Portal Dosimetry Reference Guide

Portal Dosimetry
Reference Guide
ARIA Radiation Therapy Management
13485
P1015288-001-A
DECEMBER 2015
Document ID
P1015288-001-A
Document Title
Portal Dosimetry Reference Guide
Abstract
This document provides basic information and procedures for Varian treatment
delivery solutions. The following products are used:
ARIA oncology information system 15.0
Eclipse treatment planning system 15.0
On-Board Imager kV imaging system 1.6
TrueBeam system 2.5 MR2 (or higher)
Clinac linear accelerator
Exact arm
This publication is the English-language original.
Manufacturer
Varian Medical Systems, Inc.

3100 Hansen Way
Palo Alto, CA 94304-1038
United States of America
European
Authorized
Representative
Varian Medical Systems UK Ltd.

Oncology House
Gatwick Road, Crawley
West Sussex RH10 9RG
United Kingdom
Notice
Information in this user guide is subject to change without notice and does not
represent a commitment on the part of Varian. Varian is not liable for errors
contained in this user guide or for incidental or consequential damages in
connection with furnishing or use of this material.
This document contains proprietary information protected by copyright. No part of
this document may be reproduced, translated, or transmitted without the express
written permission of Varian Medical Systems, Inc.
FDA 21 CFR 820

Quality System
Regulations
(cGMPs)
Varian Medical Systems, Oncology Systems products are designed and

manufactured in accordance with the requirements specified within this federal
regulation.
ISO 13485
Varian Medical Systems, Oncology Systems products are designed and

manufactured in accordance with the requirements specified within the ISO 13485
quality standard.
CE
Varian Medical Systems, Oncology Systems products meet the requirements of

Council Directive MDD 93/42/EEC.
EU REACH
SVHC
Disclosure
The link to the current EU REACH SVHC disclosure statement can be found at
http://www.varian.com/us/corporate/legal/reach.html
HIPAA
Varians products and services are specifically designed to include features that help
our customers comply with the Health Insurance Portability and Accountability Act
of 1996 (HIPAA). The software application uses a secure login process, requiring a
user name and password, that supports role-based access. Users are assigned to
groups, each with certain access rights, which may include the ability to edit and
add data or may limit access to data. When a user adds or modifies data within the
database, a record is made that includes which data were changed, the user ID, and
the date and time the changes were made. This establishes an audit trail that can be
examined by authorized system administrators.
WHO
ICD-O codes and terms used by permission of WHO, from:

International Classification of Diseases for Oncology, (ICD-O) 3rd edition,
Geneva, World Health Organization, 2000.
ICD-10 codes and terms used by permission of WHO, from:
International Statistical Classification of Diseases and Related Health Problems,
Tenth Revision (ICD-10). Vols 13, Geneva, World Health Organization, 1992.
Electronic labeling
This symbol on the label indicates that the Instructions for Use for the corresponding
product are available at www.MyVarian.com. Access the Instructions for Use in
electronic form by logging in with your assigned MyVarian user credentials.
In compliance with EU Commission Directive No 207/2012, Varian will send EU
customers a free printed copy of the Instructions for Use within 7 days. Use the
Paper Document Request form provided on the Varian webpage to order your
copy.
CAUTION: US Federal law restricts this device to sale by or on the
order of a physician.
Trademarks
Varian, VMS, ARIA, Clinac, Exact, RapidArc, Argus Software, TrueBeam,

Portal Vision, Eclipse, DynaLog, and Argus are trademarks of Varian Medical
Systems, Inc.
Microsoft is a registered trademark of Microsoft Corporation.
All other trademarks or registered trademarks are the property of their respective
owners.
Copyright
20092015 Varian Medical Systems, Inc.
All rights reserved. Produced in Switzerland.
Contents
CHAPTER 1 INTRODUCTION
.............................................................................................................. 8
Visual Cues
..........................................................................................................................................................8
Contact Varian Customer Support
............................................................................................................... 8
Abbreviations and Definitions
.......................................................................................................................9
Related Publications
....................................................................................................................................... 10
CHAPTER 2 SAFETY AND EMERGENCY
...........................................................................................11
Care Required
.................................................................................................................................................... 11
Responsibility
.................................................................................................................................................... 11
Further Regulations
.........................................................................................................................................12
CHAPTER 3 WORKING WITH PORTAL DOSIMETRY
..................................................................... 13
Purpose of Portal Dosimetry

......................................................................................................................... 13
Compatibility
............................................................................................................................................. 13
User Groups
...................................................................................................................................................... 14
User Rights and User Administration
......................................................................................................... 15
Graphical User Interface of Portal Dosimetry
.......................................................................................... 16
Title Bar
....................................................................................................................................................... 17
Menu Bar
.................................................................................................................................................... 17
Toolbar
.........................................................................................................................................................17
Image View Panel and Image Icons
..................................................................................................... 18
Image Approval
.........................................................................................................................................18
Patient Alert
...............................................................................................................................................18
Task Panel
................................................................................................................................................... 18
Visibility Configuration
...........................................................................................................................19
Display Mode
.............................................................................................................................................19
Navigation Panel
..................................................................................................................................... 20
CHAPTER 4 STARTUP AND SETUP TASKS
......................................................................................22
Starting the Portal Dosimetry Application

............................................................................................... 22
Configuring Portal Dosimetry
......................................................................................................................23
Manage Templates
.........................................................................................................................................26
Default Template
..................................................................................................................................... 27
Defining Templates
................................................................................................................................. 27
Exporting Templates
...............................................................................................................................29
Importing Templates
.............................................................................................................................. 29
Isodose Level Template Editor
..................................................................................................................... 30
Setup Isodose Level
.................................................................................................................................. 31
Export Isodose Templates
...................................................................................................................... 32
Import Isodose Templates
..................................................................................................................... 32
Portal Dosimetry Scripting API
.................................................................................................................... 32
Output Factor Tool
.......................................................................................................................................... 33
CHAPTER 5 DOSIMETRY REVIEW
....................................................................................................35
Loading a Patient
.............................................................................................................................................35
Saving a Patient
............................................................................................................................................... 35
Closing a Patient
..............................................................................................................................................35
Printing Images and Reports
....................................................................................................................... 36
Selecting Dose Images
...................................................................................................................................38
Comparing Dose Images
.............................................................................................................................. 40
Selecting Views in the Image View Panel
................................................................................................ 40
Context Menus in the Navigation Panel
.................................................................................................. 40
Fields
.......................................................................................................................................................... 40
Predicted Dose Images
........................................................................................................................... 41
Portal Dose Images
.................................................................................................................................. 41
Analyses
..................................................................................................................................................... 42
Composite Images
...................................................................................................................................42
Selecting the View Layout
............................................................................................................................ 43
Dose Layouts
.................................................................................................................................................... 44
Plan Overview Mode
...................................................................................................................................... 45
Dose Visualization
.......................................................................................................................................... 45
Dose Images
..............................................................................................................................................45
Dose Window/Level
................................................................................................................................ 47
Image Information
..................................................................................................................................48
Dose Profile Lines
.................................................................................................................................... 48
Image Status
.............................................................................................................................................48
Blended View
........................................................................................................................................... 49
Dose Difference View
............................................................................................................................. 50
Gamma Evaluation View
........................................................................................................................ 51
Profiles View
..............................................................................................................................................52
Histogram View
........................................................................................................................................53
Gamma/Dose Difference Height Field
...............................................................................................56
Using Measuring Tools
.................................................................................................................................. 56
Measuring Point Dose
.............................................................................................................................57
Measuring Distance
................................................................................................................................ 57
Measuring Angle
..................................................................................................................................... 58
Measuring Line Profile
............................................................................................................................58
Measuring Area Histogram
...................................................................................................................59
Window/Level
..........................................................................................................................................60
Using Drawing Tools
......................................................................................................................................60
Inserting Contour Objects
..................................................................................................................... 61
Modifying and Deleting User-Defined Contours
............................................................................ 62
Show/Hide Structures
............................................................................................................................ 63
Leaf Motion Overlay
.......................................................................................................................................64
Creating Composite Images
........................................................................................................................ 66
Image Properties
.............................................................................................................................................67
Zoom In/Zoom Out
................................................................................................................................. 67
Pan
...............................................................................................................................................................67
Digital Graticule
...................................................................................................................................... 68
Field Outline
............................................................................................................................................. 68
Contents
CHAPTER 6 DOSIMETRY ANALYSIS
............................................................................................... 69
Image Alignment
............................................................................................................................................69
Manual Align
............................................................................................................................................69
Align to Setup Image
..............................................................................................................................70
Auto Align
..................................................................................................................................................70
Normalization
...................................................................................................................................................71
Dose Evaluation
............................................................................................................................................... 72
Applying Templates
.................................................................................................................................72
Applying Templates to an Image
......................................................................................................... 73
Applying Templates to Latest Session of a Selectable Plan
...........................................................73
Applying Templates to a Selectable Session of a Plan
....................................................................73
Applying Templates to Latest Session of Multiple Plans
............................................................... 73
Assigning Templates to a Plan
..............................................................................................................74
Perform Analyses
..................................................................................................................................... 74
Setting the ROI
..........................................................................................................................................75
Defining Threshold
.................................................................................................................................. 75
Setting Options
........................................................................................................................................ 76
Performing Analysis
................................................................................................................................76
Primary Analyses
......................................................................................................................................77
Dose Constancy Check
...................................................................................................................................78
Defining Constancy Check Baseline Images
.....................................................................................78
Perform Constancy Checks Using a Template
..................................................................................79
Perform Constancy Checks Using Manual Analysis
........................................................................79
Display Constancy Trend Chart
............................................................................................................ 79
Image Approval
...............................................................................................................................................80
Checking the Image Status
....................................................................................................................81
Changing the Image Status
...................................................................................................................81
Disposing Images
.................................................................................................................................... 82
Showing Disposed Images
.................................................................................................................... 82
Patient Alert
..................................................................................................................................................... 83
Creating a New Patient Alert
................................................................................................................84
Delete a Patient Alert
............................................................................................................................. 86
APPENDIX A GUI REFERENCES
....................................................................................................... 87
Menu Entries and Toolbar Icons

.................................................................................................................. 87
Properties Dialog Box
.....................................................................................................................................91
APPENDIX B MACHINE QA PORTAL DOSIMETRY
.......................................................................97
Comparison to Reference Images

...............................................................................................................97
General Tools
............................................................................................................................................ 97
Overlaying Multiple Images
........................................................................................................................ 98
Verification Plans without Predicted Doses
............................................................................................ 98
Use of Imaging Phantoms
.......................................................................................................................... 102
References
.......................................................................................................................................................102
APPENDIX C GAMMA EVALUATION

Principle of Gamma Evaluation
............................................................................................ 103
................................................................................................................. 103
Calculation of Gamma Evaluation

............................................................................................................104
Improved Gamma Algorithm
.....................................................................................................................105
References
.......................................................................................................................................................108
INDEX ...................................................................................................................................................... 109
Contents
Chapter 1 Introduction
Visual Cues
This publication uses the following visual cues to help you find information:
WARNING: A warning describes actions or conditions that can result in serious injury or
death.
CAUTION: A caution describes hazardous actions or conditions that can result in minor or
moderate injury.
NOTICE: A notice describes actions or conditions that can result in damage to equipment
or loss of data.
Note: A note describes information that may pertain to only some conditions, readers, or sites.
Tip: A tip describes useful but optional information such as a shortcut, reminder, or suggestion,
to help get optimal performance from the equipment or software.
Contact Varian Customer Support

Varian Customer Support is available on the internet, by e-mail, and by telephone.
Support services are available without charge during the initial warranty period.
The MyVarian website provides contact information, product documentation, and
other resources for all Varian products.
1. Go to www.MyVarian.com.
2. Choose an option:
If you have an account, enter your User login information (email and
password).
If you do not have an account, click Create New Account and follow the
instructions. Establishing an account may take up to two working days.
3. Click Contact Us at the top of the window to display customer support and
training options, and international e-mail addresses and telephone numbers.
4. From the Contact Us page, choose an option:
Call Varian Medical Systems support using a phone support number for your
geographic area.
Complete the form corresponding to your request for use on a call with a live
Varian representative; then follow the instructions to complete the remote
connection.
You can order documents by phone, request product or applications support, and
report product-related issues. Links on the MyVarian website navigate to other
support resources for products, services, and education.
5. To find documents, click Product Documentation.
Online documents in PDF format include customer technical bulletins (CTBs),
manuals, and customer release notes (CRNs).
Abbreviations and Definitions

ARIA RTM
ARIA Radiation Therapy Management
ARIA OIS
ARIA Oncology Information System for Radiation Oncology
CIAO
Complete Irradiated Area Outline
c.p.
Control Point
c.m.w.
Cumulative Meterset Weight
CU
Calibration Unit
DICOM
Digital Imaging and Communications in Medicine
DRR
Digitally Reconstructed Radiograph
DTA
Distance to Agreement
DXF
Drawing Interchange File Formats
EPID
Electronic Portal Imaging Device
IEC
International Electrotechnical Commission
IMRT
Intensity Modulated Radiation Therapy
GUI
Graphical User Interface
LCA
Largest Connected Area
MLC
Multi Leaf Collimator
Chapter 1 Introduction
MUTAB
Monitor Units Table
m.w.
Meterset Weight
OIS
Oncology Information System
PD
Portal Dosimetry
PDIP
Portal Dose Image Prediction
RT
Radiation Therapy
Rtn
Rotation
TPS
Treatment Planing System
QA
Quality Assurance
Related Publications
For additional information, refer to the following sources:
Portal Dosimetry Scripting API Reference Guide
Workflow Management Reference Guide
ARIA Oncology Information System for Radiation Oncology Online Help
Eclipse Photon and Electron Algorithms Reference Guide
Beam Configuration Reference Guide
Clinac Technical Reference Guide
TrueBeam Technical Reference GuideVolume 2: Imaging
DICOM Import and Export Reference Guide
10
Chapter 2 Safety and Emergency

Care Required
Careless handling or operating can result in unsuccessful treatment or loss of data.
WARNING: Incorrect use of a radiotherapy linear accelerator can cause serious injury or
death. Only trained personnel under the supervision of a licensed physician should be
authorized by the hospital or owner to operate a clinical accelerator. The emergency and
safety procedures are described in the related Instructions for Use.
Responsibility
All persons who handle, use, or operate the system must read and understand the
chapters dealing with safety regulations and emergency procedures.
Only qualified and trained personnel are permitted to operate and maintain the
system and parts of it.
The hospital management shall establish emergency and safety procedures before
operating the system and all personnel must be trained in such procedures.
The hospital management has to ensure the correct commissioning of the used
TPS and the correct calibration of the delivery and imaging system for Portal
Dosimetry.
The system must only be run with its original and unmodified fittings and
replacement parts.
No modifications to the system, its parts or the software are permitted without
prior review and approval from Varian.
Varian cannot be held responsible for personal injury or equipment damage if:
Changes or repairs are carried out that are not in accordance with the instructions
contained in any Varian manual for the system, or if spare parts, standards and
procedures not authorized in writing by Varian are used.
Safety devices are removed or changed.
Updates, modification or repair instructions occasionally issued by Varian are not
complied with.
The equipment is used for purposes other than those intended.
The periodic inspection and maintenance instructions are not complied with and
records not kept.
Operation or maintenance work is performed by unqualified persons.
The instructions and safety regulations are not complied with by the operators,
maintenance staff, or guests.
Chapter 2 Safety and Emergency
11
Local laws and regulations have not been complied with.

Anomalies during operation and maintenance are not reported to Varian
immediately.
Legal and/or government regulations are not complied with.
Usage of incorrect calibrated treatment planning or delivery system.
Further Regulations
These instructions do not render any further hospital and/or local, state or country
regulations or laws invalid. Such regulations must be complied with at any time.
12
Chapter 3 Working with Portal Dosimetry

Purpose of Portal Dosimetry
Portal Dosimetry is an application for performing the pre-treatment IMRT &
RapidArc plan verification. Additionally, you can perform Machine QA.
You can use Portal Dosimetry in the following main situations:
To compare predicted and measured portal dose images.
To compare one measured image to another measured image.
To define templates for portal dosimetry tasks and apply these templates to dose
images.
To perform analyses and store them for documentation or review.
To set or modify the status of measured portal dose images.
Compatibility
Required Components
The full portal dosimetry process requires three components:
Eclipse portal dose calculation (PDC) to create a prediction of the expected portal
dose image
TrueBeam or C-Series Clinac image acquisition system to measure the portal dose
image
Portal Dosimetry application to compare the measured and predicted images
Requirements and Restrictions

The following requirements or restrictions apply to the portal dosimetry process:
The C-Series Clinac image acquisition system cannot acquire images, including
portal dose images, for FFF beams (also known as High Intensity Mode or HIM
beams). Therefore, Portal Dosimetry does not support FFF beams on Clinac
systems.
TrueBeam systems with software version 2.0 or higher and equipped with the
aS1000 MV imager can acquire portal dose images of FFF beams using an
extended source-to-imager distance (SID).
Example: minimum SID=125cm for 6XFFF @ 1400 MU/min; minimum SID=165cm
for 10XFFF @ 2400 MU/min.
TrueBeam systems equipped with a 43x43 MV imager can acquired portal dose
images for FFF beams at isocenter. No special setup is needed.
13
Eclipse 13.0 or higher is required to create PDC predictions for FFF beams.
Eclipse 13.0 or higher is required to create PDC predictions for 43x43 MV imagers
on TrueBeam systems. Eclipse 11.0 may be used to create PDC predictions for
43x43 MV imagers for flattened beams only (excluding FFF beams).
Eclipse 11.0 only supports PDC predictions for 43x43 MV imagers for flattened
beams (excluding FFF beams).
The listed requirements and restrictions apply to all current releases of these
components and may change with new releases. See the documentation for each
component to find the latest information on compatibility.
User Groups
Portal Dosimetry can be used by the following groups of users:
Physicists: Clinical physicists are the main user group for the Portal Dosimetry
application. Physicists are responsible for the QA process in the RT area of the
clinic and use the application as a tool to ensure proper delivery of dose in general
and for the dose dynamic plan verification (typically IMRT plans).
Physicians: After the physicist has reviewed the verification plan, physicians can
review and approve the results of the pre-treatment IMRT plan verification before
the treatment actually starts.
14
User Rights and User Administration

Portal Dosimetry provides the following user rights:
Access Portal Dosimetry to start the Portal Dosimetry application. It grants readrights for all objects in Portal Dosimetry.
Change Treatment Image Status. These rights are needed to change the status of
portal dose images to Reviewed, Approved, or Action Required, respectively. The
right to set a portal dose image to status Action Required is called Change Treatment
image to Change Request within the User Rights Administration tool.
Edit Treatment Images. This right is needed to create, edit, or delete dose analyses
on portal dose images. It is also needed to create annotations, contours or image
remarks on portal dose images.
Import/Export Data. This right is needed to export dose images and analyses to
text files and to import portal dose images from text files.
Administer QA Application. This right is needed to create, edit or delete Portal
Dosimetry templates and isoline level templates.
The User Rights Administration is available on every computer in the ARIA OIS
system.
To access the user rights administration:
1. Choose Start > Programs > Varian Tools > Platform Portal.
2. Click Platform Services.
3. In the Security menu, select Rights.
The Varian user right system is a group-based rights management system, meaning
that rights are granted to user groups, not to individual users. Each user in this
system can only be in one user group, for example, Physicist or Therapist.
The pre-defined user groups have pre-defined rights, for example, the Access Portal
Dosimetry right is granted to all these groups, except Secretary.
15

1
2 3
10
7
1.
2.
3.
4.
5.
Title bar
Menu bar
Toolbar
Image View Panel
Image Approval
Figure 1
16
6
6.
7.
8.
9.
10.
Patient Alert
Task Panel
Display Mode
Navigation Panel
Title Bar
In the title bar the program name, the name of the current patient, and the primary
ID is shown.
Tip: The patient name can be hidden using Tools > Mask Patient Name, or F10.
Menu Bar
The following table identifies all main entries in the menu bar. For the complete list
see Menu Entries and Toolbar Icons on page 87.
Table 1 Menu Entries and Functions
Menu
Description
File
This menu contains entries to perform standard file tasks. Additionally, you can import and export DICOM files, this means you can
start the DICOM Import and Export application if available.
Edit
This menu contains entries for performing editing tasks.
View
This menu contains entries for adjusting the views.
Insert
This menu contains the drawing tools.
Measure
This menu contains the measuring tools.
Portal Dosimetry
This menu contains the image properties, image navigation, image

status change, and the patient alerts.
Analysis
This menu contains entries for performing dose analyses and dose
constancy checks and for managing templates.
Tools
This menu contains the options dialog, the isodose level editor, the
output factor tool, the leaf motion overlay, and the height field. The
tools menu also contains the scripting entries. For more information
to scripting, refer to the Portal Dosimetry Scripting API Reference Guide.
Help
This menu contains the online help and information about the software version.
Toolbar
For the complete list see Menu Entries and Toolbar Icons on page 87. For changing
the toolbar icon size, see Configuring Portal Dosimetry on page 23.
17
Image View Panel and Image Icons

The Image View Panel changes based on the layout selection, see Selecting the View
Layout on page 43, and it may include individual predicted and measured images,
overlaid images, dose profiles, and histograms.
Table 2
Icon
Icons in the Image Viewer Area
Description
Maximizes the image view to the size of the image view panel.
Resets the image view size to the previously selected size.
Patient Orientation Indicator: Indicates the position of the patient
when the image was acquired.
The red nose indicates the front of the patient.
The red hand indicates the left hand.
The blue dots indicate the toes.
Further there can be image status icons or image slider icon for blended views, see
Image Approval on page 80.
Image Approval
In this area the image status buttons are shown. Using the buttons, you can change
the status of an image, see Image Approval on page 80. You can use the arrows
below to switch to the next and previous images.
Patient Alert
Using the button you can view and create patient alerts. For more information, see
Patient Alert on page 83.
Note: Patient Alerts only work in a Varian fully integrated environment with ARIA and
Eclipse.
Task Panel
In this panel you can perform dose evaluation or align and normalize images. For a
description of these functions, see Dose Evaluation on page 72, Image Alignment
on page 69, and Normalization on page 71.
18
Using the check boxes you can show some helpful information like Isodose Lines, see
table below.
Table 3 Visible Configuration
Tool
Description
Reference Image
To blend the reference image of the field with the gamma/dose difference image.
Note: This check box is only enabled if there is a reference
image attached to the field and you are not in the overlay
mode.
Graticule
To show the graticule for all images, see Digital Graticule on

page 68.
Field Outline
To show the field edge outline (using CIAO values for collimators
and MLC leaves) for all images.
Isodose Lines
To show the isodose lines for all images. Blend check box: To show
isolines of both images in blended view. By default, only isolines of
the portal dose images are shown.
Color Wash
To show the doses in color, grayscale or isodose lines without image.
Display Mode
Using the option buttons you can select the corresponding image display mode, see
table below.
Table 4
Display Mode
Mode
Description
Predicted and Portal

Dose
The blended image is shown as the main image.
Portal Dose only
The portal dose image is shown as the main image.
Predicted Dose only
The predicted dose image is shown as the main image.
19
Mode
Description
Dose Difference
The dose difference is shown as the main image, see Dose Difference
View on page 50.
Gamma Evaluation
The gamma evaluation is shown as the main image, see Gamma Evaluation View on page 51.
Navigation Panel
Using the navigation panel you can select the required images or analyses of a
patient, see Selecting Dose Images on page 38.
On top of the navigation panel there are drop down menus for course and plan
selection and two tabs, see table below.
Table 5
Options in the Navigation Panel
Option
Description
Plan (drop down

menu)
To select the active plan. All plans of the active course are listed in
this drop down menu. If All Courses is selected in the course drop
down menu, course information is included, that means C1/Plan1,
C1/Plan2, or C2/Plan3. Plans containing dose images are marked
with a leading asterisk (*).
Note: When in the Options dialog the option Show fields
without dose images is not active, only plans with dose
images are listed.
Course (drop down

menu)
To select the active course. Courses containing dose images are

marked with a leading asterisk (*).
Field tab
To list the images according to the field.
Session tab
To list the sessions in chronological order.
To Hide and Show the Navigation Panel:

1. To hide the navigation panel, click .
2. To show the navigation panel, move mouse pointer over Portal Dose Images on
the left:
20
3. To pin the navigation panel, click .
21
Chapter 4 Startup and Setup Tasks

Starting the Portal Dosimetry Application
To start the application, log in to the system and do one of the following:
Click Portal Dosimetry on the home screen.
Choose Quicklinks > Portal Dosimetry from the menu.
For more information, refer to the following publications:
22
Configuring Portal Dosimetry

You can define several user settings using the Options dialog box. The table below
lists the tabs and all the settings you can define.
Figure 2
Options Dialog Box
To define Portal Dosimetry settings:

1. Choose Tools > Options .
2. Select the required tabs and options and click Save & Close.
23
Table 6
Setting Options
Tab
Settings
Startup Settings
The drop down menus and check boxes define the startup configuration of Portal Dosimetry.
Start in: Here you can select if the program should start in Evaluation Mode, see Dose Evaluation on page 72 or in Alignment
Mode, see Image Alignment on page 69.
View Layout: Here you can select the View Layout, see Selecting
the View Layout on page 43.
Display Mode: Here you can select the display mode, see Display
Mode on page 19.
Plan Overview Mode: Here you can configure the plan overview
mode, see Plan Overview Mode on page 45.
Rendering: This option defines which graphics rendering method
is used for the application, you can choose:
Automatic: Automatic use of hardware rendering if hardware
capabilities are sufficient (default setting).
Hardware: The graphics card hardware is used for rendering.
Software: The graphics card hardware is not used for rendering. It is the slower option but recommended in case of
problems.
Startup Settings
(continued)
With the check boxes below you can change the visibility configuration settings, see Visibility Configuration on page 19. Selecting the
Show Fields without Dose Images check box you can show all fields
of all plans (also of treatment plans). With the slider Blending Pre
dicted Dose/Portal Dose you can set the intensity of predicted or
portal dose in blended images.
Note: The application must be restarted for these settings to
take effect. These are the startup defaults only; you also can
change the view settings when the program is running.
24
Tab
Settings
Profile/Histogram
Dose Profile:
Draw dose profile of predicted dose dashed
Selected: To show the profile line of predicted dose as a
dashed line.
Cleared: To show the predicted dose as a solid line differentiated by color.
Initial offset relative to field center
The initial offset of the default profile lines displayed in
the 3-View and 5-View layouts, relative to field center in
mm. This offset may be set to draw profiles at positions
different than isocenter, for example to prevent horizontal
profile being located in the groove between MLC leaves.
Dose Histogram:
Logarithmic yaxis
If selected, the scale of the y-axis in logarithmical scale is
changed, see Histogram View on page 53.
If cleared, the scale of the y-axis is in linear scale.
Locking xaxis when changing ROI
If selected, the current scale of the x-axis when you change
ROI manually is locked.
Misc Settings
Gamma Analysis:
Histogram Cut-Off
The fraction which is used to cut off the upper end of the
histogram in order to prevent outliers from being used as
the global gamma reference value.
Local Gamma Threshold
The fraction of the global gamma reference value, which is
used as the lower threshold in local gamma evaluation, see
Principle of Gamma Evaluation on page 103.
Isoline Levels:
Default templates for absolute and relative mode.
Course Selection:
Show or hide course selection dialog for patients with multiple QA courses. If not checked, Portal Dosimetry automatically opens the course with the latest portal dose image.
Printing
Header/Footer:
Here you can enter text, which appears as header/footer information in the printout. Select the check boxes below Patient
Header, if you want to print the hospital name and the birth
date.
Toolbar
Here you can set the icon size in the toolbar.
25
Manage Templates
A portal dosimetry template defines parameters for normalization, alignment and
dose evaluation. For dose evaluation, it defines the tests to perform including the test
parameters and tolerances. Templates can be applied to single dose images or to all
dose images of a session and plan. The result of applying a template to an image is a
dose analysis object. This analysis object is attached to the dose image and contains
the results of the dose evaluation tests together with the parameter and tolerance
values used for the tests.
Figure 3
Manage Templates Dialog Box
For explanation of these values see Defining Templates on page 27.
26
Default Template
You can set a created template as a default template.
The parameters of the default template are used, when an analysis is created and no
explicit template was chosen, except another template is assigned to the current
selected plan via Assigned Plans option, see Assigning Templates to a Plan on
page 74. There can only be one default template defined for the application. If one
template is set as default, then you make another template the default, the first
template will lose the default setting. The default template also determines the
initial parameters in the evaluation, alignment and normalization tab.
For example: To use absolute mode by default, change the normalization option of
the default template to Absolute Normalization. For defining a default template, see
Defining Templates on page 27.
When no template is explicitly given, the following rule is used to find a default
template:
1. Check if there is a template assigned to the corresponding plan. If yes take this
template.
2. Check if there is a default template defined. If yes take this template.
Defining Templates
Templates are defined as site settings and are therefore globally visible. Once you
have defined a template, you can assign it for every patient.
To define a template:
1. Choose Analysis > Manage Templates.
2. Click New.
3. Enter the Name, if required choose Create template based on current analysis.
In this case the values of the current analysis are taken over.
4. To create a template for a dose constancy check, choose Create constancy check
template. See Dose Constancy Check for more information.
5. Enter or redefine values in the Manage Templates window. For an explanation of
the values, see table below. You can change the values for each single analysis, see
Setting Options on page 76.
6. Click Save & Close.
Note: If you choose Absolute Normalization in the Normalization group, the template can
only be applied in the absolute dosimetric mode.
27
Table 7 Manage Templates Dialog Box

Setting
Description
Assigned Plans
Using the Assigned Plans text box, you can assign the template to
plans, see Assigning Templates to a Plan on page 74.
Default Template
Using the Default Template check box, you can optionally define the
template as a default template, see Default Template on page 27.
Constancy Check
Template
Using the Constancy Check Template check box, you can optionally
define the template as a constancy check template.
Alignment
Using Perform Auto Alignment check box, you can set if auto alignment shall be done on this image, see Image Alignment on page 69.
Using Align to Setup Image you can perform auto alignment to a
setup image instead of auto alignment to the predicted dose. Using
Rtn you can perform an imager rotation for alignment.
Note: In this case, a unique setup image must be acquired
in the session.
Normalization
Using the Normalization group, you can define the normalization

mode, see Normalization on page 71.
Region of Interest
Using the Region of Interest group, you can set the ROI, see Setting
the ROI on page 75.
Gamma Analysis Options:

Dose Tolerance
To set the percentage dose tolerance in relation to reference value.
DTA
To set the distance to agreement in mm.
Use Local Gamma

Evaluation
Check box to use local gamma evaluation. The local value is the predicted dose at the currently evaluated pixel. Local means that instead
of using a global dose reference value (maximum of predicted dose) a
local dose reference value is used. For more information, see Principle of Gamma Evaluation on page 103.
Use Improved
Gamma Evaluation
Check box to use improved gamma evaluation. This type of gamma

evaluation uses an improved algorithm to show differences between
high-doses and low-doses more precise. By default, the Improved
Gamma Evaluation mode is selected. For more information, see Principle of Gamma Evaluation on page 103.
Tests:
28
Area Gamma < 1.0
To set to allowed area of gamma with less than 1 value in %.
Maximum Gamma
To set the allowed maximum gamma value.
Average Gamma
To set the allowed average gamma value.
Setting
Description
LCA Gamma > 1.0
To set the allowed LCA Gamma > 1.0 in percent. LCA means largest
connected area of pixels having gamma value more than 1 relative to
the total number of pixels in ROI.
Area Gamma
To set an allowed area gamma, in %, that can exceed the set threshold
level.
Area Gamma
To set an allowed area gamma, in %, that can exceed the set threshold
level. Both threshold and % area can be different than the first entry.
Dose Difference Options:

Maximum Dose Dif
ference
To set the allowed maximal dose difference in %.
Average Dose Differ- To set the allowed average dose difference in %.

ence
Area Dose Difference To set an allowed area gamma, in %, that can exceed the set threshold
level.
Area Dose Difference To set an allowed area gamma, in %, that can exceed the set threshold
level. Both threshold and % area can be different than the first entry.
Exporting Templates
To exchange templates with other sites or to backup and restore templates:
2. Click Export.
3. In the Export Template dialog, select to template to export and click Export.
Tip: Selection of multiple templates is supported by pressing Shift or Ctrl key during
selection.
4. Select the folder to store the template and click OK.

The template is stored in xml format on your system.
Importing Templates
2. Click Import.
3. Select the template on your system and click Open.
The selected template is imported.
29

Using the Isodose Level Editor you can define a set of isoline levels, including colors
and appearance of the lines.
You can define three types of templates:
Dynamic templates - The level definition is relative to the maximal dose of the
image. These templates can be applied to all dose images.
Note: When a dynamic template is used, normalization has no effect on the isolines.
Relative mode templates - The levels are in percents. These templates can be
applied to images in relative mode.
Absolute mode templates - The lines are defined in Calibration Units (CU). These
templates can be applied to images in absolute mode.
1. Adjustment arrow
2. Color field
Figure 4
30
Table 8
Context Menu of Isodose Level Template Editor
Function
Description
Bold Line
To draw the isolevel line bold.
Delete Isolevel
To delete the isolevel.
Start/Create Color
Gradient
To create a color gradient.
Insert Isolevel
To insert a new isolevel (Right-click between two isolines).
Setup Isodose Level

To setup Isodose Levels:
1. Choose Tools > Isodose Level Editor.
2. Click New.
3. Enter the Name and set the Type. Optionally, you can set the Start Level, Stop
Level, and the Step Size.
4. Click OK.
Table 9
Option
Change colors
Visible Configuration
Task
1. Click on a color field.
2. Set your desired color and click OK.
Tip: Click Set Default Colors to restore the original colors.
Change levels
1. Go to an adjustment arrow of a color field.

The mouse pointer turns to .
2. Click and while holding the mouse button down drag the color
field to the required position. Alternatively the level can be set
numerically by clicking on the level number field and typing in a
new value.
3. Click Save & Close.
Create a color gradient
1. Right-click to a isolevel and choose Start Color Gradient from

Level.
2. Right-click to another isolevel and choose Create Color Gradient
from Level.
31
Export Isodose Templates

1. In the Isodose Level Template Editor, click Export.
2. In the Export Template dialog, select to template to export and click Export.
3. Select the folder to store the template and click OK.
The template is stored in xml format on your system.
Import Isodose Templates

1. In Isodose Level Template Editor, click Import.
2. Select the template on your system and click Open.
The selected template is imported.
Portal Dosimetry Scripting API

Scripts allow custom extensions of the functionality of the Portal Dosimetry
application. Scripts can access the data model of Portal Dosimetry in a read-only
mode.
Portal Dosimetry supports two types of scripts:
Plugins
Plug-ins are launched from the Portal Dosimetry user interface. After the launch, the
plug-in gains access to the data of the currently open patient.
Portal Dosimetry supports two types of plug-ins:
A single-file plug-in: A source code file that Portal Dosimetry reads, compiles on
the fly, and connects to the data model of the running Portal Dosimetry instance.
A binary plug-in: A compiled .NET assembly that Portal Dosimetry loads and
connects to the data model of the running Portal Dosimetry instance.
Executable Applications
A stand-alone executable is a .NET application that references the Portal Dosimetry
Scripting API class library. It can be launched just like any Windows application.
For more information how to use the script wizard or how to launch scripts, refer to
the following publication: Portal Dosimetry Scripting API Reference Guide
32
Output Factor Tool

Precondition for using the tool is that a test patient with a plan containing a series of
rectangular fields of size n x m centimeter has been irradiated successfully. When
loading this test patient in Portal Dosimetry, for each field one portal dose image
should be present. Navigate to the first portal dose image acquired.
Output factors are needed for configuration of the PDIP model that is used to
calculate the predicted dose images. This configuration is done in the Beam
Configuration application. For more information, see the Eclipse Photon and Electron
Algorithms Reference Guide. Portal Dosimetry provides an output factor tool that
allows measuring absolute dose values around the isocenter by averaging the dose in
a small and configurable area. The Output factor tool creates MUTAB output factor
table format. This can be imported directly in Eclipse Beam Configuration.
Figure 5
Table 10
Output Factor Tool Window
Output Factor Tool Dialog Box Settings
Setting
Description
Show Graticule
To show the digital graticule in dose images.
Automatically Go To To navigate automatically to next beam after clicking Get Dose at

Next Beam
Isocenter.
Perform Auto Align
ment
To align the portal dose image against the planned field edge automatically, see Auto Align on page 70.
33
Setting
Description
Averaged Area
(around Isocenter)
To set the length and width of the averaged area around the isocenter
in mm.
Get Dose at Isocenter Button to display the dose at isocenter in the text field below.
Copy to Clipboard
To copy all measured dose values that appear in the tool to the clipboard.
Clear
To clear the dose values.
Close
To close the dialog box.
To use the output factor tool:

1. Choose Tools > Output Factor Tool.
2. If required, you can select the check boxes Show Graticule and Automatically
Go To Next Beam.
3. Enter the required area around isocenter in the text box Averaged Area.
4. Click Get Dose at Isocenter. The value (Gy/MU) and the field size are shown.
5. If the check box Automatically Go To Next Beam is not selected, navigate to the
portal dose image of the next field.
6. Repeat step 4 and step 5 all fields are measured. The output factor table is
completed.
7. Click Copy to Clipboard to copy the output factor table to the clipboard.
The values are comma separated as required by the MUTAB format used for the
output factors. You can import these output factors in the Beam Configuration
application, see Beam Configuration Reference Guide.
8. Click Close.
34
Chapter 5 Dosimetry Review

Loading a Patient
To load a patient record, log in to the system and do one of the following:
Click Portal Dosimetry on the home screen.
Choose Quicklinks > Portal Dosimetry from the menu.
Choose File > Open Patient from the menu.
Click in the toolbar.
For more information, refer to the following publications:
Saving a Patient
To save a patient:
1. On the tool bar click , choose File > Save patient, or press Ctrl+S.
2. Confirm the saving with OK.
Closing a Patient
To close a patient:
1. Choose File > Close patient patient.
2. If required confirm the saving with OK.
The patient data are saved persistently and the patient is closed.
35
Printing Images and Reports

For available print options, see folowing table:
Table 11
Print Options
Group
Description
Printer
To choose the printer and to set its properties. Information about the
selected printer is shown.
Report
To select the type of printout.

Printout of the Current Analysis
Perform Analysis Batch Printing: Prints selectable analyses with
dose difference and gamma images.
Note: Analysis Batch Printing is only available in Plan
Overview Mode, see Plan Overview Mode on page 45.
Printout of the Active View (Portrait or Landscape)
Printout of the text-based Plan Summary including reports
Printout of the table-based Plan Brief Summary (Landscape)
Note: If a primary analysis is defined, this analysis is
printed. Otherwise the most recent analysis is printed.
Copies
To select the number of copies.

Note: Select Collate to print the copies consecutively.
Status
Status information of the printout.
Tip: Also consider the tab Printing in Options, see Configuring Portal Dosimetry on
page 23.
To print images and reports:

1. Choose File > Print, or press Ctrl+P.
2. Select the required print options, see table above.
3. Optionally, click Preview to have a look at the printout.
36
4. Click Print.
37
Selecting Dose Images

When a patient has been loaded, all fields, dose images, and analysis belonging to a
verification plan or a treatment plan are listed in the Navigation Panel.
Note: Multiple selections of images by pressing the Shift or Ctrl key are not possible in
Portal Dosimetry.
There are four types of dose images, see table below.

Table 12
Type
Dose Images Types
Description
Predicted Dose Image Dose image calculated by the planning system using the PDIP algorithm. When selected, this image is always displayed in the complete
Image View Panel. No other view layouts can be selected. In predicted dose images, not all tools can be applied and the task panel is
disabled.
Portal Dose Image
Composite Image
Portal dose images, which are composed, see Creating Composite Images on page 66. These images are collected in the folder composite
images .
Disposed Portal Dose
Dose image which has been disposed. Disposed images are only
visible, when command Show Disposed Images in Portal Dosimetry
menu is enabled, see Showing Disposed Images on page 82.
Image
Baseline Image
38
Dose image acquired with the PortalVision imager. If a predicted

dose image is available, the portal dose image and the predicted dose
image are blended automatically. All view layouts can be selected,
see Selecting the View Layout on page 43. In portal dose images, all
tools can be applied and the task panel is enabled.
Dose image which has been defined as a baseline image. Baseline images are necessary for performing constancy checks, see Dose Constancy Check on page 78.
Figure 6 Selecting Images in Navigation Panel
To select images proceed as follows:

1. Choose the requested verification plan or treatment plan from the drop-down
list.
Plans containing dose images are marked with a leading asterisk (*).
2. Choose the required tab, for example Field.
Note: Only fields having a predicted dose image or a portal dose image (or both) are shown.
3. Click the required image.
39
Comparing Dose Images

Using Portal Dosimetry you can compare a portal dose image to any other predicted
dose image. An analysis between two portal dose images is named Comparison in
the left panel. Comparison is possible to images of any plan.
Comparisons are behaving the same as analyses with the following differences:
Comparisons cannot be set as primary analysis
Comparisons are never used in plan overview mode
Comparisons are never used in plan summary printouts
To compare dose images:
1. Right-click a portal dose image in the navigation panel.
2. From context menu choose Compare to and select from the submenu the
required image.
Selecting Views in the Image View Panel

To select a view:
Click into the required image.
The selected view is highlighted with a yellow frame.
Context Menus in the Navigation Panel

Right-click the image icons in the Navigation Panel to open a context menu. The
context menu depends on the object, see Fields on page 40 to Composite Images on
page 42.
Fields
Table 13 Context Menu for Fields
40
Function
Description
Properties
To show the Properties window, see Image Properties on page 67.
Import Dose from

Text File
To import portal or predicted dose images in text format (DXF, an

ASCII based format).
Predicted Dose Images

Table 14
Context Menu for Predicted Dose Images
Function
Description
Export to Text File
To export general, geometry, patient, and field data to a text file.
Export to DICOM
To start the DICOM Import and Export application and export images.
Overlay Doses
To overlay isolines of all portal dose images of the field with the predicted dose image.
Note: Only available for predicted dose images, when at
least one portal dose image exists.
Properties
Portal Dose Images

Table 15
Context Menu for Portal Dose Images
Function
Description
Delete
To permanently delete the portal dose image.

Note: Deleted images cannot be recovered anymore. Consider disposing the image instead.
Create Composite
Image
To create a composite image, see Creating Composite Images on

page 66.
Apply Template
To apply a defined template.

Note: Only available for portal dose and composite images,
if a template has been defined.
41
Function
Description
Define as Constancy
Check Baseline
Image
To define this portal dose image as the baseline image for dose constancy checks, see Dose Constancy Check on page 78.
Perform Constancy
Check
To perform a dose constancy check against the baseline image, see

Dose Constancy Check on page 78.
Export to Text File
To export general, geometry, patient, and field data to a text file.
Export to DICOM
To start the DICOM Import and Export application and export images.
Compare to
To compare the image with another dose image, see Comparing Dose
Images on page 40.
Properties
Note: The context menu for a baseline image
for a portal dose image.
includes the same entries as the context menu
Analyses
Table 16
Context Menu for Analyses
Function
Description
Delete
To delete an analysis.
Export to Text File
To export patient, plan, and field data, and the analysis results to a
text file.
Edit Name
To rename an analysis.
Edit Comment
To create or edit a comment of an analysis.
Set as Primary Anal

ysis
To define a primary analysis, see Primary Analyses on page 77.
Composite Images
42
Table 17 Context Menu for Composite Images

Function
Description
Delete
To delete a composite image.
Apply Template

Note: Only available for portal dose and composite images,
if a template has been defined.
Export to Text File
To export patient, plan, and field data, and the analysis results to a
text file.
Compare to
To compare the image with another dose image, see Comparing Dose
Images on page 40.
Properties
Selecting the View Layout

2
1. Selected image
2. Selected layout: 5 Views
Figure 7
5-Views Layout of Portal Dosimetry
43
Portal Dosimetry provides several view layouts in the image view area to get an
overview of the dose images and the analysis.
Dose Layouts
Table 18
Layout
View Layouts of Portal Dosimetry
Description
2 Views: Predicted Dose and Evaluated Dose
3 Views: Evaluated Dose, Profiles and Histogram
5 Views: Predicted Dose, Evaluated Dose, Portal Dose, Profiles, Histogram
5 Views: Predicted Dose, Evaluated Dose, Portal Dose, X-Profile, YProfile
Plan Overview Mode: All images of a plan and session, see Plan
Overview Mode on page 45.
Note: If you want to terminate this view, select it once
again, or press the F12 key.
Evaluated Dose;
Predicted Dose;
Portal Dose;
Profiles;
Histogram
To select the required view layout:

1. Choose View > View Layout, or click the drop down arrow of the icon
2. Select the required layout.
Note: The layout modes are only available for portal dose images having a predicted dose.
44
Plan Overview Mode

For each field in the active plan, according to plan combo box in navigation panel,
and session, according to selected portal dose image, the most recent portal dose
image of the field is shown. If there is a primary analysis, the primary analysis is
shown (except for primary analyses of composite images), else the most recent
analysis is shown.
Using the Plan Overview Mode you can only view images, not edit them (Image
status change and applying tools is possible). Further you can perform Analysis
batch printing, see Printing Images and Reports on page 36.
Dose Visualization
In Portal Dosimetry, you can display portal images in different ways:
Dose Images on page 45
Blended View on page 49
Profiles View on page 52
Histogram View on page 53
Gamma/Dose Difference Height Field on page 56
Dose Images
This section is significant for predicted dose images, portal dose images, and blended
dose images, see Selecting Dose Images on page 38. For information and tools
displayed in an image, see figure below.
45
1.
2.
3.
4.
Dose Window/Level
Image Information
Dose Profile Line
Image Status
Figure 8
46
Display of Images
Dose Window/Level
In a predicted dose or a portal dose image, there is the Dose Window/Level on the
left side. In the blended view, the Dose Window/Level is displayed at the left and
right sides one for each source image. With this slider you can modify the mapping
between dose values and colors, similar to the window/level tool used in non-dose
images.
Note:
The unit of measurements on the Dose Window/Level depends on the image type.
If the option Color Wash is inactive, the Dose Window/Level is in grayscale.
Figure 9
Dose Window/Level
To use the Dose Window/Level:

1. Click a slider and hold down the left mouse button.
2. Drag the slider into the required position. Alternatively, you can click on the top
or bottom number and enter the value.
Example: If you want to display only doses over 50%, set the lower slider to 50%.
If you want to display only doses up to 50%, set the upper slider to 50%, see
Figure 10Example of Colorizing on page 47.
1
1. Doses over 50% are shown

2. Doses up to 50% are shown
Figure 10 Example of Colorizing
47
Image Information
The image type (predicted dose, blended, or portal dose), the image name and the
exposure date are shown.
Dose Profile Lines

The two intersecting dashed lines indicate the location and extent of the dose profiles
that are displayed in the profile view (lower, left view in 5-view layout). You can
move these lines in direction of the collimator axes along the image. The numbers at
the lower, left corner of the blended view indicate the coordinates of the intersection
point in the collimator coordinate system. Additionally, you can insert further dose
profile lines using the profile tool, see Measuring Line Profile on page 58.
The small circles at each end of the lines and at the crossing point of the two lines can
be shifted individually. When shifting the crossing point, the endpoints move on a
virtual constant rectangle. If the Ctrl key is pressed during shifting the crossing
point, the profiles can be moved over the view as is. If the Ctrl key is pressed during
moving one of the end points, the opposite end point is shifted symmetrically. If the
mouse wheel is rotated over the crossing point, all the end points are shifted towards
or away from the crossing point. See Measuring Line Profile on page 58.
Note: The dose profile lines are only available in 3-View and 5-View layout.
Image Status
The image status is displayed in the lower, right corner. See Image Approval on
page 80.
48
Blended View
For portal dose images of fields having a predicted dose image, the blended view can
be shown in different view layouts. A blended image is marked with the prefix
blended in the image information at the top.
1. Slider
2. Dose Profile Line
Figure 11 Blended View
To get the blended view:

1. In the Display Mode Panel, choose Overlay Predicted/Portal Dose, see Graphical
User Interface of Portal Dosimetry on page 16.
2. Using the slider on the bottom of the blended view area, you can define the
transparency of the source images. Arrow left means the predicted dose image is
fully visible, arrow right means, the portal dose images is fully visible. The
default value can be changed using Options, see Configuring Portal Dosimetry
on page 23.
49

For portal dose images of fields having a predicted dose image, the dose difference
view can be shown in different view layouts.
It shows the differences between the portal dose image and the predicted dose image.
A special color wash is used for the dose difference image. The colors are
symmetrically distributed around zero. The dose window level slider is also in a
symmetrical mode.
The colors over the upper threshold, which can be set by shifting the sliders or
entering it numerically, are red symbolizing possible overexposure.
Symmetrically to this behavior, the colors below the lower threshold are blue
symbolizing possible underexposure.
The dose difference image can be used for manual alignment and for statistical
evaluation.
Figure 12
To get the dose difference view:

1. In the Display Mode Panel, choose Dose Difference, see Graphical User Interface
of Portal Dosimetry on page 16.
2. Using the Dose Window/Level on the right, you can adjust the color settings and
make the dose difference more visible.
Note: The settings of the dose difference slider do not correlate to the analysis Maximum
Dose Difference value.
50

For portal dose images of fields having a predicted dose image, the Gamma
Evaluation view can be shown.
The gamma evaluation method is a tool to compare dose distributions in a
quantitative manner combining dose difference and distance to agreement (DTA)
criteria. Compared to dose difference, the gamma evaluation is less sensitive to
spatial deviation of the imager from the optimal position by allowing a certain spatial
deviation (DTA). For the gamma evaluation settings, see Performing Analysis on
page 76.
The reference value on a pixel is proportional to the shortest distance of predicted to
portal dose on this point. The value is so scaled that gamma 1.0 is the tolerable
maximum. Values larger than gamma 1.0 are shown red, values smaller than gamma
1.0 are shown in green color shades. The gamma image is the main source for
statistical evaluation. It is not suited for alignment because of the principle of the
underlying algorithm, which allows a certain spatial deviation. It can be used for
visual inspection of the degree of agreement between predicted and measured doses
after alignment. For information on how gamma evaluation is calculated, see
Principle of Gamma Evaluation on page 103.
Figure 13
To get the gamma evaluation view:
51
1. In the Display Mode Panel, choose Gamma Evaluation.

2. Using the Dose Window/Level tool on the right, you can adjust the color settings
of the gamma image. Mostly this can be used to set the border between
acceptance and failure, which is by default 1.0.
Note:
By default, the improved Gamma Evaluation mode is used. You can also use the local
Gamma Evaluation mode, see Setting Options on page 76.
The settings of the dose level slider do not correlate to the analysis Gamma Evaluation
values.
Profiles View
In the 3 Views layout and 5 Views layout, the Dose Profiles are shown. For Line
Profiles, which differs from Dose Profiles, see Measuring Line Profile on page 58.
Figure 14
Profiles Pane
In dose images there are a vertical and a horizontal red, dashed line with a mid point.
These lines collect dose values from the images and the dose profile shows the
values along the red collector lines, see Dose Profile Lines on page 48.
On the Profiles chart:
The blue line shows the acquired dose values of the portal dose image along the
collimator x-axis dose profile line (x-axis).
The red line shows the dose values of the predicted dose image along the
collimator x-axis dose profile line (x-axis).
The green line shows the dose values of the portal dose image along the
collimator y-axis dose profile line (y-axis).
52
The yellow line shows the dose values of the portal dose image along the
collimator y-axis dose profile line (y-axis).
Table 19 Options in Profiles Area
Task
Description
Enlarge the chart
Click the enlarge icon on the top right.
Zoom into the chart
1. Press and hold left mouse button.

2. Drag to mark the area you want to enlarge. Alternatively you can
use the mouse wheel to zoom in or out.
Pan into the chart
1. Press and hold the middle mouse button (mouse wheel).

2. Move the mouse in the required direction.
3. Right-click into the Profiles area to open a context menu, see
table below.
Table 20 Context Menu in Profiles Area
Function
Description
Collimator xaxis
To show the values of the dose profile line in x-direction.
Collimator yaxis
To show the values of the dose profile line in y-direction.
Export to Text File
To export the values to a text file.
Copy to clipboard
To copy the profiles area as an image to clipboard.
Save image as
To save the profiles image as an image. You can choose the location
and the image formats in the following pop-up window.
Reset
To reset zoom and pan of the profile chart.
Histogram View
The Histogram View area is shown in the 3-Views layout and in the 5-Views layout,
see Dose Layouts on page 44. More options are available in Measuring Area
Histogram on page 59.
53
Figure 15
Histogram View
In this view the histogram of the dose differences, respectively gamma evaluation is
shown in a histogram chart. The histogram is calculated using the dose pixels that
are inside the defined region of interest (Intersection of ROI and threshold).
Table 21
54
Options in Histogram Area
Task
Description
Enlarge the chart
Click the enlarge icon on the top right.
Zoom into the chart
1. Press and hold left mouse button.

2. Drag to mark the area you want to enlarge. Alternatively you can
use the mouse wheel to zoom in or out.
Pan into the chart
1. Press and hold the middle mouse button (mouse wheel).

2. Move the mouse in the required direction.
3. Right-click into the Histogram area to open a context menu, see
table below.
Table 22
Context Menu in Histogram Area
Function
Description
Show Statistics
To show Histogram Statistics on the right side of the area:

Max, Min, Mean
SD: Standard Deviation. This value is calculated as:
where is the arithmetic mean.

RDS: Relative Standard Deviation. This value is calculated as:
Xaxis Lock
To lock the x-axis of the histogram while changing the ROI.
Yaxis Logarithmic
To change the scale of the y-axis in logarithmic scale.
Yaxis Area Percent
To change the scale of the y-axis so that when assuming an x-scale between 0 (for the minimal x-value) and 100 (for the maximal x-value),
the area under the curve will be 100.
Export to Text File
Copy to clipboard
To copy the histogram area as an image to clipboard.
Save Image as
To save the histogram as an image. You can choose the location and
the image formats in the following dialog box.
Reset
To reset zoom and pan of the histogram chart.
55

Portal Dosimetry can display the dose value of portal dose images in a topographic
view. The height represents the dose value.
Figure 16
To use Gamma/Dose Difference Height Field:

1. Choose Tools > Gamma/Dose Difference Height Field.
2. Press and hold left mouse button and move mouse to move the height field in
any direction.
3. Using the mouse wheel you can zoom in or out.
4. Using the option buttons on the bottom, you can select the dose difference or the
gamma image overlay over the portal dose image or show the portal dose only.
Using Measuring Tools

Portal Dosimetry provides a number of measuring tools:
Measuring Point Dose on page 57
Measuring Distance on page 57
Measuring Angle on page 58
Measuring Line Profile on page 58
Measuring Area Histogram on page 59
56
Measuring Point Dose

Portal Dosimetry provides a function to measure the dose of a single pixel in an
image. This measurement can be performed on every dose image type.
It is possible to reposition the measurement as well as placing multiple
measurements in an image. For an optimized view, it is possible to reposition the
measuring tag independently from the measurement points.
To measure point dose:
1. Choose Measure > Point Dose, or click .
2. Click on the point or pixel you want to measure.
The measuring pointer is displayed .
3. To reposition the measurement tag, click and drag the tag to the desired position.
4. To show the coordinates of the measured point relative to the isocenter, rightclick to the measured value.
5. To delete the measurement, click .
It is possible to measure further image intensities by repeating this procedure.
Measuring Distance
Portal Dosimetry provides a function for measuring the Distance between any two
points in an image to within 1/10 mm (displayed resolution). This measurement can
be performed in any screen view. It is possible to move the measured points as well
as to place multiple measurements in an image. These measurements cannot be
saved.
To measure distances between marked points:
1. Choose Measure > Distance, or click .
2. Click on the point you want to start measuring from.
The start measuring point is fixed on the image.
3. Draw the mouse pointer to the desired position and click.
The end measuring point is fixed on the image.
4. To correct the measurement, click and drag the start or end measuring point to
the desired position.
It is possible to make further distance measurements by repeating the procedure.
57
Measuring Angle
Portal Dosimetry provides a function for measuring the Angle between any three
points in an image to within 1/10 degrees. The measurement can be performed in any
view.
It is possible to correct the measurement as well as to place multiple measurements in
an image. For an optimized view, it is possible to reposition the measuring tag
independently from the measurement points.
To measure angles of selected points:
1. Choose Measure > Angle, or click .
2. Click on the start point of the first line.
The start measuring point is fixed on the image.
3. Click on the end point of the first line which is at the start point of the second
line.
This point is the intersection point of the first and the second line. The angle tag
displays the current angle between the first line and the second line.
4. Click on the end point of the second line.
The points are fixed and connected by a solid line. The angle tag displays the
angle between the first and the second line. The angle tag is connected to the
intersection point by a dashed line.
5. To correct the measurement, click and drag the appropriate measuring point to
the desired position.
Measuring Line Profile

You can display a dose or gamma value profile in an image along a definable line.
To measure Line Profile:
1. Choose Measure > Profile, or click .
2. Position the mouse pointer at the start point.
3. Hold down the left mouse button and drag the pointer from the start point to the
end point.
4. Release the mouse button.
A red line along which the pixel values are to be measured and a profile window
showing the line profile are displayed.
58
5. Click an end point and hold the mouse button to move that point around the
view.
If Shift is pressed during moving, end points move along the profile direction. If
Ctrl+Shift is pressed during moving, the opposite end-point is moved
symmetrically.
6. Optionally, you can move the middle point of the profile line.
This can be used to measure the value of a mid-point by reading the number
above the midline in the profile chart.
7. Close the profile window with its close button.
8. Right-click the profile window to get the context menu, see table below.
Table 23
Context Menu of Profile Window
Function
Description
Show Statistics
To show profile statistics on the right side of the area. For an explanation of the values, see Histogram View on page 53.
Pixels
To change the legend of the x-axis from cm to pixels.
Export to Text File
Copy to clipboard
To copy the profile area as an image to clipboard.
Save image as
To save the profile area as an image. You can choose the location
and the image formats in the following pop-up window.
Reset
To reset zoom and pan of the profile chart.
Measuring Area Histogram

You can display the histogram of the values measured within an area in an image.
You can edit the properties of the rectangle.
To measure Area Histogram:
1. Choose Measure > Histogram, or click .
2. Click in the image and, while holding down the left mouse button, drag the
mouse pointer to draw the region for histogram.
3. Close the histogram window with its close button.
4. Right-click on the histogram to get the context menu, see Measuring Line Profile
on page 58.
59
Window/Level
Window/Level allows the user to select which intensity range [Imin, Imax] of an image
shall be displayed in the window on the screen. The range (interval) is defined by its
width (Window) and its center (Level). All image pixels having a lower intensity
value than Imin will be represented in the same color as the pixels having the intensity
value Imin and vice versa all pixels having a higher intensity value than Imax will be
represented in the same color as the pixels having the intensity value Imax. By
choosing to display just a certain intensity value interval, the contrast of the image in
this interval is improved.
For more information how to use this tool, refer to the Image Browser Reference Guide.
Note: This function is only available for reference images in case a reference image is available
for the beam and it is made visible in the visibility configuration of the navigation panel, see
Visibility Configuration on page 19.
Using Drawing Tools

Portal Dosimetry provides a number of drawing tools (contour editing tools) for
highlighting image contours with free hand drawn objects, rectangles, ellipses, and
points or to make image annotations. Adding, deleting or modifying contours
requires the right to modify treatment images.
Tip: Most contour editing tools support the undo and redo functionality using the Ctrl+Z and
Ctrl+Y keys.
Only User-Defined structures that were created, see Inserting Contour Objects on
page 61, in Portal Dosimetry can be edited or deleted. All other structures are ReadOnly. The following functions are provided to modify contour objects, see Modifying
and Deleting User-Defined Contours on page 62:
Selecting, repositioning, rotating, and resizing contours
Redrawing and cutting contours
Modifying contour points
Deleting user-defined contours, that is, those colored green that were created in
Portal Dosimetry, see Inserting Contour Objects on page 61 and Modifying and
Deleting User-Defined Contours on page 62.
60
Note:
Drawing tools can only be used in portal dose images.

Drawing tools are not supported on composite images.
If the image status is Approved, no drawing tools can be used.
Saving patient data also saves contours and points.
Inserting Contour Objects

Table 24
Task
Draw a freehand
contour
Contour Objects
Description
1. To display existing contours and points, choose View > Show
Structures
2. Choose Insert > Freehand, or click .
3. Click in the reference or treatment image and, while holding

down the left mouse button, drag the mouse pointer to draw a
free-hand contour.
4. If required, draw polygonal lines using single clicks of the mouse
button.
5. To close a contour with a straight line, right-click in the image
and choose Finish Closed from the list.
6. To remove the last point of the contour, right-click in the image
and choose Remove Last Point from the list.
7. To finish, right-click in the image and choose Finish from the list.
Draw a rectangle
contour
1. Choose Insert > Rectangle, or click

.
down the left mouse button, drag the mouse pointer to draw a
rectangle contour.
Draw an ellipse con

tour
1. Choose Insert > Ellipse, or click .

down the left mouse button, drag the mouse pointer to draw an
ellipse contour.
61
Task
Description
Draw a point
1. Choose Insert > Point, or click .

2. Click in the reference or treatment image; then click the left
mouse button to draw/set a point.
Create an amage an
notation text:
1. Choose Insert > Image Annotation, or click .

2. Click in the reference or treatment image.
3. In the Edit Label window, type the Annotation Text.
4. Press the Return key.
5. If required, you can move the Image Annotation. For more information, see Modifying and Deleting User-Defined Contours on
page 62.
Modifying and Deleting User-Defined Contours

User-defined contours or text that appears in green can be modified, edited or deleted.
This allows you to:
Move the contour, move points or text, rotate or resize the complete contour,
Cut or redraw parts of the contour,
Modify only certain contour points.
Table 25
Task
Modify the complete
contour
62
Modify Contour Objects
Description
1. With the left mouse button, click on the contour, you want to
modify. The selected contour gets a red bounding rectangle with
round quadratic handles. Width and length information is given
in mm.
2. To resize the contour, click on a quadratic handle and while
holding down the mouse button drag the double-headed arrow
to the desired position.
3. To rotate the contour, click on a round handle and while holding
down the mouse button drag the round arrow to the desired position.
4. To move the contour, points and/or annotation text, click the
point, text or outline of the contour and while holding down the
mouse button drag the mouse pointer to the desired position.
5. To complete the modification, click .
Task
Description
Redraw or cut parts

of the contour
1. Click Redraw or cut a contour part .

2. Using the left mouse button select the contour you want to redraw or cut.
3. While holding down the left mouse button drag the mouse to
draw a new line replacing the underlying contour part. By connecting the end points of an open contour the contour can be
closed. The drawn area is highlighted in dark yellow.
4. To complete redrawing, click .
Modify only certain

contour points
1. Click Modify the contour points .

2. Using the left mouse button click on the outline of the contour
you want to modify.
3. While holding down the left mouse button drag the red quadratic handles to the desired position.
4. Using the right mouse button an existing contour point can be
deleted or a new one can be added.
5. To complete redrawing, click .
Delete a contour,
points or annotation
text
1. Click
to select a Contour, Point or Annotation Text.
2. Press the Del key.
3. Once the message box opens, click Yes.
Show/Hide Structures
You can show or hide structures for dose images.
Structure covers the following types:
User-defined structures, including image annotations and contours drawn in
Portal Dosimetry
Isodose Lines
Image Status
To show/hide structures:
1. Choose View > Show Structures, or click .
2. Click the drop down arrow of the icon .
A floating window opens.
3. Choose the contours or overlays you want to show/hide and click Close.
63
Leaf Motion Overlay

Using Leaf Motion Overlay, you can play MLC motion on top of portal dose image or
evaluation image. Leaf Motion Overlay tool also supports RapidArc fields.
Note: The MLC leaf motion is based on the planned MLC motions contained in the treatment
plan. This is different to the Argus application that displays leaf motion based on the DynaLog
files.
3
2
1. Player Buttons
2. Status Field
3. Gantry Angle
Figure 17
Leaf Motion Overlay Player Panel
To use Leaf Motion Overlay:

1. Choose Tools > Leaf Motion Overlay, or press F11.
2. Use the player functions described in Table 26Leaf Motion Overlay Player
Settings on page 65.
64
3. Optionally, you can click the status field to get additional information about
control points (c.p.), meterset weight (m.w.) and cumulative meterset weight
(c.m.w.) of this image.
Table 26
Symbol
Leaf Motion Overlay Player Settings
Impact
To start/interrupt animation.
Note: If animation is started, the icon will be change to
.
To go to previous control point.
To stop animation.
To go to next control point.
To go to first control point.
To go to last control point.
To restart animation when the end is reached.
Table 27
Context Menu for Leaf Motion Overlay Player
Setting
Description
Display Meterset
To display the Meterset values.
Display Gantry Rtn/Dir
To display the Gantry rotation and direction.
Speed 1x/2x/4x/8x/16x
To choose the speed of animation.
Draw MLC Leaves Solid
To display the MLCs solid or transparent.
65
Creating Composite Images

Composite images display the accumulated dose of several images. Accumulation
takes the different imager positions of the images into account. Composite images
created in Portal Dosimetry are only visible in the Portal Dosimetry application. For
composite images, all dosimetry analysis functions are available and the associated
analyses can be saved, but no image status change is possible. Composite images are
not assigned to a field or session, only to a plan.
An example usage is to compose sub-arc images to display the full arc in RapidArc
images.
Note: Predicted dose images are accumulated automatically.
To create composite images:

1.
2.
3.
4.
Right-click a portal dose image in the Navigation Panel.

From the context menu, choose Create Composite Images.
In the Create Composite Image dialog box, select desired images to compose.
Optionally, you can enter an ID for the composite image.
Figure 18
Composite Images
The composite images are shown in the Navigation Panel, collected in folder
Composite Images on the plan level and marked with the icon .
Tip: To delete composite images, press Del key, or right-click the image and choose Delete from
the context menu.
66
Image Properties
To retrieve information about the selected image or edit the image description, open
the Image Property dialog box.
Choose Portal Dosimetry > Properties, or click .
Properties of the selected image, the corresponding field and plan of the current
patient are displayed. For detailed reference information, see Properties Dialog
Box on page 91.
Zoom In/Zoom Out

It is possible to zoom-in or zoom-out the selected image step-by-step or by zooming
in on a certain image area. The chosen image area is magnified to the size of the
entire window pane.
To zoom an image:
1. Choose View > Zoom In or View > Zoom out, or click or to zoom in or out.
2. To zoom the image step-by-step, select Zoom, or click the buttons several times,
or
3. Rotate the mouse wheel.
4. To zoom into a certain image area, click in the image.
5. Move the mouse pointer to the desired position and drag the mouse over the
desired area.
6. To reset Zooming (and Panning), choose View > Reset Geometry, or click .
This also resets the zoom and pan of the embedded histogram and profile view.
Pan
You can pan an image relative to the window pane. Reference image and treatment
image are synchronized and the blended image view can be panned separately.
To pan an image:
1. Choose View > Pan, or click .
2. Click into the image you want to pan.
3. Drag the left mouse/mouse pointer
as required, or press the mouse wheel and
move the mouse pointer
as required.
4. To reset Panning, choose View > Reset Geometry, or click
67
Digital Graticule
You can display a digital graticule in portal dose images.
To show the Digital Graticule:
1. Choose View > Digital Graticule, or click .
2. The images must be aligned to show the graticule in the right position. If this is
not the case, a dialog message opens. Click Yes to perform auto alignment or No
if you want to align the images manually.
Note:
Check visually if the auto align is correct.

Sometimes auto align is not possible. To show the graticule, you have to align the images
manually.
3. To hide the graticule, choose View > Digital Graticule, or click
Field Outline
You can show the field outline of images. The field outline uses CIAO values of
collimators and MLC leaves. For composite images, the union of the field edge
outlines of the source images is shown.
To show the Field Outline:
Click
to hide the field outline, click the icon again.
68
Chapter 6 Dosimetry Analysis

Image Alignment
Using the Alignment tab, you can align images manually or automatically. Portal
Dosimetry switches in the 3 Views layout mode. The images have to be aligned
before performing analyses.
Figure 19
Alignment Tab in Task Panel
Note:
On Exact arm systems, alignment should not be necessary.

All settings to align images are applied only to the portal dose image.
Manual Align
You can use the mouse or can enter vertical and horizontal correction values to align
the portal dose image. Further you can rotate the image.
To correct values and align manually:
1. Click on the blended image and drag the calculated dose image. Alternatively
you can use the arrow keys (0.1 mm translation for each key stroke, 1 mm when
the Alt key is pressed) or can enter the values in the text boxes X and Y.
2. Select check box Rtn and click outside of the red circle and rotate the calculated
dose image. Alternatively you can enter your required degree value in the deg
text box or use the left or right arrow key in combination with Alt+Ctrl key.
3. If you want to reset your settings and want the original values again, click Set
Original Values.
4. Click Set Aligned to confirm the alignment.
The images are aligned.
69
5. Optionally, you can copy the correction values to other images. Click Copy
Correction to to select the required images in the dialog box and click OK.
Note: Copy Correction to can only be applied to images acquired at the same imager
position and with the same gantry angle. All images the corrections are copied to are marked
as aligned.
6. If you want to correct your settings, click Set Unaligned and repeat the aligning
procedure.
Align to Setup Image

By default portal images are aligned against the reference dose image. You can also
align an image against a setup image. If there is a setup image acquired, you can see
in the drop-down list Align using. It is recommended to align to a setup image
because it is more stable due to the static collimator used.
To align against a setup image:
1. In the drop-down list, click Align using to see all available setup images.
2. Choose the required setup image.
The application switches to a special alignment mode which shows the setup
image together with its planned field aperture.
3. See Manual Align on page 69 or Auto Align on page 70 to align the image
against the setup image.
4. Click Set Aligned to confirm the alignment.
The corrections are copied to the portal dose image and the special mode is
terminated.
Auto Align
Before auto align is performed, check the configuration of a machine for auto
alignment in the RT Administration, see procedure below.
Portal Dosimetry can automatically align the portal dose image to the predicted dose
image by matching the dose intensity values of the two images.
To check the configuration of a machine for auto alignment in the RT
Administration:
1.
2.
3.
4.
70
Choose Quicklinks > RT Administration.

Click tab Radiation & Imaging Devices.
Double-click the entry External Beam.
Click tab External Beam.
5. Search for the group Automatic MV Imager Position Correction. For R-arm
systems, it is recommended to check this option, for Exact arm systems it is
recommended to uncheck this option.
For more Information, refer to the RT Administration Reference Guide.
To align automatically:
Click Auto Align.
The button Set Aligned changes to Set Unaligned.
Note: If you want to correct your settings, click Set Unaligned and correct the values
manually, see Manual Align on page 69.
Normalization
If images are in relative mode, you have to normalize the values. Portal Dosimetry
supports two modes for dose comparison:
Absolute mode: The dose unit is CU. It is recommended to use absolute mode. For
this the system must be calibrated for absolute dosimetry.
Relative mode: The dose unit is given as percent (%) compared to a normalization
value.
Note: Depending on the normalization method, there can be dose values > 100%.
Figure 20 Normalization Tab in Task Panel
To configure the normalization settings:

In the Normalization Mode group, set the normalization method, see table below.
71
Table 28
Normalization Methods
Method
Description
Maximum of Predicted Dose
Dose is normalized to 100% at the maximum of predicted

dose.
Maximum of Each Dose
Dose is normalized to 100% at the maximum of each dose.
Selected Point in Dose
You can select a point in the dose image. Dose is normalized

to 100% at this point for both dose images.
Dose in Isocenter
Dose is normalized to 100% for both dose images at the isocenter.
Minimize Difference
Minimizes average dose difference over the whole image.
Note: Both doses are always normalized to the selected method.
The maximum values, which are taken for the normalization are the absolute
maxima, outliers included. If outliers are making trouble for normalization, the factor
modification has to be used.
In the Factor Modification group, you can set optionally an additional normalization
factor. The dose is normalized to this factor and the changes are directly visible.
Dose Evaluation
Dose Evaluation is used for graphical and quantitative comparison of the predicted
dose with the portal dose. Dose evaluation can be performed using templates, see
Manage Templates on page 26.
Applying Templates
Once you have defined a template, you can apply it to an image or a plan. If you
apply a template to a plan or session, the template is applied to all portal dose images
of the selected plan or session.
72
Applying Templates to an Image

To apply a defined template to an image:
1. Select in Navigation Panel a portal dose image.
Portal dose images are marked with the icon .
2. Right-click the image.
3. Choose Apply Template > (Your Template).
The template will be applied and a new analysis is created. This analysis is
displayed in the Navigation Panel.
4. Click the analysis and choose the Evaluation tab in the Task Panel.
Applying Templates to Latest Session of a Selectable Plan

To apply template to latest session of selectable plan:
1. Choose All plans in plan drop-down list on navigation panel.
2. Right-click the required plan.
3. Choose Apply Template to Plan and select the template you want to apply from
the submenu.
Note: The template is only applied to the portal dose images from the most recent session.
Applying Templates to a Selectable Session of a Plan

To apply template to a selectable session of a plan:
1. Click Session tab in navigation panel.
2. Right-click the required session.
3. Choose Apply Template to Session and select the template you want to apply
from the submenu.
Applying Templates to Latest Session of Multiple Plans

To apply template to latest session of multiple plans:
1. Select in the Navigation Panel a portal dose image.
Portal dose images are marked with the icon .
2. Choose Edit > Apply Template.
3. Select the plans and images, you want to apply the template.
73
4. Select the template in the Template drop-down list.

The Summary of Portal Dose Image Analyses dialog box opens. In this dialog
box, you can see the result of application or potential errors messages. Created
analyses are attached automatically to the portal dose images and are shown in
the task panel, see Dose Evaluation on page 72.
5. Click Print Report if required.
Assigning Templates to a Plan

By assigning a template to a plan the assigned template will be used as default
template for all portal dose images in this plan.
Note: The template is assigned permanently to a plan and overrules the defined global default
template for images assigned to this plan, see Assigning Templates to a Plan on page 74.
To assign a template to a plan:

1.
2.
3.
4.
5.
Choose Analysis > Manage Templates.

Choose the template from the drop down list.
Click Edit.
Choose the plan you want to assign the template and click OK.
Click Save & Close.
The template is assigned permanently to the plan.
Perform Analyses
Using the Evaluation tab in the task panel, you can perform dose analysis of the
predicted dose image and the portal dose image. Before performing evaluation you
can make several settings and configurations.
Figure 21 Dose Evaluation Tab in Task Panel
74
Note: On R-arm systems, alignment must be done before evaluation can be performed, see
Image Alignment on page 69.
Setting the ROI

To set the ROI:
In the task panel, select your required options button:
Choose None if you do not want to consider a ROI. The whole image is taken.
Using User defined you can set the size of the ROI rectangle in the blended
view. The ROI rectangle is shown as a red frame, you can pan or resize it with
the mouse button. Click the frame borders and hold mouse button to pan.
Click the small rectangles in corners and hold mouse button to resize.
Using Field + x cm you enlarge the ROI to x cm around the field. The cm value
can be changed by clicking and entering a new numeric value. Field + x cm
and MLC CIAO + x cm use the same text box.
Using MLC CIAO + x cm you enlarge the (normally non-rectangular) ROI to x
cm around the MLC CIAO. The cm value can be changed by clicking and
entering a new numeric value.
Defining Threshold
Only those pixels are used for the analysis, which lie above a certain threshold value
of the predicted dose and of course lie within the ROI. The threshold value is a
fraction of the maximal predicted dose (outliers are excluded by cutting off the
largest 0.1% values). This fraction can be entered in the threshold edit box, left of the
Perform Analysis button. If activated, the threshold is visible as a red contour in the
dose difference image and the gamma image. When a ROI and a threshold are
defined, only pixels in the ROI and having dose values above the given threshold
value are taken into account for evaluation.
To define threshold:
1. Select the Threshold check box in Set ROI group, see Setting the ROI on page 75.
2. Enter the percentage value of the threshold.
75
Setting Options
Using this button, you can enter the evaluation pass or fail criteria for the analysis
and you can determine the Gamma Evaluation mode. This criteria is also part of the
Portal Dosimetry template and changes done on the Dose Evaluation Options
window only apply to the current transient analysis. For explanation of these values,
see Defining Templates on page 27. When persistent changes are required, the
template must be edited, see Manage Templates on page 26.
To set the options:
1. Click Options.
2. Enter or edit values and click OK.
Performing Analysis
Portal Dosimetry compares doses of the predicted dose image and the portal dose
image.
Note: The analysis is based on the values, you entered in the Dose Evaluation Options
window. See Setting Options on page 76.
To perform analysis:
Click Perform Analysis.
The report of the analysis is shown in the Task Panel. Portal Dosimetry compares
the test values with the defined tolerance values. The report is evaluated, see table
below.
Note: If the images are not aligned, a message box opens. Click OK and align the images, see
Image Alignment on page 69.
Table 29
76
Analysis Report
Result
Description
Green Tests
The evaluated value is within tolerance (passed).
Red Tests
The evaluated value is out of the tolerance (failed).
Black Tests
The test was not set in the options menu. Tests which are not set
are still performed and return a test value but are not checked
against a tolerance and therefore have no passed or failed result.
Result
Description
The analysis has passed. All values are within tolerance.
The analysis has failed. One or more values are outside the tolerance.
CAUTION: Passing or failing dose evaluation tests does not necessarily mean that the
patient can be treated or cannot be treated. The decision to treat or not treat the
patient is a clinical decision to be performed by the human user, using this Portal Dose
evaluation only as a tool to inform that decision.
All analyses will be saved in the plan and listed in the Navigation Panel. If you
click Perform Analysis, a new analysis will be created each time. It is not possible
to change an existing analysis. With a right-click on an analysis in the Navigation
Panel you can:
Delete the analysis (also possible: Del key)
Note: If the associated image has been approved, deleting the analysis is not possible.
Export the values to a text file

Edit a comment
Review analysis
Primary Analyses
You can define one of the analyses for each field done as a primary analysis. The
primary analysis is used in the plan overview mode and in the plan summary
printout. If you navigate through analyses with the navigation arrows
Dosimetry will switch to the primary analysis automatically.
, Portal
To set a primary analysis:

1. Right-click the desired analysis.
2. Choose Set as Primary Analysis from the context menu.
The analysis is marked as primary analysis with .
Tip: Further you can set primary analyses in the Status Change Confirmation window, see
Changing the Image Status on page 81.
77
Dose Constancy Check

An automated dose constancy check compares a measured Portal Dose image to
another measured Portal Dose image previously identified as a baseline image. The
workflow of a dose constancy check is identical to the workflow of a normal dose
analysis against the predicted dose with the difference that the comparison is against
the baseline image.
This constancy check may be used for the following:
Constancy check of a typical pre-treatment measured dose image, where the user
takes another measured dose image, without patient or phantom, at a later date.
Constancy check of a machine QA image, such as a beam output measurement, as
a means of determining the constancy of accelerator performance. As an example,
this process may be used to satisfy the Daily Beam Constancy Test defined in
AAPM Task Group 142.
Constancy check of a patient treatment exit dose image.
Tip: Constancy checks do not require a Portal Dose Prediction image, and so they can be used to
evaluate non-IMRT fields. See Verification Plans without Predicted Doses on page 98.
Defining Constancy Check Baseline Images

To define portal dose images of the current session as baseline images for dose
constancy check:
1. Choose Analysis > Define Constancy Check Baseline Image.
2. Images must be aligned before they can be used as baseline images. Click Auto
Align.
3. In the dialog Auto Align Baseline Images, select the fields and click Auto Align.
4. Go back to the dialog Define Baseline Images for Constancy Check and select
the fields to define the baseline image for.
5. Click OK.
Baseline images are marked with a dot in the icon on the navigation panel:
Note: Alternatively a portal dose image can be set or unset as baseline image using the
context menu of the portal dose image in the navigation panel.
78
Perform Constancy Checks Using a Template

Preconditions:
A dose constancy check template is defined, see Defining Templates on page 27.
A constancy check baseline image is defined, see Defining Constancy Check
Baseline Images on page 78.
1. Choose Analysis > Perform Constancy Check.
The latest portal dose image for each field of the current session and plan is
shown.
2. Select the portal dose images to perform the dose constancy check.
3. Select the dose constancy check template to apply.
4. Confirm with OK to perform the dose constancy check for the selected images.
A summary dialog showing the results of the constancy checks is displayed.
5. Do one of the following:
a. To print a report of the constancy checks, click Print Report.
b. To cancel all constancy checks done, click Cancel & Delete Analyses.
c. To keep the constancy checks, click Close.
Perform Constancy Checks Using Manual Analysis

To perform a dose constancy check using manual analysis:
1. From the context menu of a portal dose image in the navigation panel, choose
Perform Constancy Check > Manual Analysis.
2. In the task panel, click Options.
3. Edit the parameters and choose the tests to be performed.
4. Click OK.
5. Optionally, you can change the ROI and threshold settings, or the normalization
settings.
6. Click Perform Check.
Display Constancy Trend Chart

To display the constancy trend chart:
1. Choose Analysis > Constancy Trend.
2. Select the field and test to display the trend chart for.
79
3. If desired, use the context menu to:

Save the chart as a bitmap image.
Copy the chart as a image to the clipboard.
Export the chart data to a tab delimited text file.
Image Approval
Portal dose images have a status that uniquely identifies their position during the RT
process, which can be used to manage the clinical workflow. The status icons are
displayed in the images in the image view panel.
Note: You can only change the status of portal dose images.
Table 30
Icon
Image Status
Status
Description
New
The image has recently been acquired. The image has

not been reviewed in Portal Dosimetry.
Reviewed
The image has been reviewed in Portal Dosimetry but

has not yet been approved.
Approved
The image has been accepted and approved. This implies that no Change Request or other action is required based on this image.
Note: Depending on the clinical process defined, it may be required to set all images to
status Approved at the end of the review
process.
Note: If modifications are required, you can
reset the image status from Approved to
Reviewed.
Action required
80
A qualified user has decided that some action must be

taken based on the Portal Dosimetry analysis of this
image.
Icon
Status
Description
Disposed
A qualified user has decided that the image requires no

action and does not wish to display the image in Portal
Dosimetry.
Note: Choose Portal Dosimetry > Show
Disposed Images to display the image
within Portal Dosimetry. The status of a
Disposed Image can be changed back to Reviewed; then you can edit this image again.
Note: Images with a status of approved or
change request and composite images
cannot be changed to Disposed.
Note: Images are temporarily locked (write protected in the database) during the conversion of
the database. The images remain visible in the original image status but editing is not possible.
Checking the Image Status

In Portal Dose images the appropriate image status is shown at the right bottom
corner. If not, the overlay information is not shown. To show overlay information, see
Show/Hide Structures on page 63.
Changing the Image Status

To change the image status:
Note: Composite images derive its status from the status of the source images. Changing the
status of a composite image will change the status of all source images.
1. Click the required image.

2. Choose Portal Dosimetry > Set Image Status to, or use the icons in the Image
Approval area, see Image Approval on page 18.
3. In the pop-up window, select the image you want to change.
4. If desired, you can set Mark last analysis as primary to automatically define the
most recent analysis of each field as the primary analysis.
5. If auto-approval is not enabled, enter your user name and password.
6. Confirm with OK.
81
Disposing Images
To dispose an image:
1. Select the image.
2. Choose Portal Dosimetry > Dispose Image, or press Ctrl+D.
3. Enter your password in the confirm window and click Yes.
Showing Disposed Images

Note: Disposed images cannot be modified. The only action that can be done is setting them to
status Reviewed.
To show a disposed image:

Choose Portal Dosimetry > Show Disposed Images.
82
Patient Alert
Note: Patient Alerts only work in a Varian fully integrated environment with ARIA and
Eclipse.
A change request always results in a patient alert. However, the reviewer can use
patient alerts to communicate important information to the other radiotherapy
personnel without creating a change request. The patient alert must be
acknowledged by the user at the time of treatment.
The Patient Alert button indicates the status of the existing patient alerts. You can
show existing patient alerts of the current patient using the Patient Alerts dialog box.
Patient alerts are either created implicitly when creating a Change Request, see
Creating a New Patient Alert on page 84, or explicitly using the New Patient Alert
dialog box, see Creating a New Patient Alert on page 84.
Finally, you cannot edit but you can error out your own patient alerts not yet signed
off, see Delete a Patient Alert on page 86.
Table 31
Icon
Patient Alert Buttons
Button
Description
No Patient Alerts Available
No patient alert exists for the current patient.
Open Patient Alerts Available At least one patient alert is still open.
All Patient Alerts Signed Off
All existing patient alerts are signed off

(status 'read').
To show an existing patient alert:

1.
Choose Portal Dosimetry > Show Patient Alerts, or click the icon:
The Patient Alerts dialog box opens displaying all available patient alerts of the
current patient in chronological order, showing the latest patient alert first.
Change Request patient alerts are also displayed.
2. Double-click the required patient alert row.
83
Creating a New Patient Alert

You can create a new patient alert but you cannot edit any of the existing patient
alerts. But if required, you can error out your own patient alerts, see Delete a Patient
Alert on page 86.
To create a new patient alert:
1. Choose Portal Dosimetry > New Patient Alert, or click New Patient Alert in the
Patient Alerts dialog box.
The New Patient Alert dialog box opens. Patient name and patient ID are filled
by default and read-only.
If you use a Duet system it is detected automatically and a message will be
displayed to inform you about the following:
Caution: In Duet systems, the entered text will not appear
at treatment.
84
Note: Duet is a connection to a file server that allows clinics with mixed vendor
environments to use the following Varian image review applications, Offline Review,
Portal Dosimetry, and Image Browser. Duet allows plan information (that is, the
information required to deliver the treatment) residing on the third-party oncology
information system to be shared with the Varian image review applications.
1
2
3
5
6
7
8
1. Patient name and ID
2. Predefined alerts list box
3. Define/Edit Alerts button
4. Patient Alert text box
5. Drop-down arrow
6. Arrow button to select next month
7. OK and Cancel button
8. Calendar, a day is selected and todays date is shown
Figure 22
New Patient Alert Dialog Box Displaying the Calendar
2. From the Predefined alerts list box, select one of the predefined patient alerts.
3. To create a new, edit or error out a predefined patient alert text, click the Define/
Edit alerts button.
4. In the Edit/Define Predefined Patient Alerts dialog box, configure the required
predefined patient alerts.
The predefined patient alert is saved for the current user.
Note: Predefined patient alerts are only user-specific. They are not available system-wide.
5. Insert the required Patient Alert text and click Save and Close.
85
6. To select the date when the alert should be displayed on the 4D Treatment
Console application: In the Display Date drop-down list, click the drop-down
arrow.
Display date means that the patient alert is displayed the next time the patient
record is opened on the 4D Treatment Console on or after the date entered here.
For example, if the display date is set to July 11th, 2008, the patient alert will be
displayed when the patient is opened on July 11th and later.
The calendar pops up; today's date is selected by default.
7. Select the required display date from the calendar. If required use the Arrow
buttons to select the next month.
8. Confirm with OK.
The new patient alert is created and the dialog box is closed. The radiotherapy
personnel have to confirm that the patient alert has been read by typing the user
ID and the password. This action is called signing off the patient alert.
Delete a Patient Alert

It is only possible to edit your own patient alerts, after you have marked the existing
patient alert as an error. Then you can create a new one instead.
To delete a patient alert:
1.
Choose Portal Dosimetry > Show Patient Alerts, or click the icon:
The Patient Alerts dialog box opens displaying all available patient alerts of the
current patient in chronological order, showing the latest patient alert first.
Change Request patient alerts are also displayed. The Error Alert button is
unavailable.
2. Select one of your own patient alerts (your name is shown in the Created by
column) by clicking the line. Now, the Error Alert button is available.
3. Click Error Alert.
4. Confirm the Message box asking: Do you really want to delete the
patient alert?
If you have saved the data in the meantime (between the creation and deletion of
the change request) the change request remains in the list (stroke out and in gray
color) of patient alerts. If required, you can create a new patient alert instead.
86
Appendix A GUI References

The following table identifies all entries in the menu bar and additionally, the icons
and buttons found on the toolbar.
Table 32
Menu
Entry/Icon
Description
Open Patient
To select and load the patient(s) you want to

review from the Patient Explorer , see
Loading a Patient on page 35.
File
Reload Patient
To reload load the current patient from database.
Close Patient
To close the current patient.
Save Patient
To save the current patient data to the connected database.
Print
Displays the Windows Print dialog box. For

more information, see Printing Images and
Reports on page 36.
Exit
To exit the application.
Delete
To delete an analysis or a portal dose image.
Undo
To undo the last steps in the application history.
Redo
To redo the steps in the application history.
Edit
View
Window / Level
Auto Window/ Level
Appendix A
GUI References
To adjust the brightness and contrast of the

active image. You can use the scroll arrows of
the Window/Level slide bar at the right side
of the image.
To adjust the brightness and contrast of the
active image automatically.
87
Menu
Entry/Icon
Description
Invert Background
To change background from black to white.
Zoom In
To zoom into the image by dragging a rectangle.

Note: You can also use the mouse
wheel (forward rotation). Excep
tion: In CT images the mouse
wheel scrolls through the CT
slices/planes. Use Ctrl + mouse
wheel in this case.
Zoom Out
To zoom out of an image step-by-step.

Note: You can also use the mouse
wheel (backward rotation).
Pan
Reset View
View Layout >
View Layout >
View Layout >
View Layout >
Hide Bottom Panel
Digital Graticule
88
To pan the selected image.

To reset a temporary modification of the images (for example zoom or pan).
To select the 2 Views layout.
To select the Plan Overview layout.
To hide task panel, patient alert and image
approval.
To display/hide the digital graticule.
Menu
Entry/Icon
Description
Show Structures
To show/hide and select structures and overlays (Structures and Overlays floating
window).
Click the Drop-down Arrow and choose
the required structure/overlay from the
Structures and Overlays dropdown dialog box.
You can drag the Structures and Overlays
window in the image window to a location where you want.
Click Close. See Show/Hide Structures on
page 63.
Insert
Free hand
Rectangle
Ellipse
Point
Image Annotation
To draw a free-hand contour.

To draw a rectangle contour.
To draw an ellipse contour.
To draw a point.
To add an image annotation at a specific location in the image.
Measure
Point Dose
Profile
Histogram
To measure the dose of the set pointer.

Displays the Line Profile window.
Displays the Area Histogram dialog box.
Distance
To measure the distance between any two

points in an image to within 1/10 mm.
Angle
To measure the angle between any three

points in an image to within 1/10 degrees.
Properties
To show all treatment information of the patient.
Previous Image
To show previous image.
Portal Dosimetry
Appendix A
GUI References
89
Menu
Entry/Icon
Description
Next Image
To show next image.
Set image status to

Reviewed
To change status to Reviewed.
Set image status to

Action Required
To change status to Action Required.
Set image status to

Approved
To change status to Approved.
Dispose Image
To dispose of images.
Note: To dispose of images, the
image status must be valid.
Show Disposed Im
ages
To show disposed images.
Show Patient Alerts
To show patient alerts.
New Patient Alert
To set a new patient alert.
Apply Template
Define Constancy
Check Baseline Im
ages
To define constancy check baseline images for

multiple fields.
Perform Constancy
Check
To perform constancy checks on multiple images.
Constancy Trend
To show constancy check trend charts.
Manage Templates
To open the manage template window.
Options
To open the Options window.
Isodose Level Editor
To open the isodose level template editor.
Analysis
Tools
Leaf Motion Overlay To open the leaf motion overlay player.

Gamma/Dose Differ- To open the gamma/dose difference height
ence Height Field
field function.
Mask Patient Name
90
To hide patient name in title bar.
Menu
Entry/Icon
Description
Script Wizard
To create a new script.
Script
To run an existing script and to manage favorite scripts.
Output Factor Tool
To open the output factor tool window.
Content
To display online help.
Index
To search for a topic in online help.
Scripting API Docu

mentation
To display online help for the scripting API.
About
To display information about version and

manufacturer. (Windows) System Info can
also be shown.
Help
Additional Toolbar Icons

Show Field Outline
Select Contours
Redraw Contours
Modify Contour
To display field outline of images.

To select, move, rotate, or resize contours.
To redraw or cut a contour part.
To modify contour points.
Points
Properties Dialog Box

This table comprises the following logical and functional components in the Image
tab:
Table 33 Properties Dialog Box, Image Tab: Components
Component name
Description
ID group
This is the unique identifier for this image.
General group
Modality
Appendix A
GUI References
Displays modality.
91
Component name
Description
Patient Position
Displays position of patient.
Type
Displays the type of the image, for example

DRR (for digitally reconstructed radiograph)
or PORTAL (for a portal image).
Usage Type
Displays usage of image.
Source Rtn
Displays the Beam source rotation in degrees.
Source Pitch
Displays the pitch in degrees.
Coll Rtn
Displays the rotation of the collimator in degrees.
Energy
Displays the energy of the beam (in MV) used

for acquiring this image.
SID
Source-to-Imager-Distance.
SAD
Source-to-Axis-Distance.
Couch Rtn
Displays the rotational position of the Couch

during image acquisition in degrees.
Couch Vrt
Displays the vertical position (height) of the

Couch during image acquisition in cm.
Couch Lng
Displays the longitudinal position of the

couch during image acquisition in cm.
Couch Lat
Displays the lateral position of the couch

during image acquisition in cm.
Couch Pitch
Displays the pitch of the Couch during image

acquisition in cm.
Couch Roll
Displays the roll of the Couch during image

acquisition in degrees.
IDU Lng
Imager position longitudinal.1
IDU Lat
Imager position lateral.1
Setup group
92
For imager positions to be displayed during treatment, all imager positions must be entered. Default
values shall be specified in the machines operating limits under RT Administration.
Component name
Description
IDU Rtn
Imager rotation.1
(IDU Lat, IDU Lng) = (0, 0) means that the
isocenter on the imager and the center of the
imager are on top of each other.
Status group
Status
Displays the Image status. - For treatment images, the status Reviewed is set by default. For reference images, you can set the status in
the list box. Select New, Reviewed or Ap
proved.
Date
Displays the date of status change.
User
Displays which user performed the status

change.
Last Modification group

Last modification |
Date
Displays the date on which the last changes

were made to this image.
Last modification |
User
Displays which user performed the last

changes.
Last modification |
Task
Displays in which Varian application the

changes were performed.
Close
Closes this dialog box.
The following table comprises the following logical and functional components in the
Image Annotations tab of the Properties dialog box:
Table 34
Properties Dialog Box, Image Annotations Tab: Components
Component Name
Description
Existing Image Remarks
Displays remarks added to the image using the New Image

Remark field. Note that this field does not display annotations added using the Image Annotation command.
New Image Remark
Offers image remarks to be added to the field. Existing Image

Remarks which are applied using the Apply command
button.
Image Description
Displays the Image description which can be displayed in

the image.
Image Comment
Offers comments to be added to the image.
Appendix A
GUI References
93
Component Name
Description
Apply
Adds the remark entered in the New Image Remark field to

the Existing Image Remark field.
Close
Closes this dialog box.
Field Setup tab of the Properties dialog box:
Table 35
Properties Dialog Box, Field Setup Tab: Components
Component Name
Description
ID group
This is the unique identifier for this field.
Field Setup group
Lists the field setup values: IDU, and Jaw (similar to Table 33Properties Dialog Box, Image Tab: Components on page 91 ).
Couch group
Displays the couch position and Delta Couch Shift.
Machine group
Displays the Machine ID and Scale.
Plan Setup tab of the Properties dialog box:
Table 36
Properties Dialog Box, Plan Setup Tab: Components
Component Name
Description
ID group
This is the unique identifier for this plan.
General group
Displays the Field name and Treatment Orientation.
Comment group
Displays the comment.
Status group
Displays Status, Date and User Name.
Displays Date, Task and User Name.
Course tab of the Properties dialog box:
94
Table 37
Properties Dialog Box, Course Tab: Components
Component Name
Description
ID group
This is the unique identifier for this treatment course.
Status group
Displays the status of the treatment course. The status can

also be changed here.
Patient tab of the Properties dialog box:
Table 38
Properties Dialog Box, Patients Tab: Components
Component Name
Description
ID group
This is the unique identifier for this Patient.
ID2 group
This is a second identifier for this Patient with Last Name,

First Name and Birth Date.
General group
Displays patient name and birth date.
Assigned Doctors group
Lists doctors (oncologist) assigned to the patient with Primary

doctor.
Volume Image tab of the Properties dialog box. This tab is only available for
volumetric CBCT images:
Table 39
Properties Dialog Box, Tech Tab: Components
Component Name
Description
ID group
This is the unique identifier for this CBCT image.
Geometry group
Appendix A
Size X
Displays the amount of pixels in the image width, for

instance 512.
Size Y
Displays the amount of pixels in the image height, for

instance 384.
Resolution X
Displays the resolution in the image width in cm.
Resolution Y
Displays the resolution in the image height in cm.
Isocenter X
Displays the width of Isocenter in cm.
GUI References
95
Component Name
Description
Isocenter Y
Displays the height of Isocenter in cm.
Isocenter Z
Displays the depth of Isocenter in cm.
Position X
X-position of read-out image within imager, relative to

center of imager.
Position Y
Y-position of read-out image within imager, relative to

center of imager.
File Name
Displays the file name.
File group
DICOM UID group

Image
ID of image.
Series
ID of the series.
Study
ID of study.
FOR
ID of FOR.
Database serial number group

Image
96
Database serial number of the Image.
Appendix B Machine QA Portal Dosimetry

Comparison to Reference Images
For certain QA tasks it may be appropriate to establish a portal dose image as a
reference (or baseline) image, and to compare future images back to that reference.
By performing a dose constancy check, you can compare a portal dose image against
a baseline image defined for the beam. See Dose Constancy Check on page 78.
Using Portal Dosimetry you can also compare a portal dose image to any other portal
dose image in any plan or to any other predicted dose image and create an analysis
of compared images, see Comparing Dose Images on page 40. Such an analysis is
named Comparison instead of Analysis in the left panel.
To compare dose images:
1. Right-click a portal dose image in the navigation panel.
2. From the context menu, choose Compare to and select the required image from
the submenu.
General Tools
Rather the typical use of Portal Dosimetry for comparison of images by Dose
Difference or Gamma Evaluation, many machine QA tasks require measurements of
dose or geometry on individual images. See Using Measuring Tools on page 56 for a
description of tools to:
Measure Point Dose
Measure Distance
Measure Angle
Measure Line Profiles
Measure Area Histogram
Appendix B
Machine QA Portal Dosimetry
97
Overlaying Multiple Images

Note: Overlay of multiple images is only available for predicted dose images and only when at
least one portal dose image exists.
To study a sequence of images, you can overlay the isolines of all portal dose images
of a field with the predicted dose image.
Note: This overlay function provides only the ability to view the overlaid isodoses. No
measurement tools are available for the overlay of multiple images.
To overlay multiple portal dose images:

1. Right-click the predicted dose image in the Navigation Panel.
2. From the context menu, choose Overlay Doses.
3. In the Overlay Doses window, select the portal dose image check boxes to add or
remove images from the overlay.
Verification Plans without Predicted Doses

For certain machine QA purposes, such as RapidArc (see also References on
page 102), or static fields, the creation of a verification plan through the typical
Eclipse verification plan process, which includes the creation of Predicted Dose
Images, is either not possible or not necessary.
This procedure creates a deliverable verification plan that will acquire Integrated
Images for each field. Continue by scheduling the new verification plan for
treatment, treating the plan to acquire images, and analyzing those images in Portal
Dosimetry.
To create a verification plan without the Predicted Dose Image:
1. Start the Eclipse application.
For detailed information refer to Eclipse Photon and Electron Algorithms Reference
Guide.
2. In Eclipse create a treatment plan for any QA test patient, being sure to include
all data necessary to calculate the plan (Structure Set, Geometry, Fluence, MLC,
etc.).
Note: The Structure Set merely enables the test plan creation. It is not used for the dose
distribution calculation. Therefore, any available Structure Set (patient or phantom) can be
used for the test plan creation.
98
3. Choose Dose Prescription tab in the info window and define dose prescription
for configuration plan.
Note: Be certain to create a dose prescription, including number of fractions that permits all
planned QA sessions, including an appropriate allowance for repeat testing.
4. Calculate dose distribution by selecting the appropriate Leaf Motion Calculator.

CAUTION: The Dosimetric Leaf Gap and MLC Leaf Transmission parameters significantly
affect the value calculated by the LMC. Make sure that these parameters have the
correct values if the plan is to be used for dosimetry purposes.
Note:
Dose distribution is calculated only to display the monitor units calculated by the leaf
motion calculator. The spatial dose distribution itself does not play a role. Therefore,
single plane calculation is sufficient.
If predefined number of monitor units is required use 'Calculation with preset values'.
When using calculation with preset values for IMRT sliding window plans make sure
that the Leaf Motions are adjusted if the required monitor units are very (5%) different
than the originally calculated MUs.
5. Click Save All.

6. Choose Quicklinks > EMR > Plan Parameters.
Note: The Plan Parameters functionality is only available within ARIA.
7. In the Parameters workspace, right-click on the plan and choose Copy Plan in the
context menu.
8. Right-click on the course and choose Paste > Plan as Verification Plan, see
Figure 23Pasting a Plan as Verification Plan in Plan Parameters on page 99.
1
1. Menu entry Plan as Verification Plan
Figure 23
Pasting a Plan as Verification Plan in Plan Parameters
9. Define Plan ID and click OK to continue.
Appendix B
99
10. If you no longer need the initial treatment plan, right-click on that plan and
choose Delete, see Figure 24Deleting a Plan in Plan Parameters on page 100.
1
1. Menu entry Delete
Figure 24
Deleting a Plan in Plan Parameters
11. For each field be sure to define the appropriate Treatment Time, Tolerance table,
SSD, Couch and Imager positions, see Figure 25Entering of Field Parameters in
Plan Parameters (Example) on page 100 for an example of parameters.
1. Treatment parameters
2. Couch and images position
Figure 25
100
Entering of Field Parameters in Plan Parameters (Example)
12. Planning and approving the plan, right-click on plan and choose Plan
Approval > Planning Approved, acknowledge the warning list and authorize
plan approval.
13. Choose the Scheduling tab.
14. Switch to Treatment Preparation > Plan Scheduling.
15. Click
on the verification plan.
16. Expand Plan in timeline.
Figure 26
Expanding Plan
17. Select all the active sessions of the verification plan.

18. Click Add Imaging menu and select Integrated Image.
Figure 27
Adding Integrated Image
19. Switch to Treatment Preparation > Treatment Setup.
Appendix B
101
20. Insert Username and Password and click Approve Plan.

Note: Treatment Approval is not required when using QA Mode to acquire the Portal Dose
images.
Use of Imaging Phantoms

CAUTION: Excess weight placed on the EPID imager cover may damage the imager. Use
caution when placing imaging phantoms on the EPID cover, and never place imaging
phantoms on the imager without the imager cover in place.
Some QA tasks may require the use of an imaging phantom to delineate isocenter,
light field edges, etc.
Follow these guidelines when placing an imaging phantom directly on the imager:
Never use an image phantom that exceeds a weight of 1 kg.
Use a phantom only with the gantry at 0 IEC and the imager flat and level.
Always rest the phantom gently on the imager.
Never attempt to affix the phantom to the imager.
Never attempt to move the imager or rotate the gantry with a phantom on the
imager.
Never place an imaging phantom that is motorized or otherwise electrified (such
as for motion studies) directly on the imager.
References
For more information about Machine QA, refer to:
Ling et al., Commissioning and Quality Assurance of RapidArc Radiotherapy
Delivery System, Int. J. Radiation Oncology Biol. Phys., Vol. 72, No. 2, pp. 575-581,
2008
RapidArc Commissioning, Varian Medical Systems, Rev. 1.0.0, 2008.
102
Appendix C Gamma Evaluation

Principle of Gamma Evaluation
Graphically the principle of the gamma evaluation can be illustrated by Figure 28
Gamma Evaluation Principle on page 104, which shows the profiles of a predicted
dose together with its measured dose.
Around 4 point of the measured dose a virtual circle is drawn with radius 1. In
spatial direction (abscissa) this is 3 mm, in dose direction (ordinate) 3% of the
maximum of the predicted dose after cutting off a certain percentage of outliers
(short: near maximum). These two values are configurable. Instead of using a global
dose reference value (from which 3% is taken as dose tolerance value), it is also
possible to use a local dose reference value (from which again 3% is taken as dose
tolerance value). The local value is the predicted dose at the currently evaluated
pixel. Because of the fact, that at low doses predicted and measured values may not
match well, it is necessary to set a lower threshold for local dose reference. This is
given as ratio of the near maximum value of the predicted dose.
The collection of tolerance circles forms a kind of a tube around the measured dose
profile. The gamma value is now defined to be smaller than 1 in the areas, where the
predicted dose is within the tube and larger if it is outside the tube.
Appendix C
Gamma Evaluation
103
1. Predicted Dose.
2. Measured Dose.
3. Area with Gamma > 1.
Figure 28
Gamma Evaluation Principle
Calculation of Gamma Evaluation

The algorithm to calculate the gamma evaluation is doing:
Both dose images are scaled to have a unit of 3% of the near maximal value of the
predicted dose (global) or local value of the predicted dose. To prevent outliers
from wrongly weighting the result, not the actual maximum, but the highest value
after clipping 0.1% off the high valued end of the histogram is taken.
Note: The clipping values presented here as 0.1% are configurable using the Options
dialog box, Misc Settings tab, see Configuring Portal Dosimetry on page 23.
After scaling, the difference (scaled measured scaled predicted) is calculated.

This preliminary gamma image now contains gamma in only the dose (not
spatial) dimension. Now the system tries to optimize the gamma value for each
pixel.
The surrounding region around the pixel is scanned on the outlines of squares
(shells) with increasing size. The pixels lying on the outline of the current square
are scanned non-sequentially starting from the pixels nearest to the center
towards the four edges.
104
Essentially for each set of eight pixels on the square outline with the same
distance from the center the pixel with the smallest dose difference (from the
center pixel) is searched. The gamma value of the center pixel is then updated
with the formula
(d = distance; D = doseDifference) of course only, if this value is smaller (better)
than the current one.
Before starting the search within each new set of eight pixels, the best possible
gamma value for this set (with doseDifference = 0), which is the same as the
current distance from the center is compared with the current gamma value. If
this best possible gamma is larger (worse) than the current value, we move
forward to the next square.
If the first set of investigated pixels on this square (nearest to the center) also have
a best possible gamma value, which is larger than the current, the gamma search
for the current pixel is finished and the search procedure is started for the next
pixel until for all the pixels the optimal gamma value has been found.
In order to prevent excessive long calculation times in the case of very bad
agreement between measured and predicted doses, the initial gamma image
(scaled measured scaled predicted) is saturated to a maximal value of 10, so the
algorithm will never search farther than 10xDTA mm around each pixel, where
DTA is the Distance to Agreement set by the user.
This algorithm takes more time for execution if the two images badly agree,
because the initial gamma image (scaled measured scaled predicted) contains
large values, which lead to searching large distances around each pixel.
Improved Gamma Algorithm

The original algorithm used to calculate the gamma evaluation searches for the best
gamma value only at the integer pixel positions around the given source pixel. This
sampling limitation may result in an overestimation of the gamma value at that
point, as shown in Figure 29Gamma Calculation on page 106. The algorithm is
explained in one dimension for simplicity, but is implemented in two dimensions for
Portal Dosimetry.
Appendix C
Gamma Evaluation
105
P2
M1
P0
Figure 29
P1
Gamma Calculation
For the grey middle pixel M1, the original algorithm only considers the black
neighbor pixels, (P0, P1, P2) resulting in 0, 1 and 2 values. These values are large
compared to the improved gamma value .
To overcome this limitation, an improved Gamma calculation algorithm has been
developed. It is based on the neighbor search algorithm as described in Calculation
of Gamma Evaluation (refer to Figure 30Geometrical Calculation of Best Gamma
on page 107 for an illustration), with an extension to interpolate between
neighboring predicted points.
The improved algorithm calculates the distance of Mn to the line (Pm, Pn) and not to
the line (Pm, Pm-1). This is more conservative because it tends to overestimate the
gamma; it may potentially provide a false fail result under some circumstances.
The alternative, which is not implemented, of a linear interpolation between Pm and
Pm-1 risks underestimating gamma, which may lead to a false pass result.
Furthermore, in two dimensions, there is no clearly defined point Pm-1.
CAUTION: Any failed result should be carefully evaluated to understand the cause.
106
This algorithm has an upper bound for the underestimation or overestimation of

gamma which is the distance of two predicted pixels (pdx). The typical error is much
smaller than this upper bound.
Pm
Mn
Pm-1
Pn
Pn
pdx
sd
(0/0)
Figure 30
Appendix C
Gamma Evaluation
Geometrical Calculation of Best Gamma
107
Table 40
Abbreviations in Figure Above
Abbreviation
Description
Mn
Acquired pixel at position n.
Pn
Predicted pixel at position n.
Pn'
Point with coordinates [Pm-1(x), Pn(y)].
Pm
Predicted pixel at currently observed shell, at position m.
Pm-1
Predicted pixel at position m-1.
pdx
Distance of two predicted pixels (= pixel size of predicted pixels).
sd
Shell distance, Pm(x) Pn(x).
References
For more information about gamma evaluation, refer to: Low D.A., Harms W.B.,
Mutic S., Purdy J.A. A technique for the quantitative evaluation of dose distributions.
Med. Phys. 25, 656-661, 1998
108
Index
A
abbreviations 9
access Portal Dosimetry user right 15
action required
status icon 80
alert
patient 83
alert, patient 86
align to setup image 70
align, auto 70
align, manual 69
alignment 69
amount of pixels in the image 95
analyses 74
analyses, performing 76
analyses, report 76
analysis, options 76
anatomical structures 63
angle, measure 58
apply, image annotations 67
area histogram, measure 59
ASCII, import 40
B
baseline images 78
beam source rotation 92
blended view 49
buttons 87
C
calendar, patient alert 86
Close Current Patient, menu entry 87
command buttons 87
commands 87
compare images 42, 43
compatibility 13
composite images 41, 66
configure 23
constancy check 78, 79
context menu, analyses 42
context menu, composite images 42
context menu, fields 40
context menu, portal dose images 41
context menu, predicted dose images 41
Index
contour objects, insert 61

contour, editing tools 60
contour, move 62
contour, rotate 62
couch setup
Properties 92
course
tab
Properties 94
course selection 25
Ctrl+Y key 60
Ctrl+Z key 60
customer support 8
D
Database serial number
Properties 96
default template 27
define constancy check baseline image 42
defining templates 27
definitions 9
delete 41
delete patient alert 86
delete user-defined contours 60, 62
depth of isocenter 96
DICOM UID
Properties 96
digital graticule 68
display date 86
display date ,drop-down list 86
display day, patient alert 86
display mode 19
display, image properties 67
displaying
patient alert 83
disposed
image status 81
disposed images, show 82
distance to agreement (DTA) 104
distance, measure 57
dose difference view 50
dose evaluation 72
dose histogram 25
dose images 45
compare 40
select 38
109
types 38
dose images, portal dose 45
dose images, predicted dose 45
dose layouts 44
dose profile 25
dose profile lines 48
dose window/level 47
dose, visualization 45
draw ellipses 60
draw point 60
draw rectangles 60
draw structures 60
Drawing Interchange File Formats (DXF) 40
drawing tools 60
DTA (distance to agreement) 104
DUET 84
E
Eclipse verification plan 97, 98
Edit/Define Predefined Patient Alerts, dialog
box 85
ellipse, draw 60
emailing Varian customer support 8
energy of the beam 92
error out
patient alert 83
export to text file 4143
F
field edge plot, printing 87
field outline 68
Field Setup 94
tab
Properties 94
G
gamma algorithm, improved 105
Gamma Analysis 25
gamma evaluation view 51
gamma evaluation, calculation 104
gamma evaluation, principle 103
gamma evaluation, reference 108
gamma/dose difference height field 56
General values
Properties 91
Geometrical values
Properties 95
graphical user interface, Portal Dosimetry 16
110
graticule, digital 68
H
height of isocenter 96
histogram view 53
I
icon, legend 87
icons 87
icons, list 87
IDU Lng
imager position longitudinal 92
image
remarks 93
image alignment 69
image alignment, auto align 70
image alignment, manual 69
image annotation, apply 67
Image Annotations tab
Properties 93
image approval 18
Image description 93
image information 48
image phantom 102
Image Property dialog box 67
image status 48, 93
change 81
disposed 81
image status,check 81
image tab
properties 91
image, approval 80
image, dispose 82
image, locked 81
image, maximize 67
image, minimize 67
image, pan 67
image, properties 67
image, zoom 67
imager position longitudinal 92
import 40
import, text file 40
improved gamma algorithm 105
improved gamma evaluation 28
insert contour objects 61
isodose level 31
isodose level template editor 30
isodose templates
export 32
import 32
isoline levels 25
isolines 63
L
last modification 93
leaf motion overlay 64
line profile, measure 58
line profile, menu command 58
list, buttons 87
list, icons 87
locked image 81
M
machine configuration 70
machine QA 97
without predicted doses 98
machine QA without predicted doses 97
Machine QA, reference 102
match anatomy 63
maximize, image 67
measure area histogram 59
measure distance 57
measure line profile 58
measure, angle 58
measurements of dose 97
measurements of geometry 97
measuring tools 56
Minimize Difference
normalization method 72
minimize, image 67
misc settings 25
MLC CIAO 75
Modification History dates 93
modify user-defined contours 62
move, contour 62
move, point 62
move, text 62
MyVarian 8
N
navigation panel 20
navigation panel, context menus 40
navigation panel, show and hide 20
new
status icon 80
normalization 71
Index
normalization method
Dose in Isocenter 72
Maximum of Each Dose 72
Maximum of Predicted Dose 72
Minimize Difference 72
Selected Point in Dose 72
O
online customer support 8
Open Patient, button 87
Open Patient, menu entry 87
opening
patient alert 83
ordering product documents by phone 8
Output Factor Tool 33
overlay doses 41
overlay isolines 98
P
pan, button 88
pan, image 67
patient
load 35
patient alert 18, 83, 86
error out 83
viewing 83
patient alert, delete 86
patient alert, new 84
Patient Alerts dialog box 84
Patient tab
Properties 95
patient, close 35
patient, save 35
perform constancy check 42
Plan Setup tab
Properties 94
point dose, measure 57
point, draw 60
point, move 62
portal dose images 45
Portal Dosimetry application, graphical user
interface 16
Portal Dosimetry application, purpose 13
Portal Dosimetry application, user groups 14
Portal Dosimetry, image icons 18
Portal Dosimetry, image view panel 18
Portal Dosimetry, menu bar 17
Portal Dosimetry, select view layout 43
Portal Dosimetry, title bar 17
111
Portal Dosimetry, toolbar 17

Portal Dosimetry, view layouts 44
Predefined alerts list box 85
predefined patient alert, text 85
predicted dose images 45
predicted pixels 105
primary analyses 42, 77
print images and Reports 36
print reports 36
printing 25
printing, field edge plot 87
Profile/Histogramm 25
profiles view 52
Properties
dialog box 91
Properties, dialog box 67
properties, display 67
properties, image 67
Properties, menu command 67
Q
QA tasks 97
R
rectangle, draw 60
related publications 10
Reload Patient, menu entry 87
Reset Geometry, button 88
reviewed
status icon 80
ROI, set 75
rotate, contour 62
rotation of the collimator (Coll Rtn) 92
S
safety and emergency, care required 11
safety and emergency, further regulations 12
safety and emergency, responsibility 11
Save Current Patient, button 87
Save Current Patient, menu entry 87
script wizard 32
scripting API 32
setting options 76
setup 31
Setup values
Properties 92
show structures 60
show/hide structures 89
112
show/hide structures, button 89

showing
patient alert 83
start 22
startup settings 24
status, image 80
Structures and Overlays floating window 89
structures, hide 63
structures, show 63
structures, user-defined 63
support e-mail addresses 8
supporting tools 67
T
task panel 18
technical support 8
templates
export 29
import 29
templates, apply 72
templates, apply to an image 73
templates, apply to latest session of a
selectable plan 73
templates, apply to latest session of multiple
plans 73
templates, apply to selectable session of a plan
73
templates, assign 74
templates, manage 26
text, move 62
threshold, define 75
toolbar 25
U
user administration 15
user groups, Portal Dosimetry application 14
user rights 15
user-defined contours, delete 62
user-defined contours, modify 62
user-defined, structures 63
V
Varian customer support 8
verification plans without predicted doses 98
view layout, select 44
viewing
patient alert 83
views
select 40
views, plan overview mode 45
visibility configuration 19
visual cues 8
Volume Image tab
Properties 95
W
width of isocenter 95
window/level 60
Windows Print, dialog box 87
Z
zoom image 67
Zoom In, button 88
Zoom Out, button 88
Zoom Out, menu command 67
Index
113

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