m3® micro- multileaf collimator - brainlab user guides...1.5.2 brainlab medical software...

M3® MICRO-MULTILEAFCOLLIMATOR

Clinical user GuideRevision 7.6Copyright 2011, Brainlab AG Germany. All rights reserved.

Clinical User Guide Revision 7.6 m3 micro-Multileaf Collimator 3

TABLE OF CONTENTS

TABLE OF CONTENTSGENERAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Contact Data and Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Contact Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Symbols Used in This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Using the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Compatibility with Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Brainlab Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Brainlab Medical Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Non-Brainlab Medical Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Non-Brainlab Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Training and Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

EMERGENCY AND SAFETY INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Safety Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Safety Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Clinical Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Preventive Maintenance and Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Mounting Safety Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

4 Clinical User Guide Revision 7.6 m3 micro-Multileaf Collimator

TABLE OF CONTENTS

Electron Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

INTRODUCTION TO THE m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

About the m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

The m3 System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

m3 Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

m3 ON VARIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

System Setup on Varian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Mounting on a Varian linac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Patient Treatment Using the m3 with a Varian linac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Operational Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Starting the m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Daily Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Software Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Creating m3 Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Using Other Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Creating Data Using Data Entry Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Treating a Patient with a Static m3 Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Treating a Patient with a Dynamic m3 Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Taking Portal Films . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Software Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Mode Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Patient Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Field Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Collimator Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Special Menu (Dynamic Systems Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

View Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Service Mode Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75


TABLE OF CONTENTS

Troubleshooting m3 on Varian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Beam Interlock Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Mounting on 600N/Novalis Dose Delivery System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Jaw Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Novalis Conical Collimator Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

M3 ADVANCED INTEGRATION ON SIEMENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

linac Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Communication Interface Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Mounting m3 on Siemens Artiste/Oncor 160 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Siemens Interface Mount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Torque Wrench . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Mounting the m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Mounting m3 on Siemens Mevatron/Primus/Oncor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Siemens Interface Mount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Torque Wrench . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Mounting the m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Enabling the m3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Starting the m3 System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Daily Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Calibrating the Gantry Angle Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Software Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Brainlab m3 User Interface Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

MLC Shape Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Status Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Physics Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Troubleshooting m3 Advanced Integration on Siemens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Beam Interlock Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142


TABLE OF CONTENTS

Accessories for m3 Advanced Integration on Siemens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

m3 Power Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

m3 Gantry Angle Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

m3 Block Coding Generator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Insulation Transformer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Insulation Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

QUALITY ASSURANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

QA Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

ADDITIONAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

m3 Jaw-Related Interlocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

Situations Where the Interlock is Asserted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

Situations Where Interlock is not Asserted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

VARiS Versus Standalone Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

m3 Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Workstation File Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

m3 Integration Software File Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173


Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Terms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177


1 GENERAL INFORMATION1.1 Chapter Overview

1.1.1 Contents

Topics Covered

Section See

Contact Data and Legal Information Page 8

Symbols Page 10

Intended Use Page 11

Compatibility with Medical Devices Page 13

Training and Documentation Page 17


1.2 Contact Data and Legal Information

1.2.1 Contact Data

Support If you cannot find information you need in this guide, or if you have questions or problems, contact Brainlab support:

Feedback Despite careful review, this manual may contain errors.

Please contact us at [email protected] if you have suggestions as to how we can improve this manual.

Manufacturer Brainlab AG

Kapellenstr. 12

85622 Feldkirchen

Germany

Region Telephone Email

United States and Canada Tel: (800) 597-5911 Fax: (708) 409-1619 [email protected]

Africa, Asia, Australia, Europe

Tel: +49 89 991568-44 Fax: +49 89 991568-811

[email protected] America Tel: +55 11 33 55 33 70 Fax: +55 11 33 55 33 79

Japan Tel: +81-3-3769-6900 Fax: +81-3-3769-6901

France and French-speaking regions Tel: +33-800-67-60-30 [email protected]


1.2.2 Legal Information

Copyright This guide contains proprietary information protected by copyright. No part of this guide may be re-produced or translated without express written permission of Brainlab.

Brainlab Trademarks

• BrainSCAN™ is a trademark of Brainlab AG. • iPlan® is a registered trademark of Brainlab AG in Germany and/or the US.• m3® is a registered trademark of Brainlab AG.

Non-Brainlab Trademarks

• Microsoft® and Windows® are registered trademarks of Microsoft Corporation.• Primus® is a registered trademark of Siemens Medical Systems, Inc.• Mevatron® is a registered trademark of Siemens Medical Systems, Inc.• Saturn® and Clinac® are registered trademarks of Varian Medical Systems, Inc. • Oncor™ and Artiste™ are trademarks of Siemens Medical Solutions USA, Inc.

Integrated 3rd-Party Software

This software is based in part on the work of the Independent JPEG Group.

CE Label

Disposal Instructions

Only dispose of electrical and electronic equipment in accordance with statutory regulations. For in-formation regarding the WEEE (Waste Electrical and Electronic Equipment) directive, visit:

www.brainlab.com/weee

Sales in the US US federal law restricts this device to sale by or on the order of a physician.

Language Information

All Brainlab user guides are originally drafted in English. The corresponding reference number for this manual is 60912-14EN.

• The CE mark shows that Brainlab’s micro-Multileaf Collimator (m3) com-plies with the essential requirements of the Medical Device Directive.

• According to the MDD (Council Directive 93/42/EEC), the micro-Multileaf Collimator (m3) is a Class IIb product.


1.3 Symbols

1.3.1 Symbols Used in This Guide

Warnings

Warnings are indicated by triangular warning symbols. They contain safety-critical in-formation regarding possible injury, death or other serious consequences associated with equipment misuse.

Cautions

Cautions are indicated by circular caution symbols. They contain safety-critical infor-mation regarding possible problems with the device. Such problems include device malfunctions, device failure, damage to device or damage to property.

Notes NOTE: Notes are formatted in italic type and indicate additional useful hints.


1.4 Intended Use

1.4.1 Using the System

Indications for Use The m3 is intended to assist the radiation oncologist in the delivery of radiation to well-defined target volumes while sparing surrounding normal tissue and critical organs from excess radiation. In con-junction with Elekta and GE linacs, the m3 performs the same function as customized shadow blocks or stereotactic collimators. This standard configuration is suitable for static conformal treat-ments and “step and shoot IMRT”.

The advanced m3 Siemens integration feature available for Siemens linacs allows additionally to perform “dynamic arc” and automated “step and shoot IMRT” treatments with the m3.

The advanced Varian integration feature available for Varian linacs allows to perform “dynamic arc” and “dynamic IMRT” treatments with the m3.

Careful Hardware Handling

System components and accessory instrumentation comprise precise mechanical parts. Handle them carefully.

Only trained medical personnel may operate system components and accessory in-strumentation.


Symbols on Hardware Components

Plausibility Review

Before patient treatment, review the plausibility of all information input to and output from the system.

Symbol Explanation

Type B Applied Part according to IEC 60601-1

IEC 60601-1 Class II equipment

Attention! Consult accompanying documents

Refer to instruction manual/booklet

IPX0 The product is classified IPX0 according to IEC 529.

Warning: Crushing hazard (hand)

Serial number of parts: YY-XXX-41600-X; YY specifies the manufacturing year of the device and the last five digits document the Brainlab article number.


1.5 Compatibility with Medical Devices

1.5.1 Brainlab Medical Devices

Compatible Brainlab Medical Devices

Brainlab m3 is compatible with:

Other Brainlab Devices

Additional instrumentation may become available after release of this manual. Contact Brainlab sup-port if you have any questions regarding instrument compatibility with Brainlab software.

Only use devices and spare parts specified by Brainlab with Brainlab m3. Using unau-thorized instruments/spare parts may adversely affect safety and/or effectiveness of the medical device and endanger safety of patient, user and/or environment.

Medical Device Comment

m3 Filmholder

m3 Trolley

Novalis Conical Collimators 600N / Novalis Dose Delivery System only


1.5.2 Brainlab Medical Software

Authorization

Only authorized Brainlab employees may install software on the Brainlab system. Do not install or remove any software applications.

Compatible Brainlab Medical Software


For further information, refer to the BrainSCAN, iPlan RT Dose or iPlan RT user guides, or contact Brainlab customer support.

Other Brainlab Software

If you are running software versions other than those specified above, contact Brainlab support for clarification regarding compatibility with Brainlab devices.

Only Brainlab medical software specified by Brainlab may be installed and used with the system.

Medical Software Comment

BrainSCAN 4.03

BrainSCAN 5.0

BrainSCAN 5.21

BrainSCAN 5.31

BrainSCAN 5.32

Data planned with BrainSCAN 4.03, 5.0, 5.21, 5.31 and 5.32 is compatible with versions prior to Brain-lab m3 User Interface 3.0.

Data planned with BrainSCAN is not compatible with Brainlab m3 User Interface 3.0.

iPlan RT Dose 3.0

iPlan Dose 4.1.2

iPlan RT 4.5

Data planned with iPlan RT Dose is compatible with the Brainlab m3 User Interface 3.0.


1.5.3 Non-Brainlab Medical Devices

Compatible Non-Brainlab Medical Devices

For the Advanced m3 Siemens linac Integration, the following Siemens software versions are re-quired: the Control Software of version 6.5/7.2, the SIMTEC IMRT/IMMAXX option must be available and the PRIMEVIEW user interface must be version 1.5. If you are running software versions other than those specified above, and for compatible DMIP versions, please contact Brainlab support for clarification regarding compatibility with Brainlab devices.

Workstation and Controller Combinations

Valid m3 Workstation and m3 Controller combinations:

Other Non-Brainlab Devices

Using medical device combinations which have not been authorized by Brainlab may adversely affect safety and/or effectiveness of the devices and endanger safety of pa-tient, user and/or environment.

Medical Device Model Manufacturer

Varian l inac wi th or without existing Varian MLC

• CL 600C all serial numbers 115 and higher

• CL 2100 C or C/D all serial numbers 365 and higher

• CL 2300 C/D all seri-al numbers

• 600N Novalis Dose Delivery System

Varian, Oncology Systems, Palo Alto, USA

Siemens linac

• Mevatron• Primus• Oncor• Oncor 160• Artiste

Siemens Medical Systems, Inc, Oncology Care Systems, Concord, USA

Workstation SW Version Controller Software Version Operating System

4.8 4.9.00, 4.9.10 Windows NT

5.0 5.0.04, 5.0.05, 5.0.06, 5.1.01 Windows NT, Windows XP

6.8 5.1.01 Windows XP


1.5.4 Non-Brainlab Software

Authorization

Only authorized Brainlab employees may install software on the Brainlab system. Do not install or remove any software applications.

Compatible Non-Brainlab Software


DICOM Conformance The Brainlab DICOM implementation is based on a MERGE DICOM library. For de-

tailed information on DICOM conformance, consult the third party system DICOM Con-formance Statement and the Brainlab DICOM Conformance Statement at www.brainlab.com.

Other Non-Brainlab Software

Only software specified by Brainlab may be installed and used with m3.

Software Vendor

DMIP MMLC Vendor DMIP Monitor Interface Design Specification 8167400-EDS-002 Revision 00 o 2 March 2009

RTPConnect RTPConnect Radiotherapy Treatment Planning Import/Export Interface Specification, LED17001 /011, Jun 17, 2010

Var ian MLC Shaper Varian, Oncology Systems, Palo Alto, USA

Third-party treat-ment p lann ing system

Third-party treatment planning software can be used with m3 if it complies with the mechanical requirements of m3 and the DICOM conformance statement for the Brainlab m3 User Interface. Refer to the manufacturer of the third-party treatment planning software.


1.6 Training and Documentation

1.6.1 Training

Brainlab Training To ensure safe and appropriate use, before using the system all users should participate in a training program held by a Brainlab representative.

Responsibility

The m3 system is solely designed to provide additional assistance to medical staff. It does not substitute or replace user experience, or invalidate user responsibility dur-ing its use.


1.6.2 Documentation

Intended Audience This guide provides an introduction and reference for the effective and correct use of Brainlab’s mi-cro-Multileaf Collimator (m3). This guide is written for all members of the clinical team who use or handle the micro-Multileaf Collimator (m3) system or parts of it. You should read this guide care-fully and acquaint yourself sufficiently with the system before use.

Reading User Guides

The user guides describe complex medical devices that must be used with care.

It is important that all users of system, instruments and software:

• Read the user guides carefully before handling the equipment• Have access to the user guides at all times

Available User Guides

Other User Guides

User Guide Contents

Clinical User Guides, iPlan RT

Detailed instructions on using the iPlan RT planning applications.

BrainSCAN Software User Guide

Detailed instructions on using the BrainSCAN planning applica-tions.

Hardware User Guide, Patient Support System

Detailed instructions on using the:

ExacTrac Robotics couch top tilt adjustment system

Head & Neck Treatment System

Hardware User Guide, RT/RS Stereotactic Hardware

Detailed instructions the correct use of Brainlab RT/RS Stereo-tactic Hardware.

User Guide Contents

Earth Leakage Guard Detailed instructions on using the Earth Leakage Guard are pro-vided by Noratel.

Clinical User Guide 600N / Noval is Dose Del ivery System

Detailed instructions on using the Novalis System are provided by Varian.

International Medical Iso-lation Device

Detailed instructions on using the Insulation Transformer are pro-vided by Noratel.

Varian Shaper User Guide Detailed instructions on using the Shaper Software.


2 EMERGENCY AND SAFETY INFORMATION

2.1 Chapter Overview

2.1.1 Contents

Topics CoveredSection See

Safety Hazards Page 20

Clinical Responsibilities Page 26

Maintenance Page 27

Mounting Safety Notes Page 31

Electron Treatments Page 32


2.2 Safety Hazards

2.2.1 Overview

General Information

The emergency procedures and safety precautions described below apply to the general operation and maintenance of the m3 and its associated equipment.

To ensure safe operation and maintenance of the m3, the clinic must establish emergency and safe-ty procedures. Use this chapter, as well as warnings and cautions in other chapters of this guide, as starting point in formulating local procedures.

Potential Hazards Uninformed or careless operation or service of the m3 can result in poor performance, equipment damage, serious injury, and even death.

The clinic should require each person who operates, maintains, or is associated with the m3 to be-come thoroughly familiar with and follow the:

• Operating instructions, emergency procedures, and safety precautions in this guide and the emergency procedures for the linac that uses the m3

• Emergency and safety procedures established for local use by the clinic

Take all precautions necessary to protect yourself, patients, and other persons from injury, and to protect equipment from damage.

Brainlab cannot be responsible for personal injury or equipment damage resulting from misuse of the m3 and/or the linac.

Additional equipment connected to medical electrical equipment must comply with the respective IEC or ISO standards (e.g., IEC 60950 for data processing equipment and IEC 60601-1 for medical equipment). Furthermore, all configurations shall comply with the requirements for medical electrical systems (see IEC 60601-1-1 or clause 16 of the 3rd edition of IEC 60601-1, respectively). Anyone connecting additional equip-ment to medical electrical equipment configures a medical system and is therefore re-sponsible that the system complies with the requirements for medical electrical systems. Please note that local laws take priority over the above mentioned require-ments. In doubt, consult your local representative or the technical service department. Otherwise specified, the use of multiple socket outlet(s) is not permitted.

The system is not designed for use in areas where there is a danger of explosion. Moreover, the system must not be placed close to flammable materials, such as vola-tile anesthetics, detergents, or endogenous gases. Please observe the local regula-tions concerning the formation of explosive gas mixtures when cleaning the equipment and when it is used on a patient.

Always verify that the primary jaws limit the treatment beam to 100 mm (in leaf move-ment direction) x 98 mm or less, or, in the case of the Siemens Artiste / Oncor 160, 98 mm (in leaf movement direction) x 94 mm. Larger field sizes can cause incorrect dose delivery and equipment damage.

The displayed linac jaw positions must be reviewed for plausibility. Incorrect jaw po-sitions can cause incorrect dose delivery and equipment damage.


Do not treat patients in the case of failure conditions. Clear all interlocks before dose delivery.

This equipment can radiate radio frequency energy. The equipment may cause radio frequency interference to other medical and non medical devices and radio communi-cation. To provide reasonable protection against such interference, this equipment complies with emissions limits for Group 1, Class A Medical Device Directive as stated in EN60601-1-2.

Be careful not to allow your fingers to be caught or crushed while the m3 cover is open and the leaves are in motion.

After mounting the m3 onto the linac, do not make any modifications that change the clearance between the source and the m3.


2.2.2 Safety Hazards

General Information

The following list contains possible safety hazards involved in operating and maintaining a linac and m3 (and associated equipment). Any of these hazards, in the absence of safe operating practices and precautions, could result in serious injuries or death to the patient or other personnel.

• Collision with the Gantry• Electrical Fire• Electrical Shock• Falling Parts or Accessories• Loss of Data Integrity• Loss of Software Integrity• Power Failure

All personnel who work with or near the m3 and linac should observe the safety precautions in the following paragraphs as well as in other parts of this guide. In addition, all such personnel should observe the safety information in the appropriate linac operator manual.

These hazards and safety precautions apply to both operation and maintenance of the m3 and linac. The clinic should only permit trained and qualified personnel to operate or maintain this equipment. Operators should only perform the procedures in this guide that they are qualified to perform.

Collision with the Gantry

A collision between the gantry/m3 and the patient, operator, or other personnel could cause serious and possibly fatal injuries. A collision between the gantry/m3 and the treatment couch could cause serious damage to both units.

Although the linac gantry rotates at a maximum speed of about one revolution per minute, a sub-stantial force is required to stop it because of the inertia of its large mass. With the m3 mounted, the possibility of a collision between the gantry and the patient, operator, other personnel, or surround-ing equipment, is greater because clearance is reduced by up to approximately 15 cm (depending on m3 type).

The use of the m3 reduces isocenter clearance. Always check gantry rotations for col-lisions with hand pendant before treatment.

Use extreme caution when you operate any motorized motion of the gantry and treat-ment couch.

Keep the patient under continuous observation whenever the gantry rotates. Stop the gantry immediately if a collision seems possible.

If any part of the gantry or m3 collides with the treatment couch or any other equip-ment, shut down the m3 and do not operate it until service personnel perform a com-plete evaluation and approve its return to service.


Electrical Fire Any electrical equipment carries the risk of an electrical fire. An electrical fire in the treatment room or console area could cause severe burns, asphyxiation, and other injuries or death.

If you detect smoke, immediately follow the local emergency procedures for a fire.

Only qualified personnel trained in fire fighting procedures should attempt to put out an electrical fire. Use the correct type of fire extinguisher (not water) to put out an elec-trical fire.

Electrical Shock The normal voltages in some circuits of the m3 and linac hardware are dangerous. Serious injury or loss of life can result from bodily contact with high-voltage circuits.

Only qualified service personnel should work with the m3 and linac hardware circuitry.

Do not make bodily contact with any part of the m3 circuitry until you ascertain its volt-age and correct handling method.

The m3 power supply may only be used on Siemens if medical galvanic insulation is available.

There are hazardous voltages inside the m3 power supply. Do not remove the power supply cover. There are no user serviceable parts inside.


Falling Parts or Accessories

Nuts, bolts, and other fasteners can vibrate loose during normal operation and fall from the m3. Sim-ilarly, wedge trays, shadow blocks, and other accessories can fall from the treatment head, usually as a consequence of improper mounting. A part or accessory falling on a patient, operator, or other person could result in serious injury.

Always verify that all safety locks are properly locked!

Always mount m3 and its accessories properly.

Do not mount or remove accessories when a patient is on the treatment couch. The only exception to this precaution is when an accessory can only be mounted after the light field establishes the treatment area. In such a case, use extreme caution.

Loss of Data Integrity

The m3 workstation stores and outputs data essential to proper patient treatment. Incorrect data placed in the system, by either manual or automatic means, or loss of data integrity could result in improper treatment, possibly causing patient injury or death.

Lock the m3 workstation when you leave the control room. Use password-protected user accounts.

Carefully check all treatment data that you enter into the system, and check it again at the time of treatment.

Do not give access to the m3 workstation to unauthorized personnel.

Do not store unauthorized programs or data in the m3 computers.

The m3 does not prevent simultaneous multiple-user access to patient files. If more than one user opens and modifies a patient file at the same time, the contents of the file can become inconsistent. Since multiple-user access is possible in a LAN environment, Brainlab recommends that you estab-lish procedures to prevent multiple-user access to patient files.


Loss of Software Integrity

Software and computers included with m3 are configured and tested solely and exclusively for op-eration on the m3 system. This software remains the property of Brainlab and is licensed to you strictly for the purpose intended. Alteration of the software or hardware or the use of any other soft-ware with the m3 can seriously damage the m3 or interfere with its operation and can result in ter-mination of the warranty and removal of software by Brainlab.

Modifying any of the software provided with the m3 or using any other software on the m3 computers can seriously compromise the integrity of data stored on the m3 computers and can result in uncer-tain, unreliable, and potentially hazardous system operation. Any attempt to modify the m3 computers, its operating system or the m3 software, or to operate non-m3 software on m3 computers is considered a product alteration and can result in termination of the remainder of the warranty on an m3 system. To protect the clinic, its patients, and Brainlab from the potential consequences of unauthorized modifications, software that has been altered may be re-moved by Brainlab.

Do not modify the software supplied with the m3, including the operating system and files on the hard disk.

Restrict operation of the m3 computers to the operating system and m3 software pro-vided by Brainlab only. Do not use any other software on these computers.

Do not alter the configuration of the m3 computers installed by Brainlab personnel, in-cluding internal printed-circuit boards and switch settings.

Power Failure In the event of a power failure, the m3 halts with its leaves remaining in the position they were in at the time of the failure. When the power is restored, the m3 workstation and controller computers per-form their standard initialization procedures, during which the leaves may move. At the end of the initialization, the leaves are in the fully retracted position.

To resume treatment, reopen the appropriate patient file, select the desired treatment field, and re-turn the leaves to their position prior to the power failure.


2.3 Clinical Responsibilities

2.3.1 Overview

General Information

This section provides recommendations for establishing emergency and safety procedures that ap-ply to the operation and maintenance of the linac and m3. Further information is provided under page 157.

Routine Use In establishing operating and maintenance safety procedures for routine use of the m3, follow the recommendations below with the safety precautions described earlier in this chapter to further en-sure operational safety and reduce the likelihood of injury to personnel and damage to the equip-ment:

• Cease machine operation immediately if you detect or suspect any equipment problems, and call service personnel to correct the situation.

• Record any unusual behavior or observations in the log book when performing the daily check-out procedure or whenever anomalies are noticed throughout the treatment day.

• Brainlab recommends that you check the linac light field on the Target Positioner Overlays to ensure that the correct gantry, jaw, and leaf positions are used for each treatment.

• Do not shut down the m3 workstation or m3 controller during treatment.• Protect the m3 system from unauthorized access. This could be done by setting a password for

everyone using the m3 workstation

Perform a Winston-Lutz test prior to patient set-up.

Always enter Treat mode before turning the beam on. As a further safety precaution, you should lock the keyboard after entering Treat mode.


2.4 Maintenance

2.4.1 Recommendations

General Information

Check all nuts, bolts, and other fasteners for tightness at least once every six months. This should only be performed by a Brainlab support specialist.

Verify that all locking mechanism are functioning correctly.

The m3 system must be maintained and inspected on a regular basis, at least once a year to ensure functionality and safety.

When using m3 with the Oncor, Primus, and Mevatron: Verify the countersink position in the tray slot by mounting the Siemens Interface Mount and tightening the fixation pins. Make sure that no marks are visible around the countersink.

We recommend that Brainlab support be contacted to arrange for yearly inspections or conclude a service contract.

Only Brainlab and/or authorized partners are allowed to repair the system and the equipment.

Storing

The system, and in particular electrical equipment, must not be exposed to humid en-vironments. Humidity can destroy the system and can lead to short circuits.

The m3 and Interface Mount must be stored in a dry and safe place.

Storage Conditions Ambient Temperature: 20° C to 60° C

Humidity: 10% to 90%, non-condensing

Atmospheric Pressure: 800 hPa to 1060 hPa

Operating Conditions

Ambient Temperature: 10° C to 40° C

Humidity: 10% to 75%, non-condensing

Atmospheric Pressure: 800 hPa to 1060 hPa

Cleaning It is recommended that the m3 and Interface Mount is cleaned using a soft and dry cloth. Do not use sharp objects, rough materials or caustic soaps to remove residue, especially near the electron-ic parts. Stains may be removed using a slightly moistened cloth.

Yearly Inspections A detailed inspection should be performed by Brainlab support once a year. This inspection includes a checkup of all components and functions as well as the safety inspection.

If a service contract exists, Brainlab automatically performs the yearly inspection. If you do not have a service contract, please contact Brainlab support to arrange an inspection.


Further Periodical Inspections

Please inspect the following components in intervals as listed below:

If you continue to use equipment that has been found defective during an inspection, you risk causing injury to the patient. If you discover a defect, switch the system off and immediately disconnect from the utility power, then contact Brainlab support. Place a suitable notice such as “DO NOT USE” on the equipment to prevent it from being used inadvertently.

Component Inspection IntervalSafety locks Functionality: Visual control (abrasions) MonthlyInterface mount Functionality: Visual control (abrasions) MonthlyLabeling legibility Monthly

Cabling Functionality: Visual control (twists, cracks) Weekly

Trolley wheels and brakes Functionality Monthlym3 base plate Functionality: Visual control (abrasions) Monthly

Cover Functionality: Visual control (dents, cracks) Monthly

Accessories Check for completeness Weekly


2.4.2 Preventive Maintenance and Inspection

Mechanical Functionality Tests

Mechanical tests must be performed once a year by a qualified Brainlab or Varian support specialist.

The test items include:

Test performed (date):

By:

Electrical Inspection

Electrical inspection must be performed once a year by a qualified engineer.1

Qualified engineers have the following obligations:

• To understand and follow the safety information and instructions about the product and as writ-ten in the user manual.

• To be familiar with the local regulations regarding industrial and non-industrial accident preven-tion in the knowledge that these regulations are up-to-date.

• To inform Brainlab immediately in writing if the equipment becomes unsafe.

Please keep a record of your inspection.

For further information on the requirements regarding the electrical inspection, refer to the following standards:

UL2601-1, page 84 to page 94 (chapters 18 to 19). [Medical electrical equipment - Part1 General Requirements for Safety].

IEC 60601-2-1, page 39 (chapters 18 to 19 amendment). [Medical electrical equipment - Part2-1 Particular Requirement for the Safety of Electron Accelerators in the Range from 1MeV to 50Mev].

Tested Component TestPassed/ Not passed

Safety locks Visual control (no abrasions)Interface mount Visual control (no abrasions) Labelling LegibilityCabling Visual control (no visible twists, cracks)T ro l ley whee ls and brakes

Wheels turn easily, breaks can be applied, prevent trol-ley from moving

m3 base plate Visual control (no abrasions) Cover Visual control (no visible dents, cracks)Accessories Check for completeness (all accessories are available)

1. This refers to qualifications for carrying out safety inspections on electrical medical equipment, as can be obtained by TÜV Product Services Ltd. At the time, Brainlab provides mechanical and functional inspection but does not offer electrical safety inspection services for the m3. If you need assistance in contacting an appropriate service, please contact your Brainlab support specialist.


2.4.3 Support

General Information

If you have questions or problems, contact Brainlab support for assistance.

You will be asked for the following information:

• System serial number (located on the systems’s type plate).• Serial number of the faulty component (inscribed on the component).• A description of the problem.

The product support specialist will provide you with an estimate for repair or replacement. No charg-es will be incurred for components under warranty. The policy by Brainlab is to have you operational within 48 hours of reporting a problem. Critical system components will be shipped as loaner re-placements.

Risk of electrical shock: There are no user-serviceable parts. All servicing is to be car-ried out by trained technicians or referred to Brainlab.

Warranties do not apply to products that have been damaged due to accidents, misuse, misapplica-tion, improper reinstallation, or inadequate packaging for return shipment. Warranties do not apply to products, which are modified or replaced without written authorization by Brainlab.

Installation During installation, a hospital representative oversees the m3 system assembly and diagnostic test-ing, and agrees that all products are in working condition.

Brainlab is ready to assist you with information that helps you process claims for damaged or miss-ing cartons, or for goods damaged within cartons.

Return Instructions Only remove defective components if instructed by Brainlab support.

• Properly wrap and package every defective component in its original box, in the replacement product box, or in a suitable box.

• Complete and return the form that was faxed to you or accompanied the replacement part.• Package the faulty part in suitable packaging material, so the part will not sustain further dam-

age. • Securely tape the box shut.• Ship the defective product to one of the addresses below or follow the instructions printed by

your service provider.

Brainlab AG Brainlab Inc. RMA Dept. RMA Dept. Kapellenstr. 12 3 Westbrook Corporate Center 85622 Feldkirchen Suite 400 Germany Westchester, IL 60154

USA Brainlab KK Brainlab Ltd. RMA Dept. RMA Dept. Tamachi East Bldg. 2 8/F 3-2-16 Shibura 100 Queen’s Road Central Minato-ku Hong Kong Tokyo 108-0023 Japan


2.5 Mounting Safety Notes

2.5.1 Overview

Safety Notes

Open latches only in the mounting position. Always verify that all latches are properly locked. An m3 that is not properly mounted can disengage from the linac and cause severe patient or user injury or even death.

Always verify that all safety locks are properly locked.

Open m3 locking mechanism only in the 6 o’clock position of the gantry to remove the m3 after treatment is completed.

The m3 weighs approximately 30 kg (66 lb). Always use the provided trolley to mount/remove the m3 to/from the linear accelerator. Serious back injuries might occur when lifting the m3 without the trolley.

If the integrated MLC is independent from primary jaws (especially on Varian linacs), make sure that the MLC is completely opened and in park position before the m3mMLC is mounted. The internal MLC may never exceed the planned jaw position, if it is not used as a primary jaw. This will prevent interference of the linac’s MLC and the planned m3 mMLC field.

Take care to mount the m3 and its accessories properly.


2.6 Electron Treatments

2.6.1 Overview

Safety Note

Remove the m3 before using your linac for electron treatments.


3 INTRODUCTION TO THE m3


3.1.1 Contents


About the m3 Page 34

The m3 System Page 35


3.2 About the m3

3.2.1 Overview

What is the m3? The micro-Multileaf Collimator (m3) is an accessory for Varian C-Series and Siemens radiotherapy machines, and is attached beneath the linac’s movable collimators. The m3 shapes the X-ray beam to conform to the shape of the treatment area.

m3 provides the following functions:

• Real-time monitoring and control of the m3• linac communication for interlocks and display of collimator jaws• User interface for setup and display of the m3

The m3 supports three types of treatments, which are defined as follows:

Static Treatments Analogous to field blocking, this type of treatment holds all axes of motion in place, including the gan-try angle, couch position and m3 leaves, while the beam is applied.

Dose Dynamic Treatments

For this type of treatment, the radiation is attenuated by moving the leaves of the m3 while the beam is on, resulting in dynamic in-field compensation. The m3 leaves move as a function of delivered dose. All other axes, including gantry angle and couch position, are held fixed during dose dynamic therapy.

Arc Dynamic Treatments

For arc dynamic treatments the m3 leaves are dynamically positioned as the source of radiation moves through an arc about the patient during treatment. With this treatment type, a larger dose is built up at the center of rotation within the patient’s body than on any area of the skin. The m3 leaves move as a function of the gantry position in the arc.

m3 Networks To facilitate easy m3 patient file storage and access, some clinics set up their Shaper and m3 work-station computers with network access to a common data server. This server provides access to files required by several computers in the clinic, such as the treatment planning system, m3, shaper, network printers, and a record and verify system.

To facilitate such network connections, Brainlab delivers the m3 with local area network (LAN) card installed in the m3 workstation computer. See your LAN documentation for information on network-ing and setting the correct default path for m3 patient file access from the server.


3.3 The m3 System

3.3.1 Overview

General Information

The m3 workstation (Figure 1) uses patient files that contain one or more m3 treatment fields. Each m3 treatment field defines one set of m3 leaf positions; it is similar to a custom block. The number of treatment fields in a patient file varies according to the number of static ports used and/or the pa-rameters of a dynamic plan, which uses a series of fields.

When you select a treatment field at the m3 workstation, it transmits the information to the m3 con-troller. The controller commands the m3 to move the leaves to the desired positions. As the treat-ment progresses, the workstation displays the positions of the leaves.

m3 System

Figure 1

Varian linacs See “m3 ON VARIAN” on page 39.

Siemens linacs See “M3 ADVANCED INTEGRATION ON SIEMENS” on page 97.

No. Component

a m3 Workstation

s Treatment setup

d Treatment process

f m3 Controller

g Motion control

h m3

a

s d

f

g

h


Software Description

The m3 system includes both software and hardware. The software on the workstation operates in the Microsoft Windows operating environment (DOS on the m3 controller). For more information on the m3 software components:

• On Varian, see page 63. • Advanced Integration on Siemens, see page 126.

For information on the m3 hardware, see the m3 databook.

Patient Files The m3 patient files (treatment fields) are created in the Shaper software or in a treatment planning system such as BrainSCAN or iPlan RT Dose.

The Varian Shaper software application is described in the Varian Shaper User Guide.

For information on your planning system, consult the corresponding user guide.


3.3.2 m3 Technical Specifications

General Information

• 52 tungsten leaves (26 pairs), individually motorized• Leaf width at isocenter:

- For compatible Varian linacs, Siemens Primus, Mevatron and Oncor linacs: 14 x 3 mm, 6 x 4.5 mm, 6 x 5.5 mm

- For Siemens Oncor 160, Artiste linacs: 14 x 2.96 mm, 6 x 4.44 mm, 6 x 5.43 mm• Maximum field size:

- For compatible Varian linacs, Siemens Primus, Mevatron and Oncor linacs: 100 x 98 mm- For Siemens Oncor 160, Artiste linacs: 98 x 94 mm

• Maximum leaf overcenter travel: apr. 50 mm• Leaf transmission: < 2%• Maximum leaf speed: 10 mm/sec • Isocenter to mMLC clearance:

- 31cm for Varian Clinac with MLC, Siemens Oncor, Primus, Mevatron- 30,2cm for Siemens Artiste and Oncor 160- 37cm for Varian Clinac without MLC

• Weight: approx. 30 kg (without Siemens Interface Mount)• Dimensions (without Siemens Interface Mount):

- 48 cm wide- 60 cm long- 12 cm high (MLC Version) / 15 cm high (Non-MLC Version)

• Secondary position readouts on all leaves for high positioning accuracy


4 m3 ON VARIAN4.1 Chapter Overview

4.1.1 Contents


System Setup on Varian Page 40

Mounting on a Varian linac Page 41

Patient Treatment Using the m3 with a Varian linac Page 45

Creating m3 Data Page 52

Taking Portal Films Page 62

Software Description Page 63

Troubleshooting m3 on Varian Page 81

Mounting on 600N/Novalis Dose Delivery System Page 89


4.2 System Setup on Varian

4.2.1 Overview

m3 System Integrated in a Varian linac

No. Component

a VARiS

s m3 Workstation

d Treatment setup

f Treatment progress

g m3 Controller

h Motor control

j m3

k Accessory

l Interlocks

; Clinac Control System

A Patient File from Shaper or TPS

a s j

d

g

f

kl

;A

h


4.3 Mounting on a Varian linac

4.3.1 Overview

General Information

This section is not applicable for the 600N / Novalis Dose Delivery System. Details for the 600N / Novalis Dose Delivery System are provided from page 89.

NOTE: Electrical, software, or mechanical malfunctions detected by the m3 cause the m3 to assert a beam interlock to the Varian linac. This action prevents the Varian linac from delivering the beam. To allow Varian linac operation, be sure to power on the m3 controller while the Varian linac is in use, even when the m3 is not shaping the Varian linac beam. If power to the m3 is turned off, the m3 asserts the beam interlock to the Varian linac.

NOTE: Use m3 only with the Varian Power Supply on Varian Linacs.

Safety Notes

Open latches only in the mounting position.

Always verify that all latches are properly locked. An m3 that is not properly mounted can disengage from the linac and cause severe patient or user injury or even death.


How to Mount the m3 on a Varian linac Steps

1. Switch Varian MLC to Park mode on the Varis workstation.

2. Turn linac gantry to 180° and the collimator to 270°.

3. Move the m3 trolley to the right side of the gantry so that the m3 can slide onto the gantry head.

4. Push the trolley towards the gantry until the bumpers touch the gantry.

• a Bumper• s Brake• d m3

5. Apply brakes to the rear trolley wheels.

a

s

d


6. Push the two red accessory mount buttons and lift the blue support until you hear a click-ing sound.

• a Red button• s Clicking sound• d Blue support frame

7. Slide the m3 fully onto the accessory tray.

8. Make sure that m3 is moved completely to the end of the tray slot.

9. Release brakes on the rear trolley wheels and remove trolley.

10. Pull the two black levers away from each other on the blue m3 support frame and press the blue support downward until the two red accessory mount buttons click shut.

• a Blue support frame• s Black lever

11. The gantry accessory mount interlock lights should now be green. The m3 is now ready to initialize.

Steps

a

s

d

a

s

a

s

s


How to Remove the m3 on a Varian linac Steps

1. Turn the gantry to 180° and the collimator to 270°.

2. Move the trolley to the gantry as shown on page 42.

3. Apply the brakes to the rear wheels of the trolley.

4. Push the two red accessory mount buttons and raise the blue m3 support until you hear a clicking sound:

a Accessory mount red button

s Clicking sound

d Black lever

f Red button

g Blue support frame

5. Now push the red button on the right side of the m3 f and slide the m3 off the gantry.

6. Continue sliding until the m3 rests against the stop pin on the trolley.

7. Pull the two black levers away from each other and press the blue support downward until the two red accessory mount buttons click shut. Check that the m3 is locked on the trol-ley.

8. Release the brakes on the rear trolley wheels and move the m3 away from the gantry and park in a safe dry place.

a

s

d

f

g

a

s


4.4 Patient Treatment Using the m3 with a Varian linac

4.4.1 Operational Setup

General Information

You must set up the following options in accordance with your local procedures before beginning to treat patients with your m3:

• Password for entering Service mode• Jaw Recommendations• Default directory for opening and saving m3 patient files

Password As treating patients in Service mode is not advisable and could make the m3 unsafe, the m3 re-quires a password to enter this mode. The service password is provided at the time of installation.

To simplify off-hours service by Brainlab, Brainlab recommends retaining the password provided at installation. However, you can change the service password. Further information is provided under “Change Service Password” on page 78.

Jaw Recommendations

The m3 software can recommend how to set the jaw positions on Varian and integrated Siemens linacs. You can configure the Recommend Jaws option to respond in one of three ways if there is a discrepancy between the recommended and actual jaw positions during use:

• A message informs you that the jaws are not in the recommended positions, and you are required to enter a password to bypass the recommended jaws position and proceed with treat-ment.

• A message informs you that the jaws are not in the recommended positions, but you can pro-ceed with the treatment without taking further action.

• No message or alert informs you that the jaws are not in the recommended positions, and you can proceed with treatment.

See “Jaw Recommendations” on page 77 for more information on configuring the Recommend Jaws option.

Default Patient Path During installation, the default path c:\mlc\patient is set up for storing m3 patient files. If your practice is to use a different directory, you can change the default path using the Change Default Patient Path option on the Configuration menu. See page 33 for further details.

Patient File Backup m3 has no automatic file backup utility associated with it. Brainlab recommends that you establish standard file backup procedures for m3 patient files. Backups ensure that patient treatment is not interrupted due to file corruption or loss.


4.4.2 Starting the m3

How to Start the m3 Once the m3 is mounted to the linac use the following procedure to start the m3 computer hardware and software:

The gantry angle must be at either 0° (IEC scale) or 180° (Varian scale) during initial-ization to ensure consistent leaf positioning.

m3 Window The system starts the m3 software and opens the Multileaf Collimator window on the workstation.

Figure 2

Steps

1. Rotate the gantry to 0° (IEC scale) or 180° (Varian scale).

The gantry is now in the proper position for initialization.

2. Power on the computers, monitors and printer. The workstation computer starts up, loads the system software and displays the following message:

m3 will start in 6 seconds: hit ESC to start m3 immediately hit any other key to get the DOS prompt


Controller Initialization

Controller initialization can take several minutes following power-up.

If the controller is not communicating with the workstation, this message box opens.

Figure 3

This indicates that the controller is either not powered on or is disconnected.

Options

To use m3 in Data Entry mode, click Abort.

To use m3 in Clinical mode, ensure that the controller is properly connected to the workstation and the controller is powered on. When you are sure all connections are intact and the controller begins to initialize, click Retry.


4.4.3 Daily Initialization

General Information

If your workstation remains on all the time with m3 running, perform these steps each morning to initialize the m3 controller from the workstation.

Initialization occurs automatically every time the m3 is powered on. The initialization process takes approximately three minutes. The m3 must be in a horizontal plane for initialization to occur.

When to Initialize Initialize the m3 on a daily basis or once every 250 patterns. The initialization process resets and checks the accuracy of the m3’s two independent feedback systems for each leaf and side.

How to Initialize the m3

Initialization Failure In the event of failure during initialization, the m3 workstation displays an error message.

If repeated initializations fail, contact your local Brainlab representative.

Steps

1. Rotate the gantry to 0° (IEC scale) or 180° (Varian scale).

The gantry is now in the proper position for initialization.

2. At the workstation, click Clinical in the Mode menu.

m3 enters Clinical mode.

3. Click Initialize in the Collimator menu.

4. Click OK.

m3 begins the initialization process, moving the leaves into the starting position. The leaves on each side of the m3 extend and retract individually across a light field. The leaves repeat this process in the opposite direction. The m3 controller computer calcu-lates detected discrepancies and sends the results back to the m3 workstation.

5. When the m3 leaves stop moving, the initialization process is complete.


4.4.4 Software Overview

Window Layout

Figure 4

NOTE: In Clinical/Arc mode, the window does not show the planned leaf positions but does in-clude the gantry angle. In Clinical/Dose mode, the window does not show the planned leaf positions but does include the dose fraction.

No. Component Function

a Patient dataShows the patient name, the patient ID, the name of the current field, a musical note symbol ( ) indicating the presence of infor-mational notes and the current m3 operating mode.

s Function keys

Provide shortcuts to frequently used m3 functions. You can press the actual function keys on the keyboard, or you can click the function key buttons in the m3 window on the screen. See “Key-board Function Keys” on page 51 for further details.

d Leaf position table Shows the planned and actual leaf positions.

f Title bar

g m3 menuProvides access to m3 functions. The options available on some menus depend on the current m3 operating mode. See “m3 Oper-ating Modes” on page 50 for further details.

h Status area

Shows the interlock status. You must release all interlocks marked with an asterisk before you can turn on the linac beam. See “ADDITIONAL INFORMATION” on page 161 for information about interlock messages and releasing interlocks.

j Graphics areaShows the planned and actual positions of the leaves. It also shows the recommended and actual jaw positions and the outline of the digitized shape, if present in the file.

a

s

d

f g

h

j


m3 Operating Modes

If you are performing patient treatment with dynamic arcs, and the system indicates a communication error when a treatment modality is resumed after system restart, dis-continue treatment as the correct leaf shape for specific angles can no longer be guar-anteed. Call Brainlab support immediately.

Mode Description

Clinical Used for patient treatments with the m3

Park

Used for linac treatments that do not require the m3. When you enter Parkmode, the controller retracts all leaves so that they do not interfere with the treatment. Once the m3 retracts all leaves, it releases the beam interlock.

NOTE: While the m3 is in Park mode, all workstation functions are disabled, ex-cept the menu options to change the operating mode.

Data Entry

Used to enter patient data off-line at the workstation. m3 displays patient infor-mation and planned leaf positions but does not show actual leaf position or sta-tus information.

NOTE: The only ways to enter Data Entry mode are to start the m3 workstation when the m3 controller is not running or to disconnect the cable between the m3 workstation and the m3 controller

Service

Has features similar to Clinical mode but includes additional service-related capabilities, such as viewing the treatment fields in either isocenter or physical units and changing the password for the Service mode.

Service mode procedures are for qualified personnel only. Never use Service mode when treating patients. Uninformed or careless maintenance or use of the m3 can expose maintenance and clinic personnel and other persons to hazards that can cause serious in-jury or death.


Keyboard Function Keys

Function key Operation performed

F1 Patient Opens an existing patient file. When a patient file is open, F1 Patient is re-moved from the list of available function keys.

F2 Go Moves the m3 leaves into their treatment positions.

Not available in Data Entry and Park modes.

F3 Retract Causes the m3 leaves to retract.


F4 Field Selects the next treatment field. Not available in Park mode.

F5 Edit

Changes to Edit mode so you can edit the planned positions of the m3leaves.

Click/Press F5 Edit to leave Edit mode.

Not available in Park mode.

F6 Treat Releases the m3 interlock to the linac.


F10 Activates a menu for option selection. Similar to the Alt key.

F7, F8, F9, F11, and F12 No m3 functions are assigned to these keys.


4.5 Creating m3 Data

4.5.1 Using Other Applications

Using a Brainlab Treatment Planning System

The m3 data can be created using the Brainlab treatment planning systems BrainSCAN and iPlan RT Dose. For information on your planning system, consult the corresponding user guide.

Using Shaper Software

Shaper allows you to digitize the shape of a treatment field, and then it recommends a leaf pattern for the digitized shape. You can manually edit the leaf positions one at a time, but Shaper does the majority of the work. See the Varian Shaper software guide for detailed information.


4.5.2 Creating Data Using Data Entry Mode

General Information

Data Entry mode allows you to create and edit patient files and treatment fields. However, it was developed prior to the introduction of the Shaper software application, which provides a simpler shaping function.

In contrast, in the m3’s Data Entry mode, you must enter each leaf position individually.

Although you can use the m3’s Data Entry mode, Brainlab recommends the Shaper software appli-cation, provided with your m3 purchase, for creating and editing treatment fields and patient files used with the m3 workstation computer.

Before Using Data Entry Mode

Before entering Data Entry mode, be sure that the m3 workstation computer is not communicating with the controller.

NOTE: In Data Entry mode, you can create and edit static patient files only.

How to Create a New Patient File

Steps

1. Confirm that the power is off on the m3 controller computer.

2. Power on the m3 workstation computer.

The workstation starts up and the Controller Timeout message box opens (see Figure 3).

3. Click Abort to start m3 in Data Entry mode:

4. Click New on the Patient menu. The Enter New Patient Data dialog is displaced


NOTE: When you name a patient file and do not assign an extension to it, m3 assigns the *.mlcextension as a default. When you click Open on the Patient menu, m3 displays only files with the *.mlc extension.

NOTE: On areas of the field that require beam blocking, Brainlab recommends that the points where opposing leaves meet be as far from beam center line as possible and that these points be covered by one of the collimator jaws.

NOTE: Press the up-arrow and down-arrow keys to move the focus to up and down in the same column. Press the right-arrow and left-arrow keys to move the focus from one column to the other. Press the slash(/) and asterisk (*) keys at the top of the numeric keypad to decrease and increase values by 1 mm.

NOTE: The values you enter for the planned positions must be within the allowed range of the leaf’s travel limits. See page 56 for further information.

5. Enter the patient information, and click OK. The Add Field dialog is displayed:

6. Enter a name for the field, and click OK.

7. Press F5 Edit. Leaf 1A is highlighted in the graphics area.

8. Enter the planned position for leaf 1A for the scheduled treatment.

9. Press Enter. The value you enter becomes the planned position, moves the focus to leaf position 2A, and leaf 2A is highlighted in the graphics area.

10. After editing each field, click Save or Save As on the Patient menu. The Save As dialog opens. Enter a file name, and click OK. The system then saves the patient file.

11. Repeat the above steps.

12. When you are finished, press F5 Edit to exit Edit mode.

Steps


Adding and Editing Fields in a Patient File

To add multiple fields to a patient file:

Steps

1. Click Add on the Field menu. The Add Field dialog is displayed:

2. Enter a name for the field. Click OK.

3. Press F5 Edit. Leaf 1A is highlighted in the graphics area.

4. Enter the planned position for leaf 1A for the scheduled treatment.

5. Press Enter. The value you enter becomes the planned position, the focus moves to leaf position 2A, and leaf 2A is highlighted in the graphics area.

6. After editing each field, click Save or Save As on the Patient menu. The Save As dialog is displayed. Enter a file name, and click OK.

The system saves the patient file.

7. Repeat the above steps. When you are finished, press F5 Edit to exit Edit mode.


Leaf Travel Restrictions

As you position the leaves, consider these restrictions for leaf travel distances:

Where:

Travel Parameter m3

Maximum distance over centerline -5.00

Maximum retract position 5.00

Maximum leaf spread 10.00

Max imum d is tance over centerline

Maximum distance a leaf can extend beyond the beam centerline.

Maximum retract position

Maximum distance a leaf can retract from the beam centerline.

Maximum leaf spread

Maximum distance allowed between the most extended leaf on a side and the most retracted leaf on that same side.


4.5.3 Treating a Patient with a Static m3 Plan

General Information

Use the following procedure to treat a patient with a static m3 plan.

Set up the m3 as described under “Mounting on a Varian linac” on page 41.

Verify the gantry rotation for Varian and fully-integrated Siemens linacs in accordance with the treatment plan.

Preparing the m3 for Static Treatment

Click Clinical on the Mode menu.

How to Load Patient Data

Steps

1. Click Open on the Patient menu. The Select Patient File dialog is displayed.

2. Click on the patient file or type in the file name.

3. Click Open. The Confirm Patient ID dialog is displayed.

4. Verify the patient name and ID, and click Open.

The system validates the file, and then displays the first field in the patient file in the m3window. The leaves appear in red, indicating that the actual and planned leaf positions do not match.

5. Use one of the options on the Field menu (Next, Previous, First, or Select) to select the field you want to use for the treatment.


Field Forming When you are ready to begin the treatment, press F2 Go.

The leaves move to their target positions. When the actual leaf positions match the planned leaf po-sitions, the Actual column of the leaf table is blank; the leaves appear in green in the graphics area of the window.

linac Setup Set up the linac according to the treatment plan. For further information, refer to the relevant linac manual.

Patient Setup Prepare and position the patient according to the treatment plan. For further information, see the Hardware User Guide, Stereotactic Hardware and relevant positioning system manual.

Treatment Press F6 Treat, and deliver the treatment from the linac console.

Treatment Field Name in Red

When you open a patient file and the treatment field name appears in red, it indicates that the field contains one or more planned leaf position(s) that are not achievable due to one of the following con-ditions:

• The planned leaf positions are outside of the m3’s physical range.• Opposed planned leaf positions cause a leaf collision.• The planned leaf positions on one side are beyond the maximum allowed leaf spread. See

Table 3 on page 94 for further details.

You must edit the treatment field prior to treatment to correct problems. If editing is required, see “Jaw Recommendations” on page 77.

Do not select any menu options while in Treat mode. Doing so causes a communication time-out, and Treat mode asserts an interlock and exits. You cannot re-enter Treat mode until you release all interlocks. If there are existing conditions which could cause a beam interlock, m3 displays the fol-lowing message:

The interlocks marked * must be cleared before entering Treat mode.

As an important quality assurance step, use the light field to confirm that all leaves are in the prescribed treatment positions.


Treatment if the Jaws are Not in the Recommended Positions

If the jaws are not in their recommended positions when you press F6 Treat, even if there are no interlock conditions, one of three possible results occurs, depending on the setting of the Recom-mend Jaws option. See “Jaw Recommendations” on page 77 for more information on configuring the response required to override the jaw recommendation.

If m3 is configured to display a warning, the Clinac Jaws warning opens.

Figure 5

End of Treatment When you have delivered all treatment fields according to the treatment plan, close the patient data and remove the patient from the couch.

Steps

1. Click Treat. If the m3 is configured to require a password to bypass the jaw recommendations, the Override Jaw Recommendation dialog opens.

2. Enter the password to override the warning, and click OK.

m3 enters Treat mode.


4.5.4 Treating a Patient with a Dynamic m3 Plan

General Information

This section applies only if your m3 and linac are configured for dynamic m3 treatments.

When you prepare a patient file, you designate it as a static, arc dynamic, or dose dynamic treatment type. When you open a patient file in m3’s Clinical mode, m3 opens only files with a treatment type that corresponds to the currently selected treatment type on the Special menu.

The following procedure describes how to prepare the m3 for a dynamic treatment. Close any cur-rently open patient files before you begin. Important details are provided in the notes that follow the procedure.

Set up the m3 as described under “Mounting on a Varian linac” on page 41.


How to Prepare m3 for a Dynamic Treatment

How to Load Patient Data

linac Setup Set up the linac according to the treatment plan. For further information, refer to the relevant linac manual.

Patient Setup Prepare and position the patient according to the treatment plan. For further information, see the Hardware User Guide, Stereotactic Hardware and relevant positioning system manual.

Treatment Press F6 Treat, and deliver the treatment from the linac console.

Steps

1. Click Clinical on the Mode menu.

m3 enters Clinical mode. Be sure that no patient file is open. If you have a static plan open, the Special menu is disabled.

2. Click on a dynamic treatment mode (Arc or Dose) on the Special menu.

m3 enters the selected treatment mode, and the leaves appear in blue in the graphics area of the window.

Steps

1. Click Open on the Patient menu.

The Select Patient File dialog (see page 57) opens and displays only patient files with the extension associated with the treatment type (.ARC for arc or .DOS for dose).

2. Click on the patient file, or type in the file name; then click Open.

The Confirm Patient ID message box is displayed.

3. Verify the patient name and ID, and then click Open.

The patient file opens.


Interlocks Clicking a menu option while in Treat mode causes Treat mode to exit with the interlock asserted. You cannot re-enter Treat mode until you release all interlocks. If a cause for an beam interlock is detected, the m3 displays the following message:


For treatment plans that contain numerous treatment fields it can take several seconds to download the data from the workstation computer to the controller computer. While this takes place, m3 dis-plays the following message:

Downloading Arc/Dose Dynamic Plan.

For arc dynamic treatments, if the jaws are not in their recommended positions when you press F6Treat, even if there are no interlock conditions, one of three possible results occurs, depending on how the Recommend Jaws option is configured. For further information, see “Treatment if the Jaws are Not in the Recommended Positions” on page 59.

Editing Individual Leaf Positions in a Dynamic Plan

When the m3 is in Service mode, you can edit individual leaf positions in any treatment field of a dynamic plan.

Service mode procedures are to be used by qualified maintenance personnel only. These procedures should never be used to treat patients. Uninformed or careless maintenance or use of the m3 can expose maintenance, customer personnel, and oth-er persons to hazards that can cause serious injury or death.

Before you edit an individual leaf position in Service mode, be sure that m3 is in static mode (that is, that no check mark appears next to Arc or Dose on the Special menu) and that no patient file is open.

How to Edit a Dynamic Plan

End of Treatment When you have delivered all treatment fields according to the treatment plan, close the patient data and remove the patient from the couch.

Steps

1. Enter Service mode by clicking on Service on the Mode menu. The Service Authorization dialog is displayed.

2. Enter the service password, and click OK to enter Service mode.

3. Click Open in the Patient menu. The Select Patient File dialog is displayed (see page 57) and displays files with the extension *.mlc.

4. Type *.* in the text box at the top of the dialog, and press Enter.

The dialog displays all files in the default m3 patient file directory, regardless of their ex-tensions.

5. Select a file containing a dynamic plan (*.DOS or *.ARC), and click Open.

The dynamic plan opens in the m3 window.

6. To edit a leaf position, perform steps 3 through 7 of the instructions in “Adding and Editing Fields in a Patient File” on page 55.


4.6 Taking Portal Films

4.6.1 Overview

General Information

Port Film mode allows you to fully retract the m3 leaves so you can take an open portal film with the Varian linac.

How to Take a Portal Film

NOTE: You can use Treat mode to move the leaves to a plan position for closed port films.

Steps

1. Click Port Film on the Collimator menu.

The m3 leaves retract, and the m3 interlock releases. A message prompts you to verify the selection.

2. Click OK to confirm. The status area of the m3 window turns blue and displays the follow-ing message:

Port Film Mode

3. You can take an open port film with the linac in the usual way.

4. To exit Port Film mode, click Port Film again; the status area returns to its previous dis-play.


4.7 Software Description

4.7.1 Overview

General Information

This chapter describes m3 menus, dialogs, and function keys for the standalone version of the m3.

NOTE: Some menu options are enabled or disabled depending on the task performed and the cur-rent m3 mode (such as Data Entry or Service mode).


4.7.2 Mode Menu

Menu

Figure 6

The Mode menu allows you to change the current operating mode for the m3. If you change modes when a patient file is open, the m3 closes the file, giving you the option to save your changes.

Clinical When you start the m3 software application, Clinical is the active mode. This mode allows real-time control of the m3. You can:

• Open a patient file• Assign leaf positions• Move the m3 leaves to their actual treatment positions.

There are two phases in Clinical mode: Setup and Treat. You are in the Setup phase while setting up the linac for a treatment. When you click/press F6 Treat, you enter the Treat mode.

Function keys F1 through F6 are available in Clinical mode.

NOTE: The m3 controller must be connected to the workstation and powered on for Clinical mode to be available. If the controller is disconnected or powered off, only Data Entry mode is available.

Park This mode enables linac treatments without using the m3. When you click Park on the Mode menu, the m3 fully retracts all leaves. On an Varian linac the m3 additionally releases the interlock. The only menu options available in this mode are Clinical, Service, and Exit.

On an integrated Siemens linac changing to Park mode sets the BCG to MML-NR.

Data Entry This mode allows you to create or edit patient files. You can access this mode only if the controller is off at the time the m3 software application starts. As a result, certain functions are not available, such as the ability to move the leaves.


Service This mode adds the service related options to the Collimator menu, as well as the Options and Configure menus.

All function keys are available in this mode. Certain m3 features function differently in this mode. See “Service Mode Functions” on page 75 for further details.

Service mode procedures should be used by qualified maintenance personnel only. Never use these procedures to treat patients. Uninformed or careless maintenance or use of the m3 can expose maintenance and clinic personnel and other persons to haz-ards that can cause serious injury or death.

You must provide a password to enter Service mode. When you click Service on the Mode menu, the Service Authorization dialog opens.

Figure 7

Once you have typed in the password and clicked OK, the m3 enters Service mode, and the addi-tional menus appear in the menu bar. See “Service Mode Functions” on page 75 for further details.

Exit Click Exit to close the m3 software application and any open patient file.

When you have made any changes to the current patient file without saving them, m3 prompts you to save the changes before exiting.

After you exit, the workstation computer sends a message to the controller computer telling it to enter the off-line state, which releases the m3 interlock. The m3 workstation returns to the Windows en-vironment.

About MLC (m3) Use this option to display information about the current version of the m3 software application.


4.7.3 Patient Menu

Menu The Patient menu allows you to open and close patient files, save them under the current name or under a new name, and print files or individual fields.

Figure 8

Open Click Open to open an existing patient file.

The m3 prompts you to select a patient file and confirm the patient name and ID number. Then the m3 workstation software displays the first treatment field of the selected patient file.

The F1 function key and the F1 Patient button at the bottom of the m3 window are shortcuts for this function.

Figure 9

New Click New to create a new patient file.

m3 prompts you to enter the patient’s name, and ID.

Figure 10

Close Click Close to close the current patient file. If you made changes to the file since you last saved it, the m3 prompts you to save the changes.

Save Click Save to save changes to the current patient file under the same file name. As the patient file already exists, m3 opens a dialog, asking if you want to overwrite the file.

Save As Click Save As to save the current patient file under a new file name.


Print Click Print to print one or all of the treatment fields in the current patient file.

The Print menu opens.

Figure 11

Options

Click Current Field to print only the field displayed in the m3 window.

Click Entire File to print every field in the current patient file.


4.7.4 Field Menu

Menu The Field menu allows you to add, delete, and/or select a treatment field in a static treatment plan. This menu is available only when a static treatment plan is open or when a dynamic plan is open in Service mode. See “Service Mode Functions” on page 75 for further details.

Figure 12

Next Click Next to display the next treatment field in the current patient file.

The F4 function key and the F4 Field button at the bottom of the m3 window are shortcuts for this function.

Figure 13

Previous Click Previous to display the previous treatment field in the current patient file.

First Click First to return to the first treatment field in a multiple field treatment plan.

Select Click Select to display a list of treatment fields in the current file and to select a field from the list to display in the m3 window.

Figure 14


Note Click Note to view or edit an informational note associated with the current treatment field. The m3indicates the presence of a note for the current field by displaying a musical note symbol ( ) next to the field name in the patient data area at the bottom of the m3 window.

When you click Note, the Field Notes dialog opens.

Figure 15

The name of the operator and the text of the note are for annotation purposes only and are com-pletely optional. These parts of the Field Notes dialog allow you to provide pertinent information about the treatment field to other operators of the m3.

In addition to being an important treatment setup parameter, the Index value (that is, gantry angle) serves as the dynamic index for arc dynamic treatments or fractional dose for dose dynamic treat-ments.

The Collimator rotation value is a vital part of the leaf positioning information and must match the collimator rotation setting on the linac.

During treatment setup, verify that the collimator rotation setting for the treatment field matches the collimator rotation setting on the linac. If these settings do not match, m3 asserts an interlock and displays the following message:

* Coll. angle not set to file value

See “ADDITIONAL INFORMATION” on page 161 for further details.

Add Click Add to add a treatment field to the current patient file. When you click this option, m3 duplicates the current treatment field and opens the Add Field dialog in which you must enter a name for the new field. You can store up to a maximum of 200 treatment fields in a single patient file.

Delete Click Delete to remove the currently displayed treatment field from the patient file. A dialog opens asking you to confirm your decision.

If you attempt to delete the last field in a file, a message informs you that you cannot delete the only field in a file. To remove the only field in a file, you can take any of the following actions:

• Add a second field, and then delete the field in question.• Edit the existing field.• Close the file, and then delete the entire file.


4.7.5 Collimator Menu

Menu The Collimator menu enables you to change leaf positions or cause leaf movement. The AutoCy-cle option is available in Service mode only.

Figure 16

Go Click Go to move the leaves to their planned treatment positions for the current treatment field. When the leaves are in their planned positions, the m3 releases its interlock to the linac.

The F2 function key and the F2 Go button at the bottom of the m3 window are shortcuts for this func-tion.

Figure 17

Retract Click Retract to retract the leaves to the fully open position.

The F3 function key and the F3 Retract button at the bottom of the m3 window are shortcuts for this function.

Figure 18

Edit Click Edit to edit the planned leaf position.

Press the up-arrow and down-arrow keys to move the focus to up and down in the same column. Press the right-arrow and left-arrow keys to move the focus from one column to the other. Press the slash(/) and asterisk (*) keys at the top of the numeric keypad to decrease and increase values by 1 mm.

The values you enter for the planned positions must be within the allowed range of the leaf’s travel limits. See “Leaf Travel Restrictions” on page 56 for more information.

The F5 function key and the F5 Edit button at the bottom of the m3 window are shortcuts for this function.

Figure 19

To exit this mode click on Edit again or click/press F5 Edit.


Recommend Jaws Click Recommend Jaws to open a dialog showing the recommended position for setting the primary collimators on the linac. For more information, see “Jaw Recommendations” on page 77.

Figure 20

Use this information to determine the optimal coverage of non-treatment areas.

NOTE: This option is not available in any mode when an electron tube is installed on the linac.

Treat Click Treat to enter Treat mode. You can enter Treat mode only if there are no m3 interlock condi-tions.

When you click Treat, if the actual jaw positions reported by the linac do not match the recommend-ed jaw positions, one of three results occurs, depending on the setting of the Jaw Recommenda-tions option. See “Jaw Recommendations” on page 77 for further details.

Note NOTE: Clicking a menu option while in Treat mode causes Treat mode to exit with the interlock asserted. You cannot re-enter Treat mode until you release all interlocks. If there are existing con-ditions which could cause a beam interlock, m3 displays the following message:


Figure 21

The F6 function key and the F6 Treat button at the bottom of the m3 window are shortcuts for this function.

Port Film Click Port Film to enter Port Film mode. This mode allows you to retract the m3 leaves, release the m3 interlock, and take open port films with the linac. See “Taking Portal Films” on page 62 for more information.

Initialize Click Initialize to reposition the leaves into a predetermined starting position and release motion er-rors.

NOTE: Initialization occurs automatically when the controller is booted. Initialize the m3 controller at least once each day during the linac’s 12 minute time delay. See “Daily Initialization” on page 48 for further details.


AutoCycle (Service Mode Only)

Click AutoCycle to continuously cycle the leaves through each of the treatment fields in a patient file. This option continues to run until you click it again.

Every time an AutoCycle session runs, m3 creates a log file on the workstation computer. Log files have the generic name LOGnnn.TXT, where nnn is a three-digit sequential number assigned by m3 when it creates the file.

AutoCycle is a service-related function and should be used by qualified service per-sonnel only.


4.7.6 Special Menu (Dynamic Systems Only)

Menu The Special menu allows you to select the dynamic treatment type. This menu is available in Clin-ical and Service modes only on systems configured for arc or dose dynamic operation. If a patient file is open, you must close it before changing between treatment types.

Figure 22

Arc Click Arc to set the treatment type to arc dynamic. Be sure that no patient file is open when you at-tempt to change the treatment type.

When you click Arc, a checkmark appears next to the Arc menu option. When Arc is the active treat-ment type, m3 offers only files ending in *.ARC in the Select Patient File dialog.

• To change from Arc to Dose, click Dose on the Special menu. • To change from Arc to Static, click Arc again. The checkmark disappears, and you can open

static treatment plans.

NOTE: This menu option is available only on systems configured for arc dynamic treatments.

Dose Click Dose to set the treatment type to dose dynamic. Be sure that no patient file is open when you attempt to change the treatment type.

When you click Dose, a checkmark appears next to the Dose menu option. When Dose is the active treatment type, m3 offers only files ending in *.DOS in the Select Patient File dialog.

• To change from Dose to Arc, click Arc on the Special menu. • To change from Dose to Static, click Dose again. The checkmark disappears, and you can

open static treatment plans.

NOTE: This menu option is available only on systems configured for dose dynamic treatments.


4.7.7 View Menu

View The View menu allows you to set global preferences for viewing m3 shapes and jaws. The settings on this menu are effective for all patient files.

Figure 23

Shape Click Shape to display the shape outline data, if the patient file includes that data. When the Shapeoption is active, a checkmark appears next to it on the View menu. To remove the display of the shape outline data, click Shape again.

Jaws Click Jaws to turn on or off the display of the recommended jaw positions when the information is available from the linac. When you click Jaws, the View Jaws dialog opens.

Figure 24

The actual jaw positions are always selected. Click the Recommended check box to turn on or off the display of the recommended jaw positions.


4.7.8 Service Mode Functions

Menu When you click Service on the Mode menu, the Service Authorization dialog opens.

Figure 25

Enter the service password, and click OK. m3 enters Service mode.

Service Options Service mode adds the Options and Configure menus and the AutoCycle option on the Collima-tor menu.

Figure 26

The Options and Configure menus are described in the following sections. See “AutoCycle (Ser-vice Mode Only)” on page 72 for further information.

Service mode allows you to edit individual leaf positions of any treatment field in a dynamic plan. To support research and physics measurements, Service mode also allows you to edit leaf positions and load planned shapes while the linac is in Electron mode. Further information is provided under “Editing Individual Leaf Positions in a Dynamic Plan” on page 61.

Safety Note

Service mode procedures may be used by qualified maintenance personnel only. These procedures should never be used to treat patients. Uninformed or careless maintenance or use of the m3 can expose maintenance, customer personnel, and oth-er persons to hazards that can cause serious injury or death.


Options Menu (Service Mode Only)

The Options menu allows you to change the display of various aspects of the collimator leaf posi-tions and diagnostic information. The settings on this menu are effective for all patient files.

Figure 27

NOTE: You can select either Isocenter Units or Physical Units but not both at the same time. When you click one, the other becomes inactive.

Isocenter Units Click Isocenter Units to display the projected position at isocenter for each leaf in the leaf table.

Physical Units Click Physical Units to display the actual physical distance of each leaf from the beam centerline as measured at the collimator. This setting is available in Service mode only. In Clinical mode, m3always displays all values in isocenter units and ignores this setting.

View Diagnostic Failures

Click View Diagnostic Failures to view information about the cause of an initialization failure, if one occurred in the current m3 session.

Configure Menu (Service Mode Only)

The Configure menu allows you to configure various options in the m3 software application. The settings on this menu take effect immediately and remain effective until you change them. Further information is provided under “QUALITY ASSURANCE” on page 157.

Figure 28


Jaw Recommendations

Click J aw Recommendations to configure the m3 response in case the collimator jaws are not in the recommended positions.

The recommended jaw positions are calculated by the m3 and Shaper software and are based on the leaf positions in the current treatment plan or field.

Several criteria are considered by the software when determining the recommended jaw positions:

• The jaw positions should be as close as possible to the outermost dimensions of the shape sur-rounded by the current leaf plan, while ensuring that the linac jaws are far enough out of the treatment field so they do not produce secondary effects (such as X-ray scattering, penumbra) on the shape of the radiation field.

• The jaw positions must take into account the physical range of positions that can be attained by the linac jaws themselves.

• The jaw positions must not result in any jaw-related interlock condition.

The recommended jaw positions are recommendations only. They are not intended to replace or re-duce the need for determining optimal jaw positions through diligent and detailed treatment planning on the part of the treating clinic.

The recommended jaw positions are not enforced by the software. As long as there is no interlock condition, you can ignore the recommendation.

Brainlab recognizes that there is a wide range of clinically important treatment shapes that are best defined when the jaws are not in the positions that satisfy the criteria listed above.

For more information, see “Clinical Responsibilities” on page 26.

When you click this option, the Jaw Recommendations menu opens.

Figure 29

• Click one of the options on the menu.

Level 0 If you click this option, no message or alert informs you that the jaws are not in the recommended positions.

Level 1 If you click this option, a message informs you that the jaws are not in the recommended positions, but you can proceed with the treatment by clicking Treat in the message box.

Figure 30


Level 2 If you click this option, a message informs you that the jaws are not in the recommended positions, and you are required to enter a password before proceeding with treatment.

Figure 31

NOTE: You can obtain the override password from the your local Brainlab representative at the time of installation. You cannot change this password. If you forget the password, call your local Brainlab representative for assistance.

Change Service Password

Use this option to change the Service password. When you click this option, the New Service Pass-word dialog opens.

Figure 32

NOTE: You can obtain the override password from the your local Brainlab representative at the time of installation. You cannot change this password. If you forget the password, call your local Brainlab representative for assistance.

Change Default Patient Path

Use this option to change the default directory path for patient files. m3 initially displays the contents of the default directory when you click Open on the Patient menu. By setting this option to the di-rectory where you store patient files, you can save time when selecting files.


Scale Use this option to set the scale convention for interpreting the gantry angle and collimator rotation values.

When you click this option, the Scale menu opens.

Figure 33

• Click one of the options on the menu.

Be sure that the scale you set in m3 matches the scale set on the linac. If the scales do not match, a mistreatment can result.

Varian

• Click this option to specify that the Varian scale is used to determine the collimator rotation angle reference. A checkmark appears next to this option when it is in effect.

The Varian scale references 0° at the bottom of the shape and proceeds counter clockwise (Figure 34).

IEC

• Click this option to specify that the IEC scale is used to determine the collimator rotation angle reference. A checkmark appears next to this option when it is in effect.

The IEC scale references 0° at the top of the shape and proceeds clockwise.

Figure 34 compares the Varian and IEC scales from the perspective of an observer standing at iso-center, looking toward the radiation source.

Collimator Rotation Angle: Varian and IEC Scales

Figure 34

Varian standard scaleIEC scale

1800 / 360

0 / 360180

9090

270270 Ja

w X

2

Jaw

X1

Jaw Y1

Jaw Y2

Toward gantry bearing


Arc Tolerance Use this option to set the maximum difference permitted between the actual and the planned leaf end positions during an arc dynamic treatment before an m3 interlock is asserted. The m3 interlock halts the treatment.

The lower the arc tolerance setting, the higher the accuracy you achieve when administering the treatment, but the more likely you are to encounter frequent beam interlocks. The higher the toler-ance setting, the more tolerant (less accurate) m3 can be when administering the treatment; there-fore, higher settings result in fewer beam interlocks but lower accuracy. Try to achieve an appropriate balance when setting this option.

NOTE: This menu option is available only on systems configured for arc dynamic treatments.

Leaf Position Tolerance

Use this option to set the maximum difference permitted between the actual and the planned leaf end positions during a dose dynamic treatment before an interlock is asserted. The m3 interlock halts the treatment. This allows the leaves to catch up with the dose dynamic plan. Once the leaves are within the position tolerance, the interlock is released again, and the dose dynamic treatment continues.

NOTE: This menu option is available only on systems configured for dose dynamic treatments.


4.8 Troubleshooting m3 on Varian

4.8.1 Overview

General Information

The m3 controls a beam interlock to the Varian linac. The m3 interlock status appears on the monitor of the linac console (Version 3). In the normal (rest) state of the m3 an interlock is asserted. When all monitored conditions are safe, you can change to Treat mode, which releases the interlock.

Unsafe Condition If the m3 workstation detects an unsafe condition, it sends a message to the m3 controller, instruct-ing it to assert the interlock. The m3 workstation then displays an appropriate message in the status area of the m3 window.

If the m3 is in the Treat state of Clinical mode when the unsafe condition arises, the m3 exits the Treat state. See page 64 for further details.


4.8.2 Beam Interlock Messages

General Information

Beam interlock messages appear in the status area of the m3 window when an interlock condition occurs. The m3 cannot enter Treat mode when any of these messages (except Not in Treat mode) is displayed.

Excessive CRC Errors

The controller computer has detected an excessive number of errors while communicating with the m3 head unit. To resolve this problem:

Jaw Position The actual jaw positions are not within 5 mm of the recommended jaw position. To resolve this prob-lem:

Not in TREAT Mode The workstation is not in Treat mode. To resolve this problem:


The collimator rotation setting for the treatment field does not match the collimator rotation setting on the linac. To resolve this problem:

* Clinac IL - Coll. angle invalid

The m3 controller has received an invalid collimator angle from the linac. This can be caused by a communications error. To resolve this problem:

* Clinac IL - Gantry angle invalid

The m3 controller has received an invalid gantry angle from the linac. To resolve this problem:

* Clinac IL - Invalid dose fraction

The m3 controller has received an invalid dose fraction from the linac. This can be caused by a com-munications error. To resolve this problem:

Step

Call your local Brainlab representative.

Step

Override the recommended jaw position or move the jaws to the recommended position.

Steps

1. Clear all interlock conditions following the information in this appendix related to the par-ticular condition.

2. Press F6 Treat.

Step

Adjust the collimator rotation.

Step

Check the interface cable between the linac and the m3 controller. If the problem persists, contact your local Brainlab representative.

Step


Step



* Clinac IL - Lower coll. invalid

The m3 controller has received an invalid lower collimator position from the linac. This can be caused by a communications error. To resolve this problem:

* Clinac IL - Upper coll. invalid

The m3 controller has received an invalid upper collimator position from the linac. This can be caused by a communications error. To resolve this problem:

* Clinac not in DBD More than one carriage group was defined, but the treatment mode was neither DBD Electron nor DBD X-ray.

* Clinac not in Port Film

The m3 controller is in Port Film mode and the linac is not. To resolve this problem:

* Clinac/MLC - Dynamic mode mismatch

There was an invalid attempt to combine arc dynamic and dose dynamic treatments.

Step


Step


Step

Contact your local Brainlab representative.

Step

Set both the m3 and linac to Port Film mode.

Step

Synchronize linac and m3 by setting the correct dynamic mode.


* Collimator initialization failure

The controller computer encountered an unrecoverable hardware error during its booting initializa-tion, such as being unable to locate a leaf’s calibration zero position. To resolve this problem:

* Controller IL - Carriage service

A hardware error is detected by the m3 electronics. This includes m3 power supply status. To resolve this problem:

* Controller IL - Clinac COM

An error is detected in the communication link between the linac and the m3 controller. To resolve this problem:

* Controller IL - Clinac not ready

The m3 controller has determined that the linac is not in the ready state. To resolve this problem:

* Controller IL - CRG A tail exposed

The linac’s collimator jaw position does not provide sufficient coverage behind the leaves to prevent radiation leakage. To resolve this problem:

* Controller IL - CRG B tail exposed

The linac’s collimator jaw position does not provide sufficient coverage behind the leaves to prevent radiation leakage. To resolve this problem:

* Controller IL - Dyn. plan not loaded

In Dynamic mode, the plan in the controller is corrupted. To resolve this problem:

Steps

1. Click View Diagnostic Failures in Service mode to display information about the detect-ed condition.

2. Click Initialize in Service mode to attempt another initialization. If repeated attempts fail, contact your local Brainlab representative.

Step

Re-initialize the m3 controller. If this fails, contact your local Brainlab representative.

Step

Check the cables between the m3 controller and the linac, and retry the operation. If this fails, contact your local Brainlab representative.

Step

Make sure that the linac is not in stand-by mode.

Step

Move the linac jaws so that the leaf tails are not exposed.

Step


Steps

1. Transfer the patient file again.

2. Open the patient file.


* Controller IL - Ilock circuit failed

A hardware fault in the m3 interlock circuitry is detected. This circuitry includes the hardware watch-dog, solid state relays, and the controlling logic. This failure is detected during initialization or during normal operation when the status of the watchdog and interlock solid state relay are being monitored continuously. To resolve this problem:

* Controller IL - Incompatible mode

The controller computer received a request for a mode that is not one of the legal modes (Service, Clinical, Port Film, Data Entry, or Park).

* Controller IL - Initializing

The controller computer is initializing the m3 leaves, either on initial power-up or in response to the user command from the workstation computer.

* Controller IL - Leaf in field

The controller has detected a leaf in the treatment field when the leaves are expected to be fully re-tracted, such as during electron treatments, off-line, or in Park mode. To resolve this problem:

* Controller IL - Leaf position

A leaf not in its target position. To resolve this problem:

Step

Call your local Brainlab representative. This interlock condition can only be cleared by successful initialization after correcting the cause of the failure.

Step

This interlock condition releases when the initialization is completed.

Step

Re-initialize the controller and re-enter the desired mode. If this fails, call your local Brainlab representative.

Steps

1. Press F2 Go.

2. If the problem still exists, re-initialize the controller and reload the plan. If this fails, contact your local Brainlab representative.


* Controller IL - Leaf service

A hardware error is detected by the head electronics. This includes head power supply status. To resolve this problem:

* Controller IL - m3 Hardware COM

The controller computer has detected a communications problem with the m3 hardware. This is usu-ally detected as a communications timeout; that is, an expected message was not received from the target device before the timeout period expired. To resolve this problem:

* Controller IL - Motion error

The controller has detected a failure while obtaining leaf position data. It may be due to either a hard-ware failure code from the position readout circuitry or a time out waiting for a data valid status from the high speed link to the m3 head. To resolve this problem:

* Controller IL - Secondary position

The controller has detected that one or more leaves is out of tolerance between the position deter-mined from the primary positioning mechanism and the position indicated by the secondary feed-back. To resolve this problem:

* Controller IL - Taxi A/B swapped

During initialization test the controller has determined that the Taxi A and B optic cables are swapped. The m3 interlock cannot be cleared while this condition exists. To resolve this problem:

Step

Re-initialize the controller. If this fails, contact your local Brainlab representative.

Steps

1. Check the cables between the m3 and the controller.

2. Re-initialize both workstation and controller. If the problem persists, contact your local Brainlab representative.

Step


Step


Steps

1. Swap the A and B carriage optic cables.

2. In Service mode, reinitialize the m3 by clicking Initialize on the Collimator menu.


* Controller IL - WS COM timeout

The controller computer has detected a communications problem with the workstation. This is usu-ally detected as a communications timeout; that is, an expected message was not received from the target device before the timeout period expired. To resolve this problem:

* Controller IL - X Jaws moved * Controller IL - Y Jaws moved

These messages indicate that one of the jaws moved during treatment. When this occurs, m3 exits Treat mode. To resolve this problem:

* Controller IL - Y1 Exposes CRG box * Controller IL - Y2 Exposes CRG box

These messages indicate that part of an m3 carriage is not adequately blocked by either the X or Y jaws. This occurs when an X jaw is more retracted than recommended (determined by the position of the most retracted leaf on the side) and a Y jaw is retracted beyond the boundary defined by the outer most leaf pair (either leaf pair 1 or leaf pair 26 or 40).

This interlock prevents you from entering Treat mode. To resolve this problem:

Any adjustment to the jaw positions represents a departure from the treatment pre-scription. If this interlock message appears at the time of setup for a patient treatment, it indicates that an error was made during the treatment planning process. The pre-scribed treatment should not be changed without the authorization of the appropriate treatment planner and physician.

* Edit mode The edit function is selected. To resolve this problem:

Steps

1. Check the cables between the workstation and the controller.


Step

Stop the jaw movement on the linac.

Steps

1. Examine the graphics area of the m3 window to determine which carriage corner is ex-posed to the beam path.

2. Either extend the appropriate X jaw so it is at or within its recommended position, or ex-tend the Y jaw so it is at or within the outer edge of either leaf pair 1 or leaf pair 26 or 40 as appropriate. One of these actions releases the interlock.

Step

Exit Edit mode.


* Leaf plan and actual do not match

A leaf or some leaves are not in their planned positions, according to the currently selected patient-treatment field. To resolve this problem:

* No plan loaded No patient file is open. To resolve this problem:

* Workstation-Controller COM

A communications error between the workstation and the controller is detected. This is usually de-tected as a communications timeout; that is, the workstation computer sends a message to the con-troller computer and does not receive a reply before the timeout period expires. To resolve this problem:

Step

Press F2 Go, and all leaves move to their planned positions.

Step

Open a patient file.

Steps

1. Check the cables between the workstation and controller.



4.9 Mounting on 600N/Novalis Dose Delivery System

4.9.1 Overview

General Information

For the 600N / Novalis Dose Delivery System, m3 is rigidly attached to the linac interface. For this reason, m3 may only be installed and removed by a Brainlab representative or Brainlab-approved subcontractor.

Novalis Conical Collimators

The m3 Novalis conical collimators are available in various different sizes.

Figure 35

Do not mount an m3 Novalis collimator if the patient is directly beneath the linac gan-try.

Take care to mount m3 collimators properly.

No. Component

a Collimator Snap-in Mark

s Security Pin

a

s


How to Exchange the Conical Collimator Steps

1. Remove the fixation ring.

a Collimator mount with fixation ring

s Fixation ring removed

Make sure that the security pin is correctly snapped in before removing the fixation ring. Only in this position can it be guaranteed that the collimator re-mains securely attached, so that the fixation ring can be removed without the collimator falling off.

2. Firmly hold the collimator and press the security pin of the collimator towards the cone as shown. This opens the locking mechanism.

3. Rotate the collimator counterclockwise to remove it.

a s


4. Insert a new collimator:

• Align the collimator to be mounted so that its three protrusions match the three spacing inserts within the collimator mount.

• Insert the collimator and turn it clockwise until the security pin snaps in.

5. Replace the fixation ring and fasten it securely.

Steps


Safety Notes

If the screws of the m3 Novalis collimator mount are opened or the m3 Novalis colli-mator mount is removed, the collimator mount must be realigned using the Winston-Lutz test. For further information, contact Brainlab support.

Make sure that the collimator is securely fastened before beginning patient treatment.

Operate the linac only with photons when using Novalis conical collimators.


4.9.2 Jaw Positions

General Information

It is important to verify by inspection that the area outside the shielded central part of the Novalis conical collimator is completely covered by the jaws. The models and range of Novalis conical col-limator apertures differ significantly at each customer site.

For Novalis conical collimators, to avoid radiation outside the Novalis conical collimator or leakage at the edge of the field resulting from potential set-up inaccuracies (mechanical Novalis conical col-limator alignment, jaw positioning, and other tolerances), Brainlab recommends using the jaw set-tings listed in the table below. If properly implemented, these settings will aid in keeping the jaw shaped field size tight around the largest Novalis conical collimator.

Regardless of the jaw-shaped field size in use, Brainlab recommends using a suitable film test to verify and document the complete shielding outside the intended center beam through the Novalis conical collimator.

Please keep in mind that the jaw-shaped field must be symmetric to the central beam axis for cone treatments, and the identical jaw position must be used for all Novalis conical collimators. If you in-tend to modify the jaw positions after the initial beam data acquisition you should determine to which degree the adjustment of jaw positions requires remeasurement of certain beam profiles.

Novalis (non-Novalis Tx)

The use of a 50x50 jaw-shaped field for Novalis (non-Novalis Tx) may result in minor dose leakage at the corners of the jaw area.

Diameter of largest conical collimator in use at site [mm]

Recommended size of jaw-shaped field for all conical collimators [mm²]

Up to 7,5 14x14

8 14x14

10 16x16

12,5 18x18

15 20x20

17,5 24x24

20 26x26

22,5 28x28

25 30x30

27,5 34x34

30 36x36

32,5 38x38

35 40x40

37,5 40x40


4.9.3 Novalis Conical Collimator Specifications

Circular Field Size The engraved cipher on the Novalis conical collimator specifies the circular field size ø (mm) in the isocenter.

Cross-section of the Novalis Conical Collimator

Safety Notes

For Novalis conical collimators the linac jaws have to shield the radiation outside the cone material, but also may not be too narrow to shield the intended inner radiation field defined by the Novalis conical collimator. The linac jaw positions used during treatment must be identical to the linac jaw positions used during beam measure-ments.

To avoid unintended leakage radiation using Novalis conical collimators the linac jaw size must be smaller or equal 40x40 mm² for Novalis (non-Novalis Tx).

Ensure that the linac jaws do not overlap the circular Novalis conical collimator open-ing.

Be aware that the positioning accuracy of the linac jaws can vary depending on the type of linac used. The linac jaw positions used during treatment must be identical to the linac jaw positions used during beam measurements.

No. Component

a Bronze or aluminum

s Lead

a

s


Verify for every treatment field that the correct, intended Novalis conical collimator is actually mounted to the linac, especially if a treatment plan contains treatment fields with different Novalis conical collimator sizes.

Ensure that any treatment accessories, such as m3 collimator mount and Novalis con-ical collimator of the size which is required by the treatment plan, are installed prop-erly in the beam path before delivery. Also refer to the documentation provided for the Brainlab Treatment Planning System.


5 M3 ADVANCED INTEGRATION ON SIEMENS


5.1.1 Contents


System Setup Page 98

Mounting m3 on Siemens Artiste/Oncor 160 Page 102

Mounting m3 on Siemens Mevatron/Primus/Oncor Page 112

Enabling the m3 Page 121

Patient Treatment Page 125

Software Description Page 126

Troubleshooting m3 Advanced Integration on Siemens Page 138

Accessories for m3 Advanced Integration on Siemens Page 147


5.2 System Setup

5.2.1 Overview

m3 Advanced Integration on Siemens Setup

This diagram shows the general setup for the m3 Advanced Integration on Siemens:

• The m3 and the technical components on the Siemens linac are located in the clinical area• The m3 workstation, the m3 controller and the R&V system are located in the control area.

Figure 36

a

s

d

f

g

h

j

k

l

;

l

A

S

D F

G

H


Treatment Room

Control Area


am3 micro-Multileaf Col-limator

sm3 Siemens Interface Mount (SIFM)

Interface between linac and m3. Provides mechanical and electrical connection.

dm3 Block Coding Generator (BCG)

Provides block codes to verify the correct MLC shape during treatment. Triggers interlocks to linac control console. See page 151.

f Cable Adapter m3 Electrical connection between the m3 Interface Mount and the linac.

g Gantry Angle Sensor Measures gantry angle. See page 149.

h m3 Power Supply (PS) Electrical supply for the m3 system. See page 147.

j m3 Insulation Monitor Measures continuously the earth leakage of the m3 system (Artiste / Oncor 160 only). See page 154.

km3 Insulation Transformer

Medical insulation transformer (Artiste / Oncor 160 only). See page 153.

lCAN Communication Coupler Electrical/optical transformer.

; m3 Trolley For quick, safe and easy mounting of the m3 onto the linac head and for safe storage of the device.


A m3 controllerProvides continuous safety interlock control and leaf position-ing control. Commands the m3 to move the leafs to the de-sired position.

S m3 Workstation

Workstation allowing communication with the m3 controller. Patient data and pre-planned leaf positions are loaded onto the workstation from Record & Verify system or directly from Treatment Planning System. It provides the Brainlab m3 User Interface software for monitoring the status of the m3.

Dm3 Communication Interface Board (CIFB)

Microprocessor to control Block Coding Generator and Gan-try Angle Sensor via CAN bus

F linac Console

GRecord & Verify System (R&V) e.g. Lantis/Mosaiq and PrimeView/RTT

H VGAT-Switch 2:1 Switch between m3 controller and m3 workstation monitor


5.2.2 linac Communication

General Information

The m3 workstation uses patient files that contain one or more m3 treatment fields. Each m3 treat-ment field defines one set of m3 leaf positions; it is similar to a custom block. The number of treat-ment fields in a patient file varies according to the number of static ports used and/or the parameters of a dynamic plan, which uses a series of fields.

When you select a treatment field at the R&V system, it transmits the information to the m3 work-station and further to the m3 controller. The controller commands the m3 to move the leaves to the desired positions. As the treatment progresses, the workstation displays the positions of the leaves.

Powering the m3 Controller

Electrical, software, or mechanical malfunctions detected by the m3 cause the m3 to assert a beam interlock to the integrated Siemens linac. This action prevents the integrated Siemens linac from de-livering the beam. To allow the integrated Siemens linac operation, be sure to power on the m3 con-troller while the integrated Siemens linac is in use, even when the m3 is not shaping the integrated Siemens linac beam. If power to the m3 is turned off, the m3 asserts the beam interlock to the inte-grated Siemens linac.

Software The m3 system includes both software and hardware. The m3 user interface software operates in the Microsoft Windows operating environment. For more information on the m3 software compo-nents, see page 126. For information on the m3 hardware, see the m3 databook.

During Setup When a treatment plan has been created using a treatment planing system, this plan includes one or more m3 field shapes. Each of these m3 field shapes gets assigned a corresponding MMxyyyblock code.

These block codes are recorded in the m3 file, which is exported by the treatment planing system to the m3 workstation. It also exports an *.rtp file to the R&V database server.

With the Brainlab m3 User Interface 3.0 it is possible to generate both fields for the m3 and the R&V database during DICOM import. The *.rtp data is transferred to the R&V database server.

As a next step the R&V system downloads the treatment plan onto the control console. Then the linac is set up with the respective treatment parameters. There the m3 workstation searches for the Treatment Setup Download (TSD).

If it detects an m3 file that has a copy on the m3 workstation, it opens this file.

If it does not find a file that has a copy on the m3 workstation, the m3 workstation stays in “not ready” state.

Once the m3 is ready the m3 workstation commands the BCG to present the resistor combination for the corresponding m3 field.

The linac control console displays the corresponding block code.

The setup is completed and the treatment can start.

During Treatment If an error occurs during treatment, for example a leaf is not positioned correctly, the m3 workstation commands the BCG to present the “not ready” block code to the linac control console.

This results in immediate termination of treatment delivery.

After Treatment When the treatment is complete, the m3 workstation closes the m3 file and commands the BCG to present the “not ready” state to the linac control console.


5.2.3 Communication Interface Board

General Information

The communication interface board is a microprocessor-controlled electronics controlling the block coding generator and the gantry angle sensor box via CAN-bus. It is installed in the m3 workstation.

It controls the interlock output lines of the m3 controller computer to allow beam interruption during m3 failure conditions. It passes the jaw values received from the m3 user interface and the gantry angles received from the gantry angle sensor to the m3 controller.


5.3 Mounting m3 on Siemens Artiste/Oncor 160

5.3.1 Siemens Interface Mount

General Information

The m3 Siemens Interface Mount Artiste & Oncor 160 is part of the m3 System. The Siemens Interface Mount for Artiste and Oncor 160 is provided as mechanical and electrical interface be-tween Siemens Artiste and Oncor 160 linacs and the Brainlab m3.

The electrical connection is by means of a multicore cable.

Electric Shock Type of protection against electric shock: class II equipment type B (IEC 60601-1).

Warning Label on Siemens Interface Mount

Siemens Artiste only:

If mounting in collimator position 0° is not possible and collimator position is in 180° it is necessary to route the cable counterclockwise! Otherwise, cable damage occurs during collimator rotation.

Figure 37


5.3.2 Torque Wrench

General Information

The torque wrench used for mounting the m3 Siemens Interface Mount onto the linac prevents the user from applying the wrong torque to the grub screws.

The torque wrench must be calibrated once a year.

How to Adjust the Torque Wrench

Before mounting the m3 Siemens Interface Mount onto the linac, the torque wrench has to be ad-justed to the correct torque:

Figure 38

Always use the provided torque wrench for tightening the grub screws on the Interface Mount. Only use 100 Ncm to tighten the screws. If you don’t utilize the torque wrench, the grub screws might be tightened using too little torque, which can either cause a backlash in the m3 mounting position or the m3 to fall out of the tray slot. Applying too much torque may result in equipment damage to the Interface Mount or the Acces-sory Holder.

Steps

1. Turn the adjustment ring a until the “0” mark of the adjustment ring points to the appro-priate scale mark indicating the desired torque, 100 Ncm.

2. After correct adjustment lock the settings with locking ring s as shown in the picture.

3. Mount the hexagon insert d to the tip of the torque wrench to tighten the two grub screws.

a

s

a

s

d


5.3.3 Mounting the m3

Step 1: Install the Interface Mount

Steps

1. Turn the gantry to 180° and the collimator to 0°

2. Slide the Interface Mount into the Accessory Holder. There is an audible click noise when the tray slot latch mechanism snaps in.

NOTE: There is a safety pin on the left side which has to be manually activated according to Siemens instructions.

3. Tighten the screws according to numbering se-quence engraved on the Interface Mount with the torque wrench supplied: 100 Ncm.

Screw a and s position the Interface Mount and must be tightened first. Screw d and f fixate the Interface Mount.

The torque wrench is only for tightening the screws. Never use the torque wrench to open the fixation pin.

Always use the Allen key supplied to open the fixation screws.

Verify correct alignment of the Interface Mount on the linac. There must be no play.

Always use two fixation screws and two grub screws to mount the Interface Mount for Artiste/Oncor160 and tighten them with 100 Ncm.

as

d f


4. Mount the Interface Mount in gantry position 180° and collimator position 0°. (See page 106.)

If it is not possible to mount in collimator position 0°, mount in collimator position 180°. You must route the cable counterclockwise! Otherwise, cable damage occurs during col-limator rotation.

Collimator at 180°.

5. Connect the plug from the red Interface Mount cable with the m3 connector in the gan-try.

Bring the red point of the plug and the red mark on the connector into a line and push the plug into the connector.

NOTE: There is an audible click when plug snaps in place.

6. Check during mounting if there is any visible damage to the Interface Mount, cable or plug.

If there is damage to any part, or if the red cable covering is unfastened from the interface mount, do not perform treatment!

Steps


Step 2: Mount the m3 on a Siemens Artiste/Oncor 160 Steps


2. Push the trolley towards the gantry until the bumpers touch the gantry:



a

s

d


4. Push the two red accessory mount buttons and lift the blue support until you hear a click-ing sound:

• a Red buttons• s Clicking sound• d Blue support frame• f Black lever

5. Slide the m3 fully onto the Interface Mount.

6. Make sure that m3 is moved to the end of the Interface Mount.


Steps

a

s

d

a

s

f

f


8. Pull the two black levers away from each other on the blue m3 support frame and press the blue support down until the two red accessory mount buttons click shut.


NOTE: Make sure that the blue m3 support frame completely locks in the lowest position. The middle position is only to prevent the m3 from falling out accidentally.

NOTE: When the m3 is mounted it is powered up, and the green LED on the Interface Mount indicates operating status.

Steps

a

s

s


Monitor the multicore cable carefully. The cable must not hang in the radiation beam and shall not touch the patient.

Always verify that all safety locks are properly locked!

9. Close the safety lock a:

10. The linac control console on integrated Siemens linacs displays Not ready for tray slot # 3.

11. The m3 is now ready to initialize.

Steps

a


How to Remove the m3 from a Siemens linac

Only open the m3 lock mechanism if you want to remove the m3. Open the lock mech-anism only in gantry position 180 (IEC 61217).

Steps


2. Move the trolley back to the gantry as demonstrated on page 106.

3. Apply the brakes to the wheels of the trolley.

4. Open safety locks (page 109).

5. Push the two red accessory mount buttons and raise the blue m3 support to the upper rest position.

• a Accessory mount red button• s Clicking sound• d Black lever• f Red button• g Blue support frame

NOTE: Make sure that the blue m3 support frame completely locks in the upper position. The middle position is only to prevent the m3 from falling out accidentally.

6. Push the red button on the right side of the m3 f and slide the m3 off the gantry.

7. Continue sliding until the m3 is moved against the stop pin on the trolley.

8. Pull the two black levers away from each other and press the blue support down until the two red accessory mount buttons click shut. Check that the m3 is locked on the trolley.

9. Release the brakes on the trolley wheels and move the m3 away from the gantry and park in a safe place.

10. Unplug the Interface Mount multicore cable.

a

s

d

f

g

a

s


Do not open tray slot latch mechanism when m3 is mounted. Always remove m3 be-fore opening the latch mechanism.

11. Using the Allen key supplied, release the grub (2x) and fixation (2x) screws. Screw out till stop.

12. Open the Siemens safety pin on the left side.

13. Open the Siemens tray slot latch mechanism by pushing the button as pictured and slide the Interface Mount out of the Accessory Holder.

Steps


5.4 Mounting m3 on Siemens Mevatron/Primus/Oncor

5.4.1 Siemens Interface Mount

General Information

The m3 Siemens Interface Mount is part of the m3 System. The m3 Siemens Interface Mount is provided as mechanical and electrical interface between the Siemens Mevatron/Primus/Oncor lin-acs and the Brainlab m3.


5.4.2 Torque Wrench

General Information

The torque wrench used for mounting the m3 Siemens Interface Mount onto the linac prevents the user from applying the wrong torque to the grub screws.

How to Adjust the Torque Wrench

Before mounting the m3 Siemens Interface Mount onto the linac, the torque wrench has to be ad-justed to the correct torque:

Figure 39

Always use the provided torque wrench for tightening the grub screws on the Interface Mount. Only use 500 Ncm to tighten the screws. If you don’t utilize the torque wrench, the grub screws might be tightened using too little torque, which can either cause a backlash in the m3 mounting position or the m3 to fall out of the tray slot. Applying too much torque may result in equipment damage to the Interface Mount or the linac tray slot.

If the torque wrench is not used for an extended period of time, it is recommended that it be set to 0 Ncm for relaxation of the internal spring tension mechanism. Remember to readjust the torque to 500 Ncm before using the torque wrench again.

Steps

1. Turn the adjustment ring a until the “0” mark of the adjustment ring points to the appro-priate scale mark indicating the desired torque, 500 Ncm.

2. After correct adjustment lock the settings with locking ring s as shown in the picture.

3. Mount the hexagon insert d to the tip of the torque wrench to tighten the two grub screws.

a

s

a

s

d


5.4.3 Mounting the m3

Step1: Installing the Interface Mount

Only open the m3 lock mechanism if you want to remove the m3. Open the lock mech-anism only in gantry position 180 (IEC 61217).

Always use two fixation screws to mount the Interface Mount and tighten them with 500 Ncm.

Steps

1. Turn linac gantry to 180° and collimator to 270°.

2. Mount the Siemens Interface Mount, sliding it into the tray slot.

3. Torque the two screws with 500 Ncm:

4. Mount the m3 safety rope around the linac Accessory Post:

Verify correct alignment of the Interface Mount on the linac. There must be no play.

Ensure that the safety rope is properly locked.

5. Connect power and fiber optics cable.


Step 2: Mounting the m3

Steps


2. Push the trolley towards the gantry until the bumpers touch the gantry:



a

s

d


4. Push the two red accessory mount buttons and lift the blue support until you hear a click-ing sound:

• a Red buttons• s Clicking sound• d Blue support frame• f Black lever

5. Slide the m3 fully onto the Interface Mount.

6. Make sure that m3 is moved to the end of the Interface Mount.


Steps

a

s

d

a

s

f

f


8. Pull the two black levers away from each other on the blue m3 support frame and press the blue support down until the two red accessory mount buttons click shut.


The m3 now powers up.

NOTE: Make sure that the blue m3 support frame completely locks in the lowest position. The middle position is only to prevent the m3 from falling out accidentally.

Steps

a

s

s


Always verify that all safety locks and safety rope are properly locked!

9. Close the safety lock a:

10. Connect the m3 and the Interface Mount on the linac with the m3 power cable and the fi-ber optic cable.

11. The linac control console on integrated Siemens linacs displays Not ready for tray slot # 3.

12. The m3 is now ready to initialize.

Steps

a


How to Remove the m3 from a Siemens linac

Do not open tray slot latch when m3 is mounted. Always remove m3 before opening the latch mechanism.

Steps


2. Move the trolley back to the gantry as demonstrated on page 106.

3. Apply the brakes to the wheels of the trolley.

4. Open safety locks (page 109).

5. Push the two red accessory mount buttons and raise the blue m3 support to the upper rest position.

aRed buttons

s Clicking sound

d Black lever

f Red button

g Blue support frame

NOTE: Make sure that the blue m3 support frame completely locks in the upper position. The middle position is only to prevent the m3 from falling out accidentally.

a

s

d

f

g

a

s


6. Push the red button on the right side of the m3 f and slide the m3 off the gantry.

7. Continue sliding until the m3 is moved against the stop pin on the trolley.

8. Pull the two black levers away from each other and press the blue support down until the two red accessory mount buttons click shut.

9. Release the brakes on the trolley wheels and move the m3 away from the gantry and park in a safe place.

10. Remove power and fiber optic cable.

11. Using the Allen key supplied, release the grub screws (2x). Remove the safety rope.

12. Remove Siemens Interface Mount.

Steps


5.5 Enabling the m3

5.5.1 Starting the m3 System

How to Start the m3 Once the m3 is mounted to the linac, you can start the m3 computer hardware and software.

The workstation computer must be booted prior to the controller computer to allow proper booting.

Steps

1. Rotate the gantry to 0° (IEC scale) or 180° (Varian scale). The gantry is now in the proper position for initialization.


2. Power on the computers, monitors, and printer. The m3 controller computer starts up, loads the system software, and then displays the following message:

m3 will start in 6 seconds: hit ESC to start m3 immediately hit any other key to get the DOS prompt

The Brainlab m3 User Interface software starts on the m3 workstation:

You can use the VGAT-Switch 2:1 to toggle between the m3 workstation and the m3 con-troller display. After initialization display the m3 workstation.

3. Controller initialization can take several minutes following power-up. If the controller does not communicate with the workstation, this dialog is displayed:

The gantry angle must be at either 0° (IEC scale) or 180° (Varian scale) during initializa-tion to ensure consistent leaf positioning. This dialog indicates that the controller is either not powered on or is disconnected. Ensure that the controller is properly connected to the workstation and the controller is powered on.

When you are sure all connections are intact and the controller begins to initialize, click Retry.

Steps


5.5.2 Daily Initialization

General Information

If your workstation remains switched on all the time with m3 running, perform these steps each morning to initialize the m3 controller from the workstation.

Initialization occurs automatically every time the m3 is powered on. The initialization process takes approximately three minutes. The m3 must be in a horizontal plane for initialization to occur.

When to Initialize Initialize the m3 on a daily basis or once every 250 patterns. The initialization process resets and checks the accuracy of the m3's two independent feedback systems for each leaf and side.

How to Initialize the m3

NOTE: When the m3 leaves stop moving, the initialization process is complete.

Initialization Failure In the event of failure during initialization, the m3 workstation displays an error message.

If repeated initializations fail, contact service personnel.

Steps

1. Rotate the gantry to 0° (IEC scale) or 180° (Varian scale). The gantry is in the proper po-sition for initialization.

2. At the m3 workstation, if the m3 field shape window is shown:

• Click Full in the View menu. • Click Initialize in the Collimator menu.

A dialog informs you that the initialization process takes approximately three minutes.

If the mlc shape display is not shown, initialize the m3 by restarting the m3 controller computer.

3. Click OK.

m3 begins the initialization process, moving the leaves into the starting position. The leaves on each side of the m3 extend and retract individually across a light field. The leaves repeat this process in the opposite direction. The m3 controller computer calcu-lates detected discrepancies and sends the results back to the m3 workstation.


5.5.3 Calibrating the Gantry Angle Sensor

General Information

The calibration of the Gantry Angle Sensor is triggered by the Brainlab m3 User Interface. If a calibration message is displayed, follow the instructions.

Figure 40

Ensure that the gantry does not move during Gantry Angle Sensor calibration.


5.6 Patient Treatment

General Information

Set up the m3 as described on page 102 or page 112, and power up the system.

Safety Notes


Patient Setup

Loading Patient Data

If you have created your patient files using iPlan RT Dose, you must export your data from iPlan RT Dose.

NOTE: Brainlab m3 User Interface 3.0 does not support BrainSCAN data.

For information on your planning system, consult the corresponding user guide.

Using Brainlab m3 User Interface 3.0, treatment plans created with a third party TPS can be loaded if they conform to the mechanical specification and the DICOM Conformance Statement.

Treatment

End of Treatment When you have delivered all treatment fields according to the treatment plan close the patient data and remove the patient from the couch.

Steps

1. Prepare and position the patient according to the treatment plan.

2. Verify the treatment position.

For further information, see the Hardware User Guide, Stereotactic Hardware and rele-vant positioning system manual.

Steps

1. Use Export via DICOM RT, and choose the correct Export Platform file for the corre-sponding record and verify system.

2. The first export platform file will automatically start a second export platform that transfers the DICOM RT file to the m3 workstation.

For further information on how to configure the export platform files, refer to the iPlan RT Dose clinical user guide.

3. Import the respective *.dcm file to the R&V system.

For further information, refer to the relevant R&V system manual.

4. Load the patient data on the R&V system.

Steps

1. Transfer the field from the R&V system to the linac console.

The corresponding field shape is automatically setup on the m3 workstation.

2. When the linac setup is verified, deliver the treatment field.

3. Repeat these steps until all planned field shapes are treated.


5.7 Software Description

5.7.1 Overview

General Information

The advanced m3 integration option for Siemens linacs offers a convenient and safe way for oper-ating the m3 MLC mounted on a Siemens digital linac. With this integration option the m3 automat-ically sets correct fields for the patient that is transferred from the R&V system to the linac console. It is possible for the advanced m3 integration to signal interlock conditions of the m3 to the linac.

Export from BrainSCAN

During the data export from the BrainSCAN treatment planning system to Lantis/Impac. Brain-SCAN generates two sets of *.rtp files during the export. The first *.rtp file is a conventional RTPLink file that is transferred to the MultiAccess computer and contains all treatment parameter except for the m3 leaf positions. The second file generated is a RTPConnect file that is transferred to an import directory of the Brainlab m3 user interface. This file contains all information of the RT-PLink file plus the m3 leaf position values.

BrainSCAN cannot be used for treatment planning for Brainlab m3 User Interface 3.0.

Export from iPlan RT Dose

iPlan RT Dose exports the data as a DICOM RT Plan. The Brainlab m3 User Interface imports the DICOM data and converts it to a RTPConnect file.

When exporting a DICOM RT treatment plan files from iPlan RT Dose to the m3 workstation, the Brainlab DICOM service receives the files on the m3 workstation and transfers the DICOM files to the local import directory.

During startup the m3 user interface imports the DICOM RT plan and converts it to an RTPConnectfile. Then it moves all files from the import directory to the working directory and renames the files to avoid overwriting existing files. The new file name consists of patient's last name, patient's first name, patient's ID and the course number of this treatment. All this information is extracted from the RTPConnect file. It is recommended to place the working folder on a server that performs regular backups of the files.

When importing DICOM data, the family or given name will be truncated to 20 charac-ters. If the patient ID is longer than 20 characters, import is aborted.

Communication Between the R&V System and the linac

During the operation of the linac with the m3 attached, the communication between the R&V system and the linac is observed and the commands for loading a new field are extracted. The relevant RTPConnect file is identified, loaded, and the leaf position values for the m3 are passed to the m3 user interface.

The block code is transferred to the communication interface board that distributes the value to the block coding generator. Once a hardware interlock of the m3 is detected this condition is signaled to the communication interface board which propagates the error condition to the block coding gen-erator. The block coding generator then switches to a special error code value prohibiting or inter-rupting radiation on the linac.


General Warnings

Do not change RTPConnect data files manually. Any change prevents the software from loading these files.

For Oncor/Primus/Mevatron, always verify that the primary jaws limit the treatment beam to 100 mm(in leaf movement direction) x 98 mm or less. For Oncor 160/Artiste, always verify that the primary jaws limit the treatment beam to 98 mm(in leaf move-ment direction) x 94 mm or less. Larger field sizes can cause incorrect dose delivery and equipment damage. Large field sizes result in interlocks in the m3 MLC controller software and prevent field delivery.

iPlan RT Dose treatment plans to be exported to m3 Advanced Integration must be ap-proved.


5.7.2 Brainlab m3 User Interface Software

Interface Software The m3 user interface provides functions to monitor and process the communication between the R&V system and the Siemens linac console:

• Loading the treatment specific data and transferring the leaf positions to the m3. • Controlling the network of additional linac accessories such as block coding generator or gantry

angle sensor. • Enabling you to remove patient files from the list of available files.

The m3 user interface is designed to work silently and not to disturb the workflow on the linac con-sole as long as there are no fault conditions.

User Interface

Figure 41


a Title Bar The current patient file name and the software name

s Patient Data The patient name, patient ID, plan date and plan ID.

d Treatment Information about the current loaded treatment field.

f System Status The status of every part of the m3 system. See page 134.

g MLCThe positions of the m3 leaves. See page 130.

• Retract: Retracts the m3 to its fully open position• Status: Displays a status dialog.

h m3 Status All interlocks must be cleared before treatment with the m3. See page 131.

a

s

d

f g

h


Menus

Menu Options

Patient

• Open file by name...(Ctrl + O): Open a patient treatment file by name.• Open file by data... (Ctrl + D): Open a patient treatment file by data.• Rebuild index (Ctrl + O): Imports the patient treatment plans from the input

directory (DICOM RT Plan) and rebuilds index of all patient data files (RTP).• Remove file: Delete patient file from the m3 data directory (see page 135).• Exit: Exit the Brainlab m3 User Interface.

Physics Opens the Physics dialog (Ctrl + P): see page 136.

Command

• Go: Moves the leaves to their planned treatment position for the current treatment field.

• Retract: Retracts the leaves to the fully open position.• Status: Opens a dialog that shows the current interlock status.• Close Status: Displays the Close Status dialog.• Park: Retracts the leaves to the fully open position and sets the BCG to

MML-NR.

ViewDisplays the Communication Log dialog. Enables you to toggle between the message log of the DMIP transfer and the log messages to the Communica-tion Interface board.

About Displays Brainlab m3 User Interface information.


5.7.3 MLC Shape Display

Full Mode To display the MLC Shape Display full mode, click Full in the View menu of the MLC area:

Figure 42

Menus

Menu Options

Mode

• Exit: Closes the MLC Shape Display. It should not be closed during the m3 treatment. The Brainlab m3 User Interface will try to restart the MLC Shape Display if this is attempted.

• About: Displays information about the MLC Shape Display.

Collimator

• Go: Moves the leaves to their planned treatment positions for the current treatment field.

• Retract: Retracts the leaves to the fully open position. • Recommended Jaws: Displays the Recommend Jaws dialog, which

shows the recommended position for the primary collimators on the linac. • Initialize: Repositions the leaves to a predetermined starting position

and releases motion errors.

View

• Full / Picture: Toggles between the Full and Picture views of the MLC Shape Display. When you select Full in the View menu, the window dis-plays information about the single leaf positions at the isocenter.

• Shape / Jaws: Disabled. Do not provide any changes in the view of the MLC Shape display.


5.7.4 Status Symbols

m3 Software Status Symbols

The color of the symbols indicates:

• Red: failure• Yellow: not ready• Green: OK• Blue: m3 park mode

Symbol Function Description

FAILED (red)

An event could not be completed successfully, except Invalid Plan, Not a Plan or Interlock.

In i t ia l izat ion Failed (red) A failure occurred during initialization.

Error (red) An m3 hardware error occurred.

Communication Error (red)

The MLC Shape Display software is not run-ning, or there was an error during communica-tion with this software.

Invalid Plan (red)

Loaded plan data is not valid or patient data is not available.

Not at posi t ion (red)

m3 leaves were not correctly moved to desired position.

Interlock (red)

Fault condition of m3 (e.g., no communication to m3 controller or secondary feedback failure).


Do not treat patients if there is a failure condition. Clear all interlocks before delivering the dose.

Beam Holdoff (red)

A Beam Holdoff occurred during a dynamic treatment.

Controller Interface Communication Error (red)

The connection between MLC Shape Display software and controller is disrupted.

System Error (red)

The block code generator, the communication interface board or the gantry angle sensor re-ports a problem.

Processing Plan (yellow)

The MLC Shape Display software is currently processing and validating the dynamic arc plan.

Initializing (yellow) The m3 is currently initializing.

Retracted (yellow)

m3 leaves are retracted to their home posi-tions.

OK (green) All events have been completed successfully.

Parked (blue) m3 is in parked position.

Symbol Function Description


The Brainlab m3 User Interface software is only released for workstation software ver-sion 4.8 and controller software version 4.9, or for workstation software version 5.0 and controller software version 5.0/5.1. For later versions please contact Brainlab ser-vice or your local Brainlab representative.

The displayed linac jaw positions must be reviewed for plausibility. Incorrect jaw po-sitions can cause incorrect dose delivery and equipment damage.

Do not close the Brainlab m3 User Interface software or change the m3 field setup dur-ing treatment. This causes treatment interruption.

System Status Symbols

The System Status area provides information about the current status of every part of the m3 sys-tem.

No information about submodule status (grey).

The submodule is working correctly (green).

The submodule is currently in fault condition (red).

The submodule is not available.


System Status Indicators

If the software indicates a failure of a hardware submodule, please check the cable connection. If all cables are connected, please contact your local Brainlab representative.

Indicator Description

m3 workstation Displays the communication status with the m3 user interface.

Communication interface

Displays the current status of the communication interface board built into the workstation.

If this device cannot communicate with the m3 user interface software (status red) no statement about the status of the follow-ing devices can be made:

• m3 mMLC, CAN communication• Block coding generator• Actual mMLC code • Gantry angle sensor

In this case, the indicators for these submodules are grey.

m3 micro MLC

Displays the current status of the m3 controller computer:

• Green: No interlock • Red: Interlock• Grey: No statement can be made e.g. due to a broken commu-

nication with the m3 user interface.

CAN communication

Displays the status of the CAN bus. This connects the block cod-ing generator and gantry angle sensor submodules to the com-munication interface board.

If this indicator shows an error or the bus status cannot be deter-mined the status indicators of the Block coding generator and the Gantry angle sensors are grey. The Actual mMLC codeturns to 8 dashes (“--------”).

Block coding generator Shows the operating condition of this submodule.

Actual mMLC codeDisplays the block code passed to the linac. In case of an error, this display can give additional information about the error as Ini-tializing or Block code out of range.

Gantry angle sensor Shows the status of the additional gantry angle sensor used for dynamic conformal arc treatments.


Patient Data Management

Treatment plan data should not be removed without verifying first that this data really has to be removed. Missing patient data inhibits treating the patient.

Click Remove file… in the Patient menu to display the Remove Patient Data dialog.

Figure 43

This enables the user to accelerate the file indexing during program startup or to remove patient data files from terminated patients, where patient IDs are identical in the first eleven characters to existing patient IDs. The Patient list can either be a sorted list of patients or a sorted list of patient IDs. The edit field allows restricting the contents of the displayed patient list to patient names or IDs that begin with specified characters. The right hand side of the dialog displays the treatment data of the select-ed patient.

Options

Press Remove to remove the selected patient data from the patient directory on the hard-disk. The data is not removed from the disk but moved to special folder, where it can be recovered if it was removed erroneously.

Press Done to close the dialog.


5.7.5 Physics Mode

General Information

The Physics mode dialog provides a fast method to adjust rectangular field sizes on the m3.

Physics Mode Dialog

Click Physics mode… in the Physics menu to display the dialog.

Figure 44

This dialog enables you to commission or expose portal films. To avoid erroneous irradiation of a patient with a shape created in the Physics mode the block code for all physics mode shapes is set to the special value MML-QA (MM8767). This special block code is used for quality assurance only and not for treatment.

NOTE: The jaw positions displayed in the Physics dialog do not reflect the actual settings but dis-play the limit jaw positions. This is to ensure that the m3 controller software does not generate any interlocks due to jaw values out of the m3 limits. The linac controller software restricts the maximum field size to 144 x 122 mm².

Options

Click one of the three buttons in the Predefined Shapes area to adjust the m3 to predefined and customized field shapes.

Enter values in the Synthetic Shapes area to create asymmetric shapes.

The Real Shapes (from Plan) area can be used for field verification.

• Click << Prev. Field or Next Field >> to cycle through the available fields. • Click Current Field to adjust the currently (via the R&V system) selected field.

Click Go to start the movement of the leaves

Click Close to close the dialog and sets the jaw display to the actual jaw values. This sets the field shape to the currently (via the R&V system) selected field and adjusts the block code to this value.


Adjusting Predefined Shapes

The Predefined Shapes can be adjusted in the initialization file blm3ui.ini located in the Windows directory:

[Physics]

PreDef1=6 x 6 mm², -3, 3, -3, 3, 0

PreDef2=80 x 6 mm², -40, 40, -3, 3, 0

PreDef3=100 x 98 mm², -50, 50, -49, 49, 0

The PreDef tags determine the buttons 1-6. The values for the buttons are specified as a comma separated list. The first value is the label of the button, followed by the field extensions perpendicular to the leaves and parallel to the leaves. The scale is similar to IEC61217 where both field boundaries are based on the same coordinate system. Thus a symmetric field has a positive and a negative ex-tension.

Example (Oncor/Primus/Mevatron):

PreDef1=100 x 98 mm², -50, 50, -49, 49, 0

Example (Oncor 160/Artiste):

PreDef1=98 x 94 mm², -49, 49, -47, 47, 0

The maximal field size differs due to a different mounting position.


5.8 Troubleshooting m3 Advanced Integration on Siemens

5.8.1 Overview

General Information

This information can help troubleshoot the m3 Advanced Integration on Siemens. If the problem cannot be solved by the following measures please contact Brainlab support.

Workstation and Controller Cabling

Figure 45

No. Component

a m3 workstation computer

s Communication interface board

d linac

f R&V

g CAN

h m3 controller computer

j D-SUB 25 pol

a

s

d

fg

h

j


Resolving Patient ID Ambiguities

Figure 46

The communication between the Siemens linac console and Siemens PrimeView uses a patient ID of 11 characters, however Lantis allows a patient ID of 16 characters. This might lead to several treatment data files on the hard disk containing patient IDs with the first 11 characters identical to each other. In this case, the m3 user interface is not able to determine the correct treatment data to load.

A dialog as displayed in Figure 46 appears and the user has to identify the correct patient manually. Usually this is only necessary for the first m3 field shape of the patient unless the order of the fields was changed in PrimeView. The functionality of the dialog is as described under “Patient Data Man-agement” on page 135, but the Remove button is replaced with the Open button, which opens the selected patient for treatment.

No m3 Field Data Upload

• Check DMIP (Digital Mevatron Interface Protocol) communication by opening the communica-tion log view using View -> Communication Log….

• Verify that a Treatment setup download on the R&V system is reported for every field down-loaded from the R&V system resulting in PV: Treatment setup download or PV: Treatment setup download 5.

• If there is no log check the cabling between linac console, the R&V system, and workstation computer

• Check if the corresponding patient m3 data file is available in the working directory. See “Patient Data Management” on page 135.

• If not, transfer the m3 data file into the corresponding data directory.

If the patient *.rtp file was changed/corrupted after its creation, the software does not open the altered *.rtp file.

• Load the patient again in the treatment planning software and export the data with the same course ID as described in the treatment planning software user guide. There is no need to export the data into the R&V system. However, the corresponding data should now be available on the m3 workstation.

Do not change *.rtp data files. The software does not load a changed file.

• In case of an patient ID with more than 11 characters, the patient data is not uploaded. Change the patient ID to 11 or less characters.

• Treatment plans with duplicated block codes are rejected, thus the patient cannot be treated. The reason is that a particular field has to be identified on the m3 side by the m3 user interface using the patient ID, the treatment course ID, and the block code. If one block code is present several times in a treatment plan the correct treatment field for m3 cannot be safely determined.


Wrong Block Code

None The linac accessory box #3 displays None at the linac console. This means the BCG is powered off. This is always the case when the m3 is not mounted.

MMabcd A valid block code is displayed but does not correspond to the expected value.

• Reset the BCG by removing the m3 power cable for approximately 30 seconds. • Initialize the m3 and upload patient data on the linac console again. • If the BCG still displays the wrong block code contact Brainlab support.

MML-NR This block code is set for any failure detected by the m3 user interface or the m3 communication interface board.

• Examine the m3 status and eliminate all interlock conditions, see “ADDITIONAL INFORMA-TION” on page 161.

• Verify that the correct patient data is uploaded and corresponds to the data displayed on the linac console.

• Reset the BCG by removing the m3 power cable for approximately 30 seconds. • Initialize the m3 and upload patient data again on the linac console. • If the BCG still displays MML-NR contact Brainlab support.

Communication Software Status Lights

Communication Interface Board Failure

Are the serial cables connecting the communication interface board and the m3 workstation plugged in correctly?


Block Coding Generator Failure

• The BCG is not accessible by the communication interface board.• Check the connections at the communication interface board. • If all connections are properly plugged in, reset the BCG by removing the m3 power cable and

plug it in again. The green power LED on the BCG box is lit and signals ON status. The two yellow LEDs are flashing and signal data transfer to the communication interface board.

m3 Failure Always start the m3 workstation before starting the m3 controller.

• Check m3 user interface status by pressing the Status button. In case any error occurs, refer to the error message for detailed information on resolving the problem.

• Try to initialize. If initializing is possible, the basic connections (power supply, fiber optic cables) are correct.

• Check the communication cables between the m3 controller, workstation and communication interface board.

Gantry Angle Sensor Failure

• Status “grey”: The Gantry Angle Sensor is not installed or cannot be detected.

• Status “red”: The Gantry Angle Sensor is not responding correctly or has detected an internal failure.

CAN Communication Failure

Check if the CAN cable is connected correctly.


5.8.2 Beam Interlock Messages

General Information

If the m3 workstation detects an unsafe condition, it sends an interlock to the linac by changing the block code to MML-NR. The m3 workstation displays an appropriate message in the status area of the m3 window. The m3 cannot enter Treat mode when any of these messages (except Not in Treat mode) is displayed.

If the problem persists, contact your Brainlab support.

Excessive CRC Errors

The controller computer has detected an excessive number of errors while communicating with the m3 head unit.

Jaw Position The actual jaw positions are not within 5 mm of the recommended jaw position.

Not in TREAT Mode The workstation is not in Treat mode.


The collimator rotation setting for the treatment field does not match the collimator rotation setting on the linac.

* Clinac IL - Coll. angle invalid

The m3 controller has received an invalid collimator angle from the linac. This can be caused by a communications error.

* Clinac IL -Gantry angle invalid

The m3 controller has received an invalid gantry angle from the linac.

* Clinac IL - Invalid dose fraction

The m3 controller has received an invalid dose fraction from the linac.

* Clinac IL - Lower coll. invalid

The m3 controller has received an invalid lower collimator position from the linac.


The m3 controller has received an invalid upper collimator position from the linac.


The m3 controller has received an invalid upper collimator position from the linac.

Step

Review jaw positions in the treatment planning system and export the treatment plan again to the m3.

Step

Clear all interlock conditions following the information in this chapter related to the particular con-dition.

Step

Adjust the collimator rotation.

Step

Check the connection between the m3 workstation and the m3 controller.

Step

Check the connection between the m3 workstation and the m3 controller.


* Clinac not in DBD More than one carriage group was defined, but the treatment mode was neither DBD Electron nor DBD X-ray.

* Clinac not in Port Film

The m3 controller is in Port Film mode and the linac is not.

* Clinac/MLC - Dynamic mode mismatch

There was an invalid attempt to combine arc dynamic and dose dynamic treatments.

* Collimator initialization failure

The controller computer encountered an unrecoverable hardware error during its booting initializa-tion, such as being unable to locate a leaf's calibration zero position.

* Controller IL - Carriage service

A hardware error has been detected by the m3 electronics. This includes m3 power supply status.

* Controller IL - Clinac COM

An error has been detected in the communication link between the linac and the m3 controller.

* Controller IL - Clinac not ready

The m3 controller has determined that the linac is not in the ready state.

* Controller IL - CRG A tail exposed

The linac's collimator jaw position does not provide sufficient coverage behind the leaves to prevent radiation leakage.

* Controller IL - CRG B tail exposed

The linac's collimator jaw position does not provide sufficient coverage behind the leaves to prevent radiation leakage.

* Controller IL - Dyn. plan not loaded

In Dynamic mode, the plan in the controller is corrupted.

Step

Synchronize linac and m3 by setting the correct dynamic mode.

Step

Re-initialize the m3.

Step


Steps

1. Check the cables between the m3 workstation and the controller.

2. Re-initialize the m3 and retry the operation.

Step


Step


Steps

1. Transfer the patient file again.

2. Open the patient file.


* Controller IL - Ilock circuit failed

A hardware fault in the m3 interlock circuitry has been detected. This circuitry includes the hardware watchdog, solid state relays, and the controlling logic. This failure has been detected during initial-ization or during normal operation when the status of the watchdog and interlock solid state relay are being monitored continuously.

* Controller IL - Incompatible mode

The controller computer received a request for a mode that is not one of the valid modes (Service, Clinical, Port Film, Data Entry, or Park).

* Controller IL - Initializing

The controller computer is initializing the m3 leaves, either on initial power-up or in response to the user command from the workstation computer. This interlock condition releases when the initializa-tion is completed.

* Controller IL - Leaf in field

The controller has detected a leaf in the treatment field when the leaves are expected to be fully re-tracted, such as during electron treatments, off-line, or in Park mode.

* Controller IL - Leaf position

A leaf not in its target position.

* Controller IL - Leaf service

A hardware error has been detected by the head electronics. This includes head power supply sta-tus.

* Controller IL - m3 Hardware COM

The controller computer has detected a communication problem with the m3 hardware. This is usu-ally detected as a communications timeout, that is, an expected message was not received from the target device before the timeout period expired.

* Controller IL - Motion error

The controller has detected a failure while obtaining leaf position data. It may be due to either a hard-ware failure code from the position readout circuitry or a time out waiting for a data valid status from the high speed link to the m3 head.

* Controller IL - Secondary position

The controller has detected that one or more leaves is out of tolerance between the position deter-mined from the primary positioning mechanism and the position indicated by the secondary feed-back.

Step


Step

Re-initialize the controller.

Steps

1. Re-initialize the controller.

2. Reload the plan.

Step

Re-initialize the controller.

Steps

1. Check the cables between the m3 and the controller.

2. Restart both workstation and controller.


* Controller IL - Taxi A/B swapped

During initialization test the controller has determined that the Taxi A and B optic cables are swapped. The m3 interlock cannot be cleared while this condition exists.

* Controller IL - WS COM timeout

The controller computer has detected a communications problem with the workstation. This is usu-ally detected as a communications timeout; that is, an expected message was not received from the target device before the timeout period expired.

* Controller IL - X Jaws moved / * Controller IL - Y Jaws moved

These messages indicate that one of the jaws moved during treatment. When this occurs, m3 exits Treat mode.

* Controller IL - Y1 Exposes CRG box / * Controller IL - Y2 Exposes CRG box

These messages indicate that part of an m3 carriage is not adequately blocked by either the X or Y jaws. This occurs when an X jaw is more retracted than recommended (determined by the position of the most retracted leaf on the side) and a Y jaw is retracted beyond the boundary defined by the outer most leaf pair (either leaf pair 1 or leaf pair 26 or 40). This interlock prevents you from entering Treat mode.

Any adjustment to the jaw positions represents a departure from the treatment pre-scription. If this interlock message appears at the time of setup for a patient treatment, it indicates that an error was made during the treatment planning process. The pre-scribed treatment should not be changed without the authorization of the appropriate treatment planner and physician.

* Edit mode The edit function is selected.

* Leaf plan and actual do not match

A leaf or some leaves are not in their planned positions, according to the currently selected patient-treatment field.

Steps

1. Swap the A and B carriage optic cables.

2. Re-initialize the m3.

Steps

1. Check the cables between the workstation and the controller.

2. Re-initialize both workstation and controller.

Step

Stop the jaw movement on the linac.

Steps

1. Examine the graphics area of the m3 window to determine which carriage corner is ex-posed to the beam path.

2. One of the following actions releases the interlock. Either:

• Extend the appropriate X jaw so it is at or within its recommended position, or,• Extend the Y jaw so it is at or within the outer edge of either leaf pair 1 or leaf pair 26 or

40 as appropriate.

Step

Press F2 Go, and all leaves move to their planned positions.


* No plan loaded No patient file is open.

* Workstation-Controller COM

A communications error between the workstation and the controller is detected. This is usually de-tected as a communications timeout; that is, the workstation computer sends a message to the con-troller computer and does not receive a reply before the timeout period expires.

Step

Open a patient file.

Steps

1. Check the cables between the workstation and controller.

2. Restart both workstation and controller.


5.9 Accessories for m3 Advanced Integration on Siemens

5.9.1 m3 Power Supply

Brainlab m3 Power Supply

Figure 47

Safety Notes The equipment connected to the power supply (directly or indirectly) does not have its own power supply or is specially designed for this application.

There are hazardous voltages inside the m3 power supply. Do not remove the power supply cover. There are no user serviceable parts inside.

Always use the Brainlab m3 power supply when m3 is mounted to Siemens linacs. The use of other power supplies can cause equipment damage and even patient or user injury.

Do not obstruct ventilation slots on the power supply cover.


Technical Data

In case the over current protection or short-circuit protection is activated, turn off the power supply, and allow m3 power supply to rest about 30 seconds before turning it on again.

Only use cables and equipment released by Brainlab in combination with the m3 pow-er supply originally supplied. Brainlab is not responsible for any interference caused by using other than recommended interconnect cables or by unauthorized changes or modifications to this equipment. Unauthorized changes or modifications could void the user's authority to operate the equipment.

Protection class I (according to EN 60601-1)

Protection group B (according to EN 60601-1)

Input• 115-230VAC /50Hz/60Hz• Fuse: 250V, 3.15AT

Switch 1/0 Light switch indicates power on status

Output

m3 power connector:

• 15V 10A max• 5.7V 10A max

m3 accessory connectors (4x):

• 12V 1A max

Over current protection for I >10A

Shortcut protection Max. 175W


5.9.2 m3 Gantry Angle Sensor

General Information

The gantry angle sensor is installed inside the linear accelerator. The sensor measures the gantry angle and transmits the angle by a CAN (controller area network) connection to the m3 workstation for further processing.

Gantry Angle Sensor

Figure 48

Safety Notes

Do not remove the gantry angle sensor cover. There are no user serviceable parts in-side.

Always use the Brainlab power supply to power the sensor. The use of other power supplies can cause equipment damage and even patient or user injury.

Do not connect third-party devices to the sensor or to the CAN bus of the m3 system. The connection of third party devices can cause equipment damage and even patient or user injury. Use the sensor only within the m3 environment.


Technical Data

Protection class II (according to EN 61010-1)

Protection class 2 (according to EN 61010-1)

Measurement category CAT I

Environment rating Standard (according to EN 61010-1)

Equipment mobility Built in device (part of an electrical-medical system according IEC 60601-1-1)

Marked degree of protection to IEC 60529 IPX0

Input 12 V DC (powered by a certified Brainlab power supply) / 400mA

Output CAN bus connectors

LEDs• Green LED switch: power on status• Yellow LEDs: CAN data transmission


5.9.3 m3 Block Coding Generator

General Information

The block coding generator (BCG) is a microprocessor controlled electronic device that generates the correct resistor combination for the block.

The m3 block coding generator is installed inside the linear accelerator. The device transmits block codes from the m3 system to the linear accelerator. Block codes are used to verify the MLC shape field during a radiotherapy treatment. Block codes consist of four variable electrical resistances, which are set by the m3 block coding generator. The current block code is received by a CAN (con-troller area network) connection from the m3 system.

Resistor Combinations

The BCG passes resistor combinations to the linac during interlock or error conditions.

• If the BCG is not powered it does not pass the resistor combinations to the linac.• If the BCG is powered but does not receive information from the communication interface board

it sets the block code to MML-NR.

Block Coding Generator

Figure 49


Safety Notes

Do not remove the cover of the block coding generator. There are no user serviceable parts inside.

Do not remove the cable connection from the block coding generator to the linear ac-celerator. The disconnection of this cable can cause equipment damage and even pa-tient or user injury.

Always use the Brainlab m3 power supply to power the block coding generator. The use of other power supplies can cause equipment damage and even patient or user injury.

Do not connect other third-party devices to the block coding generator or to the CAN bus of the m3 system. The connection of third party devices can cause equipment damage and even patient or user injury. Use the generator only within the m3 environ-ment.

Technical Data

Protection class II (according to EN 61010-1)

Protection class 2 (according to EN 61010-1)

Environment rating Standard (according to EN 61010-1)

Equipment mobility Built in device (part of an electrical-medical system according IEC 60601-1-1)

Marked degree o f p ro tec t ion to IEC 60529

IPX0

LEDs• Green LED switch: power on status • Yellow LEDs: CAN data transmission.

Input 12 V DC (powered by a certified Brainlab power supply) / 400mA

Output• CAN bus connectors• linac output, which is connected to the accessory tray slot #3 and #4

(Plug p41) of Siemens linear accelerators


5.9.4 Insulation Transformer

Insulation Transformer

Figure 50

Where to Use The insulation transformer (and the m3 system) can be used in regions with 115 V or 230 V AC mains power and 50 or 60 Hz frequency.

Changing Voltage To change mains power, you must exchange the fuse at the rear end of the transformer.

Both configurations are possible for 50 and 60 Hz.

Green LED The green LED at the front end indicates the connection of valid power mains. It does not indicate the status of the m3 system.

Potential Equalization

The transformer is equipped with one POAG bolt (according to DIN 42801) at the rear end. It is used to connect the device with the potential equalization of the room. The protective earth conductor is connected with the corresponding conductors on the output side. Through the transformer is also equipped with a potential equalization according to the relevant safety standards for medical elec-trical devices (EN60601-1:2007) and systems (EN 60601-1-1).

Continuous Operation

The transformer is designed for continuous operation. A thermal switch in the primary coil avoids damages caused by excess temperature in the device.

Safety Notes

Do not remove the cover of the transformer. There are no user serviceable parts in-side.

Do not connect third-party devices to the insulation transformer of the m3 system. The connection of third party devices can cause equipment damage and even patient or user injury. Use the transformer only within the m3 environment.

For detailed instructions consult the original supplied user guide of the insulation transformer man-ufacturer, Noratel.

Voltage Fuse

115 V 6.3 AT

230V 3.15 AT


5.9.5 Insulation Monitor

General Information

The insulation monitor measures the earth leakage of the m3 system continuously. If the current (measured via the resistance) exceeds a certain limit (50 kOhm) the monitors signals an optical and acoustic warning.

Insulation Monitor

Figure 51

How the Insulation Monitor Works

The insulation monitor is powered on automatically at the same time as the m3 system. Within five seconds it performs a self-test.

After the self-test the green LED is lit continuously. During operation this test is repeated automati-cally every 8 hours.

NOTE: You can also perform the self-test by pressing the test button.

Error Situations If the maximal dielectric resistance is exceeded, the yellow LED is lit continuously and an acoustic warning signal sounds.

To deactivate the acoustic signal, press the reset button.

The LED is lit until the error is eliminated. If the system is turned off during an error and turned on again without eliminating the error, the acoustic signal is reactivated.


a Green LED Lit when power on

s Yellow LED Lit when maximal dielectric resistance is exceeded

d Reset button Fault release

f Test button Manually starts self-test function

a

s

d

f


Safety Notes

If the insulation monitor detects an error, please inform the Brainlab support immedi-ately.

Do not remove the cover of the transformer. There are no user serviceable parts in-side.

Always use the supplied insulation transformer to power the insulation monitor. The use of other power supplies can cause equipment damage and even patient or user injury.

For detailed instructions consult the original supplied user guide of the insulation monitor manufac-turer.


6 QUALITY ASSURANCE6.1 Chapter Overview

6.1.1 Contents


QA Program Page 158


6.2 QA Program

6.2.1 Overview

General Information

Quality assurance (QA) for the micro-Multileaf Collimator (m3) should be part of a comprehensive quality assurance program for the linear accelerator.

In addition to the QA program mentioned you must perform a Winston-Lutz test prior to each treat-ment (see page 26). For further details, refer to the Hardware User Guide, RT/RS Stereotactic Hardware.

Key Parameters The key parameters for the m3 are the same parameters that determine the consistent functioning of the linear accelerator:

• Light field versus beam limiting device (leaf end) setting• Light field versus radiation field coincidence• Output versus field size, depth dose

These parameters are checked routinely as part of an on-going linac quality assurance program; the addition of the m3 should not introduce any new quality assurance parameters.

QA Program Goals Quality assurance of radiation therapy equipment is primarily an on-going evaluation of functional performance characteristics. These characteristics influence the geometrical and dosimetric accu-racy of the applied dose to the patient. Quality assurance monitors equipment performance against the baselines set at the acceptance and commissioning of the equipment. The functional perfor-mance of radiotherapy equipment can change slowly due to deterioration and aging of the compo-nents or can change suddenly due to an electronic malfunction, component failure, or mechanical breakdown.

The m3 uses both primary and completely independent secondary position readout systems cou-pled with a system of interlocks to continuously monitor equipment performance. See “ADDITIONAL INFORMATION” on page 161.

Daily initialization of the m3 recalibrates the leaves relative to an absolute datum set by the photo-electric relay permanently mounted to the m3. Initialization also checks the operation of m3 inter-locks. Any degradation in m3 performance under the specified level generates an interlock that prevents the linac from beaming on.

Baseline Standards An m3 QA program should be based on the baseline standards set at acceptance testing and com-missioning of the equipment. Candidate baselines set at acceptance testing are:

• Leaf accuracy• Leaf repeatability• Leaf interdigitization in all orientations.

Dynamic use of the m3 may require the development of additional performance baselines. The pro-gram should also reflect QA procedures advocated by relevant professional literature and groups, such as the American Association of Physicists in Medicine, International Electrotechnical Commis-sion, and American College of Medical Physics.

Baseline Prerequisites

Valid baseline m3 performance data is dependent on the correct calibration of both linac and m3parameters.

• Check and calibrate the linac crosshairs and light field, if required. See “Verification of the Base-line Standards” on page 159.

• Verify the m3 offset values for leaf bank skew, leaf gap, leaf bank offset, and leaf end curvature.

To assure test repeatability as part of the ongoing m3 QA program, use the same instruments and procedures used to set the m3 performance baselines for monitoring those baselines.


Verification of the Baseline Standards

The need for high geometric and dosimetric accuracy in stereotactic radiotherapy/radiosurgery re-quires a special quality assurance program.

The rotational axes of the gantry and the treatment couch should intersect within a sphere of diam-eter < 1.0 mm for any position of the gantry and couch. The central axis of the collimator beam has to intersect this sphere, defined as the isocenter.

For further details on verification, see the Hardware User Guide, Stereotactic Hardware and the user guide for your linac.


7 ADDITIONAL INFORMATION


7.1.1 Contents


m3 Jaw-Related Interlocks Page 162

VARiS Versus Standalone Operation Page 164

m3 Files Page 166


7.2 m3 Jaw-Related Interlocks

7.2.1 Situations Where the Interlock is Asserted

General Information

The only criterion for an m3 jaw interlock condition is whether or not the light field is an accurate indication of the radiation area. The light field is not valid (and the interlock is asserted) in the follow-ing cases.

X Jaw Retracted Beyond Tail of Most Extended Leaf

An X jaw is retracted beyond the “tail” of the most extended leaf, resulting in a shielding gap as shown below.

Figure 52

To release this interlock, move the jaw or move the leaves so the tails are adequately shielded.

Y Jaw Retracted Beyond the Outside Edge of the Outermost Leaf

An X jaw is retracted sufficiently beyond the edge of the defined shape coincident with a Y jaw re-tracted beyond the outside edge of the outermost leaf. In this case, a corner of the leaf carriage blocks light but does not provide shielding against X-ray beams (see Figure 53 ).

Figure 53

To release this interlock, extend the Y jaw to overlap the outside edge of the outermost leaf, thereby covering the leaf carriage, or extend the X jaw to just behind the boundary of the leaf-defined shape, covering the leaf carriage (see Figure 54).

Figure 54


7.2.2 Situations Where Interlock is not Asserted

General Information

In some unusual conditions the interlock is not asserted.

As it is valid to define a treatment area using a combination of leaves and jaw, these could be inten-tional plans. Since the jaws are not in their recommended positions, the responses described in “Jaw Recommendations” on page 45 can occur. However, since the light field accurately shows the treat-ment region, the m3 does not assert an interlock.

Exposure Outside the Edge of Outermost Leaf in the Y Jaw Direction

In Figure 55, the jaws are not all in the recommended positions, but verification via light field does show the actual area of exposure. It could be a valid plan.

Figure 55

In Figure 56, the jaws are not in the recommended positions, but verification via light field does show the actual area of exposure. It could be a valid plan. Treatment is allowed.

Figure 56

Jaw (X or Y) inside the Area Defined by the Leaves

In Figure 57, the jaws are not in the recommended positions, but verification using light field does show the actual area of exposure. It could be a valid plan. Treatment is allowed.

Figure 57

NOTE: For m3 Advanced Siemens Integration it is not possible to have leaves or jaws blocking the isocenter.


7.3 VARiS Versus Standalone Operation

7.3.1 Overview

m3 and Shaper Differences

This sections describes some of m3’s and Shaper’s functional differences regarding jaw positions when run as standalone applications compared to when each is run from within VARiS.

Refer to the flow diagram in Figure 58 as you read through these sections.

Standalone Operation

When you attempt to enter Treat mode, if the actual jaw positions reported by the linac do not match the recommended jaw positions, one of three results occurs, depending on how the Jaw Recom-mendations option is set. See “Jaw Recommendations” on page 45 for further details.

VARiS Operation When the m3 receives a leaf plan from VARiS, it automatically moves the leaves to their target po-sitions and (providing there are no m3 interlock conditions present) automatically enters Treatmode.

NOTE: No messages or warnings are displayed if the actual and recommended jaw positions do not match. The reasons for this behavior are as follows: The purpose of VARiS is to automate the treatment process to the extent possible. Additional oper-ator actions and confirmations are intentionally minimized. The plan stored in the VARiS database at the time of treatment is a result of diligent and detailed treatment planning. In the treatment planning process, the treatment planner takes both leaf and jaw positions into consideration when determining the optimal values to achieve the desired clinical re-sults. VARiS does not attempt to override such a plan.

Standalone Operation

When you attempt to enter Treat mode, if the actual jaw positions reported by the linac do not match the recommended jaw positions the Recommended Jaws option displays a message box showing the recommended jaw positions. This message box is for informational purposes only.

Shaper does not save recommended jaw positions as part of the patient file. If, in the absence of a more sophisticated treatment planning process, you want these values to become part of the treat-ment plan entered at the linac, you must record and transfer them manually to the linac setup plan according to your clinic’s policies.

VARiS Operation When you attempt to enter Treat mode, if the actual jaw positions reported by the linac do not match the recommended jaw positions the Edit Jaw Plan menu option displays a dialog listing the recom-mended jaw positions along with text boxes showing the current jaw plan positions from the VARiS database.

This dialog also contains the Apply Recommendations button, which replaces the plan positions in the text boxes with the recommended values. When you click OK, Shaper saves the jaw position values that appear in the text boxes in the VARiS database as new plan positions.


m3 Response to linac Jaw Positions

Figure 58

Jaws in recommended

positions?

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Cancel

Treat

Leaf tails covered by jaws?

Carriage boxes covered by jaws?

Interlock asserted

Running in VARiS?

Jaw alert on

Display Jaws not at recommended

Password required?

Clear dialoges not in Treat mode

Correct password entered?

OK to treat?

Yes

(Level 1)

Yes (Level 2)

(Level 0) positions


7.4 m3 Files

7.4.1 Overview

General Information

Several files are necessary for operation of the m3. Some of these files are supplied at the time of installation, and others are created during the course of normal operation.

File Format When run as a standalone application, m3 creates standard ASCII text files (“patient files”) contain-ing the leaf position information. The m3 workstation can read and use the information in the patient files.

Naming Conventions

Patient file names must follow the DOS file naming convention of a maximum of eight characters with up to a three-character extension (even if you use Windows 95 or Windows NT, which allow longer file names). If you do not provide an extension for file names, both Shaper and m3 use the following conventions:

Controller Files Mlcx.exe is the software application that runs on the m3 controller computer. It handles the low-level calculations and commands which result in the m3 motor movement. The controller computer automatically starts this application when it is booted.

Patient Data Files When you create patient files with the m3 or Shaper software applications, the files are created in an ASCII text format.

Siemens Integration Files

:

Type of Patient File File Name Extension

Static plan .mlc

Dose Dynamic plan .DOS

Arc Dynamic plan .ARC

Backup file .Bxx (where xx is a serial number)

Type of Patient File Files

Patient data DICOM and RTP files

m3 user interface software settings•blm3ui.ini

• import platform *.ini


7.4.2 Workstation File Descriptions

General Information

The m3 workstation computer contains the user interface software: the part of the system with which you interact when you use the m3 software.

Mlcws.exe This file provides the user interface of the m3 system and runs under the Microsoft Windows oper-ating environment. When you start the workstation computer, it starts Windows and executes Ml-cws.exe.

Init0001.txt; Init9999.txt

This file is created following initialization. It contains initialization data which is useful to service per-sonnel. Delete initialization files that are more than 30 days old.

Log001.txt; Log999.txt

Whenever an AutoCycle is performed from Service mode, a cyclelog file is created. This file con-tains a time and date record for each field pattern achieved. This information can help you determine the frequency and timing of infrequent events. Unless there is reason to save these files for service records, you can delete them at any time to free up disk space. Delete cyclelog files that are more than 30 days old.

Mlctable.txt This file contains a table of physical leaf positions versus isocenter projection positions in ASCII text format.

Mlc.ini This file is created when you set one of the options in the Configure menu (which is available in Service mode only). The service password and other configured items are saved in this file.

Cmp.dll Dynamic link library utilized by the software.

Arc.dll Dynamic linked library utilized by the software.

Windows 3.1 path C:\MLC

Windows 95 and Windows NT path C:\Program Files\Varian\MLC

Windows 3.1 path C:\MLC\Initdata

Windows 95 and Windows NT path C:\Program Files\Varian\Log

Windows 3.1 path C:\MLC\Cyclelog

Windows 95 and Windows NT path C:\Program Files\Varian\Log


Windows 95 and Windows NT path C:\Program Files\Varian\Config

Windows 3.1 path C:\Windows

Windows 95 and Windows NT path C:\Winnt






Dynamic.dll Dynamic linked library utilized by the software.

Crcaen16.dll Dynamic linked library utilized by the software.






7.4.3 m3 Integration Software File Description

Safety Notes

The import platform files contain crucial settings for a correct treatment. Specifying the wrong settings might cause a mis-administration of the treatment. Therefore the setting files shall not be changed by the customer.

Verify the export by comparing the original planning data with the database entries.

The user shall not change the configuration file blm3ui.ini. The user has to be aware that changes within the setting file could lead to a fault treatment of the patient.

Whenever the system indicates a Communication error during any treatment modality that resumes after restarting the system, immediately call Brainlab support.

Displayed linac jaw positions must be checked for plausibility.

For integrated Siemens: the Leaf Tolerance for Dynamic Arc is defined by the Brainlab user interface software.

Ensure that the gantry does not move during the calibration of the relative inclinometer.

blm3ui.ini The following table contains example values:

Entry Description

TreatmentMachine= ONCOR160,ARTISTE,

Defines the treatment machine to identify beams for the m3 Advanced Integration.

CodeSize=675Specifies the range from 1..676 to 676 values. As blockcode "MM8676" is not allowed (except for QA), the CodeSize for Siemens is specified as 675 values.

CodeMax=6075

The number of all available block codes. Defined by the Y parameter range times the X parameter range 9 values (0. . . 8)

(Number of all possible codes for Siemens: 9 * 675=6075).

Ratio=i.e. 1.59236A machine-specific configuration for the m3 Ad-vanced Integration.

ScanModeDicom=*.dcm File extension for DICOM file.

DeleteDirectory= c:\brainlab\m3data\delet-ed\

Default path for deleted DICOM and RTP files.

ImportDirectory= c:\brainlab\m3data\im-port\

Default path for DICOM import.


In the blm3ui.ini Physics] section, the configuration of the Predefined Shapes can be modified (see page 137). The values are comma separated, e.g.:

PreDef1=6 x 6 mm², -3, 3, -3, 3, 0

• The first value defines the button label. • The second and third values define the bank A and B. • The forth and fifth values define the jaw Y1 and jaw Y2. • The last value defines the leaf gap position.

RTPDirectory= c:\brainlab\m3data\

Default path to store RTP files.

ScanModeImportPlatform= * RTP.ini

File extension of the import platform settings file.

ImportPlatformPath= c:\brainlab\m3data\plat-forms\

Path where the import platform file is stored.

LogFile= c:\brainlab\m3\log\

Location of DICOM log file.

GenerateFieldID=1

Generates a new field id that consists of:

• 1: Course ID and field number; • 0: Only the field number.

SerialNumber=09756 Unique serial number of the angle sensor.

InvertSign=BankB

Options: BankB/BankA

Inverts the sign of the specified bank, if required (IEC61217/IEC)

InvertSignForce=0

Options: 0/1.

Inverts the sign of the specified bank, irrespective of whether if this is required or not (IEC61217/IEC)

DefinitionsPath= C:\Brainlab\m3\DMIP\

Path where the DMIP definitions are expected.

Version= 13The DMIP version. If empty, the software tries to de-termine the correct DMIP version. This only works, if the corresponding DMIP definition is available.

Ports are assigned to the functions of the user interface under the section [Ports] of the .ini file.

Resource= c:\brainlab\m3\resource\

Path for software resources.

Workstation= c:\Program\Files\Vari-an\mlcws.exe

Location of workstation application.

ControllerVersion=5.0 m3 controller version.

Mounting=Right/Front/Left m3 mounting.

ArcTolerance

The maximum deviation between planned and actual leaf position during dynamic arc movement. The lower the arc tolerance the higher the accuracy that is achieved during treatment and more interlocks are en-countered. The higher the tolerance the more tolerant the leaf position can be.

ForceAlwaysOnTop=trueWhether the Workstation software stays on top of all other programs

Entry Description


m3_RTP.ini/RV_RTP.ini

Entry Description

RTPDirectory= c:\brainlab\m3data\

Storage path for the m3 RTP files.

SwapBanks=1

Options: 0/1

Swaps banks A and B in the resulting RTP file. Default is enabled, as this is necessary for the m3. This entry must be handled with care, as it mirrors the shape.

SwapLeaves=0

Options: 0/1

Swaps leaf 1 to N in the resulting RTP file. This entry must be handled with care, as it mirrors the shape.

WriteControlPoints=0

Options: 0/1

Defines for a m3 Advanced Integration field whether control points are to be exported.

InvertJaws=0

Options: 0/1

Defines for m3 Advanced Integration field if jaw values shall be converted to IEC61217 (0) or IEC/DIN (1).

InvertTableAngle=0

Options: 0/1

Defines for m3 Advanced Integration field if the table angle shall be converted to IEC61217/DIN (0) or IEC (1).

DoseRateForArc=0

Options: 0/1

Sets the dose rate to 0 for all arc treatments. Related to the R&V system.

SetupBeams=1

Options: 0/1

1: Convert Setup Beams from DICOM to the RTP format. Setup Beams do not contain mlc leaf positions and shall therefore only be imported for the R&V RTP file.

CodeString=MM$1x$3y Identifier to calculate the Siemens block codes.


8 GLOSSARY8.1 Chapter Overview

8.1.1 Contents


Terms and Abbreviations Page 174


8.2 Terms and Abbreviations

Arc Therapy

Radiation therapy in which the source of radiation is moved through an arc about the patient during treatment. In this way, a larger dose is built up at the center of rotation within the patient’s body than on any area of the skin. Multiple arcs may be used. Syn-onymous with arc treatment and rotation therapy.

Attenuation Reduction of the intensity of radiation upon passage through a medium caused by ab-sorption and scattering.

BeamA unidirectional or approximately unidirectional flow of electromagnetic radiation or particles. Also, the flow of therapeutically useful radiation energy through a defined ar-ea.

ClinacVarian trade name for a range of linear accelerator models used in cancer treatment and stereotactic radiosurgery. On C-Series Clinacs, isocenter is located at a TAD (tar-get-to-axis distance) of 100 cm.

CollimatorA block of radiation-attenuating material with one or more fixed or movable apertures. The collimators in the treatment head of the linac define the treatment field and limit the angular spread of the radiation.

CRC Cyclic Redundancy Check: A method for ensuring data reliability by detecting errors which might be introduced during the data-handling processes.

Digitize A process for creating data points from a port film image to be used in a treatment field.

Dose Distribution The variation of dose in any region of an irradiated object.

Extend (leaves) Moving the collimator leaves toward the beam centerline. Opposite of Retract.

FieldThe set of parameters which define a single m3 treatment segment, including leaf po-sitions, collimator and gantry angles, notes and shape data. The m3 accepts up to 200 fields in a patient file. Also referred to as “treatment field”.

GantryThe entire rotating unit of the linac that emits the treatment beam. The upper part of the gantry includes the linear accelerator and electron gun; the lower part contains a coun-terweight or a retractable beam stopper.

IEC Scale

One of two available operator interface conventions for indicating the mechanical posi-tion of the linac along its motion axes. IEC scales differ from the alternate (Varian) scale primarily in the way that rotational positions are indicated. In the IEC scale, the reference (home) position for rotation is 0°. If an observer is standing at isocenter fac-ing the rotation bearing, position values increase as the axis rotates clockwise for the gantry and collimator and counter clockwise for the couch (see “Collimator Rotation Angle: Varian and IEC Scales” on page 79).

InterlockA software instruction, electrical circuit, or mechanical device that stops or prevents the operation of the m3 or linac, or the application of power to its primary systems until one or more preliminary conditions have been met.

Isocenter

The point in space about which the gantry, collimator, and treatment couch rotate in common. The intersection of the gantry axis of rotation and the collimator bearing axis. If the treatment site is aligned with the isocenter during arc therapy, the site dose does not change as the gantry rotates.

Jaws Movable primary collimators on the linac. Can be independently controlled from the pendant or control console. See also Collimator.


Light Field

An area on the patient’s skin that is illuminated by a projection lamp in the treatment head. The dimensions and alignment of the light field duplicate those of the treatment field. Using a light field facilitates positioning the patient for X-ray treatment by identify-ing the area of beam entry.

ParameterAny of a set of physical properties whose values determine the characteristics or be-havior of something. An operating value or coefficient entered in a data space on the monitor screen which falls within the range of acceptable values.

Park Mode A standalone m3 operation mode in which non-m3 treatments can occur.

Patient File An m3 file that contains treatment fields for a particular patient. A patient file can store up to 200 fields.

Port Film Exposure

A radiograph taken with the patient interposed between the linac portal and an X-ray film. The purpose is to demonstrate that the treatment field on the patient is properly set up.

Radiation BeamA unidirectional or approximately unidirectional flow of electromagnetic radiation or particles. Also, the flow of therapeutically useful radiation energy through a defined ar-ea.

Retract Moving the collimator leaves away from the beam centerline. Opposite of Extend.

SimulationUsing a simulator (diagnostic quality X-ray beam on a therapy type mounting) to deter-mine the various treatment field outlines and orientations to be used during radiation therapy.

Simulation Films X-ray films taken on a simulator with the same field size, target-to-skin distance, and orientation as a therapy beam.

SSD Source-to-Surface Distance. The distance measured along the radiation beam axis from the effective location of the source to the surface of the irradiated object.

Treatment Field The set of parameters which define a single m3 treatment segment, including leaf po-sitions, collimator and gantry angles, notes, shape data, and magnification factor.

Treatment Plan An ensemble of machine settings and parameters designed to produce a prescribed dosage pattern in and for the patient; includes spatial and temporal distributions.

TPS Treatment Planning System

Varian Scale

One of two available operator interface conventions for indicating the mechanical posi-tion of the linac along its motion axes. Varian scale differs from the alternate (IEC) scale primarily in the way that rotational positions are indicated. In Varian scale, the ref-erence (home) position for rotation is 180°. If an observer is standing at isocenter fac-ing the rotation bearing, position values increase during counter-clockwise rotation of the gantry and collimator and clockwise rotation of the couch (see “Collimator Rotation Angle: Varian and IEC Scales” on page 79).

X-rays, X-ray FilmsPenetrating electromagnetic radiation whose wavelengths are shorter than those of visible light. In the linac, X-rays are produced by bombarding a metal target with fast electrons in a high vacuum.


INDEX

INDEXA

About menu (Siemens) ......................................... 129Actual mMLC code .............................................. 134Advanced Integration (Siemens)................................. 98arc dynamic

availability ........................................................ 34treatment ......................................................... 34

arc therapy ....................................................... 174arc tolerance ....................................................... 80Artiste ............................................................. 102attenuation ....................................................... 174AutoCycle function ................................................ 72

BBCG

See block coding generatorbeam interlock .......................................... 41, 58, 81beam interlock messages (Siemens) ......................... 142beam, described ................................................. 174block code ........................................................ 100

MML-NR ........................................................ 140none............................................................. 140wrong ........................................................... 140

block coding generatordescription ...................................................... 151failure ........................................................... 141linac communicationstatus............................................................ 134wrong code ..................................................... 140

Brainlab m3 User Interface ..................................... 122BrainSCAN, data export ................................. 125, 126

CCAN communication

failure ........................................................... 141status............................................................ 134

Change Service Password function ............................. 78circular field size ................................................... 94cleaning............................................................. 27clinac.............................................................. 174Clinical mode (Varian) ....................................... 50, 64closed port films ................................................... 62closing m3 software (Varian) ..................................... 65collimator

defined .......................................................... 174rotation............................................................ 69

Collimator menu (Varian) ......................................... 70collisions............................................................ 22Command menu (Siemens) .................................... 129communication interface board

defined .......................................................... 101failure ........................................................... 140status............................................................ 134

compatible Brainlab medical instruments....................... 13

compatible Brainlab medical software .......................... 14conditions

operating ......................................................... 27storage............................................................ 27

conical collimators................................................. 89controller

files .............................................................. 166power ............................................................. 41use in m3 system ................................................ 35

CRC............................................................... 174creating data files (Varian) ....................................... 53custom block tray.................................................. 35

DData Entry mode (Varian) ................................... 50, 64data integrity, loss of .............................................. 24default directory.................................................... 45default patient path ................................................ 45diagnostic information............................................. 76digitize ............................................................ 174digitizing field shapes ............................................. 52disk files, m3 ..................................................... 166disposal instructions ................................................ 9DMIP (Digital Mevatron Interface Protocol) .................. 139documentation ..................................................... 18dose distribution, defined ....................................... 174dose dynamic treatments......................................... 34dynamic index ..................................................... 69dynamic treatment................................................. 60

editing leaf positions for.................................... 61, 75

Eediting dynamic plans ............................................. 75electron tube ....................................................... 71emergency and safety ............................................ 19extend (leaves) .................................................. 174

FF1 Patient ..................................................... 51, 66F2 Go .......................................................... 51, 70F3 Retract ..................................................... 51, 70F4 Field ........................................................ 51, 68F5 Edit .................................................... 51, 55, 70F6 Treat ....................................................... 51, 71falling parts ......................................................... 24Field menu (Varian) ............................................... 68field, defined ..................................................... 174file name extension

.arc ................................................................ 73

.Bxx ............................................................. 166

.dos......................................................... 73, 166files


INDEX

controller........................................................ 166naming conventions ........................................... 166workstation ..................................................... 167

fireelectrical .......................................................... 23

function keys ....................................................... 51F1.................................................................. 51F2.................................................................. 51F3.................................................................. 51F4.................................................................. 51F5.................................................................. 51F6.................................................................. 51

Ggantry angle sensor

calibration....................................................... 124description ...................................................... 149failure ........................................................... 141status............................................................ 134

gantry, defined ................................................... 174guides............................................................... 18

Hhazards, safety..................................................... 22

IIEC scale .................................................... 79, 174initialization

automatic ......................................................... 71controller.......................................................... 47daily on Varian ................................................... 48

inspectionsfurther periodical ................................................. 28yearly.............................................................. 27

installation and shipment ......................................... 30insulation monitor................................................ 154insulation transformer ........................................... 153interlock

considerations, jaw-related ................................... 162defined .......................................................... 174messages....................................................... 161Treat mode ....................................................... 58

iPlan RT Dose, data export.............................. 125, 126isocenter, defined................................................ 174

Jjaw positions ....................................................... 93jaw positions, recommended ..................................... 45Jaw Recommendations function ................................. 77jaws, defined ..................................................... 174

Kkeys

function keys ..................................................... 51

LLantis ............................................................... 99leaf position tolerance............................................. 80leaf positions ....................................................... 35

editing in dynamic plans ........................................ 61editing in service mode ......................................... 75

light field .......................................................... 175linac scales......................................................... 79

Mm3

initialization (Siemens) ........................................ 123mounting on Artiste/Oncor160 ............................... 104mounting on Mevatron/Primus/Oncor ....................... 114mounting on Varian ............................................. 42starting on Siemens ........................................... 121starting on Varian................................................ 46system setup on Siemens ...................................... 98system setup on Varian......................................... 40

m3 micro MLC status ........................................... 134m3 User Interface software .............................. 122, 128maintenance ....................................................... 27manuals ............................................................ 18maximum distance over centerline .............................. 56maximum leaf spread ............................................. 56maximum retract position......................................... 56Mevatron ......................................................... 112MLC Shape Display ............................................. 130Mode menu (Varian) .............................................. 64Mosaiq .............................................................. 99

Nnetworking.......................................................... 34note symbol ........................................................ 49Novalis conical collimators ....................................... 89

OOncor ............................................................. 112Oncor 160 ........................................................ 102Options menu (Varian)............................................ 76

Pparameter ........................................................ 175Park mode........................................................ 175Park mode (Varian) .......................................... 50, 64Password

Service mode .................................................. 167password

jaw recommendations................................. 45, 59, 78Service mode .......................................... 45, 50, 75

patient data management ...................................... 135patient files ....................................................... 166

backing up........................................................ 45creating (Varian) ................................................. 66defined .......................................................... 175details ........................................................... 166printing (Varian).................................................. 67saving (Varian)................................................... 66use in workstation ............................................... 35

Patient menu (Siemens) ........................................ 129


INDEX

Patient menu (Varian)............................................. 66Physics menu (Siemens) ....................................... 129Physics mode (Siemens) ....................................... 136port film

closed ............................................................. 62defined .......................................................... 175taking.............................................................. 62

Port Film function .................................................. 71power failure ....................................................... 25power supply (Siemens) ........................................ 147predefined shapes, customizing ............................... 137PrimeView .......................................................... 99Primus ............................................................ 112projected opening ................................................. 76

Qquality assurance

rotational axes ................................................. 159

RR&V system ...................................................... 126radiation beam ................................................... 175Recommend Jaws function....................................... 71recommended jaw positions................................. 59, 77removing patient data ........................................... 135responsibility

clinic............................................................... 26retract, defined ................................................... 175return instructions ................................................. 30rotation angle ...................................................... 79RTP connect file ................................................. 126RTP link file ...................................................... 126RTT ................................................................. 99

Ssafety inspection form............................................. 29safety precautions ................................................. 19scales

IEC ................................................................ 79linac ............................................................... 79Varian ............................................................. 79

Service mode (Varian) ................................. 50, 65, 75Shaper software .............................................. 36, 52shapes, digitizing .................................................. 52shock

electrical .......................................................... 23Siemens Interface Mount (SIFM) ................................ 99

Artiste ........................................................... 102Mevatron/Primus/Oncor....................................... 112Oncor 160 ...................................................... 102

Siemens, Advanced Integration.................................. 97Siemens, integrated m3 setup ................................... 98simulation films .................................................. 175simulation, defined .............................................. 175size of jaw field..................................................... 93smoke detection ................................................... 23software integrity, loss of ......................................... 25software on Varian ................................................ 49Software status symbols........................................ 131Special menu (Varian) ............................................ 73SSD ............................................................... 175static treatments .............................................. 34, 57status symbols (Siemens) ...................................... 131

storing............................................................... 27support.......................................................... 8, 30

TTAD (target-to-axis distance) .................................. 174torque wrench

Artiste/Oncor 160 .............................................. 103Mevatron/Primus/Oncor ...................................... 113

TPS ............................................................... 175training.............................................................. 17treatment

arc dynamic ................................................. 34, 73dose dynamic ............................................... 34, 73dynamic........................................................... 60linac without m3 ................................................. 64static ......................................................... 34, 57

treatment fields ............................................... 35, 50defined .......................................................... 175editing (Varian)................................................... 55

treatment plan ................................................... 175Treatment Planning System.................................... 175Treatment Setup Download (TSD) ............................ 100troubleshooting .................................................. 138

Uunsafe conditions.................................................. 81user guides......................................................... 18

VVarian scale ................................................. 79, 175VARiS

using m3 with .................................................. 164VGAT-Switch

location ........................................................... 99using ............................................................ 122

View menu (Siemens) .......................................... 129View menu (Varian) ............................................... 74

WWEEE................................................................. 9Winston-Lutz test .................................................. 26workstation ....................................................... 134

XX-ray films ........................................................ 175


INDEX

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