MOSAIQ® User`s Guide

Transcription

MOSAIQ® User’s Guide
MOSAIQ 2.60
Document ID: LUGMSQ0010
Language: English
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Referenced documents
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Contact Software Support:http://www.elekta.com/healthcare-professionals/products/elektaservices/service-and-support/software-support.html
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Copyright 2015, IMPAC Medical Systems, Inc. Elekta, Inc.
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MOSAIQ 2.60 User's Guide
Introduction
Contents
Figures ................................................................................................................................................................... xx Tables ................................................................................................................................................................. xxiii Introduction ............................................................................................................................................................ 1 About this Guide ................................................................................................................................................. 2 Audience ............................................................................................................................................................. 3 Disclaimer ........................................................................................................................................................... 3 Training .............................................................................................................................................................. 3 Patient/User Safety and Residual Risk ................................................................................................................. 4 Document conventions ....................................................................................................................................... 4 Keyboard conventions ..................................................................................................................................... 4 Mouse conventions ......................................................................................................................................... 4 Abbreviations and Acronyms ............................................................................................................................... 6 CHAPTER 1: International Formats .......................................................................................................................... 7 International Numeric Data Settings ................................................................................................................... 7 Enter Data in MOSAIQ...................................................................................................................................... 7 CHAPTER 2: MOSAIQ Clinical General Charting ........................................................................................................ 9 UICC Staging Support ........................................................................................................................................... 9 Verification Administration ................................................................................................................................. 9 Configuring Manual Medication Verification Options ...................................................................................... 9 Verify Medication with a Bar Code .................................................................................................................. 9 Document Medication Verification Manually ................................................................................................ 10 Order Sets.......................................................................................................................................................... 11 Drug Component Window ............................................................................................................................. 13 Dose Banding ................................................................................................................................................ 14 Dose Banding Verification Rules ................................................................................................................... 15 Procedure/Supply Component Window ......................................................................................................... 16 Merge Fields Viewer ...................................................................................................................................... 18 Configuring the Enhanced Merge Pane ......................................................................................................... 19 Changing a Merge Field Value ....................................................................................................................... 19 Assessments ...................................................................................................................................................... 20 Customized Assessment Layout ..................................................................................................................... 20 Using Assessments from the Chart Workspace ............................................................................................... 20 Adding, Changing, and Displaying Assessments in the Customized Layout .................................................... 20 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Introduction
Merge Fields for eSCRIBE Word Documents ....................................................................................................... 22 Adding or Changing Clinical Data in an eSCRIBE Word Document ................................................................. 22 Diagnosis & Staging ........................................................................................................................................... 23 Configuring Default Staging System Per Diagnosis ......................................................................................... 23 Entering and Showing Staging Using Multiple Systems .................................................................................. 23 Collecting User Defined Data ......................................................................................................................... 23 Admitting Diagnosis ...................................................................................................................................... 24 Diagnosis eSCRIBE Merge Field ...................................................................................................................... 24 Adding a Diagnosis ........................................................................................................................................ 24 Adding a Diagnosis to Your Favorites ............................................................................................................ 25 Creating a New Diagnosis Code ..................................................................................................................... 25 Configuring Favorites .................................................................................................................................... 25 Reconcile the Medication List............................................................................................................................ 25 Opening the Medication List ......................................................................................................................... 25 Enhanced Medication List ............................................................................................................................. 26 Printing a Patient Medication List ................................................................................................................. 27 Updating TAH Medications/Reconcile History................................................................................................ 27 Selecting a TAH Medication by Opening the Record ...................................................................................... 28 Medication List Detail View ........................................................................................................................... 28 Pharmacy Order Details .................................................................................................................................... 28 Lab Results ........................................................................................................................................................ 29 Lab Results Work List ..................................................................................................................................... 29 Reviewing Lab Results in a Batch .................................................................................................................. 29 Associating Lab Results to Orders in a Batch ................................................................................................. 30 Associating a Lab Result to an Order ............................................................................................................. 30 Orders ............................................................................................................................................................... 31 Quick Approval for Orders ............................................................................................................................. 31 Dose Calculation ............................................................................................................................................... 31 Viewing Dose Calculation Factors in Revision ................................................................................................ 31 Viewing Dose Calculation Factors from CWS, MAR, and Dispense Details ...................................................... 32 Care Plans ......................................................................................................................................................... 32 Assigning a Care Plan to a Patient ................................................................................................................. 32 Voiding a Care Plan ....................................................................................................................................... 32 Version Control ............................................................................................................................................. 33 Allergies List ...................................................................................................................................................... 33 Accessing Allergies from MAR ........................................................................................................................ 33 Adding the Allergies and Alerts Pane to the Chart Workspace ....................................................................... 33 Allergies and Alert Options ............................................................................................................................ 34 No Known Allergies / No Know Medication Allergy ....................................................................................... 34 Drug Screening .............................................................................................................................................. 35 Reconciliation Window.................................................................................................................................. 35 Adding an Allergy Record .............................................................................................................................. 35 Changing the Status of Allergy Entries ........................................................................................................... 35 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Adding Alerts ................................................................................................................................................. 36 Marking Allergies and Alerts List as Reconciled ............................................................................................. 36 Displaying the Reconciliation History ............................................................................................................ 36 Displaying Allergy Reports ............................................................................................................................. 36 Document Identifier.......................................................................................................................................... 37 Configuring Document Options ..................................................................................................................... 37 Calculating IBW/ABW ......................................................................................................................................... 37 Configuring IBW/ABW .................................................................................................................................... 37 Calculating Dose-Based on BSA from IBW or ABW ......................................................................................... 37 Calculating CrCl Using Cockroft-Gault Formula .............................................................................................. 38 Modifying AUC Drug Dose by Changing the Calculated IBW and ABW ............................................................ 38 Automatically Converting Ht and Wt ............................................................................................................. 38 BSA Calculation ................................................................................................................................................. 38 Configuring BSA in Department Setup ........................................................................................................... 38 Calculating BSA Using Mosteller Formula in the Flowsheet Tab .................................................................... 39 CrCl Capping ...................................................................................................................................................... 39 Configuring CrCl ............................................................................................................................................ 39 Common Problem Codes ................................................................................................................................... 40 Opening the Common Problem Codes Window ............................................................................................. 40 Adding a New Problem Code ......................................................................................................................... 40 Assigning a Problem to a Patient................................................................................................................... 41 Patient Problems Options ............................................................................................................................. 42 Observation Definitions .................................................................................................................................... 42 Observation Definition Items Pane................................................................................................................ 42 Views Pane .................................................................................................................................................... 43 Tabs Pane ...................................................................................................................................................... 43 Observation Definitions Mapping .................................................................................................................. 43 Adding a Tab to the Flowsheet ...................................................................................................................... 43 Deleting a Flowsheet Tab .............................................................................................................................. 44 Adding a Major/Minor Heading to the Flowsheet window ............................................................................. 44 Adding a Tab View to the Flowsheet window ................................................................................................ 44 Cloning a Table Item/Tab View...................................................................................................................... 45 Setting Table Items, Data Items, and Table Item Choices to Active/Not Active............................................... 45 Setting Table Items, Data Items, and Table Item Choices to Preferred/Not Preferred .................................... 46 Linking System Data/Table Items .................................................................................................................. 46 Mapping Multiple Code Types to a Data/Table Item ...................................................................................... 47 Cardinality Rules ........................................................................................................................................... 47 Observation View Import .............................................................................................................................. 48 Flowsheet Window ........................................................................................................................................ 48 eScribe Inactive Assessment Views and Items ................................................................................................ 49 Pharmacy Order Unique Number ...................................................................................................................... 49 Unique Number from the Dispensing Details Window .................................................................................. 49 Unique Number from the MAR...................................................................................................................... 49 Unique Number from Order History 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Dose Adjustments ............................................................................................................................................. 50 Crystal Report Version and Runtime Engine ...................................................................................................... 50 IQ Script (Only Examples)................................................................................................................................... 50 Observation Order: Create Assessment by Procedure .................................................................................... 50 Observation Order: Create QCL by Procedure ................................................................................................ 51 Quality Checklist: Create Assessment by QCL Procedure ................................................................................ 52 Quality Checklist: Create QCL by QCL Procedure ............................................................................................ 52 Pharmacy Order: Alert on Observation Value (Text, Numerical, Check Box, Date, Table)............................... 53 Observation Order: Alert on Observation Value (Text, Numerical, Check Box, Date, Table) ........................... 54 Observation Data: Create Document by Observation Value ........................................................................... 54 Observation Order: Create Document by Procedure ...................................................................................... 54 Pharmacy Order: Create Document by Drug.................................................................................................. 55 Schedule: Create Document by Appointment Activity ................................................................................... 56 Document: Merge Inbound Document .......................................................................................................... 56 Charge: Create Document by Code Capture ................................................................................................... 57 Medication Administration ............................................................................................................................... 57 Configuring MAR Attributes in Department Setup ......................................................................................... 57 Increase Cycle Day Length ................................................................................................................................. 58 Body Mass Index (BMI) in Observation Definitions ............................................................................................ 59 Adding BMI (A/P) in Observation Definitions ................................................................................................. 59 Automate Audit Measure Report ....................................................................................................................... 60 Automate Audit Measure Report Dialog Box Components ............................................................................. 60 The Measure Table ........................................................................................................................................ 62 Automate Measure Calculation Report Buttons ............................................................................................. 63 The Details Tab ............................................................................................................................................. 63 The Non-Compliant Tab ................................................................................................................................ 63 CHAPTER 3: MOSAIQ Radiation Oncology Clinical Charting.................................................................................... 65 Radiation Prescriptions ..................................................................................................................................... 65 Configuring Dose Units and Biologic Equivalent Dose ................................................................................... 65 Adding Radiation Prescription Information................................................................................................... 66 Adding Fractionation Patterns....................................................................................................................... 67 Appending Fractionation Phases ................................................................................................................... 68 Using Site Sequencing for Multiple Radiation Prescriptions .......................................................................... 68 Approving Radiation Prescriptions ................................................................................................................ 70 Approving Multiple Radiation Prescriptions .................................................................................................. 70 Changing Radiation Prescriptions.................................................................................................................. 70 Changing Prescribed Doses............................................................................................................................ 71 Copying Radiation Prescriptions from another Patient.................................................................................. 71 Adding, Changing, or Removing a Dose Limit using Radiation Prescriptions ................................................. 72 Simulation Fields .............................................................................................................................................. 72 Adding a Site Simulation ............................................................................................................................... 73 Adding a Simulation Field When a Prescription Exists ................................................................................... 74 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Adding a Simulation Field When a Prescription Does Not Exist ..................................................................... 76 Capturing Geometric Settings/Parameters for a Simulation Field .................................................................. 76 Copying a Simulation Field ............................................................................................................................ 77 RTP Import/RT Ion Plan Import......................................................................................................................... 77 Importing the RTP File .................................................................................................................................. 77 Editing the RTP File ....................................................................................................................................... 78 Importing the RT Ion Plan ............................................................................................................................. 81 Editing RT Ion Plans ...................................................................................................................................... 83 Changing a Data Field or Folder Status to Ignore .......................................................................................... 84 Viewing RTP Import /Ion Plan Import Data for IMRT Control Point Data....................................................... 84 Locking Treatment Fields on Import ............................................................................................................. 86 Importing Brachytherapy Treatment Plans ................................................................................................... 86 Importing Site Setup Data for a New Patient ................................................................................................. 87 Importing Site Setup Data for a Patient with Existing Data............................................................................ 88 Automatic Association of Reference Images and RT Plans ................................................................................. 88 Associating Reference Images with RT Plans ................................................................................................. 89 Importing Files for the Treatment Plan ............................................................................................................. 89 Changing Treatment Plan Documents ........................................................................................................... 90 Adding PDF and Image Files to Treatment Plan Documents.......................................................................... 91 Treatment Fields ............................................................................................................................................... 93 Manually Adding Treatment Fields ................................................................................................................ 93 Manually Adding a kV Treatment Field ......................................................................................................... 95 Adding Setup Fields (Setup=MV or kV Setup=kV) .......................................................................................... 96 Showing a Hidden Treatment Field ............................................................................................................... 96 Adding Accessory Information ....................................................................................................................... 96 Adding Geometric and Couch Settings ........................................................................................................... 97 Creating Simple MLC Positions ...................................................................................................................... 98 Adding Portal Image Information.................................................................................................................. 98 Adding Field Setup Information .................................................................................................................... 99 Creating a Treatment Field by Copying a Simulation Field .......................................................................... 100 Creating a Treatment Field by Copying an Existing Treatment Field ............................................................ 101 Creating a Document-Based Treatment Field .............................................................................................. 102 Capturing Parameters from the Machine .................................................................................................... 104 Changing a Treatment Field ........................................................................................................................ 106 Copying Couch Values from a Treatment Field with Couch Copy ................................................................. 106 Reviewing IMRT Fields ................................................................................................................................. 107 Approving a Treatment Field ....................................................................................................................... 108 Approving Batch Treatment Fields .............................................................................................................. 109 Configuring Batch Field Approval in Department Setup .............................................................................. 110 Viewing the Field Delta ............................................................................................................................... 111 Particle Therapy Treatment Fields................................................................................................................... 112 Changing the Beamline ............................................................................................................................... 112 Changing the Applicator ID ......................................................................................................................... 113 Changing the # Pieces ................................................................................................................................. 114 Changing the Aperture and or Compensator Name ..................................................................................... 114 Creating a Particle Treatment Field by Copying an Existing Field ................................................................ 114 Copying a Dominant Treatment Field and the Associated Match and Patch Treatment Fields .................... 115 viii
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Moving Particle Therapy Treatment Fields from One Prescription Site to Another ...................................... 116 Adding Geometric and Couch Settings for a Particle Treatment Field .......................................................... 117 Machine-Specific Field Requirements.............................................................................................................. 118 Adding a CBCT Treatment Field for Elekta Machines ................................................................................... 118 Defining an XVI Imaging Preset for a Field (Elekta XVI Systems only)........................................................... 118 Loading Reference Data for XVI Machines with SYNERGISTIQ ...................................................................... 119 Defining High Dose Treatment Authorization ............................................................................................. 119 Site Setup Definition ....................................................................................................................................... 119 Adding Site Setup Definition ....................................................................................................................... 120 Changing the Site Setup Beamline for Particle Therapy Treatments ............................................................ 121 Defining the Site Setup for an Ion Plan ....................................................................................................... 122 Configuring Treatment Field, Protons Modality Tolerance Tables ............................................................... 124 Configuring Site Setup, Protons Modality tolerance tables .......................................................................... 124 Ocular Treatments....................................................................................................................................... 125 Approving Site Setup Definition .................................................................................................................. 125 Site Setup Data for Varian OBI and Elekta XVI Systems ................................................................................ 126 Printing Barcode Labels .................................................................................................................................. 127 Dose Tracking.................................................................................................................................................. 127 Creating Primary Dose Tracking Sites .......................................................................................................... 128 Adding Secondary Dose Tracking Sites......................................................................................................... 129 Adding and Changing Dose Coefficients ...................................................................................................... 130 Adding Prior Dose ....................................................................................................................................... 131 Adding Total Cumulative Dose and Dose Tracking Sites .............................................................................. 131 Dose Site Summary...................................................................................................................................... 132 Dose Action Points ...................................................................................................................................... 132 Adding or Changing Dose Action Points....................................................................................................... 133 Using the Treatment Calendar ........................................................................................................................ 133 Scheduling Treatment Sessions ................................................................................................................... 134 Deleting Treatment Sessions in the Treatment Calendar ............................................................................. 137 Working with Portal Images ........................................................................................................................ 137 Changing Treatment Session Due Dates ...................................................................................................... 138 Working with Treatment Fields in the Treatment Calendar ......................................................................... 140 Verifying and Recording Treatments ............................................................................................................... 145 Using eChart Chart Check ................................................................................................................................ 145 Reviewing the eChart Chart Check ............................................................................................................... 145 Reviewing eChart Chart Check Notes ........................................................................................................... 148 CHAPTER 4: MLC Fit ............................................................................................................................................. 149 Using MLC Fit .................................................................................................................................................. 150 Using MLC Fit............................................................................................................................................... 150 Creating an MLC Leaf Plan ........................................................................................................................... 151 Changing an MLC Leaf Plan ......................................................................................................................... 152 MLC Conversion ........................................................................................................................................... 153 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Digitizing a Treatment Field Shape ................................................................................................................. 153 Beam’s Eye View Calibration Point Digitization ........................................................................................... 155 Beam’s Eye View Shape Rotation ................................................................................................................. 155 Beam’s Eye View Calibration Setup.............................................................................................................. 155 Logical Context ............................................................................................................................................ 156 Packet Data ................................................................................................................................................. 156 Digitizing a Treatment Field Shape ............................................................................................................. 156 Printing and Saving Your MLC Leaf Plan .......................................................................................................... 157 MLC Leaf Plan Report .................................................................................................................................. 157 Printing Your MLC Leaf Plan ........................................................................................................................ 157 Saving Your MLC Leaf Plan .......................................................................................................................... 158 CHAPTER 5: Image Management ......................................................................................................................... 159 Assigning Image Security Attributes................................................................................................................. 159 Enabling Imaging Options in System Utilities .................................................................................................. 159 Configuring the Digitized Film Import (DFI) Option ......................................................................................... 160 Setting Beam’s Eye View Preferences in the Field Definition ........................................................................... 162 Setting Beam’s Eye View Preferences in the Image Window ............................................................................ 163 Setting Image Registration Preferences ........................................................................................................... 163 Scanning Simulation Films .............................................................................................................................. 164 Acquiring Images from Electronic Sources ....................................................................................................... 166 Viewing the Import Log and Import Status ...................................................................................................... 167 Using the Photos and Diagrams Utility ............................................................................................................ 168 Importing Images with Photos and Diagrams.............................................................................................. 169 Associating Images with Photos and Diagrams ............................................................................................ 170 Cropping Images ......................................................................................................................................... 170 Associating Images .......................................................................................................................................... 171 Associating Medical Images ......................................................................................................................... 171 Associating Non-Medical Images ................................................................................................................. 172 Reticle Scaling Reference Images .................................................................................................................... 172 Reticle Scaling a Reference Image ............................................................................................................... 173 Correcting Film Rotation Errors ................................................................................................................... 175 Clearing Reticle Scaling ............................................................................................................................... 176 Reticle Scaling Verification Images at Image Registration ............................................................................... 176 Reticle Scaling Preferences .......................................................................................................................... 176 Image Registration, Reticle Scaling, and User Preferences for the 2D Image Registration Windows ............ 176 Automatic Display of Reticle Scaling Dialog Box .......................................................................................... 176 Reticle Scaling a Verification Image with Auto Detect ................................................................................. 177 x
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Manually Reticle Scaling a Verification Image with Field Apertures ............................................................ 178 Adding Annotations as Field Apertures to Confirm Isocenter Placement ..................................................... 179 Viewing Treatment Geometry on the Image .................................................................................................... 180 Enabling the Image Underlay Option .............................................................................................................. 180 Using the Image List Window .......................................................................................................................... 181 Changing the View of the Image List Window .............................................................................................. 183 Opening and Closing Images from the Image List Window .......................................................................... 184 Deleting Images from the Image List Window ............................................................................................. 184 Copying Images ........................................................................................................................................... 185 Moving Images ............................................................................................................................................ 185 Printing Non-Medical Images ...................................................................................................................... 185 Scaling Medical Images ................................................................................................................................... 185 Image Scaling .............................................................................................................................................. 186 Print Scaling ................................................................................................................................................ 189 Printing Medical Images.................................................................................................................................. 189 Setting Up DICOM Print Options and Printing ............................................................................................. 190 Setting Up Standard Print Options and Printing .......................................................................................... 190 Viewing and Enhancing 2D Images ................................................................................................................. 191 Magnifying Images with the Zoom Tools ..................................................................................................... 191 Changing Image Color ................................................................................................................................. 192 Inverting the Image Contrast Scale .............................................................................................................. 192 Using the Window and Level Tool ............................................................................................................... 192 Using Filters ................................................................................................................................................ 193 Using Manual Save ...................................................................................................................................... 193 Using Image Controls for Multi-Slice Images................................................................................................ 194 Annotating Images .......................................................................................................................................... 195 Using the Straight Line Tool ........................................................................................................................ 195 Using the Rectangle Tool ............................................................................................................................. 195 Using Ellipse Tool ........................................................................................................................................ 196 Using the Polygon Tool ............................................................................................................................... 196 Using the Freehand Drawing Tool ............................................................................................................... 197 Using the Text Tool ..................................................................................................................................... 197 Using the Arrow Tool ................................................................................................................................... 198 Using the Fill and Color Options .................................................................................................................. 198 Setting and Saving Annotation Preferences ................................................................................................. 199 Adding Comments for Informal Communications ....................................................................................... 200 Changing Relative Object Position ............................................................................................................... 200 Adding or Changing the Label of an Annotation .......................................................................................... 200 Saving Annotated Images ............................................................................................................................ 201 Working with Multiple Annotations at a Time ............................................................................................. 201 Viewing Layers ............................................................................................................................................ 202 Changing the Orientation of Images ............................................................................................................ 202 Working with Images Annotated Outside of MOSAIQ ................................................................................... 203 Using Edge Detection Options in MOSAIQ ........................................................................................................ 204 Copyright 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Extracting Treatment Field Edges ................................................................................................................ 204 Copying and Pasting Treatment Field Edges on Multi-Slice Images (Portal Vision Only)............................... 205 Copying and Pasting Treatment Field Edges on a Separate Image (Portal Vision Only) ................................ 205 Managing the Image Review Process – Reviewers ........................................................................................... 206 Finding Images to Review in the Consolidated Work Lists Pane................................................................... 206 Finding Images to Review from the Image List Window .............................................................................. 208 Reviewing 2D Images from the Consolidated Work Lists Pane ..................................................................... 208 Reviewing 2D Images with Quick Approval.................................................................................................. 210 Batch Reviewing 2D Images from the Image List Window ........................................................................... 210 Rejecting 2D Images .................................................................................................................................... 211 Voiding 2D Images ...................................................................................................................................... 212 Using Matched Presentation and Coordinated Mode................................................................................... 212 Viewing the Review Status in the Image Information Dialog Box ................................................................ 214 Managing the Image Change Order Process - Therapists ................................................................................. 214 Finding Change Requests from the Consolidated Work Lists Pane ............................................................... 214 Completing 2D Image Change Requests from the Consolidated Work Lists Pane ......................................... 216 Completing 2D Image Change Requests from the Image Review Window ................................................... 216 Completing 2D Image Change Requests from the Image Window ............................................................... 217 Completing 2D Image Change Requests from the Verification Image Status Window .................................. 217 Planar Image Registration ............................................................................................................................... 218 Preparing the System and Patient for Image Registration ........................................................................... 220 Applying Points or Curves to Reference Images ........................................................................................... 224 Promoting Annotations ............................................................................................................................... 226 Registering Images ...................................................................................................................................... 227 Setup Intelligence ........................................................................................................................................... 238 Site Setup .................................................................................................................................................... 238 Session Offsets ............................................................................................................................................. 240 Third Party Offsets ....................................................................................................................................... 243 Distributed Registration Review .................................................................................................................. 245 Offset Couch Calculator ............................................................................................................................... 245 Localization Trend Review........................................................................................................................... 246 Completing the Setup Offset ........................................................................................................................ 250 CBCT Acquisition ............................................................................................................................................. 252 Import Reference Structure Sets and CT Data .............................................................................................. 252 Acquiring the CBCT Data ............................................................................................................................. 252 Opening the Image Review Workspace ........................................................................................................ 252 Closing the Image Review Workspace .......................................................................................................... 253 Docking and Undocking the Image Review Workspace................................................................................ 253 Expanding and Restoring the Image Workspace Panes ................................................................................ 253 Saving and Reverting Changes in the Image Review Workspace .................................................................. 253 Using the In View Toolbar in the Viewer Panes ........................................................................................... 254 Viewing Structure Sets in the Viewer Panes ................................................................................................. 254 Using the Trending Tab ............................................................................................................................... 255 Using the 3D Tab ......................................................................................................................................... 256 Finding 3D Images to Review in the Image Review Workspace .................................................................... 256 Reviewing 3D Images in the Image Review Workspace ................................................................................ 257 Finding 3D Images with Change Requests in the Image Review Workspace................................................. 257 xii
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Completing 3D Image Change Requests in the Image Review Workspace .................................................... 258 Registering 3D Images ................................................................................................................................. 258 Manually Registering 3D Images ................................................................................................................. 258 CHAPTER 6: MOSAIQ DICOM ................................................................................................................................ 261 DCM Overview ................................................................................................................................................. 261 DCM Permissions ......................................................................................................................................... 261 Opening DCM .............................................................................................................................................. 261 Operation .................................................................................................................................................... 262 Messages ..................................................................................................................................................... 262 DCM System Preferences ................................................................................................................................. 262 Logging on to the System Preferences Window............................................................................................ 262 Setting Up DICOM Import with DCM ................................................................................................................ 263 Setting Up Auto-forwarding for a DICOM Device.............................................................................................. 264 Setting Up Auto-forwarding (Manual Retry) ..................................................................................................... 266 Doing a Check on the Auto-forwarding Process ............................................................................................... 267 Log File........................................................................................................................................................ 268 DICOM-Specific Staging Area............................................................................................................................ 268 DICOM AE Configuration .................................................................................................................................. 268 DICOM AE Edit ............................................................................................................................................. 268 Setting up DICOM Print Options ...................................................................................................................... 270 Exporting DICOM Images and RT Plans ............................................................................................................ 271 Export Images Dialog Box ............................................................................................................................ 271 Exporting DICOM Images ............................................................................................................................. 271 Export RT Plans Dialog Box.......................................................................................................................... 272 Exporting DICOM RT Plans ........................................................................................................................... 272 DICOM Export: Advanced Options................................................................................................................ 272 Monitoring the DICOM Import Queue ............................................................................................................. 275 Managing Image Volume Cache Files .............................................................................................................. 277 Regenerate Cache Files for Existing Volumes ............................................................................................... 278 Purge Old Cache Files .................................................................................................................................. 278 Image Volume Cache Purge Pane ................................................................................................................ 280 Image Volume Cache Regeneration Pane .................................................................................................... 280 CHAPTER 7: MOSAIQ Data Director ...................................................................................................................... 282 MOSAIQ Data Director Components................................................................................................................. 282 MOSAIQ Data Director ................................................................................................................................. 282 MOSAIQ Browser.......................................................................................................................................... 282 Standalone Workstation .............................................................................................................................. 283 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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DICOM Communication Module (DCM) ........................................................................................................ 283 MOSAIQ Data Director Configuration ............................................................................................................... 283 MOSAIQ Data Director Related Staff Security Rights..................................................................................... 283 Department Level Configuration ................................................................................................................. 284 MOSAIQ Data Director User Interface .............................................................................................................. 285 Archived Objects Window ............................................................................................................................ 285 Adding the Shortcut Icon (Archived Objects) ................................................................................................ 286 Study and Series Level Queries .................................................................................................................... 288 Selecting a Site Configured DICON Send Destination ................................................................................... 289 RT Viewer (MOSAIQ 2.30 and Later) ............................................................................................................. 289 Opening a CT Planning Dataset in the RT Viewer ........................................................................................ 290 EMR Viewer (MOSAIQ 2.20 and earlier) ........................................................................................................ 293 Manage Data ............................................................................................................................................... 294 View Log ...................................................................................................................................................... 294 Retrieving Archived Images with MOSAIQ Restore ........................................................................................... 294 Check for Eligible Patients ........................................................................................................................... 295 Selecting Patients ........................................................................................................................................ 297 Putting Images into the Restore Queue ....................................................................................................... 297 Selecting Images.......................................................................................................................................... 301 Putting Images into the Restore Queue (Using Image Lists) ......................................................................... 302 Managing the Restore Queue ...................................................................................................................... 302 CHAPTER 8: SEQUENCER ...................................................................................................................................... 304 SEQUENCER Configuration ............................................................................................................................... 304 Virtual Machine Interface ............................................................................................................................ 304 Security Requirements ................................................................................................................................ 305 Inbound Tx Checks and Approvals ............................................................................................................... 305 QA Mode ..................................................................................................................................................... 307 Setting the Calibration Status Requirement................................................................................................. 307 Changing the Calibration Status .................................................................................................................. 308 Selecting a Patient for Treatment .................................................................................................................... 308 Treatment Readiness Check ........................................................................................................................ 309 Pre-Treatment Warnings ............................................................................................................................. 309 Field Sequencing Verification ...................................................................................................................... 309 Viewing the Verification Image Status ......................................................................................................... 310 Treatment Delivery Table ................................................................................................................................ 310 Examining Field Delta Change Warnings ..................................................................................................... 311 Logging on a Secondary Therapist ............................................................................................................... 311 Treatment Order ......................................................................................................................................... 312 Hiding a Treatment Field ............................................................................................................................ 312 Restoring a Treated Field ............................................................................................................................ 312 Site Setup Verification ..................................................................................................................................... 312 Verifying the Patient ................................................................................................................................... 313 Overriding a Parameter Mismatch ............................................................................................................... 313 Recording a Site Setup ................................................................................................................................. 314 xiv
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Verified Treatment .......................................................................................................................................... 315 Verified Treatment Views ............................................................................................................................ 315 Overriding out of Tolerance Parameters...................................................................................................... 316 Sequence Treatment Fields ......................................................................................................................... 316 Auto Setup................................................................................................................................................... 317 Portal Images .............................................................................................................................................. 319 Record Treatment and Composite Record Treatment .................................................................................. 320 Manually Recording a Treatment ................................................................................................................ 321 Treatment Chart .......................................................................................................................................... 321 Historic Treatments ..................................................................................................................................... 323 Treatment Field Definition While in SEQUENCER............................................................................................. 324 Adding a Treatment Field ............................................................................................................................ 324 Changing a Treatment Field ........................................................................................................................ 324 Core SEQUENCER Workflows ............................................................................................................................ 325 Following the Core SEQUENCER Workflow – Conventional Fields ................................................................. 326 Following the Core SEQUENCER Workflow – Particle Therapy Fields ............................................................ 327 Following the Core Interactive Interface Workflow ...................................................................................... 328 Following the Core Static Interface Workflow .............................................................................................. 329 Following the Passive Plan Interface Workflow ........................................................................................... 329 Following the Core Document-Based Treatment Fields (IHE-RO) Workflow.................................................. 330 Elekta Specific Workflows ................................................................................................................................ 331 Sending Couch Offset Values to the Desktop with Couch Move Assistant ..................................................... 331 Delivering Intrafraction kV Imaging on Elekta XVI Systems with SYNERGISTIQ ............................................ 332 Gantry Move Assistant in the SYNERGISTIQ Intrafraction Imaging Workflow ................................................ 333 Sending the Gantry Target Angle to the Console in a Non-Intrafraction Workflow ....................................... 334 Couch Move Assistant (Siemens DMIP Version 9 Treatment Machines) ............................................................ 335 Machine Characterization ............................................................................................................................... 337 Adding a Machine Location ......................................................................................................................... 337 Creating a Machine Characterization History Report ................................................................................... 338 Troubleshooting .............................................................................................................................................. 339 Abnormal Treatment Termination .............................................................................................................. 339 Completing Partial Treatments.................................................................................................................... 339 Resolving an Unrecorded Treatment Delivery ............................................................................................. 340 Beam Interruption ...................................................................................................................................... 341 Treatment Field Change .............................................................................................................................. 341 CHAPTER 9: MOSAIQ Evaluate.............................................................................................................................. 343 Evaluate User Interface ................................................................................................................................... 343 Accessing Evaluate....................................................................................................................................... 343 Evaluate Main Window ................................................................................................................................ 344 Positioning Screen Elements ....................................................................................................................... 345 Layouts ........................................................................................................................................................ 347 Loading Patients, Plans, and Images ........................................................................................................... 348 Viewing DICOM Information ........................................................................................................................ 349 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Introduction
2D/3D Views .................................................................................................................................................... 350 Beam Rendering ......................................................................................................................................... 350 Wireframe Display ....................................................................................................................................... 351 Arc Beams ................................................................................................................................................... 351 Beam Modifiers ........................................................................................................................................... 351 On-Slice Navigation ..................................................................................................................................... 352 Navigation Spacing ...................................................................................................................................... 352 Pan Tool ...................................................................................................................................................... 353 Right-Click Menu ......................................................................................................................................... 353 Zoom Tool ................................................................................................................................................... 353 Resetting Zoom and Pan ............................................................................................................................. 355 Measuring Distances.................................................................................................................................... 355 Browsing Through Images ............................................................................................................................... 355 Navigating to a New Point ........................................................................................................................... 355 Navigating to a Structure ............................................................................................................................. 356 Navigating to Views ..................................................................................................................................... 357 Resetting Position of Views ......................................................................................................................... 357 Dual Image Display ......................................................................................................................................... 357 Activating Blended Mode ............................................................................................................................ 357 Selecting a New Color for an Image Set ....................................................................................................... 357 Switching Between Color Modes ...................................................................................................................... 358 Checkerboard Display.................................................................................................................................. 359 Blended Display .......................................................................................................................................... 359 Spyglass Display .......................................................................................................................................... 360 Window Width and Level Values ..................................................................................................................... 360 Window Width and Level Values.................................................................................................................. 361 Changing the Window Level ........................................................................................................................ 361 Window/Level Presets .................................................................................................................................. 362 Plan Review..................................................................................................................................................... 363 Dose Volume Histogram .............................................................................................................................. 363 Maximizing/Minimizing DVH Controls ......................................................................................................... 363 Changing the DVH Graph............................................................................................................................. 364 Changing DVH Appearance .......................................................................................................................... 364 Hiding a DVH Column ................................................................................................................................. 365 Zooming In and Out of a DVH ..................................................................................................................... 366 Viewing DVH Annotations ........................................................................................................................... 367 Changing DVH Volume Units Range ............................................................................................................ 368 Changing DVH Dose Range .......................................................................................................................... 368 Setting Dose Goals ....................................................................................................................................... 368 Setting a Reference Dose Goal ..................................................................................................................... 369 Adding or Deleting Additional Reference Doses to the DVH Statistics Page ................................................. 370 Combining DVH Structures .......................................................................................................................... 371 Resetting DVH Values .................................................................................................................................. 372 DVH Templates ........................................................................................................................................... 372 Exporting a DVH .......................................................................................................................................... 373 Plan Spreadsheet ............................................................................................................................................ 373 xvi
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Introduction
General Window .......................................................................................................................................... 374 External Beam Window ............................................................................................................................... 375 Treatment Aid Window................................................................................................................................ 375 Notes ............................................................................................................................................................... 376 Adding Notes to a Plan or Image Set ........................................................................................................... 376 Viewing Image and Dose Information ............................................................................................................. 377 Using the Value Cursor ................................................................................................................................ 377 Viewing Markers .............................................................................................................................................. 377 Creating PDFs and Plan Documents ................................................................................................................ 377 Creating PDFs .............................................................................................................................................. 377 Creating Plan Documents ............................................................................................................................ 378 Opening Plan Documents ............................................................................................................................ 378 DRRs................................................................................................................................................................ 379 Visualizing DRRs .......................................................................................................................................... 379 Approving a Plan ............................................................................................................................................. 380 CHAPTER 10: MOSAIQ Locate workspace ............................................................................................................. 381 Launching the Workspace ............................................................................................................................... 381 Loading the Layout and Setting the Default .................................................................................................... 381 Loading the Layout...................................................................................................................................... 382 Setting the Layout Default ........................................................................................................................... 382 Loading a Data Type........................................................................................................................................ 382 Approving and Loading a Localizer ................................................................................................................. 383 Changing the Frame CAD and Localizer CAD Views .......................................................................................... 383 Changing Calibration Tolerance Preferences ................................................................................................... 383 Editing Fiducials .............................................................................................................................................. 384 Using Snap ...................................................................................................................................................... 384 Calibrating and Resetting Slices....................................................................................................................... 384 Calibrating the Slice that Shows and is Active .............................................................................................. 384 Calibrating Image Slices .............................................................................................................................. 385 Resetting the Calibration ............................................................................................................................. 386 Coordinate Types......................................................................................................................................... 386 Coordinates on the Plan Spreadsheet .......................................................................................................... 386 Saving the Calibration ..................................................................................................................................... 386 Approving the Calibration ............................................................................................................................... 387 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Introduction
Printing ........................................................................................................................................................... 387 Printing the Isocenter Template .................................................................................................................. 387 Printing the Live Report .............................................................................................................................. 388 Printing the Isocenter Stereotactic Coordinates ........................................................................................... 388 Printing the Marker Stereotactic Coordinates .............................................................................................. 388 Appendix A: Contact and Regulatory Notifications .............................................................................................. 389 MOSAIQ Legal & Regulatory Disclaimer ........................................................................................................... 389 Product Regulatory Information ..................................................................................................................... 389 Food and Drug Administration (FDA) (United States) ................................................................................... 390 CE Marking (Compliance with the MDD) (European Community) ................................................................. 390 Appendix B: Warnings and Cautions in MOSAIQ .................................................................................................. 391 MOSAIQ Treatment Warnings .......................................................................................................................... 391 Pre-Treatment Warnings ............................................................................................................................. 392 Post-Treatment Warnings ............................................................................................................................ 393 General Warnings ........................................................................................................................................ 394 Other Operational Warnings ........................................................................................................................ 395 Treatment Field Edges Warning ................................................................................................................... 396 Pediatric Warning........................................................................................................................................ 396 First DataBank Warnings ............................................................................................................................. 397 Warning Messages when Performing Tasks in MOSAIQ .................................................................................... 397 MU per Segment Difference Warning .............................................................................................................. 399 Appendix C: Intended Use & Indications for Use ................................................................................................. 403 MOSAIQ ........................................................................................................................................................... 403 Intended Use ............................................................................................................................................... 403 Indications for Use ...................................................................................................................................... 404 Intended Use/Indications for Use ................................................................................................................ 404 Intended Use Indications for Use ................................................................................................................ 405 MOSAIQ Data Director ..................................................................................................................................... 405 Indications for Use ...................................................................................................................................... 405 Intended Use Statement .............................................................................................................................. 406 Appendix D: Measurement of Accuracy for Medical Devices ............................................................................... 407 Leaf Positioning Tool....................................................................................................................................... 407 Ruler Tool in the 2D Image Viewer.................................................................................................................. 407 Evaluate, Locate, and Image Review Workspace Measurement Tool ............................................................... 407 Appendix E: kV Warm-Up .................................................................................................................................... 408 CE Marking (Compliance with the MDD) (European Community) ................................................................. 411 xviii
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Introduction
xix
Introduction
Figures
Figure 1: Error Message ................................................................................................................................................. 7 Figure 2: Order Set Library Window .............................................................................................................................. 11 Figure 3: Order Set Component Window ....................................................................................................................... 14 Figure 4: Dose Banding Window .................................................................................................................................. 15 Figure 5: Procedure/Supply Component Window ........................................................................................................... 16 Figure 6: MergeFields Viewer ....................................................................................................................................... 18 Figure 7: Site Simulation ............................................................................................................................................. 73 Figure 8: Simulation Field Dialog Box ........................................................................................................................... 75 Figure 9: RTP Import ................................................................................................................................................... 78 Figure 10: Edit Import Data Window – Fixed Data Item.................................................................................................. 80 Figure 11: Edit Import Data Window for Treatment Field ............................................................................................... 80 Figure 12: RT Ion Plan Import – Translation Failed........................................................................................................ 81 Figure 13: Promote RT Ion Treatment Plan ................................................................................................................... 82 Figure 14: RT Plan Associations .................................................................................................................................... 82 Figure 15: Edit Import Data Window – Fixed Data Item.................................................................................................. 83 Figure 16: Edit Import Data for a Treatment Field ......................................................................................................... 84 Figure 17: Action Error Drop-Down Menu ..................................................................................................................... 84 Figure 18: Import Treatment Plan Window with IMRT Fields .......................................................................................... 85 Figure 19: Edit Import Data Window for IMRT Field ....................................................................................................... 85 Figure 20: Edit Plan Document Window........................................................................................................................ 92 Figure 21: Treatment Field Definition Window .............................................................................................................. 94 Figure 22: Treatment Field Definition Dialog Box ........................................................................................................ 102 Figure 23: Capture All Parameters Message ................................................................................................................. 104 Figure 24: Treatment Field Definition with Highlighted Fields ...................................................................................... 105 Figure 25: MU Information Message ........................................................................................................................... 105 Figure 26: Control Point List for a Sliding Window IMRT Field ....................................................................................... 107 Figure 27: Status Dialog Box ...................................................................................................................................... 110 Figure 28: Field Delta for a Treatment Field ................................................................................................................ 111 Figure 29: Treatment Field Definition – Particle Therapy ............................................................................................. 112 Figure 30: Confirm Field Copy Message ....................................................................................................................... 115 Figure 31: Copying a Dominant Treatment Field and the Associated Match and Patch Treatment Fields .......................... 115 Figure 32: Alarm Message .......................................................................................................................................... 117 Figure 33: Invalid Machine Selection Message ............................................................................................................. 121 Figure 34: Beamline Change Message ......................................................................................................................... 121 Figure 35: Positional Limit Exceeded Message ............................................................................................................. 122 Figure 36: Systematic Plan Angle and Target Angle Corrections..................................................................................... 123 Figure 37: Site Setup Verification ............................................................................................................................... 124 Figure 38: Treatment Field Definition for Ocular Treatments ....................................................................................... 125 Figure 39: Example Site Setup Data Import ................................................................................................................. 127 Figure 40: Chart Check Window.................................................................................................................................. 146 Figure 41: Chart Check Report – Printed ..................................................................................................................... 147 Figure 42: Field List .................................................................................................................................................. 166 Figure 43: Enlarged Image for Reticle Scaling .............................................................................................................. 174 xx
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Introduction
Figure 44: Reticle Scaling Dialog Box .......................................................................................................................... 177 Figure 45: Straight Line Drawn with Ruler Tool – Imported Data Shown........................................................................ 186 Figure 46: Straight Line Drawn with Ruler Tool – No Imported Data ............................................................................. 188 Figure 47: Image Controls for Multi-Slice Images ......................................................................................................... 194 Figure 48: Fill and Color Options in the Annotation Settings Dialog Box ........................................................................ 198 Figure 49: Annotation Settings Dialog Box .................................................................................................................. 199 Figure 50: Setup Offset Reference Options .................................................................................................................. 220 Figure 51: Setup Offset Reference Illustration ............................................................................................................. 221 Figure 52: Shift ......................................................................................................................................................... 221 Figure 53: Couch Angle in the Site Setup Definition Window ........................................................................................ 222 Figure 54: Gantry and Couch Angles in the Treatment Field Definition .......................................................................... 223 Figure 55: Image Registration Editor Window.............................................................................................................. 225 Figure 56: Example of Curve ...................................................................................................................................... 226 Figure 57: Annotations to Promote Dialog Box ............................................................................................................ 227 Figure 58: Offset Window .......................................................................................................................................... 229 Figure 59: Image Fusion Check Box ............................................................................................................................ 229 Figure 60: Enlarged Spyglass Area .............................................................................................................................. 230 Figure 61: Checkerboard Pattern Controls ................................................................................................................... 231 Figure 62: Translation, Rotation, and Scaling Regions in Viewer ................................................................................... 232 Figure 63: Offset Window – Point Registration ............................................................................................................ 233 Figure 64: Offset Tab – Point Registration ................................................................................................................... 234 Figure 65: Offset Window - Curve Registration ............................................................................................................. 235 Figure 66: Offset Tab - Curve Registration ................................................................................................................... 235 Figure 67: Offset Window - Grayscale Registration ....................................................................................................... 236 Figure 68: Offset Tab – Grayscale Registration ............................................................................................................. 237 Figure 69: Site Setup Definition Window ..................................................................................................................... 239 Figure 70: Setup Alert Dialog Box ............................................................................................................................... 239 Figure 71: Planes of a Stereoscopic Pair of Images ....................................................................................................... 240 Figure 72: Stereoscopic Image Selection ..................................................................................................................... 241 Figure 73: Translation and Scaling Regions in Viewer .................................................................................................. 242 Figure 74: Active Check Box on Offset Tab ................................................................................................................... 243 Figure 75: Offsets May Be Invalid Message .................................................................................................................. 243 Figure 76: Third Party Offset Dialog Box ..................................................................................................................... 244 Figure 77: Third Party Offset Selection ........................................................................................................................ 245 Figure 78: Localization Trend Review Dialog Box ......................................................................................................... 247 Figure 79: Offset Graphical Analysis............................................................................................................................ 249 Figure 80: Session Offset History Dialog Box ................................................................................................................ 249 Figure 81: Chart Preferences ...................................................................................................................................... 250 Figure 82: Site Setup Definition Window ..................................................................................................................... 251 Figure 83: Question Box ............................................................................................................................................ 251 Figure 84: Image Review Workspace ........................................................................................................................... 253 Figure 85: Image Review Workspace – Trending Tab in the Tabbed Pane ...................................................................... 255 Figure 86: DICOM Maintenance Utility Window ........................................................................................................... 268 Figure 87: DICOM AE Edit Dialog Box .......................................................................................................................... 269 Figure 88: Configuring an SCP Service List in MOSAIQ 2.30 ........................................................................................... 270 Figure 89: Export Images Dialog Box .......................................................................................................................... 271 Figure 90: Export RT Plans Dialog Box ........................................................................................................................ 272 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Introduction
Figure 91: DICOM Export: Advanced Options Dialog Box .............................................................................................. 273 Figure 92: Opening the DICOM Import Queue Window................................................................................................. 275 Figure 93: DICOM Import Queue Window ................................................................................................................... 276 Figure 94: Opening the Image Volume Cache Management Window ............................................................................. 279 Figure 95: Image Volume Cache Management Window ................................................................................................ 279 Figure 96: Archive Object Selections ........................................................................................................................... 286 Figure 97: Customizing the Toolbar ............................................................................................................................ 287 Figure 98: MOSAIQ Toolbar Editor .............................................................................................................................. 287 Figure 99: Putting the Archived Objects icon on the Toolbar ........................................................................................ 288 Figure 100: Archived Objects Icon on the Toolbar ........................................................................................................ 288 Figure 101: Opening the Images Pane ........................................................................................................................ 290 Figure 102: Images Pane Toolbar ............................................................................................................................... 290 Figure 103: Configuring Image Filters for MDD ............................................................................................................ 291 Figure 104: Selecting a CT Reference Dataset for a Patient ........................................................................................... 291 Figure 105: Opening the RT Viewer from MOSAIQ ........................................................................................................ 292 Figure 106: RT Viewer Browser (MOSAIQ Browser) ....................................................................................................... 292 Figure 107: MOSAIQ Data Director RT Viewer Window ................................................................................................. 292 Figure 108: Restore Utility Window (Restore Images Tab) ............................................................................................. 298 Figure 109: Image List Window .................................................................................................................................. 302 Figure 110: Require Calibration Approval for Treatment Check Box .............................................................................. 308 Figure 111: Calibration Status Window ....................................................................................................................... 308 Figure 112: Gantry Move Assistant in Intrafraction Imaging Workflow ........................................................................... 334 Figure 113: Gantry Move Assistant in Non-Intrafraction Workflow ................................................................................. 334 Figure 114: Targets column in the Couch Motion group ............................................................................................... 336 Figure 115: Treatment Delivery Not Complete Message ................................................................................................ 340 Figure 116: Treatment Delivery Not Complete ............................................................................................................. 340 Figure 117: Treatment Field Change Message .............................................................................................................. 341 Figure 118 -Reconfigure the Evaluate main window to suit your needs ......................................................................... 344 Figure 119: DVH occupies the shaded portion of the screen when you release the mouse button.................................... 346 Figure 120: MOSAIQ RTP Layout Designer lets you set your own window layouts and arrangements ................................ 347 Figure 121: DICOM Properties shows the DICOM information for selected plans, image sets, structure sets and dose ........ 349 Figure 122: The Dose Volume Histogram contains a graph (on top) and a grid (on bottom). ............................................ 363 Figure 123: Annotation of Reference Line on a DVH .................................................................................................... 367 Figure 124: Combine Structures in the DVH in the Structure Combinations .................................................................. 371 Figure 125: General Plan Spreadsheet shows basic details on the open plan.................................................................. 374 Figure 126: External Beam tab of the Plan Spreadsheet shows details for each beam ..................................................... 375 Figure 127: Use the Treatment Aid window to see details on any treatment aids in the plan .......................................... 375 Figure 128: Add, view and edits notes on plans and images ......................................................................................... 376 Figure 129: Viewing Image and Dose Information ....................................................................................................... 377 Figure 130: DRR window lets you visualize DRRs ......................................................................................................... 379 Figure 131: A successful calibration for 1 slice............................................................................................................. 385 xxii
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Introduction
Tables
Table 1: Abbreviations and Acronyms ............................................................................................................................. 6 Table 2: Order Set Library Toolbar Descriptions............................................................................................................. 11 Table 3: Order Set Library Filters .................................................................................................................................. 13 Table 4: Drug Component Fields .................................................................................................................................. 14 Table 5: Dose Banding Field Descriptions ..................................................................................................................... 15 Table 6: Procedure/Supply Component Field Descriptions.............................................................................................. 16 Table 7: MergeFields Viewer Components ..................................................................................................................... 18 Table 8: Assessment Form Components ........................................................................................................................ 21 Table 9: Diagnosis Descriptions.................................................................................................................................... 24 Table 10: Medication List Field Descriptions ................................................................................................................. 26 Table 11: Allergies and Alert Options ............................................................................................................................ 34 Table 12: Patient Problems Options ............................................................................................................................. 42 Table 13: Observation Definitions Mapping Configuration ............................................................................................. 47 Table 14: Cardinality Rules .......................................................................................................................................... 47 Table 15: Observation View Import Fields ..................................................................................................................... 48 Table 16: Observation View Import Option Buttons ....................................................................................................... 48 Table 17: Automate Audit Measure Report Components ................................................................................................ 60 Table 18: Automate Measure Calculation Report Buttons ............................................................................................... 63 Table 19: Import Treatment Plan Field Descriptions ...................................................................................................... 79 Table 20: MLC Mapping Methods ............................................................................................................................... 153 Table 21: Graphical Elements and Controls ................................................................................................................. 154 Table 22: Digitizer Settings ........................................................................................................................................ 161 Table 23: Beam Eye View Preferences ......................................................................................................................... 162 Table 24: Namer Status ............................................................................................................................................. 168 Table 25: Treatment Geometry Color Conventions ....................................................................................................... 180 Table 26: Image Information Descriptions .................................................................................................................. 182 Table 27: Image List Field Descriptions ....................................................................................................................... 183 Table 28: Optional Review Status ............................................................................................................................... 207 Table 29: Coordinated Mode Tool Icons ...................................................................................................................... 213 Table 30: Consolidated Work Lists Pane Check Box Descriptions ................................................................................... 215 Table 31: DICOM Images Group Controls..................................................................................................................... 273 Table 32: Export to File Options ................................................................................................................................. 274 Table 33: DICOM Import Queue Column Headings....................................................................................................... 276 Table 34: DICOM Import Queue Buttons ..................................................................................................................... 276 Table 35: DICOM Import Queue State Filters ............................................................................................................... 277 Table 36: Image Volume Cache Purge Options ............................................................................................................ 280 Table 37: Image Volume Cache Regeneration Options ................................................................................................. 281 Table 38: Image Volume Cache Management Buttons ................................................................................................. 281 Table 39: Inbound Tx Checks Group Descriptions ........................................................................................................ 305 Table 40: Machine Characterization Delta Color Descriptions ....................................................................................... 338 Table 41: Pre-Treatment Warnings ............................................................................................................................. 392 Table 42: Post-Treatment Warnings ............................................................................................................................ 393 Table 43: General Warnings ....................................................................................................................................... 394 Copyright 2008-2014, IMPAC Medical Systems, Inc.
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Introduction
Table 44: Other Operational Warnings ........................................................................................................................ 395 Table 45: MU per Segment Difference Warning when Rounding Error 2 is exceeded ....................................................... 399 Table 46: MU per Segment Difference Warning when Rounding Error 1 is exceeded but not Rounding Error 2 ................. 400 xxiv
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MOSAIQ 2.60 User’s Guide
Introduction
Introduction
MOSAIQisyourimage‐enabledelectronicmedicalrecord EMR thatgivesafullyintegrated
clinicalandadministrativeoncologymanagementsolution.TheMOSAIQproductsuitecontains:

PracticeManagement,whichincludesScheduling,Billing,andManagementreporting
andanalysisfeatures.

MedicalOncology,whichletsyourecordpatientinformationthroughthemedical
assessmentandchemotherapyadministrationprocess.Patientinformationcaninclude
diagnosticimages,labresults,andexternaldocumentation.

Notinganddocumentation,whichletsyoumakeandimportdocumentsmadein
MicrosoftWord.Thesedocumentsarepartoftheelectronicchart.TheStructured
Notingfunctionminimizesormakescostlytranscriptionnotnecessary.Otherdocument
managementfeaturesincludeanelectronicpatientassessmenttoolanddocumentscan
andimport.

RadiationOncology,whichmanagescomplextreatments.Itincludes:
DICOMandDICOMRTimport.Openradiationoncologyimagesandplansfrom
multiplesourcestomakeanaccuratetreatmentprescription.
Computerizedphysicianorderentry CPOE .Template‐basedcareplanstohelpyou
makecomplexradiationtherapyprescriptionsandsupportivecare.
Treatmentdefinition,setupandverification;Customizabletreatmentcalendarsto
setupmachines,examinemachineparameters,recordtreatments,andhelpdeliver
treatmentmodalities.Thesemodalitiesincludeintensitymodulatedradiation
therapy IMRT ,protontherapy,andimage‐guidedradiationtherapy IGRT .
Pre‐treatmentQualityAssurance QA Mode™:Fullvalidationoftheactual
treatmentplanwithoutincurringdosetothepatientrecord.
Positionpatientintreatmentandtrendanalysisacrossmultiplepatientsand
multipletechnologies
Conformtodifferenttypesofmachinesaswellasmultiplemodalities.

ImageManagement:
Keepsandmanagesalltheimagesnecessaryfortheoncologyprocesstomake
oncology‐relatedmedicalimages–CTs,MRIs,DRRs,portfilms,andmore–easily
accessiblealongwithpertinentclinicaldata.
Helponlineinspectionswithtoolstocompareandanalyze2Dand3Dreferenceand
verificationimagestoguaranteeaccuratetreatmentsetupsandvalidateIMRTand
IGRTplans
Streamlineportfilmcapture,review,andapprovalaspartofthetreatment
verificationprocess.Continuetoacceptelectronicportalimagingandcomputed
radiographyfromallthemajormanufacturers.
LUGMSQ0010/4.0/24-Jun-2014
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Introduction
Acceptthelatestinimage‐guidedradiationtherapy IGRT ,whichincludescone
beamCT.
OfferstheSetupIntelligence™,whichisapartoftheViewStationmedicaldevice.
ThisfeatureextendstheradiationoncologyEMRtogiveenhancedsupportfor
patientpositionverificationandanalysis.

MOSAIQDataDirector,whichletsyouarchive,retrieve,andmanageinformation
necessarytosupportadvancedIGRTtechniquesinradiationoncologyindependentlyof
aplanningordeliverysystem.

HL7‐compliantexternalsystemsinterfaces ESIs ,whichobeythelatestHealthLevel7
HL7 communicationstandardsfortheelectronicexchangeofpatientinformation
betweenMOSAIQandothertypesofhealthcareinformationsystems. About this Guide
ThisguidegivesinstructionstodobasictasksinMOSAIQtouseElektamedicaldevices MLCFit,
ViewStation,andSEQUENCER .InthechaptersonMLCfit,ImageManagement whichincludes
ViewStation ,andSEQUENCER,thedocumentgivescompleteinstructionsonhowtosetupand
usetheseproductssafelyandeffectively.
UsethisguideasadeskreferenceforaquickreminderonhowtodosomethinginMLCfit,Image
Management,andSEQUENCER.Keepthisbooknearyourworkstationsothatyoucanfindit
whennecessary.
Thedocumentisorganizedaccordingtothebasicworkflowanoncologydepartmentfollowsto
setupanduseMOSAIQ.UsetheindexorTableofContentstofindspecifiedtasks.
TheinstructionsinthisguideassumethatyouhavebasicWindows™skills.
ThisguidedoesnotreplaceotherMOSAIQdocumentationonSupportPlus,theElektadedicated
onlinesupportsystem,orcontainedintheMOSAIQHelpsystem.TheMOSAIQHelpsystemgives
in‐depthinformationonallavailableMOSAIQfeatures. 2
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Introduction
Audience
ThisguidehelpsElekta‐trainedMOSAIQuserssafelyandeffectivelyusetheElektamedical
devices MLCFit,ViewStation,andSEQUENCER .
ThetermuserdescribesthepersonloggedontoandusingtheMOSAIQsystem.TypicalMOSAIQ
usersare:

Administrator

RadiationClinician

PhysicianandPhysicianAssistant

NurseandNursePractitioner

MedicalPhysicist

Receptionist

Dosimetrist

Transcriptionist
Disclaimer
Elektaassumesnoliabilityforuseofthisdocumentifanyunauthorizedchangestothecontent
orformataremade.Theinformationinthisguidehasbeenreviewedandvalidatedforaccuracy.
TheinstructionsanddescriptionsarebasedonMOSAIQ2.60.Elektareservestherighttoupdate
thedocumenttoimprovethecontentand/ordesign.
Thisguideisprovidedwithoutwarrantyofanykind,impliedorexpressed,including,butnot
limitedto,theimpliedwarrantiesofmerchantabilityandfitnessforaparticularpurpose.
Elektaassumesnoliabilityfordamagesincurreddirectlyorindirectlyfromnotfollowingthe
instructions,warnings,andcautionsintheguideproperlywhenusingtheMOSAIQsoftware.
Training
MOSAIQisinstalledbyaqualifiedElektaSoftwareinstaller/engineer.Theinstaller/engineer
configuressomecomponentsofMOSAIQ.Thestaffsystemadministratorsatyourfacilityalso
configuresettingsinMOSAIQaccordingtotheMOSAIQsystemconfigurationguides.Users
certifyacceptanceofvalidatedproductinstallationviaCustomerAcceptanceTesting.
MOSAIQusersmustreceiveadequatetrainingonsafeandeffectiveuseofthesoftwarebefore
attemptingtoworkwithit.Trainingrequirementsmayvaryfromcountrytocountry.Usersmust
makesurethattrainingisreceivedinaccordancewithlocallawsorregulationsthathavethe
forceoflaw.InformationontrainingisavailablefromyourlocalElektasalesrepresentative.
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Introduction
Patient/User Safety and Residual Risk
Elektaconsciouslydesignsitsproductstominimizerisktopatientandusersafety.*Elekta
incorporatesextensiveprecautionstomitigatepotentialsystemhazards.Duetothenatureof
theproduct,alowlevelofresidualriskmayexistduringuse.Allresidualrisksinherenttothis
producthavebeendeemedtobeaslowasreasonablypracticable.Elektaprovidestrainingand
userdocumentationandexpectsuserstooperatethesystemwithduediligenceandstrictlyheed
allmessagesandwarnings.Becauseitisunabletoprotectagainstallmisuses,faultsanddevice
failures,Elektamaintainsthatonlypersonnelwhohavestudiedthismaterialarequalifiedtouse
thisproduct.Thisproductshallbeusedinaccordancewithallapplicableuser,patient,and
environmentalsafetyguidelinesbyuserswithadequatetraining,experience,andqualification.
* Elekta complies with ISO 14971, Application of Risk Management to Medical
Devices.
Document conventions
Thisdocumentusesspecificconventionsorrulesintheinstructionstohelpyouperformthe
taskscorrectly.Thissectionexplainsthekeyboard,menu,andmouseconventionsusedinthis
document.
Keyboard conventions
Keysthatdonottypeacharacterappearinsentencestyleboldprint.Thesekeysinclude:

FunctionKeysF1,F2,F3,F4,F5,F6,F7,F8,F9,F10,F11,andF12.

BoosterKeysAlt,Ctrl,andShift.

PointerMovementKeysHome,PageUp,PageDown,End,Tab,andthearrowkeys.

OtherKeysBackspace,Delete,Insert,CapsLock,Esc,Enter,Spacebar,PrintScrn,Scroll
Lock,Pause,andNumLock.

Aplussigndividestwoormorekeystopressatthesametime.Example:PressCtrl F4.
Example:PressAlt N.
Mouse conventions
Dotheseactionswiththemouse:
4

Click:Pressandreleasetheleftmousebutton.

Double‐click:Clicktheleftmousebutton2timesquickly

Right‐click:Pressandreleasetherightmousebutton

Drag:Movethemousewhileyouholddowntheleftmousebutton.

Highlight:Dragthemousepointeracrossdata,whichshowsthattheinformationis
selected.
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Introduction
Warningsaredirectionswhich,ifnotfollowed,couldconstituteahealthhazardorcauseinjury,
includingfatalorseriouspersonalinjury,orcouldcauseclinicalmistreatment.
Warning example:
WARNING
Do not use cables and other parts not specified or supplied by
Elekta. Fatal or serious personal injury or clinical mistreatment
could occur.
Cautionsaredirectionswhich,ifnotfollowed,couldcausedatabasecorruptionorresultin
systematicallyerroneousdataoutput.
Caution example:
CAUTION
After Custom Coding is enabled, you can no longer type free text in
the Block field in the Treatment Field Definition dialog box. If you
do, the 4DITC machine cannot treat the field.
Notesincludeancillaryinformation.
Note example:
You can also press F5 to show the eCHART Navigator window.
Hintsincludetipstohelpyouusethesystem.
Hint example:
Print illustrations from the Help reference tools to include with patient education
materials.
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Introduction
Abbreviations and Acronyms
Table 1: Abbreviations and Acronyms
6
Abbreviation/
acronym
Description
BEV
Beam’sEyeView
CBCT
CTdatageneratedusingtheConeBeam.
CT
ComputerizedTomography
D&I
TheMOSAIQDiagnosesandInterventionswindow
DCM
TheElektaDICOM CommunicationsModule
DICOM
DigitalImagingandCommunicationsinMedicine
IEC
InternationalElectrotechnicalCommission
IGRT
ImageGuidedRadiotherapy
IMRT
IntensityModulatedRadiotherapyTreatment
MLC
Multi‐LeafCollimator
MRI
MagneticResonanceImaging
PET
PositronEmissionTomography
PnD
TheMOSAIQPhotosandDiagramsfeature
RTP
RadiotherapyTreatmentPlanning
Rx
Prescription
SAD
SourcetoAxisDistance
SID
SourcetoImageDistance
SSD
SourcetoSkinDistance
TPS
TreatmentPlanningSystem
Tx
Treatment
VMI
VirtualMachineInterface
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CHAPTER 1: International Formats
International Numeric Data Settings
MOSAIQsupportsinternationalnumericformatsbasedonlocalWindowssettings.For
example,inmanycountries,thecommaisthedecimalsymbol forexample4,50 andthe
dotisthedigitgroupingsymbol forexample4.500 .Youconfiguretheregion/country
settingsfromtheRegionalSettingsontheWindowsControlPanelforyourworkstation.
Crystal Reports that come with MOSAIQ do not support international numeric
formats at this time, but you can customize Crystal Reports to show international
numeric formats.
Imported Lab Results appear in the same format that they are received from the
sending Lab Information System.
The display (or non-display) of the digit grouping symbol depends on the type
and size of the numeric field. You cannot configure or change this.
MOSAIQ:

ShowsnumericdatainaccordancewiththeworkstationWindowssettings.
ImportedLabResultsareanexception.Theyappearinthesameformatthatthey
arereceivedfromthesendingLabInformationSystem. 
Doesnotletyouenternumericdatainadifferentformat.
Enter Data in MOSAIQ
YoumustenternumericdatainMOSAIQwiththecorrectdecimalsymbolasconfiguredin
yourworkstationregionalsettings.Ifyouenternumericdatainadifferentformat,an
errormessageappears.
Figure 1: Error Message
ClickOKtoclosethemessage.MOSAIQdoesnotchangeexistingnumericdata.Italsodoes
notaddnewdataunlessyoutypethenumericdatainthecorrectformat.
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CHAPTER 2: MOSAIQ Clinical General Charting
CHAPTER 2: MOSAIQ Clinical General
Charting
MOSAIQClinicalGeneralChartingisanelectronicmedicalrecord EMR designedtogivean
efficientmeansofdocumentingpatientinformationduringthemedicalassessmentand
chemotherapyadministrationprocess.MOSAIQClinicalGeneralChartinghelpsyoubetter
thequalityofpatientcare,standardizetreatmentregimens,andtrack/forecastmedication
use.
UICC Staging Support
YoucansetthedefaultstagingtypetobeusedontheDiagnosisandStagingpane.Select
AJCC,UICCEnglishorUICCJapanesefromtheStagingsectionoftheClinical General2 tab
inDepartmentSetup.
Verification Administration
Youcanverifyanorderduringadministrationthroughbarcodescanningandautomatically
opentheMARforapatient.Barcodesmustbeaddedtomedicationlabelsthroughthe
MOSAIQLabelDesigner.
Configuring Manual Medication Verification Options
Youcansetupuserdefinedfieldstouseduringmedicationadministrationtomonitor
patientverificationsteps.
Toconfigurethesettings:
1. ClickSystemUtilities|ObservationDefinitions|ChartViewsandItems.
2. IntheViewpane,clicktheViewTypecolumnheadingtoorderthecolumn
alphabeticallyandputApplicationViewtypesnearthetopofthecolumn.
3. FindandselectMARViewintheLabelcolumn,andthenclickEditChartItems.Chart
Builderopens.
4. InChartBuilder,draganddroptoaddorremoveChartItemstoorfromtheMARView.
5. ClickSavetosaveyourinformation.
Verify Medication with a Bar Code
Toverifyamedication,youmusthaveapprovedmedicationordersforthepatient.Youmust
haveMOTreatsecurityrights.Theorderbarcodemustbeaddedtothelabel.
Toverifyamedicationusingabarcode:
1. Selectalistofapprovedorders.
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9
2. Printalistoflabelsthatincludebarcodes,whichidentifythepatient,drug,ordering
dose,startdate,route,andfrequency.
Thesystemprintslabelswithbarcodeinformationandhumanreadableinformation.
4. Placethelabelonthemedication.
5. Atthebarcodescanner,scanthemedicationbarcode.
Thesystemshowsamessagethatthebarcodehasbeenscanned.
6. Scanthepatient.
Thematchismadeinthesystem,andthepatientchartandtheMARwiththeapplicable
orderselectedopen.
8. Scanthebarcodeidentification.
Thesystemchangesthecurrenttimetothestarttimeandputstheinitialsoftheuserin
theapplicableStartStafffield.
9. Changeothervaluesmanually basedonyourDepartmentSetupsettings ,andthen
clickSave.
Thesystemsavestheinformationandtheverificationinstance/information.Itaddsthe
informationtothehovermessageintheMARandintheMARSumcolumns.
10. Attheendoftreatment,opentheMAR,putthemousepointerinastopfield,andscan
theuserbarcode.
Thesystemaddsthecurrentdate/timeinthestopdate/timewithyouruserinitials.
11. Changeavaluemanually,andthenclickOK.
Thesystemaddsthechangestothedatabase.Thesystemshowstheverifiedstatusin
theMARSumReport,theMARhovermessage,andintheorderinfobox.
Document Medication Verification Manually
UsethesestepstodefinethelanguageoftheFiveRights patientverified,drug,dose,route,
date oranyotherdatafieldsyoursiterequiresformanualmedicationverification.You
musthaveapproveddrugorderstotreatandtheUserDefinedData UDD formmustbeset
upinObservationDefinitions.
TodefinethelanguageoftheFiveRights:
Select1ormoredrugstotreat.
TheMARwiththeselecteddrugordersopens.
2. AccessthesitedefinedManualVerificationform UDDF forordersshown.
ThesitedefinedUDDFwithoptionstoSaveorCancelisshown.
3. Recordyourinformationintheform,andclickSave.
YouarereturnedtotheMAR.A”V”indicatorisshownintheindividualVerifybuttonfor
eachdrugorder.
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4. RecordtheMARinformation,andclickOK.
Thetreatmentrecordissaved.
5. OpentheMARSumwindowtoexaminethebarcodeverificationandmanual
verificationinformation.YoucanchangetheUDDinformationuntilthetreatment
recordediscomplete.
Order Sets
Whenyoumakechangestoanordersetoranordersetcomponent,anewversionis
automaticallymadeandtheversionnumberappearsinthetable.Clickthe signadjacentto
theGroupnametoshowhistoricdata.YoucanalsoselecttheShowAllVersionscheckboxto
showallhistoricversionsforallordersets.
YoucanmarkanordersetInactive,anduserscannotselectitwhenmakingaCarePlanor
whenmakingordersforpatients.IfanordersetisinanapprovedCarePlan,itcannotbe
markedInactive.IftheordersetisPending ornotinaCarePlan ,itisremoved.
Figure 2: Order Set Library Window
Table 2: Order Set Library Toolbar Descriptions
Toolbar
Description
Filter
Showsorhidesthefiltercontrols:ShowAllVersions,ShowOnlyNoncompliant,
ShowInactive,andallTypescheckboxes.Bydefault,thefiltercontrolsarevisible.
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Toolbar
Description
Add
Letsyouaddordersetsorcomponents throughasubmenu.
WhenOrderSetisselected,theOrderSetdialogboxopensandyoucanaddan
order.
WhenComponentisselected,asubmenuopens.Youcanselectthesecomponent
types:InHouseTreat,InHousePickUp,ExternalPickUp,andProcedure.These
typesspecifythetypeoforderthecomponentcreateswhenassignedtoapatient.
WhenyouselectInHouseTreat,InHousePickUporExternalPickUp,theDrug
Componentdialogboxopens.When youselect Procedure,theProcedure/Supply
Componentdialogboxopens.Ifnoordersetisselected,thisoptionisnotactive.
Change
Letsyouchangeordersetsorcomponentsthrougha submenu.
WhenOrderSetisselected,theOrderSetdialogboxopensandyoucanchange
theselectedorderset.
WhenComponentisselected,eithertheDrugComponentdialogboxorthe
Procedure/SupplyComponentdialogboxopens thisisbasedonthetypeof
componentselected .
Inactivate
Opensasubmenuwithadrop‐downlistofOrderSet andComponent.Thisoption
isnotactiveifyouselectanordersetorcomponentthatissetasInactive.
Whenanordersetisselected,MOSAIQchecksifitisassignedtoanyapproved
careplans.Ifitis,thismessageappears“ThisOrderSetbelongstooneormore
approvedCarePlansandcannotbeinactivated”.Ifitisnot,thenitinactivatesthe
selectedorderset,withconfirmation.Thisoptionisnotavailableifanordersetis
notselected,orifanalreadyinactiveordersetisselected.Oncetheordersetis
inactive,itonlyappearsintheLibraryiftheShowInactivecheckboxisselected.
Theinactiveordersetsappearwithalightgrayfont.
Whenacomponentisselected,MOSAIQcheckstoseeifitsordersetisassignedto
anyapprovedcareplans.Ifitis,thismessageappears“ThisComponent'sOrder
SetbelongstooneormoreapprovedCarePlansandcannotbeinactivated”.Ifitis
not,thenarevisionisrolledontheordersetanditscomponentsandit
inactivatestheselectedcomponent,withconfirmation.Thisoptionisnot
availableifacomponentisnotselected,orifanalreadyinactivecomponentis
selected.
Copy
12
OpenstheCopyOrderSetdialogboxwhereyoucancopyanexistingorderset
andquicklycreateaneworderset.
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Toolbar
Description
Note
ClicktoopentheNotedialogboxwhereyoucanenteranoteforanorderset.
Thefontforthisbuttonisblueiftheordersethasanexistingnote,andblackif
theordersetdoesnothaveanote.Ifanoteexistsforthecurrentselectedorder
set,clickthebuttontoopentheOrderSetNotewindow inamodebasedupon
youruserpermissions .IftheordersetisnotinactiveandyouhaveModify
permissions,thenoteisopenedineditmode.Iftheformerdoesnotapply,the
noteisopenedinread‐onlymode.Ifthereisnoexistingnotefortheorderset,
eitherthenotecreationformopens whentheordersetisnotinactiveandthe
userhasmodifypermissions ,oramessagepopsuptoinformyouthattheorder
setdoesnothaveanote.
Table 3: Order Set Library Filters
Filter
Description
Show All Versions
Clickthischeckboxtoautomaticallyexpandthedetailrowsoneachof
theordersetsthathavehistoricalversions.Whenunchecked,it
automaticallycontractsthedetailedrowsontheordersetsthathave
historicalversions.Thedefaultisunchecked.
Show Only
Noncompliant
Clickthischeckboxtoshowonlythenoncompliantordersets.Un‐
checkingthischeckboxshowsthenoncompliantordersetsalongwithall
oftheotherordersets.Thedefaultisunchecked.
Show Inactive
Clickthischeckboxtoshowinactiveordersetsalongwithalloftheother
ordersets.Uncheckthischeckboxtoremoveinactiveordersetsfromthe
Library.Thedefaultisunchecked.
Show All Types
Clickthischeckboxtoautomaticallyselectallthetypecheckboxes.
Ordersetsforalltypesappear.Uncheckthischeckboxtoremovethe
checkmarksforalltypesandnoordersetsareshown.Thedefaultis
checked.IfanordersetdoesnothaveaGroupdefined,itonlyappearsin
thelistwhenShowAllTypesisselected.
Drug Component Window
ToaccesstheDrugComponentwindow:
1. FromtheOrderSetLibrarytoolbar,clickAdd|Component.
2. Selectthetypeofcomponenttoadd:InHouseTreat,InHousePickup,orExternal
Pickup.Foranexistingcomponent,selectthecomponentinthelowergrid,thenclick
Change|Component.
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Figure 3: Order Set Component Window
TheDrugComponentwindowlooksverysimilartothePharmacyOrderDetailwindow.The
fieldsbelowarespecifictotheDrugComponentwindow:
Table 4: Drug Component Fields
Field
Description
Dispensing
Instructions
YoucanspecifyInstructionsforthemedication s inthecomponentupto
750characters.WhentheOrderSetisappliedtoapatient,theInstructions
areshownwhentheDispenseDetailswindowisopened.
eRx Pharmacy
Instructions
Theinformationenteredinthisfieldissentwiththedrugorderduring
ePrescribing.ThisinformationisnotvisibleintheDispensingDetailswindow
ortheMAR.
Expiry
Minutes
Notinuseatthistime.Reservedforfutureuse.
Override
ThisdropdownlistappliestotheDoseLimitsentered.Whentheorderset
hasbeenassignedtoapatientandtheorderisbeingapproved,ifthedoseis
overorunderthedoselimit,oneoftheseoptionsappliesbasedonthisset
up:NotAllowed,MayExceedwithCo‐Sign,WarningMessage.Ordersetsthat
haveDoseLimitsinformationenteredwhenyourdatabaseisconvertedto
v2.5haveanOverridelevelofWarningMessage.
Dose Banding
Button
OpenstheDoseBandingwindowwhereyoucanspecifyanunlimitednumber
ofdosebandingrulesforanymedicationinanorderset.
Dose Banding
Anewdosebandingwindowletsyoucreateanunlimitedamountofdosebandsforagiven
ordersetdrugcomponent.
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Figure 4: Dose Banding Window
Table 5: Dose Banding Field Descriptions
Field
Description
Add
Addsanewemptydosebandingrow; rowappearsattheendofthegrid. You
canalsoclickinthefirstcellandenterthenumber.
Delete
Deletestheselectedrow.
Save
Savesallchangesandclosesthedosebandingwidget.Allrowsmustpass
verificationrulesorchangesarenotsaved,andthewindowwillnotclose.
Dose Banding Verification Rules
Adosebandingrecordmustpassanumberofverificationrulesbeforethedosebanding
recordcanbesavedtothedatabase.Therulesareasfollows:

CalculatedDoseMin,CalculatedDoseMax,andBandedDoseareallrequiredfields
andmusthavevalues.

CalculatedDoseMinmustbegreaterthanzero.

CalculatedDoseMaxmustbegreaterthanCalculatedDoseMin.

BandedDosemustbebetweentheCalculatedDoseMinandtheCalculatedDose
Max.

Rangescannotoverlap:

AgivenCalculatedDoseMincannotequaltheCalculatedDoseMaxofanotherdose
bandingrangeonthesameordersetcomponentdrug.

AgivenCalculatedDoseMincannotfallbetweentheCalculatedDoseMinand
CalculatedDoseMaxofanotherdosebandingrangeonthesameorderset
componentdrug.
Dosebandingrecordsthatdonotpassverificationrulesshowanerrorindicatorinthe
cell s thatareviolatingtheverificationrule.
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Common Data Entry Errors
WhenyousetupaDrugComponent,youcanenteraDoseBasisandDoseBasisUnitsoran
OrderingDoseandOrderingDoseUnits,butneverboth.Amedication’sdoseisnot
calculatedatthislevel.Ifyouentervaluesforbothtypesofdosesandattempttosave,an
errormessageisshownandindicatesthatyoucanonlyhaveaDoseBasisoranOrdering
Dose,butnotboth.Also,ifyouselectaunitofmeasurefromtheDoseBasisUnitsthatdoes
notrequirecalculation;anerrorappearsnexttothefieldtoindicatethattheunitofmeasure
canonlybeusedwithanOrderingDose.Whenyouselectaunitofmeasure,fromthe
OrderingDoseUnitsthatrequirescalculation,anerrorappearsnexttothefieldtoindicate
thatthisunitofmeasurecanonlybeusedwithaDoseBasis.
Tiered Drug Security: when you add or edit order set components from the Order
Set Component Mode, MOSAIQ does not check the drug security.
Procedure/Supply Component Window
TheProcedureandSupplyComponentwindowsarecombinedintheProcedure/Supply
Componentwindow.Youcancreateandmodifyprocedureandsupplycomponentsfrom
thiswindow.
Figure 5: Procedure/Supply Component Window
Table 6: Procedure/Supply Component Field Descriptions
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Field
Description
Add
Whenselected,asubmenuopensadrop‐downwithadditionaloptions:
Procedure,Supply.
Procedure:whenselected,openstheSelectProcedurewindow.Whena
procedureisselectedandtheSelectbuttonisclicked,theprocedureis
automaticallyaddedtotheprocedure/supplycomponentgrid.
Supply:whenselected,openstheSelectSupplywindow.Whenasupplyis
selectedandtheSelect buttonisclicked,thesupplyisautomaticallyadded
totheprocedure/supplycomponentgrid.
Delete
TheDeletebuttonisactiveonlywhenanexistingprocedureorsupplyinthe
gridisselected.Aconfirmationmessageappears.IfyouclickYes,the
selectedprocedureorsupplyisdeletedfromthecomponent.
Note
ClicktoopentheNotedialogboxwhereyoucanenteranoteforthe
component.
Thefontforthisbuttonisblueifthecomponenthasanexistingnote,and
blackifthecomponentdoesnothaveanote.Ifanoteexistsforthe
component,clickthebuttontoopentheComponentNotewindowinamode
baseduponyouruserpermissions.Ifthecomponentisnotinactiveandyou
haveModifypermissions,thenoteisopenedineditmode.Iftheformerdoes
notapply,thenoteisopenedinread‐onlymode.Ifthereisnoexistingnote
forthecomponent,eitherthenotecreationformopens whentheorderset
isnotinactiveandtheuserhasmodifypermissions ,oramessagepopsup
informingyouthatthecomponentdoesnothaveanote.
Save
SavesthecomponentdataandclosestheProcedure/SupplyComponent
window.Whenyouaddtheveryfirstcomponentoftheorderset,no
revisionisrolled.Whenyouaddtoanordersetthathasacomponent,or
youmakeachangetoanexistingcomponent,arevisionisrolled.The
VersioncolumnoftheOrderSetsgridisincrementedby1andtheprevious
versionisviewablewhenthehistoricalrowsareexpanded.
Condition
Specifiesanyinstructionsneededtoappropriatelyadministerorusethe
supply.TheConditionfieldandcheckboxvaluesarespecifictoeach
individualprocedureorsupplyinthegrid.WhenaConditionand/orcheck
boxesarecheckedforaspecificprocedureorsupplyinthegrid,thesevalues
areclearedorsettopreviouslysavedvalueswhenanotherprocedureor
supplyisselected.
Generate Order
Specifiesthatthisprocedureorsupplyshouldgenerateanorder.
Schedule
Appointment
Specifiesthatthisprocedureshouldbescheduledasanappointment.
Not Billable
Indicateswhetherthisisanon‐billableprocedureorsupplyandprevents
theprocedureorsupplyfrombeingcharged.Usethisfieldifyoudonot
wanttochargefortheprocedureorsupply,butdowanttotrackit.
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17
Field
Description
Use As
Component
Label
Specifiesthatthedescriptionfortheprocedureshouldbeusedasthelabel
name ofthecomponent.
Merge Fields Viewer
YoucanseetheMergeFieldsViewerpanefromtheChartWorkspace.Youcanselecttoview
asinglemergefieldwithitsparameterconfigurationoptionsoraFavoritethathasbeen
configuredineSCRIBE.Thecontentsofthepane,withtheconfiguredparameters,refreshes
everytimethesourcedatachanges.
Legacy merge fields cannot be used in the MergeFields Viewer pane.
MultipleinstancesoftheMergeFieldViewercanbeopenintheChartWorkspace.Notethat
aswithallpanes,theconfigurationcandifferbetweenusers,ifdesired.
Figure 6: MergeFields Viewer
Table 7: MergeFields Viewer Components
Component
Description
Pane Layout
Settings
ClickthearrowbuttontoopenamenuandselectPaneLayoutSetting.
Thisopens theLayoutSettingsdialogbox. Usethisdialogboxto
reconfigurethepane.
Widget Title
Usedtospecifythenameofthepanetitle.
Type
Clickanoptionbutton toselectMergeFieldsorFavorites.
Merge
Field/Favorite
DependingontheTypeyouselect,youwillseeaMergeFieldsor
Favoritesdropdownlist.
WhenyouselectFavorites,thenclickConfigure,thefieldsmergeand
areshown.
WhenyouselectMergeFields,thenclickConfigure,theParameters
windowforthefieldopens,asifyouwereselectingthefieldfrom
eSCRIBE.
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Configure
Button
ClicktoopentheeScribe MergeFielddialogboxwhereyouset
parameterswhenTypeisMergefields. Clicktoapplytheconfiguration
whenType isFavorites.
Configuring the Enhanced Merge Pane
1. AddanameforthepaneintheWidgetTitlefield.
2. SelecttheType:MergeFieldsorFavorites.
3. Clickthedropdownarrowandselectthemergefieldorpre‐configuredfavorite.
4. ClickConfigure.
WhenyouselectFavorites,thenyouclickConfigure,thefieldsmergeandareshown.
WhenyouselectanindividualMergeField,thenyouclickConfigure,theparameters
windowforthefieldopens,thesameasitwouldifyouwereselectingthefieldfrom
eSCRIBE.
5. Selectwhichviewandthenwhichfoldersanditemstobeincluded youcanelectto
“hideblanks”withaseparateparameter ,thendeterminethedaterange,Output
format.Onceselectionshavebeenmade,selectOKandtheresultsappearinthepane.
WhenAssessmentisselected oraFavoritethatcontainsassessments atoolbarsupporting
assessmentsappearsatthetopofthepane.Thistoolbarsupportsadding,editing,and
statusingAssessmentsdirectlyfromthepane.Ifthereisanoteassociatedwithan
assessment,thenotebuttonwillbeblue.Ifnotlockedassessmentnotescanbe
added/editedfromthepaneaswell.
IfthereismorethanoneviewwhenselectingAdd,ormorethanoneview/datewhen
selectingChange,Delete,Copy,andStatus–aflyoutmenuappearstosupportselectingthe
correctone.
AssessmentscanbemanagedthroughCWS/AssessmentsortheMergeFieldpane–theyare
thesameassessmentrecord.Viewingassessmentinformationinthepanemaybeeasierfor
someusers/someinformation.
If the pane is not wide enough to show all buttons, a dropdown arrow appears
and shows all selections. The contents of the window will, when possible, wrap
to accommodate the size of the pane. Table columns cannot be “wrapped”.
FavoritesforthepanearecreatedineSCRIBE.Whensavingafavorite,youhavetheoption
tosaveitforuseineSCRIBEdocumentsorthepane.Oncesaved,theyappearinaseparate
folder.
Changing a Merge Field Value
1. ClickConfiguretoopentheeSCRIBEMergeFieldUserParameterspane.
2. YoucanclickConfiguretoopentheeSCRIBEMergeFieldUserParameterspanewhen
theTypeisMergeFields.
3. TochangeavalueontheMergeFieldpane,clickSelectvaluetoseethelistofavailable
values.
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4. Selectanewvalue,andthenclickOKtosave.
Assessments
TheAssessmentsiconmakesiteasiertoaccessAssessmentviews.Userscanquicklyaccess
theAssessmentstabofthetraditionalflowsheetviewfromanywhereintheapplication
whenapatientispre‐selected.
Customized Assessment Layout
TheCustomizedlayoutispresentedwhenadding,editingorviewinganAssessment,Labor
VitalSignfromtheMergewindoworAssessment/Flowsheettabs.Youarenotrequiredto
reformatyourexistingAssessments,butitisaneasyprocess.
Using Assessments from the Chart Workspace
FromtheChartWorkspace,opentheMergeFieldsViewerpane.
1. ClickAdd.
Thenewassessmententryformopens.TheAddbuttonisonlyactivewhenyouhavean
assessmentconfigured.
SystemopensassessmentviewinUDDFEdit.
3. Enterassessment,note,infoandreviewassessment.
4. ClickSavetosaveyourchangesandreturntotheChartWorkspaceassessmenttab.
Viewtheupdatedassessment.
Adding, Changing, and Displaying Assessments in the Customized
Layout
1. FromtheMOSAIQtoolbar,clicktheAssessmenticon.
2. MOSAIQshowsalistofviewstoselectfromwiththelastassessmentusedforthis
patient,bythisuser,asthedefault.
3. ClickAddtoaddanassessment.
4. MOSAIQshowstheviewineditmodeincustomizedlayoutformatinclusiveof
instructionsasconfiguredUserselectstoaddanassessmentnote.
5. Userselectstoadd/updateInfo.
6. UserselectstoviewMARSum.
7. Statustheassessmentreviewed.Thesystemclosestheassessmentandsaves
additions/changestotheMOSAIQdatabase.
ThistabledescribestheAssessmentFormComponents.
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Table 8: Assessment Form Components
Component
Description
Info
ClickthisbuttontoopentheAssessmentInformationform.
MAR Summary
ClickthisbuttontoopentheMARTreatmentSummarydialogbox.
Note
OpenstheNotedialogbox.Theserulesapply:
Thefonttextisbluewhenanoteexists.
Thebuttonisnotavailableifthereisnonote,youdonothaveModify
securityrights,ortherecordissettoastatusthatdoesnotallow
editing.
IfyouhaveModifysecurityrights,andtherecordissettoastatusthat
allowsediting,andthereisanote,theNotedialogboxopens.
IfyouhaveModifysecurityrights,andtherecordissettoastatusthat
allowsediting,andthereisanote,theNotedialogboxopens.
Inallothercases,theNotedialogboxopensinread‐onlymode.
Status
ClickthisbuttontoopentheRecordStatuswindowifthevalidationon
theentriesintheformissuccessful.
ThisbuttonisactiveifyouhaveModifysecurityrightsandtherecord
statusisnotVoided.
Changethestatus,andclickOK tosaveandclosethewindow.
Print
ClickthisbuttontoopenthePrintdialogboxwhereyoucanprintthe
existinglayoutwithadditionalheaderinformation:Recordview,
Patientinformation.
Record Date and Thisisaread‐onlyfieldthatshowsthelasteditdateandtimeforthe
Time
currentrecord.
Assessmentsarelinkedtoobservationorders onceIQScriptsareconfiguredtoopenan
assessmentduringorderapproval .AnAssessmentbuttonappearsontheObservation
Orderswindow.Thisbuttonallowsuserstoviewanassessmentlinkedtothatorder.
TheAssessmentbuttonisdisabledifthereisnoassessmentassociatedwiththatorder.The
AssessmentbuttonalsoallowsyoutomodifyassessmentsinanUnreviewedorPending
status.IfyouclickedCancelontheassessmentwhenitwasfirstopenedfromtheIQScript,
youcanclickthisbuttonandaddtheassessmentdata.
AnyassessmentwithaReviewedstatusisReadOnly.IftheIQScriptsconfigurationissetto
markanassessmentasReviewedautomatically,theassessmentisReadOnly.
AnassessmentcanbedeletedfromtheFlowsheetandtheMergeFieldViewer.An
assessmentcanbevoidedfromtheFlowsheet,theAssessmentpane,andtheMergeField
Viewer.Ifyoudeleteorvoidanassessmentassociatedwithanorder,itdissociatesfromthe
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order.YoucanclicktheAssessmentbuttonontheObservationOrderswindowandfillouta
newassessmentforthatorder.
Merge Fields for eSCRIBE Word Documents
InaneSCRIBEdocument,youcanaddorchangeclinicaldatainanenhancedmergefieldfor
Assessments,VitalSigns,orLabs.Thisdataissavedinthecorrespondingdatafieldofthe
patientchart,andyoucanrecorddatawhenyouwriteaprogressnote.Youcanalsouseitin
theCCDA.
Adding or Changing Clinical Data in an eSCRIBE Word Document
IntheChartWorkspace,clicktheDocuments&Imagestab.
IntheDocumentspane,clickAdd|eSCRIBE.
1.
IntheEncounterdialogbox,recordthenecessaryinformationandclickEdit.
IntheOnsiteeSCRIBEWordwindow,clickAddIns|MergetoopentheMergeFieldsdialog
box.
2.
IntheClinicalfolder,dragAssessments,VitalSigns,orLabsintothedocument.
IntheeSCRIBEMergeFielddialogbox,selecttheparametersforAssessments,VitalSigns,or
Labs,andclickOK.
Thespecifieddataappearsinthedocument.
3.
IntheOnsiteeSCRIBEWordwindow,right‐clickonthedatathatyouwanttoedit,select
MergeFields|Recordsandoneoftheseoptions:
Add:openstheAssessmentFormthatisembeddedinthemergefieldandaddsnew
information.SelectanitemintheAssessmentFormtoadd ortypeinformationina
field ,andclickSave.Thedataissavedinthecorrespondingdatafieldofthepatient
chart,andthedatabaseischanged.ThemergefieldintheeSCRIBEWorddocument
refreshes.
Edit:openstheAssessmentFormthatisembeddedinthemergefieldineditmodeso
thatyoucanchangetheinformation.ChangeanitemintheAssessmentForm,andclick
Save.Thedataissavedinthecorrespondingdatafieldofthepatientchart,andthe
databaseischanged.ThemergefieldintheeSCRIBEWorddocumentrefreshes.
Copy‐Forward:makesanewcopyoftheselectedrecordandopenstherecordinthe
AssessmentFormsothatyoucanadd,change,orremoveanitem.WhenyouclickSave,
thedataissavedinthecorrespondingdatafieldofthepatientchart,andthedatabaseis
changed.ThemergefieldintheeSCRIBEWorddocumentisupdated.
IntheOnsiteeSCRIBEWordwindow,clickOKontheAddInstabtosaveandclosethe
document
NOTE:IfyouclickCancelontheAddInstabandthenyouclickYestotheconfirmation
message,yourchangesarenotsavedintheeSCRIBEWorddocumentandyour
documentcloses.But,thedatabaseisupdatedbecauseofthechangesyoumadetothe
AssessmentforminStep7.
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Diagnosis & Staging
Youcanconfigurewhichstagingsystemisusedasa1standifapplicable2nddefaultandthe
alternatesystemsavailablebydiagnosiscode.1stand2nddefaultsystemsappearonthe
fronttabofDiagnosis&Staging,withascrollbarasrequired.AdditionalSystemsare
availablethroughtheAdditionalClassifiersTab.
1. FromtheDiagnosisandStagingwindow,clicktheConfiguremenutoopentheDiagnosis
andStagingConfigurationdialogbox.
2. Selectdiagnosiscode orcodes toconfigure.
3. Selectfromavailablestagingsystemstoselect1stDefault.
4. ClickSave.Changesarevisibletostaff.
You must have Modify | System Utilities | Clinical security rights.
Configuring Default Staging System Per Diagnosis
UserDefinedDataForms UDDF islinkedtodiagnosis.Youcanconfigurethedefault
stagingsystem,peruser,basedontheDiagnosisCodeselected.
Toconfiguredefaultstagingsystem,followthesesteps:
1. Identifydiagnosiscode s toconfigureforstagingsystem.
2. Selectanavailablestagingsystem,andsetto1stDefault.Thechangesaremadevisibleto
staff.
Entering and Showing Staging Using Multiple Systems
1. Selectadiagnosiscodeforstaging.
2. Thedefaultedstagingsystem s isshown.
3. Identifythestagingsystemandreleaseofstagingsystem.
4. Enterstaginginformation.ThestaginginformationcannowbeseenintheChart
WorkspaceandcanbeusedineSCRIBEmergefields.
Collecting User Defined Data
Toadddiscretedatathatisassociatedwiththediagnosis,asrequiredbycustomersite
processes,followthesesteps:
1. Adduserdefineddatatothediagnosis.
2. AUDDformisshown.
3. EntersomeUDD.
4. ClickClose.
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5. ClickSavetosavetheDiagnosis&StagingRecord.
Admitting Diagnosis
Followthesestepstoaddaneworupdateadmittingdiagnosis.
1. Adddiagnosisrecordanddiagnosisvalue.
2. Addtheadmittingdiagnosisvalue.
3. Youhavethesameoptionstoselectadmittingdiagnosisasthediagnosisfield favorite,
typeandselectfromfiltered .
4. Savethediagnosisrecord.Admittingdiagnosiscanbeviewedinthediagnosispane.
Diagnosis eSCRIBE Merge Field
Toaddaneworeditadiagnosismergefieldinadocumentortemplate,followthesesteps:
1. Addadiagnosisfieldtoadocument.
2. Modifythedefaults TableB .
3. IncludeUDDandselectthefields/formats.
4. ClickOktosaveyourmodifications.Thediagnosisinformationismergedintothe
document.
Adding a Diagnosis
1. FromtheDiagnosesandProblemsList,clickAdd,thenselectAddDiagnosis.
2. FromtheDiagnosisandStagingwindow,typeadiagnosisintotheDiagnosisfield.The
listdynamicallyfilterstomatchwhatyouentered.IfyouhaveconfiguredFavorites,they
appearatthebeginningofthepopulatedlist.
3. Toonlyviewnoncancercodediagnoses,right‐clickandselectShowNon‐CancerCodes.
4. Toaddthediagnosis,doubleclickonadiagnosis.
Table 9: Diagnosis Descriptions
24
Diagnosis
Description
Morphology
ThelistisfilteredtoonlyshowtheMorphologymostlikely
associatedwiththediagnosisselected.
Recorded By
Thisisanewfieldthatshowswhorecordedthestaging
information.Thedefaultisthesignedonuser,butyoucanclick
thedownarrowandselectanotheruser.
Initial Diagnosis
Youcannowenterapartialdateinthisfield.
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Adding a Diagnosis to Your Favorites
1. Afterstep2above,right‐clickandselectAddToMyFavorites.Thediagnosisisplacedat
thetopofthelistunderFavorite.
Creating a New Diagnosis Code
1. ClickFile|Libraries|DiagnosisCodestoopentheDiagnosisCodeswindow.
2. ClickAddtoopentheDiagnosisCodedialogbox.
3. Enteryournewdiagnosiscodeinformation.UsetheAlternateDescriptionfieldtoenter
adescriptionthatisusedonlyforsearchingpurposes.
4. ClickOK.
Configuring Favorites
1. ClickFile|SystemUtilities|DiagnosisFavoritesConfigurationtoopentheDiagnosis
Favoriteswindow.
2. Toaccessthiswindow,youmusthaveSystemAdmin|Clinical|Modifyrights.Thesite
administratorusesthiswindowtoconfiguresharedfavoritesandcanusetoconfigure
myfavoritesforindividualusers.
3. FromtheDiagnosisCodeslist,youcanclickanddragacodeintotheMyFavoriteslistor
theSharedFavoriteslist.
4. ClickClosetoexittheDiagnosisFavoriteswindow.
Reconcile the Medication List
TheMedicationListshowsyoucurrentorhistoricalmedicationsprescribedindifferent
dialogboxesinsystem.Pharmacyordersmadeinthesystemarecomparedagainstthis
activelistofmedicationsfordruginteractions.Youcanelectronicallyrecord,change,and
getanactivemedicationlistandmedicationhistoryatthesametimethatyoureconcilethe
MedicationList.
Opening the Medication List
1. ClicktheMedListiconontheMOSAIQtoolbartoopentheMedicationListdialogbox.
YoucanalsoopentheMedicationListfromtheChartWorkspace.Table10describesthe
MedicationListfields.
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Table 10: Medication List Field Descriptions
Field
Description
Reconcile
Registersthereconciledevent.TheuserID,timestampandlist
ofmedicationsarerecorded.
Onlythemedicationsshowninthedialogboxarereconciled.If
drugsarenotshownbecauseofaconfiguredfilter,thosedrugs
arenotregisteredasreconciled.
Ifthemedicationslistisempty,thereconcileeventisstill
registered.Thesystemrecognizesthatanemptylistwas
reconciled.
Ifonlythesummaryrowisvisible,informationforallrowsis
recordedduringreconciliation.
Youcanreconcileasmanytimesasneeded.Eachclickregisters
anewreconcileevent.
Reorder
Makesaneworderwithpre‐populateddatafromtheselected
medication.ThePharmacyOrderDetaildialogboxopensinedit
mode.
Thisbuttonworksonlywhenyouselectonemedication.You
receiveamessageifmultiplemedicationsareselected.
AneworderisalwaysmadewhenyouclickReorder;evenif
youclickCancelfromthePharmacyOrderDetaildialogbox.
Youcanreorderinactiveorvoidedmedications.
Reconcile Hx
OpenstheReconciliationHistorywindowandshowsthe
reconciliationsthatare completed forthemedicationlistfor
thepatient.
Enhanced Medication List
1. OpentheMedicationList.TheMOSAIQsystemcheckstheStopDateofthemedication
entry.IftheStopDateisearlierthancurrentdate,thesystemmarksthismedicationas
Inactive.
2. TheSystemshowstheCarePlanHistorywiththefollowinginformationinthecolumns
foreachinstanceoftheCarePlan:
26

CarePlanname

StartDate

AssigningMD

Intent
LUGMSQ0010/4.0/24-Jun-2014

AssociatedDiagnosis

ProjectedFinishDate

StopDate basedonthedateselectedwhentheCarePlanwasdiscontinued 
DiscontinueReason
 ClinicalTrialID
3. ThesystemshowstheMedicationlistwithsummaryrowsforeachcombinationofthe
drugandroutewiththemostrecent uptotoday approvedorders.
4. Showthedetailsofthemedicationslisted.
Thesystemshowsinformationincolumnsforeachinstanceofthedrugorder,or
medicationlistchange,witharowforeachneworderorchangeinmedication.
5. ClosethedetailsbuttontoreturntothesummaryrowsintheMedicationList.
6. Asummaryrowofthedetailedmedicationentryisshown.
7. ClickReconcile.
Thesystemrecordsthereconciledinformation,thelistofmedicationswhichwere
filteredandthedateandtime.Thereconcileinformationisshownatthebottomofthe
window.Itincludesusername,dateandtime.
Printing a Patient Medication List
Toprintapatientmedicationlist,patientordersmustbeapproved.
1. FromtheMedicationList,clickPrint.
Thesystemopenstheprintconfigurationoptionwindow.
3. Selecttheapplicablefilters.
Updating TAH Medications/Reconcile History
UsethesestepstoquicklyupdateamedicationlistforapatientforthepurposeofMed
Reconciliation.
1. ViewtheMedicationwindowfromChartWorkspaceorundocked.
2. SelectaTAHmedicationrowatthedetailviewlevel.MakesuretheShowGroupedcheck
boxisnotselected.
3. Updatethereviewstatusandaddtoreviewcommentinline.
4. Reconcilethelist.
5. Viewthereconcilehistoryforthisevent.
Thesystemshowsthereconcilehistorywindowwiththemostrecentinstance
defaulted.ColumnsthatappearincludeDateandMedication;reviewstatusandreview
commentforeachmedication.
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27
Selecting a TAH Medication by Opening the Record
1. Updatetherecordasnecessary markinactive,changesreviewstatusand/orreview
comments .
2. EnterUnknownorotherpartialdateinformationintheStartorStopdatefield.
3. Saveupdates.
4. Repeatsteps4‐5above.
Medication List Detail View
ThetoolbarintheMedicationListwindowincludesaFiltersbuttontoIgnoreFiltersanda
CarePlanHxbuttontoopentheCarePlanHistorysection.
TheMedicationListletsyouviewthemedicationlistinasummaryrowvieworasan
ungroupedlistshowingalldetailrows.
Selecting the View Option
1. ViewtheMedicationwindowfromtheChartWorkspaceorundocked.
2. Setfilterstoincludeanexistingcombination,suchastakeathomemedications,andnot
toshowinactive.
3. Selecttoseedrugsasalistwithoutsummaryrows.Thesystemshowsalistofdrugsthat
meetsthefiltersselectedwithnotree/summarystructure.
Ifyouselecttoseedrugswiththesummaryrow,thesystemshowsalistofdrugsthat
meetsthefiltersselectedwithtree/summarystructure.
Pharmacy Order Details
YoucanseeasidebysidecomparisonoftheordersetcomponentsinCarePlanAuthoring
withthepatient’scurrentcareplanorderstoidentifyanychangesmadetothemedication
ordose.ItisaccessedbydoubleclickingontheCarePlannamefoldertore‐sequenceunder
theChemotherapyRegimenfolderontheleftsideofCWS.
Thecomparisonwindowtitlenowshowsthecategory,nameoftheselectedcareplan,and
thecurrentpatient.
TherearetwolistboxesintheCarePlanOrderComparisongroupbox:

TheAuthoredCarePlancontainsallofthepharmacyordersetcomponentswithin
thedefinedcareplaninthesamesequenceasdefinedinthecareplanandorderset.

ThePatientCarePlancontainsallofthepharmacyordersinthepatient’scareplan
includingtheChemotherapyRegimen,AdditionalChemotherapy,andAdditional
MedicationsfoldersinthesamesequenceasdisplayedontheCWS.
TheRegimenSequencingpaneletsyoure‐sequencetheordersintheChemotherapy
RegimenfolderontheCWS.
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Lab Results
TheLabResultsWorkListdisplayslabresultsetsandtherelatedlabresultsinthesetsfrom
theeChartmenu,intheHomeWorkspace,andintheChartWorkspace.
WhenyoudisplaytheLabResultsWorkListfromtheeChartmenuorfromtheHome
Workspace,youseestaff‐centricinformationbasedonthesecriteria:

Ifthestaffmemberistheprovideroftheorderandthelabresultsetisdirectly
linkedtotheorder importedintothesystem ,onlythisstaffmembercanseethe
labresultinformation.

IfthelabresultisnotassociatedwithanorderandifthestaffmemberistheOrder
Provider dataismanuallyrecordedintheFlowsheetandtheOrderProviderfield
iscompleted Flowsheet,Infobutton,OrderProviderfield ,thenonlythisstaff
membercanseethelabresultinformation.

IfthelabresultisnotassociatedwithanorderandtheOrderProviderfieldis
empty,thentheattendingphysicianforthepatientcanseethelabresults.
WhenyoudisplaytheLabResultsWorkListfromtheChartWorkspace,youseeinformation
fortheglobalpatient.
Lab Results Work List
TheLabResultsWorkListhasthesesections:

LabResultSetstable:showsinformationaboutthelabresultsets,withthenumber
ofresultsintheset,thestatusofthelabresult Pending,Reviewed,Unreviewed,
Voided ,thecriticalityofthelabresult Warning,Panic,OutofRange ,andthe
statusofthelabresultset Unresolved,Pending,Resolved,Ignore .

Patientinformationpanel:showsgeneralinformationaboutthepatient for
example,diagnosis,attendingphysician,ifthelabresultisreviewed,andifthelab
resultisassociatedwithanorder .Whenyoucanmoveyourmousepointerabove
thepatientname,thepatientinformationpaneldisplaysfromthePharmacy
Workspaceandhaslinkstootherpartsofthesystem.

LabResultsDetail:showsdataabouteachlabresultintheset.Atrendlineindicator
isshownadjacenttoeachlabtoletyouseethegeneraltrendofthelab.

HistoricalChart:showsahistoricalchartwhenyoucanselectalabresultfromthe
LabResultsDetailsection.
FromtheLabResultsWorkList,youcanassociatelabresultstoordersandreviewlab
resultsinabatch.YoucanusethefiltercontrolstodecreasethenumberofitemsintheLab
ResultsWorkListtable.Youcanfilterbydateranges,bythestaffmemberwhoorderedthe
lab,bythestatusofthelabresults pending,reviewed,unreviewed,voided ,andbythe
associationofalabtoanorder ignore,unresolved,resolved .
Reviewing Lab Results in a Batch
Followthesestepstoreviewlabresultsinabatch:
1. ClickeChart|LabResultsWorkList,orclicktheLabResultsWorkListtabontheHome
orChartWorkspace.
2. IntheLabResultsWorkListwindow,clickFilters.
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29
3. IntheFiltersdialogbox,setthefiltersbythedaterange,staffmembers,orothercriteria
toseethelabresultsthatneedtobereviewed,andclickSave.
4. IntheLabResultsWorkListwindow,selectthepatientthathaslabresultswitha
PendingorUnreviewedstatus.
Toselectmultiplepatientsinarow,selectapatient,presstheShiftkey,andthenselect
thelastpatientinaseries.
Toselectmultiplepatientsnotinarow,selectapatient,presstheCtrlkey,andthen
selectadifferentpatient.
5. ClickReview.
TheStatuscolumnintheLabResultSetstablechangestoReviewed.
Associating Lab Results to Orders in a Batch
Followthesestepstoassociatelabresultstoordersinabatch:
1. IntheLabResultsWorkListwindow,clickAssociateLabs.
TheAssociateLabResultstoOrdersdialogboxopensandshowsalistoflabresultsthat
arenotassociatedtoorders.
IneChartandtheHomeWorkspace,youseelabswithanUnresolvedstatusforall
patientsintheworklist.
IntheChartWorkspace,youseelabswithanUnresolvedstatusonlyfortheglobal
patient.
2. ClickthedownarrowadjacenttotheAssociatetofield,andselectanorderfromthelist
orselectIgnore .
Youcanputyourmousepointeronthedatetoseeinformationaboutthelabtohelpyou
associatethecorrectorder.
3. ClickOK.
TheResolvedcolumnforthelabresultsetshowsResolved.Ifnecessary,clickRefreshto
seethestatuschange.
Associating a Lab Result to an Order
Followthesestepstoassociatealabresulttoanorder:
1. IntheLabResultsWorkListwindow,selectalabresultthatshowsUnresolvedinthe
Resolvedcolumn.
YoucanalsoclickFilters,andselecttheUnresolvedcheckboxforDisplayAssociationto
seeonlythelaborderswithanUnresolvedstatus.
2. IntheLabResultsDetailsection,clicktheUnresolvedlinkadjacenttotheOrderfield.
AnAssociatetofieldappears.
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3. ClickthedownarrowintheAssociatetofield,andselectanordertoassociatetothelab
fromthelist.
4. ClicktheDonelink.
TheResolvedcolumnforthelabresultsetshowsResolved.Ifnecessary,clickRefreshto
seethestatuschange.
Orders
Whenyouhavethesesecurityrights:ApprovalforPharmacyOrderandObservationOrder,
andQuickApprovalsetup,youcanapproveapharmacyandobservationorderwithoutre‐
enteringthepassword.ThisfunctionisperformedfromthePharmacyOrderList,
Dispensing,HomeWorkspace,CWL,andOrders.
TheAdministrativeStatusisauserdefinedfieldontheObservationOrderspane.Thelabel
canbemodifiedbytheSystemAdministratorinDepartmentSetup.Theselectionoptions
canbemodified,addedto,ordeletedbyyourSystemAdministratorfromObservation
Definitions.
Whencommentsareaddedtoanobservationorder,theyaredisplayedontheOrderspane
fromtheHomeandChartworkspaces underObservationComments.Iftheobservation
orderhasmultiplecommentsfromtheorderleveland/orcomponentlevel,thecomments
aredisplayedonahovermessage.
Quick Approval for Orders
WhenQuickApprovalisconfiguredinDepartmentSetup,theApprovebuttonandApprove
andPrintareavailablefromPharmacyOrderList,Dispensing,HomeWorkspace,CWL,
Orderwindow,andChartWorkspace/Orderwindow.Youcanapproveanorder,or
approve/printorderwithasingleaction.
Thefollowingbuttonsareavailableintherightmouseclickmenu:Approve,Approveand
Print,FavoritePrescription,andAuthenticateVO.YoucanaccessfromtheAddOrder:
Submenuoptions–InHouseTreat,InHousePickup,ExternalPickup,FromFavorites,Quick
Orders,andOrderSet.
Dose Calculation
InseveralareasofMOSAIQ,DoseCalculationfactorsareshown.Youcanseethedose
calculationfactorsontheClinicianWorksheet,PharmacyOrders,andtheMAR.Youcanalso
viewtheDoseCalculationfactorsinOrderHistory.
Viewing Dose Calculation Factors in Revision
YoucanreviewdosecalculationfactorsinRevisionafteradrugdoseiscalculatedor
approved.
1. SelectadrugfromthePharmacyOrderDetailwindow forexample,CWS,POL,PAL,
ChangeOrder,DID thathasadosethatwascalculated.
2. ClickRevision.MOSAIQopenstheOrderHistorywindow.
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31
IfselecteddrugisBSAdosebaseddrug,MOSAIQshowstheBSAformulatype,Ht,Wt
includesTypeofWt–forexample,IBWandsoon ,anddosebasis forexample,
adjusteddosebasis,ifavailable thatwereusedfordosecalculationandthedatethe
factorswereentered/calculated.
3. Reviewthedosecalculationfactors.
4. Closethewindow.
Viewing Dose Calculation Factors from CWS, MAR, and Dispense
Details
YoucanreviewdosecalculationfactorsfromCWS,MARandDispenseDetails.

FromtheSingleDayviewintheCWS,placeyourmousecursoroveradrugdosefor
adosecalculateddrug.

Ifsamedrughasmorethanoneinstancewithinaday,youneedtogotoDetailview
toseethedosecalculationfactorsforeachdruginstance.

MOSAIQshowsthedosecalculationfactors,dosebasis,adjusteddosebasisand
doseadjustmentreason,inahovermessage.

Themessagecloseswhenyoumovethemousecursorawayfromtheorderingdose.
Care Plans
TheCarePlanLibraryshowsdataincolumns.Youcanusethefiltercontrolstoseecare
plansbydepartmentandstatus.IntheCarePlandialogbox,youcanassignacareplanto
oneormoredepartments.Also,versioncontrolletsyoumonitorchangesanddisplay
historicalchanges.
Assigning a Care Plan to a Patient
Whenyouassignacareplantoapatient,theCarePlanLibraryinitiallyshowsonlythecare
plansthatareGLOBALandtheonesthathaveyourcurrentlyloggedindepartmentselected
ontheCarePlandialogbox.
Ifyouareinmultipledepartments,clickthedownarrowadjacenttotheDepartmentsfield
andselectyourdepartmentsfromthelist.
Voiding a Care Plan
YoucannotuseDeletefromtheOptionsmenutoremoveacareplanfromtheCarePlan
Library.
YoucanuseDeletefromtheOptionsmenuonlywhenyouselectaCarePlanItem.Thisstep
causestheCarePlanItemtoberemovedfromacareplan.
1. IntheCarePlanLibrarydialogbox,selectacareplan.
2. ClickStatus orselectStatusfromtheOptionsmenu .
3. IntheCarePlanStatusdialogbox,clickVoided.
4. Recordyourusernameandpassword.
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5. ClickOK.
Version Control
VersioncontrolletsyoucontrolthehistoricalversioningofcareplansintheCarePlan
Library.
ThefirsttimeyouchangethestatusofacareplanfromPendingtoApproved,thesystem
automaticallyassignsversion1toit.IfyouchangethestatusfromApprovedtoPendingand
makechangestothecareplan,andthenchangethestatustoApproved,thesystemshows
thismessage:“Wouldyouliketoincrementthenewcareplanversionnumber?”
IfyouclickNo,theversionnumberisnotchanged.Youcannotseethechangesmadefrom
theCarePlanLibrary.IfyouclickYes,theversionnumberisincreasedby1.Youcanseethe
changesmadebetweenthecurrentversionandthepreviousversionintheCarePlan
Library.
Toseethehistoricalversionsofcareplans,selecttheShowAllVersionscheckbox,orclick
theplussignonacareplan.Thesystemmakesarevisionandrecordsthechangeinthe
databaseeachtimeyouclickSave.
Allergies List
YoucanaddtheAllergiesandAlertspanetotheChartWorkspace.TheAllergiesandAlerts
paneshowsavisualindicatorforfoodallergies.Thisindicatorletsyouseeinteraction
checkingforpatientallergiesfromtheChartWorkspace/Allergiespane.Youcanrecordthat
apatienthasnoknownmedicationallergy NKDA ornoknownallergy NKA .Inaddition,
youcanaddadditionalallergyinformationintheMAR.
Accessing Allergies from MAR
AsidefromthestandardwaystoaccesstheAllergiesandAlertsdialogbox–fromthe
toolbar,filemenu,andchartworkspace–thedialogboxcanalsobeopenedfromtheMAR,
Orderswindow,CWS,andnavigator.Inthefirstthreeareas,clickingontheredexclamation
pointiconwillopentheAllergiesandAlertsdialogbox.Inthenavigator,justclickonthe
AllergiesandAlertssectionheader.
IntheMARwhenonlyonemedicationisbeingadministered,youaretakenstraighttothe
medicationallergyentryformforthecurrentlytreatedmedication.Ifthisisnotdesired,
simplycanceltheallergyinsertion.
Adding the Allergies and Alerts Pane to the Chart Workspace
TheAllergiesandAlertspaneshowsallallergiesandalertsassignedtoapatient.Youcan
addnewallergiesandalerts,andupdateexistingallergiesandalerts.Youcanalsoopenthe
AllergiesandAlertsfromtheOrdersandMARwindows.IntheMARwindow,whenyouadd
amedicationallergy,itisalsoaddedtotheAllergiestable.
1. ClicktheCharticonfromtheMOSAIQtoolbar.
2. AdjacenttotheAllergiesandAlertsboxesatthetopofthewindow,clicktheupside‐
downtriangletoopentheoptionsmenu.
3. ClickConfigureWorkspace.
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33
4. Fromthelist,clickanddragAllergiesandAlerttotheChartWorkspacearea.
Allergies and Alert Options
Table 11: Allergies and Alert Options
Option
Description
Filter
Showsorhidesthe AllergyTypeandStatuscheckboxes.
Add
Letsyouselecttheallergytypetoadd,letsyouspecifyNoKnown
DrugAllergies,andletsyouaddanalert.Clickthedownarrowtoadd
anewallergyandopentheAllergydialogbox.Afteryouaddan
allergy,theAllergiesandAlertspaneisupdated.
Change
OpenstheAllergydialogboxtoletyouchangeinformationaboutan
allergy.
Reconcile
Registersthereconciledevent.ThesystemrecordstheuserID,
timestamp,andthelistofallergies.Thesystemreconcilesonlythe
shownallergies.Ifdrugsarenotshownbecauseofaconfiguredfilter,
thoseallergiesarenotregisteredasreconciled.Youcanreconcileas
manytimesasneeded.EachtimeyouclickReconcile,thesystem
registersanewreconcileevent.
Screen
Screenspatientmedicationsbasedonactiveallergiesandperformsa
manualdrugscreen.
Inactivate
Inactivatesthecurrentselectedallergyoralert.Whenyouclick
Inactivate,theallergieschangetogreytext.
Void
Letsyouvoidtherecord.Whenyourespondtotheconfirmation
message,theselectedallergyoralertisvoided.Whenyouvoidan
allergy,thetextappearswithastrikethroughit.Youcannolonger
deleteallergyentries;instead,youvoidtherecord.
Reconcile Hx
OpenstheReconciliationHistorywindowto showthereconciliations
thathavebeencompletedforthepatient.
DRN Note
OpenstheDNRNotedialogbox.IfthepatientalreadyhasaDNRnote,
thebuttontextisshowninredtext.
No Known Allergies / No Know Medication Allergy
NKA NoKnownAllergies andNKDA NoKnownDrugAllergies arenotshowninthe
allergylist.
IfyouclickAdd|NKDAorAdd|NKA,acheckboxappearsadjacenttotheAddNKDAorAdd
NKAmenuoption,andthetext“NoKnownAllergies”or“NoKnownDrugAllergies”isshown
atbottomoftheAllergieslist.
YoucannotaddanNKDAallergytypeifanactiveMedicationallergyorAllergengroup
allergyexists.YoucannotaddanNKAallergytypeifanyactiveallergyexists.
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Drug Screening
Ifthedrug‐allergycheckoptionisconfiguredinDepartmentSetup,drug‐allergyinteraction
screenisautomaticallyperformedbetweenthenewdrugandtheactiveallergyitemin
medicationallergiesorallergengroup.
Reconciliation Window
Thiswindowshowsthereconciliationhistoryrecordsforthecurrentpatient.Whenyou
clicktheReconcileontheAllergiesandAlertspane,asinglereconcileinstanceissavedand
shownintheReconciliationwindow.
Youcanseeanyreconcileinstance.Clickthedownarrowandselectfromthelistof
reconciliationdateandtimestamps.Thedetailsofthereconciledrecords allallergiesand
alertsvisibleinthebrowse areshown.
Adding an Allergy Record
1. ClickAddtoselectanallergytypefromthelist.TheAllergywindowopens.
2. TypeadrugnameinAllergenfieldtosearchadrugfromthepicklist.
3. Selectareactionfromthelist.Youcanselectmorethanonereactionforanallergy
record
4. Selectaseverityfromthelist.
5. TypetheIDDateaspartialorcompletedate,orUnknown
6. Typecommentsforthisallergyentryasnecessary
7. ClickSave.
You can add NKA if no active allergies record exist. You can add NKDA if no
active medication allergies record or allergen group record exist.
You can also update existing allergies in the Allergies list by clicking the
Change button.
You can configure Reaction and Severity in Obs Definition table.
Changing the Status of Allergy Entries
Bydefault,thestatusofanallergyrecordisActive.
1. SelecttheitemfromthelistandclickInactiveorVoidtochangethestatus.
Youcannotdeleteanallergiesrecord.Youmustvoidtherecord.Theinactiveandvoided
itemsarenotscreenedbydrug/allergieschecking.
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35
Adding Alerts
Youcanaddasmanyalertsasyouneedtoapatientrecord.Thealerttypecanbedefinedin
theObservationDefinitiontable.Youcandirectlyaddaninlinealert.
1. ClickAddalertintheAlerttable,orclickAddthenselectAlert.
2. Selectthealerttypefromthelist.
3. Selectastatusfromthestatuslist.
4. Selectadate,orapartialdate,fromthecalendar.
5. TypecommentsintheCommentscolumnasnecessary.
6. ClickDNRNotetoaddaDNRnote.DNRnoteisviewablefromNoteswindow;youcan
appendtheDNRnotes.IfthealerttypeisDoNotResuscitate,MOSAIQshowsDNRinred
text.
Marking Allergies and Alerts List as Reconciled
1. ClickReconciletorecordareconciledevent.TheuserID,timestamp,listofallergies,and
alertshownisrecorded.Thelastreconciliationinformationisshownatthebottomof
thepane.
Only the allergies and alerts that are shown are reconciled. If allergies are
not shown because of a configured filter, those drugs are not recorded as
reconciled.
If the Allergies and Alerts table is empty, a reconciled event is still recorded.
MOSAIQ recognizes that an empty list was reconciled.
If only the summary row is visible, information for all rows is recorded when
reconciling.
Displaying the Reconciliation History
1. ClickReconciliationHx.TheReconciliationHistorywindowopens.
2. Selectareconciledeventfromthelist.
Thereconciledallergiesandalertslistforthateventisshown.
Displaying Allergy Reports
1. Right‐clicktoshowtheoptionsmenu.
2. SelectAllergyReporttoshowthereactionandstatus.
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Document Identifier
AccountnumberscanbeincludedinDocuments.
Configuring Document Options
1. ClickFile|SystemUtilities|DepartmentSetup.
2. ClicktheClinical General2 tab.
3. FromtheDocumentssection,whenyouclicktheEnableAccountDataforDocuments
checkbox,theDefaultAccountNumberifOnlyOneActivecheckboxisactivated.
Enable Account Data for
Documents
Selectthischeckboxtoaddanaccountfieldandentry
buttonontheEncounterformsforDocuments.
Default Account Number
if Only One Active
Selectthischeckboxtodefaulttheaccountnumberfor
Documents,whenonlyoneAccountnumberforthepatient
isactivefortheencounterdate
Document Account
Required
No ‐ Addinganaccountnumbertoadocumentisnot
requiredtoapprovethedocument.
Yes‐Addinganaccountnumbertoadocumentisrequired
toapprovethedocument.
Warning‐Addinganaccountnumbertoadocumentisnot
requiredtoapproveadocument,butawarningmessage
appearsat theapprovalprocesstoinformusersnoaccount
numberattached.
Calculating IBW/ABW
ThisversionofMOSAIQautomaticallycalculatestheIBWandABWbasedonapatient’s
heightandgender.
Configuring IBW/ABW
Thedepartmentsetupcannotbedifferentforanydepartment;thisisintendedtobea
databasesetupoption.Ifthisfeatureison,thesystemautomaticallycalculatesIBWand/or
ABWoncethecalculationfactors Ht,Gender aremetbyusingRobinsonformulas.
2. ClicktheClinical General tab.
3. ClicktheCalculateIBWandABWcheckbox.
Calculating Dose-Based on BSA from IBW or ABW
MOSAIQcalculatesandshowstheBSAsifcalculatedIBWandABWareinplacewhenthe
BSAConfirmationwindowopens.IfIBWand/orABWareavailable,MOSAIQcalculatesand
showstheBSAsbasedonIBW,andABW.
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1.
ClickUseBSAfromIBWandUseBSAfromABWtocalculatethedosebasedonthe
BSAfromIBWorBSAfromABW.
Calculating CrCl Using Cockroft-Gault Formula
Thenewcalculationalgorithmsare:

Removetheruletoinvalidatetheweightifitis 7days;validageofweightdepends
solelyonthevalidageinthedataitem.Therefore,definingthevalidageforWtin
ObservationDefinitiontableismandatory.

MOSAIQcalculatestheCrCl C‐G intheFlowsheettabandmakessurethedatefor
AdjustorIBW,ABW,realWtisearlierthanorequaltothedateofCreatinine.

MOSAIQalwayscalculatestheCrCl C‐G byusingAdjustorIBW manuallyentered
byuser ifitexistsandisvalid.

IfitisvalidAdjustorIBWdoesnotexist.MOSAIQcalculatestheCrCl C‐G byusing
calculatedABWifitexists.

IfbothAdjustorIBWandcalculatedABWdonotexist,MOSAIQcalculatesthe
CrCl C‐G byusingthemostrecentvalidrealWt iftheWtexists .

WhenAdjustorIBWandcalculatedABWarenotfound,andthemostrecentreal
Wt,MOSAIQshowsawarninganddoesnotcalculateCrCl C‐G .

ThecurrentpediatricruleforCrClcalculationstillapplies.
Modifying AUC Drug Dose by Changing the Calculated IBW and ABW
IntheDoseAdjustmentwindow,whenyouclickCockroft‐Gault.Wtlistopens.Thesetwo
optionsareaddedintheWtlist:IBWandABW.YoucanselectIBWorABWtorecalculate
CrCl C‐G .
Automatically Converting Ht and Wt
IfyouenterHt/Wtinmetricsystem,whenyoutabfromthefield,MOSAIQautomatically
convertsthemetricvaluetoanSIvalue,orviceversa.Inordertoseetheconversion,the
dataitemsforHt in ,Wt lb ,Ht cm ,andWt kg mustallbeconfiguredinsameviewas
Flowsheet.
BSA Calculation
TosupportmanyoncologysitesthatarerequiredtouseMostellerformulaforBSA
calculationandchemotherapydosagecalculation,MOSAIQsupportsMostellerformulafor
BSAcalculation.
MostellerFormula:BSA m² Height cm xWeight kg /3600 ½
Or,ininchesandpounds:BSA m² Height in xWeight lbs /3131 ½
Configuring BSA in Department Setup
WhenyouchoosetheMostelleroption,MOSAIQcalculatestheBSAbyusingtheMosteller
formulainallareasthatrequireaBSAcalculation.
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To configure BSA, you must have Admin | System Utilities | Clinical |
Modify security rights.
1. ClickFile|SystemUtilities|DepartmentSetuptoopentheDepartmentSetupwindow.
3. FromtheBSACalculationsection,chooseanoption:DuBoisandDuBoisorMosteller.
ThedefaultselectionisDuBoisandDuBois.
Calculating BSA Using Mosteller Formula in the Flowsheet Tab
ToseeBSAcalculationfromMostellerformula,youmustdothefollowing:

ConfigureBSAformulaasMostellerinDepartmentSetup.
 FromtheFlowsheettab,addBSA M dataitemtotheFlowsheetview.
TheBSAdataitemistwodataitemsinObservationDefinitiontable:
BSA D BSAvaluecalculatedfromDubois–Duboisformula
BSA M BSAvaluecalculatedfromMostellerformula
1. Aftertheconfigurationismade,entertheHt/Wtforapatient,andthenMOSAIQ
calculatestheBSAbasedontheMostellerformula.
CrCl Capping
IntheUSA,theFDArecommendsthatphysiciansconsidercappingthedoseofCarboplatin
fordesiredexposure AUC toavoidpotentialtoxicityduetooverdosing.Therefore,the
CarboplatindosecalculationfeaturewasenhancedtoletyoucaptheCrCltopreventa
potentialhigherthandesiredCarboplatindose.
To configure the Cap CrCl at 125mL/min for Carboplatin AUC Dose
Calculation, you must have Admin | Clinical Modify security rights.
Configuring CrCl
ToconfigureCrCl:
2. ClickClinical General tab.
3. ClicktheCapCrClat125mL/minforCarboplatinAUCDoseCalculationcheckbox.
Whenthischeckboxisclicked,andthepatienthasavalidCrCl 125ml/min,MOSAIQ
usesCrCl 125ml/mintocalculatetheCarboplatinDose.MOSAIQcalculatesthe
maximumCarboplatinDosebyusingthisformula:MaximumCarboplatinDose mg targetAUC mg min/mL x 150mL/min .
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When an AUC dose is calculated with the option to cap CrCl, indicators are
shown in the Pharmacy Order Detail window, the Dose Adjustment window,
and the Dispensing Details windows.
From the Pharmacy Order Detail window, the capped CrCl information is
shown next to the Calculated Dose field, and also when you hover over the
Ordering Dose field.
From the Dose Adjustment window, the capped CrCl information is shown
directly in the AUC section, and also when you hover over the Ordering Dose
field.
From the Dispensing Details window, the capped CrCl information is shown
when you hover over the Ordering Dose.
Common Problem Codes
TheCommonProblemCodeswindowliststhemostcommonlyusednon‐cancerdiagnoses
problems thatcanbeassignedtopatients thisisnotacomprehensivelistofall
problems .
You must have System Utilities | Clinical |Modify rights to see Common
Problem Codes listed in the menu.
Opening the Common Problem Codes Window
1. ClickFile|Libraries|CommonProblemCodes.
Eachproblemcodehasasequencenumberthatisusedasthedefaultorderofthe
problemcodes.Sequencenumbersareaddedtotheendofthelist.
2. ClickMoveUporMoveDowntomoveeachproblemcodeupordowninthelist.
Theproblemcodescanalsobeautomaticallysortedbyclickingonacolumn.Whenthis
isdone,theproblemsaresortedbythatcolumn,andthesequenceisregeneratedon
thatorder.
Adding a New Problem Code
1. IntheCommonProblemCodeswindow,clickAddorChangetoopentheDefine
CommonProblemwindow.
2. IntheProblemfield,typethediagnosistobedefinedasacommonproblem.
3. IntheShortDescriptionfield,typeadescriptionforthecommonproblem.
4. ClickOKtosavethenewcommonproblem.
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Assigning a Problem to a Patient
FromtheDiagnosesandProblemListwindow,youcanquicklyassignaproblemtoapatient.
1. OpentheDiagnosesandProblemsListwindow.
2. Right‐clicktoshowthecontextmenu.
3. ClickAddProblemtoopentheCommonProblemsCodeswindow.
4. ChooseaCode.
5. ClickSelecttoaddtheproblemtothePatientProblemswindow.
6. ClickOKtoreturntotheDiagnosesandProblemspane.
You can add multiple codes simultaneously by holding down the Ctrl key
while you click codes. To add a block of codes, click the first code in the
block, hold down the Shift key, scroll down and choose the last code in the
block. All codes in between are selected.
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Patient Problems Options
Table 12: Patient Problems Options
Option
Description
Type
ShowstheTypeofoptionsyoucanchoose.Clickthedownarrowto
showthelist.
Status Date
ClickinthefieldandtypeUnknown,adate,orpartialdate.
Alternatively,youcanclickthedownarrowtoopenthesystem
calendarandchoosethe datetheproblemwasstatused.
Status
Clickthedownarrowandchoosetheproblemstatus.
Syndromic
ClickthecheckboxiftheproblemisSyndromic.
Cause
Clickthedownarrowtoshowavailablecausestochoosefrom.
Notes
Thisisafreeformfieldwhereyoucanrecordyournotesforthe
problem.
Observation Definitions
YoucanlinkdataitemsinObservationDefinitions.Whenadataitemislinkedtoanother
dataitem,thedataitembeinglinkedactslikeachilddataitem.Thedataitemthechilddata
islinkedtoactsliketheparentdataitem.
Dataitemsthatareusedincalculations,suchasheight,weightandCreatininecanalsobe
linked.Valuesenteredunderlinkedchilddataitemstriggerandperformcalculationsthe
sameasiftheywereenteredastheoriginalsystemitem.
Linkeditemsappearastheparentiteminthefollowingplaces:Flowsheettab,LabResults
Worklist,VitalSignstab,MergeFields Documents ,DiagnosisandStaging diagnosis
specificvalues ,andPharmacyOrderDetails.Dataenteredasalinkedchildshowsthelabel
andunitsoftheparentdataitem.
AreasofMOSAIQthatrequirethemostrecentheight,weight,orCreatininealsoconsider
dataitemslinkedtothesesystemitems.Forexample,ifthereisadataitemlinkedtoweight,
locationsinMOSAIQthatshowthelatestweight,showthelatestvaluefromthesystemorits
linkedchild.ExampleswherethesecalculationsfactordataitemsareshownincludeBSA
ConfirmationWindow,MAR,andDoseAdjustmentwindow.
You must have Admin | System Utilities | General security rights to view and
edit data items. Data items are used to collect or show data entered by a user. To
designate a data item as a lab, you must click Lab in the Item Type section of the
Observation Item-Data dialog box.
Observation Definition Items Pane
Thepanes,ObservationDefinitionsItemsandViews,appearasdefaultswhenyoufirst
accessObservationDefinitions.DataItems,TableItems previouslyknownasTableTitles ,
MajorandMinorHeadings,andTableItemChoicescanbeadded.
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Youcanshowdefinedmajorandminorheadingnames.Theseheadingsappearasfoldersin
theFlowsheet/ClinicianWorksheetwindowascategorylabelsthatgroupindividualview
items.Unlikeviews,headingnamesasshownintheObservationDefinitionswindowarenot
associatedwithanyparticularviewortab.YouassignheadingnamestoaviewinChart
Builder.SeetheChartBuildersectionbelowandtheObservationChartBuildertopicfor
detailsaboutaddingindividualitemstoaview.
Toaddaheadingname,clickAddfromtheObservationDefinitionswindow,whichopens
theObservationFolderNamedialogbox.Youcanalsoselectaheadingnamefromthelist
andclickChangetoeditit,orclickDeletetodeletetheheadingname.
Views Pane
TheViewspaneshowsdifferentviewsinselectedtab.Forexample,theLaboratorytabmay
containseveralviews.ViewsareaccessedintheFlowsheettabfromtheViewlist.Eachtab
ontheFlowsheet/ClinicianWorksheetwindowcanhaveitsownsetofviews.
Toaddatabview,clickAddfromtheObservationDefinitionswindow,whichdisplaysthe
ObservationViewdialogbox.YoucanalsoselectaviewfromthelistandclickChangetoedit
it,orclickDeletetodeletetheview.
Youcansetupuserdefinedfieldstouseduringmedicationadministrationtotrackpatient
verificationactions.FromObservationDefinitions,addtheDataand/orTableItemsasyou
wouldforanyAssessmentView.Forverifyingamedicationadministration,setuptheFive
Rightsofmedicationadmin:patientverified,drug,dose,route,dateorotherdata.Three
ApplicationViewsareincluded:DiagnosisandStagingView,EligibilityView,andMARView.
YoucannotaddnewApplicationViewsordeletethethree,butyoucanchangetheirlabel
namesandedittheirchartitems.Youcanonlyhaveoneviewforalldepartmentsforeach
view.
Tabs Pane
TheTabspaneshowstheflowsheettabsdefinedinsystem.Therearefivetabsbydefault:
Flowsheet,ClinicianWorksheet,Laboratory,VitalSigns,Assessment,andGraphs.
Observation Definitions Mapping
Beforeyoumapacodetoaspecificdataitemortableitem,youmustcreateamapping
definition.Themappingdefinitioncontrolsthetypesofcodesthatcanbesavedagainstthe
dataitemortableitem.Thisenforcesrulesthatgoverntheuniquenessandnumberof
mappingcodesthatareallowed.
Adding a Tab to the Flowsheet
YoucanaddatabtotheFlowsheetwindow.
1. GotoFile|SystemUtilities|ObservationDefinitions…|ChartViewsandItemstoopen
theSystemMaintenanceworkspace.
2. IntheTabspane,clickAddTabtoopenthe NewTab dialogbox.
3. Typethelabelanddescriptionofthenewtab.
4. PutacheckintheMakeTabcheckbox.
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43
TosetupatabbutnotshowitintheFlowsheetwindow,donotputacheckintheMake
Tabcheckbox.
5. CloseMOSAIQandopenitagainforthenewtabstoappearinMOSAIQ.
Deleting a Flowsheet Tab
1. IntheTabspane,selectthetabinthetabletodelete.
You cannot delete the standard five tabs: Vital Signs, Flowsheet, Laboratory,
Graphs, and Clinician Worksheet.
2. ClicktheDeletebuttontodeletetabselectedinthetable.
3. CloseMOSAIQandopenitagainforthetabtonotappearintheClinicianWorksheet.
Adding a Major/Minor Heading to the Flowsheet window
2. IntheObservationDefinitionItempane,clickAdd...|HeadingtoopentheHeading New
Heading dialogbox.
3. Typethelabelanddescriptionofthenewheading.
4. Selectthenewheadingasmajororminor.
5. ClickSavetosavethenewheadingandclosethedialogbox.Thenewheadingappearsin
thegrid.
Changing a Major/Minor Folder in the Flowsheet window
1. Clicktheheadingtochange,thenclickEdittoopentheHeadingActivitydialogbox.
2. Changethefieldsasnecessary.
3. ClickSavetosavetheheadingandclosethedialogbox.
Deleting a Major/Minor Folder from the Flowsheet window
1. Clicktheheadingtochange,thenclickDeletetoopentheHeadingActivitydialogbox.
2. ClickOKtodeletetheheadingandclosethedialogbox.
Theheadingnolongerappearsinthegrid.
Adding a Tab View to the Flowsheet window
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2. IntheViewspane,clickAddNewTabViewtoopentheTabView NewTabView dialog
box.
3. TypethelabelanddescriptionofthenewTabView.
4. SelectwhichtabtheTabViewshouldappearon.
5. ClickSavetosavethenewTabViewandclosetheTabView NewTabView dialogbox.
Cloning a Table Item/Tab View
IntheSystemMaintenanceworkspaceyoucannowcopy clone tableselectionsbetween
tableitems ontheObservationDefinitionItemspane andviewitemsbetweenviews on
theViewspane .
2. IntheObservationDefinitionItemspaneorTabViewspane,double‐clickatable
item/tabviewtoopentheTableItemdialogbox/TabViewdialogbox.
3. ClickClonetoopentheCloneTableChoicesdialogbox/CloneViewItemsdialogbox.
4. Clickthedropdownlistandselectthetableitem/tabview,thenclickOKtoselectthe
tableitem/viewandclosethedialogbox.
5. ClickSavetoclosetheCloneTableChoicesdialogbox/CloneViewItemsdialogbox.
6. Clicktheplussignofthetableitem/tabviewfromstep2toshowthechoices.
Theclonedchoicesfromstep4appearandareaddedtothevalues.
YoucanalsocloneaTableItem/TabViewwithdraganddrop.
1. Clickatableitem/tabviewtocloneanddragittothetableitem/tabviewtoaddthe
values.
AQuestionboxopenstoconfirm.
2. ClickYestoaddtheclonedvaluestothetableitem/tabview.
Setting Table Items, Data Items, and Table Item Choices to Active/Not
Active
Youcansettableitems,dataitems,andtableitemchoicestoappearornotappearinthe
flowsheets/assessmentviews.
Whenadataitemoratableitemisnotsettoactive,itdoesnotappearasafieldinthe
flowsheet.Whenatableitemchoiceisnotsettoactive,itdoesnotappearinthelistboxin
theflowsheet,preferredornot.Datafieldswithdatabutnotsettoactiveappearinthe
assessmentbuthave inactive nexttothefieldlabel.Also,datafieldswithnodataaregrey.
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2. IntheObservationDefinitionItemspane,double‐clickadataitem/tableitemtoopen
theDataItem/TableItemdialogbox.
3. UsetheActivecheckboxtosetthedataitem/tableItemtoActive/NotActive.
4. ClickSave.
Setting Table Items, Data Items, and Table Item Choices to
Preferred/Not Preferred
2. IntheObservationDefinitionItems,expandatableitemtoshowtheassociatedtable
itemchoices.
3. Double‐clickachoicetoopentheTableItemChoicedialogbox.
4. UsethePreferredcheckboxtosetthedataitem/tableItemtoPreferred/NotPreferred.
5. ClickSave.
Linking System Data/Table Items
1. ClickFile|SystemUtilities|ObservationDefinitions|ChartViewsandItemstoopenthe
SystemMaintenanceworkspace.
2. IntheObservationDefinitionItemspane,selecttheDataItemthatyouwanttolinkto
anotherDataItem.
2. YoucanaddanewDataItem,oryoucanchangeanexistingDataItem.ChooseaData
Item,thenclickEdit ordouble‐click toopentheDataItemdialogbox.
3. TolinkthisDataItemtoanotherDataItem,clickthedownarrownexttotheLinkedTo:
field.ThelistshowsallotherDataItemassociatedwiththeselectedtable.
Whenyoulinkdataitems,thisspecifiesthatthechilddataitem theonemarkedas
linked hasthesameclinicalmeaningastheparentdataitemitislinkedto thedata
itemchosenfromtheLinkedTodropdownlist .Dataenteredasbelongingtothechild
dataitemappearsasifthedatawasenteredasbelongingtotheparentdataitemonthe
flowsheet.Thedataalsoappearsasbelongingtothechilddataitemontheflowsheet.It
isrecommendedthatyouonlyhaveonelinkeddataitemonaflowsheetview.Data
enteredastheparentdataitemdoesnotappearasachilddataitemvalueonthe
flowsheet.
Data items cannot be linked if the data types do not match. Text data items
cannot be linked to number data items. If data items have different units
(unless the two units are linked together in table item linking) MOSAIQ
prompts a warning message. A data item cannot be linked to a data item that
is linked to another data item. For example, a parent linked data item cannot
be linked as a child data item). However, more than one child data item can
be linked to the same parent data item.
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Mapping Multiple Code Types to a Data/Table Item
Beforeyoumapacodetoaspecificdataitemortableitem,youmustcreateamapping
definition.Themappingdefinitioncontrolsthetypesofcodesthatcanbesavedagainstthe
dataitemortableitem.Thisenforcesrulesthatgoverntheuniquenessandnumberof
mappingcodesthatareallowed.
MappingCodescanbeaddedtospecificdataitemsortableitems.Mappingcodescanonly
beaddedifatleastonemappingdefinitionexistsfordataitemsorthespecifictabletitle.
1. SelecttheObservationDefinitionMappingspane.
2. ClickAddTypeandthenclickeitherData/TableItemMappingorTableChoiceMapping
fromthedropdownmenu.TheObservationMappingDefinitiondialogboxopens.
3. EnteranameintheNamefield.
4. Selectacardinalitysetting seeCardinalitybelow .
5. EnteracodesystemOID.
6.
ForTableItemChoicesonly IntheMappingTypeforTabledropdownlist,selectthe
tableforwhichyouwanttomapchoices.
Table 13: Observation Definitions Mapping Configuration
Field
Description
Name
Type thenameofthemappingdefinition.
Cardinality
Showsthetypeofrulethatcontrolsthetypesofmappingcodesentered.
Thisis disabledifyouclickedChangeontheObservationDefinitions
MappingConfigurationwindow. SeeCardinalityRulesbelow.
Code System
OID
UniversaluniqueIDforacodingsystem.
Mapping
Type for
Table
Selectthetableyouwanttomapchoicesfor.ThisisusedwithTable
Choiceonly.
Populate
Codes From
Limitstheoptionsforcodevalue enteredforthismappingtype tothe
choicesoftheselectedtable.Thisfieldisoptional.Ifacodeisnot
selected,thecodevaluesarefreetext.
Description
Typethedescriptionofthemappingdefinition.
Cardinality Rules
CardinalityRulesgovernthetypesofcodesthatcanbeenteredagainstadataitemortable
item.TherearethreetypesofCardinalityrules.
Table 14: Cardinality Rules
Rule
Description
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Single Unique
Mapping codes
Thedataortableitemcanonlyhaveonemappingcodeenteredunder
themappingdefinitionandthatmappingcodemustbeuniqueacrossall
dataitemsorall tableitemsforthegiventable.
Multi Unique
Mapping Codes
Thedataortableitemcanhavemultiplemappingcodesenteredunder
themappingdefinitionaslongasthemappingcodesareuniqueacross
alldataitemsoralltableitemsforthegiventable.
Single Nonunique Mapping
Codes
Thedataortableitemcanonlyhaveonemappingcodeenteredunder
themappingdefinitionbutitcanbeanycodeandisnotlimitedbyany
uniquenesschecks youcanhavethesamecodeonmultipledataor
tableitems .
Observation View Import
Table 15: Observation View Import Fields
Field
Description
Match
AutoUpdate:systemfindsamatch.
ManualUpdate:userfindsamatch.
Undecided:systemcouldnotfindatablematch,buttherecanbe
possibleduplicaterecords.
Multi Unique
Mapping Codes
Thedataortableitemcanhavemultiplemappingcodesentered
underthemappingdefinitionaslongasthemappingcodesare
uniqueacrossalldataitemsoralltableitemsforthegiventable.
Option Buttons
Table 16: Observation View Import Option Buttons
Button
Description
Insert as New
Addstheitemasanewitem newrecordinthedatabase .Thisoption
isavailableonlywhentheimportfileandthedatabasehavedifferent
uniqueIDs.
Use Existing Item
Usetheuser‐selecteditemfromthedatabaseforviewupdate.The
sameitemintheimportfileisnotimported.
Update Selected
Item
Updatestheuser‐selecteditemwiththeinformationintheimportfile.
Flowsheet Window
Whenyouopenatableitemlist,youcanright‐clickinthelisttoshowallitemsoronly
preferreditems.
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eScribe Inactive Assessment Views and Items
Awarningmessageappearswhenyoutrytosetanassessmenttonotactive,andthe
assessmentisinanIQScriptpreference.
Example
1. PuttheHeight cm mergefieldinaneScribedocument,thensavethedocument.
3. InObservationDefinitions,settheHeight cm tonotactive,andclickSave.
ANotificationWarningmessageopens.
4. ClickNo.
Result
TheNotificationWarningmessagegivesyouawarningthatthefieldisusedinadocument.
Youcanstoptheprocedureorcontinuetosetthedatafieldasnotactive.Themessagealso
appearsifyoutrytosetadataviewthathasanitemthatisnotsettoactive.Theinactive
mergefieldcontinuestoappearintheeScribedocumentaftertheitemisnotsettoactive.
Pharmacy Order Unique Number
MOSAIQcreatesauniquenumber acrossalldatabases foreachpharmacyorder.This
uniquenumberisacombinationoftheDepartmentAbbreviationandtheordernumber.You
canseetheuniquenumber UN fromtheDispensingDetailswindow,theMAR,and
PharmacyOrderHistoryMedicationAdministration.
Unique Number from the Dispensing Details Window
1. OpenthePharmacyWorkspace.
2. FromthePharmacyDispensingList,chooseapharmacyordertoopentheDispensing
Detailwindowwithallinformation,includingtheuniquebatchnumber,whichisshown
abovethePatientInformationsection.
Unique Number from the MAR
1. SelectanorderfromtheSelectOrderstobeTreatedwindow.MOSAIQopenstheMAR
dialogbox.
2. Whenyoupositionyourmousepointerontheboxnexttothedrugname,aboxpopsup
andshowstheuniquenumber UN .
Unique Number from Order History
TheuniquenumberisshownatthetopoftheOrderHistorywindownexttothepatient
name.
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Dose Adjustments
ThepercentadjustmentbuttonsontheDoseAdjustmentwindowreflectcommonusages:‐
10%,‐15%,‐20%,‐25%,‐30%and‐50%.Abuttontoresetto100%doseisavailable.
Theorderingdosecanbeadjustedbyavaluenotrepresentedbythequickbuttons,by
typinginavalueandclickingtheManualPctbutton.Forexample,ifyoutype125,thenclick
ManualPct,theorderingdoseisupdatedto25%morethanbefore.
Also,toadjusttheorderingdosedirectly,clickthe%buttons.Forexample,click‐20%and
theorderingdoseisreducedby20%.
Theresetto100%doseupdatestheorderingdosetothedosebasisxBSA,AUC,Wtusedto
calculate.Forexample,ifyouclickResetto100%,thedoseupdates/returnstheordering
basedonthecalculationfactorandthedosebasis.
Crystal Report Version and Runtime Engine
MOSAIQusesthelatestversionofCrystalReports SAPCrystalReports2011 .Ifyoursite
wouldliketoeditMOSAIQ’sembeddedCrystalReports,and/orruncustomCrystalReports
throughMOSAIQ,youmustsavethereportfiles *.rpt usingCrystalReports2011.
IQ Script (Only Examples)
IQScriptscanbetranslated.
ThefollowingIQScriptsareonlyExamples.
Observation Order: Create Assessment by Procedure
Anassessmentcanbepresentedtoauserinacustomizedlayoutwhileapprovingan
ObservationOrder.
Example
PresentMRIrequisitionquestionnairewhenapprovingallMRIorderstoensurenecessary
informationtoprocessorderisobtainedasefficientlyaspossible.
Howtocreateapreference:
1. SetAssessmenttopresentandsettoautomaticallystatusasreviewed,ifappropriate.
2. Applytoall,none,orspecificCarePlan s ,includingorexcludingadhocorders.
3. ChoosetheObservationorder s /procedurethatgeneratestheassessment,andifany
orallproceduresneedtobepresent.
4. Selecttheusersandpatientsthisappliesto.
5. AssignthesavedpreferencetotheapprovedObservationOrder.
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Result
WhenanyidentifiedMRIobservationordersareapproved,theMRIRequisitionassessment
formispresentedforcompletion.ApprovalcanbethroughQuickOrders,fromCarePlan,or
OrderSets.
Aftertheassessmentiscomplete,theassessmentfunctionsthesameasanassessment
enteredthroughthestandardflowsheetfunctions.AnAssessmentbuttononthe
ObservationOrderswindowprovidesalinktotheAssessment.
ThisbuttonalsoallowsyoutomodifyassessmentsinanUnreviewedorPendingstatus.If
youclickCancelontheassessment whenitisfirstopenedfromtheIQScript ,thenyoucan
clickAssessmenttoaddtheassessmentdata.TheAssessmentbuttonisdisabledifthereis
noassessmentassociatedwiththatorder.
AnyassessmentwithaReviewedstatusisReadOnly.IftheIQScriptsconfigurationissetto
markanassessmentasReviewedautomatically,theassessmentisReadOnly.
AnassessmentcanbedeletedfromtheFlowsheetandtheMergeFieldViewer.An
assessmentcanbevoidedfromtheFlowsheet,theAssessmentdialogbox,andtheMerge
FieldViewer.Ifanassessmentassociatedwithanorderisdeletedorvoided,theassessment
dissociatesfromtheorder.
OnlyuserswithOrderViewrightshaveaccesstoandcanenterinformationintothe
assessmentwithoutchangingthereviewstatus.Theusermusthavesecurityrightstoenter
assessmentinformation.
Observation Order: Create QCL by Procedure
AQCLcanbegeneratedwhenanobservationorderisapproved.
Example
AsignedinusergeneratesaQCL,duetoday,forthefinancialcounselorlocationtoobtain
authorizationwhenanyMRIorderisapproved.TheQCLisnotautomaticallymarked
complete,anddoesnotcreateaduplicate,ifonealreadyexists.Thisgeneratesiftheorderis
partofanyCarePlanoranadhocorder.Thisappliestoallpatientsandallusers.Thissaves
youtheeffortofcreatingtheQCL,andensuresthatthefinancialstaffisawareofthetask.
1. SetbaseduedateasToday,ororderdateandaddnumberofdays/weeks,asrequired.
2. ChosetheQCLproceduretogenerate.
3. ChooseoptiontoassignBillableCode/GrouptoQCL.
4. ProvidenameforResponsible/RequestingStaff.Thiscanbeaspecificuser,location,
activeuser*,orderingorattendingphysician.
5. QCLcommentcanshowtheprocedurethatproduceditoraspecificcomment.
6. ApplytoAll,Noneorspecificcareplan s ,including/excludingadhocorders.
7. ChosetheUsers/Patientsthisappliesto.
8. Selecttheobservationorder s /proceduretogeneratetheassessment,andifany/all
proceduresneedtobepresent.
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Some values, such as Active User, Ordering Physician, and Attending Physician
can only be selected from the Select Value button.
9. AssignthesavedpreferencetoanApprovedObservationOrder.
Result
AQCLisgeneratedwhenanyoftheselectedMRIproceduresareapproved.
As in the examples of MRI used here, one order can trigger multiple IQ Script
activities.
Quality Checklist: Create Assessment by QCL Procedure
AnassessmentcanbepresentedtotheuserinacustomizedlayoutwhenaQCLiscompleted
orskipped .
Example
PresentthenursingphoneassessmentwhencompletingCallpatientforsymptomsQCL–
streamliningthestepsnecessarytoobtainthoroughdocumentation.
1. Chosetheassessmenttopresent,withoptiontoautomaticallymarkasreviewed,as
appropriate.
2. ChosetheQCL s togenerate.
4. AssignthesavedpreferencetoQCLcompleted.
Result
WhentheQCLismarkedcomplete,theassessmentispresentedtotheuserinthe
customizedformat.
Any assessment view can be used. The staff can easily enter the appropriate
documentation while completing a QCL task.
Quality Checklist: Create QCL by QCL Procedure
AQCLcanbegeneratedwhenaQCLiscompleted orskipped .
Example
AutomaticallyassignthenextQCLtaskintheprocess‐Contour:PhysicianwhenContour:
DosimetryQCLiscompleted.
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1. Setbaseduedateastoday,ororderdateandaddnumberofdays/weeks,asrequired.
2. ChosetheQCLproceduretogenerate.
3. Assignbillablecode/grouptoQCL.
4. ProvidenameforResponsible/RequestingStaff.Thiscanbeaspecificuser,location,
activeuser*,orderingorattendingphysician.
5. QCLcommentcanshowtheprocedurethatproduceditoraspecificcomment.
7. ChosewhichQCLwillgeneratethenextQCL.
8. AssignthesavedpreferencetoapprovedQCL.
Result
ThecompletionoftheContour‐DosimetryQCLautomaticallygeneratesaContour‐Physician
QCL.
In a different scenario, you may want to assign a script to QCL Skipped to ensure an
appropriate reminder/notification is generated.
Pharmacy Order: Alert on Observation Value (Text, Numerical, Check
Box, Date, Table)
Thevalue orlackthereof ofanobservationcantriggeranalerttoauserwhileapprovinga
pharmacyorder.Theuserhastheoptiontocancelorproceedwiththeorderapproval.
Thereareseparatescriptsforeachdatatype–numeric,table,andcheckbox.
Example
ChemodrugshavedoseadjustmentrecommendationsbasedonseveralANCranges.For
example,ifANC 1250/mm3givefulldose,ifANC 750/mm3, 1250/mm3,reduceby
60%andifANC 750/mm3,holddose.Usingtwoscriptsthescenariocanbecovered,the
alertscanbecustomizedtoapplytospecificdrugsandeveninspecificcareplans.
Howtocreatetwopreferences:
1. Chosetheobservationvaluetomonitor.Youcanusethedataitemsvalidage,orseta
specialonewiththepreference.
2. SelecttheUpper/LowerLimit–youcansetonlyoneoflowerorupper,asnecessary.
3. Selecttheoptiontohaveanalerttriggeredwhen:valueiswithinlimits,notwithin
limits,and/orvalueisnotfound.
4. Typethemessagethatshouldappearwhenthealertistriggered.
5. Chosethedrugstoapply,andifapplicable,incontextofcareplan,withorwithoutad
hocorders.
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53
You can copy and edit a preference to save entry steps.
Thesecondpreferencehasnolowerlimit.Anythingunder750triggersanalert.
7. AttachbothpreferencestoApprovedPharmacyOrder.
Result for ANC of 800
IfYesisselected,theorderisApproved.IfNoisselected,theuserisreturnedtotherecord
statuswindowandcancancelorchangestatustoHold,asappropriate.
Observation Order: Alert on Observation Value (Text, Numerical,
Check Box, Date, Table)
Thevalue orlackthereof ofanobservationcantriggeranalerttoauserwhileapproving
anobservationorder.Theuserhastheoptiontocancelorproceedingwiththeorder
approval.ThebasicfunctionalityisthesameasDrugOrder:AlertonObservationValue,with
theexceptionthatitappliestoObservationOrdersratherthantoDrugOrders.
Observation Data: Create Document by Observation Value
YoucanaddaneSCRIBEdocumentwithtemplates/mergefieldswhenyouaddorreview
ObservationDataandwhenanexternalinterfaceimportsobservationdata.
Example
WhenyouaddanobservationwithWBC,anewpendingdocumentusingtheBreast
InformationtemplateopensinMSWord.
Howtoaddapreference:
1. SelecttheEncounterParameters,specificallytheBreastInformationtemplate.
2. Selectalldiagnoses,views,codes,users,andpatients.SelectWBCastheDataItemwith
Thresholds.
3. SelecttheBehaviortoCreateDocumentifDuplicateExistsandtoOpenDocumentAfter
Creation.
4. SelectPendingforDocumentStatus.
5. Assigntheabovescriptpreferencestotheassignmentpoint,ObservationDataCreated.
Result
AnewdocumentusingtheBreastInformationtemplateopensinMSWordwithmerged
fieldsandisreadyforediting.
Observation Order: Create Document by Procedure
YoucanaddaneSCRIBEdocumentwithtemplates/mergefieldswhenyouapprovean
observationorder.
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Example
WhenyouchangetherecordstatusofaneCHARTordertoApprove,anewpending
documentusingtheBreastInformationtemplateopensinMSWord.
2. Selectalldiagnoses,views,codes,users,andpatients.
3. SelectInfusion1HourandInfusion1.5astheProcedures.
4. SelectOrdercontainsanyflaggeddrugsforCreateDocumentCondition.
5. SelecttheBehaviortoCreateDocumentifDuplicateExistsanddonotOpenDocument
AfterCreation.
7. Assigntheabovescriptpreferencestotheassignmentpoint,OrderApproved.
Result
WhenyouchangetherecordstatusofaneCHARTorderwithaninfusionofonehouror1.5
hourstoApprove,anewpendingdocumentusingtheBreastInformationtemplateisadded.
Pharmacy Order: Create Document by Drug
YoucanaddaneSCRIBEdocumentwithtemplates/mergefieldswhenyouapprovea
PharmacyOrder.
Example
WhenyouaddanorderforDexamethasoneIV DecadronIV orDexamethasonePO a
DecadronPO ,anewpendingdocumentusingtheBreastInformationtemplateisadded.
3. SelectDexamethasoneIV DecadronIV andDexamethasonePO aDecadronPO asthe
Drugs.
4. SelectanOrderthatcontainsanyflaggeddrugsforCreateDocumentCondition.
5. SelecttheBehaviortoCreateDocumentifDuplicateExistsandtoOpenDocumentAfter
Creation.
7. Assigntheabovescriptpreferencestotheassignmentpoint,OrderApproved.
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55
Result
WhenyouapprovetheorderstatusofapharmacyorderofDexamethasoneIV Decadron
IV orDexamethasonePO aDecadronPO ,anewpendingdocumentusingtheBreast
Informationtemplateisadded.
Schedule: Create Document by Appointment Activity
YoucanaddaneSCRIBEdocumentwithtemplates/mergefieldswhenyouqueueapatient
foranappointment.
Example
Whenyouqueueapatientforanappointmenttoreceiveinfusion1hourorinfusion1.5,a
newpendingdocumentusingtheBreastInformationtemplateisadded.
3. SelectInfusion1HourandInfusion1.5astheScheduleActivity.
4. SelecttheBehaviortonotCreateDocumentifDuplicateExistsnortoOpenDocument
AfterCreation.
6. Assigntheabovescriptpreferencestotheassignmentpoint,PatientQueued.
Result
Selectanappointmentforapatienttoreceiveinfusion1hourorinfusion1.5.Whenyou
queuethepatient,anewpendingdocumentusingtheBreastInformationtemplateisadded.
Document: Merge Inbound Document
Whenanexternalinterfaceimportsadocumentinthedatabase,MOSAIQautomatically
replacesitwithaneSCRIBEdocument.
Example
1. Inacurrenttemplate,addthe InterfaceRTF‐merge mergefield.
2. IntheIQEngineConfiguration:
A. Selectthetemplatefromstep1above.
B. Selectalldocumenttypes,diagnoses,codes,usersandpatients.
C. Assigntheabovescriptpreferencestotheassignmentpoint,InboundDocument.
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LUGMSQ0010/4.0/24-Jun-2014
Result
WhenanexternalinterfaceimportsanRTFdocument,MOSAIQreplacesitwithanewly
addedeSCRIBEdocumentinthebackground.IthasthecontentsofthetemplateandtheRTF
documentandthemergedfieldsareaddedintothetemplateandtheRTFdocument.Youcan
seethedocumentwhenyougototheDocumentspaneandbrowsetothedocument.
Charge: Create Document by Code Capture
YoucanaddaneSCRIBEdocumentwithtemplates/mergefieldswhenyoucaptureacode.
Example
WhenyoudoacodecaptureforDexamethasoneIV1mg,anewpendingdocumentusingthe
BreastInformationtemplateisadded.
3. SelectDexamethasoneIV1mgastheCode.
4. SelecttheBehaviortoCreateDocumentifDuplicateExistsanddonotOpenDocument
AfterCreation.
5. SelectPendingfortheDocumentStatus.
6. Assigntheabovescriptpreferencestotheassignmentpoint,CodeCapture.
Result
IntheMulti‐CodeCapturedialogbox,selectDexamethasoneIV1mginthe
Procedures/Suppliesfield.WhenyouclickCapture,anewpendingdocumentusingthe
BreastInformationtemplateisadded.
Medication Administration
UsetheMedicationAdministrationtorecordthedetailsofamedicationadministration
sessionsuchasDose,Route,andDate.Youcanalsopreventusersfrommakingsometypes
ofchangesintheMAR.
Configuring MAR Attributes in Department Setup
UsetheClinical General tabinDepartmentSetuptoconfiguresettingsfortheLockDown
Route,LockDownStartDateandStopDate,LimitAdministeredDosetoOrderedDoseor
Lessfields.YoumakechangestothesefieldsintheMARdialogbox.
1. ClickFile|SystemUtilities|DepartmentSetuptoopentheDepartmentSetup.
3. IntheMARAttributesgroup,selecttheapplicablecheckboxes:
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57

SelectLockDownRoutetopreventchangestotheRouteinformation.Ifthischeck
boxisselectedandyoutrytochangetheRoutefieldintheMARdialogbox,a
messagetellsyouthattheRouteislocked.

SelectLockDownStartDateandStopDatetopreventchangestothesefields.Ifthis
checkboxisselectedandyoutrytochangethesefieldsintheMARdialogbox,a
messagetellsyouthattheStart/StopDatefieldsarelocked.

SelectLimitAdministeredDosetoOrderedDoseorLesstopreventthe
AdministeredDosetobechangedtoavaluethatismorethantheOrderedDosein
theMAR.IfthischeckboxisselectedandyoutrytochangethefieldntheMAR
dialogbox,amessageletsyouknowthattheAdministeredDosecannotbemore
thantheOrderedDose.
Increase Cycle Day Length
UsetheCarePlandialogboxtomakespecificationsforaCarePlan.TheCarePlanCycleDay
Length days fieldincludes366daysforMedicalOncologyCarePlans.Thesespecifications
appearwhenyouassignaCarePlantoapatient.
1. ClickFile|SystemUtilities|CarePlanAuthoring|CarePlanLibrarytoopentheCare
PlanLibrary.
2. ClickAddCarePlantomakeanewcareplan,orclickChangetochangetheselectedcare
plan.TheCarePlanopens.
3. Foranewcareplan,typeanameintheCarePlanNamefield.
4. PressTabonyourkeyboarduntilyougettotheTyp.Cycles/Length days field.
5. Typeadaylengthfrom1–366.
If you type a number greater than 366 (for example 400), you receive an
information message. Click OK, and system changes the number to 366.
Thenumberofdaysyourecordinstep5setsthenumberoftabswithcheckboxesthat
appearintheCarePlanItemdialogbox.Therecanbeamaximumof4tabsforall366
cycledays.
58

Tab1hasa“Day1‐90”label onlywhenaCarePlanhasover90cycledays .Ifthe
CarePlanhaslessthan90cycledays,Tab1hasa“Day1‐x”label wherexisthe
numberofcycledays .

Tab2appearsonlywhentheCarePlanhasmorethan90cycledays.Tab2hasa
“Day91‐180”labeliftheCarePlanhasover180cycledays.IftheCarePlanhasless
than180cycledays,Tab2hasa“Day91‐x”label wherexisthenumberofcycle
days .

Tab3appearsonlywhentheCarePlanhasmorethan180cycledays.Tabhasa
“Day181‐270”labeliftheCarePlanhasover270cycledays.IftheCarePlanhas
lessthan280cycledays,Tabhasa“Day181‐x”label wherexisthenumberofcycle
days .

Tab4appearsonlywhentheCarePlanhasmorethan270cycledays.Tab4hasa
“Day271‐366”labeliftheCarePlanhas366cycledays.IftheCarePlanhasless
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than366cycledays,Tab4hasa“Day271‐x”label wherexisthenumberofcycle
days .
Because the number of cycle days for Radiation Care Plans is not user
defined, the new default number of cycle days is 366 days. For Radiation Care
Plans, four tabs are shown with the labels “Day 1-90”, “Day 91-180”, “Day
181-270”, and “Day 271-366”.
TheCycle/DayfortheCarePlanisalsoshownontheClinicianWorksheet.
Body Mass Index (BMI) in Observation Definitions
ObservationDefinitionscomponentsintheSystemMaintenanceworkspaceareusedto
configureandbuildinformationalviews.Viewsprovidecustomizedpatientassessment
charts,laboratorycharts,andvitalsigncharts.Add,edit,anddeletesuchobservationviews
usingtheObservationDefinitionsFilterwindow.
TheBodyMassIndexautomaticallycalculatesthebodymassindex BMI basedona
patient’sheightandweight.TheBMIiscalculatedeverytimeapatient’sheightorweightis
changed,oranewoneisentered.TheBMIiscalculatedeveniftheBMIitemisnotvisibleon
thescreen.ButaddbothdataitemstoyourVitalSignsview.Theformulausedtocalculate
theBMIis:BMI weightinkilograms kg / Height m 2 .
TheMOSAIQsystemsupportstwoBMItypes:

BMI P forpediatricpatients’agerangebetween2and20years

BMI A foradultpatients’olderthan20yearsold
You must add the BMI (A/P) in the Observation Definitions | Chart Builder
window to your current Vital Signs view.
Adding BMI (A/P) in Observation Definitions
1. ClickFile|SystemUtilities|ObservationDefinitions|ChartViewsandItemstoopenthe
SystemMaintenanceworkspace.
2. SelecttheViewspane.
3. ShowthefiltersandselectVitalSignsintheTabfield.
4. SelectVitalsignsinthegridandtheclicktheEditChartItemsbutton,orright‐clickand
selectEditChartItemsfromthemenu.ChartBuilderopens.
5. IntheAvailableChartItemspane right ,selecttheDataItemfilterandthenclickthe
topoftheLabelcolumntoorderthelistalphabeticallybylabel.
6. SelectBMI A intheAvailableChartItemspaneanddragittotheCurrentChartItems
forView‘VitalSigns’paneontheleft.
7. AlsodragBMI P fromtheAvailableChartItemspanetotheCurrentChartItemsfor
View‘VitalSigns’pane.
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59
7. ClickSavetocloseChartBuilder.
If you manually add a BMI value, a warning message appears. The message
text is “BMI values cannot be manually added or changed.”
If the patient’s birth date is not registered, a warning message appears. The
message text is “Patient DOB is not entered. No BMI is calculated.” The BMI
data item must be visible on the screen.
If the patient is less than 2 years old, a warning message appears. The
message text is “Patient is under 2 years old. No BMI is calculated.” The BMI
data item must be visible on the screen.
BMI AorP isaddedtotheVitalSignswindow.Basedonapatient’sage,youseea
valueintheBMI A orBMI P field.
Automate Audit Measure Report
TheAutomateMeasureCalculationReportletsasitecalculatecompliancewiththe
MeaningfulUsemeasures.Undersomeconditions,thereportletsyouaccesstheareain
MOSAIQwhereyoucancorrectpatientdatatomakeitcompliant.
TheUIhas3mainpanesortabs:

TheMeasuretable

Detailstab

Non‐Complianttab
Automate Audit Measure Report Dialog Box Components
Table 17: Automate Audit Measure Report Components
60
Component
Description
Physician
Selectaphysiciantocalculatetheircompliancepercentage.
From/To
Setthestartandenddatesofthereportingperiodtobeevaluated
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Component
Description
Configuration (link)
OpenstheCodesWindow componentsofthiswindowlisted
below andlistsallprocedurecodesthatidentifyavisit.Tosee
thislink,youmusthaveSystemUtilities,General,Adminlevel
permission.
Searchtextbox–letsyoutypeasimplesearchtermtonarrow
downthefulllistofprocedurecodes.Thesearchtermlooksatthe
code,thecategory,andthedescriptiontofindamatch.Whena
matchisfound,thelistofcodesbelowisupdated.
Select/UnselectAll–letsyouselectallofthelistedproceduresor
unselectalloftheprocedures.Thiscontrolisonlyactivewhen
thereisasearchtermenteredintheSearchtextbox.
Thelistboxshowsallprocedures,intheformatof code :
category – description .Clickthecheckboxadjacenttoeach
proceduretoincludeitinthecurrentlyselectedcodeslist.
Currentlyselectedcodes–showsallthecodescurrentlychecked
alsoshowscodesthatarenotcurrentlyvisible,duetoanyset
filtersintheSearchtextbox .
Save–clickthisbuttontosaveallchangestothedatabase.
Cancel – clickthisbuttontoexitwithoutsavinganychanges.
QCL Task
OpensthePatientReminderTaskSelectiondialogboxandshows
theQualityCheckList QCL tasksthatyoucanidentifypatient
reminders.ThesetasksareusedtocalculatetheMeaningfulUse
compliancepercentagesforthepatientremindersmeasure.
Select/Unselect All
(link)
Clickthislinktoselectorclearallthemeasures.
Unfulfilled CCDA
Requests
IfyouselecttheElectronicCopyofHealthInfocheckbox,the
UnfulfilledCCDARequestsfieldappearsontheinterface.Youmust
manuallymonitorunfulfilledrequestsandtypethisnumberinto
theUnfulfilledCCDARequestsfieldbeforecalculatingthe
compliance.
Whencalculatingcompliance,thenumeratoristhenumberof
CCDsthathavebeenprintedorwrittentoafilewithin3business
days.
ThedenominatoristhenumberofCCDsthathavebeenprintedor
writtentoafileplusthenumberenteredintotheUnfulfilledCCDA
Requestsfield.
Begin Calculations
Clickthisbuttontostartthecalculation.Onlythechecked
measuresarecalculated.Aftercalculationiscomplete,thetexton
thelistviewchangestogreenorred,dependingonwhether the
specifiedphysicianmeet/doesnotmeetthecriteria.
Cancel
Youcanusethisbuttononlywhencalculationsareinprogress.
Clicktocancelthecalculationinprogress.Youcanthen
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61
Component
Description
reconfiguremeasures.
Report Options
Showsnon‐compliantpatientsforeachmeasure–thischeckbox
showseachmeasure'snon‐compliantdataimmediatelyaftereach
measure.
Showspatientcentricviewofnon‐compliantdata–thischeckbox
showsacrosstabviewthatshowsthenumberofmeasuresina
patientchartthatarenotcompliant.
Print Report
Clickthisbuttontolaunchacrystalreport.
The Measure Table
TheMeasureTableshowsacheckboxadjacenttoeachmeasure,thenumerator,
denominator,calculatedpercent,andtargetpercent.Thetextcolorhasthesemeanings:

Blacktextisshownwhenthecalculatedpercentageisunknown.

Greentextisshownwhenapercentagemeetsthetarget.

Redtextisshownwhenthepercentagedoesnotmeetthetarget.
Selectthecheckboxadjacenttothemeasuretoincludeitinthecalculation.ClickBegin
Calculationstocalculatethemeasures.
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Automate Measure Calculation Report Buttons
Table 18: Automate Measure Calculation Report Buttons
Button
Description
Begin Calculations
Startsthecalculationfortheselectedmeasures.When
calculationsarecomplete,thetextonthelistviewfortheselected
itemschangestogreenorred,ifthecalculatedpercentagemeets
thecriteriaforthespecifiedmeasure.
Report Options
Displaynon‐compliantpatientsforeachmeasure:selectthis
checkboxtoshownon‐compliantpatients.
Displaypatientcentricviewofnon‐compliantdata:selectthis
checkboxtoshowacrosstabviewofthetotalnumberofnon‐
compliantpatientspermeasure,includingthepatientname,MR
number,andIDofthenon‐compliantmeasure.
Print Report
OpensthePrintdialogboxsothatyoucanprintaCrystalreportto
thescreen,aprinter,orafile.Thisreportshowsalistofpatients
withthenon‐compliantinformationforaselectedmeasure.Your
selectionsinReportOptions controltheinformationincludedin
thereport.
The Details Tab
TheDetailstabshowsin‐depthinformationabouthoweachmeasureiscalculated.Thecode
sectionthatappliestothemeasureisshownadjacenttothenameofthemeasure.
The Non-Compliant Tab
Whenpossible,theNon‐Complianttabshowsthenon‐compliantdetails.A" "displaysto
theleftofthemeasuretoshowthattherearenon‐compliantrecords.
Ifyoudouble‐clickonanon‐compliantpatient forexample,whileontheRecord
DemographicsmeasureontheNon‐Complianttab ,therecordforthatpatientopensand
replacesthecurrentlyopenedpatientrecord.
ClickthePrintbuttontoshowalistofpatientswithanydetailslistedasnon‐compliant,fora
givenmeasure.Attheendofthereport,theSummaryViewisshown.
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CHAPTER 3: MOSAIQ Radiation Oncology Clinical Charting
CHAPTER 3: MOSAIQ Radiation
Oncology Clinical Charting
MOSAIQRadiationOncologyClinicalChartingisafullelectronicmedicalrecord EMR that
includescorechartingfeaturesspecifictoradiationoncology.Itincludestemplatebased
careplansthathelpautomatethegenerationofcomplextreatmentprotocolsand
customizabletreatmentcalendarstoscheduletheirdelivery.Whenconfiguredwithother
radiotherapyproducts,RadiationOncologyClinicalChartingstreamlinesthetherapy
processfrominitialdiagnosisandstagingthroughplanning,treatment,andsubsequent
follow‐up.
Radiation Prescriptions
Theradiationprescriptiondialogboxdefinesthephysiciantreatmentintentandisthe
sourceofdirectiontodefinetreatmentfieldsandscheduletreatmentsessions.
TheRadiationPrescriptionsletsyouadddetailedinformationabouttheprescriptionofthe
patientandmanagearelatedsetofprescriptionsitesinthesamecourseoftreatment.
Thetopsectionofthedialogboxdisplaysthediagnosisfortheselectedcourse.Alsoatable
displaysasummaryofalltheprescriptionsitesdefinedforthiscourse.Thelowersection
hasmultipleviews.Thisletsyouenteraprescriptionforanewsiteinanexistingornew
course,tochangetheprescriptionforthesitesinthecourse,deleteanexistingprescription,
andtodisplaytheprescriptionforeachsiteinthecourse.
SeeAddingRadiationPrescriptionInformation.
Configuring Dose Units and Biologic Equivalent Dose
UsetheDosimetryConfigurationdialogboxtoconfigurethedefaultdoseunitandseta
defaultthresholdanddosetodeliverapartialtreatmentasafraction.
Tospecifythedoseunit,youmusthaveClinical|Coefficients|Modifyrights.
Toconfigurethedoseunit:
2. ClickClinical RO tab.
3. ClickDosimetryConfigurationtoopentheDosimetryConfiguration.
4. IntheDoseUnitsgroup,selectcGray cGy orGray Gy forthewindowsinMOSAIQ
thatdisplaydoseunits.
5. IntheFractionCalculationgroupMinimumIntervalfield,typetheminimumtime
intervalbetweentreatmentsessionsandthedoserequiredtocountapartialtreatment
asafraction.
6. Inthe%ofthePrescribedFractionalDosefield,typetherelativeminimumdose
thresholdasapercentageoftheprescribedfractionaldose.
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65
Thispercentageisdeliveredduringatreatmentsessiontobecountedasafraction.For
example,ifyoutype10percentinthisfieldandthepatientonlyreceives20cGyoutof
theprescribedfractionaldoseof200cGy,thetreatmentsessioncountsasafraction.
7. Determinethedosethresholdusingarelativeoranabsolutedose:

Minimumrelativedoseinpercentage
 Minimumabsolutedoseasawholenumber
a. SelectAndifbothcriteriamustbemet.
b. SelectOrifthelesserofeithercriteriamustbemet.
Whenregisteredforparticletherapy:
8. IntheBiologicEquivalentDoseCharacterizationgroup,BEDUnitsfield,selectCGEor
CcGEfromthedrop‐downlist.
9. SelectthePrescribingDoseUnitcheckboxtomaketheBEDunitastheprescribingdose
unit.
10. IntheBEDCoefficientUnitfield,typetheBiologicEquivalentDosecoefficientunitfor
convertingCobaltGrayEquivalent CGE toGray Gy .
11. ClickOKtosavethedefaultdoseunitconfigurationandclosetheDosimetry
Configuration.
The MOSAIQ software lets you see and define only the physical dose for
carbon ion prescriptions. You cannot see or define the biologically effective
dose (BED) or add biologic dose coefficients for carbon ion treatment fields
or prescriptions.
Adding Radiation Prescription Information
Toaddorchangearadiationprescription,youmusthaveClinical|Prescription|Modify
rights.
ToapprovearadiationprescriptionyoumusthaveApproverights.
Tochangeanapprovedradiationprescription,youmustalsohaveApproverights.
1. Openthechartofthepatient,andthenopentheDiagnosesandInterventionswindow.
2. Createanewcourseoftreatmentorselectanexistingcourseoftreatment,clickRadRx,
andthenclickConventionalorProtonstoopentheRadiationPrescriptionsinAdd
mode.
If there are already one or more prescription sites in the course, the
Radiation Prescription Sequencing appears. You can add the Radiation
Prescription Sequencing for the new prescription relative to an existing
prescription.
3. TypeanameoftheradiationprescriptionintheRxSitefield.Thisradiationprescription
namemustbeuniquefortheselectedpatient.
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4. Click
toselecttheradiationtechnique,suchasObliquesfromtheTechniquelist.
5. Click
toselectthetreatmentmodalitytouseintheradiationprescriptionfromthe
6. Click
toselectthedosespecification,suchasDepthdosefromtheDoseSpeclist.
Modalitylist.
Thisisthecalculationpointorvolumefortheprescribeddose forexample,D‐Max,
midplane,orpertreatmentplan .Click toselectfromthelistortypethefirst
character s oftheknownspecification.
TheDoseSpecfieldhasthreeparts:

Calculationspecificationtype

Calculationpointorisodoselevelvalue
 Numericvalue
Dependingonwhatyouselectforthefirstfield,itmaynotbenecessarytofillinthe
othertwofields.
7. PressTABandtypetheseconddosespecificationvalueintheRxDepthfield textfield
totherightoftheDoseSpecfield .
8. PressTABandclick
toselectaunitforthevalueyoutyped,suchascm.
9. TypethetotaldoseintheRxDosefield.
ThisisdefinedincGyunitsforconventionaltreatmentmethodandconfiguredunits
physicalorbiological forparticletherapy.
Adding Fractionation Patterns
TheFractionationPatternidentifiesthepatternoftreatmentsessionsthepatientistobe
treated.
1. IntheRadiationPrescriptions,typethefractionaldoseintheFractionalDosefieldand
pressTAB.
ThisisdefinedincGyunitsforconventionaltreatmentmethodandconfiguredunits
physicalorbiological forparticletherapy.
TheNumberofFractionsfieldisautomaticallycalculated.ForexampleiftheRxDoseis
5040cGyor200CGEwithaFractionalDoseof180cGyor10CGE,theNumberof
Fractionsshows28or20.Thisindicatesthat,todelivertheprescribeddose,thepatient
needs28or20treatmentsessions.Thecalendarviewontherightsideofthe
fractionationphasefieldshows28FxPattern?or20FxPattern?Thisindicatesthatthe
fractionationpatternhasnotbeenadded.
2. Typethefractionationpatterndescriptioninthetextfield,suchasDaily,BID,andsoon,
bypassingtheWaveSetupForm.Youcanalsoclick adjacenttotheFractionation
PatternfieldtoopentheWaveSetupForm.
You can add more complex fractionation patterns, such as BID using the
Wave Setup Form.
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67
TheWaveSetupFormletsyoudeterminewhentotreatthepatientwiththefractional
dose.Thesearethetypicalfractionationpatterns.
Type
For
Daily
Everyday
EveryOtherDay
Everyotherday
BID
Twicedaily
3. IntheTimesPerDaygroup,selectthenumberoffractionsperday.
4. InthePatterngroup,selectapattern,suchasDaily,EveryOtherDay,orWeeklypattern.
5. ClickOKtoclosetheWaveSetupFormandreturntotheRadiationPrescriptions.
Atextdescriptionoftheconfiguredfractionationpatternthendisplaysinthe
Fractionationpatternfield.
6. ClickOKtosavetheradiationprescriptionwiththefractionationpattern.
Appending Fractionation Phases
Youcanappendaprescriptiontoaddfractionstoanexistingprescriptionsite.Whenyou
haveappendedaprescription,youcanchangethetotalprescribeddose,fractionaldose,and
thefractionationpattern,orremovefractionationphases.
1. IntheRadiationPrescriptions,selecttheradiationprescriptiontowhichtoappenda
radiationprescription,andclickChange.
Thisactivatestheradiationprescriptionfieldssothatyoucanmakechanges.
2. IntheFxPhasegroup,clickAppendtoopentheRadiationPrescriptionPhaseStart.
TheRadiationPrescriptionPhaseStartsetsthetimeintervalbetweenfractionation
phasesinaprescriptionsite.
3. Typethetimeintervalbetweenfractionationphases,andclickOKtosavethephase
sequencingstartdate.
4. IntheRadiationPrescriptions,typethetotalfractionationdoseforthephasesequence
intheRxDosefield.
5. TypetheFractionalDose.
6. TypetheFractionationPattern,suchasDaily.
7. ClickOKtoappendthenewradiationprescription.
Using Site Sequencing for Multiple Radiation Prescriptions
RadiationPrescriptionSequencing alsocalledsitesequencing letsyousetupastart
sessionofthenewprescriptionsiteinrelationtootherprescriptionsite s inthesame
courseoftreatment.
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1. IntheRadiationPrescriptions,clickAddtoopentheRadiationPrescriptionSequencing.
TheRadiationPrescriptionSequencingonlydisplayswhenyouareaddingprescription
sitestothesamecourse.IfyouclickCancel,Sequencing?appearsinthesecondcolumn
ofthecalendarview.Thisindicatesthatthereisnositesequencing.TheRadiation
PrescriptionSequencingcontainstheoptionsdescribedinthistable.
Table 1: Radiation Prescription Sequencing Fields
Field
Description
Treat this Rx Site
Concurrent with
beginning of
Specifiestodeliverthefirstfractionfortheprescriptionsitein
thesametreatmentsessionasthefirstfractionoftheselected
prescriptionsite.
Overlapping with
Specifiestodeliverthefirstfractionfortheprescriptionsite
afterapriorsitehasstartedbutbeforeithasbeencompleted.
TheoverlapisdefinedintheTreatthefirstfractionofthisRx
Siteatleast sectionofthisdialogbox.
After
Specifiestodeliverthefirstfractionfortheprescriptionsite
aftercompletionoftheselectedprescriptionsiteintheSitefield.
Thisisthedefaultsetting.
Site
Specifiestheprescriptionsitetouseinsitesequencing.Thelist
onlycontainstheprescriptionsitesinthesamecourse,which
precedes theprescriptionsiteforwhichyouaredefiningsite
sequencing.
Treat the first fraction of this Rx Site at least
Number of days
or hours
Specifieshowlongafterthespecifiedfractionoftheprescription
siteintheSite fieldtobeginthefirstfractionfortheprescription
site.
Days or hours
Specifiestheunitoftime daysorhours .Forexample,ifyou
type7andselecthours,thefirstfractionbeginssevenhours
afterthespecifiedfractionoftheprescriptionsiteintheSite
field.
After Fraction
Specifiesoneofthefractionsfortheselectedprescriptionsitein
theSite field.Thisisthelastfractiondeliveredwhenyoubegin
treatingthefirstfractionoftheprescriptionsiteforwhichyou
aredefiningsitesequencing.Thisfielddefaultstothenumberof
fractionsintheprecedingprescription.
Of Site
ShowstheprescriptionsiteselectedintheSitefield.
2. Selectwhentostartthenewradiationprescription,suchasConcurrentwithbeginning
of.
3. ClickOKsaveandclosetheRadiationPrescriptionSequencing.
4. CompletetheRadiationPrescriptionswiththenewradiationprescriptioninformation.
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5. ClickOKtosavethenewradiationprescriptionsite.
Aplussign
date.
inthecalendarindicatesthatmorethanoneprescriptionappliestothe
Approving Radiation Prescriptions
Oncetheinformationintheradiationprescriptionisaccurateandcomplete,youcan
approvetheradiationprescription.Youcanstillmakechangestoanapprovedradiation
prescription,butifyoudo,theapprovalisremoved.
1. IntheRadiationPrescriptionsselecttheradiationprescriptiontoapprove,andthen
clickStatustoopentheRecordStatus.
2. IntheNewStatusgroup,clickApproved,andthentypeyourPassword.
3. ClickOKtoapprovetheradiationprescription.
Approving Multiple Radiation Prescriptions
Youcanalsoapprovemultipleradiationprescriptionsatthesametime.
1. IntheRadiationPrescriptions,tagtheradiationprescriptionsbyclickingeachinthe
upperpaneadjacenttotheleftmargin.
A“»”appearsadjacenttotheradiationprescriptions.Thisindicatesthattheyaretagged
orselected.
2. ClickStatustoopentheRecordStatus.
3. IntheNewStatussection,selectApproved,typeyourPassword,andthenclickOKto
approvetheradiationprescriptions.
Changing Radiation Prescriptions
Toaddorchangearadiationprescription,youmusthaveClinical|Prescription|Modify
rights.ToapproveorchangeanapprovedradiationprescriptionyoumusthaveApprove
rights.
Youmayhavetosetupphaseorsitesequencingagainifthefractionschange.

UsetheRadiationPrescriptionSequencingtosetupsitesequencing.Youcanenter
ormodifythestartofthisPrescriptionSiterelativetoafractioninaPrescription
Sitelistedinthesamecourse.

UsetheRadiationPrescriptionPhaseStarttosetupphasesequencing.Youcan
enterormodifytheminimumtimeintervalbetweenthelastfractionoftheprevious
treatmentphaseandthefirstfractionoftheneworselectedphaseinthe
prescription.Youhavetodefinephasesequencingwhenaddingnewfractionstoa
prescriptionsite.
1. InDiagnosesandInterventions,double‐clicktheprescriptiontovieworchange.
2. InRadiationPrescriptions,clickChange.
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MakeyourchangesandclickOK.
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4. Ifnecessary,approvetheradiationprescriptionagain.
Changing Prescribed Doses
Youcanchangethetotalprescribeddose,thefractionaldose,oranydoseinaprescription.
Ifyouchangeanapprovedprescription,theapprovalstatusgoesbacktopending.The
applicablestaffmembermustreapprovetheprescriptionafteryouchangethedose.
1. Openthechartforyourpatient.
2. OpentheDiagnosesandInterventionswindow.
TheRadiationtabappearsbydefault.
3. Double‐clickaprescription.
4. ClicktheprescriptionsiteinthetableinthetopsectionoftheRadiationPrescriptions,
andthenclickChange.
5. Tochangethetotalprescribeddose,double‐clickintheRxDosefieldofthe
fractionationphasefortheremainingdose,typethenewtotalprescribeddose,andthen
pressTAB.
6. Tochangethefractionaldose,double‐clickintheFractionalDosefieldofthe
fractionationphasefortheremainingdose,typethenewfractionaldose,andthenpress
TAB.
7. Ifyoureceivetheerrormessagefortotaldosecalculation,clickOK,andthendostep5
or6againtocorrectthetotalprescribeddoseorfractionaldose.
8. ClickOKintheRadiationprescription.
Do the same steps when you change the fractional dose in the radiation
prescription. Make sure that you receive a whole number for the number of
fractions when you divide the fractional dose by the total prescribed dose.
When you change the fractional dose, change the dose in the Treatment Field
Definition for all of the treatment fields associated with the radiation
prescription.
Copying Radiation Prescriptions from another Patient
YoucanusetheRadiationPrescriptionCopyoptiontoquicklyandefficientlyenterdatafor
patientswhoseprescriptionsarenearlyidentical.Thisprovidesafasterwaytoenterasetof
prescriptionsites.Ifapatienthasaradiationprescriptionthatisessentiallysimilartoone
youcouldcreateforanotherpatient,youcancopythatfirstradiationprescriptionofthe
patient.
1. IntheRadiationPrescriptions,right‐clickanywhereorpressF4toopentheRadiation
Prescriptionsoptionsmenu.
2. ClickCopyRxsfromAnotherPatient…toopentheSelectPatientwindow.
3. Double‐clickthepatientwiththeradiationprescription s tocopy.
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Adding, Changing, or Removing a Dose Limit using Radiation
Prescriptions
YoucanopentheDoseLimitwindowfromtheRadiationPrescriptions.
TheDoseLimitshowsalloftheDoseLimitDoseActionPointsfortheselectedpatientand
letsyoucreate,change,orremoveDoseLimits.
1. IntheRadiationPrescriptions,selecttheradiationprescriptionforwhichtoaddaDose
Limit,andthenclickChange.
2. IntheDoseLimitgroup,clickOthertoopentheDoseLimitwindow.
3. ClickAddtoopentheDoseLimitdialogbox.
4. Typeanewcumulativedosetrackingsitenametocreateanewdosetrackingsiteor
selecttheDoseTrackingSitefromthelist.
5. TypethemaximumdoseforthedosetrackingsiteintheDoseLimitfield.
6. TypeamandatoryCommentfortheDoseLimitDoseActionPoint.
7. ClickOK.
8. IntheDoseLimitswindow,clickClose.
9. IntheRadiationPrescriptions,right‐clickorpressF4,andclickDoseActionPoints.
10. ClickClose.
11. IntheRadiationPrescriptions,clickCancel,andthenclickDosimetry.
Simulation Fields
Ifyouchosenottoimportatreatmentplan,youcanaddsimulationortreatmentfieldsfor
thepatientonceyouhaveaddedbasicinformationonthepatient,suchasadiagnosis.You
addanddisplaysimulationfieldinformationintheSimulationFielddialogbox.Youcanadd
asmanySimulationFielddefinitionsasnecessarythroughoutthecourseoftherapyforthe
patient.

TheGeneraltabletsyouadddetailedinformationaboutthesimulationsetupfor
thefieldandcontainsbasicheaderinformation,measurement,andgeometric
settingfields.Youcanaddsimulationsettingsmanually,orcapturethemdirectly
fromthesimulator.

TheRadiographytabletsyouaddKVp,mA,andthetimeittooktoacquirethe
simulationfilm.
Youcanalsoaddtreatmentfields.TheTreatmentFieldDefinitionletsyouspecifytreatment
fieldinformationusedduringexternalbeamtherapy.Youcanaddtreatmentfielddefinitions
manually,bycopyingsimulationfields,copyingothertreatmentfields,automatically
capturingtreatmentunitsettings,orbyimportingthemfromyourtreatmentplanning
system.SeeRTPImport/RTIonPlanImportforinformationonhowtoimportatreatment
plan.
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Adding a Site Simulation
UsetheSiteSimulationtorecordpatientsetupinformationattheSitelevelwhenyou
performavirtualsimulation.Asitesimulation virtualsimulation isthefirstphaseofthe
treatmentplanningprocess.Thesetupinformationgatheredforaradiationprescriptionsite
duringavirtualsimulationisusedinSiteSetup.SeeSiteSetupintheImageManagement–
ViewStation&PhotosandDiagramschapteronpage238formoreinformation.
Toviewasitesimulation,youmusthaveClinical|Simulation|Viewrights.
Toaddorchangeasitesimulation,youmusthaveModifyrights.
MOSAIQ does not keep historical versions of site simulations.
1. IntheDiagnosesandInterventions,selecttheradiationprescriptiontoassociatewith
thenewsitesimulation.
2. IntheAddgroup,clickSimulation,andthenclickSitetoopentheSiteSimulation,shown
inFigure7.
Figure 7: Site Simulation
3. Click adjacenttothePatientOrientationfield,andthenclickthepatientorientation,
suchasHeadIn,Prone.
For particle therapy radiation treatment sites, MOSAIQ supports the sitting
patient orientation.
4. IntheAccessoriesgroup,click adjacenttothePtSupportfield,andifnecessary,
selectthemethodofpatientsupport.
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5. Selecttheaccessorydevice s fromtheDevice1–4fields.
6. Ifnecessary,addapatientnoteorviewthesimulationimages.
TheSimulationImageListpaneshowsanynon‐portalmedicalimagesassociatedwith
theselectedtreatmentsite.
7. Toviewanimage,clicktheimageintheSimulationImageList,andthenclickViewto
opentheImagewindow.
TheSiteSetupNoteboxshowsnotesaddedtothesitesimulation.
8. Toaddanote,clickintheSiteSetupNotebox,andthentypeyournote.
YoucanalsoclickNotetoaddanote.
9. ClickOKtosavethesitesimulation.
Adding a Simulation Field When a Prescription Exists
Whenyouhavearadiationprescription,whichisusuallyaddedbyaphysician,addthe
simulatorsettingsthatrequiremanualinput.
To view a simulation, you must have Clinical | Simulation | View security
rights. To add a simulation, you must have Modify rights.
1. IntheDiagnosesandInterventions,selecttheradiationprescriptiontoassociatewith
thenewsimulationfield.
2. IntheAddgroup,clickSimulation,andthenclickFieldtoopentheSimulationField,
showninFigure8.
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Figure 8: Simulation Field Dialog Box
3. TypethesimulationfieldinthefirstSimFieldtextbox.
4. Typeanameforthesimulationfield,upto20characters,inthesecondSimFieldtext
box.
5. Click adjacenttotheMachinefield,andthendouble‐clickthetreatmentmachine.
6. IntheMeasurementsgroup,typetheSourcetoSkinDistanceintheSSDfield.
7. Ifnecessary,intheSeparationsgroup,typethemeasurementstorecordtheAP,PA,
Lateral,andTangentialseparationmeasurements.
8. IntheOthersgroup,selectalabelfromthedrop‐downlists.
9. TypetheSourcetoFilmDistanceintheSFDfield.
10. TypetheSourcetoAxisDistanceintheSADfield.
11. TypethegantryangleforthesimulationintheGantryfield.
12. Settheothergeometricparameters,suchastheXandYjaws.
13. Setthegeometricparametersforthecouch.
14. Toaddafieldsetupnote,clickFieldNotetoopentheSimulationNote.Add,andsave
yournote.
Ifasimulationhasanote,agreencheckmarkappearsadjacenttotheFieldNotebutton.
15. ClickRadiographytoshowtheRadiographytab.
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Radiographysettingsletyouenterradiographicsettingsforaspecificsimulationfilm.
YoucanenterthekVpandmAvalues,thenumberofsecondstoexposethefield,andthe
bladepositionsduringexposure.
16. Ifnecessary,addtheradiographyinformation,andclickOK.
Adding a Simulation Field When a Prescription Does Not Exist
Inmostconditions,youaddasimulationfieldwithitsradiationprescription.Insome
instances,itisnecessarytosimulateatreatmentwherenoradiationprescriptionis
associated.
1. IntheDiagnosesandInterventions,right‐clickinthewindoworpressF4.
2. IntheDiagnosesandInterventionsoptionmenu,clickAddSimulationwithoutRadRx….
Because you are adding a simulation field without a radiation prescription,
the Rx Site and Rx Note display fields are blank.
3. IntheSimulationFielddialogbox,typethesimulationfieldIDinthefirstSimFieldtext
box.
4. TypethenameofthesimulationfieldinthesecondSimFieldtextbox.
5. Click adjacenttotheMachinefield,andthendouble‐clickthetreatmentmachine.
6. Addtheappropriateparameters,suchasthegantryangle,asdescribedinAddinga
SimulationFieldWhenaPrescriptionExists.
7. Addafieldsetupnoteorradiographicinformation.
8. ClickOKtosavethenewsimulationfield.
Capturing Geometric Settings/Parameters for a Simulation Field
YoucanalsouseSIM‐SETtocaptureandrecordfieldinformationfromyourradiotherapy
simulator.Youcanthenusetheresultingfieldinformationforauto‐setupandverification.
Toviewcapturesettingsdirectlyfromasimulator,youmusthaveClinical|Simulation|
Modifyrights.
1. Positionyourpatientandmachineinthesimulationposition.
2. IntheDiagnosesandInterventions,double‐clickthesimulationfieldtoopenthe
SimulationField.
3. Right‐clickinthedialogboxorpressF4toopentheSimulationFieldoptionsmenu.
4. ClickCaptureSettingstoaddthesettingsfromthesimulator.
5. ClickOKtosavethecapturedsettings.
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Copying a Simulation Field
Toaddasimulationfield,copyanexistingsimulationfield.Changeonlythoseparameters
thataredifferentbetweenthetwofields.
Tocopyasimulationfield,youmusthaveClinical|Simulation|Modifyrights.
1. IntheDiagnosesandInterventions,selectthesimulationtocopy,clickSimulation,and
thenclickField.
2. IntheConfirmFieldCopymessage,clickYestoconfirmthatyouwanttocopythe
simulationfieldandopentheSimulationFielddialogbox.
3. TypetheIDforthenewsimulationfieldinthefirstSimFieldtextbox.
4. ClickthesecondSimField,textbox,andthentypethenameofthenewsimulationfield.
5. Capturethegeometricparameters.Typethemeasurements,geometricparameters,and
radiographicparameters,ifnecessary.
6. ClickOKtosavethecopiedsimulationfield.
RTP Import/RT Ion Plan Import
To use RTP Import and RT Ion Plan Import, you must have Clinical | Dosimetry
General | Modify and Clinical | Action Points | Approve security rights.
Importandexport:

Radiotherapytreatmentplans RTP 
DigitalImagingandCommunicationsinMedicine DICOM data

RTIonplansforparticletherapytreatments

Brachytherapytreatmentplans
You cannot import Cobalt-60 fields. You must manually define them in
MOSAIQ.
SeeImportingtheRTIonPlanandEditingRTIonPlanstoimportandeditRTIonplans.
Importing the RTP File
1. ClickFile|Import/Export|RTPImporttoopentheRTPImportwindow.
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Figure 9: RTP Import
Before you can import files through RTP Import, your system administrator
must set up the RTP import location in MOSAIQ. For a particle therapy
treatment, set up the RT Ion Plan import location in DCMWIN. If there are
no RTP import locations when you click
your system administrator.
in the Look in field, contact
2. ClickthepatientnameandclickSelect,ordouble‐clickanRTPfiletoopentheImport
TreatmentPlan.
3. ClickPromote.
Ifconfigured,thisopenstheDelete/MoveImportedFilemessage.Youcanmovethe
importedfiletoanewsubdirectory.
2. ClickYestoimportthefileintothesystem,removethefile,andclosethewindow.
IfyouclickNo,thesystemcreatesanImportedsubdirectoryandmovesacopyofthe
importedfiletothislocation.
3. ClickViewLogtoshowthecontentsofthelogfilefortheimportedRTPfile.
IfthereareerrorsintheImportTreatmentPlan,youcannotimporttheplanuntilyouedit
thefiledatatocorrecttheerrorsorchangetheaction.
Editing the RTP File
Ifthereisfiledatathatdoesnotagreewiththedataofthepatient,thenthisdataappearsas
errorsintheImportTreatmentPlan.ChangethefiledataintheImportTreatmentPlanto
correcterrorsorchangetheActionbeforeyouimportthefile.
1. ClickFile|Import/Export|RTPImporttoopentheRTPImportwindow.
2. IfthenecessaryimportpathdoesnotappearintheLookinfield,click
path.
andselectthe
3. ClickthepatientnameandclickSelect,ordouble‐clickanRTPfiletoopentheImport
TreatmentPlan.
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RTPImportvalidatesthecontrolpointsandothercontentsoftheplanasthefile
informationappearsintheappropriatefields.Oncevalidationiscomplete,PlanWillBe
Importedappearsatthebottomofthewindow.
ThePromotebuttonisavailableonlywhentheimportdatadoesnotcontainanyerrors
highlightedinred.Themessagecolorsaredefinedinthistable.
Table 19: Import Treatment Plan Field Descriptions
Color
Description
Red
Theimportdatacontainserrors.Youcannotimportorpromote
theplanwhenthereareerrors.
Yellow
Theimportdatacontainsapplicableerrormessages,butyoucan
stillimportorpromotetheplan.Theerrormessageappearsinthe
EditImportDatawindow.
Green
Theimportdatacanbeimportedorpromoted.
Blue
Theimportdatadoesnotcontainanyerrors,butwillnotbe
importedorpromoted.
3. ClicktheradiationprescriptionintheImportDatacolumnandclickContents.
ThisopenstheEditImportDataforthecoursedatainthesystemandtheRTPfile.The
titlebarofthewindowshowsPrescriptionSite,andmessagesshowinthe
Error/WarningMessagecolumn.
4. ClickintheImportDatacolumnforadatafieldthatisnecessarytochange.
You can click in the Import Data column of the Edit Import Data for courses,
prescriptions, and treatment fields to change the value of the data to be
imported.
5. Typethenewdatatocorrecttheerror,andthenclickinthewindow.
Thetextappearsingreentoindicatethatyoucanimportthedata.
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Figure 10: Edit Import Data Window – Fixed Data Item
6. ClickOKtoclosetheEditImportData.
7. ClickatreatmentfieldintheImportTreatmentPlan,andclickContentstoopentheEdit
ImportData.
8. ClickintheImportDatacolumnforadataiteminredtochangethefield.
Figure 11: Edit Import Data Window for Treatment Field
9. Typeavalidvalueforthedataitem,andthenclickinthewindow.
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10. ChangeorignorethedataintheEditImportDatawhenthefiledataandsystemdatado
notmatch.
SeeChangingaDataFieldorFolderStatustoIgnore.
Importing the RT Ion Plan
1. ClickFile|Import/Export|IonPlanImporttoopentheRTIonPlanImport.
For a particle therapy treatment, set up the RT Ion Plan import location in
DCMWIN. If there are no RT Ion Plan import locations when you click
the Look in field, contact your system administrator.
in
2. IfTranslationFailedappearsintheStatuscolumn,thenclickViewLogtoshowthe
ContentsofLogFile.
YoucanalsohoverovertheTranslationFailedStatustoseeatooltipthatdescribesthe
translationerror.
Figure 12: RT Ion Plan Import – Translation Failed
3. ClickthepatientnameandclickSelect,ordouble‐clickanRTIonPlanfiletoopenthe
PromoteRTIonTreatmentPlan.
RTIonPlanImportvalidatesthecontrolpointsandothercontentsoftheplanasthefile
informationappearsintheappropriatefields.Oncevalidationiscomplete,Planwillbe
promotedappearsatthebottomofthewindow.
ThePromotebuttonisavailableonlywhentheimportdatadoesnotcontainanyerrors
highlightedinred.ThemessagecolorsaredefinedinTable19:ImportTreatmentPlan
FieldDescriptions
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Figure 13: Promote RT Ion Treatment Plan
4. ClickPromote.
5. ClickOKintheRTIonPlanPromotemessage.
6. IntheRTPlanAssociations,clickNewnexttotheRadiationprescription,orclick
ExistingifthisisanexistingRTPlan,andclickOK.
Figure 14: RT Plan Associations
7. ClickCloseintheRTIonPlanImport.
IfthereareerrorsintheImportTreatmentPlan,youcannotimporttheplanuntilyouedit
thefiledatatocorrecttheerrorsorchangetheaction.
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Editing RT Ion Plans
Ifthereisfiledatathatdoesnotagreewiththedataofthepatient,thenthisdataappearsas
errorsinthePromoteRTIonTreatmentPlan.Changethefiledatainthiswindowtocorrect
errorsorchangetheActionbeforeyouimportthefile.
1. InthePromoteRTIonTreatmentPlan,clicktheRadiationOncologyCourseinthe
ImportDatacolumnandclickContents.
ThisopenstheEditImportDataforthecoursedatainthesystemandtheRTIonPlan.
ThetitlebarofthewindowshowsCourse,andmessagesshowintheError/Warning
Messagecolumn.
2. ClickintheImportDatacolumnforadatafieldthatisnecessarytochange.
You can click in the Import Data column of the Edit Import Data window for
a Course, Prescription Site, Site Setup, and Treatment Field to change the
file data.
3. Typethenewdatatocorrecttheerror,andthenclickinthewindow.
Figure 15: Edit Import Data Window – Fixed Data Item
5. ClickatreatmentfieldinthePromoteRTIonTreatmentPlan,andclickContentstoopen
theEditImportData–TreatmentField.
6. ClickintheImportDatacolumnforadataiteminredtochangethefield.
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Figure 16: Edit Import Data for a Treatment Field
7. Typeavalidvalueforthedataitem,andthenclickinthewindow.
8. ChangeorIgnorethedataintheEditImportDatawhenthefiledataandsystemdatado
notmatch.
SeeChangingaDataFieldorFolderStatustoIgnore.
Changing a Data Field or Folder Status to Ignore
YoucanimportafilewitherrorsifyouchangetheActiontoIgnore,butMOSAIQdoesnot
importthedatathatistobeignored.
1. IntheImportTreatmentPlanortheImportRTIonTreatmentPlan,clickintheAction
columnforthedataitemyouwanttoignore.
2. ClickXX–Ignore.
Figure 17: Action Error Drop-Down Menu
Viewing RTP Import /Ion Plan Import Data for IMRT Control Point
Data
ViewandchangetheRTPImportorIonPlanImportdataforIntensityModulated
RadiotherapyTreatment IMRT controls.SeeRTPImport/RTIonPlanImport.
1. ClickFile|Import/Export|RTPImport.
2. Double‐clickanRTPfilewithIMRTfieldstoopentheImportTreatmentPlan.
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Figure 18: Import Treatment Plan Window with IMRT Fields
3. Double‐clickoneoftheIMRTtreatmentfieldstoopentheEditImportData.
Figure 19: Edit Import Data Window for IMRT Field
TheDisplayChildDatabuttonisonlyavailablewhenyouareintheSimulationFieldor
TreatmentFieldview.TheEditImportData–ControlPointshowsthecontrolpointdata
forthetreatmentfieldyouselectedintheImportTreatmentPlan.
4. ClickDisplayChildDatatoopentheEditImportData–ControlPoint.
5. ClickintheControlPointfieldtoshowthedataforaspecificcontrolpoint.
6. ClosetheEditImportData–ControlPointandtheEditImportData–TreatmentField
windows.
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Locking Treatment Fields on Import
ConfigureMOSAIQtoautomaticallylocktreatmentfieldswhenyouimportthemfromthe
TPS.Thisletsyoutrackallchangestoatreatmentfield.
2. ClicktheClinical RO tab.
3. IntheRTPImportRulesgroup,makesurethattheLockFieldonPlanImportcheckbox
isselected.
If you set MOSAIQ to lock fields on import, you cannot change
the field ID or delete the field once it is imported. To change
the field ID of the treatment field, you must do it at the time of
CAUTION the import.
Importing Brachytherapy Treatment Plans
Brachytherapyisaformofradiotherapywheretheradiationsourceisplacedinsideornext
tothearearequiringtreatment.Abrachytherapytreatmentletsyouuseahighertotaldose
ofradiation.Thisletsyoutreatasmallerareainashortertimethanispossiblewithan
externalbeamradiationtreatment.
TouseBrachytherapyPlanImport,youmusthaveClinical|DosimetryGeneral|Modifyand
Clinical|ActionPoints|Approverights.
1. Withthepatientselected,clickFile|Import/Export|BrachytherapyPlanImport.
Thelistofplansappears.TheseareplansthathavebeensuccessfullysenttoDCMWIN.
TheyareintheBinaryDataStorage BDS foldersetupbyyoursystemadministrator.
Theplansarebasedonthe“Modifiedwithinthelastxxdays”valueconfiguredinthe
PlanImportArea.Tochangethisvalue:
a. ClickSettingsintheBrachytherapyPlanImport.
b. ClickAddorChangeintheRTPlanImportArea.
For more information, contact Elekta Support.
2. IntheBrachytherapyPlanImport,clickaplanthathasa“Translated”status.
AFileTranslatedmessagealsoappearsatthebottomoftheBrachytherapyPlanImport.
Thistellsyouthattheplanispreparedforimport.Youcannotimportaplanthathasa
statusof“TranslationFailed.”
Ifnecessary,clickViewLogtoexaminethefilefortranslationerrors.
3. ClickSelectordouble‐clicktheplantoopenthePromoteTreatmentPlan.
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ThePromotePlanbuttonisonlyavailableiftheimportdatadoesnothaveanyerrors
highlightedinred.Formoreinformationonthecolorcodes,seethetableinImporting
theRTPFile.
4. ClicktheImportDataitemthatyouwanttoseeorchange,andthenclickContentsto
opentheEditImportData.
TheerrormessageappearsintheError/WarningMessagecolumn.Scrolltotherightto
readtheentireerrormessage.
5. ClicktheImportDatacolumnforadataitemthatishighlightedinredorthatyouwant
tochange,andtypetheapplicabledata.
Thetextappearsingreenandyoucanimportthedata.
Ifitisnotnecessarytoimportadataitem,youcanyoucanselectIgnoreintheAction
column.
7. ClickPromotePlaninthePromoteTreatmentPlan.
IfthePromotebuttonisnotavailable,youcanclickintheActioncolumnandselectXX‐
Ignoreforthedataitemtobeignored.Youcanpromotetheplanifyouchangethe
ActiontoIgnore,buttheMOSAIQsoftwaredoesnotpromotethedatathatismarked
Ignore.
8. ClickClosetoclosetheBrachytherapyPlanImport.
Importing Site Setup Data for a New Patient
Importdataforanewpatient withnoorminimaldataintheDiagnosesandInterventions
window thatincludesthecourse,radiationprescription,treatmentfields,andthesitesetup
atthesametime.
2. IntheRTPImportwindow,clicktheplanofthenewpatient.
3. ClickSelectordouble‐clicktheplantoopentheImportTreatmentPlan.
4. Double‐clicktheSiteSetuprowintheImportDatacolumn.
TheisocentervaluesandstructuresetUIDappearintheEditImportData.
a. TheFrameofReferenceUIDisoptionalandcanbeblank.Iftherearenoisocenter
values,youcannotdoCBCTuntilyoumanuallysetthosevaluesandidentifythesite
setup.
b. Thetreatmentmachineisidentifiedfromtheplanwhenallfieldsareassignedtothe
samemachine.Toselectfromalist,clicktheImportDatacolumnintheTreatment
Machinerow.YoucanselecttheToleranceTableIDinthesameway.
CouchparametersareaddedfromtheRTPImportDefaultssectioninMachine
Characterization.
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5. ChangetheimportdataasnecessaryandclickOK.
6. ClickPromoteintheImportTreatmentPlantoimportthepatientdataintothe
electronicchartofthepatient.
7. OpentheSiteSetupDefinitionfromtheDiagnosesandInterventionstoviewthe
isocenterandreferencedstructureset.
TheRTplanmustreferencethestructuresetyouexportedfromtheTPS.MOSAIQwill
thenautomaticallyadddatatotheStructureSetfieldintheSiteSetupDefinition.
You can select a different structure set from the Structure Set drop-down
list on the Images/Reference Data tab in the Site Setup Definition
window. This step sets your isocenter values to Zero. Make a note of the
CAUTION isocenter values BEFORE you select a new structure set.
Importing Site Setup Data for a Patient with Existing Data
Forapatientwithanexistingradiationprescription,sitesetup,andtreatmentfield
information,youmustchangethesitesetupdataintheEditImportData.
2. IntheRTPImportwindow,clicktheplanofthenewpatient.
3. ClickSelectordouble‐clicktheplantoopentheImportTreatmentPlan.
4. Double‐clicktheSiteSetuprowintheImportDatacolumn.
TheisocentervaluesandstructuresetUIDappearintheEditImportData.
5. ClicktheRxSiteNamerowintheImportDatacolumn.
6. ChangethenameoftheRadiationPrescriptionsite.
7. EdittheimportdataasnecessaryandclickOK.
8. IntheImportTreatmentPlan,settheotherRTPimportvaluestoIgnore.
9. ClickPromotetoimportthepatientdataintotheelectronicchartofthepatient.
CAUTION
Site setup imports NULL/Blank isocenter values from the RT plan if the RT
plan includes fields with different isocenter values.
Automatic Association of Reference Images and RT Plans
BeforeyouimporttheRTplan,youcanusetheimagebrowseroropentheImageList
windowandseethatthereferenceimagesarenotassociatedwithatreatmentfield.You
knowthatanimageisnotassociatedwithatreatmentfieldwhentheAssociationIDfieldis
blank.
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SendtheRTplanandreferenceimagesfromyourTreatmentPlanningSystem TPS to
MOSAIQ.TheNamerprogramsavesthebeamIDandtheplanUIDintheimage.The
referenceimagesareintheimagelist,andtheyarenotassociatedwithtreatmentfieldsuntil
youimportaRTplan.
AfteryouimporttheRTplan,MOSAIQcanautomaticallyassociatethe“relatedand
unmodified”referenceimagestothetreatmentfieldsforyourRTPlan.

RelatedmeansthatthereferenceimagemusthavespecifiedDICOMdata beamID
andplanUID tolinkittotheRTplan.ThismakessurethatMOSAIQautomatically
associatesthetreatmentfield.

Unmodifiedmeansthata“related”referenceimageisnotalreadyassociatedwitha
treatmentfieldorthata“related”referenceimageisnotchanged.Ifyoumakea
changetoyourimages forexample,commentsornotesthatsubsequentlyalters
theedittime ,MOSAIQcannotautomaticallyassociatethemwiththetreatment
field.
Associating Reference Images with RT Plans
IfyousendDRRs referenceimages toMOSAIQ,itisnecessarytoassociatethemwiththe
applicabletreatmentfieldsfortheRTplan.AfteryouimporttheRTplan,MOSAIQ
automaticallyassociatesthetreatmentfieldwiththereferenceimages.
1. Makesurethatthepatientfileisselected.
2. ClickFile|Import/Export|RTPImportorclicktheRTPimporticon,andclickSelect.
3. ClickPromotetoopentheRTPImport.
TheStatuscolumnshows“Imported...”
4. ClickClose.
ToseetheimagesaftertheRTplanimport,opentheImageListwindow.Youcanseethat
theimagesareassociatedandthetreatmentfieldgeometryshowsasanoverlayonthe
referenceimage.
You can create a new RT plan and DRRs in the TPS with the same
field ID and import the plan over the existing treatment fields. The
new DRRs will not replace the existing DRRs associated to the
CAUTION treatment field. You must go to the Image List window and change
the field association to the new DRRs.
Importing Files for the Treatment Plan
ImportPDFdocumentsandJPEGorTIFFimagefilestoaddatreatmentplanintheImport
PlanDocument.
ImportPDFdocumentsandJPEGimages,whichweregeneratedduringtreatmentplanning,
intotheDiagnosesandInterventions.Youcanprint,save,andnavigatethroughmultiple‐
pagedocumentsinthiswindow.TheimportedtreatmentplancanincludemultiplePDFor
JPEGfiles.Multiple‐pagetreatmentplanscanbemultiplefilesormultiplepagesofoneor
morefiles.
TousetheImportPlanDocumentwindow,youmusthaveClinical|TxPlans|Viewand
Modifyrights.
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1. OpenthepatientchartandclickeChart|DiagnosesandInterventions.
2. ClickPlanDoc.
YoucanalsopressF4orright‐click,andthenclickAddPlanDocumenttoopenthe
ImportPlanDocument.
3. Click adjacenttothefolderintheDocumentsAvailablepanetoshowfilesavailable
forimport.
4. ClickaPDFdocument,whichappearsinthePreviewpanetotherightsideofthe
window.
Ifyouclickanimagefile,theuppertoolbardoesnotappear.Thelowertoolbaralways
appearsandletsyounavigate,zoom,andadjustthepage.
5. Right‐clicktheselecteddocumentintheDocumentsAvailablepane,andthenclickAdd.
ThePDFdocumentorimagefileappearsintheDocumentSavedpane.
a. UseyourmousetodraganddropfilesbetweentheDocumentsAvailableand
DocumentsSavedpanes.
b. Selectafile,right‐click,andthenclickDeletetoremovethePDFdocumentorimage
filefromtheDocumentsAvailablepane.
6. DoStep5againuntilyouhaveaddedallofthefilesforthetreatmentplan.
7. ClickoneofthefilesyouaddedtotheDocumentSavedpane,andthenclickImportto
opentheImportPlanDocument.
If you import multiple files, MOSAIQ merges the files into one multiple-page
treatment plan document.
8. TypethetreatmentplannamefortheimportedfilesinthePlanLabelfield.
9. ClickOKtoimportthefiles.
TheimportedtreatmentplanappearsinaTxPlansfolderintheDiagnosesand
Interventionswindow.
The imported treatment plans appear in the sequence you import them into
MOSAIQ. The latest treatment plan you imported appears first in the Tx
Plans folder of the Diagnoses and Interventions window.
Changing Treatment Plan Documents
Afteryouimportthetreatmentplandocuments,usethePlanDocumentEditortosee,
change,add,andremovedocuments.Youcanalsoaddnotes,approve,print,andassociate
treatmentcoursesandprescriptionstothetreatmentplandocument.
1. OpenapatientchartandclickeChart|DiagnosesandInterventions.
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2. Double‐clicktheimportedplandocumentinthePlanDocsfoldertoopenthePlan
DocumentEditor.
ThePlanDocumentEditorusesthesametoolbarsasthoseintheImportPlan
Document.

Usethetoptoolbartosave,print,movethepageintheviewer,navigatethrough
multiplepages,andchangethepagelayoutofmultiple‐pagedocuments.

Usethelowertoolbartobrowsethroughmultiple‐pagetreatmentplans.Changethe
dimensionsofthepagewiththezoomtools.
3. TypeanewnamefortheplandocumentinthePlanLabelfieldifitisnecessaryto
changeit.Youcanalsochangethenameifyoudidnotnameitwhenyouimportedthe
files.
4. TypeashortdescriptionoftheplanintheDescriptionfield.
5. ClickAssociationstoassociatethetreatmentplanorimagewithradiationprescriptions
andcourses.
ThePlanAssociationshowsthecoursesandprescriptionsfortheselectedpatient.
6. Clicktheprescriptionorcourse,andthenclickSelect.
TheassociatedprescriptionappearsinthePlanDocumentEditor.
a. Ifitisnotnecessarytoassociatethetreatmentplanorimagewithaprescription,
clickNoneinthePlanAssociation.
b. Ifthepatienthasmultipleprescriptionsandcourses,presstheSPACEBARtotagthe
prescriptionsandcoursestoassociatewiththetreatmentplan.
7. ClickNoteandaddnotesorcommentsaboutthistreatmentplan.
8. ClickStatusinthePlanDocumentEditortochangethestatusfortheimported
treatmentplan.
9. Clickthestatusoftheimportedtreatmentplan,suchasApprovedtoapprovetheplan.
10. Typeyourusername,password,andclickOKtoapprovethedocument.
YourStaffTypemustmatchoneoftheconfiguredandavailablestafftypesunder
Approvals.YoursignatureisautomaticallyassociatedwiththecorrectStaffType.The
PlanDocumentEditorclosesandtheDiagnosesandInterventionswindowshowsthe
approvedtreatmentplan.
Adding PDF and Image Files to Treatment Plan Documents
AddorremovePDFandimagefilesintheEditPlanDocumentwiththesameoptions
availableintheImportPlanDocument.
1. OpenapatientchartandclickeChart|DiagnosesandInterventions.
2. Double‐clicktheimportedplandocumentinthePlanDocsfoldertoopenthePlan
DocumentEditor.
3. ClickEdittoopentheEditPlanDocument.
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Figure 20: Edit Plan Document Window
4. Click adjacenttothefolderintheDocumentsAvailablepanethatcontainstheimage
fileorPDFdocumenttoadd.
5. Right‐clickthefileandclickAdd.
6. Dosteps4and5againuntilyouhaveaddedthefilestotheimportedtreatmentfile.
Right-click the file, and then click Delete to remove files from the
Documents Available or Documents Saved panes.
7. ClickOKtoaddthenewfilesortoremovefilesfromtheimportedtreatmentplan.
8. ClickStatusinthePlanDocumentEditortochangethestatusfortheimported
treatmentplan.
9. Clickthestatusoftheimportedtreatmentplan,suchasApprovedtoapprovetheplan.
10. Typeyourusernameandpassword,andthenclickOKtoapprovethedocument.
YourStaffTypemustmatchoneoftheconfiguredandavailablestafftypesunder
Approvals.YoursignatureisautomaticallyassociatedwiththecorrectStaffType.The
PlanDocumentEditorclosesandtheDiagnosesandInterventionswindowshowsthe
approvedtreatmentplan.
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Treatment Fields
Youcanadd,create,copy,andapproveconventional,non‐particletherapytreatmentfields,
suchaskVOrthoanddocument‐basedtreatmentfields.
Conventionalexternalbeamradiationtherapyusestreatmentsystemstodeliverafocused
beamofradiationtothecanceroustissue.TreatmentsystemsincludetheElektalinear
accelerator,AccurayCyberKnifesystem,LeksellGammaKnifePerfexionsystem,
Synergy,TomoTherapysystem,andVarian.
Forinformationonparticletherapytreatmentfields,suchasprotonsandions,seeParticle
TherapyTreatmentFields.
Manually Adding Treatment Fields
Tocreatetreatmentfields,youcopysimulationfieldsorothertreatmentfields.Youcanalso
createatreatmentfield“fromscratch”–forexample,ifthepatienttreatmentdoesnot
importfromyourtreatmentplanningsystemusingDICOM.
Mosttreatmentfieldsareimportedfromatreatmentplanningsystem,butyoumay
sometimesneedtoaddatreatmentfieldmanually.
Toaddatreatmentfield,youmusthaveClinical|FieldDefs|Modifyrights.
You cannot manually add particle therapy particle treatment fields. You can
copy a particle therapy treatment field. See Creating a Particle Treatment Field
by Copying an Existing Field.
1. IntheDiagnosesandInterventionswindow,clicktheradiationprescriptionforwhichto
createatreatmentfield.
2. ClickTXFieldtoopenLocationDirectory.
3. Double‐clickortypethelinearacceleratorusedtotreatthepatienttoopenthe
TreatmentFieldDefinition.
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Figure 21: Treatment Field Definition Window
TheTreatmentFieldDefinitioncontainstheheaderinformationandgeometric
parametersfromtheSimulationFielddialogbox,plusadditionalfieldstodefinethe
dose.Youmust,atminimum,completetheField,Tolerance,TypeandModalityfields,
andapplyatolerancetable.
4. TypethenumberofthetreatmentfieldinthefirstFieldtextbox.
5. TypethenameofthetreatmentfieldinthesecondFieldtextbox.
6. Click
adjacenttotheMachinefieldtochangethemachineusedtotreatthepatient.
7. Click adjacenttotheTolerancefield,andthenselectthetolerancetableforthe
anatomicalareatotreat.
Thisdefinesthedegreeoftolerancewithinwhichthetreatmentunitparametersmust
remainwhensettingupthepatient.
8. TypethedoseinDosefield.
Dosimetry lets you calculate dose site coefficients and define the dose
contributions from each applicable prescription site.
9. Click
adjacenttotheTypefield,andthenselectthetypeofbeam.
10. Click
adjacenttotheModalityfield,andthenselectthemethodoftreatment.
11. IntheBeamConfigurationdialogbox,selecttheMvintheEnergycolumn,selectthe
doserateintheDoseratecolumn,andthenclickOK.
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Theenergyanddoserateoptionsthatappeararedefinedinthemachine
characterizationoftheselectedlinearaccelerator.Ifanenergylevelordoseratewas
notdefinedinthemachinecharacterization,itdoesnotappearintheBeam
Configuration.
Forflatteningfilterfree FFF treatments,MOSAIQadds“FFF”totheenergyvalueand
highlightsitinyellowintheBeamConfiguration.
12. IntheTreatmentFieldDefinition,typethemonitorunitsintheMonitorUnitsfield.
The Wedge MU parameter is only significant for sites with Elekta or GE linear
accelerators. If you have a Varian or Siemens linear accelerator, never use
the Wedge MU parameter. MOSAIQ disables the Wedge MU parameter when
a Co-60 modality field is selected.
13. TypethetreatmentdeliverytimeintheTimefield.
MOSAIQ shows these parameters only when a Co-60 modality field is
selected or shown: SDD (Source to Diaphragm Distance), Head Angle, RPM
(Revolutions Per Minute), which replaces MU/Deg on arc fields. MOSAIQ
hides these parameters when a Co-60 modality field is selected or shown:
Energy, Doserate.
The Theratron Equinox machine does not use the SDD, Head Angle, and
RPM parameters. MOSAIQ does not show, record, or verify these parameters
for this interface.
Manually Adding a kV Treatment Field
AkVtreatmentfieldisafieldthatisassignedtoanorthovoltageorsuperficialtreatment
machine.
1. ClickeChart|DiagnosesandInterventions,clicktheradiationprescriptionforwhichto
createatreatmentfield,andclickTxField.
2. SelectakVtreatmentmachinefromtheLocationDirectory.
3. SpecifytheFieldandDoseinformationasdescribedinManuallyAddingTreatment
Fields.
4. IntheBeamgroup,MOSAIQautomaticallyselectsStaticforTypeandkVforModality.
5. Fordose‐basedkVmachines,typethemonitorunitsforthefieldintheMonitorUnits
field.Fortime‐basedkVmachines,typethedurationofthetreatmentinminutesinthe
Minutesfield.
TheDoserate,whichappearsonlyfordose‐basedkVmachines,istheMUorcGy
deliveredineachminute.Thisisbasedontheselectedfilter derivedfromtheMachine
Characterization .
6. IntheFiltergroup,selectthefilterfromtheFilterdrop‐downlist.
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TheEnergy kV ,HVL,andTubeCurrent mA valuesthatappeararedefinedinthe
MachineCharacterizationfortheselectedfilter.
7. IntheApplicatorgroup whichappearsonlyiftheselectedkVmachinesupports
applicators ,selecttheapplicatorfromtheApplicatordrop‐downlist.
TheFSD mm andShapevaluesthatappeararedefinedintheMachine
Characterizationfortheselectedapplicator.
Make sure that the configuration of the filter and applicator in the Machine
Characterization is the same as on the machine.
Adding Setup Fields (Setup=MV or kV Setup=kV)
ASetupfieldspecifiesthetreatmenttypeforImageGuidedRadiationTherapy IGRT .
Setupfieldsdonotcontributetodose.

CharacterizetheSetupfieldinthemachinecharacterizationtomakethefield
availableontheTreatmentFieldDefinition.

SpecifythetreatmenttypeintheTypeslistintheBeamgroupontheTreatment
FieldDefinition.
MOSAIQletsyouimportsetupfieldsonlyfromEclipsetreatmentplanningsystems.
ForothertreatmentplanningsystemsthatdonotcreateSetupfields,youmustaddthem.
1. CopyatreatmentfieldintheTreatmentFieldDefinition.
2. ChangethetreatmenttypefromFixedtoSetuporkVSetup.
Showing a Hidden Treatment Field
YoucanonlyunhidetreatmentfieldsfromtheDiagnosesandInterventions.
1. ClickeChart|DiagnosesandInterventionsorclicktheD&Iicononthetoolbar.
2. SelectthehiddentreatmentfieldintheDiagnosesandInterventions,andpressF4or
right‐clicktoopenthemenu.
YoucanalsopressCTRL HtounhidethefieldandskipStep3.
3. ClickHiddenTxField.
Adding Accessory Information
Specifyparametersforaccessoriessuchaswedges,applicators,compensators,andblocks.
1. IntheAccessories/SlotsgroupoftheTreatmentFieldDefinition,click
Wedgebox,andselectthewedgetobeusedintreatment.
adjacenttothe
Ifyouselectelectronsforthetreatmentmodality,theApplicatorparameterappears
insteadoftheWedgeparameter.Selectanapplicatorfromthedrop‐downlist.
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Youcanalsodefineafieldfortreatmentwithastereotacticconicalcollimator
stereotacticcone .Todefineastereotacticcone,selectXraysasthemodalityandan
applicatorfromtheWedge/Appldrop‐downlist.
2. TypethenameofthecompensatorrequiredfortreatmentintheCompensatorfield.
3. TypetheblockrequiredfortreatmentintheBlockfield.
4. TypethebolusrequiredfortreatmentintheBolusfield.
If you are using barcode verification of accessory devices, type the word
‘Custom’.
Adding Geometric and Couch Settings
Mostofthetime,youtransfertreatmentfieldgeometricsettingsfromthetreatment
planningsystemthatyouuse.Youcanalsoaddthegeometricandcouchsettingsmanuallyif
necessary.
1. IntheGantry/CollimatorgroupoftheTreatmentFieldDefinition,typethegantryangle
intheGantryAnglefield.
2. TypethecollimatorangleintheCollimatorAnglefield.
3. TypethewidthandlengthoftheXjawsintheFieldSizeXfield.
4. TypethewidthandlengthoftheYjawsintheFieldSizeYfield.
The field sizes for the selected stereotactic cone (X-ray applicator) are
assigned by the field sizes configured in the Machine Characterization and
are read-only. You can also configure the field sizes for electron applicators
in the Machine Characterization. If the applicator information in the
Machine Characterization is not sufficient, MOSAIQ shows the field size
values as zero (0) and lets you set them in the Treatment Field Definition.
This also applies to stereotactic cones.
5. IftheXjawsareasymmetrical,right‐clickandselectAsymmetricJaws|ASYX.Typethe
width/lengthofeachXjawintheJawX1andJawX2fields.
6. IftheYjawsareasymmetrical,right‐clickandselectAsymmetricJaws|ASYY.Typethe
width/lengthofeachYjawintheJawY1andJawY2fields.
7. Right‐clickandselectEnableMLCifanMLC multileafcollimator planisthereforthis
treatmentfield.
Forfieldsthatarecharacterizedwithfixedbackupjaws:

Youcandefinesimplerectangularfields non‐MLCfields withonlytheMLCleaves
andcollimatingjaws.Theleavesdefinetheedgeoftheapertureonthesideswith
thefixedbackupjaws.

ForMLCfields,thebackupjawsalwaysshowasfullyretracted.Theleavesand
collimatingjawsdefinetheshapeoftheaperture.
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8. TypethecouchsettingsintheCouchgroup,suchastheAnglefield.
For particle therapy fields, the couch positions defined in site setup are the
starting couch positions. The treatment field values are relative to site
setup. See Adding Geometric and Couch Settings for a Particle Treatment
Field.
If the machine is characterized to show the couch angle as ring angle,
MOSAIQ shows Ring Swing in the Couch group.
Creating Simple MLC Positions
TheSimpleMLCoptionletsyoudefineMLCleafpositionsthatconformasmuchaspossible
basedonthecharacterizedlimitsoftheMLC tothespecifiedrectangulardimensions.
The Simple MLC option is enabled only for machines that are characterized with
variable MLC leaf pair retraction limits.
1. Right‐clickorpressF4intheTreatmentFieldDefinition,andthenclickSimpleMLC.
2. IntheCreateSimpleMLCthatappears,entertheFieldSizeXorJawX1andJawX2and
FieldSizeYorJawY1andJawY2values.
TheMOSAIQsoftwaregeneratesleafpositionsthatopenasmuchaspossibletothe
specifiedfieldsizedimensions.
3. ClickOKintheCreateSimpleMLC.
TheMOSAIQsoftwareshowsthegraphicalrepresentationoftheMLCandjawpositions
intheBEVViewer.
4. ClickOKintheTreatmentFieldDefinitiontosavethenewpositions.
Adding Portal Image Information
YoucanspecifyMUandotherparametersspecificallyforportalimages.
1. OpentheTreatmentFieldDefinition.
2. Completeanyofthefieldsthatwerenotfilledinwithdatafromthetreatmentplan.
3. InthePortalImagegroup,typetheplannedportalimagemonitorunitsinthePlanned
MUfield.
YoumusttypeaMUvaluelessthanthemaximumportalimageMUcharacterizedforthe
selectedmachine.IfyoutypeavaluegreaterthanthemaximumportalimageMU,an
errormessageappears.
4. TypetheopenfieldportalimagemonitorunitsintheOpenMUfield.
5. Ifyouwanttotrackdose,typethedosecoefficientinthePlannedandOpengroupDose
Coefffields.
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IfyourtreatmentmachineisaVarian4DITCorTrueBeam,youmustselecttheimage
qualityinthePlannedandOpengroupImageQualityfields.
5. Typetheincrementalnumberofcentimetersthecollimatorfieldsizeopensfromthe
treatmentfieldsizeforanopenfieldportalimageexposureintheOpengroupDelta
field.
TheDeltafieldappliestodouble‐exposureimages.Forexample,ifyoutype8,thefieldis
opened4 4.
The EPID and SID check boxes are required fields for the Varian 4D and
Siemens Coherence machines.
6. ClicktheEPIDcheckboxifyouuseanElectronicPortalImagingDevice.
7. TypetheSourcetoImageDistanceintheSIDfield.
Adding Field Setup Information
UsetheFieldSetuppaneoftheTreatmentFieldDefinitiontoaddinformationthatis
necessaryfortherapiststoknowwhensettingupthepatientfortreatment.Thisincludes
thepatientpositionoraccessoriesnotlistedintheAccessoriesgroup,suchasangle
cushionsorbreastboards.
1. IntheTreatmentFieldDefinition,click
FieldSetup.
2. IntheFieldSetuppaneoftheTreatmentFieldDefinition,typethefieldsetup
informationintheFieldSetuptextfield.
Ifyournoteisanalert,clicktheDisplayFieldSetupFirstwhenTreatingthisFieldcheck
box.Whenthisboxischecked,theFieldSetupviewautomaticallyappearswhenthe
therapistselectsthefieldfortreatment.Ifitisnotanalert,thedefaultviewappears.
3. ClickOKtosavethenewtreatmentfield.
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Creating a Treatment Field by Copying a Simulation Field
Tosavetimeandeffort,youcancopysimulationfieldstoaddtreatmentfields.
1. IntheDiagnosesandInterventions,selectthesimulationfield,andthenclickTxFieldto
opentheConfirmFieldCopymessage.
2. ClickYestoconfirmthatyouwanttocopythesimulationfieldandopentheTreatment
FieldDefinition.
Ifyoucopyasimulationfieldtoaddanewtreatmentfield,onlythefieldnumberand
name,thelinearaccelerator,andthegeometricsettingscopyover.Youcankeepthe
copiedinformationortypenewinformation.
3. IntheTreatmentFieldDefinition,typethedoseforthetreatmentfieldintheDosefield.
4. Click adjacenttotheTolerancefield,andthenselectthetolerancetableforthe
anatomicalareatobetreated.
5. Click
6. Click
7. IntheBeamConfiguration,selecttheMVintheEnergycolumn,selectthedoseratein
theDoseratecolumn,andthenclickOK.
8. TypethemonitorunitsforthetreatmentfieldintheMUfield.
9. Typetheback‐uptimeintheTimefield.
10. AddanyAccessoriesinformation,suchasWedgeorBolus,aswellasPortalImage
information.
11. Changeanygeometricandcouchsettingsifnecessary.
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Creating a Treatment Field by Copying an Existing Treatment Field
Youcancopyanothertreatmentfieldtoaddatreatmentfield.Thisissimilartothe
procedurewhereyoucopyasimulationfieldtoaddatreatmentfield.But,sinceyouhave
addedallthebeamandaccessoryparametersforthefirsttreatmentfield,youcancopythat
treatmentfield,andthenchangeonlythoseparametersnecessaryforthesecondtreatment
field.Whenyoucopyatreatmentfield,notonlydoyoucopythegeometricsettings,butalso
itsMLCshape ifapplicable .
You can copy a particle therapy treatment field. See Creating a Particle
Treatment Field by Copying an Existing Field.
You can copy a protected treatment field, but the new treatment field is not a
protected field.
1. IntheDiagnosesandInterventions,selectthetreatmentfield.
2. ClickTxFieldtoopentheConfirmFieldCopymessage.
3. ClickYestoconfirmthatyouwanttocopythetreatmentfieldandopentheTreatment
FieldDefinition.
4. IfthereisanMLCplandefinedforthetreatmentfield,amessageappears.ClickYesto
copytheMLCplanorNoifyoudonotwishtocopytheMLCplan.
When you copy the MLC plan defined with the treatment field, be
aware that if you disable the MLC, it could cause serious injury or
WARNING
mistreatment.
5. IftheMachineCharacterizationmessageappears,clickOK.
6. TypethetreatmentfieldnumberinthefirstFieldtextbox.
7. TypethenameofthenewtreatmentinthesecondFieldtextbox.
8. Changetheaccessory,geometric,couch,andothersetupinformationifnecessary.
At treatment delivery, the MHI-TM2000/Vero machine uses its own
copy of the RT Plan that it has from the treatment planning
system. New fields created in MOSAIQ cannot be delivered on the
CAUTION MHI-TM2000/Vero machine.
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Creating a Document-Based Treatment Field
Youcanmanuallycreateadocumentbasedtreatmentfieldorimportplansthatresultin
documentbasedtreatmentfieldsforunconventionaltreatmentinterfaces,suchas
TomoTherapy®,CyberKnife®,GammaKnife®,andsoon.
Toaddadocument‐basedtreatmentfield,youmusthaveClinical|FieldDefs|Modifyrights.
1. IntheDiagnosesandInterventions,clicktheradiationprescriptionforwhichtocreatea
treatmentfield.
2. ClickTXFieldtoopentheLocationDirectory.
3. Selectamachinecharacterizedtocreateadocument‐basedtreatmentfield,forexample,
TomoTherapytoopentheTreatmentFieldDefinition.
Figure 22: Treatment Field Definition Dialog Box
Thedocument‐basedTreatmentFieldDefinitionhasatwo‐sectionheaderandfourtabs:
FieldDocument,PlanDocument,FieldSetup,andProcedureCoding.
The Procedure Coding tab is available only when you select the Region as
France on the International tab of the Department Setup window.
Youmust,atminimum,completetheField,TypeandModalityfields.
4. TypethenumberofthetreatmentfieldinthefirstFieldtextbox.
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5. TypethenameofthetreatmentfieldinthesecondFieldtextbox.
6. TheMachinefieldshowsthelinearacceleratorusedtotreatthepatientwiththefield.
Click adjacenttotheMachinefieldtochangethemachinename.
7. Click
9. Click
10. Click adjacenttotheEnergyfield,andthenselecttheenergyofthetreatment,based
onwhatisconfiguredinthemachinecharacterizationoftheselectedlinearaccelerator.
11. IntheDosefield,typetheresultingdoseatthedosespecificationpointwhenthe
Metersetvalueisdeliveredfromthetreatmentunit.
The Dose field is highlighted in yellow when the dose is zero only if Dose
Tracking Check is selected on the Clinical (RO) tab of the Department Setup.
12. TheFieldDocumenttabshowsifanydocumentisassociatedwiththetreatmentfield.
Toassociateadocumenttothetreatmentfield,clickImportintheFieldDocgroupto
opentheImportFieldDocument,andthenselectthefielddocument.
13. InthePlanDocumenttab,click adjacenttothePlanDocumentfieldtoselectthe
treatmentplanyouwanttoview.
14. IntheFieldSetuptab,thePhotos/Diagramsgroupshowsyouthedigitalphotosand
diagramsassociatedwiththetreatmentfield.
TheRxSitegroupshowsyouthetreatmenttechnique,modality,patientorientation,
prescribedoffset,localizationoffset,andtotaloffsetinformation.
IntheFieldSetupgroup,typefreetextasanote,clicktheDisplayFieldSetupFirstwhen
TreatingthisFieldcheckboxtohavetheFieldSetupappearwhenthisfieldistreated,
andtypethesourcetoskindistanceintheSSDfield.
15. IntheProcedureCodingtab:
a. SelectacostcoefficientforthetreatmentfieldfromtheCostCoefficientdrop‐down
list.
b. TypethebillingdoseratioforthetreatmentfieldintheBillingDoseRatiofield.
c. ClickOK.
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Capturing Parameters from the Machine
Youcanautomaticallycapturegeometricsettingsfromyourtreatmentmachine.Thisisnot
availableforVarian4D/TrueBeamtreatmentmachines.
If the System Administrator checked the Disable Capture Console check box in
the File | System Utilities | Department Setup… | Clinical (RO) tab, MOSAIQ
only captures the settings for the Gantry/Collimator and Couch groups.
1. Setthetreatmentmachinetothecorrectparameters.
If you capture parameter settings from the treatment machine, the
parameter settings on the machine overwrite settings you manually added
in MOSAIQ or captured before. Make sure the settings on the treatment
machine are correct.
2. IntheDiagnosesandInterventions,double‐clickthetreatmentfieldforwhichyouwant
tocaptureparameters.
3. IntheTreatmentFieldDefinition,right‐clickinthedialogboxorpressF4.
4. Intheoptionsmenu,clickCouchCaptureOnlytoopentheCaptureCouchParameters
Onlymessage.
Whenyoucapturecouchfromthemachine,theVertical,Lateral,andLongitudinalcouch
settingsarecaptured.ItwillnotcapturetheAngleandthePedestal.Youcanmanually
changetheAngleandPedestalvalues,ifneeded.
5. Intheoptionsmenu,clickSettingsCapturetoopentheCaptureAllParametersmessage.
Figure 23: Capture All Parameters Message
Whenyoucapturesettingsfromthemachine,allvalues,includingconsole suchas
Energy andaccessoryinformation suchasaWedge arecaptured.MOSAIQoverwrites
theinformationintheTreatmentFieldDefinitionwiththisnewinformation.Ifthe
consoleoraccessoryinformationcaptureddiffersfromtheTreatmentFieldDefinition
inMOSAIQ,awarningmessagedisplays.
6. Ifyouaresurethesettingsonthelinearacceleratorarecorrect,clickYestocapturethe
settings.
7. IftheConsoleRxWarningmessageopens,clickYes.
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Thisindicatesthatoneormoreparametersettingsonthelinearacceleratordonot
matchthetreatmentfielddefinitionasshowninFigure24.Themismatchesare
highlightedinred.
Figure 24: Treatment Field Definition with Highlighted Fields
IfyouclickYes,theexistingparametersareoverwritten,includingparametersettings
thatdonotmatch.IfyouclickNo,MOSAIQdoesnotcapturetheconsoleparameter
settings,butitdoescaptureothersettings,suchasthegantryandcollimator.
IftheMUdiffers,theMUInformationmessageopens,showninFigure25.
Figure 25: MU Information Message
ThisindicatestheMUonthetreatmentmachinedoesnotmatchtheMUforthe
TreatmentFieldDefinitioninMOSAIQ.
8. IftheMUInformationmessagedisplays,clickOK.
NotethattheMUinthetreatmentfielddidnotchange.IftheMUvalueonthelinear
acceleratoristhecorrectvalue,youmustmanuallychangetheMUinthetreatmentfield
definition.
9. ClickOKtosaveparameterstothetreatmentfielddefinitionorclickCanceltokeepthe
originalparametersettings.
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Changing a Treatment Field
Youcanchangeatreatmentfielddefinitionif,forexample,someelementofthemachine
characterizationchangesorifthepatienttreatmentplanchanges.
YoucannotchangeprotectedfielddefinitionsinMOSAIQ.Protectedfieldsarethosethatare
identifiedasprotectedatthetimeofimportforamachinethatisconfiguredtoprotectfields
onimport.MOSAIQlimitsthechangesyoucanmaketotheprotectedfieldsintheTreatment
FieldDefinition.
Tochangeatreatmentfield,youmusthaveClinical|FieldDefs|Modifyrights.
1. IntheDiagnosesandInterventions,double‐clickthetreatmentfieldtochange.
2. IntheTreatmentFieldDefinition,changethetreatmentfield.
TheFieldDeltaautomaticallyopens.Examinethedetailsofthechangesinthisdialog
box.
Any changes you make to the treatment field definition apply
when you treat the patient. Review any changes to make sure
CAUTION they are correct BEFORE treatment.
3. ClickOKtosaveyourchanges.
At treatment delivery, the MHI-TM2000/Vero machine uses its
own copy of the RT Plan that it has from the treatment planning
system. Changes that you make to the fields in MOSAIQ are not
CAUTION available on the MHI-TM2000/Vero machine.
Copying Couch Values from a Treatment Field with Couch Copy
Copythevertical,lateral,andlongitudinalcouchvaluesfromaprescribedtreatmentfieldor
thelast mostrecent verifiedtreatmentfieldtootherdestinationfields.
The couch copy function is available only if the source field is a conventional
treatment field.
1. OpentheCouchCopywindowinoneoftheseways:
106

ClickeChart|DiagnosesandInterventions,selectatreatmentfieldfromwhichto
copythecouchvaluesintheDiagnosesandInterventionswindow,andthenclick
CouchCopy.

ClickeChart|RadiotherapyTreatment,andselectatreatmentfieldfromwhichto
copythecouchvaluesintheTreatmentChart.Right‐clickanywhereinthewindow
andthenselectCouchCopy.

ClickeChart|RadiotherapyTreatment,selectatreatmentfield,andthenclickTreat.
IntheTreatmentDeliveryTable,clickCouchCopy.
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
Ifyouchangethecouchvaluesduringtreatment,youcancopythosevaluesatthe
endofthetreatmentsession.Selectthefieldfromwhichtocopythecouchvaluesin
theCompositeRecordTreatment,andselectCouchCopy.
2. IntheCouchCopy,clickCopyRxValuestocopytheprescribedcouchvalueofthe
sourcefield,orclickCopyLastVxValuestocopythelastverifiedcouchvalues.
Tocopytomultipledestinationfields,holddowntheCTRLkeyandselectmultiple
destinationsfields.
3. Toapprovethecouchcopy,typeyourPassword.
4. Tocopyandsavethenewcouchvalues,clickCopythenclickOK.
CAUTION
You must click OK after Copy in the Couch Copy window to save
the new couch values.
Reviewing IMRT Fields
IntensityModulatedRadiotherapyTreatmentletsyoudelivermulti‐controlpoint
treatments.Controlpointsarespecificpointsduringabeam‐onatwhichthetreatment
machinechangespositionorcollimation.MOSAIQsupports2IMRTtypes,StepandShoot,
andSlidingWindow.StepandShootplansbeam‐offbrieflybetweentreatmentmachine
movements.SlidingWindowfieldskeeptheinitialbeam‐onduringthetreatment.
YoucanseecontrolsintheTreatmentFieldDefinitionwhenyouselectafieldwithmultiple
controlpoints.YoucanshowandbrowsethroughallcontrolpointsforbothArcand
dynamicdoseMLCtreatmentfields.YoucanzoomtheBEVandstillusethenavigation
controls.
1. IntheDiagnosesandInterventions,double‐clickthetreatmentfieldtoopenthe
TreatmentFieldDefinitionfortheselectedIMRTtreatmentfield.
NoticetheIMRTsectionappearsinsteadoftheMLCdisplayandEnlarge/EditBeam’s
EyeView.Also,theAsymenuandsub‐menuoptionsforJawX1andJawY1donot
appearbecausetheydonotapplytothistreatmentfield.
2. Click
intheIMRTsectiontoshowalistthecontrolpointsforthistreatmentfield.
Figure 26: Control Point List for a Sliding Window IMRT Field
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107
3. Click intheIMRTsectiontoshowtheIMRTsequenceintheviewerasifthe
treatmentmachineiscompletingtheplan.
4. Click
tostopthetestrunoftheIMRTsequenceintheviewer.
5. Click ,andthen tonavigatetoothercontrolpoints,displayinganimageofthe
planfortheselectedcontrolpointintheviewer,andthepoint,index,andMUdatainthe
IMRTsection.
6. Click toshowanimageoftheplanforthelastcontrolpointintheviewerandthe
point,index,andMUdataintheIMRTsection.
7. Click toshowanimageoftheplanforthefirstcontrolpointintheviewerandthe
point,index,andMUdataintheIMRTsection.
8. Right‐clickandclickEnlarge/EditBeam’sEyeView…toopentheBeam’sEyeViewfor
theIMRTplan.
NoticethesameIMRTsectionintheTreatmentFieldDefinitiondisplaysintheBeam’s
EyeView.
You cannot change an imported IMRT plan in Beam’s Eye View.
9. ClickCanceltoclosetheBeam’sEyeView.
10. Right‐clickandclickDisplayShapedPort…toopentheBeam’sEyeViewfortheIMRT
shapedport.
TheShapedPortistheoutermostleafpositionsfortheIMRTtreatmentfield.Itisalso
calledtheCIAO completelyirradiatedareaoutline .
11. ClickCanceltoclosetheBeam’sEyeView.
12. Right‐clickandclickImport…toopentheTreatmentFieldDefinition.
TheTreatmentFieldDefinitionsletsyouimportparametersfromanothertreatment
fielddefinitionintothecurrentdefinition.OnlyplanswithMLCfieldsarelisted,
includingMLCfieldsthatarenotIMRT.IfanyoftheMLCfieldsincludeafieldshape,itis
indicatedintheShapesection.
13. ClickClosetoclosetheTreatmentFieldDefinition.
Approving a Treatment Field
Onceyouaddandchangeatreatmentfield,approvethetreatmentfieldbeforeyoutreatthe
patient.Infact,dependingonhowyouhaveconfiguredMOSAIQ,youmaynotbeableto
treatthepatientusinganunapprovedfield.Onceyouhaveapprovedafield,youcannot
removeit,thoughyoucanmakechangestothefield.Ifyouchangeanapprovedfield,the
statusofthefieldautomaticallychangestoUnapproved.SeeSettingtheCalibrationStatus.
Toapproveatreatmentfield,youmusthaveClinical|FieldDefs|Approverights.
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Always review all data before you approve a treatment field.
1. IntheDiagnosesandInterventions,double‐clickthetreatmentfieldtoapprove.
2. IntheTreatmentFieldDefinition,right‐clickinthedialogboxorpressF4toopenthe
optionsmenu.
3. ClickApprove…toopentheApproveTreatmentFieldDefinition.
4. TypeyourpasswordinthePasswordfield,andclickOKtoapprovethetreatmentfield.
5. IntheTreatmentFieldDefinition,clickOKtosavethechangetothetreatmentfield.
Approving Batch Treatment Fields
Youcanapproveallthetreatmentfieldsthatbelongtothesamecourseoftreatmentatthe
sametimewiththeBatchFieldApproval.
YoumusthaveClinical|FieldDefs|ModifyrightstoopentheStatusdialogboxandClinical|
FieldDefs|ApproverightstoapprovefieldsintheStatusdialogbox.
This option is available only for document-based treatment fields.
1. IntheDiagnosesandInterventions,selectatreatmentfield,andclickStatus.
ThenewStatusdialogboxappearswiththefieldthatyouselectedintheDiagnosesand
Interventionsautomaticallyselectedhere.Allthefieldsthatappearinthisdialogbox
areforthesamecourseoftreatment.
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109
Figure 27: Status Dialog Box
2. ToapprovetheselectedtreatmentfieldintheStatusdialogbox,typeyourpasswordin
theStatusAuthorizationgroup,andthenpressEnterorclickStatus.
a. Toselectmorethanonefield,holddowntheCTRLkeyandclickthefieldsyouwantto
approve.
b. Toapproveallthefieldsatonetime,pressCTRL Atoselectallthefields,typeyour
passwordintheStatusAuthorizationgroup,andpressEnterorclickStatus.
ThestatusofthefieldchangesfromPendingtoApproved.Ifyouseeawarningicon
adjacenttotheStatus,youmustexaminethetreatmentfielddefinitionandmake
,youmustcorrect
surethatitissafetoapprovethefield.Ifyouseetheerroricon
theerrorthattherelatedToolTipshowsyoubeforeyoucanapprovethefield.Todo
this,double‐clickthetreatmentfieldtoopentheTreatmentFieldDefinitionandmake
thenecessarychanges.Whenyousavethefielddefinition,youcomebacktotheStatus
dialogbox.Iftheerrorwascorrected,theicongoesaway.
3. ToclosetheStatusdialogbox,clickClose.
Configuring Batch Field Approval in Department Setup
1. ClickFile|SystemUtilities|DepartmentSetupandclicktheClinical RO tab.
2. ClickAllowBatchFieldApproval.
3. ClickOK.
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Viewing the Field Delta
TheFieldDeltaletsyouviewrecentchangestoatreatmentfield.Ifconfiguredtodoso,
MOSAIQopenstheFieldDeltawhenyoumakeoneormorechangestoatreatmentfieldand
clickOK.
The Field Delta dialog box does not appear for particle therapy treatment fields.
1. Double‐clickthetreatmentfieldintheDiagnosesandInterventions.
2. Right‐clickorpressF4intheTreatmentFieldDefinition,andclickFieldDelta.
TheFieldDeltaopensinreadonlymode,asshowninthisfigure.
Figure 28: Field Delta for a Treatment Field
Changesbetweenversionsarehighlightedinyellow.ClickRollbacktogobacktoa
previousfieldversion.YoucannotusetheRollbackoptionifthefieldwasapprovedor
treated.YoucannoteditfieldsintheFieldDeltadialogbox.TheFieldDeltaletsyou
acceptchangesmadetotheselectedtreatmentfield,returntotheTreatmentField
Definitiontomakecorrections,orgobacktoapreviouslyapprovedversionofthe
treatmentfield.
SeeExaminingFieldDeltaChangeWarningsfortheinteractivemode.
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Particle Therapy Treatment Fields
UsetheTreatmentFieldDefinitionforparticletherapytoseetreatmentfieldinformationfor
particletherapyandtochangetheparticletherapytreatmentfielddefinitions.
TheBeam’sEyeViewtoolbaroptionisenabledonlywhenanMLCisdefinedforthe
treatmentfield.
Figure 29: Treatment Field Definition – Particle Therapy
Toviewandchangeparticletherapytreatmentfields,youmusthavethesepermissions:

ToopentheDiagnosesandInterventionswindow,youmusthaveClinical|General|
Viewrights.

Tocopyorchangeatreatmentfield,youmusthaveClinical|FieldDefs|Modify
rights.

Toaddorchangeanunapprovedsitesetup,youmusthaveClinical|SiteSetupDef|
Modifyrights.

Tochangeanapprovedsitesetup,youmusthaveClinical|SiteSetupDef|Approve
rights.

Toapproveatreatmentfield,youmusthaveClinical|FieldDefs|Approverights.

Toassignthetreatmentfieldcalibrationstatus,youmusthaveClinical|
QA/Calibration|Approverights.
Changing the Beamline
Youcantreatapatientonacompatiblebeamlinewithoutre‐planning.Thisgivesyouthe
flexibilitytooptimizethemachineandpatientschedulesiftheintendedbeamlineis
unavailable.
Beforeyoutreatapatientonadifferentbeamline,thebeamlineyouselectisvalidatedfor
thetreatmentfield.Thisletsyouknowifthereareincompatibilitiestobefixedbeforeyou
treatthefield.
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Whenyouchangethebeamline,ifthecalibrationstatusforthefieldisCalibratedor
CalibrationApproved,thenthatcalibrationstatusiscleared.
1. Openthepatientchart,andclickeChart|DiagnosisandInterventions,orclick
.
2. SelectatreatmentfieldfromtheDiagnosesandInterventionsandclickChange.
3. FromtheTreatmentFieldDefinition,selectaparticletherapyBeamlinefromthe
MachineNamelist.
Thebeamlinemustsupportthetreatmentfield’sModalityandScanMode.
IfthetreatmentfieldusesanMLC,thenthebeamlinemustbecharacterizedwithan
equivalentMLC.Iftheselectedmachineisnotvalidforthetreatmentfield,thenthe
InvalidMachineSelectionmessageappearsthattellsyouwhythemachineisnotvalid.
4. Afteryouchangethebeamline,ifatreatmentfieldparameterisinvalid,thenthis
parameterismarkedwithan erroricon.
5. Changetheinvalidfieldvalueorselectadifferentbeamlinetorepairtheerror.
Forexample,iftheGatingfieldissettoYesforthetreatmentplan,butthebeamlineyou
selectdoesnotsupportGating,thentheerroricontellsyouthat“RespirationGating
cannotbeachievedontheselectedbeamline.”ChangetheGatingfieldtoNoifitis
clinicallyacceptabletotreatwithoutgating,orselectadifferentbeamlinetofixthe
error.
6. Afteryouhavemadesurethatalltheparametersarevalid,clickSave,orclickApprove
inthetoolbar.
Whenyouchangethebeamlineforaparticletherapytreatmentfield,youmustalsochange
thebeamlineintheSiteSetup.SeeChangingtheSiteSetupBeamlineforParticleTherapy
Treatments.
Changing the Applicator ID
Whenyouchangethebeamlineforatreatmentfield,iftheApplicatorIDhasadifferent
name,thenyoucanselectthatname.
IftheApplicatorIDfieldisinitiallyblank,thenyoucannotchangethisfield.IftheApplicator
IDfieldisdefined,thenyoualsocannotdeletethisvalue.
.
2. Double‐clickaparticletherapytreatmentfieldtoopentheTreatmentFieldDefinition.
3. IntheApplicatorIDfield,selectanewvaluefromthedrop‐downlist.
ThevaluesinthislistareconfiguredintheMachineCharacterization.Whenyouimport
theRTIonPlan,theApplicatorIDisvalidated.Onlytheapplicatorsthathaveamatching
shapeandmodalityappearsinthislist.
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Changing the # Pieces
Ifthe#PiecesvalueintheGantry/Nozzlegroupforatreatmentfieldisdifferentfromthe
actual#Piecesmilled,thenyoucanchangethe#Piecesvalue.
Ifthisfieldisdefinedwithanaperture,thenyoucannotsetthe#Piecesvalueto0.Ifthe
fieldisnotdefinedwithanaperture,thenyoucannotaddone.
.
3. Inthe#Piecesfield,typeanewvalue.
Changing the Aperture and or Compensator Name
YoucanchangethenameoftheApertureand/orthenameoftheCompensatorforaparticle
therapytreatmentfield.Thisisadisplaynamechangeonly.Theunderlyingparameter
valuesdonotchange.Itisnotnecessarytoreprintabarcodelabelifyouchangethe
ApertureorCompensatorname.
IfitisnecessarytochangetoadifferentApertureorCompensator,thenyoumustre‐planat
theTreatmentPlanningSystem.
.
2. Double‐clickaparticletherapytreatmentfield,orselectaparticletherapytreatment
fieldandclickTxField.
3. IntheTreatmentFieldDefinition,typeanewnameintheAperturefieldorinthe
Compensatorfield.
Creating a Particle Treatment Field by Copying an Existing Field
Copy is the only option for particle treatment fields.
When you copy a treatment field with an MLC, then the MLC leaf plan will
automatically be copied with the treatment field.
Youcancopyandeditaparticletherapytreatmentfieldinthesameprescription.You
cannotmanuallycreateaparticletherapytreatmentfield.Ifitisnecessarytocopya
dominantparticletherapyfield,seeCopyingaDominantTreatmentFieldandtheAssociated
MatchandPatchTreatmentFields.
.
2. SelectaparticletherapytreatmentfieldfromtheDiagnosesandInterventions,andclick
TxField.
3. ClickYesintheConfirmFieldCopymessagetoopenTreatmentFieldDefinitionforthe
newfield.ClickCanceltoreturntoDiagnosisandInterventions.
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Figure 30: Confirm Field Copy Message
4. IntheTreatmentFieldDefinition,typethenewtreatmentfieldIDintheFieldtextbox,
andclickSave.
Copying a Dominant Treatment Field and the Associated Match and
Patch Treatment Fields
Youcancopyandchangeadominantparticletherapytreatmentfieldanditsassociated
matchand/orpatchtreatmentfieldsinthesameprescription.Youcannotcopythesefields
individually.Thedominant,match,andpatchtreatmentfieldscanonlybecopiedasaset.
.
Theassociatedmatchandpatchtreatmentfieldsareindicatedbyanmorp.The
dominantfieldIDisinparenthesis.Forexample,infigure,thedominantfieldIDisPA1A,
sothematchandpatchfielddescriptionincludesthetextm PA1A andp PA1A .
2. Selectadominantparticletherapytreatmentfieldoroneoftheassociatedmatchand
patchtreatmentfields,andclickTxField.
TheConfirmFieldCopymessageappears.
Figure 31: Copying a Dominant Treatment Field and the Associated Match and Patch Treatment Fields
3. ClickYesintheConfirmFieldCopymessage.
Inthisexample,threenewtreatmentfieldsappearintheDiagnosesandInterventions.
ThesefieldsareautomaticallyassignedanewFieldID.Theauto‐generatedfieldIDs
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115
startwiththe&character.Thenumbersthatfollowthischaracterrangefrom0001
through9999.ThelowestnumbersthatresultinuniqueFieldIDsforthepatientare
used.
You can replace the auto-generated Field IDs as other systems may not accept the
‘&’ character.
4. ToeditoneofthenewfieldIDs,double‐clickonthetreatmentfieldtoopenthe
TreatmentFieldDefinition.
YoucanchangetheFieldIDwhenyouedittheTreatmentFieldDefinitionto:

ChangetheBeamline.

Modifytheparametervaluesifnecessary.

SettheCalibrationstatus.

ApprovetheTreatmentFieldDefinition.
Moving Particle Therapy Treatment Fields from One Prescription Site
to Another
Youcandraganddropatreatmentfield conventional,proton,orion onlytoanother
radiationprescriptionsitethathasthesametreatmentfieldmodality.
Ifyoutrytomoveatreatmentfieldtoanincompatibleradiationprescriptionsite,thena
messageappearsthattellsyouthetreatmentfieldmodalityisnotcompatiblewiththe
radiationprescriptionsite.
Ifyoumoveadominantparticletreatmentfield,oroneoftherelatedmatchorpatchfields,
thenthesetoftreatmentfieldsaremovedtothenewradiationprescriptionsite.Thisis
becausethedominant,match,andpatchparticletherapytreatmentfieldscanonlybemoved
asaset.Theoriginaldisplayorderofthetreatmentfieldsispreserved.
.
2. Clickandholdtheleftmousebuttononatreatmentfieldfromaradiationprescription
anddragittoanotherprescriptionsite.
If you move a protected field to another prescription site, then a Confirm
Protected Field Move message appears that tells you that this can prevent
synchronization with the treatment field in the plan on the machine. Click Yes in
the message to move the protected field.
Awarningmessageappears.Thismessagetellsyouwhenyoumoveatreatmentfieldto
anotherprescriptionsitemayaffectdosetracking,andtousetheDosimetryoptionto
verifythedosecoefficients.
3. ClickOKinthewarningmessage.
Thetreatmentfieldappearsinthenewprescriptionsite.IfyouselecttheHistoricalView
optionfromtheright‐clickmenu,thiscreatesahistoricalversionofanApproved
treatmentfieldwhenyoudraganddropthefieldtothenewprescriptionsite.Thenew
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treatmentfielddisplaysunderthehistoricalversion.Historicalitemsareshowningray
text.
Adding Geometric and Couch Settings for a Particle Treatment Field
TheMOSAIQsoftwareletsyouimporttheSetupCouchAnglefromtheRTIonPlanfromthe
treatmentplanningsystem.Youcanseeandchange ifnecessary thisvalueintheEdit
ImportData–SiteSetup.
YoucanseetheplannedCouchAnglevalueforthefieldintheEditImportData–Treatment
Field.Youmustnotchangethisvaluethatisimportedfromtheplanforthefield.
Thecouch orchair anglevalueistheplannedcouch orchair angle.Ifyouhaveafield
definitionwitharelativecouchanglevalue,thenyoucannottreatthefield.Youmustchange
therelativecouch chair angletotheapplicableplannedcouch chair anglebeforeyoucan
treatthefield.
You must change the relative couch (chair) angle to the applicable planned
couch (chair) angle for all your patients after your upgrade and before the
patient is scheduled for treatment.
.
Ifyouhaveafielddefinitionwitharelativecouchangle,itappearsintheRelativeCouch
Chair groupoftheTreatmentFieldDefinition,andthisAlarmmessageappears:
Figure 32: Alarm Message
3. ClickOKintheAlarmmessagetoopentheTreatmentFieldDefinition.
4. IntheRelativeCouchgroup,double‐clicktheAngleθ deg fieldvalue.
TheCouchgroupappearsandtheAngleθ deg fieldmovestothisgroup.
5. TypetheplanCouchAngle orChairforSittingpatientorientation intheAngleθ deg field.
YoumustchangetheRelativeCouch chair Angletotheabsolutecouch chair anglebefore
apatientisscheduledfortreatment.Ifyoudonot,youseethemessage“Couch orChair is
Relative”intheTreatmentReadinessCheckatthetimeoftreatmentandMOSAIQprevents
treatmentinthatsession.
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Machine-Specific Field Requirements
Adding a CBCT Treatment Field for Elekta Machines
YoumustaddtheCTfieldsinMOSAIQbeforeyoucanscanthepatientwiththethirdparty
imageacquisitionsoftware,suchasXVI.Thesefieldssendinformationthattheimage
acquisitionapplicationuseswhenthepatientisonthetableandreadytobeimaged.This
topicalsoappliestotheVarian4DIntegratedTreatmentConsole ITC interface,
TrueBeam™interface,andtheSiemenssyngointerface.
1. Makeanewtreatmentfield,inwhichthefieldtypeisCTorMVCTforSiemenssyngo
machines.
YoucancopyacurrentfieldandchangetheTypefieldvalue notarequiredchangefor
VarianorSiemens .Allfieldsmusthaveidenticaltablevalues.
If have an Elekta XVI, you must select a preset. XVI will prompt you for a
preset at the time of acquisition.
2. WhenapatienthasmultipleprescriptionsiteswithdifferentCTsandStructureSetson
theTreatmentDeliveryTable,selectafieldfromsite1.
3. Right‐click,andclickLoadReferenceData.
If have an Elekta XVI, the DICOM transfer to XVI begins after you select a
site.
4. Selectafieldfromsite2.
5. Right‐click,andclickLoadReferenceData.
6. Dothisforallsites.
Defining an XVI Imaging Preset for a Field (Elekta XVI Systems only)
YoucandefineanXVIpresetforthetreatmentfielddefinitionwhentheseconditionsare
true:

TheselectedmachineischaracterizedasanElektamachine.

Theselectedmachineischaracterizedwithatleastonepresetthatisvalidforthe
selectedfieldtype.
TodefineanXVIpresetforafield,dothesesteps:
adjacenttoXVIPresetinthe
1. IntheTreatmentFieldDefinition,click
Accessories/SlotsgrouptoopentheXVIPresetList.
TheXVIPresetListshowstheXVIimagingpresetsthatareconfiguredforthemachine
andvalidfortheselectedfieldtype.
2. ClickavalidXVIpresetforthefieldtypeoftheselectedtreatmentfielddefinition,and
clickSelect.
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3. ClickOKintheTreatmentFieldDefinition.
Loading Reference Data for XVI Machines with SYNERGISTIQ
Loadreferencedata CTandisocenter forXVImachineswithSYNERGISTIQenabled.Send
thereferencedatastoredinMOSAIQfromaconfiguredworkstationtoamachinefora
selectedprescriptionsitefromtheDiagnosesandInterventions.Theprescriptionsitemust
haveasitesetupconfigured.
1. ClickeChart|DiagnosesandInterventions.
2. Selectaprescriptionsiteandright‐clickorpressF4toopentheoptionsmenu.
3. ClickLoadReferenceDatatoopentheSelectMachine.
Iftherearenomachinesavailable,amessageappears.Iftheprescriptionsitedoesnot
haveasitesetupconfigured,anerrormessageappearsandthereferencedatadoesnot
load.
4. Selectthemachinetowhichtosendthereferencedatainthedrop‐downlist.
ThislistshowsallXVImachinesthatyoucanselect.
5. ClickOKtosendthereferencedatatotheXVImachine.
Amessageappearsasthereferencedataissent.
Defining High Dose Treatment Authorization
TheMOSAIQHighDoseTreatmentAuthorizationappliesonlytotheVarianTrueBeam
machines.
You must have Clinical | Coefficients | Modify and Clinical | Field Defs
| Modify security rights to enable or disable the High Dose Treatment
Authorization (HDT) or to make changes to the fields that are defined with
this feature.
YoucanimportplansthathaveHighDoseTreatmentAuthorizationenabledfromtheTPS,or
defineHighDoseTreatmentAuthorizationforafieldatthetimeofplanimport,orinthe
TreatmentFieldDefinition.MOSAIQsendsthisinformationtothetreatmentmachine.Atthe
timeoftreatment,amessageonthemachineconsoletellsyoutoauthorizethetreatment
deliverywithyourusernameandpassword.
IftheselectedmachineischaracterizedforHighDoseTreatmentAuthorization,MOSAIQ
showstheUseHighDoseTreatmentAuthorizationcheckboxintheTreatmentField
Definition.SelectorclearthischeckboxtoenableordisableHighDoseTreatment
Authorization.
Site Setup Definition
Youusethesitesetupfeaturetoaddanewsitesetupdefinition.Yourfacilitymusthave
eChartregisteredtouseSiteSetup.
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Whenyouchangethebeamlineforaparticletherapytreatmentfield,youmustalsochange
thebeamlineintheSiteSetup.
Adding Site Setup Definition
YouusetheSiteSetupDefinitiontoaddpatientpositioningandimagereferencedataintoa
treatmentsiteforsubsequenttreatmentverification.Patientorientationisnecessaryto
communicateshiftsandoffsetsinpatientcoordinates,andtotranslateisocenterchanges
frompatientcoordinatestomachinecoordinatesforcouchcalculations.MOSAIQcreatesthe
sitesetupatthetimeofplanimport,oryoucanmanuallycreateasitesetupdefinition.
Toaddorchangeanunapprovedsitesetup,youmusthaveClinical|SiteSetupDef|Modify
rights.
1. Openthechartforyourpatient,andthenopentheDiagnosesandInterventions.
2. Selecttheradiationprescriptionfoldertowhichyouwanttoaddasitesetup,andthen
clickSiteSetuptoopentheSiteSetupDefinition.
TheSetupNameisthenameofthesitesetupdefinitionandisalsothesameasthe
radiationprescriptionname.
3. SelectavalidpatientorientationonthecouchfromthePatientOrientationdrop‐down
list forexample,HeadIn,Supine .
For particle therapy radiation treatment sites, MOSAIQ supports sitting
patient orientation.
4. SelectthetreatmentmachinetowhichthesitesetupappliesfromtheMachine
drop‐downlist.
For particle therapy radiation treatment sites, select the beamline for this
site setup from the Beamline drop-down list. See Changing the Site Setup
Beamline for Particle Therapy Treatments.
5. Selecttheappropriatetolerancetabletoapplytothesitesetupdefinitionfromthe
Tolerancedrop‐downlist.
Thereareseparatetolerancetablesforparticletherapysitesetupsandconventional
sitesetups.
6. ClicktheSetuptab.
IntheSetupInstructionstextboxyoucanaddfree‐formtextthatidentifiessetup
informationthatisnotcoveredelsewhere,suchaswhichtreatmentsitesthesetupis
validfor.Youcantypeamaximumof2000characters.
For particle therapy ocular treatment sites, set the Azimuthal and Polar
Gazing Angles in the Geometrics section.
7. ClicktheImages/ReferenceDatatab.
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TheReferenceImagesgroupshowsDRRorsimulatorimagesthatbelongtothe
currentlyselectedpatient.
8. IntheVolumeReferenceDatagroup,selectthestructuresetthatyouwanttoassociate
withthePrescriptionSitefromtheStructureSetdrop‐downlist.
9. ClicktheSetIsocentercheckboxandsettheX,Y,andZisocenterstothevaluesfromthe
structuresetyouselected.
10. IfyouuseElekta’sAutomatedTableMovement,youcanreplacethedefaultThreshold
andMaximummotiontolerancesforthetreatmentunit.Todothis,selecttheapplicable
tolerancetablesintheCouchMovementgroup.
11. ClickOKtoaddsitesetupdefinitionintothetreatmentsiteandclosetheSiteSetup
Definition.
Changing the Site Setup Beamline for Particle Therapy Treatments
Totreatapatientonadifferentparticletherapybeamlinewithoutre‐planning,changethe
beamlineintheSiteSetupDefinition.Beforeyouchangethebeamlineinthesitesetup,
makesurethatthebeamlinemodalityischaracterizedasprotonsorion carbon .This
dependsontheparentprescriptionsitemodality.
.
2. SelectaSiteSetupforaparticletherapyprescriptionandclickChange.
3. IntheSiteSetupDefinition,selectaparticletherapyBeamlinefromtheMachineName
list.
Iftheselectedmachineisnotvalidforthesitesetup,thenamessageappearsthattells
youwhythemachineisnotvalid.Forexample:
Figure 33: Invalid Machine Selection Message
IftheselectedbeamlineisvalidfortheSiteSetup,thenthismessageappears.
Figure 34: Beamline Change Message
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MOSAIQalsodoesapositionallimitcheckofthesitesetupparametersforthenew
beamline.Forexample,iftheVerticalZparametervalueintheCouchSettingsgroupis
morethanthepositionallimitsspecifiedinthemachinecharacterization,thismessage
appears.
Figure 35: Positional Limit Exceeded Message
Defining the Site Setup for an Ion Plan
Site Setup Definition is mandatory for particle therapy treatment fields.
TheMOSAIQsoftwaredefinesthesitesetupfromtheRTIonPlan.Thepatientorientation,
structureset,andisocentervaluesfortheplanareimportedanddisplayedintheSiteSetup
Definition.
ForIonfieldsthataretreatedwithabeamlinethatischaracterizedforoculartreatments,
theSiteSetupDefinitionshowstheGazingAngles AzimuthalandPolar intheGeometrics
section.IfyouimportedthesevaluesintheRTIonPlanfromtheTPS,theyappearhere.You
caneditthesevaluesifnecessary.TherangefortheAzimuthalGazingAngleis0–360
degreesin0.1degreeincrements.TherangeforthePolarGazingAngleis0–90degreesin
0.1degreeincrements.
IntheSetupInstructionspane,youcanaddsitesetupinstructionssuchasthechairheight,
themaskorbiteblockheadtiltangle,andthenumberanddistancesoftheclipsfromeach
other.
.
2. Double‐clickSiteSetupundertheradiationprescription.
3. ViewthePatientOrientation,Beamline,andTolerancevalues.
4. MakesurethattheGantrySettingsandCouch chair Settingsarecorrectlyspecified.
TheSiteSetupDefinitionshowsthePlanAngleandTargetAnglevaluesintheCouch
Settings orChairSettings groupintheGeometricssection.ThePlanAnglemustbethe
sameastheintendedpatientsetupposition.
Aftersometreatmentsessions,apatternofangularcouchcorrectioncanbecome
apparent.Systematiccorrectionsaresmallandmustbewithin 5or‐5unitsto
continuewithtreatment.
5. ChangetheTargetAngletoincludeasmallcouchrotationadjustmentforsystematic
setupcorrectionifthepatientisconsistentlyrotatedrelativetothecouchtop.
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IfyouchangetheTargetAngletoenterasetupcorrection,thedifferencebetweenthe
TargetAngleandthePlanAngleisthesetupcorrectionandappearsadjacenttothePlan
Angle.
Systematic
correction
Figure 36: Systematic Plan Angle and Target Angle Corrections
Forsomesystems,itisimportanttocommunicatethePlansetupangletotheimaging
softwareandtheTargetAngletothepatientsupportsystem.Thesesystemsmakesetup
DRRsforeachpositionverificationevent.SeeyoursystemReferenceManualfor
specificrequirements.
IfyouimportthePlanAngleorthePatientOrientation,theTargetAngleautomatically
updatestothesamevalueasthePlanAngle.Thesystematiccorrectionshowsas0.0
zero .
6. ClicktheVolumeReferenceDatatab.
YoucanseetheStructureSetvaluesintheReferenceStructureSet/Isocentergroup.
CorrectstructuresetselectionisnecessarytosendthecorrectreferenceCTtothe
treatmentunitandforlaterimagereview.
CAUTION
Do not change the structure set in Site Setup Definition. If you do,
the isocenter values are automatically cleared. To change the
Structure Set without isocenter disruption, resend the plan to
MOSAIQ. Use RT Ion Import to change the structure set in Site
Setup.
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Information icon that
shows the Plan Angle
Target Angle from
Site Setup
Figure 37: Site Setup Verification
Configuring Treatment Field, Protons Modality Tolerance Tables
Youmustconfiguretreatmentfieldtolerancesinwhichthetreatmentunitparametersmust
beatthetimeoftreatmentdelivery.Settolerancesforparameters,suchasGantryAngle,Air
Gap,SnoutPosition,SnoutRotation,Meterset,Range,SOBP Spread‐OutBraggPeak ,Width,
andFieldDiameter.
3. ClickTolerances.
4. IntheTolerancewindow,click
adjacenttoToleranceType.
5. SelecttheTreatmentField,ProtonsModality.
ThismodalityalsoappliestoIons.
6. ClickAddtoopentheToleranceTable–ProtonTreatmentFieldandtypetheapplicable
information.
Configuring Site Setup, Protons Modality tolerance tables
Youmustconfiguresitetolerancesinwhichthetreatmentunitparametersmustbeatthe
timeofsitesetupverification.Settolerancesforparameters,suchastheGantryAngle,Air
Gap,SnoutPosition,SnoutRotation,Meterset,Range,SOBP Spread‐OutBraggPeak ,Width,
andFieldDiameter.
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3. ClickTolerances.
4. IntheTolerancewindow,click
adjacenttoToleranceType.
5. SelectSiteSetup,ProtonsModality.
ThismodalityalsoappliestoIons.
6. ClickAddtoopentheToleranceTable–ProtonSiteSetupandtypetheapplicable
information.
Ocular Treatments
Fortreatmentfieldsthataretreatedwithabeamlinethatischaracterizedforocular
treatments,theTreatmentFieldDefinitionshowstheGazingAzimuthalandGazingPolar
anglesintheClinicalgroup,whichareread‐onlyvalues.YouspecifythesevaluesintheSite
SetupDefinitionrelatedtothefield.TheGantry/NozzlegroupshowstheWedgedata,which
isalsoread‐only.TheRelativeCouchvaluesbecometheRelativeChairvalues.
Figure 38: Treatment Field Definition for Ocular Treatments
Approving Site Setup Definition
YouusetheApprovedialogboxtoauthenticateandapprovethesitesetupdefinition.
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Tochangeanapprovedsitesetup,youmusthaveClinical|SiteSetupDef|Approverights.
1. Openthepatientchart,andthenopentheDiagnosesandInterventions.
2. SelecttheSiteSetupdefinitionyouwanttoapprove,andclickChangetoopentheSite
SetupDefinition.
3. EnteralltheinformationintherequiredfieldsandclickApprove.
4. EnteryourusernameintheUserfield.
5. EnteryourpasswordinthePasswordfield.
6. ClickOKtocompletetheapprovalprocessandclosetheSiteSetupDefinition.
Site Setup Data for Varian OBI and Elekta XVI Systems
Sitesetupdatadefinesthepatientposition,structureset,andisocentervalues.Youmust
sendtheRTplan,structureset,andplanningCTdataofthepatientfromyourtreatment
planningsystem TPS toMOSAIQ.
IfyousendthesameplanningCTagain,MOSAIQignoresit.EachCTimageispatient‐specific
andyoucannotuseitforadifferentpatient.IfyouexportanewstructuresetfromtheTPS,
MOSAIQshowstheimportedstructuresetsintheStructureSetfieldoftheSiteSetup
Definition.
TheElektaDICOMCommunicationsModule DCM :

RemovestheisocentervaluesandstructuresetUIDreferencedatafromtheRT
planreceivedfromtheTPS.

CreatesasitesetupthatyoucanimportintheRTPImportwindow.
TheisocentervaluesareimportanttothecorrectdisplayoftheplanningCTontheVarian
on‐boardimager OBI ortheElektaX‐rayVolumeImaging XVI systemformatching.
Image Guided Radiotherapy (IGRT) systems require DICOM
isocenter values, which are included in the RT plan sent from the
TPS. MOSAIQ imports these values directly from the RT Plan.
Isocenter values generated by the TPS in the RT Plan are relative to
CAUTION the CT DICOM “Origin.” These values may or may not match the
shown and/or printed TPS isocenter values. Contact your TPS
vendor for more information. Figure 39 shows an example.
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CT Scanner
10 mm slices
“Zero” CT Scanner
at this position
CT in TPS
Transfer CT
to TPS
For example,
CT Origin
0, 0, 0 (x, y, z)
Lower left corner
of 1st slice
New DICOM isocenter
Contained in the RT plan
190, 140, 10
“CT DICOM”
coordinates are
now 200, 150, 10
“NEW” TPS
Isocenter
-10, -10, 0
TPS Isocenter 0, 0, 0
DICOM “iso” is still
200, 150, 10
Figure 39: Example Site Setup Data Import
Printing Barcode Labels
Printthedifferenttypesofbarcodelabelsusedinbarcodeverification.
1. ClickFile|PrintBarcodes.
2. Selecttheappropriateoptionfromthedrop‐downlist.
For particle therapy, you can print barcode labels for machine specific
devices such as snout, energy filter, energy absorber, and wedge.
Dose Tracking
Onceyouhaveaddedthediagnosis,CarePlan,prescription,andtreatmentfields,youuse
Dosimetrytocreateprimarydosetrackingsites.Dosetrackingletsyoumonitorandtrack
cumulativedosedeliveredtositeswhentreatingapatient.
Dosimetryalsoassignsdefaultcoefficientsforfieldcontributionstotheprimarydose
trackingsites.Youcantrackdosefromthecurrentprescriptionsiteandalsofromotherpast
orcurrentprescriptionsites.
TheDosimetrySetupwindowautomaticallydisplaysPrimaryDoseTrackingsitesand
CumulativePrimaryDoseTrackingSites.YoucanaddSecondaryDoseTrackingSitesand
SecondaryCumulativeDoseTrackingsitestotheDosimetrySetup.Thisletsyoumonitorand
trackdosetoallsitesrelatedtotheprescribedsite.
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Creating Primary Dose Tracking Sites
TheDosimetryoptioncreatesdosetrackingsitesfromthefieldandprescription
information.PrimaryDoseTrackingSitesaredefinedautomaticallybasedonthe
informationintheprescription.ThePrimaryDoseTrackingSiteletsyouenterorchangethe
priordoseandaddanotefortheselecteddosetrackingsite.
Tocreateaprimarydosetrackingsite,youmusthaveClinical|Coefficients|Modifyrights.
1. Openthepatientchart,andthenopentheDiagnosesandInterventions.
2. ClickDosimetryorright‐clickintheDiagnosesandInterventions,andclickDosimetry…
toopentheDosimetrySetupInformation.
The Dosimetry Setup Information appears if you select the Dosimetry option
for the first time after a prescription site has been added.
TheDosimetrySetupInformationshowstheprescriptionsites,treatmentfields,and
cumulativedosesitesthathavenotbeensetupbeforeorthosethathavebeenchanged.
Dosetrackingisautomaticallysetupfortheprescription.Dosecoefficientsare
automaticallyassignedforeachtreatmentfieldwithadefaultcoefficientof1.000.Dose
coefficientsdefinetherelativedosecontributionofatreatmentfieldorradiation
prescriptiontoavolumeofinterest.
Thiswindowalsoshowsdetailsofanymissinginformationfornewlydefined
prescriptionsitesortreatmentfields,aswellasidentifyingthosefieldsforwhich
coefficientshavealreadybeengenerated.Ifyouchangetheprescriptionsite,or
add/changeatreatmentfield,andclickDosimetry…again,MOSAIQautomatically
changestheprimarydosetrackingsites,andrecalculatesdosecoefficients.
3. ClickOKtoopentheDosimetrySetup.
TheDosimetrySetuphastwosections.

Thetableinthetopsectionshowscumulativedosetrackingsiteinformation,
assigningtherelativecontributionofprescriptionsitedosestocumulativedose
trackingsites.

Thetableinthebottomsectionshowsdirectdosetrackingsiteinformation,
assigningtherelativecontributionoftreatmentfielddosestodirectdosetracking
sites.
CumulativePrimaryDoseTrackingSites inthetopsection andPrimaryDoseTracking
Sites inthebottomsection aredefinedintheprescriptions.Youcannotremoveoredit
thenamesofCumulativePrimaryorPrimarydosetrackingsitesintheDosimetrySetup.
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Use the buttons in the Dose Site and Coefficient groups to add, change, and
remove dose site and coefficient information in the top and bottom sections
of the Dosimetry Setup window.
Or:
Highlight a cell and double-click to insert, change, or delete a dose
coefficient.
Click on the list box header in a particular column to edit dose tracking site
information.
4. Double‐clicknearthePrior:fieldintheCumRx:dosesitecolumn.
5. ClickNotetoaddinformationaboutthepriordosedeliveredtothissiteoutsideofthe
department’sEMR.
6. ClickOKtosavethenoteandshowtheDosimetrySetup.
7. Double‐clicknearthePrior:fieldforRx:dosesitecolumn.
8. ClickNotetoaddinformationaboutthepriordosedeliveredtothissiteoutsideofthe
departmentEMR.
9. ClickOKtosavethenoteandshowtheDosimetrySetup.
10. ClickClosetoclosetheDosimetrySetup.
Adding Secondary Dose Tracking Sites
YoucanhaveMOSAIQtrackdosedeliveredtonon‐prescriptionorsecondarysites,suchas
criticalstructures.Thisalsoletsyoumakesurepatientsreceivetheexactdosethatis
necessary.ThereareCumulativeSecondaryDoseTrackingSitesandSecondaryDose
TrackingSites.
Although you can define an unlimited number of sites, a maximum of 21 dose
tracking site columns can appear at a time. This includes 21 CumRx: and Cum:
dose tracking site columns. You can configure them to show the most
applicable dose tracking sites.
1. IntheDiagnosesandInterventions,clicktheradiationprescription,andthenclick
ChangetoopentheRadiationPrescriptions.
2. ClickDosimetry.
3. Double‐clickAddNewDoseTrackingSiteintheuppersectionoftheDosimetrySetup,or
clickintheAddNewDoseTrackingSitecolumn,andthenclickAdd.
4. IntheCumulativeSecondaryDoseTrackingSite,typeanamefortheCumulative
SecondaryDoseTrackingSiteintheSiteName:field.
CumulativeSecondaryDoseTrackingSitestrackthedosecontributiontoanothersite,
suchasacriticalstructure,thatisaccumulatingfromtheprescriptionsite.Secondary
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DoseTrackingSitestrackdosecontributionstoanypointorvolume notprescribed in
thefield.Theseincludeoff‐axispointsandcriticalstructures.
5. ClickOK.
6. Double‐clickAddNewDoseTrackingSiteinthelowersectionoftheDosimetrySetup
window,orclickintheAddNewDoseTrackingSitecolumn,andthenclickAdd.
7. IntheSecondaryDoseTrackingSite,typeanamefortheSecondaryDoseTrackingSite
intheSiteName:field.
8. ClickOKtosavethesecondarydosetrackingsite.
Adding and Changing Dose Coefficients
Dosecoefficientsdefinetherelativedosecontributionofatreatmentfieldorradiation
prescriptiontoavolumeofinterest.Adefaultdosecoefficientof1.000isautomatically
assignedtoeachtreatmentfieldwhendosetrackingissetupfortheprescription.This
indicatesa1:1relationshipbetweenthedosetrackedtothetreatmentfieldandthe
secondarysite.
Youcansetupmultiplecoefficientsforasinglefield.Forexample,ifyoustartthefirstdayof
treatmentsdeliveringaspecifieddosetoasite,andthenaddablocktothesetuphalfway
throughthetreatmentschedule,youcanspecifyadifferentcoefficienttobeeffectiveonthe
dayyoustartusingtheblock.Youcanalsochangethecoefficientforsecondarysites,which
normallydonotreceivethesamedoseastheprescriptionsite.
You cannot add a dose site coefficient from a proton treatment field to a
conventional or ion prescription, from a conventional treatment field to a
proton or ion prescription, and from an ion treatment field to a conventional or
proton prescription.
1. IntheDosimetrySetup,double‐clickthefirstfieldundertheSec:dosesitecolumn,and
thenpressTAB,orclickinthecolumn,clickAdd,andthenpressTAB.
2. Double‐click1.000thatyoujustenteredintheSec:dosesitecolumn,orclick1.000,and
thenclickChange.
3. Typethenewdosecoefficient,andthenpressTAB.
4. ClickintheCumdosesitecolumn,right‐click,andthenclickEditCoefficients…toopen
theDoseCoefficientdialogbox.
YoucanusetheDoseCoefficienttoaddandchangecoefficients.Youcanspecifythedate
tostartthedosecalculationifitdiffersfromthetreatmentstartdate.Youcanalsoadd
aneffectivedatetoanexistingcoefficient.
5. Click
adjacenttotheStartDatefield.
6. IntheCalendardialogbox,selectadate,andthenclickOK.
7. Typeadosecoefficient,andthenpressENTERtoopentheDoseCoefficientswindow.
YoucanusetheDoseCoefficientstosetupnewdosecoefficientsforafieldandtoedit
theeffectivedateofexistingfields.
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8. ClickAddtoopentheDoseCoefficients.
9. Click
adjacenttotheStartDatefield.
10. IntheCalendar,selectadate,andthenclickOK.
11. TypethenewcoefficientandpressENTER.
12. ClickClose.
Adding Prior Dose
IfyouknowthequantityofdoseadministeredtoasitebeforeyourecordthesiteinMOSAIQ,
youcanrecordthepriordoseintheDosimetrySetupwindow.Priordosemaybe,for
example,fromapatienttreatmentatanotherfacility.
1. IntheDosimetrySetup,double‐clickthePrior:columnheaderforanyoftheprimaryor
secondarydosetrackingsitecolumns.ThisincludesCumulativePrimaryand
CumulativeSecondarydosetrackingsitecolumns.
TheCumulativeSecondaryDoseTrackingSiteappears.
2. Inthedialogboxfortheselecteddosetrackingsite,typethedosedeliveredtothissite
outsideofthedepartmentEMRinthePriorDosefield.
3. InthePriorDoseBEDCoefficientgroup,selectthebiologicalequivalentdosefor
Conventional,orProtonsasconfiguredintheDepartmentSetup,ortypeacustomprior
dosebiologicalequivalentdosecoefficient.
4. IntheCumulativeSecondaryDoseTrackingSite,clickNote.
5. Enteranoteregardingthepriordoseifneeded,andthenclickOK.
6. ClickOK.
Adding Total Cumulative Dose and Dose Tracking Sites
Onceyouhaveassignedthecourse/CarePlanandcreatedtheradiationprescription s ,you
canusetheDosimetryfeaturetoadddosetrackingsitesfromtreatmentfieldandradiation
prescriptioninformation.
1. IntheRadiationPrescriptionsdialogbox,clickChange.
2. Enterthetotaldosefortheprescriptionsite,includingthedosebeingadministeredto
thissitefromotherprescriptionsintheTotalCumfieldunderDoseLimitssection.
3. ClickOK.
4. ClickDosimetry.
5. IntheDosimetrySetupInformation,clickOK.
6. Double‐clickeachrowoftheCumRx:columntoaddthedosecoefficient.
7. IntheRadiationPrescriptions,clickChangeandenterthetotaldosefortheprescription
site,includingthedosebeingadministeredtothissitefromotherprescriptions.
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Dose Site Summary
TheDoseSiteSummaryshowstheradiationdoseadministeredtoeachtreatmentsite
definedasadosetrackingsite.Youcanaddsecondarydosetrackingsitestothetablelist
fromtheDosimetrySetupwindowandtheSecondaryDoseTrackingSite.
You must have Clinical | Tx Status View security rights to view the Dose
Site Summary.
OpentheDoseSiteSummaryintheseways:

ClickeChart|RadiotherapyTreatment...|Summary.

ClickeChart|DiagnosesandInterventions…

Click

PressF4orright‐clickandselectDoseSiteSummary...
ontheMOSAIQtoolbar

Click |ConfigureWorkspace…toopentheChartwindow,andthendouble‐click
DoseSiteSummary...
TheActionbuttonletsyouadd,change,ordeleteDoseActionsPoints.
Dose Action Points
MOSAIQcantrackthedosedeliveredtocriticalstructures,suchastheheartorspine,called
secondarysites.DoseActionPointsspecifythemaximumdosetocriticalstructuresand
makesurepatientsreceivetheexactdosenecessary.
TherearethreetypesofDoseActionPoints:

Standard
ShowsanalertaftertheActionDoseisreached.Youdonothavetoacknowledgea
StandardDoseActionPointtocontinuewithtreatment.

Mandatory
YoumustacknowledgeaMandatoryDoseActionPointtocontinuewithtreatment.

DoseLimit
YoumustacknowledgeaDoseLimitDoseActionPointtocontinuewithtreatment.
Thisactionpointcontinuestotriggerwarningmessagesduringtreatmentdelivery
evenafteryouacknowledgeit.Thismakessurethatthetherapistsseethealerteach
timetheytreatthepatient.Toclosethisactionpointtypeandstopthealert,you
mustchangeittoaStandardorMandatorytype,andthenacknowledgeit.
TheDoseActionPointswindowliststhepastandcurrentDoseActionPointscreatedforthe
patient.DependingontheView,youcansee:
132

AlltheDoseActionPoints

AcknowledgedDoseActionPoints

UnacknowledgedDoseActionPoints
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Adding or Changing Dose Action Points
Onceyouhavecreateddosetrackingsites,youcanaddDoseActionPoints.Whenyouuse
eCharttotrackdosetopatientsundertreatment,youcanusetheDoseActionPointsto
automaticallywarnyouwhenaspecifieddoseisapproachingataspecifiedsite.
1. IntheDosimetrySetupwindow,clickActiontoopentheDoseActionPoints.
TheDoseActionPointslistsallpastandcurrentDoseActionPointscreatedforthe
patient.DependingontheViewselected,youcanviewallDoseActionPoints,only
acknowledgedDoseActionPoints,oronlyunacknowledgedDoseActionPoints.
2. ClickAddtoopentheDoseActionPoint.
YoucanaddanewDoseActionPointorchangeanexistingone.Theonlytworequired
fieldsareDoseSiteandComment.Whileitisnotarequiredfield,alsotypetheAction
DoseorthedoseatwhichtheactionenteredintheCommentfieldshouldbeperformed.
IfyoudonottypetheActionDose,thenitiszero.
3. Click adjacenttotheDoseSitefield,andthenselectthedosesiteforwhichtocreatea
DoseActionPoint.
4. TypetheActionDosefieldorthedoseatwhichtheDoseActionPointistriggered.
TheLeadDosefielddisplaysthedosequantitythatissubtractedfromtheActionDose
andtheDoseActionPointbecomesactive.ActiveDoseActionPointstriggernotification
attreatmentdeliverythatanActionPointisapproaching.IfUseDefaultcheckboxis
checked,thedefaultleaddosespecifiedintheDepartmentSetupisentered.
5. IntheDoseActionPointTypegroup,clicktheoptionbuttontospecifythetypeofDose
ActionPoint:Standard,orMandatory,orDoseLimit.
AstandardDoseActionPointshowsanalertaftertheActionDoseisreached,butyoudo
nothavetoacknowledgeittocontinuewithtreatment.Youmustacknowledgea
mandatoryDoseActionPointtocontinuewithtreatment.DoseLimitDoseActionPoints
DAP aremandatoryandcontinuetotriggerwarningnotesduringtreatmentdelivery
evenafteracknowledgment.
6. TypetheactionintheCommentfield.
8. ClickOK.
9. IntheDoseActionPointswindow,clickClose,andthenclickClose.
SeeAdding,Changing,orRemovingaDoseLimitusingRadiationPrescriptions.
Using the Treatment Calendar
TheTreatmentCalendarisapowerfultoolthatyoucanusetocreatetreatmentsessionsso
yourtherapistscanseewhichfieldstotreatonwhichdays,andwhentotakeportalimages.
Youcandomorethanjustscheduleandtreat.Youcanalsouseitslayouttobettertrack
treatments,doses,portalimages,andmore.Youcaneasilyassignmultipleprescription
treatmentsorsingleprescriptionswithalternatingfieldpatterns.
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Scheduling Treatment Sessions
Youcandomorethanscheduletreatmentsessionsforasingleradiationprescription.You
canscheduletreatmentsessionsformultipleprescriptions,singleprescriptionswith
alternatingpatterns,andBIDtreatmentsessions.Inaddition,youcanscheduleportal
images,movetreatmentsessions,changetreatmentfieldorder,andmore.
Scheduling Treatment Sessions for a Single Prescription
Singleprescriptiontreatmentsessionsarethesimplestofsessionstoinsertandschedule.
,andthenclickTxCalendartoopentheTreatmentCalendar.
1. Click
TheTreatmentCharthastwoviews:

TreatmentCalendarforplanningradiationtherapytreatments.

TreatmentChartforreviewinghistoricandplannedtreatments,initiatingtreatment
deliveryorQAModesessions.TheInsertSessionstabletsyouaddnewsessionsand
appearsfirstifthepatienthasnoplannedtreatmentsessions.Youcanschedulethe
sessionsbasedonthepatientprescribedfractionationorusetheWaveSetupForm.
2. IntheInsertSessionstab,clickForCoursenPrescription s ifitisnotalreadyselected.
3. Click adjacenttothefieldtotherightoftheForCoursenPrescription s option,and
thenclicktheprescriptionsiteforwhichtoschedulesessions.
If you had selected another care plan, for example, Course 3, the option
button would have read: For Course 3 Prescription(s).
4. TypethedateonwhichtostarttreatmentforthisprescriptionintheStartDatefield.
5. ClickInsertSessionsforCourse1.
6. IntheResultsofInsertSessionsmessage,clickOK.
7. IntheInsertSessionstaboftheTreatmentCalendar,clickScheduleAllFields
opentheFieldsToBeScheduled.
to
TheFieldsToBeScheduledshowsalltheradiationprescriptionsassociatedwiththe
CourseyouselectedfromtheDiagnosesandInterventionsanditstreatmentfields.
8. Clicktheprescriptionsiteorindividualtreatmentfields,andthenclickAdd
.
9. ClickOK.
TheScheduleFieldstabisactiveandshowsthefieldsyoujustselected.Youcandefinea
setandsequenceoffieldstoscheduleintheselectedsessions.Ifyouhavenotyet
definedthefieldsetswhenyouclickthistab,theFieldsToBeScheduledopens.
10. IntheScheduleFieldstaboftheTreatmentCalendar,clickScheduleFields.
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Scheduling Treatment Sessions for Multiple Prescriptions
Frequentlypatientshavemorethanoneradiationprescriptionsite.Forexample,aprimary
radiationsiteandaboostorconedownprescriptionsitefollowstheprimaryprescription
site.
1. IntheTreatmentCalendar,clicktheSelectSessionstab.
2. IntheSelectSessionstab,clickForCoursenPrescription s ifitisnotalreadyselected.
thenclickAll.
4. TypethedateonwhichtostarttreatmentforthisprescriptionintheStartDatefield.
6. IntheResultsofInsertSessionsmessage,clickYes,andthenOK.
7. IntheInsertSessionstaboftheTreatmentCalendar,clickScheduleMultipleFieldSets
.
TheSelectSessionstabletsyouselectallorasubsetoftheplannedsessionsbyentering
asetofcriteria.Thetabappearsfirstifthepatienthasplannedtreatmentsessions.Once
youselectyoursessions,youcanschedulefieldsfortheselectedsessions,changefields,
changesessions,removesessions,scheduleorchangeportalimaging,orchangethe
statusofsessions.
8. IntheSelectSessionstab,clickthePrescriptioncheckbox,click adjacenttothefield
totherightofthecheckbox,andthenclicktheprescriptionsite.
9. ClickScheduleFieldsToBeTreatedinTheseSessions
.
10. InFieldsToBeScheduled,clicktheprescriptionsiteortreatmentfields,andthenclick
Add .
11. ClickOK.
12. IntheScheduleFieldstaboftheTreatmentCalendarwindow,clickScheduleFields.
13. Click
NextSessions.
14. RepeatSteps8to13fortheeachadditionalprescriptionsite.
Scheduling Treatment Sessions for a Single Prescription with an Alternating
Pattern
Patientscanhaveasingleprescriptionsitewithanalternatingtreatmentfieldpattern.For
example,onesetoffieldsusesabolusorwedgeandtheothersetdoesnot.
1. IntheTreatmentCalendar,inserttreatmentsessionsfortheprescriptionsite.
2. IntheInsertSessionstab,clickScheduleMultipleFieldSets
.
3. IntheSelectSessionstab,clicktheRepeatingcheckbox.
4. TypethenumberoftreatmentfieldsthatcomprisetheONpatternintheOnfield.
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5. TypenumberoftreatmentfieldsthatcomprisetheOFFpatternintheOfffield.
.
7. IntheFieldsToBeScheduled,addthetreatmentfieldsfortheONpatterntotheFields
tobeScheduledpanel,andthenclickOK.
9. Click
NextSessions.
10. IntheSelectSessionstaboftheTreatmentCalendar,clicktheRepeatingcheckbox,and
thenclicktheInvertcheckbox.
.
12. IntheFieldsToBeScheduled,addthetreatmentfieldsfortheOFFpatterntotheFields
tobeScheduledpanel,andthenclickOK.
Scheduling Treatment Sessions for Overlapping Treatments
Overlappingorconcomitanttreatmentsinvolveoverlappingtreatmentbydifferentradiation
prescriptions.Forexample,asecondaryprescription,suchasaconedownorboost,may
overlaptheprimaryradiationprescriptionbyfiveortendays.
ToscheduletreatmentssessionsautomaticallyusingtheTreatmentCalendar,formorethan
oneprescription,definethepatternintheprescription.
1. IntheTreatmentCalendar,insertthefirstprescriptionofthesitetreatmentsessions.
2. ClickInsertSessionstab,andthenclickForCoursenPrescription s ifitisnotalready
selected.
thenclicktheprescriptionsite.
4. TypethedateonwhichtostarttheoverlappingtreatmentsessionsintheStartDate
field.
7. IntheInsertSessionstaboftheTreatmentCalendarwindow,clickScheduleMultiple
FieldSets .
8. IntheSelectSessionstab,clickthePrescriptioncheckbox,andthenclickthe
prescriptionsiteoftheoverlappingtreatment.
.
10. IntheFieldsToBeScheduled,addtheoverlappingtreatmentfieldstotheFieldstobe
Scheduledpanel,andthenclickOK.
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Scheduling BID Treatment Sessions
1. IntheTreatmentCalendar,clicktheInsertSessionstab.
2. IntheInsertSessionstab,clickForCoursenPrescription s ifitisnotalreadyselected.
thenclicktheBIDprescriptionsite.
4. TypethedateonwhichtostarttreatmentintheStartDatefield.
5. IntheInsertSessionstaboftheTreatmentCalendar,clickInsertSessionsforCourse1.
7. IntheInsertSessionstaboftheTreatmentCalendar,clickScheduleAllFields
.
8. IntheFieldsToBeScheduled,addthetreatmentfieldstoschedule,andthenclickOK.
Deleting Treatment Sessions in the Treatment Calendar
IfyoumakeamistakeinthepatientTreatmentCalendarorhavetreatmentsessions
scheduledthatarenotnecessary,youcanremovetreatmentsessionsandtheirfields.You
cannotremovetreatmentsessionsthatyouhavealreadytreated,approved,orchangedto
QAmodesessions.
1. IntheTreatmentCalendar,clickSelectSessionstab,andthenclickAllorclickthe
treatmentsessionstodelete.
2. ClickDeletetoopentheConfirmDeletemessage.
3. ClickYestoopentheInformationmessage.
4. ClickOKtodeletethetreatmentsessions.
Working with Portal Images
YoucanscheduleandchangeportalimagesforapatienttreatmentintheTreatment
Calendar.Youcanscheduleportalimagesbefore,during,orafteryoutreatthepatientwith
thefield.YoucanaddaportalimageandaseriesofportalimagestoanexistingTreatment
Calendar,addportalimageswhileinsertingtreatmentsessionsandfieldsforapatient,and
removeportalimages.
Adding a Series of Portal Images to an Established Treatment Calendar
Youcanscheduleoraddaseriesofportalimageexposurestotreatmentfield s insingleor
multipletreatmentsessions.
1. IntheTreatmentCalendarwindow,clicktheSelectSessionstab.
2. IntheSelectSessionstab,clickapattern,suchasweeklyonTuesday,toselectthe
treatmentsessionstowhichtoaddtheportalimageseries.
3. ClickChangetoopentheTreatmentCalendarSession.
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4. Clickatreatmentfield,andthenclickthePrecheckboxinthePortalImagegroupto
scheduleaportalimagebeforethefieldistreated.
5. Toscheduleaportalimageduringtreatment,clickatreatmentfield,andthenclickthe
DuringcheckboxinthePortalImagegroup.
6. Toscheduleaportalimageafterthefieldistreated,clickatreatmentfield,andthen
clickthePostcheckboxinthePortalImagegroup.
7. Tochangethescheduledtreatmentfieldtotakeaportalimageonly,clickatreatment
field,andthenclicktheOnlycheckboxinthePortalImagegroup.
8. ToscheduleintrafractionimagingforatreatmentfieldontheElektaX‐rayVolume
Imaging XVI v5.0andlater,clickatreatmentfield,andthenclickthekVDuringcheck
boxinthePortalImagegroup.
9. ClickOKtoopentheConfirmSelectedSessionsChangedmessage.
10. ClickYestoaddtheportalimages.
Changing a Portal Image in an Established Treatment Calendar Session
InthePortalImagesectionyoucanscheduleportalimagingfortheselectedtreatmentfield.
Thecheckboxescanbecheckedifportalimagingisscheduledfortheselectedtreatment
field.Youcanunchecktheboxestochangetheportalimagingschedule.
1. IntheTreatmentCalendar,click adjacenttothetreatmentsessiontowhichtochange
aplannedportalimage.
2. Clickthetreatmentfieldtowhichtoaddtheportalimage,andthenclickthePre,During,
Post,orOnlycheckboxinthePortalImagegrouptotherightofthePlannedand
HistoricTreatmentList.
Changing Treatment Session Due Dates
Ifapatientmissesatreatmentsessionorencountersadelayintreatment,youcanchange
thetreatmentsessiondates.Youcanchangethedatesofalltreatmentsessions,changejust
thesessionyouselect,ormovetheaffectedtreatmentsessiontotheendofthetreatment.
Changing All Treatment Sessions’ Due Dates
Youcanchangetheduedateofalltreatmentsessions.
1. IntheTreatmentCalendar,clickthefirsttreatmentsession,andthenclickChange.
2. IntheTreatmentCalendarSession,typethenewduedateforthetreatmentsessionin
theDuefield.
3. IntheDueDateShiftgroup,clickAllsessionafterthisoneby.
4. TypethenumberofsessionsinthefieldadjacenttotheAllsessionafterthisoneby
option.
5. ClickPreviewShifttoopentheTreatmentCalendarPreviewShift.
Theasterisk * identifiesthefirstcalendarsessionthatyouwanttomove.An‘X’
identifiesthesessionsafterit.IntheShiftedgroup,weekdaydatesmaynothave
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sessionsscheduledifthenumberofshiftdaysisexcessive.Inthiscaseyoucanchange
theshiftintheDaysfieldsothatweekenddaysarenotcounted.Youcanchangethe
DaysfieldintheShiftafterFirstgroupuntiltheday’slineup.
YoucanalsoclickanindividualsessionintheShiftedgroupCalendarview,thendrag
anddropittoadifferentdayintheShiftedgroupCalendarview.IntheShiftAfterFirst
group,theDaysfieldisnowdisabledandtheAdHoccheckboxappears.Ifyouuncheck
theAdHoccheckbox,theTreatmentCalendarShiftPreviewreturnstotheoriginal
Days.
6. Makeanychangesnecessary,andthenOKtosavethechanges.
IfyouusedanAdHocshiftpreview,anewcheckboxappearsintheTreatmentCalendar
Sessions,AdHocperPreview.TheDueDateShiftofAllsessionsafterthisoneDay s fieldaredisabledbecausethead‐hocduedatechangesisnotstrictlyashiftbyacertain
numberofdays.
Toclearyourad‐hocchanges,clickAdHocperPreviewsothatitisnotchecked.
PreviewRecommendedappearsandtheDay s fieldisenabledwiththeoriginal
numberofshiftdaysandyourad‐hocchangesarelost.
Whetheryouchoosetoshiftbyacertainnumberofdaysorad‐hoc,duedatechangesto
theTreatmentCalendarareeffectivewhenyouclickOK.
7. ClickOKtochangetheduedate.
Changing the Due Date of One Treatment Session
Youcanalsochangetheduedateofonetreatmentsessionsothatitdoesnotchangeor
movetheduedatesofothertreatmentsessions.Forexample,youcanrescheduleamissed
treatmenttoaSaturday,whichwouldnotchangetheduedatesforothertreatmentsessions.
1. IntheTreatmentCalendar,clickthetreatmentsession,andthenclickChangetoopen
theTreatmentCalendarSession.
Youcancreatetreatmentsessionsandscheduleorchangetreatmentfieldsandportal
imagingwithinsessions.YoucanalsoscheduleQAModesessionstocheckfield
accuracybeforeorduringacourseoftherapy,createnotesforthesession s ,and
changetheapprovalstatusofatreatmentfield.
2. TypethenewduedateforthetreatmentsessionintheDuefield.
3. IntheDueDateShiftgroup,clickNoothersessionsifitisnotalreadyselected.
4. ClickOKtochangetheduedateofthetreatmentsession.
Moving a Treatment Session to the End of the Treatment Calendar
YoucanmoveatreatmentsessiontotheendofthepatientTreatmentCalendar.Thisis
almostthesameastheAddtoEndfeatureintheWaveEditForm.
A treatment session can have more than one prescription, such as a primary
followed by a boost or cone down. If you move this treatment session for the
primary to the end, it moves to the end of the treatment sessions. It does not
move to the end of the primary’s treatment sessions.
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1. IntheTreatmentCalendar,clickthetreatmentsessiontomovetotheend.
3. IntheDueDateShiftgroup,clickMovethissessiontotheend.
4. ClickOKtomovethetreatmentsession.
TheTreatmentCalendarautomaticallyschedulesaroundweekendsifyoumovethedate
totheendofthetreatmentsessions.IfyourSystemAdministratorschedulesyour
holidaysinMOSAIQ,theTreatmentCalendaralsoautomaticallyschedulesaroundthem.
Working with Treatment Fields in the Treatment Calendar
Youcanmanagetreatmentfieldswithintreatmentsessions.Forexample,ifyouneedto
replaceonescheduledtreatmentfieldwithanother,youcanusetheReplaceField…
commandoftheTreatmentCalendaroptionsmenu.
Adding a Treatment Field to an Established Treatment Session
Ifnecessary,youcanaddatreatmentfieldtoanalreadyestablishedtreatmentsessionusing
theTreatmentCalendar.
1. IntheTreatmentCalendar,clickSelectSessionstab.
2. Selectthetreatmentsession s whoseorderyouwanttochange.ClickAlltochangethe
orderofallthetreatmentsessions.
3. ClickDefinetoopentheFieldsToBeScheduleddialogbox.
4. Clickthetreatmentfieldsitisnecessarytoaddtothetreatmentsessions,andthenclick
Add .
5. ClickOKtoopentheTreatmentCalendarSession.
6. ClickOKtoshowtheConfirmSelectedSessionChanges.
7. ClickYestoaddthetreatmentfieldstothetreatmentsessions.
Changing the Treatment Order in the Treatment Session
Theorderyouaddedthetreatmentfieldstotheradiationprescriptionmaynotbetheorder
totreat.YoucanchangethetreatmentorderfromtheTreatmentCalendarSession.
1. IntheTreatmentCalendar,clickSelectSessionstab.
2. IntheSelectSessionstab,clickAlltoselectallthetreatmentsessions.
4. Clickatreatmentfield,andthenclick
field.
or
tochangetheorderofthetreatment
5. ClickOKtoshowtheConfirmSelectedSessionChangesmessage.
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6. ClickYestochangethetreatmentorder.
Removing a Treatment Field from All Treatment Sessions
Toremoveatreatmentfieldthatfromalltreatmentsessionsforaprescriptionfield,youcan
usetheRemoveField…commandoftheTreatmentCalendaroptionsmenu.Youdonothave
topressDeleteforeachtreatmentfield.
1. IntheTreatmentCalendar,clickthetreatmentfieldthatyouwanttoremove.
2. Right‐clickanywhereintheTreatmentCalendartoopentheTreatmentCalendar
optionsmenu.
3. ClickRemoveField…toopentheConfirmRemovemessage.
4. ClickYestoremovethetreatmentfield.
Replacing a Treatment Field for All Treatment Sessions
Youcanreplaceatreatmentfieldwithadifferenttreatmentfield.YouusetheReplaceField…
commandoftheTreatmentCalendaroptionsmenu.
1. IntheTreatmentCalendar,clickthetreatmentfieldthatyouwanttoreplacewith
differenttreatmentfield.
2. Right‐clickinthewindow,andthenclickReplaceField….
3. IntheConfirmReplacemessage,clickYes.
4. IntheTreatmentFieldDefinitions,clickthetreatmentfieldtoreplacetheotherfield.
5. ClickSelecttoreplacethetreatmentfield.
WorkingwithtreatmentsessionsfromtheTreatmentCalendar,youcandomorethan
insertsessionsandschedulefields.
Scheduling Treatment Sessions with Incomplete Information
Youcanaddtreatmentsessionsandscheduletreatmentfieldswhenyouhavenoradiation
prescription,oryouhavearadiationprescriptionbutnotreatmentfields.Forexample,the
physicianhasnotwrittentheradiationprescription.Or,thephysicianhaswrittenthe
radiationprescriptionbutnotthetreatmentfields.Or,thephysicianhaswrittenone
radiationprescription,butnotthesecondboost/conedownradiationprescription.
1. Right‐clickintheDiagnosesandInterventions,andthenclickAddTxFieldwithoutRad
Rx….
2. IntheTreatmentFieldDefinition,addfieldinformationforthenewfield.
3. Repeatsteps1and2toaddallofthefieldsyoudonotwantassociatedwitha
prescription.
4. Click
,andthenclickTxCalendartoopentheTreatmentCalendar.
5. RemovetheexistingtreatmentsessionsintheTreatmentCalendar,ifany.
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6. ClicktheInsertSessionstab,clickOther,andthenclickWavetoopentheWaveSetup
Form.
7. IntheEndgroup,double‐clickintheTimesfield,andthentypethenumberofsessionsit
isnecessarytoinsert.
8. ClickOKtosavethewavesetupandshowtheTreatmentCalendar.
10. IntheResultsofInsertsSessionsmessage,clickOKtoschedulethetreatmentsessions.
Defining a Field Group First When Scheduling Treatment Sessions
Youcandefinethefieldgroup,andthenschedulethetreatmentfieldsandtreatment
sessions.
1. IntheTreatmentCalendar,clicktheScheduleFieldstab.
2. IntheFieldsToBeScheduled,right‐click,andthenclickShowTreatmentFieldsforAll
Courses.
3. AddthetreatmentfieldstomakeupthefieldgrouptotheFieldstobeScheduledpane.
4. IntheFieldsToBeScheduled,clickOK.
5. IntheTreatmentCalendar,InsertSessionstab,clicktheAssignFieldsDefinedon
“ScheduleFields”toeachInsertedSessioncheckbox.
6. Double‐clickintheStartDatefield,andthentypethedatefortomorroworkeepthe
defaultdate.
7. ClickOther,andthenclickWavetoopentheWaveSetupForm.
8. IntheEndgroup,double‐clickintheTimesfield,andthentypethenumberofsessionsit
isnecessarytoinsert.
9. ClickOKtosavethenumberofsessionstoinsertandshowtheTreatmentCalendar.
12. IntheResultsInsertSessionsmessage,clickOKtoinsertthesessionsintothetreatment
calendar.
Scheduling AFS Treatment Sessions
Youcanspecifythetreatmentfieldsyouwantincludedintreatmentsessions.Youcanalso
scheduleAutomaticFieldSequencing AFS orManualFieldSequencing MFS forthe
selectedtreatmentsessionorspecificfieldsintheselectedtreatmentsession.AFS
automaticallyshowsthenexttreatmentfieldduringthetreatmentsession,andrecordsall
fieldsaftertreatment.
Siemens Primus and Elekta Synergy: The gantry and collimator
move to the next field parameters before the beam turns on. Make
CAUTION sure that you correctly define the AFS treatment fields.
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1. IntheTreatmentCalendar,addtreatmentsessionsfortheprescriptionsite,andthen
clickScheduleAllFields .
2. IntheFieldsToBeScheduled,click
AFSGroup
,andthenclickAdd
.
3. AddthetreatmentfieldstoincludeintheAFSgrouptotheFieldstobeScheduledpane.
and
arrowstospecifywhichofthescheduledfieldstoinclude
Youcanuse
andinwhatorderintheAFSgroup.
ElektaCompositeFieldSequencing CFS deliversmultipletreatmentfieldsusinga
singlebeam‐on.YoucanuseAFStodefineaCFS,whichconsolidatesaseriesofseparate
fieldsintoasinglecontrolpointsequence.WhentreatedasaCFS,theAFSgroup
consistsofagroupoffieldsintendedfordeliveryasasinglecompositefield.TouseCFS,
youmustconfigurethisoptioninthemachinecharacterization.
4. ClickOKtoclosetheFieldsToBeScheduled.
5. IntheScheduleFieldstaboftheTreatmentCalendar,clickScheduleFieldstoschedule
theAFStreatmentsessions.
Scheduling MFS Treatment Sessions
MFSautomaticallyshowsthenexttreatmentfieldduringthetreatmentsession,butyou
mustrecordthetreatmentmanuallybeforeyoucantreatthenextfield.
1. IntheTreatmentCalendar,inserttreatmentsessionsfortheprescriptionsite,andthen
clickScheduleAllFields .
2. IntheFieldsToBeScheduledd,click
MFSGroup
,andthenclickAdd
.
3. AddthetreatmentfieldstoincludeintheMFSgrouptotheFieldstobeScheduledpane.
and
arrowstospecifywhichofthescheduledfieldstoinclude
Youcanuse
andinwhatorderintheMFSgroup.
4. ClickOKtoclosetheFieldsToBeScheduled.
5. IntheScheduleFieldstaboftheTreatmentCalendar,clickScheduleFieldstoschedule
theMFStreatmentsessions.
Scheduling a QA Mode Treatment Session
InQAMode,youcanrunaqualitycheckonatreatmentfieldwithoutcontributingtodoseor
fractionsinthepatientchart.QAmoderecordingsdonotchangefieldfractioncounts,field
dose,dosesitefractions,dose,orelapseddays.WhenyoutreataQAmodetreatmentsession
fromtheTreatmentChart,amessagetellsyouthatQAmodetreatmentsdonotcontributeto
patientdosetracking.YoucanscheduleQAmodesessionsfromtheTreatmentCalendaror
theTreatmentChart.
You must have Clinical | QA/Calibration: | Modify security rights to go
into QA Mode.
1. Double‐clickthetreatmentsessiontoscheduleasaQAmodetreatmentsessioninthe
TreatmentCalendar.
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2. IntheTreatmentCalendarSession,right‐clickorpressF4toshowtheoptionsmenu.
3. ClickQAMode.
4. ClickOKtochangethesessiontoaQAmodesessionandclosetheTreatmentCalendar
Session.
Approving a Treatment Session
Somesitesmakeitnecessarytoapprovetreatmentfieldsbeforeyoucantreatthescheduled
treatmentsessions.Foraddedsecurity,youcanalsoconfigureMOSAIQtomakeitnecessary
thatyouapproveafieldbeforetreatment.
SeeSettingtheCalibrationStatus.
1. IntheTreatmentCalendar,clickthetreatmentsessionthatyouwanttoapprove,and
thenclickStatus.
2. IntheNewStatusgroupoftheRecordStatus,clickApproved.
3. TypeyourpasswordinthePasswordfield.
4. ClickOKtoapprovethetreatmentsessionandclosetheRecordStatus.
5. ClicktheSelectSessionstab.
6. Ifyouwanttoapproveallsessions,clickAll,andthendosteps2through4again.
7. Ifyouwanttoapproveaspecificgroupofsessions,clicktheRangecheckbox,andthen
dosteps8and9.
8. Double‐clickintheFromfield,typethenumberofthefirsttreatmentsession,double‐
clickintheTofield,andthentypethenumberofthelasttreatmentsession.
9. Dosteps2through4again.
Closing an Incomplete Treatment Session
IfyoudidnotfullytreatapatientforasessionwiththeTreatmentCalendar,youcanclose
theincompletesession.Youmustfirstapprovethetreatmentsessionbeforeyoucancloseit
changethestatustoClosed .
1. IntheTreatmentChart,clickTxCalendar,andthenclickatreatmentfieldthatyoudid
notfullytreat.
2. ClickStatustoopentheRecordStatus.
3. IntheNewStatusgroup,clickApproved.
4. TypeyourPasswordandclickOK.
5. Clickthetreatmentsessionyoujustapproved,andthenclickStatus.
6. IntheRecordStatus,clickClosed.
7. TypeyourPasswordandclickOKtoclosetheincompletetreatmentsession.
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Verifying and Recording Treatments
SeeUsingtheVerifiedTreatmentWindowonpage334forhowtoverifyandrecord
treatments.
Using eChart Chart Check
TheeChartChartCheckreportschangesmadetoyourelectronicchartssincethelastchart
check.Thissupportsyourweeklychartreviews.
To use eChart Chart Check, you must have Clinical | Dosimetry Gen |
View and Modify security rights.
Reviewing the eChart Chart Check
YoucanruntheeChartChartChecktoreviewchangesmadetotheradiationtreatmentchart
overaselectedtimeperiod.
To view the Chart Check window, you must have Administrative | General
| View security rights.
1. Openthepatientchart.
2. ClickeChart|ChartCheck…toopentheChartCheckOptions.
YoucanusetheChartCheckOptionstoidentifywhethertochargeforthechartcheck,
chartcheckprintingoptions,andthedatefromwhichtocheckthechart.
3. ClickCurrentinthePatient s toCheckgroup.
4. ClickPromptintheChargegroup.
5. Click adjacenttotheActivityfieldandselecttheactivitytochargeforwhenrunning
thechartcheck.ThecodeappearsintheActivityfield,withadescriptionbelowit.
6. ClickPromptinthePrintgroupifnotalreadyselected.
7. ClickOKtodothechartcheckandthenopentheChartCheck.
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145
Figure 40: Chart Check Window
TheChartCheckhas2sections.Thetopsectioncontainstheinformationyouaddedin
theChartCheckOptions.Thetextboxshowstheelectronicchartinginformationofthe
selectedpatientinbluetext.Youcanclickthebluetext,andthenclickGoTheretoopen
theapplicablewindowordialogboxfortheselectedinformation.
8. ClickLunginbluetextundertheDiagnosisCheckedcategorytoselecttheentirelineof
informationintheDiagnosisCheckedcategory.
9. ClickGoTheretoopentheDiagnosisandStagingfortheselectedbluetextintheChart
Checkwindow.Youcanalsodouble‐clickthebluetext.
10. ClickCanceltoclosetheDiagnosisandStaging.
11. Usethescrollbartoscrollthroughthechartcheck.Thediagnosis,prescription,and
simulationsforthepatientareautomaticallyaddedinthetable.
12. ClickOKtosavethechecklistasapatientnote,andthenopentheCodeCapture.
TheCodeCaptureopensbecauseyouaddedtheprocedureintheActivityfieldonthe
ChartCheckOptions.
13. ClickOKtocapturethecode.
ThePrintChartCheckmessageopens.
14. ClickYestoprintthechartcheckreport,andthenclosetheChartCheck.
Figure41showsanexamplereport.
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Figure 41: Chart Check Report – Printed
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147
Reviewing eChart Chart Check Notes
YoucangenerateanelectronicpatientnotewhenyouperformaChartCheck.Thisisa
configurablefeature,whichyoucanenableinDepartmentSetup.Suchnotesappearasview‐
only,intheAdmin‐GeneralnotesinthePatientNoteswindow.However,theyare
automaticallylockedandcannotbeunlocked,edited,ordeleted.
To view the Patient Notes window, you must have Administrative | Notes
2. ClickeChart|Notes…toopenthePatientNotes.
ThePatientNotesletsyouviewandattachnotestotheelectronicpatientrecord.
3. ClickAllPatientNotesfromtheViewfieldtoshowtheeChartChecknote.
TheeChartChecknotetypeisautomaticallylocked,asshownbytheasterisk * adjacenttoeChartCheckintheTypecolumn.Youcannotchangeorremovethenote.
4. Double‐clicktheeChartChecknotetoopenthePatientNotewindow.
5. Usethescrollbartoscrollthroughthenote.
6. Right‐clickinthePatientNotewindowtoopenthePatientNoteoptionsmenu.
YoucanusethePatientNoteoptionsmenutosendeChartchecknotetothestaff
memberorlocationfromtheMOSAIQmailfeature.Youcanalsoprintacopyofthe
eChartchecknote.
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CHAPTER 4: MLC Fit
CHAPTER 4: MLC Fit
TheMLCFitfeatureletsyoucreate,view,andeditgeometricinformationthatisultimately
usedtogeneratetreatmentfieldshapes.YoucannotuseMLCFitforparticletherapy
treatmentfields.TherequiredimplementationstepsforanMLCleafplaninclude:

Characterizingyourtreatmentmachine‐Becausemultileafcollimatorsare
manufacturedbyseveralvendors,thesystemletsyoupre‐definethephysicallimits
andgeometricparametersofeachtypeofmultileafcollimatorusedbyyourcenter.
MLCFitthenfitstheleavesaroundtheshapebasedonthespecifiedmachineandits
associatedcharacterizationrecord.

Calibratingyourdigitizeranddigitizing entering thetreatmentfieldshape‐The
filmdigitizerprovidesagridonwhichtoplaceasimulationfilmfordigitization.
Afterusingahand‐heldcursortocalibrate,effectively“trace”theareayouwantto
treat,thesystemprovidesabeams‐eyeviewoftheresultingshapebasedonyour
machine’sparameters.Foradditionalinformationondigitizinganimage,seethe
ImageManagement–ViewStation&PhotosandDiagramschapteronpage159.

CreatingtheMLCleafplan specifiesleaf,jaw,collimator,andgantryposition
information ‐MLCFitusescolortoclearlyindicatethedefinedtreatmentarea,
leaves,jaws,andanyexposedareaorregionsofoverlap,thennumericallydisplays
allthecriticalinformationandcontrolsyouneedtoadjustthefit.Individualleafand
jawpositionscanbeeditedmanuallywiththemouseorkeyboard,oralltheleaves
canbeautomaticallypositionedusingtheflexiblefitfeatures.

Savingandprintingyourplan‐ThesystemletsyousavealloraportionoftheMLC
leafplanyougeneratedandgivesprintedoutputifdesired.

Usingyourplanwiththeverify&recordsystem‐Uponcompletion,theplanis
savedaspartoftheelectronictreatmentrecordandcanthereforebeusedbythe
verifyandrecordsystemtoautomaticallysetupthemultileafcollimatorduring
treatment,verifythattheleavesarepositionedaccordingtoplan,andrecordthe
actualleafpositionsduringtreatment.
MLC Leaf resolution may be characterized to 0.10 cm or 0.01 cm. MLC Fit
calculates the leaf positions for a machine to a resolution of either 0.10 cm
or 0.01 cm based on this MLC resolution setting in the machine
characterization. MLC area calculations have sufficient internal precision to
achieve the output resolution required by the characterization regardless of
the computational methods employed. MLC leaf positions are stored in the
CAUTION MOSAIQ database in units of 0.01 cm and displayed in MOSAIQ to a precision
of 0.01 cm.
See your MLC manufacturer for more information.
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CHAPTER 4: MLC Fit
Using MLC Fit
TheMLCFitfeatureletsyoucreate,view,andeditgeometricinformationthatisultimately
usedtogeneratetreatmentfieldshapes.Todoso,MLCFitletsyoudigitizetreatmentfield
shapes,deriveMultileafCollimator MLC leafplansfromthesedigitizedshapes,andchange
thoseshapesinMOSAIQ.
Using MLC Fit
YoucanclickFitfortheMLCFitfeaturetodotheseoperations:
1. ExtracttheleafsizesandpositionlimitsfromtheMachineCharacterizationrecordfor
theselectedmachine.Theleafretractionlimitscanbecharacterizedasthesamevalue
foralltheleavesordifferentvaluesfordifferentleaves,asnecessaryforthefunctionof
theMLC.
2. AutomaticallydoaFit,whichfitstheleavestothedigitizedshapewiththeconstraint
specifiedintheFitMethodgroupoftheBeam’sEyeViewwindow.
150

IftheFitMethodspecifiedisIntrusive,theleavesarepositionedsothattheleading
edgeofeachleafiscompletelywithintheshape.Additionally,theleafpositionis
roundedtotheresolutionspecifiedintheMachineCharacterizationrecord.

IftheFitMethodisCentered,theleavesarepositionedsothatthecenterofeach
leaf’sleadingedgecrossesanedgeoftheshape.Theleafpositionisroundedtothe
resolutionspecifiedintheMachineCharacterizationrecord.

IftheFitMethodisNon‐Intrusive,theleavesarepositionedsothatnopartofaleaf
intrudeswithintheshape.Theleafpositionisroundedtotheresolutionspecifiedin
theMachineCharacterizationrecord.

IfthereisnoleafpositionthatsatisfiestheFitMethodconstraint,theleafismoved
totouchitsopposingleaf.

Ifafittedleafpositionismorethanitspositionallimit,thentheleafissettothe
positionallimit.

Thepositionofopposing,touchingleafpairsisadjustedinordertoprevent
opposingadjacentleavesfromextendingbeyondeachother.

Thecollimatingjaws JawXorJawYiftheleafaxisischaracterizedasX‐axisorY‐
axisrespectively aresettotherecommendedjawpositionspecifiedintheMachine
Characterizationrecord.Ifarecommendedjawpositionisnotspecifiedinthe
record,thecollimatingjawsaremovedtotheirmostextendedposition aslongas
theydonotintrudeintotheshape forallfitmethods.Ifthecollimatingjawsare
characterizedasfixed,theyaresettothefixedfieldsizepositionsthatarespecified
intheMachineCharacterization.

ThebackupjawsaresettotherecommendedjawpositionspecifiedintheMachine
Characterizationrecord.Ifarecommendedjawpositionisnotspecifiedinthe
record,thebackupjawsaremovedtotheirmostextendedposition aslongasthey
donotextendpasttheendofanyleaf forallfitmethods.Ifthebackupjawsare
characterizedasfixed,theyaresettothefixedfieldsizepositionsthatarespecified
intheMachineCharacterization.

Ifafittedjawpositionismorethanitspositionallimit,thejawissettothe
positionallimit.
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
CHAPTER 4: MLC Fit
TheFitisdoneatthecollimatoranglespecifiedintheAnglefieldoftheCollimator
groupintheBeam’sEyeViewwindow.
Creating an MLC Leaf Plan
1. ClickeChart|DiagnosesandInterventionstoopentheDiagnosesandInterventions
window.
Ifapatientisnotcurrentlyselected,theSelectPatientwindowopens.IntheSelect
Patientwindow,double‐clickapatient,andthenopentheDiagnosesandInterventions
window.
2. Double‐clickthetreatmentfieldrequiringanMLCdefinition,orclickthetreatmentfield,
andthenclickTxFieldtoopentheTreatmentFieldDefinitionwindow.
3. Ifyouwanttousesettingsassociatedwithanothertreatmentfieldfortheselectedfield,
usetheImportoptiontodoso.Right‐clickorpressF4intheTreatmentFieldDefinition
window,andthenclickImporttoopentheTreatmentFieldDefinitionswindow.
TheImportoptionprovidesalistofTreatmentFieldDefinitionshavingMLCfields.
4. Clickthefieldwhosesettingsyouwanttoimport bydouble‐clickingitorclickingSelect
intheTreatmentFieldDefinitions .
TheTreatmentFieldDefinitionswindowclosesandtheTreatmentFieldDefinition
windowappears.ImportingtheMLCleafplancanchangetheparametersoftheselected
treatmentfield.MOSAIQchangesthejaw,collimator,leaf,andshapedataofthecurrent
treatmentfieldtotheparametersofthetreatmentfieldyouimported.Aftertheimport,
youcanmakeanynecessarychangesmanually.
5. SelectthetreatmentmachinenamefromtheMachinefield.
MLCFitautomaticallyappliestherelatedMLCtypewhenyouselectamachine.TheMLC
typeconsistsofthephysicalconstraintsandparametersthatcontrolthebehaviorof
MLCFitandispartoftheMachineCharacterizationrecordfortheselectedmachine.If
theparametersoftheimportedMLCleafplan orotherparameters aremorethanthe
machinecharacterizationlimitsoftheselectedmachine,anerrormessageappears.
6. ClickBEVintheViewergroupinTxFieldviewoftheTreatmentFieldDefinition
window.
7. ClicktheviewerorEnlarge/EditBeam’sEyeViewtoopentheBeam’sEyeView.
8. UsetheCollimatorAnglegroupcontrolstorepositionthecollimatorasnecessarytoget
thedesiredfit.Anychangemadetothisanglecausestheleavestoautomaticallyrefit.
9. UsetheJawgroupcontrolstomanuallyrepositionthejawsasnecessarytogetthe
desiredfit.Theleadingedgeofthecurrentlyselectedjawappearsinblueforediting.
ThevalueinthePositionfieldshowsthepositionofthejaw,whichyoucanchange.
IfthejawischaracterizedasfixedintheMachineCharacterization,youcannotchange
thejawposition.
10. UsetheLeafgroupcontrolstomanuallyrepositionleavesasrequiredtogetthedesired
fit.Thecurrentlyselectedleafappearsinblueforediting.TheselectedSideshowswhich
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sideoftheleafisbeingedited.TheNumberfieldshowswhichleafisselectedforediting.
ThePositionfieldshowsthepositionoftheleaf,whichyoucanchange.
YoucanalsouseAutoFittoautomaticallysetthecollimatorangle,jaws,andleaves.
Youcancomparethecurrentjawsettingstotherecommendedsettings,andif
necessary,setthejawstotherecommendedsettingsintheBeam’sEyeView
RecommendedJawsdialogbox.Toopenthisdialogbox,right‐clickintheBeam’sEye
Viewdialogbox,andthenclickRec.Jaws.Therecommendedjawvaluesarederived
fromtherecommendedjawfunctionintheMachineCharacterizationrecord.Forjaws
thatarecharacterizedasfixed,therecommendedjawvaluesarethefixedfieldsize
positionsthatarespecifiedintheMachineCharacterization.
11. SelecttheapplicableFitMethod.IfyouselectIntrusive,MOSAIQusesanintrusive
constraintforthisfitandallsubsequentfits.ThisisthesamefortheCenteredandNon‐
Intrusiveconstraintsalso.
Intrusivechangestheparameterssothatmoreoftheshapeiscoveredandtheleaves
intrudeintotheMLCshape.Non‐intrusivechangestheparametersandleafpositionsso
thattheleavesdonotintrudeintotheMLCshape.Centeredchangestheparametersand
leafpositionssothattheypartlyintrudeintotheMLCshape.
12. ClickOKtosaveyourchangesandclosetheBeam’sEyeViewdialogbox.
TheTreatmentFieldDefinitionwindowopens.
13. TypetheapplicablegantryangleintheGantryAnglefield.
14. Saveyourchangestothetreatmentfield.
Changing an MLC Leaf Plan
TochangeanMLCleafplanisasimpleprocess.Yousimplyclicktheleafyouwanttomove
anddragittotheapplicableposition.Bearinmindthatyouareconstrainedbyyour
MachineCharacterization.
Mouse Functions

Clicktheleftmousebuttononaleaftoselecttheleaftomakechanges.

Clicktheleftmousebuttonatalocationwheretheactiveleafcouldbeplacedto
movetheleadingedgeoftheactiveleaftothatposition.

Clicktheleftmousebuttononaleafanddragthemouseintheareawherethe
activeleafcanbeplacedtomovetheleadingedgeoftheactiveleafasyoumovethe
mouse.

Dragthemouseintotheleafthatisoppositetheeditleaftotouchtheeditleafinto
theoppositeleaf.

Dragthemousebeyondapositionallimitforthatleaftomovetheactiveleaftothe
positionallimit.

Shift‐clicktheleftmousebuttonintheareaofajawtoselectthejawtomake
changes.Forbestresults,alwaysselectthecentralareaofajaw.
152
If the jaw is characterized as fixed in the Machine Characterization, you
cannot change the jaw position.
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
Shift‐clicktheleftmousebuttonatalocationwheretheactivejawcouldbeplaced
tomovetheleadingedgeoftheactivejawtothatposition.

Shift‐clicktheleftmousebuttonanddragthemousetoalocationatwhichthe
activejawcanbeplacedtodragtheleadingedgeoftheactivejawasyoumovethe
mouse.

Shift‐dragthemousetotheedgeoftheoppositejawtotouchtheactivejawagainst
theoppositejaw.

Shift‐dragthemousebeyondapositionallimitforthatjawtomovetheactivejawto
thejawpositionallimit.
MLC Conversion
MOSAIQIntelligent MLC ConversiontriestochangeastaticMLCleafplanforaparticular
machinetoanequivalentplanforadifferentmachinebymappingtheleaves.Ingeneral,if
thesourceandtargetmachineshaveequivalentleafwidths,thenMOSAIQcanmapthe
leaves.Leafmappingkeepsmanualchangesaslongastheyremainlessthanthepositional
limits.Iftheleavescannotbemapped,MOSAIQwilltrytofittheleavesifthefollowing
conditionsaremet:thefieldisaStaticMLC dynamicfieldscannotbeconverted ,MLCFitis
aregisteredfeature,andShaperecordispresentandafitmethodisavailable.Whenafitis
done,manualchangestotheleafpositionsarelost.Ifneitherleafmapping Intelligent
Conversion norafitcanbedonewithamachinechange,asimple1:1mappingwilloccur,
andinmostcasesresultsinaninappropriateMLCleaffield.Warningmessageswillappear
inallcasesinwhichdirectleafmappingcannotbedone.
Ifthesourcemachineisequippedwitha120‐leafMLCandthetargetmachinehaseithera
52‐leaforan80‐leafMLC,MOSAIQgivesthreewaystohandlethe2to1mappingrequired
bythe0.5cmleaves:intrusive,average,andretracted.MOSAIQgivesasimilarintelligent
conversionbetweentheElekta80‐leaf 1.0cm and160‐leaf 0.5cm MLCheads.Thisis
onlyavailableforsimpleMLCfieldsanddoesnotapplytoStepandShoot,DMLC,orVMAT
fields.
Table 20: MLC Mapping Methods
Mapping
Method
Description
Intrusive
Therelativepositionsof adjacent0.5cmleavesaremappedtomatch
theleafthatismostextended.
Average
Therelativepositionsofadjacent0.5cmleavesareaveraged.
Retracted
Therelativepositionsofadjacent0.5cmleavesaremappedtomatch
theleafthatismostretracted.
IfitisnecessarytouseMLCFitandyouwanttokeepmanualchanges,youmustcopythe
fieldbeforechangingmachines.WhenMOSAIQisconnectedtothenewmachine,youcan
thenrunMLCFitontheoriginalplanandrecoveryoureditsfromthecopiedfield.
Digitizing a Treatment Field Shape
WhiletheverifyandrecordsystemsupportsmachinesequippedwithMLCsby
automaticallysettingupleafpositionsaccordingtoapre‐definedplanandrecordingtheir
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positionsduringtreatment,MLCFitstreamlinestheprocessbylettingyougeneratethe
actualmultileafcollimatordataaswell.UsingMLCFit,youcandigitizetreatmentfield
shapesandgenerateMLCleafplansthatusethesedigitizedshapes.MLCFitusesleaf,jaw,
collimator,andgantrypositioninformationtospecifygeometry.
Foradditionalinformationondigitizingatreatmentfield,seetheImageManagement–
ViewStation&PhotosandDiagramschapteronpage159.
Thistabledescribesthegraphicalelementsandcontrols.
Table 21: Graphical Elements and Controls
Element
Description
Green
Leaves
Yellow
Treatmentfieldshape
Turquoise
Jaws
Blue
Leafcurrentlyactiveforediting
Dark Blue Leading Edge
Jawcurrentlyactiveforediting
Red
Isocentercrosshairs
Window and Level Control
Usetoadjustthedarkestandlightestvaluesinthe
displayedimagetoobtainthedesiredcontrast
and/ordetail.Clickanywhereinthecontroland
dragtotheleftorrighttomakeadjustments.
Image Underlay
You must have at least Clinical | Field Defs | View and Image |
ViewStation | Images | View security rights for the image to appear.
YoucanenableImageUnderlaybycheckingtheEnableImageUnderlaycheckboxin
DepartmentSetup.Whenenabledandthecriteriadescribedbelowaremet,thecurrent
referenceimageforthepatientappearsbeneaththeshapedfieldor,forhistoricalviews,the
referenceimagethatwasviewableatthetimeoftreatment.
TheDisplayImageoptionmustbeenabledfromeithertheTreatmentFieldDefinition
window,ortheBeam’sEyeViewdialogbox.Ifyoudisablethisoptionfromeitherdialogbox,
theimageishidden.YoumustalsoclicktheUseforTxDefinitioncheckboxintheImage
dialogbox.ThischeckboxisonlyavailableafterthesimulatorimageorDRRhasbeenreticle
scaled.
Thedisplaymaybeaffectedbythecurrentimagestate:Ifyouchangethegantryangle,
couchangle,orcouchtopusingeditcontrols,capturesettings,orimport,theReference
Imagebecomesunavailable.
GeometrydisplayinImage:Checktoshowthetreatmentgeometryontheimage,andun‐
checktohidethetreatmentgeometrylayer.Thischeckboxisonlyavailablewhenthe
followingtenconditionsoccur:
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
Theimageisforthecurrentlyselectedpatient.

TheimageisaSimulatororDRRimage.

Theimageisnotanimageseries.

TheimageisenabledforTxDefinition.

Theimageisareferenceimageandisreticle‐scaledandhassquarepixels.

Theimageisassociatedwiththecurrentlyselectedfield,andthetreatmentmachine
assignedtothefieldischaracterized.Thetreatmentgeometrycomesfromthe
associatedtreatmentfielddefinition.

TheShadowfilterisnotapplied.

TheimagedoesnothaveanincompleteRe‐Imagechangerequest.

Theimageisnotvoided.
 Theimageisnotarchived.
MOSAIQalertsyouwhentheimageisarchived.
MOSAIQalertsyouwhenyoumanuallydisplayreferenceimageforthefirsttimebecauseit
didnotautomaticallyappear.
MOSAIQalertsyouwhenanotherusereditstheimagebetweenthetimeyouopenedthe
Beam’sEyeViewdialogboxandattempttosave,abortingthesaveandkeepingtheBeam’s
EyeViewdialogboxopen.Youcanonlyclosethedialogboxbycanceling.
You can change the Vertical, Lateral, and Longitudinal couch parameters, and
the reference image remains available.
Beam’s Eye View Calibration Point Digitization
TheBeam’sEyeViewCalibrationPointDigitizationdialogboxpromptsyoutodigitizea
pointandgivesthecoordinatesofthepointdigitized.Afterdigitizingeachpoint,abeep
soundsandyouarepromptedtoenterthenextpoint.Upondigitizingthesecondpointthe
transformationparametersarecomputed.Afterdigitizingthethirdandfourthpoints,the
scaleddigitizedvaluesarecomparedwiththespecifiedvalues.Ifthescaledvalueisnot
withinthespecifiedtoleranceofthedesiredvalue,thecalibrationprocessterminates.
Beam’s Eye View Shape Rotation
Thisdialogboxenablesyoutoenteranewangletorotatethetreatmentshape.Ifthe
orientationofthereticleanglewasincorrectwhenyoudigitizedthetreatmentshape,you
cansimplyrotatetheshapeusingthisdialogboxinsteadofdigitizinganewshape.
Beam’s Eye View Calibration Setup
Youcandigitizeatreatmentfieldshapeusingyourmouseoradigitizertabletthatis
connectedtoyourworkstation.Ifyouchoosethelatter,youmustcalibrateyourdigitizer
beforedigitizingeachshapeenteredintoMLCFit.Thisprocessbeginswhenyouopenthe
Beam’sEyeViewCalibrationSetupdialogbox.
TheBeam’sEyeViewCalibrationSetupdialogboxiswhereyouselectyourdigitizingdevice,
chooseafitmethodfortheplacementoftheleafedge,andifyouareusingadigitizertablet,
setupthecalibrationpoints.Toaccountforscaling,translation,androtationofthefilm
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coordinatesystemrelativetothedigitizercoordinatesystem,youmustdigitizefour
calibrationpointswithknownfilmcoordinates.
Logical Context
TheLogicalContextdialogboxenablesyoutoverifythatthedigitizersoftwareisloaded
properly.Ifthedigitizersoftwareisloadedproperly,clickViewPackettoverifythatMOSAIQ
isreceivingdatafromthedigitizer.
Packet Data
Ifthedigitizersoftwareisloadedproperly,thePacketDatadialogboxletsyoumakesure
thatMOSAIQisreceivingdatafromthedigitizer.
Digitizing a Treatment Field Shape
1. ClickeChart|DiagnosisandInterventions.Ifapatientiscurrentlyselected,the
DiagnosesandInterventionswindowopens.
Ifapatienthasnotbeenselected,theSelectPatientwindowopens.Clickapatient,after
whichtheDiagnosesandInterventionswindowopens.
2. OpentheTreatmentFieldDefinitionwindowforthetreatmentfield.
3. ClickEnlarge/EditBeam’sEyeViewtoopentheBeam’sEyeViewdialogbox.
4. Positionthedigitizerpuckcrosshairsoverthefirstpointonthefilmtodigitize,and
thenclickDigitizetoenterthepoint.MLCFitbeepstoindicatethatthepointisaccepted.
5. Movethepuckandpositionthecrosshairsoverthesecondpointyouwanttodigitize,
andthenclickDigitize.Again,asthepointisdigitized,MLCFitbeepstoindicatethatthe
pointisaccepted.ThelinesegmentdefinedbythepointsappearsintheBeam’sEye
Viewwindow.Thelinesegmentappearsinyellow.
6. Continuetodigitizethetreatmentfieldshape.Ifyoumakeamistake,usetheUndo
buttontoerasethelast‐digitizedpointorgroupofpoints.Makingthelinesegments
smallincreasesthedisplayaccuracyofthetreatmentfieldshape.
7. Whenyouareaboutto“re‐enter”thefirstpointdigitized,thetreatmentfieldshapeis
almostcompletelyoutlinedinyellow.Ratherthanre‐enteringthefirstpointtoclosethe
shape,clickDone.
ClickingDonecompletesthedigitizingprocess.Thepointsyouenteredbeforeclicking
DoneandthefinallinesegmentinsertedbyMLCFitdefinethenewshape.Inadditionto
closingtheshape,theshapeareafillsinyellow,andtheMLCleavesappearandtouch
thefieldbasedonthespecifiedFitMethod.
8. IntheTreatmentFieldDefinitionwindow,clickOKtosaveyourwork.Youarenow
readytocompletetheremainderofyourMLCleafplan.
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Printing and Saving Your MLC Leaf Plan
OnceyouhavecompletedanMLCFittreatmentfieldplan,youcansendanMLCleafplan
reporttoyourprinter.UsetheBeam’sEyeViewPrintSetupdialogboxtosettheOutput
Scalingforyourreport.Oncethescalingisset,clickPrinttosendthereporttothedefault
printer.ClickSetuptoopentheWindowsPrintSetupdialogboxifyouwanttospecifya
differentprinter.
MLC Leaf Plan Report
Header
Patient
Printsthepatientname Last,First,MI andprimaryID.
Field
PrintsthetreatmentfieldID,fieldName,andtheDateandTime thefield
waslastedited.
Angles
PrintstheCollimator andGantry angles.
Graphical Display Area
ThegraphicalMLCleafplaninformationiscenteredinthepagebelowthereportheader.
Theorientationisabeam’seyeview picturethegantrypositionedontopofthepage .

Isocenterisindicatedbya symbol.

ThegraphicalMLCleafplaninformationincludestheshapeperimeter,leafoutlines,
andYJawleadingedges.

Eachleafislabeledwithitsleafnumberandposition 24 ‐1.40 .

Thetop‐mostleafoneachsideofthepageislabeledwiththeleafsidename B1,
B2 .
Footer
Printsthescalinginformation.Thisinformationincludesthescalingoptionselectedinthe
Beam’sEyeViewPrintSetupdialogbox STD,SAD,SFD,orPrintToPage aswellasthe
actualscale 0.56cm 1.00cm .
Printing Your MLC Leaf Plan
1. ClickeChart|DiagnosesandInterventions....toopentheDiagnosesandInterventions
window.
Ifapatientiscurrentlyselected,theDiagnosesandInterventionswindowopens.Ifnot,
theSelectPatientwindowopens.IntheSelectPatientwindow,double‐clickapatient,
andthenopentheDiagnosesandInterventionswindow.
2. OpentheTreatmentFieldDefinitionwindowforthetreatmentfieldthatneedsanMLC
definition.
3. ClickBEVintheViewergroupoftheTxFieldview.
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4. ClicktheviewerwindoworEnlarge/EditBeam’sEyeViewtoopentheBeam’sEyeView
dialogbox.
5. Clicktheright‐mousebuttonintheBeam’sEyeViewdialogbox orpressF4 .
Theoptionsmenuappears.
6. ClickthePrintoption.TheBeam’sEyeViewPrintSetupdialogboxopens.
7. UsetheBeam’sEyeViewPrintSetupdialogboxtosettheOutputScalingforyour
report.
STD SourcetoTrayDistance printsanMLCPlanreportscaledtotheblocktray
distanceprojectionasspecifiedintheMachineCharacterization.SAD SourcetoAxis
Distance printsareportscaledtotheisocenterdistanceprojectioniftheSADisless
thanorequaltotheSFDandgreaterthan0formeasurementplaneconversions.SFD
SourcetoFilm/ImageDistance printsareportscaledtofilmdistanceprojectionifitis
greaterthanorequaltotheSADandgreaterthan0formeasurementplaneconversions.
FitToPageprintsareportscaledtothedimensionsofthepaperusedbytheprinter.
8. ClickPrinttosendthereporttothedefaultprinter.Or,clickSetuptoopentheWindows
PrintSetupifyouwanttospecifydifferentsettings.
Saving Your MLC Leaf Plan
1. IntheBeam’sEyeViewdialogbox,addorchangetheMLCleafplan.
2. ClickOKtosavetheMLCleafplan.
3. IntheTreatmentFieldDefinition,clickOKtosaveallchangestothetreatmentfield.
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CHAPTER 5: Image Management
TheimagemanagementsysteminMOSAIQhastwocomponents:ViewStationandthe
PhotosandDiagramsutility,referredtoasViewStationandPhotosandDiagrams.
Using the Photos and Diagrams Utility is the only section for Photos and
Diagrams in this chapter. All other sections are instructions for ViewStation
functions.
Assigning Image Security Attributes
1. ClickFile|Directories|StaffDirectory…toopentheStaffDirectorywindow.
2. ClickAddtoopentheStaffdialogbox.
3. TypeyourlastnameintheLastNamefield,andthenpressTAB.
4. TypeyourfirstnameintheFirstNamefield,andthenpressTAB.
5. TypeyourmiddleinitialintheMdlInitialfield,andthenpressTABtwotimes.
6. TypeyourusernameintheUserNamefield.
7. Click
adjacenttotheTypefield,andthenselectyourpositioninyourdepartment.
8. Click adjacenttotheCategoryfield,andthenselecttheworkcategorythat
describesthepeergroupofindividualstowhichyoubelong suchasPhysician,
Dosimetrist,Nurse. .Thisisanon‐configurablefield,andisassociatedwith
ViewStationfunctions.
9. ClickSecuritytoopentheSecuritydialogbox.
10. ClicktheImagingtab.
11. Clickthecheckboxestoassigntheimagesecurityattribute,andthenclickOK.
Enabling Imaging Options in System Utilities
1. ClickFile|SystemUtilities|DepartmentSetup…toopentheDepartmentSetupdialog
box.
3. IntheInboundTxChecksgroup,clickVerificationImageCheckifitisnotselected.
4. BelowtheSequencerSLIDgroup,click
andthenclickBeamorAnatomy.
adjacenttotheSetupOffsetReferencefield,
5. IntheTxImagesgroup,clicktheEnableImageUnderlaycheckboxifitisnotselected.
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6. ClickOKtoclosetheDepartmentSetupdialogbox.
Configuring the Digitized Film Import (DFI) Option
Turn on the scanner before you turn on your MOSAIQ workstation. If you do not,
MOSAIQ will not detect the scanner.
1. StartMOSAIQonaworkstationconnectedtoafilmscanner.
2. Logonwithyourusernameandpassword.
3. ClickFile|Import/Export|DFIConfiguration…toopentheDFIConfigurationdialog
box.
TheGeneraltabappearsbydefault.
4. Click
intheMachinefield.
5. Clickthenameofthemachineonwhichthefilmoriginated.
Click Unspecified if the images were not taken on a machine configured on
your system.
6. Typethesource‐to‐axisdistanceincentimetersfortheselectedmachineintheSAD
field.
7. Typethesource‐to‐filmdistanceincentimetersfortheselectedmachineintheSFD
field.
8. Click inthePixelSizeTypefield,andthenclickSFD,whichistypicallyforsimulator
orotherfilms,orActualtoidentifytheactualpixelsizeonthefilmasthetypeofpixel
size.
9. Click intheImageTypefield,andthenclickthetypeofimagesacquiredatthe
selectedmachine.
10. ClicktheReviewRequiredcheckboxifimagesacquiredontheselectedmachinemust
bereviewedbyaFinalreviewer.
11. ClickSetuptosavetheFilmInformationsettingsyouhaveconfiguredfortheselected
machine.
Click Reset to use the system default values as the Film Information settings
for the selected machine.
12. IntheDFIDestinationStagingAreafield,typethenetworkpathtothedirectoryfor
thedigitizedfilmimagesonyourworkstation.
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The default for this field is configured in the Staging Areas window. Your
Elekta installer or systems administrator configures the staging areas. If the
network path does not appear, you must type the correct path.
13. ClicktheAdvancetabtoreviewthedigitizersettingsand/ortocalibratethedigitizer.
IntheToolkitVersiongroup,theVidarToolkitsoftwareversionappears.Thisisthe
softwareMOSAIQusestointeractwiththedigitizer.Ifyourversionofthissoftwareis
nolongersupported,theversionnumberappearsinredtext.MOSAIQsupportsthe
scannersthatfollow:

DosimetryPROAdvantage:71,75,142,and150

VXR‐16DosimetryPRO:71and142

VXR‐16,VXR‐12,andVXR‐12plus:75and150
 VXR‐8andVXR‐8plus:75and150
Theotheroptionsandfieldsonthistabaredescribedinthistable.
Table 22: Digitizer Settings
Setting
Description
Model
Showsthemodelofthedigitizerconnectedtoyour
workstation.
Reference
Identifiestheresolutionfordigitizingfilms.Thehigherthe
resolution,thelargertheimagesize.
Bits per Pixel
Identifiesthepixelbitdepthfordigitizingfilms.Forthefour
digitizermodelssupported,thepixelbitdepthsavailableareas
follows:

DosimetryPROAdvantage:8,12,and16.

VXR‐16DosimetryPRO:8and16.

VXR‐16,VXR‐12,andVXR‐12plus:8and12.

VXR‐8andVXR‐8plus:8.
Dimensions
Identifiesthedimensionsofthefilm.Thelistcontainsstandard
filmdimensions,andthedefaultis14x17 inches .
Image Size
Showsthe resultingimagesize.Youcanusethisnumberto
establishstoragesizerequirementsforyourdepartment.
Translation Table
Identifiesatranslationtabletousefordigitizing.Thedefaultis
Log.
Exposure
Identifiesanexposuretimetousefordigitizing.Thegreaterthe
exposuretime,thelongerthefilmtakestodigitize.Valuesare
inmilliseconds.Thevalidrangeis4‐20fortheDosimetryPRO
Advantage,and10‐ 20forallotherdigitizermodels.The
defaultistheminimumvalueforthedigitizermodel.
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If you change the exposure time, you must calibrate your digitizer. If you
change the exposure time and click OK, but do not do a calibration, you can
still calibrate the digitizer and keep the new exposure time. Or, you can skip
the calibration and discard the new exposure time. If you skip the
calibration at that point, all changes except the exposure time that you
made on the Advanced tab are saved.
Digitizer
Information
Whenyourworkstationisconnectedtoadigitizer,this
groupshowsthe digitizerserialnumber,firmwareversion,
andhardwareversion.
Calibrate Digitizer
Button
Calibratesthelightsourceofthedigitizer.Forolderdigitizer
models,makesureyoudothiscalibrationonetimeeachday,
preferably1hourorlongerafteryouturnonthedigitizer.
Newermodels,suchastheVXR‐16DosimetryPROwith
firmwareversion13.0orgreater,andtheDosimetryPRO
Advantage,havetheAutomaticDigitizerCalibration ADC function.Thisfunctionissometimescalledbackgroundor
drifttracking.ADCdoesperiodiccalibrationwhilethe
digitizeristurnedonandnotinuse.Youcanstilldoa
manualcalibrationwhennecessary.
14. ClickOKtosaveyourchanges,andthenclosetheDFIConfigurationdialogbox.
Setting Beam’s Eye View Preferences in the Field Definition
1. TosettheviewingpreferencesfortheMLCbeamgeometryandgraticuleinthe
Beam’sEyeView,clickeChart|DiagnosesandInterventions…toopentheDiagnoses
andInterventionwindow.
2. Double‐clicktheMLCtreatmentfieldassociatedwiththeimagetoopentheTreatment
FieldDefinitionwindow.
3. Right‐clickorpressF4,andthenplaceyourmousepointeroverPreferences.
4. ClicktheMLCbeamgeometryviewingpreferencetoconfigure.
Thepreferencesaredescribedinthistable.
Table 23: Beam Eye View Preferences
162
Preference
Description
View MLC Edge
ShowstheMLCedgeonly,providingtheclearestviewof
surroundinganatomy.Thisisthedefaultview.
View MLC
Aperture
ShowstheMLCaperture,whichshowstheMLCinterleaflines
inthejawboundaries.
View MLC All
ShowsalltheMLCleaves.
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5. ClickZoomBEVtoFieldSizetoseethefieldintheBeam’sEyeViewdialogboxwhen
youopenit.
For MLC fields, if the backup jaws are configured as fixed in the Machine
Characterization, MOSAIQ zooms to a field size that is defined by the
collimating jaws and the most retracted leaf (MRL) position on each leaf side.
This gives a better zoomed view of the field.
6. ClickViewGraticuletoseethegraticulewhenyouopentheImagewindowand/or
Beam’sEyeViewdialogbox.
7. ClickOKintheTreatmentFieldDefinitionwindowtosavethepreference,andthen
clickCloseintheDiagnosesandInterventionswindow.
Setting Beam’s Eye View Preferences in the Image Window
YoucanalsoconfiguretheviewingpreferencesfortheMLCbeamgeometryandgraticule
intheImagewindow.
1. ClickeChart|Images…toopentheImageListwindow.
2. Double‐clickanimageassociatedwithanMLCtreatmentfieldtoopentheImage
window.
3. Right‐clickorpressF4,andthenplaceyourmousepointeroverPreferences.
4. ClickViewGraticuletoseethegraticulewhenyouopentheImagewindowand/or
Beam’sEyeViewdialogbox.
5. Right‐clickorpressF4,placeyourmousepointeroverPreferences,andthenclickthe
MLCbeamgeometryviewingpreference.
SeeStep4ofSettingBeam’sEyeViewPreferencesintheFieldDefinitionformore
informationonMLCbeamgeometryviewingpreferences.
6. ClickOKtosaveyourchangesandclosetheImagewindow.
Setting Image Registration Preferences
Youcanconfiguresomesettingsinthe2Dand3Dimageregistrationwindows.The
changesapplyeachtimeyouopentheapplicablewindow.Youcanset2Dand3D
preferencesfromanimagingindividualwindow:ImageRegistration,ImageRegistration
Editor,StereoscopicImageRegistration,andImageReviewworkspace.Intheexample
below,thesettingsareconfiguredfromtheImageRegistrationwindow.
1. Openthechartforapatient,andthenclickeChart|ImagestoopentheImageList
window.
2. Clickaverification portal imagethathasarelatedreference DRR image,andthen
clickReviewtoopentheImageReviewwindow.
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3. ClickRegistertoopentheImageRegistrationwindow.
toopentheImagingUserPreferencesdialogbox.
4. Click
The2DImageRegistrationtabopensbydefaultforall2Dimageregistration
windows:ImageRegistration,ImageRegistrationEditor,andStereoscopicImage
Registration.IfyouopenedtheImagingUserPreferencesdialogboxfromtheImage
Reviewworkspace,the3DImageReviewtabappearsbydefault.Youcanconfigure2D
and3Dpreferencesregardlessoftheregistrationwindowfromwhichyouopenedthe
dialogbox.
5. SelecttheRegistrationMethodand/orDisplayModepreferences.
Thesettingsareappliedeachtimeyouopenoneofthe2Dimageregistration
windows.
6. Inthe2DImageRegistrationtab,settheReticleScalingMethodpreferences.
ThedefaultisGraticule,butyoucanalsoselectFieldAperture.
Iftheconditionsthatfollowoccur,GraticuleisselectedastheReticleScalingMethod.
ThisoccursevenifyouselectedFieldApertureasyourpreference.

IfyouopentheReticleScalingdialogboxfromtheImageRegistrationEditor
window.Thisisbecauseyoumusthaveareferenceandverificationpairof
imagestousetheFieldAperturemethod.

Ifthereferenceimagedoesnotcontainafieldapertureandyouopenthe
ReticleScalingdialogboxfromtheImageRegistrationorStereoscopicImage
Registrationwindows.
7. ClickOK.
Scanning Simulation Films
Before you start, make sure you configure the applicable settings in the DFI
Configuration dialog box.
Turn on the scanner before you turn on your MOSAIQ workstation. If you do
CAUTION
not, MOSAIQ will not detect the scanner.
1. ClickFile|Import/Export|DigitizedFilmImporttoopentheDigitizeFilmImport
dialogbox.
TheStatusfieldshowsWaitingforfilm.Theotherscanningstatusesareasfollows:

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“Waitingforfilm”whennofilmisloaded.
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
“Digitizernotready...”whenafilmisloadedandwhilethedigitizerdoes
AutomaticDigitizerCalibration ADC .

“Digitizing…”whilethefilmisbeingdigitized.

“Processingimage…”afterthefilmhasbeendigitizedandwhiletheimageisbeing
processed.

“Done”whenimageprocessingiscompleteandathumbnailoftheimageis
shown.

“Readytodigitize”whendigitizingiscompleteandanotherfilmisloaded.

“Savingimage…”whilewritingtheimagefile.
 “Imagesaved”whentheimagefileiswrittentothestagingarea.
2. Click nexttotheMachinefield,andthenclickthemachineusedtoacquirethe
imageonthesimulatorfilm.
Ifthefilmwasacquiredonamachineinyourdepartmentandyouconfigureddefault
settingsforthatmachine,thedefaultFilmInformationsettingsforthemachine
automaticallyappearwhenyouselectthemachinename.
3. Verifyortypethesource‐to‐axisdistanceintheSADfield,pressTAB,andthenverify
ortypethesource‐to‐filmDistanceintheSFDfield.
Thisidentifiesimagedistancesforspecifiedplanessothatmeasurementscanbe
madefromViewStation.YoubypassedthePixelSizeTypefieldtoacceptthedefault,
SFD.UseSFDforstandardfilmstakenfromasimulatororaccelerator.Youselect
ActualwhenyoudonotknowtheSFD.
4. Click
adjacenttotheImagetypefield,andthenclickthetypeofimage.
5. ClickthattheReviewRequiredcheckboxifaFinalreviewermustreviewtheimage.
6. Placethefilminthescanner.
Thescanningprocessstartsimmediately.Thescanningstatuschangesforeachstepin
scanningprocessandtheimageappearsinthethumbnailboxwhenthescanningis
complete.
If you scan an image upside down or backwards, you can cancel the process
and scan the image again, or you can flip or rotate the image later.
7. Toassociatethescannedimagewithatreatmentfield,clickFieldintheAssociation
group.
You must associate the simulation image with a treatment field to show
the image with the treatment geometry in the Image window, Treatment
CAUTION Field Definition window, and Beam’s Eye View dialog box.
8. Click adjacenttotheFieldlist,andthenclickthefieldwithwhichtoassociatethe
image.
Figure42showsanexampleoftreatmentfieldslistedintheFieldlist.
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Figure 42: Field List
The fields must already exist for the patient. You cannot add them at this
time.
9. Toassociatethescannedimagewithaprescriptionsite,clickSiteintheAssociation
group.
10. Click nexttotheSitelist,andthenclicktheprescriptionsitewithwhichto
associatetheimage.
11. Toassociatethescannedimagewithapatient,clickPatientintheAssociationgroup.
12. TypeanamefortheimageintheImageNamefield.
13. ClickSavetosavetheimageandyourconfigurations.
TheStatusfieldshowsSavingimage…whileMOSAIQwritestheimagefile,andthen
Imagesavedwhentheimagefileiswrittentothestagingarea.
14. ClickeCHART|Images…toopentheImageListwindowandverifythatthescanned
imagewasimported.
Acquiring Images from Electronic Sources
Youcancaptureimagesdirectlyfromyoursimulator,electronicportalimager,orother
electronicdevices.Whenyouacquireanimagefromanelectronicsource,theimageis
importedintoMOSAIQ,andyoucanautomaticallyassociateitwiththeapplicable
treatmentfield,prescriptionsite,orpatientname.Iftheimportedimageisnotassociated
oryoumustchangetheassociation,youmustassociatetheimagetouseiteffectively
duringtreatmentplanning.
To associate an image with a patient, you must use the same patient ID in
CAUTION
the image acquisition system and in MOSAIQ.
1. Prepareyoursimulatororacceleratorforimaging.
2. Captureanimagewithyourdevice,andthenexporttheimagetotheNamerstaging
areasetupforthedevice.
3. Openthechartforyourpatient.
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TheimageisimporteddirectlyintothepatientchartandaddedtotheImageList
window.
5. Toassociatetheimagewithatreatmentfieldorprescriptionsite,clicktheimage
capturedfromyourimagingdevice,andthenclickOpentoopentheImagewindow.
6. Right‐clickorpressF4,andthenclickImageInformationtoopentheImage
Informationdialogbox.
7. Toassociatetheimagewithatreatmentfield,clicktheFieldoptionbutton,andthen
selectthefieldtoassociatewiththeimage.
You must associate the image with a treatment field to see the image
with the treatment geometry in the Image window, Treatment Field
CAUTION Definition window, and Beam’s Eye View dialog box.
8. Toassociatetheimagewithaprescriptionsite,clickSiteoptionbutton,andthen
selecttheprescriptionsitetoassociatewiththeimage.
9. ParticleTherapyOnly:Toassociatetheimagewithanimagername,clickthe
Machine/Imageroptionbutton,click inthedroplistthatappears,andthenselect
theimagername.
10. ClickOKtwotimestoassociatetheimagewiththeselectedtreatmentfieldor
prescriptionsite,andthenclosetheImageInformationdialogboxandImagewindow.
Viewing the Import Log and Import Status
Imagesnormallyareimportedwithnoproblems.But,ifyouarenotsureanimagewas
importedproperlyorwasassignedtothewrongpatient,youcanlookattheImportLog
andtheNamerStatusdialogbox.
1. ClickFile|SystemUtilities|ImageMaintenance|ReviewImportLog…toopenthe
ImportLogdialogbox.
TheImportLogdialogboxshowstheimportedimages,withthemostrecentimageat
thetopofthelist.Thelistshowsthedateandtimeanimagewasimported,thepatient
withwhichitwasassociated,andthefieldorlocation whensupplied .
2. ClickClosetoclosetheImportLogdialogbox.
3. ClickFile|SystemUtilities|ImageMaintenance|NamerStatus…toopentheNamer
Statusdialogbox.
TheNamerStatuswindowletsyoulookatthestatusoftheNamerapplicationinall
departmentsfromMOSAIQ.YoudonothavetousetheNamerworkstation.
DescriptionsofthestatusesaredescribedinTable24.
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Table 24: Namer Status
Status
Description
Database Access
Appearsgreenifthedatabasespecificationisvalid pathexists
andknowndatabasefilesexist andredifthedatabase
specificationisinvalid pathandknowndatabasefilesdonot
exist .
Staging Areas
Appearsgreenifallaccessiblestagingareasareavailable,
yellowifatleastoneaccessiblestagingareaisavailable,and
redifnoneoftheaccessiblestagingareasareavailable.
Storage Locations
Appearsgreenifallaccessiblestoragelocationsareavailable,
yellowifatleastoneaccessiblestoragelocationisavailable,
andredifnoneoftheaccessiblestoragelocationsareavailable.
Image Scan
Appearsgreenwhenallofthosethatfollowaretrue:

TheScanforImagespreferenceisset.

Thedatabasecanbeaccessed.

Atleastoneaccessiblestagingareaisavailable.

Atleastoneaccessiblestoragelocationisavailable.
Appearsyellowwhenoneofthosethatfollowistrue:

Therearenoavailablestagingareasfromthepoolof
accessiblestagingareas.

Therearenoavailablestoragelocationsfromthepool
ofaccessiblestoragelocations.
Appearsredwhenoneofthosethatfollowistrue:

TheScanforImagespreferenceisclear.

Thedatabasecannotbeaccessed.

Therearenoavailablestagingareas.

Therearenoavailablestoragelocations.
4. ClickRefreshifyoufeelthedisplayeddatadoesnotreflectthecurrentstate.
5. ClickClosetoclosetheNamerStatusdialogbox.
Using the Photos and Diagrams Utility
Youcanacquireandviewdigitalphotosanddiagramsaspartoftheelectronicchart.You
canuseadigitalcameraoroneofawidevarietyofindustry‐standarddevicestocapture
imagesthatyoucanimportintothesystem.ThePhotosandDiagramsutilitydoesnot
interfacedirectlywithimagesourcessuchasdigitalcameras.
The camera or scanner you use must be able to save images to disk in JPEG, PCX,
BMP, or TIFF format. TIFF compatibility is limited, so we do not recommend
devices that only support TIFF format. JPEG works best in most situations.
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TheMOSAIQapplicationautomaticallyresizes downsamples largeimagefilesimported
fromthePhotosandDiagramsImportwindowtoimproveperformanceiftheImageType
isIDPhoto.ImageswithanImageTypeotherthanIDPhoto Diagram,FldSetup,or
Unknown arenotresizedandappearintheirnativesize/resolutionatalltimes.
Afteryouimporttheimages,youmustassociatethemwithatreatmentfieldor
prescriptionsitebeforeyoucanusetheimagesinthetreatmentset‐upprocess.
Importing Images with Photos and Diagrams
1. Scanoraddimageswithascannerordigitalcamera,andthensavethoseimagesto
theapplicabledirectory.
2. ClickFile|Import/Export,andthenclickPhotosandDiagramsImport…toopenthe
PhotosandDiagramsImportdialogbox.
ThePhotosandDiagramsImportdialogboxshowsalltheimagesinthespecified
directory.Forthisreason,youcanimportmultipleimagesatonetime.Forexample,if
youhavefiveimagesforonepatientandsiximagesforanotherpatient,youcan
processtheimagesforthefirstpatient,andthenthesecondpatient–andyoudonot
havetoclosethePhotosandDiagramsImportdialogbox.
3. IftheDirectoryfielddoesnotshowtheapplicablepathtothedirectorywiththe
images,click ,selecttheapplicabledirectory,andthenclickOK.
4. IntheMarkAllasgroup,clickImporttoimportalloftheimages.Thischangesthe
statusindicatorstogreen.
5. IntheMarkAllasgroup,clickDeletetoremovealloftheimages.Thischangesthe
statusindicatorstored.TheimagesarepermanentlyremovedwhenyouclickOK.
6. IntheMarkAllasgroup,clickIgnoretoignorealloftheimages.Thischangesthe
statusindicatorstoyellow.Imagesstayinthedirectorysothatyoucanimportthem
atadifferenttimeortoadifferentpatient.
7. IntheMarkAllasgroup,click adjacenttotheImageTypeSelectorfield,andthen
clickUnknownifyoudonotknowtheimagetype.ClickFldSetuptoidentifythe
imagesasfieldsetups.ClickDiagramtoidentifytheimagesasdiagrams.
8. Ifdifferenttypesofimagesappear,click ineachofthephotoimagegroups,and
thenclicktheimagetype–Unknown,Diagram,Document,FldSetup,orIDPhoto.
9. Toimportspecifiedimagesonly,click
import.
inthephotoimagegroupofeachimageto
10. Toremovespecifiedimages,click inthephotoimagegroupoftheimagesto
permanentlyremovetheimagesfromthedirectory.
11. Toimportspecifiedimages,click
ignore.
inthephotoimagegroupsoftheimagesto
12. ClickOKtoimportorremovetheimages.TheimagesyouselectedtoIgnorestill
appearinthePhotosandDiagramsImportdialogboxthenexttimeyouopenit.
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13.Click
,orclickCanceltoclosethePhotosandDiagramsImportdialogbox.
14. ClickeChart|Images…toopentheImageListwindowandverifythattheimageswere
importedintothesystem.
15. ClickClosetoclosetheImageListwindow.
Associating Images with Photos and Diagrams
You can also associate non-medical images with treatment fields and
prescription sites from the Image List window. See Associating Non-Medical
Images on page 172.
1. ClickFile|Import/Export|PhotosandDiagramsImport…toopenthePhotosand
DiagramsImportdialogbox.
2. Tochangetheimagetypetofieldsetupordiagram,click adjacenttothephoto
imagegroupforeachimagetoassociatewithaprescriptionsiteortreatmentfield,
andthenclickFldSetuporDiagram.
3. Double‐clicktheimagetoassociatewithaprescriptionsitetoopenthePhotosand
DiagramsImageEditdialogbox.
4. IntheAssociationgroup,clicktheSiteoptionbutton.
5. Click adjacenttotheSitelist,andthenclickthenameoftheprescriptionsite.
6. ClickOKtoclosethePhotosandDiagramsImageEditdialogbox,andthengotothe
7. Double‐clicktheimagetoassociatewithatreatmentfieldtoopenthePhotosand
DiagramsImageEditdialogbox.
8. IntheAssociationgroup,clicktheFieldoptionbutton.
9. Click inthedroplistadjacenttotheFieldoptionbutton.
10. Clickthetreatmentfieldtoassociatewiththeimage.
11. ClickOKtoclosethePhotosandDiagramsImageEditdialogbox.
Cropping Images
1. FromthePhotosandDiagramsImportdialogbox,double‐clicktheimagetocrop.
2. ClickCroptoaddayellowcroppingbordertotheimage.
3. Positionthemousepointeronthelowerrightcorneroftheimage,ontheyellow
border.Themousepointerchangesto .
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4. Clickandholdtheleftmousebutton,andthendragthemousepointertoalignthe
yellowoutlinewiththeedgeoftheimage.Onlythepartofthepictureinsidethe
yellowoutlineissaved.
5. Positionthemousepointerintheyellowbordertochangethemousepointertoa arrow,andthendragit. Holddowntheleftmouseanddragtheyellowborderinto
thenewposition. 6. Continuetore‐sizeandmovetheyellowbordertoalignitwiththeedgeoftheimage.
7. ClickOKtocroptheimage,savethechange,andclosethePhotosandDiagramsImage
Editdialogbox
Associating Images
Beforeyoucanuseimagesinkeyareasofthesystemduringthetherapyprocess,you
mustassociatetheimagewithatreatmentfield,aprescriptionsite,orthepatient.For
example,youassociateanimagewithatreatmentfieldtoshowtheimagebehindthefield
geometryandfieldshape.ThisletsyoudoprecisetreatmentplanningintheTreatment
FieldDefinitionandBeam’sEyeViewdialogboxesandtheImagewindow.Youcan
associatebothmedicalimages simulator,portal,andDRRimages andnon‐medical
images digitalphotosanddiagrams .
To associate images with a treatment field or prescription site, you must
have Clinical | Field Defs | View and Modify rights.
To open the Diagnoses and Interventions window, you must have
Clinical | General | View rights.
Associating Medical Images
YoucanassociateorchangetheassociationofmedicalimagesintheImageInformation
dialogbox.
You can also associate scanned medical images in the Digitized Film Import
dialog box. See Scanning Simulation Films on page 164.
2. ClickaDRRorsimulationimagethatdoesnothaveanassociation,andthenclick
OpentoopentheimageintheImagewindow.
3. Right‐clickorpressF4,andthenclickImageInformationtoopentheImage
4. Toassociatetheimagewithafield,clickField,click inthedroplistthatappears,
andthenselectthetreatmentfield.
5. Toassociatetheimagewithasite,clicktheSiteoptionbutton,click inthedroplist
thatappears,andthenselecttheprescriptionsite.
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6. ParticleTherapyOnly.Toassociatetheimagewithanimagername,click
Machine/Imager,click inthedroplistthatappears,andthenselecttheimager
name.
7. Toassociatetheimagewiththeselectedpatient,clickthePatientoptionbutton,and
thentypeanamefortheimageintheImageNamefield.
8. ClickOKtwotimestoclosetheImageInformationdialogboxandImagewindow.
ImageInformationdialogboxinformationisnotsaveduntiltheImagewindowis
saved.
Associating Non-Medical Images
Youcanassociateorchangetheassociationofnon‐medicalimagesintheImagewindow.
You can also associate non-medical images in the Photos and Diagrams Image
Edit dialog box when you import them with the Photos and Diagrams utility. See
Associating Images Using the Photos and Diagrams Utility on page 170.
2. Double‐clickthenon‐medicalimagetoassociatewithaprescriptionsiteortreatment
fieldtoopentheimageintheImagewindow.
3. IntheImagewindow,clickAssociatetoopentheImageAssociationdialogbox.
4. Toassociatetheimagewithaprescriptionsite,clicktheSiteoptionbutton,andthen
clickOK.
5. InthePrescriptionSiteswindow,clicktheprescriptionsitetoassociatewiththe
image,andthenclickSelect.
6. Toassociatetheimagewithatreatmentfield,clicktheFieldoptionbutton,andthen
clickOK.
7. IntheTreatmentFieldDefinitionswindow,clickthefieldtoassociatewiththeimage,
andthenclickSelect.
Reticle Scaling Reference Images
Reticlescalingreferenceimagesistheprocessthatidentifiesthemagnification scaling factors,beamcenter,androtationofareferenceimage DRRorSimulation .Thislets
MOSAIQaccuratelyshowthetreatmentgeometryontheimage.Imagescannotappearin
theTreatmentFieldDefinitionwindowuntiltheimagehasbeenreticlescaled.Before
reticlescaling,youmustassociatetheimagewithaprescriptionsiteortreatmentfield.
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Images exported from electronic sources with DICOM RT Image can include
scaling data that can be used in MOSAIQ. Therefore, you do not have to reticle
scale these images.
To manually reticle scale an image you must have a visible reference such as
a “burned-in” graticule that represents the central axis and relative scale of
the image. The reference image:
CAUTION

Must have square pixels

Must NOT have a Shadow filter applied

Must not have already been used in a treatment field that has been
treated

Must not have an associated offset
You must also associate the image with a treatment field, prescription site,
or patient before reticle scaling.
Reticle Scaling a Reference Image
1. IntheImageListwindow,clickareferenceimagethathasalreadybeenassociated
withatreatmentfield,andthenclickOpen.
2. Right‐clickorpressF4,andthenclickReticleScaleImage.
AredreticletoolappearsinthecenteroftheimageintheImagewindow.Youcanalso
clickRegistrationEditortoopentheImageRegistrationEditorwindow.Thisletsyou
reticlescaletheimageandalsodootherfunctions.Forexample,youcanconfigure
yourimagingpreferenceswiththeImagingUserPreferencesdialogbox.
The major ticks on the reticle tool equal 5 cm, and the magenta arrow always
points toward the gantry stand with respect to the image.
3. Click
untiltheimageislargeenoughtoaligntheredreticletooleasilywiththe
reticleontheimage.Ifyouzoomintoomuch,click
image.
todecreasethesizeofthe
Figure43showsanimageenlargedforreticlescaling.
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173
Figure 43: Enlarged Image for Reticle Scaling
4. Clickthereticletoolanddragittoplaceitrelativetothereticleontheimage.Usethe
sizinghandles smallboxes atthemiddleandendsofeacharmofthereticletoolto
rotateandstretchthereticletooltoalignitwiththe“burnedin”graticuleonthe
image.
The center of the reticle remains fixed when you drag a sizing handle.
If you hold the CRTL key down while you drag a sizing handle, the opposing
sizing handle remains fixed instead of the tool center.
5. Verifythattheapplicablesource‐to‐axisdistanceistypedintheSADfield,ordouble‐
clickinthisfieldandtypetheapplicableSAD.
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If the source-to-axis distance is not added in the SAD field, you must type
the correct value for SAD in this field.
The tick marks of the “burned-in” graticule on the reference image are
calibrated to the SAD defined at the treatment machine. The tick marks
therefore represent the tick marks of the graticule used by the machine
when the image was added.
CAUTION
When reticle scaling, you must type the correct SAD in the Image window,
and precisely align the center and tick marks of the MOSAIQ reticle tool
with the center and tick marks of the “burned in” graticule on the image.
This must be done correctly to add accurate image scaling information
and a central axis position for the image in MOSAIQ.
6. Double‐clickintheSIDfield,andthentypethesource‐to‐imagedistanceifnecessary.
TheSIDisoptional.
7. ClickOKtosavethereticlescalingdata,andthenshowtheImageListwindow.
Correcting Film Rotation Errors
If,forexample,thesimulationfilmwascrookedwhenscannedorthefilmholderwas
crookedduringtheexposure,theimagecanalsoberotatedwhenimportedintothe
system.Ifso,theimageappearscrookedintheImagewindow.Or,forexample,thereticle
anglethatappearsintheAxisRelativeAnglesgroupoftheImagewindowisnotthesame
asthecollimatorrotationusedtoacquiretheimage.
1. IntheImageListwindow,clicktheimagewithafilmrotationerror,andthenclick
Open.
2. Right‐clickorpressF4,andthenclickReticleScaleImage.
AredreticletoolappearsinthecenteroftheimageintheImagewindow.
untilyoucanclearlyseetheticksofthegraticuleontheimage,andthen
3. Click
clickanddragtheredreticletooltoalignitwiththegraticuleontheimage.
4. IntheReticlefield,typetherelativeangleatwhichthecollimatorwaspositionedwith
respecttothegantrywhenthefilmwasacquired.
5. PressTABtotypethefilmrotationerrorintheFilmfieldandshowthefilmrotation
errorontheimageintheVieweroftheImagewindow.
Makeanoteofthealignmentofthepurplereticleaxisvector.Thereticlescaleaxis
identifiestheplannedgantryaxisintheimage.Thearrowpointstowardthegantry
stand gantryupposition .Whenyousavethereticlescaling,theimageisrotatedto
alignthereticleaxisvectorandthegantryaxis.
6. ClickOKtosavethereticlescalinginformationandclosetheImagewindow.Youcan
alsoright‐clickorpressF4,andthenclickReticleScaleImagetosavethereticle
scalinginformationandreturntothenormalviewoftheImagewindow.
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Clearing Reticle Scaling
1. IntheImageListwindow,clicktheimagetoclear,andthenclickOpen.
2. Right‐clickorpressF4,andthenclickClearReticleScaling.
You cannot clear reticle scaling in an image already used in a treatment field
that was treated. The Image window shows Historic for these images.
3. ClickOKtoclosetheImagewindow.
Reticle Scaling Verification Images at Image Registration
Reticle Scaling Preferences
Youcanselectapreferredreticlescalemethod GraticuleorFieldAperture fromthe
ImagingUserPreferencesdialogbox.IntheImageRegistration,ImageRegistrationEditor,
orStereoscopicImageRegistrationwindow,clickPreferencestoopenthedialogbox.
SelecttheapplicableReticleScalingMethodoptionbutton,andthenclickOK.
Iftheconditionsthatfollowoccur,GraticuleisselectedastheReticleScalingMethod.This
occursevenifyouselectedFieldApertureasyourpreference.

IfyouopentheReticleScalingdialogboxfromtheImageRegistrationEditor
window.Thisisbecauseyoumusthaveareferenceandverificationpairofimages
tousetheFieldAperturemethod.

IfthereferenceimagedoesnotcontainafieldapertureandyouopentheReticle
ScalingdialogboxfromtheImageRegistrationorStereoscopicImage
Registrationwindows.
Image Registration, Reticle Scaling, and User Preferences for the 2D
Image Registration Windows
TheImagingUserPreferencesdialogboxletsyouselectthepreferredreticlescaling
methodandpreferredimageregistrationmethodwhenyouopenthe2Dimage
registrationwindows.IfyouusetheFieldAperturemethodforreticlescaling,theimage
registrationmethodisfirstsettoManualintheImageRegistrationandStereoscopic
ImageRegistrationwindows.Thisletsyoureviewthefieldaperturelayerandisocenter
placementontheimagebeforeyouregistertheimages.Thisdoesnotchangethe
registrationpreferencethatyouconfiguredfromtheImagingUserPreferencesdialogbox.
EventhoughtheregistrationmethodissettoManualwhenyouenteredisocenterand
scalewiththeFieldAperturemethod,youcanuseanyregistrationmethodintheImage
RegistrationandStereoscopicImageRegistrationwindows.
Automatic Display of Reticle Scaling Dialog Box
TheReticleScalingdialogboxcanappearautomaticallyifaverificationimageisnotreticle
scaled.ThesystemautomaticallyselectstheimageandopenstheReticleScalingdialog
box.Toreticlescaleanimage,clickAutoDetect,manuallydragtheReticletoolinto
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position,orusetheFieldAperturefunction.YoucantypetheReticle,SAD,andSIDvalues
fortheimage.
Reticle Scaling a Verification Image with Auto Detect
Youcanonlyusetheseinstructionstoreticlescaleverificationimagesthathada1cm
calibratedgraticuleinplacewhenthepatientwasimaged.This“burned‐in”graticuleon
theimageidentifiesthecentralaxisandrelativescaleoftheimage.
IftheimportedimagehasaLockedScale,AutoDetectisdisabled.Youcanonlychangethe
isocenter.Imagesareimportedaslockediftheyhavevalidscaling pixelsize,SAD,and
SID andfilmrotationangleinformation,butnodefinedisocenter.Elektadoesnot
recommendthatyoucleartheimportedscaling.
Images with significant artifacts or radiographic noise can fail auto detection.
1. Openthepatientchart,andthenclickeChart|ImagestoopentheImageListwindow.
2. Clicktheimagetoreview,andthenclickReviewtoopentheimage s intheImage
Reviewwindow.
3. ClicktheOffsettab,andthenclickRegistertoopentheimagesintheImage
Registrationwindow.
Ifthereisnoreticlescaleinformation,theimageisselectedandtheReticleScaling
dialogboxautomaticallyappears.RefertoFigure44.Alternatively,youcanclicka
toopentheReticleScaling
verificationimagetomakeitactive,andthenclick
dialogbox.
Figure 44: Reticle Scaling Dialog Box
4. SelecttheGraticuleoptionbuttonifnecessary.
5. ClickAutoDetecttoautomaticallydetectthebeamisocenterandcalculatedistances.
The Reticle Scaling dialog box lets you correct for film rotation. When you
align the graticule and the beam isocenter, make sure the reticle angle is the
same as the collimator angle of the image. If these values are not the same,
you can type the actual collimator angle to correct the film rotation. A
mismatch is often caused by film/cassette rotation.
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6. Afteryoureticlescaletheverificationimage,youcanclick
tozoomallimages
together.Moveyourmousetothelefttodecreasethemagnificationandtotherightto
increasethemagnification.
7. Clickyourmouseagaintoseetheregularview.
8. Youcanalsoclick
toshowonlyoneimage.
Manually Reticle Scaling a Verification Image with Field Apertures
TheReticleScalingdialogboxalsoletsyouassignisocenterandscalinginformationto
verificationimagesacquiredwithoutaphysicalgraticule.Afieldaperturemustbe
assignedtothereferenceimage.YoucanaddthisapertureasaMOSAIQannotationor
importitfromatreatmentplanningsystem.Youcanmanuallymatchthereferenceimage
fieldwiththeedgeoffieldexposureregiononthesingleordoubleexposureverification
image.Youcanmoveorscalethefieldapertureintheregistrationwindow.Youcannot
rotatethefieldaperture.
Make sure you added your annotations and assigned them as apertures in
the Annotations to Curve Export before you reticle scale the verification
image. If you use the right-click option Field Aperture option in the Image
window, the annotations are automatically assigned as apertures. Refer to
Adding or Changing the Label of an Annotation on page 200 for more
information.
Ifthereisnoreticlescaleinformation,theimageisselectedandtheReticleScalingdialog
boxautomaticallyappears.RefertoFigure44.Alternatively,youcanclickaverification
imagetomakeitactive,andthenclick
toopentheReticleScalingdialogbox.
Ifyouseeabluecrosshairintheverificationimage,theReticleScaledialogboxdoesnot
appearautomatically.Theimageisalreadyreticlescaled.
1. IntheImageListwindow,clicktheimagepair,andthenclickReview.
2. ClicktheOffsettabintheImageReviewwindow,andthenclickRegister.
3. ClicktheFieldApertureoptionbuttontoshowthereferenceimagefieldapertureon
theverification red andreference blue images.
Theisocenterandallannotationsidentifiedasfieldaperturecurvesappearonthe
referenceimage.Ifselected,theReticlefieldandtheAutoDetectbuttonaredisabled.
IfselectedandtheCurve,Point,orGrayscaleregistrationmethodswereselected,the
registrationmethodchangestoManualafteryoureticlescaletheimage.Thisletsyou
confirmyourplacementofimageisocenterandscale.
TheFieldAperturemethodisdisabledifthereferenceimagedoesnothaveavalid
fieldaperture.ThisoptionbuttonisalsodisabledintheImageRegistrationEditor
window.
4. Usetheregionalcontrolstotranslateorscaletomatchthereferenceimagefield
apertureobjectwiththeedgeofthefieldexposureregiononthesingleordouble
exposureverificationimage.
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Youcanpositionyourmousecursorindifferentsectionsoftheimagetoenablethe
optionthatappears.Then,useyourleft‐clickmousebuttontoadjustthetranslation
orscaling.
Toremovethemanualadjustment s made,butnotsaved,right‐click,andthenclick
ResetOffset.YoucanalsopresstheMINUSkey ‐ onyournumberkeypad.
5. ClickOKafteryoualignthefieldaperturefromthereferenceimagewiththeedgeof
thefieldexposureonthesingleordoubleexposureverificationimage.Thered
crosshairsshowtheverificationimageisocenter.
Adding Annotations as Field Apertures to Confirm Isocenter
Placement
MOSAIQautomaticallyderivestheisocenterpositionduringimageimportforiVIEWGT
imageswithafieldmatchingalgorithm.Theisocenterappearsasbluecrosshairinthe
importedimage.ThisappliestosingleanddoubleexposureiVIEWGTimages.MOSAIQ
supportstheseiViewimagetypesforautomaticisocenterplacement:

SingleExposure

DoubleExposure

Single‐segmentIMRTimagesthatusethe1st oronly segmentofaprescribed
field

AllElektaMLCtypes thisexcludesApex Iftherequiredinformationisnotavailableatthetimeofimageimport,theiVIEWGT
imageisimportedwithoutanisocenter.MOSAIQmusthavetheinformationinthe
databaseatthetimeofimageimportthatfollows:

Portalimage

PrescribedFieldEdge PFE  FieldID establishesfieldassociatedbetweenportalimageandPFE AftertheisocenterisderivedandtheimageimportedintoMOSAIQ,usetheFieldAperture
menuOptionintheImagewindowtomakesurethattheisocenterpositioniscorrect.This
optionisavailablewhentheconditionsthatfollowoccur:

MLCTypeofapplicabletreatmentmachineis“Elekta”.

Imageisreticle‐scaledandhasafieldassociation.

ImagehasastatusofNotReviewedorNotRequired.

Imageisnotrotatedforgantryuprequirement.

Imageisnotahistoricalimage.
1. IntheImageListwindow,double‐clicktheapplicableimagetoopentheImage
window.
2. Right‐clickandclickFieldAperture.
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Viewing Treatment Geometry on the Image
Afteryouhaveassociatedtheimagewiththecorrecttreatmentfieldandreticlescaledthe
image,youcanshowthetreatmentgeometryoftheassociatedfieldoverlaidontheimage
intheImagewindow.Thisoptionisnotavailableforreferenceimagesthathavenoscaling
informationorarenotassociatedwithatreatmentfield.
You must have the Image Underlay check box selected to connect the treatment
geometry with the reference image. See Enabling Imaging Options in System
Utilities on page 159.
1. Clickareferenceimagethatisassociatedwithatreatmentfield,andthenclickOpen
toopentheimageintheImagewindow.
The Geometry and Use for Tx Definition check boxes are NOT active until
you have:
CAUTION

Selected the Image Underlay check box in the Department Setup

Associated the image with a field

Reticle scaled the image
If you have already done the last one and the Geometry and Use for Tx
Definition check boxes are not active, contact your system administrator
to examine the machine characterization of the machine selected for the
associated treatment field.
2. ClicktheGeometrycheckboxintheViewgroupoftheImagewindow.
ThecolorconventionsforthetreatmentgeometryintheImagewindowaredescribed
inthistable.
Table 25: Treatment Geometry Color Conventions
Color
Description
Red
Theisocentercrosshair reticle
Turquoise
Thejaw
Yellow
Thefieldshape
Green
TheMLCleaves
Enabling the Image Underlay Option
IntheImagewindow,youcanalsoconfiguretheimagetoappearintheTreatmentField
Definitionwindow.ThisletsyouviewthereferenceimagebehindMLCparametersand/or
leafandjawsetupinBeam’sEyeView.Youmustassociatetheimagewiththeapplicable
treatmentfieldandreticlescaletheimagetousethisimageunderlayoption.
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To use the Image Underlay option, you must have Image | ViewStation |
Images | View security rights. To open the Diagnoses and Interventions window,
you must have Clinical | General | View security rights.
2. Clickareferenceimagethathasbeenassociatedwithatreatmentfield,andthenclick
OpentoopentheimageintheImagewindow.
3. ClicktheUseforTxDefinitioncheckboxintheImagegroup.
4. ClickOKtosavethenewsetting,andthenclosetheImagewindow.
5. ClickClosetoclosetheImageListwindow.
6. ClickeChart|DiagnosesandInterventions…toopentheDiagnosesandInterventions
window.
7. IntheDiagnosesandInterventionswindow,double‐clickthetreatmentfield
associatedwithyourimage.Theimageappearsintheviewer.
8. IntheTreatmentFieldDefinitionwindow,clickEnlarge/EditBeam’sEyeView.
TheBeam’sEyeViewdialogboxhasanexpandedgraphicaldisplayofthejawsand
isocenter.Italsohasanouterfieldboundaryforthetreatmentfieldasviewedfrom
theperspectiveoflookingdownthroughthecollimator.Inthisdialogbox,youcan
changethesetreatmentfieldparameters,digitizeatreatmentfieldshape,and/or
manipulateanMLCplanforthetreatmentfieldwithimageunderlay.
9. ClickCanceltoclosetheBeam’sEyeViewdialogbox.
10. ClickOKintheTreatmentFieldDefinitionwindow.
Committed changes to the beam or beam parameters will invalidate the Use
for Tx Definition status. Applicable beam parameters include the gantry
angle, source angle for kV setup fields, couch angle, and couch top.
Temporary, unsaved Field Definition changes do not change the validity of
the Use for Tx Definition status.
Using the Image List Window
TheImageListwindowshowsalltheimagesinthesystemfortheselectedpatient,along
withimportantinformationoneachimage.ImagesappearintheImageListwindowwhen
theyareimportedintothesystem.ThiswindowisthecoreoftheMOSAIQImage
Managementfunctions.YoumustfirstopentheImageListwindowtocompleteavariety
oftasks.Youcanassociatemedicalimages,reticlescaleimages,reviewimages,annotate
images,andconfigureimagestoappearwiththefieldgeometryandfieldshapeforprecise
treatmentplanning.
UsetheImageListwindowtomanagethelistofimagesinyoursystem.Inthiswindow,
youcanremove,copy,move,andprintimages.
Descriptionsofthefieldsintheimageinformationtableareasfollows.
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Table 26: Image Information Descriptions
Field
Description
Status
Showsthestatusofthemedicalimageasarchived,open,or
identifiedasUseforTxDefinition.
Date/Time
Showsthestudydateandtimeoftheimage.
Association ID
ShowsthetreatmentfieldIDnumberwithwhichtheimageis
associatediftheimageisassociatedwithatreatmentfield.Shows
Site iftheimageisassociatedwithaprescriptionsite.
Association
Name
Showsthetreatmentfieldnameiftheimageisassociatedwitha
treatmentfield.Showsthesitenameiftheimageisassociatedwitha
prescriptionsite.
Type
Showsthe imagetype,suchassimulator,portal,andsoon.
Imager
Showsthenameoftheimageacquisitionsource treatmentorkV whenprovidedintheimagefile.
Proj.
Showsthederivedprojectionanglefortheimageinnative
coordinates.TheProjectionAngle iscalculatedfromtheimage’s
gantryangleandassociatedmachinecharacterization.Thisfieldis
notblankfortheconditionsthatfollow:

Theimageisaplanarimage simulator,portal,radiograph,
DRR,orsetupverification .

Theimageissite‐associatedorfield‐associated,orhasan
associatedmachine.

Theimagehasavalidgantryangle.

Theimagedoesnothaveapitchedgantryangle.

Theimagehasavalidmachinecharacterization.
Cp
Showsthecopynumberifthemedicalimageisacopy.
Fld
YesappearsifarequestispendingandDoneiftherequestis
completed.
Blk
Yes appearsifarequestispendingandDoneiftherequestis
completed.
Oth
Yes appearsifarequestispendingandDoneiftherequestis
completed.
Img
Yes appearsifarequestispending.
Off
Yes appearsifanoffsetrequestisactive,No iftheoffsetsequalzero,
Cmpl iftherequestiscompleted,andExcl iftheoffsethasbeen
excluded.
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Field
Description
Final Review
Approved appearsiftheimagewasapproved,Rejectediftheimage
wasrejected,NotRvw iftheimagehasnotbeenreviewed,VoidApp
iftheimagewasapprovedandvoided,VoidRejiftheimagewas
rejectedandvoided,orNA iftheimageisanon‐medicalimageora
medicalimageforwhichreviewisnotnecessary.
Final Review
Details
Showstheinitialsofthefinalreviewerandthedate/timeoftheFinal
review.
Optional Review
Approved appearsiftheimagewasapproved,Rejectediftheimage
wasrejected,NotRvw iftheimagehasnotbeenreviewed,orNA if
theimageisanon‐medicalimageoramedicalimageforwhich
reviewisnotnecessary.
Optional Review
Details
Showstheinitialsoftheoptionalreviewerandthedate/timeofthe
Optionalreview.
Sup
Showsthemagnitudeofthesuperiororinferioroffsetoftheimagein
centimeters.
Lat
Showsthemagnitudeoftheleftorrightoffsetoftheimagein
centimeters.
Ant
Showsthemagnitudeoftheanteriororposterioroffsetoftheimage
incentimeters.
Mag.
Showstheoffsetvectormagnitude.
Cor
Showsthecoronalangularcorrectionindegrees.
Sag
Showsthesagittalangularcorrectionindegrees.
Trans
Showsthetransverseangularcorrectionindegrees.
Comment
ShowscommentsaddedintheCommentfieldoftheImageorImage
Reviewwindow.
Changing the View of the Image List Window
IntheImageListwindow,youcanshowalltypesofimages,medicalimagesonly DRR,
Portal,andSimulator ,non‐medicalimagesonly fieldsetupphotos,diagrams ,orDICOM
ExportImages.DICOMExportImagesonlyappliestomedicalimageseligibletobe
convertedintoclinicallyrelevantDICOMImageobjects.
1. Right‐clicktoopentheOptionsmenu.
2. Clickoneoftheoptionsthatfollow:
Table 27: Image List Field Descriptions
Field
Description
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All Images
Clicktoshowallphotosanddiagrams,aswellasmedicalimages,
fortheselecteddepartment s .Thisisthedefault.
Photos and
Diagrams
Clicktoshowonlyphotosanddiagramsimportedfromthe
Medical Images
Clicktoshowonlymedicalimages.
DICOM Export
Images
ClicktoshowonlyDICOMExportimages.
Opening and Closing Images from the Image List Window
Opening and Closing Images
1. Toopenoneimage,clicktheimagetoopen.
Toopenmultiple2Dimagesatatime,usetheWindowsstandardCTRLorSHIFT
methods.
2. ClickOpentoopentheimage s .
Closing Images
1. Ifyouopenedmultipleimages,clickCloseAllintheImageListwindowtocloseallof
theImagewindows.
2. Ifyouonlyopenedoneimage,clickCancelintheImagewindow.
Opening and Closing Non-Medical Images
1. Clickthenon‐medicalimage,andthenclickOpentoopenthePhotosandDiagrams
window.
,orclickCancelinallofthePhotosandDiagramswindowsopened.
2. Click
Deleting Images from the Image List Window
You cannot delete multiple tagged images, reviewed images, images for
CAUTION
which the treatment history is set, or images with offsets.
1. IntheImageListwindow,clicktheimagetodelete,andthenclickDelete.
TheDeleteImagemessageappearstoconfirmthatyouaredeletingthecorrectimage.
2. ClickYestodeletetheimageintheDeleteImagemessage.
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Copying Images
Youcancopyonlymedicalimages.Youcanmakeamaximumof99copiesofanimage.All
copiesthatyoumakearenewimageswithnochangerequestsorcomments,andastatus
ofUnapproved.
1. ClickFile|SystemUtilities|ImageMaintenance|CopyandMoveImagestoopenthe
CopyandMoveImagesdialogbox.
2. Clicktheimagetocopy,andthenclickCopy.
3. ClickYesintheCopyImagemessage.
Moving Images
1. ClickFile|SystemUtilities|ImageMaintenance|CopyandMoveImagestoopenthe
CopyandMoveImagesdialogbox.
2. Selecttheimagetomove,andthenclickMovetoopentheMoveImagedialogbox.
3. Click adjacenttotheToPatientfield,andthendouble‐clickthenameofpatient
whosechartistherecipientofthisimage.
4. ClickOKintheMoveImagedialogboxtomovetheimagefromthecurrentpatient’s
ImageListtotheImageListofthenewpatient.
If the image to be moved is associated with a treatment field or prescription
site, the system removes the association when the image is moved to the
Image List of the new patient.
5. Openthepatientchartthatistherecipientoftheimage,andthenclickeChart|
Images…toconfirmthatthemovewassuccessful.
Printing Non-Medical Images
See Printing Medical Images on page 189 for information on how to print scale
and print medical images in the system.
1. IntheImageListwindow,clickafieldsetupphotoordiagram,andthenclickPrint.
Theimageandrelateddataissentdirectlytothedefaultprinter.
Scaling Medical Images
Therearethreescalingprocessesforimages:printscaling,reticlescaling,andimage
scaling.PrintscalingissettingtheprintscalingoptionsintheStandardPrintandDICOM
Printdialogboxestofitthemedicalimagetotheprintmedium paperorfilm .Theprint
scalingoptions especiallySAD,SIDandCustomSID dependonimagescalingdata,such
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asthepixeltype,pixelsize,SADvalue,andSIDvalue.Imagesmustthereforehaveaccurate
imagescalingdatabeforeyousettheprintscalingoptionsintheprintdialogboxes.
Reticlescalingistheprocessthatdefinesthemagnification scaling factors,beamcenter,
androtationofareferenceimage DRRorSimulation .SeeReticleScalingReference
Imagesonpage172.Imagescaling sometimescalledcalibratingtheruler isadding
calibrationdatatoidentifythesizeofthepixelsintheimagesothatyoucanmake
subsequentmeasurements.Ifyoucannotreticlescaleimages,youfollowtheimagescaling
process.
Image Scaling
Withimagescaling,youmanuallyaddthescalingdatawiththerulerannotationtooland
theImageMeasurementsdialogbox.Theimagescalingprocessisslightlydifferentfor
imagesimportedwithsomescalingdataandimagesimportedwithnoscalingdata.
AddingScalingDataforVerificationImagesImportedwithSomeScalingData
1. ClickaverificationimageintheImageListwindow,andthenclickOpentoopenthe
Imagewindow.
2. Click
untilyoucanclearlyseethegraticuleorBBontheimage.
3. Click
,andthenclickalargeBBontheimageanddragthemouseinastraightline
tothenextlargeBB.SeeFigure45.
Figure 45: Straight Line Drawn with Ruler Tool – Imported Data Shown
InFigure45,themeasurementisforSID.ThistellsyouthatthepixelsizetypeisSID,
andthattheimagewasimportedwithaspecifiedpixelsize.
4. Right‐clickorpressF4,andthenclickMeasurementstoopentheImage
Measurementsdialogbox.
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IfapixelsizeisaddedforSADorSID,theimagewasimportedwithaspecifiedpixel
size.
5. Click
inthePlanefieldoftheCalibrationgroup,andthenclickSAD.
6. ClickthecheckboxneartheDistancefield.
7. Double‐clickintheDistancefield,typetheknownSADforthetreatmentmachine
fromwhichtheimageoriginated,andthenpressTAB.
8. ClickApplytoapplythedistanceforSADincentimeters.
9. ClickthecheckboxneartheRulerLengthfield.
10. Double‐clickintheRulerLengthfield,typetheactualrulerlengthfortherulerline
youdrewforaSADof100cmandBBsthatare1cmapart,andthenpressTAB.
11. ClickApplytoapplytheactualrulerlengthfortherulerlineyoudrewforaSADof100
cmandBBsthatare1cmapart.
12. ClickOKtoaddthescalingdatainthesystem,andthenclosetheImage
13. ClickOKtosavethescalingdata,andthenclosetheImagewindow.
Adding Scaling Data for Verification Images Imported with No Scaling Data
1. IntheImageListwindow,double‐clickaverificationimagethatdoesnothavescaling
data.Youcanalsoclicktheimage,andthenclickOpen.
2. IntheImagewindow,click
image.
untilyoucanclearlyseethegraticuleorBBonthe
3. Click
,andthenclickalargeBBontheimageanddragthemouseinastraightline
tothenextlargeBB.
Whentherearenotickmarksandrulerlengthshownforarulerline,theimagewas
notimportedwithaspecifiedpixelsize.SeeFigure46.
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Figure 46: Straight Line Drawn with Ruler Tool – No Imported Data
4. Right‐clickorpressF4,andthenclickMeasurementstoopentheImage
5. Click
inthePlanefieldoftheCalibrationgroup,andthenclickSAD.
6. ClickthecheckboxneartheDistancefieldtomaketheDistancefieldfortheSAD
planeactive.
7. Double‐clickintheDistancefield,type100,whichistypicallytheknownSADforthe
treatmentmachinefromwhichtheimageoriginated,andthenpressTAB.
8. ClickthecheckboxneartheRulerLengthfield.
9. Double‐clickintheRulerLengthfield,type10,whichistheactualrulerlengthforthe
rulerlineyoudrewforaSADof100cmandBBsthatare1cmapart,andthenpress
TAB.
10. ClickApplytoapplythedistanceforSADincentimetersandtheactualrulerlengthfor
therulerlineyoudrewforaSADof100cmandBBsthatare1cmapart.
11. ClickOKtoaddthescalingdatainthesystem,andthenclosetheImage
12. ClickOKtosavethescalingdata,andthenclosetheImagewindow.
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Print Scaling
1. IntheImageListwindow,double‐clickanimagetoprint.Youcanalsoclicktheimage,
andthenclickOpen.
2. IntheImagewindow,clickPrint,orright‐clickorpressF4,andthenclickPrint.
3. VerifythattheFittoImageBoxoptionbuttonisselectedtoscaletheimagetofititin
theimagevieweroftheStandardPrintdialogbox.
4. ClicktheScale % optionbuttontoaddthepercentagewithwhichtoenlargeor
reducetheimageforprinting.
5. Double‐clickintheScale%field,typethepercentagewithwhichtoenlargeorreduce
theimageforprinting,andthenpressTAB,orclick untilthevalueappearsinthe
field.
6. ClicktheSADoptionbuttontoscaletheimagebasedontheSADvalue.
7. ClicktheSIDoptionbuttontoscaletheimagebasedontheSIDvalue.
8. ClicktheCustomSIDoptionbuttontoaddorchangetheSIDvalueforprintingonly.
9. Double‐clickintheCustomSIDfield,typetheSIDvalue,andthenpressTAB,orclick
untilthedesiredvalueappearsinthefield.
Printing Medical Images
YoucanprintmedicalimagesonastandardoraDICOM DigitalImagingand
CommunicationsinMedicine printer.Werecommendthatyouconfigureyoursystemto
printtoastandardprinterbydefault.IfyourfacilitypurchasedtheDICOMoption,an
ElektainstalleroryoursystemadministratorsetsuptheDICOMprintoption.Whenthey
doso,theyalsoinstalltheMergeapplicationandgiveyouImage|DICOM|DICOM
Configuration|Modifysecurityrights.Youcanusethesameprintinterfaceforpaperand
filmprintwiththeStandardorDICOMprintoption.
Before you print, you must add accurate scaling information for the image.
CAUTION
See Scaling Medical Images on page 185.
To print images, you must have Administrative | General | Modify security
rights.
To view and work with images, you must have Image | ViewStation | Image
Information | View and Image | ViewStation | Images | View and Modify
security rights.
To print images on a DICOM printer, you must have Image | DICOM | DICOM
Configuration | Modify security rights.
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Setting Up DICOM Print Options and Printing
1. IntheImageListwindow,clickPrinttoopentheStandardPrintdialogbox.
2. ClicktheDicomPrintoptionbuttontoopentheDICOMPrintdialogbox.
3. IntheImageIDgroupoftheStandardPrintdialogbox,verifythatthePatientName
checkboxisselectedtohavethepatientnameprintedontheimage.
4. VerifythatthePatientMedRec#checkboxisselectedtohavethepatientmedical
recordnumberprintedontheimage.
5. VerifythatthecorrectDICOMprinterisselectedintheFormatgroup.Ifyoumust
changetheprinter,click ,andthenselectthenameoftheprinter.
6. Click adjacenttotheTypefieldintheMediagroup,andthenclicktheprinting
medium.
7. Click adjacenttothePriorityfieldintheSessiongroup,andthenclickthepriority
ofprintingthisimageifthereareprintjobsinthequeue.
8. Verifyorchangeifnecessarythenumberofcopiestoprintofthisimagetypedinthe
NumberofCopiesfield.
9. ClickStatusintheFilmPrintergrouptoshowthestatusoftheprinterinbluetext.
10. ClickPrint.
Setting Up Standard Print Options and Printing
1. IntheImageIDgroupoftheStandardPrintdialogbox,verifythatthePatientName
checkboxisselectedtohavethepatientnameprintedontheimage.
2. VerifythatthePatientMedRec#checkboxisselectedtohavethepatientmedical
recordnumberprintedontheimage.
3. InthePrintOverlaygroup,clicktheWhiteoptionbuttonsothetreatmentgeometry
andotherdataisnotoverlaidontheimagetoprintincolor ifyouprinttoacolor
printer .
4. ClickPrintSetupverifythatthecorrectprinterandprintingpropertiesareselected.
5. ClickPrint.
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Viewing and Enhancing 2D Images
TheImagewindowhastoolsthatletyouenhanceandchangethedisplayofimages.
To apply basic image viewing options, you must have Image | ViewStation |
Basics | Enable security rights.
To view and change images, you must have Image | ViewStation | Images |
View and Modify security rights and Image | ViewStation | Image
Information | View and Modify security rights.
To save and print images, you must have Administrative | General | Modify
security rights.
To copy and remove images, you must have Image | ViewStation and
Maintenance | Copy/Move Images | Enable and Delete Images | Enable
security rights.
Magnifying Images with the Zoom Tools
1. Openthechartforthepatient.
3. Double‐clicktheimage,orclicktheimage,andthenclickOpentoopentheimagein
theImagewindow.
4. Inthetoolbox,click
tozoominontheimage.
ThezoomtoolsandzoomfactorappearatthetopoftheImagewindow.
You cannot change the zoom factor field.
5. Click
twicetozoomoutontheimage.
100% identifies a 1:1 mapping of image pixels to monitor pixels. When the
zoom ratio is reduced below 100%, a single monitor pixel shows multiple
image pixels that have been combined by re-sampling.
twotimes.
7. TousetheSlidingZoom,left‐clickontheimage,andthendragthemouseleftorright
tomakeitactive.Dragthemagnifyingglasstothelefttodecreasethezoomfactoror
magnification,dragtotherighttoincreaseit.
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Whenactive,thecursorchangesfromanarrowtoamagnifyingglass.Youcanmake
theSlidingZoomactiveiftheSelecttoolisselectedandnoannotationsareselected.
8. ClickCancel,andthendouble‐clickthesameimagetoresettheimagemagnificationto
theoriginalsettingsifyoucannotremembertheoriginalzoomfactor.
Changing Image Color
2. Click
tochangetheimagetinttogreen.
torestoretheimagetograyscale.
Inverting the Image Contrast Scale
1. Click
toreversetheimageintensitymap.Thisbasicallyreversesthecolors.
If you reverse the image intensity map, this changes the image from positive
to negative and vice versa. It is as if you looked at a photograph and then its
negative.
2. Click
torestoreimageintensitymaptoitsoriginalconfiguration.
Using the Window and Level Tool
Youcanalsomanuallychangethecontrast window andbrightness level ofanimage
withtheWindowandLeveltool.Changestoimagewindowandleveldonotchangethe
imagepixeldata,justhowthedataappears.
1. Positionyourmousepointerovertheredbaronthelefttochangethemousepointer
to .
2. Clickanddragtheredbarslowlyallthewaytothelefttolengthentheimagecontrast.
Thisaddsdarkershadesofgrey,butkeepsthebrightestpixelsconstant. 3. Clickanddragtheredbarontherightsideofthetoolslowlytothefarrightto
lengthentheimagecontrastagain. Thisaddsbrightershadesofgrey. 4. Clickanddrageachoftheredbarsbacktotheiroriginalpositiontoshortenthe
contrast. Thisshowsfewershadesofgrey. 5. Clickanddragtheyellowbarslowlyallthewaytotherighttochangethewindow
center. Thisincreasesthebrightness. 6. Clickanddragtheyellowbarslowlyallthewaytothelefttochangethewindow
center. Thisdecreasesthebrightness. 7. Experimentwiththebrightnessandcontrastcontrolstogetthenecessarycontrastor
detail.
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Using Filters
1. Click adjacenttotheFilterfield.
2. ClickSharpentoapplythesharpenfilterandidentifytheedgesoftheimage.
3. Click adjacenttotheFilterfield,andthenclickReduceNoisetoremovenoiseinthe
image.
4. Click adjacenttotheFilterfield,andclickPeakHOtoapplythePeakHistogram
Optimizationfilter.
5. Click adjacenttotheFilterfield,andclickCLAHEtoapplytheContrastLimited
AdaptiveHistogramEqualizationfilter.
6. Click adjacenttotheFilterfield,andclickAHEtoapplytheAdaptiveHistogram
Equalizationfilter.
7. Click adjacenttotheFilterfield,andclickDisplayEqualizationtoapplytheDisplay
Equalizationfilter.
Morefieldsappear.Youcanselectthelevelofdisplayequalization CoarseorFine
adjacenttotheFilterfield .YoucanalsousetheFieldDetectcheckboxwithDisplay
Equalizationtoexcludepixelsoutsidetheexposedregionfromtheequalization
algorithm.
8. Click adjacenttotheFilterfield,andclickShadowFiltertoapplytheShadowfilter.
Theimageappears3‐Dembossedandtheimageshiftsinthewindowasthefilteris
applied andremoved .
9. Click adjacenttotheFilterfield,andthenclickNonetoremovetheappliedfilters.
10. ClickOKtosaveyourchanges,orclickCanceltoclosetheImagewindowwithout
savingthechanges.
Using Manual Save
TheManualSaveoptionintheImagewindowletsyousavethepanandzoomsettingsfor
animage.ItcanalsosaveyourWindow/Levelsettings,butonlyifyouhavenotchanged
theFilterfortheimage.YoucanuseManualSavebeforeandafterfinalreview.Youcannot
cancelorundothisoption,butyoucanmakedifferentchangesandsaveagain.
1. Pantheimagetotheanatomyofinterest.
2. Setthezoomfortheimage.SeeMagnifyingImageswiththeZoomToolsonpage191
formoreinformationonzooming/magnificationofanimage.
3. SettheWindow/Levelsettings,ifnecessary.SeeUsingtheWindowandLevelToolon
page192formoreinformationontheWindow/Levelcontrol.
4. Right‐clickorpressF4,andthenclickManualSave.
YoudonothavetoclickOKtosaveyourpreferences.
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Using Image Controls for Multi-Slice Images
Whenyouviewandenhanceimagesthathavemultipleslices calledmulti‐sliceimages ,
morewindowandlevelanddisplaycontrolsareavailable.SeeFigure47.
Figure 47: Image Controls for Multi-Slice Images
TheApplytoW/Ltoallcheckboxisselected.Whenthecheckboxisselected,theimage
sliceshavethesamecontrast window andbrightness level .Clearthischeckboxto
changethewindowandlevelingfortheimagesliceshownonly.
1. IntheImageListwindow,double‐clickamulti‐sliceimage.
2. ClicktheApplyW/Ltoallcheckboxtoclearit.
3. ClickanddragtherightredbaroftheWindowandLeveltoolslowlytothefarrightto
lengthenthegrayscaleandbrightenthecenteroftheimageforthesliceshownonly.
4. Clickanddragtheyellowbartoattainthedesiredbrightnessordetailtochangethe
brightnessinthewindowcenter.
5. Click inthesliceseriesdisplaycontrolstoshowthenextsliceinthesequence.
194
6. Click
toautomaticallystartshowingtheslicesinthesequence.
7. Click
toincreasethespeedofthedisplaysequence.
8. Click
todecreasethespeedofdisplaysequence.
9. Click
tostoptheautomaticdisplay.
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Annotating Images
Youcanaddannotationstoimagestocommunicateinstructionsorotherinformation.For
annotatedimages,theimageviewerintheImagewindowshowstwolayers:

ImageLayer–containstheactualimage.

ObjectLayer–containsobjectsthatyouaddtoanimage,suchasrulers,lines,
rectangles,andtext.
When you change the brightness and contrast, the change applies to the image
layer of the image. When you add objects to the image, the change applies to the
object layer.
TheToolboxalsogivesyoutoolsthatyoucanusetodrawshapesandlines,andtypetext
onyourimage.
Using the Straight Line Tool
1. IntheToolbox,click
toselectthestraightlinetool.
2. Dragthemousepointeracrosstheimagetoaddastraightline.
3. Tochangethesizeorangleyourline,click
intheToolbox,andthenclicktheline
youaddedtoselectthelineobjectandshowthesizinghandles thesmallboxesat
eachendoftheline .
4. Positionthemousepointerononeofthesizinghandles,andthenclickanddragthe
sizinghandletochangethelengthorangleoftheline.
5. Tomovethelinetoanotherlocation,click
dragthelinetothedesiredlocation.
6. Toremovetheline,click
,clickonthelinetoselectit,andthen
,clickonthelinetoselectit,andthenpressDELETE.
Using the Rectangle Tool
toturnontherectangletool.
2. Dragthemousepointeracrossanddowntothedesiredsizeofyourrectangle.
3. Toremovetherectangle,click
,clicktherectangle,andthenpressDELETE.
4. Tochangethesizeoftherectangle,click
toselecttheselectiontool.
5. Placethemousepointerononeofthesizinghandlesoftherectangle,andthendrag
thesizinghandletothedesiredsizeoftherectangle.
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Using Ellipse Tool
toselecttheellipsetool.
2. Dragthemousepointerdownandtotherighttodrawthedesiredsizeofyourovalor
circle.
3. Toremovetheovalorcircle,click
,clicktheobject,andthenpressDELETE.
4. Tochangethesizeoftheovalorcircle,click
toselecttheselectiontool.
5. Placethemousepointerononeofthesizinghandlesoftheobject,andthendragthe
sizinghandletothedesiredsize.
Using the Polygon Tool
Youcanalsochangethelabeland/ordescriptionofyourannotationsintheImage
windowafteryouaddthemwiththePolygontool.SeeAddingorChangingtheLabelofan
Annotationonpage200formoreinformation.
toselectthepolygontool.
2. Identifyashapeintheimagewithatleastsixsides.
3. Selectapointontheedgeoftheshapewiththemousepointer,andthenclicktheleft
mousebuttontoanchorthefirstpointofthepolygon.
4. Movethemousepointertoanotherpointontheedgeoftheshape,andthenclickthe
leftmousebuttontoanchorthesecondpoint.
5. Continuetodrawthesidestothepolygon clickateachpoint .
You can add as many points to a polygon as necessary to add a shape.
6. Whenyouaddthelastside,clickthefirstpointyouaddedinthepolygonorpress
SPACEBARtoclosethepolygon.
To keep a polygon open, press END rather than adding the last side.
.
8. Tochangetheshapeofthepolygon,positionthemousepointeronasizinghandlein
thepolygon,andthendragthesizinghandleawayfromtheotherpointsinthe
polygon.
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9. Movethepointsofthepolygontoseehowitchangestheshapeandsizeoftheobject.
10. Returnthepolygontoitsapproximateoriginalshapeandsize.
11. Toremovethepolygon,click
,clicktheobject,andthenpressDELETE.
Using the Freehand Drawing Tool
Youcanalsochangethelabeland/ordescriptionofyourannotationsintheImage
windowafteryouaddthemwiththeFreehandDrawingtool.SeeAddingorChangingthe
LabelofanAnnotationonpage200formoreinformation.
.
2. Identifyashapeintheimage,andthendragthemousepointeraroundtheoutlineof
theshape.Endtheshapeatthestartingpoint.Beforeyoureleasethemouse,pressthe
SPACEBARtoclosethefreehandshape.
You must press the SPACE BAR before you release the mouse button to close
the freehand object. If you do not, you cannot fill the object with a pattern.
Using the Text Tool
toselectthetexttool.
2. Clicktheleftmousebuttoninthelocationontheimagewhereyouwilltypethe
information.
3. Typetheinformation,suchasMove0.5cm.
toopentheAnnotationSettingsdialogbox.
5. Click inthefirstdroplistintheFontgroup,andthenclickafonttype,suchas
TimesNewRoman.
6. Click
12.
intheseconddroplistintheFontgroup,andthenclickafontsize,suchas
7. ClicktheSelectedoptionbuttonintheBold,Italic,and/orUnderlinefieldsoftheText
Stylegrouptoapplyatextstyle.
8. ClickacolorsquareintheColorgrouptoapplythedesiredcolorforthetext.
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Using the Arrow Tool
toaddanarrowthatpointsthetexttoaspecifiedobject.
2. Dragthemousepointerfromthetexttotheobject.
Using the Fill and Color Options
YoucanenhanceobjectswiththefillandcoloroptionsintheAnnotationSettingsdialog
box.TheoptionsareshowninFigure48.
Figure 48: Fill and Color Options in the Annotation Settings Dialog Box
1. Makesuretheselectiontool,click
object.
,isturnedon,andthenclicktheedgeofan
3. Inthepatternbar,click
object.
,andthenclickOKtoaddafinedottedpatterntothe
4. Drawarectangle,andthenclick
.
5. Clicktheedgeoftherectangletoselectit,andthenclick
6. InthePatterngroup,click
rectangle.
,andthenclickOKtoaddafinehatchpatterntothe
7. Drawacircleinsidetherectangle,click
selectit.
8. Click
.
,andthenclicktheedgeofthecircleto
9. Inthepatternbar,click
,andthenclickOKtoaddacutoutholethroughthe
rectangle,sothattheimageappearsintheperimeteroftheselectedobject.
To add a cutout hole, the object used to add the hole must be on top of the
other object. That is, you must add it after the first object. If it was not,
change the positioning. Right-click or press F4, and then click Bring to Front
or Send to Back commands. See Changing Relative Object Position on page
200.
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10. Clicktheedgeofanotherobject,andthenclick
dialogbox.
11. InthePatterngroup,click
object.
toopentheAnnotationSettings
,andthenclickOKtoaddacoarsedottedpatterntothe
12. Clicktheedgeofanotherobject,andthenclick
dialogbox.
inthepatternbar,andthenclickOK
13. ClickacolorsquareintheColorgroup,click
toapplyadifferentcolorandastripedpattern.
14. Clicktheedgeofafilledobject,andthenclick
dialogbox.
15. Click
inthepatternbar,andthenclickOKtoremovethepatternfromtheobject.
Setting and Saving Annotation Preferences
YouusetheAnnotationSettingsdialogboxtoapplytextattributes,objectpatterns,and
color.Tosetdefaultsforalloftheseattributes,clickthedesiredstylesintheAnnotations
Settingsdialogboxbeforeyouselectanobject.Afteryousetthedefaults,subsequenttext
objectsareautomaticallyassignedthedefaultstyles.Youcanalsoreverttotheoriginal
defaultannotationsettingsinMOSAIQ.
Figure 49: Annotation Settings Dialog Box
2. IntheColorgroup,clickacolor,andthenclickapattern,suchas
bar.
,inthepattern
3. IntheFontgroup,click inthefirstdrop‐downlist;clickthefonttouse,click
theseconddroplist,andthenclickfontsizetoapply.
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4. IntheTextStylegroup,clicktheSelectedorDeselectedoptionbuttonsforBold,Italic,
andUnderlinetospecifytextstyles.
5. ClickOKtosaveyoursettingsandclosetheAnnotationSettingsdialogbox.
6. Drawanobjectontheimagetoseeallofyoursettingsapplied.
,andthenclickResettochangetheannotationsettingsbacktothedefault
7. Click
settingsinMOSAIQ.
ThesearetheoriginalsettingsselectedwhenMOSAIQwasinstalled,notthesettings
configuredintheAnnotationSettingsdialogbox.
8. ClickOKtosavethedefaultsettings,andthenclosetheAnnotationSettingsdialog
box.
Adding Comments for Informal Communications
1. ClickinafreeareaoftheCommentfield.
2. Typeyourinformalnote,suchasBlocksshouldbecutfromshapesindicatedonthe
image.
3. ClickOKintheImagewindowtosavethecomment.
The Comment field is designed for informal notes and is not part of the
CAUTION
clinical record. You cannot lock the notes typed in this field.
Changing Relative Object Position
1. Clicktheedgeofanobjectthatisinsideanotherobject,suchasacircleinsidea
rectangle.
2. Right‐clickorpressF4,andthenclickSendtoBacktosendtheobjecttotheback.
3. Right‐clickorpressF4,andthenclickBringtoFronttobringtheobjecttothefront.
Adding or Changing the Label of an Annotation
YoucanaddorchangelabelstoannotationsthatyouaddedwiththeFreehandDrawingor
Polygontool.Ifyoudonotaddalabel,theannotationhasthedefaultlabelof“No
DescriptionAvailable”.Youcanalsochangethelabelordescriptionofimported
annotations.
1. OpenanimagewithMOSAIQfreehandorpolygonannotationsoraddannotations.
2. Right‐clickorpressF4,thenclickCurveExporttoopentheAnnotationstoCurve
Exportdialogbox.
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Dual-byte characters are not DICOM compliant. Label and Description fields
only accept single-byte characters.
3. SelecttheimportedorMOSAIQannotationtoaddorchangealabel.
4. ClickEditLabel.
5. TypethenewlabelintheLabelcolumn.
6. Dosteps3‐5againasnecessary.
7. SelecttheimportedorMOSAIQannotationtoaddorchangethedescription.
8. ClickEditDescription.
9. TypethenewdescriptionintheDescriptioncolumn.
10. Dosteps7‐9againasnecessary.
11. Tolabelanannotationasafieldaperture,selecttheannotation.
12. ClickMarkAperture.
13. Dosteps11and12againasnecessary.
14. ClickOKtoclosetheAnnotationstoCurveExportdialogbox.
Saving Annotated Images
WhenyouhavecompletedannotatingtheimageintheImagewindow,clickOK.
CAUTION
If you click Cancel or
in the title bar of the Image window, your changes
in the Image window are not saved.
Working with Multiple Annotations at a Time
1. Right‐clickorpressF4,andthenclickSelectAllAnnotations.
2. Clickoneoftheobjectsandcontinuetopressthemousebutton,andthendragthe
objectstothedesiredlocationintheimageviewer.
3. Click
4. Changethecolor,pattern,font,andtextstyleasnecessary,andthenclickOKtoapply
thenewsettingstoalloftheselectedobjects.
5. Clickintheimageviewertode‐selecttheobjects.
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6. Right‐clickorpressF4,andthenclickDeleteAlltoremovealloftheannotationsinthe
imagevieweroftheImagewindow.
7. ClickCancelor
toclosetheImagewindowwithoutsavingthechanges.
8. OpenthesameimageagainfromtheImageListwindow.
9. Clickoneoftheobjects,pressandholdtheSHIFTorCTRLkey,andthenclicktextora
differentobjecttoselecttwoobjects.
You can press and hold the SHIFT or CTRL keys, and then click as many
objects as necessary.
10. PressDELETEtoremovetheselectedannotations.
11. ClickOKtosaveyourchanges,orclickCanceltoclosetheImagewindowwithout
savingthechanges.
Viewing Layers
1. Openanimagethatisassociatedwithatreatmentfieldandhasannotationsinthe
Imagewindow.
2. Right‐clickorpressF4,pointtoPreferences,andthenclickViewAnnotationstohide
theannotationsandshowonlytheimageintheimageviewer.
3. ClicktheAnnotationscheckboxtoshowtheobjectandimagelayersatthesametime
again.
Changing the Orientation of Images
1. OpenanimagewithannotationfromtheImageListwindow.
2. Right‐clickorpressF4,andthenpointtoImageOrientation.
3. ClickFlipHorizontallyintheImageOrientationsub‐menu.
Amessageappears.Ittellsyouthattheannotationsandscalinginformationwillbe
lost.
4. ClickYesinthemessagetofliptheimageintheImagewindow.
5. Right‐clickorpressF4,pointtoImageOrientation,andthenclickRestoreOrientation.
Thischangestheimagetoitsoriginalposition,butdoesnotrestoretheannotations
andscalinginformation.
6. ClickOK.
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Working with Images Annotated Outside of MOSAIQ
YoucanimportimagesthatalreadyhaveannotationsintoMOSAIQ.IntheImagewindow,
youcanviewandhidetheimportedannotationsanddescriptivelabels,andaddnew
annotationstotheimage.
In MOSAIQ, DICOM curves are synonymous with imported annotations. DICOM
curves have two parts: a curve or line and a label.
1. IntheImageListwindow,double‐clickanimagethathasimportedannotationsandis
associatedwithatreatmentfield.
You cannot change or remove imported annotations.
2. ClicktheImportedAnnotationscheckboxtohidetheimportedannotations.
The Imported Annotations check box appears under these conditions:

The image has imported annotations.

The image is not reoriented.

The Imported Annotations check box appears but is grayed out
when you reticle scale the image.
3. ClicktheImportedAnnotationscheckboxagaintoshowtheimportedannotations
again.
4. Right‐clickorpressF4,andthenpointtoPreferences.
5. ClickViewAnnotationLabelstoshowdescriptivelabelsfortheimportedannotations
ontheimage.
You can add annotations to images with imported annotations.
6. ClickOKtosavethechanges,andthenclosestheImagewindow.
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Using Edge Detection Options in MOSAIQ
MOSAIQViewStationhasanautomaticedgedetectionfunction.Italsohasoptionsthatlet
youmanuallyaddafieldedgepolygoniftheautomaticedgedetectionfunctiondoesnot
giveyouthedesiredresults.YoucanuseautomaticEdgedetectiontocorrecttreatment
fieldedgeextractiondoneonimportofPortalVisionimages.Youcanalsouseitto
establishverificationimagescaleandbeamcenterinimageregistration.
The Tx Field Image option is only available for these conditions:

The image is part of the treatment history of the selected patient.

The portal image can be changed.

The source of the portal image is Varian Portal Vision v5.x or 6.x.

The image is associated with a treatment field.

The image does not have a locked field edge.

The image has not been approved, voided, or rejected.

The image is not in VS Format.

The Shadow filter has not been applied to the image.
The Tx Field Edge Extraction option is only available when the conditions above
and also those that follow occur:

The image is identified as a treatment field image.

The AHE filter has not been applied to the image.
Extracting Treatment Field Edges
2. Double‐clickaportalimagethatisassociatedwithatreatmentfield.
3. Right‐clickorpressF4,andthenclickLockTxFieldEdgetounlockthetreatment
edge.
4. Right‐clickorpressF4,andthenclickTxFieldImagetoidentifytheverificationimage
asatreatmentfieldimage.
5. Right‐clickorpressF4,andthenclickTxFieldEdgeExtractiontoshowtheextracted
treatmentfieldedgeontheimage.
6. ClickanddragthecenterbarontheWindowandLeveltooluntilyougettheoptimal
viewoftheextractededges.
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7. Clickontheextractededgetoselecttheedge.
8. Clickoneofthesizinghandles,andthendragtheextractededgetoadjustitas
necessary.
Copying and Pasting Treatment Field Edges on Multi-Slice Images
(Portal Vision Only)
You must verify that a pair of portal images consists of a matching open/shaped
port before you can copy a field edge from one image to a different one.
1. Openanopenfieldportalimagewithextractedfieldedges.
2. Onthefirstimagesliceoftheopenfieldportalimage,right‐clickorpressF4,andthen
clickCopyTxFieldEdge.
3. Click inthesliceseriesdisplaycontrols.
4. Right‐clickorpressF4,andthenclickPasteTxFieldEdge.
5. ClickOK.
Copying and Pasting Treatment Field Edges on a Separate Image
(Portal Vision Only)
1. Openanopenfieldportalimagewithextractedfieldedges.Thisiscalledthesource
image.
The image must be associated with a treatment field.
2. Right‐clickorpressF4,andthenclickCopyTxFieldEdge.
3. ClickanddragtheImagewindowwiththesourceimagetotheside,sothatyoucan
seetheImageListwindow.
Do not close the Image window for the source image. If you close the Image
window with the source image, you cannot paste the copied field edges.
4. IntheImageListwindow,double‐clicktheportalimageonwhichtopastethe
treatmentfieldedges.Thisiscalledthetargetimage.
5. Right‐clickorpressF4,andthenclickPasteTxFieldEdge.
6. ClickOKintheImagewindowforthetargetimage.
7. ClickOKintheImagewindowforthesourceimage.
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Managing the Image Review Process – Reviewers
WhenthefilmsareacquiredorimagesareimportedintoMOSAIQandthetherapistsor
dosimetristshavecompletedtheirtasks,theimagesarereadyfortheFinalreview.The
Finalreviewerisusually,butnotalways,theattendingphysician.
YoucandesignateastaffmemberasaFinal orOptional reviewerfromtheImagetabof
theSecuritydialogbox.
To act as a Final reviewer, you must have Image | ViewStation | Review
Images | Final security rights.
To act as an Optional reviewer, you must have Image | ViewStation | Review
Images | Optional security rights.
To view and change images, you must have Image | ViewStation | Images |
View and Modify security rights and Image | ViewStation | Image Information
| View and Modify security rights.
rights.
security rights.
IfyouselectedtheQuickApprovalcheckboxwhenyouloggedon,theReviewApproval
dialogboxdoesnotappearwhenyouapproveanimage.Ifselected,yournameappearsin
theFinalorOptionalfieldwitha“ ”infrontofittoidentifythatQuickApprovalwas
selected.ClickApprovedtoautomaticallyapprovetheimage.TheQuickApprovaloption
doesnotapplyifyouclickRejectedorVoided.SeeUsingtheQuickApprovalFunctionon
page208formoreinformation.
Finding Images to Review in the Consolidated Work Lists Pane
1. LogontoMOSAIQwiththeusernameandpasswordofaFinalorOptionalreviewer.
2. Right‐clickintheConsolidatedWorkListspane,andthenclickOptionsandFilters.
3. ClicktheImagescheckboxontheleftifitisnotalreadyselected.
4. ClicktheImageslabeladjacenttothecheckbox.
5. ClicktheReviewcheckboxintheImagesRequiringReviewgroup.
PhysiciansmostoftenselecttheReviewfilter.TheReviewfilterlimitsthepatientlist
generatedtothosepatientswithimagesthatrequirereviewsonly. Therapistsand
dosimetristsmostoftenusetheAnyChangefilters.
6. Toseealistofimagesfromaspecifiedtimeperiod,click
Rangefield.Then,selectoneoftheoptions.
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7. Optional.Toseealistofimagesforspecificphysicians,click
field.Then,selecttheapplicableoption.
adjacenttotheMD

YournameifyouareanAttendingphysicianreviewingtheimagesofyour
patients.

ThenameofanAttendingphysicianwhoseimagesyouneedtoreview.

OthertofindpatientswithoutanAttendingphysicianidentifiedinthePatient
Demographicsworkspace.
Keepalloptionsclearedtoshowimagesforallphysicians.
Optional reviewers must select the name of the physician whose patient
images they must review.
8. Optional.Toseealistofimagesbytreatmentmachine,click adjacenttothe
Machinefield.Then,clicktheapplicabletreatmentmachine s .
Keepalloptionsclearedtoshowimagesfromalltreatmentmachines.
9. Optional.Toseealistofimagesbydepartment,click
field.Then,clicktheapplicabledepartment s .
adjacenttotheDepartment
Keepalloptionsclearedtoshowimagesforalldepartments.
10. Optional.ToseealistofimagesbyOptionalreviewstatus,click
OptionalReviewfield.Then,clicktheapplicableoption.
adjacenttothe
KeepalloptionsclearedtoshowimagesforallOptionalReviewstatuses.
Table 28: Optional Review Status
Status
Description
Any Status
Toselectallstatusoptions.
Not Reviewed
ToincludepatientimagesthattheOptionalreviewerdidnot
review.
Reviewed
ToincludepatientimagesthatthattheOptionalreviewer
approvedorrejected.
Approved
ToincludeonlyimagesthattheOptionalreviewerapproved.
Final reviewers can use this search filter to examine the changes the Optional
reviewer made to the review status.
11. Optional.Toseealistofimageswithspecifiedimagetypes,click
ImageClassfield.Then,clicktheapplicableimagetype s .
adjacenttothe
Keepalloptionsclearedtoshowimagesforallimagetypes.
12. ClickOK.
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13. ClicktheImagestaboftheWorkListspanetoseetheimagestoreview.
Finding Images to Review from the Image List Window
YoucanalsousethesamefilteringcriteriaintheImagespanetofindimagestoreviewfor
theglobalpatient.
1. IntheImageListwindow,clicktheFilterbuttontoopentheImageFilterdialogbox.
2. ClicktheMedicalcheckboxifnecessary.
3. ClicktheNotReviewedcheckbox.
4. MakesureallothercheckboxesintheTypegrouparecleared.
5. RefertoSteps6–11inFindingImagesthatRequireReviewintheConsolidatedWork
ListsPanetosetthefilteringcriteria.
6. ClickOK.
Reviewing 2D Images from the Consolidated Work Lists Pane
1. ClickImagesintheConsolidatedWorkListspaneontheHomeworkspace.
2. Usethesearchfilterstogeneratethelistofpatientimagesyoumustreview.
RefertoFindingImagestoReviewfromtheConsolidatedWorkListsPaneonpage
206.
3. Click adjacenttoapatientnamethatappearsintheImagestaboftheWorkLists
pane.
Thisshowstheimagestoreviewfortheselectedpatient.
4. Clickthe2Dimagetoreview.
To review a 2D image pair, click the verification image.
5. IntheWorkListDetailpane,clickReviewtoopentheimage s intheImageReview
window.
In the Image Review window, you must click the image in the viewer to select
it before you can annotate or enhance the image.
6. Toshowthetreatmentgeometryontheimage:
208

ClicktheGeometrycheckboxintheViewgroupofthewindow.

Toshowagraticuleontheimage,right‐click,pointtoPreferences,andthen
clickViewGraticule.
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7. TorequestachangeintheChangestab,useoneoftheoptionsthatfollowunder
Requested:

Torequestafieldchange,clicktheFieldcheckbox.
Torequestablockchange,clicktheBlockcheckbox.
Toidentifythatanewimagemustbetakenafterthechangerequestiscompleted,click
theRe‐imagecheckbox.
Toidentifyachangeotherthanafield,block,orre‐imagechange,clicktheOthercheck
box.
8. Click
,andthentypeyourreviewcommentifnecessary.
CAUTION
Do not type important information about change requests in the
Comment field. If someone removes the information, it is no longer part
of the clinical record. The Comment field is designed for informal notes.
You cannot lock the notes added in this field.
To annotate or enhance images during your review, refer to Annotating
Images on page 195.
9. IntheReviewStatusgroup,clicktheFinaloptionbuttonifitisnotselected.Ifyouare
anOptionalreviewer,clickOptional.
The Final reviewer status supersedes the Optional reviewer status.
10. Ifyoudidnotlogonwithyourusernameandpassword,click inthedroplistbelow
theFinalandOptionaloptionbuttons,andthenclickyourname.
11. Ifyouaresatisfiedwiththeimage,clicktheApprovedoptionbutton.
Torejectanimage,refertoRejecting2DImagesonpage211.Tovoidanimage,refer
toVoiding2DImagesonpage212.
12. Clickadifferentimagetoreviewintheimageinformationtableinthelowerpaneof
theImageReviewwindow.
13. Dosteps4–11againuntilyouhavereviewedalloftheimagesforthepatient.
Review and select the review status for all of the patient images in the image
information list of the Image Review window. Then, click OK once when you
have completed your changes. This lets you save your review of all the images
at the same time.
14. ClickOK,whichopenstheReviewApprovaldialogbox.
YourusernameautomaticallyappearsintheNamefield.
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15. TypeyourpasswordinthePasswordfield,andthenclickOKtosavethereview
statusesandchangerequestsforalloftheimagesyoureviewed.
TheMOSAIQapplicationrecordsthedate/timeandinitialsofloggedinuser.
Reviewing 2D Images with Quick Approval
YoucanuseQuickApprovaltoapproveimagesintheImage,andImageReviewwindows
for2Dimages.Youcanalsousequickapprovalfor3DimagesintheImageReview
workspace.WithQuickApproval,youcanapproveanimage,butdonothavetotypein
yourusernameandpassword.TheQuickApprovalfunctiondoesnotapplyifyouclick
RejectedorVoided.Italsoappliesonlytotheloggedinuser.
Quick Approval is configured by Elekta. Contact your System Administrator if you
have any questions.
Configuring Quick Approval
1. LaunchMOSAIQ.
TheStaffLoginappears.
2. ClicktheQuickApprovalcheckbox.
3. LogontoMOSAIQ.
TheQuickApprovalcheckboxstaysselecteduntilyoudeselectit.
Using Quick Approval
1. IntheImageListwindow,clicktheverificationimage.
2. ClickReviewtoopentheImageReviewwindow.
3. ClicktheApprovedoptionbutton.
4. IntheReviewStatusgroup,clicktheFinaloptionbuttonifitisnotselected.Ifyouare
anOptionalreviewer,clickOptional.
TheFinalreviewerstatussupersedestheOptionalreviewerstatus.
5. ClickOKtoapprovetheimage.
Batch Reviewing 2D Images from the Image List Window
Toreviewasingle2Dimageorimagepair,dosteps1–5below,andthengotostep8.
1. Usethesearchfilterstogeneratethelistofpatientimagesyoumustreview.
RefertoFindingImagestoReviewfromtheImageListWindowonpage208.
2. Selectthe2Dimage.
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3. ClickReviewListtoopentheImageReviewwindow.
TheImageReviewwindowshowsall2Dimagesthatyoumustreviewfortheglobal
patientinalistundertheimageviewers.
4. ClickanimagetoreviewintheimageinformationtableinthelowerpaneoftheImage
Reviewwindow.
5. Dosteps6‐11inReviewing2DImagesfromtheConsolidatedWorkListsPaneon
page208.
6. Clickadifferentimagetoreviewintheimageinformationtableinthelowerpaneof
theImageReviewwindow.
7. Dosteps5and6inthistaskagainuntilyouhavereviewedalloftheimagesforthe
patient.
8. ClickOK,whichopenstheReviewApprovaldialogbox.Yourusernameautomatically
appearsintheNamefield.
9. TypeyourpasswordinthePasswordfield,andthenclickOKtosavethereview
statusesandchangerequestsforalloftheimagesyoureviewed.
Rejecting 2D Images
YoucannotuseQuickApprovalwhenyourejectanimage.
1. IntheImageListwindow,selectthe2Dimagetoreject.
2. ClickOpentoopentheimageintheImagewindow.
YoucanalsoclickReviewtorejecttheimagefromtheImageReviewwindow.
3. ClicktheRejectedoptionbutton.
4. TorequestachangeintheChangestab,useoneoftheoptionsthatfollowunder
Requested:

TorequestafieldchangeclicktheFieldcheckbox.

Torequestablockchange,clicktheBlockcheckbox.

Toidentifythatanewimagemustbetakenafterthechangerequestis
completed,clicktheRe‐imagecheckbox.

Toidentifyachangeotherthanafield,block,orre‐imagechange,clickthe
Othercheckbox.
5. Click
,andthentypeyourreviewcommentifnecessary.
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211
CAUTION
Do not type important information about change requests in the
Comment field. If someone removes the information, it is no longer part
of the clinical record. The Comment field is designed for informal notes.
You cannot lock the notes added in this field.
6. ClickOK,whichopenstheReviewApprovaldialogbox.Yourusernameautomatically
appearsintheNamefield.
7. TypeyourpasswordinthePasswordfield,andthenclickOKtorejecttheimage.
Voiding 2D Images
YoucanonlyvoidimagesthathaveastatusofApprovedorRejected.OnlyFinalReviewers
canvoidimages.YoucannotuseQuickApprovalwhenyouvoidimages.
1. IntheImageListwindow,selectthe2Dimagetovoid.
2. ClickOpentoopentheimageintheImagewindow.
YoucanalsoclickReviewtovoidtheimagefromtheImageReviewwindow.
3. ClicktheVoidcheckbox.
4. ClickOK,whichopenstheReviewApprovaldialogbox.
YourusernameautomaticallyappearsintheNamefield.
5. TypeyourpasswordinthePasswordfield,andthenclickOKtovoidtheimage.
Using Matched Presentation and Coordinated Mode
TheImageReviewwindowletsyouviewanimagepairwiththesameimagescale
MatchedPresentation iftheimageseachhaveadefinedpixelsize.Youcanalsoscroll
andchangethezoomfactorofeachimagepairatthesametimewiththeCoordinated
Modetool.
Matched Presentation
AMatchedPresentationoccursifeachimagehasadefinedpixelsizeatSADandhasa
definedisocenterthatMOSAIQalignsinbothviewers.Youcanviewtwoimagesin
MatchedPresentationwhen:
212

Thereferenceimage ontheleftside isopenedtoitssavedzoomedandpanned
position.Ifthereisnosavedzoom/panposition,theimageopenscenteredinthe
viewer.

Whenthereviewimage ontherightside isopened,itsdisplayischangedso
thattheanatomyintheimagematchesthesizeasthereferenceimage.Its
isocenterisalsoalignedtothesamepositioninthereferenceimage.
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
TheCoordinatedModetoolissettoONwhenthereferenceimagezoomandpan
canbematchedbetweenthetwoviewers.
MatchedPresentationisnotavailablewhen:

Eachimagehasadefinedpixelsizeandisocenter,butMOSAIQcannotpanthe
reviewimagesothattheimageisocentersarealigned.

OneormoreimagesdoNOThaveadefinedpixelsizeORoneormoreimagesdo
NOThaveadefinedisocenter.
WhenMatchedPresentationisnotavailable,imagesappearintheviewerswiththe
informationavailable:

Ifscalinginformationisavailableforeachimagebutoneimagedoesnothavean
isocenter,theimagesarezoomed,buttheimagewithoutanisocenterisonly
centeredintheviewer.

Iftheimagesdonothavescalingandisocenterinformation,theimagesopento
theiruser‐preferredviews ifavailable orcenteredintheviewer.
Coordinated Mode Tool
TousetheCoordinatedModetool,clicktheCoordinatedModeicontomakeitactive ON ornotactive OFF .
Table 29: Coordinated Mode Tool Icons
Icon
Coordinated Mode
Description
ON
Theimageszoomandpaninthesamemanner.Ifyou
zoomorpanoneimage,thezoom/panoftheotherimage
alsochanges.
OFF
Onlytheimageintheselectedviewzoomsandpans.The
imageintheotherviewerdoesnotchange.
WhenCoordinateModeisON,viewersaresubjecttotheircollectiveconstraints.For
example:

Ifyouzoomoneimagetothemaximumof400%,youcannotincreasethezoom
factoroftheotherimage.

Ifyoupanoneimagetotherightandreachitslimit,youcannotcontinuetopanto
therightintheotherimage.
Using the Coordinated Mode Tool
1. IntheImageReviewwindow,clickoneoftheimages,andthenmoveit.
IftheimagesareinMatchedPresentation,bothimagesmoveorpaninthesame
direction.
If you pan one image to the right and reach its limit, you cannot continue to
pan to the right in the other image.
2. Clickoneoftheimages,andthenchangethezoomfactor.
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IftheimagesareinMatchedPresentation,thezoomfactorofbothimageschanges.
If you zoom one image to the maximum of 400%, you cannot increase the
zoom factor of the other image.
3. ClicktheCoordinatedModeicontoturnitOFF.
Changesto
.
4. Clickoneoftheimages,andthenchangethepanorzoomfactor.
Thezoomorpanoftheotherimagedoesnotchange.
Viewing the Review Status in the Image Information Dialog Box
1. IntheImagewindow,right‐click,andthenclickImageInformationtoopentheImage
2. ClicktheReview/RequestStatustabtoviewthereviewstatusandchangerequestsfor
theimageintheImagewindow.
3. ClickCanceltoreturntotheImagewindow.
Managing the Image Change Order Process - Therapists
AftertheFinalreviewercompletesthereview,youcanlookattheImagestaboftheWork
Listspanetoseewhatpatientshaveimageswithchangerequests.Alternatively,youcan
lookattheImageListwindowforaspecifiedpatienttoseeifthepatienthasimageswith
changerequests.Youcanthenlookatandcompletetherequestedchanges.
To view and modify images, you must have Image | ViewStation | Images |
View and Modify security rights and Image | ViewStation | Image
Information | View and Modify security rights.
rights.
security rights.
To view the Treatment Delivery Table, you must have Clinical | Tx Delivery
Finding Change Requests from the Consolidated Work Lists Pane
1. LogontoMOSAIQwiththeusernameandpasswordofatherapist.
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3. ClicktheImagescheckboxontheleftifitisnotalreadyselected.
4. ClicktheImageslabeladjacenttothecheckbox.
5. CleartheReviewcheckboxintheImagesRequiringReviewgroupifnecessary.
6. Clicktheapplicablecheckboxoptions:
Table 30: Consolidated Work Lists Pane Check Box Descriptions
Check Box
Descriptions
Any Change
Showsallimageswithchangesrequests.
Block Change
Showsonlythosepatientswithimagesthatrequireblock
changesinthepatientlist.
Field Change
Showsonlythosepatientswithimagesthatrequirefield
changesinthepatientlist.
Re-image Change
Showsonlythosepatientswithimagesthatmustbetakenagain
inthepatientlist.
Other Change
Showsonlythosepatientswithimagesthatrequirechangesin
thepatientlist.
7. Toseealistofimagesfromaspecifiedtimeperiod,click
Rangefield.Then,selectoneoftheoptions.
adjacenttotheDate
8. Optional.Toseealistofimagesforspecificphysicians,click
field.Then,selecttheapplicableoption.
adjacenttotheMD

YournameifyouareanAttendingphysiciantoseealistofpatientimages
thatyoumustreview.

ThenameofeachAttendingphysicianwhosepatientimagesyoumust
review.

OthertofindpatientsthatdonothaveanAttendingphysicianselectedinthe
Demographicsworkspace.
Keepthefieldblanktoshowimagesforallphysicians.
9. Optional.Toseealistofimagesbytreatmentmachine,click adjacenttothe
Machinefield.Then,clicktheapplicabletreatmentmachine s .
Keepthefieldblanktoshowimagesfromalltreatmentmachines.
10 Optional.Toseealistofimagesbydepartment,click
field.Then,clicktheapplicabledepartment s .
adjacenttotheDepartment
Keepthefieldblanktoshowimagesforalldepartments.
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11. Optional.Toseealistofimageswithspecifiedimagetypes,click
ImageClassfield.Then,clicktheapplicableimagetype s .
adjacenttothe
Keepthefieldblanktoshowimagesofallimagetypes.
12. ClickOK.
13. ClicktheImagestaboftheWorkListspanetoseetheimagesthathavechange
requests.
Completing 2D Image Change Requests from the Consolidated Work
Lists Pane
TheinstructionsassumethatyouhaveloggedontoMOSAIQasatherapist.Italsoassumes
thatyouhaveconfiguredtheConsolidatedWorkListspanetoshowonlychangerequests
thatyoumustcomplete.RefertoFindingImageswithChangeRequestsfromthe
ConsolidatedWorkListsPaneformoreinformation.
2. ClickanimagewithchangerequestsintheWorkListspane.
3. ClickReviewintheWorkListsDetailpanetoopentheImageReviewwindow.
4. IntheChangestab,clickthecheckboxunderCompletedtoidentifythechange
requestasCompleted.
It is not necessary to clear the Re-image check box. When the new images are
imported by Namer, this check box automatically clears.
5
ClickOKtosaveyourchanges,andthenclosetheImageReviewwindow.
ThechangerequestshaveastatusofDone.MOSAIQrecordsthedate/timeandinitials
ofloggedinuser.
6. Dosteps2‐5againuntilyouhavecompletedallofthechangerequests.
7. ClickOKtosaveyourchanges,andthenclosetheImageReviewwindow.
ThechangerequestsnolongerappearintheImagestaboftheWorkListspane.
Completing 2D Image Change Requests from the Image Review
Window
TheinstructionsassumethatyouhaveloggedontoMOSAIQasatherapist.Elekta
recommendsthatyoulookforimageswithchangerequestsintheConsolidatedWork
Listspane.RefertoFindingImageswithChangeRequestsfromtheConsolidatedWork
ListsPaneonpage214
1. Openthepatientchart,andthenclickeChart|Images…toopentheImageList
window.
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2. Selecta2Dimagewithachangerequest,andthenclickReviewtoopentheImage
Reviewwindow.
3. ClickthecheckboxunderCompletedtoidentifythechangerequestasCompleted.
ItisnotnecessarytocleartheRe‐imagecheckbox.Whenthenewimagesare
importedbyNamer,thischeckboxautomaticallyclears.
4. Intheimageinformationtable,clickthenextimageforwhichyoumustcompletea
changerequest.
5. Dosteps3and4againuntilyouhavegivenallofthecompletedchangerequestsa
statusofCompleted.
6. ClickOKtosaveyourchanges,andthenclosetheImageReviewwindow.
ThechangerequestshaveastatusofDoneintheImageListwindow.TheMOSAIQ
applicationrecordsthedate/timeandinitialsofloggedinuser.
Completing 2D Image Change Requests from the Image Window
TheinstructionsassumethatyouhaveloggedontoMOSAIQasatherapist.Lookfor
imageswithchangerequestsintheConsolidatedWorkListspane.RefertoFindingImages
withChangeRequestsfromtheConsolidatedWorkListsPaneonpage214.
1. Openthepatientchart,andthenclickeChart|ImagestoopentheImageListwindow.
2. Selecta2Dimagewithachangerequest,andthenclickOpentoopentheImage
window.
3. IntheImagewindow,clickthecheckboxunderCompletedtoidentifythechange
requestasCompleted.
ItisnotnecessarytocleartheRe‐imagecheckbox.Whenthenewimagesare
importedbyNamer,thischeckboxautomaticallyclears.
4. ClickOKtosaveyourchanges,andthenclosetheImagewindow.
ThechangerequestshaveastatusofDoneintheImageListwindow.TheMOSAIQ
applicationrecordsthedate/timeandinitialsofloggedinuser.
5. IntheImageListwindow,double‐clickthenextimagewithachangerequest.
6. Dosteps3‐5againuntilyouhavegivenallofthecompletedchangerequestsastatus
ofCompleted.
Completing 2D Image Change Requests from the Verification Image
Status Window
1. ClickeChart|RadiotherapytoopentheTreatmentChartwindow.
You can also click the RO Treat icon to open the Treatment Chart window.
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2. ClickTreattoopentheTreatmentDeliveryTabledialogbox.
3. Right‐click,andclickViewImages…toopentheVerificationImageStatuswindow.
All the fields with images that require changes or reviews appear in this
window.
4. Clickthe2Dimagewithachangerequest,andthenclickReviewtoopentheImage
Reviewwindow.
5. ClickthecheckboxunderCompletedtoidentifythechangerequestasCompleted.
You can complete all of the change requests for the images shown in the
image information table of the Image Review window. Refer to Completing
2D Image Change Requests from the Consolidated Work Lists Pane on page
216.
6. ClickOKtoclosetheImageReviewwindow,andthenclickOKtoclosetheVerification
ImageStatuswindow.
MOSAIQrecordsthedate/timeandinitialsofloggedinuser.
7. ClickClosetwicetoclosetheTreatmentDeliveryTableandTreatmentChart.
If you are treating a field, when you click Select in the Treatment Delivery
Table, the Verification Image Status window opens if the field has associated
images that require changes or reviews, or has a Voided or Rejected review
status.
The system only issues the alert to open the Verification Image Status
window if the Verification Image Check is selected in the Department
Setup. Click File | System Utilities | Department Setup…, and then click
the Clinical (RO) tab to make sure that this check box is selected.
CAUTION
If the Verification Image Check is not selected, contact your system
administrator.
Planar Image Registration
ImageRegistrationistheprocessthatyouusetofuseaverification portal/treatment imagewithareference DRRorsimulator imagethencalculatepositionaloffsetsfor
patientpositioning.Theverification portal imageletsyoureviewcurrentbeamposition
relativetointendedpositionasshownonthereference DRRorsimulator image.Given
thetwoimageswiththeircorrespondingbeamisocenters,MOSAIQcomputesthe
translationalshiftsnecessarytoalignthepatienttomatchtheanatomyintheverification
imagewiththeanatomyinthereferenceimage.Thedifferencebetweenthebeam
isocentersoftheseimagesyieldsthecomputedpositionalshifts. Thecomputedpositional
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shiftsaretheshiftsnecessarytomovethepatientsothathe/sheisproperlyalignedwith
respecttotheplannedtreatmentsetup. In the registration process, make sure that the reference and treatment
images are in Beam’s Eye View coordinates. That is, the anatomy in the
images appears as if the gantry axis is perpendicular to the top of the image
viewer and the gantry stand is at the top of the window (gantry-up position).
Use applicable caution when you flip images to be used by the registration
CAUTION process. (If you flip an image, it does not have the same effect as if you
rotated the same image 180˚.) It is your responsibility to review calculated
shift direction and magnitude before you save images. Make modifications if
clinically necessary.
You must have Image | ViewStation | Image Information | Modify security
rights to register treatment images for planar (2D) shift analysis.
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Preparing the System and Patient for Image Registration
Make sure that your treatment machine gantry, collimator, SAD, and all
couch sections are properly characterized. Your Elekta installer typically
does this. The Image Registration process will not work properly if your
CAUTION machine is not properly characterized. Contact Elekta to assist you with
proper machine characterization.
Configuring the Setup Offset Reference
TheSetupOffsetReferencefieldintheDepartmentSetupletsyouselecttheoffset
referencetobeusedbyViewStation.Setupcorrectionsonimagesaredescribedinpatient
coordinates Ant/Post,Sup/Inf,R/L .
1. ClickFile|SystemUtilities|DepartmentSetup…,andthenclicktheClinical RO tab
intheDepartmentSetupdialogbox.
2. Click
adjacenttotheSetupOffsetReferencefield.
ShowsthetwoSetupOffsetReferenceoptions,asshowninFigure50.
Figure 50: Setup Offset Reference Options
Figure50showsthetwoSetupOffsetReferenceselections.Theseselectionsconfigure
MOSAIQtoshowsetupcorrectionsdirectionrelativetobeamparametersorpatient
anatomyshownintheimage.Thesettingsareoppositeofeachother.Ifyoumovethe
patientintheinferiordirection,theisocentermovesinthesuperiordirection.Ifyou
selectBeam,offsetsshowthedirectionthecurrentlydisplayedisocenter/aperture
mustmoveacrossthedisplayedanatomytoalignwiththeplannedtargetposition.If
youselectAnatomy,offsetsshowthedirectionthepatientmustmovebelowthe
immobilebeam.ThedefaultisBeam.
220

Beam thedirectionthecurrentbeamreferences jaw/isocenter mustbe
movedtoalignwiththetargetanatomy.

Anatomy thedirectiontargetanatomyshownintheimagemustbemovedto
alignwiththedisplayedbeamreferences.
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Figure 51: Setup Offset Reference Illustration
Figure52showsa0.5cmshift.IfyouconfiguredMOSAIQtorefertotheisocenter
beam directionofmovement,theoffsetisshownas0.5cminthesuperiordirection.
IfyouconfiguredMOSAIQtorefertothedirectionofpatient anatomy movement,
theoffsetisshownas0.5cmintheinferiordirection.Thisdocumentassumesthatyou
selectedBeam.
3. ClickBeamtoconfigureMOSAIQtoshowcorrectionsasthedirectionofisocenteror
beammotion.
Theoffsetis0.5cminthesuperiordirectionfortheBeamsetting.
Figure 52: Shift
4. ClickPatienttoconfigureMOSAIQtoshowcorrectionsasthedirectionofpatient
motion.
Theoffsetis0.5cmintheinferiordirectionforthissetting.
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Adding the Site Setup for the Prescription
MOSAIQusesthemachinecoordinatesfromthemachinecharacterizationandthepatient
orientationidentifiedintheSiteSetupDefinitionwindowforset‐upcorrectionsinpatient
coordinates.TheElektainstallersoryoursystemadministratorcharacterizesthe
machinesinMOSAIQ.YoumustaddthepatientorientationintheSiteSetupDefinition
windowifitisnotimportedwiththetreatmentplan.AsitesetupisnecessaryforImage
Registrationofallprescriptionsites.
1. ClickeChart|DiagnosesandInterventions…toopentheDiagnosesandInterventions
window.
2. ClicktheradiationprescriptionintheDiagnosesandInterventionswindow,andthen
clickSiteSetup.
3. MakesurethepatientorientationisimportedorselectthePatientOrientation.
Forsafetypurposes,thereisnodefaultpatientorientation.
BeforeyoucanuseImageRegistrationforsetupverificationimages,youmustaddthe
couchangleintheSiteSetupDefinitionwindow.
Withregardtothecouchangle,2DImageRegistrationisonlyavailableforcardinal
couchangles.Cardinalanglesare0°,90°,180°,and270°.
Adding the Couch Angle
1. IntheSiteSetupDefinitionwindow,typethecouchangleintheAnglefield.
Figure53showstheCouchSettingsgroupintheSiteSetupDefinition.
Figure 53: Couch Angle in the Site Setup Definition Window
2.ClickOKtosaveyourchange.
Configuring Gantry Angle and Couch Angle For Planar Registration
If your site has purchased and registered Setup Intelligence, you can also
register stereoscopic and 3D image sets.
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Configuring Treatment Field Definition Data
BeforeyoucanuseImageRegistrationfortreatmentfields,youmusttheassociatethe
imagetoatreatmentfield.
Withregardtothegantryorsourceangle,2DImageRegistrationisonlyavailablefor
imagesatcardinalangles.Cardinalanglesare0°,90°,180°,and270°.
Thecouchmustbeperpendiculartothegantry.Thisangleis0.0°or180°andis
dependentonyourmachinecharacterization.
Adding the Gantry and Couch Angles
1. ClickeChart|DiagnosesandInterventions…toopentheDiagnosesandInterventions.
2. Double‐clickthetreatmentfieldtoopentheTreatmentFieldDefinition.
3. TypethegantryangleintheGantryAnglefieldandthecouchangleintheAnglefield.
Figure54showstheGantry/CollimatorandCouchgroupsintheTreatmentField
Definition.
Figure 54: Gantry and Couch Angles in the Treatment Field Definition
4. ClickOKtosaveyourchange.
5. Dosteps2‐4foreachtreatmentorfieldusedforimagingonly.
Configuring Setup Verification Images
Withregardtosetupverificationimages,2DImageRegistrationisonlyavailablefor
imagesthatcontaincardinalgantryangles.Cardinalanglesare0°,90°,180°,and270°.
ThecouchanglemustbeconfiguredcorrectlyintheSiteSetupDefinition.
Using the Image Registration Editor
MOSAIQhasfourimageregistrationmethods:Point,Curve,Grayscale,andManual.
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
PointRegistrationappliestoimageswithGoldSeedorFiducialmarkerstoalign
theimages.


CurveRegistrationuseslinesandshapestoshowvisibleanatomy.
GrayscaleRegistrationusesaspecifiedregionofinterestwithdistinguishable
anatomyontheverificationimagetomatchagainstthereferenceimage.

Manualregistrationrequiresyoutoaligntheanatomyintheimages.
IftheverificationimageintheImageRegistrationwindowisasetupverificationimage,
onlyManualRegistrationisenabled.Point,CurveandGrayscaleregistrationmethodsare
disabled.
ForImageRegistration,youmustuseareferenceimagethatisassociatedwitha
treatmentorsetupfield.SeeAssociatingImagesonpage171.Thereferenceimagemust
alsobereticlescaled.YoucanreticlescaleimagesfromtheImageRegistrationEditor
window.SeeReticleScalingReferenceImagesonpage172andReticleScaling
VerificationImagesonpage176.
Somereference simulatororDRR imagesarereticlescaledbeforetheyareimported
intoMOSAIQ.IntheImageRegistrationEditorwindow,youcanidentifyreference
Fiducial pointsandcurvesforimageregistrationandreview.MOSAIQusesreference
imagesduringthecourseoftreatmentandlocksimagesafteritrecordsaregistration.
You can also reticle scale images in the Image Registration Editor window. See
Reticle Scaling Verification Images on page 176.
Applying Points or Curves to Reference Images
1. Openthepatientchart,andthenclickeChart|Images…toopentheImageList
window.
2. ClickaDRRtowhichyouwanttoapplypointsorcurves,andthenclickOpentoopen
theImagewindow.
Do not click Review.
3. Right‐clickorpressF4,andthenclickRegistrationEditor…toopentheImage
RegistrationEditorwindow.Figure55showstheImageRegistrationEditorwindow.
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Figure 55: Image Registration Editor Window
Inthiswindow,tofirstidentifythecurves,Fiducialpoints,orregistrationregion,
selecttheImageRegistrationmethodtousebeforeyouregistertheimages.Theother
stepstellyouhowtodothisforthePointandCurveRegistrationmethods.
If you must change points or curves on a locked reference image, copy the
image in the Image List window. See Copying images from the Image List
window on page 185. The copied image is unlocked. Make your changes to
the new image, and then click Use for Tx Definition in the Image window.
Make sure to consider your maximum portal image exposure area. Add your
points and curves in this area.
4. ClickthePointRegistrationcheckboxintheImageRegistrationMethodsgroupto
applypointstotheimage.
5. Click
fromthetoolpalette.
6. PuttheredXwhereyouwantapointandclicktosetthefirstpoint.MOSAIQ
automaticallygivespointslabels.
7. Dostep6againuntilyouhaveallthepointsnecessary.
Youmustaddaminimumof2points.
8. Tomoveapoint,select
.Thepointsturngreenwhenyouplace
9. Clickanddragthepointwith
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overthem.
tothepositionyouwant.
225
10. ClicktheCurveRegistrationcheckboxtodrawcurveswiththePoints,Curves,or
RegistrationRegiontool.
11. PuttheredXwhereyouwanttostartthecurve,andthenclickanddrag
thecurve.SeeFigure56forexampleofthecurvedrawnontheimage.
todraw
Figure 56: Example of Curve
12. Continuetodrawcurvesuntilyouhaveallthecurvesnecessary.
13. Right‐click
anddragitbackoverapointorcurvetoerasethem.
14. ClickSaveintheImageRegistrationEditorwindow.
15. ClickOKtosaveyourchangesintheImageRegistrationEditorwindowandclosethe
Imagewindow.
Promoting Annotations
ForimagesimportedintoMOSAIQwithannotations,selectandcopyimported
annotationstothepatientpositioningcurvelayerforcurvematching.Selectandpromote
annotationsaddedinMOSAIQwiththePolygonandFreehandDrawingtoolsfromthe
Imagewindow.
intheImageRegistrationwindowtoopentheAnnotationstoPromote
1. Click
dialogbox,asshowninFigure57.
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Figure 57: Annotations to Promote Dialog Box
2. Clickthecheckboxesfortheannotationcurvesthataretoappearonthereference
image.
3. ClickOKtocopytheselectedannotation s tothepatientpositioningcurvelayer.
Registering Images
Reticle scale images before you try to register them. To register an image,
you must have an isocenter on both images to calculate offsets, regardless of
the registration method. See Reticle Scaling Reference Images on page 172
CAUTION and Reticle Scaling Verification Images on page 176.
Whenyoureviewanimagepairwithoffsets,theimagepairautomaticallyopensinthe
Offsetwindowinthefusedview.Thisapplieswhenyoureviewtheimagepairfromthe
ImageListwindow,ImagestaboftheWorkListpane,andConsolidatedWorkListpane.
Toaddoffsets,theImageRegistrationprocesshastherequirementsthatfollow:

Yourtreatmentmachinemustbecorrectlycharacterized.ThisincludestheSAD
andcouchsections.

YoumustidentifyaPatientOrientation.

Youmustidentifythecouchandgantrypositionsforthetreatmentandsetup
fieldsintheTreatmentFieldDefinition.

Thereferenceimagemustbereticlescaledandassociatedwithaprescription
site.
2. Setthesearchcriteriatoshowalistofallimagesrequiringreview.
SeeFindingChangeRequestsfromtheConsolidatedWorkListsPaneonpage214.
4. IntheImagestaboftheWorkListspane,clicktheverificationimageoftheimagepair
toregister.
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5. IntheWorkListDetailpane,clickReviewtoopentheimagesintheImageReview
window.
Thestatusoftheimageappearsinthelowerpane,belowtheimage s .
blank :imagewasnotviewedduringthisreviewsession.
V:imagewasviewedduringthisreviewsession.
C:imagewaschanged.
O:imagehasanassociatedstereoscopicpositioningoffset.
6. ClicktheOffsettab,andthenclickRegistertoopentheImageRegistrationwindow.
Tobeeligible,portalimagesmustbeassociatedwithatreatmentfield,thecouch
anglemustbecentered,andthecouchmustbecharacterizedforthetreatment
machine.ThepatientorientationmustbedefinedintheSiteSetupDefinitionwindow.
Tobeeligible,setupverificationimagesmustbeassociatedwithasiteandthesite
musthaveasitesetup.Couchangleandpatientorientationmustbeconfiguredinthe
SiteSetupDefinitionwindowandthecouchanglemustbecardinal.Thesetup
verificationimagesmustbeassociatedwiththesamemachineasthesitesetup.
TheOffsettabisdisabledfortheSittingpatientorientation.
7. FollowtheinstructionsinoneofthefoursubsectionsbelowfortheapplicableImage
Registrationmethod.
Manual Registration
1. Makesurethatyourreferenceandverificationimagesarereticlescaled.
2. IntheRegistrationMethodsgroup,clicktheManualRegistrationcheckbox.
3. ClickCalculateShiftsintheImageRegistrationwindow.
TheOffsetwindowopens.SeeFigure15.
IfyouselectedAnatomyfortheSetupOffsetReferencesettingintheDepartment
Setup,thiswindowislabeledOffset Anatomy ,insteadofOffset Beam .MOSAIQ
registersthecentralaxisofeachimagetotheotherandfusestheimages.SeeFigure
58.
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Figure 58: Offset Window
IntheOffsetwindow,theTreatmentcheckboxisselectedbydefault,asisthe
treatmentimageintheviewer.AsofMOSAIQ2.30,theShowBeamIsocenters,Show
Points,andShowCurvescheckboxesareselectedbydefaultwhenapplicable.
4. MakesuretheImageFusioncheckboxisselectedintheDisplayModegroup.
ImageFusionisselectedbydefault.Imagefusionshowstheimagesoverlaid.
Figure 59: Image Fusion Check Box
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5. PressandholdtheCTRLkey,andthenclicktheleftmousebuttontoshowthe
Spyglasstool.
TheSpyglasstoolappearssuperimposedoverthereferenceimage,andonlyshowsa
portionofverificationimageinthe1.5cmX1.5cmredsquare,whichchangesasyou
dragtheSpyglasstooloverthereferenceimage.Thistoolletsyouseetheapplicable
anatomyataspecifiedlocation.
6. Changethesizeofthespyglass:

Toenlargethespyglassarea,pressandholdtheCTRLkey,andthenpressthe
RightArrowkey.SeeFigure60foranexample.

Toreducethespyglassarea,holdtheCTRLkeydown,andthenpresstheLeft
Arrowkey.
Figure 60: Enlarged Spyglass Area
7. UsetheImageFusioncontrolsasfollowstochangethetranslucenceoftheimagesand
thecolors.Youcandistinguishbetweenimagesbytheimagecolorsanddifferent
opacitylevels.
.Tochangethecolorof
Tochangethecolorofthereferenceimage,double‐click
.Tosavethenewcolororthereferenceor
theverificationimage,double‐click
verificationimage,right‐clickthenewcolor,andthenclickSaveSettings.
withyourmouseandmovetothe
Tousetheimagefusioncontrols,clicktheslider
rightorleft.Ifyoumoveittotheright,thetransparencyvaluesofthetreatmentand
referenceimageschange.MOSAIQusesthepercentagetoconstructthedisplayed
image.Thedefaultis50%/50%.SeeFigure59.
Reference
Value
Treatment
Value
Description
100%
0%
Allreferenceimageinformationisused.No
treatmentimageinformationisused.
0%
100%
Noreferenceimageinformationisused.All
treatmentimageinformationisused.
Ifyouadjustthetransparencyto80%/20%or20%/80%,theWindow/Levelfocus
changestothe“dominant”image.Ifthe“dominant”imageisthetreatmentimage,the
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Treatmentcheckboxisselected.Ifthedominantimageisthereferenceimage,the
Referencecheckboxisselected.Youcanmanuallychangethisselection.
8. UsetheSliderkeystoincreasetheReference/Treatmentimagetransparency
percentage.Left‐clickontheslidercontrol.

ForReferenceimages,pressHOME 100% ,PAGEUP 10%increments ,andUP
ARROW 1%increments .

ForTreatmentkeys,pressEND 100% ,PAGEDOWN 10%increments ,and
DOWNARROW 1%increments .
9. ClicktheCheckerboardPatterncheckboxintheDisplayModegrouptoshow
alternatingareasofeachfusedimage.Thedefaultsettingisfourareas.
10. ClickanddragtheslidersfortheCheckerboardPatternControlsgrouptochangethe
numberofareasonthecheckerboard.SeeFigure61.
Figure 61: Checkerboard Pattern Controls
11. KeeptheLockcheckboxselected default tosetthesamenumberofhorizontaland
verticalareaswhenyoumoveoneofthesliders.
ClicktheLockcheckboxtodeselectit,sothatyoucansettheverticalorthe
horizontalareasindependently.Thismethodcanbehelpfultoregisterfieldswith
severalbonylandmarkssuchasthepelvis,head,orspine.
12. PressandholdtheCTRLkey,andthenclickanddragyourmouseovertheimage
viewertomovethecheckerboard.
13. UsetheTranslateRotate,andScaleoptiontomanuallyregistertheimage.Thisright‐
clickoptionisautomaticallyenabled.
Positionyourcursorintheregionoftheviewerasshowntoenabletheapplicable
control.Then,useyourleft‐clickmousebuttontoadjusttherotation,scaling,or
translation.SeeFigure62.
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Figure 62: Translation, Rotation, and Scaling Regions in Viewer

Translate:Moveyourcursortotheuppertwo‐thirdsoftheimageviewer.
appears.Thistranslatesthetreatmentimage moveinthex/yplane .Left‐click
andmovethemousedowntoreducethex‐coordinatevaluesoruptoincrease
thex‐coordinatevalues,andupordowntoincrease/reducethey‐coordinate
values.ThecurrentOffsettabtranslationvaluesupdatebasedonpatientand
fieldorientation.

Rotate:Moveyourcursortotheleftandrightsidesoftheimageviewer.
appears.Thisrotatesthetreatmentimageinplane.Left‐clickandmovethe
mousetothelefttoincreasethetreatmentimageangleortotherightto
decreasethetreatmentimageangle.ThecurrentOffsettabrotationvalue
updates.

Scale:Moveyourcursortonearthebottomoftheimageviewer. appears.This
scalesthetreatmentimage.Left‐clickandmovethemousetothelefttodecrease
thetreatmentimagescaleortotherighttoincreasethetreatmentimagescale.
TheOffsettabcurrentscalingvalueupdates.

Toremovethemanualadjustment s made,butnotsaved,right‐click,andthen
clickResetOffset.YoucanalsopresstheMINUSkey ‐ onyournumberkeypad.
WhenyouuseManualRegistration,youmustaligntheanatomyinbothimages
yourself,soyouusetheseoptionstoimproveyouralignment.Theseoptionsare
availableregardlessoftheoptionselectedintheDisplayModegroup.
14. Usethenumberpadonyourkeyboardtomakesmalladjustmentstoregistration
results.

232
Pressanumberpadarrowkey 2,4,6,8 tomovetheverificationimageinhalf
pixelincrements.

Pressthe7keytodecreasethescaleoftheverificationimagebyafactorof
0.0016.

Pressthe9keytoincreasethescaleoftheverificationimagebyafactorof
0.0016.
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
Pressthe1keytorotatetheverificationimageclockwisein0.02°increments.

Pressthe3keytorotatetheverificationimagecounterclockwisein0.02°
increments.

Pressthe‐keytoreturntheverificationimagetoitsoriginallocation.
15. ClickOKwhenyouhavecompletedtheregistration.
Point Registration
1. ClickthePointRegistrationcheckboxintheImageRegistrationwindow.
2. SetpointsontheverificationimageintheImageRegistrationwindowthatmatch
thoseonthereferenceimage.
SeeApplyingPointsorCurvesonpage195.
3. ClickCalculateOffsettoopentheOffsetwindow.
Figure 63: Offset Window – Point Registration
MOSAIQautomaticallycalculatestheoffsetforPointRegistration.Youcanseethe
shiftthatMOSAIQcalculatedontheOffsettab.SeeFigure64.
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233
Figure 64: Offset Tab – Point Registration
4. Youcanmanuallyadjusttheimagealignmentandstartthematchingalgorithmagain.
ClickStartSearch.
MOSAIQautomaticallymatchesthepointsonthereferenceandverificationimages.
5. Tomanuallystopthematchingalgorithm,clickStopSearch.
Curve Registration
1. ClicktheCurveRegistrationcheckboxintheImageRegistrationwindow.
2. DrawcurvesontheverificationimageintheImageRegistrationwindowthat
correspondswiththoseonthereferenceimage.
SeeApplyingPointsorCurvesonpage195.
UnlikePointregistration,youdonothavetodraweverycurvethatyouseeonthe
referenceimage.
3. ClickCalculateOffsettoopentheOffsetwindow.SeeFigure65.
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Figure 65: Offset Window - Curve Registration
MOSAIQautomaticallycalculatestheoffsetwhenyouselectCurveregistration.You
canseetheshiftthatMOSAIQcalculatedontheOffsettab.
Figure 66: Offset Tab - Curve Registration
ClickStartSearchontheOffsettab.
MOSAIQautomaticallymatchesthecurvesonthereferenceandverificationimages.
5. Tomanuallystopthematchingalgorithm,clickStopSearchtostopthematching
algorithm.
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Grayscale Registration
1. ClicktheGrayscaleRegistrationcheckboxintheImageRegistrationwindow.
2. Clickanddragyourmousediagonallyacrosstheregistrationareaontheverification
image.
ThisdrawsaboxtoidentifytheareathatMOSAIQusestomatchthecorresponding
areaonthereferenceimage.
3. ClickCalculateOffsettoopentheOffsetwindow.
Figure 67: Offset Window - Grayscale Registration
MOSAIQautomaticallymatchestheanatomyonthereferenceandverificationimages.
YoucanseetheshiftthatMOSAIQcalculatedontheOffsettab.SeeFigure68.
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Figure 68: Offset Tab – Grayscale Registration
ClickStartSearchontheOffsettab.
GrayscaleRegistrationseeksanoptimalsolution.
5. Tomanuallystopthematchingalgorithm,clickStopSearchtostopthecalculation.
When you review an image pair with offsets, the image pair automatically
opens in the Offset window in the fused view. This applies when you review
the image pair from the Image List window, Images pane, and Consolidated
Work List pane.
Click Register in the Image Review window to see other merged images with
their associated offset applied. The offset values are part of the image record.
When you approve or reject the verification image, image review is complete.
This locks the offset values.
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Setup Intelligence
SetupIntelligenceisthepatientpositioningverificationsysteminMOSAIQImage
Management.WithSetupIntelligence,youcanexaminereproduciblepatientpositioning
andtreatmentlocalization.SetupIntelligencehelpsyouaccuratelyreproducetreatment
positioningwithsophisticatedonlineandofflinequantitativeanalysistools.Youcan
examinepositionalshiftinformationcalculatedbytheSetupIntelligenceimage
registrationandfusionfunctionsorathird‐partypositioningproduct.SetupIntelligence
includesthesedecisionswiththetreatmentworkflowandinthepatienttreatmentrecord.
You must have Clinical | Site Setup Defs | Modify security rights to change
an unapproved Site Setup. You must have Clinical | Site Setup Defs |
Approve security rights to change an approved Site Setup.
Site Setup
SetupIntelligencehelpsyousetupthepatientwithSetupAlerts.Thesetellyoutomove
thepatientfromthepositioningmarksbeforetreatmentorsetupverificationimaging.
YouidentifySetupAlertsintheSiteSetupDefinitionwindowasyouidentifythePatient
Orientation.SetupIntelligenceregistrationusestheSetupOffsetsgroupintheSiteSetup
Definitionwindow.Youidentifyadjustmentstotheplannedtreatmentisocenterposition
relativetosimulationlandmarks,liketattoos,intheSetupOffsetsgroupasaPrescribed
RelativeOffset.
TheLocalizationOffset LO isthesetupadjustmentthatSetupIntelligencecalculatesto
correctforsystematicsetupvariation.ThisisdescribedinLocalizationTrendReview.
When you use MOSAIQ for particle therapy, the couch positions identified in the
Site Setup Definition are the starting points on which the relative positions
configured in the Treatment Field Definitions are applied.
Prescribed Relative Offset
Protocolsthatuseoffsets shifts betweenthesimulationisocenterposition zeropoint andthetreatmentisocenterarecommon.Youcanimporttheseoffsetvaluesfromthe
treatmentplanningsystemorenterthemmanuallyintheSiteSetupDefinitionwindow.
Thesevaluesappearwiththeothersetupparameterswhenyousetupthepatientfor
treatment.
1. ToopentheSiteSetupDefinitionwindow,clickeChart|Diagnosesand
Interventions…,clicktheradiationprescriptionfolder,andthenclickSiteSetup.
Or,ifyouhavetheTreatmentFieldDefinitionwindowopen,right‐clickorpressF5,
andthenclickSiteSetup.SeeFigure69.
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Figure 69: Site Setup Definition Window
Prescribed Relative Offsets are also shown in the Treatment Definition, Verified
Site Setup, and Verified Treatment dialog boxes.
Setup Alerts
Whenyousetupthepatient,SetupIntelligencecanalertyouifyoumustshiftthebeam
isocenter alsocalledthezeropoint frominitialsetupmarks.
1. Clickthefirsttreatmentfieldassociatedwithaprescriptionsitethatcontainsan
offsetvalue PrescribedRelativeOffsetand/orLocalizationOffset toopentheSetup
Alertdialogboxandshowtheoffset.
Or,ifyouhavetheTreatmentDeliveryTablewindowopen,right‐clickorpressF4,and
thenclickViewSetupAlert…toopentheSetupAlertdialogbox.
Figure 70: Setup Alert Dialog Box
Afteryousetupthepatientandalignhis/hersetupreferenceswiththelasersand
lightfield,youthenapplytheTotalOffset.Makesureyouapplytheseoffsetsbefore
treatmentorimaging.
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Session Offsets
MOSAIQcollectssetuperrordataduringeachtreatmentsessionthatyoucanusefor
patientpositioningbeforetreatment.MOSAIQalsorecordsSessionOffsetscalculatedwith
imagesontheOffsettaboftheImageReviewwindow.RecordSessionOffsetsfrom
externalsystemsintheThirdPartyOffsetdialogbox.
MOSAIQ Image Review and Session Offsets
SetupIntelligenceletsyouregisterstereoscopicand3DCBCTimages.
Figure 71: Planes of a Stereoscopic Pair of Images
Valid Stereoscopic Image Pairs
ForMOSAIQtorecognizeasecondreviewimageasstereoscopictothefirstselected
image,itmustsatisfythecriterionthatfollows:

Portalimages:
- Imagesmustbeassociatedwithdifferentfieldsforthesamesiteandthe
couchmustbecentered.
- Imagedate/timemustbemorerecentthantheeditdate/timeofthe
treatmentfield.

Setupverificationimages:
- Imagesmustbeassociatedwiththesamesiteandavalidsitesetup.

240
-
Imagesmustbeassociatedwiththesamemachineinthesitesetup.
-
ImagesmustbeassociatedwithdifferentkVimagersforthesamemachine.
-
Couchanglemustbecardinalinthesitesetupdefinition.
-
Imagedate/timemustbemorerecentthantheedit/datetimeofthesite
setup.
Theanglebetweenincidentbeamsmustbegreaterthan30andlessthan150
degreestothatofthereviewimage.
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
Thestudydate/timemustbe /‐10minutesofthereviewimagestudydate/time.

Theimagemustbetakenonthesametreatmentmachineasthereviewimage.

Theimagemusthavesquarepixels.

Theimagecannotbeapproved,rejected,orvoided.
Stereoscopic Image Registration for Setup Verification Images
IftheverificationimagesintheStereoscopicImageRegistrationwindowaresetup
verificationimages,onlyManualRegistrationisenabled.Point,CurveandGrayscale
registrationmethodsaredisabled.
Registering Stereoscopic Images
Theinstructionsthatfollowgiveyouoneexampleoftheworkflowwhenyouregister
imagesatthelinacwithSetupIntelligence.
1. Right‐clickorpressF4ontheTreatmentDeliveryTabledialogbox,andthenclick
ImageReview…toopentheImageReviewwindow.
2. ClicktheOffsettab,andthenclickRegistertoregisterastereoscopicpairofimages.
MOSAIQautomaticallylooksforpotentialstereoscopicpairimagesontheworklist.
Theseimagesmustmeetgantryseparationrequirementsandbetakenwithin10
minutesoftheoriginalimage.Forexample,whenyouviewthePAimageandalateral
orobliqueimagewastakenwithin10minutes,youcanapplyastereoscopic
registration.
Whenmorethanoneimagemeetsthesecriteria,theStereoscopicImageSelection
dialogboxopens.
Figure 72: Stereoscopic Image Selection
3. ClicktheimagetouseintheStereoscopicImageSelectiondialogbox.
IfyouclickCancel,theImageRegistrationwindowopensfortheinitiallyselected
image.
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4. IntheImageRegistrationwindow,reticlescaletheverificationimagesifnecessary,
andthenclickthecheckboxfortheregistrationmethodtouse.
Youcanusedifferentmethodsforeachimageexceptforgrayscalematching,which
youmustuseonbothimages.SeeRegisteringImagesonpage227.
5. AfteryouhavecompletedthetasksforyourregistrationmethodintheImage
Registrationwindow,clickCalculateOffsettoseethefusedimagepair.
Thestereoscopicregistrationcalculatesoffsetinformationinthreedimensions,which
appearsontheOffsettaboftheOffsetwindow.Themagnitudeshownisthelinear
distanceofthecorrectionin3Dspace thediagonalofthethreecorrectional
directions .
Forstereoscopicimagesregistration,onlytheTranslationandScalingright‐click
optionsareavailable.TheimageregionsintheViewerareshowninFigure73.See
Step13inManualRegistrationonpage231formoreinformation.
Figure 73: Translation and Scaling Regions in Viewer
6. ClickOKintheOffsetwindowwhenyouhaveaddedtheapplicableoffsetsonthe
Offsettab.
If you do offline image registration with Setup Intelligence, open the image
pair from the Consolidated Work Lists pane, and then follow steps 2-6 above.
See Managing the Image Review Process – Reviewers on page 206 and
Managing the Image Review Process – Therapists on page 214 for instructions
on how to use the Consolidated Work Lists pane.
The Active Check Box in the Image Review Window
IntheImageReviewwindow,theActivecheckboxontheOffsettabisselectedwhenthe
SessionOffsetisincludedintheLocalizationTrendReview.Toincludeazerovaluein
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analysis,youmustmanuallytype0ineachorientationandsave zero null .See
Figure74.
Figure 74: Active Check Box on Offset Tab
CleartheActivecheckboxwhentheoffsetshouldnotbeincludedintheLocalization
TrendReview.Ifthecheckboxisnotselectedbeforeyousavetheoffset,thetab
informationisnotsaved.AninactiveoffsetdoesnotappearintheLocalizationTrend
Reviewdialogbox,butyoucanseeitonprintedreports.AfteraFinalreviewerreviews
theimage,youcannotchangetheoffsetstatus.Whenareviewerrejectsanimagewithan
activeoffset,the“Offsetsmaybeinvalid”messageappears.
Figure 75: Offsets May Be Invalid Message
Thisisaremindertomakethedecisiontoincludeorexcludetheassociatedoffsetfrom
theLocalizationTrendReview.
Third Party Offsets
SetupIntelligenceisanopensystemapplication.Itisnotlimitedtochartingitsownimage
registrationresults.TheThirdPartyOffsetdialogboxletsyourecordoffsetscalculatedby
non‐Elektasystems,suchasAcculoc,BAT,Calypso,orOBI.Youcanalsousetorecord
offsetsforElektasystemssuchasiViewandXVI.Youcanrecordpositioningverification
resultsinMOSAIQfordistributedLocalizationTrendReviewonanyworkstationinthe
department.Theseresultsbecomepartofthepatient’streatmentrecordanddonotstay
onthepositioningdeviceworkstationatthetreatmentmachine.
1. Right‐clickorpressF4intheTreatmentDeliveryTable,VerifiedPort,orVerified
TreatmenttoopentheOptionsmenu.
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2. ClickRecordThirdPartyOffset…toopentheThirdPartyOffset.SeeFigure76.
Figure 76: Third Party Offset Dialog Box
3. ClicktheOffsetwasappliedduringtreatmentcheckboxintheOffsetgroup.
Thisidentifiesthatyouaddedtheshiftbeforeyoutreatedthepatient.
4. Clickthecheckboxadjacenttothedirectionoftheshiftyouwanttoapply,andthen
clickthedirection.
5. TypetheshiftsintheKnownComponentsgroup.
Ifyoutypeanegativevaluetheshiftdirectionwillchange.Torecordknownzero
values,clickthecheckboxtodistinguishthezerovaluefromanunknownorblank
value.
6. Typethedateandtime,andthenclickthesourceintheOffsetgroup.
Ifyouselectasource,thatsourceappearsintheDescriptioncolumnofthe
LocalizationTrendReviewdialogbox.Thisisusefulifyourdepartmentusesmore
thanonetypeofpatientpositioningdevice.Ifyourthirdpartysourceisnotonthelist,
youoranElektaadministratorcanselectthe EditList menuitemtoaddthe
source.
7. Ifyouhaveasixdegreecouch,typethecoronal,sagittal,andtransverseangle
informationintheKnownComponentsgroup.
On a Varian 4DITC, right-click in the Treatment Session In Progress window
after you send the plan to open the Third Party Offset.
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TheshiftsyouidentifiedintheImageReviewwindoworThirdPartyOffsetdialogbox
arenowpartofthepatienttreatmentrecord.Youcanusethemimmediatelyto
calculatenewcouchtargetsandlatertofindsystematicsetupvariationor
LocalizationOffsets.
Distributed Registration Review
Whenyoureviewimages,youcanassignarecordedthirdpartyoffsettotheimages.
MOSAIQthenshowstheimagesregisteredwiththeselectedoffset.TheThirdPartyOffset
Selectiondialogboxopensafteryouselecttheimagestoberegistered.
Figure 77: Third Party Offset Selection
CAUTION
Valid Third Party Offsets must be within a time constrained by study
date/time of image(s) ( +/- 60 minutes).
YoucanassociateaCBCTimagewithaprescriptionsitewhenyouselectathirdparty
offsetif:

TheimageselectedintheImageListwindowisalocalization CBCT volume,and
 Thelocalizationvolumedoesnothaveasiteassociatedwithit.
Themessage“SelectanoffsetanditsrelatedSitetoassociatewiththeimage,orclick
Cancelfornone”alsoappearsbelowthelistinthedialogbox.
Offset Couch Calculator
WhenyouidentifyaPrescribedRelativeOffset,calculateanoffsetinMOSAIQ,orrecorda
ThirdPartyOffset,theOffsetCouchCalculatorfunctioncalculatesnewcouchtargets.You
have10minutesfromthetimeatwhichyoutookthefirstimageuntilyouopentheOffset
CouchCalculatordialogboxtocalculatetheCurrent AverageSessionOffset.Right‐click
orpressF4intheVerifiedTreatmentorVerifiedPortdialogboxthenclickCalculateOffset
Couch….Youhavethreeoptionsinthecouchpositiongroup,whichareexplainedinthis
section.
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The Current Option
TheCurrentoptionshowsthepositionofthecouchwhenyouopenedtheOffsetCouch
Calculatordialogbox.
The Current + Total Offset Option
TheCurrent TotalOffsetoptionshowsthecouchtargetsformovingthepatientfrom
marksintothesetupposition.Youcandopre‐treatmentimagingorotherpatient
positioningverification PPV afterthisstep,ordeliverthetreatment.
The Current + Average Session Offset
TheCurrent AverageSessionOffsetoptionshowsthecouchtargetstomovethepatient
fromthesetuppositiontothetreatmentposition.YoucanuseanyavailablePPVmethod.
YoumustopentheOffsetCouchCalculatordialogboxwithin10minutesofimagingor
recordingthesessionoffset.
Afteryouadjustthecouch,youcandopositioningverificationifnecessary.Totake
anothersetofimages,youcanopentheOffsetCouchCalculatordialogboxagainto
calculatenewcouchpositions.
MOSAIQaveragesmultiplesessionoffsetsrecordedwithinthe10minutesandadjustsfor
differencesinasharedplane usuallysup/inf .Forexample,ifyoutooktwoplanarimages
butregisteredthemindependently.Iftheoffsetsincludeimagestakenatdifferentcouch
settings,closeandopentheOffsetCouchCalculatordialogboxagain.Inthiscase,youdo
notwanttoaveragetheresults.Theinitialoffsetsexpire10minutesafteryoutakethe
firstimageset.
The Offset Couch Calculator is not available with the Varian 4DITC interface.
Localization Trend Review
LocalizationTrendReviewletsyouexaminethesetupcorrectionandsessionoffset
historyforapatient.2DimageregistrationandclickOKintheImageReviewwindow,the
LocalizationTrendReviewdialogboxopens.For3Dimages,youcanopenitfromthe
TrendingtabInViewtoolbarintheImageReviewworkspace.
TheLocalizationTrendReviewdialogboxshowsactivepatientoffsetdata.Youcan
quicklyexaminethehistoryofrecordedsetupcorrectionsforpasttreatmentsessionsand
nothavetoopenaseriesofimages.YoucanopentheLocalizationTrendReviewdialog
boxfromtheTreatmentDeliverytable,DiagnosesandInterventionswindow,andthe
LocalizationReviewWorklist.
Interfractionsetupvariation,asmeasuredwithsetupimaging,consistsofrandomand
systematiccomponents.YoucanexamineSessionOffsetsforpatternsandcorrect
systematicsetupvariationduringsetupbeforeverificationimaging.Whenyouremove
systematicerrorfromtreatmentsetup,thedailyworkflowefficiencyincreasesandcan
reducedependencyondailysetupimagingformanytreatmentsites.Thesystematic
componentofatreatmentcourseisthesameastotheaveragesetupvariationovera
courseoftreatment.Youcancloselydeterminethisvariationwithmeasurementsfromthe
firstseveraltreatmentsessions.
SetupIntelligencereferstosystematicvariationcorrectionasaLocalizationOffset.You
includeonlytheinitialSessionOffsetforaseriesoftreatmentsessionswhenyoucalculate
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aLocalizationOffset.Theconstantistheisocenterpositionrelativetothelocalization
references tattoos .Makesureyouassigntheoffsetsyourecordwhenyouverifyanew
couchpositionafterpositionalverificationastatusofInactiveorExcluded.
TheLocalizationTrendReviewdialogboxopens,andshowsoffsetswithanActivestatus
only.TheLocalizationTrendReviewReportletsyouselectfilterssuchasShowHistory.
Thereportcanshowthecurrentand/orhistoricoffsetinformation.
Figure 78: Localization Trend Review Dialog Box
Automatic Display of Localization Trend Review
TheLocalizationTrendReviewdialogboxcanautomaticallyappearafteryouclosethe
ImageReviewwindowif:

YousavedanoffsetfortheimagepairintheOffsetwindow

TheAutoDisplayLocalizationTrendReviewcheckboxisselectedintheClinical
RO taboftheDepartmentSetup.
Excluding Session Offset
Youcanrejectarecordedtreatmentsessionoffsetfortrendanalysisforthereasonsthat
follow:

Didnotincludeoffsetsrecordedfrompostcorrectionorconfirmationimaging
whenyoucalculateaLocalizationOffset.
 Didnotincludeoffsetsrecordedatdifferentsetuppositions.
OtherreasonscanincluderejectionoftheimagesetbytheFinalreviewer,knownpoor
patientpositioning,patientmotion,orothersetupcomplications.
ClicktheExcludecheckboxintheLocalizationTrendReviewdialogboxtoremovea
SessionOffsetfromtrendanalysis.
Localization Offset
DeriveLocalizationOffsetButton
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Whenyoucorrectforsystematicvariation,yousetupthepatientmorepreciselyandcan
reducethefrequencyofrepeatimaging.Whenyouseeatrendintheshiftdata,youcan
manuallyidentifyanoffsetintheAdditionalgroupoftheLocalizationTrendReview
dialogbox.YoucanalsoclickDeriveLocalizationOffsettocalculatetheaveragesession
offsetofalltaggedSessionOffsets.ThecalculatedaverageisshownintheAdditional
group.YoucanmanuallychangethecalculatedvaluesbeforeyouclickOKtosavethem.
Youcanseerecordedresultsoffiveimageregistrationsforthesametreatmentsitefor
thispatient.NoCurrentLocalizationOffsetappears.
1. Clicktheoffsetstoincludeinthecalculation,andthenpresstheSPACEBARtotag
them.Youcanalsoclickinthefarleftmarginofeachoffsetrow.
2. ClickDeriveLocalizationOffsettocalculatetheaverageoffsetofthetaggedsessions.
ThedataappearsintheAdditionalgroupoftheLocalizationTrendReviewdialogbox.
The“new”LocalizationOffsetappearsintheSetupAlertdialogboxafteryousave
pendingchanges.
Thedatashowsasuperior/inferioroffsetvalueof0.0.SincetheaverageisInfaverage
is0.1andtheoffsetis0.1.
ThedatashowsleftandrightoffsetvaluesfromLt0.3toLt0.8foreachtreatment
day.TheaverageisLt0.5.
ThedatashowsposterioroffsetvaluesfromPos0.6toPos1.2.TheaverageisPos0.9.
TheCurrentgroupshowsanyLocalizationOffsetinuse.Theseoffsetvaluesarefor
referenceMOSAIQaddstheentriesintheAdditionalcolumntocreateaNew
LocalizationOffset.
TheAdditionalgroupisforchangestotheexistingLocalizationOffset.
TheNewgroupshowswhattheLocalizationOffsetwillbeafteryouclickOK.Setup
IntelligenceletsyouchangetheLocalizationOffsetsasoftenasnecessarytooverthe
courseoftreatment.
SavedLocalizationOffsetsappearadjacenttothePrescribedRelativeOffsetsinthe
TreatmentFieldDefinitionwindow,pre‐treatmentSetupAlert,andtheSetupviewofthe
VerifiedTreatmentdialogbox.TheTotalOffsetappliesafteryoualignthepatientwith
setupmarksandbeforeverificationimagingisthecombinedPrescribedRelativeand
LocalizationOffsets.
Offset Graphing
1. Tomakeagraphofoffsetsforyourtrendanalysis,clickGraphsintheLocalization
TrendReviewtoopentheOffsetGraphicalAnalysiswindow.See
Figure79.
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Figure 79: Offset Graphical Analysis
TheOffsetGraphicalAnalysiswindowshowsoffsetvaluesgraphedonachart.Youcan
seeaoffsethistoryforapatient,whichincludescompletedandexcludedoffsets.
Offsetpointinformationappearswhenyouplaceyourmousecursoroverapoint.You
canright‐clicktoopentheOptionsmenu,fromwhichyoucanselectExcludePoints,
ShowHistory,oropentheChartPreferencesdialogbox.
TheExcludePointsoptionisavailablewhenanoffsetpointisaSessionorThirdParty
OffsetandthestatusisactiveortemporarilysettoExcluded.
2. ClickOKtochangetheoffsetpointstatustoexcluded,removethatpointfromtrends,
refreshallcharts,andidentifythatpointwitharedtriangle.
Right‐clickanoffsetpointtoopentheSessionOffsetHistory,whichshowsthehistory
ofthatpoint.
Figure 80: Session Offset History Dialog Box
3. Right‐click,andclicktheChartPreferencestoopentheChartPreferencestoconfigure
yourdisplaypreferences.SeeFigure81.
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Figure 81: Chart Preferences
Completing the Setup Offset
WhenyoureachthepointatwhichtheSetupAlertandshiftsfromsurfacereference
marksarenolongernecessary,youcancompletethoseoffsets.Thistypicallyoccurswhen
youremarkortattooapatientatsometimeafterthefirsttreatmentday.
1. CompletetheSetupOffsetsgroupintheSiteSetupDefinition.
2. FromtheDiagnosisandInterventionswindow,double‐clickthesitesetuporselectit
andclickChange.
3. ClicktheCompletedcheckbox.SeeFigure82.
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Figure 82: Site Setup Definition Window
4. AfteryouclickOKintheSiteSetupDefinitionwindow,aQuestionmessageappears.
ClickYestoexcludetheremainingactiveoffsets.
Figure 83: Question Box
Typically,youanalyzetheSessionOffsettrendsfromthesamesetupposition.When
youcompletethesetupcorrection,youhaveanewsetupposition.Youusuallydonot
wanttoincludeSessionOffsetsfromanolderstartingpositionintrendanalysiswith
offsetscalculatedfromnewlandmarks.Ifyouchangethesitesetupafteryourecorded
apositioningverificationfromnewlandmarks,youcanclickNoandmanuallyselect
whichsessionoffsetstoexclude.
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CBCT Acquisition
Import Reference Structure Sets and CT Data
Youmustimportthepatient’sreferenceCT,StructureSet,DRRs,andtheRTPlanviaDCM.
ThisisdoneautomaticallyiftheCTandStructureSetaresentfromyourTPStothe
configuredElektaDCMworkstationonyournetwork. All CTs, MRs, and Structure Sets are sent to DCM and saved directly to the
database. They do not go through NAMER.
TheRTPlangoesthroughDCMandisavailableforRTPImport.Arawcopyisstoredinthe
\\MOSAIQ_app\nonimagefolder.DRRsgothroughDCMandthentoNAMERforimport.
YoucanalsoimportacquiredCBCTimagesintoMOSAIQwithamappednetworkdrive.All
TreatmentCalendarSessions,forwhichyouwanttodoCT‐basedmatching,mustinclude
theCTfield,alongwiththenecessarytreatmentfields.Allthesefieldsmusthavetheexact
samecouchparameters.
For more information about importing site setup data, see page 126.
Acquiring the CBCT Data
1. ImporttheRTPplan.Double‐clickthesitesetupthatisavailableforimport.The
isocentervaluesoftheplanandthestructuresetUIDshow therewillnotbeanydata
forFrameOfReferenceUID .Iftherearenoisocentervalues,youmustmanuallytype
themtoacquireaCBCT.
2. OpentheDiagnosesandInterventionswindow,andthenopenthesitesetup.
3. SelecttheapplicablePatientOrientation,structuresets,andisocenter.UsetheVolume
ReferenceDatatabtoselectthestructuresetsandisocenter.
TheVolumeReferenceDatatabletsyouviewvolumereferencedata,suchas
structures,isocenters,andXVIreferenceparametersets.
4. Approvethesitesetup,andthenclickOK.
Opening the Image Review Workspace
1. OpentheImageReviewworkspaceinoneofthemethodsthatfollow:
252

Click

IntheImagespaneorImageListwindow,selecta3Dimage,andthenclick
Review.

IntheImagestaboftheWorkListspane,selecta3Dimage,andthenclick
ReviewfromtheWorkListDetailpane.
ontheMOSAIQtoolbar.
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Figure 84: Image Review Workspace
Closing the Image Review Workspace
IfyouexittheImageReviewworkspace dockedorundocked ,itdoesnotclose.
1. ShutdownorlogoffofMOSAIQ.
Docking and Undocking the Image Review Workspace
YoucanusetheImageReviewworkspaceasadockedpaneorasanundockedwindow
fullscreenmode thatyoucanresize.IfyoucloseanundockedImageReviewWorkspace
window,youdonotclosetheImageReviewworkspace.
1. ToundocktheImageReviewworkspace,
Undock.
2. TodocktheImageReviewworkspace,
Dock.
toopentheOptionsmenu,andthenclick
toopentheOptionsmenu,andthenclick
Expanding and Restoring the Image Workspace Panes
1. Click
intheupperrightcorneroftheviewerortabbedpanetoexpandit.
2. Click
torestoretheviewerpane.
Saving and Reverting Changes in the Image Review Workspace
Youcansaveorrevert discard thechangesthatyoumaketothefieldsthatfollow:

Commentfield
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
Date,Time,Type,Machine,NamefieldsontheImageInformationwindow

Imagenotes

Offsettab offsetfieldsandtheActiveandAllowRotationcheckboxes 
Reviewstatus
1. Click
tosaveallchangestotheimagethatappearsintheviewerpanes.
2. Click
todiscardallchangessincethelastsavetotheimagethatappearsinthe
viewerpanes.
Using the In View Toolbar in the Viewer Panes
TheInViewtoolbarappearsatthebottomofeachoftheviewerpanes.
1
PutyourmousecursoratthebottomoftheviewerpanetoshowtheInViewtoolbar.
.
2. Tozoom,click
Changestothezoominoneviewerpaneapplytoallviewerpanesequally.
3. Topan,click
.
Theimageintheviewerpanemovesinthedirectionofthemouse.Theotherimages
moveintheirapplicableanatomicaldirection.
4. Tochangethewindow/level,click
image.Click
tochangethewindow/levelofthereference
tochangethewindow/levelofthelocalizationimage.
5. Toaddameasurement,click
,andthendragyourmouse.
6. Toremoveameasurement,click
todeletethemeasurement.
7. Tousethespyglass,checkerboard,orquarteredviewsduringimagereview,click
spyglass ,
checkerboard ,or
quartered .
8. Toviewonlythereferenceimage,click
.Toshowonlythelocalizationimage,click
.
9. Tocleartheselectedtool,opentheInViewtoolbar,andthenselectthetooliconagain.
Viewing Structure Sets in the Viewer Panes
TheStructuresListisenabledwhenthereferenceandlocalizationimagesareopeninthe
ImageReviewworkspaceinDualMode.ThereferenceandlocalizationimagesareinDual
Modewhenthelocalizationimageisassociatedwithasite.Ifyouonlyloadthereference
imageintotheworkspace,youcannotseethestructures.
1. Click
254
toseetheStructuresListdrop‐downlist.
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Thedrop‐downlistletsyoushoworhideoneormorestructures,isocenters,markers,
orXVIreferenceparametersets.Thedrop‐downlisthasthecheckboxesfor
Structures,Isocenters,Markers,andRef.ParametersSets.Thesecheckboxesappearif
theimagehastherespectivedata.
2. Tohidetheselectedstructuresintheviewerpanes,clicktheHideSelectedbutton.
3. Toshowtheselectedstructuresintheviewerpanes,clicktheShowSelectedbutton.
4. Toshowaspecifiedstructureintheviewerpanes,selectthecoloredoptionbutton
adjacenttothestructure.
Thecoloredoptionbutton coloredborderwithablackcenter changestoasolid
coloredoptionbutton.Thestructureappearsintheviewerpanes.
5. Tohideaselectedstructure,clicktheapplicableoptionbutton.
Thesolidcoloredoptionbuttonchangestoacoloredoptionbutton coloredborder
withablackcenter .Thestructuredoesnotappearintheviewerpanes.
6. Toshowselectionsforanentiretype forexample,Markers ,clicktoselectthecheck
boxadjacenttothetypename.
7. Tohideselectionsforanentiretype,clicktoclearthecheckboxadjacenttothetype
name.
Using the Trending Tab
TheTrendingtabshowsa3Dscatterplotoftheoffsetsthatapplytotheselectedimage
volume.
Figure 85: Image Review Workspace – Trending Tab in the Tabbed Pane
TheTrendingtabdoesnotappearifsingleimageisonlyloaded forexample,referenceCT
loaded .Ifyouhaveselectedanoffset,butSetupAssistisnotregistered,theTrendingtab
appears,accesstoLocalizationTrendTableisdisabled.
1. Toseeatooltipofoneoftheoffsets,holdyourmousecursoroveranoffset.
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ThetooltipshowstheStudyDate,Description,SourceName,Status,Offset
translationsonly incm,andOffsetDate.
2. Toshoworhidethelegend,clickthearrowbuttontotheleftoftheLegendlabel.
3. Tochangetheoptions,clickthearrowbuttontotheleftoftheOptionslabel,andthen
selectorclearoneoftheoptions.

Scale

Coordinatesystem

Gridlines
4. TousetheInViewtoolbar,putyourmousecursoratthebottomofthepanel,and
thenclicktheicon.
TheInViewtoolbarletsyouzoom,pan,rotate,zoomwithrectangle,zoomtofullest
extent,resettheview,andopentheLocalizationTrendReviewwindow.
Using the 3D Tab
The3DViewtabispartofthetabbedpaneinthelowerright.Itletsyouseeandadjustthe
transverse,sagittal,andcoronalviewsasa3Dimage.
1. Torotatethe3D,use
.
2. Addorremovestructures,isocenters,orreferenceparametersetswiththeStructures
List.
RefertoViewingStructureSetsintheViewerPanesonpage254.
3. Tozoom,right‐click,andthendragyourmouseinthepane.
Finding 3D Images to Review in the Image Review Workspace
1. SetthefiltercriteriaintheConsolidatedWorkListspane.
206.
TheembeddedImageWorkListintheImageReviewworkspaceusesthefiltering
criteriaoftheConsolidatedWorkListspane.
2. OpentheImageReviewworkspace.
3. Optional.Click
imagecarousel.
tomovebetweenPatientTimelineandWorkListmodesinthe
4. ClicktheembeddedImageWorkListtotherightoftheviewerpanes,andexpanditas
necessary.
5. ClickanimageintheembeddedImageWorkListorimagethumbnailintheimage
carouseltoreviewit.
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Reviewing 3D Images in the Image Review Workspace
1. SettheConsolidatedWorkListspanefiltercriteriatoshowimagesthatrequire
review.
206.
3. Right‐click,andthenclickRefreshtomanuallyrefreshtheworkspace,ifnecessary.
4. SelecttheimageintheembeddedImageWorkList.OR,selecttheimagethumbnailin
theimagecarousel.
5. AddshortnotesintheCommentfieldorclickNotestoaddalonger,morepermanent
note.
6. Click
intheReviewStatusgrouptoopentheChangeRequestgroup.
7. Clicktheapplicablereviewertype:FinalorOptional.
8. Selectyournamefromreviewerlistinthefieldtotheright,ifnecessary.
9. Click
.
10. Enteryourusernameandpassword,andthensaveyourchanges.
YoudonothavetotypepasswordwhenyouapproveanimageifyouhaveQuick
Approvalconfigure.
Agreenoutlineappearsaroundthethumbnailintheimagecarousel.AsmallApprove
iconwiththeinitialsoftheloggedinuserandthedateappearintheReviewStatus
group.
Finding 3D Images with Change Requests in the Image Review
Workspace
1. SettheConsolidatedWorkListspanefiltercriteriatoshowimageswithchange
requests.
RefertoFindingImageswithChangeRequestsfromtheConsolidatedWorkListsPane
onpage214.
3. Optional.Click
tosettheimagecarouseltoWorkListmode.
4. ClicktheembeddedImageWorkListtotherightoftheviewerpanes,andexpanditas
necessary.
5. ClickanimageintheembeddedImageWorkListorimagethumbnailintheimage
carousel.
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Completing 3D Image Change Requests in the Image Review
Workspace
1. SetthefiltercriteriaintheConsolidatedWorkListspanesothatonlyimageswith
changerequestsappearintheimagecarouselorembeddedImageWorkList.
RefertoFinding2DImageswithChangeRequestsfromtheConsolidatedWorkLists
Paneonpage214.
3. Right‐click,andthenclickRefreshtomanuallyrefreshtheworkspace,ifnecessary.
4. SelecttheimageintheembeddedImageWorkList.OR,selecttheimagethumbnailin
theimagecarousel.
5. AddshortnotesintheCommentfieldorclickNotestoaddalonger,morepermanent
note.
6. Click
intheReviewStatusgrouptoopentheChangeRequestgroup.
7. ClicktheCompletedcheckboxintheChangesgroup.
8. Saveyourchanges.
Registering 3D Images
1. IntheImageReviewworkspace,selecttheverificationimageintheembeddedImage
WorkListorclickthethumbnailoftheapplicableimage.
2. SelecttheRegistrationMethodintheAlignmentToolsgroup.
3. Optional.CleartheLockClipboxcheckbox,andthenadjusttheclipboxintheviewer
panes.
4. ClickStart.
TheAllowRotationcheckboxisselectedautomatically.TheTranslation cm and
Rotation deg groupsaredisabled.
5. Tomanuallystoptheimageregistration,clickStop.
6. Saveyourchanges.
Manually Registering 3D Images
1. IntheImageReviewworkspace,clicktheEnableManualAlignmentcheckbox
TheTranslation cm andRotation deg groupsareenabled.TheLockClipboxcheck
boxisselectedanddisabled.
2. Useyourmousetoadjustthepositionofthelocalizationimageoverthereference
imagesothattheisocenter,markers,clipbox,orotherstructuresarealigned.
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3. TypeoffsetsintheTranslation cm androtationsintheRotation deg groupsif
necessary.
4. Ifnecessary,clickResettodiscardallmanualalignmentchanges.
4. CleartheEnableManualAlignmentcheckbox.
5. Saveyourchanges.
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CHAPTER 6: MOSAIQ DICOM
ThefunctionofthischapteristotellyouhowtousetheDICOMauto‐forwarding,DICOM
AEconfiguration,DICOMimportorexport,andtheDICOMprintingfeatures.This
documentalsogivestheaccesspermissionsthatarenecessarytousethesefeatures.
Thebackgroundofthesefeaturesisgivenintheparagraphthatfollows.
MOSAIQgivesyouastandards‐based,fullfidelitystorage,archiving,andrestorationof
medicalimagesinDICOMformat.MOSAIQalsoletsyoueasilyimportmedicalimagesand
otherDICOMdataintothelocalMOSAIQdatabase.Withtheauto‐forwardingfeature,
MOSAIQreadsatypeofmedicalimageorotherDICOMdatamadeintheclinic.Then,
MOSAIQautomaticallyexportstheDICOMdatatoanexternalDICOMdevice,forexample,
MOSAIQDataDirectororatreatmentplanningsystem TPS .YoucanusetheDICOMdata
immediatelyontheDICOMdevice.MOSAIQgivesyouflexibilityinyourworkflows
becauseitcanmanagealargespanofDICOMdata.DICOMdataincludes,forexample:
medicalimages,radiotherapy RT structuresets,andRTplans.
ThisdocumenttellsyouhowtosetuptheDICOMCommunicationsModule DCM .DCMis
agatewaywhenyouimportDICOMdataintothelocalMOSAIQdatabase,orautomatically
forwardDICOMdatatoDICOMdevice auto‐forwarding .
DCM Overview
DCMisagatewaybetweenDICOMdevicesonaDICOMbasedTCP/IPnetworkandthe
oncologymanagementsystem’snetwork.DCMisaServiceClassProvider SCP thatgives
StorageServiceClass C‐STORE servicesasspecifiedintheDICOMVersion3.0Standard.
DCMmonitorsandimportsDICOMmessagesthataresentoveraTCP/IPnetworkfrom
variousServiceClassUsers SCUs .DCMassociateseachmessagewithamodality‐specific
importarea,andsavesthemessageasaDICOMfile.Onceproperlyconfigured,DCMis
completelyautomatic,andneedsnouserinput.
ForadetaileddescriptionoftheStorageServiceClass C‐STORE servicesprovidedby
DCM,seetheDICOMConformanceStatement.
DCM Permissions
MakesurethatyouhaveaccesstotheDCMapplicationandaDCMadministrative
password.
Opening DCM
1. OnyourDICOMworkstation,double‐click
Modulewindow.
toopentheDICOMCommunication
DCMshowsacopyrightscreenuponstartup.
IfDCMisnotconfigured,analertmessageappearsandtheapplicationcloses.Ifthe
systemisconfigured,andthentheapplicationperformsasystemstatuscheck.
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DCMteststomakesurethattheimportareascanbewrittentoandupdatestheStatus
Displayappropriately.TheimportprocessstartsafterDCMreadsconfiguration
information.
Operation
DCMhastwobasicoperationalstates:WaitingModeandImportMode.InWaitingMode,
DCMdoesnotmakeanyimportscans.InImportMode,DCMscanstheTCP/IPportfora
validrequestforanassociationfromanSCU.
Ifanassociationisvalid,DCMfollowsthisprocessingsequence:
Message Validation
DCMidentifiesindividualDICOMmessagesreceivedthrough
theTCP/IPportandvalidatesthemagainsttheDICOM
standard.
Import Area Association
DCMusesthemodalityextractedfromtheDICOMmessage
toassociatethemessagewithaspecificimportarea.
File Creation
DCMsavestheoriginalDICOMmessageinaDICOMfile.
Messages
DCMrecordsthecommunicationmodule’seventsandtheirtimesofoccurrenceinthe
ActivityLog.Thewindowhelpstoverifythatthecommunicationmoduleoperatesinits
intendedmanner.Anyunanticipatedbehaviorduetoinadvertentpreferencesettings,
databasedifficulties,networkproblems,andsoonisshownhere.Adailylogfileofalllog
entriesiskeptinalogsdirectoryonthenetworkvolume.Thenameofthelogfileshows
thedatewithwhichitisassociated.
DCM System Preferences
TheSystemPreferenceswindowisagraphicaluserinterfaceforconfiguringDCM.Ithas
fivetabs:General,Scan,ImportAreas,AutoForward,andPassword.Changingtabsdoes
notsaveorcancelanychangesonanothertab.IfyouclickCanceltoclosetheSystem
Preferenceswindowwithpendingchanges,amessageopens.Itasksyoutomakesurethat
youwanttoexitthewindowwithoutsavingthechanges.
Logging on to the System Preferences Window
TheSystemPreferenceswindowispassword‐protected.Thepurposeistolimitaccessto
onlythoseuserswiththeprivilegetochangetheDCMconfiguration.Ifanewpasswordis
notconfigured,contactSoftwareSupport.Afteranewpasswordisconfiguredand
confirmedonthePasswordtab,theimportscanningconfigurationoptionsareenabled.
1. FromtheFilemenu,clickFile|Utilities|SystemPreferencestoopentheLogindialog
box.
2. InthePasswordfield,typeyourDCMadministrativepasswordinthetextbox,and
thenclickOK.Ifyoudonotknowyourpassword,contactyoursystemadministrator.
MOSAIQopenstheSystemPreferenceswindow.
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Setting Up DICOM Import with DCM
1. OpenDCM.
For more information, see the procedure—Logging on to the System
Preferences — on page 262.
2. IntheSystemPreferenceswindow,clicktheImporttabtoopenit.
3. AtthetopoftheSystemPreferenceswindow,clicktheEnableImportcheckboxto
maketheImportIODsfieldavailable.
Bydefault,alloftheImportIODscheckboxesareselected.
4. IntheImportIODsfield,foundbelowtheEnableImportcheckbox,selecteitherone
typeofDICOMdataorasetforDICOMimporting.
Dooneormoreofthestepsinthetablethatfollows.
Do this…
ClickanImportIODs checkbox
To clear or select…
onetypeofDICOMdata.
Note:Clickacheckboxagainto
selectorclearit.
OR
ClickeachImportIODscheckbox
thatisnotadjacenttoanother
checkbox
asetofDICOMdata.
Note:Clickacheckboxagainto
selectorclearit.
OR
a.ClickthefirstDICOMdataname.
asetofDICOMdata.
b.PressSHIFT clickthelast
DICOMdataname.
c.ClickoneoftheImportIODs
checkboxesintheselectedrange.
Note:Whiletherangeofcheck
boxesisselected,click again onlyoneImportIODscheckboxin
therangetoselectorclearthe
entireDICOMdata IOD set.
5. AtthebottomoftheSystemPreferenceswindow,clickOKtosetupDCMto
automaticallyDICOMimporttheselectedtypeofDICOMdataorDICOMdataset.
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Setting Up Auto-forwarding for a DICOM Device
1. OpenDCM.
For more information, see the procedure—Logging on to the System
Preferences — on page 262.
2. ClicktheAutoForwardtabtoopenit.
3. AttherightsideoftheDeviceName,clickAdd/DeletetoopentheAdd/DeleteDICOM
Devicedialogbox.
4. IntheAdd/Deletetextbox,typethedevicename.
Asyoutypeinthetextbox,MOSAIQmakestheAddbuttonavailable.
5. ClickAddtoputthedevicenameintotheDeviceNamefield.
TheDeviceNamefieldshowsthedevicename.
6. IntheDestinationAEgroup,click
thedevicename.
,adjacenttotheDeviceNamefield,andthenselect
Forexample,youcanselectMOSAIQDataDirectororanexternaltreatmentplanning
system.
7. AbovetheDestinationAEgroup,clicktheEnableAutoForwardcheckboxtostartthe
auto‐forwardingsetupfortheselecteddevicename.
Thedevicenameisset,buttheDICOMdeviceisnot yet fullysetupforauto‐
forwarding.
TheAETitle,HostName,andPortNumberfieldsareavailable.TheAutoForward
IODsdialogboxisavailableatthistime.
8. DoallofthestepsinthetablethatfollowstosetuptheAEtitle,hostname,andport
numberoftheDICOMdevice.
264
Do this…
To set the DICOM device…
IntheAETitle:field,typetheAE
titleinthetextbox
destinationApplicationEntity AE title for
example,theAETitleforMOSAIQDataDirector
isMDD_SCP .
IntheHostName:field,typethe
hostnameinthetextbox
hostnameorIPaddress forexample,for
MOSAIQDataDirector .
InthePortNumber:field,type
theportnumberinthetextbox
portnumber.
Forexample,type4000 fortheMOSAIQData
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Directorportnumber.
9. IntheAutoForwardIODsfield,clickoneormoreAutoForwardIODcheckboxesto
selectatypeofDICOMdataoraDICOMdatasetforauto‐forwarding.Bydefault,none
oftheAutoForwardIODcheckboxesareselected.
Dooneormorestepsinthistable.
Do this…
To select…
ClickanAutoForwardIODs
checkbox
onetypeofDICOMdata forexample,youcan
auto‐forwardastandardCTimagetoMOSAIQ
DataDirector .
Note:ClicktheAutoForward
IODscheckboxagaintoclear
Example:
it.
OR
Clickeachnon‐adjacentAuto
ForwardIODs checkbox
Note:ClickanyAutoForward
IODscheckboxesagainto
clearit/them.
aDICOMdataset.
Example:
OR
Do this…
To select…
a.Clickthefirstnameofthe
DICOMdataset.
aDICOMdata set.
b.PressSHIFT clickthelast
nameoftheDICOMdataset.
Example:AdjacentAutoForwardIODcheckboxes
inarange.
c.ClickoneoftheAuto
ForwardIODscheckboxesin
theselectedrange.
Note:Whiletherangeofcheck
boxesisselected,clickanAuto
ForwardIODscheckboxagain
toclearthem.
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10. BelowtheAutoForwardIODsfield,intheNumberofAutoRetriesfield,typea
numericvalue integer inthetextbox.
If you type a value of zero in the text box, this feature becomes unavailable.
Whenthisfeatureisavailable,afteranauto‐forwardingfailure,DCMtriestoauto‐
forwardtheDICOMdataagain.DCMhasalimitonthenumberofattempts,setbythe
NumberofAutoRetriesfield.
11. IntheAutoRetryFrequency inseconds textbox,typeanon‐zero,numericvalue
integer .
Ifthereisanauto‐forwardingfailure,afterthisnumberofseconds,DCMtriestoauto‐
forwardtheDICOMdataagain.Thedefaultvalueis5seconds.
12. AtthebottomoftheSystemPreferenceswindow,clickOKtocompletetheauto‐
forwardingsetup.
Setting Up Auto-forwarding (Manual Retry)
ItispossiblethatDCMfailstoautomaticallyforwardDICOMdatatoaDICOMdevice.In
thiscase,DCMsavestheDICOMdata files inanorphanedfolderwithagivenfilename.
YoucanmanuallyforwardthesefilesonadifferentdatethroughtheAutoForward
ManualRetry windowinMOSAIQ.
TheDICOMAutoForward ManualRetry windowhasthefieldsthatfollow:devicename,
patientname,patientID,andDICOMobjectmodality forexample,CTimage .
Dothestepsthatfollowtosetupauto‐forwardingofDICOMdatatoaDICOMdevice,for
example,toMOSAIQDataDirectorortoatreatmentplanningsystem TPS .
1. InMOSAIQ,clickFile|Import/Export|DICOMAutoForward ManualRetry ...toopen
theDICOMAutoForward ManualRetry window.
2. Dotheproceduresinthetablethatfollows.
In the…
To…
adjacenttotheDevice
Namefield,andthenselectthe
devicename
SelectthedestinationDICOMdevice s thatyou
setupinDCM orinMOSAIQ .
Click
Note:OnlyDICOMSCPdeviceswitha
corresponding OrphanedPath \Manual
Retry\ DeviceName folderthathasoneor
moreDICOMfilesarelistedinthisfield,where:
OrphanedPathisthepathspecifiedinthe
orphanedpathkeybelowthe DCMOrphan sectioninthemerge.inifile.
DeviceName isthenameofthedevicethatyou
setupinMOSAIQorDCM.
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In the…
To…
Patient Name (DICOM) field
Examine thepatientnamerelatedtotheDICOM
data.
Patient ID field
Examine thepatientmedicalrecordIDrelatedto
theDICOMdata.
Modality field
Examine themodalityoftheDICOMdata for
example,CTimages,MRimages,RTPlan,RT
structuresets .
Study ID field
Examine theuserorequipment‐generatedstudy
identifierfortheDICOMdatarelatedtothe
patientname.
File Name field
Examine thefilenamerelatedtotheDICOM
object.
File Date field
Examinethedateandtimeofthefilename
relatedtotheDICOMobject.
3. AtthebottomoftheDICOMAutoForward ManualRetry window,clickSendto
transmittheselectedDICOMfilestotheDICOMdevice.
The Send button is available only if a device name is set up and available.
Doing a Check on the Auto-forwarding Process
1. Doaninspectionoftheinformationinthetablethatfollows.
If DCM…
successfullytransfersthe
DICOMfileorfilestotheDICOM
device
doesnottransfertheDICOMfile
orfilestotheDICOMdevice
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Then…

AProcessStatusmessageatthebottom
ofthewindowbrieflyshowssuccess.

MOSAIQupdatesthe

MOSAIQdeletestransmittedfilesfrom
theorphandirectory.

AProcessStatusmessageatthebottom
ofthewindowindicatesFAILURE.

MOSAIQupdatesthe
AutoForwardSessionCtrl.logfile.

MOSAIQkeepsthefilesintheorphaned
directory,sothatyoucansendthem
later.
AutoForwardSessionCtrl.logfile.
267
Log File
Thereisalogfile—AutoForwardSessionCtrl.log—thathasarecordoftheactivitiesforthe
DICOMauto‐forwarding ManualRetry process.
TheAutoForwardSessionCtrl.loglogfilehasaLOGsubfolderintheMOSAIQapplication
folder.Thelogfilehasatimeanddatestampof MM/DD/YYYYhh:mm:ss ,witha12‐hour
clockformat.Theactuallogmessagecomesafteradashsymbol ‐ .
DICOM-Specific Staging Area
ADICOMSpecificStagingAreaacceptsimagesfromDCM,whichreceivesimagessentfrom
othermachinesandmakesimagefilesforNAMERinanyformat mostlikelyDICOM‐CT,
DICOM‐MR,andDICOM‐RT .AdepartmentcanhaveonlyoneDICOMSpecificStaging
Area.
DICOM AE Configuration
You must have Image | Maintenance | DICOM | DICOM Configuration | View
security rights to view the DICOM AE Edit dialog box. You must have Modify
rights to create or edit DICOM application entities. You must have Admin rights
to add/edit/delete DICOM AE configurations.
DICOM AE Edit
TheDICOMAEEditdialogboxletsyouconfigureanApplicationEntity AE .AnAEis
necessarytousetheDICOMPrintfeature,theVarian4D/TrueBeaminterface,and
MOSAIQDataDirector.TheMergeapplicationmustalsobeinstalledandproperly
configured.ContactElektaifyouhaveproblemswithDICOMAEconfiguration,orifthe
Mergeapplicationisnotproperlyinstalledandconfigured.
1. IntheMOSAIQapplication,clickFile|Import/Export|DICOMConfiguration|DICOM
Maintenance....toopentheDICOMMaintenanceUtilitywindow.
Figure 86: DICOM Maintenance Utility Window
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2. ClickAdd,orselectanAE,andthenclickChangetoopentheDICOMAEEditdialog
box.
Figure 87: DICOM AE Edit Dialog Box
3. TypetheDeviceName,Hostname,AETitle,andScanningPortnumber.
For MOSAIQ Data Director, the Device Name must be MOSAIQ Data Director,
the AE Title must be MDD_SCP and the Scanning Port must be 4000.
4. SelecttheDeviceActivecheckbox.
The Device Active check box applies to only DICOM Print and Varian 4D
Console support. It does not apply to MOSAIQ Data Director.
To designate a DICOM destination as a research device (that is, a non-clinical
device), select the Non Clinical check box in the DICOM AE Edit window.
5. ForMOSAIQ2.30:ClickSCPServiceListtoopentheConfigureSCPServiceList
window.
6. ForMOSAIQ2.30:ClickSyntaxListtoconfigureaservicelist.
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Figure 88: Configuring an SCP Service List in MOSAIQ 2.30
Setting up DICOM Print Options
TheMergeapplicationmustbeinstalledbeforeyoucanconfigureaDICOMprinter.
You can use the Print Formats dialog box to select the formats that a
particular Application Entity supports for DICOM printing, for example, the
Basic Gray Scale. You must have Image | DICOM | DICOM Configuration:
Modify security rights to use the Print Formats.
Contact Elekta for assistance.
1. OpentheDICOMAEEditdialogboxandselecttheapplicableAE.
For more information, see the DICOM AE Edit topic on page 268.
2. ClickSCPServiceListtoopentheConfigureSCPServiceListwindow.
3. ClickPrintFormatstoopenthePrintFormatsdialogbox.
4. IntheAvailablepane,selecttheformat s thatisnecessaryforthisAEtosupportand
clickAdded .
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Ifyouwanttosupportallformats,clickAll
wanttoadd,contactElektaforassistance.
.Ifyoudonotseetheformatyou
5. ClickOKseveraltimestoclosetheDICOMAEEditdialogbox.
6. ClickCloseintheDICOMMaintenanceUtilitydialogbox.
Contact Elekta if you are unable to print from the Print Formats dialog box.
Exporting DICOM Images and RT Plans
Export Images Dialog Box
TheExportImagesdialogboxletsyouexportcopiesofmedicalimagesinanindustry
standardDICOMformatfromtheMOSAIQdatabase.Youcanconfigureandselectexport
destinationsintheDICOMAEEditdialogbox.
You must have Image | ViewStation | Images | View security rights to
export DICOM images and Export to Clinical Destination and/or Export to
Non-Clinical Destination rights. If you do not have these rights, the Export
button from the Image List is disabled.
Exporting DICOM Images
1. ClickeChart|ImagestoopentheImageListwindow.
2. Selectanimage.
3. ClickExporttoopentheDICOMImageExportdialogbox.
Figure 89: Export Images Dialog Box
ThisshowstheexporttofiledestinationandconfiguredDICOMImageExport‐relevant
ServiceClassProviders SCPs .Youcanhighlightoneormoredestinations.ContactElekta
ifyouneedtoconfigureadditionalSCPs.
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Export RT Plans Dialog Box
TheExportRTPlansdialogboxletsyouexportRTplansinanindustrystandardDICOM
formatfromMOSAIQstorage.Youcanconfigureandselectexportdestinationsinthe
DICOMAEEditdialogbox.
You must have Image | ViewStation | Images | View security rights to
export DICOM images and Export to Clinical Destination and/or Export to
Non-Clinical Destination rights. If you do not have these rights, the Export
button from the Image List is disabled.
Exporting DICOM RT Plans
1. Selectapatient.
2. OpenthePlanBrowsepane.
3. Selectaplan.
4. ClickExporttoopentheDICOMImageExport.
Figure 90: Export RT Plans Dialog Box
ThisshowstheexporttofiledestinationandconfiguredDICOMImageExport‐relevant
ServiceClassProviders SCPs .Youcanhighlightoneormoredestinations.ContactElekta
ifyouneedtoconfigureadditionalSCPs.
DICOM Export: Advanced Options
ClickAdvancedOptionsintheExportImagesdialogboxtoopentheDICOMImageExport:
AdvancedOptions.ThisletsyouconfigureadvancedDICOMimageexportoptions.
MOSAIQsavesyourchanges,otherthantoselecttheDe‐IdentifyDICOMheadercheckbox,
whenyouclickOK.
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Figure 91: DICOM Export: Advanced Options Dialog Box
DICOM Export: Advanced Options
1. OpentheExportImagesdialogboxinMOSAIQ.
2. ClickAdvancedOptions.
For DICOM Images Group
ThesecontrolsapplytoexportsoffullfidelityDICOMimages.
Table 31: DICOM Images Group Controls
Control
Description
Override existing header
with MOSAIQ patient
demographics (check
box)
Selecttouserecent updated patientdemographics
containedwithintheMOSAIQdatabaseinsteadoftheoriginal
DICOMheaderwithoutalteringtheoriginalfile.Thedefaultis
thelastsavedsetting.
Keep Original DICOM
UID (check box)
SelecttoexporttheexistingUIDcontainedwithintheDICOM
header notrecommended .Thedefaultisthelastsaved
setting.
ThisboxbecomesactivewhenyouselecttheOverride
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Control
Description
existingDICOMheaderwithMOSAIQpatientdemographics
checkbox.
Export related Dose, RTPlan, Structure Object(s)
with referenced images
(check box)
Export related Dose,
Image, Structure
Object(s) with RT Plan
(check box)
MarkthisboxtoexportrelateddatawiththeDICOMobject.
Relateddatamayinclude:

Dose

RTPlans

SRO SpatialRegistrationObject 
RTStructureSet.
MarkthisboxtoexportrelateddatawiththeRTplan.
Relateddataincludes:

Dose

Images

SpatialRegistrationObject SRO 
RTStructureSet.
Export To File Options Group
ThesecontrolsapplytoexportingtofileonlyanddonotapplytoexportstoDICOMSCPs.
Table 32: Export to File Options
Option
Description
Export as DICOM Stream
(option button)
SelecttoexporttherawDICOMdata,whichpopulatesan
imagelevellistinthedestinationdirectory.Thedefaultisthe
lastsavedsetting.
Export as DICOM File
(option button)
Clicktoexportthefile s withaPart10header,which
updatestheDICOMDIRinthedestinationdirectory.The
defaultisthelastsavedsetting.
De-identify DICOM
header (check box)
SelecttoremovethepatientIDandmedicalrecordnumber
from theexportedfile s .Thisletsyoumakeanonymous
DICOMfiles.Applicabletobothstreamandfileexports,the
defaultisthelastsavedsetting.Youmustselectthisbox
everytimeyouwanttoexportanonymousDICOMfiles.
Status Bar View Options Group
Open status control
minimized (check box)
274
SelecttoopentheDICOMExportStatusdialogboxina
minimizedstate.Youhavetheoptiontorestorewhen
minimized.Ifnotselected,youhavetheoptiontominimize.
Thedefaultisthelastsavedsetting.
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Auto Retry Options Group
Thisisonlyapplieswhenatransfererroroccurs.
Number of Retries
TypethenumberoftimesthatyouwantMOSAIQtoretrya
DICOMimageexportbeforereturningamessagestatingthat
theexportfailed.Thedefaultisthelastsavedsetting.
Retry Interval (Seconds)
TypethenumberofsecondsyouwantMOSAIQtowait
betweentries.Thedefaultisthelastsavedsetting.
Monitoring the DICOM Import Queue
YoucanviewtheelementsintheDICOMImportQueueandmonitortheirstatusinthe
DICOMImportQueuewindow.
Whenyouclickonacolumnheading,thelistissortedalphabeticallybythefield
correspondingtothecolumn.
Youcanclickonarowentrytoselecttheentry.Youcanselectmultipleentries.
You must have Admin | System Utilities | Clinical | Modify security
rights to access the DICOM Import Queue window.
1. IntheMOSAIQapplication,clickFile|Import/Export|DICOMImportQueuetoopen
theDICOMImportQueue.
Figure 92: Opening the DICOM Import Queue Window
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TheDICOMImportQueuewindowopens.Thewindowshowstheelementsinthequeue,
WqeId,State,numberofretriesattempted,andmessagesassociatedwiththeelements,if
any.
Figure 93: DICOM Import Queue Window
ThistabledescribesthecolumnheadingsintheDICOMImportQueue.
Table 33: DICOM Import Queue Column Headings
Heading
Description
Patient Name /
MR#
Showsthepatientnameandmedicalrecordnumber.
Wqe Id
ShowstheuniquedatabaseIDoftheelementstablebeing
referenced.
State
Showsthefilterstate.
Retries
Attempted
Showsthenumberofretriesthathavebeenattempted.
Message
Iftheprocessingoftheelementfails,thiscolumncontainsfailure
information.
ThistabledescribesthebuttonsintheDICOMImportQueuewindow.
Table 34: DICOM Import Queue Buttons
Button
Description
Close
ClosestheDICOMImportQueuewindow.
Refresh
ClearsthelistandperformsanewqueryusingtheStateFilter.
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Retry
SetsallselectedlistelementstoQueued.
Retryisnotattemptedforlistelementswiththefollowingstates:

Queued

Completed

Bookmarked
Youcanselectthesestatefiltersfromthedropdownlist.
Table 35: DICOM Import Queue State Filters
Filter
Descriptions
Queued
TheelementintheDICOMImportQueueisqueuedbutnotyet
processing.SelectingtheRetryButtonchangesthestateofa“retry‐
able” failed,mostlikely entrytoQueued.
In Progress
TheprocessingofanelementintheDICOMImportQueueisin
progress.
Completed
TheprocessingoftheelementintheDICOMImportQueueis
complete.Theelementisremovedautomaticallywhencompletion
isdetectedbytheapplication.
Failed
TheprocessingofanelementintheDICOMImportQueuehasfailed
forsomereason.
Fatal Error
Thisisnotcurrentlyused.
Bookmarked
Processinghasbegun,buttheworkhasbeenbookmarked
paused ,andiswaitingforanotheroperationtocomplete.
All
ThisshowsallstatesfortheelementsintheDICOMImportQueue.
Managing Image Volume Cache Files
YoucanmanagestoragespaceconsumptionforCT,MR,andPETcachefilesintheDICOM
ImageVolumeCacheManagementwindow.ThePurgeandRegenerationtasksruninthe
backgroundanddonotimpactnormaloperations.
Imagevolumecachingisnecessarytomeettheperformancerequirementsofthe3D
Viewer,PlanReview,andEvaluateworkspaces.Cachedimagefilesarestoredalongwith
originalDICOMdata,greatlyincreasingtheamountofspaceconsumed.
WhenanewImageVolumeisimportedthroughDCMWinforapatient,cachefilesfor
existingvolumesforthatpatientareregenerated.
YoucancustomizerulesintheImageVolumeCacheManagementwindowto:

Regeneratecachefilesforexistingvolumes

Purgeoldcachefiles
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Regenerate Cache Files for Existing Volumes
WhenanewImageVolumeisimportedthroughDCMWinforareturningpatient,the
cachefilesforexistingvolumesinthedatabaseareregeneratedforthatpatient.
Purge Old Cache Files
OldcachefilesarepurgedbasedontherulesspecifiedintheImageVolumeCachePurge
paneoftheImageVolumeCacheManagementwindow.
Youcanspecifythefollowingcriteriaforpurges:



Purgeimagestudiesolderthan:days specifythenumberofdaystokeepcache
filesbeforepurging RecursEvery: specifyadayoftheweekforthepurge,SundaythroughSaturday,
orselectalldaysoftheweek StartTime: specifyastarttimeforthepurgebetween12:00AMand11:00PM Make sure to select a purge time that will not conflict with your system’s
backup operations. For some users, this might be the middle of the day.
You must have Image | Maintenance | Utilities / Configuration security
rights to open the Image Volume Cache Management window.
1. ToopentheImageVolumeCacheManagementwindow,clickFile|SystemUtilities|
ImageMaintenance|ImageVolumeCacheManagement.
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Figure 94: Opening the Image Volume Cache Management Window
Figure 95: Image Volume Cache Management Window
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Image Volume Cache Purge Pane
Thedefaultforthisoptionisunchecked,whichmeansthepurgeoptionisnotactivated.
1. Clickthecheckboxtoturnonthepurgeoption.
ThistablelistsanddescribestheoptionsforImageVolumeCachePurge.
Table 36: Image Volume Cache Purge Options
Option
Description
Purge image studies
older than: days
Selectanumberfromthedrop‐downlistboxortypea
number.
Cachefilesarepurgedbasedonthefollowingtriggers:
RecordAge,Dayssincecreated.
Forexample:
If0days thedefault isselected,allcachedfilesforimage
studiesarepurged.
If10daysisselected,allcachedfilesolderthan10daysare
purged.
(Enable/disable the
Purge option)
Themaximumnumberofdaysyoucanspecifyis9999.The
defaultis90days.
SelectthecheckboxnexttothePurgeimagestudiesolder
thanthedaysfieldtoenablethePurgeoption.
Ifthecheckbox isnotselected,cachedfilesforimagestudies
arenotpurged.
Recurs Every:
Selectadayoftheweek,SundaythroughSaturday,orselect
alldaysfromthedrop‐downlistbox.
Start Time:
Selectastarttimeforthepurge.
Note:StartTimeformatmayvary,dependingonthesettings
configuredforRegionandLanguageintheControlPanel
Clock,Language,andRegion .
Image Volume Cache Regeneration Pane
Thedefaultforthisoptionisunchecked,whichmeanstheregenerationoptionisnot
activated.
Clickthecheckboxtoturnontheregenerationoption.
ThistablelistsanddescribestheoptionsforImageVolumeCacheRegeneration.
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Table 37: Image Volume Cache Regeneration Options
Option
Description
Regenerate volumes for a returning
patient when importing new objects
Thisoptionregeneratesthecachefilesfor
existingvolumesinthedatabaseforapatient
whenanewImageVolumeisimportedforthat
patient.
(Enable/disable the Regenerate
option)
Selectthecheckboxnexttothefieldaboveto
enabletheRegenerateoption.
IfRegeneratevolumesforareturningpatient
whenimportingnewobjectsisnotchecked,the
cachefilesforexistingvolumesinthedatabase
arenotregenerated.Onlythecachefileforthe
importedvolumeiscreated.
Keep regenerated volumes for:
days
Specifiestheamountoftimetokeepregenerated
cachedvolumes.Selectanumberfromthedrop‐
downlistboxortypeanumber.
Forexample:
Ifyouselect0days,cachedvolumesare
regeneratedbutnotkept.
Ifyouselect10days,cachedvolumesare
regeneratedandkeptfor10days.
Thedefaultis60days.
ThefollowingtablelistsanddescribesthebuttonsintheImageVolumeCacheManagement
window.
Table 38: Image Volume Cache Management Buttons
Button
Description
OK
SavesthePurgeandRegeneraterules.
Cancel
Discardstheselectionorselectionsandclosesthewindow.Changes
arenotsaved.
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CHAPTER 7: MOSAIQ Data Director
AsImageGuidedRadiotherapy IGRT grows,theamountofdataandimagesthatmustbe
managed,stored,andreadilyaccessiblethroughouttherapyincreases.MOSAIQData
Director MDD seamlesslyintegratesthepatient’sMOSAIQElectronicMedicalRecord
EMR witharchivedimages,plansandsupportingdocumentation.
AccesspointswithinMOSAIQletyousendaquerytoretrievealistingoftheselected
patient’sarchivedDICOMstudiesandseries,regardlessoftheactualstoragelocation.You
canseeobjectsarchivedwithinMOSAIQDataDirectoralongsidethosecontainedwithin
theEMR.YoucanalsoselectthesedataandsendthemtootherdevicesinstandardDICOM
formats.
MOSAIQDataDirectorgivesyoustandards‐based,fullfidelitystorageforallDICOM
InformationObjectDefinitions IODs ,includingDICOMRTandDICOMRTIon particle
therapy .Patient‐specificnon‐DICOMstoragesupportisalsoavailableforavarietyoffile
formats.Flexible,user‐definedstoragerulesmakethedataorganizationhighly
configurabletobestmeetyourneeds.
FormoreinformationseetheMOSAIQDataDirectorUserInterfaceGuide.
MOSAIQ Data Director Components
MOSAIQ Data Director
MOSAIQDataDirectoristhecoreproductdesignedtomanagethevolumeofoncology
dataandseamlesslyintegratewithMOSAIQ.MOSAIQDataDirectorrunsonadedicated
server orserversorcluster andmanagesDICOMandNon‐DICOM,ImageandNon‐Image
dataarchivalandretrievalfromsourceswithinandoutsideanoncologydepartment.The
installationengineerdoestheinitialMOSAIQDataDirectorconfigurationandthereare
manyuser‐configurableaspects.
MOSAIQ Browser
TheMOSAIQBrowerisaMicrosoftInternetExplorershellorskinwithonly
,
,
,and
.TheMOSAIQBrowserrunsMOSAIQDataDirectorandthe
EMRViewer.WorkstationsconfiguredtorunMOSAIQDataDirectorhaveadesktopicon
thatpointsattheMOSAIQBrowserandthewebaddressofMOSAIQDataDirector.Click
ViewintheMOSAIQArchivedObjectswindowtolaunchtheEMRViewerintheMOSAIQ
Browser.ClickManageDataintheMOSAIQArchivedObjectswindowtostartMOSAIQ
DataDirector.
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Standalone Workstation
YoucangetaMOSAIQBrowserdesktopshortcuticontoMOSAIQDataDirectoronanon‐
MOSAIQworkstation typicallyusedbytheSystemAdministrator,ITDepartment,etc.
responsibleformaintainingthesystem .ContactElektaifyouwantaccesstoMOSAIQ
DataDirectorfromanon‐MOSAIQworkstation.Standaloneworkstationsmusthave
MicrosoftInternetExplorerv6orhigherandMicrosoft.NETFramework2.0installed
priortoMOSAIQDataDirectorconfiguration.
DICOM Communication Module (DCM)
BeforetheinstallationengineerinstallsMOSAIQDataDirector,youmustconfigureall
DICOMsourcestosenddatatoDCM.TheinstallationengineercanconfigureDCMtoAuto‐
ForwardsomeorallofthisDICOMdatatoMOSAIQDataDirector.Theinstallation
engineerconfiguresDCMduringinstallationbutyoucanmakechangesafterthe
installation.Specifically,youcanchangetheIODfiltersthatspecifythetypeofDICOMdata
tobeAuto‐ForwardedtoMOSAIQDataDirector.
SeetheMOSAIQDICOMchapteronpage261forproceduresrelatingtoDCM.
MOSAIQ Data Director Configuration
MOSAIQ Data Director Related Staff Security Rights
System Utilities Security Modify Rights
You must have System Utilities | Security | Modify security rights to change
the MOSAIQ users’ security rights.
1. ClickFile|Directories|StaffDirectory…,selecttheuserwhoserightsyouwantto
changeandclickChangetoopentheStaffdialogbox.
2. ClickSecurityandontheAdmintab,verifythatSecurity:|ModifyintheSystem
Utilitiesgroupisselected.
Administrative General View Rights
To activate the Archived Objects buttons in MOSAIQ, you must have Admin |
Administrative | General: | View security rights.
1. ClickFile|Directories|StaffDirectory…,selecttheuserwhoserightsyouwantto
changeandclickChangetoopentheStaffdialogbox.
2. ClickSecurity,andthenverifyontheAdmintabthat atleast General:|Viewinthe
Administrativegroupisselected.
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DICOM Configuration Admin Rights
To modify DICOM Devices in MOSAIQ, you must have Image | DICOM |
DICOM Configuration | Admin security rights.
1. OpentheSecuritydialogbox,andthenselecttheImagetabtoopenit.
2. SelecttheDICOM|DICOMConfiguration:|Admincheckbox.
3. ClicktheOKbutton.
Department Level Configuration
YoucanclickArchivedObjectstoquerytheMOSAIQDataDirectordatabasefromMOSAIQ.
OncethequeryreturnsresultsyoucansendoneormoreseriestoaSendDestination.
FollowthestepsbelowtofillinthelistofSendDestinations.SeeNewDICOMDevicesas
DataReceiversinthissectionformoredetails.ThislistofdevicesshouldincludeMOSAIQ,
andotherdevicesthatcanreceiveandstoreDICOMobjects,suchasTreatmentPlanning
Systems.
Adding New DICOM Devices as Data Receivers
You must have Image | DICOM | DICOM Configuration: | Admin rights to
change DICOM Maintenance.
1. ClickFile|Import/Export|DICOMConfiguration|DICOMMaintenance…toopenthe
DICOMMaintenanceUtilitydialogbox.
The DICOM Maintenance Utility dialog box already has a list of configured
devices, completed as part of the MOSAIQ and MOSAIQ Data Director
configuration.
2. ClickAddtoopentheDICOMAEEditdialogboxandtypetheDICOMconnectivity
informationforyournewDICOMsource.
3. TypeadescriptivenameastheDeviceName,suchasNomosCorvusServer.TheHost
NamecanbeeitherthehostnameortheIPaddressoftheDICOMsource.TypetheAE
TitleandtheScanningPortasspecifiedbythedevicevendor.SelecttheDeviceActive
boxtoenablethedevice.
The Device Active check box lets you disable a device and retain the
configuration.
4. ClickSCPServiceList.
5. SelecttheVerificationandStoragecheckboxesintheSCPlist.Donotconfigureany
optionsintheSCUgroup.
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The SCP Storage option is reserved for DICOM devices that appear on the
Send Destination list.
5. ClickOKtosavechanges.
RepeatthisprocesstoenterDICOMconnectivityinformationforeachdeviceto
includeontheSendDestinationlistintheExportImagesdialogbox.
6. ForeachSendDestinationdevice,typeauser‐readable/recognizableDeviceName.
GettheHostName,AETitle,andScanningPortfromthedevicevendor’s
documentationandyoursite’snetworkadministrator.ClicktheDeviceActivecheck
boxtoenablethedevice.
7. DonotselectanyoptionsintheSCUgroup.SelectVerificationandStorageintheSCP
groupandclickExportFormats.Moveanyapplicableavailableformatstothe
supportedformatslistforthisDICOMSendDestinationdeviceandclickOK.
The Varian 4D Console interface requires the available Varian 4D related
formats. Storage devices configured with these formats will not appear on
the Send Destination list.
8. ClickCloseintheDICOMMaintenanceUtilitydialogboxafteryouconfigureallofthe
DICOMdevices.
MOSAIQ Data Director User Interface
Archived Objects Window
TheArchivedObjectswindowletstheclinicalsiteuseMOSAIQtoseeandexportimages
thathavebeensentdirectlytotheMOSAIQDataDirector.Thisletssitesstoreimagesin
theMOSAIQDataDirectoronaseparateserverandstillseethoseimagesintheMOSAIQ
application.
TheArchivedObjectswindowisthegraphicaluserinterfacebetweenMOSAIQ,the
Query/RetrieveServiceandMOSAIQDataDirector.
Opening the Archived Objects window applies only to MOSAIQ 2.20 as well as
the use of the EMR Viewer. For MOSAIQ 2.30, the Tools > Archived Objects
command opens the Images window/Images Pane toolbar, from which you can
open the RT Viewer instead of the EMR Viewer. For more information about the
RT Viewer, see the MOSAIQ Data Director - RT Viewer User's Guide.
ThereareseveralmeansbywhichyoucanopentheArchivedObjectswindowinMOSAIQ.

ToolsMenu

DiagnosisandInterventionsWindow

ImageListWindow

ShortcutIcononthetoolbar
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If the Archived Objects icon is not visible on the MOSAIQ toolbar, click the dropdown arrow at the far right of the toolbar to select it. Infrequently used toolbar
icons can become “hidden”.
Figure 96: Archive Object Selections
Adding the Shortcut Icon (Archived Objects)
TheArchivedObjectsshortcuticonisnotautomaticallyshownonthemaintoolbar.You
caneasilyaddthisicon.
1. LogontoMOSAIQ.
2. Right‐clickthetoolbar,thenselectCustomizetoopentheMOSAIQToolbarEditor.
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Figure 97: Customizing the Toolbar
3. IntheCategoriesgroup,selectAllCommands,andintheCommandsgroup,select
ArchivedObjects.
Figure 98: MOSAIQ Toolbar Editor
4. Left‐clickanddragtheArchivedObjectsitemtothemaintoolbar,preferablyonthe
leftsideoftheHelpicon,andthenreleasethemousebuttontoputtheiconatthe
placeofinterest.
Thereisaverticallinetohelppositiontheicononthetoolbar.
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Figure 99: Putting the Archived Objects icon on the Toolbar
5. MakesurethattheArchivedObjectsiconisshownonthetoolbar.
Figure 100: Archived Objects Icon on the Toolbar
6. ClickClose.
Study and Series Level Queries
SelectyourpatientandopentheArchivedObjects.MOSAIQautomaticallysendsaStudy
LevelandSeriesLevelQuery/Retrieve Q/R requesttoMOSAIQDataDirectorwhenyou
opentheArchivedObjectswindow.StudiesinMOSAIQDataDirectorforthepatientthat
arewithinthedesiredstudydaterangeappearasstudyfoldersintheArchivedObjects
window.Ifavailable,eachstudyishasaStudyDescriptionandStudyDate.Clickthe to
theleftofthestudythatyouwanttoopenthatstudyfolder.SeriesinMOSAIQData
Directorforthepatient,towhichthespecifiedSeriesModalityconstraintapplies,appear
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intheirexpandedstudyfolderintheArchivedObjectswindow.Ifavailable,eachseries
hasaSeriesDescription,SeriesDate,Modality,andSeriesNumber.
TheinitialdefaultQ/RStudyDateRangeisAll everystudyfromtheinceptionofthe
archivetothepresent .YoucanselecttheappropriateoptionbuttonintheArchive
Objectswindowtospecifyoneoftheotherpresetranges Today,LastWeek,orLast8
Weeks ormakeacustomrangeintheFromandTofields.ClickRefreshtosendtheQ/R
requestwiththenewdaterange.TheinitialdefaultQ/RSeriesModalityConstraintsetting
isALL.Click toselectoneoftheotherpresetconstraints modalitygroupingor
individualmodality .ClickRefreshtosendtheQ/Rrequestwiththenewselectionasthe
SeriesLevelQueryConstraint.MOSAIQremembersthelastselectedsettingforeachuser
anditbecomesthedefaultthenexttimethatuseropenstheArchivedObjectswindow.
If “No Series Found” appears instead of a list of series, set the Series Modality to
ALL and Refresh the Q/R request.
If “No Studies Found” appears instead of study folders, increase the size of the
Study Date Range and Refresh the Q/R request.
You can have 1 or more study folders open at a time. You can click the - to the
left of that study to close an open study folder.
Selecting a Site Configured DICON Send Destination
1. Click toselectasiteconfiguredDICOMSendDestinationfromtheavailableoptions
onthelist.
Whenyouhighlighteitheranentirestudyor1ormoreserieswithinastudy,theSend
DestinationSendbuttonbecomesactive.
2. ClickSendtosendacopy theoriginalremainsinplace oftheselectedseriestothat
SendDestination.
MOSAIQremembersthelastselectedsettingforeachuseranditbecomesthedefault
thenexttimethatuseropenstheArchivedObjectswindow.
RT Viewer (MOSAIQ 2.30 and Later)
TheviewerenablesvisualizationofradiotherapyplanningdatainDICOMRTformatusing
anymodernwebbrowser.Thereisnorequirementforplug‐insorothercustomsoftware
tobeinstalledontheclientworkstation.Currently,thefollowingDICOMobjectscanbe
rendered:

DICOMImagedata–CT,MRorPETimages.

RTStructureSets–contoursoutliningregionsofinterest.

RTPlans–beamorientationsandenergylevels.

RTDose–calculateddosein3Dpatientspace.

RTImages–beam’seyeviewreconstructionofscannedimagedata Digitally
ReconstructedRadiographs,orDRR .
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Opening a CT Planning Dataset in the RT Viewer
1. Selectapatient.
2. SelecttheCharticontoopentheChartWorkspace.
3. SelecttheDocuments&Imagestab.
4. IftheImagesPanedoesnotappear,click |ConfigureWorkspace...toopenthe
Chartwindowanddouble‐clickImageBrowsefromthelist.
Figure 101: Opening the Images Pane
MOSAIQopenstheImagesPanetoolbaratthetopoftheImageswindow.
Figure 102: Images Pane Toolbar
5. Ifyoudonotseeimagetypesthathaveagreycolorforitsrowentry,makesurethat
youhavequeriedpatientdatafromMDD.
5a. OntheImagesPanetoolbar,clickFilterstoopentheImageFilterdialogbox.
5b.IntheMOSAIQDataDirectorarea,makesurethattheSearchMOSAIQDataDirector
andtheFilterDuplicatescheckboxesareselected.
5c. IntheTypeareamakesurethattheMedicalcheckboxandtheapplicabletreecheck
boxesareselected.
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Figure 103: Configuring Image Filters for MDD
6. ClickOKtoreturnbacktotheImageswindowandImagesPanetoolbar.
7. ScrolltoanimageType,suchasCT,thathasagreycolor butnotdarkgrey .
Figure 104: Selecting a CT Reference Dataset for a Patient
8. Double‐clicktheapplicableReferenceCTplanningdatasettoopenitintheRTViewer.
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Figure 105: Opening the RT Viewer from MOSAIQ
MOSAIQopenstheDataDirectorRTViewerwindow.Therearenowtwoseparate
windowsfortheMOSAIQapplicationandtheMOSAIQBrowser RTViewer .
Figure 106: RT Viewer Browser (MOSAIQ Browser)
Figure 107: MOSAIQ Data Director RT Viewer Window
For more information, see the MOSAIQ Data Director RT Viewer User's
Guide.
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EMR Viewer (MOSAIQ 2.20 and earlier)
In addition to the EMR Viewer, there is an RT Viewer where you can inspect
images, dose display and structures, for example.
For MOSAIQ 2.30, the Tools > Archived Objects command opens the Images
window/Images Pane toolbar, from which you can open the RT Viewer instead
of the EMR Viewer. For more information about the RT Viewer, see the MOSAIQ
Data Director - RT Viewer User's Guide.
View
WhenyouselectasinglestudyorasingleimageserieswithinastudyintheArchived
Objectswindow,theViewbuttonbecomesactive.ClickViewtoopenaMOSAIQBrowser
basedEMRViewer.TheindependentEMRViewerletsyouviewthecurrentpatientimages
anddocumentsinMOSAIQDataDirectorwithintheMOSAIQworkflow.
TheMOSAIQBrowserisalimitedversionofInternetExplorer.Fromabrowser
perspective,onlytheBack,Forward,Stop,andRefreshbuttonsareavailable.Noother
functionalityisavailable.
You can only use the EMR Viewer to see image series. The View button is
disabled when you select a non-image series, such as RT Plan, RT Dose, and RT
Structure Set.
TheEMRViewerautomaticallyshowsthumbnailsoftheselectedimageseries.Youcan
click totheleftofthedescriptiontoshowthumbnailsofadditionalimageseries.Click tohidethethumbnailsforthatseries.
If you select a study that contains 1 or more image series, the EMR Viewer
automatically shows the thumbnails for each image series.
Youcanbrowsethroughthethumbnailswiththescrollbartoseeadditionalimages
withintheseries.Youcanalsoclickathumbnailtoshowalarger,reviewonly non‐
diagnostic image.
IftheAdditionalStudieslistisavailable,youcanalsoswitchtooneoftheotherpatient
studies ifpresent .Thisletsyoureviewanyimageseriesitmaycontainandnotgoback
totheArchivedObjectswindow.
FromtheSingleImageView,youcanexpandorcontractadditionalpatientinformation
with and ,respectively.Youcanbrowsethroughtheimagesintheserieswiththescroll
barorgodirectlytoaparticularimage.YoucanalsoshowaSlideShow cinemode ofthe
imagesataFast,Medium,orSlowspeed.Click
imagealongwithbasicpatientinformation.
The
buttonsjusttotheleftofthe
nextimageseries,respectively.Click
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toopenaseparatewindowtoprintthe
buttonletyoubrowsetothepreviousor
toreturntothethumbnailview.
293
ThecorrespondingStudyandPatientLevelnon‐DICOMdocumentsstoredinMOSAIQData
Director ifavailableandconfiguredforviewing appearlistedbelowtheimageseries
foldersintheEMRViewerThumbnailView.MOSAIQDataDirectorcanstoreavarietyof
non‐DICOMfileformats,includingBMP,JPEG,PDF,TIFF,TXT,DOC,ZIP.Clickeitherthe
filenameortheicontoitslefttoopenorsavethedocument.
The application required to open a given file format (Microsoft Word for DOC
files, Adobe Reader for PDF files, and so on) must be installed and available on
the client workstation.
The MOSAIQ Data Director can store Non-DICOM documents.
YoucanstorefilesthatyouimportfromyourTreatmentPlanningSysteminthe
supportedformats.MOSAIQDataDirectorautomaticallyimportsandstoressinglepatient
TARfilescreatedbyPinnacle™TreatmentPlanningSystems.
Manage Data
TheManageDatabuttonintheMOSAIQArchivedObjectswindowstartsMOSAIQData
DirectorwithinaMOSAIQBrowser.MOSAIQDataDirectorrunsasaseparateapplication
independentofMOSAIQ.
When you start MOSAIQ Data Director from MOSAIQ, it shares the MOSAIQ Data
Director login. The current user gets their functional access based on their
configured Level 1-4 or named account setting.
Theavailabilityofthefollowingmenuoptionsdependsonthedepartment‐specifiedand
userconfiguredMOSAIQDataDirectorsecurityrightsforagivenuser.
Typically,someoralloftheMainmenuoptionsareavailabletoadvancedMOSAIQusers.
TheToolsandSetupmenuoptionsareusuallyfortheSystemAdministrator.
View Log
TheViewLogbuttonintheArchivedObjectswindowletsyoureviewthehistoryofthe
StudyandSeriesQ/RandtheSendDestinationFind/Moverequestsmadeforthecurrent
patient.YoucanseetheDate/TimeStamp,OperationRequested,StudyorSeries
Description/Identifier asapplicable ,SendDestination asapplicable andthe
Operation’sSuccessorFailureStatuses.
TheViewLogbuttonbecomestheCloseLogbuttonwhilethelogisexpandedforreview.
ClickCloseLogtocollapse/hidethelog.
Retrieving Archived Images with MOSAIQ Restore
TheMOSAIQRestorefeatureintegrateswiththeMOSAIQArchivefeature.Youmusthave
archivedimagesinMOSAIQDataDirectortoputtheminthelocalMOSAIQdatabase.With
MOSAIQRestore,youimportthemedicalimagesforapatientfromMOSAIQDataDirector.
Then,MOSAIQre‐attachestheimagestotheinitialpatientrecordinMOSAIQ.Then,you
canusetheimages.Forexample,whenapatientgoesfora6monthfollow‐up,the
physicianexaminestheCTimagesfromthelasttreatment.Thephysiciancanimmediately
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retrievetheCTimagesfromMOSAIQDataDirector.Ifnecessary,thephysiciancanseethe
CTimagesfromallMOSAIQworkstationsthatareconnectedtotheclinicalnetwork.
AfterMOSAIQstartstherestoreprocess,itcontinueswithoutyourinterventionand
operatesindependently.
MOSAIQ restore You can restore only medical images in DICOM format. After
you restore the images, they are not eligible for re-archiving for a minimum of
30 days (or the number that your system administrator sets).
Check for Eligible Patients
Thefirststepintherestoreprocedureistomakesurethatyouknowwhichpatientshave
medicalimagesthatareeligibleforretrieval.
WhenyouopentheRestoreWorklistwindowforthefirsttime,thedefaultpatientsare
shown.Atableshowstheeligiblepatientsinalist.Youcanfilterandsortthepatientlistto
findotherpatientsthatareeligible.
Youcanusethefiltersthatfollow:attendingphysician,medicaldepartment,orselection
statusofapatient forexample,whetherapatientrecordisactiveorinactive .Also,the
RestoreWorklistwindowcansortbythepatientname,dateofbirth,socialsecurity
number SSN ,ormedicalrecordnumber.
Toseewhichpatientsareeligible,dothestepsintheproceduresthatfollow.
Opening the Restore Worklist Window
1. ClickFile|Import/Export|DICOMArchive/Restore|RestoreUtilitytoopenthe
RestoreWorklistwindow.Atableshowstheeligiblepatients.
All of the patients that are shown in the table have archived images.
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Filtering Patients in the Restore Worklist Window
1. Ontherightsideofthepane,intheFilterBy:group,click adjacenttotheAttending
MDfieldtoselecttheattendingphysicianwhoisrequestingtheretrievalofthe
medicalimages.
If you are logged on as the attending physician, the Attending MD field
shows your name.
2. AtthebottomoftheFilterBy:group,clickRefreshtoupdatethetable.
3. Ifyouwanttoselectallattendingphysicians,cleartheAttendingMDfieldandclick
Refresh.
4. IntheFilterBy:group,click adjacenttotheDepartmentfield,andthenselectthe
clinicaldepartmentinwhichyouortheattendingphysicianworks.
To select all departments, in the Department field, select Global then click
Refresh.
5. ClickRefreshtoupdatethetable.
6. Doyouwanttosetthefiltertoshowallclinicalstatuses?

Ifyes,belowthePatientClinicalStatusfield,clickAll.ClickRefreshtoupdate
thetable.
Ifno,belowthePatientClinicalStatusfield,clickOne.Click adjacenttoOne,and
thenselecttheapplicableclinicalstatus.ClickRefreshtoupdatethetable.
After you select a one clinical status, the Patient Selection Status field shows
the clinical status as opposed to a blank box.
7. Doyouwanttosetthefiltertoshowallpatientselectionstatuses?
296

Ifyes,belowthePatientSelectionStatusfield,clickAll.ClickRefreshtoupdatethe
table.

Ifno,belowthePatientSelectionStatusfield,clickOne.Click adjacenttothe
Onebutton,andthenselecttheapplicablepatientstatus.ClickRefreshtoupdate
thetable.
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Sorting Patients in the Restore Worklist
1. IntheSortbygroup,selectoneoftheitemsthatfollows:patientname Name ,social
securitynumber SSN ,anddateofbirth DOB ,forexample.
The Sort by group is found at the bottom, right side of the pane, below the
Refresh button.
Thetablesortsthepatientsautomatically.YoudonothavetoclickRefreshtoupdate
thetable.
The sort selection is kept as a user preference for the subsequent time that
you open the Restore Worklist window.
Selecting Patients
Thesecondstepintherestoreprocedureistoselectpatientstoputtheirimagesintothe
restoreutilityforfinalprocessingandrestoreselection.
1. ClickFile|Import/Export|DICOMArchive/Restore|RestoreUtilitytoopenthe
RestoreWorklistwindow.
MOSAIQ shows a list of eligible, archived images.
2. Inthetable,tagtheapplicablepatientorpatients.
3. Inthetop,rightofthepane,clickSelecttomaketheimagesavailableintheRestore
Utilitywindow.
MOSAIQopenstheRestoreUtilitywindowandputstheimagesinatable.
Putting Images into the Restore Queue
Thethirdstepintherestoreprocedureistoputimagesintotherestorequeue.Youcan
putimagesintothequeuethroughtheRestoreUtilitywindow.Thefiltersandsortingin
thewindowletsyoufirstnarrowdownthelistofimages.
TheRestoreUtilitywindowhasaRestoreImagestab.Thetabshowsatableofimagesfor
eachpatient.Youcansorttheimages.Tosorttheimages,youdragcolumnheaderstoa
rectangulararea,orGroupByBox.Also,youcanusethefiltersthatfollow:thetypeof
image forexample,CTorMR ,orarangeofdateswhentheimagewasmadeintheclinic.
Toputimagesintotherestorequeue,dothestepsintheproceduresthatfollow.
Opening the Restore Utility Window
1. Dooneofthestepsthatfollow.

ClickFile|Import/Export|DICOMArchive/Restore|RestoreQueue,andthen
clicktheRestoreImagestabtoopentheRestoreUtilitywindow.
OR
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
IntheRestoreWorklistwindow describedinthepreviousprocedure ,select
apatient,andthenclickSelecttoopentheRestoreUtilitywindow.
2. IntheRestoreUtilitywindow,clicktheRestoreImagestab,ifitisnotalreadyselected.
MOSAIQopenstheRestoreUtilitywindow,asshowninFigure108.
Restore Images tab
Drag column headers to the
Group By Box to set up a
group for sorting images.
Click the Restore button to put
the images into the queue for
processing.
Column
header
Click the
Refresh button
to update the
table.
Figure 108: Restore Utility Window (Restore Images Tab)
Sorting Images in the Restore Utility Window
1. Right‐clickonacolumnheader,andthenselectGroupByBoxtoopenorcloseit.
The Group By Box is found at the top of the pane, above the column
headers. By default, it is open.
The column headers are found directly below the Group By Box.
ThepaneopensorclosestheGroupbyBoxaccordingly.
2. Fromthecolumnheaderrow,dragacolumnheadertoaddittotheGroupByBox.For
example,dragthePatientNamecolumnheadertotheGroupByBox.
Thepaneremovesthecolumnheaderfromtherow.Thetablesubsequentlysortsthe
images.
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3. IntheGroupByBox,right‐clickacolumnheading,andthenselectUnGrouptoremove
itfromtheGroupbyBox.
You can also drag a column header back into its initial position to remove it
from the Group By Box.
Thetablere‐sortstheimages.
4. IntheGroupbyBox,clickagrouptochangethesorttoanascendingordescending
sequence.
In the Group By Box, there is an arrow on each group (column heading). An
up arrow shows an ascending sequence, and a down arrow shows a
descending one. For example, if there is an up arrow on the Patient Name
group, then the table sorts the patient, in an ascending sequence.
Clearing the Sorting
1. Right‐clicktheGroupbyBox,andthenselectClearGroupingtoclearthegroupfrom
theGroupByBox.
ThepanekeepstheGroupByBoxopenandputsallcolumnheadersbackintothe
headerrow.Thetableclearsthesortingoftheimages.
Filtering Images in the Restore Images Tab
1. ClicktheRestoreImagestabtomakesurethattheDICOMImageRestorepaneis
opened.
2. Ontherightsideofthepane,intheFilters:group,click adjacenttotheImageType
fieldtoopenthedrop‐downlist.
3. Selectoneormorecheckboxes,andthenclick againtosetthetypesofmedical
images.
4. IntheFilters:group,clicktheStudyDateRangecheckboxadjacenttotheImageAge
field.
TheFromandTofieldsbecomeavailableforselection.
5. Click adjacenttotheFromfieldtoopenthecalendar.
6. Setthestartdate.
7. Click adjacenttotheTofieldtoopenthecalendar.
8. Settheenddate.
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If you do not set a correct range of study dates, MOSAIQ shows an “Invalid
Date Range” message. An example is when the start date occurs after the
end date.
10. IntheRTPlanRestoreoptionsgroup,MarktheRestoreRTPlanandrelatedobjects
fieldtoseeRTplans.
Expanding or Closing the Table
1. ClicktheRestoreImagestabtomakesurethattheRestoretabisopen.
2. Makesurethatyousetagroupforsorting.
For more information, see the “Sorting Images in the Restore Utility
Window” procedure on page 298.
3. Dooneofthethreeproceduresthatfollowtoexpandorclosethetable:

Right‐clickontheGroupbyBox,andthenclickFullExpandorFullCollapse.

IntheDisplayOptionsfield,foundinthebottomrightcornerofthepane,
selecttheExpandcheckboxoragaintoclearit.
Make sure that you have set up a minimum of one group for sorting to
correctly use the Expand check box. Without a specified group, you cannot
expand the table.
OR

Ontheleftsideofanimage,clicktheplussigntoexpanditortheminussign
tocloseit.
Setting the Query Threshold
1. ClicktheRestoreImagestab.
2. Dothestepsthatfollow.
a..IntheQueryResultsThresholdfield,foundatthebottom,rightcorner,clicktheup
ordownarrowstosetthevalue.
The default value is 50,000. The maximum number is 150,000.
b.ClickRefreshtoupdatethetable.
Thetableshowstheimagesifthenumberislessthanthethresholdvalue.Ifitismore,
amessagetellsyoutomakeadecision.Ifitisnecessarytotruncatethedisplay,accept
themessagetotruncatethedisplaytothequerythreshold.
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MOSAIQ truncates the display, but images of a specified patient are always
kept together to prevent a division of the images.
Selecting Images
2. Dooneofthestepsthatfollow.

Clickoneimage.

Clickthefirstapplicableimage,andthenpressCTRL clickotherimagesto
selectmultiple,non‐sequentialimages.

Clickanimage,andthenpressCTRL Atoselectallimagesinthetable.

IntheDisplayOptionsfield,clicktheSelectAllcheckboxtoselectallimages
inthetable.
OR
Thetableshowstheselectedimages,whicharehighlightedinalight‐bluecolor.
3. ClickRefreshtoclearallselectedimagesinthetable,orcleartheSelectAllcheckbox.
To select images again, refer to step 2.
Putting Images into the Restore Queue
2. Clickoneormoreimagestorestore.
3. ClickRestore,foundinthetoprightcornerofthepane,andthenwaitforafew
minutes.
MOSAIQputstheimagesintherestorequeueandstartsprocessingtheimages.
4. ClickClose,foundinthetoprightcornerofthepane,toclosetheRestoreUtility
Window,ifdesired.
If you close the window too early, then MOSAIQ displays a message that tells
you to make a decision. Click Yes to stop the queuing. Otherwise, click No to
keep the window open and continue the queuing.
5. ContinuetotheManagingtheRestoreQueueonpage302toseeiftherestoreprocess
completedsuccessfully.
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Putting Images into the Restore Queue (Using Image Lists)
1. InthemainMOSAIQwindow,selectapatientofinterest.
2. ClickeChart|ImagestoopentheImageListwindow.
3. FindapatientrecordthathasanAintheStatusfield.
4. SelectapatientrecordasshowninFigure109.
Figure 109: Image List Window
5. Ontherightsideofthewindow,clickRestore.
MOSAIQsendsthetaggedimagetotherestorequeue.MOSAIQdoesnotopenany
windows.MOSAIQonlyaddstheimageorimagestotheRestoreQueue.
6. ContinuetotheManagingtheRestoreQueueonpage302toseeiftherestoreprocess
completedsuccessfully.
Managing the Restore Queue
YouworkintheRestoreUtilitywindow,specificallywithintheManageQueuetab,to
managetherestoreprocess.
Opening the Manage Queue Pane
1. ClickFile|Import/Export|DICOMArchive/Restore|RestoreQueuetoopenthe
RestoreUtilitywindow.
Sorting Images
Formoreinformation,seethe“SortingImagesintheRestoreUtilityWindow”procedure
onpage298.
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Doing a Check of the Restore Progress
For all filters, the selection that you make is saved as a user preference for the
next time that you open the Manage Queue pane.
1. OntherightsideoftheManageQueuepane,intheQueueSettingsgroup,click adjacenttotheJobStatefieldtoopenthejobstatelist.
2. Inthejobstatelist,selectoneormorejobstates:Queued,InProgress,Cancelled,
andFail.Click againtoclosethelist.
3. AbovetheQueueSettingsgroup,clickRefreshtoupdatetheimagestodoacheckof
theirstatusintherestoreprocess.
Removing an Image from the Restore Queue
1. Selecttheapplicableimageorimages.
2. ClickRemove,foundinthetop,rightcornerofthepane.
3. ClickRefresh,foundintop,rightcornerofthepane.
MOSAIQremovestheimageorimagesfromtherestorequeue.
Expanding the Table
Formoreinformation,see“ExpandingtheTable”onpage303.
Retrieving an Image that Failed
1. ClicktheupordownarrowsadjacenttotheMaximumRetriesfieldtosetthe
maximumnumberoftriesthatMOSAIQmakestoretrieveanimage.
Thedefaultvalueis3.
2. ClickRefresh,foundinthetoprightcornerofthepane,toupdatethetable.
3. Selectoneormoreimagesthatfailedduringtherestoreprocess.
4. ClickRetrytoletMOSAIQtrytoretrievethefailedimages.
Setting the Query Threshold
Formoreinformation,seethe“SettingtheQueryThreshold”procedureonpage300.
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CHAPTER 8: SEQUENCER
SEQUENCERistheVerifyandRecordfeatureofMOSAIQ,that:

Makessurethatthetreatmentmachineissetupasspecifiedintheprescription,the
geometricvaluesarelessthantolerances,andthenecessaryaccessoriesarein
place.

Sendsthetreatmentfieldtothetreatmentmachine.

Makessurethatthetreatmentmachineisinthecorrectmodebeforeyoucanbeam‐
on.

Letsyourecordtreatmentsintheelectronicmedicalrecord EMR .
If you use the Varian 4D Integrated Treatment Console (ITC) interface,
TrueBeam™ interface, or the Siemens syngo interface, then SEQUENCER only
records the geometric machine and treatment data and images. These
interfaces do not verify the treatment delivery.
The MHI-TM2000/Vero interface only coordinates the plan selection and
recording of the geometric machine and treatment data. This interface does not
use the plan from MOSAIQ.
See Following the Passive Plan Interface Workflow for these interfaces.
SEQUENCER Configuration
AtypicalradiotherapydepartmentconfigurationincludesoneSEQUENCERworkstationfor
eachtreatmentmachine.TherapistsusetheSEQUENCERworkstationto:

Selectapatientfortreatment.

Sendtheprescriptionparameterstothemachine.

Recordimagingandtreatments.

Verifythetreatmentdelivery.
Ifyourdepartmentuses:

RemoteTreatmentRoom,useSEQUENCERwhileyousetuppatientsintheroom.

Barcodes,useSEQUENCERtoscanapatientandaccessorybarcodes.
Virtual Machine Interface
AVirtualMachineInterface VMI ,withtheinitialization .ini andconfiguration .cfg files,
letsSEQUENCERcommunicatewiththetreatmentmachine.ElektahasaVMIforeach
treatmentmachinetype.
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Security Requirements
You must have Clinical | Tx Delivery | Modify security rights to verify and
record delivered treatments with SEQUENCER.
You must have Approve security rights to approve treatment delivery
information and override out-of-tolerance parameters (you must have
Clinical | General | Approve security rights to go into standby mode),
approve machine characterizations, and complete a partial field delivery.
Inbound Tx Checks and Approvals
SetthenecessaryapprovalsintheInboundTxChecksgroupontheClinical RO tabin
DepartmentSetup.MOSAIQtellsyouwhenanapprovalisnecessarytocontinue.
Table 39: Inbound Tx Checks Group Descriptions
Field
Description
Require Rx Approval
for Treatment (check
box)
Selectsoradiationtreatmentprescriptionsmustbeapproved
beforeMOSAIQpermitstreatment.
Require Field
Approval for
Treatment (check
box)
Selectsoradiationtreatmentfieldsmustbeapprovedbefore
MOSAIQpermitstreatment
Require Session
Approval for
Treatment (check
box)
Selectsoradiationtreatmentsessions mustbeapproved
beforeMOSAIQpermitstreatment.
MOSAIQ interprets all treatments delivered within three hours of the first treatment in
any given session as part of the same session. Also, if a portal image has no associated
treatment field, MOSAIQ makes a chart entry, but the session number is not
incremented.
Require Plan
Approval for
Treatment (check
box)
Selectsoradiationtreatmentplansmustbeapprovedbefore
MOSAIQpermitstreatment.
Require Calibration
Approval for NonParticle Treatment
(check box)
Selectsoradiationtreatmentcalibrationmustbeapprovedbefore
MOSAIQpermitstreatmentfornon‐particlefields,like
conventional,kVortho,ordocument‐basedtreatmentfields.
Require Calibration
Approval for Particle
Selectsoradiationtreatmentcalibrationmustbeapprovedbefore
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Field
Description
Treatment (check
box)
MOSAIQpermitstreatmentorparticlefields.
Portal Image Check
(check box)
SelecttoactivateanalertthatappearsbeforeMOSAIQopensa
treatmentfieldordeliversatreatmentiftheportalimagewasnot
reviewedorifaphysicianrejectedtheportalimage.Thisonly
appliesifyourdepartmenthasImageManagementregistered.
Dose Tracking Check
(check box)
Selecttoshowdosecheckwarnings.Thesewarningsappear
wheneveryouselectafieldfortreatmentthatwillnotcontribute
dosetotheprescriptionsiteoritisnotassociatedwitha
prescriptionsite.
Thewarningmessagesareasfollows:

Treatmentfielddoseiszero.Doyouwanttotreatthefield
withnodosedefined?

Treatmentfieldisnotassociatedwithprescriptionsite.
Continue?

Adosesitecoefficienthaseithernotbeendefinedorsetup
sothatthetreatmentofthisfieldwillnotcontributeany
dosetotheprescriptionsite.Continue?
SeePre‐TreatmentWarnings inAppendixB.
Field Change
Selecttoshowawarningmessageifafieldwaschangedsincethe
Warnings (check box) lasttimethepatientwastreated.Ifselectedandafieldwas
changed,the"Thisfieldhaschangedsincethelasttreatment.Do
youwishtoviewthedetails?”messageappearsbeforethe
TreatmentDeliveryTableopens.ClickYestoopentheFieldDelta
dialogbox.ClickNotocontinuetreatment.Thisdoesnotapplyto
QAModetreatments.
MOSAIQhasthischeck boxselectedbydefault.
Dose Action Setting
Typethedefaultdoseamountpriortoaspecifieddoseaction
pointatwhichyouwantMOSAIQtoalertyouthatadoseactionis
necessary.Thedoseamountyoutypebecomesanapproximate
notificationtime.Forexample,theaveragefractionaldosefora
fieldis200cGy.Youwant2‐3daysnoticebeforeyougettothe
doseactionpoint,soyoutype500inthisfield.Amessagewill
appeartotellyouthatyouarewithin500cGyofthespecified
doseactionpoint.
Total Dose Tolerance Typethetotaldosetolerance.Thishelpstopreventdelivering
morethantheprescribeddose.MOSAIQtellsyouwhenthe
calculateddoseplusthefielddose minusthevalueinthetotal
dosetolerancefield isgreaterthantheprescribedtotaldose.See
WarningMessageswhenPerformingTasksinMOSAIQ.
Fractional Dose
306
Typeafractionaldosetolerancevaluetopreventdeviationsfrom
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Field
Description
Tolerance
theprescribedfractionaldose.MOSAIQtellsyouwhentheactual
dosedeliveredduringatreatmentsessionplustheprojected
additionalfractionaldosedoesnotequaltheprescribedfractional
dose.MOSAIQalsotellsyouwhentheactualdoseplusthe
projectedadditionalfractionaldoseisgreaterthanthetolerance
valuethatyouspecified.SeeWarningMessageswhenPerforming
TasksinMOSAIQ.
QA Mode
You must have Clinical | QA/Calibration | Modify security rights to enter QA
mode.
Thepre‐treatmentQualityAssurance QA modeletsyouvalidateatreatmentplan.QA
modedoesnotadddoseorfractionstothepatientrecord.
StartQAModeto:

Delivertreatmentswithoutthepatientpresenttochecktheplan.

Takeportalimages.

Runreports.
SeeSchedulingaQAModeTreatmentSession.
Setting the Calibration Status Requirement
QualityAssurancemayberequiredbeforethetreatmentisallowed.FieldCalibrationgives
anadditionalapprovaltoshowrequiredQAwascompleted.Whenacalibrationapprovalis
required,thecalibrationapprovalstatusischeckedatthetimeoftreatmentdelivery.
You must have Clinical | QA/Calibration | Approve security rights to assign
treatment field calibration status.
If the treatment field is not approved, you must have Clinical | Field Defs |
Modify rights to use this option. If the treatment field is approved, you must
have Clinical | Field Defs | Approve rights to use this option.
Setthecalibrationapprovalrequiredfor:

Conventional,non‐particletherapytreatmentdelivery.

Particletherapytreatmentdelivery.
YoumustberegisteredforProtonsparticletherapytreatmentdelivery.
2. InDepartmentSetup,clicktheClinical RO tabandselectwhichtreatmentswillrequire
calibration QA beforethetreatment:
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
ClickRequireCalibrationApprovalforNon‐particleTreatment.
 ClickRequireCalibrationApprovalforParticleTreatment.
Thisoptiononlyappearsifyouareregisteredforprotontreatmentdelivery.
3. ClickOK.
Figure 110: Require Calibration Approval for Treatment Check Box
Changing the Calibration Status
Changeandapprovethecalibration QA statusfortreatmentfieldsfromtheTreatment
FieldDefinition.
1. OpenthepatientchartandclickeChart|DiagnosesandInterventions.
2. InDiagnosesandInterventions,double‐clicktheapplicabletreatmentfield.
3. Right‐clickintheTreatmentFieldDefinition,andselectCalibrationStatus,or
.
click
Figure 111: Calibration Status Window
4. SelectaNewStatus.
5. TypeyourUserNameandPasswordandclickOK.
Selecting a Patient for Treatment
OpentheTreatmentChartfromtheeChartmenuortheLocationSchedulewindow.
1. Ifthemachinelocationsdonotappearautomatically,clickSchedule|Locationtoopen
theLocationSchedule.
2. Click
adjacenttotheLocationfield.
3. Double‐clickyourtreatmentmachinetoshowthetreatmentmachinelocation.
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Thislocationshowsyoutheappointments.Usuallythepatientsscheduledfortreatment
onagivendayappearontheschedule.YoucanconfigureeCharttoautomaticallyqueue
patientsfortreatmentwhentheyarrive.Ifnot,youcanqueuepatientsmanually.
You can scan a patient barcode to select a patient. Identify the photograph
of the patient to make sure that the correct patient is selected.
4. Selecttheappointmentandright‐click,orpressF4.
5. IntheLocationScheduleoptionsmenu,clickChart/CapturetoopentheTreatment
Chart.
TheTreatmentChartshowsthetreatmentfieldsthataredefinedintheTreatment
Calendar.Italsoletsyouscheduleportalimagesandmore.
6. SelecttheTreatmentCalendarsessiontobetreated.
7. ClickTreatontheTreatmentCharttoopentheTreatmentDeliverywindow.
Treatment Readiness Check
SEQUENCERdoespre‐treatmentcheckswhenyouselectafieldfortreatmentbeforeitopens
theTreatmentDeliveryTable.IfSEQUENCERfindsprescriptionsiteortreatmentfield
problems,thentheTreatmentReadinessCheckopens.Youmustcorrect,acknowledge,or
overridethehighlightedtreatmentfieldproblembeforeyoucantreat.
You must have Clinical | Field Defs | Approve and Clinical | Tx Delivery |
Approve security rights to override parameters in the Treatment Readiness
Check.
FollowtheinstructionsintheTreatmentReadinessCheck.
Ifthehighlightcolorisyelloworgreen,youcanContinue.Ifthehighlightcolorisred,you
mustoverrideorchangeanyfieldforwhichSEQUENCERpreventedtreatment.Youcan
Continueafteryouoverride.
Forsometreatmentmachines forexample,Varian4DITC,TrueBeam,Siemenssyngo ,
SEQUENCERmakesanoutboundcheckafteryouclickSendPlanfromtheTreatment
DeliveryTable.Thisistomakesurethatanychangesyoumake suchaschangeorhide
fields donotcauseadditionalproblems.
Pre-Treatment Warnings
SEQUENCERmakesaseriesofchecksafteryouclickTreat.SEQUENCERalsoinformsyou
whenachangehasbeenmadetoafieldsincethelasttreatmentifyouselectedFieldChange
WarningsinDepartmentSetup.
Field Sequencing Verification
TheTreatmentReadinessCheckdoesthesamevalidationsastheTreatmentCalendar.If
MOSAIQfindsCFS ConsolidatedFieldSequencing errorsduringthestandardTreatment
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ReadinessCheck,thenthetreatmentdeliverywithaCFSoranAFS AutomaticField
Sequencing sessionisprevented.
YoumusttreatthefieldsontheTreatmentCalendarseparately.Acknowledgewarningsor
overrideparametersasnotedbytheTreatmentReadinessChecktodelivertreatment.You
canstoptheCFSsessiontoacknowledgeoroverrideerrors.
AvalidCFSmustincludethefollowing:

Allfieldsmusthavethesametreatmentmachine.

AllfieldsmustbeofTypeStaticorStepNShoot.

AllfieldsmustbeofModalityX‐Rays.

AllfieldsmusthaveanMLCdefined.

Nofieldsmayhaveaphysicalwedge.

Nofieldsmayhavethetext“CUSTOM”forcompensator,block,orbolus.

Allfieldsmusthavethesamedefinedtextintheblockcode,ifablockcodeis
presentinanyofthefields.

Allfieldsmusthavethesamedefinedtextintheboluscode,ifaboluscodeis
presentinanyofthefields.

Allfieldsmusthavethesamedefinedtextinthecompensatorcode,ifa
compensatorcodeispresentinanyofthefields.

Allfieldsmusthavethesamecouchpositionsorbewithin /‐1mmtoleranceofthe
firstfieldinthesession.

Allflatteningfilterfree FFF energyorallnon‐FFFenergyfields.
MOSAIQ uses only Asymmetric jaw modes for all the treatment fields in a
CFS. Do a QA Mode session for CFS to make sure that all the components of
the CFS delivery are correct.
TheCFSsequencemaypassinitialTreatmentCalendarCFSchecks.However,oneormore
fieldsintheCFSsessionmaynotpassmoretreatmentreadinesschecks.Repairoutstanding
errorduringthesessionorskipthoseunresolvederrorstotreattheeligiblefields
separately.
Viewing the Verification Image Status
Whenyouopenatreatmentsession,MOSAIQdoesapre‐treatmentcheckoftheverification
imagesforthetreatmentsessionforthepatient.Theverificationimagesappearinthe
VerificationImageStatuslist.Iftherearenoverificationimagesthatmustbechecked,the
VerificationImageStatusdoesnotappear.
1. ClicktheimagetochangethenclickReviewtoopentheImageReviewwindow.
2. ClickOKorCanceltoopentheVerifiedTreatmentwindow.
Treatment Delivery Table
TheTreatmentDeliveryTableshowsthetreatmentfieldsthatareavailablefortreatment.
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You must have Clinical | Tx Delivery | View security rights to view the
Treatment Delivery Table.
You must have Modify security rights to treat.
You must have Approve security rights to approve treatment delivery
information, complete partial treatments, and override out of tolerance
parameters.
You must have Clinical | General | Approve security rights to start standby
mode.
TreatmentfieldsappearinthesequenceyouconfiguredontheTreatmentCalendar,the
TreatmentOrderyouset,orastheyappearintheDiagnosesandInterventions.SeeUsing
theTreatmentCalendar.
Youcannotchangeanyoftheinformationthatappears.Iftheinformationisincorrect,
changethatinformationatthepointoforigin.
Examining Field Delta Change Warnings
TheFieldDeltaopensautomaticallywhenyouchangeatreatmentfield.IftheFieldChange
WarningscheckboxinDepartmentSetupisselected default ,thenafieldchangemessage
appearstellingyouthatthetreatmentfieldwaschangedsincethelasttreatment.
1. ClickYeswhenthefieldchangewarningmessageappears.
TheFieldDeltadialogboxappears.
2. Examinethefieldchanges,andthenclickReturntocontinuewiththetreatment.
Logging on a Secondary Therapist
Whenmorethanonetherapistworksonatreatmentmachine,logonthesecondtherapist.
MOSAIQrecordsthesecondtherapistuserinitialswiththoseoftheprimarytherapistuntil
theprimarytherapistlogsoutofMOSAIQ,oryouclickSecondaryTherapistLogoutonthe
optionsmenu.Theinitialsofthesecondarytherapistappearinthelowerrightcornerofthe
MOSAIQscreen.
1. Right‐clickorpressF4intheTreatmentDeliveryTable.
2. ClickSecondaryTherapistLogin.
3. TypetheuserNameandPasswordofthesecondarytherapistandclickOK.
MOSAIQrecordstheinitialsofthesecondtherapistforalltreatmentsuntiltheprimary
therapistlogsoutofMOSAIQoryouclickSecondaryTherapistLogoutontheoptions
menu.Theinitialsofthesecondarytherapistalsoappearinthelowerrightcornerofthe
MOSAIQscreen.
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Treatment Order
Whenyoustarttotreatthepatient,youcanchangetheorderofthefieldsifnecessary.Your
treatmentmachinemayhavelimitationswithregardtothetreatmentfieldorder.See
ChangingtheTreatmentOrderintheTreatmentSession.
Hiding a Treatment Field
YoucanhidetreatmentfieldsintheTreatmentDeliveryTable.Thisisusefulforfieldstobe
treatedatalatertime,suchasboostfields.Toshowhiddenfields,seeShowingaHidden
TreatmentField.
1. SelectthetreatmentfieldtohideintheTreatmentDeliveryTable,andthenpressF4or
right‐clicktoopenthemenu.
YoucanalsopressCTRL HtohidethefieldandskipStep2.
2. ClickHideField.
ThefieldnumberappearsintheHiddenFieldsfieldatthebottomofthedialogbox.
The number that shows in the Hidden Fields field is not the number of
hidden fields. It is the Field ID of the hidden field. For example, if the
hidden field ID is 3ap, then 3ap appears in the Hidden Fields.
CAUTION
Fields that are hidden in MOSAIQ do not change the plan or
the fields that are delivered on the MHI-TM2000/Vero
machine.
Restoring a Treated Field
Afteryoutreatafield,itnolongerappearsintheTreatmentDeliveryTable.Youcanrestore
treatedfieldstoseethemormakeaportalimage.
1. Right‐clickorpressF4intheTreatmentDeliveryTabletoopenthemenu.
2. ClickRestoreFields.
Site Setup Verification
SetupandverifypatientsfortreatmentdeliveryandimagingbeforetreatmentintheSite
SetupVerification.
SiteSetupVerificationismandatoryforparticletherapytreatmentdelivery,which
establishestheabsolutecouchreferencefortheactivetreatmentsessionandsite.Youcan
alsoverifythepatientsetupwhileinQAMode.SeeQAMode.
SiteSetupVerificationletsyoumakesurethatthecorrectpatientisatthemachinewith
patientverification.SeeVerifyingthePatient.Forparticletherapy,wheninaverifiedmode,
MOSAIQcomparesactualvaluestothedefinedvaluestomakesurethatthereareno
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mismatches.Youcannotcompletethesitesetupuntilyouhaveclearedthemismatches.See
OverridingaParameterMismatchformoreinformation.
MOSAIQindicatesifaparameterisinoroutoftolerance.Ifaparameterisoutoftolerance,it
ishighlightedinred.SeeOverridingoutofToleranceParameters.
Youcanconfigureifyouwanttoverifythepatientandthesitesetupparametersfromthe
Clinical RO taboftheDepartmentSetup.Yoursystemadministratorcanhelpyouwiththis.
Verifying the Patient
YoucanuseRightPatient,RightSite,andRightTechniqueinSiteSetupVerification.When
youverifythepatient,youcanuseapatientbarcode seePrintingBarcodeLabels orenter
oneormoreelectronicsignatures.Configurehowmanyandwhichsignaturesarenecessary
fromtheDepartmentSetup.
TouseSiteSetupVerification,youmusthaveClinical|TxDelivery|ModifyorApprove
rights.
Use multiple methods to identify a patient as a best practice, even with barcode
identification. When you use a patient barcode or a patient fingerprint to select
a patient, make sure the correct patient is selected by photo identification or
other means.
1. IntheSiteSetupVerification,clickthePatientVerificationhyperlinktoopentheManual
PatientVerification.
Thiswindowletsyouverifythepatientsetupwithstaffapprovals.TheManualPatient
VerificationshowsinformationaboutthePatientandthePatientIDPhototomakesure
youtreatthecorrectpatient.Youcanaddcommentsforthistreatmentsessioninthe
Notegroup.TheApprovalgroupshowstherequiredandoptionalsitesetupapprovals,
uptoamaximumof3.Optionalapprovalsappearinitalics.
2. InthePatientVerificationApprovalgroup,theloggedinusernameappearsbydefault.
TypeyourpasswordandclickApprove.
YoursignatureappearsintheApprovalsgroup.
3. ClickClose.
The Manual Patient Verification remains open until all required signatures
are entered.
Overriding a Parameter Mismatch
TheSiteSetupVerificationshowstheparametermismatchesinredtext.Amismatchoccurs
whentheactualvalueofaparameteriseitheroutoftoleranceorisnotanexactmatchtoits
prescribedvalue.TheOverrideswindowletsyoucleartheparametermismatchtocontinue
withthetreatmentworkflow.
Tooverrideaparametermismatch,youmusthaveClinical|TxDelivery|Approverights.
1. IntheSiteSetupVerification,clickOverride.
TheOverrideParametersgroupshowstheparametersthatyoucanoverride.
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2. ClicktheparametercheckboxorpresstheSPACEBARfortheparameterinredto
overridetheparameterthatisoutoftolerance.
3. TypeyournotesintheNotegroup.
4. IntheOverrideApprovalgroup,theloggedinusernameappearsbydefault.Typeyour
passwordandclickOK.
5. ClickClose.
Recording a Site Setup
RecordthesitesetupdetailsinVerifiedorManualmode.
TheRecordSiteSetupshowsthe:

Courseoftreatment.

Prescriptionsitetowhichthesitesetupdefinitionapplies.

Initialsoftheprimaryandsecondaryloggedontherapists.

DateandtimeonwhichyouopenedtheSiteSetupVerification.

Nameofthelinearacceleratororparticletherapymachinetowhichthesitesetup
definitionapplies.
TouseRecordSiteSetup,youmusthaveClinical|TxDelivery|ModifyorApproverights.
2. ClickeChart|RadiotherapyTreatmentandclickTreattoopentheTreatmentDelivery
Table.
2. SelectatreatmentfieldandclickTreatorright‐click,andthenclickPerformSiteSetup
toopentheSiteSetupVerification.
3. Clearallinterlocks.
4. Verifythepatient.
5. ClickRecordtoopentheRecordSiteSetup.
Site Setup Verification is mandatory for particle therapy treatment delivery,
which establishes the absolute couch reference for the active treatment
session and site. Click Accept to record and establish the initial couch
setting for the treatment site and session.
6. ClicktheIn‐Patientcheckboxtochangeinpatientoroutpatientstatusforthistreatment
sessionfromtheinpatientoroutpatientstatusdefinedinPatientDemographicData.
7. TypeyournotesintheNotegroup.
8. ClickRecordtocompleterecordingofthesitesetup.
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Verified Treatment
TheVerifiedTreatmentwindowshowstheprescriptionparametersandtheactual
parametervaluesasreadbythemachineinterface ifavailable .Parametersthatareoutof
toleranceareinred.ChangebetweenthetwomodeswiththeTxField/FieldSetupbutton.
Usethiswindowtostartatreatment.
You must have Clinical | Tx Delivery | Modify security rights to record
treatments.
You must have Clinical | Tx Delivery | Approve security rights to approve
treatment delivery information, complete partial treatments, and override
out of tolerance parameters.
You must have Clinical | General | Approve security rights to start standby
mode.
Onceyourecordthetreatment,thesystemaddsthedosedeliveredandshowsthe
cumulativeamountintheDoseSiteSummary.IftheDoseSiteSummaryisopen,thenthe
doseinformationisupdatedthenexttimethesummaryappears.
MOSAIQ lets you do barcode verification of stereotactic cones and Dynamic
Multileaf Collimators (DMLCs) used by Elekta treatment machines. Elekta
supplies the cones and devices with a barcode attached to them.
At the time of treatment verification, MOSAIQ reads the barcode value that you
scan and shows it in the Actuals column in the Verified Treatment window to
make sure that the correct cone or DMLC device is selected.
Although the MOSAIQ software lets you print applicator-specific barcodes, do
not print barcodes for the stereo cones, and DMLC (MkIV and MkV) devices.
Contact your Field Support Engineer if you need a new barcode.
Verified Treatment Views
TheVerifiedTreatmentwindowhasthreedifferentviewswhenyouclickFieldView .You
canalsoright‐click,orpressF4andselectaview.YourSystemAdministratorcanconfigure
MOSAIQtoshowoneoftheseviewsbydefault.

In‐RoomView
Thisviewhaslargefonts.Theinformationthatismostnecessarytoatherapistisin
thelargerfontsize.Thisviewalsoshowsthetreatmentparametersandsetup
instructions.

SetupView
TheinformationinthisviewmatchestheTxFieldviewoftheTreatmentField
Definition.Itshowsnotesfromtheradiationprescriptionandfieldsetup.Diagrams
andfieldsetupimagesaretotheleftoftheFieldSetupandRxSitegroups this
dependsonyourPhotosandDiagramsconfiguration.SeeUsingthePhotosand
DiagramsUtility.

FullFieldView
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Thisisthesameviewaswhenyouselectedthefieldfortreatment.
Overriding out of Tolerance Parameters
Youcanoverridetheout‐of‐toleranceinterlockandtreatapatientwithsettingsdifferent
fromthoseintheprescription.SEQUENCERkeepsarecordofoverridesandthecredentials
oftheuserwhoapprovedthem.Outoftoleranceparametersappearinred.Overridesare
temporarychanges.
1. Double‐clickthefieldtotreatintheTreatmentDeliveryTable.
2. Right‐clickpressF4intheVerifiedTreatment,andclickOverride.
You can also press CTRL+O to open the Overrides dialog box.
3. SelecttheoutoftoleranceparameterthatisnecessarytooverrideintheOverrides
dialogbox,andthenpresstheSPACEBARtotagit.
4. TypethereasonfortheoverrideintheNotefield.
5. TypeyourPasswordandclickOK.
Theoutoftolerancevaluesthatyouoverrodeappearinyellow.
Temporary field changes, such as changing the couch geometric parameters,
do not invalidate the reference image for the selected treatment field. You
can show this image behind the treatment geometry in the Beam's Eye
View.
Sequence Treatment Fields
SequencetreatmentfieldsontheTreatmentCalendar.YoucanconfigureAutomatedField
Sequences AFS andManualFieldSequences MFS .
If an AFS or CFS session ends before you complete treatment, SEQUENCER does
not try to continue the session with the partially treated field and any
remaining untreated fields. The sequence becomes invalid for that session.
SEQUENCER shows a message to that effect, but you can complete the partial
field delivery and treat the remaining fields separately.
Automatic Field Sequences and Manual Field Sequences
TheTreatmentDeliveryTableshowsAFSorMFSsequences.Eachfieldthatispartofa
sequenceshowsthefieldnumberandthetotalnumberoffieldsinthesequence.When
multi‐segmentedIMRTfieldsarepartofanAFS,eachsegmentinthetreatmentfield
becomesonesegmentinthesequence.IfyouchangeafieldinanAFSfromtheTreatment
DeliveryTable,thentheAFSsequencebecomesinvalidforthatsession.Youcantreatthe
fieldsinthesequenceasnon‐sequencedfieldsinthesession.
SelectthefirstfieldinthesequencetostartanAFSorMFSsequencetreatment.Ifyoudonot
selectthefirstfieldinanAFSsequence,MOSAIQshowsa"TreatSequenceOutofOrder?"
message.IfyouclickYes,thentheVerifiedTreatmentopensforthatfield.Ifyoutreatthe
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field,thentheAFSsequencebecomesinvalidforthatsession.Youcantreattheremaining
fieldsinthesequenceasnon‐sequencedfieldsinthesession.
SeeSchedulingAFSTreatmentSessionsandSchedulingMFSTreatmentSessions.
Consolidated Field Sequences (CFS)
ConfigureCFSsequencesontheTreatmentCalendarasyoudowithstandardAFS
sequences.MOSAIQvalidatestheAFSorCFSwhenyousavethesession.MOSAIQvalidates
thesequenceagainaspartoftheTreatmentReadinessCheckbeforeyoutreat.SeeField
SequencingVerificationformoreinformation.
Your machine must be correctly characterized to use CFS. Do a QA Mode session
for CFS to make sure that all the components of the CFS delivery are correct.
MOSAIQsupportssomeparameterchangesduringaCFSsession.Youcanchangegantry,
collimator,jaws X&Y ,energy,motorizedWedgeposition,doserate,andMLCpositions.
Fortheseparameters,verificationisdonewiththefirstfieldoftheCFSsession.Nofurther
verificationisdoneonsubsequentfields.Whenthesequencestartsdelivery,theDesktop
consolehandlesvalidationforthemovementofthesubsequentsegmentsinthe
consolidatedfield afterbeamon .AllfieldparametersnotlistedinFieldSequencing
VerificationChecksmuststayconstantduringthecontrolpointsequence.
AllfieldsinaCFSsessionmustbelongtothesameparentprescriptionsite.Youcannot
includeportalimagesinaCFSsession.But,youcanselectafieldontheTreatmentDelivery
Table,right‐click,andselectaportalimageoption.Fortreatmentdelivery,keepthese
considerationsinmind:

YoumustselectthefirstfieldoftheCFSontheTreatmentDeliveryTable.

TheTreatmentReadinessCheckvalidatesthesameastheTreatmentCalendar.

ThetolerancetableselectedinthefirsttreatmentfieldoftheCFSgivesthe
verificationtolerancesfortheCFS.

ConsoleEditislimitedtocouchparameters.ConsoleEditsapplytoallsegmentsand
allcontrolpoints.Everyfieldandsubsequentcontrolspointswillhavethesame
couchpositionapplied.

Youcanonlyoverridecouchparameters.Ifoneormoreparametersthatyoucannot
overrideareoutoftolerancewhenyouopentheOverrideswindow,amessage
appears.Themessagetellsyouthatonlycouchparameterswillappearinthelistfor
youtooverride.
MOSAIQ only validates the initial positions for the first field before
initial beam on. Once the delivery begins validation, the Desktop
console manages the movement of the subsequent segments in the
CAUTION consolidated field.
Auto Setup
UseAutoSetuptoautomaticallysetupthetreatmentmachineparameters.
You cannot use Auto Setup if you use the Elekta Precise, Varian EXCI, or the
Varian 4DITC/TrueBeam treatment machines.
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
UsingAuto‐SetupwithConsoleSetupletsyoumanuallychangethemachinevalues
fromMOSAIQ.ThisoptionisonlyavailablefortheVarianEXCIandElektaPrecise
machines.

UsingAuto‐SetupwithoutConsoleSetupdoesnotletyoumanuallychangethe
valuesfromMOSAIQ.
Using Auto-Setup without Console Setup
IfyouuseatreatmentmachineotherthananElektaPrecise,aVarianEXCIoraVarian
4DITC/TrueBeam,youcanautomaticallysetupthetreatmentmachineparametervalues.
ThedifferenceisthatyoucannotmanuallychangevaluesfromMOSAIQinthesamewayas
UsingAuto‐SetupwithConsoleSetup.
1. GotoeChart|RadiotherapyTreatment.
2. IntheTreatmentChart,clickTreat.
3. IntheTreatmentDeliveryTable,double‐clickthefieldtotreat.
4. IntheVerifiedTreatment,clickAutoSetup.
5. IntheAuto‐SetupParametersmessage,clickYes.
6. GointothetreatmentroomtomakesuretheAutoSetupparametersarecorrect.
On Varian non-EXCI treatment machines, you have two minutes from the
time you click Yes until you hold the enable bars and press the Auto button
on the pendant. If you take longer than two minutes, you must do AutoSetup again.
Also, the gantry and collimator move only as long as you hold the enable
bars. You must continue to hold the enable bars until the gantry and
collimator are at the desired angles.
5. UseAutoMotionforyourtreatmentmachineasdirectedbyyourequipment
manufacturer.
6. Manuallychangetheremainingout‐of‐tolerancevaluesonthetreatmentmachineto
agreewiththeMOSAIQvalues,andverifytheaccessories.
Using Auto-Setup with Console Setup
Onsometreatmentmachines,youcanusetheConsoleSetupoptiontoadjustthemachine
settingsfromMOSAIQ.
1. GotoeChart|RadiotherapyTreatment.
2. IntheTreatmentChart,clickTreat.
3. Double‐clickthefieldthatyouwanttotreatintheTreatmentDeliveryTable.
4. ClickAutoSetupintheVerifiedTreatmenttoopentheConsoleSetup.
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Youcanmaketemporary,“planlevel”asopposedto“prescriptionlevel”changesto
fieldsandsendthemtothetreatmentmachine.
Theoptionbuttonsatthebottomofthescreenarea“shortcut”.Choosebetweenthe
parametersyousetinthetreatmentfielddefinition Rx orthemodeled Actual values.
5. ClickSetupMechanicalParameterswithRxValuesormanuallychangetheparameter
values.Selectthecheckboxnexttotheparameterandselectortypethenewparameter
value.
You cannot change the backup jaw values on an MLC field that is
characterized with fixed backup jaws.
6. ClickOK.
On Varian linear accelerators, you must also press the Auto button on the
pendant.
7. GointothetreatmentroomtomakesurethattheAuto‐Setupparametersarecorrect,
andthenverifytheaccessories.
Portal Images
Theportalimagesareassociatedwithatreatmentfield.Youcan:

ScheduleandchangeportalimagesforapatienttreatmentontheTreatment
Calendar.Dothisbefore,during,orafteryoutreatapatientwithatreatmentfield.

Makeaportalimageonlyanddonottreatthefield.

AddaportalimageoraseriesofportalimagestoaTreatmentCalendar.

Addportalimageswhileyouinserttreatmentsessionsandfieldsforapatient.

Removeportalimages.
SEQUENCERverifiesandrecordstheportalimages.Youcanalsorestoretreatedfieldsto
recordapostportalimage.
Making Portal Images Before, During, and After Treatment
Makeportalimagesforapatienttreatmentbefore,during,orafteryoutreatapatientwitha
treatmentfield.Or,onlymakeaportalimageanddonottreatthefield.
1. FromtheTreatmentDeliveryTable:
a. ClickPrePortfilmfromtheOptionsmenutomakeaportalimagebeforetreatment.
b. ClickPostPortfilmtoamakeaportimageaftertreatment.
c. ClickPortDuringOnlytomakeaportalimageduringtreatment.
d. ClickPortfilmOnlytomakeaportalimage,butnottreatthefield.
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ThePortfilmandPrePortfilmoptionsopentheVerifiedPortimmediately.ThePost
PortfilmoptionopenstheVerifiedPortafteryourecordthetreatmentfield.
2. IntheSelectPort,selecttheOpenoption,andclickOK.
3. IntheVerifiedPort,correctanyoutoftoleranceparametersandclickRecord.
4. IntheRecordPort,ifitisnecessary,typeanoteintheNotefieldandclickRecord.
5. Capturethechanges.
Record Treatment and Composite Record Treatment
ExaminetheinformationintheRecordTreatment,CompositeRecord,orRecordPortdialog
boxbeforeyousave.Makesurethatthecorrectpatientandtreatmentfieldappears.Make
surethatthecorrectnumberofmonitorunitsappears,ascomparedtotheelectronicand
mechanicalmonitorunitreadoutonthetreatmentmachine.

TheRecordTreatmentletsyourecordtreatments.Makesurethattheinformation
thatappearsintheRecordTreatmentiscorrectbeforeyouclickRecord.If
necessary,youcantypenotesintheNotefield.

TheCompositeRecordTreatmentisforAFS,CFS,andtheVarian4DITCinterface.As
withotherinterfaces,youcanreviewmultiplebeamentriesthatweredeliveredfor
oneormorefieldsincludingallportalimagesandsetupfieldimagestoverifythat
thetreatmentinformationiscorrect.
CAUTIO
N
If the meterset value on the treatment machine is not the same
as in SEQUENCER, type the treatment machine meterset value in
the Notes field of the Record Treatment dialog box to have a
record of what was delivered. Contact your department physicist
immediately before you continue with the treatment.
If you change the couch values during treatment, you can copy those values
at the end of the treatment session. Select the field from which to copy the
couch values in the Composite Record Treatment, and select Couch Copy.
Formachinesthatarecharacterizedtoshowdecay,theMOSAIQsoftwareshowsthe
metersetcorrectionfactorfordecayasC Decay intheRecordTreatment Manual and
HistoricTreatmentdialogboxes.Forthesemachines,youcannotrecordatreatmentwitha
C Decay valueofzero 0.0 .
Forsomemachines,thedecaycorrectionfactordataisincludedinthebeamrecordthatis
senttotheMOSAIQsoftwareaftertreatment.
Ifdecayorsourcereplacementoccurs,thedeliveredmetersetvalueisusuallydifferentfrom
theplannedvaluefortheapplicabledose.Thismeansthattherecordedmetersetinthe
TreatmentChartandtheHistoricTreatmentisdifferentfromtheplannedvalueforausual,
completetreatment.
Whennodecayorsourcereplacementoccurs,theDose/MetersetvalueintheTreatment
ChartandtheHistoricTreatmentisthevaluethatwasdefinedintheTreatmentField
Definitionforausual,completetreatment.
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TheMOSAIQsoftwareappliesthemetersetcorrectionfactortotheDose/Metersetvalue
fromtheTreatmentFieldDefinitiontogetthecorrectDose/Metersetvalueforthe
treatment.
ThemetersetvalueintheRecordTreatmentisthedeliveredvalue.
Manually Recording a Treatment
SEQUENCERdoesnotletyoumanuallyrecordtreatments.Youcanmanuallyrecord
TreatmentCalendarsessions.
1. Ataworkstationnotconnectedtoatreatmentunit,opentheLocationSchedulewindow,
andselecttheappointmentwhosetreatmentyouwanttorecord.
2. Right‐clickorpressF4.
3. ClickChart/CaptureorpressCTRL PtoopentheTreatmentChart.
4. ClickTreattoopentheRecordManualTreatment.
5. Makesurethatthedateandtimeshownforthetreatmentthatyouwanttorecordare
whenthetreatmentwasdelivered.
The date and time matches a session defined in the Treatment Calendar.
The date and time is current if a session is not defined.
6. ClickRecord.
7. Capturethecharges.
Manually Recording Portal Images
1. ClickPortfilmorPostPortfilmintheManualTreatmentdialogbox.
TheManualPortfilmdialogboxopens.
2. TypetheMUvaluesintheMUfieldoftheTreatPortorOpenPortgroup.
3. Makesurethatthedateandtimearecorrect.
4. TypeanoteintheNotefield.
5. ClickRecord.
Treatment Chart
TheTreatmentChartkeepsanelectronicrecordofpastandplannedradiotherapy
treatments.Thechartalsoshowshistoric,treatedfields,orfieldstotreat.
UsetheTreatmentDeliveryTabletochangethetreatmentsequenceandtologonasecond
therapist.SeeTreatmentDeliveryTableformoreinformation.
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OpentheVerifiedTreatmentwindowtostartthetreatmentofafield.SeeVerified
Treatmentformoreinformation.
OpentheTreatmentCalendar seeUsingtheTreatmentCalendar fromtheTreatmentchart
to:

SetupFieldSequencing.

SeeSchedulingAFSTreatmentSessionsandSchedulingMFSTreatmentSessions.
 Delivertreatmentregiments.
Whenyoucompletethetreatmentdelivery,youcaninspectthetreatmentintheTreatment
Chart.Thetreatmentthatyourecorded historictreatment appearsinblacktext.
Thethreeheaderpanesshowsummaryinformationabouttheselectedrowinthelower
sectionoftheTreatmentChart.Thelowersectiongivesyouachronologicallistofhistoric
andplannedtreatment,andtheQAsessionsscheduledfromtheTreatmentCalendar.



Notesareassociatedwithatreatmentsession.Thenotetypeindicatorsare:
o
T:HistoricSetuporTreatmentNote
o
S:FieldDefinitionorSiteSetupNote
o
P:PrescriptionSiteNote
o
F:FractionSpecificNote
o
D:DoseActionPoint
o
C:TreatmentCalendarSession
TheStstreatmentstatusindicatorsare:
o
m:Thetreatmentorsitesetupwasrecordedmanually.
o
H:Hiddenfieldsforaplannedtreatment.
o
A:Approvedtreatmentcalendarsession.
o
p:Partialtreatmentoftheplannedtreatment.
o
^:Thefirstrecordedorplannedtreatmentwithanewtreatmentfield
orthefirstrecordedorplannedtreatmentwithatreatmentfieldor
radiationprescriptionthathasbeenchangedsincethelasttreatment.
o
*:Overridesrecorded.
o
:Includesdatacombinedfrommultipletreatmentand/orportal
imagerecordsforafieldinthesamesession.Thismayalsobefroma
partialtreatmentandacompletedsessioninthesametreatment
session.
TheBycolumnshowstheinitialsofthestaffwhoapprovedtheplannedtreatment
session.
o
322
Forrecordedtreatments,thiscolumnshowstheinitialsofthestaff
loggedonatthetimeoftreatment.IfSecondaryTherapistLoginisused,
theinitialsofasecondarytherapistarerecordedwiththeinitialsofthe
loggedonuser.
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o
Forrecordedsitesetupactivities,thiscolumnshowsthestaffloggedon
atthetimeofsitesetupverification.
o
Whenamanualpatientverificationisdone,theinitialsofthestaffthat
didtheverificationappearinthiscolumn.Amaximumof2staff
memberinitialsappearinthiscolumn.
o
Ifbarcodeorbiometricpatientverificationisdone,thiscolumnshows
theinitialsofthestaffloggedonatthetimeoftreatment.IfaSecondary
TherapistLoginisused,theinitialsofasecondarytherapistarealso
recorded.
Adding additional comments to the Note field
EdittheTxNotefromtheTreatmentChart.
1. IntheTreatmentDeliveryTable,clickClose.
2. Double‐clickthefieldyoutreatedintheTreatmentChart.
3. IntheHistoricTreatment,changetheoriginalnoteyoutypedintheRecordTreatment.
4. ClickOK.
Historic Treatments
EachlineitemontheTreatmentChartinblacktypethathasbeentreatedisaHistoric
Treatmentfield.ThedataintheCourse,Site,Staff,Override,Field,Tx,MU,Dose,FieldTx,
andElapsedfieldsappearinNavytextandcannotbechanged.Thisisinformationrecorded
duringtreatment.
DoubleclickanalreadytreatedfieldontheTreatmentCharttoopentheHistoricTreatment
window.ThedataintheBeam,Accessories,Gantry/Coll,andCouchgroupsappearinNavy
textandcannotbechanged.YoucanonlychangetheDose/MUfield,Inpatientcheckbox,
Machinefield,andtheTxNotefields.
If you select a treatment field that has an associated reference image with a
shadow filter applied, the shadow filter does not show in the Historic Treatment
window.
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Treatment Field Definition While in SEQUENCER
You must have Clinical | Field Defs | View security rights to view the
Treatment Field Definition.
You must have Modify security rights to specify, change, or copy treatment
field definitions (except for MU and dose), capture machine parameters,
associate field setup photos and diagrams, and use the Treatment Field
Definition in ViewStation.
You must have Approve security rights to approve (lock) treatment field
definitions, machine characterizations, and delete setup photos and
diagrams.
You must have Clinical | QA/Calibration | Approve security rights to assign
treatment field calibration status.
Adding a Treatment Field
AddtreatmentfieldsfromtheDiagnosesandInterventionsandfromtheTreatmentDelivery
Table.
1. Right‐clickorpressF4intheTreatmentDeliveryTabledialogboxtoopenthemenu.
2. ClickInsertField.
AblankTreatmentFieldDefinitionopens.
3. Configurethefielddefinitionforthenewfield.
ThenewfieldyoumadeappearsintheDiagnosesandInterventionsabovethe
diagnosis.BecauseyoumadeitfromtheTreatmentDeliveryTable,itwasnotassigned
toaradiationprescriptionsite.
4. DraganddropthenewfieldtothedesiredRxfordoseandfractionstobetracked,and
clickDosimetry.
4. ClickOK.
Changing a Treatment Field
Beforeyoutreatapatient,youcanchangeoneormoreofthetreatmentfieldsbeforeyou
closetheTreatmentDeliveryTable.
1. SelectthetreatmentfieldtochangeintheTreatmentDeliveryTable,andthenright‐click
orpressF4toopenthemenu.
2. ClickChangeFieldtoopentheTreatmentFieldDefinitionfortheselectedfield.
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3. Changethetreatmentfield.
Ifyouhaveaninteractiveinterface,youcancaptureactualmachinesettings.Youcan
alsoaddportalimages.Ifyouchangethetreatmentmachine,SEQUENCERtellsyouthat
themachinecharacterizationisdifferent.
4. ClickOKandtheFieldDeltaopens.
TheFieldDeltashowsallchangeshighlightedinyellow.Thisletsyoumakesurethat
youdonotsaveachangethatyoudidnotintendtomake.
5. ClickAccepttosaveyourchanges.
IfyouclickReturn,thechangesarenotsaved,theFieldDeltaclosesandtheTreatment
FieldDefinitionopensagain.
6. Approvethetreatmentfielddefinitionifthatisnecessaryforyourdepartment.
Core SEQUENCER Workflows
TheworkflowthatyoufollowdependsonyourSEQUENCERinterfaceconfiguration.sentto
MOSAIQaftertreatment.

FollowingtheCoreSEQUENCERWorkflow–ConventionalFields
ThisworkflowappliestoaSEQUENCERinterfaceconfigurationforconventional
treatmentfields.Followthisworkflowafteryouselectapatientfortreatmentand
openthepatientchart.

FollowingtheCoreSEQUENCERWorkflow–ParticleTherapyFields
ThisworkflowappliestoaSEQUENCERinterfaceconfigurationforaparticle
therapytreatment.Followthisworkflowafteryouselectapatientfortreatmentand
openthepatientchart.

FollowingtheCoreInteractiveInterfaceWorkflow
Inthisworkflow,SEQUENCERconstantlycommunicateswiththetreatment
machineoveranEthernetoraserialconnection.Anexampleofaninteractive
interfaceistheinterfacetoanElektaSynergytreatmentmachine.

FollowingtheCoreStaticInterfaceWorkflow
Inthisworkflow,SEQUENCERsendsdatatothetreatmentmachinethenreceives
datafromthetreatmentmachine.Anexampleofastaticinterfaceistheinterfaceto
aSiemensCOHERENCEtreatmentmachine.

FollowingthePassivePlanInterfaceWorkflow

ThisworkflowappliestoaDICOMinterface.Theactualmachinevaluesdonot
appear.Youmustwaitformachinecommunicationstocompletebetweensteps.
Thesystempromptsyoutocontinue.ExamplesofaspecialtypeofDICOMinterface
areVarian4DITC,TrueBeam™,Siemenssyngo,andMHI‐TM2000/Vero.
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SEQUENCER:


SendsandreceivesdatawithTCP‐IP.
Sendstheplantothetreatmentmachineandthetreatmentmachinedoesthe
validation.
Afteryoucompletetheimagesandtreatment,thetreatmentmachinesendsall
imagesandbeamrecordstoSEQUENCERtorecord.
TheMHI‐TM2000/Verointerfaceonlycoordinatestheplanselectionandrecording
ofthegeometricmachineandtreatmentdata.Thisinterfacedoesnotusetheplan
fromMOSAIQ.

FollowingtheCoreDocument‐BasedTreatmentFields IHE‐RO Workflow
Thisworkflowappliestoamachinethatisconfiguredforadocument‐basedfield
definition.Usually,adocument‐basedfieldshowsaspecializedsetofdataand
showstheplaninformationinadocumentformat,suchasPDF.Machinesthattreat
document‐basedfieldsincludeTomoTherapy®,LeksellGammaKnife®,andElekta
Brachytherapydeliverysystems.
TheMOSAIQsoftwareusestheIHE‐RO IntegratingtheHealthcareEnterprisein
RadiationOncology interfacetocommunicatewithmachinesthattreatdocument‐
basedfields.ThisinterfaceusestheDICOMPlanUniqueIdentifier UID .TheUID
makessurethatthe:


Correctpatientandtreatmentplanareselectedonthemachine.
BeamrecordandimagesaresenttoMOSAIQaftertreatment.
Following the Core SEQUENCER Workflow – Conventional Fields
ThisworkflowappliestoaconventionalSEQUENCERinterfaceconfiguration.Followthis
workflowafteryouselectthepatientandopenthepatientchart.SeeSelectingaPatientfor
Treatment.
1. SelectaTreatmentCalendarsession Optional .
SEQUENCERsendsthetreatmentfielddatatothetreatmentmachineandopensthe
VerifiedTreatmentwindow.SeeVerifiedTreatmentformoreinformation.
YoucanusetheAutoSetupoptiontosetupthetreatmentmachinetodeliverthe
selectedtreatmentfield.SeeAutoSetupformoreinformation.
2. Selectthefirstfieldtotreat,andthenclickSelect
IftheTreatmentReadinessCheckopens,youmustrespondbeforeyoucancontinue.See
TreatmentReadinessCheck.
3. Setupthepatientonthecouch.
Ifyourdepartmentusesaccessorybarcodes,youmustscantheaccessorybarcodesto
clearinterlocks.SeeSiteSetupVerification.
4. Makepre‐treatmentportalimagesifnecessary.
SeePortalImagesformoreinformation.
5. Modeupthetreatmentmachine.
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IfSEQUENCERisconnectedtoyourtreatmentmachinethroughaninteractiveinterface,
thenSEQUENCERcomparestheprescribedparametervaluesagainstthemachine
parametervalues.SEQUENCERpreventstreatmentifoneormoreparametersareoutof
tolerance.SeeOverridingaParameterMismatchformoreinformation.
6. Beam‐onthetreatmentmachine.
TheRecordTreatmentopenswhenthetreatmentiscomplete.SeeRecordTreatment
andCompositeRecordTreatmentformoreinformation.
7. Treatthefirstfield.TakePortDuringand/orpost‐treatment PostPortfilm portal
images,ifnecessary.
SeeMakingPortalImagesBefore,During,andAfterTreatmentformoreinformation.
8. TypeanyrelevantcommentsintheNotefieldoftheRecordTreatment.
9. ClickRecord.
The Verified Treatment opens for the next field because you set the
treatment sequence earlier. If you had not set the treatment sequence, the
Treatment Delivery Table opens after you record the treatment.
10. ClickCloseintheTreatmentDeliveryTable.
11. ClickOKintheCodeCapturedialogbox.
Following the Core SEQUENCER Workflow – Particle Therapy Fields
ThisworkflowappliestoaSEQUENCERinterfaceconfigurationforaparticletherapy
treatment.Followthisworkflowafteryouselectthepatientandopenthepatientchart.See
SelectingaPatientforTreatment.
1. SelecttheTreatmentCalendarsession.
2. SelecttheRTIonPlan site tosendtotheTreatmentControlSystem TCS .
SEQUENCERautomaticallyentersSiteSetupVerification.
3. Makesurethatthecorrectpatientisselected.
SeeVerifyingthePatient.
4. Makesurethatthesitesetupiscorrect.
5. Makepatientpositionimagesandperformimageregistration.
6. Adjustthecouchandmakepatientpositionimages,asnecessary.
7. Acceptthesitesetup,whichspecifiestheabsolutecouchsettingsforthistreatmentsite
andsession.
SEQUENCERentersintoFieldVerificationandrelativecouchvaluesareappliedtothe
storedsessionvalues.
8. Ifitisnecessary,makefieldimages,registration,andcouchorbeamadjustments.
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9. Treatthefield.
***Treating***appearsbelowtheheader.TheRecordTreatmentopenswhenthe
treatmentiscomplete.
10. TypeanyrelevantcommentsintheNotefieldoftheRecordTreatment.
11. ClickRecord.
12. Continuetotreatfieldsorendthesession.Ifitisnecessary,dothefieldimage
verificationagain.
13. Capturecharges.
Following the Core Interactive Interface Workflow
SEQUENCERconstantlycommunicateswiththetreatmentmachineoveranEthernetora
serialconnection.ActualgeometricvaluesfromthetreatmentmachineshowintheVerified
Treatmentwindow.AnexampleofaninteractiveinterfaceistheinterfacetoanElekta
Synergytreatmentmachine.Thesestepsbeginatthepointwhenyoumodeupthetreatment
machine.TheprecedingstepsarethesameasthebasicSEQUENCERworkflow.
SeeFollowingtheCoreSEQUENCERWorkflow–ConventionalFields.
SEQUENCERcomparestheprescribedparametervaluesagainstthemachineparameter
values.SEQUENCERpreventstreatmentifoneormoreparametersareoutoftolerance.
2. Treatthefirstfield.Ifitisnecessary,capturePortDuringandposttreatment Post
Portfilm portalimages
SeeMakingPortalImagesBefore,During,andAfterTreatment.
3. ClickRecordintheRecordTreatment,RecordPort,orCompositeRecordTreatment.
SeeRecordTreatmentandCompositeRecordTreatmentformoreinformation.
4. Selectthenexttreatmentfield,thenmodeupthetreatmentmachine.
5. Changethepatientpositionifnecessary.
6. Ifitisnecessary,treatthenextfieldandmakeportalimages.
7. Continuetotreattheremainingfieldsorcompletethesession.
8. Capturecharges.
WARNING
328
Do not change any treatment field parameter (such as gantry,
collimator, and couch) after beam-on. If a beam interruption
occurs that requires you to change the treatment field
parameters or a machine fault moves parameters out of
tolerance during treatment, you must terminate the beam and
go back to the Treatment Delivery Table.
LUGMSQ0010/4.0/24-Jun-2014
Following the Core Static Interface Workflow
Inthisworkflow,SEQUENCERsendsdatatothetreatmentmachine,andthenwaitsto
receivedatafromthetreatmentmachine.
1. Selectthefirstfield.
SEQUENCERsendsthetreatmentfielddatatothetreatmentmachineandopensthe
VerifiedTreatmentwindow.SeeVerifiedTreatmentformoreinformation.
YoucanusetheAutoSetupoptiontochangethevaluesonthetreatmentmachine.See
AutoSetupformoreinformation.
2. Acceptthefieldonthetreatmentmachineconsole.
3. Setthepatientuponthecouch.
Ifyoursiteusesaccessorybarcodes,youmustscantheaccessorybarcodesnowto
preventaninterlock.
4. Ifitisnecessary,makepre‐treatmentportalimages.
6. Treatthefirstfield.Ifitisnecessary,takePortDuringandpost‐treatment Post
Portfilm portalimages.
SeeMakingPortalImagesBefore,During,andAfterTreatment.
7. ClickRecordintheRecordTreatment,RecordPort,orCompositeRecordTreatment.
SeeRecordTreatmentandCompositeRecordTreatmentformoreinformation.
8. Selectthenextfieldandmodeupthetreatmentmachine.
9. Ifitisnecessary,changethepatientposition.
10. Ifitisnecessary,treatthenextfieldandmakeportalimages.
11. Dosteps2‐10againuntilyoutreatallfieldsormustcompletethesession.
Following the Passive Plan Interface Workflow
Theinterfacetosomesystems forexample,Varian4DITCandTrueBeam,Siemenssyngo,
andMHI‐TM2000/Vero isaspecialtypeofDICOMinterface.SEQUENCERsendsand
receivesdatathroughTCP‐IP.SEQUENCERsendstheplantothetreatmentmachineandthe
treatmentmachinedoesthevalidation.
Afteryoucompletetheimagesandtreatment,thetreatmentmachinereturnsallimagesand
beamrecordsforSEQUENCERtorecord.
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The MHI-TM2000/Vero interface only coordinates the plan selection and
recording of the geometric machine and treatment data. This interface
does not use the plan from MOSAIQ.
1. SelectthepatientinMOSAIQ,selectafield,andclickTreatontheTreatmentDelivery
Table.
TheTreatmentReadinessCheckappears.
YoumustusetheTreatmentCalendarSessiontoscheduleportalimagesoraddthe
unscheduled adhoc portalimagesonthe4DITCworkstationorTrueBeammachine.
Ad‐hocportalimagingisnotavailablefromMOSAIQ.Setupfieldsthatyouaddaspartof
theTxCalendarSessiononlyrequireastatuschangewhenyoutreatthem.
2. IntheTreatmentReadinessCheck,clickContinue.
3. ClickSendPlanontheTreatmentDeliveryTable.
SEQUENCERsendstheplantothetreatmentmachine.
3. Dothenecessarystepsonthemachineconsole.
TheinterfacesendsthetreatmentdatatotheSEQUENCERworkstation.TheRecord
TreatmentorCompositeRecordTreatmentappearsontheSEQUENCERworkstation
whenthetreatmentiscomplete.SeeRecordTreatmentandCompositeRecord
Treatmentformoreinformation.
4. ClickRecordtorecordthetreatment.
5. Capturecharges.
Following the Core Document-Based Treatment Fields (IHE-RO)
Workflow
Adocument‐basedtreatmentfieldisassignedtoamachinethatisconfiguredfordocument‐
basedfielddefinition.Typically,adocument‐basedfieldshowsthefielddefinitionina
documentformatsuchasPDF.Machinesthattreatdocument‐basedfieldsinclude
TomoTherapy®,GammaKnife®,andElektaBrachytherapydeliverysystems.
TheMOSAIQsoftwareusestheIHE‐RO IntegratingtheHealthcareEnterpriseinRadiation
Oncology interfacetocommunicatewithmachinesthattreatdocument‐basedfields.This
interfaceusestheDICOMPlanUniqueIdentifier UID .TheUIDmakessurethatthecorrect
patientandtreatmentplanareselectedonthemachine.
1. SelectthepatientinMOSAIQ,selectafield,andclickTreatintheTreatmentChart.
TheTreatmentReadinessCheckappearsifthereareconditionsthatyoumustcorrect,
acknowledge,oroverride.SeeTreatmentReadinessCheckformoreinformation.
2. Dothenecessarystepstocorrect,acknowledge,oroverrideconditions,andclick
Continue.
3. ClickPrepareintheTreatmentDeliveryTable.
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SeetheTreatmentDeliveryTableformoreinformation.
SEQUENCERpreparestheplantobesenttothetreatmentmachine.TheTreatment
DeliverySessionopens.Thissessionshowsreadonlyinformationaboutallthefields
thataresenttothemachineaspartofthetreatmentplan.
4. Dothenecessarystepsonthemachineconsole.
Whenthetreatmentiscomplete,theinterfacesendsthetreatmentdatatothe
SEQUENCERworkstation.TheCompositeRecordTreatmentappearsonthe
SEQUENCERworkstation.
5. ClickRecordtorecordthetreatment.
6. Capturecodes.
Elekta Specific Workflows
Sending Couch Offset Values to the Desktop with Couch Move
Assistant
UsetheCouchMoveAssistantonlyforElektaiCommachinesthatarecapableofAssisted
Set‐up ASU .
TheCouchMoveAssistantwindowinMOSAIQletsyouenterandsendthecouchoffsets
valuestotheDesktop.TheSYNERGISTIQworkflowincludestheautomaticdisplayofoffset
valuesfromXVI.
Setupoffsetsandsessionoffsetsthatarecalculatedatthetimeofpatientsetupverification
areauto‐populatedwhenyouimporttheprescribedoffsetsonRTPImport,ortheycanbe
manuallyentered.IfyoursiteislicensedforSetupIntelligence,youcanrecordsession
offsetsforlatertrendanalysis.
You must have Clinical | Tx Delivery | View security rights to view the
Couch Move Assistant window, and Clinical | Tx Delivery | Modify rights to
treat patients. Assisted Set-up must be registered to record offset values.
1. ToopentheCouchMoveAssistant,right‐clickandselectCouchMoveAssistantfromthe
TreatmentDeliveryTable,VerifiedTreatment,VerifiedPort,orSiteSetupVerification
windows.
IfyoursiteusesSYNERGISTIQ,theCouchMoveAssistantopensautomaticallywhen
MOSAIQreceivesacorrectionfromXVI.
WhentheCouchMoveAssistantopens,itisautomaticallyupdatedwiththeoffsets
storedinMOSAIQbasedonwhereyouareintheworkflow.
IfyouopentheCouchMoveAssistantfromtheTreatmentDeliveryTable,itshowsthe
third‐partyorimageoffsets sessionoffsets .FromtheVerifiedTreatment,Verified
Port,orSiteSetupVerificationwindows,itshowsthesetupoffsets.
2. Tochangetheoffsets,selecttheapplicableoffsetvaluesintheSiteOffsets which
minimizeserrors ormanuallytypethechanges.
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TheSiteOffsetsshowstheTotalOffsetforpatientsetupbeforeimagingandtheoffsets
thatwererecordedfortheselectedsiteinaspecifiedtimespan.
3. ToopentheSiteOffsetsdialogbox,clickShowOffsetsintheCouchMoveAssistant.If
youclickanoffsetandthenclickSelect,itgetsaddedautomaticallyintheCouchMove
Assistant.
TheMaximumandThresholdtolerancevaluesarethedefaultsspecifiedforthe
treatmentmachineorassignedtothetreatmentplaninSiteSetupDefinition.These
valuesareinrediftheyareoutsidethetolerancevaluesspecifiedforeachparameter.If
amaximumvalueisinred,couchmovementisnotallowedandtheAllowoptionisnot
available.IfyouselectAllowforathresholdvaluethatisinred,itbecomesyellowand
youcanthenusetheApplyoptionforthatdirection.
4. ExaminetheTargetscolumnintheCouchMotiongroup.
TheTargetsvaluesareinrediftheyaremorethanthemachinecharacterizationvalues
specifiedfortheparameter.Couchmovementisnotallowed theApplyoptionisnot
available .YoucancleartheApplycheckboxtonotsendthatoffsettothemachine.
5. Dooneofthesesteps:

Tosendtheselectedcouchmovementparameterstothetreatmentmachine,click
Send.

Tosendtheselectedcouchmovementparameterstothetreatmentmachineand
recordthemasaThird‐PartyOffset,clickSend/Record.
 Torecordoffsetswithoutcouchmovement,clickRecordOnly.
6. Aftersendingthecouchvaluestothemachine,youcanmovethecouchautomaticallyat
thetreatmentmachineasfollows:

Outsidethetreatmentroomoffsetslessthan2.0cm:Usethefunctionkeypadatthe
consoleifyouhaveDesktopPro’sASUlicense.

Insidethetreatmentroom:UseThumbwheel1fromthetreatmentmachine
pendant.
 Insidethetreatmentroom:Usethehand‐heldcontrollerwithiViewGT.
7. Monitorthecouchmotion.
TheStartValuescolumnshowsthecouchpositionswhentheCouchMoveAssistantis
opened.
TheActualscolumnshowsthecurrentactualvalues,whichareupdatedasthecouch
moves.
TheTargetscolumnshowsyouwherethecouchmustbetocompletethecorrection.A
cyanflag
appearsadjacenttothetargetvaluesuntilthecouchisinthecorrected
position.DonotclosetheCouchMoveAssistantuntilthecyanflaggoesaway.
Delivering Intrafraction kV Imaging on Elekta XVI Systems with
SYNERGISTIQ
Whendeliveringtreatment,youcan:

332
SelectatreatmentfieldthathasintrafractionimagingscheduledintheTreatment
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Calendar.
IfyouselectatreatmentfieldthathasascheduledintrafractionCBCTimaging,and
adefinedXVIVolumeViewDuringpreset,theGantryMoveAssistantopens
automatically.Setupthegantrycorrectlyforpretreatmentandposttreatment
imagingarcsintheSYNERGISTIQIntrafractionImagingWorkflow.SeeGantry
MoveAssistantintheSYNERGISTIQIntrafractionImagingWorkflow.

Doanunscheduled adhoc intrafractionimagingofatreatmentfieldfromthe
TreatmentDeliveryTable.
1. Todeliverandrecordunscheduledintrafractionimagingofatreatmentfield,right‐click
intheTreatmentDeliveryTable,andselectkVDuring.
TheIntrafractionPresetwindowopensautomaticallyifoneoftheseconditionsistrue:

TheselectedfieldisscheduledforintrafractionimagingintheTreatmentCalendar
butdoesnothaveanintrafractionXVIpresetdefinedinitstreatmentfield
definition.

YouselectkVDuringintheTreatmentDeliveryTabletodointrafractionimaging.
However,theselectedfielddoesnothaveanintrafractionXVIpresetdefinedinits
treatmentfielddefinition.
TheIntrafractionPresetwindowletsyouselecttheXVIpresettobeusedatthetimeof
intrafractionimagingoftheselectedtreatmentfield.
2. ClickavalidXVIpreset,andclickSelect.
PlanarViewDuring images will automatically associate to the MV treatment
field. You can change the image association for comparison against the
DRR orthogonal to the treatment projection. See Associating Medical
Images for more information.
Gantry Move Assistant in the SYNERGISTIQ Intrafraction Imaging
Workflow
TheGantryMoveAssistantisavailablefortheintrafractionimaging SYNERGISTIQ workflowonElektamachineswithXVIv5.0.
AsmallerversionoftheGantryMoveAssistantisavailableinthenon‐SYNERGISTIQ
configurationsforElektamachines.Usethisversiontosendthegantryangletothemachine,
whichmovesthegantrytoatargetpositioninnon‐intrafractionimagingworkflows.See
SendingtheGantryTargetAngletotheConsoleinaNon‐IntrafractionWorkflow.
IftheselectedtreatmentfieldhasanintrafractionXVIVolumeViewDuringpresetdefined
scheduledorselectedad‐hocforimaging ,theGantryMoveAssistantopensautomatically
atthetimeoftreatmentdelivery.Intheintrafractionimagingworkflow,theGantryMove
Assistantletsyousetupthegantrycorrectlyforpre‐andpost‐treatmentimagingarcs.See
DeliveringIntrafractionkVImagingonElektaXVISystemswithSYNERGISTIQ.
ThefirsttimetheselectedXVIpresetisused,thegantryImageAnglesStartandStopvalues
areempty.YoumusttypethevaluesthatappearontheXVIunit orchangethemif
necessary .TheMOSAIQsoftwarekeepsthesevaluesinthedatabase.Thenexttimeyouuse
thesameXVIpreset,theMOSAIQsoftwareautomaticallyaddsthesevalues.Youcan
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333
comparethevaluesintheGantryMoveAssistantwiththosethatappearontheXVIunitand
changethemifnecessary.
IntheSYNERGISTIQintrafractionimagingworkflow,theGantryMoveAssistantappears.
Figure 112: Gantry Move Assistant in Intrafraction Imaging Workflow
LookattheXVI5.0displaytofindtheimagingStartandStopangles.TypetheTargetangles
tobesenttotheconsolewhereautomaticgantrymovementisdonewiththefunction
keypad FKP .
Sending the Gantry Target Angle to the Console in a Non-Intrafraction
Workflow
UsethesmallerversionoftheGantryMoveAssistanttosendthegantryangletothe
machine,whichmovesthegantrytoatargetpositioninanon‐intrafractionimaging
workflow.
1. ToopentheGantryMoveAssistant,right‐clickintheTreatmentDeliveryTable,and
clickGantryMoveAssistant.
ThesmallerGantryMoveAssistantdialogboxappears.
Figure 113: Gantry Move Assistant in Non-Intrafraction Workflow
2. TypetheapplicableGantryTargetAngle,andthenclickSendtosendthetargetangleto
theconsolewhereautomaticgantrymovementisdonewiththefunctionkeypad FKP .
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Couch Move Assistant (Siemens DMIP Version 9 Treatment
Machines)
You must have Clinical | Tx Delivery | View security rights to view the Couch
Move Assistant, and Clinical | Tx Delivery | Modify rights to treat patients.
AlimitedversionoftheMOSAIQCouchMoveAssistantisavailablefortheSiemensDMIP
Version9treatmentmachines.
TheCouchMoveAssistantletsyouentercouchoffsetscalculatedduringthepatientsetup
verificationprocessandrecordthem iflicensedforSetupIntelligence .Youcanreview
offsetsasrelativevaluesandnewtargetpositionsasabsolutepositions.Offsetdirection
displaysinpatientcoordinatesaccordingtotheSetupOffsetReferencesettinginthe
DepartmentSetup|Clinical RO tabandpatientorientationfromtheSiteSetupDefinition.
MOSAIQcheckstargetsagainstthemachinecharacterizationtomakesurethatthenew
targetsarevalidpositionsforthecouch.MOSAIQsendsoffsetstothetreatmentmachineas
newtargets.
1. ToopentheCouchMoveAssistant,right‐clickandselectCouchMoveAssistantfromthe
TreatmentDeliveryTableorfromtheSiteSetupVerification.
Whencalculatedcouchshiftsarriveoverapre‐configuredandlicensedPatient
PositioningSystem PPS ,theCouchMoveAssistantisautomaticallyopenedbythePPS
fromtheTreatmentDeliveryTableandfromtheSiteSetupVerification.
IftheCouchMoveAssistantisautomaticallytriggeredtoopenbyoffsetscomingfrom
thePPSorcalculatedinMOSAIQ,thentheoffsetvaluesareautomaticallypopulated
basedonwhereyouareintheworkflow.
IfyouopentheCouchMoveAssistantfromtheTreatmentDeliveryTable,itshowsthe
third‐partyorimageoffsets sessionoffsets .FromtheSiteSetupVerification,itshows
thetotaloffsets.
2. IntheSiemensDMIP9treatmentmachine,pressAccepttosendtheActualcouch
positionvaluesbacktoMOSAIQ.
MOSAIQautomaticallyupdatestheCMAStartValuesandActualswiththereceived
couchActuals.TheTargetsvaluesareautomaticallyupdatedwiththesumoftheActuals
andthedirectionaloffsets.
Previously, the CMA automatically sent a request to the Siemens machine to
retrieve the current couch Actuals, which were then sent to MOSAIQ after you
pressed Accept.
3. Tochangetheoffsets,selecttheapplicableoffsetvaluesintheSiteOffsets which
minimizeserrors ormanuallytypethechanges.
TheSiteOffsetsshowstheTotalOffsetforpatientsetupbeforeimagingandtheoffsets
thatwererecordedfortheselectedsiteinaspecifiedtimespan.
4. ToopentheSiteOffsets,clickShowOffsetsintheCouchMoveAssistant.Ifyouclickan
offsetandthenclickSelect,itgetsaddedautomaticallyintheCouchMoveAssistant.
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335
TheMaximumandThresholdtolerancevaluesarethedefaultsspecifiedforthe
treatmentmachineorassignedtothetreatmentplaninSiteSetupDefinition.These
valuesareinrediftheyareoutsidethetolerancevaluesspecifiedforeachparameter.If
amaximumvalueisinred,couchmovementisnotallowedandtheAllowoptionisnot
available.IfyouselectAllowforathresholdvaluethatisinred,itbecomesyellowand
youcanthenusetheApplyoptionforthatdirection.
5. ExaminetheTargetscolumnintheCouchMotiongroup seeFigure114 .
TheTargetsvaluesareinrediftheyaremorethanthemachinecharacterizationvalues
specifiedfortheparameter.Couchmovementisnotallowed theApplyoptionisnot
available .YoucancleartheApplycheckboxtonotsendthatoffsettothemachine.
Figure 114: Targets column in the Couch Motion group
6. Dooneofthesesteps:

Tosendtheselectedcouchmovementparameterstothetreatmentmachine,click
Send.

Tosendtheselectedcouchmovementparameterstothetreatmentmachineand
recordthemasaThird‐PartyOffset,clickSend/Record.
 Torecordoffsetswithoutcouchmovement,clickRecordOnly.
7. Afteryousendthecouchvaluestothemachine,movethecouchtothenecessary
positionandpressAccepttosendtheActualcouchpositionvaluesbacktotheCouch
MoveAssistant.
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
TheStartValuescolumnshowsthecouchpositionswhentheCouchMoveAssistant
isopened.

TheTargetscolumnshowsyouwherethecouchmustbetocompletethecorrection.
Acyanflag appearsadjacenttothetargetvaluesuntilthecouchisinthe
correctedposition.DonotclosetheCouchMoveAssistantuntilthecyanflaggoes
away.
TheCouchMoveAssistantcanbeautomaticallyopenedbythePPSfromtheVerified
PortandtheVerifiedTreatmentwindowstoonlyrecordshifts.Theshiftscannotbesent
totheSiemenstreatmentmachinefromthesewindows.
Machine Characterization
Machinecharacterizationperforms:

Dataconversionbetweenfields.

DataconversiononRTPimport requiressourcecharacterization .

Fieldsetupvalidation:
- Specifiesthephysicallimitsofatreatmentmachine.
- Specifiesconsoleparameters.
MOSAIQletsyoucharacterizetreatmentmachinelocations,sources,andcreate
characterizationtemplatesusingawidevarietyofparametersandoptions.A
comprehensivelistof“stock”templatesisavailable.Youcanthesetemplatesasisormodify
themtocreateyourownsite‐specifictemplates.TheMachineCharacterizationEditorlets
youspecifygeometricinformationaboutyourtreatmentmachineandaccessories.
Theinformationaboutyourtreatmentmachinethatyouspecifyisrequiredtoensureproper
communicationbetweenMLCFit,eCHART,SEQUENCER,andyourtreatmentmachine.
Becausethetemplatesareforgenericmachinetypes,seethemanufacturer‐provided
informationaboutyourtreatmentmachineorMLC.
CAUTION
Make sure you characterize your machine correctly. Incorrect
machine characterization could lead to mistreatment of
patients. Contact Elekta Client Services for help with machine
characterizations.
Adding a Machine Location
Addamachinelocationtoentertreatmentmachinedefinitions.
1. ClickFile|Directories|LocationDirectorytoopentheLocationDirectory.
TheLocationDirectoryshowsthelocationsspecifiedinyoursystem.Youcansee
machinelocationsorotherlocationsatyourfacility.
2. Ifnecessary,clickon
Locations.
adjacenttotheViewdrop‐downlist,andthenclickMachine
3. ClickAddtoopentheLocationdialogbox.
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TheLocationdialogboxletsyouaddorchangethenameandtypeoflocation.Notice
thatsinceyouaccessedthedialogboxfromtheMachineLocationviewintheLocation
Directory,MOSAIQautomaticallysetsthelocationasamachinelocation.
4. TypethenameofthetreatmentmachineintheNamefield.
5. PressTABtwice,andthentypeanabbreviationforthetreatmentmachineinthe
Abbreviationfield.
6. Click
adjacenttotheCategoryfield,andthenclickAccelerator.
Select a Chart Destination. The default destination is the Diagnoses and
Interventions window.
7. ClickOKtosavethenewmachinelocation.
Creating a Machine Characterization History Report
Youcancreateareportofthechangesmadetothemachinecharacterizationofaselected
machine.TheMachineCharacterizationHistoryUtilityshowsyoualistofthedifferent
versionsofaselectedmachinecharacterization.TheMachineCharacterizationDeltaletsyou
comparetwoormoreversionsoftheselectedmachinecharacterization.
Tomakeareportofthemachinecharacterizationhistoryforaselectedmachine:
1. ClickFile|SystemUtilities|MachineCharacterization.
2. IntheMachineCharacterizationwindow,clickShowHistory.
TheMachineCharacterizationHistoryUtilityappears.
3. Tocomparetwoormoreversionsofthemachinecharacterization,clicktheversions
fromthelist,andthenclickCompare.
TheMachineCharacterizationDeltaappearswhereyoucanseethedetailsofthe
changesthatweremadeineachversion.Toeasilyidentifythechanges,theyarecolor‐
codedasfollows:
Table 40: Machine Characterization Delta Color Descriptions
Color
Thedatathatwasaddedbetweenversionsofthemachine
characterization.
)
Green (
Orange (
)
Yellow (
Gray (
338
)
)
Shows
Thedatathatwasremovedbetweenversionsofthemachine
characterization.
Thedatathatwaschangedbetweenversionsofthemachine
characterization.
Thedatathatwasnotdefined.
LUGMSQ0010/4.0/24-Jun-2014
Troubleshooting
Abnormal Treatment Termination
TheAbnormalTerminationdialogboxopenswheneverthereisaninterruptiontoorlossof
communicationbetweenSEQUENCERandthetreatmentmachine.Themessage,“Anerrorin
machineorsoftwarecommunicationhasoccurred.Verifytreatmentinformationandselect
correctrecordingoptionbelow.”appears.Youmustacknowledgethemessageandclick
Continuebeforeyoucaneithercontinuetreatmentorchangescreens.Makesuretowrite
downtheMUonthetreatmentmachine.
Field Sequences
IfanAFSorCFSsessionendsprematurely,SEQUENCERdoesnotattempttoresumethe
sessionwiththepartiallytreatedfieldandanyremaininguntreatedfields.Thesequence
becomesinvalidforthatsession.SEQUENCERshowsamessagetothateffect,butyoucan
completethepartialfielddeliveryandtreattheremainingfieldsseparately.
Completing Partial Treatments
TheCompletePartialFieldDeliveryletsyoucompletetreatmentsthatwerenotcompleted
asoriginallyscheduled.
You must have Clinical | Tx Delivery | Modify security rights to see the
Complete Partial Delivery.
You must have Approve rights to complete a partial field delivery.
1. FromtheTreatmentDeliveryTable,highlightafield,right‐clickorpressF4,andclick
CompletePartial.
2. TypethedeliveredmetersetvalueandSEQUENCERwillthensendtheremaining
metersettothetreatmentmachinewiththefieldparametersfordelivery.
SEQUENCERthenverifiesandrecordsthecompletedtreatmentasnormal.Thisis
particularlyusefulforIMRTfieldsinwhichyoucannotchangethetreatmentmachinesetup
anddoanoverridetocompleteapartialtreatment.
SEQUENCERlogsanauditentrytoshowwhetheryouchosetocompletethepartial
treatmentorcancelit.
This caution applies only to partial treatments with IBA Spot
Scanning particle therapy.
CAUTION
Complete Spot Index information is not available. The actual
resumption spot and the MU necessary to complete that spot
depend on the accuracy of the MU delivered and reported by the
treatment machine. Do an MU accuracy check with the equipment
manufacturer.
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For the resumption of an arc field on the Equinox machine, you must manually
set the applicable resumption angle and override the new start gantry position.
MOSAIQ does not automatically calculate the resumption gantry position.
Resolving an Unrecorded Treatment Delivery
Thiscouldhappenwithanetworkfailure,MOSAIQcrash,orlossofconnectionwiththe
database.Ifthisoccurs,MOSAIQshowsaTreatmentDeliveryNotCompletemessagethe
nexttimeyoulogintoMOSAIQ.
Figure 115: Treatment Delivery Not Complete Message
MOSAIQalsoshowstheTreatmentDeliveryNotCompletewhenyouopenthetreatment
chartofthepatient.Thisdialogboxtellsyouthatthedeliveryprocessstartedbutdidnot
completenormallyandthedetailsabouttheunrecordedfields.
Figure 116: Treatment Delivery Not Complete
Toresolveandacknowledgetheresolutionwhenatreatmentisdeliveredbutnotrecorded:
1. Examinethechartforanymissingrecords.
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2. Manuallyrecordanyfieldsthatweredeliveredbutnotrecorded.
3. IntheTreatmentDeliveryNotComplete,clickResolvedfortherecordedfields.
4. TypeyourusernameandpasswordintheResolutionAcknowledgementbox,andthen
clickAcknowledge.
5. Afteryouacknowledgetheresolutionofallthefields,clickClose.
The Treatment Delivery Not Complete appears only on the SEQUENCER
workstation.
Beam Interruption
Abeaminterruptioniswhensomethingcausesapauseinthedeliveryofthebeam.Whena
beaminterruptionoccurs,thecontrolstayswiththemachineandnotMOSAIQSEQUENCER.
TheverificationfunctionofSEQUENCERisonlyavailableduringsetup.Therefore,youmust
terminatethebeamandgivebackthecontroltoMOSAIQSEQUENCERwhenabeam
interruptionoccurs.
Ifabeaminterruptionoccursafterthetreatmentstartsforafieldanditisnecessaryto
changethetreatmentfieldparameters,youmustexitthetreatmentfielddefinitionandgo
backtotheTreatmentDeliveryTable.Thefieldthatisnotfullytreatedappearsinthe
TreatmentDeliveryTablewithastatusof“P”.Youcanthenselectthatfieldanddotheusual
stepstocleartheinterlocks ifneeded andcompletethetreatment.
WARNING
Do not change any treatment field parameter (such as gantry, collimator,
and couch) after beam-on. If a beam interruption occurs that requires you
to change the treatment field parameters or a machine fault moves
parameters out of tolerance during treatment, you must terminate the
beam and go back to the Treatment Delivery Table.
Treatment Field Change
Atthetimeoftreatmentdelivery afteryouopentheTreatmentDeliveryTable ,youseea
TreatmentFieldChangemessageifoneormoretreatmentfieldsintheselectedtreatment
sessionarechangedexternallytotheTreatmentDeliveryTable.
Figure 117: Treatment Field Change Message
Ifoneormoretreatmentfieldsintheselectedtreatmentsessionarechangedexternallyto
theTreatmentDeliveryTable,itispossiblethattheyarenotvalidfortreatment.
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
ClickCancelinthemessage,closetheTreatmentDeliveryTable,andexaminethese
treatmentfielddefinitionstomakesuretheyarecorrect.

Tonotexaminethetreatmentfielddefinitionsatthistimeandcontinuewiththe
treatment,youmustauthorizethetreatmentwithyourusernameandpassword,
andthenclickContinue.
This message does not appear if only the couch parameter values are changed.
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CHAPTER 9: MOSAIQ Evaluate
MOSAIQEvaluateletsyoureviewplansandimagesfromMOSAIQandtreatmentplanning
systemsandapprovethemforuseinyourclinic.
MOSAIQEvaluateisalicensedproduct.Formoreinformationaboutit,seetheMOSAIQ
EvaluateTrainingModuleortheMOSAIQEvaluatesectionoftheMOSAIQHelpSystem.
Evaluate User Interface
Accessing Evaluate
YoucanuseoneofseveralmethodstoopenEvaluate:
Evaluate Icon
1. ClicktheEvaluate41Icon
.
2. Selectapatient ifyouhavenotdonesoalready .
Main Menu
1. SelecteChart|Evaluate.
2. Selectapatient ifyouhavenotdonesoalready .
Plan Browse Workspace
1. Right‐clickontheplanyouwanttoreview.
2. SelectReview.YoucanalsopressCtrl RtoopentheselectedplaninEvaluate.
Plan Details Workspace
1. SelecttheRTPlanDetailstab.
2. ClickReview.Ifyouconfiguredyourdepartmenttorequireareviewbeforestatusing,
youcanclickStatustoopenEvaluate.
Diagnoses and Interventions
Double‐clickonaplanintheDiagnosesandInterventionsdialog.
Plan Document Editor
1. SelectaplaninthePlanDocumentEditorandclickViewRTPlan.
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Evaluate Main Window
Figure 118 -Reconfigure the Evaluate main window to suit your needs
TheEvaluatemainwindowcontainsseveralcomponents.Theyare:

Ribbon‐containsthebuttonsforEvaluate

MainContainer‐spacethatcontainsallofthelayoutwindows,globalwindows
andlayoutblocks

LayoutBlock‐containsoneormorelayoutwindows.Youcanhavemorethanone
layoutblockopen

LayoutWindows‐containoneviewofadataset

GlobalWindows‐containcontrolssuchastheIsodoseControl,BeamControl,
DoseControlorStructureControl.Thesecontrolscontaininformationaboutthe
selecteddatasets.Typically,globalwindowsaredockedalongthesidesofthe
maincontainer.
Floating Windows
Youcandragglobalwindowsandlayoutblocksoutsidetheapplicationwindowsothey
floatonthescreen.Whileyoucanfloatagroupoflayoutwindows,youcanonlyfloat
layoutblocksindividually.
Floating Blocks
1. Totogglefloatingonoroffonablock,clicktheFloat/Unfloatglyph
.
Youcanclickthetitlebartodragfloatedblocksaroundthescreen.
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Layout Windows
Youcanclickthe
buttoninthetoprightcornerofalayoutwindowtomaximizeit.
Clickthebuttonagaintorestorethewindow.
Positioning Screen Elements
Youcanpositionthecontrolsinordertoconfigureyourscreenforoptimaluse.Withthe
mouse,youcandragthecontroltoanywhereonyourscreen orofftoyoursecond
monitor .
However,youcanalsousetheDockcontrol,whichappearswhenyoudragatoolbaror
control,to:

Setthepositionofyourtoolbarorcontroltoaparticularquadrantonthescreen
 Setthelayeringorder
Thereareseveralseparatedockpoints,locatedinthesepositionsonthemainwindow:

Outertop

Innertop

Outerleft

Innerleft

Outerright

Innerright

Outerbottom

Innerbottom
 Dockastab
Whenyouclickonadockinaparticularareaofthemainwindow,itwillplacethescreen
elementwithinitsregion.So,forexample,ifyoumoveacontrolovertheOuterrightdock,
yourcontrolwillappearontherightedgeofthewindow.
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Figure 119: DVH occupies the shaded portion of the screen when you release the mouse button
Docking a Control
1. Positionthecursoratthetopofthecontrol.
2. Clickthetopofthetoolbarorcontrolanddragitoverthedock.
3. Positionthecursoroverthepositioncontrolwhileyouholddownthemousebutton.
Youwillseeablueoutlineonthewindow.Theoutlineshowsthepositionofthedialog
boxorcontrol.
4. Releasethemousebutton.Youwillseethetoolbarorcontrolstretchedacrossthe
sectionofscreenyouselected.
Creating Control Tabs
1. Positionthecursoratthetopofthecontrol.
2. ClickthetopofthetoolbarorcontrolanddragitovertheDockastab inthecenterof
thewindow .
3. Positionthecursoroverthepositioncontrolwhileyouholddownthemousebutton.
Youwillseeablueoutlineonthewindow.Theoutlineshowsthepositionofthe
dialogboxorcontrol.
4. Releasethemousebutton.
Youwillseethetoolbarorcontrolstretchedacrossthesectionofscreenyouselected.
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Layouts
Figure 120: MOSAIQ RTP Layout Designer lets you set your own window layouts and arrangements
YoucandefineawindowlayoutwiththeMOSAIQRTPLayoutDesigner.Afteryoudesigna
layout,youcanusetheLayoutSelectortochoosealayout.
MOSAIQ RTP Layout Designer
TheMOSAIQRTPLayoutDesignerletsyouorganizeyourwindow.Youcanuseitto:

PositionGlobalWindows

Setthenumberofrowsandwindowsinthemainviewingarea

Setdefaultlayouts
Creating a New Layout
1. OpentheMOSAIQRTPLayoutDesignerdialogbox.
2. ClickNewLayout.
3. Enterthenumberofrowsandcolumnsthatwilldeterminehowmanywindowswill
appearinthegraphicsarea.
4. DragtheGlobalWindowsyouwantinyourlayout.Positionthemoverthedockstoset
themtoaposition.
5. DragtheLayoutWindowsyouwantintotheMaindisplayarea.
6. Ifyouwanttousethelayoutasthedefault,markDefault.
7. TypeaNameforyourlayout.
8.
Optional TypeaDescriptionofthelayout.
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9. ClickSave.
Editing a Layout
2. Selectalayoutfromthedrop‐downlistoflayouts.
3. ChangetheGlobalandLayoutWindows.Todeleteawindow,selecttheXintheupper
rightcorner.Youcanalsoswaplayoutwindowswitharight‐mouseclick.
4. Ifyouwanttousethelayoutasadefault,markDefault.
5. TypeaNameforyourlayout.
6. TypeaDescriptionofthelayout.
7. ClickSave.
Deleting a Layout
2. Selectalayoutfromthedrop‐downlistoflayouts.
3. ClickDelete
.
4. Confirmthatyouwanttodeletethelayout.
Loading Patients, Plans, and Images
Youcanloadpatients,plansandimagesfromseveralsources,includingthe:

Navigator

3DViewer

DiagnosesandInterventionsdialog

PlanWorklist
Navigator
Whenyoudragapatient,planorimagefromtheNavigatortothevisualizationarea,you
willseeseveraloptionsappear.Dragtheimagesontotheoptionyouwant.
Ifyoualreadyhaveasingleimageset,structuresetordoseloaded,youcanaddanother
imagesetifthereisaregistrationbetweenthem.ChoosetheAddtoBlockoptiontoload
theadditionalobjectasasecondaryimage,doseorstructureset.
Ifyouhaveastructureandimagesetopened,youcanaddadditionalstructureandimage
setstothesameblockiftheyhavearegistrationbetweenthem.
Forplanswithmultipledoses,onlytheplanandstructuresetwillload.Youneedto
manuallyloadthedoseifyouwanttouseit.
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Diagnoses and Interventions and Plan Worklist
Ifyouloadplansfromoneofthesedialogs,thesoftwarewillcleartheblocksofanyplans
youhavecurrentlyloaded.
Loading Plans/Structures/Images/Dose
1. Selectapatient.
2. Usethemousetodragtheplan,structure,imagesordosesetintothevisualization
area.
3. Ifyoualreadyhavealoadedstructureset,dragthestructuresetovertheAddtoBlock
optiontoaddittothelistofstructuresetsinthevisualizationarea.Toviewthe
secondarystructureorimagesetinaseparatewindow,selecttheAddasNewBlock
option.
4. Toreplacethecurrentstructureset,dragthenewstructuresetovertheReplaceBlock
Contentsoption.
Unloading Plans, Images, and Structure Sets
1. Right‐clickontheloadedplan,imageorstructureset.
2. SelectUnload.
Viewing DICOM Information
Figure 121: DICOM Properties shows the DICOM information for selected plans, image sets,
structure sets and dose
YoucanviewDICOMpropertiesofanyloaded:
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
Plan

ImageSet

StructureSet

Dose
 Registration
1. Right‐clickontheplan,imagesetorstructuresetintheNavigatorortheInformation
Block.
2. SelectDICOMProperties.
2D/3D Views
Youcanviewimages,beamsandstructuresas2Dand3Dviews.Available2Dcutplane
viewsare:

Transverse

Sagittal

Coronal
Beam Rendering
Whenyouviewbeams,youcanchoosebetweentwodifferentmodes:

ControlPointletsyouviewthebeamgeometryforasinglecontrolpoint.This
includesjawandleafpositions.

FullExtentsmodeshowsthemaximumextentsofthejawsandleavesforagiven
gantryangle.
Control Point View
Youcanswitchbetweendifferentcontrolpointsonabeam.Todoso,typeanewcontrol
pointintheControlPointfieldintheBeamControl youcanalsousetheUp/Downarrows
tosetanewcontrolpoint.
Full Extents
InFullExtentsmode,youwillseethewidestjawandleafpositionsforsetsofcontrol
pointsateachangle.
Changing Beam Rendering
1. LoadoneormoreplansintoEvaluate.
2. OntheLegendBeamControl,selecttheplanyouwanttoview.
3. MarkFullExtentstoviewthemaximumextentsforthejawsandleaves.
4. MarkControlPointstoviewthebeamgeometryforasinglecontrolpoint.
5. Mark2Dtoviewthebeaminthecutplaneviews transverse,sagittal,orcoronal .
6. Mark3Dtoviewthebeaminthe3Dview.
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7. ClickontheColornexttoabeamtochooseanewcolorforit.
8. AdjusttheGantrypositionwiththeupanddownarrows.
9. AddorremoveControlPointswiththeupanddownarrows.
Wireframe Display
Externalradiationbeamsappearaswireframes.Eachbeamdisplayshows:

Isocenter

IsocenterPlane

BeamCentralAxis

EntryPoint

EntryPointPlane
Arc Beams
ArcsappearwhentheGantryangleortheCollimatorangleofthebeamchanges.Youcan
seebotharcandbeamgraphicswithinthesameview.Beamswitharcsappearasa
circulararccenteredontheisocenterandprojectedintotheview.
Beam Modifiers
Youcanalsoviewanymodifiersattachedtothebeam.
MLC
In3Dviews,theprojectionofMLCsappearsonthe:

EntryPointPlane
 IsocenterPlane
Incutplaneviews,theMLCappearsonanycutplanethatintersectstheMLCprojection.
Foreachcontrolpoint,youwillseethepositionofthejawsandleaves.
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Blocks and Apertures

Blocksappearontheentrypointandisocenterplanein3Dviews.Incutplane
views,theyappearonanycutplanethatintersectstheblockprojection.Blocks
appearasadiagonallineextendingfromthetoplefttobottomright.Ifablock
extendspastthejawextent,therenderedblockwillnotexceedthejawextent.

Multipleblocksonthesamebeamwillbesuperimposedoveroneanotherinthe
display.

Aperturesappearasblankshapeswithinarenderedblock.
Wedges
Wedgesappearas20‐degreewedgesoutsidetheentrypointinboth3Dandcutplane
views.Theheelofthewedgeappearscorrectlyinrespecttothepatientmodel.Wedges
appearasawedgeshapebetweentheentrypointplaneandthesource.
Compensators
Compensatorsalwaysappearoutsidetheentrypointinboth3Dandcutplaneviews.
Toggling the 3D Cutplane
ClicktheToggle3DCutplaneon/offbutton
view.
toshoworhidethecutplanesonthe3D
Rotating the 3D View
1. Pressandholdthemousebutton.Note:Youneedtodeactivatezoomorpaninorder
torotate.
2. Dragthemouseleftorrighttorotatetheviewalongthex‐axis.
3. Torotatealongthey‐axis,dragthemouseupordown.
4. Torotatealongthez‐axis,positionthecursoroutsidethepatientextents,pressthe
mousebuttonanddraginanydirection.
On-Slice Navigation
On‐slicemodeconstrainsthecutplaneoftheimagesettothepositionoftheoriginal
slices.Whenyouactivateon‐slicenavigationandmovethroughslices,youwill"snap"to
theclosestsliceposition.On‐slicemodeisavailablewhentheimagesetcomesfroma
seriesofsliceswithknownslicepositions.
Activating On-Slice Navigation
1. Toactivateordeactivateon‐slicenavigation,clickOnslicemodeonthetoolbar.
2. Clickina2DViewandthenscrollthrougheachslice.
Navigation Spacing
Navigationspacingisthedistancetheimagesmovewhenyouadvancetheimage.To
advanceimages:
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
Clickorturnthescrollwheel.

Typeanewvalueinthelowerleftcornerofeachview.

PressthePageUporPageDownkeysonthekeyboard.

PresstheLkeytoautomaticallyjumptothelocationofyourmouse.
 DragthegreenTsontheedgeofeachview.
Thesettingdefaultsto0.2cm.Acceptablerangeisfrom0.10to10cm.
Changing the Navigation Spacing
1. Tochangethespacingonthecutplaneor3Dviews,enteranewvalueinthe
NavigationSpacingfieldintheVisualizationribbon.
2. Tousethedefinednavigationspacingmethodmentionedabove,youmustturnoffthe
On‐SliceSpacingbutton
.Whenthebuttonison,thedefaultnavigationspacing
usestheDICOMslicespacing.
Pan Tool
YoucanfindthePantoolintheVisualizationgroupoftheRibbon.
WiththePantool,youcanclickandmoveanimagetothenecessarylocation.Theposition
oftheimagecenterchangescorrespondinglyintheView.Youcanuseitinthe2Dor3D
cutplaneViews.
ActivatethePanTool:ClickPantohighlightandactivateit.
DeactivatethePantool:ClickPanagaintoremovethehighlightanddeactivateit.
Right-Click Menu
Youcanalsoright‐clickinaView,andthenclickPan.
Zoom Tool
TherearetwoZoomtools:

TheZoomtool
 AOIZoomtool
YoucanfindbothtoolsintheVisualizationgroupoftheribbon.Bothtoolsincreasethe
sizeoftheopenimage.TheAOIZoomtoolincreasesthemagnificationofauser‐defined
area.Youcanclicktheappropriatebuttontoactivateordeactivatebothtools.Youcan
alsoactivatetheZoomtoolwiththeright‐mousemenuofanyview.
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Zoom Modes
Youcanzoominonaparticularareaofanimage.Therearetwozoommodesthat
determinewhichimagesyouwillzoominon:

AreaZoomletsyouselectanareatozoomon.Thisappliestoallcutplanepanels
ofthesameorientation.Forexample,ifyouhavemultipleplansopenintwo
blocks,ifyouzoominontheTransverseviewoftheplaninblock1,the
transverseviewinblock2willalsozoom.

AreaZoomAllletsyouzoomonanareaofallcutplaneviews.Panelsmustbe
navigationallylinked.Forexample,ifyouzoominonthetransverseview,the
sagittalandcoronalviewswillalsozoomin.However,the3Dviewwillnotzoom
alongwiththe2Dviews.Youmustzoomthe3Dviewseparatelyfromthe2D
views.
Using the Toolbar Zoom Button
1. ClickZoominthetoolbar.Clickthedrop‐downarrowtoswitchtoanewzoommode.
2. Positionthecursorwithintheimageyouwanttozoominon.Thecursorwillchange
appearanceto:
.
3. Pressandholdtheleftmousebutton.
4. Movethecursorupanddowntoincreaseordecreasethezoomlevel.Youcanalso
movethecursorleftandrighttoincreaseordecreasethezoomlevel.
Using the Right-Mouse Menu
1. Positionthecursorwithintheimageyouwanttozoominon.
2. Right‐clickintheimageandselectZoom.Thecursorwillchangeappearanceto:
.
4. Movethecursorupanddowntoincreaseordecreasethezoomlevel.Youcanalso
movethecursorleftandrighttoincreaseordecreasethezoomlevel.
Zooming In with Area Zoom
1. ClickAOIZoominthetoolbar.Clickthedrop‐downarrowtoswitchtoanewAOI
zoommode.
2. Positionthecursorclosetotheareayouwanttomagnify.
Thecursorwillchangeappearanceto:
.
4. Dragthecursoruntiltherectanglethatappearsencompassestheareayouwantto
zoominon.
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Theselectedareawillfilltheentirepanel.
Resetting Zoom and Pan
With the Toolbar
1. Forthecutplaneviews,clickResetT/S/C
2. For3Dviews,clickReset3D
.
.
Theactiveviewwillreturntoitsdefaultmagnificationandposition.
With the Menu
1. Inthepanelyouwanttoreset,right‐clickontheimage.
2. SelectResetT/S/Cforcutplaneviews.SelectReset3Dfor3Dviews.
Measuring Distances
Youcanmeasurethedistancebetweentwopointsinanycutplane.Youusethe
measurementtooltodeterminethedistance.Onceyoudrawameasurementline,it
remainsinthepaneluntilyoudeleteitorunloadthepatient.Measurementsmustbeat
least.01cm.Theywillnotappearinthepaneliftheyaresmallerthanthat.
How to Determine a Measurement
1. ClickMeasure
.
2. Positionthecursorwhereyouwanttostartthemeasurement.
3. Holdtheleftmousebuttonanddragthecursortotheendpoint.
Youcanalsoclickatthestartpointandclickattheendpoint.Themeasurementbar
willappearinthepanel.Youwillseethedistancebetweenthetwopoints.
How to Delete a Measurement
1. ClickClearMeasurement
todeleteallmeasurementsinthelayout.
Browsing Through Images
Navigating to a New Point
Youcanquicklycentera2Dor3Dcutplaneviewonaparticularpoint.Therearethree
methodsavailable:
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
In‐ViewNavigation

In‐ViewSliceTrackers

ToolbarNavigation
Navigating with In-View Navigation
FollowthesestepstouseIn‐ViewNavigation:
1. Right‐clickinoneofthecutplaneviews.
2. SelectNavigateTo.
3. Selectifyouwanttonavigatetoaparticularstructure,theglobalmaxoraparticular
isocenter.
Navigating with In-View Slice Trackers
TheIn‐ViewSliceTrackersaretheT‐shapedverticalandhorizontalhandlesinthe
cutplaneview.Youcaneither:

Dragoneofthehandlestoviewanewpositionintheotherviews

DragtheNavigationPointCross,whichappearsifyournavigationpointisinthe
currentcutplanewindow.
Toscrolltoanewpoint:
1. Positionthecursoronthescrollbartothesideoftheview.
2. Holddowntheleftmousebuttonanddragthescrollbarupordowntomovetoanew
position.
Youcanalsoclickthegreencircle attheintersectionofthehorizontalandverticalscroll
bars anddragittoanewpositiontoviewthepoint.
Navigating with the Keyboard and Mouse
Keyboard
Youcan:

PressthePageUporPageDownkeystomoveupordowntheimagesintheset

PresstheLkeytogotothelocationofyourmousecursor.
Mouse
Ifyourmousehasawheel,youcanrotatethewheeltoadvancethroughtheimages.
Navigating to a Structure
YoucancentertheviewsonthecenterofaparticularstructurefromtheStructureControl
ortheDVHStatisticsPage.
Navigating to a Structure
Followthesestepstocentertheviewsonthecenterofastructure:
1. ClickActions|Navigatetocenteroftodisplayalistofstructuresintheplan.
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2. Selectastructurefromthelist.
Navigating to Views
Youcanopenaviewofanavigationpointwithinaparticularstructurefromthedose
volumehistogram DVH .
1. IntheDVHStatisticsGridControl,Right‐clickthemouseinacellthatcontainsadose
value.
2. SelectNavigateTo.
Theviewswillautomaticallynavigatetothepointintheselectedstructurethat
containsthedosevalue.
Resetting Position of Views
With the Toolbar
1. Forthecutplaneviews,clickResetT/S/C
2. For3Dviews,clickReset3D
magnificationandposition.
.
.Theactiveviewwillreturntoitsdefault
With the Menu
1. Inthepanelyouwanttoreset,right‐clickontheimage.
2. SelectResetT/S/Cforcutplaneviews.SelectReset3Dfor3Dviews.
Dual Image Display
Youcanviewasecondaryimagesuperimposedoveraprimaryimage.Bothimagescan
appearindifferentcolors,whichyoucanchange.
Activating Blended Mode
1. ClicktheBlendedbutton
toactivatethePrimary/Secondaryslider.
2. Tocontrolthedegreeofblendingbetweentheimagesets,dragthesliderbarbetween
theP
andS
onthePrimary/Secondarytoolbar.
Selecting a New Color for an Image Set
1. ClickthedownarrownexttoPrimary
Primary/Secondaryslidercontrol.
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orSecondary
fromthe
357
2. ClickthecolorsquarenexttotheColoroption.
3. Clickonacolortoassignittotheselectedimage.
4. ClickOK.
Switching Between Color Modes
1. ClickAllGrayscaletomaketheprimaryandsecondaryimagesetsswitchbetween
colorandgrayscale.
2. SelectColororGrayscalefromthedrop‐downlist.
InEvaluate,youcanapplyoneofseveraldualdisplaymodestoanycutplaneview.This
letsyouviewportionsofaprimaryandsecondaryimageinthesamepanel.Ifyouapplya
displaymodetoablockinalayout,thedisplaymodeappliestoallotherblocksthat
containthesameprimaryimage.
Checkerboard‐Showsportionsof
theprimaryandsecondaryimage
intherectanglesofa
checkerboard.Youcanresizethe
checkerboardboxesandthe
positionoftheboardoverthe
images.
Spyglass ‐ Showstheprimary
imageinthepanel.Thesecondary
imageappearsinasmallmoveable
shape,thespyglass.
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Blended‐Showstheprimaryand
secondaryimage,bothappearina
user‐definedcolor.Defaultcoloris
purple/green.Theprimaryimage
appearsinthepanelwiththe
secondarysuperimposedoverit.
Checkerboard Display
Thecheckerboarddualimagedisplayletsyouviewbothprimaryandsecondaryimages
alternatinginacheckerboardpattern.Toactivatethecheckerboarddisplay,click
.
Checkerboard
Increasing or Decreasing the Number of Squares
1. ClickthedownarrownexttotheCheckerboardbutton
.
2. Selectthenumberofsquaresyouwanttoappearinthewindow.Optionsare:

2x2

4x4

8x8

16x16

32x32
Panning the Checkerboard
1. Positionthecursorinthecheckerboardpanel.
2. Presstheleftmousebuttonanddragthecheckerboardtoitsnewposition.
Blended Display
Youcanviewasecondaryimagesuperimposedoveraprimaryimage.Bothimagescan
appearindifferentcolors,whichyoucanchange.ToactivateBlendedmode:
1. ClicktheBlendedbutton
toactivatethePrimary/Secondaryslider.
2. Tocontrolthedegreeofblendingbetweentheimagesets,dragthesliderbarbetween
theP
andS
onthePrimary/Secondarytoolbar.
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Selecting a New Color for an Image Set
1. ClickthedownarrownexttoPrimary
Primary/Secondaryslidercontrol.
orSecondary
fromthe
2. ClickthecolorsquarenexttotheColoroption.
3. Clickonacolortoassignittotheselectedimage.
4. ClickOK.
Switching Between Color Modes
1. ClickAllGrayscaletomakeprimaryandsecondaryimagesetsswitchbetweencolor
andgrayscale.
2. SelectColororGrayscalefromthedrop‐downlist.
3. ClickAllGrayscaletomaketheprimaryandsecondaryimagesetsswitchbetween
colorandgrayscale.
Spyglass Display
Thespyglassdualdisplaymodeletsyouviewtheprimaryimageinapanel.Youviewthe
secondaryimagethroughasmallshapethatyoucanmoveorresize.Toactivatethe
Spyglassdisplay:
1. ClicktheSpyglassicon
.
2. Positionthecursorinapanelthatcontainsaloadedprimaryandsecondaryimage.
Positioning the Spyglass
1. Positionthecursoroverthespyglassintheimage.
2. Dragthespyglasstoitsnewposition.
Resizing the Spyglass
Toincreaseordecreasethesizeofthespyglass,holdtheleftmousebuttonandmovethe
scrollwheeltochangethesizeofthespyglass.
Window Width and Level Values
Theviewsprovideadjustablewindowandlevelvaluessoyoucanchangethebrightness
andcontrastoftheimagedisplay.Thismakestheindividualanatomicalstructuresmore
distinguishable.Youcancontrolthesesettings‐individually‐forseveralimagetypes:
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
Primaryandsecondaryimagesets.

Anterior/posterior,lateral,andBeam’sEyeViewDRRs.

Primaryandsecondarythresholds.
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CTimagesarecreatedwith256grayshadestorepresentrangesofpixeldensityvalues.To
enhancethecontrastbetweenstructures,youcanadjustthewindowandlevelvalues
imagebrightnessandcontrast .Notethatthewindow/levelvaluesofCTimagesare
adjustedindependentlyofthosefortheDRRviews.Youcanalsostoreandreusewindow
levelsettings.
The256shadesofgrayrangeincolorfromblack shade0 tomediumgray shade127 towhite shade255 .Theactualshadecanbedeterminedbyusingthevaluesonthe
Window/Leveltoolbar.Thelocationofthepixelvalueonthisslidingscaledeterminesthe
shadeofgray.Thisscaleiscontrolledbytwoquantities:windowvalueandlevelvalue.
Window Width and Level Values

Windowwidthvalueisthetotalrangeofpixeldensityvaluescoveredbyall256
shadesofgray.Itisdeterminedbysubtractingtheminimumpixelvaluefromthe
maximumpixelvalue.Itcontrolstherangeofpixelvaluesthatwillbedistributed
acrosstheavailable256graylevels.Alargewindowcoversawiderrangeofpixel
values,whileasmallerwindowshowsdifferenceswithinatightrangemore
clearly.

Levelvalueisthedensityvalueformediumgray shade127 .
Changing the Window Level
Using the Window/Level Button
Usethefollowingstepstochangethewindowlevelonopenstudysets:
1. ClickWindowLevelontheWindowLevelcontrol.Thecursorwillappearasahalf
black/halfwhitecircle.
2. Positionthecursorina2Dor3Dview.
3. Holddowntheleftmousebutton.
4. Movethecursoruptoincreaseordecreasethewindowwidth.
5. Movethecursorleftorrighttoincreaseordecreasethewindowlevel.
Using the Window/Level Fields
1. TypeanewvalueintheWindowandLevelfields.
Using the Window/Level Presets
Usethefollowingstepstochangethewindowlevelonopenstudysets:
1. ClickthedownarrownexttotheWindowLevelbuttonontheWindowLevelcontrol.
2. Selectapresetfromthelist.
3. Tosetanewpresetvalue,selecttheManageoptiontogototheWindowLevelPresets
window.
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Window/Level Presets
Youcanapplypreset pre‐defined windowlevelvaluestooneormoreimagesetsthat
youloadinEvaluate.YouaddthepresetvaluesintheWindowLevelPresetswindow.
FollowthesestepstoaddaWindowLevelpreset:
1. ClicktheWindow/LeveldropdownlistadjacenttotheMouseWindowLevelbutton.
2. ClickManagetoopentheWindowLevelPresetswindow.
3. TypethenameofthepresetintheNametextbox.
4. TypethewindowwidthintheWindowtextbox.
5. TypethelevelsettingintheLeveltextbox.
6. ClickOKtoapplythechangesandclosetheWindowLevelPresetswindow.
Applying a Window/Level Preset
Afteryouaddawindowlevelpreset,youapplyittooneormoreloadedimagesetsfora
patient.Followthesestepstoapplywindowlevelpresetstooneormoreloadedimage
sets.
1. ClicktheW/LAffectsdrop‐downlisttoopenit.
2. Clickthecheckboxadjacenttooneormoreimagesetstotagthem.
OR
ClicktheSelectAllcheckboxtotagallloadedimagesets.
If a check box is clear, you cannot apply the window level presets to loaded
image sets.
3. ClicktheWindow/Leveldrop‐downlistadjacenttotheMouseWindowLevelbutton.
4. Clickthepresetname,suchas"Ultrasound".
This applies the preset to all images in the loaded image sets that you tag in
the W/L Affects drop-down list.
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Plan Review
Dose Volume Histogram
Figure 122: The Dose Volume Histogram contains a graph (on top) and a grid (on bottom).
Thedosevolumehistogram DVH isagraphthatshowseacheligiblestructureinthe
treatmentplan s .Ahistogramrepresentseachstructure.Thehistogramplotsthedose
distributionagainstthevolumesoftumorsandstructures.YoucanswitchtheDVH
betweencumulativeordifferentialDVHs:

Cumulative‐thegraphshowsthevolumewithadosevaluethatfallswithinor
exceedsthedosebin.

Differential‐thegraphshowsthevolumewithadosethatfallswithinthedose
bin.
YouuseDVHsto:

Evaluatedoseinformationprovidedbyisocurvesandisosurfaces.

Showdoseuniformityinastructure.

Select"hotspots"outsidethetargetvolumethatcouldpotentiallydamagenormal
tissueorcoldspotsinthetargetvolume.
TheDVHdisplaycontainsuptofiveDVHsets,whichcontainthecomputationoftheDVH
foreachstructureinastructuresetforagivendose.Youcancontrolseveraldisplay
functionsontheDVHgraphitself.
Maximizing/Minimizing DVH Controls
YoucanmaximizethesizeoftheDVHcontrols.Thiswillcausethemaximizedcontrolto
filltheentirecontrolspace.Thishidestheothercontrol.Youcanalsoreversetheprocess
tominimizethecontrol,whichrestoresittoitsoriginalsize.Thiswillproportionally
resizethefieldsandobjectsinthecontrol.
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Maximizing with the Glyphs
Therearetwoglyphsinthetopright‐handcorneroftheDVHchartthatletyouminimize
ormaximizethesizeofthecontrol.
1. ClickMaximize
entirewindow.
inthetoprightcornerofthecontrol.Thecontrolwillfillthe
2. Torestorethecontroltoitsoriginalsize,clickMinimize
.
Maximizing with the Splitter Bar
ThesplitterbaristhehorizontallinebetweentheDVHgraphandtheDVHStatisticsPage.
1. Clickonthesplitterbarandholdthemousebutton.
2. Dragthesplittertothesizeyouwantthecontroltobe.
Changing the DVH Graph
Youcancustomizetheappearanceofthedosevolumehistogram DVH tomakeitmore
usefultoyouwhenyouworkwithit.OntheDVHSettingsdialog,youcan:

Addorremovegridlines

Changethegridlinestyle
 ChangetheDVHbackgroundcolor.
ChangesmadetotheDVHwillupdateautomaticallywhenyouclickApplyontheDVH
Settingsdialog.
1. PositionyourmousewithintheDVHgraph.
2. Right‐clickinthechart.
3. SelectDVHSettings.
4. Toaddgridlines,marktheShowHorizontalGridlinesorShowVerticalGridlinescheck
boxes.
5. Tochangethegridlinestyle,selectastylefromtheGridlineStyledrop‐down.
6. Tochangethebackgroundcolor,selectonefromtheBackgroundColordrop‐down.
Changing DVH Appearance
Changing DVH Styles, Colors, and Thickness
YoucanchangeDVHlinestyles,colorandthicknesstomakecertainstructurelinesstand
outfromoneanother.
1. Right‐clickintheVisibilitycolumnforthestructureyouwant.
2. SelectStyle.
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3. Clickonthelinestyleyouwant.
4. ChooseanewWidth.
Validvaluesarebetween1and8.
5. ClicktheColorPickertoselectanewcolorfortheline.
Showing 2D Structures
Followthesestepstoshow2Dstructuresintheloadedplan:
1. LocatethestructureintheStructureControl.
2. Markthe2Dcheckboxnexttothestructure.
3. Toshowallstructures,clickthe2Dcheckboxatthetopofthecolumn.
Showing 3D Structures
Followthesestepstoshow3Dstructuresintheloadedplan:
2. Markthe3Dcheckboxnexttothestructure.
3. Toshowallstructures,clickthe3Dcheckboxatthetopofthecolumn.
Hiding Structures
Followthesestepstohidestructuresintheloadedplan:
2. Clearthemarknexttothe2Dor3Dcheckboxnexttothestructure.
3. Tohideallstructures,clickthe2Dor3Dcheckboxatthetopofthecolumn.
Youcanalso:
1. Right‐clickonastructurerowintheDVHStatisticsPagecontrol.
2. SelectHideDVHfromtheoptionmenu.
Hiding a DVH Column
IntheDVHStatisticsPage,youcanhidesomeofthecolumnsinordertofocusyour
attentionontheremainingcolumns.Hiddencolumnswillnolongerappearinthe
DVHStatisticsGridControluntilyourecallit.
How to Hide the Column
1. Right‐clickontheheadingofcolumnyouwanttohide.
2. SelectHideColumnfromtheoptionmenu.Thecolumnwilldisappearfromthegrid
control.
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Zooming In and Out of a DVH
IfyouwanttolookmorecloselyataparticularpartoftheDVHStatisticsPage,youcan
zoomintooroutofit.WhenyouzoominonaparticularpartofaDVH,theMinimumand
MaximumVolumevalueswillupdateatthelowerleftandupperleftcornerofthe
selectionarea,respectively.
WhenyoudeactivateZoommode,theDVHgraphreturnstoitsdefaultsettings.
Zooming In on a Particular Area
1. PositionthecursorovertheDVHgraph.
2. Right‐clickandselectZoom.
3. PresstheShiftkeyanddragthemousetocreatearectangleovertheareayouwantto
zoominon.
Zooming in the Entire DVH
2. Right‐clickandselectZoom.
3. PresstheShiftkeyandclicktheleftmousebuttontozoominonetime.Youcanzoom
inuptothreetimes.
4. Tozoomout,presstheAltkeyandclicktheleftmousebutton.
Resetting the Zoom
2. Presstheright‐clickbuttonandselectResetZoom.ThiswillreturntheMinimumand
MaximumVolumeandMinimumandMaximumDosevaluestotheirdefaultsettings.
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Viewing DVH Annotations
Figure 123: Annotation of Reference Line on a DVH
YoucanviewdetailsabouttheDVHwhenyoumoveyourmouseoverthecurve.Awindow
containinginformationaboutthestructure,volumeanddoseatthepointappears.
To View an Annotation on the DVH
1. Positionthecursoroverapointalongthecurve.
Youwillseetheannotationboxappearoverthepoint.
2. Movethecursortoremovethebox.
Maintaining an Annotation on a Reference Line
1. Positionthecursoroverapointalongthecurve.
2. Whentheannotationboxappears,clicktheleftmousebutton.
3. Positionthecursorabovetheintersectionofthecurveandthelinetoseta"Hot"
referenceline.
Youwillseetheannotationbox.
4. Toseta"Cold"referenceline,presstheShiftkeywhileyoupositionthecursor.Move
thecursorawayfromthepoint.
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Theannotationboxwillremain.
Changing DVH Volume Units Range
Youcanchangethevolumeunitrangeinadosevolumehistogram DVH .Thiswillletyou
lookatalargerorsmallerrangeofvolumesasnecessary.
1. Right‐clickintheDVHGraph.
2. SelectDVHSettingstoopentheDVHSettingsdialogbox.
3. TypeaMin.Volumevalue.
4. TypeaMax.Volumevalue.
5. ClickApplytoacceptthechanges.
6. ClickOKtoacceptthechangesandclosethedialog.
Changing DVH Dose Range
Youcanchangethedoserangeinadosevolumehistogram DVH .Thiswillletyoulookat
alargerorsmallerrangeofdosesasnecessary.
1. Right‐clickintheDVHGraph.
2. SelectDVHSettingstoopentheDVHSettings.
3. EnteraMin.Dosevalue.
4. EnteraMax.Dosevalue.
5. IfyouwantsosettheMax.DosevalueasthemaximumforallthedosesintheDVH,
marktheGlobalMaxfield.
6. ClickApplytoacceptthechanges.
7. ClickOKtoacceptthechangesandclosethedialog.
Setting Dose Goals
YoucansetdosegoalstostructuresintheDVH.TheSetGoalsandTolerancedialogbox
letsyousetthesedosetypes:

Maximum

MeanDose

Minimum
Setting a Maximum Goal
1. Right‐clickontheMax.Goalvalue.
2. SelectSetGoalandTolerancefromtheoptionmenu.
TheSetGoalandTolerancedialogopens.
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3. EnteradosevalueintheMax.DoseGoalfield.
4. EnteraTolerancevalue.Thisisanoptionalvalue.
5. ClickOKtoacceptthevaluesandclosethedialogbox.
Thenewmaximumvaluewillappearinthefield.
Setting a Mean Dose Goal
1. Right‐clickontheMeanDosevalue.
3. ClicktheGoalTypetogglebuttontotogglethegoaltypebetweenNoMoreThanand
NoLessThan.
4. EnteraminimumormaximumdosevalueintheMeanDoseGoalfield.
5. TypeaTolerancevalue Optional .
Thenewmeangoalvaluewillappearinthefield.
Setting Minimum Dose Goal
1. Right‐clickontheMin.Goalvalue.
3. EnteraminimumdosevalueintheMin.DoseGoalfield.
4. EnteraTolerancevalue.
Thisisanoptionalfield.
Thenewminimumvaluewillappearinthefield.
Setting a Reference Dose Goal
Ondialogsorcontrolsthathaveareferencedose,youcandefinehowmuchofthevolume
youwanttoreceiveaspecifieddose.
Forexample,youcouldsetacoldreferencedosegoalof7000cGyforthePTVinorderto
findouthowmuchofthePTVreceiveslessthan7000cGy.Youcouldalsosetahot
referencedosegoalof6000cGytothebladdertoseehowmuchofthebladderreceives
morethan6000cGy.
Followthesestepstosetreferencedosegoals:
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1. Right‐clickontheRef.Dosevalue.
3. ClicktheReferenceTypedrop‐downbuttontotogglethegoaltypebetweenNoLess
ThanandNoMoreThan.
4. EnteravolumevalueintheRef.Vol.Goalfield.
5. SelectaunitfromtheGoalUnitdrop‐downmenu.Selecteither%orcc.
6. EnteraTolerance.
Thisisanoptionalfield.
7. EnteradoseintheRef.Dosefield.
Thenewgoalvaluewillappearinthefield.
Adding or Deleting Additional Reference Doses to the DVH Statistics
Page
Youcanaddsub‐rowstotheDVHStatisticsPage.Thesesub‐rowscanletyoulistmultiple
hotandcoldreferencevalues.Youcanalsodeletesub‐rows.
Adding a Sub-Row
1. Selecttherowcontainingthestructureyouwant.
2. Right‐clickontherow.
3. SelectAdd.
Thenewrowwillappearbelowtherowyouselected.ItwillhavetheReferenceDose
oftheoriginalrow.
4. TypeanewReferenceDosevalue.
Deleting a Sub-Row
1. Choosethesub‐rowyouwanttodelete.
2. Right‐clickonthesub‐row.
3. SelectRemoveRef.Value.
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Combining DVH Structures
Structure Combinations
Figure 124: Combine Structures in the DVH in the Structure Combinations
UsetheStructureCombinationstomakedifferentcombinationsofstructuresinthedose
volumehistogram DVH .ThesecombinedstructureswillappearintheDVHasasingle,
newstructure.
Creating a Combined Structure
1. Right‐clickanywhereintheDVHgraph.
2. SelectStructureCombinationstoopentheStructureCombinations.
3. SelectthestructuresetyouwanttousefromtheStructureSetdrop‐downlist.
4. TypeanameforthenewStructureCombination.
Youcanalsousethedefaultnameinthebox.
5. ClickontheColorControltoselectanewcolorforthecombinedstructure.
6. SelectastructureinthetwotopStructuredrop‐downlists.
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7. SelectanoperationtocreatethecombinedstructurefromtheOperationdrop‐down
listbetweenthetwoStructuredrop‐downlists.
8. Ifyouneedadditionalstructuresoroperations,clickAddLevel.
9. ClickAccepttoretainthenewstructure.
10. ClickOKtoclosethedialogbox.
Resetting DVH Values
WhenyouzoominonaDVH,theminimumandmaximumdoseandvolumevaluesupdate
toreflecttheareaoftheDVHthatappearsinthecontrolspace.Youcanresetthemtotheir
defaultvalues.
1. Right‐clickontheDVHgraphtoopentheright‐mousemenu.
2. SelectResetZoom.
Thevalueswillresettotheirdefaults.
DVH Templates
Youcanretaingoalsanddoseinformationfromadosevolumehistogram DVH and
applyittosimilarDVHsthatcontainthesamestructures.
DVHtemplatescontainthefollowinginformationforeachstructure:

Goals

HotandColdReferenceDoses
 Tolerances
Alldataforeachstructuremusthaveavalueotherthanzero.Otherwise,itwillnotbe
includedintheDVHtemplate.
Ifthetemplate:

Includesstructureswithnamesthatdonotmatchtheplan‐Youwillgetamessage
thattellsyouthestructuresdonotmatch.Thesystemwillstillapplythetemplate
totheplan.

Includesthesamestructuresastheplan withoutgoals,doseortolerances ‐The
systemwillstillapplythetemplatetotheplan.Itwilladdthegoals,doseand
tolerancestothestructure.

Includesthesamestructuresastheplan withgoals,doseandtolerance ‐The
valuesfromthetemplatewillreplacethecurrentvalueintheplan.Youwillgeta
warningmessagethatliststhestructuregoalsthatwillbereplaced.

Doesnotincludethesamestructuresastheplan‐Nochangesaremadetothe
plan.
Youcanapplyonlyapprovedtemplatestoaplan.
Applying a Template to a DVH
1. Right‐clickintheDVHStatisticsGridControlandselectApplyTemplateTo Dose
Name : StructureSetName .
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DoseName and StructureSetName arethenamesofthedosesandstructure
setsinthetemplate.ThisappliestheselectedtemplatetothecurrentDVH.Thiswill
starttheTemplateWizard,whichopenswiththeApplyTemplatedialog.
2. Selectatemplatefromthelistoftemplates.
2. ClickApplytoapplythetemplatetotheselectedDVH.
Changing a Template Before You Apply It
1. Right‐clickintheDVHStatisticsGridControlandselectApplyTemplateTo Dose
Name : StructureSetName .
ThisstartstheTemplateWizard,whichopenswiththeApplyTemplatedialog.
2. Selectatemplatefromthelistoftemplates.
3. ClickModifytoopentheModifyTemplatedialogbox.
Saving a DVH Template
IfyouwanttoapplyyourgoalsorreferencepointsfromoneDVHtoanother,youcansave
themasaDVHtemplate.
1. Right‐clickintheDVHStatisticsGridControl.
2. SelectCreateTemplateFrom DoseName ‐ StructureSetName .
DoseName and StructureSetName representthenamesofthedoseandstructure
setintheDVH.ThiswillsavetheDVHasatemplatethatyoucanapplytootherDVHs.
Exporting a DVH
YoucanexportDVHcalculationstoafileforreviewwithaspreadsheetorotherprogram.
ExporteddatausesthecurrentsettingsthatyouusedtoshowtheDVH.Thesystemsaves
exportedDVHsasa.csvfile,whichyoucanopenwithaspreadsheetprogram.
Exporting a DVH
1. Right‐clickintheDVHandselectExport.
2. SelecttheDVHyouwanttoexport.ASaveAswindowopens.
3. IfyouwanttorenametheDVHfilename,typeanewnameintheFileNamefield.
Otherwise,thesystemwillsavetheDVHnameas PatientName _ Plan
Name _ StructureLabel .csv.
4. Browsetothelocationyouwanttosavethefile.
5. ClickSave.
Plan Spreadsheet
TheEvaluatePlanSpreadsheetletsyouviewavarietyofinformationonplans,including:
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
Specificdetailsrelatedtotheplantype

Individualbeamparametersfortheplan
 Detailsonanytreatmentaidsincludedintheplan.
ToaccessthePlanSpreadsheet:
1. LoadaplaninEvaluateandclickonthePlanSpreadsheettabbelowtheDVH
2. ClickBeamDetailsintheWorkListDetailspane.
3. ClickthePlanSpreadsheetoptionundertheGlobalWindowsicon
.
General Window
Figure 125: General Plan Spreadsheet shows basic details on the open plan
Thedetailwindowshowsdetailsoneachcontrolpointwithintheplan.Italsoshows
specificdetailsfor:
374

Ionplans

Photonplans
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External Beam Window
Figure 126: External Beam tab of the Plan Spreadsheet shows details for each beam
TheExternalBeamwindowshows:

Individualbeamparameters

Informationabouteveryradiationbeamorsource
Treatment Aid Window
Figure 127: Use the Treatment Aid window to see details on any treatment aids in the plan
TheTreatmentAidwindowshowsdetailedinformationonalltreatmentaidsincluded
withtheplan.
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Notes
Figure 128: Add, view and edits notes on plans and images
ThePlanNotesletsyouaddnotestoplansorimagesets.Toopenit:

Right‐clickonaplanorimagesetintheNavigatorandclickReview/AddNotes.

Right‐clickonaplanintheInformationBlockandclickReview/AddNotes.
Adding Notes to a Plan or Image Set
1. Right‐clickonaplanorimagesetintheNavigatororInfoBlock.
2. SelectReview/AddNotes.
ThisopenstheAddNotesdialog.
3. TypethenoteintheNotefield.
4. ClickSave.
Yournotewillappearintherightcolumnwiththedate,time,andreviewerinitials.
Themost‐recentlyenterednotealsoappearsasatooltipfortheplanorimageinthe
NavigatorandInformationBlock.
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Viewing Image and Dose Information
Figure 129: Viewing Image and Dose Information
YoucanusetheValuecursortoviewinformationabouta2Dimagethatincludes:

Coordinatesofthecursor

Doseinformation

Whethertheimageisprimaryorsecondary

HounsfieldUnits.
Using the Value Cursor
1. ClicktheValueCursorbutton
.
2. Positionthecursorovertheviewyouwanttostudyandclickthemousebutton.A
windowwillautomaticallyopenwiththeinformation.
Viewing Markers
TheMarkersdialogletsyouseethepositionofallthemarkersinaplan.Italsoshowsthe
doseatthepositionofeachmarker.Youcanusethedialogtoquicklynavigatetoamarker
locationinthecutplaneviews.
Creating PDFs and Plan Documents
Creating PDFs
YoucantakeascreencaptureofthemainEvaluatewindowandgenerateaPDFofit.The
PDFdoesnotshowfloatingpanes,nordoesitexpanddockedpanes.Ifyouhavemultiple
plansopen,youselectwhichplanswillprintasaPDF.Todoso:
1. ClickthePrinticon
toopenthePDFOptionsdialogbox.
2. SelectwhichplanyouwanttoassociatethePDFwith.
3. ClickOK.
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AsnapshotofthedisplayedscreenwillopeninthePDFwindow.
Creating Plan Documents
AfteryougenerateaPDFofaplan,youcansaveitasaplandocumenttoviewinother
areasofMOSAIQ.
1. ClickthePrint
icontoopenthePDFOptionsdialogbox.
2. Selectwhichplanyouwanttheplandocumentstobeassociatedwith.
3. ClickOK.
ThePDFReportvieweropens.Itcontainstheplanyouselected.
4. ClickPlanDocument.
TheSavePlanDocumentdialogboxopens.
5. TypeaPlanDocumentName.
6. Selectwhichplanyouwanttoassociatetheplandocumentwith.
7. ClickOKtocreatetheplandocument.
Opening Plan Documents
YoucanopenexistingplandocumentsinEvaluatetoviewspecialinformationthatwas
capturedinthetreatmentplanningsystem.
1. ClickthePlanDocumentsicon
.
2. Selectaplandocumentfromthelist.
ThedocumentwillopeninthePDFReportViewer.
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DRRs
Figure 130: DRR window lets you visualize DRRs
DRRsletyou:

Visualizethetargettoverifythe beam isocenterlocationortumorposition.

Visualizethepositionandvolumetricpropertiesoftargetvolumesandnormal
structurestodeterminetheappropriatebeamarrangementsandfieldshaping.

Visualizesubtledetailsandhigh‐contrasttissuescharacteristicofcertaintypesof
cancerousornormaltissue.

Identifyorganmotionandverifyingpositionalstabilityofanatomicalstructures.

Assurethequality,appropriateness,andcorrectnessoftheplannedpatientand
beamsetupparameters.
ToopenaDRR:
1. ClicktheEvaluateicontoopenthe Evaluate PlanReviewtab.
2. FromtheToolsgroup,clicktheDRRicon.
3. SelecttheDRRofinterestfromthedrop‐downlisttoopenitwithintheImage
window.Forexample,selectthe"RLAT"DRR.
Visualizing DRRs
1. FromtheImagewindow,clickanddragtheyellowbarintheWindow/Levelcontrol
toadjustthecenterofthewindow.
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Note:Ifyoudragtheyellowbaracrossthehistogram,thebrightnesschanges.
2. Clickanddragtheredbar s tochangetherangeofpixeldensitieswhereyoucansee
maximumcontrast pixeldensitiesoutsidethewindowappearasblackorwhite .
3. Right‐click,andclickManualSave Ctrl D tosavechangestotheWindow/Level.
Note:Youcandothisbeforeandafteryoureviewanimage.
4. Ifnecessary,printtheDRR.
5. ClickOKortheclosebutton.
Approving a Plan
YouusetheStatusdialogtoapproveaplanorchangeittoanotherstatus.
1. Right‐clickonaplanintheNavigator,InformationBlockorPlanWorklist.
2. SelectStatustoopentheStatusdialogbox.
3. SelectaNewStatus.
4. EnteranyComments.
5. VerifyyourUserNameiscorrect.
6. TypeyourPassword.
7. ClickStatus.
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CHAPTER 10: MOSAIQ Locate workspace
CHAPTER 10: MOSAIQ Locate
workspace
TheMOSAIQLocateworkspaceisalicensedproduct.Formoreinformationaboutthe
workspace,seetheMOSAIQLocateTrainingModuleortheMOSAIQLocatesectionofthe
MOSAIQHelpSystem.
UsetheMOSAIQLocateworkspacetoestablishstereotacticcoordinatesfortreatmentsetup
andtodothesetasks:

Useacontrastthresholdtoincreasetheautomaticrecognitionofstereotactic
fiducials

Provideareal‐timereportthatidentifiesmiscalibratedindividualimages

SupportCTandMRdatasets

Calibratea3Dimagesetthathasastereotacticlocalizertosetthestereotactic
coordinatesystemforthedataset

Usethestereotacticcoordinatestoidentifymarkersandisocentersforthe
stereotacticlocalizer
Launching the Workspace
YoumusthaveClinical|StereoCalibrations|ViewsecurityrightstolaunchtheMOSAIQ
Locateworkspace.IfyouhaveClinical|ManageLocalizerrights,youhaveViewrightsby
default.
Youcanlaunchtheworkspace1of2ways:
1. ClickLocateontheMOSAIQtoolbar.
Or
1. ClickLocatefromtheeChartmenu.
Loading the Layout and Setting the Default
SeeMOSAIQRTPLayoutDesignerintheMOSAIQHelpSystem.
Thelayoutincludes2imagespacesand5controls:

TheIn‐ViewAreahastheimagespaces:
o 3Dontheleft
o Transverseontheright

Thecontrolpanelhasthecontrols:
o Navigator
o Livereport
o Structure
o Beam
o Dose
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Loading the Layout
1. IntheLayoutgroupofthePlanReviewribbon,clicktheLayoutdrop‐downlist.
TheLayoutmenuappears.
2. Selectalayout.
Thelayoutloadsintheworkspace.
Setting the Layout Default
AlsoseeMOSAIQEvaluate:Creating/EditingalayoutintheMOSAIQHelpSystem.
FollowthesestepstosettheMOSAIQLocatelayoutasthedefault.
1. ClicktheLayoutdrop‐downarrow.
TheLayoutmenuappears.
2. ClickManage.
TheMOSAIQRTPLayoutDesignerdialogboxappears.
3. Clickthedrop‐downarrowatthetop‐leftofthedialogbox.
4. SelectLocate.
5. SelecttheDefaultcheckbox.
6. ClicktheSaveicontotheleftofthetopdrop‐downmenu.
LocateisthedefaultlayoutforMOSAIQLocateandMOSAIQEvaluate.
7. Closethedialogbox.
Loading a Data Type
Afteryouloadalayout,youcanloadadatatype,usuallyanimageoraplan.
ToseetheLiveReportcontrol,youmustselecttheLocatelayout.
1. Toloadthedata,dragthenameofitfromtheNavigatorcontroltotheIn‐Viewarea.
Yousee2imagesintheIn‐Viewarea:The3Dandtransverseviews.Theimagefiducials
appearonthetransverseviewoftheimage.
2. Toenablethecorrectalignmentofimagefiducials,adjusttheImageWindow/Level
settings.
Thegoalistogivetheimagesahighblack‐and‐whitecontrast.SeeMOSAIQEvaluate:
WindowLevelPresetsWindowintheMOSAIQHelpSystem.
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Approving and Loading a Localizer
Thisprocedurehasthese2prerequisites:

YoumusthaveClinical|ManageLocalizersecurityrightstousetheLocalization
FrameManager.
 Youcannothaveadoseorplanloaded.
1. Loadthependinglocalizertoanimageset.
If you load an unapproved localizer, you see this message at the top of the image set:
“The selected localizer is not validated.”
2. Editfiducialsandcalibrateaslice.
3. Makesurethattheresultsarewithintolerance.
4. Doafullcalibration.
5. Makesurethattheresultsprovethatthelocalizermatchesthescanneddataofthe
clinic.
6. OntheLocalizationFrameManager,clickChangeStatus.
TheStatusdialogboxappears.
7. ChangetheNewStatustoApprovedandclickStatus.
Thelocalizerisnowreadyforclinicaluse.
Changing the Frame CAD and Localizer CAD Views
ThelocalizerappearsontopoftheimagesofthepatientwithanimageoftheLocalizer.
ThelocalizershowsaComputer‐AssistedDesign CAD ofthestereotacticframeand
localizerwhenitispartofthedataset.
CADbuttonsareintheSetupgroupofthePlanReviewribbon.
1. ClickFrameCADtotoggletheCADdisplayforthestereotacticframeonandoff.
2. ClickLocalizerCADtoshoworhideamodelofthestereotacticlocalizer.
Youcanviewthegraphicrepresentationofthemodelstogetherorapartfromeach
other.
Changing Calibration Tolerance Preferences
UsetheLocalizationFrameManagerPreferenceoptiontoeditthecalibrationtolerances.
1. OpentheLocalizationFrameManager.
2. Selectanameintheleftpanel.
3. ClickPreferencesintherightpanel.
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383
TheCalibrationTolerancesdialogboxappears.
4. ChangethetolerancesifnecessaryandclickSave.
Editing Fiducials
Whenyoueditfiducials,youalignfiducialindicatorswiththeirrelatedimagefiducials.This
tellsthesystemwherethelocalizerison1slicebeforethecalibration.
Toeditfiducials:
1. IntheEditgroupoftheMOSAIQLocateribbon,clickEditFiducials.
Theturquoisefiducialindicatorsappearontheimage.
2. DrageachfiducialindicatortotheimageFiducialitmustalignwith.
Using Snap
TheSnaptoolusescontrastthresholdtorecognizetheimagefiducials.Whenyouenable
SnapandeditaFiducial,thefiducialindicatorsnapstotheclosestpixelwiththehighest
densitywithin2cmofitsposition.
1.
Optional IntheEditgroup,clickSnaptotoggleitonandoff.
2. Youhave2choiceswhenSnapison:

DrageachfiducialindicatortothecorrespondingimageFiducial.TheFiducial
indicatormoves snaps tothehighestdensitypixel.

Ordouble‐clickeachfiducialindicatortoautomaticallymove snap theclosest
pixelwiththehighestdensitywithin2cmofitsposition.
Thisisnotalwaysthebestchoice,becausetheclosestfiducialindicatorisnot
alwaysthecorrectselection.
Calibrating and Resetting Slices
Thistopicincludesthesetasks:

Calibratingtheslicethatshowsandisactive

Calibratingallimageslices

Resettingthecalibration

Changingcoordinatetypes

ViewingthePlanSpreadsheet
Calibrating the Slice that Shows and is Active
1. IntheCalibrationgroupofthePlanReviewribbon,clickSliceCalibration.
Thisstepchecksuser‐definedpositionsagainsttheknowngeometryforthelocalizer.
2changesshow:

384
Inthe3Dview,color‐codeddotsshowtheresultsofcalibratedslices.
LUGMSQ0010/4.0/24-Jun-2014
o
o
o

Green Passed
Red Failed
Grey Ignored
CALIBRATEDandtheMaxAverageErrortolerancevalueshowsintheupper‐left
cornerofthetransverseimage.
Figure 131: A successful calibration for 1 slice
2. ClicktheLiveReportcontroltabontheworkspace.
3. ScrolltofindthecalibratedsliceMaxLocalError cm andMaxAvgError cm value.
CalibrationresultsshowintheMaxLocalErrorandMaxAverageErrorColumn:

GreenCheckMark Passed withinthedefinedcalibrationtolerance 
RedX Failed doesnotmeetthedefinedtolerance .
Calibrating Image Slices
Beforeyoucancalibrateallimageslices,youmustcompletethecalibrationof1slice.
1. IntheCalibrationgroup,clickCalibrateAll.
Thisstepalignsthelocalizerwiththepatientimage.Itgoesbytheplacementofthe
fiducialindicatorsandimagefiducials.Thequalityofthelastcalibration CalibrateAll dependsonthequalityofthe1‐slicecalibration.
Areddotonthe3Dimageshowsthatthecalculatedfiducialalignmentisexternaltothe
predefinedtolerance.Youcanignoreaslicethatisoutoftoleranceifitisnotpartofthe
overallcalibration.
2. Youhave2choices:

Ignoreasliceanddonotincludeitinthecalibration:
o SelectthecheckboxintheIgnorefieldforeachrowthathasaredX.
CALIBRATEDandtheMaxAverageErrortolerancevalueshowinthe
upper‐leftcornerofthetransversewindow.

Oriftheautomaticcalibrationresultonsomeslicesarenotsufficient:
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385
o
o
Editthefiducialstothecorrectpositions.
Calibratethe1sliceagaintomakethecalibrationresultsbetter.
3. ClicktheLiveReportcontroltab.
4. ScrolltomakesurethatallofthecheckmarksaregreenintheMaxLocalError cm andMaxAvgError cm fields.
TheImageVolumeAveragesboxshowsthefollowing:

AxisRotation deg value

MaximumLocalError cm value

MaximumAverageError cm value
Resetting the Calibration
1.
Optional IntheCalibrationgroup,clickResetCalibration.
Thelocalizerframereturnstothecenteroftheimagevolume.
Coordinate Types
Afteryoucalibrateallslices,theSTXCoordinatesbuttonappears.Thebuttoninteractswith
theValueCursorbuttonontheToolsblockofthePlanReviewribbon:

WhentheSTXCoordinatesbuttonison,andyouclicktheValueCursorbutton,you
seethestereotacticcoordinatepoints.

WhentheSTXCoordinatesbuttonisoff,andyouclicktheValueCursorbutton,you
seetheDICOMcoordinates.
SeeSTX Stereotactic CoordinatesintheMOSAIQHelpSystem.
Coordinates on the Plan Spreadsheet
Afteryouloadaplanforcalibration,youcanseethestereotacticcoordinatesonthePlan
Spreadsheet.SeeMOSAIQEvaluate:PlanSpreadsheet Detail WindowintheMOSAIQHelp
System.
SeeMOSAIQLocate:SavingandapprovingthecalibrationintheMOSAIQHelpSystem.
Saving the Calibration
1. IntheCalibrationgroup,clickSaveCalibration.
TheSaveCalibrationdialogboxappears.
2. TypeanameintheCalibrationNamefieldandclickOK.
YoucannowusetheSaveAsandStatusbuttons.
3.
386
Optional Torenamethecalibration;clickSaveAsintheCalibrationgroup.
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Approving the Calibration
1. ClickStatus.
TheStatusdialogboxappears.
2. Selecttheapplicablestatus:

3.
Ifthecalibrationisnew,PendingappearsintheStatusfield.
 Ifthecalibrationisapproved,Rejectedappears.
Optional TypeacommentintheCommentfield.
4. TypeyourpasswordinthePasswordfieldandclickStatus.
PendingshowsintheNewStatusfield.
Printing
Thistopichas4sections:

PrintingtheIsocenterTemplate

PrintingtheLiveReport

PrintingtheIsocenterstereotacticcoordinates

PrintingtheMarkerstereotacticcoordinates
Printing the Isocenter Template
BeforeyouprintanIsocenterTemplate,youmustmakesureof3conditions:

YouloadedaplanoryouloadedanSSwithmarkers

Yourprinteriscalibratedtoprinttoscale

Youapprovedthecalibration
FollowthesestepstoprintanIsocenterTemplate:
1. ClickthePrintdownarrowontheToolsgroupandselectIsocenterTemplate.
TheIsocenterTemplatePDFOptionsdialogboxopensandshowstheisocenters.
2. Selectthecheckboxfortheisocentertoprint.
3. ClickOK.
ThePDFReportViewershows.
4. ClickPrintinthePDFReportViewer.
5. Trimtheprintouttosize.
6. Attachittothelocalizerboxonthepatient.Makesurethelocalizermarksmatch.
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Printing the Live Report
YoucanprintaLiveReportasarecordofthecalibration.
1. ClicktheLiveReportcontroltab.
2. ClickPrint.
ThismakesaPDFfile.
3.
Optional PrintthePDFfile.
Printing the Isocenter Stereotactic Coordinates
BeforeyouprinttheIsocenterstereotacticcoordinates,youmustmakesureyouhave
loadedaplan.
1. ClickPlanSpreadsheetbelowthebottom‐leftcornerofthe3Dview.
2. Right‐clickinthePlanSpreadsheetpanelandselectPrintIsocenterstomakeaPDFfile.
Printing the Marker Stereotactic Coordinates
BeforeyouprinttheMarkerstereotacticcoordinates,youmustmakesureyouhaveloadeda
StructureSetwithmarkers.
1. ClickMarkersintheToolsgroupofthePlanReviewribbon.
2. ClickPrinttomakeaPDFfile.
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Appendix A: Contact and Regulatory Notifications
Appendix A: Contact and Regulatory
Notifications
MOSAIQ Legal & Regulatory Disclaimer
TheMOSAIQapplicationmustnotbecopiedinwholeorinpartforanypurpose.The
applicationincludesthefollowingregulatorystatement:
ProfessionalResponsibilityCustomeracknowledgesthattheprofessionaldutytothe
patientinprovidinghealthcareservicesliessolelywiththehealthcareprofessional
providingpatientcareservices.Customertakesfullresponsibilityfortheuseof
informationprovidedbythelicensed/sublicensedproductsinpatientcareand
acknowledgesthattheuseofthelicensed/sublicensedproductsinnowayisintendedto
replaceorsubstituteforprofessionaljudgment.FirstDataBankandElektadonotassume
anyresponsibilityforactionsofCustomerwhichmayresultinanyliabilityordamages
duetomalpractice,failuretowarn,negligenceoranyotherbasis.Customershallensure
thatallhealthcareprofessionalsusingthelicensed/sublicensedproductsareawareofthe
limitationsoftheuseofthelicensed/sublicensedproducts.
SaxComm.andSaxZipcomponents©1991‐2001SaxSoftwareCorp.SaxBasicEngine
components©1993–2000SaxSoftwareCorp.adPolarEngineeringandConsulting.
TXTextControlcomponents©1991‐2002TheImagingSourceEuropeGmbH.
PortionsofthisproductwerecreatedusingLEADTOOLS©1991‐2001,LEAD
Technologies,Inc.ALLRIGHTSRESERVED.
Product Regulatory Information
Manufacturer
Elekta Business Area Software Systems
IMPAC Medical Systems, Inc.
100 Mathilda Place
5th Floor
Sunnyvale, CA 94086
USA
LUGMSQ0010/4.0/24-Jun-2014
389
Appendix A: Contact and Regulatory Notifications
Food and Drug Administration (FDA) (United States)
U.S.FederalLawrestrictsthisdevicetosalebyorontheorderofaphysician.
CE Marking (Compliance with the MDD) (European Community)
MDD
MOSAIQ
ElektamaintainsaQualitySystemthatcomplieswithallessentialrequirementsofthe
MedicalDeviceDirective 93/42/EEC andallotherstandardsapplicablethereunder.A
TechnicalFileismaintainedforreviewviatheAuthorizedRepresentativeandElekta
directly.
AuthorizedRepresentative EuropeanUnion :
Elekta Limited
Linac House, Fleming Way
Crawley, West Sussex
RH10 9RR,
United Kingdom
Phone: +44 129 365 4242
Fax: +44 1293 471347
eu_ar@elekta.com
AustralianSponsor:
Elekta Pty Ltd
Suite 2 Level 14 168 Walker Street,
North Sydney, NSW, 2060
Australia
Phone: 1 800 006 035
ANZ-software@elekta.com
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Appendix B: Warnings and Cautions in MOSAIQ
Appendix B: Warnings and Cautions in
MOSAIQ
MOSAIQ Treatment Warnings
TheSEQUENCERverifyandrecordsystemisprimarilyaqualityassuranceandrecording
tool.ThepurposeofSEQUENCERistohelptherapistsdelivertreatmentstopatients.
SEQUENCERcheckssetupparametersandrecordsactualtreatmentdata.SEQUENCERis
notasubstituteforthemanychecksthatatherapistorthetreatmentmachinemakes
beforeandduringtreatmenttomakesurethatthepatientissetupandtreatedaccording
toplan.Duringthecourseoftreatment,SEQUENCERshowsappropriatewarning
messagesthatalerttheusertosituationsinwhichimproperuseofthesystemcouldresult
inpotentialsafetyhazards.
Wheneveryouseeawarningmessage,carefullyreadthedescriptionofthepotential
safetyhazardandtheactionstotaketoavoidcompromisingthequalityofthetreatment.
Remember the Following When Reading SEQUENCER Messages

SEQUENCERonlyverifiesfieldparameterswithinthetolerancesestablishedby
thedepartmentandselectedforthefield.DoNOTrelyonSEQUENCERtoverify
thepatientandtreatmentmachinesetupposition.Checkthetreatmentsetup
againsttheparametersintheTreatmentFieldDefinition.

SEQUENCERreceivestheactualpositionandconsolesettinginformationfromthe
electronicreadoutsonthetreatmentmachine.Iftheelectronicreadoutsare
incorrect,thentheinformationSEQUENCERreceivesisalsoincorrect.

Neveroverrideatreatmentfieldparameterbeforeyouknowwhytheparameter
mustbeoverridden.Anout‐of‐toleranceparameterdoesnotnecessarilymean
thatthetreatmentsetupisincorrect.

Alwaysverifythetreatmentsetupusinganalternativemethodormethodsin
additiontoSEQUENCER.

Afterbeamingonthetreatmentmachine,SEQUENCERcannotturnthebeamoff.
Youmustcloselymonitorthetreatmentmachineandthepatientduring
treatmentandshouldnotlookattheSEQUENCERscreen.

Donotchangeatreatmentfieldwhileyouareintheprocessoftreatment
delivery.
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391
Pre-Treatment Warnings
Everytimeyoustarttreatmentdelivery,SEQUENCERmakesaseriesofinitialchecks.The
followingisadescriptionofeachcheck,intheorderthatSEQUENCERmakesthem,and
thewarningmessagethatappearsifthesystemfindsadiscrepancy.
Table 41: Pre-Treatment Warnings
392
Warning
Description
Field Treated Today!
Continue?
Thismessageappearsasawarningifyouareabouttotreata
patientfieldthatwasalreadytreatedtoday.ClickYes ifyou
stillwanttotreatthefield s .
Fractions will be
Exceeded! Continue?
Thismessageappearswhenyouareabouttoexceedthe
numberoffractionsprescribed.
Field dose is undefined.
Continue?
Thiswarningappearsiftheselectedfielddoesnothavea
dosevalue greaterthanzero 0 andyourdepartmentis
configuredtoreceivedosecheckwarnings.Youcaneither
canceltheapprovalorcontinuewiththeapprovalprocess
andnotchangethedosevalue.
Treatment field is not
associated with
prescription site.
Continue?
Thiswarningappearsifthefieldselectedisnotassociated
withaparentRxsiteandyourdepartmentisconfiguredto
receivedosecheckwarnings.
A dose site coefficient
has either not been
defined or set up so that
the treatment of this
field will not contribute
any dose to the
prescription site.
Continue?
Thiswarningmessageappearsifthefieldisassociatedwitha
parentRxsite,butdoesnothaveaneffectivedosesite
coefficient.
Dose Will Be Exceeded
by #! Override?
Thiswarningmessageappearswhenyouareabouttoexceed
theprescribedtotaldose.Ifyoustillwanttotreatthefield,
clickYes,andthentypeyourusernameandpasswordinthe
approvaldialogboxandpressEntertooverridethewarning.
Onlyuserswithoverrideprivilegescanexceedtheprescribed
totaldose.
This field has changed
since the last treatment.
Do you wish to view the
details?
ThiswarningmessageappearsbeforetheTreatment
DeliveryTableopensifafieldwaschangedsincethelasttime
thepatientwastreated.ClickYestoopentheFieldDelta
dialogbox.ClickNo tocontinuetreatment.Thisdoesnot
applytoQAModetreatments.
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Warning
Description
Treatment Machine
Mismatch! Override?
Thiswarningmessageappearswhenyouareabouttotreata
patientonanytreatmentmachineotherthantheonedefined
inthepatient'sTreatmentFieldDefinition.Ifyoustillwantto
treatthefield,clickYes,andthentypeyourusernameand
passwordintheapprovaldialogboxandpressEnterto
overridethewarning.Onlyuserswithoverrideprivilegescan
treatonatreatmentmachinethatisnotspecifiedinthe
setup.IfSEQUENCERstilldoesnotrecognizethetreatment
machineyouareabouttouse,themessage"Unknown
Machine.Exiting."appearsandyoumustexitthedialogbox.
Youcannottreatonatreatmentmachinethatisnot
characterized.Themachinemismatchcheckisuser‐
configurableatinstallation.
Treatment Field Note
BeforetheVerifiedTreatmentdialogboxopens,eachfield
notetypedandmarkedAlert foranyactivefield will
immediatelyappear‐ onebyone.TheTreatmentFieldNote
willappearatthebottomofthescreen.
Portal Image Dose
Compensation
YoucanconfigureSEQUENCERtoautomaticallychangethe
treatmentfielddoseondayswhenyoumakeportalimages,
tokeepthefractionaldoseconstant.Youcaneasilytrack
portalimagedosagesaspartofthedailytreatment.
SEQUENCERcanaccomplishthisregardlessofwhetheryou
makeportalimagesbeforeorafteryoutreatthefield.
Settings Capture
Foremergencypatients,orpatientswhohavenotbeen
simulated,youcanset upthepatientonthetreatment
machine andthencapturethesetupparametersina
TreatmentFieldDefinitionwindow.
Are you sure you want
to disable the MLC?
ThismessageappearswhenyoudisableMLConthe
TreatmentFieldDefinitionwindow.IfyoudisabletheMLC,
beawarethatitcouldcauseseriousinjuryormistreatment.
Post-Treatment Warnings
Table 42: Post-Treatment Warnings
Warning
Description
Actual MU Less Than Set
MU. Record?
SEQUENCERshowsthiswarningmessagewhenyouare
abouttorecordatreatmentwithoutdeliveringthemonitor
unitsastheyweresettobedeliveredwhenthetreatment
began beam‐on .
Actual MU GREATER
THAN Set MU!
SEQUENCERshowsthismessagewhenyouhavedelivered
moremonitorunitsthanthenumbersettobedelivered
whenthetreatmentbegan beamon .Ifyoureceivethis
message,contactyoursupervisor.
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393
Warning
Description
All Fields Not Treated!
Exit?
IfyoustartTreatmentDeliveryandtreatatleastonefield,
afteryouclickExit,thismessageappears.Thisistoprevent
youfrominadvertentlyexitingbeforeyoutreatallofthe
prescribedfields.
All Fields Treated. Exit?
SEQUENCERgivesyoutheflexibilitytoreturntothe
TreatmentDeliveryTableandselectanotherfieldfor
treatment.
Treatment Delivery Not
Complete
SEQUENCERshowsthismessagewhenatreatmentis
deliveredbutnotrecorded thatis,MOSAIQdidnotrecordit
totheDose_Hstdatabasetable .Thiscouldhappenduetoan
eventsuchasanetworkfailure,MOSAIQcrash,orlossof
connectionwiththedatabase.ClickOK.
General Warnings
Inadditiontothewarningmessagesappearingon‐screen,familiarizeyourselfwithallthe
followinggeneralwarningsbeforeyoutreatpatients.
Table 43: General Warnings
394
Warning
Description
Settings Capture
BeforeyouusetheSettingsCaptureoption,makesurethat
youselectedthecorrectpatient,thatthetreatmentmachine
geometricparametersaresetupaccordingtoplanwiththe
patientinthecorrecttreatmentposition,andthatthecorrect
consoleparametersshowonthetreatmentunitconsole.
MOSAIQreceivestheincorrectormissinginformationfrom
thetreatmentmachine.
Auto-Setup
YoushouldonlyuseAutoSetupasanapproximatemethodto
positionthetreatmentmachine totreatapatient.Youcannot
relysolelyontheelectronicreadoutstopositionthe
treatmentmachine.Youmustverifythetreatmentmachine
positionwithanalternativemethodormethods.Improper
useoftheautosetupfeaturecouldresultinseriousinjuryto
thepatient.Youshouldbeinthetreatmentroom,and
constantlymonitorthetreatmentunitwhileyouuseAuto
Setup.Youmustbethoroughlyfamiliarwiththeemergency
procedurestostopmotions,suchasdisengagingmotion
enableswitches,pressingemergencyoff,andsoonbefore
youusetheauto‐setupfeature.Ifacollisioncondition
appearslikely,itisyourresponsibilitytostopmotionand
disengagethemotionenableswitchortakeother
recommendedactiontostopmotionasrecommendedbythe
treatmentmachine manufacturer presstheemergencyoff .
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Warning
Description
Geometric Tolerances
SEQUENCERonlyverifiesgeometricsetupparametersto
withinthespecifiedtolerances.DoNOTrelyonSEQUENCER
toverifythepatientandtreatmentmachinesetupposition.
Checkthetreatmentsetupusingtheparametersspecifiedin
theTreatmentFieldDefinitionwindow
Treatment Setup
YoucannotuseSEQUENCERasthesolemethodtoverifyand
recordthetreatmentsetup.Youmustuseanalternative
methodormethodstoverifyandrecordthetreatmentsetup
inadditiontoSEQUENCER.
Recording Treatments
AlwaysreviewallinformationintheRecordTreatment
dialogboxbeforesavingit.Makesurethatthecorrectpatient
andtreatmentfieldappears.Makesurethatthecorrect
numberofmonitorunitsappearsascomparedtothe
electronicand/ormechanicalmonitorunitreadoutonthe
treatmentmachine.Ifthemonitorunitvalueisnotthesame
inSEQUENCERandthetreatmentmachine,thenrecordthe
monitorunitsvalueonthetreatmentmachineasaNoteand
contactyourdepartmentphysicistimmediatelybeforeyou
continuethetreatment.
Partial Treatments
Makesurethatthecorrectmonitorunitsdeliveredvaluefor
thepartialtreatmentgetsproperlyrecorded.
Overrides
Overridingout‐of‐toleranceparameterscanresultin
mistreatingthepatient.Youshouldonlyoverrideparameters
afteryoumakesurethatthetreatmentmachinegeometric
parametersandconsoleparametersaresetupcorrectlybya
methodotherthanSEQUENCERandthatthecorrectpatient
andtreatmentfieldsareselected.
Beam Interruption
Donotchangeanytreatmentfieldparameter suchasgantry,
collimator,andcouch afterbeam‐on.Ifabeaminterruption
occursthatrequiresyoutochangethetreatmentfield
parametersoramachinefaultmovesparametersoutof
toleranceduringtreatment,youmustterminatethebeamand
gobacktotheTreatmentDeliveryTable.
Other Operational Warnings
Table 44: Other Operational Warnings
Warning
Description
Verified Treatment
mode is unavailable
Appearsifaworkstationisconfiguredasatreatment
workstation,butverificationisunavailable themachine
interfaceisnotoperating .Ifyouchoosetocontinue
administeringthetreatment,thentheTreatmentDelivery
Tableopensinmanualtreatmentrecordingmode.
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395
Warning
Description
Prescription is not
approved. N fractions
remain before
treatment is prevented
AppearswhenyouselectRxApprovalforTreatment in
DepartmentSetup prescriptionsitesmustbeapprovedprior
toallowingtreatment andthefollowingaretrue:
Beam is not approved. N
fractions remain before
treatment is prevented

thedeliveredfractionsfortheassociated
prescriptionsiteplusthefractionstobedeliveredby
thistreatmentdonotexceedthespecifiedfractions

theprescriptionisnotapproved
AppearswhenyouselectFieldApprovalforTreatment in
DepartmentSetup treatmentfieldsmustbeapprovedprior
toallowingtreatment andthefollowingaretrue:

ifthedeliveredfractionsforprescriptionsiteforthe
selectedtreatmentfieldplusthefractionstobe
deliveredbythistreatmentdonotexceedthe
fractionsdefined

ifthebeamhasnotbeenapproved
<Beam ID Name> was
treated today at <time
last treated>
Appearsifthefieldselectedisnotpartofatreatment
calendarsessionandifthattreatmentfieldwasalready
treatedinthecurrentsession.
Treatment Field Change
Appearsifoneormoretreatmentfieldsintheselected
treatmentsessionarechangedexternallytotheTreatment
DeliveryTableatthetimeoftreatmentdelivery afteryou
opentheTreatmentDeliveryTable .
An error in machine or
software
communication has
occurred. Please verify
treatment information
and select correct
recording option below.
TheAbnormalTerminationdialogboxopenswheneverthere
isaninterruptiontoorlossofcommunicationbetween
SEQUENCERandthetreatmentmachineandthismessage
appears.Youmustacknowledgethemessageandclick
Continuebeforeyoucaneithercontinuetreatmentorchange
screens.MakesuretowritedowntheMUonthetreatment
machine.
Treatment Field Edges Warning
Whenyoucopyandpastetreatmentfieldedgesonmulti‐sliceimagesforPortalVision,
youmustverifythatapairofportalimagesconsistsofamatchingopen/shapedport
beforeyoucancopyafieldedgefromoneimagetoadifferentone.
Pediatric Warning
MOSAIQMedicalOncologyChartingProductisdesignedfortheadultpatientand
calculatesalldosesaccordingly.Failuretotakethisintoaccountcouldpotentiallyleadto
mistreatmentofpediatricpatients.Whencalculatingamedication'sdoseforapediatric
patient,carefullyreviewtheBSAandtheresultingdose,adjustingeitherasneeded.
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First DataBank Warnings
 FirstDataBankisseparatelypurchasedandlicensed.
 InteractionscreeningisonlyallowedwhenFirstDataBankispurchasedandlicensed.
 Interactionscreeningisonlyallowedwhentheproductisconfiguredbyestablishing
theappropriatelinks.
 InteractionscreeningremainsaccurateonlywhentheperiodicFirstDataBank
updatesareapplied,whichareavailablethroughElekta.
Warning Messages when Performing Tasks in MOSAIQ
ThefollowingmessageappearswhenyoutrytospecifyaCarePlanwhennoDiagnosis
wasspecifiedforthepatient.ClickOKtocontinue.
ThefollowingmessageappearswhenyoutrytospecifyanOrderSetwhennoCarePlan
wasspecifiedforthepatient.ClickOKtocontinue.
Thefollowingmessageappearswhenyoutrytoaddatreatmentfieldbycopyinganother
inDiagnosesandInterventions.ClickYestocopythefield,orclickNotoopenablank
TreatmentFieldDefinitionwindow.
Thefollowingmessageappearswhenyoutrytoaddasimulationfieldbycopyinganother
fieldintheDiagnosesandInterventionswindow.ClickYestocopythefield,orclickNoto
openablankSimulationFielddialogbox.
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397
ThefollowingmessageappearswhentheTotalDosedoesnotequaltheFractionalDose
timesthenumberoffractions.SeeDoseandFractionReview,ortheRadiation
Prescriptiontocorrectthenumberoffractions.
ThefollowingmessageappearswhentheRxSitelimitof100fractionsisexceeded.You
mustchangethenumberoffractionsbeforeyoucansavethefield.
ThefollowingmessageappearsthefirsttimeyouopenafieldinMOSAIQafterimport.
ClickOKtocontinue.
Thefollowingmessageappearsthefirsttimeyouopenafieldafteryouchangethe
MachineCharacterization.ClickOKtocontinue.
Thefollowingmessageappearsthefirsttimeyouopenafieldafteryouchangetreatment
machines.ClickOKtocontinue.
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Thefollowingmessageappearsafterasuccessfuldocumentimport.ClickOKtocontinue.
ThefollowingmessageappearstowarnyouthatMOSAIQisabouttodeletearecord.Click
Yestodeletetherecord.
Thismessageappearswhenyouhaveaparticletherapytreatmentfielddefinitionwitha
relativecouch orchair anglefrombefore MOSAIQversionsbefore2.50 .Youmust
changetherelativecouch chair angletotheapplicableplannedcouch chair angle
beforethepatientisscheduledfortreatment.
MU per Segment Difference Warning
ThiswarningappearstoalertyouthatthedifferencebetweenPlanandDeliveryMUon
oneormoresegmentsofthefieldthatyouselectedgoesbeyondthetolerancespecified
fortreatment.YoucanconfigurethesetolerancesinMachineCharacterization,usingthe
RoundingErrorkeys.Dependingonwhetheryouwereeditingatreatmentfieldor
treatingafield,oneofthemessagesspecifiedbelowappears.
Thiswarningalsoappearswhenyouimport,orchangeastepandshootIMRTfieldinthe
TreatmentFieldDefinition.ThedifferencebetweenthePlanandDeliveryMUcannotgo
beyondtheminimumtolerancespecifiedfortreatment.
When Rounding Error 2 is Exceeded:
Table 45: MU per Segment Difference Warning when Rounding Error 2 is exceeded
LUGMSQ0010/4.0/24-Jun-2014
399
Condition
Description
Editing a field
ThedifferencebetweenPlanandDeliveryMUononeormore
segmentsexceedsthetolerancespecifiedfortreatment.
Unlessapproved,youcanonlydeliverthisfieldinQAmode.
ClickDetails toreviewtheMUpersegment.
Approving a field
Approvethisfieldtotreatitnotreceiveawarningfor
segmentMUdifferences.ClickDetailstoreviewtheMUper
segment.
Treating a field
segmentsexceedsthetolerancespecifiedfortreatment.You
cannottreatthefieldonthismachine.ClickDetailstoreview
theMUpersegment.Note:TheContinuebuttonwillbe
disabled.
Completing a partial
treatment
segmentsinthedefinedfieldexceedsthetolerancespecified
fortreatment.Youcannottreatthefieldonthismachine.
ClickDetails toreviewtheMUpersegment.Note:The
Continue buttonwillbedisabled.
Treating a field in QA
Mode
Unlessyouapproveit,youcannottreatthefieldoutsideof
QAmodeonthismachine.ClickDetailstoreviewtheMUper
segment.
treatment in QA Mode
segmentsinthedefinedfieldexceedsthetolerancespecified
fortreatment.Unlessyouapproveit,youcannottreatthe
fieldoutsideofQAmodeonthismachine.ClickDetails to
reviewtheMUpersegment.
When Rounding Error 1 Is Exceeded, But Not Rounding Error 2:
Table 46: MU per Segment Difference Warning when Rounding Error 1 is exceeded but not
Rounding Error 2
400
Condition
Description
Editing a field
ThedifferencebetweenthePlanandDeliveryMUofoneor
moresegmentsexceedstheminimumtolerancespecifiedfor
treatment.Untilyouapprovethefield,awarningwillappear
attreatment.ClickDetails toreviewMUpersegment.
LUGMSQ0010/4.0/24-Jun-2014
Condition
Description
Approving a field
ThedifferencebetweenthePlanandDeliveryMUononeor
treatment.Approvethisfieldtotreatitwithoutthewarning
forsegmentMUdifferences.ClickDetailstoreviewtheMU
persegment.
Treating a field
treatment.ClickDetails toreviewtheMUpersegment.
treatment
moresegmentsinthedefinedfieldexceedsminimum
tolerancespecifiedfortreatment.ClickDetailstoreviewthe
MUpersegment.
Treating a field in QA
Mode
treatment.Untilyouapprovethefield,awarningwillappear
attreatment.ClickDetails toreviewtheMUpersegment.
treatment in QA Mode
moresegmentsinthedefinedfieldexceedstheminimum
tolerancespecifiedfortreatment.Untilyouapprovethefield,
awarningwillappearattreatment.ClickDetails toreview
theMUpersegment.
LUGMSQ0010/4.0/24-Jun-2014
401
402
LUGMSQ0010/4.0/24-Jun-2014
Appendix C: Intended Use & Indications for Use
Appendix C: Intended Use &
Indications for Use
MOSAIQ
Intended Use
MOSAIQisanimage‐enabledelectronicmedicalrecordsystem EMR usedforoncology
workflowmanagement.Itletsusers:

Supplyelectronicpatientchartsandassemblecareplans,orderdiagnostictests,
andprescribemedications.

Import,view,annotate,manipulate,enhance,manage,andarchiveimages.

Import,keep,andexportinformationrelatedtopatienttreatmentstomonitor
treatmentprogressfromacentrallocation.Thisincludesorders,documents,lab
information,andotherrelatedinformationfromcompatibleprograms.

Generateandkeepmedicationandformularylistsandcalculateapplicable
medicationdosagesformedicaloncology.

Designleafplansforoperationwithradiotherapytreatmentmachinesthathave
multileafcollimators.Userscangive,viewandchangegeometricdatarelatedto
treatmentfields,includingtheMLCaccessory.

Ensureplansimportedfromtreatmentplanningsystemsagreewithtreatment
machineconstraints.
Additionally,MOSAIQ:

Suppliesotheradministrativefunctionalitynecessarytooperatemedicaland
radiationoncologydepartments.

Showsreferenceimagesforsetuppurposes,referstopredefinedsettingstohelp
treatmentmachinesetup,andtellscliniciansofnecessarystepsbeforetreatment.

Readsactualsettingsfromthetreatmentmachinethroughthemachine’s
communicationinterface.Itcomparesthesesettingswithpredefinedvalues.Ifa
mismatchoccursbetweentheplannedvaluesandtheactualmachinesettings,the
systeminhibitstreatment.

Verifiestheactualtreatmentagainstradiationtreatmentplans.Atapplicable
pointsduringthetreatment,itrecordstheactualdeliveredvaluestoprovide
treatmenttracking.
LUGMSQ0010/4.0/24-Jun-2014
403
Indications for Use
MOSAIQsupportsinformationflowamonghealthcarefacilitypersonnel.Itcanbeused
whereverradiotherapyand/orchemotherapyareprescribed.MOSAIQisnotintendedfor
useindiagnosis.Medicaloncologydosecalculationfunctionsaredesignedforusewith
patients18yearsorolderonly.
The optional plan review feature (MOSAIQ Evaluate) was introduced in MOSAIQ
2.5. The following MOSAIQ Intended Use applies to customers who use MOSAIQ
2.5 and subsequent versions with an active license enabling plan review features.
This Intended Use, and the availability of MOSAIQ Evaluate, is pending regulatory
clearance in some countries.
Intended Use/Indications for Use
MOSAIQ®isanoncologyinformationsystemusedtomanageworkflowsfortreatment
planninganddelivery.Itsupportsinformationflowamonghealthcarefacilitypersonnel
andcanbeusedwhereverradiotherapyand/orchemotherapyareprescribed.
UserscanconfigureMOSAIQ®forMedicalOncologyuse,RadiationOncologyuse,orthe
twotogether.Itletsusers:

Assembleelectronicpatientchartsandtreatmentplans,orderdiagnostictests,

Generateandkeepmedicationformularylistsandcalculateapplicablemedication
dosagesformedicaloncology.

Import,view,annotate,adjust,enhance,manageandarchiveimages.

Compareradiationtreatmentplansandevaluatedosecoverage.

multileafcollimators.

Makesureradiationtreatmentplansimportedfromtreatmentplanningsystems
agreewithtreatmentmachineconstraints.MOSAIQ®readsactualsettingsfrom
thetreatmentmachinethroughthemachinecommunicationinterface.It
comparesthesesettingswithpredefinedvalues.Ifamismatchoccursbetween
theplannedvaluesandtheactualmachinesettings,thesystemwarnstheuser.

Viewreferenceimagestosetuptreatment.MOSAIQ®referstopredefined
settingstohelptreatmentmachinesetup,andcommunicatespatientandmachine
setupinstructions.
 Recordactualdeliveredradiationvaluesinanelectroniccharttotracktreatment.
MOSAIQ®isnotintendedforuseindiagnosis.Medicaloncologydosecalculation
functionsaredesignedforusewithpatients18yearsorolderonly.
404
LUGMSQ0010/4.0/24-Jun-2014
The optional stereotactic localization feature (Locate) was introduced in MOSAIQ
2.6. The following MOSAIQ Intended Use applies to customers who use MOSAIQ
2.6 and subsequent versions with an active license enabling stereotactic
localization. This Intended Use, and the availability of Locate, is pending
regulatory clearance in some countries.
Intended Use Indications for Use
MOSAIQ®isanoncologyinformationsystemusedtomanageworkflowsfortreatment
planninganddelivery.Itsupportsinformationflowamonghealthcarefacilitypersonnel
andcanbeusedwhereverradiotherapyand/orchemotherapyareprescribed.
YoucanconfigureMOSAIQ®forMedicalOncologyuse,RadiationOncologyuse,orthetwo
together.Itletsyou:

Assembleelectronicpatientchartsandtreatmentplans,orderdiagnostictests,

Generateandkeepmedicationformularylistsandcalculateapplicablemedication
dosagesformedicaloncology.

Import,view,annotate,adjust,enhance,manageandarchiveimages.

Compareradiationtreatmentplansandevaluatedosecoverage.

multileafcollimators.

Makesureradiationtreatmentplansimportedfromtreatmentplanningsystems
agreewithtreatmentmachineconstraints.MOSAIQ®readsactualsettingsfrom
thetreatmentmachinethroughthemachinecommunicationinterface.It
comparesthesesettingswithpredefinedvalues.Ifamismatchoccursbetween
theplannedvaluesandtheactualmachinesettings,thesystemwarnstheuser.

Viewreferenceimagestosetuptreatment.MOSAIQ®referstopredefined
settingstohelptreatmentmachinesetup,andcommunicatespatientandmachine
setupinstructions.

Recordactualdeliveredradiationvaluesinanelectroniccharttotracktreatment.
 Usestereotacticlocalizationtocalculateset‐upcoordinatesfortreatments.
MOSAIQ®isnotintendedforuseindiagnosis.Medicaloncologydosecalculation
functionsaredesignedforusewithpatients18yearsorolderonly.
MOSAIQ Data Director
Indications for Use
MOSAIQDataDirectorprovidesadatabasethatiscapableofstoring,managing,displaying
andarchivingsubstantialvolumesofradiationoncologyrelatedtreatmentimagesand
image‐relateddata.RadiationoncologytreatmentpersonnelcanuseMOSAIQData
Directortoprovidestorageforandensuretimelyretrievalofimageandimage‐related
LUGMSQ0010/4.0/24-Jun-2014
405
datatoandfromtheMOSAIQOncologyInformationSystem.MOSAIQDataDirectorcanbe
usedforimagedatamanagementandarchivalwhereverdigitalmedicalimagesand
image‐relateddataareusedforradiationplanningortreatment.
Intended Use Statement
MOSAIQDataDirectorisintendedtoprovideanefficientmeansofprovidingsizecapable
storage,organizedhandlingandavailability,andfinalarchivalofthelargevolumesof
imageandimage‐relateddataassociatedwithimage‐intensiveradiationoncology
treatmentpractices.Seamlesslyembeddedintotheradiationtherapyworkflowandthe
useoftheMOSAIQOncologyInformationSystem,MOSAIQDataDirectorpermits
treatmentpersonneltoquicklyandeasilystoreandavailcontinuingaccessibilityto
substantialquantitiesofimagesandimage‐relateddata.MOSAIQDataDirectorprovides
permanentdatastorageandarchival,whileensuringimageandimage‐relateddata
availability,displayandretrievalwheneverandwhereverneededbyradiationtreatment
providersusingtheMOSAIQOncologyInformationSystem.
406
LUGMSQ0010/4.0/24-Jun-2014
Appendix D: Measurement of Accuracy for Medical Devices
Appendix D: Measurement of
Accuracy for Medical Devices
Leaf Positioning Tool
MLCLeafresolutionmaybecharacterizedto0.10cmor0.01cm.MLCFitcalculatesthe
leafpositionsforamachinetoaresolutionofeither0.10cmor0.01cmbasedonthisMLC
resolutionsettinginthemachinecharacterization.MLCareacalculationshavesufficient
internalprecisiontoachievetheoutputresolutionrequiredbythecharacterization
regardlessofthecomputationalmethodsemployed.MLCleafpositionsarestoredinthe
MOSAIQdatabaseinunitsof0.01cmanddisplayedinMOSAIQtoaprecisionof0.01cm.
TheprecisionofmeasurementormarginoferrorofMLCFitisinadditiontotheprecision
ormarginoferrorthroughouttheentiresystemofuse,includingtheMLCitself.Seeyour
MLCuser’smanualforinformationregardingtheaccuracyofyourparticularequipment.
Someexamplesofadditionalfactorsaffectingoverallprecisionofleaffittoshapearethe
accuracyofuserdigitization ifused ,uservariationinleafpositiondragging ifused ,fit
toshapevariationduetoleafshape,andsoon.
Ruler Tool in the 2D Image Viewer
ThemeasurementsoftheViewStationrulerarecalculatedbasedonthepixelsize
mm/pixel oftheunderlyingimage.TheunitsofmeasurementfortheViewStationruler
lengtharedisplayedincentimeters cm ,withaprecisionormarginoferrorofone‐tenth
ofamillimeter .1mm .Precisionofmeasurementsaredirectlyproportionaltothe
appliedzoomfactor forexample,at200%zoom,ameasurementtwiceasfinecanbe
achievedat100%zoom .
Evaluate, Locate, and Image Review Workspace Measurement
Tool
Themeasurementsofthemeasurementtoolarecalculatedinthespatialcoordinate
systemdefinedbytheDICOMattributesoftheprimaryimagestudybeingdisplayed.The
unitsofmeasurementforthemeasurementtoolaredisplayedincentimeters cm ,witha
precisionormarginoferrorofone‐tenthofamillimeter .1mm .Precisionof
measurementsaredirectlyproportionaltotheappliedzoomfactor forexample,at200%
zoom,ameasurementtwiceasfinecanbeachievedat100%zoom .
LUGMSQ0010/4.0/24-Jun-2014
407
Appendix E: kV Warm-Up
Fororthovoltageorsuperficialtreatmentmachines,thekVWarm‐Upoptionisavailable
ontheToolsmenuinMOSAIQ.YoumustwarmuptheX‐raytubeofakV kilovoltage treatmentmachinedailytomeetitswarrantyorotherclinicalrequirementsspecifiedby
theequipmentmanufacturer.MOSAIQdeliversthiswarm‐upprocessinminutesforboth
dose‐basedandtime‐basedkVtreatmentmachines.
Youcanrecordthewarm‐upprocessinatext‐basedlogfilethatisstoredinthelogfolder
inthesamelocationastheMOSAIQapplication.YoucanalsoopenthislogfileinMicrosoft
Excel.MOSAIQcreatesanewlogfileforeachmonthandnamesitas
kVWarmUp_YYMM.log,whereYYisatwodigityearandMMisatwodigitmonth.
You must have Clinical | Tx Delivery | View security rights to view the kV
Warm-up log file.
You must have Clinical | Tx Delivery | Modify rights to do the kV warm-up
process and record the warm-up information into the log file.
TorecordthekVwarm‐upprocess:
1. ClickTools|Warm‐UptoopenthekVWarm‐Updialogbox.
Figure 122: The kV Warm-Up Dialog Box Example
ThekVWarm‐UpdialogboxshowstheSetTimeandtheElapsedTimeinminutes.The
SetTimeistheplannedwarm‐uptime,asspecifiedonthekVmachineconsole.This
valuemustbemorethanzero.Duringsetup,SEQUENCERverifiesthevalueandshows
thefieldinredifthisvaluedoesnotmatchwiththemachinevalue.
TheElapsedTimeistheactualwarm‐uptime.Duringsetup,thisvaluemustbezero.
SEQUENCERverifiesthevalueandshowsthefieldinredifthisvaluedoesnotmatch
themachinevalue forexample,ifthemachinewasnotremodedaftertheprevious
warm‐upprocess .
2. Afterthewarm‐upprocess,clickRecord.
LUGMSQ0010/4.0/24-Jun-2014
408
Copyright 2015, IMPAC Medical Systems, Inc.
LUGMSQ0010/4.0/24-Jun-2014
409
100 Mathilda Place, Fifth Floor, Sunnyvale, CA 94086
Manufacturer
Elekta Business Area Software Systems
IMPAC Medical Systems, Inc.
100 Mathilda Place, Fifth Floor
Sunnyvale, CA 94086
Phone: +1 408 830 8000
Fax: +1 408 830 8003
European Union Authorized Representative
Elekta Limited
Linac House, Fleming Way
Crawley, West Sussex
RH10 9RR,
United Kingdom
Phone: +44 129 365 4242
Fax: +44 1293 471347
eu_ar@elekta.com
CE Marking (Compliance with the MDD) (European Community)
MOSAIQ
MOSAIQDataDirector
Human Care Makes the Future Possible
www.elekta.com
Corporate Head Office:
Regional Sales, Marketing and Service:
Elekta AB (publ)
Box 7593, SE-103 93 Stockholm,
Sweden
Tel +46 8 587 254 00
Fax +46 8 587 255 00
info@elekta.com
North America
Atlanta, USA
Tel +1 770 300 9725
Fax +1 770 448 6338
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info.asia@elekta.com

MOSAIQ® User`s Guide

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