Radiation Therapy - SXRT Operations Manual · Web viewImager Vert [cm]-----Imager Lng [cm] 0 Imager...

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Canberra Hospital and Health ServicesOperations Manual Radiation Therapy - Superficial X-Ray Therapy TOPEX-SRT100Contents

Contents....................................................................................................................................1

Introduction..............................................................................................................................5

Scope........................................................................................................................................ 5

Key Objectives...........................................................................................................................5

Alerts.........................................................................................................................................5

Section 1 – SXRT Calculations....................................................................................................6

1.1 Treatment Sheet.............................................................................................................6

1.2 SXRT Calculations............................................................................................................6

1.2.1 Commencement of planning tasks...........................................................................6

1.2.2 Calculating BSF of an irregular field (if applicable)...................................................7

1.2.3 Complete SXRT Calculation Task..............................................................................8

1.2.4 Cut-out and Accessories...........................................................................................8

1.3 ARIA Plan/Data Entry......................................................................................................8

1.3.1 Creating a New Course.............................................................................................8

1.3.2 Creating a New Plan...............................................................................................10

1.3.3 Creating a New Treatment Field.............................................................................10

1.3.4 Field Parameters....................................................................................................11

1.3.5 Adding a New Volume and Reference Point..........................................................12

1.3.6 Adding Setup Photos..............................................................................................14

1.3.7 Scheduling the Plan................................................................................................15

1.3.8 ARIA Planning Approval..........................................................................................15

1.4 Completing the Treatment Preparation Task................................................................17

1.4.1 Planner SXRT Calculation & QA Check....................................................................17

1.4.2 Template Upload....................................................................................................17

1.4.3 Care Path Task........................................................................................................17

Section 2 – SXRT Final Planning QA.........................................................................................18

2.1 Initiating a SXRT Final Planning Check Task...................................................................18

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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2.2 Open the Previous SXRT Final Planning Check Dynamic Document..............................18

2.3 Complete the SXRT Final Planning Checklist.................................................................18

2.4 Aria Details....................................................................................................................18

2.4.1 Plan Parameters check...........................................................................................18

2.4.2 Reference Points....................................................................................................19

2.4.3 Treatment Preparation...........................................................................................19

2.4.4 Plan and Appointment Scheduling.........................................................................19

2.4.5 Completion of Information.....................................................................................20

2.5 Signoff/ Dynamic Document approval..........................................................................20

Section 3- SXRT Treatment General Information....................................................................21

3.1 Roles and Responsibilities.............................................................................................21

3.2 Staff Organisation..........................................................................................................22

3.3 SXRT Unit Components.................................................................................................22

Section 4 – Equipment Operation...........................................................................................22

4.1 Machine Power-up........................................................................................................22

4.2 Warm-up.......................................................................................................................23

4.2.1. Automatic Warm-up Cycle....................................................................................24

4.2.2 Manual Selection of Warm-up Cycle......................................................................24

4.3 Daily Machine Output Check.........................................................................................24

4.4 Notes on Applicators.....................................................................................................25

4.4.1 Applicator Sizes......................................................................................................25

4.4.2 Applicator Tips....................................................................................................... 25

4.4.3 Applicator Attachment...........................................................................................26

4.5 Programming the Treatment Console...........................................................................26

4.5.1 Setting the Treatment Mode..................................................................................26

4.5.2 Setting the Exposure Time......................................................................................26

4.6 Treatment Delivery.......................................................................................................27

4.6.1 Treatment Delivery Information............................................................................27

4.6.2 Enabling X-ray emission.........................................................................................28

4.6.3 Abnormal Exposure Termination...........................................................................29

4.7 Close of SXRT Business (Daily).......................................................................................30

4.7.1 Power off................................................................................................................30

4.7.2 Other Close of Business Matters............................................................................30

Section 5 – Fault Documentation............................................................................................31



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5.1 SXRT Faults preventing the progression of treatment..................................................31

5.2 SXRT Faults not preventing the progression of treatment............................................31

5.3. Faulty accessories.........................................................................................................31

Section 6 – Safety....................................................................................................................31

Section 7 – Accidents/Incidents Reporting..............................................................................33

Section 8 – Loss/Theft/Damage of Property...........................................................................33

Section 9 – Commencing a New SXRT Case.............................................................................34

9.1 New Case Alerts & Warnings.........................................................................................34

9.2 New SXRT Case Procedure............................................................................................34

9.2.1 Commencing the SXRT Pre-Treatment Check........................................................34

9.2.2 Create New Dynamic Document for the SXRT Pre-Treatment Check.....................34

9.2.3 Complete the SXRT Pre-Treatment Check..............................................................34

9.2.3.1 Treatment Document Management...............................................................34

9.2.3.2 Plan Data Integrity Checks (ARIA Details)........................................................35

9.2.3.3 Other...............................................................................................................37

9.2.3.5 Approve the Dynamic Document....................................................................37

9.2.3.6 Complete the SXRT Pre-Treatment Task.........................................................38

Section 10 – Billing Procedures...............................................................................................38

Section 11 – Patient Reviews..................................................................................................38

Section 12 – Weekly Chart Checks..........................................................................................39

12.1 Weekly Chart Check Alerts..........................................................................................39

12.2 Weekly Chart Check Procedure...................................................................................39

12.2.1 Initiating a Weekly Chart Check............................................................................39

12.2.2 Load RT-Weekly Chart Check Encounter..............................................................39

12.2.2.1 Review Dose..................................................................................................40

12.2.2.2 Remaining Appointments..............................................................................40

12.2.2.3 Review Tasks.................................................................................................41

12.2.2.4 Review Patient Notes/Journal Entries...........................................................41

12.2.2.5 Treatment Parameters Review......................................................................42

12.2.2.6 Other.............................................................................................................43

12.2.3 Completion of Encounter.....................................................................................44

12.2.3.1 New Journal Entry.........................................................................................44

12.2.3.2 Patient Alerts.................................................................................................45

12.2.3.3 Finalisation of the RT- Weekly Chart Check Encounter.................................45



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Section 13 – Course Completions............................................................................................46

13.1 Course Completion Alerts...........................................................................................46

13.2 Course Completion Procedures...................................................................................46

13.2.1 Initiating a Course Completion Check..................................................................46

13.2.2 Load RT-Course Completion Check Encounter.....................................................46

13.2.2.1 Course Summary...........................................................................................47

13.2.2.1 Review Progress Notes..................................................................................48

13.2.2.2 Other Items...................................................................................................49

13.2.3 Finalisation of the Encounter and Task................................................................50

Section 14 – Internal Eye Shields............................................................................................50

14.1 Internal Eye Shield Alerts............................................................................................50

14.2 Use of Internal Eye Shields..........................................................................................50

14.2.1 Equipment & Materials........................................................................................50

14.2.2 Sequence of Actions...........................................................................................51

14.2.2.1 Anaesthetising the eye..................................................................................51

14.2.2.2 Preparing to insert the eye shield.................................................................51

14.2.2.3 Insertion of the Eye Shield.............................................................................52

14.2.2.4 Removal of the Eye Shield.............................................................................52

14.2.2.5 Aftercare....................................................................................................... 52

14.2.2.6 Cleaning of the Eye Shield (Single Use, Completion of Treatment)...............52

14.2.2.7 Cleaning of the Eye Shield (Individual Patient, Multiple Use)........................52

Section 15 – Routine Lead Shielding Thickness.......................................................................53

List of Significant/Associated Documents...............................................................................53

Related Policies, Procedures, Guidelines and Legislation.......................................................54

References/Related Documentation.......................................................................................54

Search Terms.......................................................................................................................... 54

Appendices............................................................................................................................. 55

Appendix 1 Calculation Sheet for TOPEX SRT 100...............................................................56



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Introduction

This document describes the general work procedures and guidelines associated with the TOPEX- SRT100 Superficial X-ray Therapy Unit. This Manual is applicable to all patients undergoing radiation therapy treatment at the Canberra Region Cancer Centre, Radiation Oncology Department.

This Manual is not intended to replace theoretical principles of Radiation Therapy Practice and should not be followed by rote.

Radiation Therapists (RTs) are advised to direct any planning or treatment matters of uncertainty relating to this Manual to the Head of Planning, Head of Treatment or Radiation Therapist Educator.

Back to Table of Contents

Scope

This Manual is a reference for Radiation Therapists (RTs) treating patients undergoing radiation therapy treatment at the Canberra Hospital.


Key Objectives

Safe operation of the Radiation Therapy Service


Alerts Staff without adequate training in planning/treatment delivery must not participate When doing a manual entry of patient data ensure the correct information is entered

and that the correct patient has been selected. Do not proceed with treatment until all pre-procedure documentation is accurate and

complete. For patients who are transferred from locations within the hospital who are incapable of

personally participating in the verification process, and with no authorised representative present, identification can be made from a hospital armband or from a member of staff from the preceding location who may act as the patient’s representative for the verification.

If a discrepancy arises at any point during the Correct Identification Procedure Verification, the procedure will not commence until the discrepancy is resolved.


Section 1 – SXRT Calculations



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1.1 Treatment SheetFor each treatment field a Prescription must be completed and signed on front of the paper based treatment sheet. Fill out all the necessary data: Ensure the RO writes and signs the prescription Attach a RT signature page to the treatment sheet

1.2 SXRT CalculationsSuperficial calculations are to be completed using the ARIA Dynamic Document Template named 'SXRT Calc + Final Planning Check'

1.2.1 Commencement of planning tasks Log into ARIA using your user name and password From your User Home screen select the SXRT Calculation Task to auto assign the logged

in user as the task owner and hyperlink to the Documents Workspace Select New Select Template Select and open the Dynamic Document named 'SXRT Calc + Final Planning Check' Complete calculation section of the document For each field:

o Enter the site name in the format Xxxxxxx (e.g RT Temple)o Enter the Field Numbero Select the appropriate applicator size from the dropdown menuo Specify the amount of standoff used for the calculation

Using the data from the Planning Data Book, enter the Dose Rate for the Applicator (DR App) selected, backscatter factors (BSF) (see section 1.2.2 for backscatter calculations for irregular fields) and SSD correction (if applicable)o NOTE: A value of 1 must be entered in the SSD correction if there is no correction

applicable. Once the DR App, BSF Field, BSF App and SSD Correction Values have been entered,

right-click on the Green text box and select Update Field o This will automatically calculate the Corrected Dose Rate (CDR) based on the values

previously entered into the calculation Ensure the Dose text box has been populated. Next, right-click on the yellow text box

and select Update Fieldo This will automatically calculate the Time based on the values previously entered into

the calculation Click OK or Apply to save the document to complete the planning checklist at a later

stage.1.2.2 Calculating BSF of an irregular field (if applicable)For field shapes that are not highly irregular, or very narrow, it has been shown that equivalent diameters can be determined by measuring the length and width of a rectangle approximating the field shape. See Figure 1 below. The shape in Figure 2 below is moderately irregular and may warrant Clarkson sector integration, but careful measurement may yield an approximate rectangle. Figure 3 below is highly irregular and



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it is not suitably approximated by a rectangle. It would require Clarkson sector integration.

Figure 1 Figure 2 Figure 3Mildly irregular Moderately irregular Highly irregular

Equivalent DiameterFor mildly irregular or moderately irregular field shapes, Figures 1 and 2 above, an equivalent diameter method can be used to measure the field shape. A rectangular shape should be approximated over the irregular shape so that the areas outside the rectangle (red section) are roughly equalled by the areas inside the rectangle (blue section).

The length and width measures of this rectangle can be converted to an equivalent diameter using the table supplied in the SXRT section of the planning data book. The BSF is then able to be looked up for the corresponding diameter (and SSD).

Clarkson Sector integrationFor highly irregular fields (or very narrow fields) the Clarkson Sector integration method should be used to calculate the diameter of the field for BSF calculation. The



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Calculation Sheet for TOPEX SRT100 (Appendix 1) should be used. Trace the field onto the sector lines with the centre of the field at approximately the centre of the lines. The BSF for each sector line then needs to be looked up and averaged out over the 36 measurements.

NOTE: While this method can be used to successfully calculate back-scatter factors for highly irregular field shapes, it involves many repetitious measurements and table look-ups. As such, there are many opportunities for errors to be made inadvertently, care must be taken.

1.2.3 Complete SXRT Calculation TaskOnce the calculation section of the document has been completed, select Done at the top toolbar. This will automatically complete the SXRT Calculation Task and return to the User Home.

1.2.4 Cut-out and Accessories Cut-out/Accessory OrdersEnsure any cut-outs or accessories that need to be made in the mould room have been requested. Care Path Task

o Navigate to the Care Path moduleo Set the task “Order Cut-out + Accessories” to completeo If nothing is to be ordered, delete the task

1.3 ARIA Plan/Data EntryAll data and details for the SXRT plan are to be manually entered in ARIA

1.3.1 Creating a New Course Navigate to the Plan Parameters workspace Open the correct patient From the Insert menu, select New Course

Figure 1: New Course

From the Course Properties dialogue box, in the general tabo Select the Course Intent from the dropdown listo Enter the Ready for Care date in the Start box



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Figure 2: Course Properties

From the Course Properties dialogue box, in the Diagnosis tabo Highlight the appropriate diagnosis from All Available Diagnoseso Select Attacho Click OK

Figure 3: Diagnosis Tab

If no diagnosis is available to attach to the Course, or the available diagnoses are for previous, unrelated courses, then the Primary Oncologist will need to attach this at a later stage and complete the corresponding task in the patient’s Care Path.



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1.3.2 Creating a New Plan Navigate to the Plan Parameters workspace (if not already there) From the Insert menu, select New Plan

Figure 4: Insert New Plan

From the Plan Properties dialogue box, in the General tab ensure that the:o Treatment site is entered in the ID fieldo Treatment site is entered in the Name fieldo Select the Plan Intent from the drop down menuo Select the most appropriate Patient Positiono Select OK

1.3.3 Creating a New Treatment Field Navigate to the Plan Parameters workspace (if not already there) From the Insert menu, select New Field Ensure the Field Type is set as Treatment Select SXRT from the Machine drop down menu Select OK

Figure 5: Plan Properties



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Figure 6: New Field Figure 7: Field Type

1.3.4 Field ParametersUsing the data and definitions contained in the following table, enter all relevant information into the field parameters.

PARAMETER DATAField ID Field NumberField Name Name of FieldTechnique StaticScale IEC61217Energy/Mode 1X (Default)Time [Min] Calculated TimeTol. Table SXRTCalculated SSD [cm] ------Planned SSD [cm] ------Gantry [deg] 0Coll Rtn [deg] 0Field Size X [cm] Width of Treatment FieldField X1 [cm] ------Field X2 [cm] ------Field Size Y [cm] Length of Treatment FieldField Size Y1 [cm] ------Field Size Y2 [cm] ------MLC NONEDynamic Wedge ------Int Mount Applicator’s SSDAcc Mount Applicator UsedComp Mount 100kV/8mAe – Aperture HVL 2.123mmAlBolus ------Couch Vert [cm] 0Couch Lng [cm] 0Couch Lat [cm] 0Couch Rtn [deg] 0Imager Vert [cm] ------Imager Lng [cm] 0Imager Lat [cm] 0Setup Note Enter All Setup Details in Treatment

Preparation SectionTable 1: SXRT Field Parameter Definitions



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1.3.5 Adding a New Volume and Reference Point Navigate to the Reference Points workspace From the New menu, select New Patient Volume From Patient Volume Properties dialog box opens, in the General tab

o Enter the treatment site in the ID sectiono Enter the treatment site in the Name sectiono From the Volume Type drop down list select PTVo Select OK

Figure 8: New Patient Volume

Figure 9: Patient Volume Properties



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Under the Reference Point column, select the correct Reference Point from the drop down list

Figure 10: Selecting the Reference Point

Enter the field dose for each field

Figure 11: Entering the field dose

Click the green arrow next to Dose Per Fraction to update the dose Select Yes to the warning that appears

Figure 12



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Figure 13: Field Dose Warning

Complete the Total Dose Limit, Daily Dose Limit and Session Dose Limit

Figure 14: Dose Contribution Limits

Enter the Number of Fractions, then ensure the Total Dose and Planned Fraction Dose are each correct

Figure 15: Completing the Number of Fractions

1.3.6 Adding Setup Photos Navigate to the Treatment Preparation workspace

o Identify the Setup Photo/Note Workspaceo Select the Edit drop down menuo Select Add Photo(s)



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Figure 16

Navigate to the location of the patient’s photos. The folder in which these are stored is located at: Q:\TCH\medicalservices\Radiation Oncology\Radiation Therapists\3. Simulation & Planning\17. Patient Setup Photos

Select the desired photos and click Open. Repeat this process for all additional field/ set up photos required

1.3.7 Scheduling the Plan Navigate to the Plan Scheduling workspace

o Checkmark the box next to the plan(s) to be scheduled

o Select the Schedule button . This will schedule treatments in the standard once per day regime.

1.3.8 ARIA Planning Approval To Planning Approve the Plan, navigate to the Plan Parameters workspace

o Click the Validate button . The Plan Validation dialog will appear listing any errors. Investigate and resolve any errors

o Click OKo Right click the plan and select Plan Approval > Planning Approved. The Planning

Approved dialog window will open



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Figure 17: Planning Approval

o At the Planning Approval-Parameters select the Next button. It is not possible to enter a planned SSD in this field

Figure 18: Plan Approval Parameters

o At the Planning Parameters-User Authentication Window, review and action the warnings in the Help Pane

o Enter in your ARIA Username and Passwordo Select Finish



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Figure 19: Planning Approval-User Authentication

1.4 Completing the Treatment Preparation TaskThe items and their criteria within this document will be checked by both the Planning RT and the Checking RT

1.4.1 Planner SXRT Calculation & QA Check Log into ARIA using your user name and password From the User Home, select the Treatment Preparation task. This will hyperlink the

logged in user to the Dynamic Documents workspace Open the “SXRT Calc + Final Planning Check” document which has the field calculation

already completed within it Using the criteria listed in the document carefully cross check parameters/calculations

and information to ensure all required tasks are completed. By ticking each item you are acknowledging you have carefully reviewed each of the items in accordance with departmental policy. For full details describing the SXRT Final Planning Check criteria, refer to Section 2 below.

Once complete, select Signoff Enter User Name and Password.

1.4.2 Template Upload Upload a copy of the template into Aria as a document

1.4.3 Care Path Task Once the document has been Signed Off, the checklist item of final check sheet

complete will need to be ticked off. Once the checklist item is tick off click the Done button on the top toolbar. This will

complete the task and return to the User Home screen




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Section 2 – SXRT Final Planning QA

2.1 Initiating a SXRT Final Planning Check Task Log in to ARIA using your user name and password From the User Home, select the appropriate Planning Tasks Workspace/Tab Select the appropriate SXRT Final Planning Check task to auto assign the logged in user

as the task owner and hyperlink to Dynamic Documentso The planner will click on the ‘Complete SXRT Planning Checklist’ tasko The checker will click on the ‘Final Plan Check’ task

2.2 Open the Previous SXRT Final Planning Check Dynamic DocumentThe planner has already created the SXRT Final Planning Check document to complete the SXRT Calculation. The check list for both the planner and the checker is found in this document underneath the calculation section. Search for and double-click on the previously created document

2.3 Complete the SXRT Final Planning ChecklistWork down the list ticking items off as they are checked. Complete the Calculations and Treatment Sheet Prescription items as previously described.

2.4 Aria Details2.4.1 Plan Parameters check Course + Diagnosis + RFC

Ensure an appropriate course is created with the correct Diagnosis and Ready for Care Date attached

Plan + IntentEnsure the Plan Name reflects the area being treated and has the correct intent selected

Field ID Field Name Energy (1X = SXRT in ARIA) Time Tol. Table Gantry/Coll/Rtn = 0 Field X = Field Width and Field Y = Field Length

Measure the treatment field width and length from the template and ensure there are no discrepancies between those measured and those used for planning

Int Mount = Applicator SSD Ensure the specified applicator SSD matches what was used for the field calculations

Acc Mount = Applicator Ensure the applicator matches what was used for the field calculations and what is recorded on the CT-Sim Record

Comp Mount = 100kV/8mA e- Aperture = HVL:2.123mm Al Setup Notes



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Ensure the patient position and set-up/immobilisation devices recorded on the CT record match the ARIA setup note and are appropriate for use on treatment:o Ensure the applicator size is specifiedo Ensure the use of a lead cut-out has been specified (if applicable)o Ensure other set-up equipment is described (e.g. internal nose shields, external eye

shields etc.)o Ensure any planned standoff is clearly documented

Prescription recorded in Comments of Plan PropertiesEnsure the Prescription has been recorded in the Comments section of the Plans Properties.

2.4.2 Reference Points Volume

Ensure an appropriate Volume has been created with an appropriate Volume Type selected

Reference PointEnsure an appropriate Reference Point has been created and the correct prescription attached for each field

Dose per Fraction per FieldEnsure the GD per fraction matches that of the prescription for each field

Total DoseEnsure the Total GD matches that of the prescription for each field

2.4.3 Treatment Preparation Landmark Diagram(s) Correct Uploaded to Field Photos

Ensure the Landmark Diagram is correct has been uploaded into the field photos Field Photos Uploaded Planning Approved

Ensure the plan is valid for treatment prior to Plan Approving.

2.4.4 Plan and Appointment Scheduling Plan Scheduled

Ensure the total number of fractions scheduled in the Plan Scheduling workspace matches that of the prescription

AppointmentsEnsure the scheduled number of bookings in Appointment Scheduling workspace match the prescription. Also confirm the appointment times during the day are appropriate for the superficial operational hours.

Adequate Appointment TimesEnsure that adequate appointment time has been allocated to the patient/techniqueThings to take into consideration include the patient’s mobility and complexity of setup. Discuss required modifications with the Senior RT

Tasks



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Ensure all necessary tasks are attached to the patient’s care path and have the correct resources/staff assigned.

2.4.5 Completion of Information Care Path Complete

Ensure all tasks/appointments within the patient’s Care Path are up to date and complete

Billing Codes Captured (CT + Planning) ‘Course’ Assigned in Patient Manager (Not ‘New Course’)

Ensure the Hospital Visit Status is set to Course and not New Course within the Patient’s Registration

Inpatient/Outpatient status correctEnsure the patient’s Inpatient/Outpatient status is correct in Patient Manager. If an Inpatient, also ensure the correct ward has been entered

Template Appropriate and CompleteEnsure the Template is appropriate and complete for use and that a copy has been uploaded to ARIA

Accessories Appropriate and CompleteEnsure all treatment accessories have been created and are appropriate for treatmentConsent Form Completed Uploaded to DocumentsEnsure the Consent Form has been scanned in and uploaded into ARIA

SXRT Calculation+ Final Check signed off by Planning RTEnsure the planner has checked all items within their section of the document and ‘Sign Off’ the document.

Figure 20: Sign Off Button

Alert:If there are any additional comments that need to be documented, they may be done so in the grey text box next to ‘Notes’ found underneath the last section of the document.

2.5 Signoff/ Dynamic Document approvalOnce the Checker has checked all items within their section of the document, they must ‘Approve’ the document locking it from being edited any more.



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Figure 21: Approve Button

This will stamp the document with your name, the date, and time.


Section 3- SXRT Treatment General Information

3.1 Roles and ResponsibilitiesThe clinical practice of Superficial X-ray Radiation Therapy (SXRT) is complex and dynamic. The Radiation Therapist (RT) must exercise professional judgement, skills and due care and must have the appropriate qualification and training to practice radiation therapy in a safe, effective and efficient manner.

Each RT working on the SXRT Unit is expected to: Be familiar with the TOPEX-SRT100 procedures and relevant vendor supplied manuals Follow all associated, relevant and related procedures and policies described at a

departmental and portfolio wide level. Familiarise or re-familiarise themselves with the contents of the SXRT Procedure Manual

and any relevant notices posted on the notice board and in the Notices/Memoranda File.

Sign the SXRT Procedures Acknowledgement Sheet at the front of this manual.

Both Accredited RTs in the treatment team have equal, shared responsibility, for ensuring the treatment is delivered according to the treatment instructions outlined in this Manual.

The routine duties for the SXRT team include, but are not limited to, undertaking: Confirmation of patient identity and treatment site prior to treatment delivery Accurate treatment set-up Treatment delivery Continuous visual monitoring of the patient on CCTV Sign off of the treatment to acknowledge treatment delivery Determination and application of correct Medicare billing codes Restocking supplies Administrative duties Other duties as requested by the Head of Treatment

The RT who switches on the SXRT Unit is responsible for ensuring no other member of staff or public is within the SXRT Bunker while the machine is switched on. Doc Number Version Issued Review Date Area Responsible PageCHHS16/241 1 05/12/2016 01/11/2019 CACHS 21 of 56


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3.2 Staff OrganisationUnder the current RT organisational structure, the Head of Treatment RT is responsible for the overall management of the treatment section including LA1, LA2, LA3, LA4, Brachytherapy Treatment and Superficial X-Ray Therapy Treatment.

In conjunction and collaboration with the Head of Treatment RT, the SXRT RT’s will: Maintain efficient operation of the Unit. Provide hands on clinical service delivery. Discharge of operational level administrative duties. Participate in quality assurance. Undertake other adhoc duties as requested by Head of Treatment.

3.3 SXRT Unit Components


Section 4 – Equipment Operation

4.1 Machine Power-up The circuit breaker switch applies power to the SXRT Base and the Control Console. The circuit breaker is located on the rear of the SRT100 Base Unit.

To switch on the SRT100 place the circuit breaker switch in the “ON” position. The “ON” position is indicted by the 1 on the circuit breaker panel (see Figure 23 below).



Figure 22: TOPEX 100 SXRT Unit.

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Figure 23: SRT100 Circuit Breaker

Power to the Base Unit and the Control Console is indicated by the illumination of the blue power indicator led.

NOTES: (1) Do not turn off power while the heat exchanger motor is running (approximately 3

minutes after termination of irradiation or until coolant temperature is less than 35ºC) as damage may occur to the SXRT Unit, unless an Emergency arises.

(2) Power can be immediately shut off by pressing one of the three EMERGENCY OFF switches. One is located on the Control Console front panel, another is located at the SXRT room entrance and the other is on the Base Unit. Do not use these switches for routinely turning off the power.

(3) When a POWER FAILURE Message is observed on the Control Console, press the Reset Button on the top right of the Control Console

4.2 Warm-upThe SRT100 must be gradually warmed up to the operating kilovoltage.

The Port Block Applicator must be installed for each Warm-up cycle. Failure to install the Port Block Applicator will result in the display of the following interlock message at the control console: “BEAM BLOCK APPL. REQUIRED”.

The Warm-up cycle will be automatically determined based on the length of time that has expired since the last use of the SRT100.

The SRT100 is considered warmed up if the STATUS bar shows a TREATMENT READY message when the key is switched to X-RAYS and there is no warm-up countdown timer displayed on the Control Console LCD screen.

Following the successful completion of the warm-up cycle, the RT must sign and record notation that indicates the SRT100 machine has been warmed up and the time of warm-up in the ‘SXRT Daily Treatment Log Book'.



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4.2.1. Automatic Warm-up CycleEnsure all personnel and patients have been removed from the SXRT treatment room. When the unit is powered up and the key switched to X-RAYS, any necessary warm-up cycle will be automatically displayed at the top of the LCD screen at the Control Console.

To commence the warm-up cycle, the RT must: Ensure the Port Block Applicator is correctly installed Close the SXRT treatment room door Switch the power key from SAFE to X-RAYS Depress the START button for approximately one second.

NOTE: A PRE-HEAT phase usually precedes any X-Ray emission After the completion of the warm-up cycle wait for READY message to be displayed on

the SXRT console before turning the key to SAFE or opening the SXRT treatment room door.

The Port Block Applicator must be removed prior to proceeding with a Radiation Output Check or treatment delivery.

4.2.2 Manual Selection of Warm-up CycleAt 15 minutes prior to requiring a full warm-up, a timer will be displayed on the Control Console LCD screen indicating the time remaining until a full warm-up cycle is required. To commence the Manual Warm-up cycle the RT must: Ensure the Port Block Applicator is correctly installed Ensure all personnel and patients have been evacuated from the SXRT treatment room Close the SXRT treatment room door Switch the power key from SAFE to X-RAYS Select the “Warm-up Now” option from the X-Ray Menu using the UP/DOWN arrows Depress the START button for approximately one second.

NOTE: A PRE-HEAT phase usually precedes any X-Ray emission. After the completion of the Warm-up cycle wait for READY message to be displayed on the SXRT console before turning the key to SAFE or opening the SXRT treatment room door.

4.3 Daily Machine Output CheckAt the completion of the warm-up cycle and prior to the commencement of the first scheduled patient of each treatment day, dose output must be checked using the inbuilt dose check system known as RADCHECK. To perform the RADCHECK procedure: Attach the RADCHECK sensor to the applicator mount Ensure all personnel and patients have been evacuated from the SXRT treatment room Close the SXRT treatment room door Switch the power key from SAFE to X-RAYS Set the timer to 0.2 minutes Depress the start button for approximately one second



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Note: A PRE-HEAT phase usually precedes any X-Ray emission

The percentage variation in dose output relative to the 'Reference Value' will be displayed on the Control Console LCD screen. This value must also be recorded in the SXRT Daily Treatment warm up appointment in time planner. If the variation in the RADCHECK value is 2% or greater: The system is not operable until a service is completed Entry must be made in the SXRT fault book Radiation Engineering (RE) or Medical Physics (MP) must be notified An 'Out of Service' sign must be posted at the Control Unit and on the SXRT Bunker

Door. The SRT100 Unit will be considered 'Out of Service' until maintenance has been performed and equipment handed over from RE or MP by means of documentation recorded in the SXRT fault book.

4.4 Notes on Applicators4.4.1 Applicator SizesThe following applicators are commissioned and available for use with the SRT100: 2.0 cm diameter, 15cm SSD 2.5 cm diameter, 15cm SSD 3.0 cm diameter, 15cm SSD 4.0 cm diameter, 15cm SSD 5.0 cm diameter, 15cm SSD 10.0cm diameter, 25cm SSD

4.4.2 Applicator TipsAn applicator must be installed before an exposure is enabled. The applicator must have a clean tip installed on the distal end. The applicator tip must be cleaned between each patient exposure. The applicator tip must be correctly seated against the shoulder of the applicator to maintain the correct Source to Skin Distance (see figure 3)

Figure 24: Applicator Seating

To remove a damaged or contaminated applicator tip pull it away from the applicator.



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To replace an applicator tip, slide it on to the end of the applicator until it seats firmly against the applicator shoulder as shown in Figure 3. Notify the Head of Treatment who will order a replacement applicator tip.

4.4.3 Applicator AttachmentRotate the spring-loaded outer collar counter clockwise.

While holding the outer collar, place the Applicator into the mount so that the groove in the applicator corresponds with the red mark on the applicator mount.

Slowly release the outer collar to its normal position- being careful not to release the spring-loaded collar too quickly.

If the outer collar does not fully return to its normal position, the applicator is not positioned properly in the inner mount. Rotate the outer collar again, and reseat the applicator tabs into the inner collar.

Figure 25: Applicator Attachment

4.5 Programming the Treatment Console4.5.1 Setting the Treatment Mode At the control console turn the key to the X-RAYS position. Select the kV setting by depressing the up/down arrows. The SRT100 automatically

selects the:o mA settingo appropriate filtero calibrated values for HVLo calibrated values for dose rate

4.5.2 Setting the Exposure TimeAt the control console: Depress the RESET button Rotate the Black Time Control Knob to display the desired exposure time as indicated in

the treatment sheet.o Pressing the knob whilst turning will advance the time in increments of 0.01 minutes.o Turning the knob without depressing will advance the time in 0.1 minute increments



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The SET time will indicate the selected exposure time setting.

4.6 Treatment Delivery4.6.1 Treatment Delivery Information The Radiation Oncology Patient Liaison Officer schedules appointments for new cases. Upon commencing a course of treatment, the RT will provide the patient with a printed

list of all treatment appointments. The Appointment Schedule in ARIA will determine the order of patient treatments. The LA4 Senior is responsible for the maintenance and monitoring of SXRT patient

bookings to ensure the smooth operation of the Work Unit. All patients treated within the department are to check-in to the department using the

ARIA Barcode Check-In System. The RT will use the SXRT Appointment Schedule Workspace within ARIA to monitor patient attendance.

Inpatient treatment times will be communicated with Canberra Hospital & Health Service Ward Services using the inpatient ward list. Where possible, all inpatient treatments should be performed during core business hours to ensure medical and/or nursing cover.

During quiet periods the Head of Treatment or LA4 Senior RT may delegate cleaning, stock replenishment, quality assurance or administrative tasks to any member of the team.

After patient setup and prior to leaving the SXRT Bunker, the RT should clearly call out important details, set-up details and geometric parameters. These include, but are not limited to: Patient Name Treatment Site/Field Name Positioning Details Applicator Size Lead Shielding Other appropriate patient/treatment specific information.

The second RT shall cross check the verbalised parameters and set-up details.

Outside the Bunker, the RT will program the Treatment Console. The second RT crosschecks the X-ray Mode and the time setting before recording the manual treatment in the SXRT Daily Treatment Log Book.

RT’s must keep a close watch of the patient and ensure that the audio intercom is switched on during every field of every treatment.

Both RT’s must not to be interrupted or distracted by other team members or staff during treatment delivery. The RT’s must remain focussed on the task at hand and not become involved in dialogue with the other staff members.

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The RT at the console will record the date and get both treating RTs to sign the treatment sheet.

At the completion of each treatment, each treating RT should check that the time shown in the treatment record has been correctly delivered according to the ELAPSED Time counter on the Control Console. Once all treatment fields have been delivered, a manual treatment completion must be finalised in ARIA for that patient’s appointment To complete a treatment manually: Navigate to Plan Scheduling in ARIA Open the correct Patient From the Edit dropdown menu on the right, select Add Manual Treatment Select the correct plan from the dropdown menu Select Save

On releasing the patient, ensure they are directed to the sub wait change area (if applicable) and report to the front desk before leaving the department. The patient is to be informed if they have a scheduled nursing or RO review follow their treatment.

If the patient is from the ward, ensure the Nurses are informed so that the ward services are informed to take the patient and their ward file back.

4.6.2 Enabling X-ray emissionAll patient treatments will be administered according to the documentation contained in the ARIA electronic record. This serves as the primary source of treatment delivery information which must be thoroughly examined before each treatment fraction. Any discrepancies or anomalies must be clarified prior to proceeding with treatment.

The field size on the electronic treatment sheet will be entered with length in the Y Jaw Setting and Width in the X Jaw Setting.

All measurements are entered in centimetres and time in minutes.

To deliver an X-ray exposure: Ensure the TREATMENT READY message on the console is displayed when the key is

switched to X-RAYS. Set the time indicated in the SXRT Treatment record. Depress and hold the START button for 1 second.

NOTE: A PREHEAT phase usually precedes any X-Ray emission

A one second tone will sound to indicate the exposure has been completed and a TREATMENT COMPLETE message will be displayed on the Control Console LCD Screen.

Turn the key to the SAFE position after the tone stops.



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Visually confirm the correct time has been delivered as per the digital readout on the Control Console.

Depress the RESET button to return all counters to 0.00.

4.6.3 Abnormal Exposure TerminationExposures may be terminated anytime by pressing the STOP button or by depressing any of the Emergency OFF switches located: on the control console at the entrance to the SXRT door on the SXRT Unit base

In all instances of termination, it is imperative that the elapsed time is recorded prior to attempting any termination recovery sequence (see Table 4-1 from the Manufacturer’s Manual for common exposure terminations and their recovery actions.

4.7 Close of SXRT Business (Daily)4.7.1 Power offAt close of daily SXRT business, the SXRT Unit must be powered off.

To switch off the SXRT Unit the heat exchanger motor must not be running (It runs for 3 minutes after termination of irradiation or until coolant temperature is less than 35° C.) Doc Number Version Issued Review Date Area Responsible PageCHHS16/241 1 05/12/2016 01/11/2019 CACHS 29 of 56


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NOTE: Wait for the PUMP ON message on the LCD console to disappear before powering off the SXRT unit.

To switch off the SRT100 place the circuit breaker switch in the “OFF” position. The “OFF” position is indicted by the O on the circuit breaker panel (see Figure 5).

Figure 26: SRT100 Circuit Breaker

4.7.2 Other Close of Business MattersRT’s must:- Ensure that the current days scheduled appointments are completed, showing all

patients as being treated by a tick, or if not treated by a cross indicating the appointment was cancelled

Ensure all patients that day have had a manual treatment added in the Plan Scheduling workspace of ARIA

Record any down time as either a Scheduled or an Unscheduled Appointment at the time the incidence occurred

Clean and tidy the treatment room; change the linen; replenish the linen Power-off the SXRT Unit Switch off the CCTV monitors and audio intercom Put away all treatment folders and case histories Lock up the SXRT key Ensure all patients have left the department




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Section 5 – Fault Documentation

All RTs must use their professional judgement when determining the implications of machinery and equipment faults and failures. As a rule, all machinery faults should be brought to the immediate attention of the Radiation Engineer (RE) on duty for their advice and follow-up action.

5.1 SXRT Faults preventing the progression of treatmentIf the SXRT Console indicates a fault that prevents the continuation of treatment, notify the RE immediately via telephone and document the fault in the SXRT Fault Book. An Unplanned Maintenance appointment should also be created in the SXRT schedule within ARIA.

One RT remains at the SXRT Control while the other treating RT enters the SXRT treatment room to notify and monitor the patient.

The RT will liaise with the RE as to whether the patient needs to be evacuated from the treatment room.

When the fault is cleared, the RE will: Advise of any necessary action required by the RT in order to recommence treatment

and; Make appropriate notation in the SXRT Fault Book

5.2 SXRT Faults not preventing the progression of treatmentIf the SXRT indicates, a fault that does not require the intervention of a Radiation Engineer it must be clearly documented in the Fault Book. If the fault persists, MTS must be notified via telephone.

5.3. Faulty accessoriesAll details of faulty equipment, detected through general observation or during the scheduled Monthly Equipment Condition Checks must be logged in the SXRT Fault Book. Poor equipment condition must be discussed with the Head of Treatment who will either arrange repair, replacement or render the equipment temporarily out of service.


Section 6 – Safety

All Safety Procedures are to be strictly adhered to.

Observe all safe practices for lifting heavy objects including patients. Points concerning safety listed in the following are by no means exhaustive. Every RT is expected to exercise due care at all times to ensure the safety of patients, of himself/herself, of his/her colleagues, and of the public.



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"At all times act in such a way as to .... ensure that by no action or omission on his/her part their (patients') condition or safety is placed at risk. ....Have regard to the physical working conditions and make known to the appropriate authority if these endanger safe standards of practice in any way."Quoted from, "A Code of Professional Conduct for Radiographers" by the College of Radiographers. Radiography Sep/Oct 1985 Vol 51 NO 599 p286.

Whenever necessary, use the PATSLIDE, MEDILIFT, Lifting Equipment or Slide Sheet for patients who are not ambulant or have disease/injuries of the spinal column.

Be conscientious about radiation hazards to patients, staff, visitors and the public. Radiation protection is a joint effort/responsibility of all RT's.

DO NOT enter/remain in the treatment room when the beam is on.

DO NOT stand unnecessarily at the entry to the room while the beam is on.

Do not switch the beam on if any person (except a patient who is being treated) is in the treatment room.

When treating patients both RTs should check that no person other than the patient being treated is left in the treatment room before leaving the treatment room and should be the only ones to activate the door interlock.

If any RT has a legitimate need to enter or return to the treatment room, against the general movement to leave the treatment room by the treatment team, he/she must first make it known to the second RT treating the patient.

Similar precautions should be taken for non-patient work: only the last person to leave the treatment room should activate the door interlock.

During work hours, the treatment room and console area are Controlled Areas. For radiation protection and operational safety, effectiveness and efficiency, only authorised staff or persons under their supervision have access to the treatment room and the console area. Patient’s relatives and friends generally do not have access to these areas except for special situations. Patients’ privacy also needs to be protected.

Equipment must never be left unattended while operating (Beam On), or in an active state where accidental irradiation is possible.

Whenever the machine is unattended, it must be placed in ‘Standby’ with the SXRT keys removed from the console and placed under the writing mat or other similar place.All staff must adhere to all Workplace Health and Safety Policies and Practices relative to ACT Health.

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Section 7 – Accidents/Incidents ReportingIn case of an accident involving a patient or visitor, please ensure that the patient or visitor is seen by a doctor as soon as possible before the patient/visitor leaves the Department, even if the patient/visitor is not keen to see a doctor.

A patient should be seen by the doctor in-charge of his/her case, or by the Registrar. (If neither is available, see the doctor at the Accident and Emergency Department.)

A visitor should be seen by a doctor at the Accident and Emergency Department. If the patient/visitor insists on not seeing a doctor, or going away to see his/her own doctor, record this in the report.

If the accident involves a staff member, for the well-being of himself/ herself and for possible future needs of workers compensation claim, the staff member should see the staff doctor or the doctor at the Accident and Emergency Department.

Accident/incident reports must be filled out IMMEDIATELY after an accident/incident by all staff involved. It is a legislative requirement under the ACT Occupational Health & Safety Act 1989.

The correct means of reporting an incident involving a patient or staff member is via the Riskman Portal on the ACT Health Intranet.

If there is a patient or staff related accident or injury, RISKMAN must be completed by staff involved and then reported to the Head of Treatment, Head of Planning and the Deputy Chief Radiation Therapist.

If there is a Radiation Therapy incident involving a patient’s treatment, RISKMAN must be completed by staff involved and then reported to the Head of Treatment, Head of Planning and the Deputy Chief Radiation Therapist.


Section 8 – Loss/Theft/Damage of Property

If there is a theft/loss of property of staff, patient, or visitor, the "NOTICE OF LOSS/THEFT OR DAMAGE TO PROPERTY" form must be filled in. Contact the Deputy Chief Radiation Therapist to report the theft and collect the appropriate forms.


Section 9 – Commencing a New SXRT Case

9.1 New Case Alerts & WarningsEach RT must ensure they are logged into ARIA using their own login account when completing a New Case Pre-Treatment QA



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As there is no 4DITC associated with SXRT treatments, patient Alerts will not automatically appear in ARIA for staff as they do at the Linac consoles. Therefore ARIA Patient Alerts must be reviewed manually before each treatment.

9.2 New SXRT Case Procedure9.2.1 Commencing the SXRT Pre-Treatment Check Log in to ARIA using your user name and password From the User Home, select the appropriate Linac Tasks Workspace/Tab Select the SXRT Pre-Treatment Check task to hyperlink to Dynamic Documents

9.2.2 Create New Dynamic Document for the SXRT Pre-Treatment Check Select “New” to create a new document Select and open the template named ‘SXRT Pre-Treatment Check’ Ensure your ARIA user ID is populated in the Authored by, Supervised by and Entered by

sections

Figure 27: Document User Details

Enter the Course and site details in the appropriate section of the Dynamic Document

9.2.3 Complete the SXRT Pre-Treatment CheckUsing the dynamic document checklist ensure all items are checked, marked off and/or followed up. Placing a Checkmark against each of the criteria indicates that the item has been completed and/or follow-up action initiated.

9.2.3.1 Treatment Document Management Patient details

Ensure the patient details including primary RO are correct Prescription/RO’s Signature

Ensure the prescription has been signed by the Radiation Oncologist Fractionation and Bi-daily Treatments

Ensure the Radiation Oncologist has indicated the treatment fractionation as 9 or 10 fractions per fortnight. Ensure bi-daily treatment requests are appropriately booked

Special InstructionsEnsure any ‘Special Instructions’ indicated by the RO are documented in an appropriate space, such as Set-up Notes in ARIA and followed

Previous Tx Calc & DiagramIf there has been any previous treatment, ensure a previous treatment diagram and dose information sheet is completed and uploaded to ARIA

Doses Reported



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Ensure that all applicable dose reporting sections are completed on the front of the treatment sheet.

RT Planner SignatureEnsure the Treatment Sheet has been signed by the Planning RT

Counter Signature for NPDPsEnsure the treatment Sheet has been signed by a fully accredited RT. Mark this item not applicable as appropriate.

SXRT Calculation ‘Signed Off’ by planning RTEnsure the SXRT Calculation dynamic document has been ‘Signed Off’ by the planning RT

SXRT Calculation ‘Approved’ by checking RTEnsure the SXRT Calculation dynamic document has been ‘Approved’ by the checking RT

9.2.3.2 Plan Data Integrity Checks (ARIA Details) Plan Parameters Diagnosis + RFC

Check the diagnosis has been attached to the course and RFC date is correctly specified in the course start date

Field IDEnsure the Field ID has been entered in ARIA

Field NameEnsure the Field Name has been entered in ARIA

Energy Ensure the beam energy has been entered in ARIA

TimeEnsure the calculated treatment time for each field has been entered in ARIA

Tol. TableEnsure the SXRT tolerance table has been selected

Gantry/CollEnsure the gantry and collimator fields are set to 0

Field XMeasure the treatment field width from the template and ensure there are no discrepancies between those measured and those used for planning. Ensure the field width is entered in ARIA

Field YMeasure the treatment field length from the template and ensure there are no discrepancies between those measured and those used for planning. Ensure the field length is entered in ARIA

Applicator SSD (Int Mount)Ensure the specified applicator SSD matches that used for the field calculations

Applicator (Acc Mount)Ensure the applicator matches that used for the field calculations and what is recorded on the CT-Sim Record

Energy (Comp Mount)Ensure the energy of 100kv/8mA is selected in the Comp Mount section.

HVL (e-Aperture)Ensure the HVL of 2.123mm Al is selected in the e-Aperture section



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Couch ValuesEnsure all couch values are set to 0

Set-up NotesEnsure the patient position and set-up/immobilisation devices recorded on the CT Record match the ARIA setup note. Ensure any special instructions are documented. As a minimum ensure:o the applicator size is specifiedo the use of a lead cut-out has been specified (if applicable)o other set-up equipment is described, e.g. internal nose shields, external eye shields

etc.o any planned standoff is clearly documented.

Reference Points Correct Dose per fraction

Ensure the GD per fraction matches that of the prescription Total GD

Ensure the Total GD matches that of the prescription

Treatment Preparation Landmark Diagram Uploaded

Ensure the landmark diagram has been uploaded and is correctly labelled Field Photos Uploaded

Ensure the field photos have been uploaded and orientated correctly. Upload any additional field photos as required.

Treatment ApprovalEnsure the plan is valid for treatment prior to treatment approving.

Plan and Appointment Scheduling Plan Scheduled

Ensure the total number of fractions scheduled in the Plan Scheduling workspace matches that of the prescription

AppointmentsEnsure the scheduled number of bookings in Appointment Scheduling workspace matches the prescription. Also, confirm the scheduled appointment times are appropriate for the SXRT operational hours

Adequate Appointment TimeEnsure adequate appointment time has been allocated to the patient/technique. Things to take into consideration include the patient’s mobility and complexity of setup. Discuss required modifications with the Senior RT

Tasks scheduledEnsure all necessary tasks are attached to the patient’s care path and have the correct resources/staff assigned

9.2.3.3 Other Billing Codes pre-filled in patient Care Path



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Ensure the correct Activity Codes have been pre-filled in the patient’s Care Path ‘Course’ Assigned in Patient Manager (Not ‘New Course’)

Ensure the Hospital Visit Status is set to Course and not New Course within the Patient’s Registration

Inpatient/Outpatient status correct in Patient ManagerEnsure the patient’s Inpatient/Outpatient status is correct in Patient Manager

TemplateEnsure that the treatment area/field template is available for use by staff for treatment

Accessories at UnitEnsure all accessories required for the patient’s treatment are present at the superficial machine

Consent Form CompletedEnsure the Consent Form been signed or witnessed by the patient/carer

NOTE: If there are any additional comments that need to be documented, they may be done so in the grey text box next to ‘Notes’ found underneath the last section of the document

9.2.3.5 Approve the Dynamic Document Once each item has been checked within the dynamic document, click the Approve

button and enter your user name and password details

Figure 28: Approve Button

This will stamp the document with your name, the date, and time

9.2.3.6 Complete the SXRT Pre-Treatment Task Once the document has been approved, click Done at the top This will complete the task and return to the User Home screen


Section 10 – Billing Procedures

During the Pre-Treatment Verification Check, including technique changes, boosts and subsequent phases, the RT will pre-fill the correct Medicare billing codes for each treatment appointment.



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Upon completing the treatment appointment, the treating RTs will ensure the Activity Capture codes are correctly populated, or otherwise make any necessary adjustments. Repeat this process for each treated patient appointment. The RT must pay particular attention to supplying the correct Medicare Code including supply of code suffixes for new or subsequent treatment courses.

The Administration Billing Clerks hold responsibility for translating billing codes to third party systems and referring any billing issues or errors with the Head of Treatment for resolution.


Section 11 – Patient Reviews

Review Appointments will be booked in ARIA by administration staff.

Treatment Staff are to use the ARIA Treatment Review Schedule to determine if the patient is required to visit the RO/Nurse. Patient files do not need to be sent out with the patient at this time, as treatment information is readily available by other means in ARIA. This minimises the risk involved with these files becoming lost or misplaced.

Prior to delivery of each treatment fraction, the journal notes in ARIA must be reviewed. RT staff must ensure any instructions are carried out or followed up with the appropriate staff.

Treatment Reviews will automatically have codes attached upon completion of the review appointment and can be billed by administration staff later.




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Section 12 – Weekly Chart Checks

12.1 Weekly Chart Check AlertsEach RT must ensure they are logged into ARIA using their own login account

Placing a Checkmark against each of the criteria indicates that the item has been completed and/or follow-up action initiated.

Patient Alerts in ARIA will not automatically appear for staff before treating a patient, as they do on the Linac consoles as there is no integration between ARIA and the SXRT console. Therefore, ARIA Patient Alerts should be manually searched for and viewed before each treatment.

12.2 Weekly Chart Check Procedure12.2.1 Initiating a Weekly Chart Check Log in to ARIA using your user name and password From the User Home, select the appropriate Linac Tasks Workspace/Tab Select the Weekly Chart Check task to auto assign the logged in user as the task owner

and hyperlink to Chart QA.

12.2.2 Load RT-Weekly Chart Check Encounter Click on the Encounters tab Select New From the Type drop down menu, select RT- SXRT Weekly Chart Check The following steps detail the components of each menu item within this encounter.

Each menu item must be ticked off in the RT-Weekly Chart Check encounter. Ticking items off indicates that you have read all the relevant entries and initiated any follow-up action required.

Figure 29: Chart Check Template



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12.2.2.1 Review Dose From the Dose Summary Section:

o Select Review Dose. For the Current Course of treatment review the Dose/Fractions, number of Fractions and Total Dose delivered in ARIA

o Tick this item off to indicate this item has been completed.

Figure 30: Radiation Plan Review

12.2.2.2 Remaining Appointments Select the Remaining Appointments Menu Item From the Appointments Tab, review all scheduled appointments ensuring:

o The appointment type is correcto The correct number of remaining appointments have been scheduled o The correct numbers of fractions per fortnight have been scheduledo Adequate appointment time has been allocated to the patient

To open or add appointments, right mouse click the Appointments tab and select the appropriate option

Tick this item off to indicate this item has been completed



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Figure 31: Remaining Appointments Review12.2.2.3 Review Tasks Select the Review Tasks Menu Item From the Task Tab ensure:

o All overdue/outstanding treatment tasks must be followed up or actioned prior to setting the task to completed

o All upcoming tasks have been correctly scheduled To open or add tasks, right mouse click the Tasks tab and select the appropriate option Tick this item off to indicate this item has been completed

12.2.2.4 Review Patient Notes/Journal Entries Review all Journal and/or review note entries and ensure any follow-up action is

initiated:o RO Notes: Review all RO Journal entries and ensure all items have been

appropriately actioned and billed for correctlyo Nurses Notes: Read through all Nursing Journal entries and ensure all documented

items have been appropriately actionedo RT Notes: Read through all RT Journal entries and ensure all documented items

have been appropriately actioned Ensure any prescription or field changes (such as time, standoff, applicator etc.) have

been documented and updated correctly within ARIA

12.2.2.5 Treatment Parameters Review This section relates to the review of all previous fractions with regards to all technical, set-up and field geometry data: Navigate to the Treatment History tab Ensure Show All Treatments, Hide Completed Courses, Hide Completed Plans, Hide

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o Right Mouse Click the Blue Column Headero Select Show Data Filter

Use the Data Filter to select one field only by filtering by the field name

Figure 32: Filtering by Field Name

Review each column to ensure that the planned data (blue) matches the actual data for the following fields:o Time deliveredo Energyo Field Sizeo Applicator Used

Ensure any prescription or field changes (such as time, standoff, applicator etc.) have occurred at the intended treatment fraction and are reflected in the treatment history correctly

Repeat the process of checking field parameters for each field using the Data Filter Click QA’d to QA each fraction Navigate to the Encounters Tab Tick this item off to indicate this item has been completed.

Set reviewed data to “QA’d” Click on the Treatment History tab Click the QA’d button in the top right hand corner. The summary tab will indicate that

the patient has had a Chart Check completed.

12.2.2.6 Other Document Review Select Document Review from the Encounter Menu Look through the current Course’s documents



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Ensure that Treatment related documents have been approved. Initiate any follow-up action

If this is the first Weekly Chart Check, review the SXRT Pre-Treatment QA check document and ensure that any comments made have been actioned

Tick this item off to indicate this item has been completed.

Signatures/Staff Ensure all signatures are present for each fraction on the treatment sheet Ensure each completed treatment appointment has the correct treating staff attached.

Activity Capture Review Quick link to Activity Capture Open a new Patient Review for the desired patient

o Select Viewo Select Add Viewo Select Patient Review

Search for the patient using surname, first name and ID1 Select OK Ensure the following columns are displayed:

o Patiento Activityo In Patient Statuso Course IDo Date of Serviceo Procedure Codeo Hospital Procedure Codeo Staff/Resourceso Diagnosiso Reviewedo Reviewed Byo Primary Oncologist.

Check:o Inpatient status is correcto Correct Medicare Codes have been billedo Play close attention to the commencement of new phases etc, where codes may have

been incorrectly auto filled.o Ensure the Course is set to New, or Subsequent, for the Initial Fraction o Correct number of fields for each treatment have been billedo Treatment Linac is specifiedo Imaging code is correct and attached to the correct fraction

NOTE: When changing or updating a billing code ensure the date of Service is adjusted as the software defaults the date to the current date.



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Ensure the correct Diagnosis is attached to course When data has been validated or updated, highlight the relevant rows and select the

review button Quick link to Chart QA Tick this item off to indicate this item has been completed.

12.2.3 Completion of Encounter12.2.3.1 New Journal Entry If the Chart Check has detected any anomalies throughout the course of treatment, then a Journal Note is to be created to document the anomaly and any follow-up action that was undertaken.

Next to the New Journal Note item, click the New Entry Icon The Journal dialog will appear. In the Details section, write in the required information Click Approve. This should tick the item off in the Encounter Item list

Figure 33: Journal Dialog

12.2.3.2 Patient Alerts A patient alert is to be entered if there is anything detected/discovered during the completion of the weekly check that needs to be communicated to the treating staff of the next fraction(s)

Patient Alerts in ARIA will not automatically appear for staff before treating a patient like they do on the Linac consoles as there is no integration between ARIA and the SXRT console. Therefore ARIA Patient Alerts will have to be manually searched for and viewed before each treatment

If it is something of great importance, it should be communicated to staff by other means as well so that it is not missed



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12.2.3.3 Finalisation of the RT- Weekly Chart Check Encounter To finalise the encounter checkmarks must be placed against all of the Items Once all steps of the RT- Weekly Chart Check Encounter have been completed (indicated

by a tick in either the Completed or N/A columns) a tick should appear next to the current Weekly Chart Check in the Encounters list to the left

Figure 34: Completing the Encounter

Select Save Click Done at the top to complete the task and return to the User Home




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Section 13 – Course Completions

13.1 Course Completion Alerts Each RT must ensure they are logged into ARIA using their own login account Placing a Checkmark against each of the criteria indicates that the item has been

completed and/or follow-up action initiated.

13.2 Course Completion Procedures13.2.1 Initiating a Course Completion Check Log in to ARIA using your user name and password From the User Home, select the appropriate Linac Tasks Workspace/Tab Select the Course Completion task to auto assign the logged in user as the task owner

and hyperlink to Chart QA

13.2.2 Load RT-Course Completion Check Encounter Click on the Encounters tab Select New From the Type drop down menu, select RT- SXRT Weekly Course Completion The following steps detail the components of each menu item within this encounter.

Each item must be ticked off in the RT-SXRT Course completion encounter. Ticking items off indicates that you have read all the relevant entries and initiated any follow-up action required.

Figure 35: Course Completion Template

13.2.2.1 Course Summary Review Dose Select Review Dose Encounter Item



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o For the Current Course of treatment review the Dose/Fx, number of Fx and Total Dose delivered in Aria

o Ensure there are no remaining fractionso Ensure a manual treatment has been created for each fraction

Remaining Appointments Select the remaining appointments Menu Item

o Ensure the status of all delivered treatment appointments are set to completed or manually completed

o Query and delete any unnecessary Treatment Appointments

Review Tasks Select the Review Task Menu Item

o Ensure the status of all completed tasks has been set to completedo Query and delete any unnecessary Tasks

Delivered Treatment Parameters Navigate to the Treatment History tab Ensure Show All Treatments, Hide Completed Courses, Hide Completed Plans, and Hide

Retired Plans is selected Ensure each field/fraction has been QA’d

o If all QA’d return to the Encounters Tab and tick off this item o If not, continue with the process below

Switch on the Data Filtero Right Mouse Click the Blue Column Headero Select Show Data Filter

Use the Data Filter to select one field only by filtering by the field name



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Figure 36: Filtering by Field Name

Review each column to ensure that the planned data (blue) matches the actual data for the following fields:o MUo Energyo Field Size

Ensure any prescription or field changes (such as time, standoff, applicator etc.) have occurred at the intended treatment fraction and are reflected in the treatment history correctly

Repeat the process of checking field parameters for each field using the Data Filter Click QA’d to QA each remaining fraction Navigate to the Encounters Tab Tick this item off to indicate it has been completed

13.2.2.1 Review Progress Notes Select the Progress Notes Menu Item Review all journal entries in ARIA and hand written progress notes on the treatment

sheet, ensuring all items requiring attention have been actionedPatient Alerts Review and ensure all Patient Alerts have been SignedSignature Check Ensure all required signatures are recorded on the treatment sheet Ensure any signatures missing are followed up Ensure each completed treatment appointment has the correct treating staff attachedDynamic Document Review Select the Dynamic Documents Review Menu Item Ensure all treatment related documents, such as Pre-Treatment Verification Check (V1)

are present and set to Approved



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Ensure any documents that still requiring approval are followed up with the staff responsible.

13.2.2.2 Other Items Activity Capture Codes Quicklink to Activity Capture Check that the:

o Inpatient status is correcto Correct Medicare Codes have been billedo Play close attention to the commencement of new phases etc, where codes may have

been incorrectly auto filled.o Ensure the Course is set to New, or Subsequent, for the Initial Fraction o Correct number of fields for each treatment have been billedo Imaging code is correct and attached to the correct fraction

NOTE: When changing or updating a billing code ensure the date of Service is adjusted as the software defaults the date to the current date.

Ensure the correct Diagnosis is attached to course When data has been validated or updated, highlight the relevant rows and select the

review button Tick this item off to indicate this item has been completedCourse Status Set to Completed Navigate to Plan Parameters Change the status of the course to complete once all items checked If there are items outstanding, the encounter and its associated task should be left in

progress until it is available to do so.Templates Ensure any treatment templates have been scanned into ARIA prior to disposal Ensure the template, once scanned in, is disposed of in the confidential waste bin.Accessories/Photos Ensure all cut-outs/masks are clearly marked with an “F” or “Finished” and returned to

the Mould Room for disposal Ensure any other custom treatment accessories are de-identified and disposed of

correctly.RT File Contents Scanned to ARIA Ensure all remaining contents of the RT file are scanned into ARIA. This includes the

prescription page and the signature sheet on the back Once scanned documentation has been verified as present in ARIA original documents

can be discarded as confidential waste Return the empty RT File to Administration.



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NOTE: It is imperative that all parts of the scanned document are legible

13.2.3 Finalisation of the Encounter and Task Navigate to Encounters To finalise the encounter checkmarks must be placed against all of the Items Once all steps of the Finish Check have been completed, click Done at the top This will automatically complete the SXRT Course Completion Task and return to the

User Home.


Section 14 – Internal Eye Shields

14.1 Internal Eye Shield AlertsThis procedure should not be used on any patient other than those specifically prescribed internal eye shields by a Radiation Oncologist or on a radiation emitting device other than the SRT100 SXRT Unit.

The person responsible for inserting the eye shield should have trimmed nails and remove all nail polish and other items that may flake/fall into the eye.

All items (excepting the internal eye shields and stopwatch) are single use only.

Prior to each use the eye shield should be inspected for damage such as cracks or breakage. If damage is evident do not use the eye shield.

As the eye may remain anaesthetised for up to two hours, it is important to protect the eye after treatment from dust and other particles which may damage the eye surface without the patient being aware. See 'Aftercare' Section 14.2.2.5 below for details of the procedure.

14.2 Use of Internal Eye Shields14.2.1 Equipment & Materials Sterile internal eye shield:

o We have one small eye shield that is silver-plated lead. o The eye shield is to be properly cleaned and sterilised before initial use (in some

cases it may be necessary to sterilise device between uses on an individual patient. Refer to standard hospital infection control guidelines for determination of sterilisation need between uses on an individual patient).

Sterile gloves Two packets of 7.5 x 7.5cm sterile gauze swabs Oxybuprocaine Hydrochloride 0.4% Minims Sterile Eye Drops This is obtainable from Pharmacy – a Doctor is required to fill in an inpatient script

which can then be taken to Pharmacy Sterile liquid Paraffin 5g (available from the Nursing Drug storeroom) 10ml sterile water Micropore Tape



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Sterile Eye Pad(s) Asepti Rapidzyme PR (Enzymatic chemical) Distilled water Sterile Specimen Pot Stopwatch.

14.2.2 Sequence of Actions Place the patient in the treatment position and explain the procedure for anaesthetising the eye, inserting the eye shield, treatment and removal of the eye shield.

14.2.2.1 Anaesthetising the eye (as advised from TCH Pharmacy Department June 1999)14.2.2.1.2 Nursing responsibilities: Wash hands in warm soapy water Tilt the patients head back Ask the patient to open their eyes wide Pull down the lower eye lid of the eye being anaesthetised Hold the dropper close to the eye, being careful not to touch the cornea, and insert

one drop of Oxybuprocaine Hydrochloride 0.4% Sterile Eye Drops into the conjunctival sac of the eye

Allow the patient to close their eyes Wait 90 seconds (use stopwatch) Insert a second drop of Oxybuprocaine Hydrochloride 0.4% Sterile Eye Drops into the

same eye, wait a further 90 seconds Insert a third drop of Oxybuprocaine Hydrochloride 0.4% Sterile Eye Drops into the

same eye and wait 5 minutes before inserting an eye shield.

This procedure will result in 8 minutes of anaesthesia to the eye.

14.2.2.2 Preparing to insert the eye shield 14.2.2.2.1 Radiation Therapist responsibilities: Thoroughly wash and dry hands Using aseptic technique, don sterile gloves and do not touch anything that is not sterile

up until the actual insertion of the shield Ask your partner to open the plastic packaging containing the shield Remove the sterile container and open it Pick up the sterile eye shield using the handle and inspect it for any damage such as

cracks or breakage. If damage is evident, do not use the eye shield Ask your partner to lubricate the shield by dropping one or two drops of sterile liquid

paraffin onto the concave surface. Carefully rotate the eye shield to spread the lubricant over the surface of the shield

Ask the patient how their eye is feeling. If it is not yet feeling numb, wait a few more minutes before inserting.



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14.2.2.3 Insertion of the Eye Shield The eye shield is most stable when placed under both eyelids and should be attempted wherever possible. If it is only placed under one eyelid as listed below, ensure that the shield is secured in place using micropore tape around the handle: For a corner lesion: the internal eye shield should be placed under BOTH eye lids. The

patient should be instructed to look downwards whilst the internal eye shield is placed under the top eyelid. Holding the shield in place, the patient should be instructed to look upwards whilst the lower lid is pulled down and slipped over the shield

For a superior lesion: the internal eye shield can be placed under the UPPER lid only. The patient should look downwards during the insertion

For an inferior lesion: the internal eye shield can be placed under the lower lid only. The patient should look upwards during the insertion.

14.2.2.4 Removal of the Eye Shield Where the shield has been placed under the upper or lower lid only, gently remove the

micropore from the patient and hold the handle to slip the eye shield out Where the shield has been placed under both eyelids:

o Hold the shield by its handleo Apply sterile water between the eye and eye shield to reduce suction against the

eyeball.o Ask the patient to look downwards, raise the upper eyelid and gently pull the

shield away from the eye.o Ask the patient to look upwards and the shield should slip out of the eye.

14.2.2.5 Aftercare At the conclusion of each treatment, the eye must be covered with a sterile eye pad until the anaesthetic wears off (up to two hours). When applying the eye pad the patient must close their eyes. Patients will have reduced vision whilst wearing the eye pad and must not drive home. Patients must be advised against smoking whilst wearing an eye pad to reduce the risk of igniting the eye pad.

14.2.2.6 Cleaning of the Eye Shield (Single Use, Completion of Treatment) Wash the shield with warm soapy water. Rinse the shield free from soap with tap water. Dry the shield with gauze. Return the shield to its container. Place the identification sticker from sterilisation within the patients progress notes Arrange for the Internal Eye Shield to be returned for sterilisation and fill out the form

that came with it.

14.2.2.7 Cleaning of the Eye Shield (Individual Patient, Multiple Use) Using gloves wash the shields under hot water with hospital grade soap (Asepti

Rapidzyme PR – Enzymatic chemical – see instructions on bottle) and sterile gauze.



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Rinse with distilled water, dry with sterile gauze and store in a sterile specimen pot clearly labelled with patient sticker.

Alert: DO NOT store in liquid. MUST be stored dry. DO NOT use or store in a sodium chloride or sodium nitrite solution, as this will cause

the silver coating on the eye shield to dissolve. Products that contain sodium chloride or sodium nitrite include, but not limited to,

saline solutions, PSS Select Glutaraldehyde Plus and CidexPlus. Sterilising services have confirmed that Asepti Rapidzyme PR does not contain sodium

chloride or sodium nitrate or any nitrates that would be of concern for compatibility with silver.


Section 15 – Routine Lead Shielding Thickness

Unless otherwise specified by the Radiation Oncologist, or the Planner, the routine lead thickness used in Radiation Oncology for the TOPEX-SRT100 for clinical treatment (100kV beam energy) is 1.7mm. Transmission through lead of this thickness is in the Data Book.

NOTE: There may be instances where a double layer of lead is required to shield highly radiosensitive structures such as lenses.


List of Significant/Associated Documents

The following list of significant documents can be found at the SXRT Control Room for reference/use: 1. TOPEX SRT100 Documentation Pack2. Treatment Files of current cases.3. SXRT Fault Book4. SXRT Notices/Memoranda File.5. Planning Databook Version V1 - 10 SXRT6. Additional Planning Data Set - SXRT




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Related Policies, Procedures, Guidelines and Legislation

Policies CHHS Clinical Policy Patient Identification and Procedure Matching CHHS14/051 CHHS Clinical Procedure Healthcare Associated Infections Procedure CHHS15/072 CHHS Consent and Treatment Policy CHHS16/026

Guidelines Radiation Oncology Practice Standards Australian Commission on Safety and Quality in Health Care, National Safety and Quality

Health Service Standards (NSQHSS) September 2012, Standard 5 – Patient Identification and Procedure Matching. Available at http://www.safetyandquality.gov.au


References/Related Documentation

1. Healthcare Associated Infections Procedure on the Policy Register2. Infection Prevention site at http://acthealth/c/HealthIntranet?

a=da&did=5085259&pid=1197946306

3. Management of Health Care Workers for Potential Occupational Risk Exposure to Blood Borne Pathogens Clinical Procedure on the Intranet

4. International Commission on Radiation Units and Measurements, ICRE Report 50 www.icru.org

5. The Canberra Hospital Emergency Plan on the Intranet6. ARIA Oncology Information System for Radiation Oncology Instructions for Use at

https://varian.force.com/apex/CpProductDocumentation7. Radiation Products Design Inc instruction sheet for eye shields INFO 934-008-A included

in SXRT Notices/Memoranda File


Search Terms

Radiation Therapy, Superficial X-Ray therapy, TOPEX-SRT100




https://varian.force.com/apex/CpProductDocumentation

http://acthealth/c/HealthIntranet?a=da&did=5085259&pid=1197946306

http://acthealth/c/HealthIntranet?a=da&did=5085259&pid=1197946306

http://www.safetyandquality.gov.au/

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Appendices

Appendix 1 - Calculation Sheet for TOPEX SRT 100

Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

(to be completed by the HCID Policy Team)Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair



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Appendix 1 Calculation Sheet for TOPEX SRT 100



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