Portal Dosimetry 11, Rev. 1.2 - Annotated - Flattened-2

Portal Dosimetry 11
Revision 1.2
April, 2014
© Varian Medical Systems Portal Dosimetry 11
For education purposes only pg 2 Rev. 1.2
Portal Dosimetry
Abstract The Portal Dosimetry 11 course provides a working understanding of the Portal
Dosimetry system and the pre-treatment IMRT and RapidArc QA process.
Notice Information in this release note is subject to change without notice and does not
represent a commitment on the part of Varian. Varian is not liable for errors
contained in this user guide or for incidental or consequential damages in
connection with furnishing or use of this material.
This document contains proprietary information protected by copyright. No part of

this document may be reproduced, translated, or transmitted without the express
written permission of Varian Medical Systems, Inc.
HIPAA Varian’s products and services are specifically designed to include features that
help our customers comply with the Health Insurance Portability and Accountability
Act of 1996 (HIPAA). The software application uses a secure login process,
requiring a user name and password that supports role-based access. Users are
assigned to groups, each with certain access rights, which may include the ability
to edit and add data or may limit access to data. When a user adds or modifies
data within the database, a record is made that includes which data were changed,
the user ID, and the date and time the changes were made. This establishes an
audit trail that can be examined by authorized system administrators.
Trademarks Varian®, Clinac® linear accelerator, Exact® Arm are registered trademarks,
AriaTM, EclipseTM, Enhanced Dynamic WedgeTM, Millennium™ MLC, Portal
TM
Imaging are trademarks of Varian Medical Systems, Inc.
© 2011 Varian Medical Systems, Inc.

All rights reserved. Printed in the United States of America.
© Varian Medical Systems iii

© VarianTRAINING
FOR PURPOSES ONLY!
Medical Systems Portal Dosimetry 11
Contacting Support
Support services are available without charge during the initial warranty period. If you
seek information not included in this publication, call Varian Medical Systems support
at the following locations:
North America toll-free telephone support +1.888.827.4265

Global telephone support +1.702.938.4807
Global Telephone support for treatment planning +1.702.938.4712
Ordering Additional Documents
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Global +1.702.938.4700
Communicating Via the World Wide Web
If you have access to the Internet, you will find Varian Medical System support at the
following location:
Oncology Systems — http://www.varian.com/oncy/
Then click Support from the menu list along the left side of the window.
Sending E-Mail
Send your e-mails to the following locations for support:
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Systems
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Treatment Planning Systems support-americas@varian.com
Brachy Therapy Systems brachy.support@varian.com
© Varian Medical Systems

FOR TRAINING
© Varian PURPOSES ONLY!
Introduction
The Portal Dosimetry 11 course will cover commissioning, calibration and operation of
Portal Dosimetry system. Among covered topics are: Portal Dose Image Prediction
algorithm, Beam data requirements and algorithm configuration, introduction to Portal
Dosimetry system covering hardware and software components, Portal Dosimetry
calibration described on the Varian machines, acquisition of portal dose images for
dynamic delivery and analysis of portal dose images.
This document uses the following visual cues to help you locate and find information:
CAUTION: A caution describes actions or conditions that can

result in minor or moderate injury to personnel or can result in
damage to equipment.
WARNING: A warning describes actions or conditions that can

result in serious injury or death to personnel.
NOTE: A note describes actions or conditions that can help the

user obtain optimum performance from the equipment or
software

FOR TRAINING
FOR TRAINING
Course Introduction TAB 1
 Course introduction
System Overview TAB 2
 System Overview
 GUI overview
aSi Characteristics and Algorithms TAB 3
 aSi Detector Characteristics

 PDIP Algorithm
 Dose Evaluation Algorithms
System Preparation and Data Acquisition TAB 4
 Software Administration for PD

 Hardware Calibration C-Series
 Hardware Calibration TrueBeam
 PDIP Beam Data Requirements
 Hardware Calibration - C-series – Imaging system calibration
 Output Factor Measurements
PDIP Algorithm Configuration TAB 5
 PDIP Algorithm Configuration
Portal Dosimetry Commissioning TAB 6
 PD Commissioning

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Clinical Use of Portal Dosimetry TAB 7
 Portal Dosimetry User Preference Configuration

 Analysis template management
 LFIMRT Usecase
 Print Images and Reports
 RA splitarc Usecase
 RA fullarc Usecase
 Portal Dose Image Status and Patient Alert
 PD Clinical Case EXERCISE
References TAB 8
 Portal Dosimetry Publication Reference List
Appendix TAB 9
 IsoCal Calibration C-Series machines

 IsoCal Verification on TrueBeam
 MV Dosimetry Calibration on TrueBeam
 CTB-PV-887-A Installation and Verification of the Portal Dosimetry
Pre-Configuration Package 1.0

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Course Introduction TAB 1
 Course introduction

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System Overview TAB 2
 System Overview
 GUI overview

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Portal Dosimetry System Overview
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 Portal Dosimetry (PD) has been designed as a pre-treatment IMRT and VMAT plan QA
tool
 Verifies 2D dose matrix of an IMRT/VMAT field against the dose predicted by a TPS
 PD is not designed as a transit dosimetry
- There is no patient or phantom in the beam during the acquisition
 Varian PD is an integrated, fast and precise IMRT QA system
 Portal Dosimetry system provides:
- Advanced evaluation tools, custom analysis templates
- Advanced printing and Export features
 High Resolution of PDIP algorithm is 512x384 pixels giving pixel pitch of 0.78mm
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 In order to perform pre-treatment QA verification of IMRT or RapidArc plan, verification

plan is created using portal dose prediction method.
 Once the verification plan is created it needs to be prepared for delivery in Treatment
Preparation (Schedule, Portal Dose Image sequence template)
 Verification plan is delivered on the machine and Portal dose Images are acquired for
each field.
 After the delivery the plan is opened in the Portal Dosimetry application Images are
compared and evaluated.
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 Varian PD can be installed in different environment configurations

 Integrated Varian environment doesn’t require any additional data transfer from one
system to another
 Customized ARIA workflow templates can be prepared to streamline department process
workflow
 PD can also be installed with a 3rd party R&V system
- Varian provides an application island consisting of TPS, acquisition and evaluation
module
- If possible the PD plan is handled by the 3rd party R&V system, or DICOM import to
4DiTC and after delivery subsequent DICOM import of acquired images and
treatment record to ARIA
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 The system consists of:

- TPS capable of portal dose prediction
- Image Acquisition (IAS) on the HE C-series machines capable of the integrated dose image acquisition
- or MV - Image Acquisition Module on Xi node (Xi node, PU-MV node, BGM node coordinated by SPV)
on the TrueBeam machine capable of the integrated dose image acquisition
- Portal Dosimetry application used for image evaluation
 In the integrated environment the Dose prediction is handled by Eclipse
- Dose image acquisition is done on 4DTC (4D Treatment Console@ C-Series) or TrueBeam’s Treatment
workstation
- Dose evaluation is done in the Portal Dosimetry application and all data are stored in the Integrated
Database
 Above is the data flow example in the integrated environment:
- A Verification plan with predicted dose images is created from the original patient plan in Eclipse.
- The verification plan is delivered on machine and integrated images are acquired on the imager previously
calibrated for absolute dosimetry
- Predicted and measured images can now be aligned and compared in Portal Dosimetry application
 In case of third party R&V dose prediction is calculated in Eclipse
- The verification plan needs to be transferred to the R&V database or DICOM imported to 4DITC or
Treatment Workstation
- Images are acquired by 4DITC or Treatment Workstation. The images along with the treatment history
saved as a DICOM files and imported to Varian DB
- The images might be sent over to the 3rd party R&V as well
- Dose evaluation is done in the Portal Dosimetry application
 There is also possibility to import the prediction to the database via DICOM
- The prediction must be DICOM RT Image modality, CALCULATED DOSE type
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 PD system consists of three major components:

 Acquisition of the dose image typically involves
- Hardware: Electronic Portal Imaging Device (EPID) mounted on a support arm and
connected to the acquisition electronics
- Software: Image acquisition and processing software
 Dose prediction
- Calculation algorithm for the dose prediction at EPID
 Evaluation software
- Image management
- Alignment and dose image evaluation tools
- Analysis Templates
- Print and Export
©©Varian
 Varian has offered two types of the imager support devices

 Retractable Arm (R-Arm)
- Older type of the support arm
- Two robotic arms (“fork” type)
- Drive motors are not equipped with brakes
- Positioning accuracy specification is ± 5mm (from the value reported by the arm read-
out system)
 Exact Arm (E-Arm)
- Shipped with the new machines since summer 2003
- Two single robotic arms
- Drive motors equipped with brakes
- Positioning accuracy is ± 1mm
 If R-Arm is used, the image alignment can be forced by Portal Dosimetry application. This
setting is controlled in Radiation Oncology Administration under Machine properties.
 IsoCal becomes optional feature on the HE C-series machines with OBI 1.5
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 The older (discontinued) type of the Varian image detector was Liquid Ion Chamber (LIC)
 The new imagers are based on the Amorphous Silicon (aSi) detector technology
 aSi active detector area is 30x40cm
 aSi 500 system: imager type was delivered with the Image Acquisition System 2 (IAS2)
- Maximum imager resolution is 512x384 pixels (0.78mm)
 aSi 500-II system: is shipped with IAS3
- IAS3 frame rate is roughly twice of IAS2 (faster read-out electronics)
- Maximum imager resolution is 512x384 pixels (0.78mm)
 aSi 1000 uses IAS3
- Optional (licensed) hi-resolution mode
- Standard with Trilogy accelerators
- Maximum imager resolution is 1024x768 (0.39mm)
©©Varian
 All systems use 4DTC as the acquisition workstation

- Images are stored to the VMS Integrated database
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Imaging isocenter is confined in the circle well below radius of +/- 0.5mm
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 MV Acquisition module is part of the Xi node responsible for the Image acquisition
 TrueBeam workstation contains: Treatment Application, Imaging Application and auxiliary
applications in order to perform Imaging Calibration, IsoCal, Service Console (to perform
PU calibration
 Data Flow:
1) Treatment Application imports the treatment plan in the DICOM format
2) The Treatment Application transfers the treatment data which contains image
acquisition related information to the Imaging Application
3) Imaging Application prepares the acquisition on the XI node (MV module)
4) Imaging Application sends commands with beam and image acquisition parameters to
Treatment application
5) Treatment Application sends the set-up beam and set-up target commands to the
Supervisor. This Prepares the beam.
6) The Supervisor triggers the image acquisition on the Xi system.
7) The Xi system sends the acquired data to Imaging application. When the plan is closed
images are stored in the integrated system.
©©Varian
 Dose image prediction algorithm is part of Eclipse TPS

 First prediction (Eclipse 7.1.67) was calculated using the PBC algorithm kernel
- PBC kernel was calculated in water-equivalent media
- Kernel doesn’t represent lateral beam scatter in aSi accurately
- Inaccurate modeling of the sharp gradients
 PDIP algorithm in Eclipse 7.2.24+
- Separate algorithm (with its own kernel)
- Kernel calculated specifically for the given aSi detector
- Precise gradient modeling, closer prediction to measurement agreement
 Since Eclipse 8.5 also Tongue & Groove effect is modeled by LMC and the actual fluence
is used for prediction
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 Useful documents in Adobe Acrobat Reader can be found on RT & Imaging CD

 There are also release notes delivered with each software version or upgrade.
 Help Desk can be contacted via phone or e-mail.
 Tech Tips are available on My.varian.com website.
 CTBs (Customer Technical Bulletins) are available through My.Varian.com website.
 PNLs (Product Notification Letter) are mailed to one person at each site.
©©Varian
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 Internet browser is started and user can browse available manuals.

 Manuals are in Adobe Acrobat PDF format.
 Multiple languages are supported.
 Main documentation resources for Portal Dosimetry:
- Eclipse Algorithms Reference Guide, RT Administration Reference Guide
- Portal Dosimetry Reference Guide ARIA
- Image Acquisition System 3 Reference Guide, Exact Arm Reference Guide Clinac Exact
Arm
- Beam Configuration Reference Guide
- Eclipse External Beam Planning Instructions for Use
- Eclipse External Beam Planning Reference Guide
- Workflow Management Instructions for Use
- Workflow Management Reference Guide
©©Varian
 For urgent issues dial 1.888.VARIAN5,

 If the issue does not require immediate attention or a document needs to be attached,
send an e-mail to help desk address
©©Varian
For training purposes only! mam/tmo,pg
November 12 Rev. 1.2
For education purposes only 51
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November 12 Rev. 1.2
For education purposes only 52
 All information for all the products can be accessed with one login. Customers are given
access to information based upon which products they have purchased.
 Access to: Product Documentation; Customer Support (Help); Event Center
 application tips, manuals, reference materials, release notes, safety notifications, CTB’s,
FAQ’s, presentations, user group links, announcements, events, demo lab
©©Varian
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©©Varian
 Requirements:
- Eclipse Version 10 including the Portal Dosimetry package or higher

- Machine types: All High-Energy Clinacs (C-series) or Unique
- IAS3 with IDU20 on E-arm (aS500II or aS1000).
- Multi Leaf Collimator: 52 / 80 / 120 leaf Millennium MLC or Mark MLC
 Note: TrueBeam is not supported with this version.

 Note: High Definition (HD) MLC not supported with this version.
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GUI Overview
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For training purposes only!
Portal Dosimetry 11
GUI Overview

Portal Dosimetry 11
GUI Overview
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 Portal Dosimetry application has the following layout:

- Title Bar – Displays Program name, Patient name and Patient ID
- Assistant – is part of ARIA workflow management. It is available in all
workspaces. Can be used to access home screen, worklists, completing tasks,
opening patients and opening workspaces not related to task
- Menu Bar – All functionalities can be accessed via menu bar
- Tool Bar – Most commonly used functionalities can be accessed via tool bar
- Navigation Panel – Allows Plan selection, image and session navigation
- Image View panel - provides Image graphical display in different window layouts
- Visibility Configuration – using option buttons in the visibility configuration
window more information can be displayed in the Image View Panel
- Display Mode – by selecting option buttons enables different image display
modes
- Task Panel – designed for dose evaluation, Image alignment and Normalization
- Image Approval buttons – Image status can be changed here
- Patient Alert – user can create or view patient alerts

Portal Dosimetry 11
GUI Overview
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Portal Dosimetry 11
GUI Overview
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Portal Dosimetry 11
GUI Overview
 At the top of navigation panel there is Plan selection dropdown list

 Navigation Panel is divided into two tabs:
- Field tab – Lists the images according to the field.
- Session tab – Lists the sessions in chronological order.
 It is possible to hide the Navigation Panel by pressing the Auto Hide button.

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Portal Dosimetry 11
GUI Overview
 User can choose between different view layouts for image display: 2 Views; 3 Views;
5 Views and Plan Overview Mode
 Visibility Configuration, Display Mode and View Layout enables user to customize the
user interface
 These settings can be set as default per user

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 Visibility configuration gives many options how to display images and allows to place
graticule and field outline (Complete Irradiation Area Outline)

Portal Dosimetry 11
GUI Overview
 Predicted and Portal Dose display mode creates blended image – also blending slide
bar allows to blend from Predicted to Portal Dose image
 Dose difference displays the difference map between Predicted and Portal Dose
(Dose Difference = Portal Dose – Predicted Dose)
 Gamma Evaluation mode displayes Gamma map based on the user selected
Gamma Evaluation criteria (Dose difference and Distance to agreement)

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 Task Panel is divided into three tabs that give user comprehensive Evaluation,
Alignment and Normalization functionalities

Portal Dosimetry 11
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 Threshold value is applied in addition to selected ROI.

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 Gamma Evaluation offers the following tests for Global or Local gamma or
improved Gamma evaluation:
- Area Gamma < 1.0 >xx.x%
- Maximum Gamma < x.x%
- Average Gamma < x.x%
- LCA(Local Connected Area) Gamma >1 < x% -test for user given smallest
acceptable connected area with gamma larger than 1
- Area Gamma > xx < xx.x% test for total acceptable areas expressed in % with
gamma value smaller than user given value
- Area Gamma > x.x < x.x% -test for total acceptable areas expressed in % with
gamma value larger than user given value
 Dose Difference offers the following tests:
- Maximum Dose Difference < x.x%
- Average Dose Difference < x.x%
- Area Dose Difference > x.x% < xx.x% - test for total acceptable areas expressed
in % with the dose difference value smaller than user given value
- Area Dose Difference > x.x% < x.x% - test for total acceptable areas expressed
in % with dose difference value larger than user given value

Portal Dosimetry 11
GUI Overview
 Point Dose and Profile measurement tools can be used in both absolute and relative
modes on blended gamma or dose difference images

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 Leaf Motion Overlay (PD 10 and higher) offers MLC leaves and motion to be
displayed over any evaluated image – this gives advanced evaluation options during
identifying of areas of disagreement
 Show Field Outline displays field CIAO Complete Irradiated Area Outline over any
evaluated image.

Portal Dosimetry 11
GUI Overview
 This functionality automatically creates Composite images for both Portal Dose and
Predicted Dose images
 Composite Image could be used to create composite images from split IMRT fields
or RA segments …
 This functionality is available from PD 10 and higher

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 Gamma/Dose Difference Height Field allows to identify whether the areas of high
gamma or dose difference are located outside/inside of the field and steep field
gradients

Portal Dosimetry 11
GUI Overview
 Portal Dosimetry application requires all images to be aligned. In a typical clinical

workflow images are considered aligned after the acquisition process. The default
alignment rules can be preset per machine in the Administration application or via
evaluation template.
 If Retractable arm is used the user may need to realign the images.
 If necessary Portal Dosimetry allows automatic or manual alignment of images
based on the Reference Image (Setup Reference Image) or Reference Dose.
- Resulting correction can be copied to other images if acquired under the same
gantry angle

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 If desired to use relative mode Normalization tab gives many choices for image
normalization

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Portal Dosimetry 11
aSi Characteristics and Algorithms TAB 3
 aSi Detector Characteristics

 PDIP Algorithm
 Dose Evaluation Algorithms

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aSi Detector Characteristics
3 3

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 Portal dose on the beam axis as a function of beam-on time

- SDD = 145 cm
- Field size of 10x10 cm2
- 6 MV and 18 MV
 Imager response is linear in wide range of MU
- Gated (or step and shoot) delivery has no or very little effect on the response
linearity
 Linear dose response enables easy imager calibration
- Only one point can be established during the imager calibration (e.g.
100MU=100CU)
- Imager response can be modeled by a simple linear function of a known slope

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 Measurements in water are done in 8mm, because of water equivalent thickness of

layers above aSi
 Imager response vs. Inverse square law
- Field size of 10x10 cm2
- aSi detector and an ion chamber in water at 8 mm depth
- Varying SDD
 aSi Imager response with the distance can be modeled by Inverse square law
- Enables portal dose prediction at different SDD without the need for additional
measurements

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 For more information on saturation effect with the early IAS2 see the following
reference: Van Esch A, Radiotherapy and Oncology 2004; 71(2)
 Saturation with IAS2 can be minimized with increasing SID(Source to Imager
Distance)

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 6 MV output factors
- Ion chamber data: 8 mm depth and SDD = 145 cm
- aSi detector data: SDD = 105 cm and 145 cm
- All data series are normalized to the 10x10 cm2 field
- Portal dose measurements for rectangular field size are plotted as a function of
their corresponding equivalent square field size
 aSi output is field size dependent
- The output factors must be provided for the correct dose prediction

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 18 MV output factors
- Ion chamber - 8 mm depth and SDD = 145 cm
- aSi detector - SDD = 105 cm and 145 cm
- All data series are normalized to the 10x10 cm2 field
- Portal dose measurements for rectangular field size are plotted as a function of
their corresponding equivalent square field size
 aSi output factors are significantly different from the machine ones especially for the
higher energies and larger field sizes
- It is recommended to measure the output factors for each imager and each
energy separately
- Do not use the machine (ion chamber) output factors

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 Tissue maximum ratio measurements

- 6 MV and 18 MV
- aSi (open symbols) and with an ion chamber in water (closed symbols)
- SDD = 145 cm
- The 8 mm water equivalent thickness of aSi detector material was added to the
surplus amount of polystyrene to obtain the displayed total build-up depth
 Water equivalent thickness of the aSi detector build-up material is 8mm, although the
physical thickness is 12mm, it’s water equivalent thickness is 8mm.

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 Mechanical parts of the imager cassette and arm produce backscatter radiation
captured by the imager
 Backscatter is corrected by the flood field calibration
- FF calibration is done for the maximum imager field size
- Amount of the backscatter changes with the field size
- Mostly pronounced for medium open fields
- IMRT fields generate relatively low amount of backscatter as these fields are
delivered by small segments
 See references:
- Lung, Ko, Jong Oh Kim and Jeffrey V Siebers, “Investigation of the optimal
backscatter for an aSi electronic portal imaging device”, Phys. Med. Biol. 49
(2004) 1723-1738
- Joseph A Moore and Jeffrey V Siebers, “Verification of the optimal backscatter for
and aSi electronic portal imaging device”, Phys. Med. Biol. 50 (2005) 2341-2350

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 Known limitations:
As the backscatter is field size dependent the PDPC backscatter correction is a

compromise to provide acceptable backscatter correction for clinical field sizes up to
15cm, while slightly increasing deviations can be observed for large field sizes

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3 3
 Picture above describes image orientation when displayed on the monitor of Imaging
application or Portal Dosimetry Application

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Portal Dose Image Prediction Algorithm

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 PDIP algorithm is used only for the PD prediction calculation purpose

 Separate algorithm in Eclipse
 Predicted images are absolutely scaled (CU)
 Distance of the imager is taken into account (by ISL correction)
- ISL is calculated relative to the algorithm calibration point
 Predicted images are always displayed at SAD
 Assumes beam through air only

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 PDIP is a 2D convolution algorithm

 Given input fluence f’ is convolved with the kernel derived in the algorithm
configuration process
 Correction for the imager distance and field size are applied

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 Open field fluence is typically not uniform across the field

 Compensation is performed by modifying the original actual fluence by the intensity
profile

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 The original fluence is multiplied by the intensity profile

- The profile is assumed to be radially symmetrical
 Input fluence scaling is performed at this step by:
- MU factor from dose calculation
- Maximum fluence value

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 SDD correction is relative to the given reference distance (SAD)

- Source-axis distance parameter given in Beam Configuration, PDIP General
Parameters
 SAD distance is defined for the PDIP algorithm
- Independent of the machine calibration distance (doesn’t have to be the same)
- Default value is 100cm

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 Fluence of flat field is convolved with the kernel

- Fluence value inside the field is 1, outside 0
 Value of central pixel after the convolution is used as PSF value
 Calculation performed at SAD

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 PDIP convolution kernel is described by sum of Gaussians

 Assumes radial symmetry

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 Kernel is calculated during the algorithm configuration phase

 Deconvolution reverses the convolution process
 Therefore, all the data in the convolution formula (except the kernel itself) must be
known
- Predicted image is replaced by an acquired image
- Intensity profile must be also known for the Actual Fluence correction
- SAD is defined in the algorithm properties, SDD is extracted from the measured
image properties
- Imager output factors play their role in the final kernel shape
- PSF is calculated iteratively during the configuration
 Kernel parameters are extracted in an iterative process of deconvolution with
Tikhonov regularization

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 After the configuration, the kernel shape is displayed in the Beam Configuration (BC)
in the logarithmic scale
 Individual Gaussian parameter are tabulated and displayed as a graph as well
 There may be small negative ai (amplitude) values
 The ultimate test of the prediction kernel quality is to compare prediction with the
measurement

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 Ideal image alignment assumed

 99% of the entire imager area should have the gamma score better than 1 (with the
given criteria)

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3 3
 Actual fluence is calculated by selected Volume Dose algorithm and thus the input
fluence calculation is defined by user selected calculation grid.
 If AcurosXB is used as a Volume Dose algorithm, resolution of actual fluence is ½ of
selected calculation grid.

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PDIP Algorithm
EXERCISE
Objective:
 After completing this lesson the student will have understood input data needs
and algorithm limitations by identifying the principles of the PDIP algorithm
configuration and calculation process
3
A. The PDIP algorithm is based on a single kernel _________________
principle.
B. What fluence is used by PDIP algorithm to perform convolution?
 Optimal fluence
 Actual fluence
C. The input fluence is first corrected by the _____________ profile before the
convolution.
D. What is the input fluence resolution for predicted image calculation?
1. 2.5x2.5mm
2. Calculation grid size of selected Volume Dose calculation algorithm.
E. The PDIP kernel is extracted by the process of ______________.
F. The prediction is corrected for the field size effects by ________ factor and
__________ _________ factor.
G. The four variables needed for the kernel calculation are __________ profile,
________ factors, measured _________ image and ___________ fluence of
the test plan.
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© Varian MedicalSystems
FOR TRAININGpurposes
For education PURPOSES ONLY!
only pg 111 Rev. 1.2
Dose Evaluation Algorithms
3 3

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3 3
 Portal Dosimetry is the only workspace where the dose images can be visualized and
evaluated
 Evaluation can be performed in two modes
- Absolute: CU image calibrations are used to compare the images
- Relative: Images are first normalized relative to the selected reference point and
then compared
 Dose evaluation methods
- Dose Difference: simple 2D dose matrix subtraction
- Gamma Evaluation: Quantitative dose evaluation (D.A. Low at.al; A technique for
the quantitative evaluation of dose distributions; Medical Physics 25(5), 1998

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 Relative mode normalization options:

 Manual normalization
- Normalization value defined numerically for each dose separately
- Values represent a percentage of the original (absolute) normalization factor (50
reduces the calculated normalization in half)
 Normalizations
- Maximum of predicted dose: both doses normalized to the reference (predicted)
image maximum point (e.g. dose ratio is the same as in the absolute mode)
- Maximum of each dose: Dose is normalized to 100% at the maximum of each
dose.
- Selected point. in dose: You can select a point in the dose image. Dose is
normalized to 100% at this point for both dose images
- Dose at Isocenter: Dose is normalized to 100% for both dose images at the
isocenter.
- Minimize Difference: Minimizes average dose difference over the whole image

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3 3
 The fraction which is used to cut off the upper end of the histogram in order to prevent
outliers from being.
 The last remaining bin is then used as the reference dose for global gamma as well
as threshold for ROI calculation.

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 Threshold is defined as fraction (percentage) of reference dose

- Evaluation performed only within the area defined by the threshold
- Can be combined with ROI
- Default value is 5%

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 Dose Difference images is simple subtraction of two 2D doses

- Does not take the spatial differences into account

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* D. Low et al., Medical Physics 25(5), 1998

 Gamma evaluation provides single value (gamma score) evaluating both distance and dose
difference agreement
- Excellent tool for evaluation of IMRT/VMAT fields with sharp gradients
 Gamma value represents the shortest “distance” from the point on the reference curve to the
evaluated curve
 Gamma criteria are ∆Dmax and DTA
 ∆Dmax is the dose difference expressed in %
- The ∆Dmax can be calculated as a percentage of the reference dose (see Histogram Cut-
Off) or as percentage of local dose. The former way of calculation may be selected by
checking Use local gamma calculation checkbox in Evaluation Options.
The local gamma calculation may be cut off at user defined threshold. (Tools>Task
Configuration>Misc Settings, Local Gamma Threshold)
 DTA is an absolute distance from the evaluated point
 Given criteria defines an “ellipsoid of agreement” around each point
- Gamma value is equal to 1 at the perimeter of this ellipsoid
- If the evaluated curve lays inside the ellipsoid, gamma score is less than 1, the point
passes
 3 points are evaluated in this example
 Evaluated curve is within the “ellipsoid of agreement” of points 1 and 2
- These points pass the test with the gamma < 1
 Point 3 fails the test, gamma >1

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3 3
 The original algorithm implementation used to calculate the gamma evaluation is

limited by searching for the best gamma value only at integer pixel position around the
given source (reference) pixel. This sampling limitation may result in an
overestimation of the gamma value at that point. Values of 0, 1 and 2 are large
compared to improved impr. value as displayed on the picture above.
 Mn – denotes Acquired dose
 Pn – denotes Predicted dose
 For simplicity the improved gamma evaluation is explained on one dimension, but it is
implemented in two dimensions in Portal Dosimetry.
 For more details see the Portal Dosimetry Reference Guide.

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 Before starting the evaluation the status of the images has to be set to aligned if the
alignment is required.
 The user can align images manually by moving the images with a mouse or providing
displacement values
 The alignment can be performed automatically. The auto align function matches
intensity values of the images
 After the images are aligned the user can copy the alignment to other fields.

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System Preparation and Data Acquisition TAB 4
 Software Administration for PD

 Hardware Calibration C-Series
 Hardware Calibration TrueBeam
 PDIP Beam Data Requirements
 Hardware Calibration - C-series – Imaging system calibration
 Output Factor Measurements

education Systems
Software Administration for Portal Dosimetry
Software Administration for Portal Dosimetry

PROCEDURE
Objective:
 After completing this exercise the student will have successfully defined all the
system parameters necessary for the Portal Dosimetry system
A. Radiation Oncology Administration – Machine definition
4 4
1. Login to Home Screen ( ).
2. Select Quick Links > Administration > RT Administration. See Figure 1.
Figure 1: Quick Links > Administration > RT Administration
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Setup of software for Portal Dosimetry
3. Read the message and press Yes to continue. See Figure 2.
Figure 2: Administration module Startup Manager
4. Select Radiation & Imaging Devices workspace. See Figure 3.
Figure 3: Radiation and Imaging Devices selection
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5. From machine list select appropriate machine(To_Config machine is used for the
purpose of the class exercise). See Figure 4.
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Figure 4: Radiation and Imaging Devices
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6. Double click on selected machine to display property window and select External
Beam tab. Verify the setting of Automatic MV Imager Position Correction. Click
OK to continue. See Figure 5.
Figure 5: External Beam Properties – External Beam tab
NOTE: Portal dosimetry requires alignment of predicted and

acquired images if Automatic MV imager position correction is
required. The images in that case may be aligned automatically but
only if the realignment in any of the axis are smaller than Maximum
Distance Correction. If the Automatic MV imager position correction
is unchecked then images are considered aligned.
NOTE: The selection of Automatic MV Imager Position Correction
is not needed for ExactArm and TrueBeam PU arms. For more
information see also CTB RO-813 Correct Use Of Automatic MV
Imager Position Correction.
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7. Select Imager tab. If there are no MV imagers defined click on New Port Imager.
See Figure 6.
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Figure 6: Radiation & Imaging devices workspace – Imager tab
8. Click on the New Port Imager button, to create new imager. In General tab
define ID, Machine Model and Manufacturer Name. See Figure 7.
Figure 7: Port Imager properties.
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9. Continue to Port Imager tab and select MV Imager. Click OK to continue.

See Figure 8.
SAD, Default Gantry Angle and Gantry Pitch

parameters are not used.
These parameters are utilized only for reference
image creation in Eclipse Proton Planning
Figure 8: Port Imager Properties – Port Imager tab
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B. Radiation Oncology Administration – Sequence templates

2. Select Quick Links > Administration > RT Administration. See Figure 9.
4 4
Figure 9: Quick Links > Administration > RT Administration
3. Read the message and press Yes to continue. See Figure 10.
Figure 10: Administration module Startup Manager
4. Select Templates workspace. See Figure 11.
Figure 11: Templates selection
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5. Select Sequence Templates tab and click on New Sequence Template button
to create sequence template. See Figure 12.
Figure 12: Sequence Templates tab.
6. Define sequence template ID and Name. Click OK to continue. See Figure 13.
Figure 13: Sequence Template Properties
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7. Click on a newly created image sequence template in Sequence Templates list,

click on the button New Sequence Template Image and from displayed list
select New Sequence Template MV Image. See Figure 14.
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Figure 14: New Sequence Template Image selection
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8. In General tab of Sequence Template Image Properties select During setup and
deselect Beam off function. Continue to Setup tab and select Integrated Image.
Click OK to continue. See Figure 15.
Figure 15: Sequence Template Image Properties
9. Save All ( ).
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C. 4DITC Treatment Administration – Definition of sequence template
1. Open Treatment Administration

2. Login as service user with password 1111
3. Go to machine configuration – click in the toolbar

4. In the machine configuration go to the Sequence Templates tab, hit Add button
and in next window enter ID for new template (Portal Dosimetry) and press OK.
See Figure 16.
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Figure 16: 4DTC Administration - Sequence templates
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5. Select the new template in the template list and press the Edit Images button to
add images to this template. See Figure 17.
4
Figure 17: Edit Images selection
6. In the next window press the Add button, select DURING Setup and from Quality
dropdown select Integrated. Click OK to continue. See Figure 18.
Figure 18: Edit Digital Images
7. Save All ( )
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D. AM Maintenance
1. Open AM Maintenance
2. Login as service user with password 1111
3. From Maintenance menu select Acquisition Technique… See Figure 19.
4 4
Figure 19: Acquisition Technique selection
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4. In displayed window verify that technique is set properly for all energies.
See Figure 20.
Figure 20: Acquisition technique setup for IAS2 (Left) and IAS3 (Right)
NOTE: If the Full resolution license was not purchased only Half will
be available under Integrated Image acquisition technique.
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Information Disclaimer
Abstract
The Eclipse Inverse Planning Training material is an educational aid for Varian Eclipse treatment planning
System.
Worldwide Headquarters
Varian Medical Systems, Inc.
3100 Hansen Way, Bldg. 4A
Palo Alto, CA 94304-1030, U.S.A.
Notice
This information is an educational aid only and is intended solely as a supplemental document. This information
provides information concerning the use of the Eclipse Treatment Planning System. For complete information
concerning components, safety instructions, installation, maintenance, troubleshooting, etc., refer to the
applicable Varian product Operator’s Manual. This document does not replace the Varian Operator’s Manual.
Carefully read all instructions prior to use. Observe all contraindications, warnings and precautions noted in these
instructions. Failure to do so may result in patient and/or user complications.
Information within the manual is subject to change without notice and does not represent a commitment on the
4 part of Varian. Varian is not liable for errors contained in this information or for incidental or consequential 4
damages in connection with furnishing or use of this material. This contains proprietary information protected by
copyright. No part of this information may be reproduced, translated, or transmitted without the express written
permission of Varian Medical Systems, Inc.
FDA 21 CFR 820 Quality System Regulations (CGMPs)

Varian Medical Systems, Oncology Systems products are designed and manufactured in accordance with the
requirements specified within this federal regulation.
ISO 13485
requirements specified within ISO 13485 quality standards.
HIPAA
Varian’s products and services are specifically designed to include features that help our customers comply with
the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The ARIA and VARiS Vision systems
use a secure login process, requiring a user name and password that supports role-based access. Users are
assigned to groups, each with certain access rights, which may include the ability to edit and add data or may limit
access to data. When a user adds or modifies data within the database, a record is maintained of the data that
was changed, the users ID and the date and time the changes were made. This establishes an audit trail that can
be examined by authorized system administrators.
CE
Varian Medical Systems, Oncology Systems products meet the requirements of Council Directive MDD
93/42/EEC.
Trademarks
Argus Software®, Clinac®, On-Board Imager®, SonArray®, Trilogy® and VARiS® are registered trademarks of
Varian Medical Systems, Inc. 4D Integrated Treatment Console™, Acuity™, ARIA™, Eclipse™, FastPlan™,
Millennium™ MLC, PortalVision™, Real-Time Position Management™ and SmartBeam™ are trademarks of
All other trademarks or registered trademarks are the property of their respective owners.

All rights reserved.
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Hardware Calibration C-Series
©©Varian
4 4
©©Varian
©©Varian
4 4
 Imager detector plate is 1.2cm below the imager surface

 To assure the proper image scaling, the imager must be calibrated so that the machine
isocenter is 1.2cm below the imager faceplate
- After the correct calibration, SDD shall therefore be 98.8cm at the imager surface
- If calibrated correctly, the imager hand pendant should read 0;0;0 at the isocenter
position
 Perform the calibration without the detector cover
- Align the imager center crosshair (on the faceplate) precisely with the machine CAX
 NOTE: Since all imager calibrations are performed with imager at CAX, make sure the
imager is always aligned with the CAX. Performing the pretreatment QA with the imager
displaced from the CAX may lead to discrepancies between the prediction and
measurement.
 Isocenter calibration is accessible via hand pendant in the P3 Physics menu
- Hand pendant button sequence: [MODE] > [P3] (Physics) > 4x[P1] (access code) >
[P3] (IDU Iso Cal) > [P4] (Calibrate all)
©©Varian
 Imager positioning for PD is crucial

 Saving the selected position(s) for PD purposes simplifies the imager setup
 Imager positions can be saved via hand pendant in the P1 Save position menu
- Hand pendant button sequence: [MODE] > [P1] (Clinical 1) > [P1] (Save position) >
select the position [P1-5]
WARNING: The imager position is typically close to the isocenter for the PD measurements.
If a consequent treatment field doesn’t have a predefined imager position, after pressing
the AUTO GO button the imager will attempt to go to the last known position, which might
be the one used for PD (close to isocenter) and result in an imager-table collision!
©©Varian
4 4
 Detector calibrations are performed in the AM Maintenance’s Service Monitor

 Dark field (DF) sets the detector response to 0 when there is no radiation to the imager
 Flood field (FF) adjusts the gain of each pixel to produce a flat image
- Flattens out the beam profile (the “horns”) to achieve a uniform image intensity
desired for the imaging purposes
 DF/FF calibration must be done separately for each energy/dose rate combination within
the technique
 Successful DF/FF calibration is a prerequisite for the dosimetry calibration
©©Varian
 Imager calibration for dosimetric purposes is done in AM Maintenance > Dosimetry

Calibration
 Dose Normalization can be omitted for relative dose acquisition
- Acquired images are in the relative units only
 Calibration distance is user definable
- SDD same as the usual SDD used routinely for PD is recommended for better
accuracy
©©Varian
4 4
 Non-flatness of the beam is re-introduced by the diagonal profile

- Imager response is flat after the FF calibration
- Beam profile shall be taken into account for dosimetry purpose
 Diagonal profile must be provided in the w2cad format
- One curve in the file
- Measured for the largest field size (40x40cm)
- Shallow depth (ideally 8mm, Dmax is sufficient)
- Point separation is 2.5mm
- Distance increases in the x-axis (positive half of the profile)
©©Varian
 Files have extension cdp and can imported exactly like regular w2cad file even though
these are not w2cad files
©©Varian
4 4
 Dose normalization links the imager response to the desired CU value

 Normalization is performed by delivering 10x10cm field with 100MU to the imager at a
given position
- Afterwards, the imager readout is displayed and the desired number can be entered
 The imager calibration must be linked to the prediction algorithm calibration
- Predicted image is calculated at SAD=100cm
- Therefore when calibrating imager at a SDD, the imager calibration value must
contain the inverse square law correction that is calculated with the prediction SAD
not the Clinac calibration point! (see the example above with the SDD=105 cm)
 NOTE: Preferred calibration geometry is to position the imager at the plane of isocenter
(SDD=SAD No inverse square law correction necessary).
©©Varian
©©Varian
4 4
©©Varian
TrueBeam Hardware Calibration

Portal Dosimetry 11
4 4

Portal Dosimetry 11
 Hardware calibration consists of 3 calibrations

- Calibration of robotic arms
- IsoCal is required for active imager position correction and is performed before
the TrueBeam is accepted by customer.
- Calibration of MV Imager Detector unit

Portal Dosimetry 11
4 4
 The Installation Calibration determines the reference position (hardstops) for all
rotational axes. It is prerequisite for all other calibrations and initialization routines.
This calibration is responsibility of Varian Service representative.
 The Axis Calibration is a process which establishes the offset between the fixed
reference position (hardstop) and the axis home position. This calibration is
responsibility of Varian Service representative.
 The Axis Initialization is calibration verification procedure that compares baseline
calibration values (hardstops and home positions) against the actual values. Axis
initialization is necessary to be performed after Axis Calibration (Varian Service),
power failure, Emergency Off or severe fault
 System Calibration is calibration of the robotic arms in respect to the TrueBeam
mechanical isocenter.
Imaging system IsoCal will be performed once the System Calibration is complete to
determine the Positioning Unit isocenter correction as a function of the gantry
rotation.

Portal Dosimetry 11
 The IsoCal verification should be performed before dosimetry calibration.

 The purpose of IsoCal verification is to verify if the IsoCal calibration is valid. Imaging
Calibration application or Service Console can be used to perform this verification.
 Imaging system IsoCal will be performed once the System Calibration is
complete to determine the Positioning Unit isocenter correction as a function of
the gantry rotation. This is performed by Varian Representative before the
Customer Acceptance procedure. Verification and if necessary subsequent
recalibration is the responsibility of the end-user.
- IsoCal calibration uses calibrated MV continuous mode for low energy and 300
MU/min dose rate and dynamic gain KV mode to refine geometrical calibration of
PU arms. This calibration enables active imager position correction with gantry
rotation.
 For more information on IsoCal calibration and verification refer to TrueBeam
Technical Reference Guide Volume 2 or TrueBeam Administration education course
book.

Portal Dosimetry 11
4 4
 The Isocal phantom consists of 16 tungsten carbide BBs arranged in a special

pattern with each BB being 4 mm in diameter and all BBs embedded in a
polyoxymethylene ((POM) (Delrin)) cylinder. The manufacturing tolerances are
±0.5mm
 The plate is made from 3 mm aluminum and is designed to lock into the accessory
interface mount. A locking handle as well as a lock pin ensure reliable positioning of
the plate and ensures that it does not move during gantry rotation. A 6 mm diameter,
8 mm thick, stainless steel pin is pressed into the plate to form the partial
transmission structure. At 6 MV, the transmission of the pin is 85%.

Portal Dosimetry 11

Portal Dosimetry 11
4 4
 Calibration steps for MV imaging modes are described in logical order:

- The first step is the Dark field calibration
- Then the Flood field calibration is performed
- Pixel Correction map will be generated based on Flood field calibration

Portal Dosimetry 11
 To perform the Dosimetry calibration, in addition to above calibration another two

steps need to be performed:
- Beam Profile Correction
- Normalization (Absolute Calibration in terms of Calibration Units (CU))

Portal Dosimetry 11
4 4
 Non-flatness of the beam is re-introduced by the diagonal profile

- Imager response is flat after the FF calibration
- Beam profile shall be taken into account for dosimetry purpose
 Diagonal profile must be provided in the w2cad format and these parameters

Portal Dosimetry 11
 Dose normalization links the imager response to the desired CU value

 Normalization is performed by delivering 10x10cm field with 100MU to the imager at
a given position
- Expected response to reference beam in CU is defined/typed in before the
reference beam is delivered.
 The imager calibration must be linked to the prediction algorithm calibration

Portal Dosimetry 11
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Portal Dosimetry 11

Portal Dosimetry 11
Beam Data Requirements
4 4

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 Diagonal profile must be provided in the w2cad format and these parameters

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 %BMTY PHO – beam type has to be set to PHO (photons)

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 Single field should be used for a verification plan. The configuration optimal fluence
needs to be imported. The configuration fluence is delivered with the system and can
be found at the following path:
\\”DCFServer”\DCF$\client\PreconfiguredBeamData\Portal Dose Image Prediction
(“version number”)\PDIP-Configuration.optimal_fluence
 The fluence displayed on the picture above is for MLC120

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4 4
 Verification plan should be created for PDIP configuration

 The verification plan can be calculated on any image
 The verification plan should be calculated for 2 fractions
 Single field should be used for a verification plan. The configuration optimal fluence
needs to be imported. The configuration fluence is delivered with the system and can
be found at following path: \\”DCFServer”\DCF$\client\PreconfiguredBeamData\Portal
Dose Image Prediction (“version number”)

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 The acquired images will be exported to ASCII from Portal Dosimetry application and
used in the configuration process of PDIP algorithm

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4 4
 Actual fluence is corrected by the intensity profile before convolution

 NOTE: Do not copy intensity profile from AAA or AcurosXB source model. Use
measured diagonal profile measured at shallowest depth instead.

©For training
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 OF account for a change in detector response for various field sizes

 PDIP algorithm requires imager specific output factors
- Minor OF variations observed due to differences in aSi panel and read-out
electronics manufacturing process
 Imager OF are different from output factors measured with ionization chamber
- Difference pronounced with higher energies and larger field sizes
- Do not use output factors measured by ionization chamber for PDIP configuration
 Output factor table represents number of CUs for calibration MU at SAD distance
- Make sure measured outputs are correctly calibrated after import into PDIP

©For training
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4 4
 An example of a output factor table measured at 100cm SID

 The delimiter is a comma
 The file starts with header line.
- First 3 characters are reserved for unit code – not used in Eclipse
- Next field is for add-on id. 00 will be used for Portal Dosimetry as it stands for
open field.
- Next number is SID
- Fourth field is for calibration value for reference field size
- Fifth and sixth field are reference field size width and height respectively.
- Last field identifies Output factor or dose rate table. Use Gy/MU for output factor
table
 Next line are X field sizes, notice that there is no empty cell at the beginning of this
line and no trailing commas
 Each next line starts with y field size and output factor value
 Notice that for biggest field size in this example (38x38cm2) which cannot be acquired
the output factor value is 0

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 PDIP calibration has to match absolute dose (in CU) calibration of the imager done at
the machine for reference/calibration beam.

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 OF table calibration

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 In Eclipse
- Create the configuration plan
- Import provided optimal test fluence
- Calculate actual fluence by running the final dose calculation)
- Prepare plan for treatment (schedule the Integrated images)
 On Clinac
- Measure the imager output factors
- Deliver the test plan and acquire the test image(s)
 In Beam Configuration
- Create a new PDIP Model
- Import the actual fluence of the test plan
- Import the test image(s)
- Insert the intensity profile
- Import and calibrate the output factors

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4 4

©For training
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 CTB-PV-887-A is also available in appendix of this manual

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Hardware Configuration – C-series
PROCEDURE
Objective:
 After completing this lesson the student will have successfully completed the
hardware calibrations necessary to use the Portal Dosimetry system
A. MV imager arm isocenter
1. Remove the imager cover

2. Align the imager center pixel (crosshair on the imager face plate) with the CAX 4
using the front pointer (measure 98.8cm to the imager surface)
CAUTION: Since all imager calibrations are performed with imager

at CAX, make sure the imager is always aligned with the CAX.
Performing the pretreatment QA with the imager displaced from the
CAX may lead to discrepancies between the prediction and
measurement.
WARNING: If the IsoCal is installed, a new IsoCal calibration must

be performed following the Isocenter calibration of the Exact Arms.
(see procedure in the appendix of the Portal Dosimetry course
manual).
3. Using the imager hand pendant, select the Physics mode [MODE] [P3] (access
code: 4x [P1]) 187-1
4. Select IDU Iso Calibration [P3] and calibrate all axis [P4]
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188-1
B. Preset imager position
1. Move imager to the position typically used for PD (e.g. -5, 0, 0)

2. Verify the imager position using the front pointer (measure 103.8cm to the imager
surface)
3. Using the imager hand pendant, select the Clinical Mode [MODE] [P1]
4. Press [P1] to save the position under a selected button [P1 – P5]
4 4
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189-1
C. Imager Dark and Flood field calibration - IAS3 Service Monitor
1. Align the arm of the PV imager with the beam central axis, SDD e.g. 105cm (Vrt=-
5.0, Lng=0, Lat=0).
2. Put the Treatment application to Standby mode.
3. Open the AM Maintenance application on the Treatment workstation ( ).

4. From the Maintenance menu select Service monitor. See Figure 1.
Figure 1: Maintenance menu
5. Select the Integrated image mode from the Acquisition Technique list. See
Figure 2.
6. Energy/Dose Rate mode will be selected automatically upon the Clinac mode up
(if Manual Selection is unchecked)
7. Click the Dark Field button. It’s recommended to acquire at least 60 frames for
the dark field calibration
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Figure 2: IAS3 Service Monitor window
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8. Setup the field size to cover the active part of the detector. Press the Flood Field
button and then Beam On. See Figure 3. It is recommended to acquire at least 30
frames for IMRT flood field calibration.
Figure 3: Flood Field calibration in IAS3
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9. When requested number of frames is delivered Beam OFF. Then click Save
Calibration Set to update calibration information (save acquired Dark field and
Flood field images). See Figure 4.
4 4
Figure 4: Save Calibration Set button
10. Repeat dark/flood field calibrations for all energy/dose rate combination used for
the Portal Dosimetry.
11. When finished with the calibration, close the IAS3 Service Monitor window.
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D. Dosimetry Calibration
1. From the Maintenance menu select Dosimetry Calibration. See Figure 5.
Figure 5: Dosimetry Calibration menu
2. Select all acquisition modes to be calibrated and click OK. See Figure 6.
Figure 6: Acquisition mode selection
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3. Select Dose normalization and Beam Profile Correction check box and define
the imager position for calibration, then click OK. See Figure 7.
Figure 7: Dosimetry calibration parameters

4 4
4. Select the diagonal profile file (w2CAD format) for the corresponding energy,
and then click Open. See Figure 8.
Figure 8: Diagonal profile selection
NOTE: If using Portal Dosimetry Pre-Configuration Package select

appropriate 2D beam profile correction file from the package at this
step.
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5. Mode up the Clinac for a 10x10cm reference field with the selected number of
MUs (e.g. 100MU).
6. Press the Start button, wait at least 10s and then start the beam - BEAM ON.
See Figure 9.
NOTE: If the beam is started before the IDU is ready, the yellow
beam icon will not be displayed in the Acquisition and Beam
Status section.
Figure 9: Dose acquisition control window
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7. After the delivery, define the desired value in CU’s in the Measured Dose box for
given imager position and delivered number of MU’s. Click OK to continue.
See Figure 10.
4 4
Figure 10: Imager absolute calibration window
8. Repeat steps 5 - 7 for each selected dose rate and energy combination. When
finished press OK. See Figure 11.
Figure 11: Dose Normalization window
9. Exit the AM Maintenance application.
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E. Imager Dark and Flood field calibration - IAS2 Service Monitor
1. Align the arm of the PV imager with the beam central axis, SDD e.g. 105cm (Vrt=-
5.0, Lng=0, Lat=0).
2. Put the Treatment application to Standby mode.
3. Open the AM Maintenance application on the Treatment workstation ( ).

4. From the Maintenance menu select Service monitor. See Figure 1.
Figure 12: Maintenance menu
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5. Select an IMRT acquisition mode to calibrate from the drop down list.
 Frame Averages value (9996) is used to enable the integrated acquisition
mode.
6. Click the Dark Field button.
4 4
Figure 13: IAS2 service Monitor window
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7. The acquisition can be stopped using the Abort button. It’s recommended to
acquire at least 60 frames for the dark field calibration. See Figure 14.
Figure 14: Acquisition control window
8. Setup the field size to cover the active part of the detector. Start the beam and
then click on the Flood Field button. See Figure 15. Maximum field size for the
flood field calibration at SDD=105cm is X=38cm, Y=28.5cm (0˚ collimator 4
rotation).
Figure 15: Flood field calibration
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CAUTION: The beam must be turned off using the “BEAM OFF”
button (on the Clinac console) at least 2 frames before the total
number of frames is reached.
9. The acquisition must be stopped using the “BEAM OFF” button (Clinac Console)
10. It is recommended to acquire at least 30 frames for IMRT flood field calibration
11. After each Dark Field and Flood field acquisition click Update Cal. Set to update
calibration information within the IAS2 unit. See Figure 16.
4 4
Figure 16: Update calibration set button
12. Repeat dark/flood field calibrations for all energy/dose rate combinations used for
Portal Dosimetry.
13. When finished with calibration select Close. See Figure 16.
14. To perform Dosimetry Calibration follow the instructions described in section D
page 7 of this procedure.
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Abstract
System.
Notice
4
part of Varian. Varian is not liable for errors contained in this information or for incidental or consequential

ISO 13485
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Imager Output Factor Measurement
PROCEDURE
Objective:
 After completing this procedure, the student will have successfully created a test
plan for imager output factor measurement and use the output factor tool in Portal
Dosimetry application to get the doses at iso-center for different field sizes.
A. Output factor patient creation

4 4
2. Select Quicklinks > EMR > Plan Parameters. See Figure 1.
Figure 1: Quicklinks > EMR > Plan Parameters
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3. Select Tools > Task Configuration. See Figure 2.
Figure 2: Tools > Task Configuration
4. Make sure the Advanced Feature Set is turned on. Press OK. See Figure 3.
Figure 3: Task Configuration
5. Restart the application.
NOTE: If the Advanced Feature Set was turned on the setting will
take effect only after restart of the User Home.
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6. Create new patient. Press the New Patient button. See Figure 4.
Figure 4: Plan parameters
7. In the patient explorer fill in required fields. Click OK to continue. See Figure 5.
4 4
Figure 5: Patient explorer – New tab
NOTE: Create new patient for every energy the output factors will
be measured.
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8. Create new course. Select Insert > New Course. See Figure 6.
Figure 6: Insert > New Course
9. In the Course Properties define course ID. Press OK. See Figure 7.
Figure 7: Course Properties
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10. Create new plan. Select Insert > New Plan. See Figure 8.
Figure 8: Insert > New Plan
11. In the plan Properties General tab define ID=Y03, Plan Intent and Patient
Position. In the Dose tab define Number of Fractions and Prescribed dose
Per Fraction. Press OK. See Figure 9.
4 4
Figure 9: Plan Properties General tab
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12. Create new field. Select Insert > New Field. See Figure 10.
Figure 10: Insert > New Field
13. Select the treatment unit, make sure Treatment field type is selected. Click OK.
See Figure 11.
4
Figure 11: New Field type – Machine selection
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14. In the parameter window Define field ID, Energy, Dose Rate, MU, Treatment
Time, Tolerance Table, change Field X , Y and define couch and imager
position. See Figure 12.
4 4
Figure 12: Field parameters display
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15. In the Plan Parameters RMC on the field in the Scope window and select Copy
Field. See Figure 13.
Figure 13: Copy field menu
16. RMC on the plan in the Scope window and select Paste > Field. See Figure 14.
Figure 14: Paste field menu
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17. Change the new field’s ID and Field X size.

18. Repeat steps 16 and 17 for the rest of the fields with the same Y jaw setting so
the X jaw will be set to desired sizes of the output factor table (e.g. 3x3cm to 5x3;
10x3; 15x3; 20x3; 28x3 and 38x3cm). See Figure 15.
4 4
Figure 15: Field parameter display
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19. When done, RMC on the plan in the Scope window and Select Copy Plan.
See Figure 16.
Figure 16: Copy plan menu
20. RMC on the course and select Paste > Plan. See Figure 17.
Figure 17: Paste plan menu
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21. Change the new plan ID to correspond to Y jaw size and click OK. See Figure 18.
4 4
Figure 18: Verification Plan properties
22. Change Y jaw settings for all the fields in the new plan to the next increment
value.
23. For clarity change the field ID’s to correspond to field X and Y jaw sizes.
24. Repeat steps 20 to 22 for other Y field sizes to be created.
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25. For the plan with largest Y jaw setting (Y38) change also Collimator rotation, to
90 dgr. See Figure 19.
Figure 19: Field parameter display
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26. RMC on the 38x38 field and select Delete. See Figure 20.
4 4
Figure 20: Delete field selection
27. Confirm deletion of the field. See Figure 21.
Figure 21: Delete field confirmation
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28. Go to Reference Points. See Figure 22.
4
Figure 22: Reference Points
29. Create new patient volume. Select New > Patient Volume. See Figure 23.
Figure 23: Add New > Patient Volume
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30. In the Patient Volume Properties define ID and Volume Type. Press OK.
See Figure 24.
4 4
Figure 24: Patient Volume Properties
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31. Create new reference point. Select New > Reference Point. See Figure 25.
Figure 25: Add New > New Reference Point

4
32. In the Reference point properties define ID and select Patient Volume.
Press OK. See Figure 26.
Figure 26: Reference point Properties
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33. From the Reference Point dropdown select reference point for each plan.
See Figure 27.
4 4
Figure 27: Select Reference Point
34. Define field dose contribution. See Figure 28.
Figure 28: Field Dose contribution
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35. Go to Plan Parameters. See Figure 29.
Figure 29: Plan Parameters
36. Approve plans. RMC > Plan Approval > Planning Approved. See Figure 30.
Figure 30: Plan approval
37. Read warnings if present. Press Next.

38. Press Next. See Figure 31.
Figure 31: Planning Approval – Delta Couch Shifts
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39. Define parameters and press Next. See Figure 32.
4 4
Figure 32: Planning Approval – Parameters
40. Authorize planning approval. Press Finish. See Figure 33.
Figure 33: Planning Approval – User Authentification
41. Repeat steps 28 through 41 for all plans.
42. Save All ( ).
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43. Go to Treatment Preparation. Read Validation findings. See Figure 34.
Figure 34: Treatment Preparation
44. Click on the validation links. Press Plan is not scheduled. See Figure 35.
Figure 35: Validation links
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45. Scheduling workspace opens. Schedule each plan by pressing the Schedule
button. Prescribed fractions will be scheduled. See Figure 36 and Figure 37.
Figure 36: Scheduling
4 4
Figure 37: Scheduling
46. Press Show Images button. See Figure 37.
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47. Highlight scheduled fields in the imaging section and schedule integrated images.
Select Add Imaging > Integrated Image. See Figure 38.
Figure 38: Integrated image sequence scheduling
48. As a result integrated imaging templates are scheduled. See Figure 39.
4
Figure 39: Scheduled Image templates
49. Repeat for every plan.

50. Treatment Approve all plans. See Figure 40
Figure 40: Treatment approval
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51. Authorize. See Figure 41.
4 4
Figure 41: Approval – Approved plans
52. Save All ( ).
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B. Imager Output Factors acquisition
CAUTION: Calibrate the imager first!
1. Schedule the test patient for the treatment.

2. Deliver all planned fields and acquire the Integrated Images.
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C. Output factor measurement
1. Select Quicklinks > Imaging > Portal Dosimetry. See Figure 42.
4 4
Figure 42: QuickLinks >Imaging > Portal Dosimetry
2. Select Output Factor patient and click OK. See Figure 43.
Figure 43: Patient Explorer
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3. From the plan dropdown select plan for the first field size. See Figure 44.
4
Figure 44: Portal Dosimetry plan selection
4. In the Field display select the first acquired image to be evaluated. See Figure 45
Figure 45: Field display
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5. Select Tools > Output Factor tool. See Figure 46
Figure 46: Tools > Output Factor Tool
6. Select the Automatically Go To Next Field checkbox, define Averaging Area

and click Get Dose at Isocenter. See Figure 47.
4 4
Figure 47: Output Factor tool
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7. After pressing the Get dose at Isocenter button tool automatically selects
another acquired Portal Dose image. See Figure 48.
Figure 48: Get dose at isocenter
8. Repeat step 7 for all the fields in the plan.
Figure 49: Output factor tool
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9. Select next plan and the first field. Click Get dose at Isocenter and repeat for all
fields within the plan. See Figure 50.
4 4
Figure 50: Portal dose images and Output factor tool
10. Repeat step 7 for all plans.
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11. When complete, press the Copy to Clipboard button. See Figure 52.
Figure 51: Copy collected output factor table in the clipboard
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12. Paste the copied result in the opened Notepad. See Figure 52.
Figure 52: Text document with pasted output factors
13. Save the document. See Figure 53.

4 4
Figure 53: Save document
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Abstract
System.
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part of Varian. Varian is not liable for errors contained in this information or for incidental or consequential 4

ISO 13485
HIPAA
CE
93/42/EEC.
Trademarks

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4 4

PDIP Algorithm Configuration TAB 5
 PDIP Algorithm Configuration

education Systems
PDIP Algorithm Configuration
PROCEDURE
Objective:
 After completing this lesson the student will have successfully configured the
PDIP algorithm in the Eclipse Beam Configuration and evaluated the configured
data
NOTE: This procedure is not to be followed if Portal Dosimetry

Pre-Configuration Package is to be used. In such case follow the
package documentation (CTB-PV-887-A) to import pre-configured
PDIP model in Eclipse Beam Configuration
5 5
A. Eclipse: Configuration plan creation

2. Select QuickLinks > Treatment Planning > External Beam Planning.
See Figure 1.
Figure 1: QuickLinks > Treatment Planning > External Beam Planning
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3. Open patient ( ) to be used for the test plan creation. See Figure 2.
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4. In the object explorer highlight All Structure Sets in the left pane and select
Structure Set in right pane. Click OK to continue. See Figure 3.
5 5
Figure 3: 3D image selection in Object Explorer
NOTE: The Structure Set merely enables the PDIP configuration

plan creation. The actual fluence needed for model configuration is
computed by final dose calculation algorithm and depends only on
imported optimal fluence and MLC properties.
The actual volume dose is insignificant and thus any available
Structure Set (patient or phantom) can be used for the PDIP
configuration plan creation.
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5. Select Inset > New Plan. See Figure 4.
Figure 4: Insert > New Plan
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6. Select the target volume. Click Next to continue. See Figure 5.
5 5
Figure 5: Select Target Volume
7. Select existing Primary Reference Point or define new one. See Figure 6.
Figure 6: Select Primary Reference Point
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8. Select patient position during the treatment. See Figure 7.
5
Figure 7: Select Patient Position
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9. Define plan ID and Click OK to continue. See Figure 8.
5 5
Figure 8: Plan properties – General tab
10. Select treatment unit. Click OK to continue. See Figure 9.
Figure 9: Treatment unit selection
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11. In Field Properties window select Geometry tab and set Collimator Rotation to
90º, Field X to 12cm, Y1 to -13 and Y2 to 12cm (IEC 61217). Click OK to
continue. See Figure 10.
Figure 10: Field properties window
NOTE: For the HDMLC, set the Field X to 12cm and Field Y to
22cm. For SRS, set the Field X to 12cm and Field Y to 15cm.
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12. Import the configuration optimal fluence, RMC on the field in the focus window
and select Import Optimal Fluence. See Figure 11.
Figure 11: Optimal fluence import
13. From \\<ServerName>\DCF$\client\PreconfiguredBeamData\Portal Dose Image

Prediction <version>\ select PDIP-configuration.optimal_fluence file. Click the
Open button. See Figure 12.
5 5
Figure 12: Test fluence file location
NOTE: HDMLC-PIDIP-configuration.optimal_fluence is for use with

the HDMLC model.
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NOTE: For SRS, open fluence editor and erase the fluence outside
the Y jaw settings (3 middle bars will stay) See Figure 13 and
Figure 14.
Figure 13: Fluence Editor

5
Figure 14: Optimal fluence for SRS after editing
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14. Select Dose Prescription tab in the info window and define dose prescription for
configuration plan - 2 fractions, 1.0Gy/Fraction. See Figure 15.
Figure 15: Info window - Dose Prescription tab
15. Go to Calculation Models tab, select desired Volume Dose calculation model
and make sure the calculation grid selected is 2.5mm or smaller. See Figure 16.
5 5
Figure 16: Info window Calculation Models tab and Calculation Options window
NOTE: Selected calculation grid will determine resolution of the

actual fluence used in the PDIP configuration process. It is
recommended to use calculation grid of 2.5mm or smaller.
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16. Calculate dose distribution ( ).

17. Select Leaf Motion Calculator to use. Proceed by clicking OK.
See Figure 17.
Figure 17: Leaf Motion Calculator selection window
18. Set the delivery method to Sliding window and select Fixed Jaw. See Figure 18.
Figure 18: Delivery options selection
19. Save All ( ).
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20. Approve the plan. RMC > Plan Approval > Planning Approved. See Figure 19.
21. Acknowledge and press Next. See Figure 20.
5 5
Figure 20: Planning Approval – Warnings and Errors
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22. Press Next. See Figure 21.
5
Figure 21: Planning Approval – Delta couch shift
23. Define multiplication factor for treatment time. Press Next. See Figure 22.
Figure 22: Planning Approval – Parameters
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24. Authorize planning approval and press Finish. See Figure 23.
5 5
Figure 23: Planning Approval – User Authentication
25. Save All ( ).
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26. Select Quick Links>EMR>Treatment Preparation. See Figure 24.
Figure 24: Quick links> EMR > Treatment Preparation
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27. Define couch, imager parameters, tolerance table and read the Validation
findings. Define tolerance table. See Figure 25.
5 5
Figure 25: Treatment Preparation
28. In Validation Findings section click on the suggested link. Click Plan is not
scheduled. See Figure 26.
Figure 26: Validation findings – click to swich to scheduling module
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29. In the plan scheduling section select the course and press the Schedule button.
See Figure 27.
5
Figure 27: Treatment Preparation – Scheduling
30. Press the show images button, highlight the slots where to attach imaging
template. Then select Add Imaging > Portal Dosimetry. See Figure 28.
Figure 28: Scheduling imaging templates
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31. Approve the Plan. Authorize the treatment approval by typing in username and
password. See Figure 29.

5 5
32. Read and acknowledge remaining warnings. Press Yes. See Figure 30.
Figure 30: Verification plan properties
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B. Image acquisition
CAUTION: Calibrate the imager first!
1. Schedule the test patient for the treatment.

2. Deliver all planned fields and acquire the Integrated Images.
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C. Export of the DXF files from Portal Dosimetry
1. Open Portal Dosimetry. Select Quicklinks > Imaging > Portal Dosimetry.
See Figure 31.
5 Figure 31: Quicklinks > Imaging > Portal Dosimetry

5
2. Open desired patient. Press OK. See Figure 32.
Figure 32: Patient explorer
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3. Make sure correct plan is selected. Highlight the first acquired image, RMC and
select export to text file. See Figure 33.
Figure 33: Portal dosimetry – export to text file
4. Select save location and define the file name. See Figure 34.
Figure 34: Export to text file dialog box
5. Repeat steps 3 and 4 to export the second acquired image.
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D. Beam Configuration: Configuring the PDIP algorithm
1. Open Beam Configuration. Select Quicklinks > Treatment Planning > Beam
Configuration. See Figure 35.
Figure 35: Quicklinks > Treatment Planning > Beam Configuration

5 5
2. Read and acknowledge the beam configuration warning. See Figure 36.
Figure 36: Beam configuration warning
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3. Select a corresponding treatment unit and energy.

4. Right click the PDIP algorithm and select New Beam Data See Figure 37.
5
Figure 37: New beam data context menu item
5. Select Start with empty data and define the Therapy Unit Name. Click OK to
Figure 38: New beam data definition
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6. Review General Parameters. The source-axis distance value in the General

Parameters is the algorithm calibration/reference distance. Values in the output
factor table relate to this distance. See step D.28.
Figure 39: General Parameters
7. RMC on the therapy unit name and select New Add-on. See Figure 40.
5 5
Figure 40: New add-on selection
8. Select the Open Field add-on and click the OK button.
Figure 41: New Add-on window
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9. Highlight PDIP Parameters and define the Calibration MU parameter

See Figure 42. This parameter defines the reference dose in MU for the output
factor table calibration. See step D.28.Typically, it corresponds to the number of
MU used for the imager calibration (usually 100MU).
5
Figure 42: Calibration MU parameter definition
10. Highlight Portal Image Parameters and define Number of Portal Images, the
Rotation and Acquisition MU parameters of the acquired configuration images.
See Figure 43.
Figure 43: Portal Image Parameters window
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11. Highlight Image 1 – Import Portal Image File From field then select Beam Data
> Parameter Values > Browse File Path to Parameter Value. See Figure 44.
5 5
Figure 44: Beam Data > Parameter Values > Browse File Path to Parameter Value
12. Browse to the folder containing previously exported acquired images. Select the
first image and click Open. See Figure 45.
Figure 45: Browse File Path to Parameter Value
13. Repeat steps 11 and 12 to define path to the second image.
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14. Right click on the Open Field add-on and select Insert > New Intensity Profile.
See Figure 46.
Figure 46: Insert New Intensity Profile selection
15. Save All ( ) 5

16. Navigate to configured PBC model. See Figure 47.
Figure 47: List of calculation models for To_Config – 6X
NOTE: The PDIP model can be configured with measured diagonal

profile if the configured PBC model is not commissioned.
NOTE: Do not use intensity profile from AAA/AcurosXB source

model.
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17. In the focus window select Intensity Profile object and click on intensity profile at
the shallowest depth in the detail window. See Figure 48.
5 5
Figure 48: Focus and detail window – Configured PBC model
18. From the Edit menu select Copy Curve. See Figure 49.
Figure 49: Copy the intensity profile
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19. Go back to the PDIP model, RMC on the Intensity Profile and select Paste
Curve. See Figure 50.
Figure 50: Paste the intensity profile in the PDIP algorithm
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20. Highlight Intensity Profile object and in Parameter View define the Distance
From Source value. See Figure 51.
5 5
Figure 51: Intensity profile distance value
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21. Select File> Import> Actual Fluence From Database. See Figure 52.
5
Figure 52: File > Import > Actual Fluence from Database
22. In the patient explorer select configuration patient and click OK. See Figure 53.
Figure 53: Patient explorer
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23. Select the configuration plan in the Object Explorer and click OK.
See Figure 54.
5 5
Figure 54: Configuration plan selection in the Object Explorer window
24. RMC the Open Field add-on and select Import > Output Factors. See Figure 55.
Figure 55: Import > Output Factors
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25. Browse to the folder with output factor files. Select the output factor file and click
the OK button. See Figure 56.
5
Figure 56: Output factor file selection
26. RMC on the Output Factors and select Interpolate Missing Values.
See Figure 57.
Figure 57: Interpolate Missing Values menu
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27. RMC on the Output Factors, select Calibrate Dose Rates. See Figure 58.
Figure 58: Calibrate Dose Rates selection
28. Define the expected number of CU for the given reference field size FX, FY and
5 Calibration MU (see step D.9) and source -axis distance (see step D.6) in the 5
New Output Factor box. Click OK. See Figure 59.
CAUTION: Output factor table calibration must correspond to the

imager calibration. Wrong calibration will result in the creation of a
bad kernel and wrong prediction
expected number of CU
Figure 59: Output factor table calibration
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29. RMC on the Open Field add-on and select Calculate Beam Data.
See Figure 60.
Figure 60: Calculate Beam Data selection
30. Approve data set by selecting the Therapy Unit Name, RMC > Approve Data.
See Figure 61.
5
Figure 61: Approving the data set
31. Save All ( ).
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5 FDA 21 CFR 820 Quality System Regulations (CGMPs) 5
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Portal Dosimetry Commissioning TAB 6
 PD Commissioning

education Systems
PD Commissioning workflow
6 6
 After the configuration (in gray, solid lines):
 The PDIP model (yellow) is used to calculate the predicted image (pink) for the Test Plan
 The verification plan would be, in a routine use, sent to Clinac for the delivery and
acquired images would be compared in Portal Dosimetry (gray dashed line)
 For the commissioning (solid black line), the original images (exported to the DXF files for
configuration) can be imported to Portal Dosimetry for evaluation
©©Varian
PDIP calculation model commissioning
EXERCISE
Objective:
 After the completion of this lesson the student will have successfully performed
commissioning of configured PDIP algorithm.
NOTE: This commissioning exercise is one example that can be

used for the purpose of Portal Dosimetry system validation and
should not be considered as the only and sole method. In addition
also independent methods (Film Dosimetry, Detector arrays) should
be used to validate and QA the Portal Dosimetry system.
A. PDIP algorithm commissioning
6
2. Select QuickLinks > Treatment Planning > External Beam Planning.
See Figure 1.
Figure 1: QuickLinks > Treatment Planning > Beam Configuration
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3. Open the patient ( ) that was used for creation of the PDIP configuration.
See Figure 2.
6 6
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4. Open the test plan that was used for PDIP configuration. See Figure 3.
Figure 3: Object Explorer
5. Create a verification plan, Planning > Create Verification Plan. See Figure 4.
6
Figure 4: Create Verification Plan menu
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6. Create a new course by clicking on the New Course button. See Figure 5.
Figure 5: Create a new course for the verification plans
7. Define the new course ID (e.g. PD Commissioning) and click OK. See Figure 6
6 6
Figure 6: New course ID definition
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8. Click Next > to continue. See Figure 7.
Figure 7: Create verification plan – Select course
9. Select Portal Dose Prediction; define Source-Imager Distance for prediction

equal to SID of the first configuration image. Click Next. See Figure 8. 6
Figure 8: Verification method selection
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10. Select the parameters of the verification plan and proceed by clicking the Next
button. Do not reset the collimator rotation. See Figure 9.
Figure 9: Verification plan parameters
6 11. Click Next to continue. See Figure 10. 6
Figure 10: Create Verification Plan – Select Field Parameters
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12. Review selections and proceed by clicking Finish. See Figure 11.
Figure 11: Verification plan summary
13. Eclipse will calculate predicted dosimetric portal image. See Figure 12.
6
Figure 12: Portal dose prediction calculation
NOTE: Dose information (CU) from predicted images can only be

accessed in Portal Dosimetry application. A predicted portal dose
image icon attached to the fields is visible in Eclipse Focus window
to indicate presence of calculated dose image
14. Save All ( ).
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15. In the Focus Window highlight the verification plan RMC and select Add Field
Image…. See Figure 13.
Figure 13: Focus Window selection
16. Object Explorer window opens. Under correct Study ( ) and Series ( )
select the acquired image and click OK to add it to the Field. See Figure 14.
6 6
Figure 14: Object Explorer – Select Field Image
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17. An acquired image will be added to the field. See Figure 15.
Figure 15: Objects in the Focus Window
18. Save All ( ).

19. Go to the Portal Dosimetry by selecting Quick Links > Imaging > Portal
Dosimetry. See Figure 16.
Figure 16: Portal Dosimetry selection
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20. As a result the same patient should be opened. From the Plan dropdown make
sure the correct plan with predicted and acquired image is opened.
See Figure 17.
6 6
Figure 17: Portal Dosimetry user interface
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21. Align the images. Select the Alignment tab and press the Set Aligned button.
See Figure 18.
Figure 18: Portal Dosimetry – Alignment tab
22. Select the Evaluation tab. See Figure 19.
Figure 19: Portal Dosimetry – Evaluation tab
NOTE: Since the pyramid like fluence represent an extreme dose

gradients, for the purpose of configured PDIP model
commissioning, at least 99% of points within the 2D matrix of
acquired and predicted images have to satisfy the following Gamma 6
analysis criteria: Dose Tolerance 4%, DTA=4mm and with None
ROI selected.
23. Define the criteria. Press the Set ROI button and select the None option button.
See Figure 20.
Figure 20: Dose Evaluation tool selection
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24. Press the Options… ( ) button, to define Gamma Analysis criteria.

6 6
Figure 21: Dose Evaluation Options
25. Perform the analysis by pressing the Perform Analysis ( ) button

and check the results. See Figure 22.
Figure 22: Gamma Analysis results
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26. In the Display Mode window select the Gamma Evaluation option button and
review the Gamma map. See Figure 23.
Figure 23: Display Mode window (left) Gamma Evaluation window (right)
27. Print the results. From the menu select File > Print…See Figure 24.
6
Figure 24: File > Print menu selection
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28. Define print preferences in the Print window and press Preview. See Figure 25.
6 6
Figure 25: Print window
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29. This is the analysis printout example. See Figure 26.
Figure 26: Analysis printout example
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Abstract
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6 ISO 13485
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Clinical Use of Portal Dosimetry TAB 7
 Portal Dosimetry User Preference Configuration

 Analysis template management
 LFIMRT Usecase
 Print Images and Reports
 RA splitarc Usecase
 RA fullarc Usecase
 Portal Dose Image Status and Patient Alert
 PD Clinical Case EXERCISE

education Systems
PD – Workstation and User Preferences
PROCEDURE
Objective:
 After completing this procedure, the student will have successfully performed the
following tasks:
 Identified Portal Dosimetry Options
 Reviewed and created Isodose Level templates
A. Portal Dosimetry Workstation and Task Configuration

7 7
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3. Select Tools > Options. See Figure 2.
Figure 2: Tools > Workstation Configuration selection
4. In the Startup Settings tab define the default Start in mode, View Layout,
Display Mode, Plan Overview Mode display and default Visibility
Configuration by selecting appropriate checkboxes. See Figure 3.
Visibility
Configuration
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Figure 3: Options - Startup Settings
NOTE: All settings in this tab take effect when the application is
started next time. These settings are saved per user.
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5. In the Profile/Histogram tab define default Dose Profile and Dose Histogram
settings. See Figure 4.
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Figure 4: Options - Profile/Histogram tab
NOTE: These settings affect new histograms only. These settings

are saved per user.
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6. In the Misc Settings tab define default Histogram Cut-Off, Local Gamma
Threshold for Gamma Analysis, password Grace Period and default Isodose
level Templates. See Figure 5.
7
Figure 5: Options – Misc Setting tab
NOTE: Settings in Gamma Analysis window affect new Analysis

only. These settings are saved per user and are in effect right after
pressing the Save & Close button. See Figure 5.
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7. In the Printing tab type the text to be printed for Header and Footer.
Enable/disable this options by checking the Print Header and Print Footer
checkboxes. When done press the Save & Close button. See Figure 6.
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Figure 6: Options – Printing tab
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8. In the Toolbar tab chose the size of the toolbar buttons. Press OK when done.
See Figure 7.
NOTE: This setting is saved per user.
Figure 7: Options – Toolbar tab
9. Read and Acknowledge the message. See Figure 8. 7
Figure 8: Message window
NOTE: These settings are saved per user and the application must
be restarted for these settings to take effect.
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B. Isodose Level Templates
1. Open Patient. In the Toolbar press the Open Patient ( ) button. In the Patient
Explorer utilize filtering options and select patient. PD-005 will be used in this
procedure. Press OK. See Figure 9.
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Figure 9: Patient Explorer window
2. Select Tools > Isodose Level Editor. See Figure 10.
Figure 10: Tools > Isodose Level Editor selection
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3. Create new isodose level template. Press the New button. See Figure 11.
Figure 11: Isodose Level Template editor
4. There are three types of templates: Dynamic, Absolute or Relative

See Figure 12.
Figure 12: Iso-Line Template type selection
 Dynamic Type – The level definition is relative to maximal dose of image.

These templates can be applied to all images.
NOTE: When the dynamic template is used, normalization has no

effect on the isolines.
 Relative Type – The levels are in percents. These templates can be applied
to images in relative mode only.
 Absolute Type – The levels are in CU. These templates can be applied to
images in absolute mode only.
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5. In the Create New Template window type in the template Name, Type,
Start/Stop Level and Step Size. Press OK.
Figure 13: Create New Template window
6. If necessary modify the values or colors by clicking in the fields. RMC to change
the isoline thickness to Bold Line or Start Color Gradient from selected color. In
order to insert a new isolevel RMC on background between existing isolevels.
Press Save & Close when done. See Figure 14.
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Figure 14: Isodose Level Template Editor
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7. In the Visibility Configuration window select only Isodose Lines checkbox.

See Figure 15.
Figure 15: Visibility Configuration window
8. From the Isodose Level Template dropdown in the Toolbar select the previously
created isodose level template and apply it to the image display. See Figure 16.
Figure 16: Isodose Level Template selection
9. Review the Isodose Level display in the Image view. See Figure 17.
Figure 17: Isodose Level display in the Image view
10. Create Relative Isodose Level Template by repeating steps from 2 to 6.

11. Select Relative Mode under Normalization tab of Task window and apply the
relative Isodose Level template as described in the steps 8 and 9.
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Abstract
System.
Notice

ISO 13485
7 Varian Medical Systems, Oncology Systems products are designed and manufactured in accordance with the
7
HIPAA
CE
93/42/EEC.
Trademarks

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Analysis template management
PROCEDURE
Objective:
 After completing this procedure, the student will have reviewed:
 Access to Analysis Template Manager
 Creation of new analysis template in the manager

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3. Open Analysis Template Manager. Select Tools > Manage Templates.

See Figure 2
Figure 2: Tools > Manage Templates
4. Create new template. Press the New button. See Figure 3.
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Figure 3: Manage Templates – no template present in the system
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5. Type in the name of the new template. See Figure 4.
Figure 4: Create new template
6. Enable desired tests and modify evaluation parameters. Press Save & Close.
See Figure 7.
Figure 5: Manage Tempaltes
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7. If it is desired to create another template open Analysis Template Manager.

Select Tools > Manage Templates. See Figure 6.
8. Analysis template manager is opened and shows the default template.

See Figure 7.
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Figure 7: Analysis template manager
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9. It might be easier to create new template by copying existing template and

changing the evaluation options. Click Copy and define Name of a new template.
See Figure 8.
Figure 8: Copy of existing template
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10. Modify evaluation parameters as desired. In this example change the Region of
Interest to Field + 0 cm. Click Save and Close to save changes to template. See
Figure 9.
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Figure 9: Template parameters changes
11. Save changes ( ).
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Abstract
The training material is an educational aid for Varian Portal Dosimetry System.
Notice

ISO 13485
HIPAA
Varian’s products and services are specifically designed to include features that help our customers comply with 7
CE
93/42/EEC.
Trademarks

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IMRT QA usecase
PROCEDURE
Objective:
 Verification plan generation options for IMRT plan with combination of
IMRT and Large Field IMRT (LFIMRT) fields
 Plan processing for QA purposes in RT chart
 Setting evaluation options
 Evaluation of acquired images including analysis template generation and
application
A. Verification Plan Generation

2. Go to the External Beam Planning by selecting Quick Links > Treatment
Planning > External Beam Planning. See Figure 1.
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Figure 1: Quick Links > Treatment Planning > External Beam Planning
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IMRT QA usecase
3. Select Open Objects ( ) from the toolbar. In opened Patient Explorer

utilize filtering options, and select PD-004 patient. Press OK. See Figure 2.
4. In the object explorer open the plan to be evaluated. See Figure 3.

7
Figure 3: Object explorer
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IMRT QA usecase
5. Select Planning > Create Verification Plan. See Figure 4.
Figure 4: Planning > Create Verification Plan
6. Create New Course for Verification Plan. Select New Course. See Figure 5.
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Figure 5: New Course - Verification Plan Creation
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IMRT QA usecase
7. Define Course ID and click OK to continue. See Figure 6.
Figure 6: Course properties
8. Click ( )
9. Select Portal Dose Prediction verification method and define Source Imager
Distance (SID). Click Next to continue. See Figure 7.
Figure 7: Verification method and SID definition
NOTE: The last SID is remembered as a user preference.
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IMRT QA usecase
10. Define geometry for verification plan and define tolerance table. Click Next
to continue. See Figure 8.
Figure 8: Verification plan geometry definition
7 NOTE: The Field Geometry, Tolerance table and IMRT field 7

splitting is remembered as a user preference.
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IMRT QA usecase
11. Decide if to verify fields with multiple carriage groups (LFIMRT fields) as single
fields or if to split each carriage group into separate field. Click Next to
continue See Figure 9.
For the purpose of this exercise

keep the box un-checked.
Figure 9: LFIMRT field split
7
NOTE: The machine used for verification must be LFIMRT capable
to allow verification of LFIMRT fields without splitting. Eclipse
recognizes LFIMRT enabled machine by motion mode of collimator
operating limits. The motion mode must be set to Mulitple Static
Positions or Dynamic if the machine also allows jaw tracking.
See Figure 10.
Figure 10: Operating limits of LFIMRT enabled machine
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IMRT QA usecase
12. Review verification plan selections and click .

13. Eclipse calculates predicted images and creates new verification plan.
See Figure 11.
Figure 11: Eclipse scope window showing generated verification plan
14. If a setup image should be used for imager alignment insert a new setup field.
Right Mouse Click (RMC) on the Verification plan and select New Setup
Field. See Figure 12.
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Figure 12: New setup field creation
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IMRT QA usecase
15. In the info window define ID and geometry for the setup field. See Figure 13.
Figure 13: Info window
16. Planning approve verification plan. Select Edit > Plan Approval > Planning
Approved. See Figure 14.
Figure 14: Plan Approval
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IMRT QA usecase
17. Read the warning message and continue Next. See Figure 15.
Figure 15: Planning Approval – Warnings and Errors
18. Delta couch shift calculation will be displayed. Skip this step by clicking
7 . 7
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IMRT QA usecase
19. Check to calculate treatment times, provide multiplication factor and click
Next. See Figure 16.
For the purpose of this exercise

keep the box un-checked.
20. Authorize plan status change. Type in your username and password. Click
Finish. See Figure 17.
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Figure 17: Plan status change authorization
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IMRT QA usecase
B. Verification plan preparation for image acquisition in ARIA
1. Select Quicklinks > EMR > Treatment Preparation. See Figure 18.
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Figure 18: Quicklinks > EMR > Treatment Preparation
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IMRT QA usecase
2. In the Scheduling make sure the correct course is selected and press the
Schedule ( ) button. See Figure 19.
Figure 19: Treatment preparation Scheduling
3. Press the Show Images button. See Figure 20.
Figure 20: Scheduling – Show Images.
4. Schedule images to be acquired. Highlight all treatment fields and assign

sequence image template which uses integrated mode of acquisition. Select 7
Add Imaging > Integrated Image. See Figure 21
Figure 21: Integrated image scheduling
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IMRT QA usecase
5. If setup fields are defined, select those and assign a single exposure image.
See Figure 22
Figure 22: Setup image scheduling
6. When done press the approve button and authorize the approval. See Figure
23.
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7. Schedule the plan in time planner and deliver it acquiring images at previously
selected SID.
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IMRT QA usecase
C. Evaluation of acquired images
1. Open Portal Dosimetry application. Select Quicklinks > Imaging > Portal
Figure 24: Select Quicklinks > Imaging > Portal Dosimetry
2. Open Patient ( ). In the Patient Explorer utilize filtering options, and select
PD-004 patient. Press OK. See Figure 25.
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IMRT QA usecase
3. Select the plan to be evaluated using dropdown. See Figure 26.
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Figure 26: Portal dosimetry application
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IMRT QA usecase
4. If alignment is necessary select the Alignment tab in the Task Panel.

See Figure 27.
5. In the Task Panel – Alignment tab press Set Unaligned. See Figure 27.
6. For purpose of this exercise Setup image alignment will be used. Select Setup
Image from Align using dropdown. See Figure 28
Figure 28: Align using setup image
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IMRT QA usecase
7. Perform auto alignment ( ), review the results, set

the image status to aligned using button and
copy the correction to other fields in the plan using
.
8. Apply the correction to all other fields. See Figure 29.
Figure 29: Copy Correction
7 7
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IMRT QA usecase
9. Go back to Evaluation tab in the task panel and click Set ROI button to define the
Evaluation Region Of Interest. See Figure 30.
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Figure 30: Portal Dosimetry - set ROI
10. For purpose of this exercise set the ROI to MLC CIAO + 0.5cm. This will set
the region of interest to Complete Irradiated Area Outline + 5 mm.
11. Click to select evaluation options.
CAUTION: The ROI, Evaluation Options and Normalization options

are reset to default values (as defined in default Analysis Template)
if next acquired image is selected.
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IMRT QA usecase
12. Define gamma evaluation parameters and select tests to use for evaluation.
See Figure 31.
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Figure 31: Dose evaluation options
13. Switch the display mode to Gamma Evaluation. See Figure 32.
Figure 32: Display mode
14. Review gamma evaluation image. Red areas represent gamma > 1.
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IMRT QA usecase
15. Turn on MLC overlay to estimate if the high gamma is in between leaves.
Select Tools > Leaf Motion Overlay. See Figure 33
Figure 33: Tools > Leaf Motion Overlay
16. By default the leaves are displayed as solid. RMC on the tool bar in the Leaf
Motion Overlay view and disable solid rendering for leaves. See Figure 34.
Figure 34: MLC motion overlay options
VarianMedical
IMRT QA usecase
17. Click the play button( ) to review leaf motion.

18. Select Tools > Gamma/Dose Difference Height field. See Figure 35.
Figure 35: Tools > Gamma/Dose Difference Height field
19. The gamma/Dose Difference Height field displays acquired image as height of
the graph and gamma or dose difference as a color map. This display helps
identifying if the discrepancy is on steep dose gradients, low dose region etc.
See Figure 36.
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Figure 36: Gamma Image on Portal Dose image
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IMRT QA usecase
20. Close the Gamma/Dose Difference Height field display and apply previously
defined tests by clicking in the Task panel.
21. Rename the analysis to Initial Evaluation and set it as primary. RMC on the
analysis and select Edit Name. See Figure 37
Figure 37: Analysis context menu
22. RMC on the analysis and set it as primary. See Figure 38
Figure 38: Analysis context menu
23. The primary analysis is indicated by number 1 on the icon ( ).
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IMRT QA usecase
D. Creation of Analysis template from current analysis
1. Save the analysis to template. Access Template Manager. Select

Tools>Manage Templates. See Figure 39
2. Click to create new template.

3. Define template Name and select option to create template based on
current analysis. See Figure 40
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Figure 40: Analysis template creation
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IMRT QA usecase
4. Options from current analysis are copied to template. Click Save and Close to
store the template. See Figure 41.
Figure 41: Analysis template options
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IMRT QA usecase
E. Image analysis using template
1. Apply created analysis template to other fields in the plan. RMC on each
acquired image for a field and select Apply template >
IMRT(3%,2mm,Improved).
See Figure 42
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Figure 42: Apply template
2. Review results. The calculated parameters and evaluation status are

displayed in the Task panel/ Evaluation tab. See Figure 43
Figure 43: Task panel
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IMRT QA usecase
3. If a template is to be applied to all images in a session select Session tab in

the Navigation panel and apply evaluation template to whole session.
See Figure 44.
Figure 44: Navigation Panel > Apply template to session
4. Summary window will be displayed. Press Close. See Figure 45.
Figure 45: Summary of Portal Dose Image Analysis
5. Approve the images. Use image approval button ( ).
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IMRT QA usecase
6. In the approval dialog box select images to approve and decide if to set the
most recent analysis as primary. Authorize status change. See Figure 46.
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Figure 46: Image approval dialog
7. Enable plan overview mode. Select the View Layout button ( ) and
change the layout to Plan Overview Mode. See Figure 47
Figure 47: Plan overview mode
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IMRT QA usecase
8. Change Display Mode to Gamma Evaluation. See Figure 48.
Figure 48: Portal dosimetry application - plan overview mode
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IMRT QA usecase
9. Print analysis batch print. Select File > Print. From Report dropdown select
Analysis batch print and set other print options. Click Print. See Figure 49.
7 Figure 49: Print options 7
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IMRT QA usecase
Abstract
Notice

ISO 13485
HIPAA
CE
93/42/EEC.
Trademarks

VarianMedical
Printing Images and Reports
PROCEDURE
Objective:
following tasks:
 Print Images and Reports from Portal Dosimetry
 Export Objects from Portal Dosimetry
A. Open Patient

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3. Select the Open Patient ( ) button. In the Patient Explorer utilize filtering
options, and select PD-005 patient. Press OK. See Figure 2.
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4. In the Navigation Panel select Session tab and the *QA/5FIMRT1 plan.
See Figure 3.
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5. RMC on session and select Apply Template to Session. See Figure 4.
Figure 4: Apply Template to Session selection
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6. Summary of the evaluation will be displayed. See Figure 5.
Figure 5: Summary of Portal Dose Image evaluation
7. Approve selected evaluated images and define the primary analysis. Press the
Approved button( ). Confirm the status change by entering the User Name and
Password and press OK. See Figure 6.
Figure 6: Status Change Confirmation
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8. Approved image will have checkmark sign with a user time stamp in the lower
right corner of the evaluated image. See Figure 7(left). Primary analysis is
denoted by #1 in the icon. See Figure 7(right).
Figure 7: Approved image(left) and primary analysis(right)
7 7
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B. Print Images and Reports - General
 Depending on selected object in the Navigation Panel and selected View

Layout, there are more possibilities to print images and reports:
 Print Active View (Portrait/Landscape) – Prints the active view
and is always available even though there is no analysis performed.
 Print Plan Summary - Prints a text-based summary of the most
recent analyses done for the current plan and session. Available
only if at least one analysis exists.
 Print Current Analysis – Available only if Analysis is selected or in
the Plan Overview Mode layout. Prints the analysis results as well
as the dose difference image and the gamma evaluation image.
 Analysis Batch Print - Prints selected analyses as well as the dose
difference image and the gamma evaluation image for every image.
This option is only available when application is in Plan Overview
Mode layout.
 Plan Brief Summary (Landscape, table) - Prints a patient
information together with a table which lists the plan fields together
with analyses information associated with individual fields. This
option is always available
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C. Print Active View
1. Customize Display Mode and Visibility Configuration. See Figure 8.
Figure 8: Visibility Configuration and Display Mode
2. Select File > Print. See Figure 9.
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Figure 9: File > Print selection
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3. Select the Active View Report to be printed (Portrait or Landscape). Press

Properties to define Page Setup. See Figure 10.
Figure 10: Windows Print (left), Page Setup (right) window
4. Press the Preview button to see the example. See Figure 11.
7
Figure 11: Active View (Portrait) print preview
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D. Print Plan Summary
2. Select the Plan Summary Report to be printed. Press Properties to define Page
Setup. See Figure 13.
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Figure 14: Plan Summary print preview\
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E. Print Current Analysis
1. In the Navigation Panel select the desired analysis object. See Figure 15.
Figure 15: Navigation Panel
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3. Select the Current Analysis from Report dropdown to be printed. Select Zoom
to Field and/or Color Legend if desired. Press Properties to define Page Setup.
See Figure 17.

7
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7 7
Figure 18: Current Analysis print preview
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F. Analysis Batch Print
1. In the Toolbar press the View Layout button and select Plan Overview Mode.
See Figure 19.
Figure 19: Plan Overview Mode selection
Figure 20: Plan Overview Mode display
NOTE: If there are multiple analyses for an image the primary will
be displayed and printed. If there is no primary analysis then the
latest will be displayed and printed.
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3. Select the Analysis Batch Print from Report dropdown to be printed. Select
Zoom to Field and/or Color Legend if desired. Press Select Analysis to define
and check the analysis to be printed. Close. See Figure 22.
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Figure 22: Windows Print (left), Select Analysis (right) window
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Figure 23: Analysis Batch Print preview
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G. Object Export/Import from/to Portal Dosimetry
1. In the Navigation Panel highlight the Predicted/Portal Dose Image, RMC and
select Export to Text File. See Figure 24.
Figure 24: Export Predicted Dose (left) and Portal Dose (right)
2. Define file name and location. Press Save. See Figure 25.
7 7
Figure 25: Export to Text File window
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3. In the Navigation Panel highlight the Predicted/Portal Dose Image, RMC and
select Export to DICOM > To [configured DICOM export filter]. See Figure 26.
Figure 26: Export Predicted Dose (upper) and Portal Dose (bottom)
4. Follow the export wizard. Review/Select Output directory( ) and press the arrow
( ). See Figure 27.
7
Figure 27: Export wizard
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5. Read the export summary and detailed log. See Figure 28.
Figure 28: Export summary and detailed log
7 7
NOTE: If selected export filter is configured for automatic export
only the last summary page of the export wizard is displayed
NOTE: Dose image in a proper text format ( general dosimetry

exchange format *.dxf ) can be imported to Portal Dosimetry.
See Figure 29.
Figure 29: Import dose from text file
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NOTE: Dicom objects can be imported to Portal Dosimetry using

configured DICOM Media File Import filter. See Figure 30.
Figure 30: DICOM Import
6. If desired also analysis can be exported to text file. In the Navigation Panel
highlight the Analysis, RMC and select Export to Text File. See Figure 31.
Figure 31: Navigation Panel

7
7. Define file name and location. Press Save. See Figure 30.
Figure 32: Analysis export to Text File
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Abstract
System.
Notice

ISO 13485
7 HIPAA
7
CE
93/42/EEC.
Trademarks

VarianMedical
RA QA Usecase - split arc verification
PROCEDURE
Objective:
 Verification plan generation options for RA plan
 Evaluation of acquired images using previously created template

2. Go to the External Beam Planning by selecting Quick Links > Treatment Planning
> External Beam Planning. See Figure 1.
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3. In the Patient Explorer utilize filtering options, and select PD-007 patient. Press
OK. See Figure 2.
7 7
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6. Create New Course ( ). In the Course Properties

define course ID. Press OK. See Figure 5.
Figure 5: Course Property window

7 7. Click Next to continue. See Figure 6.
7
Figure 6: Course Verification Plan – Select Course
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Distance (SID). Click Next to continue. See Figure 7
NOTE: The last SID is remembered as a user preference. 7
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9. Define geometry for verification plan and define tolerance table. Click Next to
7 7
NOTE: The Field Geometry, Tolerance table and arc field splitting
is remembered as a user preference.
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10. Decide if to split each arc field into multiple subarcs and define the size of subarc..
For the purpose of this exercise the arc fields will be splited into arcs of 36 deg
each. Click Next to continue. See Figure 9
Figure 9: Arc split
11. Review generation options and click . 7

12. Eclipse calculates predicted images and creates new verification plan.
See Figure 10.
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Approved. See Figure 11
7 7
14. Read warnings. Click Next( ).

( ).
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7
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7 7
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Figure 15: Treatment preparation Scheduling
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4. Schedule image templates. Highlight treatment fields and assign sequence image
template using integrated mode of acquisition. Select Add Imaging > Integrated
Image. See Figure 17.
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5. When done press the approve button and authorize the approval. See Figure 18.
selected SID.
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2. In the Patient Explorer utilize filtering options, and select PD-007 patient.
7 7
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3. Select verification plan the Plan dropdown, select Session tab. navigation
window to see the plan ID. See Figure 21.

7
4. Switch the display mode to Gamma Evaluation. See Figure 22
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5. Apply analysis template to all images in the plan. Highlight the session RMC and
select Apply Template to Session > RA default.See Figure 23.
Figure 23: Apply template to Session
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6. Summary of image analyses is displayed. Click on each result to review the

details in the Task Pane/ Evaluation tab. See Figure 24 and Figure 25.
7. the Summary of analyses window.
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8. Create composite predicted and acquired image. RMC on one of the acquired
images in the plan and select Create Composite Image. See Figure 26.
Figure 26: Create Composite Image
9. In the Create Composite Image dialog define composite image ID and select the
images to be used for composite image creation. Press OK to continue.
7 See Figure 27. 7
Figure 27: Create Composite image dialog
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10. Composite image is created in separate folder. See Figure 28.
Figure 28: Navigation window
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11. To evaluate the composite image using template RMC on the image and select
Apply Template > RA default. See Figure 29.
Figure 29: Apply template to composite image
12. Review the evaluation results in Task panel / Evaluation tab. See Figure 30
7 7
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14. In the approval dialog box select images to approve and decide if to set the most
recent analysis as primary. Authorize status change. See Figure 31.
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15. Print Plan Summary. Select File > Print. From Report dropdown select Plan
Summary and set other print options. Click Preview. See Figure 32.
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Figure 32: Print options
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Abstract
Notice

ISO 13485
HIPAA
CE
93/42/EEC.
Trademarks

VarianMedical
RA QA Usecase - full arc verification
PROCEDURE
Objective:
 Verification plan generation options for RA plan
 Evaluation of acquired using previously created template

2. Go to the External Beam Planning by selecting Quick Links > Treatment
Planning > External Beam Planning. See Figure 1.
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Systems mm/tm Nov 07 Portal Dosimetry
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OK. See Figure 2.
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6. Create New Course ( ). In the Course Properties

define course ID. Press OK. See Figure 5.
Figure 5: Course Property window
7. Click Next to continue. See Figure 6.

7
Figure 6: Course Verification Plan – Select Course
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Distance (SID). Click Next to continue. See Figure 7
7 NOTE: The last SID is remembered as a user preference. 7
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5/19 11
9. Define geometry for verification plan and define tolerance table. Click Next to
7
NOTE: The Field Geometry, Tolerance table and arc field splitting
is remembered as a user preference.
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10. Decide if to split each arc. For the purpose of this exercise the arc field will not be
split. Click Next to continue. See Figure 9.
Figure 9: Arc split
11. Review generation options and click .

7 12. Eclipse calculates predicted images and creates new verification plan. 7
See Figure 10.
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Approved. See Figure 11
14. Read warnings. Click Next( ).

( ).
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Figure 15: Treatment preparation scheduling
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4. Schedule image templates. Highlight treatment fields and assign sequence image
template using integrated mode of acquisition. Select Add Imaging > Integrated
Image. See Figure 17.
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5. When done press the Approve button and authorize the approval. See Figure 18.
selected SID.
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OK. See Figure 20.
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3. Make sure the plan to be evaluated is selected and go to session tab

See Figure 21.

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4. Switch the display mode to Gamma Evaluation. See Figure 22
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5. Apply analysis template to all images in the session. RMC on the session and
select Apply Template to Session > RA default. See Figure 23.
Figure 23: Apply template to Session
6. Summary of image analyses is displayed. Click on each result to review the

details in the Task Pane/ Evaluation tab. See Figure 24 and Figure 25.
7. the Summary of analyses window.
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9. In the approval dialog box select images to approve and decide if to set the most
recent analysis as primary. Authorize status change. See Figure 26.
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10. Print Plan Brief summary. Select File > Print. From Report dropdown select Plan
Brief Summary and set other print options. Click Print. See Figure 27.
Figure 27: Print options
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Abstract
Notice

ISO 13485
HIPAA
7 Varian’s products and services are specifically designed to include features that help our customers comply with 7
CE
93/42/EEC.
Trademarks

VarianMedical
19/19 11
Portal Dose Image Status and Patient Alert
PROCEDURE
Objective:
following tasks:
 Identified all portal dose image statuses
 Reviewed, Created New and Managed Patient Alerts
A. Open Patient

2. Open Portal Dosimetry. Select Quick Links > Imaging > Portal Dosimetry.
See Figure 1.
Figure 1: Quick Links > Imaging > Portal Dosimetry
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3. Select the Open Patient ( ) button. In the Patient Explorer utilize filtering
options, and select PD-006 patient. Press OK. See Figure 2.
7 7
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4. In the Navigation Panel select Session tab and the first plan. See Figure 3.
5. Make sure Portal Dose Image Analysis has been performed. If not RMC on
session and Apply Template to Session. See Figure 4.
Figure 4: Apply Template to Session
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B. Portal Dose Image status - General
 Portal Dose images have a status that uniquely identifies their position during
the RT process, which can be used to manage the clinical workflow.
 The status icons are displayed in the lower right corner of every Portal Dose
image. Status can be changed for Portal Dose Images only. See Figure 5.
7 7
Figure 5: Image status display – new image
 There are following Portal Dose Image statuses:
 New ( ) – The image has been recently acquired and has not
been reviewed in Portal Dosimetry. See also Figure 5.
 Reviewed ( ) – The image has been reviewed in Portal
Dosimetry but has not yet been approved. User and Time stamp is
also placed next to the Reviewed icon. See also Figure 6.
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 Approved ( ) – The image has been accepted and approved.

This implies that no change request or other action is required. User
and Time stamp is also placed next to the Approved icon. See also
Figure 6.
Figure 6: Portal Dose image status – Reviewed (left), Approved (center) Action Required (left)
NOTE: If modification is required the image status can be reset

from Approved to Reviewed.
 Action Required ( ) - A qualified user has decided that some 7

action must be taken based on the Portal Dosimetry analysis of this
image. See Figure 6.
 Disposed ( ) - A qualified user has decided that the image

requires no action and does not wish to display the image in Portal
Figure 7: Image status – Disposed – Field icon (left), Image view (right)
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C. Changing the Portal Dose Image status
1. In the Navigation Panel select required Portal Dose image.
2. Set the image status to reviewed by pressing the Review ( ) button in the
Image approval corner. See Figure 8.
Figure 8: Image status and navigation tool buttons
3. Authorize the status change for selected Images and press OK. See Figure 9.
7 7
Figure 9: Status Change Confirmation window
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4. Image status will be changed from new ( ) to reviewed ( ) as indicated in the

lower right corner of the image along with the user and time stamp.
See Figure 10.
Figure 10: Image status
5. Approve the images. Select the images that passed the Analysis test, press the
Approve button ( ) and approve the images that passed the analysis. Authorize
and press OK. See Figure 11.
Figure 11: Image approval
NOTE: If the Portal Dose Image associated with analysis is

approved, it is not possible to delete existing or perform new
analysis.
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6. Press the Action Required button ( ) and request action on the images that
did not pass the analysis. Authorize and press OK. Create more descriptive
Patient Alert if necessary, press OK. See Figure 12.
Figure 12: Action Required image status change
NOTE: Patient Alert is always created when the image status is

7 changed to Action Required. 7
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7. Dispose one of the images. Images with a status Approved or Action Required
cannot be changed to Disposed. Their status needs to be changed to Reviewed
first.
8. Press the Review ( ) button in the Image approval panel. Authorize and press
OK.
Figure 13: Status Change Confirmation window
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9. Highlight the image that needs to be disposed and select Portal Dosimetry >
Dispose Image. See Figure 14.
Figure 14: Portal Dosimetry > Dispose Image selection
10. Authorize and press OK. See Figure 15.
7 7
Figure 15: Confirm window
11. Image will be hidden. To see Portal Dose Images with the status Disposed select
Portal Dosimetry > Show Disposed Images. See Figure 16.
Figure 16: Portal Dosimetry > Show Disposed Images
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12. As a result all disposed images will be displayed in the Image View Panel and
corresponding icon will be displayed in the Navigation Panel. See Figure 18.
Figure 17: Disposed Image display
NOTE: The status of Disposed Image can be changed back to

Reviewed. Then it is possible to edit this image again.
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D. Patient Alert – General
 A change request always results in a patient alert. The reviewer can use
patient alerts to communicate important information to the other radiotherapy
personnel without creating a change request.
 The patient alert must be acknowledged by user at the time of treatment.
 The Patient Alert button indicates the status of existing patient alerts.
See Figure 18.
Figure 18: Patient Alert, Image Status and navigation buttons
 There are the three Patient Alert statuses. See Figure 19.
7 7
Figure 19: Patient Alert statuses
NOTE: Patient Alerts only work in a Varian fully integrated

environment with ARIA and Eclipse.
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E. Review, Create New and Manage Patient Alerts
1. To Review Patient Alerts select Portal Dosimetry > Show Patient Alerts.
Alternatively this can be done by pressing the Patient Alert button.
See Figure 20.
Figure 20: Portal Dosimetry > Show Patient Alerts selection(left), Patient Alert button (right)
2. Patient Alerts window opens. To see more detailed description highlight the
Patient Alert line and double click. See Figure 21.
Figure 21: Patient Alerts window
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3. More detailed information about patient alert will be displayed. Press Close.
See Figure 22.
Figure 22: Patient Alert window
4. If the Patient Alert is not relevant any more it can be errored. Press the Error
Alert button to delete selected alert. See Figure 23.
7 7
5. Confirm message. Press Yes. See Figure 24.
Figure 24: Acknowledge window
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6. As a result the Patient Alert will be crossed out. Press Close. See Figure 25.
NOTE: User can modify own existing Patient Alerts that are not
signed off using the Error Alert functionality and create new instead.
7. Create new patient alert. Select Portal Dosimetry > New Patient Alert.
See Figure 26.
Figure 26: Portal Dosimetry > New Patient Alerts
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8. Type in the Patient Alert, define Display Date. Press OK. It is possible to create
Predefined Patient Alert if necessary by pressing the Define/Edit Alerts.
See Figure 27.
Figure 27: New Patient Alert window
NOTE: Patient Alert will be displayed when the patient record is

7 opened on Treatment workstation on or after the date defined in 7
Display Date field. See Figure 27.
CAUTION: In Duet system which is used in mixed vendor

environments, the entered message will not appear at the
treatment.
NOTE: Predefined Patient Alerts are only user-specific. They are

not available system-wide.
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9. Press Close. See Figure 28.
10. Save All ( ).
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Abstract
System.
Notice

ISO 13485
7 HIPAA
7
CE
93/42/EEC.
Trademarks

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PD Clinical Case 2
EXERCISE
Objective:
 After completing this lesson the student will have successfully accomplished pre-
treatment verification of a given IMRT plan using the Portal Dosimetry system
A. Verification Plan (External Beam Planning)
1. Open External Beam Planning, Field Setup workspace.

2. Open patient ID: PD-007 (Name: HeadNNeck), plan 7fldIMRT in the course C1.
3. Create a Portal Dose Prediction verification plan, Planning > Create
Verification Plan.
4. In this exercise define Source-Imager Distance to be 100cm. (Images that will
be used later on were acquired at this distance).
5. Approve the plan.
6. Save All ( ).
7
B. Portal Dose Prediction Verification plan preparation
1. Go to the Treatment Preparation.

2. Prepare the verification plan for the treatment.
3. Go to Scheduling workspace, activate session and schedule Integrated Image
sequence template.
4. Approve the plan.
5. Save All ( ).
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PD Clinical Case 2
C. Portal Dose Verification Plan delivery (4DiTC)
1. Schedule the patient for treatment in Time Planner.

2. Start the Treatment application and log in.
3. Align the PV imager with the beam CAX to the selected SDD (e.g. for 105cm:
Vrt= -5.0, Lng=0, Lat=0).
4. Click the Open Patient button on the 4DTC console and select the patient from
the Queue.
5. Select the plan and click the Mode Up button.
6. Mode up the treatment unit and deliver all verification plan fields.
D. Import of previously acquired images into configuration plan
NOTE: This part of the procedure applies to this exercise only to

simulate results of image acquisition on student’s computers. It is
not to be followed in the clinical environment.
7 1. Open patient (PD-007) in Portal Dosimetry. 7

2. RMC over the first field and select Import Dose from Text File. See Figure 1.
Figure 1: Portal Dosimetry – Import Dose from Text Fle
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PD Clinical Case 2
3. Select desired file and press Open. See Figure 2.
Figure 2: Import Dose Image from the text file
4. Portal dose image is imported. See Figure 3.
Figure 3: Predicted and Portal dose images
5. Repeat for all fields. See Error! Reference source not found..
6. Save All ( ).
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PD Clinical Case 2
E. Portal Dose Image Evaluation
1. In Portal Dosimetry open the patient with predicted and acquired dose images.
2. In Portal Dosimetry perform manual evaluation. Define ROI, define options and
Perform Analysis.
3. Perform the evaluation applying Analysis templates. Apply more then one
template.
4. Look at the Gamma Evaluation and Dose Difference window.
5. Perform more detailed review using dose evaluation tools ( , ).

6. Export profiles in X and Y direction.
7. Discuss the results with instructor and class participants.
CAUTION: Passing or failing dose evaluation tests does not

necessarily mean that the patient can be treated or cannot be
treated. The decision to treat or not to treat the patient is clinical
decision to be performed by the qualified user, using this Portal
Dosimetry evaluation as a tool to inform that decision.
7 8. Create Change Request if necessary. 7

9. Approve images that passed the analysis.
10. Discuss the image approval, change request and patient alerts tools in the frame
your department workflow.
11. Print evaluation results.
12. Print Batch Print analysis.
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PD Clinical Case 2
Abstract
System.
Notice

ISO 13485
requirements specified within ISO 13485 quality standards. 7
HIPAA
CE
93/42/EEC.
Trademarks

VarianMedical
7 7

References TAB 8
 Portal Dosimetry Publication Reference List

education Systems
Portal Dosimetry Publication Reference List
Revision 3.0.0
A. PORTAL/EXIT DOSE CALCULATIONS
1. Chang J, Mageras GS, Chui CS et al. Relative profile and dose verification of
intensity modulated radiation therapy. Int. J. Radiat Oncol Biol Phys
2000;47(1):231-240
2. Depuydt T, Van Esch A, Huyskens DP. A quantitative evaluation of IMRT
distributions: refinement and clinical assessment of the gamma evaluation.
Radiother Oncol 2002;62:309-319
3. El-Mohri Y, Antonuk LE, Yorkston J et al. Relative dosimetry using active matrix
flat-panel imager (AMFPI) technology. Med Phys 1999;26:1530-1541
4. Essers M, Boellaard R, van Herk M, Lanson JH, Mijnheer BJM. Transmission
dosimetry with a liquid-filled electronic portal imaging device. Int J Radiat Oncol
Biol Phys 1996;34:931-941
5. Heijmen BJM, Pasma KL, Kroonwijk M et al. Portal dose measurement in
radiotherapy using an electronic portal imaging device (EPID). Phys Med Biol
1995;40:1943-1955
6. Kausch C, Schreiber B, Kreuder F, Schmidt R, Dössel O. Monte Carlo simulations
of the imaging performance of metal plate/phosphor screens used in radiotherapy.
Med Phys 1999;26:2113-2124
7. Low DA, Harms WB, Mutic S., Purdy JA. A technique for the quantitative
8 evaluation of dose distributions. Med Phys 1998;25:656-661 8
8. McCurdy BMC, Luchka K, Pistorius S. Dosimetric investigation and portal dose
image prediction using an amorphous silicon electronic portal imaging device.
Med Phys 2001;28(6):911-924
9. McCurdy BMC, Pistorius S. A two-step algorithm for predicting portal dose images
in arbitrary detectors. Med Phys 2000;27:2109-2116
10. McCurdy BMC, Pistorius S. Photon scatter in portal images: Physical
characteristics of pencil beam kernels generated using the EGS Monte Carlo
code. Med Phys 2000;27:312-320
11. Pasma K, Heijmen BJM, Kroonwijk M, Visser AG. Portal dose image (PDI)
prediction for dosimetric treatment verification in radiotherapy. I. An algorithm for
open beams. Med Phys 1998;25:830-840
12. Van Esch A, Vanstraelen B, Verstraete J, Kutcher GJ, Huyskens DP. Pre-
treatment dosimetric verification by means of a liquid-filled electronic portal
VarianMedical
Portal Dosimetry Publication Reference List
imaging device during dynamic delivery of intensity modulated treatment fields.

Radiother Oncol 2001;60:181-190
13. Depuydt T, Van Esch A, Huyskens DP. A quantitative evaluation of IMRT dose
distributions: refinement and clinical assessment of the gamma evaluation.
Radiother Oncol 2002 ;62 :309-319
14. Van Esch A, Depuydt T, Huyskens DP. The use of an aSi-based EPID for routine
absolute dosimetric pre-treatment verification of dynamic IMRT fields. Radiother
Oncol 2004; 71(2):223-34
15. Vetterli D, et al. Electronic Portal Imaging: A useful tool in patient related QA for
IMRT (abstract). Strahlentherapie und Onkologie 2001;177(10):578
16. Chang J, Mageras GS, Ling CC. Evaluation of rapid dose map acquisition of a
scanning liquid-filled ionization chamber electronic portal imaging device. Int J
Radiat Oncol Biol Phys 2003; 55(5):1432-45Heijmen et al, “Portal dose
measurement in radiotherapy using an electronic portal imaging device (EPID)”,
Med. Phys. Biol, 40, pp. 1943-1955 (1995).
17. Pasma et al, “Accurate portal dose measurement with a fluoroscopic electronic
portal imaging device (EPID) for open and wedged beams and dynamic multileaf
collimation”, Phys. Med. Biol., 43, pp. 2047-2060, (1998).
18. Weidong Li, Jeffrey V. Siebers, and Joseph A. Moore, “Using fluence separation
to account for energy spectra dependencein computing dosimetric a-Si EPID
images for IMRT fields”, Med. Phys. 33, No. 12, December 2006
19. Peter B. Greer, Philip Vial and Lyn Oliver, Clive Baldock, “Experimental
investigation of the response of an amorphous silicon EPIDto intensity modulated
radiotherapy beams”, Medical Physics, Vol. 34, No. 11, November 2007
20. Lung Ko. Jong Oh Kim, and Jeffrey V Siebers, “Investigation of the optimal
backscatter for an aSi electronic portal imaging device”, Phys. Med. Biol, Vol. 49,
(2004) 1723-1738 8
21. Joseph A Moore, and Jeffrey V Siebers, “Verification of the optimal backscatter
for an aSi electronic portal imaging device”, Phys. Med. Biol, Vol. 50, (2005)
2341-2350
22. Philip Vial, Peter B. Greer, Peter Hunt, Lyn Oliver, Clive Baldock “The impact of
MLC transmitted radiation on EPID dosimetry for dynamic MLC beams” Med.
Phys. 35 „4 April 2008, 1267-1277
23. Awusi Kavuma, Martin Glegg, Garry Currie and Alex Elliott “Assessment of
dosimetrical performance in 11 Variana-Si500 electronic portal imaging devices”
Phys. Med. Biol. 53 (2008) 6893–6909
24. Ann Van Esch and Dominique P. Huyskens “Implementing RapidArc into clinical
routine: A comprehensive program for machine QA to TPS validation and patient
QA.
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8 8

Appendix TAB 9
 IsoCal Calibration C-Series machines

 IsoCal Verification on TrueBeam
 MV Dosimetry Calibration on TrueBeam
 CTB-PV-887-A Installation and Verification of the Portal Dosimetry
Pre-Configuration Package 1.0

education Systems
IsoCal-Calibration – C-Series
PROCEDURE
Objective:
 After completing this lesson the student will have successfully performed
IsoCal calibration tasks relevant to physicists in the lab exercise.
A. IsoCal Description and Recommendations
1. IsoCal Description:
 In an ideal environment, MV and kV central beam axes intersect at the
treatment isocenter for all gantry angles. The treatment isocenter therefore
coincides with the rotation center of the kV and MV imaging system. For real
installations, these three locations may not exactly overlap.
 The purpose of IsoCal is to determine the location and alignment between the
treatment isocenter and MV / kV rotation center, and to generate corrections
for imager and X‐ray source shifts—caused by repeatable mechanical
deflections and arm position errors—as a function of gantry angle. OBI may
apply the generated IsoCal calibration data to correct the acquired images for
an even more precise patient positioning.
 IsoCal consists of a cylindrical polyoxymethylene phantom with 16 inserted
tungsten‐carbid ball bearings (BB’s), an aluminum collimator plate with a
central steel pin and the IsoCal Application for OBI. (Figure 1)
9  The general approach consists of finding the treatment isocenter, the phantom 9
position and Source‐Imager‐Distance (SID), and then find and relate the
kV/MV rotation centers to the treatment isocenter. Therefore the phantom
does not need to be positioned precisely (within 5 mm) into the laser isocenter
position.
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Figure 1: IsoCal Phantom and Collimator plate
2. IsoCal Recommendations
 The frequency of IsoCal calibration must be based on the professional
judgment of the person in charge and also based on the requirements of the
institutions calibration program. Documents such as the AAPM Task Group
142 may be referenced for guidance. Varian recommends performing an
IsoCal calibration no more frequently than monthly and no less frequently than
annually.
 IsoCal calibration must be performed:
After a new Isocenter calibration has been done on any of the Exact Arms
(Chapter 7 of the OBI Maintenance Manual).
If the geometric check done for your periodic QA (Chapter 4 of the OBI
Maintenance Manual) fails to meet your ‘pass‘ criteria.
WARNING: If the IsoCal option is installed, a new IsoCal calibration

9
must be performed following the Isocenter calibration of any of the
Exact Arms.
NOTE: Indexing the Exact Arm without calibrating the arms to

Isocenter does not require a new IsoCal.
B. Calibration Process Overview
1. The basic calibration process involves the following steps (Figure 2):
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 Preparation-Mounting phantom and collimator plate to machine and setup

workstations for image acquisition.
 Image Acquisition- Acquiring several MV and kV images at different gantry
and collimator angles from predefined IsoCal Dicom plans.
 Image import- Importing the previously acquired MV and kV images into
IsoCal Application.
 Phantom tracking- IsoCal algorithms detect the tungsten carbid inserts of the
phantom and the steel pin of the collimator plate in the images and extracts
the position information.
 IsoCal Analysis- From the previously detected BB’s IsoCal determines the
central MV beam axis and then the treatment isocenter as the best fit
intersection point of the central MV beam axis at all gantry angles (analogous
to gantry star shots). The phantom position and nominal SID is computed and
from this the rotation axis for MV and kV is derived. IsoCal determines the
rotation center as the intersection point of rotation axis and the straight line
perpendicular to the rotation axis going through the x ray source point. In the
next step, the rotation center and the treatment isocenter projections on the
imager (kV/MV) are evaluated to calculate a 2D shift vector describing the
positions relative to the imager center for all gantry angles. The result of the
calibration is presented in a review screen.
 Calibration data export- The result may then be discarded or accepted. For
the latter IsoCal will save the calibration result to the file system.
 Correction- If enabled, OBI and PD will correct the imager position of
acquired images (DICOM Tag) with the 2D shift vector which describes the
displacement of imager center to treatment isocenter. The result is a more
precise patient positioning.
NOTE: Personnel performing calibration and maintenance tasks

9 must be familiar with the On Board Imager Reference Guide. All 9
calibration and maintenance tasks follow strict sequences.
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Figure 2: IsoCal Process Chart
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C. In Room Preparations
1. Rotate gantry to Varian IEC 0° (head up position).

2. Insert the IsoCal Collimator plate into the slot of the MV collimator interface
mount. When the plate is correctly positioned the indicator diode on the gantry
switches from red to green light.
3. Place the IsoCal phantom at the front end of the treatment couch.
4. Move couch to align the scribed marks in the phantom with the room lasers.
D. OBI Preparations
1. On the OBI Workstation close the OBI Application if running.

2. Remove old calibration data:
 Open File Explorer and browse to D:\VMSOS\AppData\IsoCal\Calibration\
 Delete all files in the two folders COLL and MV
 Remove all additional folders (not named COLL or MV) in the directory
D:\VMSOS\AppData\IsoCal\Calibration\. Do not delete the three IsoCal plans
(DICOM files).
 Calibration Folder should contain three IsoCal plans and two empty folders
named COLL and MV.
3. Start OBI Administration from Windows Start menu > All Programs > Varian >
OBI > OBI Administration. In OBI Administration > App & Misc Tab, turn off the
IsoCal correction:
 Uncheck the Apply IsoCal Correction for 2D Images box.
9  Uncheck the Apply IsoCal Correction for 3D Images box. 9
4. Save settings: File > Save or press Ctrl+S.
5. Exit OBI Administration and restart the OBI Application.
6. Either abort or perform the tube warm‐up when prompted at startup.
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E. Acquire IsoCal Images
1. On the 4D ITC Workstation, verify that Treatment Application is running and no

patient session is active. Otherwise close patient session.
2. Select Tools > DICOM RT mode.
3. Load the plan named CalibrationPlan_Collimator.dcm from the X:\ drive on the 4D
ITC workstation.
NOTE: The X:\ drive letter on the 4DITC Workstation is assigned by

default to the shared folder D:\VMSOS\AppData\IsoCal\Calibration
on the OBI Workstation. If the X:\ is missing, assign it as a new
drive letter.
4. Perform machine override by selecting Machine Override > Select All >
Convert.
NOTE: If the SCIC cannot be overridden, close the Treatment

Application, open the 4DC Administration > Machine Configuration
> Preferences, and uncheck Second Chanel Integrity Check.
5. Mode up the first field of the plan (CalibrationPlan_Collimator.dcm).

9
6. Select RV Mode up on the Clinac console. Execute gantry‐ and collimator motion
to target position.
7. Bring the PV imager into the planned position [Vrt = ‐50,Lat = 0,Lng = 0]
8. Turn key on the Clinac console keyboard and press Beam On to acquire the MV
image. After the acquisition select the next field if not automatically done by the
Treatment Application. Proceed the same way with the remaining three fields of
the plan to acquire images.
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9. In automatic mode‐up mode, confirm closing of patient by pressing Yes in the

Close Patient dialog that opens when the last field is treated. Otherwise select
Close Patient.
10. From the Save As dialog that is displayed upon close, name the dataset ‘COLL’
and save it in the X:\ COLL folder.
11. In the Treatment Application, load the plan named CalibrationPlan_MV.dcm.
Convert.
13. Mode up the first field of the plan (CalibrationPlan_MV.dcm).
14. Execute gantry‐ and collimator motion to target position on Clinac console.
15. Verify that the PV imager is at the planned position [Vrt = ‐50,Lat = 0,Lng = 0].
16. Turn key on the Clinac console keyboard and press Beam On to acquired the MV
image.
17. Proceed the same way with the remaining seven fields of the plan.
18. In automatic mode‐up mode, confirm closing of patient by pressing Yes in the
Close Patient dialog that opens when the last field is treated. Otherwise select
Close Patient.
19. From the Save As dialog that is displayed upon close, name the dataset ‘MV’ and
save it in the X:\ MV folder.
20. In the Treatment Application, load the plan CalibrationPlan_KV.dcm.
Convert.
22. Mode Up the first field of the plan (CalibrationPlan_kV.dcm).
23. Bring out the On Board Imager arms to the planned position: [SAD = 100, kV
Imager Vrt = ‐ 50, kV Imager Lat = 0, Imager Lng = 0].
24. Execute gantry‐ and collimator motion to target position on Clinac console.
9 25. In OBI Application, verify that the generator technique settings are as follows: 9
[60.0 kV/ 32.0 mA / 16.0 ms / Large Focal Spot / Dual Gain Standard Resolution]
To verify that Dual Gain is enabled, right click on the Single Exposure button (B)
and confirm that Dual Gain Standard Resolution is ticked. (Figure 3)
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Figure 3: Dashboard
26. Acquire the kV image by pressing either foot‐ or handswitch.

27. Acquire images for the remaining seven fields.
28. When all kV images have been acquired close the plan.
F. Loading Images
1. Start the IsoCal Application on OBI Workstation from Windows Start menu >
All Programs > Varian > IsoCal > IsoCal
2. Load the four acquired Collimator images:
 Press one of the Browse buttons in the MV Collimator Shots pane and
select the first DICOM file from D:\VMSOS\AppData\IsoCal\Calibration\COLL.
 Load the remaining three images.
 Verify that the following Coll Rtn are displayed: 195, 270, 0 and 90 (for Varian 9
IEC scale). Order doesn’t matter.
3. Load the acquired MV images:
 Press Browse in the MV Scan pane and select the folder
D:\VMSOS\AppData\IsoCal\Calibration\MV and press OK.
 The names of the eight images appear in the list left to the button.
 Verify that Coll Rtn is 90.
4. Load the eight acquired kV images:
 Press Browse in the kV Scan pane and navigate to
D:\VMSOS\AppData\IsoCal\Calibration\
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 You should find three new folders name according to creation date and time
(YY‐MM‐DD HH_MM_SS). Select the most recent one and press OK.
 If the correct folder has been selected, then eight names appear in the list,
otherwise none.(Figure 4)
NOTE: Every time a plan is loaded via RT DICOM mode in 4D ITC,

the DSS creates a folder. If the procedure has been followed
exactly, select the kV images from the most recently created folder.
If a kV plan has been re-loaded, make sure to select the folder with
the correct date and time.
9 9
Figure 4: Importing kV Images
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G. IsoCal Calibration
1. Press Start to initiate the calibration. The four collimator shots are analyzed first
in order to detect central steel pin (Figure 5).
NOTE: When performing IsoCal the first time, press Yes on

warning ʺCould not read current calibration dataʺ.
2. Press Next to start MV scan tracking (Figure 5).

3. Press Next to start kV scan tracking (Figure 5).
4. Press Next to review the results (Figure 5).
5. At the end of the IsoCal processing routine, details of the results will be shown in
the Review Details window. Review results and close Review Details window.
Press Accept to accept, or Cancel to discard the new calibration in IsoCal
Application:
 If the colored bar on top of the result screen is green, all parameters are within
tolerance. Review the data. If comfortable with the results, proceed and accept
the result.
 If the colored bar is yellow (warnings) the calibration is within tolerance but the
difference between the values of the new calibration and the previous
calibration exceeds expected tolerances. Review the data and clarify the
cause of the discrepancy (e.g. an Exact Arm calibration was performed since
the previous IsoCal calibration). If comfortable with the results, proceed and
accept the result.
9
 If the colored bar is red (out of tolerance) please review the details of the out
of tolerance parameters to determine if they are a concern or not. If
comfortable with the results, proceed and accept the result. If the description
of the out of tolerance parameters suggests repeating the measurements,
repeat the IsoCal calibration before accepting the result.
6. Press Done to close IsoCal Application.
7. Press Yes to close the application completely.
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Figure 5: Calibration
H. Post Calibration Procedure
1. Close the OBI Application.

2. Enable IsoCal correction in the OBI Administration > App & Misc Tab:
 Check the Apply IsoCal Correction for 2D Images box
 Check the Apply IsoCal Correction for 3D Images box.
9 3. Save settings: File > Save or press Ctrl+S. 9
4. Exit OBI Administration and restart OBI Application.
5. In the treatment room, remove the IsoCal phantom and partial transmission plate.
6. To verify the IsoCal calibration result follow the Daily QA Schedule(Chapter 4 of
the OBI Maintenance Manual)
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Abstract
The On-Board Imager® Training material is an educational aid for Varian On-Board Imager® System.
Notice
provides information concerning the use of the On-Board Imager® System. For complete information concerning
components, safety instructions, installation, maintenance, troubleshooting, etc., refer to the applicable Varian
product Operator’s Manual. This document does not replace the Varian Operator’s Manual.
FDA 21 CFR 820

Quality System
Regulations
(CGMPs)
ISO 13485
HIPAA
CE
9
93/42/EEC.
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12/12 11
IsoCal Verification
PROCEDURE
Objective:
 After completing this lesson, the student will have performed imaging system
IsoCal Verification.
A. Exercise Key:
1. Right mouse click denoted as RMC.

2. Brackets denote additional selection options.
3. The ‘>’ symbol denotes drill down from menus.
9 9
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IsoCal Verification
B. System preparation
1. Imaging system IsoCal Calibration and Verification uses calibrated MV continuous

mode for low energy and 300 MU/min dose rate and dynamic gain KV mode to
refine geometrical calibration of PU arms. Those imaging modes have to be
calibrated first in order to run IsoCal Calibration or Verification
2. Select the Imager Calibration mode. See Figure 1.
Figure 1: Mode selection
3. Login. See Figure 2

9
Figure 2: Login screen
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IsoCal Verification
4. Verify the state of the system. Click Continue. See Figure 3
Figure 3: Service startup screen
NOTE: Arms have to be initialized before starting imager calibration

or verification.
5. Imager calibration mode is opened. See Figure 4.
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Figure 4: Screen configuration in the Imager Calibration mode
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IsoCal Verification
6. Click on the Axis Position button in order to display current axis positions.
See Figure 5.
Figure 5: Axis position button
7. The Calibration workspace window will open on the Summary tab displaying all
Imager calibration modes. See Figure 6.
9
Figure 6: PVA Calibration Summary screen
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IsoCal Verification
8. Enter the treatment room and mount the IsoCal mounting device at the end of the
treatment table. The device should be locked in H4 index position and latched
under the table. See Figure 7.
Side Bottom Couch View

Side Top Couch View
Figure 7: IsoCal phantom mounting device
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IsoCal Verification
9. Mount IsoCal phantom at the end of the treatment table. See Figure 8
Figure 8: IsoCal phantom mounted at the end of treatment couch
10. Position the IsoCal phantom at isocenter. Use crosshair and room lasers as a
reference. See Figure 9.
Figure 9: IsoCal phantom in the isocenter position
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IsoCal Verification
11. Place the partial transmission plate into Interface mount. See Figure 10.
Figure 10: Partial attenuation plate mounted in the interface slot
9 9
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IsoCal Verification
C. Isocenter Verification
1. In Calibration Workspace RMC on one of the modes and select Isocenter

Verification. See Figure 11.
Figure 11: RMC > Isocenter verification
2. Isocenter verification screen will open. All calibration steps will be displayed on
the left side of the screen. See Figure 12.
Figure 12: Calibration screen
3. Follow the calibration wizard by reading instructions in the lower left part of the
imager calibration screen.
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IsoCal Verification
4. Acquire images at 4 different collimator rotations. The beam will be prepared by

Imaging Application. Check the parameters. See Figure 13.
Figure 13: Field parameters for MV collimator shots
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IsoCal Verification
5. Move the system to position select Motion axis and Imager arms and enable
motions. See Figure 14.
Figure 14: Control console
6. Turn the beam on. Select MV Ready and then MV Beam On. See Figure 15.
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IsoCal Verification
7. Images at 4 different collimator orientations will be acquired. The collimator

rotation will be done with the beam on hold. No user interaction is required. Press
Next> to continue. See Figure 16.
Figure 16: Imaging application after MV collimator shots
9 9
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IsoCal Verification
8. A new arc beam will be prepared. See Figure 17.
Figure 17: Imaging application
9. Move the axes to position. Select Motion axis and Imager arms and enable
motions. See Figure 18.
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IsoCal Verification
11. Approximately 120 projections will be acquired during arc rotation. Click Next to
continue. A new beam will be prepared. See Figure 20.
9 9
Figure 20: Acquired MV projections
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IsoCal Verification
12. Move the axes to position. Select Motion axis and Imager arms and enable
motions. See Figure 21
13. Turn the beam on. Push KV Beam On half way for KV Ready status and then all
the way to beam on. See Figure 22.

9
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IsoCal Verification
14. kV projections are acquired. Click Next to continue. See Figure 23.
Figure 23: Acquired KV projections
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IsoCal Verification
15. The system will detect center pin on the MV collimator shots. Review the images.
Click Next to continue. See Figure 24.
Figure 24: Detected pins on MV collimator shots
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IsoCal Verification
16. The system will detect BBs on the MV projections. Review the images – use the
slider to select projections. Click Next to continue. See Figure 25.
Figure 25: Detected BBs on MV projections
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IsoCal Verification
17. The system will detect BBs on the kV projections. Review the images – use the
slider to select projections. Click Next to continue. See Figure 26.
Figure 26: Detected BBs on kV projections
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IsoCal Verification
18. Review Isocenter Verification results. If needed display detailed report by

selecting Show Details. When done exit from isocenter verification by selecting
button. See Figure 27.
Figure 27: Isocenter verification results
NOTE: If the IsoCal verification fails repeat the IsoCal calibration.
9 9
VarianMedical
IsoCal Verification
Abstract
The training material is an educational aid for Varian TrueBeam machine.
Notice

ISO 13485
HIPAA
CE
93/42/EEC.
9
Trademarks

VarianMedical
MV Dosimetry Calibration on TrueBeam
PROCEDURE
Objective:
 After completing this lesson, the student will have performed the following tasks:
o Calibration of MV imaging system for Portal Dosimetry
A. Exercise Key:
1. Right mouse click denoted as RMC.

2. Brackets denote additional selection options.
3. The ‘>’ symbol denotes drill down from menus.
B. General information on imaging system calibration
1. Imaging system calibration consists of calibration and alignment of Positioning

Unit (PU), calibration of acquisition modes, and geometry calibration.
2. Calibration and alignment of PU is performed by service personnel and consists
of following steps:
 Installation calibration – performed once for lifetime of PU arms, determines
the angular difference between well defined arm orientation (all arms
perpendicular to each other) and mechanical end stop. It accounts for any
variation on how the arms are mounted and ensures correct trajectories for
arm extension and retraction.
9  Axes calibration – calculates distance between mechanical end stop and 9
axes home position
 System calibration – determines offsets of the reference position from
isocenter.
3. IsoCal calibration uses calibrated MV continuous mode for low energy and 300
MU/min dose rate and dual gain KV mode to refine geometrical calibration of PU
arms.
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C. MV Dosimetry mode calibration
1. Select the Imager Calibration mode. See Figure 1.
Figure 1: Mode selection
2. Login. See Figure 2.
Figure 2: Login screen
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3. Select user profile. Press Continue. See Figure 3.
Figure 3: Select User Privileges
4. Verify the state of the system. Click Continue. See Figure 4.
Figure 4: Service startup screen
NOTE: Arms have to be initialized before starting the imager

9 calibration. 9
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5. Imager calibration mode is opened. See Figure 5.
Figure 5: Screen configuration in the Imager Calibration mode
6. Click on the Axis Position button in order to display current axis positions.
See Figure 6.
Figure 6: Axis positions button
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7. The Calibration workspace window will open on the Summary tab displaying all
Imager calibration modes. See Figure 7.
Figure 7: PVA Calibration Summary screen
8. Select MV Modes in the Imaging Application. See Figure 8.
Figure 8: Imaging application

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9. In order to calibrate particular energy, select Details section. Select

mode/energy combination to be calibrated by clicking on the row representing
required combination. Notice that all calibration steps to be performed are
highlighted. To calibrate selected mode click Calibrate. See Figure 9.
Figure 9: MV Modes - Details section
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NOTE: Only particular step can be calibrated by selecting the step

in the Details section, RMC > Calibrate Selected Steps. Multiple
steps or energy/dose rate/mode combinations may be selected for
calibration by holding Control key and highlighting the steps with
mouse. See Figure 10.
CTRL +
CTRL +
Figure 10: Multiple step calibration
10. MV mode calibration screen will open. All calibration steps will be displayed on
the left side of the screen. Acquisition of dark field for selected energies and dose
rates will start. See Figure 11.
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11. Read the wizard instructions and follow the calibration flow. Acquire flood fields.
12. Calibration screen will set required imager, couch, gantry, jaw positions. Once all
the options are set press OK to set the beam. See Figure 12.
NOTE: Include Couch checkbox will move the couch to predefined

lateral and longitudinal position based on the setting in the System
Administration (Configuration>General Tab).
13. Required beam will be set on the service console. See Figure 13.
Figure 13: Set beam on service console 9
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14. Move the system to position. Select Prepare, select Motion axis and Imager
arms and enable motions. See Figure 14.
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16. The flood field image will be acquired. Once required number of frames is
acquired the beam will be turned off.
17. The calibration screen will display dark field and flood field images for evaluation.
Evaluate the images and click Accept Correction when images are accepted.
See Figure 16.
Figure 16: Calibration evaluation

9
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18. The Review Pixel Correction Map window will open displaying the current pixel
correction map. Existing ‘defective’ pixels are displayed in Red. Newly detected
defective pixels appear in Blue. Decide if to Keep Current Map, Update Map or
Reset Map. See Figure 17.
19. Select desired button in the lower right corner. See Figure 17.
Figure 17: Pixel Correction Map

9 20. Dark Field, Flood Field and Pixel correction map are common calibrations for all 9
MV modes.
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21. The calibration screen will proceed to Beam Profile Definition. Figure 18.
Figure 18: Dosimetry calibration steps
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22. Click Open Beam Profile. See Figure 19
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23. Navigate to folder where the diagonal profile is stored. If needed change the
extension filter. Select the file and click Open. See Figure 20.
Figure 20: Beam profile selection
24. Review beam profile settings. If approved click Accept. See Figure 21.
Figure 21: Calibration screen - Beam profile - Accept
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25. Dose normalization step will be selected. A Beam will be prepared in the
Calibration screen. Define Reference Dose [CU] – reference dose establishes
CU value. Typically reference dose corresponds to MU if the imager is at
isocenter. When done click OK. See Figure 22.
Figure 22: Dose normalization
9 9
NOTE: For the purpose of dosimetry calibration system
automatically sets the reference MU to 100, reference field size to
10x10cm2 and imager is moved to the plane of isocenter.
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26. The beam will be set in the Service console. See Figure 23.
Figure 23: Service console
27. Move the system to position. Select Prepare, select Motion axis and Imager
arms and enable motions. See Figure 24.
Figure 24: Control console 9
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29. Make sure all MUs are delivered. The image is acquired. Review dose
normalization image and parameters. If satisfactory click Accept. See Figure 26.
Figure 26: Dose normalization review
30. Continue with calibration of other modes or Close ( ) the service

console.
9
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Abstract
The training material is an educational aid for Varian TrueBeam machine.
Notice

ISO 13485
HIPAA
CE
9 Varian Medical Systems, Oncology Systems products meet the requirements of Council Directive MDD
93/42/EEC.
9
Trademarks

VarianMedical
Customer
Technical Bulletin
CTB Information
Title Installation and Verification of the Portal Dosimetry Pre-configuration Package 1.0
DWG Number 100058491 CTB PV-887

Complaint No. N/A Est. Labor Hrs 3 hrs.
Purpose Installation and verification of the Portal Dosimetry pre-configuration package. This package
consists of two parts:
(a) The pre-configured PDIP algorithm for import into ‘Beam Configuration’.
(b) A file for 2D profile correction including backscatter correction of the support arm
imported during ‘Dosimetry Calibration’ on the treatment console.
Product Product Code: H81, Product Name: Portal Vision
Code(s) Product Code: H48, Product Name: Eclipse
Affected
Prerequisites  Eclipse Version 10 including the Portal Dosimetry package or higher
 Machine types: All High-Energy Clinacs (C-series) or Unique
Note, TrueBeam is not supported with this version.
 IAS3 with IDU20 on E-arm (aS500II or aS1000).
 Multi Leaf Collimator: 52 / 80 / 120 leaf Millennium MLC or Mark MLC
Note, High Definition (HD) MLC not supported with this version.
AN UPDATE TO THIS CTB MAY BE AVAILABLE ON MY.VARIAN.COM
Tools Information
Tools and Download S/W Portal Dosimetry Pre-Configuration package 1.0.02 from
Equip https://my.varian.com
Reference Eclipse Algorithms Reference Guide
Documents
Modification  PDIP in Beam Configuration
Overview  Dosimetric Calibration of the Portal Imager
 Verification of Portal Dosimetry using provided plans
Order Kit Information
Order Number Description

100058491-01 Download S/W Pre-Configuration package 1.0.02 from https://my.varian.com
Revision Information
9
REV DATE STB AUTHOR NAME DESCRIPTION OF CHANGE FILE NAME
A Oct 15, 2012 N/A Christof Baltes Initial Release uopn MRD_1203_PDPC CTB-PV-887-A.docx
ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no representation to the qualifications of any service technicians other than its own employees. Improper or
uninformed maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including but not limited to one or more of the following: mechanical collision, electrical shock, and radiation.
Any of these hazards could cause serious injury and even death. Copyright © 2012, Varian Medical Systems, Inc. All rights reserved.
SHEET
1 OF 40
100058491
DWG NO. REVISION
© Varian Medical Systems PortalFormat

Dosimetry 11
TMP-GE-CTB-R
Customer Technical Bulletin
GENERAL INFORMATION
Read this entire document, carefully reviewing all instructions.
PERFORMANCE CHECK
Complete a thorough performance verification before disassembling and modifying any system. Make a
note of any operational discrepancies.
SAFETY PROCEDURES
Become familiar with Customer Support Service’s safety policies before working on Oncology Systems
Products. Ensure compliance with CSS’s safety practices and procedures while performing this
modification. Refer to the Product Users’ Manual for safety instructions.
CONTACT INFORMATION
If there are any questions, issues, or concerns contact Varian at 1.888.VARIAN.5 (1.888.827.4265) or go
to https://my.varian.com and click on Contact Us.
9 9
ATTENTION: This information is provided for use by qualified service technicians. Varian Medical Systems, Inc. makes no SHEET
representation to the qualifications of any service technicians other than its own employees. Improper or uninformed 100058491
maintenance or repair of the Product may expose a maintenance technician, operator and/ or patient to safety hazards including PV-887 Rev 2 of 40
but not limited to one or more of the following: mechanical collision, electrical shock, and radiation. Any of these hazards could
DWG NO.

cause serious injury and even death. Copyright © 2012, Varian Medical Systems, Inc. All rights reserved. Portal Dosimetry 11
Table of Contents
1. INTRODUCTION ........................................................................................................... 4
2. PREREQUISITES.......................................................................................................... 5
3. ORGANIZATION OF THIS DOCUMENT ...................................................................... 5
4. EXPECTED EXPENDITURE OF TIME ......................................................................... 6
5. BACKUP OF EXISTING PORTAL DOSIMETRY CONFIGURATION ........................... 7
5.1. Backup of existing PDIP Beam Data on Eclipse workstation ........................................................ 7
5.2. Configuration of new PDIP Calculation Model on Eclipse workstation ......................................... 8
5.3. Backup of existing Dosimetry Calibration on 4DITC workstation .................................................. 8
6. INSTALLATION ............................................................................................................ 9
6.1. Beam Configuration on Eclipse workstation: PDIP beam data ..................................................... 9
6.2. Dosimetric Calibration of the Portal Imager on 4DITC workstation ............................................. 13
6.2.1. Dark field and flood field correction .............................................................................. 13
6.2.2. Dosimetry Calibration ................................................................................................... 16
7. VERIFICATION ........................................................................................................... 20
7.1. Intention of verification plans ....................................................................................................... 20
7.2. Creation of verification plans on Eclipse workstation .................................................................. 20
7.2.1. Configure import filter ................................................................................................... 20
7.2.2. Import of verification plans ........................................................................................... 22
7.2.3. Dose calculation for treatment plans ............................................................................ 22
7.2.4. Create verification plans ............................................................................................... 24
7.2.5. Schedule acquisition of Portal images ......................................................................... 26
7.2.6. Book Machine Time using Time Planner ..................................................................... 27
7.3. Irradiation of verification plans on treatment console .................................................................. 27
7.4. Evaluation of verification plans on Eclipse workstation ............................................................... 28
7.4.1. Verification of MLC parameter settings ........................................................................ 28
7.4.2. Output factors ............................................................................................................... 32
7.4.3. Beam profile correction ................................................................................................ 33
7.4.4. Backscatter correction .................................................................................................. 35
7.4.5. Exemplary patient IMRT and RapidArc plans .............................................................. 37
7.5. Acceptance of Portal Dosimetry Configuration ............................................................................ 38
8. UNINSTALLATION AND RECOVERY OF PREVIOUS PORTAL DOSIMETRY

CONFIGURATION ...................................................................................................... 38 9
8.1. Beam Configuration on Eclipse workstation: PDIP beam data ................................................... 38
8.2. Dosimetry Calibration on 4DITC workstation .............................................................................. 39
9. CUSTOMER DOCUMENTATION ............................................................................... 39

10. REFERENCES ............................................................................................................ 39
DWG NO.
cause serious injury and even death. Copyright © 2012, Varian Medical Systems, Inc. All rights reserved.
1. INTRODUCTION
The optimal performance of the current Portal Dosimetry (PD) solution used for pre-treatment
verification of intensity-modulated radiation therapy (IMRT) plans and volumetric modulated arc
therapy (VMAT or RapidArc©) plans is hampered by three aspects: (a) the cumbersome calibration
procedure, (b) the backscatter effect of the portal imager support arm and (c) less than optimal
beam profile correction for dosimetric images. Based on the long lasting experience of the 7sigma1
company (a qA-team in radiotherapy physics) with quality assurance using the Portal Dosimetry
solution, a joint effort resulted in the creation of the Portal Dosimetry Pre-Configuration (PDPC)
package. The intention of this package is to provide a pre-configured set of files allowing for a
customer-friendly configuration of the Portal Dosimetry solution. The configuration procedure is
simplified to an easy import of Eclipse beam data and the absolute calibration of the MV detector
on the console. In addition, the PDPC package incorporates an improved backscatter and beam
profile correction to enhance the performance of Portal Dosimetry.
The PDPC package consists of two parts: (a) Pre-configured Portal Dosimetry Image Prediction
(PDIP) beam data and (b) the 2D beam profile correction. The pre-configured PDIP algorithm can
be easily imported into Beam Configuration. In doing so it is assumed that the scatter behavior of
different EPIDs of the same type (e.g. IDU20) can be modeled by identical scatter kernels.
The 2D beam profile correction is imported on the treatment console during Dosimetry Calibration.
This correction accounts for two aspects introduced during flood field calibration of the MV imager
for dosimetric images.
 The flood field is acquired using a 40x30cm2 field and inherently contains beam profile as well
as support arm backscatter. Thus, the flood field correction removes the beam profile in EPID
images.
 A diagonal profile of a 40x40 cm2 field is used to recover the beam profile. As consequence the
penumbra region in the acquired PD image is overestimated resulting in discrepancies between
acquired and predicted PD image.
In the PDPC package a 2D beam profile correction file is introduced taking the field size of the
flood field correctly into account. Furthermore, as the backscatter is dependent on field size, the
flood field overcorrects the backscatter effect for small field sizes. As a compromise, the 2D beam
profile correction contains a compensation for this overcorrection at small field sizes. Effectively,
9 the PDPC package corrects the support arm backscatter for small - clinically relevant - field sizes,
9
while it under-corrects for large field sizes.
The intended use of the PDPC package is to allow for a fast and simple configuration of the Portal
Dosimetry solution by providing pre-configured PDIP beam data and 2D beam profile correction
files.
DWG NO.
2. PREREQUISITES
The Portal Dosimetry pre-configuration package was developed to support the following software
and hardware configurations:
 Eclipse Version 10 including the Portal Dosimetry package and higher
 IAS3 with IDU20 on E-arm, thus aS500II and aS1000.
 Machine types: All High-Energy Clinacs (C-series) and Unique
o Note: TrueBeam is not supported with this version.
 Multi Leaf Collimator: 52 / 80 / 120 leaf Millennium MLC or Mark MLC
o Note: High Definition (HD) MLC is not supported with this version.
The PDPC calibration files (2D beam profile correction) are intended for calibrating Portal
Dosimetry for pre-treatment verification at source-imager distances (SID) of 100cm or 105cm (E-
arm).
3. ORGANIZATION OF THIS DOCUMENT

This document describes installation, verification and, if desired, uninstallation of the PDPC
package.
The installation procedure describes in detail how to import the pre-configured PDIP algorithm into
Beam Configuration. During creation of pre-treatment verification plans this pre-configured PDIP
algorithm is used to predict the Portal Dosimetry images.
On the 4DITC console the 2D beam profile correction file is imported during Dosimetry Calibration
to recover the beam profile as well as correct for the backscatter effect of the support arm.
The verification procedure describes in detail how to import a set of verification plans, how to
create the corresponding pre-treatment verification plans and how to irradiate and analyze them
with respect to a successful installation of the PDPC package.
CAUTION The verification procedure is an essential step during PDPC installation

verifying the proper installation and the applicability of the PDPC package to
the specific system and must not be skipped.
Note The performance of the Portal Dosimetry solution is sensitive to proper

commissioning of the treatment planning system and MLC parameter
9
adjustment. However, commissioning and MLC parameter adjustment are
directly affecting treatment and remain solely the responsibility of the
customer and should be carefully verified using independent measurements.
The uninstallation procedure describes in detail how to uninstall the PDPC package and, if Portal
Dosimetry was configured before, how to recover the original Portal Dosimetry configuration.
DWG NO.
4. EXPECTED EXPENDITURE OF TIME

The import of the PDIP beam data in the Eclipse treatment planning system and the preparation of
the pre-treatment verification plans can be performed beforehand without requiring any machine
time (Duration: 45min depending on DCF performance).
The installation of the PDPC package on the treatment console comprises Dosimetry Calibration
and, subsequently, the irradiation of the pre-treatment verification plans. In total a time slot of 60-
90min should be allocate for installation and verification.
Analysis of the acquired pre-treatment verification plans can be performed on a separate offline
workstation using the Portal Dosimetry application (Duration: 30min).
Durations are estimated for installation and verification of one beam energy and dose rate.
9 9
DWG NO.
5. BACKUP OF EXISTING PORTAL DOSIMETRY CONFIGURATION

The installation of the PDPC package requires the import of PDIP beam data as well as the
creation of a new Dosimetry Calibration on the 4DITC workstation. In the case an existing
configuration is replaced, it is required to backup these data first, in order to be able to restore this
configuration at a later time point:
- An existing version of the PDIP beam data can either be replaced (5.1) or a new calculation
model (5.2) can be configured.
- The Dosimetry Calibration on the 4DITC workstation needs to be backed up (5.3).
5.1. Backup of existing PDIP Beam Data on Eclipse workstation
1. Go to Beam Configuration task using Quick Links.

2. Select appropriate treatment machine and energy.
3. Select the Portal Dose Image Prediction (PDIP) algorithm.
4. Select the PDIP beam data and Unapprove the data using the right-mouse button menu
(Figure 1).
Beam Configuration
Select PDIP Algorithm
Select PDIP beam data
Unapprove Data
9
Figure 1: Unapprove beam data of PDIP algorithm
5. Write down the beam model folder number (e.g. here 004) for unambiguous identification of the
original PDIP beam data.
DWG NO.
6. Clear the beam data using the right-mouse button menu.
Note Clearing the beam data will remove the assignment to this treatment
machine, but not delete the beam data. Thus, these beam data can be
reassigned to this treatment machine again at a later point in time. The
backup of the beam data inherently exists on the Eclipse server.
5.2. Configuration of new PDIP Calculation Model on Eclipse workstation

2. Select in the menu Beam Data the item Configure Calculation Models… .
3. Press the button Add Model and enter the following information:
- Model name: PDIP_PDPC
- Algorithm: Portal Dose Image Prediction
- Select bullet point: Create new beam data
4. Click the button Add and close the dialog Calculation Models.
5.3. Backup of existing Dosimetry Calibration on 4DITC workstation
1. The dosimetry calibration is stored on the console in the directory (Figure 2):
C:\Program Files\Varian\Oncology\Treatment\AM\config\AM\IAS3\do
Figure 2: The complete dosimetry calibration is stored in the folder do on the console
2. Navigate to this directory using MS Windows Explorer and create a copy of the entire folder in
the parent directory and rename it to do_backup.
9 3. Navigate into the folder do and delete all files in this folder. 9
Note Please do not delete the folder ‘do’ itself, as the SW will not create a
missing directory in the subsequent dosimetry calibration procedure. It is
sufficient to delete the content of the folder ‘do’ to undo a dosimetry
calibration.
DWG NO.
6. INSTALLATION
The installation of the Portal Dosimetry pre-configuration package is split into two separate parts:
- The configuration of the Portal Dosimetry Image Prediction (PDIP) algorithm (6.1).
- The configuration of the image acquisition software (IAS3) on the 4DITC treatment console
(6.2).
6.1. Beam Configuration on Eclipse workstation: PDIP beam data

3. Select the Portal Dose Image Prediction (PDIP) algorithm (e.g. PDI10028 or PDIP_PDPC).
4. Insert New Beam Data (Figure 3).
Beam Configuration
treatment machine
PDIP algorithm
New beam data
Figure 3: Create new beam data for PDIP algorithm.
5. Enter Therapy Unit Name and select Start with empty data (Figure 4).
Note The therapy unit name will be overwritten by the imported beam data.
DWG NO.
Therapy Unit Name

Start with empty data
Figure 4: Enter temporary therapy unit name
6. In the focus window, right-mouse-click on the treatment unit and select Import Eclipse Beam
Data.
treatment unit
Import Eclipse Beam Data
9 Figure 5: Import Eclipse beam data from disk

9
7. Browse to the directory with the appropriate pre-configured PDIP beam data
Note Select the folder containing the ‘mapfile.txt’. For this purpose select ‘All
Files [*.*]’ as ‘Files of type’ to be displayed in the dialog box (Figure 6). Do
not select the subdirectory itself.
DWG NO.
Figure 6: Select mapfile.txt for importing pre-configured PDIP beam data
8. Select from the PDPC package the corresponding machine type and energy and press OK
(Figure 7).
Figure 7: Select appropriate machine type and energy
9. Set In Use checkmark for OPENFIELD and press Close (Figure 8).
DWG NO.
Figure 8: Select add-ons
10. Rename the therapy unit name on the General Parameters tab as desired (Figure 9).
therapy unit name
9 9
Figure 9: Adapt therapy unit name
11. Right-mouse-click on the folder Beam Data and approve the beam data (Figure 10).
DWG NO.
Beam Data
Approve Data
Figure 10: Approve beam data
6.2. Dosimetric Calibration of the Portal Imager on 4DITC workstation
Note The dosimetric calibration of the portal imager shall be performed when you
are confident of your machine output, as any deviations will be inherently
included in the calibration of the portal imager.
Preparations:
 For dosimetry calibration of the imager, start up the Linac in Service mode, without ARIA and
with the MLC in standby mode.
 Copy the appropriate 2D beam profile correction file (e.g. SID100_x06_40x32_aS1000.cdp)
from the PDPC directory (e.g. PDPC_package\packages\EPID calibration\x06\aS1000) to a
temporary folder on the 4DITC treatment console.
6.2.1. Dark field and flood field correction
1. Open the application AM Maintenance on the 4DITC treatment console.

2. Start the application Maintenance → Service Monitor (Figure 11).
9
Maintenance
Service Monitor
Dosimetry Calibration
Figure 11: Select Maintenance → Service Monitor
DWG NO.
3. Move the Portal Imager to the position at which Portal Dosimetry measurements will be
performed. This is most often the isocentric position (Vertical [cm]: 0, Lateral [cm]: 0,
Longitudinal [cm]: 0).
On the tab Support Arm (Figure 12), enter for Preset Position at Source-Imager Distance
(SID)
SID = 100 cm: Vertical [cm]: 0
Longitudinal [cm]: 0
Lateral [cm]: 0
SID = 105 cm: Vertical [cm]: -5

Longitudinal [cm]: 0
Lateral [cm]: 0
Select Auto Go and press the Download button.

Enable the movement of the Portal imager by pressing Auto + PV Motion enable on the
On-Board Imager (OBI) controller.
Figure 12: Support Arm tab in Service Monitor application
9 9
4. Set the field size according to the used SID (Table 1):
Note For flood field acquisition Y field sizes slightly larger than the EPID
size are adjusted aiming for largely homogeneous irradiation.
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SID X Y Gantry Collimator

[cm] [cm] [cm] Angle Rotation
[deg] [deg]
100 40 32 0 0
105 40 30 0 0
Table 1: Appropriate field sizes for flood field calibration according to the SID
5. On the tab Mode: Select Integrated Image as Acquisition Technique (Figure 13).
Mode
Acquisition Technique
Integrated Image
Dark Field
Flood Field
Figure 13: Selection of Acquisition Technique on tab Mode
6. On the Clinac, set energy and dose rate. Adjust a sufficient (maximum) amount of MUs
to allow the acquisition of all frames for the flood field calibration.
7. Press Dark Field and wait until the acquisition is completed.
8. Press Flood Field.
9. Turn the beam on.
10. Turn the beam off after the acquisition has completed.
11. Typical flood field images look as shown in Figure 14.
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Figure 14: Exemplary flood field image
12. Optional: Press Image to acquire a test image

Turn the beam on.
Turn the beam off after ~ 50 frames.
Check if the image looks fine.
13. Optional:
If defective pixels can be observed in the test image, please update the defective pixel
map.
14. Press Save Calibration Set to accept the acquired dark field and flood field images and
store the calibration set to be applied to integrated portal images.
15. Repeat steps 8-15 for all energies and dose rates used for IMRT.
16. Close the IAS3 Service Monitor.
6.2.2. Dosimetry Calibration
9 Note Once a dosimetric calibration has been performed, test images are 9
corrected for the beam profile and are no longer displayed in grayscale.
1. The dosimetric calibration should be performed at the same SID used for the dark field
and flood field calibration.
2. On the treatment machine, set:
 Field size: X = 10 cm, Y = 10 cm
 Monitor Units = 100
3. Open the application AM Maintenance on the 4DITC treatment console.
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4. Select Dosimetry Calibration on the menu Maintenance (Figure 11).

5. Select all calibration modes used for IMRT or RapidArc (Figure 15) and press OK.
Note The verification plans delivered together with the PDPC package are
initially prepared for dose rates of 400MU/min and 600MU/min, but
should be adapted to the dose rates used for IMRT and RapidArc
treatment.
Figure 15: Selection of dosimetry calibration modes used for IMRT
6. Select the checkboxes Beam Profile Correction and Dose Normalization.

7. Set the vertical calibration position (IDU Vert) to the required value (e.g. 0cm → SID =
100cm or -5cm → SID = 105cm).
Beam Profile Correction
Dose Normalization
9
Figure 16: Select desired dosimetry calibration steps and set the vertical IDU
calibration position
8. Press OK.
9. Select the path to the appropriate 2D beam profile correction file (Figure 17). For each
energy a separate file is needed (Figure 18).
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Figure 17: Browse to the folder containing the 2D beam profile correction file
Figure 18: 2D beam profile correction file for 6MV including correction of the
backscatter from the support arm at SID = 105 cm
Note The 2D beam profile correction file (Figure 18) contains an image
correcting the beam profile as well as the support arm backscatter
9 effect during flood field calibration. 9
DWG NO.
Note The following steps are required to make the 2D beam profile
correction file accessible on the 4DITC workstation with Varian
shell installed:
1. Copy the 2D correction file onto the Image server share for
Data Transfer (typically ‘D:\Varian\Transfer’ on Image server).
2. On 4DITC workstation, login to ‘Advanced Mode’.
3. Select File Manager and copy 2D correction files from Transfer
to Work directory (The Transfer share is setup by default
during the installation of Varian Shell).
4. Navigate to ‘D:\work’ when selecting the correction files from
AM Maintenance.
10. Set the required beam energy and dose rate at the machine.
11. Turn the beam on and irradiate 100MU.
12. After the beam has switched off, enter the corresponding value in the pop-up window
(Figure 19) e.g. at SID=100 cm enter 1 CU as Measured Dose.
Figure 19: Scaling of the imager read-out to calibrated unit in [CU]
Note When using the imager at an alternative SID for Portal Dosimetry,
enter the calibrated unit scaled according to the inverse square law
(Table 2). Please notice that 1CU is scaled to 100MU (at
SID=100cm) in order to match the PDIP configuration.
9
SID [cm] Measured Dose [CU]
100 1.000
105 0.907
Table 2: Calibrated unit according to the imager position (SID)
13. Repeat steps 7-13 for all energy - dose rate combinations to be calibrated.
14. After finishing all required measurements press OK.
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7. VERIFICATION
7.1. Intention of verification plans

A set of plans is delivered along with the PDPC in order to verify the correct installation of
the PD Pre-Configuration package and its validity for the customer’s machine. The imported
patient (ID: PDPC_VV_plans) consists of a dummy water phantom with a segmented body
contour to allow for dose calculations within Eclipse. Course C1 contains a set of
verification plans focusing on the correct installation and on the improved characteristics of
the PDPC solution. A detailed description of the verification plans as well as the expected
outcome is given in Section 7.4.
Beside the verification plans provided with the PDPC package the customer should create
their own verification plans as well as clinical plans to evaluate the performance of the
configured Portal Dosimetry solution on the specific system.
Note The following description assumes the ARIA environment to be installed.

Users without ARIA need to adapt the workflow of data transfer between
Eclipse and treatment workstation.
7.2. Creation of verification plans on Eclipse workstation
7.2.1. Configure import filter
1. Log into Eclipse → External Beam Planning.

2. Configure the import filter to allow for converting the machine IDs using Tools →
Import/Export Configuration.
3. Press Manage External IDs … and create a new entry in the ID Mapping Table (Figure
20):
External ID: 2300CD
Internal ID: Internal machine ID
9 9
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2300CD Internal machine ID
Figure 20: Manage external IDs
4. Select import filter DICOM Patient Import Filter and enable external ID conversion by
selecting the checkbox Use external Id conversion (Figure 21).
Use external Id conversion

9
Figure 21: Enable external ID conversion during DICOM import
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7.2.2. Import of verification plans
1. Log into Eclipse → External Beam Planning

2. Import patient using Import → Patient… → DICOM Patient Import Filter
3. Select the appropriate directory on the distribution CD or download of the Portal
Dosimetry pre-configuration package:
.\PDPC_package\verification\PDPC_VV_plans
and click Next.
4. Create new patient using the information automatically provided by the Import Wizard
and ignore warnings and click Next.
7.2.3. Dose calculation for treatment plans
1. Select each treatment plan individually and Drop to view using the right-mouse-button
menu.
2. Go to the tab Calculation Models and select the calculation models at least for Volume
Dose (select the dose calculation model used in clinical routine) as well as for Portal
Dose (PDIP algorithm commissioned in section 6.1).
Note Any calculated doses will be invalidated and have to be

recalculated.
3. Verify that for all fields the desired machine and your tolerance table for quality
assurance measurements are selected.
4. Verify that all fields are using only dose rates calibrated for IMRT (6.2.2).
Note When using the EPID at SID = 105 cm the square field size
2
of 30x30 cm in the qOpen plan needs to be reduced to
2
28x28 cm to avoid irradiation of the EPID electronics.
5. Perform dose calculation by selecting Planning → Calculate Volume with Preset Values
or pressing SHIFT+F5.
6. Enter the corresponding MUs per field as listed in Table 3 and Table 4, respectively.
9 9
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qMLC qOpen
Field Name MU Field Name MU
DynChair 200 3x3 100
FlatFluence 100 5x5 100
AIDA 200 10x10 100
15x15 100
20x20 100
30x30 100
(28x28 @ SID=105cm)
30x20 100
3 fields 7 fields
Table 3: Preset MU values for artificial MLC verification (qMLC) and open field
(qOpen) plans
iIMRT_1 iIMRT_2
RPO_P1_0 75 LPO1_P2_1 112
RPO_ P1_1 59 LPO1_ P2_0 80
RAO_ P1_0 78 LPO_ P2 142
RAO_ P1_1 52 LAO_ P2_1 44
AP_ P1_0 49 LAO_ P2_0 117
AP_ P1_1 79 AP_ P2_1 82
LAO_ P1_0 71 AP_ P2_0 106
LAO_ P1_1 45 RAO_ P2_1 83
LAO1_ P1 91 RAO_ P2_0 61
LPO_ P1_0 63 RPO1_ P2 99
LPO_ P1_1 116 RPO_ P2_0 94
LPO1_ P1_0 89 RPO_ P2_1 84
LPO1_ P1_1 60
13 fields 12 fields
Table 4: Preset MU values for two patient IMRT (iIMRT) plans
iRA_1 iRA_2 9
RA1 269 RA2 237
RA2 286 RA1 240
2 fields 2 fields
Table 5: Preset MU values for two patient RapidArc (iRA) plans
7. Start Leaf Motion Calculator for non-RapidArc fields.
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Note In case changes to the MLC file were automatically

performed due to physical constraints, please accept these
changes and verify them using the item ‘Verify MLC Leaf
Positions…’ under the menu ‘Planning’.
8. Repeat steps 1 – 7 for each plan.
7.2.4. Create verification plans
1. Select each treatment plan individually and Drop to view using the right-mouse-button
menu.
2. Create verification plan by selecting Planning → Create Verification Plan… to open the
corresponding wizard (Figure 22).
3. Create new course with ID C1_Verification and click Next.
4. Select Portal Dose Prediction at the desired calibration distance of the Portal imager and
click Next.
Note For pre-treatment verification using Portal Dosimetry it is

recommended to use a SID = 100cm.
9 9
Figure 22: Selection of verification method and Portal imager distance
5. Select the checkbox Reset gantry to and enter the value 0.0 degree, if applicable (Figure
23).
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Note The gantry angle cannot be reset for RapidArc pre-treatment

verification plans.
6. Deselect the following checkboxes:

 Reset collimator to
 Reset couch to
Note The RapidArc test plan iRA_2 contains large fields in in-
plane direction. For this reason it is strongly recommended
to reset the collimator to 0 deg to avoid irradiation of the
EPID electronics.
7. Select the checkbox Use tolerance table, select your tolerance table for quality
assurance measurements from the drop-down menu and then click Next.
Reset gantry to
Reset collimator to
Reset couch to
Figure 23: Proper selection of checkboxes and associated values
8. Click Next until the verification plan is created.

9. When setting the Plan Approval status to Planning Approved:
9
 Do not apply any Delta couch shifts and press Next
 If applicable, accept all Planned SSD by selecting the checkboxes OK.
 Verify that the checkbox Split large IMRT fields in Eclipse is unchecked.
 Select the checkbox Calculate treatment times and set the value Multiply with
factor to 2.0 (Figure 24)
 Sign off the planning approval with your password
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Note In case the option Large Field IMRT is not available on the system,
one can irradiate split fields and create a composite PD image
during analysis in the Portal Dosimetry application.
10. Repeat steps 1 – 9 for each plan.
2.0
Figure 24: Calculation of treatment time during planning approval
7.2.5. Schedule acquisition of Portal images
1. Log into Eclipse → EMR → RT chart.

2. Go to the tab Scheduling.
3. Select a verification plan and Fill plan using right-mouse-button menu.
4. Tick the checkbox Show Sequence Imaging Schedule.
5. Select the first session and schedule for all fields in all plans an Integrated Image using
the right-mouse-button menu (Figure 25).
9 9
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Select a verification plan

Show Sequence Imaging
Schedule
Figure 25: Scheduling an Integrated Image for each field
7.2.6. Book Machine Time using Time Planner
1. Log into Time Planner using Quick Links → EMR.

2. Select the agenda of the Linac on which you would like to configure Portal Dosimetry.
3. Book sufficient time (60 - 90 min) to allow for dosimetry calibration as well as irradiation
of the verification plans.
7.3. Irradiation of verification plans on treatment console

The PDPC verification plans can be irradiated on the treatment machine as standard pre-
treatment verification plans. For this purpose the following steps are required:
1. Start the Clinical mode on the Linac console.

2. Start the Treatment application on the 4DITC workstation.
3. Select the patient PDPC_VV_plans and open the scheduled verification plans in QA mode (or in
treatment mode for 4DITC systems without OBI or PVAI).
4. Irradiate all fields using the Auto sequence mode.
5. After all fields were successfully irradiated, close the patient and the acquired PD images are
stored. 9
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7.4. Evaluation of verification plans on Eclipse workstation

All data shown in this chapter on the evaluation of the verification plans were acquired on a
UNIQUE system using beam energy of 6MV.
7.4.1. Verification of MLC parameter settings

The accuracy and performance of the Portal Dosimetry solution strongly depends on
a proper setting of the MLC parameters Transmission Factor and Dosimetric Leaf
Gap. These parameters can be found in Beam Configuration by first selecting
appropriate machine and energy and then Beam Data→Dosimetric Data. Three
IMRT fields are included in the PDPC_VV_plans to verify whether the current MLC
parameter settings (DynChair, FlatFluence, AIDA) are compatible with the PDPC
package.
Note Portal Dosimetry requires a proper adjustment of the MLC

parameters. The plans DynChair and FlatFluence are used
to verify whether the current MLC parameters are
compatible with the PDPC package. In case deviations are
observed, an adaptation of the MLC parameters can be
considered. However, the proper tuning of the MLC
parameters cannot be verified using Portal Dosimetry. It
needs to be verified by an independent dose measurement.
As changing the MLC parameters impacts clinical
treatment, it is the responsibility of the customer to properly
adjust and verify the MLC parameters.
Evaluating these fields is solely intended for assessing the MLC parameter settings,
as they indirectly influence the performance of Portal Dosimetry. Nevertheless,
passing the Gamma analysis is not mandatory for verifying the successful
installation of the PDPC package, but might indicate to consider a fine-tuning of the
MLC parameter settings (see Note above).
Gamma analysis of these fields shall be performed using the settings:
 Dose tolerance: 3%
 Distance-to-Agreement: 3mm
9  Gamma analysis: global
9
(Use Local Gamma Evaluation not selected)
 ROI selection: Threshold of 5%
 Area Gamma < 1.0: 97.0 %
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a) Dynamic chair (DynChair)

The dynamic chair pattern as described in van Esch et al.2 is used to separate
the impact of Transmission Factor and Dosimetric Leaf Gap. As illustrated in
Figure 26, the upper part of the pattern (Figure 26b) is used to estimate the
proper settings of the Transmission Factor, as the zero dose region (right side)
of the crossline profile corresponds to pure transmission through the leaves. The
central part (Figure 26c) is intended for absolute dose verification against an ion
chamber measurement (not part of the PDPC verification procedure). In the
lower part of the pattern (Figure 26d) the leaves are moving at maximum speed
in the zero dose area between the legs of the chair regardless of MLC
parameter settings. The leaf motion is not altered in this area by the MLC
parameter settings. However, the actual fluence is influenced by both
Transmission Factor and Dosimetric Leaf Gap, thus affecting the calculated
dose. Accordingly, MLC parameters can be optimized by comparing calculated
versus measured dose distributions.
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(b)
(c)
(d)
(a)
(b) (c)
(d)
Figure 26: Evaluation of DynChair field: (a) Predicted PD image, gamma map and
acquired PD image. Crossline profiles (blue: acquired PD image; red:
9 predicted PD image) at different levels in the chair pattern allow for 9
determining Transmission Factor (b), absolute dose values in
comparison to an ion chamber measurement (c) and combination of
Transmission Factor and Dosimetric Leaf Gap (d)
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b) Flat fluence (FlatFluence)

The FlatFluence field consists of a large field which is split into two parts as the
MLC motion range is limited. Accordingly, summing up the two irradiated fields
should result in the calculated dose distribution. The transition area between the
two parts is strongly affected by Transmission Factor and Dosimetric Leaf Gap,
thus a proper adjustment of the MLC parameters can be evaluated using the
FlatFluence field.
(a)
(b) (c)
Figure 27: Evaluation of FlatFluence field: (a) Predicted PD image, gamma map
and acquired PD image. Inline profiles (blue: acquired PD image; red:
predicted PD image) show small (b) and large (c) dips (arrows) at the
overlap of the subfields which are in this case in an acceptable range
for well-adjusted MLC parameters
9
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c) AIDA pattern (AIDA)

The AIDA pattern3 was developed to commission the PDIP algorithm and is
irradiated again to verify the proper calculation of the EPID kernel used in the
PDIP algorithm (Figure 28).
Figure 28: Gamma analysis of AIDA pattern verifying proper commissioning of the
PDIP algorithm
7.4.2. Output factors

The verification plan qOpen is used to verify whether the output factors used in the
PDIP algorithm do match the actual output factors of the EPID. For this purpose the
central axis point in the square fields of increasing field size (50, 100, 150, 200, 300
mm) is evaluated using the Point Dose Tool (Measure→Point Dose) of the Portal
Dosimetry application:
1. Log into the Portal Dosimetry application and select the patient PDPC_VV_plans.
2. Select the plan qOpen using the navigation panel on the left.
9 9
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Figure 29: Selection of the plan qOpen and evaluation of the central axis value
of acquired and predicted PD images
3. Use the Point Dose tool to extract the central axis (CAX) value for all square field
sizes both of the acquired as well as the predicted PD images.
4. Calculating the relative difference between the corresponding values for field sizes
2
ranging from 5 x 5 cm to the maximum square field size in the plan qOpen should
be less than ±1.0% (using output factor values from predicted PD images as
reference).
7.4.3. Beam profile correction

The flood field acquired during calibration of the EPID inherently contains the beam
profile. Accordingly, the flood field correction removes the beam profile in integrated
EPID images and needs to be recovered subsequently. In the standard
configuration procedure a diagonal profile of a 40x40 cm2 field is used for this 9
purpose. However, the acquisition of the flood field is performed using an open field
of size 40x30 cm2. As consequence the penumbra region in the acquired PD image
is overestimated resulting in discrepancies between acquired and predicted PD
image. The PDPC package uses a 2D beam profile correction matrix instead of a
diagonal beam profile. This 2D matrix takes the penumbra region of the 40x30cm 2
field correctly into account. The accuracy of beam profile correction can be
observed in the crossline direction of the EPID (Figure 30), while the beam profile
correction is masked by the backscatter effect in inline direction.
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(a) (b)
(c)
Figure 30: The accuracy of the PDPC beam profile correction is displayed for
crossline profiles of square field sizes of 10x10 cm2 (a), 15x15 cm2 (b) as
well as 30x30 cm2 (c)
When verifying the installation of the PDPC package, central crossline profiles of the
square fields in the plan qOpen shall be evaluated by:
 Automatically aligning predicted and acquired PD image.
 Relative normalization based on the isocenter dose (To isolate potential
deviations due to output factor differences from deviations in beam profile).
 Calculation of the mean relative difference between predicted and acquired
crossline profiles within the flat field region (defined as 80% area within the
50% field limit):
o Select the display mode Dose Difference.
o Turn on the graticule (View→Digital Graticule).
9 o Use the Profile tool (Measure→Profile) to select a crossline profile
9
covering the central flat field region (Figure 31).
o Display Statistics using the right-mouse-button menu in the dialog
window Profile Dose Difference Image.
o The mean relative difference is given by the Mean value in the Profile
Statistics.
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Figure 31: Dose difference normalized relative to the dose at the isocenter. Use the
Profile tool to select a crossline profile covering the central flat field
region. The mean relative difference is given by the Mean value in the
Profile Statistics
Resulting mean relative differences shall be within ± 1% for field sizes ranging from
5 x 5 cm2 to the maximum square field size in the plan qOpen.
7.4.4. Backscatter correction

During irradiation the EPID support arm leads to backscatter effects in the EPID
images. The flood field correction removes the backscatter effect for field sizes of
40x30 cm2. However, as the backscatter effect is field size dependent, the flood field
correction overcorrects the backscatter effect for small field sizes. A pragmatic
solution was followed reducing the backscatter effect for clinically more relevant field
sizes rather than large field sizes as achieved by the flood field correction. 9
DWG NO.
(a) (b)
(c)
Figure 32: The valid range of the PDPC backscatter correction can be observed in
central half inline profiles of square field sizes of 10x10 cm2 (a) as well as
15x15 cm2 (b). A reduced performance of the backscatter correction can
be observed for large – clinically less relevant – field sizes e.g. 30x30 cm2
(c)
When verifying the installation of the PDPC package, central half (covering the area
above the support arm) inline profiles of the square fields in the plan qOpen shall be
evaluated by:
 Automatically aligning predicted and acquired PD image.
 Relative normalization based on the isocenter dose (To isolate potential
deviations due to output factor differences from backscatter effects).
 Calculation of the signed maximum difference between predicted and
acquired central half inline profiles within in the flat field region (defined as
80% area within the 50% field limit):
o Select the display mode Dose Difference.
o Turn on the graticule (View→Digital Graticule).
o Use the Profile tool (Measure→Profile) to select a half inline profile
covering the central flat field region (Figure 33).
o Display Statistics using the right-mouse-button menu in the dialog
window Profile Dose Difference Image.
o The signed maximum relative difference is given by the Min or Max
9 value in the Profile Statistics, respectively. 9
DWG NO.
Figure 33: Dose difference normalized relative to the dose at the isocenter. Use the
Profile tool to select a half inline profile covering the central flat field
region. The signed maximum relative difference is given by the Min or Max
value in the Profile Statistics, respectively
Resulting signed maximum relative differences shall be within ± 1.5% for field sizes
ranging from 5 x 5 cm2 up to 15 x 15 cm2
7.4.5. Exemplary patient IMRT and RapidArc plans

Two IMRT as well as RapidArc plans were added to the set of test plans to
investigate the performance of the PDPC under clinical conditions. In addition to
these clinical test plans the user is encouraged to investigate the performance of the
PDPC package using own clinical cases.
After successful installation of the PDPC package clinical fields should pass the
gamma analysis with the following settings: 9
 Dose tolerance: 3%
 Distance-to-Agreement: 3mm
 Gamma analysis: global
(Use Local Gamma Evaluation not selected)
 ROI selection: Threshold of 5%
 Area Gamma < 1.0: 97.0 %
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7.5. Acceptance of Portal Dosimetry Configuration

The above described verification procedure describes a guidance for the customer to verify
the proper installation and the applicability of the PDPC package to the actual customer
Portal Dosimetry system. The final acceptance of the Portal Dosimetry configuration
remains in the responsibility of the customer.
In case the above listed acceptance criteria are not met, the conventional Portal Dosimetry
configuration procedure has to be followed as described in the Eclipse Algorithms
Reference Guide. It is not possible to re-calculate the pre-configured PDIP beam data as
the PDPC package does not provide the input data (irradiated AIDA patterns) required for a
re-calculation.
8. UNINSTALLATION AND RECOVERY OF PREVIOUS PORTAL DOSIMETRY CONFIGURATION

This chapter describes the uninstallation of the PDPC package as well as the recovery of a
previous customer configuration, if available. Accordingly, two scenarios are considered:
- Portal Dosimetry was already configured on your system and the original configuration is
recovered.
- Portal Dosimetry was not configured on your system and you would like to uninstall the
PDPC package.
Similar to the installation procedure (Chapter 6), the uninstallation procedure is split into two steps:
- Uninstallation / Recovery of PDIP beam data.
- Uninstallation / Recovery of dosimetry calibration.
8.1. Beam Configuration on Eclipse workstation: PDIP beam data

3. Select the Portal Dose Image Prediction (PDIP) algorithm.
4. Select the PDIP beam data and Unapprove the data using the right-mouse button menu (Figure
1).
5. To permanently remove the PDPC PDIP algorithm delete the beam data using the right-mouse
button menu (Figure 1).
6. To remove the beam data assignment of PDPC data to the PDIP algorithm clear the beam data
9 using the right-mouse button menu (Figure 1). The PDPC beam data can be recovered at a later
9
time point.
7. To recover your original PDIP beam data select the PDIP algorithm and use the right-mouse
button menu New Beam Data…
8. Check the bullet point Assign existing data to the calculation model and select your original
beam data from the list (Figure 34).
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Assign existing data to the

calculation model
Figure 34: Assign existing beam data to PDIP algorithm
9. Match and assign OPENFIELD (Figure 8).

10. Approve beam data using right-mouse button menu (Figure 10).
8.2. Dosimetry Calibration on 4DITC workstation
1. The dosimetry calibration is stored on the console in the directory (Figure 2):
C:\Program Files\Varian\Oncology\Treatment\AM\config\AM\IAS3\do
2. Navigate to this directory using MS Windows Explorer and:
 Create a copy of the entire folder in the parent directory and rename it to do_pdpc, in case
you would like to backup the PDPC dosimetry calibration.
 Delete the entire content of this directory if you would like to permanently remove the PDPC
dosimetry calibration.
3. In case a previous dosimetry calibration was backed up, copy the entire content of the backup
directory (e.g. do_backup) to the actual do folder.
9. CUSTOMER DOCUMENTATION
Customer release notes (PDPC1000RN) are available via MyVarian.com.
10. REFERENCES 9
1
7sigma – qA-team in radiotherapy physics (website: http://www.7sigma.be/)
2
van Esch A. et al., Acceptance tests and quality control (QC) procedures for the clinical
implementation of intensity modulated radiotherapy (IMRT) using inverse planning and the
sliding window technique: experience from five radiotherapy departments, Radiother Oncol.
2001; 65(1): 53-70
3
van Esch A. et al., The use of an aSi-based EPID for routine absolute dosimetric pre-
treatment verification of dynamic IMRT fields, Radiother Oncol. 2004; 71(2): 223-34
DWG NO.
Bill Of Materials
-01 Part Number Description

S/W CD Portal Dosimetry Pre-Configuration package 1.0.02
DNLD B504800R01
Download S/W from https://my.varian.com
DNLD PDPC1000RN Customer Release Note
Drawing or
Document Other Documents Included
Number
N/A
9 9
DWG NO.
Notes i
oct 16, 2014 3:59 PM

187-1
Am maintanance support arm
oct 16, 2014 3:59 PM

188-1
1. Mover el imagen a la posición típica usada (0,0,0)
oct 16, 2014 3:59 PM

189-1
Realizar flood fill con tapa y demás pruebas
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NOTE: A note describes actions or conditions that can help the

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System Overview TAB 2

aSi Characteristics and Algorithms TAB 3

 aSi Detector Characteristics

System Preparation and Data Acquisition TAB 4

 Software Administration for PD

PDIP Algorithm Configuration TAB 5

 PDIP Algorithm Configuration

Portal Dosimetry Commissioning TAB 6

© Varian Medical Systems Portal Dosimetry 11

 Portal Dosimetry User Preference Configuration

 Portal Dosimetry Publication Reference List

 IsoCal Calibration C-Series machines

© Varian Medical Systems Portal Dosimetry 11

© Varian Medical Systems Portal Dosimetry 11

© Varian Medical Systems Portal Dosimetry 11

© Varian Medical Systems Portal Dosimetry 11

 In order to perform pre-treatment QA verification of IMRT or RapidArc plan, verification

 Varian PD can be installed in different environment configurations

 The system consists of:

 PD system consists of three major components:

 Varian has offered two types of the imager support devices

 All systems use 4DTC as the acquisition workstation

 Dose image prediction algorithm is part of Eclipse TPS

 Useful documents in Adobe Acrobat Reader can be found on RT & Imaging CD

 Internet browser is started and user can browse available manuals.

 For urgent issues dial 1.888.VARIAN5,

- Eclipse Version 10 including the Portal Dosimetry package or higher

 Note: TrueBeam is not supported with this version.

© Varian Medical Systems

© Varian Medical Systems

 Portal Dosimetry application has the following layout:

© Varian Medical Systems

© Varian Medical Systems mam/tmo, April 14

© Varian Medical Systems mam/tmo, April 14

 At the top of navigation panel there is Plan selection dropdown list

© Varian Medical Systems

© Varian Medical Systems

© Varian Medical Systems

© Varian Medical Systems

© Varian Medical Systems

© Varian Medical Systems

 Threshold value is applied in addition to selected ROI.

© Varian Medical Systems