myQA SRS - Quick Start Guide

This chapter provides a streamlined workflow to get the device setup and SW started quickly. For detailed device setup, additional information can be found in:

• Chapter 3 and Chapter 4 of this document
• myQA Platform Instructions for Use
• myQA Patients Instructions for Use

Install the myQA Software

• Right-click myQAFull.exe > Run as administrator.
  
• Follow the installation instructions.
• Activate license keys with the IBA License Manager (installed with myQAFull.exe)
  
  • For data storage, the full SQL Server version is recommended
  • For issues, please contact register@iba-group.com
• Allow myQA through Windows Defender Firewall:
  Type “Allow an App through Windows Firewall” in the Windows search bar and click to open the Control Panel.
• Check Domain, Private, and Public for the myQA Apps.
  
• Click OK.

Install myQA SRS Service

• Connect the myQA SRS via ethernet cable to your computer and turn ON the device.
• In the myQA SW DVD, right-click myQA SRS Service Setup.exe > Run as administrator and follow the installation instructions.

Factory Uniformity Correction

The myQA SRS has been corrected for uniformity before delivery. Before using the myQA SRS, the Factory
Calibration File (USB stick) must be placed in the C:\ProgramData\IBA Dosimetry\SBRTAdapter\Store.

Assembling the myQA SRS Phantom

Note: Please note, the myQA SRS Phantom2 does not require assembly. The following section only applies             to the myQA SRS Phantom (the first version; V1) and the myQA SRS Cyberknife Phantom.

• Insert the cap into to the cylinder so the three holes on both parts are aligned.
• Please ensure there are no air gaps between the two pieces.
  
  To aid in orientation of the phantom, the top of the phantom body has a “THIS
  SIDE UP” sticker. If the sticker is missing, please contact IBA Dosimetry. When
  the phantom is properly assembled, there should be one screw hole at the top
  (1) and two at the bottom (2).
  Note: To ensure proper alignment of the SRS sensor, the insert slot is slightly asymmetric with respect             to the x-axis of the main phantom body. It is important that the zero orientation is respected                for QA measurement tasks, calibration procedures, and proper handling of the inserts.

Preparation of the myQA SRS Phantom in the TPS System

If using the Virtual CT dataset, ensure you are using the correct dataset for the correct phantom type, see
Section 2.6.

Determine the reference dose with a CT scan:

• Place the myQA SRS in the myQA SRS phantom (detector-phantom assembly) and position it in the CT scanner using the alignment lasers.
  Note: If using the myQA SRS Cyberknife, ensure that the fiducial / filler plate has been secured to the            detector area with the alignment pins before inserting it into the myQA SRS Cyberknife Phantom.
• Align the CT origin with the isocenter markings (1).
  
  • The solid lines on the phantom body indicate the isocenter.
  • The myQA SRS Phantom2 has additional dashed lines that are 1 cm off center from the isocenter markings (2). These can be used for offset measurements to aid with alignment.
• Position the device phantom assembly in the CT scanner so the central point of the measurement is at the CT origin.
• Point zero of the measurement system always coincides with point zero of the CT data set (the DICOM origin)
• In the TPS, the isocenter can be positioned precisely at the DICOM origin.
• Scan the entire phantom, taking care to not scan the electronics area of the myQA SRS.
  Note: If using couch kick with the myQA SRS, irradiation of the electronics may be unavoidable. See               Section 8.8 for more information.
  A CT slice thickness of 2.5 mm or smaller should be used with standard departmental scanning protocol for soft tissue (pelvis, abdomen) imaging.

Cross-Calibration with TPS / Chambers

• Import the CT scan into the TPS.
• Create an external contour and perform mass density overrides of the following:
  • the phantom body (1)
  • the device housing (2)
  • the detector area (3)

Example CT image with myQA SRS Phantom2 dimensions

Note: If required, add a support (couch) to the CT scan.Example of possible mass density overrides:

•  
  • myQA SRS Detector (ABS): 1.040 g/cm3
  • myQA SRS Phantom2 (RW3): 1.045 g/cm3
  • Detector area (High Z Material): N/A

See Section 2.1 in myQA Patients Instructions for Use for more information on densities.

Note: Homogeneous density override is possible with RW3 density for the whole assembly.

• Verify the structures against the dimensions of the detector-phantom assembly (total height of the
  phantom and distance to isocenter).
  Note: Pay attention to phantom type when verifying dimensions. The dimensions of the different                   phantoms are available in Section 7.2.
• On the image, set a point on the plane that corresponds to the LINAC isocenter alignment marks on
  phantom surface and is shown on both coronal and transverse views. Label it.
• In the TPS, create an open reference field (it is recommended to use the same algorithm as the patient plan) at 0° and have the system calculate the dose using a grid size of 2.5 mm or smaller.
• Find the isocenter plane and export the dose. The isocenter is set up geometrically based on the depth and central chamber position in the TPS image.

For cross-calibration with a calibration chamber:

• Align the phantom on the couch.
• Place the chamber in the chamber insert of the phantom.
• Attach the chamber to an electrometer, measure the background, and pre-irradiate the chamber.
• Irradiate an open field (dimensions and MU according to TPS) and write down the chamber reading.
• Apply all necessary correction factors to the chamber reading
• Repeat the cross-calibration 3 to 4 times in order to ensure that the reading is stable.
  Note: If not done by the electrometer, apply the KTP correction and calculate the dose. Verify the                  calculated measured dose matches the dose calculated by the TPS. 

Virtual CT for the myQA SRS Phantom and myQA SRS Phantom^2

CAUTION: VERIFY CORRECT VIRTUAL CT DATA
A virtual CT is available for both the myQA SRS Phantom (V1) and myQA SRS Phantom2. The user should verify the selection of the correct virtual CT data for any plan QA verification purposes.

See the Virtual myQA SRS Phantom CT Dataset Quick Guide or Virtual CT myQA SRS Phantom2
Quick Guide for more information.

Import and Prepare the Virtual SRS Phantom in the TPS System:

• Download the Virtual CT scan of the myQA SRS Phantom or myQA SRS Phantom^2, and the corresponding structure file.
• Import the CT scan into the TPS. Verify the import contains the correct number of images:
  • myQA SRS Phantom: 262 CT images
  • myQA SRS Phantom2: 194 CT images
• In the TPS, position the isocenter at the DICOM origin (0,0,0).
• Check that the CT scan resolution is 1 mm.
• Optional: Adjust Window width and level of the CT images.
• Select the HU display tool in your TPS system and verify the Hounsfield Units (HU) of the CT scan or crosscheck the HU:
  • myQA SRS Phantom / myQA SRS Phantom^2: 45 HU [Default]
  • myQA SRS dectector: 0 HU [Default]

Cross Calibration with TPS:

• Verify the dimensions of the phantom in the Virtual CT.
• Verify the HU against the densities of the SRS systems using your CT HU to electron or mass density
  conversion curve. When needed override to the corresponding densities.
• Create an open reference field (recommended: 10 cm × 10 cm open field, 100MU) at 0° and have the system calculate the dose using a grid size of 1.25 mm or the one used clinically for SRS plans.
• Verify SSD:
  • myQA SRS Phantom: 90.5 ± 0.1 cm.
  • myQA SRS Phantom^2: 95.1 ± 0.1 cm.
• Find the isocenter plane and export the dose.

Setup the Device

• Place the myQA SRS or the detector-phantom assembly on the treatment couch. Ensure the device electronics face away from the LINAC gun and is not within the irradiated area.
  Note: For Halcyon / Ethos users, place the assembly in the center of the couch.
• When using the detector-phantom assembly, use the handles of the phantom to lift and / or adjust the detector position and alignment.
• Align to the isocenter using the room-lasers (1) and light field (2). Connect the power and Ethernet cables and power ON the device.
  
  A: Alignment to the isocenter, B: Offset alignment
• For acquiring longitudinally extended plans, the myQA SRS Phantom2
  has a dashed line set 6 cm from the isocenter see Section 4.1 myQA Patients Instructions for Use for Combine Fields measurement procedure.

If you are using the myQA SRS for the first time, check the NIC settings:

• Type “Device Manager” in the Windows Search bar and click to open the Control Panel.
• Go to Network Adapters > Internet Ethernet connections and right click.
• Go to Properties > Advanced. Check the following settings / values:
  • Receive buffers, change value to 2048
  • Jumbo packet, change to 9014 Bytes
  • Interrupt Moderation Rate, change to High
• Click OK.

Setup a Clinic / Machine / Device in myQA

• Open myQA. Enter the default username and password. username: admin, password: admin
• Navigate to myQA Platform (1) > Equipment Setup (2) and create a new Clinic (3)
• Create a New department / room (4) and machine (5)
  
• Define Beam Quality Index (BQI) prior to measurement. Please calculate the BQI according to the
  selected energy (MV).
  BQI definition LUTs is performed according to IAEA TRS-398; therefore, conversion of the beam quality is needed for customers using TG-51 beam quality definition. The simple ratio of D200/D100 should not be used as beam quality specifier for the LUTs. LUTs are for the density overrides as specified below.

Note: All energies used during measurement QA MUST have a BQI defined. The customer is responsible for             the BQI value of their own machines.

        Please verify the LUT tables used. The LUT Creator tool is available for customers to create custom                lookup tables (see Chapter 5 of myQA Platform Instructions for Use).

Add the myQA SRS as detector

• Click New detector (6) to open the Detector Editor.
  
• If the device is connected / online, it will appear under Online devices (this can take up to 30 seconds during the first connection).
• Click Copy device properties, name the device, and click Save.

Detector Calibrations

Preconditions: Warm-up and pre-irradiation have been performed.

The user can create Output and Dose rate calibrations for the myQA SRS device.

Create an Output Calibration:

• Select the myQA SRS device in the Calibrations section. Click Edit.
• The myQA SRS Editor opens, click the New output calibration button.
  Please ensure that a background measurement has been performed.
• Enter the necessary information for the Machine and Reference value sections (The reference value
  used is from the TPS dose or the measurement with a chamber).
  Recommendation: Perform the output calibration at the maximum dose rate of the dose rate
  calibration.
• For the output calibration enter the MU value into the LINAC console.
  Note: Use the same MU, field size and energy used in the TPS calculation (e.g., 100 MU, 10 cm × 10               cm, 6MV).

Perform a measurement:

• Click Measure to start the measurement.
• Turn on the beam.
• Click Stop when the beam has been delivered.
  Note: You can perform multiple measurements (at least 3 are recommended). The final measured                 value will be an average of all the measurements.
• Enter the necessary information in the Save as section of the Output Calibration dialog.
• Click Finish. The myQA SRS Editor opens with the new output calibration (Calibration measurements are listed in order of oldest to newest).

Create a Dose Rate Calibration (for conventional myQA SRS only):

• Select the myQA SRS device in the Calibrations section. Click Edit.
• The myQA SRS Editor opens, click the New dose rate calibration button.
• A background measurement is mandatory.
  If it is not available the Background Compensation Editor pops up. Enter the sampling time and click the Compensate button. Enter the necessary information for the Machine and Measurement sections.
• Click Measure to start the measurement. Repeat the procedure to measure the next dose rate.
• After a minimum of three measurements at three different dose rates have been performed, the
  calibration can be saved. Enter the necessary information in the Save as section of the Dose rate calibration dialog.
• Click Finish. The myQA SRS Editor opens with the new dose rate calibration.
  Note: If there are any issues with the measurements, a detailed warning will appear under the list
           of measurements.

Add a Patient

• Switch to the myQA Patients (1) workspace. 
  
• Click Import DICOM to import a new patient (2). The Select study to import dialog opens
• Under the File Based tab, click Update and select the correct file.
• In the Import dialog select the Patient, RTDOSE, and RTPLAN boxes.
• Click OK to create a patient and import the datasets
• Select a patient and click Create project from selected patient (3).
• Enter a name and the appropriate source axis distance.

Perform a Measurement

• Place the myQA SRS Phantom assembly on the treatment couch; the detector is aligned and power it on. A 30-minute warm-up time is required before performing clinical measurements.
• If using the conventional myQA SRS for LINAC, place the GS+ on the Gantry and turn it on.
• Go to the MeasuSrement (1) workspace.
  
  The Measurement ribbon for myQA SRS device with conventional LINAC
  
  The Measurement ribbon for myQA SRS device with Cyberknife. When using Cyberknife the Device status and calibration section changes and the Angle sensor button is greyed out.
  Note: For the myQA SRS Cyberknife angular information is extracted from the path.xml file                           corresponding to the respective treatment. Please see Section 2.4.2 in the myQA Patients                       Instructions for Use.
• In the Equipment section, choose the online device and accelerator. Click Connect (2).
• Open the Background (3) dropdown menu and ensure the settings are correct.
• Click Measure Background (or the Background icon) to start the background measurement.
• Only for myQA SRS with conventional LINACs: Click Angle Sensor (4) and follow the instructions in the Bluetooth Angle Sensor Selection and Setup dialog.
• Click on Settings (5) and ensure the following parameters are correct:
  Machine Tab: Machine and Energy
  Detector Tab: Rotation and SSD Phantom
  
  
  Calibration Tab:
  • Conventional myQA SRS: Output calibration, Gantry angle correction, and Dose rate calibration
    Note: Gantry angle correction is energy dependent.
  • myQA SRS Cyberknife: Output calibration and Angular & source position correction.
    
• For the Beam Detection Tab retain the default settings.
• Choose the Measurement Mode (6) from the dropdown menu and click Start (7).
• Turn on the accelerator and irradiate the patient plan. Click Stop after the irradiation is done.

Analyze the Measurement

• Go to the Home (1) workspace
  
• After the measurement stops, the integral dose, which is computed automatically, can be found in the Measurement folder (2).
  • Before analyzing the measurement, check to see if all factors were applied. In the Measurement
    folder simply check to see if there is a green tick (3).
  • For easy comparison, drag-and-drop measurements and TPS dose to different panes.

Note: For an SRS TPS, the software expects the lower resolution image (TPS) to be used as the                       reference, and the high-resolution image be used as the comparison.

• For aligning the images in the A and B panes, click the Align data icon. 
  This opens the Align data… dialog showing the alignment information.
• Click OK when the images have been aligned.
• Click (in the lower-right pane). The Gamma results are shown on the right of myQA Patients. The default Gamma Parameters are a distance of 3 mm and a threshold of 3%. These values can be changed according to the specific PQA validation protocols being used.
• Check the passing rate (4) in Verification results.
  
• You can track your Workflow status (5) to indicate the progress of the plan: Import – Measure – Verify – Finalize – Approve.
  
• Click Approval (6) to open the Approval dialog (6a). Here you can indicate if the project is Open,
  Approved, Needs revision, or Declined. Comments can be added if necessary. Click OK to close the dialog.
  
• Save your project (7) and click Print (8) to generate a Plan Verification Report.
• Select the Plan Verification Report type (10). If Default is selected, choose a Template (11).
  
• Select how you would like to generate the Plan Verification Report page for report example.
  
• When finished click Close (9) to close the current project. You can now exit the program or start with the next patient.

Plan Verification Report Example

myQA SRS for Machine QA

The myQA SRS can be used for machine QA: 

• Profile constancy test with myQA SRS device and buildup plates 
• Numerical test for output constancy check with myQA SRS Phantom and chamber adapter 

For Machine QA measurement of small fields with myQA SRS device, a dedicated analysis protocol called Small Field (<5 cm x 5 cm) is available which covers measurements for field sizes <5 cm x 5 cm. For more information about analysis protocols and computed parameters, see Chapter 7 of myQA Platform Reference Guide.

Profile Constancy for myQA SRS in myQA

myQA SRS device is available as measurement device in myQA Machines for Profile constancy test as part of the Dosimetry QA tests. In order to perform profile analysis, a set of RW3 buildup plates for myQA SRS are also available (see Section 3.2.4 and Build-up Plates).

• Setup the build-up plates on the detector to collect the correct measurements. See Section 4.4.
  

For Machine QA, myQA SRS device supports energies of: 

• Photons from 1.2 (60Co) to 15 MV, and
• Electrons from 6 to 15 MeV.

Electron energies of around 4MeV are not supported by myQA SRS device due to the internal build-up (2 cm) of the detector which could lead to small undetectable signals. 

Multiple analysis protocols are already available in myQA Machines for standard photon and electron field sizes (e.g., 5 cm × 5 cm – 40 cm × 40 cm) which together with myQA SRS device can match water phantom standard square field sizes up to 12 cm × 12 cm as illustrated to the right. 

For Machine QA measurement of small fields with myQA SRS device, a dedicated analysis protocol called Small Field (<5 cm x 5 cm) is available which covers measurements for field sizes <5 cm x 5 cm. For more information about analysis protocols and computed parameters, see Chapter 7 of myQA Platform Reference Guide.

myQA Machines

To setup a profile constancy test with myQA SRS in myQA Machines, the following steps shall be followed: 

• Switch to the myQA Machines workspace. 
• In the Test Setup (1), click Edit (2) in the ribbon, select Protocol Templates (3) in the Machines & Templates panel. 
• Click New (4) in the ribbon or context menu to create a new Test Template.
  

• To define a Test Template for Profile Constancy the profile directions (5) and the analysis method (6) are required. These two parameters affect the acceptance criteria entries and cannot be edited in the Test Definition panel for a machine protocol.
  
  CAUTION USE SMALL FIELDS PROTOCOL FOR FIELD SIZES < 5 cm x 5 cm
  For profile constancy tests with field sizes < 5 cm x 5 cm, the Small Fields protocol has to be used. The use of a standard protocol may lead to erroneous QA results.

  IMPORTANT NOTICE USAGE OF THE MYQA SRS DEVICE WITH SFPM PROTOCOL 
  To increase the consistency of the measurements for the parameters associated with the SFPM protocol, it is recommended to use 500 MU or more for performing profile constancy analysis with this protocol

• The available analysis methods are listed in Chapter 7 of myQA Platform Reference Guide.
• When setting up the Test definition, ensure the reference detector type has been selected (7), and then connect the device (8) and ensure the background measurement (9) has been taken.
• The expected values can be taken from a measurement by clicking the Measurement button (10) or from an imported one by clicking the Import Measured Data button (11) or paste with the Paste button (12) if the measurement has been copied from FastTrack (see Section 2.1.1, myQA FastTrack Reference Guide) or manually enter them.
  
• When using the myQA SRS device in myQA Machines the dose rate (13) is not applied for measurements. To avoid erroneous measurements, the same dose rate shall be used for Test Setup (baseline) and Test Run (measurement). An input box is available to manually enter the used dose rate value.
• The imported data will be assigned to the selected radiation device and can only be used for this device in the myQA Machines workspace.
• Please ensure the device has had an adequate warm-up period before taking measurements. A background measurement is necessary for correct readings.
• After a baseline measurement is done, the reference detector type will be shown.
• If there is measurement data available, click Chart View button and the profiles can be viewed graphically.
• Click Save in the ribbon when all test templates are created. This template can be used for as many machines as desired.
  After the machine protocol is set up, select the protocol in the Protocol Tree View panel, and click Set Active in the Test Setup ribbon. Finally click Save in the Test Setup ribbon to exit the Edit mode. The protocol is now ready to be run in the Test Run page.
• On the Test run page, select the to-be-tested Machine (14) and task from the Active Task group (15).
  

myQA FastTrack

Movie mode measurements of the myQA SRS can be taken in myQA FastTrack.

• Switch to the myQA FastTrack workspace.
  
• On the Measure page (1), go to the Measurement ribbon (2).
• To perform a measurement for the myQA SRS in FastTrack, follow the same procedure as Section 2.10.
• Please note, when performing a measurement with the myQA SRS, it is recommended to increase the Sampling time to 2 secs to reduce the noise in the frame since no integral computation is possible in this workspace. 
  Open the Movie mode dropdown menu (3) and enter the correct number in the Sampling time box.
  
• The measurement stops automatically. For manual stop, click the Stop icon (Once the measurement starts, the Start icon becomes the Stop icon.).
  Each measurement will be added as a frame set in the Frame panel when the measurement is started. The name of the frame set will be:
  [YYYY-MM-DD hhmm]
  As soon as a frame arrives from the device, it will be added to the frame set. The frame name will be: Frame [frame number]
  The first frame number is 001. It increases in increments of 1 per frame.
  The measured results are displayed automatically in the main area as, e.g., 2D display, profile list, and graphics (inline/crossline/diagonal, depending on the choice of the user) if the Profile tab is selected.

Data Import and Comparison

The profiles listed on the Data Import page can be selected for comparison. The comparison can be performed in the Compare page.

• Switch to the myQA Platform workspace and go to the Data Import page.
• Here the profiles previously added from the Data Import page (1) can be displayed and then compared on the Compare page. See Sections 3.3 and 3.4 in myQA Platform Instructions for Use for more information.
  
• Select profiles from the list and right click to open the Data file context menu (2). Here the user can:
  • Add a profile to comparison
  • Add a profile and directly switch to the comparison page
  • Clear the selected profiles
  • Delete the selected profiles
• Detailed information on the selected profiles will be displayed to the right (3).
• Go to the Compare page and use the Profile Comparison ribbon (4) to select the desired analysis parameters, set tolerances, and adjust the comparison view of the selected profiles.
  
• All profiles added from the Data Import page are listed in the Profile parameter table (5). The parameters are grouped into four groups: Properties, Analysis, Math Results (rel.), and Math Results (abs.). The group of parameters will be displayed when it is selected in the ribbon.
• On the main screen of the page the user can see:
  • 6a: A graphical display of profiles including legend and cursor reading on the right.
  • 6b: Comparison graphical display of results including legend and cursor reading on the right.

Numerical test for output constancy check with myQA SRS Phantom and Chamber adapter

myQA SRS Phantom with the uniform insert and corresponding chamber adapter can be used to measure output constancy tests (see Section 3.2.3).

• For this, a numerical test can be created by the user in myQA Machines and be added to the corresponding task and protocol.
• For instance, a numerical test setup in myQA Machines for output constancy test for field size of 10 cm × 10 cm and various energies is displayed below. For detailed information about numerical tests creation in myQA Machines (see Section 2.1.4 and Chapter 10 in myQA Machines Instructions for Use).