7 The Control Panel bottom right section sseessssssessrensessrrereesrrrrressrrrresssrrreesrsrrressrrtressrerrressrreressererreseene 8 Aus Une Te VIEW e E E E E A 9 Mend nave ON ae E A E 9 Changing treatment Machihie Seerscseiiereen ranse a E E e 9 Chapter Loading apalen ienne E E 11 Loading a oye is a 18 108002 al a meisoun EEEE E EAE eee ee 12 PM Oy NS ae acess nase ecco teers ware sepa E woe temas euros gta eden Saeeiee poe eseuhesacuteeecetioe 13 HVAC IIS ARVO ICC VICSS is S con sysysneenuene E E E 16 PCIE DO Oaa cern chedisis eerie ican rtearia diene na eine dnote 16 Chapter 3 Manipulating Structures ccccccccsssccccsseccccesececcesececaesececseeecceseusecessuecessenseceseusecessuneceeseneeeetas 19 DST AMINE WIG WY arr E E A E coneoudtebsnurets cans uhesoastuclorosauiantpeceehe rok ndaunpenuevessemnleteacees 19 NTS CUS IO NON CTE EE r E E E vated reget ea paces vet E E N NE 21 Caner a Beon A D ea E R 26 Single TS A display sarees umaettecnanseavnne apaucn soasucd ssanaessnsatieseiaaeccerupateedGananeensace terest 26 BS MUS ree tere cece A gener cea neg org eters oases trent E E teoe
12. describing this as the viewpoint that patient s first experience Explain to the students the importance of informing patients of the visual identity of the machine prior to their first treatment as it can be intimidating Vertual Ltd Nov 2011 Page 103 of 111 Version 1 0 e Pan around the room slowly Get the students to identify the two main components of the linear accelerator the couch and the ganiry e Get the students to identify the position of the emergency stops e Give students the mouse X box controller iPad so they can move the camera around and view the Varian linear accelerator Now visualise the Elekta Synergy platform and Siemens Artiste linear accelerators e Explain some basic design differences like the Elekta gantry assembly being hidden behind the false wall hence making the machine look a little smaller e Zoom in on the Elekta pendant on the virtual wall if available hold up the real pendant for comparison e Visualise the Varian iX and Elekta Synergy systems and deploy both the MV and kV imaging systems Briefly explain the concepts of patient imaging and accuracy e Return to the Varian CX e Explanation of Basic Linear Accelerator Components to the students e Gantry the gantry rotates 360 around the patient and rotates around the isocentre e Patient support the couch Can the students identify the weight limits on the VARIAN couch Explain why this is necessary introducing the concep
13. or phone 44 1482 634739 Vertual Ltd November 2011 www vertual co uk Vertual Ltd Nov 2011 Page 111 of 111 Version 1 0
14. visible patient and get the students to state in which direction you are moving e Ask any further questions that you deem are relevant e Finally check if there are any questions from the students END OF SESSION Vertual Ltd Nov 2011 Page 102 of 111 Version 1 0 Chapter 15 Linear accelerator initial visualisation session Facilitator Notes Introduction and initial scoping This session should be timed at around 1 hour Check the students requirements as to whether or not they all are comfortable utilising the VERT system in stereoscopic 3D mode Ascertain basic understanding of the linear accelerator e g o Have you all visited a clinical department prior to starting this course o When you visited the department what machines did you see Brief background from facilitator on the linear accelerator and its application in radiation therapy Historical rise to dominance over the DXT Cobalt machines that were the mainstay of radiation therapy in the mid 20 century Three primary manufacturers worldwide Multi modality question students what do mean by this choice of energy Accuracy range of movement Ongoing development MLC EPID dynamic radiation beam modulation and fluency of dose distribution O O O Oe 2 Demonstration facilitator led Linear Accelerator Room Commence with the Varian CX linear accelerator Position the camera towards the rear of the maze Slowly zoom into the room
15. will display the planned position and the new image at the new location with set up error introduced A purple and green wash will be displayed where the images are not aligned Planned image is purple and Actual image is green In the main VERT window the patient will now appear with a random set up error and the lasers will not be on the skin marks Vertual Ltd Nov 2011 Page 94 of 111 Version 1 0 The setup error box will also register that a shift has taken place Dose Setup Error pati 4 gt Dose Setup Error Anterior Pos 0 2 mm Anterior Pos 2 mm Superior Inf o mm Superior Inf JE mm Right Left 0 imm Right Left 11 mm pa z Rotation E 2 deg Roll ae l deg Roll o deg Pitch deg Pitch a deg Show values E Show values Setup error tab before random error has been generated Setup error tab after random error has been generated Once the show values option is selected the magnitude of the shift is seen Matching the Images 6 Inthe IGRT window holding down the left mouse move the image so the green and purple are overlaid and little colour or no green or purple is displayed This indicates the images are aligned Vertual Ltd Nov 2011 Page 95 of 111 Version 1 0 Once the images are aligned the Lat Long and Vert fields in the touchscreen interface will display the translation values to move the patient to the isocentre location Magnitude of Lat
16. 9 cGy Dose Surface Display Dose Level 100 0 Transparency f Colour Once relative dose is selected the option to enter the prescription dose becomes available Units Relative v 100 8549 Global Maximum 8549 cGy Enter the prescription dose Units Relative vi 100 8100 Global Maximum 8549 cGy Now view values over 100 using the slider bar underneath the Dose level option Vertual Ltd Nov 2011 Page 44 of 111 Version 1 0 Dose Surface Display Dose Level Yo a Transparency Colour ff Vertual Ltd Nov 2011 Page 45 of 111 Version 1 0 Chapter 7 Simulated Errors Patient required any patient loaded onto VERT Time 15 minutes This session will cover the following Setup error menu Viewing simulated set up errors using the dose surface and dose cloud display The set up error tab is located in the bottom right hand corner of the VERT screen Use the small arrows to scroll through the options if the setup error tab is not visible Dose Setup Error pati Anterior Pos 0 mm J SuperiorjInf 0 mmo Right Left o mm Rotation o E deg 3 J f a Roll 0 lis deg Pitch 0 deg NE Show values Enter an Anterior posterior shift of 5mm and view the dose colourwash display resulting from the shift Y E lt pne Dose Setup Error pati lt a Anterior Pos 5 mm Superior Inf 0 mm A t 4 mf Right L
17. A mikali ay Beams Ga ay Beam 1 GH ay Beam 2 E ay Beam 3 gt The beam name is no longer bold Now only two beams are displayed Rotate the gantry in the machine tab the gantry will not be at the position of either beam Select a beam to move the gantry back into the correct position for the selected beam Vertual Ltd Nov 2011 Page 30 of 111 Version 1 0 Ej El m a 1 a m E Hue 40 Red 255 Sat 240 Green 255 Define Custom Colors ColorlSolid Lum 120 Blue 0 OFS Change the colour of the beams use the colour option from a right mouse click on the beam name Beam colours can be selected individually so adjacent beams can be viewed differently Change the beam display so that one beam is active and the name is bold Rotate the gantry using the pendant and see how two beams now become visible This is an active beam and a projected beam Beam Eye View display CT BEY MLC Port visualization Show MLC Leaves Style Transparent C Rotate MLC Leaves Zoom to Fit Collimator _ Enable DRR Invert DRR Preset Standard Window S tang CAF Pee peat pram 6 Vertual Ltd Nov 2011 Page 31 of 111 Version 1 0 The Beam Eye View BEV menu is on the bottom right hand side of the screen a CT BEY Dose lt gt MLC Port Visualization Show MLC Leaves Style Transparent v Rotate MLC Leaves Zoom to fit C
18. Long and Vert shift is shown once the images are matched m Random Mi Acquire E Shift _ 7 Pressing shift will move the patient back to the isocentre location using the moves calculated from the image matching process The setup error menu will still display values at this point Vertual Ltd Nov 2011 Page 96 of 111 Version 1 0 Dose Setup Error pati 4 gt Anterior Pos 2 Superior Inf 14 Right Left 11 Rotation Roll Show values 8 Select zero in the VERT setup error menu this will reset the values in the setup error window and the separate fields will display O Dose Setup Error pat Anterior Pos 0 nm Superior Inf eo a mm Right Left S a mm Rotation Eo S deg Roll w i deg Pth 0 ideg Show values Vertual Ltd Nov 2011 Page 97 of 111 Version 1 0 Chapter 13 Using keyboard shortcuts Patient required any patient loaded onto VERT Time 10 minutes This session will cover the following Keyboard shortcuts for use with VERT Below is the list of key codes for the software K Show Skin Marks Left Arrow Gantry Right Arrow Gantry Up Arrow Collim Down Arrow Collim A CT Slice Z CT Slice E Eye flip reverse left right eyes in stereo Numpad 4 or C Couch Ang Numpad 6 or V Couch Ang Numpad 8 or S Couch Lng Numpad 2 or X Couch Lng B Couch Lat N Couch Lat Numpad Add Couch Vrt Numpad Sub Couch Vert
19. ROM Time 10 minutes This session will cover the following How to show the separation easily using VERT Procedure 1 Import the block patient Turn on the skin marks and the lasers 2 Raise the couch so the lasers are positioned on the couch surface Vertual Ltd Nov 2011 Page 76 of 111 Version 1 0 3 Turnon the field light and SSD indicator and read the value This is 80cm 4 Drop the couch so the laser is level with the surface of the patient Vertual Ltd Nov 2011 Page 77 of 111 Version 1 0 5 Read the SSD value dil i i 6 The value will be 100cm Therefore the student will be able to see that 100cm 80cm the patient separation In this case it is 20cm Vertual Ltd Nov 2011 Page 78 of 111 Version 1 0 When positioning the patient so the isocentre crosses line up the pin reads 90cm equal to half the patient separation Vertual Ltd Nov 2011 Page 79 of 111 Version 1 0 Chapter 11 Making shifts from an origin marker Patient required any patient loaded onto VERT Time 20 minutes This session will cover the following Display of skin marks The skin marks of the patient can be accessed using the Tools menu from the top left hand set of menus on the VERT screen The Apply skin marks option actually turns on the isocentre of the patient To use VERT to setup to a reference mark such as a tattoo or permanent marker the following methods can be used Method 1 Patient has ma
20. S mm car olan Dose Level cGy Right Left 0 mm Superior Inf _ gt mm Rotation 0 deg Right Left O mm Transparency Colour Roll 0 deg amp Pitch o Ja deg C Extend patient v M Show values Height 1828 mm C Show Colour Map a offset oim Colours Colour Wash Le Range cGy Min 0 E Max 6060 Units Absolute cGy vi 100 Global Maximum 6060 cGy Dose tab Setup error Patient position tab Adjusting the View The mouse must be in the main VERT display area to adjust the view To rotate the view hold down the left mouse button and move the mouse to the right to rotate to the right and to the left to rotate the view to the left To pan the view within the window hold down the mouse wheel and move the mouse until the view is changed as needed To zoom the main view hold down the right mouse and push the mouse away from you to zoom in navigate in to the view and towards you to pull the view away and zoom out Menu navigation The bottom right hand side of the user interface contains the menu tabs To navigate through the tabs and reveal the options available use the small arrows to the right of the tabs Machine cT eev 4 gt Use the small arrows to select menu tabs Changing treatment machines To change treatment machine use the drop down menu in the machine tab Once the machine is changed the patient will be cleared and needs to be reloaded Vertual Ltd Nov 2011 Page 9 of
21. Wi HS T a dhe Wome H NT r hday l Coronal 0 00 Sagittal 0 00 Window 400 Level scroll the CT using the slider until the white CT markers can be seen at the patient origin position Vertual Ltd Nov 2011 Page 88 of 111 Version 1 0 3 The patient outline can now be made opaque the markers will protrude from the patient outline 4 Set up the patient to the CT marker using the field light lasers and SSD oC The lateral markers will also line up Vertual Ltd Nov 2011 Page 89 of 111 Version 1 0 5 Make the isocentre shift as required The in room monitor will again be showing the inhibit bar at this stage 6 Turn on the skin marks The lasers should line up with the skin marks if the isocentre move has been performed correctly 7 The display monitor will now be free from inhibits Vertual Ltd Nov 2011 Page 90 of 111 Version 1 0 x 123456 7890 Field Y ra 0 0 a ssh Accacenry Field X 20 0 20 0 Sige ColRn 088 00 Gantry Rtn 0 0 0 0 Couch Lng 149 5 149 5 Couch Lat 0 8 0 8 Couch Rtn 0 0 0 0 mage SSD Hint It can be useful to have a dummy treatment sheet for demo plans stored by the VERT system This can be an anonymised copy of the treatment sheet containing the prescription dose and shifts from the permanent marks In some cases the outlining may have been performed in such a way that the CT markers will not protrude through the patient outline In th
22. a 6MV photon beam Ask them why considering the patient separation they have recently measured you wouldn t use a higher energy e Introduce the concept of phased treatments and how the geometry of the machine treatment plan can be changed to minimise any further dose to some of the critical structures Import a 3 field bronchus to illustrate this with dose wash e Check if there are any questions at this juncture Vertual Ltd Nov 2011 Page 101 of 111 Version 1 0 Demonstration facilitator led Terminology e Import the VHF and introduce the concepts of Sup Inf Ant Post etc e Import a pelvic plan and activate the skin marks e Demonstrate laser alignment to skin marks via a random setup error and how students will have to develop this terminology as second nature when they are in the department Stress the importance of communicating clearly within the treatment room during setups and the need for a half and half approach to movements during alignment Student Exercise o Get the students to all practice alignment and mastering fine movements on the handset virtual couch controls if available Summarise session e Ask the students to explain beam divergence and how we can utilise this in extended distance techniques e Reiterate the importance of how the lasers and ODR can help us to align and reproduce setups on a daily basis e Position and move the mouse pointer Sup Inf etc from a skin mark on a
23. adiation therapy concept visualisation USING VERT ccccccesescceescceseseceesecesceeeeeceeeeseeeneeees 67 Isocentre ViSUAlISATION USING AXIS FEATULE monen 67 Demonstrating isocentre location within the patient cccecccccsssccccessececeeseccceeeeececeesecesseneceeseeeeeetes 72 Demonstrating the Anti collision Option within VERT cccceseccccsssececeesececeeececseeseceeseecesseneceeseneeetes 74 Chapter 10 Demonstrating patient separation using VERT and a DIOCK ccc ceecccesececeeececeeceeeeseeeeeees 76 PO COU rnictais tela nace cathe a Be ten a el nc ant ba aa hte nia belt acl et ahh Sal a hte Ea eae tela 76 Chapter 11 Making shifts from an origin MALKeL ccccccccsssccccesececceececeesececeuseceeseuecceseeecesseneceeseneeeetas 80 Method plait Contains Marker ssstaseetcesiantes otra N A E N NN 80 Couch Control Sirs crnayasalucnast n E T EE N E 86 Method 2 plan does not CONTAIN Markers ccccccesesseccccceeseeccccceeeeccceseeeeecccseeueeeceeseeeeeeeseseueeeceeseeeenes 87 Chapter 2 IGRI WOOL KMOW auch toes er tus dancinedenannc N A ce cutee men EN 92 IGRT WY OFKTOW swisseareccontsioataravadanbssiivncaveesdcwesn E A 92 Chapter 13 Using keyboard SNOrme UU S sieniin a eguseeteteeiesy 98 SECTION 2 Chapter 14 Example sessions to USE with STUCENTS cceeccccssececeesececceeceeeeescceeaesececeuseceseuneceeeeeeeeetas 100 Linear accelerator Machine geometry SESSION scsccccsesccsonssscn
24. anew file use a unique name and click save Virtual presenter files are machine specific although slides created for a Linac can be loaded when a different Linac is visible The follow message will appear in this case Warning These slides were created for Varian ix They may not display correctly on Elekta Synergy Platform due to differences between the equipment Would you like the slides to be converted anyway This will convert the slides Please be aware that any slides saved with the beams eye view will display the collimator of the Linac they were saved for Using automatic timings to run through the virtual presenter slides The option is available to set a time for each slide to run instead of using the manual option This allows hands free presenting lf a question is asked and the slide changes before the presenter is ready just click on the slide you wish to start from and press the play slides button once again To set up timings for the slides either click one slide to set timings individually or select all the Slides in the list by holding the shift key down and clicking the first and last on the list Vertual Ltd Nov 2011 Page 60 of 111 Version 1 0 Virtual Presenter 3D Slides X Slide 1 Slide 2 Slide 3 irtual Presenter 3D Slides X structures CT images Slide Properties Advance Slide C Manually Automatically After seconds Insert the time needed for each slide and click OK
25. axes and the beam are now visible In the machine tab click the home button This sends the machine to the isocentre location for the patient and sets the gantry angle to zero Vertual Ltd Nov 2011 Page 70 of 111 Version 1 0 To demonstrate the beam isocenire rotate the gantry collimator and couch Turn the beam off by clicking beams once wy Beams ey Beam 1 Contours H Surfaces Oy CT Vertual Ltd Nov 2011 Page 71 of 111 Version 1 0 Demonstrating isocentre location within the patient 1 Select the patient surface and make it opaque The lasers should be on 2 Turn on the patient s skin marks isocentre marks using the tools apply skin marks option The lasers will line up with the markers on the patients skin 3 Turnon the field light and SSD to show how the patient can be set up Vertual Ltd Nov 2011 Page 72 of 111 Version 1 0 4 Zoom inside the patient by pushing the mouse away from you to drive in to the view 5 The relationship between the isocentre lateral and anterior skin marks is now visible Different angles will show this relationship well Vertual Ltd Nov 2011 Page 73 of 111 Version 1 0 When choosing another patient with a target volume make the PTV transparent and turn on the axes The isocentre for the plan is clearly visible Demonstrating the Anti collision option within VERT 1 Activate the anti collision option in VERT
26. bar to change the dose value Move the slider underneath for Transparency to see the target volume inside the dose surface Vertual Ltd Nov 2011 Page 38 of 111 Version 1 0 Dose Surface Display Dose Level 5900 cGy Transparency Colour a Move the transparency slider to the left most position the dose surface will be opaque Units Absolute cGy _ Ji 7 100 8549 Global Maximum 8549 cGy The default viewing option for dose is absolute dose in cGy Look to the bottom of the dose menu The option to enter the prescription dose is greyed out a Eee Units Relative V Units Relative 100 8549 cGy 100 8100 cay Global Maximum 8549 cGy Global Maximum 8549 cGy Change the Units to Relative in the drop down menu The 100 value can now be changed Enter the prescription dose into this box Vertual Ltd Nov 2011 Page 39 of 111 Version 1 0 V Dose Surface Display Dose Surface Display Dose Level 100 0 Dose Level 105 5 i i i i i i i i i i i i i i Transparency Colour Transparency Colour o HI o M This changes the maximum dose value visible to the percentage global maximum of the plan Dose Surface Display Dose Level 103 7 Transparency Colour Make the target volume transparent and view doses over 100 within the target volume Turn on the dose surface display and view CT images for the pa
27. ble to the Linac the simulated couch controls on the web browser touch screen display or by using the machine tab The couch controls are accessed from the home page in the touch screen option on the 3 tab Varian Elekta and Siemens couch controls will appear depending on the Linac selected in the main VERT window VERT Remote VERT Presenter Linac Control Couch Control S PANEL TEST ROOM FIELD SSD LASER BKPTR Vertual Ltd Nov 2011 Page 86 of 111 Version 1 0 een ae Uae a sores bx 7 r gt VERT Remote Windows Internet Explorer lie JEJ EJ gt 6 http localhost 8080 touchscreen index html l r adi B Google E File Edit View Favorites Tools Help zs E Ea jy Favorites 9 heyt email Microsoft Outlook Web Acce Q vertual Ltd WebEx Enterpris Home vertual webmail Suggested Sites Free Hotmail a K VERT Remote ie VERT Presenter Linac Control Couch Control A VERT Remote le il VERT Presenter Linac Control Couch Control Od Zi p all does Oot COntaln marKersi 1 Load the patient into VERT make the patient outline transparent and turn off other structures Vertual Ltd Nov 2011 Page 87 of 111 Version 1 0 2 Choose the CT tab from the bottom right hand menu section and turn on the transverse CT Machine CT BEY COM Visible Transparent Transverse 145 00 A
28. by selecting Activate Collision Detection from the scene menu Block 4 Field 20x20x20 water VERT File View Tools ERSE Machine gt Room k Activate Collision Detection Face Mask gt Show Volumes Breast Board gt Electron b 2 Rotate the gantry collimator and couch to cause a collision T x The gantry and couch will appear red and an alarm bell will sound on collision Vertual Ltd Nov 2011 Page 74 of 111 Version 1 0 A margin is allowed around the machine and also around the patient The show volumes option is seen below with the patient margin This show volumes option is not usually needed in normal VERT operation 3 To extend the patient so a full length patient is taken into account select the patient position tab and extend patient volume Patient Position Anterior Pos mm Superior Inf o0 mm Right Left o0 mm Extend patient Height 1828 mm a Offset o0 z mm This option ensures that when the area of collision is outside the CT slice set the collision will still be shown Vertual Ltd Nov 2011 Page 75 of 111 Version 1 0 Chapter 10 Demonstrating patient separation using VERT and a block This exercise provides an example of how VERT may be used to demonstrate the concept of separation to students This example may also be useful to explain SSD field and isocentric fields Patient required the Block demonstration patient from the CD
29. ccussectonssscnensssessouevecuonesscneosssestonssss 100 PAC ALOM INOUE S nire reire heidi cere ENA cuales ANN cub daca N E N naan ued 100 PAGE OCU CUION ss jcis toot nt cues dernctich otietauictiscni eu teenbata a ta dy ald tanh ea teas sds a 100 REVISION aes isex vated nes aen a a Ee T e E A E EA 100 Demonstration facilitator led aniier E E EN 100 Student EXErO SES aaran a a a aN 101 Demonstration facilitator led Single fields Parallel pair techniques cccccccccscssseeeeeeeeeeeeeeeeeeees 101 Demonstration facilitator led Terminology sscseccosesscsosssscsecsssectonssscnensssessousvectenssscneosssessenssss 102 SLUGS ME IE MEN CISC 2 53565 hetcaaccacen a sense ondae lee a a wake nuboe dea teGoeehsoacgaewhas cacekemabeaten aeaepaaoeates 102 SUMMA E SECSSION ses casaceceiecscet cans teca ti talte sa E eacivnaceta bana E lacs ear aceto seatene 102 Chapter 15 Linear accelerator initial visualisation SESSION cccccceeccceeecccenecccenccceecseeueceseueceeeneceeenses 103 FACHILAUOl NOLES erann a a adi ex gaylean a e a e NN 103 Vertual Ltd Nov 2011 Page 3 of 111 Version 1 0 INtFOGUCTION ANC iNitial SCOPING sisser isiin endinn EE EE E E E EiS 103 D mon straton taciltatorledsraerae n an hesaa A a 103 Hned Accelerator ROOM iresi N E E ius eedeuh tna acitedu ceereubtannesevens 103 SUMMI E SE SON eea E N E oes 105 Chapter 1o Technidue Prostate niai a A toons 106 Facilitator Notes cascani T T EN T 106 intro
30. d ctonand inital SCO DIN sirieias nde a n 106 REVISION anato ern O a re ere 106 DISCUSSION pre treatment carie E A A EA A Ao 106 Demonstration focilitator led serna a a N 107 SUEN E MON CISC pn dean scat E N a oe donedets bevadatace 107 DEMONStration Taciitator led nren N E 107 Student Exercise plan CritigUe sive eisar a iaeaa Salant nee a ieee tae lee noe eae ead 108 PS CUSSION posttreatment N a N a EN 108 SUMMAS ESE SSON iea EE E EE EEE EEN aadoenasnntesmeas 108 SECTION 3 EXaMmPIE lea a a a a a A al cat ira a E rok 109 FCAT NINN OTOS ta tects ctu A E E E E E EEE EEN E 109 MOUORT R 109 REVISION a R E E E E A sient 109 Demonstratiom faclhitator led aee E vue S E EA N vein 109 Student EXErO SES aarne A 109 Demonstration further demonstration next concept to be explained ccesccccssecceeesseeeeeeeeees 109 Demonstration facilitator led Next concept essssssssessersssrrressrerssrrrsssreresrrressreresreressrerssreresereesseerese 110 Student EXEO S E aar e e NN 110 SUMMAS E SESSION ceert a A N E E E 110 EXIME Zeci wiaacecdaeucubes segauocdausanete pian qecaauncse se acomosdanec asia wtoneouaaecsbanavounatiabcaeete Wakes 111 LESSON Plan OMUSING WER I cahaieiesnicusaete Basdatatcosecs S S 111 Vertual Ltd Nov 2011 Page 4 of 111 Version 1 0 Purpose This workbook will be used during VERT training and can also be used to refresh VERT knowledge post training Each session is designed for use with the demon
31. e Ee FE SF eee EF FF te FF ies im Custom colors al ta Hue 0 Red 255 BEER HEH SE d Sat 240 Green 173 Define Custom Colors gt gt ColorlSolid Lum 204 Blue 173 Change the transparency of the patient outline by right clicking the name external or patient outline and choosing the required transparency level EA Colour t F Dose Colour Wash Eo iF Transparency Opaque Appearance b 25 yee 50 C 7 0 75 iN a ete Change the transparency so the patient outline is opaque The outline should look like the image below Vertual Ltd Nov 2011 Page 20 of 111 Version 1 0 When choosing 75 transparent the body outline should look like the image below Turn on the CTV using the toggle box cm 4 Surfaces i w 1 External Q zem CO 3 re long 4 lilong oC 5 litteken f 6 GTY O 9 PT1 r 10 CTV1 geclipt _ 11 PTY2 geclipt 12 beide longen ii rT 75 transparency gives good visualisation of internal structures Visualisation of CT slices Select the CT tab from the lower right hand menu Vertual Ltd Nov 2011 Page 21 of 111 Version 1 0 Visible Transparent C Transverse 747 00 O Coronal 0 00 sagittal 0 00 f eek fear tei D Aue GAY RNA CB band 8 Bat WAM Seare oar 8 Click visible and turn on the transverse CT by using a left mouse click in the toggle box The CT planes are now visible Move the Transverse slider to nav
32. e and change the transparency to fully opaque Add dose colour wash and ask the students to explain why there is very little dose deposited on the skin in this technique e Get the students to give you a proposed prescription for this patient activating the dose surface display will confirm what the delivered total dose was Discussion post treatment e Based on the dose distribution prescription applicable to this patient discuss possible side effects that may occur both acute and chronic e Discuss how these side effects might be treated alleviated to include patient instructions e Discuss how a change in technique may improve worsen the side effects the patient may experience Summarise session e Ask any additional questions that you deem are relevant e Review additional prostate plans if available and there is time e Finally check if there are any questions from the students Vertual Ltd Nov 2011 Page 108 of 111 Version 1 0 Section 3 Example Session Planners Example 1 Please complete the session description using the outline below e Title of session here Facilitator Notes Introduction e Insert time for the session e What other sessions or technique anatomy sessions should this session be delivered close to e Check with the students whether 2D or 3D is preferred Revision Set the scene Ask some brief revision questions of the students Demonstration facilitator led e Plan import
33. e switched on and the body is made transparent Vertual Ltd Nov 2011 Page 15 of 111 Version 1 0 Immobilisation devices VERT has the option of a breast board and also a face mask The process for moving the patient onto the immobilisation device is the same for both Patient position When a patient is first loaded into VERT and the breast board turned on using the Machine Breast Board option it is likely the patient will not be in the correct potion on the couch The position can be selected using the Anterior Pos Superior Inf and Right Left arrows as shown here Vertual Ltd Nov 2011 Page 16 of 111 Version 1 0 Patient Position one Anterior Pos S mm Superior Inf mm Right Left o mm Extend patient Height 1828 gt mm Offset o0 mm This needs to be done once only for the patient When importing the patient again the position will be remembered Vertual Ltd Nov 2011 Page 17 of 111 Version 1 0 When setting up the patient on the breast board zoom inside the patient outline and see if the patient is in the couch Use the Anterior Posterior arrows to lower the couch as above Turn off the breast board and note that the patient remains in the position they were in when the breast board was present Remove the breast board before importing another patient Vertual Ltd Nov 2011 Page 18 of 111 Version 1 0 Chapter 3 Manipulating structures Default
34. eated Ask them to describe the beam arrangements that they have witnessed in the clinical department Revision anatomy Import a prostate plan and ensure that all surfaces and contours are invisible Ensure that no beams are visible In Scene gt Machine remove the gantry and the couch Activate the CT visualisation in all three planes view may be changed to full screen if required Get the students to identify key structures and relations to the prostate on the CTs to include Prostate Seminal vesicles Bladder Rectum Left and right femoral heads Associated small bowel O OF Oo 0 O In particular with bladder and rectum get the students to indicate what the tolerance doses are for these structures Discussion pre treatment Vertual Ltd Nov 2011 Page 106 of 111 Version 1 0 e Ask the students to explain what pre treatment preparation the patient would need to do This is in particular relation to the requirement for a full bladder and the reasons for this Demonstration facilitator led e Reactivate the gantry and couch e Visualise the following internal structures Bladder Rectum Femoral Heads GTV and or CTV O O 0 e Use the CT sliders to move through the slices in all three planes demonstrating how internal structures are outlined and rendered from the CT dataset on the planning system Once this is completed deactivate the CTs Student Exercise o Ask the students what the
35. eencodecsemaoaiaeates 28 ES IEC OS CAINS variscserrroncetece te vtse var E E dem aus nasa ongennc ost outs nc acaduisss eons vasneatesaueute veueeie 29 B am Eye View display i cesecteecnceaae ch tecteiacoocasmubseseegenevecnicbeorencesaavossutaevecaesssucoudh EE EA AE AE ENERE aE A EEEE 31 Deliver an IMRT or VMAT beam ccccccsssssssseccccccceneesseecccceesaaeeseeeceeeessaaeuseeeeceeessueassseeceeesesuaeaseseeeeeenaaas 35 Chanter S 9B 051 2 0 lt 1 9 eeri E E 37 Chapter 6 Viewing ICRU dose levels USING VERT c csseccccsssececesececeesecceceusececeuneceeeeeeeeeseuaeceeseneceeseneeeetes 44 CAET Z SIMUL EOTS ean E ceeistnen death cicaiomsin cats anaaad nenigu tau abeadanuuewas badcosaecet roman nce 46 CAMES N 0 ec Medd cial e eet ee me ne ee ne nen E 50 Use olihe VIN Ula Presem E T cernar serch nite sc Seisspea sees naps seen pes pes sacs ease nese eee eee 50 FCF OG IC ni1 scxicceteahtactcencce sense PESES TET E E EET E EE EE E E EEE EEA 50 EEI TUO a S E 53 Savine ESNIE NON asea E A T N 57 Vertual Ltd Nov 2011 Page 2 of 111 Version 1 0 Creatine a New SIC CSOW sisi dscoacescsvansesdave teaSesundoadavnassvacsnniace E tae an eedanaaaaetaniee 58 Using automatic timings to run through the virtual presenter slides ccccceeccceeecceeeseeeeeseeeeeseeeeeeees 60 creatine SSIIDCSMOW En reene cdot adc ett Sia a lana aiNe N eek iaaanlca xe 62 Deleting a Virtual Presenter Tle ssie a a dere veteteuioadvedies 65 Chapter 9 R
36. eft 0 mm Rotation lo deg I Yv A Roll 0 Is deg he A Pitch 0 deg Show values Vertual Ltd Nov 2011 Page 46 of 111 Version 1 0 Wh Le F i il gt Dose Setup Error pati 4 gt Dose Setup Error Pati Anterior Pos 9 mm Anterior Pos mm Superior Inf nin Superior Inf 1 mm Right Left mm Right Left 7 mm Rotation deg Rotation 0 deg Roll deg Roll 0 deg iii deg Pitch 1 deg Show values Fra a Show values Click the Zero button to reset the error and move the patient back to the isocentre position Click the Random button to generate a random error The magnitude of the shift can be made visible by ticking the show values box When a setup error is generated the patient moves off the isocentre position so the lasers and field light do not align with the patients marks Turn on the dose surface display and then generate an ant post shift The dose surface will no longer cover the target volume Vertual Ltd Nov 2011 Page 47 of 111 Version 1 0 The beams will also not cover the target volume when a set up error is entered into VERT and the Beams eye view will display the field centre and isocentre in different locations as below Add the patient outline to a plan with a setup error and view the dose coverage and the location of the lasers with respect to the skin marks Turn on a beam and view the bea
37. he software live Reminder the scenes created are not a fixed jpeg image the software options can still be selected in the usual way and the view manipulation tools are still active The scenes are a Starting point to begin explaining concepts The virtual presenter is Patient specific two patients cannot be combined into the same slideshow file and two plans for the same patient will also require separate slideshows The file created is machine specific Introduction Access the virtual presenter option from the view menu Vertual Ltd Nov 2011 Page 50 of 111 Version 1 0 File Tools Scene Help Toolbar Status Bar Re Plan Browser Control Panel Display Monitor Virtual Presenter Simulated Errors and Yariances Stereo 3D b Tracking Layout d Full Screen Fii Focus on Iso Center Reset Camera The following window will open Virtual Presenter 3D Slides X To create a virtual presenter slide click the camera icon Create 5 slides for a Virtual Presenter file irtual Presenter 3D Slides R Rename each slide to do this click the left mouse slowly twice on the slide name Vertual Ltd Nov 2011 Page 51 of 111 Version 1 0 Virtual Presenter 3D Slides X Slide 2 Slide 3 Slide 4 Slide 5 T e s Delete the 3 slide EJ irtual Presenter 3D Slides structures CT images dose visualisation set up error x aj a z To delete a
38. igate through the slices Transverse 747 00 Use the Window and Level sliders to adjust the greyscale appearance of the CT slices Window 4 Level Vertual Ltd Nov 2011 Page 22 of 111 Version 1 0 Click to turn on the Sagittal and Coronal CT planes The sliders can be used to navigate through the other CT planes 5 ey Beams E e Beam 1 j Beam 2 4 Beam 3 E Contours E P Points surfaces W 1 External 2 cT 1 D 3 re long oa O 4 lilong S litteken C 6 GTY C 7 cTv2 a PTV 35 gt LLL Explore the contours option to view how structures appear when using this option The contours drawn on the CT slices will be visible This can be useful when reviewing contouring and is an alternative to using the transparency option for a structure Contours Al O 1 External J C 2 cTv1 D 3 re long C 4 lilong C S litteken C clipt 7 clip2 8 clip3 Mi Structures are turned on in the same way as contours Vertual Ltd Nov 2011 Page 23 of 111 Version 1 0 Turn on the patient outline as contours and rotate the view to see how the internal structures can be viewed when using this option Vertual Ltd Nov 2011 Page 24 of 111 Version 1 0 Markers are easily visualised I P Points a 1 11 AA 2 12 3 Isocenter 1 4 Isocenter 2 5 Isocenter 3 JR surfaces ay CT Vertual Ltd Nov 2011 Page 25 of 111 Version 1 0 Chapter 4 Beam display Patient
39. ing display J ay Beams A SE Eeam 1 Segment 1 ay Beam 2 ey Beam 3 Standard plan or conformal plan with 1 segment SJ Beams A E my Beam 1 4 H Segment 1 H Segment 2 H Segment 3 H Segment 4 Segment 5 Segment 6 H Segment 7 Segment 8 Segment 9 Segment 10 Segment 11 H Segment 12 F Senment 13 4 IMRT plan with multiple segments Vertual Ltd Nov 2011 Page 28 of 111 Version 1 0 a Beam 1 a fy Beams f a i Segment 1 E I Segment 2 Beam 1 a Segment 3 ae Ss Segment 4 3 Beam 2 A Segment 5 7h GA Segment 6 E Contours G Segment 7 re 4 Surfaces E g ge H Segment 8 ED Segment 9 oy CT 2 4 Segment 10 H Segment 11 Segment 12 8 Segment 13 G1 Seament ia Y Arc beams the A on the folder show this type of plan this will be the display for RapidArc and VMAT plans Display multiple beams Click the beams option and right click for the menu to appear Select Show All Show All am 1 Hide All Segment 1 am 2 Colour m3 Transparency gt H P Points ey Beams i y Beam 1 E my Beam 2 B ay Beam 3 The beam names will show in bold and all will be visible Vertual Ltd Nov 2011 Page 29 of 111 Version 1 0 Individual beams can be switched off using a right click and the hide beam option P Poi Hide Beam Play Animate Colour Eo amp Transparency gt C Full Length i f
40. is case a new patient should be selected Vertual Ltd Nov 2011 Page 91 of 111 Version 1 0 Chapter 12 IGRT workflow Patient required any patient loaded onto VERT Time 30 minutes This session will cover the following Accessing the IGRT option Using random error option Matching images Interaction between IGRT interface and VERT set up error menu To access the IGRT window select IGRT from the VERT touch screen home page if you don t have a VERT touch screen you can also view the touch screen page on your VERT PC screen An internet connection is not required this is a local internet connection x Be Windows Live Bing O What sNew Profile Mail Photos Calender MSN Share A gt IGRT Workflow 1 Within the main VERT window a patient is loaded Ideally have the patient outline visible and the skin marks switched on 2 With the lasers on it is clear that they pass through the isocentre marks skin marks on the patients skin Vertual Ltd Nov 2011 Page 92 of 111 Version 1 0 3 Wenow need to introduce a simulated error in position We can do this by pressing the Random button as shown below Press random to introduce a set up error 4 Inthe IGRT window web browser click Acquire You will now see the planned and actual images overlaid Vertual Ltd Nov 2011 Page 93 of 111 Version 1 0 Click acquire to generate a pair of Mages 5 A pair of images are generated which
41. isplay on a touch screen PC installed with the main VERT system or Apple iPad this iPad option requires additional software Select the touch screen option see VERT user manual or ask trainer how to do this and then select the slides on the right hand side to advance them Vertual Ltd Nov 2011 Page 64 of 111 Version 1 0 lice K EAEAN Fie Edt View Favortes Toos Heb Wy Fevortes eB heyt emal Microsoft Outlook Web Acce Q vertual Ltd WebEx Enterpris Home Vertual webmail Sug ected i Home Ju TouchScreen R NERT Remote VERT Presenter Linac Control Couch Control Camera Control Slide Control Slide 1 Slide 2 HEE Heacoo Virtual presenter slides can also be advanced using the buttons on an xBox controller Separate instructions are available to install this option Deleting a Virtual Presenter file To delete a file overwrite an existing slideshow file using a new slideshow with the same name Vertual Ltd Nov 2011 Page 65 of 111 Version 1 0 Open the open folder option and select delete on the keyboard The following message will display Select yes and the slideshow will be deleted workbook sho My Recent Documents eC Confirm File Delete Deskto aS 7 oa o AUS f pm Pa d My Computer File name workbook sho v a Files of type Slideshow files sho v My Network C Open as read only Vertual Ltd Nov 2011 Page 66 of 111 Versi
42. lected dose value are displayed in dark blue y 3 Bladder int PTY 4 Bladder C 5 Bones f actw ha g E gn BEV Dose Setup Entsik Transparency Colour E Show Colour Map Colours Colour Wash Range l Yo Min 50 0 Max 95 0 Choose the threshold option for dose colourwash display from the drop down menu l V Show Colour Map Colours Colour Bands Colour Wash Colour Bands Threshold Range Min 0 0 Max 104 8 The structures will all be yellow Move the range sliders as before to view dose thresholds EE JA Surfaces 1 Body 2 Bladder wall 3 Bladder int PTY 4 Bladder O 5 Bones f act x gt BEY Dose Setup Eridi Dose Surface Display Dose Level 103 7 Transparency f Colour a E iel Shon Colour Map Colours Threshold v Range o Min 0 0 Max 104 8 Units Relative v 100 7000 Global Maximum 7333 cGy Vertual Ltd Nov 2011 Page 42 of 111 Version 1 0 Vertual Ltd Nov 2011 Page 43 of 111 Version 1 0 Chapter 6 Viewing ICRU dose levels using VERT Patient required any VERT patient Time 10 minutes This session will cover the following Entering dose prescription Viewing dose values over 100 When the dose menu is first selected the dose display will be in absolute mode and the maximum visible dose will be 100 Units AbsolutecGy 100 Global Maximum 854
43. m coverage relating to the target and the increase in the volume of organs at risk within the field Vertual Ltd Nov 2011 Page 48 of 111 Version 1 0 The set up error option is highly visual when used with the dose colourwash option Recreate the image above using the colourwash option the dose slider and the set up error Further exercise incorporating the set up error menu is available in Chapter 12 IGRT workflow Vertual Ltd Nov 2011 Page 49 of 111 Version 1 0 Chapter 8 Virtual Presenter Patient required any patient loaded onto VERT Time 30 45 minutes This session will cover the following Creating virtual presenter files using camera icon Deleting individual slides Renaming slides Reordering slides Adding an image Deleting a virtual presenter file Starting a new file Slideshow storage location Creating a virtual presenter file on a laptop and moving to the main VERT system Use of the virtual presenter The virtual presenter can be used to prepare sessions up front This has the following advantages Time saving less mouse clicks to get to what is required A way pointer to the next discussion point Delivery by anyone with facilitator notes Saves scenes points in time in the software Allows the presenter to focus on teaching rather than on the software allowing more time to spend on explaining less on driving the software Can reduce the pressure of driving t
44. n the right mouse button and push the mouse forward to zoom closer into the image Show MLC Leaves Style Outline w Rotat Transparent d Zoom Outline Change the appearance of the MLC leaves in the image by selecting a different option from the dropdown menu The above image shows the MLC leaves visible as outlines Vertual Ltd Nov 2011 Page 34 of 111 Version 1 0 Show MLC Leaves Style Transparent v Show MLC Leaves a Style Solid v When choosing the transparent or solid MLC leaf visualisation option the image will look like the examples above Deliver an IMRT or VMAT beam To animate the leaf motion during beam delivery right click on the beam and select Play animate The sounds of the MLC leaves travelling can be heard rs stn d Show Beam am 2 Hide Beam am 3 Play Animate am 5 Colour rs Transparency P x Full Length Vertual Ltd Nov 2011 Page 35 of 111 Version 1 0 a Beams E ay Beam 1 Segment 1 Segment 2 Segment 3 Segment 4 4 Segment 5 Segment 6 Segment 7 Segment 8 Segment 9 f Segment 10 Segment 11 H Segment 12 4 Senment 13 Clicking on an individual segment will show the MLC leaf positions during the segment Click on a segment under the beam name and view the MLC leaves Vertual Ltd Nov 2011 Page 36 of 111 Version 1 0 Chapter 5 Dose display Patient required any patient loaded onto VERT
45. ollimator Tick the MLC Port visualisation option A small beams eye view display will appear at the lower left hand corner of the main VERT window Change the beams eye view by left clicking on a different beam name in the plan browser Rotate MLC Leaves Zoom to Fit Collimator Change the orientation of the beams eye view window the collimator will be angled and the patient straight using the Rotate MLC leaves tick box Tick the Enable DRR box to show the DRR image Select a bone preset and change the window level and window width Split the main screen by choosing the dual view option from the view menu Vertual Ltd Nov 2011 Page 32 of 111 Version 1 0 lle Tools Scene Help Toolbar N Status Bar Plan Browser v Control Panel Display Monitor virtual Presenter Simulated Errors and Variances Stereo 3D d Tracking A y Single view Full Screen Fil Dual view Focus on Iso Center mee Reset Camera Ra a s iia wn aioi uo myne man The DRR image will appear on the right side of the screen An in field image is present by default To view DRRs or structures outside the field borders untick the zoom to fit collimator option Eg ver Tools Scene Help g Rotate MLC Leaves Zoom to Fit Collimator Vertual Ltd Nov 2011 Page 33 of 111 Version 1 0 aa LA ni II ANIL HITTIN g AI Sy More information is now available To zoom in hold dow
46. on 1 0 Chapter 9 Radiation therapy concept visualisation using VERT Patient required block patient Time 15 minutes This session will cover the following lsocentre visualisation using axis feature Front pointer Full length shortened Skin marks View skin marks from inside the patient Patient separation Anti collision lsocentre visualisation using axis feature Isocentre visualisation using axis feature Load the block patient Turn on the axis feature from the scene machine menu Vertual Ltd Nov 2011 Page 67 of 111 Version 1 0 Block Single Field 20x20x20 water VERT File view Tools Siam Help mi Gantry Visible Room gt y Couch Yisible Collision gt Couch Wireframe Face Mask gt Breast Board Block 10x10x3cm Electron Front Pointer 100cm oe Front Pointer 95cm Adjust Couch Rails ky Imager MY Imager The axes appear at the patient isocentre Turn on the lasers and see the isocentre sphere co incidence with the lasers Vertual Ltd Nov 2011 Page 68 of 111 Version 1 0 Turn on the front pointer using the Scene Machine Front pointer 100cm option Click with left mouse on beam 1 to view the beam Select the machine tab and type 180 into the gantry angle Vertual Ltd Nov 2011 Page 69 of 111 Version 1 0 Select the patient surface and make the patient 20 transparent to see the axes inside the patient The patient and
47. owser top right section The section to the top right of the main VERT screen contains information from the DICOM files of the loaded patient Prior to a patient being loaded this section will be blank Once a patient is loaded the beams contours reference points structures and CT slices will appear mx gt gt Machine cT BEV Jay Machine Varian CX v The empty Plan Browser in the top right prior to patient loading Kox e Beams 4 ay Beam 1 ay Beam 2 ay Beam 3 ay Beam 4 Beam 5 ay Beam 6 e Beam 7 Contours Points Surfaces CT BDO H H ee ee ee be et The Plan Browser in the top right once a patient is loaded Vertual Ltd Nov 2011 Page 7 of 111 Version 1 0 This section is used to change the displayed objects from the treatment plan where a circle or Square appears in VERT this is a toggle on toggle off box Using a right click of the mouse when hovering over a structure will give further options for beams contours structures and points E Sey Beam 5 P E E Beam 6 a 7 5 FEMUR_LT a E Beam 7 2 6 FEMUR RT CI Contours S k E F Points 1 8 5KIN EHF Points i Surfaces 7 1 Fiducial Marker 4 1 LGTY 2 Fiducial Marker vw 2 RECTUM _ 3 Fiducial Marker wv 3 BLADDER D 4 Fiducial Marker 4 PENILE_BULB a Sea Marker PU 5 FEMUR_LT LGN 6 FEMUR_RT GA 2 RECTUM K 7 PTV S 7 fri ANNFP z iw 8 SKIN co
48. patient information does not appear in the top left hand side of the VERT screen Some Anonymisation programs do not remove data from this tag in the RT plan file mamma3D2 lemporary_56_defplan0 50Gy VERT aG view Tools Scene Help e Plan type Select the plan type option from the patient tab lower left of the VERT screen Patient Position 4 gt Anterior Pos Ei S mm Superior Inf o S mm Right Left o mm _ Extend patient Height 1828 s mm Offset 0 mm e The same window will open as during the plan load process e Change the plan type and see where the patient is positioned on the couch Examples are below e Plan type unknown Vertual Ltd Nov 2011 Page 14 of 111 Version 1 0 e Plan type head neck p e Plan type thorax e Plan type prostate Selecting a plan type is needed the first time a patient is loaded into VERT when subsequently loading a patient the position will be based on the plan type chosen and where applicable any shift in patient position will be remembered The plan type can be changed by the user at any time using the option to select plan type in the patient position tab e The easiest way to turn on structures is to right click the structures option in the plan browser and select default view Select this option Default View Default Dose Wash GTV Show All CTY Hide All PW GA 5 Pulm de v 6 Pulm sir Y7 Cor e All structures ar
49. phase 2 are not one directory level lower This will result in the following error messages in VERT Loading DIC Pier Failed to import DICOM plan correctly lf this happens reselect file import and locate the correct directory the directory containing the plan files and the plan will load as normal Vertual Ltd Nov 2011 Page 12 of 111 Version 1 0 Browse for Folder Choose DICOM Plan Folder H PUB_CMS_HeadandNeck_CM5_080 S E PUB_CMS_Lung_CMS_081 gt phase2 PUB_CMS_Lung_IMRT_CMS_E_079 O PUB_CMS_Lung_IMRT_CMS_E_085 E PUB_CMS_Prostate_CMS_083 phase1 O phase2 PUB_OISI_Brain_RA_ECL_ _072 PUB_OISI_Prostate_RA_ECL_ _073 F DIR S Hasad arl TAMOT DOW S mA A e Select the required patient and hit OK Loading DICOM plan step 2 of 5 Loading DICOM plan step 3 of 5 Creating contours For Pulm dex Plan type The first time a patient is loaded into VERT the plan type will be requested Plan Type Eg Please confirm plan type Unknown Cancel This places the patient in a reasonable location for the plan type Select one of the options The patient plan will be loaded into the plan browser on the top right hand side of the VERT screen Vertual Ltd Nov 2011 Page 13 of 111 Version 1 0 J ay Beams ay Beam 1 ay Beam 2 ay Beam 3 Contours LP Points H surfaces bat CT Machine cT Bey lt gt e Ensure the
50. position support apparatus would be for this patient o Add the external structure and activate the skin marks Add a random setup error and get the students to align the patient with the lasers and field light o Once aligned activate the axes and make the external structure semi transparent Zoom into the axes within the CTV to indicate how accurate alignment of the patient is critical in order to ensure that our isocentre is in the right position Demonstration facilitator led e Ask the students to comment on what they think the beam arrangement for this case is e Click on each beam in turn to visualise Discuss any MLC shaping static dynamic IMRT at this juncture e Ask the students to explain which of the beams would be wedged and why e Visualise all beams together and zoom into their intersection around the GTV CTV At this point activate the PTV surface Vertual Ltd Nov 2011 Page 107 of 111 Version 1 0 e Display the dose colour wash on all surfaces except the external and add the colour map Change the units to whatever is most appropriate and familiar to the student group Student Exercise plan critique Ask the students to comment on the dose distribution paying particular attention to the following Bladder Rectum Femoral heads PTV GIV CTV O O OOO e Ask the students how the distribution might differ if alternative beam arrangements techniques were used e Display the external structur
51. relevant to session Describe patient and what structures etc the patient should have e Steps needed to show the required elements Student Exercises e Hands on description the students will partake in e Next steps once the initial hands on is complete e Further questions and answers Demonstration further demonstration next concept to be explained Activity 1 Activity 2 Activity 3 Questions Vertual Ltd Nov 2011 Page 109 of 111 Version 1 0 Demonstration facilitator led Next concept e Activity 1 e Activity 2 e Activity 3 Student Exercise o Describe hands on for the students Summarise session e Activity 1 Activity 2 Activity 3 e Ask any further questions that you deem are relevant e Finally check if there are any questions from the students Vertual Ltd Nov 2011 Page 110 of 111 Version 1 0 Example 2 Lesson plan for using VERT Subject Created by Tags key words Subject description Suggested year group and number of students Previous student experience Session aim The aim of this session is to J Session By the end of this session you should be able to objectives outcomes e Approx Content amp teacher activity Resources Student activity time Suggestions Example 2 courtesy of Louise Coleman from University College Suffolk For further information about VERT and VERT training please contact the training department Email training vertual co uk
52. required any patient Time 30 minutes This session will cover the following Single beam display Full length shortened Multiple beams display Active beam v etc Beam visualisation options BEV visualisation and dual view How to tell what type of beams are available Beam animation Viewing a single segment Single beam display The number of beams for a plan will be shown in the plan browser on the top right hand side of the screen Contours Z amp surfaces ey CT To view a beam click on the beam name Vertual Ltd Nov 2011 Page 26 of 111 Version 1 0 The beam will display transparent and shortened as above Right click on the beam and select the full length option The beam will be lengthened making it easy to show divergence Right click on the beam name and select transparency Choose 20 transparent The beam will appear as below This can be useful when viewing the coverage of beams and inclusion of structures and organs at risk Vertual Ltd Nov 2011 Page 27 of 111 Version 1 0 Click on the minus sign on the left of beams This will collapse the menu so the number of beams is not visible During student discussion where the number of beams is under discussion this option can be useful j Beams it Contours H surfaces H A CT Beam Types To view the type of beam in the plan click plus next to the beam name The plan type can be determined from the result
53. rkers created and exported from the treatment planning system Method 2 No markers are exported from the treatment planning system Method 1 plan contains markers 1 Load the patient into VERT make the patient outline opaque using right click on the Body outline in the structures section of the top right hand menu and turn off other structures 2 Turnon the marker points to be used as reference markers Turn on the markers using the points option on the top right hand side of the screen Here the markers are called 11 12 and 13 if possible left lat right lat and anterior would have been useful To turn the markers on use the round green tick box to toggle them on Vertual Ltd Nov 2011 Page 80 of 111 Version 1 0 g By Beams po iS ary Beams ay Beam 1 q wy Beam 1 Beam 2 ay Beam 2 Contours Contours P Points EP Points if eres W 1 11 OO 2 22 2 12 0 3 3 W 3 13 a 4 14 OO 4 14 5 15 5 15 oO 6 16 ae 6 16 a 7 Isocenter 1 Isocenter 1 3 C e ocene 2 7 _ 8 Isocenter 2 2 bie z cp 4 hea 3 l 1 Patient Tata ad 3 Set up the marker appearance to maximise the visibility of the markers on the patient s skin and according to preference The appearance size and colour can be changed by right clicking on the marker name and choosing an option S P Points wv 1 11 wv 2 12 iw 3 in Appearance a size b Siy el Colour S 7 Isocenter 1 __ 8 Isocenter
54. slide highlight the slide for deletion using a left mouse click and then push the cross button Recreate a slide to replace the 3 one The last slide created will always be placed at the end of the list irtual Presenter 3D Slides X structures CT images dose visualisation set up error Slide 1 rhs e s Vertual Ltd Nov 2011 Page 52 of 111 Version 1 0 Reorder the slides so the 3 slide is now labelled slide 1 To do this pick the slide up with the left mouse and drop it in the slide name in the position you would like it be in Yirtual Presenter 3D Slides X structures CT images Slide 1 dose visualisation set up error Inserting pictures Insert a photograph into the slideshow To do this use the insert picture button at the bottom left of the menu on the third row irtual Presenter 3D Slides X structures CT images Slide 1 dose visualisation set up error Look in O BrairNXarian_Rapid4RC_PTVI5F1_SIB_0O072 5d e m My Recent Documents Files of type All image types jpa png v C Open as read only File name My Network Insert picture the windows explorer box will open Go to the directory containing the image you wish to use and click open Vertual Ltd Nov 2011 Page 53 of 111 Version 1 0 irtual Presenter 3D Slides X structures CT images Slide 1 dose visualisation set up error verttest
55. stration patients provided by Vertual Similar patients can be substituted if required This workbook is designed to improve knowledge of the VERT system in practice and complements the VERT user manual Vertual Ltd Nov 2011 Page 5 of 111 Version 1 0 Chapter 1 Interface overview The interface of VERT has been designed to be simple to use intuitive and user friendly Block 4 Field 20x20x20 water VERT olx File View Tools Scene Help a S E Beans Top right hand menu Aen Beam 3 Ej Contours Ea lk Bottom right hand menu Anterior Pos Right Left C Extend patient Height 1828 Offset The Main Menu top left menu This contains options to change the viewing and display of the main VERT window Also the top left hand section is used to load patients and set preferences for the system status Bar w Plan Browser Control Panel Display Monitor Virtual Presenter Tracking Layout Focus on Iso Center Reset Camera Vertual Ltd Nov 2011 Page 6 of 111 Version 1 0 The View menu as selected from top left area of the screen W Gantry Visible yw Couch Visible Collision Couch Wireframe Face Mask Show Axes Breast Board Block 10x 10x3icm Electron d Front Pointer 100cm Front Pointer 35cm Adjust Couch Rails MV Imager The Scene menu as selected from top left area of the screen The Plan Br
56. t of sag and replication of the same patient position on a daily basis e Import in the VHF plan so that a field can be visualised e Explain the concept of the primary and secondary collimation systems these define the radiation field Focus on the secondary collimation system They are a combination of straight collimators creating a rectangular square field notated by an X and Y value and multi leaf collimators which can shape to the target Introduce the term field size e xX and Y the field size on most linear accelerators can be set between 4 x 4cm 40 x 40cm The field is the same as the radiation beam and this is a divergent Vertual Ltd Nov 2011 Page 104 of 111 Version 1 0 beam This means that the radiation beam is bigger the further away from the target Demonstrate this by extending the visible beam to full length and projecting onto the treatment room wall with the gantry at 270 or 90 degrees ODR the Optical Distance Reader This may be referred to as the ODI optical distance indicator SSD source to skin distance or FSD focus to skin distance depending upon the department you are in This indicator shines onto the patient s skin and demonstrates the distance from the patient s skin to the focal spot in the treatment machine The isocentre the isocentre is the point around which everything rotates This is a fixed point inside the room which is 100cm from the focal spot Vis
57. this folder Other Places E PUB_CMS_Lung_CMs_081 age_ CT_Image_ oa e L s CT_Image_ CT_Image 3 B CT _Image_ CT_Image_ RT_Plan_St RT_Structur Anonymisation e During export the patient data should be anonymised Vertual recommends that all data used for training should be fully anonymised prior to use Vertual Ltd Nov 2011 Page 11 of 111 Version 1 0 e For assistance with the process please email support vertual co uk Loading a patient into VERT To load a patient into VERT select the file import option Untitled VERT sim view Tools Scene Help New Ctrl N Modules gt DICOM Plan Export Ai Preferences Exit e A window will open allowing navigation to the correct directory where VERT plans are stored If all VERT patients are stored in one location this default directory will always be correct making it easier to find the required plan Browse for Folder Choose DICOM Plan Folder PUB_CMS_HeadandNeck_CM5_080 PUB_CMS_Lung_CMS_081 gt PUB_CMS_Lung_IMRT_CMS_E_079 O PUB_CMS_Lung_IMRT_CMS_E_085 PUB_CMS_Prostate_CMS_083 phase E 5 phase2 PUB_OISI_Brain_RA_ECL_ _072 PUB_OISI_Prostate_RA_ECL_V _073 PUB_S_HeadNeck_IMRT_PRW_5_062 O PUB_S_Prostate_IMRT_PRW_5_061 A DUR STAD CMS V Nde ae gt A e Make sure the directory contains only the elements needed and that phase 1 and
58. tient Another dose visualisation option within VERT is the dose colourwash option Right click on the word structures and select the Default Dose Wash option Vertual Ltd Nov 2011 Page 40 of 111 Version 1 0 m ve Surfaces Default View 1 Body Default Dose Wash 2 Bladder Wall Show All 3 Bladder int PTY Hide All 4 Bladder iw 5S Bones C 6 cT A coloured view of the dose distribution will appear Select the Show Colour Map option from the dose menu to view the dose values for the colours o n surfaces C 1 Body 2 Bladder Wall 3 Bladder int PTY 48 ee G 4 Bladder C 5 Bones ArT Mi J lt gt RA R a BEY Dose SetupEri Dose Surface Display 62 9 Dose Level 103 7 j D Transparency f Colour E 4 9 and Show Colour Map Ane Colours Colour Wash Y Range Yo 21 0 J Surfaces C 1 Body Vertual Ltd Nov 2011 Page 41 of 111 Version 1 0 C 2 Bladder Wall 3 Bladder int PTY Qe 4 Bladder C 5 Bones f Yactw x gt P BEY Dose SetupEr Dose Surface Display Dose Level 103 7 a Transparency Colour 3 m Show Colour Map Colours Colour Wash Range Yo Min 0 0 Max 85 2 Units Relative v Move the right hand handle of the slider in the range window The dose over the selected value will appear as a dark maroon colour Now move the left hand handle of the slider Doses below the se
59. ualise the isocentre via the Show axes option in the Scene gt Machine menu and also add the 100cm front pointer and the lasers Rotate the gantry and move the couch to visualise how movements relate to it If available all students should now take turns with the Varian Elekta and Siemens handsets By the end of the session all of them should be able to demonstrate an ability to toggle the room lights field lights ODR and lasers and the capability to use all couch and gantry movements If available visualise the virtual couch controls for each machine Allow the students to explore and use these controls Summarise session Ask the students to name the three main manufacturers of linear accelerators Get them to tell you the two modalities that linear accelerators operate on Ask them what the isocentre is and explain that this concept will be expanded upon in future sessions What does collimation enable us to do Ask any further questions that you deem are relevant Finally check if there are any questions from the students END OF SESSION Vertual Ltd Nov 2011 Page 105 of 111 Version 1 0 Chapter 16 Technique Prostate Facilitator Notes Introduction and initial scoping This session should be timed at around 1 hour Check the students requirements as to whether or not they all are comfortable utilising the VERT system in stereoscopic 3D mode Confirm that all students have seen prostate patients tr
60. ve this file Copy this file Send To A Publish this file to the Web Cut G E mail this file Copy XK Delete this file raal Sheckcur Delete Rename Other Places Properties s Removable Disk Es E My Documents Shared Documents 4 My Computer My Network Places Details Right click on the file and select the copy option Open the folder icon in the virtual presenter menu and click paste in the window Open x Look in Brain_Varian_RapidSRC_PTVI5F1_SIB_OO 72 w 09 F e g 1 My Recent Documents Files of type Slideshow files sho v My Network C Open as read only Vertual Ltd Nov 2011 Page 63 of 111 Version 1 0 Look in Brain Varian RapidSRC_PTVISF1_SIB_OO77 v O P e m E workbook2 sho My Recent Documents E Desktop My Documents 43 My Computer File name workbook2 sho v M Files of type Slideshow files sho i My Heak C Open as read only Select open and the slides will be present as usual N B When creating a slideshow file on a remote machine any pictures e g JPEG images will need to also be saved and reloaded into the slideshow file on the main VERT system The images are not actually saved in the slideshow file only the link is saved irtual Presenter 3D Slides X A Slide 1 E Slide 2 4 Slide 3 i z The virtual presenter slides can also be advanced using the touch screen d
61. view Structure visualization options Structure manipulation CT data visualisation Default view In the plan browser menu on the top right hand side of the VERT screen select the default view by right clicking on the word structures and selecting the default view option from the dropdown menu Default view aie Default Dose Wash Show All Hide All Patient GTV CTY gt o PIT KA 5 Pulm de 6 Pulm sir L Frar The result is that all structures will be turn on including the patient outline The patient outline will be rendered transparent Right click on surfaces and select hide all from the drop down menu This is the easiest way to have all structures invisible Structures can be toggled on and off individually by ticking the red circle using a left mouse click Turn the patient outline on Vertual Ltd Nov 2011 Page 19 of 111 Version 1 0 SB surfaces wv 1 External w 2 CT 1 3 re long 4 lilong 5 litteken 6 6T 7 cTv2 8 PTy2 9 PTv1 10 CT 1 geclipt 11 PT 2 geclipt C 12 beide longen co oT bu Change the colour of the patient outline using a right mouse click on the patient outline name and select the colour option T Colour F Dose Colour Wash i yd ong Transparency dng Appearance b leken A window will open with colour options Select the desired colour Color Basic colors ni Ge eee EESE fee FF ioe gE ee ee e
62. with dose information Time 15 30 minutes This session will cover the following Patient without dose information Dose Cloud display Changing transparency of dose cloud display Changing colour of dose cloud display Dose colourwash Dose colourwash and adding structures Dose colourwash options Dose colourwash slider Viewing dose distributions from the planning system Viewing comparing plans When importing a plan the following message sometimes appears This can happen when the dose per beam has been exported from the treatment planning system Also if several dose grid files are present in the patient directory VERT will sum the dose files more than one DICOM DOSE File exists in this Folder attempting to merge BEV__ Dose SetupEn Dose Surface Display Dose Level 100 cGy oe Transparency Colour 4 E C Show Colour Map Colours Colour Wash v Range cGy J Min o Max 100 Units Absolute cGy v 100 Global Maximum 100 cGy The dose tab is located at the bottom right hand side of the VERT interface Vertual Ltd Nov 2011 Page 37 of 111 Version 1 0 Dose Surface Display Dose Level cGy Transparency Colour If a dose file is not present for a patient the dose surface display box will be greyed out Choose a plan with dose turn on the target volume and two organs at risk Tick the dose surface display box and use the slider

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