Varian Medical Systems VCDT711N Visual Coaching Device (VCD) User Manual UserManual

Varian Medical Systems, Inc. Visual Coaching Device (VCD) UserManual

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UserManual.pdf

Respiratory Gating forScanners Instructionsfor Use13485P1010335-004-C DECEMBER 2015Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)
Document ID P1010335-004-DDocument Title Respiratory Gating for Scanners Instructions for UseAbstract This document provides reference information and procedures for the followingproduct:■Respiratory Gating for Scanners 1.1This publication is the English-language original.Manufacturer Varian Medical Systems, Inc.3100 Hansen WayPalo Alto, CA 94304-1038United States of AmericaEuropeanAuthorizedRepresentativeVarian Medical Systems UK Ltd.Oncology HouseGatwick Road, CrawleyWest Sussex RH10 9RGUnited KingdomNotice Information in this user guide is subject to change without notice and does notrepresent a commitment on the part of Varian. Varian is not liable for errorscontained in this user guide or for incidental or consequential damages inconnection with furnishing or use of this material.This document contains proprietary information protected by copyright. No part ofthis document may be reproduced, translated, or transmied without the expresswrien permission of Varian Medical Systems, Inc.FDA 21 CFR 820Quality SystemRegulations(cGMPs)Varian Medical Systems, Oncology Systems products are designed andmanufactured in accordance with the requirements specied within this federalregulation.ISO 13485 Varian Medical Systems, Oncology Systems products are designed andmanufactured in accordance with the requirements specied within the ISO 13485quality standard.CE Varian Medical Systems, Oncology Systems products meet the requirements ofCouncil Directive MDD 93/42/EEC.EU REACHSVHC DisclosureThe link to the current EU REACH SVHC disclosure statement can be found at hp://www.varian.com/us/corporate/legal/reach.htmlHIPAA Varian’s products and services are specically designed to include features that helpour customers comply with the Health Insurance Portability and Accountability Actof 1996 (HIPAA). The software application uses a secure login process, requiring auser name and password, that supports role-based access. Users are assigned togroups, each with certain access rights, which may include the ability to edit andadd data or may limit access to data. When a user adds or modies data within thedatabase, a record is made that includes which data were changed, the user ID, andthe date and time the changes were made. This establishes an audit trail that can beexamined by authorized system administrators.WHO ICD-O codes and terms used by permission of WHO, from:■International Classication of Diseases for Oncology, (ICD-O) 3rd edition,Geneva, World Health Organization, 2000.2Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
ICD-10 codes and terms used by permission of WHO, from:■International Statistical Classication of Diseases and Related Health Problems,Tenth Revision (ICD-10). Vols 1–3, Geneva, World Health Organization, 1992. Electronic labelingThis symbol on the label indicates that the Instructions for Use for thecorresponding product are available at www.MyVarian.com. Access the Instructionsfor Use in electronic form by logging in with your assigned MyVarian usercredentials.In compliance with EU Commission Directive No 207/2012, Varian will send EUcustomers a free printed copy of the Instructions for Use within 7 days. Use the“Paper Document Request” form provided on the Varian webpage to order yourcopy.CAUTION: US Federal law restricts this device to sale by or on theorder of a physician.Trademarks ARIA® is a registered trademark, TrueBeam™, VitalBeam™, Edge™, Clinac™, andReal-time Position Management™ are trademarks of Varian Medical Systems, Inc.Microsoft® is a registered trademark of Microsoft Corporation.All other trademarks or registered trademarks are the property of their respectiveowners.Copyright © 2013–2015 Varian Medical Systems, Inc.All rights reserved. Produced in Swierland.Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)3
ContentsCHAPTER 1 INTRODUCTION ...............................................................................................................7About this Publication ......................................................................................................................................7About Respiratory Gating for Scanners ....................................................................................................... 7Intended Use ............................................................................................................................................... 7Clinical Workflow for Scan and Training Session .............................................................................. 8Visual Cues ......................................................................................................................................................... 9Contact Varian Customer Support ............................................................................................................... 9CHAPTER 2 SAFETY ............................................................................................................................. 11Safety Overview ................................................................................................................................................11Symbols Used on Equipment Labels .................................................................................................... 11Battery Safety ............................................................................................................................................ 13Maintaining System Integrity ............................................................................................................... 13Unauthorized or Modified Software ............................................................................................ 13Unauthorized Hardware ................................................................................................................. 14Network Impact ........................................................................................................................................14Third-Party Devices ..................................................................................................................................14Authorized Maintenance and Service ........................................................................................................ 15Preventive Maintenance .........................................................................................................................15System Specifications and Requirements ..................................................................................................15Electrical Specifications ..........................................................................................................................16Environmental Specifications ...............................................................................................................16Environmental Specifications for Transport and Storage .............................................................. 17Backpointer Laser Specifications ..........................................................................................................17CHAPTER 3 SYSTEM OVERVIEW ......................................................................................................18Client Application ............................................................................................................................................18Scan Workspaces ......................................................................................................................................18User Interface ............................................................................................................................................19Hardware Layout ..............................................................................................................................................21Camera and Reflector Block ..........................................................................................................................22Camera Controls .......................................................................................................................................23RGSC Cabinet ................................................................................................................................................... 24Patch Panel ................................................................................................................................................ 25Visual Coaching Device (VCD) ......................................................................................................................26VCD Battery and Charging Station ......................................................................................................27CHAPTER 4 PREPARE THE EQUIPMENT ........................................................................................ 28Prepare the Equipment (Overview) ............................................................................................................28Clean the Reflector Block ..............................................................................................................................28Cleaning Other Equipment .......................................................................................................................... 28Start up the System and Log in ................................................................................................................... 29Mount the Camera on the Couch ............................................................................................................... 294Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Calibrating the Camera ................................................................................................................................. 30Calibrate the Camera (Couch-Mounted) ........................................................................................... 30Verify the Camera is Calibrated (Wall- or Ceiling-Mounted) .........................................................31Calibrate the Camera (Wall- or Ceiling-Mounted) ........................................................................... 31Mount the Visual Coaching Device on the Couch ...................................................................................33Replace and Recharge the Battery of the VCD ................................................................................. 34Power On/Off of the VCD ...................................................................................................................... 34Using the VCD in Maintenance Mode ................................................................................................ 35Resolve Alerts ...................................................................................................................................................36CHAPTER 5 PREPARE THE SESSION AND THE PATIENT ..............................................................37Prepare the Session and the Patient (Overview) ..................................................................................... 37Patient and Session Data .............................................................................................................................. 38Open or Create a Patient Record ..........................................................................................................38Entering the Date of Birth .....................................................................................................................39Open or Create a Session .......................................................................................................................39Choosing a Type of Scan ................................................................................................................................39Saving and Loading Default Settings ................................................................................................40Using the Breathing Predictive Filter ..........................................................................................................41Enabling Visual Monitoring of Patient Motion ........................................................................................41Choosing a Coaching Mode ..........................................................................................................................42Visual Prompt Styles ............................................................................................................................... 42Using the VCD in Demo Mode .....................................................................................................................44Place the Reflector Block ...............................................................................................................................45Learning the Breathing Pattern .................................................................................................................. 46Baseline ...................................................................................................................................................... 47Adjusting the Gating Window .....................................................................................................................47Scaling ................................................................................................................................................................47CHAPTER 6 ACQUIRE RESPIRATION-SYNCHRONIZED IMAGES ..............................................48Prepare the Scanner .......................................................................................................................................48Acquire Images with Prospective Gating ................................................................................................. 48Acquire Images with Retrospective Gating ............................................................................................. 49Gating Buttons ................................................................................................................................................49Monitoring the Respiratory Trace ...............................................................................................................49Colors Used in The Respiratory Trace Chart ......................................................................................50Phase Dial ..................................................................................................................................................50Periodicity Meter ...................................................................................................................................... 51Monitoring of Patient Motion .............................................................................................................. 52About Phase Calculation in Real Time ................................................................................................ 53CHAPTER 7 FINALIZE THE SESSION ................................................................................................55Finalize the Session (Overview) ................................................................................................................... 55Reviewing a Session ........................................................................................................................................55Shifting the Baseline ...............................................................................................................................56Gating Type for Treatment ............................................................................................................................57Export for Treatment ...................................................................................................................................... 57Export for 4D Reconstruction .......................................................................................................................58Select a Start Time for VXP Export ...................................................................................................... 58ContentsDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)5
Close the Session ............................................................................................................................................ 59Shut Down the System ..................................................................................................................................59APPENDIX A SYSTEM CONFIGURATION ...................................................................................... 60User Groups .....................................................................................................................................................60Application .......................................................................................................................................................60Export ................................................................................................................................................................. 61Export File Structure and Format ........................................................................................................ 63Scanner ..............................................................................................................................................................65VCD ..................................................................................................................................................................... 67Database ...........................................................................................................................................................68Archive .............................................................................................................................................................. 69Camera ..............................................................................................................................................................69APPENDIX B EMC DATA AND GUIDANCE ..................................................................................... 71Electromagnetic Compatibility (EMC) ........................................................................................................ 71Electromagnetic Interference (EMI) .....................................................................................................71Varian Test Declarations and Guidance ..............................................................................................72Visual Coaching Device WLAN Specifications ...................................................................................77INDEX ........................................................................................................................................................ 786Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Chapter 1 IntroductionAbout this PublicationThis publication is primarily intended for physicists, radiation oncologists, andradiation therapists, who perform respiration-synchronized image acquisition andtreatment delivery. It describes the most common procedures for using theRespiratory Gating for Scanners (RGSC) system in clinical use and providessupporting information.The appendix has basic information about system conguration for systemadministrators.About Respiratory Gating for ScannersRespiratory Gating for Scanners (RGSC) is an accessory system to diagnostic imagingdevices. The system is used to observe and record the respiratory motion of a patientand to transfer this information to the imaging device and to radiation treatmentplanners. With integrated audio coaching and optional visual coaching, the systemguides the patient in achieving a more regular and predictable breathing paernduring image acquisition or treatment delivery.■Imaging devices use respiratory motion information to synchronize theiroperation with the respiratory motion of the patient. They either acquire imagesbased on the trigger signal received from RGSC (prospective mode) or they use therespiratory motion information for 4D reconstruction after the scanning process(retrospective mode).■Radiation treatment planners use respiration-synchronized images to ensure thatthe images used for planning and simulation correspond to a know breathingstate that can be detected or reproduced before and during treatment, therebyenabling beam-on when and only when the patient is in that respiratory state.Intended UseFor image acquisition, Respiratory Gating for Scanners supports the followingprocesses:■Acquire respiratory traces by optically detecting the motion of a reector block,typically positioned on the abdomen of the patient.■Acquire respiration-synchronized images in connection with a diagnostic CT orPET scanner.Chapter 1 IntroductionDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)7
■Acquire respiration-synchronized 4D images (referred to as retrospectively gatedimages) in connection with a diagnostic CT or PET scanner.To assist respiration-synchronized image acquisition and treatment delivery,Respiratory Gating for Scanners supports the following processes:■Assess the amplitude and regularity of the external respiratory motion of thepatient.■Provide audio and visual coaching to the patient to achieve more regularrespiration.■Congure three dierent types of gating: phase gating, amplitude gating andbreath-hold gating.The system uses chest wall or abdominal motion as a surrogate for respiratorymotion of the tumor and other organs and structures within the body. The adequacyof this surrogate indicator for application to the treatment of any specic patientcondition or setup must be based upon clinical evaluation using CT imaging andother studies as deemed appropriate. These judgments are the sole responsibility ofqualied medical personnel using the equipment.Clinical Workflow for Scan and Training SessionIn addition to respiration-synchronized image acquisition (scan session), you canexecute training sessions for the following purposes.■Check whether a patient is able to breathe as needed for respiration-synchronizedimage acquisition or treatment delivery.■Familiarize the patient with coaching techniques.■Select appropriate options for respiration-synchronized image acquisition.The training session workow is a subset of the scan session workow, according towhich the chapters in this publication are structured.Table 1 Clinical WorkflowStep Task Description Scan Training1Chapter 4 Prepare the Equipment ✓ ✓2Chapter 5 Prepare the Session and the Patient ✓ ✓3Chapter 6 Acquire Respiration-Synchronized Images ✓-4Chapter 7 Finalize the Session ✓-You can use a training session later to acquire respiration-synchronized images andnalize the session. If you do, the training session becomes a scan session.8Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Visual CuesThis publication uses the following visual cues to help you nd information:WARNING: A warning describes actions or conditions that can result in serious injury ordeath.CAUTION: A caution describes hazardous actions or conditions that can result in minor ormoderate injury.NOTICE: A notice describes actions or conditions that can result in damage to equipmentor loss of data.Note: A note describes information that may pertain to only some conditions, readers, or sites.Tip: A tip describes useful but optional information such as a shortcut, reminder, or suggestion,to help get optimal performance from the equipment or software.Contact Varian Customer SupportVarian Customer Support is available on the internet, by e-mail, and by telephone.Support services are available without charge during the initial warranty period.The MyVarian website provides contact information, product documentation, andother resources for all Varian products.1. Go to www.MyVarian.com.2. Choose an option:■If you have an account, enter your User login information (email andpassword).■If you do not have an account, click Create New Account and follow theinstructions. Establishing an account may take up to two working days.3. Click Contact Us at the top of the window to display customer support andtraining options, and international e-mail addresses and telephone numbers.Chapter 1 IntroductionDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)9
4. From the Contact Us page, choose an option:■Call Varian Medical Systems support using a phone support number for yourgeographic area.■Complete the form corresponding to your request for use on a call with a liveVarian representative; then follow the instructions to complete the remoteconnection.You can order documents by phone, request product or applications support, andreport product-related issues. Links on the MyVarian website navigate to othersupport resources for products, services, and education.5. To nd documents, click Product Documentation.Online documents in PDF format include customer technical bulletins (CTBs),manuals, and customer release notes (CRNs).10Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Chapter 2 SafetySafety OverviewGeneral safety precautions apply to the operation of Respiratory Gating for Scannersand all associated equipment. Procedures include warnings and cautions describinga particular hazard.Where applicable, hardware and software are designed to meet current internationaltechnological and safety standards, for example, IEC for the protection of users andpatients.The hospital is responsible for establishing emergency and safety procedures toensure safe operation and maintenance conditions. Hazards can be encountered, andrisks cannot be ruled out completely. Thus operators must follow instructions andprocedures in this manual to guarantee safety of patients and operators.Symbols Used on Equipment LabelsSymbols found on equipment labels have the following meanings:Potential injury or damage to equipment: Observe safety precautions.Consult accompanying documents.Laser radiation: Do not stare into beam; observe laser safety precautions.Radio frequency radiation: Do not operate this equipment with the covers,output cable, or interlock cover removed. Radio frequency energy cancause injury or burns.Hazardous voltage: Disconnect power before servicing. Contact may causeelectric shock or burn.Baery safety: Do not expose baery to re.Baery safety: Do not expose baery to water.Chapter 2 SafetyDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)11
Baery safety: Do not charge baery that may be damaged.Consult instructions for use. Follow operating instructions.Type B applied part: This part complies with the specied requirements ofEN 60601-1 to protect against electric shock, particularly regardingallowable leakage current.Protective earth (ground): Identied terminals are intended for connectionto earth (ground) for protection against electric shock.EEE waste: The equipment has been designated as electrical and electronicequipment (EEE) that is not to be disposed of at the end of its life asunsorted municipal waste. EEE contains substances that may be hazardousto human health and to the environment. It must be recovered, reused,recycled, or otherwise treated and disposed of properly.Recyclable material: This item can be recycled where correct facilities exist.Equipment manufacturer: This symbol appears adjacent to the name andaddress of the equipment manufacturer.Serial number: This symbol appears adjacent to the manufacturer’s serialnumber.Reference number: This symbol appears adjacent to the manufacturer’sreference number (catalog number).CE conformity: The equipment conforms to the ocial journal of theEuropean Communities Council Directive 93/42/EEC.ETL conformity: The equipment conforms to UL STD 60601-1. Certied toCAN/CSA STD C22.2 No 601.1-M90.China RoHS conformity: The equipment conforms to People’s Republic ofChina Electronic industry standard SJ/T11364-2006.12Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Battery SafetyThe baery for the optional Visual Coaching Device (VCD) is a lithium ion baery.Improper baery use may result in re, explosion, or other hazard. To avoid risk ofinjury, follow these instructions for using or storing the baery:■Only use the baery with the VCD.■Only use the baery with the dedicated charging station. Use of another chargingstation may present a risk of re, explosion, leakage or other hazard.■Do not disassemble or open, crush, bend or deform, puncture or shred the baery.■Do not modify the baery or insert foreign objects into the baery.■Do not immerse the baery in water or other liquids, or expose it to water, re,explosion, or other hazard.■Do not short-circuit the baery or allow metallic or conductive objects to contactthe baery terminals.■Replace the baery only with another VCD baery. Use of any other baery mayrisk re, explosion, leakage, or other hazard.■Promptly dispose of used baeries in accordance with local regulations.Maintaining System IntegrityModifying or altering the products, or the software in the products, in any wayconstitutes willful infringement of Varian's intellectual property and may endangerpatient safety. Any such modication or alteration will render the system adulteratedunder the United States Federal Food, Drug, and Cosmetic Act (or applicable law inthe territory) and could subject the customer or the authorized users to action by theUnited States Food and Drug Administration, resulting in seizure, injunction, civilpenalties, or criminal prosecution.WARNING: Do not modify the hardware or software. Unauthorized modification oralteration of the hardware or software may endanger patients, operators, or servicepersonnel.Unauthorized or Modified SoftwareModifying any of the software provided with the system, or installation and use ofany software other than that provided or validated by Varian, can seriouslycompromise the integrity of stored data and the performance of operationalapplications and can result in uncertain, unreliable, and potentially hazardoussystem operation.Chapter 2 SafetyDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)13
By accepting Varian's Terms and Conditions of Sale, you authorize Varian to removeany unauthorized software that has been added to, or altered, the system computer,its operating systems, or the control applications.To minimize system corruption that may result in serious damage to your system orin patient harm, follow these instructions:■Do not modify the system software, including the operating system, controlapplications, and data les.■Do not install software on the system.■Do not alter the conguration of the system installed by Varian personnel,including printed circuit boards, control devices, and all seings.Unauthorized HardwareUnapproved supplemental devices include the following:■Any device interfaced to the system using an unauthorized interface.■Any unapproved device interfaced to the system using authorized interfaces.Be aware that installation of an unapproved supplemental device has theseconsequences:■May modify or damage the calibration, performance, treatment, or safetymeasures installed.■Will void the Varian warranty.■Can result in the termination of applicable software licenses.■Could lead to severe patient injury or death.Network ImpactThe Varian Respiratory Gating for Scanners system is connected to your network,which may include other equipment. Varian has no control over how the network isused. It is possible that data trac from the Varian RGSC system could impact theoperation of other equipment and could result in previously unidentied risks topatients, operators, or third parties. The system owner is responsible for identifying,analyzing, evaluating, and controlling these risks.Third-Party DevicesYour site may use one or more non-Varian devices in the scanner room. Be sure torefer to the documentation that accompanies these devices.14Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Authorized Maintenance and ServiceOnly service personnel who have received the appropriate maintenance training andare authorized by the owner are allowed to perform maintenance and serviceprocedures.Authorized service personnel must know and follow safety procedures establishedfor local use by the owner during all service and maintenance procedures. They arealso required to take all precautions necessary to protect themselves, patients, andother persons from injury, and to protect the equipment from damage.Preventive MaintenancePreventive maintenance of the system is very basic and simple and if followedproperly can eliminate potential defects and hazards. Preventive maintenance isconducted to keep the equipment working and extend the life of the equipment.Elements of a good preventive maintenance program should include the following:■Identication of components that may malfunction.■Establishment of schedules and procedures for routine inspections.■Periodic testing of equipment for sound functioning.■Inventory of spare parts.For more information about general maintenance, contact Varian service personnel.System Specifications and RequirementsSpecications and requirements include electromagnetic, electric, environmental, andother specications.Note: Respiratory Gating for Scanners is a medical device that requires special safetyprecautions and must be installed and placed in operation in accordance with the publishedEMC test declarations and guidance provided.Related TopicsElectromagnetic Compatibility (EMC) on page 71Chapter 2 SafetyDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)15
Electrical SpecificationsType SpecificationMode of operation The system is classied as being suitable for continuous con-nection to the supply mains in the Power Saver mode. Thismeans that some elements of the system may be connected tomain electrical power even when the system is powered o.Type of protection againstelectric shockClass IDegree of protection againstelectric shockType BOperating voltage 100–240 V, 50/60 HzWARNING: To avoid risk of electric shock, ensure that the equipment is connected to asupply mains with protective earth.Environmental SpecificationsType SpecificationHumidity 15% to 75% relative, non-condensing humidityTemperature 15° to 28° C (60° to 80° F)Degree of safety of applica-tion in presence of a am‐mable anesthetic mixtureUnsuitable for use in the presence of a ammable anestheticmixture with air, oxygen, or nitrous oxideDegree of protection againstingress of waterIPX0 (Ingress Protection Rating) or not waterproof16Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Environmental Specifications for Transport and StorageType SpecificationHumidity 0% to 50% relative, non-condensing humidityTemperature −20° to 60° C (−4° to 140° F )Atmospheric pressure ≤ 15,000 feet elevationBackpointer Laser SpecificationsType SpecificationLaser class IIWavelength 650–660 nmPulse duration ContinuousPower output ≤ 1 mWChapter 2 SafetyDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)17
Chapter 3 System OverviewClient ApplicationThe client application is divided into three main areas:New Scan / Open Scan starts the main workow for dening a new sessionand acquiring respiration-synchronized images or for reviewing an existingscan session.Verication / Calibration starts the verication and calibration workowfor the camera. For ceiling-mounted or wall-mounted cameras, it guidesyou through the acquisition of the reector block positions on the couch inorder to calibrate the camera to the couch top.Conguration is where administrators can view the conguration ofapplication, export, scanner, VCD, database, archive, and camera. In addition, you also nd the following controls:Log Out / Log In opens the user authentication prompt.Exit Application closes the application.Related TopicsStart up the System and Log in on page 29User Groups on page 60Scan WorkspacesThe application is designed to facilitate navigation along the clinical workow. Whileit guides you from workspace to workspace, you can jump back or forth at any time.The typical workow for respiration-synchronized image acquisition guides youthrough the workspaces as follows:1. Initiate the workow under New Scan / Open Scan.2. Create or open a patient record under Patient.3. Create or open a session under Session.18Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
4. Specify scan seings under Seings.■Select a type of scan.■Specify gating and coaching options.5. Acquire respiration-synchronized images under Scan.■Actively coach the patient: Start and stop coaching.■Adjust the gating thresholds.■Record the breathing.■Monitor the breathing.■Turn gating on and o.6. Review a session under Review.■Review and apply the calculated baseline shift.■Review and export data for 4D reconstruction.■Review and export data for treatment delivery.■Close the session.User InterfaceThe user interface is divided into the following sections:12341. Info Panel2. Workflow Panel3. Control Bar4. Workspace PanelFigure 1 User InterfaceChapter 3 System OverviewDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)19
Info panel The info panel displays the name of the current user, the date ofbirth, rst name, and last name of the patient, and the patient ID.After opening a session, the info panel also displays the name of thecurrent session.The info buon i under the Varian logo opens the About RGSCwindow. It provides information about the operating system andthe application.If there are any pending alerts (RGSC Messages) for the system, anorange buon appears. The buon provides information about analert or opens a dialog box.WorkowpanelThe workow panel accommodates the buons for navigatingbetween workspaces. There is one buon for each workspace.Workspace buons are active according to user rights andworkow.WorkspacepanelPressing a buon in the workow panel opens the correspondingworkspace in the workspace panel. A workspace typically consistsof one panel, but it can include tabs.Control bar The control bar accommodates conrmation and cancellationbuons. It also displays the current date and time, and workow‐specic messages.20Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Hardware Layout1. RGSC Cabinet2. Workstation Unit3. Real-Time Unit4. Wireless Access Point (optional)5. Camera (on couch, wall, or ceiling)6. Visual Coaching Device (optional)7. Couch8. ScannerFigure 2 Hardware LayoutHardware components are installed in two main areas: the control room and thescanner room. The illustration shows the location of the main hardware components.The RGSC cabinet (including Workstation Unit and Real-Time Unit) and othercomputer peripherals are installed in the control room. The Real-Time Unit controlsthe interface to the scanner, camera and wireless access point in the scanner room.The camera can be mounted in a xed position on the wall or ceiling, or as a mobileversion on the couch with a dedicated couch mount.Chapter 3 System OverviewDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)21
Camera and Reflector BlockFigure 3 Infrared Tracking ConceptSupported Tracking DistancesThe camera delivers live video image data by tracking an infrared spectrum. It emitsinfrared light and detects the reections from the passive markers of the reectorblock. This allows identifying the exact position and orientation of the reector blockand tracking the respiratory motion. The camera is optimized to provide a high-contrast image of the reector block markers.Depending on the camera mount (couch, ceiling, or wall), one of the followingcamera lenses is in use:Camera Mount Lens DistanceWall or ceiling 25 mm 2500-5600 mmCouch 12 mm 1000-2500 mm22Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Camera ControlsThe following controls are available on the front of the camera.Connection Error indicates that there is no Ethernet connection betweencamera and the Real-Time Unit.Tool Detected indicates when reector block is detected by the camera, thereported position is within the dened volume and acquisition is started.IR Illumination indicates that infrared illumination is ON.Power indicates that power is ON.Conrm (buon) conrms the calibration process and can be used as analternative to the OK buon in the calibration workspace.Chapter 3 System OverviewDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)23
RGSC Cabinet1234351. Firewall and Network Switch2. Workstation Unit3. Status Indicators4. Real-Time Unit5. Height Adjustment (extract/retractwheels)Figure 4 CabinetThe RGSC cabinet includes two processor units. The Workstation Unit runs thesoftware application of Respiratory Gating for Scanners, the Real-Time Unit isresponsible for real-time image data processing.The Workstation Unit and the Real-Time Unit use the same three status indicatorsOn the Workstation Unit, red indicates a fan error is active.On the Real-Time Unit, the status indicator is not in use.Blue indicates that power is on.On the Workstation Unit, white indicates drive activity (SDD).On the Real-Time Unit, white indicates ash card activity.24Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Patch PanelAll interfaces to the hardware are connected through the patch panel located at theback of the cabinet.J3J5J6J4J13J12 J11 J10 J8J1J2J9 J7Supply Ratings100-240V, 50-60Hz, 240VA100-240V, 50-60HzJ3 DVI Monitor Output (primary) J12 Service PortJ13 DVI Monitor Output (secondary) J11 Hospital NetworkJ5 USB 1 J10 Wireless Access PointJ6 USB 2 J8 Camera NetworkJ4 Audio Output J1 Main Power Inlet and SwitchJ9 Scanner I/F J2 Monitor Power OutletJ7 Camera I/F Figure 5 Patch PanelNote: Use the monitor power outlet only for the monitor provided with the system. Use theaudio output to connect a speaker system and enable audio coaching.Chapter 3 System OverviewDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)25
Visual Coaching Device (VCD)The Visual Coaching Device (VCD) is an optional accessory used in the scanner roomto help the patient maintain a steady breathing paern. Visual coaching gives visualfeedback to the patient by displaying the current position and the targeted positionof breathing. Visual coaching can increase the accuracy of the absolute position of thebreathing process and the relative position within the breathing period.The VCD operates in combination with following other components:RGSCapplicationThe client application starts tracking on the Real-Time Unit,congures the coaching seings, and starts/stops the visualprompt on the VCD.Real-Time Unit The Real-Time Unit processes image data from the camera tocalculate the position and orientation of the reector block. Itthen distributes the data to the VCD and the workstation unit.The VCD includes various connectors, all located on the left side behind a cover.142351. Status LED (lit when booting or ready)2. External DC Power Supply3. Video Output4. USB5. Audio Output (no function)Figure 6 VCD ConnectorsThe external power supply used to power the charging station can also be connectedto the VCD. This connection may be required when no baery is available orsuciently charged.The video output can be used to connect to an external monitor, projector or goggles.The USB port can be used as power supply for external goggles (must be turned onand o in the VCD seings).26Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
VCD Battery and Charging StationTo ensure that one baery is always charged and available, the VCD comes with anadditional baery and a charging station. The charging station indicates the status ofcharging.1 2 31. Charging Station2. Charging Status Indicators3. BatteryFigure 7 VCD Battery and Charging StationDierent colors indicate the charging status:Red An error occurred. The red indicator is always accompanied by a greenindicator that identies the type of error.■If the rst indicator from the left is green, the connection is faulty.■If the second indicator from the left is green, the temperature of thebaery is too high or low (> 50°C or < 10°C).■If the third indicator from the left is green, an undened error occurred.To resolve the error, remove and reinsert the baery. If this does notresolve the error, replace the baery as it is likely damaged.■If the fourth indicator from the left is green, the power supply is faulty.Orange No baery is in the charging station.Green The baery is charging. The number of green indicators increases whilethe baery charges. The ashing indicator represents the current charginglevel. When the baery is charged, all indicators are lit (ashing stops).Related TopicsReplace and Recharge the Baery of the VCD on page 34Chapter 3 System OverviewDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)27
Chapter 4 Prepare the EquipmentPrepare the Equipment (Overview)This document describes use of Respiratory Gating for Scanners, but not itsinstallation and conguration. Such tasks must be performed by trained Varianpersonnel only. For information about conguration seings, refer to the appendix.1. Clean the reector block.2. Clean other equipment.3. Start and log in to the application.4. If the camera is couch-mounted, mount it.5. If necessary, verify the calibration of the camera or calibrate it or both.6. If available, mount and switch on the Visual Coaching Device (VCD).Make sure the baery is loaded.7. Review and resolve any remaining alerts (RGSC Messages).Proceed to prepare the patient and the session.Clean the Reflector BlockBefore each new patient, take special care to clean and inspect the reector block.1. Spray the reector block with a 70% to 90% isopropyl alcohol solution.2. Wipe with white sterile cloth.3. Allow to dry according to the manufacturer's instructions.4. Inspect for damage.Cleaning Other EquipmentUnlike the reector block, which requires special care, clean any other equipmentonly when needed:■Use only the following cleaning solutions and follow the instructions of themanufacturer:■Isotropy alcohol■CIDEX PLUS■Soap and Water (do not use to clean VCD couch mount)■Mild spray cleaner28Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
■Diluted chlorine bleach■Do not spray cleaning solutions. Pour solutions onto a cloth and wipe surfacesclean.■Wipe o excess cleaning solution.If you have questions about cleaning with chemical solutions, contact an authorizedVarian representative.Start up the System and Log in1. Switch on the workstation and log in to Windows.After logging in to Windows, the application initiates automatically.2. Log in to the application.Note: Your credentials for Windows and Respiratory Gating for Scanners are notsynchronized.Related TopicsClient Application on page 18User Groups on page 60Mount the Camera on the CouchThe following instructions only apply if the system has a couch-mounted camera.You can mount the camera before or after starting up the system. If the system isrunning, but the camera is not mounted, the application states Camera not ready.1. Engage the camera stand with the docking unit on the couch top.CAUTION: To avoid situations where the camera falls off the couch or on the patient,ensure that the locking mechanism is fully engaged.2. If unplugged, plug the camera cable into the stand and secure the plug with thetwist lock.CAUTION: To avoid situations where the cable disconnects during couch movements orscanning, ensure that the locking mechanism of the cable connector is fully engaged(snapped in).Chapter 4 Prepare the EquipmentDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)29
Up to a certain degree, the system is capable of detecting whether the camera ismounted correctly and will state Camera misaligned if a mismatch is detected.Nonetheless, an additional manual check is required.Calibrating the CameraCalibration of the camera is critical to the acquisition of reference data. If theequipment is not calibrated correctly, a discrepancy can occur between actualpositions and positions as determined by the system.Access to the Calibration workspace requires that the system be connected andrunning properly, and that you have the necessary access rights.WARNING: The camera must be calibrated after installation and after its position haschanged. If the camera has been moved and the calibration is no longer correct, theacquired data will be incorrect. Ensure that the camera is calibrated after being moved.Verify periodically.Calibrate the Camera (Couch-Mounted)The following instructions only apply if the system has a couch-mounted camera.Calibrate the camera periodically or when prompted by the system.1. Open the Calibration workspace.2. Place the reector block in the eld of view of the camera on the couch top,aligned with the couch axes.Use the laser system of the scanner for orientation.3. Click OK.Successful calibration is conrmed with the calibration result Calibrationpassed.30Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Verify the Camera is Calibrated (Wall- or Ceiling-Mounted)The following instructions only apply if the system has a wall-mounted or ceiling-mounted camera.Verify that the camera is calibrated under the following circumstances:■Daily (recommended)■When prompted by the system1. To access the verication wizard, choose Verication / Calibration >Verication.2. Place the reector block in the isocenter of the scanner.Use the laser system of the scanner for orientation.3. Click OK.The system automatically calculates reector block positions. After completion, theresult appears under Progress.■If verication was successful, Verication Results states Verificationpassed.■If verication was unsuccessful, Verication Results states Verificationfailed.If verication failed, ensure that no reective body interferes with the IR signalfrom the camera. To prevent reections from the couch top, place the calibrationboard under the reector block. Verify the correct alignment of the reector block.If verication fails several times, perform a new calibration procedure.Calibrate the Camera (Wall- or Ceiling-Mounted)The following instructions only apply if the system has a wall-mounted or ceiling-mounted camera.Calibrate the camera under the following circumstances:■If calibration verication failed■After repositioning the camera■After updating the software■Periodically or when prompted by the system1. To access the calibration wizard, choose Verication / Calibration > Calibration.2. Place the calibration board with position 1 in the isocenter of the scanner.Chapter 4 Prepare the EquipmentDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)31
3. Place the reector block on position 1 on the calibration board.Note: This position will be used for the verication process.A correct alignment of the reector block in the isocenter is essential for the entire calibrationprocess.4. Press the Conrm buon on the camera or click OK in the application.5. Move the reector block on the calibration board, following the chart displayedat the boom of the calibration display. After each position (2 to 9), press theConrm buon on the camera or click OK in the application. 32Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
The number of each step is highlighted successively through the positioningprocess.During calibration, the position of the reector block is displayed as follows:■If the system was already calibrated, it shows coordinates relative to thecalibrated isocenter position.■If this is the rst calibration of the system, no coordinates are displayed.Instead Valid or Not valid signals.At the end of the calibration, the system calculates the plane values.■If calibration is successful, Progress states Plane calculation is finished.■If calibration is not successful, an alert pops up and states The calibrationof the couch plane failed. Investigate and resolve possible causes, thenrepeat the calibration process. Possible causes can be the following:■Reections from other objects than the reector block (such as, couch top)interfere with the IR signal of the camera.■The distance between center position and any other position on the calibrationboard is too small (< 10 cm).■The orientation of the reector block at center position of the calibration boardis not valid.■The camera is not installed properly (wrong orientation, wrong angle to couchplane).■The surface on which the calibration is performed is not at enough.Mount the Visual Coaching Device on the CouchThe following instructions only apply if the system has a couch-mounted VisualCoaching Device (VCD).1. Aach the VCD couch mount base unit to the couch.2. Aach the VCD on the telescope to the couch mount base unit.CAUTION: If the Visual Coaching Device is not properly mounted, it can fall on thepatient causing injury. When using the Visual Coaching Device, always verify that thebase part of the couch mount is correctly attached and locked to the scanner couch topand that the telescopic arm is correctly inserted and locked in the base part.3. Switch on the VCD.4. Check the baery status and replace the baery if necessary.5. Check the network connection.6. If you are using video goggles, connect them to the video output terminal of theVCD.Chapter 4 Prepare the EquipmentDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)33
Replace and Recharge the Battery of the VCDTo avoid an unexpected shutdown of the VCD during image acquisition, check thebaery status of the VCD before each use.Note: The Visual Coaching Device must be running properly during the entire scan to ensurethat the patient is breathing periodically. Failure of coaching during acquisition can lead toirregular breathing. The scan may have to be repeated.1. Check the baery status on the VCD itself or in the desktop application■On the VCD, check the baery icon in the status bar. Alternatively, enter themaintenance mode (draw a capital M on the touchscreen), then choose theBaery tab.■In the desktop application, hover over the baery symbol in the coachingview. Alternatively, choose Conguration > VCD.2. If necessary, replace the baery with a recharged one.If you fail to replace the baery in time, the VCD shuts down without warning.3. Connect the dedicated charging station to the power supply and insert the emptybaery for recharging.CAUTION: Incorrect voltage applied to the charging station can cause overheating orfire. Connect only the power supply provided by Varian (P/N B503887R01) to the VisualCoaching Device or to the charging station.Related TopicsVCD Baery and Charging Station on page 27Power On/Off of the VCDThe power buon of the VCD has the following functions:■Press short: The VCD boots, goes to sleep, or wakes up.■Press long: The VCD announces that it is shuing down (normal shutdown). Ifyou keep the buon pressed for more than 5 seconds, the VCD forces a hardshutdown.34Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Using the VCD in Maintenance ModeThe VCD includes a maintenance mode to view the current state of the baery, toselect or check the network, and to adjust display seings.■To enter the maintenance mode from the home screen, draw a capital M on thetouchscreen.■To return to the home screen, touch the arrow symbol at the top left of thetouchscreen.Figure 8 Enter Maintenance Mode of VCDRelated TopicsUsing the VCD in Demo Mode on page 44Chapter 4 Prepare the EquipmentDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)35
Resolve AlertsIf the system has any pending alerts (RGSC Messages), the info panel of theapplication displays an orange buon labeled Functionality limited. Alerts can beerror messages, warnings and informational messages.1. To open the RGSC Messages dialog box, click Functionality limited.2. Resolve the cause of the rst alert (details and required actions are stated), thenclick it for conrmation.3. Resolve the cause of the next alert, then click it for conrmation.4. Repeat this step until all alerts are resolved and the OK buon is active.5. Click OK.36Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Chapter 5 Prepare the Session and the PatientPrepare the Session and the Patient (Overview)The following instructions assume that you have prepared the equipment.1. Open the patient record or create a new one.2. Open a session or create a new one.3. Select a type of scan (gating type), if applicable as prescribed.■To scan throughout the entire respiratory trace and reconstruct a 4D scan,choose 4D Scan.■To scan only while the respiratory trace is within the phase gating window(1 scanner rotation per window), choose Phase Gating.■To scan only while the respiratory trace is within the amplitude gatingwindow (1 scanner rotation per window), choose Amplitude Gating.■To scan only while the respiratory trace is held within the breath-hold gatingwindow (x scanner rotations per window), choose Breath-hold.4. If necessary, adjust the default seings of the selected type of scan.■To detect non-periodic breathing and prevent image acquisition if necessary,specify the breathing predictive lter.■For image acquisition with breath-hold gating, specify the delay with whichto acquire scans after reaching the gating window.■For image acquisition with phase gating, specify the thresholds of the gatingwindow in % relative to the inspiration peak (0% or 100%) and the expirationpeak (50%).■For image acquisition with amplitude gating and breath-hold gating, specifythe thresholds of the gating window in cm relative to the baseline determinedduring the learning process.5. If necessary, enable visual patient motion monitoring.6. Enable and congure coaching.■For audio coaching, select the language.■For visual coaching, select and congure a visual prompt style.You can set the motion range and coaching speed manually or allow the systemto determine them during the subsequent learning process.7. Instruct the patient on how coaching works and on how to breathe withassistance of the VCD (demo mode).Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)37
8. Set up the patient on the couch.WARNING: A mismatch between the patient on the couch and the patient data ondisplay can lead to the storage of the wrong gating data for that patient. Check thepatient details carefully against the patient on the couch to verify the correct patient isselected in the system.WARNING: RGSC supports only Head First Supine (HFS). If the patient orientation is notHFS, an inconsistency will result of the reference session with the delivery systemtreatment session. Ensure that only HFS is applied.9. Verify that the patient sees the VCD.10. Verify that the reector block is clean and undamaged.11. Place the reector block on the patient.12. Instruct the patient to breathe regularly.13. Start the learning process.The system starts to track four cycles of the respiratory trace. Based on thelearning process, the system determines the baseline (average expiration peaks).If enabled, the system also determines the motion range and coaching speed.Alternatively, both can be changed manually.14. If necessary, restart the learning process.The position of thresholds relative to their reference may change as a result.15. If necessary, adjust the gating seings and coaching seings.Depending on the purpose of the session, proceed as follows:■If the session is intended for training only, help up the patient, and close thesession.■If the session is intended for image acquisition, proceed to prepare the scannerand acquire respiration-synchronized images.Patient and Session DataDepending on the system conguration, the system saves and retrieves patient andsession data either in database mode or le mode.When you open the Patient workspace in le mode, it lists the patients that are in thesystem. In database mode, the list is empty.Open or Create a Patient Record1. To clear any previous entries and start a new search, click Clear.2. Enter search criteria in the available text boxes.38Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
3. Depending on the local conguration, do one of the following:■Click Find.■Click Filter.4. Do one of the following:■If the patient appears in the list, select it and click Open, or double-click it.■If the patient does not appear in the list, enter the mandatory data and clickCreate.Mandatory entries are highlighted.Entering the Date of BirthWhen you create a new patient record and go to Date of Birth, the current dateappears. You can then adjust the date in dierent ways.■Click the calendar symbol and select the correct date from the calendar.■Adjust the date via keyboard.■To move between day, month, and year, use the division key (on the numerickeypad) or the left and right arrow keys.■To adjust day, month, and year, enter the numeric value or use the up anddown arrow keys.Open or Create a SessionBefore you can open or create a session, you must open a patient record.The Session workspace lists the sessions (training and scan) that the patient has hadin the past. You can create a new session from scratch or use an existing session of thesame gating type as basis.Depending on your approach, do one of the following:■To create a new session from scratch, enter a unique session name and clickCreate.■To create a new session based on a previous session, select an existing session andclick Open, or double-click an existing session.The session opens in the Review workspace. To create a new session, change tothe Scan workspace, make adjustments as needed, and click Record. The systemprompts you to give the session a new name.Choosing a Type of ScanBefore you can choose a type of scan, you must open or create a session.Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)39
Retrospective Scan4DScanThis type of gating is intended for continuous acquisition of motion data toreconstruct a 4D scan retrospectively. Depending on the scanner model onsite, the gating system sends trigger signals at a predened phase (0° bydefault). Once the scan is complete, the scanner synchronizes therespiratory trace with the acquired image data to generate the 4D imageset.Prospective ScansPhaseGatingThis type of gating is intended for phase-gated image acquisition of afree-breathing patient. With phase gating, you dene the gatingthresholds based on phase values. The gating system sends a triggersignal to the scanner when the respiratory trace enters the gatingwindow. This allows acquiring a set of images at a specic couchposition. Once acquisition at a couch position is complete, thescanner moves to the next position and waits for the next triggersignal.AmplitudeGatingThis type of gating is intended for amplitude-gated imageacquisition of a free-breathing patient. With amplitude gating, youdene the gating thresholds based on amplitude values. The gatingsystem sends a trigger signal to the scanner when the respiratorytrace enters the gating window. This allows acquiring a set of imagesat a specic couch position. Once acquisition at a couch position iscomplete, the scanner moves to the next position and waits for thenext trigger signal.Breath-holdGatingThis type of gating is intended for gated image acquisition of apatient able to hold breath. With breath-hold gating, you dene thegating thresholds based on amplitude values. Depending on thescanner, the gating system sends one or several trigger signals to thescanner for as long as the respiratory trace is within the gatingwindow. During that period, the scanner acquires sets of images,moving from couch position to couch position.Saving and Loading Default SettingsYou can save and load specic gating seings as default for reuse on other scans.Save Gating Default Seings saves the current seings as default seingsfor a particular type of gating.40Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Click the arrow to the right on the buon to choose the applicable type.Load Gating Default Seings loads the default seings for a particulartype of gating. Once the site‐specic default seings are saved, defaultseings are automatically loaded for each new scan with the same type ofgating.Click the arrow to the right on the buon to choose the applicable type.Using the Breathing Predictive FilterFor image acquisition with amplitude gating, phase gating, or for 4D reconstruction,the breathing predictive lter monitors and predicts the breathing paern of thepatient to protect against misapplied radiation. The breathing predictive ltercalculates a periodicity value by comparing phase and amplitude values of the latestbreathing sample with the previous breathing paern of the patient. If the periodicityvalues fall below the dened range, the system stops triggering scans. You can adjustthe sensitivity of the lter to detect non-periodicity.100% means maximum sensitivity. 0% means the lter is disabled. The followingvalues are recommendations:■For image acquisition with amplitude gating and phase gating, use 20%.■For image acquisition for 4D reconstruction, use 5%.For images acquired with breath-hold gating, the lter is disabled by default.Related TopicsPeriodicity Meter on page 51Enabling Visual Monitoring of Patient MotionSelect Enable Visual Patient Motion Monitoring to continuously verify if thereector block position is within the learned range. If the reector block moves out ofthe learned range, the color of the ball (representing respiratory motion) changes.This monitoring is purely visual and has no eect on any other seings.Related TopicsMonitoring of Patient Motion on page 52Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)41
Choosing a Coaching ModeTo access the coaching seings, open the Coaching tab. Based on patientrequirements, you can choose either audio or visual coaching or both. If you useaudio and visual coaching together, consider the audio coaching oset (dened in theapplication seings).The goal of both coaching modes is to guide the patient toward a regular andreproducible breathing paern and speed.AudioCoachingAudio coaching supports two audio commands (Inhale and Exhale) ineach of the oered languages.Note: Audio coaching requires that a speaker system be installed. It is notincluded in the scope of supply.VisualCoachingVisual coaching supports three visual prompt styles, which aredisplayed simultaneously on the Visual Coaching Device (VCD) andthe desktop application if enabled. Communication to the VCD is rstestablished by the application.■For gating based on free breathing, choose Curve or Dog (orSlider).■For gating based on breath-hold, only Slider is available.You can set the motion range for visual coaching manually or let thesystem determine it during the learning process. Motion Rangedetermines the vertical range of the visual prompt style.CoachingSpeedYou can set the coaching speed (for audio and visual coaching)manually or let the system determine it during the learning process.Inspiration determines the time provided for breathing in, Expirationthe time provided for breathing out.Visual Prompt StylesWhen visual coaching is enabled, a visual prompt appears on the VCD and underCoaching in the Scan workspace. The patient is required to follow the visual promptand breathe accordingly. The following visual prompt styles are available:■Curve ■Dog ■Slider 42Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Curve and Dog visualize the targeted respiratory motion. These prompt styles areintended for free-breathing gating. The waveform shape is determined during thelearning process and bases on the actual breathing paern of the patient.1 12 23 31. Expiration peak target (optional)2. Current breathing position3. Inspiration peak target (optional)Figure 9 Curve and DogSlider visualizes the target area in which the patient is expected to hold breath. Eventhough this prompt style is primarily intended for breath-hold gating, it can also beused for the free-breathing gating types. In the laer case, the target area representsthe gating window that the patient is expected to cover while breathing. Gating stopsas soon as the white slider touches the blue area.1 2 1 21. Current breathing position2. Gating window (target area)Figure 10 Slider (breath-hold and free-breathing)Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)43
Using the VCD in Demo ModeThe VCD includes a demo mode to show the visual prompt styles to patients andinstruct them on how to breathe with assistance of the VCD.■To enter the demo mode from the home screen, draw a capital D on thetouchscreen.■To exit a prompt style animation, swipe from right to left on the touchscreen.■To return to the home screen, touch the arrow symbol at the top left of thetouchscreen.Figure 11 Enter Demo Mode of VCDRelated TopicsUsing the VCD in Maintenance Mode on page 3544Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Place the Reflector BlockBefore you place the reector block on the patient, always verify that it is clean andundamaged.CAUTION: Reuse of the reflector block can cause contamination to the patient. To avoidcontamination ensure that the reflector block is cleaned prior to each use according tothe cleaning instructions provided in this manual.If a patient has open wounds, cuts, or other breaks in the skin, apply gauze or otherprotective barrier between the reflector block and the skin surface to prevent risk ofinfection or contamination.WARNING: A wrong or damaged reflector block can cause an incorrect reflector blockposition to be measured. Do not use any other reflector block other than the oneprovided with the system (P/N B501928R02). Always visually inspect the reflector blockprior to each use. Replace the reflector block if any damage is noticed.After seing up the patient, place the reector block as follows:1. For the rst session, place the reector block with the reectors facing thecamera, where it is visible to the camera.■For the actual placement take into account the consistency of chest wallmotion. Also, consult with the treatment planning team to establish the bestposition. To obtain optimum performance, place the reector where verticalmovement is at least 4 mm.■If no permanent or anatomical marks are used, mark the corners of the blockon the skin and use hospital tape or other appropriate means to replicate theposition as closely as possible from one session to the next. Advise the patientnot to let the marks wash or rub o.2. For consecutive sessions, place and aach the reector block at the positionmarked during previous sessions and refresh marks if necessary.3. Ensure that the camera has unobstructed view of the reector block, and removeobjects or clothing if necessary.Related TopicsClean the Reector Block on page 28Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)45
Learning the Breathing PatternBefore the system is able to display and record respiratory motion data, it has toadapt to the breathing paern of the patient. The learning process runs for aminimum of four respiratory cycles. During the process, the system determines theminimal and maximal vertical position of the reector block, the average inspirationand expiration time, and the baseline. The generated data provides the scale of thereector block motion for display purposes and for seing the thresholds. At thispoint the periodicity lter checks that the respiratory trace (the reector blockposition in relation to time) is regular. Once the stability of the minimal and maximalpositions is veried and breathing is regular, the system can be placed in recordmode.Learning aects the motion range and coaching speed.Motion Range If Automatically set motion range to learned range is enabled inthe coaching seings, the learned motion range is used forcoaching.CoachingSpeedIf Automatically set coaching speed to learned speed is enabledin the coaching seings, the learned breathing speed is used forcoaching.For correct learning, the patient must exercise free breathing. If the system does notcomplete the learning process, check the following:■The reector block is visible to the camera for the entire respiratory cycle.■Patient breathing is periodic (check the periodicity meter).■The motion of the reector block is at least 4 mm in vertical direction.■The breathing frequency is within 6-20 respiratory cycles per minute.You can restart the learning process at any time for the following purposes:■Adapt to signicant changes (range, speed and baseline) between the learningprocess and the actual acquisition.■Repeat an aempt that failed due to irregular breathing.Note: If a couch-mounted camera is used on site and the camera gets disconnected whiletracking the reector block (during learning or else), reconnect the camera and restartlearning.46Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
BaselineThe reference point from which respiratory motion and thresholds are measured isthe reector block position at the expiration peak, when the patient is relaxed andbreathing normally. Based on this position acquired during the learning process, thesystem denes the baseline as 0.0 amplitude.Adjusting the Gating WindowThe system oers various ways of adjusting the thresholds of the gating window:■In the Seings workspace, change the numeric value of the threshold.■In the Scan workspace, you have the following options:■Drag the threshold lines (blue and orange) one by one, or both together.For amplitude and breath-hold gating, the threshold lines are located in therespiratory trace chart. For phase gating, they are located in the phase dial.To move the thresholds together (that is, the entire gating window), clicksomewhere between the threshold lines and drag the gating window.To move one threshold alone, click and drag the threshold line.■Change the numeric value of the threshold, then press TAB to apply thechange.ScalingThe respiratory trace chart visualizes two axes: time and motion. The default scale inthe time axis is 5 seconds. The scale of the motion axis depends on the learnedrespiratory trace. Auto Scale is selected by default, but you can adjust the scale andview. As a consequence of some types of adjustments, auto-scaling is disabled.■To change the scale of the time axis, press Shift and scroll.■To change the scale of the motion axis, press Ctrl and scroll.■To move the respiratory trace up and down (including baseline and thresholds)without changing the scale, press Shift and drag.■To choose dierent views (Left-Right and Head-Feet) of the respiratory tracewithout changing the scale, right-click.Chapter 5 Prepare the Session and the PatientDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)47
Chapter 6 Acquire Respiration-SynchronizedImagesPrepare the ScannerThe following instructions assume that you have prepared a session and set up thepatient.1. Open the patient record on the scanner.2. Prepare the scan (that is, select a scan protocol, adjust scan parameters).3. Verify that the patient sees the VCD, and that the VCD does not collide with thescanner gantry.CAUTION: A collision of the Visual Coaching Device with the scanner can cause damageto the scanner, VCD and other accessories. To avoid a collision with the scanner alwaysverify that the clearance inside the scanner gantry is sufficient for the definedconfiguration of the Visual Coaching Device mount with regard to couch movementsduring the scanning process.4. Acquire a scout image (topogram).5. Determine the scan range and reconstruction volume for nal image acquisition.Proceed to acquire respiration-synchronized images with prospective orretrospective gating.Acquire Images with Prospective GatingThe following instructions assume that you have prepared the scanner and a session,and set up the patient for one of the following types of gating:■Phase gating■Amplitude gating■Breath-hold gating1. Start audio or video coaching or both and instruct the patient to breatheaccordingly.2. Start recording the respiratory trace.3. Start the gating signal.4. When the respiratory trace is regular, start the scanner.5. Monitor the respiratory trace for irregularities.6. When image acquisition is complete, stop recording the respiratory trace.48Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
7. Instruct the patient to breathe regularly again.Proceed to review and nalize the session.Acquire Images with Retrospective GatingThe following instructions assume that you have prepared the scanner and a session,and set up the patient for 4D scan gating.1. Start audio or video coaching or both.2. Start recording the respiratory trace.3. Start the gating signal.For some scanners, you do not need to start gating for 4D scans.4. When the respiratory trace is regular, start the scanner.5. Monitor the respiratory trace for irregularities.6. When image acquisition is complete, stop recording the respiratory trace.7. Instruct the patient to breathe regularly again.Proceed to review and nalize the session.Gating ButtonsStarts recording of respiratory motion. Recording does notinclude sending trigger signals to the scanner. Duringrecording, it is not possible to change the thresholds.Starts and stops the sending of trigger signals to the scanner.ON means that trigger signals are sent to the scanner.Starts and stops the sending of trigger signals to the scanner.OFF means that no trigger signals are sent to the scanner.Stops recording of respiratory motion and disables the gatingoutput.Monitoring the Respiratory TraceThe system provides various features for monitoring the quality of the respiratorytrace and the gating process.Stop gating if the periodicity is continuously poor, or if the baseline driftssignicantly (according to clinical policy).Chapter 6 Acquire Respiration-Synchronized ImagesDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)49
Colors Used in The Respiratory Trace ChartOnce you start recording, the respiratory trace and gating data is visualized indierent colors.32 64 511. Black trace: regular periodic breathing2. Orange line: lower threshold3. Blue line: upper threshold4. Yellow column: breathing within gating window5. Red trace: Irregular non-periodic breathing or reflector block not tracked correctly6. Yellow trace: X-Ray On signal from scannerFigure 12 Respiratory Trace Chart ColorsFor comparison, you can select the Verication option, which adds a greenverication trace behind the current trace. The verication trace is only available if arecording has been made or opened for the same session beforehand (for example, ina training session).Note: If the scanner does not provide X-Ray On information, the respiratory trace does notturn yellow during image acquisition.Phase DialThe phase dial shows the gating thresholds along a clockwise motion of therespiratory cycle. If breathing is irregular (poor periodicity), the needle jumpsaround.50Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
60%33%100%350%0%2547161. Phase dial with indicators after each 10% (1% indicators appear in the gating window)2. Needle indicating the current phase position in percent3. Inspiration peak (approximate)4. Expiration peak (approximate)5. Upper gating threshold (blue)6. Lower gating threshold (orange)7. Gating windowFigure 13 Phase DialPeriodicity MeterThe system is capable of tracking respiratory rates ranging of 6-20 respiratory cyclesper minute. An algorithm is used to calculate the similarity or dierence ofrespiratory motion data over time. Assuming that the patient generally has a regularand steady breathing paern, the goal of the calculation is to monitor any variancebetween the current and previous respiratory cycles.The calculated value is referred to as the periodicity. The system recalculates theperiodicity in real time.The periodicity meter visualizes the regularity of breathing as a bar stretching alonga horizontal line. This visual aid enables an estimate for the regularity and quality ofthe breathing paern. A threshold (marked by a vertical line) is specied with thebreathing predictive lter. As long as the periodicity is good, the bar is displayed inblack.Chapter 6 Acquire Respiration-Synchronized ImagesDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)51
As soon as the periodicity becomes poor, the bar stretches to the right, it turns red,and the system stops the trigger signals. The same applies when the system is unableto track the reector block.13241. Current quality (turns red if poor)2. Good quality3. Threshold of breathing predictive filter (always in the middle of the range).4. Poor qualityFigure 14 Periodicity MeterRelated TopicsUsing the Breathing Predictive Filter on page 41Monitoring of Patient MotionMonitoring of patient motion tracks in real time the position of the reector block invertical, lateral, and longitudinal dimensions. If visual monitoring is enabled and thereector block moves out of the motion range identied during the learning process,the color of the ball (representing the reector block) and of the aected axis changes.If visual monitoring is disabled, the position of the reector block is tracked butdeviations are not visualized.Figure 15 Monitoring of Patient MotionThe following visual aids are in use:52Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Ball The ball represents the current position of the reector block in relation tothe body axes.Green Patient motion is within the motion range identied during the learningprocess.Yellow Patient motion is out of the motion range identied during the learningprocess by 1% to 15%.Red Patient motion is out of the motion range identied during the learningprocess by more than 15%.In addition to the visual aids, the following reference information is available.CapitalLeersThe capital leers designate the orientation of the body axes: A(anterior), P (posterior), R (right), L (left), H (head), F (feet).NumericValuesThe value at the top of the anterior-posterior axis indicates the currentposition of the reector block in relation to the baseline.The value on the right of the left-right axis indicates the currentposition of the reector block in relation to the average left-rightposition identied during the learning process.The value at the boom left indicates the current position of thereector block in relation to the average head-feat position identiedduring the learning process. Head-to-feet motion is not visualized butonly indicated as numeric values.Related TopicsEnabling Visual Monitoring of Patient Motion on page 41About Phase Calculation in Real TimePhase calculation is used both for phase gating and for determining the periodicity.The calculation converts the respiratory trace from a displacement signal as afunction of time into values representing where the current sample falls along a sinuscurve as a function of time. The phase is therefore an indicator of where the currenttime point falls within the interval of two consecutive end-inhale time points.To obtain the phase, a peak-trough detection algorithm estimates the end-inhale andend-exhale time points and generates an estimate of the breathing period (time of arespiratory cycle) that is updated with every newly detected end-inhale and end-exhale time point. The breathing period is then used to select the points in therespiratory trace that are required for phase calculation.Chapter 6 Acquire Respiration-Synchronized ImagesDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)53
The phase of each new sample of the respiratory trace is dened as the phase angle ofthe rst harmonic complex Fourier coecient calculated over a sliding time window,which is dened by the breathing period. The resulting value is shifted by π becausethe end-inhale is at signal minimum. In a sinus curve, phase calculation results in avalue of 0% for the inspiration peak, 50% (π) for the expiration peak, and 100% (2 π)for the consecutive inspiration peak.ChallengesThe challenge in phase calculation is that the breathing period used to estimate thephase is a lagging value, representing the duration of the previous breathing period.The duration of the current breathing period is unknown until detection of the nextend-inhale time point. As long as the breathing period does not change substantiallyfrom one respiratory cycle to the next (for example, by ≤10%), the phase is a linear(saw tooth) plot as a function of time. If the breathing period changes signicantly(for example, by ≥ 10%) from one respiratory cycle to the next, the phase is not alinear function of time and the phase values of 0% and 100% do not represent theexact end-inhale time points.If the breathing paern of a patient is asymmetric (varying duration of inspirationversus expiration) or irregular (varying duration of breathing periods, or varyingamplitude values), the system does not establish xed phase values for inspirationand expiration peaks.Audio and visual coaching can support the patient to breathe regularly with aconstant breathing period. This will ensure a stable phase calculation. When usingphase values for retrospective 4D reconstruction, use phase recalculation whenreviewing the session.Related TopicsReviewing a Session on page 5554Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Chapter 7 Finalize the SessionFinalize the Session (Overview)The following instructions assume that you have just acquired respiration-synchronized images.1. Review the recorded respiratory trace with special aention to the following:■Breathing phase (for 4D reconstruction)■Thresholds■Baseline drift2. If necessary, change the gating type for treatment delivery.3. If necessary, export the session (breathing data) to the le system, and import itfrom there to the scanner or the treatment delivery system.In database mode with ARIA® OIS for Radiation Oncology 13.0 or higher, manualdata export is not required.4. Close the session.5. Help up the patient.6. If necessary, dismount the VCD and the camera from the couch.Reviewing a SessionRetrospective GatingFor retrospective gating, you can recalculate the breathing phase, adjust thresholds,and add or delete peaks of the respiratory trace. Breathing phase values are indicatedas a gray line that typically has a saw tooth shape.Use Auto Detect to have the system recalculate the breathing phase of the recordedtrace. Contrary to phase calculations during image acquisition, this considers theentire trace information and generally leads to higher image quality in 4Dreconstructions. For phase recalculation, the system auto-detects the inspirationpeaks of the respiratory trace and interpolates the phase linearly over time from 0%to 100% between two consecutive peaks. As a result you get consistent phase valueseven if breathing periods dier signicantly from one respiratory cycle to the next. Ifautomatic phase recalculation is enabled, the eect is the same as selecting AutoDetect.Chapter 7 Finalize the SessionDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)55
Use the + and – buons to add or remove inspiration peaks manually. Click therespective buon again to disable the editing of the breathing phase. This switchesback to editing of the gating thresholds if gating thresholds are dened.Note: Various factors can lead to data being unusable for 4D reconstruction on the scannersystem. Always review the recorded respiratory trace. If necessary, correct the inspirationpeaks and execute a phase recalculation.Prospective GatingFor prospective gating, you can review and adjust thresholds.Note: This task requires special user rights and user authentication.If you adjust the thresholds, the yellow columns in the chart as well as the values forduty cycle and gated motion change accordingly. Adjustments to the thresholds arestored in the current session.■To adjust amplitude thresholds, drag the respective line in the Recording chart tothe wanted location or enter the corresponding values.■To adjust phase thresholds, drag the respective line in the Phase dial to thewanted location or enter the corresponding values.All Types of GatingRecording Use the playback buons and the position slider, to move alongthe recorded trace and view the parameters.MeasuredValuesReview the values set for the recorded session.Baseline The baseline shift is calculated based on the average of allexpiration peaks of the recorded respiratory trace compared withthe learned baseline. If you apply a baseline shift, the trace shiftsaccordingly and amplitude thresholds are adapted.Shifting the BaselineDuring recording, the expiration peaks can move away from the 0.0 referenceposition. This change is referred to as baseline drift.A baseline drift occurs when the average of the expiration peaks calculated duringthe learning phase diers from the expiration peaks after starting the recording.56Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Figure 16 Baseline DriftApplying a Baseline ShiftIn connection with treatment delivery, a baseline drift leads to incorrect thresholdsfor amplitude and breath-hold gating. Therefore, apply a baseline shift when it isapparent that the baseline has drifted. You can edit the calculated shift value ifnecessary.Applying a shift means shifting the coordinate system. It leads to the recalculation ofthe respiratory trace and thresholds.Note: This task requires special user rights and user authentication.Gating Type for TreatmentExcept for images acquired with breath-hold gating, you can change type of gatingfor future treatment sessions. That is, you can acquire an image with a certain gatingtype, change it, adjust thresholds and store the new seings for treatment delivery.The goal is typically to have comparable conditions for image acquisition andtreatment delivery. Only change the gating type for treatment if compelling reasonsexist (for example, if site policy mandates one gating type for image acquisition andthe other for treatment delivery).■To adjust amplitude thresholds, drag the respective line in the Recording chart tothe wanted location or enter the corresponding values.■To adjust phase thresholds, drag the respective line in the Phase dial to thewanted location or enter the corresponding values.Note: This task requires special user rights and user authentication.Export for TreatmentDepending on the system conguration, one or both of the following features areavailable to export data for gated treatment delivery:Chapter 7 Finalize the SessionDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)57
Export to RPMUse this feature for Clinac™ systems that support gating with an Real-time PositionManagement™ system (RPM). It exports gating data and patient data to the RPMdatabase, and includes all seings (gating seings, coaching seings) of the gatingsession and the recorded trace.Export to DICOMUse this feature to export data to TrueBeam™, VitalBeam™, or Edge™ systems with thefollowing OIS:■Third-party OIS■ARIA® OIS for Radiation Oncology 11.0 or lower■If in le mode, ARIA® OIS for Radiation Oncology 13.0 or higherNote: If in database mode, manual export is not required with ARIA® OIS for RadiationOncology 13.0 or higher.Export for 4D ReconstructionUse the Export to VXP feature to export data from a recording session to apredetermined location and to use the data for 4D reconstruction on a scannerworkstation.To create an export le according to local le name convention, enter the requestedinformation (depends on scanner).Depending on the scanner on site, manual VXP export may not be required thanks toreal-time data exchange via serial interface.Select a Start Time for VXP ExportWhen exporting data for 4D reconstruction, you can select a starting point fromwhich to start the export. This can be useful when scout scan data is part of therecorded trace and you want to exclude that data from the export.1. Under Export for 4D Reconstruction select Start Time.2. Move the position slider in the recording control bar to the relevant time range.For scanners that provide X-Ray On signal on the RGSC interface, the scout scanand actual scan can be identied on the trace where it appears yellow (X-RayOn).3. Move the cursor into the recording chart, to the beginning of the time range youwant to export.A green vertical line appears and follows the cursor.58Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
4. To set the start time, click into the recording chart.Close the SessionHow you can close a session depends on the workspace. Closing the session saves allrelated data.■In the Review workspace, click OK in the control bar or Close in the workowpanel.■In any other workspace, click Close in the workow panel.Shut Down the SystemShut down the system at the end of each working day.1. On the application home screen, click Exit Application.2. Shut down Windows.NOTICE: Do not turn off the Real Time Unit or main power switch. Switching off the RealTime Unit can result in damage to the scanner interface and to the flash card.Chapter 7 Finalize the SessionDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)59
Appendix A System ConfigurationUser GroupsNote: User administration is integrated into the Varian Oncology Systems Platform (OSPserver or client) and independent from Windows.The following user groups are available:Table 2 User Groups and RightsUser Group Rights Therapist Oncolo-gistPhysicist Admin ServicePerform a clinical workow. ✓ ✓ ✓ ✓ ✓Verify camera calibration. ✓ ✓ ✓ ✓ ✓Change the gating mode for treatment. - ✓ ✓ - -Change thresholds in review. - ✓ ✓ - -Save scan seings as template. - - ✓ ✓ ✓Calibrate the camera. - - ✓ ✓ ✓Congure the system. - - ✓ ✓ ✓Install the camera. - - - - ✓Congure the camera. - - - - ✓Congure the scanner. - - - - ✓Upload software for VCD. - - - - ✓Upload software for Real-Time Unit. - - - - ✓ApplicationTo access the workspace, choose Conguration > Application.60Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
CoachingControl DescriptionAudio Coaching Oset[s]Specify the oset according to the desired time lapse.Audio coaching starts with this oset before the inspiration or ex-piration peak is predicted.VerificationThis seing is only enabled in connection with a wall-mounted or ceiling-mountedcamera.Control DescriptionVerication Period [days] Specify the number of days during which the camera vericationis valid. If the verication is outdated, a new verication will beenforced.CalibrationThis seing is only enabled in connection with a couch-mounted camera.Control DescriptionCalibration Period [days] Specify the number of days during which the camera calibrationis valid. If the calibration is outdated, a new calibration will be en-forced.DICOM Import/ExportControl DescriptionSpecic Character Set Select the applicable character set.The applicable character set depends on the DB daemon or, if ap-plicable, on the TrueBeam system.ExportTo access the workspace, choose Conguration > Export.Appendix A System ConfigurationDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)61
VXP ExportControl DescriptionEnable VXP le export Select to enable the VXP export option in the Review workspace.Directory Specify the le path of the target database for export.File Name Format Specify the le name format according to the format that is ex-pected by the 4D reconstruction software of the scanner.Automatic phase recalcu-lationSelect to enable automatic o‐line phase processing when en-tering the Review workspace.Prompt for VXP exportin retrospectively gatedcasesSelect to activate an export prompt when you close the sessionafter review.RPM ExportControl DescriptionEnable RPM data export Select to enable the RPM export option in the Review workspace.RPM Database File Specify the le name and path of the target database for export.Automatic export afteracquisitionSelect to enable automatic export when you close the session afterreview.Prompt for manual ex-port after acquisitionSelect to activate an export prompt when you close the sessionafter review.RPM System Frame Rate Select the required frame rate.DICOM ExportControl DescriptionEnable DICOM le ex-portSelect to enable the DICOM export option in the Review work-space.Directory Specify the le path of the target database for export.Patient‐specic FolderFormatSpecify the folder name format for patient data.Automatic export afteracquisitionSelect to enable automatic export when you close the session afterreview.Prompt for manual ex-port after acquisitionSelect to activate an export prompt when you close the sessionafter review.62Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Export File Structure and FormatThe system supports the export of motion data les for post-processing. Motion datales are created in text format after data acquisition is nished or when a previouslyrecorded session is retrieved.A text le is used for the export parameters. Depending on the scanner, the le namemust follow one of the following formats for 4D reconstruction.■PatientID_ExamNumber_SeriesNumber.vxp■PatientID_SessionNumber.vxpData contained in the export le is organized into a header section and a data section.The <cr> symbol represents a carriage return.Header SectionLine Data Format Description1 [Header]<cr> Prex of the header section2 CRC=crcChecksum<cr> CRC checksum3 Version=versionNumber<cr> The version number of the export le4Data_layout=eld1[,eld2...],eldn<cr>The layout of the data section; eld1 through eldnrepresent the names of the elds in the data section.5 Patient_ID=patId<cr> The Patient ID of the patient record created in RGSCsystem6 Date=mm-dd-yyyy<cr> The date the acquisition session was recorded7 Total_study_time=studyTime<cr>The actual recording length in seconds to a thou-sandth of a second8 Samples_per_second=sampl-eRate <cr>■NTSC: 30 or 15■CCIR: 25 or 12.59 Scale_factor=scale<cr> The scale factor for the signal data (in mm). For ex-ample, if the data eld ValueOfRespiratoryWave isgiven in cm, the scale factor is 10.0.Data SectionAt line 10, [Data]<cr> is used to demarcate the beginning of the data section, whosedata elds are separated by comma.The layout of the data section, is dened in line 4 of the header section. This version’sformat is described in the following table.Appendix A System ConfigurationDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)63
Field DescriptionValue_of_respiratory_wave Position in centimeters relative to referencePhase_value Phase value for the current sampleTime_Stamp Time of the sample measurement in millisecondsValid_Flag ■≥ 0: a valid track and a periodic signal■< 0: either a lost track, a bad video signal, or a non-periodic signalTTL_In Bit value indicating the status of a sensed x-ray on signalfrom scanner■1: +5 VDC■0: 0 VDCMark Leer specifying the sample when the phase value isclosest to 0 or pi■Z: 0 phase■P: pi phase null string: no dataTTL_Out Bit value indicating the status of a gating signal to thescanner■1: +5 VDC■0: 0 VDCExampleThe following is a fragment of a sample export le:[Header]CRC=53224Version=1.6Data_layout=amplitude,phase,timestamp,validflag,ttlin,mark,ttloutPatient_ID=990310BDate=10-06-2012Total_study_time=32.533Samples_per_second=30Scale_factor=10.0[Data]4.7171,1.4994,29441,0,1,,064Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
4.7189,1.5135,29464,0,1,,0...5.0888,2.3434,30384,0,1,,05.0998,2.3695,30401,0,1,,0ScannerTo access the workspace, choose Conguration > Scanner.Select ScannerControl DescriptionManufacturer Select the manufacturer of the scanner:■User dened (all seings customizable)■Siemens■Toshiba■Philips■GE HealthcareProduct Name Select the scanner/interface.Description Comment in the context of the seing.Scanner InterfaceThese seings dene how data is transferred through the binary lines and throughthe serial interface.Note: For a compatible scanner connection, the following seings need to be conguredproperly. These seings can only be changed when User dened is selected as manufacturer.Control DescriptionTrigger Signal Length [s] Specify the length of the trigger signal. Default is 0.50.Trigger Signal Polarity Select the polarity of the binary output line.■Positive Pulse (default)■Negative PulseX-Ray On Signal Polarity Select the polarity of the binary input line.■High signal means ON (default)■Low signal means ONAppendix A System ConfigurationDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)65
Control DescriptionX-Ray On Signal Circuit ■Single-Ended (default)■DierentialHeartbeat Signal Specify whether a heartbeat signal between scanner and RGSC ex-ists.■Not supported (default)■SupportedHeartbeat Timeout [s] Specify the length of the heartbeat timeout. Default is 0.5.Serial Data InterfaceControl DescriptionBaud Rate ■34800 (default)■1152000Stop Bits ■1 (default)■2Parity ■None (default)■Even■OddFlow Control ■None (default)■RTS/CTSOutput for 4D ScanningControl DescriptionTrigger at [°] Specify the phase at triggers are to be sent for retrospective gating(4D reconstruction). Default is 0.Output for Breath Hold ScanningControl DescriptionBreath Hold Signal ■Continuous (default)■Single Trigger■Burst TriggersBurst Trigger allows acquiring multiple slices per breath-holdcycle.66Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
VCDTo access the workspace, choose Conguration > VCD. The workspace is onlyavailable, if visual coaching is in use.Note: The VCD must be connected and turned on.Software VersionControl DescriptionApplication Version Current application version installed on the VCDOperating System Ver-sionCurrent operating system version installed on the VCDBattery StatusControl DescriptionCharge Status [%] Status of the baeryRemaining Capacity[mAh]Remaining capacity of the baeryVoltage [V] Current cell voltageLow Baery WarningLevel [%]Specify when to issue an alert that the baery charge status is low.If the charge status is lower, do not start a new recording.Power Supply External or baery poweredNumber of Charging Cy-clesAccumulated number of charge and discharge cyclesTemperature [°C] Temperature of the baerySoftware UpdateControl DescriptionApplication Download leOperating System Download leAppendix A System ConfigurationDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)67
DatabaseTo access the workspace, choose Conguration > Database.DICOM Stream Service ConnectionControl DescriptionDSS Host Specify the host name of the DSS (DICOM Stream Service) work-stationDSS Port Specify the port number to connect to the DSS.Daemon ConnectionControl DescriptionEnable Database Mode(with ARIA DB)Enable the system to run in database mode. Only a Varian Systemdatabase is supported.Enable Patient Creation(Activate UI)Enable the system to support local patient creation. If disabled,the patient must exist in the database.Local Host Specify the host name of the DSS workstation.Local Port Specify the port number of the connection from DB Daemon toDSS.Local AE Title Specify the entity name of the DSS application.Remote Host Specify the host name of the DB Daemon workstation.Remote Port Specify the port number of the connection from DSS to DBdaemon.Remote AE Title Specify the entity name of the DB Daemon.File ModeControl DescriptionEnable File Mode Enable the system to run in le mode. Data is stored as DICOMles.Patient Data Path Specify the location where the system creates a subfolder per pa-tient and stores all sessions and DICOM les.Patient Archive Path Specify the location where the system archives patient data.68Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
ServicesControl DescriptionDICOM Stream Service Status of the DSSDB Daemon Service Status of the DB Daemon Service (may not be applicable in lemode)ArchiveTo access the workspace, choose Conguration > Archive.■To nd a specic patient, enter search criteria in the available text boxes.■To select consecutive les, click the rst le, press and hold down Shift, and thenclick the last item.■To select non-consecutive les, press and hold Ctrl, then click each le you wantto select.Patient Data ContentControl DescriptionMove Selection to Ar-chiveArchive selected patient les.Patient ArchiveControl DescriptionRestore Selection fromArchiveRestore selected patient les.Note: If you change from database mode to le mode or vice versa, the Archive only becomesavailable after exiting and re-entering the application.CameraTo access the workspace, choose Conguration > Camera.Appendix A System ConfigurationDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)69
CameraControl DescriptionConguration Changing the camera seings is reserved to Varian Service per-sonnel.Available congurations are the following:■Wall Mount (25 mm)■Ceiling Mount (Upside down, 25 mm)■Couch Mount (12 mm)Camera Installation Changing the camera seings is reserved to Varian Service per-sonnel.70Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Appendix B EMC Data and GuidanceElectromagnetic Compatibility (EMC)Respiratory Gating for Scanners (RGSC) is EMC-tested in conformity with therequirements of IEC 60601-1-2:2007 and can be used in the vicinity of other EMC-tested devices that fulll the requirements of the relevant IEC 60601-1-2 standard.Untested HF (high-frequency) sources, radio networks or the like can inuence theoperation of the device and may not be operated in combination with the system.Use of accessories, transducers and cables other than those specied (or suppliedwith the system as replacement parts for internal components) may result inincreased emissions or decreased immunity of the system.The following table is pursuant to IEC 60601-1-2. The cables listed meet IEC60601-1-2emissions requirements.Table 3 Cables and Maximum LengthsPart Number Name Maximum LengthB501272 Cable CTIF – Single Camera (W01) 35 mB504863 Cable Ethernet Single Camera (W02) 35 mB504867 Cable Ethernet AP6511 (W03) 35 mB503295 Cable GND Cabinet – Cam Mount (W04) 35 mB504864 Cable GND Camera – Cam Mount (W05) 15 cmP1012814 Camera Cable (W06) 10 mElectromagnetic Interference (EMI)To prevent damage or injury to electronic equipment resulting from EMIinterference, follow these instructions:■Avoid use of unnecessary electrical devices near the scanner and the system.■Use only Varian accessories, transducers, and cables.■Do not use or stack the equipment with other equipment than compatiblescanners. If adjacent or stacked use is necessary, place the equipment in theconguration in which it will be used prior to clinical use and observe its behaviorto verify normal operation.■Allow only trained, qualied personnel to operate or maintain the system.Appendix B EMC Data and GuidanceDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)71
Varian Test Declarations and GuidanceNote: This equipment has been tested and found to comply with the limits for a Class B digitaldevice, pursuant to Part 15 of the FCC Rules and meets all requirements of the CanadianInterference-Causing Equipment Standard ICES-003 for digital apparatus. These limits aredesigned to provide reasonable protection against harmful interference in a residentialinstallation. This equipment generates, uses, and can radiate radio frequency energy and, ifnot installed and used in accordance with the instructions, may cause harmful interference toradio communications. However, there is no guarantee that interference will not occur in aparticular installation. If this equipment does cause harmful interference to radio or televisionreception, which can be determined by turning the equipment o and on, the user isencouraged to try to correct the interference by one or more of the following measures:■Reorient or relocate the receiving antenna.■Increase the separation between the equipment and receiver.■Connect the equipment into an outlet on a circuit dierent from that to which the receiveris connected.■Contact Varian Support services for help.Note: You must verify the actual shielding eectiveness and lter aenuation of the shieldedlocation to ensure that they meet the minimum specications.Electromagnetic ImmunityThe system is intended for use in the electromagnetic environment specied below.The customer or the user of the system should assure that system is used in suchenvironment.72Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Table 4 Electromagnetic Compatibility (EMC, IEC 60601-1-2:2007, Table 1)Emissions Test Compli-anceElectromagnetic Environment GuidanceRF emissionsCISPR 11Group 1 The system uses RF energy only for its internal function.Therefore, its RF emissions are very low and are not likely tocause any interference with nearby electronic equipment.RF emissionsCISPR 11Class B The system is suitable for use in all establishments, in-cluding domestic establishments and those directly con-nected to the public low-voltage power supply network thatsupplies buildings used for domestic purposes.Harmonic emis-sionsIEC 61000-3-2Class AVoltage uctu‐tions / ickeremissionsIEC 61000-3-3CompliesTable 5 Electromagnetic Compatibility (EMC, IEC 60601-1-2:2007, Table 2)Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Envi-ronment GuidanceElectrostatic dis-charge (ESD)IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should bewood, concrete or ce-ramic tile. If oors arecovered with syn-thetic material, therelative humidityshould be at least30 %.Electrical fast tran-sient/burstIEC 61000-4-4±2 kV for powersupply lines±1 kV for input/output lines±2 kV for powersupply lines±1 kV for input/output linesMains power qualityshould be that of atypical commercial orhospital environment.SurgeIEC 61000-4-5±1 kV dierentialmode±2 kV line(s) to earth±1 kV dierentialmode±2 kV line(s) to earthAppendix B EMC Data and GuidanceDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)73
Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Envi-ronment GuidanceVoltage dips, short in-terruptions andvoltage variations onpower supply inputlinesIEC 61000-4-11<5% UT (>95% dip inUT) for 0.5 cycle40% UT (60% dip inUT) for 5 cycles70% UT (30% dip inUT) for 25 cycles<5% UT (>95% dip inUT) for 5 seconds<5% UT (>95% dip inUT) for 0.5 cycle40% UT (60% dip inUT) for 5 cycles70% UT (30% dip inUT) for 25 cycles<5% UT (>95% dip inUT) for 5 secondsMains power qualityshould be that of atypical commercial orhospital environment.If the user of thesystem requires con-tinued operationduring power mainsinterruptions, it is rec-ommended that thesystem be poweredfrom an uninterrup-tible power supply ora baery.Power frequency(50/60 Hz) magneticeldIEC 61000-4-8100 A/m 30 A/m Power frequencymagnetic eldsshould be at levels ofa typical commercialor hospital environ-ment.Note: UT is the a.c. mains voltage prior to application of the test level.74Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Table 6 Electromagnetic Compatibility (EMC, IEC 60601-1-2:2007, Table 4)Immunity Test IEC 60601Test LevelCompliance Level Electromagnetic Environment GuidanceConducted RFIEC 61000-4-63 Vrms 150kHz to 80MHz10 Vrms Portable and mobile RF communicationsequipment should be used no closer toany part of the system, including cables,than the recommended separation dis-tance calculated from the equation ap-plicable to the frequency of the trans-mier.Recommended separation distance:d= 0.35 Pd= 0.35 P 80 MHz to 800 MHzd= 0.7 P 800 MHz to 2.5 GHzP is the maximum output power ratingof the transmier in was (W) accordingto the transmier manufacturer and isthe recommended separation distance inmeters (m).Field strengths from xed RF transmit-ters, as determined by an electromag-netic site survey, should be less than thecompliance level in each frequencyrange.1Interference may occur in the vicinity ofequipment marked with the followingsymbol: Radiated RFIEC 61000-4-33 V/m80MHz to2.5 GHz10 V/mNote: At 80 MHz and 800 MHz, the higher frequency range applies.1Field strengths from xed transmiers, such as base stations for radio (cellular/cordless) telephones andland mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predictedtheoretically with accuracy. To assess the electromagnetic environment due to xed RF transmiers, anelectromagnetic site survey should be considered. If the measured eld strength in the location in whichthe system is used exceeds the applicable RF compliance level, the system should be observed to verifynormal operation. If abnormal performance is observed, additional measures may be necessary, such asreorienting or relocating the system.Over the frequency range 150 kHz to 80 MHz, eld strengths should be less than 10 V/m.Appendix B EMC Data and GuidanceDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)75
Note: These guidelines may not apply in all situations. Electromagnetic propagation is aectedby absorption and reection from structures, objects and people.Recommended separation distance between portable and mobile RFcommunications equipment and RGSCThe system is intended for use in an electromagnetic environment in which radiatedRF disturbances are controlled. The customer or the user of the system can helpprevent electromagnetic interference by maintaining a minimum distance betweenportable and mobile RF communications equipment (transmiers) and the system asrecommended below, according to the maximum output power of thecommunications equipment.Table 7 Electromagnetic Compatibility (EMC, IEC 60601-1-2:2007, Table 6)Rated Maximum OutputPower of TransmitterWSeparation Distance According to Frequency of Transmitter [m]150 kHz to 80 MHzd= 0.35 P80 MHz to 800 MHzd= 0.35 P800 MHz to 2.5 GHzd= 0.7 P0.01 0.04 0.04 0.070.1 0.11 0.11 0.221 0.35 0.35 0.7010 1.11 1.11 2.21100 3.50 3.50 7.00For transmiers rated at a maximum output power not listed above, therecommended separation distance d in meters (m) can be estimated using theequation applicable to the frequency of the transmier, where P is the maximumoutput power rating of the transmier in was (W) according to the transmiermanufacturer.Note: At 80 MHz and 800 MHz, the separation distance for the higher frequency rangeapplies.Note: These guidelines may not apply in all situations. Electromagnetic propagation is aectedby absorption and reection from structures, objects and people.76Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
Visual Coaching Device WLAN SpecificationsWLAN specications for wireless commnication between VCD and wireless accesspoint are as follows:Type SpecificationFrequency range 2400 MHz to 2485 MHz (802.11b/g)Rated RF output 18 dBmModulation DSSSAppendix B EMC Data and GuidanceDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)77
Index4D scan 39AaboutRGSC 7this publication 7access rights 60acquire imagesprospective gating 48retrospective gating (4D) 49alerts 36amplitude gating 39applicationconguration 60archiveconguration 69auto-detect phase 55auto-scale 47Bbaselinedrift 56reference point 47shift 56breath-hold gating 39breathing predictive lter 41buonscamera 23gating 49home screen 18Ccabinetconnectors 25patch panel 25units 24wheels 24calculationphase and periodicity 53calibrate 30couch-mounted camera 30wall-mounted / ceiling-mounted camera31camera 22calibrate (couch-mounted) 30calibrate (wall-mounted / ceiling-mounted) 31conguration 69controls 23mount (couch-mounted) 29symbols 23verify calibration (wall-mounted / ceiling-mounted) 31chart colors 50cleanother equipment 28reector block 28client application 18closesession 59coaching modes 42coaching speed 42, 46colors 50components 21cabinet 24camera 22reector block 22congurationapplication 60archive 69camera 69database 68export 61scanner 65VCD 67connectors 25couch mountcamera 29VCD 33createpatient record 38session 39Curve 42customer support 9Ddatabaseconguration 68database (DB) mode 3878Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
date of birth 39default seings for gating 40demo mode 44DICOM export 57Dog 42Eelectromagnetic compatibilitysee EMCelectromagnetic interferencesee EMIemailing Varian customer support 9EMC 71emissions 72immunity 72test declarations and guidance 72WLAN specications 77EMI 71enable visual patient motion monitoring 41equipmentprepare 28prepare the scanner 48error messages 36exportconguration 61for 4D reconstruction (VXP) 58for treatment (RPM/DICOM) 57select start time (VXP) 58Fle formatexport le structure and format 63le mode 38nalize a session 55rewall 24Functionality limited 36Ggatingprepare 37gating buons 49gating type for treatment 57gating types 39default seings 40gating window 47Hhome screen 18Iiconssymbols on labels 11imagesfor 4D reconstruction 49with amplitude gating 48with breath-hold gating 48with phase gating 48with prospective gating 48with retrospective gating 49infrared detection 22intended audience 7intended use 7Llayout 21learning processbaseline 47coaching speed 46motion range 46login 29Mmaintenance 15maintenance mode 35monitoringbreathing predictive lter 41enable monitoring of visual patientmotion 41periodicity meter 51phase dial 50respiratory trace 49visual patient motion 52motion range 42, 46mount camera on couch 29mount VCD on couch 33MyVarian 9Nnetwork impact 14network switch 24New Scan / Open Scan 18IndexDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)79
Oonline customer support 9openpatient record 38session 39ordering product documents by phone 9Ppatch panel 25patientopen or create record 38prepare 37patient motion 41, 52periodicity meter 51phasecalculation 53recalculation 55phase dial 50phase gating 39place the reector block 45prepareequipment 28gating 37patient 37scanner 48session 37preventive maintenance 15prospective scan 39RReal-Time Unit 24reector block 22clean 28prepare and place 45requirements 15resolve alerts 36respiratory trace 49restart learning 46retrospective scan 39review 55export to DICOM 57export to RPM 57export to VXP 58gating type for treatment 57RGSC Messages 36RPM export 57Ssafetybaery 13network impact 14overview 11symbols on labels 11system integrity 13third-party devices 14unauthorized hardware 14unauthorized software 13savesession 59scaling 47scan session 8scan session workowby workspace 18scannerconguration 65service 15sessionclose 55, 59export 55open or create 39prepare equipment 28prepare gating 37prepare patient 37review 55sessionstraining vs. scan 8seingsprepare gating 37shutdown 59Slider 42specications 15backpointer laser 17electrical 16environmental 16transport and storage 17start learning 46start time for VXP export 58start/stopgating 49recording 49startup 29support e-mail addresses 9symbols on labels 11Ttechnical support 980Draft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)Respiratory Gating for Scanners Instructions for Use
thresholds 47training session 8transport and storage 17types of scans 39default seings 40Uuser groups 60user interface 19VVarian customer support 9VCDbaery and charging station 27baery safety 13conguration 67connectors 26couch mount 33demo mode 44maintenance mode 35operation 26power on/o 34recharge 34WLAN specications 77Verication / Calibration 31verify calibrationwall-mounted / ceiling-mounted camera31visual coachingprompt styles 42Visual Coaching Devicesee VCDvisual cues 9visual prompt styles 42VXP export 58select start time 58Wwheels 24WLAN specications 77workowscan session (by workspace) 18workspaceshome screen 18New Scan / Open Scan 18Workstation Unit 24IndexDraft (rco1321352456798 / Authoring:formal review / 11-Nov-2015 04:57 PST / asteinma)81

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