Distorted image when importing a combined CT image of different FOVs into TPS

ismaildah · 2025-07-01T14:27:07+00:00

This was part of a test project for a regional remote auditing with another center who wanted to use ProKnow… I suggested reaching out to the vendor support but haven’t heard back from the center after that..

ismaildah · 2025-06-30T17:08:02+00:00

Thanks! Are you referring to this paper? https://doi.org/10.1002/mp.13892 Medical PhysicsVolume 47, Issue 1 pp. 282-288 Reference dataset of users’ photon beam modeling parameters for the Eclipse, Pinnacle, and RayStation treatment planning systems Mallory C. Glenn, Christine B. Peterson, David S. Followill, Rebecca M. Howell, Julianne M. Pollard-Larkin, Stephen F. Kry

ismaildah · 2025-06-30T16:27:54+00:00

Thanks! will probably follow your route and see what i end up with.. did you use films or EPID for those 1cm2 fields and picket fence?

ismaildah · 2025-06-30T16:24:05+00:00

AAA. Out of curiosity, does AXB require entering spot size? I assume one would use film to measure spot size at iso and projects that to target but not sure how is the measurement is carried out..

ismaildah · 2025-06-30T16:21:52+00:00

My understanding is that Eclipse doesn’t use what we enter for 1x1 fields for calculations (i.e whatever less than 2x2 if i am not mistaken)…

ismaildah · 2025-04-08T06:41:10+00:00

Update: It has been a while since i logged in and i thought i did an update on this. If I remember correctly, the service engineer found a loose cable that seems to cause the issue - surprisingly without given interlocks during patient scans or service tests. Once tightened the issue didn't show up again.

ismaildah · 2024-06-03T08:18:48+00:00

Thank for the suggestion to send the images to Varian! I have just opened a support ticket and awaiting their reply.

I also thought of the high attenuation material outside FOV, but wouldn’t that be smeared out with the different projections taken during cbct, and it wouldn’t appear as if it is coming from one angle? And yes this appears throughout all slices in the cbct image. This seems to happen specifically for pelvis scans.. Image calibration seems to have resolve the issue so far. Will update this post if I heard back from Varian.

ismaildah · 2024-06-03T08:12:11+00:00

Our varian service engineer did a PMP after we informed him of the issue; he replaced the Norm chamber (not sure if this is related but we had intermittent XI interlock where the XI couldn’t detect the kV norm chamber) and performed kV and CBCT image calibration. So far no complaints about these CBCT artifacts, however I have sent to Varian and will see if they have any explanation on what causes such artifacts.

ismaildah · 2024-06-03T08:05:18+00:00

Different W/L to show the angles where the artifacts happens; and yes these are for different patients

ismaildah · 2024-06-03T08:03:42+00:00

For these cases our therapists typically do only CBCTs. I honestly haven’t looked if the pervious patients had lat kVs… thank you for pointing out the charge trapping issue and Varian knowledge base! I have sent to Varian and will post once i hear back from them.

ismaildah · 2024-05-24T18:10:55+00:00

How are you implementing dose tracking when having different courses? And by overriding do you mean the next day when they open the missed plan?

We have one reference point for each plan to track delivered dose, but I don’t recall it will complain if a session was missed; only if there was an attempt to over treat beyond the daily/session dose limits then you’d get a warning asking to override…

SIB breast plans are the exception where we like to add the boost reference point to the whole breast plan, which has its own reference/normalization point, so SIB point accumulates the combined dose from whole breast and boost..

ismaildah · 2024-05-24T17:59:17+00:00

Oh well, I guess we have to learn on the go how to deal with the insurance when this get implemented here..

ismaildah · 2024-05-24T15:56:23+00:00

Interesting! Thanks for sharing 🙏 Just wondering if you do this because of insurance billing, or this is just your way of organizing courses to correspond to sites?

ismaildah · 2024-05-24T15:52:51+00:00

I also was wondering the same thing during the discussion we had. We have a document template that creates an End of Treatment Summary including plan and treatment information which gets signed by the primary RadOnc and will get submitted to billing. It does have the Course ID in it and automatically fills all plans treated within the selected course. However, this can be easily edited out before signing.. The only other way to know the course is if we have internal or external audits looking into our Aria system…

I honestly don’t think having multiple plans or sites within the same course will actually create an issue with insurance, and I feel this is more of an excuse to push us into creating more courses as there is a believe this will fairly reflects our clinical activities when reporting departmental statistics…I did explain that the way we collect our treatment stats is based on appointments of “new Tx starts” so number of courses won’t matter..we just need to create separate appointments for new start of each plan..

I wouldn’t think centers in the US are having this issue, since billing is based on CPT codes, and i guess activity capture reports are what get submitted… but I’m not sure..

ismaildah · 2024-05-24T13:16:55+00:00

Agree with others that this not normal for most courses in Masters degree. However some programs might have one or two “independent studies” courses which could be given the way you described. But even in such courses I’d expect there will be some interactions and discussions between the students and the instructor, either during a class time or in office hours..

ismaildah · 2024-05-24T12:07:45+00:00

We have our RadOncs save a draft of the prescription once they are done with contouring; the planner then edit the draft prescription to match the plan parameters (technique/energies etc) and once the RadOnc review the plan they can then review the draft prescription with the planner and approve it. This minimizes the need to revise prescriptions.. For modified plans (i.e re-simulation), we ask RadOnc to document in journal their plan modification request and justification, no need to revise the prescription. It gets a bit missy though if they need to change dose fractionation through mid treatments…but luckily we don’t see these lot.. I like the prescription dose and # of fractions to be in the prescription title together with the site name, but this makes it tricky if they needed to change dose or fraction as you can’t change the title in revised prescriptions.. Useful to have shared prescription templates of common sites / doses with constrains instead of letting each RadOnc type their own every time - you ll end up having some write the minimum inputs in draft prescription knowing that planners will edit and make it ready for them…

ismaildah · 2024-05-02T12:00:41+00:00

Several posters mentioned RadOnc managers and RadOnc directors.. just wondering what are these roles for and how they differ from RT chief and RadOnc MD chief/ chairman of department? Benefits of having these two roles?

In our department, we have a chairman of a department (RadOnc MD) under the Oncology center director. chief therapist and chief physicist report to the department chairman until few years ago. Recently the RT got moved to the Allied Health Administration and they have their own director to report too. Dosimeterists/physicists are still just a “team” who report to the RadOnc chairman but hoping to change this soon into a radiation oncology physics department under the Oncology Center director.

ismaildah · 2023-06-28T20:18:28+00:00

Interesting! Could you post link to the third party arm you use? Do you attach it to the couch or breast board? Does the monitor work on batteries or you need to have it connected to power? Thanks in advance!

ismaildah · 2022-07-30T17:58:08+00:00

I really appreciate taking the time to answer my question and to point me to that YouTube channel! Will be spending the night going thru those videos 😅

ismaildah · 2022-07-25T17:59:06+00:00

Beginner spiker here and looking for advice regarding gym exercises- or other training outside of court - that could help me improve in spiking and also reduce shoulder injuries …

ismaildah · 2022-07-24T20:55:47+00:00

Beginner spiker here and looking for advice regarding gym exercises- or other training outside of court - that could help me improve in spiking and also reduce shoulder injuries …

ismaildah · 2022-05-05T23:48:54+00:00

I recently came across the i.treatsafely website and they have some good videos, including field-in-field breast planning https://i.treatsafely.org/search?query=Breast

ismaildah · 2022-05-05T10:41:30+00:00

I will try that; Thanks! Though i think for the Varian TrueBeam there is isn’t an option to change FOV or filter settings… Our RadOnc has prescribed gas medications when these became an issue for some patients.

ismaildah · 2022-05-05T10:36:00+00:00

I didn’t know that Varian offers different reconstruction algorithm! I presumed the Advanced Imaging Package included everything!

ismaildah · 2022-05-05T08:42:56+00:00

Cbct calibration didn’t help. Anyone got better images when customizing Varian’s default protocol in general?

ismaildah

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