VIEWRAY MRIdian System 4.5 User manual

Operator’s Manual
for the
MRIdian® System 4.5
For Software Release 4.5
November 2016
Document No. L-0009
This document contains the confidential and proprietary information of ViewRay, Inc. Neither
this document nor any of the information contained is to be reproduced, distributed, used or
disclosed, either in whole or in part, except as specifically authorized by ViewRay, Inc.

This page intentionally left blank.

ViewRay Inc. MRIdian® system L-0009 Release 4.5 i
Copyright Statement
Copyright © 2016 ViewRay, Inc. All rights reserved. No part of this manual may be
photocopied, reproduced or translated into another language without written permission
from ViewRay, Inc.
ViewRay, Inc., has taken care to ensure the accuracy of this document; however, ViewRay Inc.
assumes no liability for errors or omissions and reserves the right to make changes without
further notice to any products herein to improve reliability, function or design.
ViewRay provides this manual without warranty of any kind, either implied or expressed,
including but not limited to, the implied warranties of merchantability and fitness for a
particular purpose.
This document contains proprietary information that is protected by copyright. ViewRay Inc.
reserves the right to revise this publication and to make changes in content from time to time
without obligation on the part of ViewRay to provide notification of such revision or change.
Additional Manuals
To download a PDF of this manual visit www.viewray.com/resource_center_home and sign in
with your username and password.
Trademark Information
ViewRay is a trademark of ViewRay, Inc.
MRIdian is a trademark of ViewRay, Inc.
Windows®is a registered trademark of Microsoft® Corporation. Other brand or product
names are trademarks or registered trademarks of their respective holders.
Patent Information
The MRIdian® system is protected by one or more patents.
Visit www.ViewRay.com/patents for a complete list of MRIdian system patents.

ii MRIdian® system L-0009 Release 4.5 ViewRay Inc.
Contacting Support
Support services are available without charge during the initial warranty period.
For service:
Telephone—1.855.286.8875
To submit system issues or product improvement requests online:
www.viewray.com/resource_center_service
European Authorized Representative:
MedPass International Ltd.
Winsor House Bretforton
Evesham, Worcestershire.
WR11 7JJ, United Kingdom

ViewRay Inc. MRIdian® system L-0009 Release 4.5 iii
CAUTION: The MRIdian® system is for PRESCRIPTION USE ONLY. Federal
law restricts the device to sale by or on the order of a physician, or
licensed healthcare provider.
Intended Use
The MRIdian system, with magnetic resonance imaging capabilities, is intended to provide
stereotactic radiosurgery and precision radiotherapy for lesions, tumors, and conditions
anywhere in the body where radiation treatment is indicated.
The MRIdian system may be contraindicated for patients with implants due
to the presence of the MRI magnetic field. All patients must be screened for
MRI compatibility prior to treatment.
The MRIdian system must be operated according to the intended use and only
by qualified persons with the necessary knowledge in accord with country-
specific regulations.
All personnel must complete user training before operating the system. The user must be
familiar with all potential hazards and all safety guidelines. In addition, before using the
system, the user must read and understand the operator’s manual.
To find the software version your system is running Click > the MRIdian icon and a dropdown
menu opens. From that dropdown menu Click > About MRIdian®

iv MRIdian® system L-0009 Release 4.5 ViewRay Inc.
Technical and performance data for the system is in “Technical Manual for the
MRIdian System” (L-0016) that was supplied with the system.

ViewRay, Inc. MRIdian® system L-0009 Release 4.5 v
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Chapter 1: MRIdian® System Overview . . . . . . . . . . . . . . . . . .1
1.1 System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 MRIdian® System Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Treatment Planning and Delivery Software. . . . . . . . . . . . . . . . . . . . 4
1.4 System Logging Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4.1 Creating a Support Package of Log Files . . . . . . . . . . . . . . . . . . . . . . .5
1.5 System Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.6 Uninterruptible Power Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.7 System Status Icons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.8 Environmental Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.9 Imaging System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.10 Cooling System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.10.1 Magnetic Shielding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
1.10.2 Gradient System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
1.11 Patient Handling System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.12 Receive Coils. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.12.1 Coil Sockets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
1.13 Radiation Therapy Delivery System . . . . . . . . . . . . . . . . . . . . . . . . 14
1.13.1 Radioactive Source and Shielding. . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.13.2 Multi-leaf Collimator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.14 Patient Communication System . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
1.14.1 Patient Headphones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.14.2 Treatment Room Speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
1.14.3 Treatment Room Microphones . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
1.14.4 Flat-Panel Display Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
1.14.5 Intercom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
1.14.6 Video Camera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
1.15 Electronics Cabinets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.16 About this Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 2:Safety Information and Alerts . . . . . . . . . . . . . . . .21
2.1 Safety Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1.1 Definition of Hazard Levels and Symbols . . . . . . . . . . . . . . . . . . . . . .22

vi MRIdian® system L-0009 Release 4.5 ViewRay,
2.1.2 General MRIdian® System Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.2 Product Performance Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2.2.1 Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.3 Guidance and Declaration for Electromagnetic Compatibility . . . .25
2.3.1 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.3.2 Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.4 Treatment Room Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
2.4.1 Slipping and Falling Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.4.2 Pinch Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.5 Patient Transport Safety and Communication . . . . . . . . . . . . . . . . .32
2.5.1 Patient Transport System Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.5.2 Patient Alert for Patient-Initiated Communication . . . . . . . . . . . . . 32
2.5.3 Communicating with the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.6 Laser Positioning Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
2.7 Imaging Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
2.7.1 MR Safety Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.7.2 Magnetic Field Emergency Procedures . . . . . . . . . . . . . . . . . . . . . . 35
2.7.3 Devices Contraindicated for MRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.7.4 Patients Typically Contraindicated for MRI. . . . . . . . . . . . . . . . . . . 36
2.7.5 Pre-screening Prior to Imaging or Treatment on the MRIdian® System37
2.7.6 MR Worker Screening and Reporting Requirements . . . . . . . . . . . 38
2.7.7 Safety Screening Form, MR Hazard Checklist and Patient Instructions39
2.7.8 Supervision of Patients and Equipment . . . . . . . . . . . . . . . . . . . . . . 41
2.8 Artifacts and Imaging Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
2.9 Controlled Access Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
2.9.1 Fringe Field Effects on Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
2.9.2 MR Restricted Access Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2.10 Exposure to RF Electromagnetic Fields . . . . . . . . . . . . . . . . . . . . . .44
2.10.1 Warming of Body Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.10.2 Noticeable Effects on the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . 46
2.11 Peripheral Nerve Stimulation (dB/dt) . . . . . . . . . . . . . . . . . . . . . . .46
2.11.1 Operating Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
2.11.2 First Level Controlled Operating Mode . . . . . . . . . . . . . . . . . . . . . 47
2.12 Current Loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
2.13 Effects of Antenna. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
2.14 Risks of Non-MR Safe Monitoring and Interventional Devices . . .50
2.15 Hazardous Noise Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
2.16 Magnet Quench. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
2.16.1 Half Quenches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.16.2 Gauss Line After a Patient-End Magnet Quench . . . . . . . . . . . . . . 52

ViewRay, Inc. MRIdian® system L-0009 Release 4.5 vii
2.16.3 Gauss Line After a Service-End Magnet Quench . . . . . . . . . . . . . . .55
2.17 Fire Safety in the Treatment Room . . . . . . . . . . . . . . . . . . . . . . . . 56
2.18 Measurement Phantom Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
2.18.1 Contact with Phantom Fluid Spills. . . . . . . . . . . . . . . . . . . . . . . . . .57
2.18.2 Risks Due to Aerosol Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
2.19 Radiation Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
2.19.1 Radiation Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
2.19.2 Exposure Control for Operators . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
2.19.3 Audible Radiation Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
2.19.4 Radiation Safety Interlocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
2.20 Emergency Response Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
2.21 Unintended Radiation (Stuck Source) Exposure . . . . . . . . . . . . . . 61
2.22 Using the E-Stop in an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . 62
2.23 Emergency Magnet Shutdown . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
2.23.1 Magnet Emergency Discharge Button . . . . . . . . . . . . . . . . . . . . . . .63
2.23.2 Emergency Quench Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
2.23.3 Rescuing the Patient in an Emergency . . . . . . . . . . . . . . . . . . . . . . .64
Chapter 3:System Coordinates . . . . . . . . . . . . . . . . . . . . . . . .67
3.1 MRIdian® System Coordinates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
3.1.1 Direction Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
3.1.2 Gantry Coordinate System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
3.1.3 Gantry Rotation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
3.1.4 Beam Limiting Coordinate System. . . . . . . . . . . . . . . . . . . . . . . . . . .69
3.1.5 Beam’s Eye View of Multi-Leaf Collimator (MLC). . . . . . . . . . . . . . .70
3.1.6 Orientation of an MLC Relative to the Gantry . . . . . . . . . . . . . . . . .71
3.1.7 MLC Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
3.1.8 Planning and Visualization using Coordinate System. . . . . . . . . . . .73
Chapter 4:System and Administrative Tasks . . . . . . . . . . . . .77
4.1 Starting Up the Planning Consoles . . . . . . . . . . . . . . . . . . . . . . . . . . 77
4.2 Starting Up the Delivery System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
4.2.1 Additional Treatment Delivery Console Checks . . . . . . . . . . . . . . . .81
4.3 Shutting Down the Planning System . . . . . . . . . . . . . . . . . . . . . . . . 82
4.4 Shutting Down the Delivery and MRI Systems . . . . . . . . . . . . . . . . 82
4.5 Logging on to System Administration. . . . . . . . . . . . . . . . . . . . . . . . 84

viii MRIdian® system L-0009 Release 4.5 ViewRay,
4.6 Adding Users to the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
4.7 User Group Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
4.8 Editing User Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
4.9 Resetting a User Password . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
4.10 Using Global Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
4.10.1 Editing Structures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.11 Managing Templates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
4.11.1 Renaming Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.11.2 Removing Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.11.3 Exporting Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.11.4 Importing a Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chapter 5:Prescription and Patient Management . . . . . . . . 99
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
5.1.1 Organization of Patient Management Information. . . . . . . . . . . . 100
5.2 Adding New Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
5.3 Adding a Patient Photo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
5.4 Using the Patient Information Features . . . . . . . . . . . . . . . . . . . . .103
5.5 Filtering the Patient List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
5.5.1 Sorting the Patient List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
5.6 Editing Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
5.7 Editing Patient Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
5.8 Adding a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
5.8.1 Editing a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
5.9 Entering a Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
5.10 Entering TNM Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
5.11 Using Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
5.12 Adding Structure, Dose, and Point Constraints . . . . . . . . . . . . . .114
5.12.1 Customizing a Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
5.12.2 Setting Structure Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
5.12.3 Adding a Point Constraint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
5.13 Adding a Primary Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
5.14 Plan Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
5.14.1 Scheduling Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
5.14.2 Viewing the Delivery Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
5.14.3 Assigning Treatment Plans to Fractions . . . . . . . . . . . . . . . . . . . 122
5.14.4 Locking Treatment Fractions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

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5.14.5 Unlocking Treatment Fractions. . . . . . . . . . . . . . . . . . . . . . . . . . . 125
5.14.6 Discontinuing Fractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.14.7 Undoing Discontinue Fraction . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
5.14.8 Reviewing Individual Fraction Deliveries . . . . . . . . . . . . . . . . . . . 129
5.14.9 Viewing the Delivery Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
5.14.10 Viewing the Tracking Points Chart . . . . . . . . . . . . . . . . . . . . . . . 133
5.14.11 Generating a New Plan After a Fraction Review . . . . . . . . . . . . 134
5.14.12 Completion Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
5.15 Setting QA Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
5.16 Comparing Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
5.17 Hiding Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
5.18 Patient Archive and Restore System (PARS) . . . . . . . . . . . . . . . . 146
5.18.1 Archiving Patient Plan Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
5.18.2 Restoring Patients after Purging. . . . . . . . . . . . . . . . . . . . . . . . . . 149
5.18.3 Exporting Patient Plan Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
5.18.4 Importing MRIdian Treatment Plan Data. . . . . . . . . . . . . . . . . . . 151
5.18.5 PARS Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
5.18.6 Status Refresh and Filter Options . . . . . . . . . . . . . . . . . . . . . . . . . 154
5.19 Deleting Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
5.20 Returning to Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
5.21 Screen to PDF capture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Chapter 6: Treatment Planning . . . . . . . . . . . . . . . . . . . . . . .159
6.1 Treatment Planning Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 159
6.1.1 The MRIdian System Treatment Planning Process . . . . . . . . . . . . 159
6.2 Patient Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
6.3 Creating a New Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
6.4 Selecting an Existing Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
6.5 Loading a Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
6.5.1 Viewing Only. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
6.6 Adding Images to a Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
6.7 Importing Images and RTDOSE from DICOM. . . . . . . . . . . . . . . . . 168
6.8 Importing Images and RTDOSE from DICOM Files . . . . . . . . . . . . 171
6.9 Importing Structures/Contours. . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
6.10 Importing Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
6.11 Exporting MRIdian Data via DICOM . . . . . . . . . . . . . . . . . . . . . . . 179
6.12 Removing Slices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

x MRIdian® system L-0009 Release 4.5 ViewRay,
6.13 Interpolating and Editing Image Sets. . . . . . . . . . . . . . . . . . . . . . .183
6.14 Creating a 4D Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184
6.15 Viewing a 4D Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
6.16 Image Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188
6.17 Viewing Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
6.17.1 Ortho MPR and 3D Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
6.17.2 Using Multiplanar (MPR) Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
6.17.3 Using Window/Level Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
6.17.4 Using the Zoom Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
6.17.5 Using the Pan Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
6.17.6 Using the Measurement Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
6.17.7 Using the Point Tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
6.17.8 Using the Length Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
6.17.9 Image Orientation Reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
6.18 Using the Display Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
6.19 Removing Overlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
6.20 Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
6.20.1 Adding Structures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
6.20.2 Expanding Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
6.20.3 Auto-Contouring Skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
6.20.4 Using the Draw Contours Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . 200
6.20.5 Interpolating Contours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
6.20.6 Keyboard Shortcuts and Context Menu Options. . . . . . . . . . . . . 203
6.20.7 Using the Clean Up Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
6.20.8 Using the Boolean Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
6.20.9 Using Iso-Intensity Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
6.20.10 Using Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
6.20.11 Saving Auto-Contouring Templates . . . . . . . . . . . . . . . . . . . . . . 213
6.20.12 Auto-Contouring Using a Saved Template . . . . . . . . . . . . . . . . . 214
6.20.13 Approving Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
6.21 Image Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216
6.21.1 Registration Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
6.21.2 Advanced Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
6.21.3 Aligning Volumes Using Overlays . . . . . . . . . . . . . . . . . . . . . . . . . 232
6.22 Using Image Masks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234
6.23 Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
6.23.1 Adding Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
6.23.2 Using 3-Point Landing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
6.23.3 Fine-tuning Point Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
6.23.4 Setting Points at the Center of a Structure . . . . . . . . . . . . . . . . . 242
6.23.5 Manually Placing Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

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6.23.6 Entering Values for Point Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
6.23.7 Deleting Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
6.23.8 Renaming a Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
6.24 Couch and Isocenter Placement . . . . . . . . . . . . . . . . . . . . . . . . . . 245
6.24.1 Finding Valid Isocenters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
6.25 Beams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
6.25.1 Beams Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
6.25.2 Placing a Beam Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
6.25.3 Locking Same-Isocenter Beam Groups. . . . . . . . . . . . . . . . . . . . . 249
6.25.4 Changing a Single Beam Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
6.25.5 Adding Pseudo-Arc Beams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
6.25.6 Manually Adjusting Beam Angles . . . . . . . . . . . . . . . . . . . . . . . . . 251
6.25.7 Adjusting Beam Angles Using Beam Values. . . . . . . . . . . . . . . . . 251
6.25.8 Saving Beam Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
6.25.9 Loading Beams from Templates . . . . . . . . . . . . . . . . . . . . . . . . . . 251
6.25.10 Deleting Beam Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
6.26 Setting MLCs for Conformal Beams . . . . . . . . . . . . . . . . . . . . . . . 254
6.27 Viewing Structures from the Beam’s Eye View . . . . . . . . . . . . . . 256
6.28 Viewing the Complete Irradiated Area Outline . . . . . . . . . . . . . . 256
6.29 Setting Electron Densities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
6.29.1 Use CT Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
6.29.2 Use Structure Densities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
6.30 Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
6.30.1 IMRT Prescription Offset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
6.30.2 Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
6.30.3 Using IMRT Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
6.30.4 Setting the Resolution for the Dose Grid . . . . . . . . . . . . . . . . . . . 264
6.31 IMRT Interdigitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
6.32 MRIdian® System Algorithms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
6.33 Dose Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
6.34 Optimizing Dose for IMRT and Conformal Beams. . . . . . . . . . . . 270
6.35 Advanced Dose Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
6.35.1 Changing Structure Constraints After Optimizing Dose . . . . . . . 274
6.36 Normalizing the Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
6.36.1 Fixed Conformal Beams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
6.36.2 Plan Evaluation Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
6.36.3 Isodose Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
6.36.4 Saving Isodose Line Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
6.36.5 Loading a Saved Isodose Line Template. . . . . . . . . . . . . . . . . . . . 283
6.37 Managing Motion Using Isodose Lines. . . . . . . . . . . . . . . . . . . . . 283

xii MRIdian® system L-0009 Release 4.5 ViewRay,
6.38 RealTarget® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285
6.38.1 Numerical Margins and Structure Boundaries. . . . . . . . . . . . . . . 287
6.38.2 Finding Valid Spatial Integrity Region for RealTarget . . . . . . . . . 287
6.38.3 Real-Time RealTarget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
6.38.4 RealTarget Delay and Wait Time. . . . . . . . . . . . . . . . . . . . . . . . . . 288
6.39 Treatment Plan Evaluation and Approval . . . . . . . . . . . . . . . . . . .288
6.39.1 Calculating Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
6.40 Comparing Two Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
6.41 Comparing 2 Plans that have 2 Prescriptions . . . . . . . . . . . . . . . .291
6.42 Setting Registration Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292
6.43 Approving a Treatment Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294
6.44 Remote Connectivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Chapter 7: Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
7.2 Time-Varying Magnetic Fields (dB/dt) and Peripheral Nerve Stimula-
tion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
7.3 Managing Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299
7.4 Searching for Images. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299
7.5 Importing Images from PACS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300
7.6 Importing DICOM Images from Files . . . . . . . . . . . . . . . . . . . . . . . .302
7.7 Exporting Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
7.8 Viewing Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
7.9 Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
7.10 Adding a New Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306
7.11 Using the Patient Sidebar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
7.12 Searching for Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .308
7.13 Editing Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .308
7.14 Filtering the Patient List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .309
7.15 Sorting the Patient List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310
7.16 Acquiring Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310
7.16.1 Acquiring Low Resolution Images . . . . . . . . . . . . . . . . . . . . . . . . 311
7.16.2 Acquiring a High Resolution Image. . . . . . . . . . . . . . . . . . . . . . . . 312
7.16.3 Field of View Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
7.17 Setting Image Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312
7.18 Saving Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313

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7.19 Deleting Images. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
7.20 Simulating Treatment Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
7.20.1 Preview Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
7.20.2 Saving a Ciné. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
7.21 RealViewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
7.21.1 Exporting a Ciné . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Chapter 8:Patient Set-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . .321
8.1 Patient Transport Safety and Communication . . . . . . . . . . . . . . . 321
8.1.1 Pinch Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
8.1.2 Slipping and Falling Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
8.2 Monitoring the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
8.2.1 Intercom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
8.2.2 Squeeze Bulb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
8.2.3 Using Patient Headphones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
8.3 Patient Set-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
8.4 Displays and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
8.5 Couch Control Buttons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
8.6 Buttons Available On The in-Room Control Panel Only . . . . . . . . 329
8.7 Understanding the Stored Couch Position. . . . . . . . . . . . . . . . . . . 329
8.8 Patient Load Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
8.9 Loading and Positioning the Patient Without A Stored Couch Position
331
8.10 Patient Positioning Using Stored Couch Position . . . . . . . . . . . . 332
8.11 Couch Motion Control Lockout. . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Chapter 9:Treatment Delivery. . . . . . . . . . . . . . . . . . . . . . . .335
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
9.2 Powering Up the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
9.3 Retrieving the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
9.4 Loading the Plan for Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
9.4.1 Treating More than One Daily Fraction . . . . . . . . . . . . . . . . . . . . . 337
9.5 Using Daily Images to Position the Patient . . . . . . . . . . . . . . . . . . 338
9.5.1 Acquiring a High-Resolution Image . . . . . . . . . . . . . . . . . . . . . . . . 341
9.5.2 Registering Daily Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

xiv MRIdian® system L-0009 Release 4.5 ViewRay,
9.6 Finding the Couch Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .343
9.6.1 Manually Finding the Couch Shift . . . . . . . . . . . . . . . . . . . . . . . . . 344
9.6.2 Automatically Finding the Couch Shift . . . . . . . . . . . . . . . . . . . . . . 347
9.6.3 Set to Center of Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
9.7 Saving the Patient’s Couch Position. . . . . . . . . . . . . . . . . . . . . . . . .348
9.8 Viewing Beams on the Positioning Screen . . . . . . . . . . . . . . . . . . .349
9.9 Editing Contours for Patient Positioning . . . . . . . . . . . . . . . . . . . . .349
9.9.1 Editing Rule-Based Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
9.10 Predicting Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351
9.10.1 Normalizing New Plan to Prescription . . . . . . . . . . . . . . . . . . . . . 356
9.11 Editing New Plan in Planning Workflow . . . . . . . . . . . . . . . . . . . .357
9.12 Treating with Re-Optimized Dose . . . . . . . . . . . . . . . . . . . . . . . . .358
9.13 New Plan Comparison Export. . . . . . . . . . . . . . . . . . . . . . . . . . . . .360
9.14 Checking RealTarget Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
9.15 Using Tracking Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .363
9.16 RealTarget Preview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .364
9.16.1 Tracking Result and Decision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
9.16.2 Beam On and ROI% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
9.16.3 Correlation Graph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
9.17 Applying a 2D Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .368
9.18 Delivering a Treatment Fraction . . . . . . . . . . . . . . . . . . . . . . . . . .370
9.19 Treatment Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .372
9.20 Delivering a Multi-Isocenter Plan. . . . . . . . . . . . . . . . . . . . . . . . . .373
9.21 Ending Treatment Early . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .374
9.21.1 Adding Completion Plans to the Delivery Calendar . . . . . . . . . . 376
9.22 Consolidating Treatment Fractions . . . . . . . . . . . . . . . . . . . . . . . .380
9.23 Monitoring Treatment Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . .381
9.24 Two-Headed Treatment Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . .383
Chapter 10:Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . 389
10.1 Recommended QA Tests and Procedures . . . . . . . . . . . . . . . . . . .389
10.1.1 Recommended Frequencies for QA Tests . . . . . . . . . . . . . . . . . . 390
10.2 Accessing the QA Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .393
10.3 Plan QA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .394
10.3.1 Creating a QA Plan from a Treatment Plan . . . . . . . . . . . . . . . . . 394
10.3.2 Exporting Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397

ViewRay, Inc. MRIdian® system L-0009 Release 4.5 xv
10.3.3 Saving a QA Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
10.3.4 Positioning Couch on Points Screen for a QA Plan. . . . . . . . . . . 400
10.4 Localization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
10.5 CT to Relative Electron Density. . . . . . . . . . . . . . . . . . . . . . . . . . . 406
10.5.1 Adding and Removing Look-Up Table Data Points. . . . . . . . . . . 407
10.6 Viewing Delivery Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
10.7 SNR/Uniformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
10.8 Source Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
10.9 Calibration Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
10.10 Spatial Integrity QA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
10.11 Daily Laser Alignment Calibration Test . . . . . . . . . . . . . . . . . . . 425
10.12 Sealed Source Leak Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
10.13 MLC Speed Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
10.14 Optional Physics QA Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Chapter 11:Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .437
11.1 Cleaning the LCD Monitor and Video Display . . . . . . . . . . . . . . . 437
11.2 Cleaning Plugs and Connectors. . . . . . . . . . . . . . . . . . . . . . . . . . . 437
11.3 Cleaning RF Coils and Positioning Aids. . . . . . . . . . . . . . . . . . . . . 437
11.4 Cleaning the Patient Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
11.5 Cleaning System Components . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
11.6 Electrical Cabinets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
Chapter 12:Receive Coils . . . . . . . . . . . . . . . . . . . . . . . . . . . .439
12.1 Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
12.2 Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
12.3 Coil Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
12.4 Decoupling Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
12.5 Symbols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
12.6 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
12.7 Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
12.8 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

xvi MRIdian® system L-0009 Release 4.5 ViewRay,
Mechanical Source Retraction Procedure . . . . . . . . . . . . . . 447
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451

ViewRay Inc. MRIdian® system L-0009 Release 4.5 1
Chapter 1: MRIdian® System Overview
Chapter 1: MRIdian® System Overview
1.1 System Overview
The MRIdian system is a hybrid medical device for radiation treatment that combines a
magnetic resonance imaging system (MRIS) with a Cobalt-60 (Co-60) radiation delivery
system (RDS). The imaging and radiotherapy fields of view are coincident permitting
imaging of the patient at the radiotherapy isocenter before and during treatment. The
MRIdian system is operated with the MRIdian Treatment Planning and Delivery Software
(TPDS).
The MRIdian radiation delivery system (RDS) consists of three Cobalt-60 sources mounted
120 degrees apart on a radiotherapy ring gantry. The radiation isocenter is in the middle of
the imaging field of view, permitting imaging at the radiotherapy isocenter before and during
therapy. The RDS includes:
Radioactive Source
Gantry and Base
Source Shielding Heads and Movement Mechanism
Multi-leaf Collimators
Patient Handling System
Radiation Therapy Control System and Console
The sealed sources are housed in source-shielding heads made of Tungsten Alloy and
Depleted Uranium encased with stainless steel. The heads are mounted on a ring gantry and
base located in the gap between the two magnets. The sources are positioned for therapy
(BEAM ON), standby (BEAM HOLD) and shielding (BEAM OFF) by a source movement
controller. The beams from the sources are shaped to conform to the target using a double-
focused multi-leaf collimator.
The RT (Radiation Therapy) Control system is the central point of control designed to provide
fail-safe operation of the MRIdian system. It consists of the Radiation Therapy Controller
(RTC) and the Auxiliary Controller (AUXC)
The RTC is the primary controller and the AUXC is the secondary controller and provides
safety control functions in the event of an RTC failure. The RTC and AUXC control and monitor
Gantry Rotation
Source Movement Control (SMC)
MLC Control System
Patient Handling System
Emergency Stops and System Safety Interlocks
AC and DC Power Distribution

2 MRIdian® system L-0009 Release 4.5 ViewRay, Inc.
Chapter 1: MRIdian® System Overview
1.2 MRIdian® System Training
Before using the MRIdian system, physicians, physicists, dosimetrists, therapists, and nurses
must be trained. It is highly recommend that at least one person assume the role of “super
user” and be involved in all phases of training. The super user would likely hold administrative
rights and train new employees on the system as needed.
On-site training and training for additional users is available from ViewRay. For further
information, contact your local ViewRay representative.
The following table lists training topics and recommended participants.
Topic Recommended participants
MD Physicist CMD RTT Nurse
System safety
MRI safety issues and emergency
procedures including the controlled
access area, emergency field shut down
and emergency actions in the event of a
quench.
    
Radiation safety issues and emergency
procedures
    
Site safety and emergency procedure
including fire precautions
    
Patient safety, loading, and
immobilization
    
Patient emergency medical procedures     
System operation
System start-up procedures   
Daily system maintenance inspection   
Daily calibration and QA   
Use of coordinate systems   
Use of laser alignment system   
MRIdian MR imaging basics
Patient body and head coils (utilization,
placement, and CT simulation)
   
Imaging protocols    
Console operation    