Therapist Training Module I - UCSF Radiation Oncology

MOSAIQ 

Therapist 

Training Module I 

Version 1.60

Therapist 

Training Module I 

MOSAIQ 

Oncology Management System 

Version 1.60 

Copyright 2010 

All Rights Reserved 

IMPAC Medical Systems

PUBLISHED BY: 

IMPAC Medical Systems, Inc. 

100 Mathilda Place, 5 th Floor, 

Sunnyvale, CA 94086 

COPYRIGHT 2010 by IMPAC Medical Systems 

All Rights Reserved 

Instructional Designer/Writer: Robin Bonke 

LTG19002A - 1.0 - 5/11/2009 

This manual contains proprietary information to be used exclusively 

by customers of IMPAC Medical Systems. All rights reserved. 

No part of the contents of this book may be reproduced or transmitted 

in any form or by any means without the written permission 

of IMPAC Medical Systems.

Table of Contents 


Introduction..................................................................................................................................................1 

What’s in this Course................................................................................................................................................................................1 

SupportPlus Online....................................................................................................................................................................................2 

Document Conventions.............................................................................................................................................................................3 

Text Conventions ......................................................................................................................................................................................3 

Mouse Conventions...................................................................................................................................................................................4 

Keyboard Conventions...............................................................................................................................................................................5 

Lesson 1: Accessing the Electronic Treatment Chart .................................................................................7 

Objectives.....................................................................................................................................................................................................7 

Displaying eCHART ...................................................................................................................................................................................8 

Displaying the eChart Menu.....................................................................................................................................................................8 

Displaying the eCHART Navigator Window ..........................................................................................................................................11 

Displaying the Diagnoses and Interventions Window.......................................................................................................................13 

Displaying the Treatment Window.......................................................................................................................................................17 

Displaying the Treatment Calendar Window .....................................................................................................................................21 

Displaying the Dose Site Summary Window.......................................................................................................................................23 

Displaying the Dose Action Points Window.......................................................................................................................................24 

What’s Next..............................................................................................................................................................................................28 

The Quick Version ...................................................................................................................................................................................29 

Displaying the eChart Menu...................................................................................................................................................................29 

Displaying the eCHART Navigator.........................................................................................................................................................29 

Displaying the Diagnoses and Interventions Window ...........................................................................................................................29 

Displaying the Treatment Chart Window..............................................................................................................................................29 

Displaying the Treatment Calendar Window.........................................................................................................................................29 

Displaying the Dose Site Summary Window.........................................................................................................................................29 

Displaying the Dose Action Points Window...........................................................................................................................................29 

Lesson 2: Scheduling and Treating from the Schedule .............................................................................31 

Objectives...................................................................................................................................................................................................31 

Working with Wave (Recurring) Appointments ................................................................................................................................32 

Displaying the Location Schedule............................................................................................................................................................32 

Creating a Wave Appointment...............................................................................................................................................................34 

Modifying a Wave Appointment ............................................................................................................................................................41 

Using the Add to End Feature................................................................................................................................................................46 

Treating Patients from the Schedule .....................................................................................................................................................48 

Selecting a Patient for Treatment..........................................................................................................................................................48 

Recording a Manual Treatment.............................................................................................................................................................49 

Working with Treatment Charges.........................................................................................................................................................54 

Printing a Location Schedule ..................................................................................................................................................................56 

What’s Next..............................................................................................................................................................................................59 


Displaying the Location Schedule............................................................................................................................................................60 

Copyright 2010, IMPAC Medical Systems i 

LTG19002A /1.0/ 11-May-2009

Therapist Training Guide Module I 

Creating a Wave Appointment...............................................................................................................................................................60 

Modifying a Single Wave Appointment..................................................................................................................................................60 

Modifying Multiple Wave Appointments................................................................................................................................................61 

Using the Add to End Feature................................................................................................................................................................61 

Recording a Manual Treatment.............................................................................................................................................................61 

Charging a Recorded Treatment............................................................................................................................................................62 

Printing a Location Schedule ...................................................................................................................................................................62 

Lesson 3: Entering Clinical Data...............................................................................................................63 

Objectives...................................................................................................................................................................................................63 

Working with Diagnoses.........................................................................................................................................................................64 

Quick Admitting a New Patient..............................................................................................................................................................64 

Entering a Basic Diagnosis .....................................................................................................................................................................66 

Affirming a Diagnosis..............................................................................................................................................................................69 

Entering a Basic Course/Care Plan........................................................................................................................................................71 

Entering a Basic Prescription ..................................................................................................................................................................75 

Adding a Second Prescription ................................................................................................................................................................79 

Ordering Standard Lab Tests / Medications using Quick Rx Ad-Hoc Orders.............................................................................81 

What’s Next ..............................................................................................................................................................................................85 


Entering a Basic Diagnosis .....................................................................................................................................................................86 

Affirming a Diagnosis..............................................................................................................................................................................86 

Entering a Basic Course/Care Plan.........................................................................................................................................................86 

Entering a Basic Prescription ..................................................................................................................................................................86 

Adding a Second Prescription..................................................................................................................................................................87 

Ordering Standard Lab Tests / Medications using Quick Rx Ad-Hoc Orders......................................................................................87 

Lesson 4: Creating Simulation Fields........................................................................................................89 

Objectives...................................................................................................................................................................................................89 

Creating a Simulation Appointment......................................................................................................................................................90 

Scheduling a Simulation Appointment ....................................................................................................................................................90 

Opening the Chart from the Schedule...................................................................................................................................................94 

Creating Simulation Fields.......................................................................................................................................................................96 

Creating a Simulation Field When a Prescription Exists........................................................................................................................96 

Entering Simulation Field Parameters Manually.....................................................................................................................................99 

Creating a Simulation Field When a Prescription Does Not Exist..................................................................................................... 101 

Capturing Simulation Field Geometric Settings ................................................................................................................................... 103 

Copying a Simulation Field................................................................................................................................................................... 106 

Adding a Site Simulation....................................................................................................................................................................... 109 

Capturing Simulation Charge Codes.................................................................................................................................................. 111 

Viewing Multi-Code Capture ................................................................................................................................................................ 111 

Selecting a Diagnosis ........................................................................................................................................................................... 115 

Capturing Multiple Codes..................................................................................................................................................................... 116 

Printing a Simulation Report................................................................................................................................................................ 120 

What’s Next........................................................................................................................................................................................... 122 

The Quick Version ................................................................................................................................................................................ 123 

Scheduling a Simulation Appointment ................................................................................................................................................. 123 

Opening a Patient’s Chart from the Schedule.................................................................................................................................... 123 

ii Copyright 2010, IMPAC Medical Systems 

LTG19002A /1.0/ 11-May-2009


Creating a Simulation Field When a Prescription Exists..................................................................................................................... 123 

Creating a Simulation Field When a Prescription Does Not Exist..................................................................................................... 124 

Entering Geometric Settings/Parameters Manually ........................................................................................................................... 124 

Capturing Geometric Settings/Parameters ......................................................................................................................................... 125 

Copying a Simulation Field.................................................................................................................................................................... 125 

Adding a Site Simulation ...................................................................................................................................................................... 125 

Selecting a Diagnosis from Multi-Code Capture................................................................................................................................. 126 

Capturing Multiple Charge Codes from Multi-Code Capture............................................................................................................. 126 

Printing a Simulation Report ................................................................................................................................................................ 126 

Lesson 5: Creating Treatment Fields ...................................................................................................... 129 

Objectives................................................................................................................................................................................................ 129 

Manually Creating Treatment Fields................................................................................................................................................... 131 

Manually Creating a Treatment Field.................................................................................................................................................. 131 

Manually Creating Geometric Settings................................................................................................................................................ 134 

Manually Creating Accessory Information........................................................................................................................................... 135 

Manually Creating Portal Image Information...................................................................................................................................... 136 

Adding Field Setup Information............................................................................................................................................................ 138 

Adding Site Setup Information............................................................................................................................................................. 139 

Creating a Treatment Field by Copying a Simulation Field ........................................................................................................... 142 

Creating a Treatment Field by Copying an Existing Treatment Field.......................................................................................... 145 

Capturing Parameters from the Machine.......................................................................................................................................... 149 

Editing a Treatment Field ..................................................................................................................................................................... 153 

Approving a Treatment Field............................................................................................................................................................... 155 

Viewing the Field Delta and Historic Views...................................................................................................................................... 158 

Viewing the Field Delta View ............................................................................................................................................................... 158 

Viewing an Historical Treatment Field................................................................................................................................................. 160 

Adding Dose Tracking to Radiation Prescriptions.......................................................................................................................... 161 

Creating the Primary Dose Tracking Site ........................................................................................................................................... 161 

Creating a Dose Action Point .............................................................................................................................................................. 162 

Working with MLC Parameters........................................................................................................................................................... 165 

Importing an MLC Plan........................................................................................................................................................................ 165 

Viewing MLC Parameters (No MLC Fit) ............................................................................................................................................. 169 

Editing MLC Parameters (MLC Fit)..................................................................................................................................................... 170 

What’s Next........................................................................................................................................................................................... 175 

The Quick Version ................................................................................................................................................................................ 176 

Manually Creating a Treatment Field.................................................................................................................................................. 176 

Manually Creating Geometric Settings................................................................................................................................................ 176 

Manually Creating Accessory Information........................................................................................................................................... 177 

Manually Creating Portal Image Information...................................................................................................................................... 177 

Adding Field Setup Information............................................................................................................................................................ 177 

Creating a Treatment Field by Copying a Simulation Field................................................................................................................. 177 

Creating a Treatment Field by Copying an Existing Treatment Field................................................................................................ 178 

Capturing Parameters from the Machine........................................................................................................................................... 178 

Editing a Treatment Field .................................................................................................................................................................... 179 

Approving a Treatment Field ............................................................................................................................................................... 179 

Viewing the Field Delta View ............................................................................................................................................................... 179 

Viewing an Historical Treatment Field................................................................................................................................................. 179 

Copyright 2010, IMPAC Medical Systems iii 

LTG19002A /1.0/ 11-May-2009


Creating the Primary Dose Tracking Site ........................................................................................................................................... 180 

Creating a Dose Action Point .............................................................................................................................................................. 180 

Importing an MLC Plan........................................................................................................................................................................ 180 

Viewing MLC Parameters (No MLC Fit) ............................................................................................................................................. 181 

Editing MLC Parameters (MLC Fit)..................................................................................................................................................... 181 

Course Evaluation: Radiation Therapist.................................................................................................... 183 

iv Copyright 2010, IMPAC Medical Systems 

LTG19002A /1.0/ 11-May-2009


Copyright 2010, IMPAC Medical Systems 1 

LTG19002A / 1.0/ 11-May-2009 

Notes 

Introduction 

Welcome to IMPAC Medical Systems and MOSAIQ Therapist’s Training Guide. 

There are three training modules in Therapist’s Training Guide, and this document is 

Training Module I. This book is your guide to unlocking the possibilities of MOSAIQ 

8.0 application software, hereafter referred to as MOSAIQ. It is designed to be used 

during your instructor-led training and as a handy desk reference any time you need a 

quick reminder how to do something in MOSAIQ. We recommend that you keep 

this book near your workstation so you can find it easily when needed. 

This training guide is not intended to replace the MOSAIQ documentation, which is 

contained in the MOSAIQ Help system. The MOSAIQ Help system provides indepth 

information on all available MOSAIQ features. 

Therapist’s Training Guide Module I is an intermediate course that along with Therapist’s 

Training Guide Modules II and III covers how to treat patients with radiotherapy. This 

course assumes that you have basic Windows skills and have taken, and are familiar 

with, the concepts presented in MOSAIQ General Introduction training. Topics 

presented in this course build upon the concepts learned in the General Introduction. 

What’s in this Course 

In this course, you will learn how to access the electronic treatment chart, schedule 

daily treatments, add clinical data such as a diagnosis, and create simulation and 

treatment fields. 

This course will not teach you basics on using MOSAIQ, which are covered in the 

General Introduction. 

Note that when you are working in the practice database, all activities are enabled for 

the practice ID. In your clinical database, you may or may not have security rights to 

do all the activities that you will do in this course.

Therapist Training Guide 

Notes 

SupportPlus Online 

SupportPlus is IMPAC’s dedicated online support system, which gives you the most 

from your IMPAC oncology management system. SupportPlus contains valuable 

support information including installation and troubleshooting documents, training 

manuals, upgrade checklists, downloadable software tools, and much more. 

Access may be restricted based on your IMPAC service 

agreement. 

You can find this document under the Oncology tab in the Training folder. 

Turn to SupportPlus for resources on implementation, training, support, and 

upgrades for all IMPAC products. 

For more information, contact support@impac.com, or call 800.488.4672. 

Log in to SupportPlus every week or two to check for new 

announcements, new document postings, and new training events. 

Please take a moment to send us a Product Suggestion. 

2 Copyright 2010, IMPAC Medical Systems 

LTG19002A /1.0/ 11-May-2009

Introduction 


LTG19002A / 1.0/ 11-May-2009 

Notes 

Document Conventions 

This document uses specific conventions, or rules, in the instructions to help you 

perform the exercises correctly. This section explains the text, mouse, and keyboard 

conventions used in this document. 

Text Conventions 

The instructions in this guide are formatted to make them easy to read and to 

recognize when you should perform a particular task. The following text conventions 

are used in the instructions: 

Bold Print Indicates menu or list items that you select. 

Example: Click File | Register New Patient…. 

Example: In the Select Patient window, click Lamb, Mary. 

Italics Indicates words or phrases that appear on the computer 

screen, references to text or a number as itself, or new terms 

that are being defined. 

Highlighted 

Print 

Explanation 

s 

Example: Position the insertion point to the left of p in 

patient. 

Example: Annotation is the process of adding customized 

notes to a Help topic. 

Indicates something you type. 

Example: Type 3000. 

Located directly below the step. 

Menus Menu commands that are executed one directly after the 

other are separated by a vertical line. 

Buttons and 

Icons 

Example: Click File | System Utilities | Supplies… 

means from the menu bar, click File, from the 

File menu, point to the System Utilities 

command, and from the System Utilities menu, 

click the Supplies… command. 

Indicate items on which you click. 

Example: Click . 

Example: Click .


Notes 

Notes, 

Hints, and 

Warnings 

Note example: 

Hint example: 

Warning example: 

Mouse Conventions 

Notes, hints and warnings are preceded by unique symbols 

and are presented in a shaded box. Notes provide ancillary 

information, hints provide tips to help you use the system, 

and warnings provide important information on the 

consequences of performing a particular action. 

You can also open the eCHART Navigator window if you press F5. 

You may find it helpful to print out illustrations from the Help 

reference tools to include with patient education materials. 

Once you change the status of an order to Voided, you cannot 

change the status again. 

The following terms are used to describe actions you perform with the mouse: 

Click Press and release the left mouse button. 

Double-click Click the left mouse button twice in rapid succession. 

Right-click Press and release the right mouse button. 

Drag Move the mouse while holding down the left mouse button. 

Highlight Drag the mouse pointer across data, causing the information 

to appear in reverse video. 


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Introduction 


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Notes Keyboard Conventions 

Keys that do not produce a character appear in all upper case bold print. These keys 

include: 

Function 

Keys 

F1, F2, F3, F4, F5, F6, F7, F8, F9, F10, F11, and F12. 

Booster Keys ALT, CTRL, and SHIFT. 

Pointer 

Movement 

Keys 

HOME, PAGE UP, PAGE DOWN, END, TAB, and the 

arrow keys. 

Other Keys BACKSPACE, DELETE, INSERT, CAPS LOCK, 

ESC, ENTER, SPACEBAR, PRINT SCRN, SCROLL 

LOCK, PAUSE, and NUM LOCK. 

Two or more keys that should be pressed simultaneously are separated by a plus sign. 

Example: Press CTRL+F4. 

Example: Press ALT+N.


Notes 


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Notes 

Lesson 1: Accessing the 

Electronic 

Treatment Chart 

Objectives 

You will learn how to: 

• Display the eChart menu and eCHART Navigator 

• Display the Diagnoses and Interventions window 

• Display the Treatment Chart window using the RO Treat button 

• Display the Treatment Calendar window 

• Display the Dose Site Summary and Dose Action Points windows 

For this lesson, we recommend that you use an existing patient with radiation 

oncology treatments already recorded or planned. For the remainder of this course, 

you can either use an existing patient or quick-admit a patient, though we recommend 

that you also use an existing patient for the second lesson. If you choose to quickadmit 

a patient before Lesson 3 where it is covered, ask your instructor for assistance. 

In this lesson, you will display the various windows that you use as a therapist, such as 

the eCHART Navigator window and the Treatment Chart window. In addition, you 

will learn about the contents of each window or dialog box and what you can do 

from that window or dialog box. 

To select an existing patient, you must have Administrative | 

General | View rights. 

To view the eCHART Navigator, Diagnoses and Interventions 

window, and the Treatment Chart window, you must have Clinical | 

General | View rights. 

To view the Treatment Calendar, you must also have Clinical | Care 

Plans | View rights. 

To view the Dose Site Summary window, you must also have 

Clinical | Action Points | View and Clinical | Tx Status | View 

rights. 

To view the Dose Action Points window and Dose Action Point 

dialog box, you must also have Clinical | Action Points | View


Notes rights. 

Displaying eCHART 

eCHART is a multi-functional electronic treatment chart that organizes and maintains 

the critical treatment information required throughout the course of radiation therapy. 

In the following exercises, you will display the eChart menu and the eCHART 

Navigator window. 

Displaying the eChart Menu 

In this exercise, you will select an existing a patient, then display the eChart menu. 

1. Log on to MOSAIQ, then click File | Open Patient Chart…. 

Displays the Select Patient window, shown in Figure 1. 

Figure 1: Select Patient Window 

2. Double-click SMITH, JAMES H (or a practice database patient of your 

instructor’s choice). 

Displays the patient’s name in the Patient button, located on the toolbar, shown in 

Figure 2. If a message box displays, indicating the patient is missing a Privacy 

Notice, click . 


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Lesson 1: Accessing the Electronic Treatment Chart 


LTG19002A / 1.0/ 11-May-2009 

Notes 

3. Click eChart. 

Figure 2: Patient Button on Toolbar 

Displays the eChart menu, shown in Figure 3. 

Figure 3: eChart Menu 

The eChart menu contains the following commands: 

Navigator… 

Diagnoses and 

Interventions 

… 

Orders… 

Flowsheet… 

Clinician 

Worksheet… 

Displays the eCHART Navigator window, from 

which you can create clinical patient notes, view 

summary information on a patient’s diagnosis, etc. 

Displays the Diagnoses and Interventions window, 

from which you can define a patient’s diagnosis, as 

well as define courses of treatment for each patient. 

Displays the Orders dialog box, from which you 

can enter or update lab and pharmacy orders. 

Displays the Flowsheet window, from which you 

can display user-configured views of the patient’s 

medical oncology chart. This provides an up-tothe-minute 

record of actual treatments and 

observations. 

Displays the Clinician Worksheet tab of the 

Clinician Worksheet window, from which you can 

display patient's diagnosis, histology, stage, course, 

vital signs and assessments. You can assign Care


Notes Plans, order medications or labs, approve 

treatment, calculate doses, set treatment delays, or 

change ordered doses and/or treatment times. 

Radiotherapy 

Treatment… 

Vital Signs… 

Laboratory… 

Lab Results 

Worklist… 

Assessments… 

Allergies and 

Alerts… 

Medication 

List… 

Notes… 

Documents… 

Images… 

Follow-Up… 

Displays the Treatment Chart window, from 

which you can duplicate the patient’s daily 

treatment charts currently maintained within your 

radiotherapy department. 

Displays the Vital Signs tab of the Flowsheet 

window, from which you can record a patient’s 

vital signs, such as blood count, weight, and 

reactions. 

Displays the Laboratory tab of the Flowsheet 

window, from which you can record labs results. 

Displays the Lab Result Worklist window, from 

which you can view patients having outstanding 

labs and filter the list of patients based on various 

criteria. 

Displays the Assessments tab of the Flowsheet 

window, from which you can create a user-defined 

patient care record. This enables you to objectively 

assess a patient’s status by selecting from 

standardized criteria. 

Displays the Allergies by Severity dialog box, from 

which you can create a patient-specific table listing 

any allergies and alerts that could affect the course 

of therapy. 

Displays the Medication List window, from which 

you can track additional medications that are not 

part of the patient’s Care Plan. 

Displays the Patient Notes window, from which 

you can attach notes to the patient’s electronic 

medical record, as well as read existing notes. 

Displays the Documents window, from which you 

can add and edit eSCRIBE documents and PhAST 

Notes, as well as import eSCAN documents. 

Displays the Image List window, from which you 

can view a complete listing of all of the patient’s 

acquired images. 

Displays the Follow-Up Status Summary window, 


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Notes from which you can record and track patient 

progress post-treatment. 

Chart Check… 

Displays the Chart Check Options dialog box, 

from which you can support the physicist’s weekly 

chart reviews.


Notes Displaying the eCHART Navigator Window 

The eCHART Navigator window gives you access to patient information from a 

single window. You can also enter or update summary information from selected 

areas of eCHART for the selected patient, such as diagnoses or medication orders. 

You can create clinical notes about the patient and assign them to a clinical category. 

In this exercise, you will display the eCHART Navigator window. 

1. Click on the toolbar. 

Displays the eCHART Navigator window, shown in Figure 4. 

Other clinical 

note tabs 

Current clinical note tab 

Clinical note 

contents 

Figure 4: eCHART Navigator Window 

Diagnosis and patient 

information 

Summary information from the 

Diagnoses and Interventions window 

You can also display the Diagnoses and Interventions window by 

clicking eChart | Navigator…. 


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Notes The eCHART Navigator window contains the information and components 

below: 

Patient 

Information 

Header 

Shows basic patient information, such as patient name, 

referring physician, medical record number, and date of 

birth. If the patient has multiple attending or referring 

physicians, an arrowhead appears on the right side of the 

Attending MD and Referring MD fields. Move the mouse 

pointer to to show the names of the other physicians. 

Summary Tabs Changes the category of notes shown in the Patient 

Clinical Summary box. You can configure the tab names 

(on a global basis) if you have the applicable security 

rights. Right-click or press F4 in the eCHART Navigator, 

then click Configuration…. 

Patient 

Clinical 

Summary Box 

Summary 

Writer Box 

Shows brief notes added from the Summary Writer box. 

When you click a Summary tab, the contents change. 

Adds a note to the currently shown Summary tab. The 

button above the Summary Writer box shows the 

currently selected tab. 

Displays the main tab of the Flowsheet window, from 

which you can view assessment, lab, or other information 

about a patient. 

Displays the Assessment tab in the Flowsheet window, 

from which you can view or change assessment 

information on a patient. 

Displays the Image List window, from which you can 

view or change images for a patient. 

Displays the patient’s Quality Checklist window, from 

which you can view or change Quality Checklist items for 

a patient. 

Displays the Patient Schedule window, from which you 

can view or change scheduled appointments and activities 

for a patient. 

Displays diagnosis information entered from the 

Diagnoses and Interventions window. Clicking 

displays the Diagnoses 

and Interventions window.


Notes 

Displays lab and medication orders, as well as their status, 

for the last 14 days. Clicking 

displays the Orders 

dialog box. 

Displays any eSCRIBE, eSCAN, or PhAST Note 

documents related to the patient, as well as the date and 

status of the documents. Clicking 

displays the 

Documents window. 

Displays the labs and vital statistic information for the last 

21 days. Information is listed alphabetically. Clicking 

displays the 

Laboratory tab in the Flowsheet window. 

Displays the additional medications that are not part of the 

patient’s Care Plan. Clicking 

displays the 

Medication List window. 

Displays any allergies the patient may have, as well as any 

medical alerts (such as DNR or Do Not Resuscitate). 

Clicking displays the 

Allergies by Severity dialog box. 

Displaying the Diagnoses and Interventions 

Window 

The Diagnoses and Interventions window displays diagnosis, course, and simulation 

or treatment field information for a selected patient. You can add, edit, and view 

simulation or treatment fields as well. In this exercise, you will display the Diagnoses 

and Interventions window. 

1. From the eCHART Navigator window, click Diagnoses and 

Interventions…. 

You can also click from the toolbar. 

Displays the Diagnoses and Interventions window, shown in Figure 5. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Divisional tabs 

Expanded Item 

Radiation prescription 

Course of treatment 

Diagnosis 

Figure 5: Diagnoses and Interventions Window 

You can also display the Diagnoses and Interventions window by 

clicking eChart | Diagnoses and Interventions…. 

Notice that this patient has existing entries for radiotherapy treatment and that the 

window defaults to the Order Set level of detail. You can switch tabs by clicking 

the tab you want to view. Some information may be restricted to a specific tab. 

The Radiation tab of the Diagnoses and Interventions window contains the 

information and components below: 

Level Determines the level of detail displayed. 

Diagnosis/Car 

e Plan 

Information 

Add diagnosis, care plan, prescription, simulation field, 

and treatment field command buttons 

Display level 

Simulation field ID and name 

Treatment field ID and name 

Edit or delete existing diagnosis, 

care plan, etc.; refresh data; change 

status; change dosimetry setup, etc; 

open Archived Objects and Couch 

Copy window 

Displays diagnosis and related care plan, prescription, and 

activity information.


Notes Start Displays the date of the diagnosis, the start date of the first 

instance of the care plan, the start date of the prescription, 

the due date, or the approval date, depending on the item 

displayed. 

Status Displays the status of the care plan, course, or 

prescription. If the item’s status is Pending, this column is 

blank. Any other status for an item displays one of the 

following indicators: 

A Approved 

C Completed 

H On Hold for cycles; Hidden for treatment fields 

P Partial treatment of a radiation treatment field 

V Voided 

X Closed 

O Associated orders (as in AO or CO) 

The date the status was last changed displays to the right. 

Displays the Diagnoses and Problem List dialog box, 

from which you can add, change, or delete diagnosis and 

staging information for the patient. 

Displays the Patient Care Plan dialog box, from which 

you can assign a course to the patient and the option to 

add pre-defined radiation oncology Care Plans. 

Displays the Order Sets window, from which you can 

add an individual order set to a care plan cycle. 

Displays the Import Tx Plan window, from which you 

can import treatment plans in PDF format. 

Displays the Radiation Prescriptions dialog box, from 

which you can add a radiation therapy prescription. 

Displays the Treatment Field Definition dialog box, from 

which you can add a treatment field. 

Displays the Simulation Field dialog box, from which you 

can add a simulation field. 

Displays the Site Setup dialog box, from which you can 

select patient orientation, enter prescribed relative offsets, 

and add CT structure sets. 

Displays the selected item for editing. 

Deletes the selected item. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

2. Click . 

Refreshes the data in the Diagnoses and Interventions 

window. 

Displays the Record Status dialog box, from which you 

can approve planned or scheduled radiation treatment 

sessions, and radiation oncology order sets. 

Displays the Dosimetry Setup window, from which you 

can configure dose tracking. 

Displays the Archived Objects window. This is active only 

if your site purchased MOSAIQ Oncology PACS. 

Displays the Couch Copy window for treatment fields. 

Select a treatment field from which you can copy couch 

parameters (vertical, longitudinal, or lateral) from one 

treatment, setup, kV setup, or CT field to another 

prescribed field. 

Closes the Diagnoses and Interventions window.


Notes 

Displaying the Treatment Window 

The RO Treat button enables you to display the Treatment Chart window directly 

from the toolbar. In this exercise, you will use the RO Treat button to display the 

Treatment Chart window. 


Displays the Treatment Chart window, shown in Figure 6. 

Prescription Group – Displays radiation 

prescription info for the treatment event. 

Diagnosis Group – Displays diagnosis and 

course information for the treatment event. 

Historic and Planned Treatment List – Displays 

a listing of daily treatments for the patient. 

Treatment Detail Group – Displays field 

detail information for the treatment event. 

Figure 6: Treatment Chart Window 

You can also display the Treatment Chart window by clicking 

eChart | Radiotherapy Treatment…. 


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Notes The Treatment Chart enables you to review previous and planned treatments, as 

well as initiate treatment delivery. You will learn more about the Treatment Chart 

window in later lessons. The Treatment Chart window contains the information 

and components below: 

Diagnosis 

Group 

Prescription 

Group 

Treatment 

Detail Group 

Displays diagnosis and course information for the 

treatment session selected in the Historic and Planned 

Treatments List. Click to the left of the left-most to 

display the Diagnosis and Staging window. Click to the 

right of the right-most to display the Patient Care Plan 

dialog box. 

Displays radiation prescription information for the 

treatment session selected in the Historic and Planned 

Treatments List. The lets you click in the group to 

display the Radiation Prescriptions dialog box. 

Displays field detail information for the treatment session 

selected in the Historic and Planned Treatments List. The 

lets you click in the group to display the Historic 

Treatment dialog box. 

Historic and Planned Treatments List 

Session Displays basic information about the treatment session: 

No Displays the treatment session number for the 

summary treatment session only. Click to 

display the individual treatment field records. 

Date Displays the date of pending/administered 

treatment for the summary treatment session only. 

Time Displays the time of the administered/pending 

treatment.


Notes Field Displays information on treated or planned fields and 

delivered or planned portal imaging: 

ID Displays the number of treated or planned 

fields for the summary treatment session. For 

individual treatment fields, displays the field ID. 

Tx Displays the number of times the treatment 

field was or will be recorded. 

ED Displays the number of days that have elapsed 

or will elapse between the first treatment and 

the current treatment. 

Seq Displays field sequencing, if applicable. 

PI In the main treatment session, displays the 

number of fields that have or will have portal 

imaging. In the individual treatment fields, 

displays the number of port image monitor 

units recorded for treated fields and the 

planned portal image(s) for planned fields. 

MU In the individual treatment fields, displays the 

number of monitor units delivered or 

scheduled for the field. 

Dose Displays the calculated field dose delivered or 

planned. 

Machine Displays the machine used or scheduled. 

Notes Displays the notes type indicator as applicable for both 

treatment sessions and individual treatment fields: 

T Historic Treatment Note 

S Field Setup Note 

P Prescription Site Note 

F Fraction Specific Note 

D Dose Action Point 

C Treatment Calendar Session Note 


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Notes Sts Displays the treatment status for delivered treatment or 

planned treatment: 

m Manually recorded treatment 

H Hidden fields for a planned treatment 

A Approved treatment field or session 

p Partial treatment of a planned treatment 

^ First actual or planned treatment with a new or 

updated treatment field definition or radiation 

prescription 

* Overrides were recorded 

+ Includes data combined from multiple treatment 

and/or portal image records for a field in the same 

session 

By Displays the initials of the user(s) logged in at the time of 

treatment or approved the planned treatment session. 

Rx: Displays as many as 20 dose site columns, but all dose 

sites are tracked even if they do not display. Each dose site 

column contains sub-columns providing recorded or 

planned treatment information for the specified dose site. 

The dose site column heading indicates the dose site type: 

Rx: Prescribed Treatment Sites 

Sec: Secondary Sites 

RxCum: Cumulative Primary Dose Tracking Sites 

Cum: Secondary Cumulative Dose Tracking Sites 

The dose site type is followed by the dose site; for 

example, Rx:Left Central Breast or Cum:Lung. 

The columns displaying in this section also provide the 

following information: 

Fx Displays the calculated number of fractions treated 

or planned for the prescription dose site or 

summary treatment sessions. 

Ses Non-Rx sites only. Displays the number of dose 

site-specific treatment sessions delivered or planned 

for summary treatment sessions 

ED Displays the number of days that have elapsed or 

are projected to elapse since the first treatment of 

the dose site for summary treatment sessions. 

Dly Displays the calculated daily dose actually delivered, 

or planned to be delivered, to the dose site during 

the session. 

Cum Displays the actual or planned cumulative dose to 

be delivered to the dose site.


Notes 

Displays the Treatment Calendar window, from which 

you can create, modify, or delete treatment sessions, as 

well as schedule or modify fields to treat. You can also 

arrange portal imaging within sessions. 

Displays the Dose Site Summary window, from which 

you can view the radiation dose, defined as a dose 

tracking site, administered to each treatment site. 

Displays the Treatment Delivery Table dialog box, from 

which you can deliver actual or manual treatments. 

Displays the Treatment Chart Notes window, from which 

you can view notes regarding the patient’s radiation 

treatments. 

Displays the Treatment Delivery Table dialog box in QA 

(Quality Assurance) mode, from which you can run a 

treatment field quality check QA mode treatment sessions 

not add to dose or fractions in the patient’s chart. 

Displaying the Treatment Calendar Window 

The Treatment Calendar window is part of the Treatment Chart window and enables 

you to manage treatment sessions. In this exercise, you will display the Treatment 

Calendar window. 

1. From the Treatment Chart window, click . 

Displays the Treatment Calendar window, shown in Figure 7. 


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Notes 

Session Tabs: Enables you to 

insert/manage sessions 

or schedule fields. 

Planned treatment session 

Recorded Individual treatment 

Recorded treatment session 

Calendar View: Displays 

weeks of treatment and any 

session(s) scheduled. 

Portal Image: Schedules the type of portal 

image planned for the treatment. 

Figure 7: Treatment Calendar Window 

Treatment session listing 

You can also display the Treatment Calendar window from the 

Diagnoses and Interventions window. Select a radiation 

prescription, right-click or press F4 to display the Options menu, 

then click Treatment Calendar….


Notes The Treatment Calendar has three tabs: Insert Sessions, Select Sessions, and 

Schedule Fields. In addition, the Treatment Calendar has a calendar (Calendar 

View) and a list of all sessions (Historic and Planned Treatment List). Notice that 

the Historic and Planned Treatments List at the bottom of the window is the 

same as the one that displays in the Treatment Chart window. The Treatment 

Calendar window displays the following information: 

Calendar View Displays scheduled treatment sessions in a calendar format. 

The format includes a week number (start of treatment is 

Week 1), the dates for each week, and the days of the 

week (starting with Sunday). When you select a single day 

of the week, the date displays above the Calendar View. 

You can also select a treatment session listed in the History 

and Planned Treatment List by clicking a day of the week 

(cell) in the Calendar View. 

Portal Image Schedules portal images for the selected planned field. 

You can schedule a field for up to one treatment per 

session and as many portal images as necessary. 

Pre Schedules portal imaging to occur before you 

treat the planned treatment field. 

During Schedules portal imaging to occur during 

treatment of the planned treatment field. 

Post Schedules portal imaging to occur after you treat 

the planned treatment field. 

Only Schedules portal imaging only (no treatment) for 

the planned treatment field. 

Adds a portal image-only instance of the selected planned 

treatment field to the same treatment session. This enables 

you to schedule a portal image and maintain the scheduled 

field separately. 

Displays the main Treatment Chart window. 

Displays the Dose Site Summary window. 

Displays any notes associated with the patient’s treatment 

session. 

Displays the Treatment Calendar Session dialog box for a 

new treatment session. 

Displays the Treatment Calendar Session dialog box for 

an existing treatment session. 

Deletes the selected treatment session(s). 


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Notes 

Displays the Record Status dialog box, which lets you 

change the status of a treatment session. 

Descriptions of the Insert Sessions, Select Sessions, and Schedule Fields tabs are 

covered in Lesson 8. 

Displaying the Dose Site Summary Window 

The Dose Site Summary window displays information about the amount of dose 

already delivered to a specific site. In this exercise, you will display the Dose Site 

Summary window. 

1. From the Treatment Calendar/Treatment Chart window, click . 

Displays the Dose Site Summary window, shown in Figure 8. 

Figure 8: Dose Site Summary Window 

You can also display the Dose Site Summary window from the 

Diagnoses and Interventions window. Right-click or press F4 to 

display the Options menu, then click Dose Site Summary…. 

The Dose Site Summary window displays the following information: 

Site Displays all primary and secondary dose tracking sites. 

Start Tx Displays the date on which treatment to the site began. 

Last Tx Displays the date the site was last treated. 

Days Displays the number of days between the first and most 

recent treatments. 

Frac Displays the number of fractions administered to date, as 

well as the total number of fractions planned.


Notes Dose Displays the radiation dose delivered to date, as well as the 

total dose planned for this course of treatment. 

Prior Displays any dose previously delivered to this site as noted 

in the Primary Dose Tracking Site or the Secondary Dose 

Tracking Site dialog boxes. 

Total Displays the dose delivered to date, dose administered to 

the dose tracking site before the electronic medical record, 

and the total prescribed dose. 

Frac Dose Displays the dose to be delivered in each fraction. 

Technique Displays the radiation therapy technique used to administer 

dose to the site. 

Tx Fields Displays the treatment fields contributing dose to the 

selected site. If no site is selected, this field is blank. 

Action Doses Displays the Dose Action Points, if any, assigned to the 

selected site. If no site is selected, this field is blank. 

Displays the Dose Action Points window, from which 

you can add, view, or change Dose Action Points. 

Displays the Treatment Plans window, from which you 

can display all associated treatment plans for the 

prescription or course associated with the highlighted 

treatment field. You can add, view or change treatment 

plans. 

Displaying the Dose Action Points Window 

Dose Action Points display dose-driven pre-treatment reminders that you can 

configure to require Acknowledgement through the use of electronic signatures. When 

you use eCHART to track dose for patients under treatment, Dose Action Points 

display pre-treatment in an Active view and provide an automatic warning when a 

specified dose is approaching for a specified site. In this exercise, you will display the 

Dose Action Points window. 

1. From the Dose Site Summary window, click . 

Displays the Dose Action Points window, shown in Figure 9. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 9: Dose Action Points Window 

You can also display the Dose Action Points window from the 

Diagnoses and Interventions window. Right-click or press F4 to 

display the Options menu, then click Dose Action Points…. 

The Dose Action Points window displays the following fields and information: 

View Selects which type of Dose Action Points display: 

Dose Tracking 

Site 

All - All Dose Action Points display. 

Active - Only active (acknowledged or 

unacknowledged) Dose Action Points display. 

Acknowledged - Only acknowledged Dose Action 

Points display. 

Not Acknowledged - Only unacknowledged Dose 

Action Points display. 

Displays the name of the dose tracking site. 

Action Dose Displays the dose to be administered if Active or Not 

Acknowledged is selected in the View field. 

Current Dose Displays the total dose administered if Active or Not 

Acknowledged is selected in the View field. 

Acknowledged Displays the date of acknowledgment if All or 

Acknowledged is selected in the View field. If the Dose 

Action Point is unacknowledged, this field is blank. 

By Displays the initials of the user who acknowledged the 

Dose Action Point if All or Acknowledged is selected in the 

View field. If the Dose Action Point is unacknowledged, 

this field is blank.


Notes Dose Displays the dose at which the specified action must be 

performed if All or Acknowledged is selected in the View 

field. 

Type Displays the type of Dose Action Point: Standard, 

Mandatory, or Dose Limit. 

Comment Displays the action to perform when the patient receives 

the specified dose. 

You can also change individual Dose Action Points, as well as add or delete them. 

Dose action points produce notification of activities to complete as the patient’s 

treatment reaches a pre-defined dose. 

2. Double-click any Dose Tracking Site. 

Displays the Dose Action Point dialog box for that site, shown in Figure 10. 

Figure 10: Dose Action Point Dialog Box 

The Dose Action Point dialog box enables you to assign Dose Action Points to 

any defined dose site and displays the following information: 

Dose Site Selects the dose site for which you want to enter a Dose 

Action Point. The dose sites listed are specific to the 

current patient. 

Action Dose Enters the dose at which the action defined in the 

Comment field must be completed. 


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LTG19002A / 1.0/ 11-May-2009 

Notes Lead Dose Displays the dose quantity subtracted from the Action 

Dose. When the delivered dose equals the Action Dose 

minus the Lead Dose, the Dose Action Point becomes 

Active. Active Dose Action Points trigger notification at 

treatment delivery. 

Use Default Indicates whether to use the default lead dose. This is set 

by your System Administrator. 

Dose Action 

Point Type 

Selects the type of Dose Action Point: 

Standard The Dose Action Point is not mandatory, 

which means that you do not have to 

acknowledge it. 

Mandatory The Dose Action Point is mandatory, which 

means you cannot administer further 

treatments until the Dose Action Point is 

acknowledged (after the Action Dose is 

reached). 

Dose Limit The Dose Action Point is mandatory and 

continues to trigger warnings during 

treatment even after acknowledgment. 

Comment Enters the text describing the action to complete when the 

patient has received the specified dose, up to 60 characters 

maximum. 

Acknowledged 

/ By / Date 

3. Click . 

Displays the initials of the user who acknowledged the 

Dose Action Point and the date of the acknowledgment. 

If unacknowledged, these fields are blank. 

Displays the Dose Action Note window, from which you 

can add additional information/instructions about the 

Dose Action Point. 

Closes the Dose Action Point dialog box, then returns to the Dose Action Points 

window. 

4. Click . 

Closes the Dose Action Points window, then returns to the Dose Site Summary 

window. 

5. Click . 

Closes the Dose Site Summary window, then returns to the Treatment Chart 

window.


Notes What’s Next 

In this lesson, you learned how to view the eChart menu and eCHART Navigator, the 

Diagnoses and Interventions window, the Dose Site Summary window, and the Dose 

Action Points window. In addition, you learned how to use the RO Treat button to 

display the Treatment Chart window, as well as how to display the Treatment 

Calendar window. Use the Quick Version as a concise, step-by-step guide when you 

must quickly apply any of the skills you’ve learned in this lesson or if you simply want 

to reinforce what you have learned. In the next lesson, you will learn how to create 

and modify recurring appointments, treat and capture charges from the schedule, and 

print location schedules. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

The Quick Version 

Displaying the eChart Menu 

1. Click File | Open Patient Chart…. 

2. From the Select Patient window, double-click an existing patient or quick admit a 

new one. 

3. Click eChart. 

Displaying the eCHART Navigator 


Displaying the Diagnoses and Interventions Window 

1. Click eChart | Diagnoses and Interventions……, or click . 

Displaying the Treatment Chart Window 


Displaying the Treatment Calendar Window 



Displaying the Dose Site Summary Window 

1. From the Treatment Calendar/Treatment Chart window, click . 

Displaying the Dose Action Points Window 

1. From the Dose Site Summary window, click .


Notes 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Lesson 2: Scheduling and 

Treating from the 

Schedule 

Objectives 


• Create and modify recurring appointments 

• Manually treat patients from the schedule 

• Capture charges for treatments 

• Print location schedules 

Working from the schedule is basic to using the MOSAIQ system. Although you can 

access treatments from the eChart menu, most of the time you will treat from the 

Location Schedule for your machine. In this lesson, you will schedule and modify 

recurring appointments, select a patient for treatment, record a manual treatment, and 

use schedule printing filters. 

To create and/or modify a recurring appointment, you must have 

Scheduling | General | Modify rights. 

To manually treat a patient from the Schedule, you must have 

Scheduling | General | View , Clinical | General | View and Clinical | 

Tx Delivery | Modify rights. 

To capture charges for a treatment, you must also have 

Administrative | Code Capture | Modify rights. 

To print a Location Schedule, you must have Scheduling | General | 

View rights.


Notes Working with Wave (Recurring) Appointments 

In some instances, you may need to schedule appointments yourself, rather than go 

through reception to schedule them. Since most patients require several appointments 

involving the same activity and location, you can schedule recurring appointments in a 

pattern known as a wave. You can only schedule wave appointments for the same 

activity. If you have multiple activities for a single appointment, each activity must 

have its own wave pattern (recurring appointments). In the following exercises, you 

will display the Location Schedule, schedule a wave appointment, modify wave 

appointments, and use the Add to End feature. 

Displaying the Location Schedule 

In this exercise, you will display the Location Schedule, from which you will schedule 

wave appointment. 

1. Click Schedule. 

Displays the Schedule menu, shown in Figure 11. 

Figure 11: Schedule Menu 

The Schedule menu lists the various types of schedules, including schedules that list 

appointments by staff or patient. 

2. Click Location…. 

Displays the Location Schedule window, shown in Figure 12. 


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Lesson 2: Scheduling and Treating from the Schedule 


LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 12: Location Schedule Window 

The Location Schedule lists all activities for the location selected in the Location 

field, in this example, Mevasim. The columns list the appointment time, patient, 

activity, and other information. 

3. Click next to the Location field. 

Displays the Location Directory window, shown in Figure 13. 

Figure 13: Location Directory Window 

4. Double-click Clinac MLC [80] (or the linear accelerator you are currently 

using). 

You can also click the location, then click .


Notes Selects the new location, closes the Location Directory window, then returns to 

the Location Schedule window for the selected location, shown in Figure 14. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 14: Location Schedule for Clinac 120 

The Location Schedule shows all the appointments scheduled for the selected 

location. Depending on the linear accelerator you are using, you may or may not 

have any pre-existing entries. 

Creating a Wave Appointment 

Scheduling wave appointments that do not take place on consecutive days is 

important for patients who are undergoing multiple treatments at a specified interval. 

You can quickly and easily schedule all required appointments for a patient at one time 

using the wave feature. In this exercise, you will schedule a wave appointment. 

1. From the Location Schedule, select an open time slot, then click . 

Displays the Appointment Slip dialog box, which contains all the fields that you 

need to set up an appointment. Note that you do not have to enter all the fields in 

the Appointment Slip dialog box. The required fields display in red. 

The Patient and Location fields are automatically filled in with 

currently selected patient and location. If one or the other has not 

been selected, the field(s) display in red and are required. 

2. Click next to the Patient field, then double-click Smith, James (or a practice 

database patient of your instructor’s choice that has fields you can treat). 

Displays the Appointment Slip dialog box with the newly selected patient, shown 

in Figure 15.


Notes 

3. Click next to the Activity field. 

Figure 15: Appointment Slip Dialog Box 

Displays the Select Procedure dialog box, shown in Figure 16. 

Figure 16: Select Procedure Dialog Box 

4. In the Group column, select Clinical Treatment Management. 

Displays the associated codes and descriptions for the selected code group, 

shown in Figure 17. 


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Notes 

Figure 17: Charge Codes for Clinical Treatment Management Code Group 

5. In the Code column, double-click X77412. 

You can also click X77412, and then click . 

Adds the activity to the Activity field, closes the Select Procedure/Lab dialog box, 

then returns to the Appointment Slip dialog box, shown in Figure 18. 

Figure 18: Appointment Slip with Activity Added 

The charge code displays in the Activity field, and the description of the charge 

code displays to the right of the Activity field.


Notes 6. Click in the Date field, then type the date of the appointment. 

Specifies the start date, which defaults to the current date. 

7. Click . 

Specifies that you want the appointment to be a wave or recurring appointment, 

then displays the Wave Setup Form dialog box, shown in Figure 19. 

Figure 19: Wave Setup Form Dialog Box 

The Wave Setup Form dialog box contains the following options: 

Start Specifies the date and time of the first appointment. 

End Specifies when the wave appointments end, such as after a 

certain number of times or by a certain date. 

Times Per Day Specifies how many times a day the appointment occurs. 

Pattern Specifies the pattern of the appointment, such as daily, 

weekly, and monthly, as well as whether the appointment 

should occur on weekends or holidays. The exact fields in 

the Pattern section change depending on the pattern you 

select (Weekly, for example). 


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LTG19002A / 1.0/ 11-May-2009 

Notes 8. In the End section, select the After a certain number of times radio 

button if it is not already selected. 

Specifies that the appointments should end after the wave appointment has 

occurred a specific number of times. 

9. Click in the field to the right of the End section radio buttons, then type 25. 

Specifies the number of times that the wave appointment should occur. Your 

entries should look similar to the ones shown in Figure 20. 

Figure 20: Wave Setup Form with End Selected 

For this exercise, leave the Times Per Day section set to Once. Notice that the 

number of times (1) the wave appointment occurs per day displays in the Times 

text field. You can also set the number of times to two (BID radio button), three 

(TID radio button) or a number between 1 and 24 (Times radio button and 

field). 

If you set the number of times to greater than one, the Interval fields (Hours and 

Minutes fields) display. You then indicate the number of hours or minutes 

between wave appointments for that day. 

You will also leave the Pattern section set to Daily. The Pattern section 

determines how often the wave appointment occurs, such as daily or weekly. You 

can then further define the wave appointment, such as whether it should occur 

every day or every other day. 

10. Click .


Notes Creates the wave appointment, closes the Wave Setup Form dialog box, then 

opens the Wave Edit Form window, shown in Figure 21. 

Figure 21: Wave Edit Form Window 

If your administrator has defined your facility’s holidays, the scheduler 

automatically schedules around those days. The Wave Edit Form window enables 

you to view every appointment in a wave and make changes if needed. The Wave 

Edit Form window displays the following information: 

# Displays the number of the appointment. In this case, the 

appointments number from 1 to 25. 

Date Displays the date and day of the week on which the 

appointment takes place. 

Time Displays the time at which the appointment takes place. 

Activity Displays the procedure or activity to be performed. 

Duration Displays how long the appointment takes, such as 1:00 for 

one hour. 

Status Displays the status of the appointment: Unresolved, Break, 

No Show, Cancelled, Machine Down, New Start, Old Start, Final 

Treatment. You may also have statuses that are specific to 

your facility. 

Staff Displays the staff member responsible. 

Location Displays the location where the appointment takes place. 


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Notes Comment Displays any comments associated with the appointment. 

Status Assigns a status to the group of appointments: New Start, 

Old Start, or Final Treatment. This option is only available 

after the initial wave appointments are set up. 

11. In the Status section, check the New Start checkbox, then check the Final 

Treatment checkbox. 

Specifies the wave appointment as a new wave appointment, and that it is the 

patient’s final treatment session(s). 

12. Click . 

Closes the Wave Edit Form window, closes the Appointment Slip dialog box, 

then returns to the Location Schedule window, shown in Figure 22. 

Figure 22: Location Schedule for Clinac 120 with New Appointment 

The Location Schedule window displays all appointments for the machine listed 

in the Location field for the date listed in the window title. The All section 

displays the total number of appointments for the current date. The Patient 

section lists the total number of patient appointments for this machine for the 

current date.


Notes Modifying a Wave Appointment 

In the previous exercise, you created a wave appointment in the Wave Setup Form 

dialog box. You can change wave appointments individually or you can change all or 

part of the wave. In this exercise, you will make a change to your wave appointments 

from the Wave Edit Form window. 

1. From the Location Schedule window, select the wave appointment you created in 

the previous exercise, then click . 

Displays the Wave Edit Form window for the wave appointment, shown in 

Figure 23. 

Figure 23: Wave Edit Form to Modify Wave Appointment 

Notice that additional buttons display now that the wave appointment has been 

created: 

Displays the Appointment Slip dialog box for the selected 

wave appointment, enabling you to make changes. 

Deletes the selected wave appointment(s). 

Adds appointments to the end of a wave. 

Enables you to status the selected wave appointment(s). 

Selects all the wave appointments. 

Unselects the tagged wave appointments. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Initiates conflict checking for the wave appointments 

throughout the scheduling system. 

Displays the Choose an Available Slot dialog box to select 

an alternate slot for the appointment. 

2. Select a wave appointment for your patient, then click . 

Displays the Appointment Slip dialog box for the selected appointment, as 


Figure 24: Appointment Slip for the Selected Wave Appointment 

3. Click in the Time field, then type 2:45 PM (or another open time slot). 

Changes the time of the appointment from 2:15 pm to 2:45 pm. 

4. Click . 

Changes the appointment, then displays the Conflict Checking message box, 

shown in Figure 25. This message box may or may not appear depending on 

how your system administrator has configured your site. 

Figure 25: Conflict Checking Message Box


Notes 

5. Click . 

Checks for conflicts. Because your practice database is new, you should have no 

conflicts. Closes the Appointment Slip dialog box, then displays the Wave Edit 

Form window, with your change, shown in Figure 26. 

Figure 26: Wave Edit Form with Changed Appointment 

Note that the change was to a single appointment. Even though you have made 

this change, the system still recognizes the appointment as being part of the wave. 

If you wanted to change the other appointments, you could either change each 

appointment individually or tag the other appointments and make the change 

once for all tagged appointments. 

6. Click . 

Selects every appointment in the wave pattern, shown in Figure 27. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 27: Wave Edit Form with All Appointments Tagged 

7. Select the appointment you just changed, then press SPACEBAR. 

Untags the appointment that you just changed. 

8. Click . 

Displays the Multiple Wave Update Form dialog box, shown in Figure 28. 

Figure 28: Multiple Wave Update Form Dialog Box 

9. Check the checkbox to the left of the Time field. 

Specifies that you are changing the Time field, then highlights the text in the field.


Notes 10. In the Time field, type 2:45 pm. 

Changes the time of the appointments to 9:00 AM. Your entries should look 

similar to the ones shown in Figure 29. 

Figure 29: Multiple Wave Update Form with Time Changed 

11. Click . 

Makes the change, closes the Multiple Wave Update Form dialog box, then 

returns to the Wave Edit Form window, shown in Figure 30. 

Figure 30: Wave Edit Form with Changes to Tagged Appointments 


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LTG19002A / 1.0/ 11-May-2009 

Notes Using the Add to End Feature 

If a patient takes a break in the middle of their treatments, or if the patient cancelled 

or missed an appointment, you can use the Add to End feature to automatically 

reschedule the missed appointment to the end of the wave. In this exercise, you will 

use the Add to End feature. 

1. From the Wave Edit Form window, select the first appointment. 

Specifies the appointment that you want to add to the end of the wave. 

2. Click . 

Displays the Add To End Of Schedule dialog box, shown in Figure 31. 

Figure 31: Add To End Of Schedule Dialog Box 

You can specify to add any number of appointments to the end of a wave. You 

should also indicate the status of the missed appointment(s). 

3. Click . 

Displays the Schedule Status menu, shown in Figure 32. 

Figure 32: Schedule Status Menu 

The statuses reflect reasons for a missed appointment. Your administrator can 

also add additional statuses as needed from Schedule Status Configuration, which 

is part of System Utilities. 

4. Click Cancelled. 

Cancels the selected appointment, statuses it as cancelled, adds the new 

appointment to the end of the wave, closes the Add to End of Schedule message 

box, then returns to the Wave Edit Form window, shown in Figure 33.


Notes 

Figure 33: Wave Edit Form with Appointment Cancelled and Rescheduled 

Notice that the status of the appointment changed to X, indicating a cancelled 

appointment and that a new appointment was added to the end of the wave. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Treating Patients from the Schedule 

Once a patient has arrived for their appointment, you can select them for treatment. 

In the following exercises, you will select the patient for a manual treatment, record 

the treatment, and charge the patient for the procedure. 

Selecting a Patient for Treatment 

In this exercise, you will select a patient for treatment. 

1. Open patient chart and then double-click Conner, Rosanne (or a practice 

database patient of your instructor’s choice that has fields you can treat). 

2. Click Schedule | Location…. 

Displays the Location Schedule window. 

3. Click next to the Location field, then double-click Clinac MLC [80] (or the 

linear accelerator you are currently using). 

Specifies and displays the schedule for the linear accelerator location whose 

appointments you want to display. 

4. Click or until the date for the appointment you scheduled, then cancelled, 

in an earlier exercise displays. 

When you select a date, make sure that it is the current or a past 

date. You cannot treat a patient using an appointment that takes 

place on a future date. 

Displays the Location Schedule window for the selected date, shown in Figure 

34.


Notes Figure 34: Location Schedule with Appointment to Be Treated 

Even though you cancelled the appointment, you can still chart and charge the 

treatment. 

Recording a Manual Treatment 

Although this exercise has you recording a treatment from the Location Schedule, you 

can also record a treatment directly from the Treatment Chart window. In this 

exercise, you will use the Location Schedule window to open the Treatment Chart 

window, then record a manual treatment. 

You can only record a manual treatment on a non-SEQUENCER 

machine. 

1. From the Location Schedule window, select the appointment whose treatment 

you want to record, then right-click anywhere in the window or press F4. 

Displays the Schedule Options menu, shown in Figure 35. 

Figure 35: Schedule Options Menu 

2. Click Chart/Capture… or press CTRL+P. 

Displays the Treatment Chart window, shown in Figure 36. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 36: Treatment Chart Window for the Selected Appointment 

The Treatment Chart window enables you to schedule and treat a patient’s 

treatment fields. Even though the status of the appointment was Cancelled, you 

can still chart and capture the appointment. Because you have not scheduled or 

treated any sessions for this patient, the historic/planned treatment listing is blank. 

3. Click . 

Displays the Treatment Delivery Table dialog box, shown in Figure 37. 

Figure 37: Treatment Delivery Table Dialog Box


Notes The Treatment Delivery Table dialog box displays a listing of the fields to treat 

for the selected patient. 

If the Dose Action Points window displays, click to 

bypass it for this exercise. 

4. Double-click the 1 LT MED TANG treatment field. 

Displays the Port Film Status dialog box. Click 

Displays the Manual Treatment dialog box, shown in Figure 38. 

5. Click . 

Figure 38: Manual Treatment Dialog Box 

Displays the Manually Record a Treatment message box, shown in Figure 39. 

6. Click . 

Figure 39: Manually Record a Treatment Message Box 

Closes the Manually Record a Treatment message box, closes the Manual 

Treatment dialog box, then displays the Record Treatment dialog box, shown in 

Figure 40. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 40: Record Treatment Dialog Box 

Notice that the date, time, and prescription MU are automatically entered in the 

appropriate fields. When recording a manual treatment, make sure that the date 

field reflects the day that the actual treatment is delivered; so the elapsed days will 

be correct if it is not the same day as actual treatment. 

7. Click . 

Records a treatment for the field, closes the Record Treatment dialog box, then 

displays the Treatment Delivery Table dialog box, shown in Figure 41. 

Figure 41: Treatment Delivery Table with Remaining Fields 

You will verify and record treatments in a later lesson. 

Notice that the field no longer displays in the Treatment Delivery Table dialog 

box, and 1 displays in the Treated Fields display field. This is the Field ID of the 

field (1 LT MED TANG) that you just treated.


Notes 8. Manually treat the remaining fields by repeating steps 4 through 7. 

When you have recorded the treatment for the last field, the All Fields Treated 

message box displays, shown in Figure 42. 

9. Click . 

Figure 42: All Fields Treated Message Box 

Closes the All Fields Treated message box, closes the Treatment Delivery Table 

dialog box, then returns to the Treatment Chart window, shown in 

Figure 43. 

Shows all fields 

m status for Manually 

treated 

Recorded Treatments 

Figure 43: Treatment Chart with Recorded Treatments 

Notice that the treatment fields you just recorded display in black. 

You are now ready to record the charge for the treatment. 


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LTG19002A / 1.0/ 11-May-2009 

Notes Working with Treatment Charges 

Once you have completed the manual treatment, you can record the charge. In this 

exercise, you will capture the charge for the treatment you manually recorded in the 

previous exercise. 


Displays the Code Capture dialog box, shown in Figure 44. 

Figure 44: Code Capture Dialog Box 

The Code Capture dialog box enables you to charge a patient for a completed 

procedure. Notice that the information for the completed activity is automatically 

entered in the appropriate fields. 

2. Click . 

Captures the charge code, closes the Code Capture dialog box, then returns to 

the Location Schedule window, shown in Figure 45.


Notes 

Figure 45: Location Schedule with Completed and Charged Appointment 

Notice that a C displays in the Status column for the selected appointment. 

If you are asked to queue the patient to another location because 

of another appointment, click No. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Printing a Location Schedule 

You can view the Location Schedule for your machine from MOSAIQ, or you can 

print a paper copy of the schedule for your convenience or record-keeping purposes. 

In this exercise, you will print a location schedule. 

1. From the Location Schedule window, right-click anywhere in the window or 

press F4. 

Displays the Location Schedule Options menu. 

2. Move your mouse pointer over Reports…. 

Displays the Reports submenu, shown in Figure 46. 

Figure 46: Schedule Options Menu – Reports Submenu 

3. Click Schedule by Location. 

Displays the Schedule by Location dialog box, shown in Figure 47. 

Figure 47: Schedule by Location Dialog Box 

For this exercise, you will skip the Sort By section, which specifies whether to sort 

the report by appointment time or patient name, as well as the Time Format 

section, which specifies whether to use AM/PM or 24-hour (military) time.


Notes 4. In the Print Additional Detail section, check the Activity (Hosp Code) and 

Patient Phone Numbers/Adm Status checkboxes. 

Indicates what information should also display, such as the patient’s medical ID 

and diagnosis. Your entries should look similar to the ones shown in Figure 48. 

5. Click . 

Figure 48: Finished Schedule by Location 

Displays the Location Directory window, shown in Figure 49. 

Figure 49: Location Directory Window 


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LTG19002A / 1.0/ 11-May-2009 

Notes 6. Double-click Clinac 120 (or the linear accelerator you are currently using). 

You can also click the location, then click . 

Specifies the location whose schedule you want to display, then displays the Print 

dialog box, shown in Figure 50. 

7. Click . 

Figure 50: Print Dialog Box 

Displays the report on your computer screen, as shown in Figure 51. 

Figure 51: Location by Schedule Report for Clinac 120


Notes What’s Next 

In this lesson, you learned how to create and change recurring (wave) appointments, 

treat a patient from the schedule, capture charges after treatment, and print location 

schedules. Use the Quick Version as a concise, step-by-step guide when you must 

quickly apply any of the skills you’ve learned in this lesson or if you simply want to 

reinforce what you have learned. In the next lesson, you will learn how to enter basic 

clinical data prior to creating simulation and treatment fields, such as a diagnosis, 

course of treatment, and radiation prescription. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 


Displaying the Location Schedule 

1. Select a patient. 

2. Click Schedule | Location…. 

3. From the Location Schedule window, click next to the Location field. 

4. From the Location Directory window, double-click the location you want. 

Creating a Wave Appointment 

1. From the Location Schedule of the location to which you want to add a wave 

appointment, click . 

2. From the Appointment Slip dialog box, click next to the Patient field, then 

double-click the patient if not the current one. 


4. From the Select Procedure/Lab dialog box, select the group to which the activity 

you want belongs. 

5. In the Code column, double-click the activity code. 

6. Type in the number of appointments in the Appointments field. 

7. Click . 

8. From the Wave Edit Form window, check the New Start checkbox, then 

check the Final Treatment checkbox. 

9. Click . 

Modifying a Single Wave Appointment 

1. From the Location Schedule window, double-click the patient whose wave 

appointment you want to modify. 

2. From the Wave Edit Form window, select the wave appointment you want to 

modify, then click . 

3. From the Appointment Slip dialog box, make the change(s) to the appointment. 

4. When finished, click . 

5. From the Conflict Checking message box, click .


Notes Modifying Multiple Wave Appointments 

1. From the Wave Edit Form window, click . 

2. To unselect a tagged wave appointment, select the appointment, then press 

SPACEBAR. 

3. Click . 

4. From the Multiple Wave Update Form dialog box, check the checkbox of each 

field you want to change. 

5. Make the change(s). 


Using the Add to End Feature 

1. From the Wave Edit Form window, select the wave appointment you want to 

add to the end of the wave. 

2. Click . 

3. From the Add To End Of Schedule dialog box, click . 

4. From the Schedule Status menu, click the status of the wave appointment which 

you are moving to the end of the wave. 

Recording a Manual Treatment 

1. From the Location Schedule window, select the location from which you plan to 

treat the patient. 

2. Click or until the date for the appointment displays. 

3. Select the appointment you want, then right-click anywhere in the window or 

press F4. 

4. From the Schedule Options menu, click Chart/Capture…. 


6. From the Treatment Delivery Table dialog box, select the treatment field you 

want to record, then click . 

7. From the Manual Treatment dialog box, click . 

8. From the Manually Record a Treatment message box, click . 

9. From the Record Treatment dialog box, click . 


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LTG19002A / 1.0/ 11-May-2009 

Notes Charging a Recorded Treatment 

1. From the Treatment Chart window after recording a treatment(s), click 

. 

2. From the Code Capture dialog box, click . 

Printing a Location Schedule 

1. From the Location Schedule window, right-click anywhere in the window or 

press F4. 

2. From Schedule Options menu, move your mouse pointer over Reports…. 

3. From the Reports submenu, click Schedule by Location. 

4. From the Schedule by Location dialog box, type the date of the scheduled 

appointments you want to view in the Schedule Date field. 

5. In the Sort by section, indicate whether the schedules should list appointments by 

time or patient name. 

6. In the Time Format section, indicate whether to use AM/PM or 24-hour (military) 

time for appointment times. 

7. Specify if any additional information should display, such as activity code or 

patient phone numbers, from the Print Additional Detail section. 

8. Click . 

9. From the Location Directory window, double-click the location whose scheduled 

you want to view. 

10. From the Print dialog box, click .



LTG19002A / 1.0/ 11-May-2009 

Notes 

Lesson 3: Entering Clinical 

Data 

Objectives 


• Enter and affirm a basic diagnosis 

• Enter a basic course/care plan for a patient 

• Enter a basic radiation prescription 

Before you can create simulation and treatment fields, you must enter some basic 

clinical data about your patient, such as their oncology diagnosis, a basic course or 

care plan, and a basic radiation prescription. 

To admit a new patient, you must have Administrative | New 

Patient | Modify rights. 

To view the Diagnoses and Interventions window, you must have 

Clinical | General | View rights. 

To enter and affirm a diagnosis, you must also have Clinical | 

Diag/Staging | Modify rights. 

To enter a basic course/care plan, you must also have Clinical | 

Care Plans | Modify rights. 

To enter a basic radiation prescription, you must also have Clinical 

| Prescription | Modify rights.

Lesson 3: Entering Clinical Data 


LTG19002A / 1.0/ 11-May-2009 

Notes Working with Diagnoses 

Before you can create a simulation field or add a course/radiation prescription, your 

patient must have a basic diagnosis entered and affirmed. In the following exercises, 

you will quick admit a new patient, then enter and affirm a basic diagnosis for the 

new patient. 

Quick Admitting a New Patient 

In this exercise, you will quick admit the patient you will use throughout the rest of 

this training guide. 

1. Click File | Register New Patient…. 

Displays the NEW Patient Registration dialog box, shown in Figure 52. 

Figure 52: NEW Patient Registration Dialog Box 

2. Enter the required information: 

Last: SMITH 

First: ANNA 

Birth Date: 1/1/1955 

MedRc: 05-54321 

Gender: Female 

3. Click tab. 

Displays the Admission/Referral tab of the NEW Patient Registration dialog box.


Notes 4. Click next to the Attending Physician field, then double-click CRUSHER, 

BEVERLY A. 

Selects the Attending Physician, then fills in the Department field. Your entries 

should look similar to the ones shown in Figure 53. 

Figure 53: NEW Patient Registration – Admission/Referral Tab 

5. Click . 

Displays the No Duplicate Patients Found message box, shown in Figure 54. 

6. Click . 

Figure 54: No Duplicate Patients Found Message Box 

Creates the patient, closes the No Duplicate Patients Found message box, then 

closes the NEW Patient Registration dialog box. 


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LTG19002A / 1.0/ 11-May-2009 

Notes Entering a Basic Diagnosis 

Now that you have created your new patient, you can begin to enter the clinical data. 

In this exercise, you will enter a basic diagnosis. 

1. Click eChart | Diagnoses and Interventions…. 

Displays the Diagnoses and Interventions window, shown in Figure 55. 

Figure 55: Diagnoses and Interventions Window 

2. In the Add group, click . 

Displays the Diagnoses and Problem List dialog box, then displays the Diagnosis 

and Staging dialog box, shown in Figure 56.


Notes 

Figure 56: Diagnosis and Staging Dialog Box 

Note that you do not have to fill in all the information on this dialog box to enter 

the diagnosis. The Diagnosis field is the only required field. 

3. Click in the Category field, then type LUNG. 

Specifies the category of the diagnosis, which includes the diagnosis code group 

number (162). Note that this field is used in the many reports. 

4. Click in the Diagnosis field, type 162, then click next to the field. 

The Diagnosis list displays, showing a list of potential matches. Select the specific 

diagnosis group from the drop-down list, as shown in Figure 57. 

Figure 57: Select Diagnosis Code Dialog Box 

5. In the Code column, double-click 162.3. 

Adds the diagnosis to the Diagnosis dialog box. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 6. Click next to the Laterality field, then select 2 – Left – origin of primary. 

Specifies that the left lung is involved. Your entries should look similar to the ones 


Figure 58: Diagnosis Dialog Box with Diagnosis and Laterality Selected


Notes Affirming a Diagnosis 

Before you can create a course of treatment or a radiation prescription, at least one of 

the patient’s diagnoses must be affirmed. In this exercise, you will affirm a diagnosis. 

While you have the rights to Affirm a diagnosis in the practice 

database, you may not have those same rights when operating in a 

clinical setting. In a clinical setting, the patient’s physician will 

likely Affirm the diagnosis. 

1. From the Diagnosis dialog box, click . 

Changes the diagnosis and the State display field to The diagnosis has been affirmed. 

2. Click . 

Adds the affirmed diagnosis, closes the Diagnosis dialog box, then displays the 

Diagnoses and Problem List dialog box, shown in Figure 59. 

Figure 59: Diagnoses and Problem List Dialog Box with New Diagnosis 

The Diagnoses and Problem List dialog box displays all diagnoses for the current 

patient. It also enables you to status, modify, delete and add diagnoses, as well as 

optionally view the patient’s Code Capture information. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 3. Click . 

Closes the Diagnoses and Problem List dialog box, then returns to the Diagnoses 

and Interventions window with the new diagnosis, shown in Figure 60. 

Figure 60: Diagnoses and Interventions with New Diagnosis


Notes 

Entering a Basic Course/Care Plan 

Now that you have created your patient, added a diagnosis, and affirmed the 

diagnosis, you can create a simple course of treatment. In this exercise, you will enter a 

basic course of care from the Diagnoses and Interventions window. 

1. From the Diagnoses and Interventions window, click . 

Displays the Patient Care Plan dialog box, shown in Figure 61. 

Figure 61: Patient Care Plan Dialog Box 

The Patient Care Plan dialog box enables you to create a Course of treatment and 

assign a Care Plan to the patient. It is designed as a working document that you 

can complete during the course of a patient’s work-up. 

2. Click next to the Care Plan field. 

Displays Care Plans dialog box, shown in Figure 62. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 62: Care Plans Dialog Box 

In a clinical setting, the physician may want to add an Ad-Hoc Radiation 

Oncology Care Plan. 

The Care Plan dialog box enables you to construct a process model (selected on a 

disease basis) of the recommended procedures, medications, resources, and 

supplies required to treat a patient in a clinically optimal manner. The Care Plans 

feature enables you to achieve consistency in the delivery of patient care, monitor 

patient progress, forecast/measure utilization, monitor compliance, and improve 

your pattern of care. 

3. Select a care plan from the top pane and the related individual order set item 

from the bottom pane. 

4. Click . 

Creates the care plan for the patient, closes the Care Plans dialog box, then returns 

to the Patient Care Plan dialog box. Your entry should look similar to the one 

shown in Figure 63


Notes 

5. Click . 

Figure 63: Care Plans Dialog Box 

Creates the care plan and course for the patient, closes the Patient Care Plan 

dialog box, then returns to the Diagnoses and Interventions window. Your entry 

should look similar to the one shown in Figure 64. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 64: Diagnoses and Interventions with New Course


Notes 

Entering a Basic Prescription 

While you can add simulation and treatment fields to a patient’s chart without a 

radiation prescription, most simulation and treatment fields are associated with a 

radiation prescription. In this exercise, you will enter basic prescription information. 

1. From the Diagnoses and Interventions window, select the course you created in 

the previous exercise, then click . 

Opens the RadRx Options Menu, as shown in Figure 65. 

2. Click Conventional. 

Figure 65: RadRx Options Menu 

Displays the Radiation Prescriptions dialog box, shown in Figure 66. 

Figure 66: Radiation Prescriptions Dialog Box 

The Radiation Prescriptions dialog box enables you to enter and manage radiation 

prescription sites for a course of treatment. The dialog box has three different 

views that enable you to enter a prescription for a new site in an existing or new 

treatment course, as well as to edit or display the prescription of any existing site 

in the course. The prescription defines the physician’s treatment intentions and is 

the source of direction for defining beams and scheduling treatment sessions. 

3. In the Rx Site field, type LUNG. 

Specifies the name of the prescription site. You can enter up to 20 characters. 

4. Click next to the Technique field, then select AP/PA. 


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LTG19002A / 1.0/ 11-May-2009 

Notes Specifies the radiation technique. 

5. Click next to the Modality field, then select x06. 

Specifies the treatment modality. 

6. Click next to the Dose Spec field, then select Plan. 

Specifies the dose specification. For this radiation prescription, you will skip the 

last two dose specification fields. The second field specifies a numeric value and 

the third field is a unit of measure, such as centimeters (cm). Your entries should 

look similar to the ones shown in Figure 67. 

Figure 67: Partially Finished Radiation Prescription 

7. Click in the Rx Dose field, then type 4500. 

Specifies the total dose prescribed to treat this prescription site for a specific 

fraction size and temporal fractionation pattern. 

8. Click in the Fractional Dose field, type 180, then press TAB. 

Specifies the dose to deliver for each treatment session. Notice that the Number 

of Fractions field is automatically calculated, indicating that, to deliver the 

prescribed dose, the patient needs 25 treatment sessions. 

9. From the Fractionation Pattern field, type Daily. 

Specifies that the Fractionation Pattern is daily, which is the default. If you click 

next to the field, the Wave Setup Form dialog box displays. You could then 

define a fractionation pattern, such as BID or every other day. 

For this exercise, skip the Total Cum field, which specifies the total dose for the 

prescription site, including any dose(s) being administered to this site from other


Notes prescriptions. Cumulative dose is verified at the time of treatment. You will also 

skip the Pattern field, which contains additional information that supplements 

what you entered in the Fractionation Pattern field. This information displays in 

the Treatment Delivery Table dialog box. 

10. Click in the Comment field, then type CBC 1 st week and 2 nd week. 

Specifies a short note or comment. You can enter up to 60 characters. If you 

need to enter more information or details, click , then add that 

information. Your entries should look similar to the ones shown in Figure 68. 

11. Click . 

Figure 68: Finished Radiation Prescription 

Completes the prescription, then re-displays the Radiation Prescriptions dialog 

box. Notice that your prescription is now view only. Your new prescription 

should look similar to the one shown in Figure 69. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

12. Click . 

Figure 69: Newly Created Radiation Prescription 

Closes the Radiation Prescriptions dialog box, then returns to the Diagnoses and 

Interventions window, shown in Figure 70. 

Figure 70: Diagnoses and Interventions with New Prescription


Notes 

More advanced radiation prescriptions are discussed in detail in 

the Radiation Oncology Physician’s Training Guide. 

Adding a Second Prescription 

Often a patient has more than one radiation prescription site, typically a primary 

prescription site and a cone down or boost radiation prescription site. In this exercise, 

you will create a second prescription site that you will use in a future lesson. 

1. From the Diagnoses and Interventions window, select the course you created in a 

previous exercise, then click . 

Opens the RadRx Options Menu, as shown in Figure 71. 

2. Click Conventional. 

Figure 71: RadRx Options Menu 

Displays the Radiation Prescription Sequencing dialog box, shown in Figure 72. 

Figure 72: Radiation Prescription Sequencing Dialog Box 

The Radiation Prescription Sequencing dialog box determines where the new 

radiation prescription fits; for example, concurrent with the selected prescription 

or occurring a period of days after the selected radiation prescription. If you had 

more than one other radiation prescriptions, you could select which one of the 

prescription sites the new prescription site would be concurrent with, 

overlapping, or after from the Site field. For this exercise, you will accept the 

default(s). 

3. Click . 

Specifies that the new radiation prescription occurs one day after the LUNG 

prescription site, closes the Radiation Prescription Sequencing dialog box, then 

displays the Radiation Prescriptions dialog box. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 4. Enter the following information: 

Rx Site: LUNG Boost 

Technique: Obliques 

Modality: 15x (or 18x if your machine does not support 15x) 

Dose Spec: Plan 

Rx Dose: 1800 

Fractional Dose: 180 

Fractionation Pattern: Daily 

5. Click . 

Saves the new prescription site. Your new prescription should look similar to the 

one shown in Figure 73. 

Figure 73: Radiation Prescriptions Dialog Box with Second Prescription Site 

6. Click . 

Closes the Radiation Prescriptions dialog box, then returns to the Diagnoses and 

Interventions window, as shown in Figure 74.


Notes 

Figure 74: Diagnoses and Interventions with Second Prescription Site 

Ordering Standard Lab Tests / Medications using 

Quick Rx Ad-Hoc Orders 

You can order for frequently used medications and frequently performed 

observations / lab tests using the Quick Rx Ad-Hoc Orders dialog box. In this 

exercise, you will learn how to order medications. 

1. Click eChart | Orders…. 

Displays the Orders window, shown in Figure 75. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

2. Click Add. 

Figure 75: Orders window 

Opens the Add Options Menu, as shown in Figure 76. 

3. Click Quick Rx. 

Figure 76: Add Options Menu 

Displays the Quick Obs Orders window, shown in Figure 77.


Notes 

Figure 77: Quick Obs Orders window 

You can also click 

Hoc Orders window. 

on the tool bar to show the Quick Rx Ad- 

4. Click in the Date field, then type a past date, such as yesterday’s date, or leave it at 

the default. 

The field defaults to today’s date. 

5. Click next to the MD field, then double-click CRUSHER, BEVERLY (or 

whomever you added as the patient’s physician). 

Specifies the physician ordering the test/lab or medication if different from the 

patient's attending physician. 

6. The Diagnosis field displays 162.3 Upper Lobe, Lung. 

Specifies the primary diagnosis of the patient. 

7. Type any additional or general information about the order in Comment field. 

8. Click next to the Priority field, and select Medium. 

Specifies the priority for the order. 

9. Uncheck the Patient Administrable checkbox. 

Specifies patient may not self-administer the medication. 

10. Select the PRN checkbox. 


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LTG19002A / 1.0/ 11-May-2009 

Notes Specifies PRN is to be appended to the administration frequency. 

11. Click and select the medications you want to order. 

Displays the Medication List dialog box to choose the medications you want to 

order. 

12. Click Simulation tab. In the Observation section, select the Simulation : S checkbox. 

13. Select the Generate Approved checkbox. 

Specifies the order to have approved status. 

14. Click . 

Generates the orders. The new tests/lab(s) or medication(s) display in the Quick 

Obs section. 


The medication(s) or test(s)/lab(s) you ordered from the Quick Rx Ad Hoc 

Orders dialog box are displayed in the Orders window as shown in the . 

16. Click 

Figure 78: Orders window with a new order 

to exit the Orders window.


Notes 

What’s Next 

In this lesson, you learned how to enter basic clinical data, such as the patient’s 

diagnosis, course of treatment, and radiation prescription. Use the Quick Version as a 

concise, step-by-step guide when you must quickly apply any of the skills you’ve 

learned in this lesson or if you simply want to reinforce what you have learned. In the 

next lesson, you will learn how to schedule a simulation appointment, create a 

simulation field with or without a radiation prescription, enter simulation parameters 

manually or capture them from the simulator, create simulation fields by copying 

existing simulations, capture simulation charges, and print simulation reports. 


LTG19002A /1.0/ 11-May-2009



LTG19002A / 1.0/ 11-May-2009 

Notes 


Entering a Basic Diagnosis 

1. Select a patient, then click eChart | Diagnoses and Interventions…. 


3. From the Diagnosis and Staging dialog box, type the diagnosis category in the 

Category field. 

4. Enter a complete diagnosis code or a partial diagnosis code and click next to 

the Diagnosis field. 

5. From the drop-down menu, identify the appropriate oncology diagnosis group 

and double-click the diagnosis code. 

7. From the Diagnosis and Staging dialog box, click next to the Laterality field, 

then select the appropriate laterality. 

8. Enter additional information as needed, such as Morphology and Stage. 

Affirming a Diagnosis 

1. From the Oncology Diagnosis/Diagnosis dialog box, click . 

2. Click . 

3. From the Diagnoses and Problem List dialog box, click . 

Entering a Basic Course/Care Plan 


2. From the Patient Care Plan dialog box, click . 

Entering a Basic Prescription 

1. From the Diagnoses and Interventions window, select the course to which you 

want to associate the prescription, then click . 

2. From the Radiation Prescriptions dialog box, type the name of the site to be 

treated in the Rx Site field. 

3. Click next to the Technique field, then select the radiation technique. 

4. Click next to the Modality field, then select the treatment modality. 

5. Click next to the Dose Spec field, then select the dose specification name.


Notes 6. Type the radiation prescription depth in the Rx Depth field (text field to the right 

of the Dose Spec field), then select cm in the next field. 

7. Type the total dose in the Rx Dose field. 

8. Type the fractional dose to deliver at each treatment session in the Fractional Dose 

field, then press TAB. 

9. Type or select how often the treatment sessions should occur in the Fractionation 

Pattern. 

10. Type any additional or general information about the prescription in the Pattern or 

Comment fields. 

11. Click . 

12. Click . 

Adding a Second Prescription 

1. From the Diagnoses and Interventions window, click the course to which you 

want to associate the prescription, then click . 

2. From the Radiation Prescription Sequencing dialog box, indicate whether the 

prescription is Concurrent with the beginning, Overlapping with, or After the primary 

prescription, then click . 

3. From the Radiation Prescriptions dialog box, complete the radiation prescription. 

4. Click . 

5. Click . 

Ordering Standard Lab Tests / Medications using Quick Rx Ad- 

Hoc Orders 

1. Click eChart | Orders…. 

2. From the Orders window, cick Add. 

3. From the Add Options menu, click Quick Rx. 

4. From the Quick Rx Ad-Hoc Orders window, click in the Date field and type a 

past date, such as yesterday’s date, or leave it at the default. 

5. Click next to the MD field, then double-click the patient’s physician. 

6. The Diagnosis field displays 162.3 Upper Lobe, Lung. 

7. Type any additional or general information about the order in Comment field. 

8. Click next to the Priority field, and select Medium. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 9. Uncheck the Patient Administrable checkbox. 

10. Select the PRN checkbox. 

11. Click and select the medications you want to order. 

12. Click Simulation tab. In the Observation section, select the Simulation : S checkbox. 

13. Select the Generate Approved checkbox. 

14. Click to generate the orders. The new tests/lab(s) or medication(s) 

display in the Quick Obs section. 

15. When finished, click . The medication(s) or test(s)/lab(s) you ordered 

from the Quick Obs Orders dialog box are displayed in the Orders window 

16. Click to exit the Orders window.


LTG19002A / 1.0/ 11-May-2009 

Notes 

Lesson 4: Creating 

Simulation Fields 

Objectives 


• Schedule a simulation appointment and open the chart from the schedule 

• Create a simulation field with and without a radiation prescription 

• Copy simulation field to create a new simulation field 

• Capture charges for simulations 

• Print simulation reports 

The Simulation Field feature enables you to enter patient treatment information 

obtained during simulation, including the geometric settings, separation 

measurements, other patient measurements, setup instructions/notes, and 

radiographic settings. 

You can copy the information stored in the Simulation Fields feature directly from 

one simulation field to another. You can then modify only those values that differ. 

You can also copy the contents of a simulation field definition into an empty 

treatment field definition (this feature is covered in Lesson 5). 

To schedule a simulation appointment, you must have Scheduling | 

General | Modify rights. 

To open the patient’s Treatment Chart from the Schedule, you 

must have Clinical | General | View and Scheduling | General | View 

rights. 

To capture charges for a simulation appointment, you must have 

Administrative | Code Capture | Modify rights. 

To create/change simulation fields, you must have Clinical | 

General | View and Clinical | Simulation | Modify rights. 

To print a simulation report, you must have Clinical | General | 

View and Clinical | Simulation | View rights.

Lesson 4: Creating Simulation Fields 


LTG19002A / 1.0/ 11-May-2009 

Notes 

Creating a Simulation Appointment 

You can select patients from the patient list to create a simulation appointment, or you 

can select them directly from the appointment slip. In the following exercises, you will 

schedule a simulation appointment and then open the patient’s chart from the 

Schedule. 

Scheduling a Simulation Appointment 

In this exercise, you will schedule a simulation appointment. 

1. Click Schedule | Location…, click next to the Location field, then doubleclick 

Ximatron (or the simulator you are currently using) if it is not already 

selected. 

Displays the Location Schedule window for Ximatron, shown in Figure 79. 

Figure 79: Location Schedule Window for Ximatron 

2. Select the 9AM slot or another open slot, then click . 

Displays the Appointment Slip dialog box, shown in Figure 80.


Notes 


Figure 80: Appointment Slip Dialog Box 

Displays the Select Procedure/Lab dialog box, shown in Figure 81. 

Figure 81: Select Procedure/Lab Dialog Box 

4. In the Group column, select Simulations. 

Displays the Simulation group procedures, shown in Figure 82. 


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Notes 

Figure 82: Select Procedure/Lab Displaying Simulation Activities 

5. In the Code/Description column, double-click X77290. 

Specifies the procedure or activity to perform during the appointment, closes the 

Select Procedure/Lab dialog box, then returns to the Appointment Slip dialog 

box. Your entry should look similar to the one shown in Figure 83. 

Figure 83: Appointment Slip with Simulation Activity Selected 

6. Click in the Date field, then type a past date, such as yesterday’s date, or leave it at 

the default. 

Specifies the date on which the activity takes place. The field defaults to today’s 

date. Because you clicked the 9AM open slot, you can skip entering the time in the 

Time field, which enters the time at which the appointment takes place.


Notes For this exercise, you will skip the Duration and Appointments field. The 

Duration specifies the length of the appointment and defaults to the activity’s predefined 

time, which is configured in the Procedure Code dialog box. The 

Appointments field specifies how many appointments to schedule. 

7. Click next to the Staff field, then double-click CRUSHER, BEVERLY (or 

whomever you added as the patient’s physician). 

Specifies the staff member who will perform the simulation. 

In this exercise, you will skip the Template checkbox and the Location field. The 

Template checkbox enables you to turn this appointment into a template that you 

can use to create other appointments. The Location field displays the currently 

selected simulator, which should be the Ximatron (or the simulator you are 

currently using). 

8. Click in the Comment field, then type See physician after treatment. 

Enables you to enter a comment that adds additional information, up to 60 

characters. If your comment is longer than that, click , then enter the 

information in the Appointment Slip Note window. 

In this exercise, you will skip the Alert section, as well as the Private and Skip Co- 

Pay checkboxes. The Alert section specifies the type of alert that should display 

for this appointment. The Private checkbox restricts who can view the scheduled 

appointment. The Skip Co-Pay checkbox, specifies that the appointment does not 

require a co-pay from the patient. Your entries should look similar to the ones 


9. Click . 

Figure 84: Finished Simulation Appointment Slip 

Adds the appointment to the Location Schedule for the selected simulator, then 

displays the Conflict Checking message box, shown in Figure 85. 


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Notes 

10. Click . 

Figure 85: Conflict Checking Message Box 

Checks for conflicts, closes the message box, closes the Appointment Slip dialog 

box, then returns to the Location Schedule window. Note that if the appointment 

was scheduled for any day other than today, such as yesterday, it does not display 

on the Location Schedule. 

Opening the Chart from the Schedule 

In this exercise, you will open a patient’s chart from the Location Schedule, effectively 

switching from one patient to another. 

1. On the toolbar, click. 

Displays the Select Patient window. 

2. Double-click a different patient. 

Displays the patient you just selected in the Patient toolbar button. An example is 


Figure 86: New Patient Selected 

3. From the Location Schedule window, select the appointment, then right-click or 

press F4. 

Displays the Location Schedule Options menu, shown in Figure 87.


Notes 

Figure 87: Location Schedule Options Menu 

4. Click Open Patient Chart Only…. 

Opens that patient’s chart. 

5. Re-select your lesson patient. 


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Notes 

Creating Simulation Fields 

Once you have entered basic information on the patient, such as a diagnosis, you can 

create simulation fields for the patient. Simulations enable you to simulate the 

treatment field settings, such as the gantry angle, without having to actually treat the 

patient. In the following exercises, you will create simulation fields, then enter or 

capture geometric settings for each of the simulation fields. 

Creating a Simulation Field When a Prescription Exists 

Once you have a radiation prescription, which is usually entered by a physician, you 

can begin entering the simulator settings that require manual input. In this exercise, you 

will create a simulation field when you have an existing prescription. 

1. Click eChart | Diagnoses and Interventions…. 

Displays the Diagnoses and Interventions window. 

2. Select the LUNG radiation prescription. 

Specifies the radiation prescription to which the simulation field belongs. 

3. Click and select Field from the floating sub-menu as shown in the 

following figure. 

Displays the Simulation Field dialog box, shown in Figure 88. 

Figure 88: Simulation Field Dialog Box


Notes The Simulation Field dialog box enables you to enter and display simulation field 

information in a Simulation Field dialog box as many times as necessary 

throughout the patient’s course of therapy. 

The General tab of the Simulation Field dialog box enables you to enter detailed 

information about the simulation setup for the field and contains basic header 

information, measurement, and geometric setting fields. You can enter simulation 

settings manually, or capture them directly from the simulator. The Radiography 

tab enables you to enter kVp, and mA, and the time that was used to acquire the 

simulation film. Note that these features are not covered in this guide. 

4. Click in the first Sim Field text box, then type 01. 

Specifies the Simulation field ID, up to five characters. This identifies the 

simulation field and differentiates it from other fields. If you use numbers, use the 

format 01 or 001, 02 or 002, etc. This ensures that the simulation fields display in 

order. 

5. Click in the second Sim Field text box, then type LT AP LUNG. 

Specifies a more detailed description of the simulation field, up to 20 characters. 

If your initial description is longer than 20 characters, you should 

abbreviate as needed. 

6. Click next to the Machine field, then double-click Clinac MLC (80) (or the 

linear accelerator you are currently using). 

Specifies the linear accelerator on which the treatment will be delivered. Your 

entries should look similar to the ones shown in Figure 89. 


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Notes 

Figure 89: Simulation with Sim Fields and Machine Selected 

7. In the Measurements section, click in the SSD field, then type 92.5. 

Specifies the Source to Skin Distance. 

8. Click in the SFD field, then type 145. 

Specifies the Source to Film Distance. 

9. Click in the SAD field, then type 100. 

Specifies the Source to Axis Distance. Your entries should look similar to the ones 

shown in Figure 90.


Notes 

Figure 90: Nearly Completed Simulation Field 

Once you have entered the required simulation field(s), you will want to enter or 

capture the geometric settings or parameters, such as the collimator angle. 

You are now ready to enter the simulation field parameters manually. 

Entering Simulation Field Parameters Manually 

Once you have entered the required simulation field(s), you will want to enter or 

capture the geometric settings or parameters, such as the collimator angle. In this 

exercise, you will enter field information/parameters manually. 

1. From the Simulation Field dialog box for the simulation field you created in the 

previous exercise, accept the defaults for the Gantry and Coll Ang fields. 

2. Click in the Field X field, then type 12. 

Specifies the size of the X jaws for the simulation. 

3. Click in the Field Y field, then type 15. 

Specifies the size of the Y jaws for the simulation. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 4. Set the geometric parameters for the couch: 

Couch Vrt: 111.2 

Couch Lat: 97.1 

Couch Lng: 125 

Skip the Couch Ang and Couch Ped fields. Substitute the appropriate parameters 

for your simulator if necessary. When finished, your simulation field should look 

similar to the one shown in Figure 91. 

Figure 91: Simulation Field with Manually Entered Parameters 

5. Click . 

Adds the simulation field, closes the Simulation Field dialog box, then returns to 

the Diagnoses and Interventions window, shown in Figure 92.


Notes 

Figure 92: Diagnoses and Interventions with New Simulation Field 

Creating a Simulation Field When a Prescription Does Not Exist 

In most cases, you will create a simulation field with an associated radiation 

prescription. However, there may be instances where you want to simulate a 

treatment where there is no associated radiation prescription. In this exercise, you will 

add a simulation without a radiation prescription. 

1. From the Diagnoses and Interventions window, right-click anywhere in the 

window or press F4. 

Displays the Diagnoses and Interventions Options menu, shown in Figure 93. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 93: Diagnoses and Interventions Options Menu 

2. Click Add Simulation without Rad Rx…. 

Displays the Simulation Field dialog box, shown in Figure 94. 

Figure 94: Simulation Field Dialog Box – No Radiation Prescription 

Because you are creating a simulation field without a prescription, 

the Rx Site and Rx Comment display fields are blank.


Notes 3. From the first Sim Field text box, type 03. 

Specifies the Simulation ID. 

4. Click in the second Sim Field text box, then type LAO Lung. 

Describes the simulation in more detail. 

5. Click next to the Machine field, then double-click Clinac 120 (or the linear 

accelerator you are currently using). 

Specifies the linear accelerator on which the treatment will be delivered. 

6. Type the following in the Measurements section: 

SSD: 92.5 

SFD: 145 

SAD: 100 

You are now ready to capture geometric settings for the second simulation field. 

Capturing Simulation Field Geometric Settings 

For the previous simulation field, you manually entered the geometric settings, such as 

the couch angle. In this exercise, you will use SIM-SET, an option that you can 

purchase with MOSAIQ, to capture field information from your simulator, which it 

then records. You can then use the resulting field information for auto-setup and 

verification. 

1. Position your phantom patient in the final simulation position. 

Ensures that the simulator is set to the correct simulation parameters. 

2. From the Simulation Field dialog box for the simulation field you created in the 

previous exercise, right-click anywhere in the dialog box or press F4. 

Displays the Simulation Field Options menu, shown in Figure 95. 

Figure 95: Simulation Field Options Menu 


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Notes The Simulation Field Options menu contains the following commands: 

Field Note Enters treatment set up instructions. 

Capture 

Settings 

Automatically enters the geometric settings from the 

simulator into the geometric fields on the Simulation Field 

dialog box. 

Auto-Setup Automatically moves the simulator to the geometric settings 

displayed on the Simulation Field dialog box. 

3. Click Capture Settings. 

Captures the geometric settings from the simulator. Notice that the geometric 

fields are automatically filled in with the simulator parameters as shown in 

Figure 96. 

Figure 96: Simulation Field with Captured Geometric Settings 

4. Click . 

Adds the simulation field with the captured geometric parameters, closes the 

Simulation Field dialog box, then returns to the Diagnoses and Interventions 

window, shown in Figure 97.


Notes 

Figure 97: Diagnoses and Interventions with Second Simulation Field 

5. Select the simulation field you just created, drag it until it is over the second 

prescription site (LUNG Boost), then release your mouse button. 

Moves the simulation field to the prescription site to which it applies. Your 

change should look similar to the one shown in Figure 98. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 98: Diagnoses and Interventions with Moved Simulation 

Copying a Simulation Field 

You can create a simulation field by copying an existing simulation field, then changing 

only those parameters that are different between the two fields. In this exercise, you 

will create a new simulation field by copying an existing simulation field. 

1. From the Diagnoses and Interventions window, select 01 LT AP LUNG (or the 

first simulation field you created in a previous exercise), then click and 

select Field from the floating menu 

Displays the Confirm Field Copy message box, shown in Figure 99. 

2. Click . 

Figure 99: Confirm Field Copy Message Box 

Displays the Simulation Field dialog box, shown in Figure 100.


Notes 

Figure 100: Copied Simulation Field 

Notice that the first Sim Field text box is the only field that does not have the 

same value as the simulation field you copied. 

3. Click in the first Sim Field text box, then type 02. 

Specifies the simulation field number. 

4. Click in the second Sim Field text box, highlight the text, then type LT PA LUNG. 

Changes the description of the simulation field. 

5. Click in the Gantry field, then type 180. 

Edits the gantry angle for this simulation field. Your changes should look similar 

to the ones shown in Figure 101. 


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Notes 

6. Click . 

Figure 101: Copied Simulation Field with Edited Fields 

Saves your changes to the new simulation field. Notice that you now have two 

different simulation fields that are part of the first radiation prescription, as shown 

in Figure 102.


Notes 

Figure 102: Diagnoses and Interventions with Copied Simulation Field 

Adding a Site Simulation 

You can use the Site Simulation dialog box to record patient setup information at the 

Site level when you do a virtual simulation. A site simulation (virtual simulation) is the 

first phase of the treatment planning process. The setup information gathered for a 

radiation prescription site during a virtual simulation is used in Site Setup. In this 

exercise, you will add a site simulation. 

1. In the Diagnoses and Interventions window, click the Lung radiation prescription. 

Specifies the radiation prescription to associate with the new site simulation. 

2. In the Add group, click , then click Site. 

Opens the Site Simulation dialog box, shown in Figure 103. 


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Notes 

Figure 103: Site Simulation Dialog Box 

3. Click adjacent to the Patient Orientation field, then click Head In, Supine. 

Specifies the patient orientation. 

4. In the Accessories group, click adjacent to the Pt Support field, then click the 

method of patient support. 

Specifies the method of patient support. 

5. Click the positioning device(s) from the Positioning Device 1 – 4 fields. 

Specifies the method of patient support. 

6. Add a patient note or view simulation images, if necessary. 

The Simulation Image List pane shows any non-portal medical images associated 

with the selected treatment site. To view an image, click the image in the Simulation 

Image List pane, then click to open the Image List window. 

The Site Setup Note box shows notes added to the site simulation. To add a note, 

you can click in the Site Setup Note box, then type your note. You can also add a 

note with the button. 

7. Click . 

Saves the site simulation, then closes the Site Simulation dialog box. The new site 

simulation appears in the Simulations folder of the Diagnoses and Interventions 

window, shown in Figure 104.


Notes 

Figure 104: Diagnoses and Interventions with Site Simulation 

Capturing Simulation Charge Codes 

In Lesson 2, you used single code capture to capture a charge for a treatment. In 

many cases, however, an appointment involves multiple charges. In this case you 

would use Multi-Code Capture to capture all the applicable codes at one time. In the 

following exercises, you will view Multi-Code Capture, select a diagnosis, and capture 

multiple codes. 

Discussing the Code Capture dialog boxes and Super Bills in detail 

is beyond the scope of this training guide. For more information on 

code capture, see the Code Capture Training Guide (LTG05001). 

Viewing Multi-Code Capture 

Multi-Code Capture is your key to simplifying the code capture process. Instead of 

displaying a separate Code Capture dialog box for each charge, you can capture all 

the codes at once. In this exercise, you will view the Multi-Code Capture dialog box. 


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Notes 

Your administrator can configure Multi-Code Capture to display 

directly from the Location (or Staff) Schedule window for a 

specific location, such as a simulator or linear accelerator. 

1. Click Schedule | Location…, click next to the Location field, then select 

Ximatron. 

Displays the Location Schedule for the selected simulator, shown in Figure 105. 

Figure 105: Location Schedule for Ximatron 

2. Select the simulation appointment you created in an earlier exercise, then rightclick 

anywhere in the window or press F4. 

Displays the Schedule Options menu. 

3. Click Capture Only…. 

Displays the Multi-Code Capture dialog box. 

4. In the Super Bills tab, click . 

Displays the Simulation tab of the Multi-Code Capture dialog box, shown in 

Figure 106.


Notes 

Diagnosis information associated 

with each captured charge 

Standard code capture info 

Figure 106: Multi-Code Capture Dialog Box 

Since there are no approved orders for your patient, the system automatically 

bypasses the Auto tab and displays the Super Bills tab. The Super Bills tab of the 

Multi-Code Capture dialog box displays view tabs which are set up in the System 

Utilities. Different views can contain different categories and codes. Categories, or 

code groups, are highlighted in blue, with all the associated charges listed below. 

The Multi-Code Capture dialog box contains the following fields and options: 

Primary 

Payer 

Super Bill view tabs 

Displays patient’s diagnoses 

Displays patient’s medication 

administration record 

Captures, modifies or deletes selected codes 

Codes associated with the tab group 

Displays the primary payer defined for the patient. 

Patient Specifies the patient for whom you are capturing codes. 

From Date Specifies the starting date if you are capturing codes for a 

range of dates. If you are capturing codes for a single date, 

leave this field blank. 


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Notes To Date Specifies the ending date for which to capture the codes. This 

field defaults to the current date. If you are capturing codes 

for a range of dates, this date is the end date. 

Time Specifies the time for which to capture codes. This field 

defaults to the current time. 

Rendering 

Staff 

Specifies the physician for whom you are capturing codes. 

This field defaults to the patient’s attending physician. 

Dept Specifies the department where the charges occurred. This 

field defaults to the department specified in the IMPAC.INI 

file. 

Location Specifies the location where the service was performed. 

Account Displays the Accounts window which has information 

associated with accounts assigned to a particular patient. You 

can use this to link patient charges to appropriate accounts. 

Facility Specifies the facility where the services were performed. 

Inpatient Indicates if the patient is an inpatient (hospitalized) medical or 

radiation oncology patient while billing for this service. 

Admit Displays Calendar dialog box to select the patient’s hospital 

admission date. 

Discharge Displays Calendar dialog box to select the patient’s hospital 

discharge date. 

Diagnoses Specifies up to four diagnoses for the charge. The diagnoses 

listed in these four fields can be associated with any captured 

codes. 

Update 

Code 

Capture 

Sequence 

Billing 

Comment 

Updates to the default code capture diagnosis sequence 

captured in the Admission tab of the Patient Demographic 

Data dialog box 

Enables you to enter any comments about the codes. 

Auth Num Specifies the insurer authorization number if required. 

Supervising 

MD 

Displays Physician’s Directory window to select the name of 

the supervising physician or other staff member 

Displays Authorizations window and enables you to view any 

active authorizations.


Notes Group 

Codes 

Captures the codes as a common group. This feature is not 

currently used. 

Auto Tab Displays all charges associated with orders that have been 

approved and completed within eCHART. 

Super Bills 

Tab 

Charge 

Panels Tab 

Displays procedures and supplies which you can use to 

manually capture multiple codes at one time. 

Displays items that contain several component charges, all of 

which must be listed separately. Charge Panels may contain 

procedures, supplies, and/or medications. 

Displays a window listing all the diagnoses for your patient. 

You can use the window to enter diagnoses in the fields in 

the Diagnoses group. The displayed diagnoses originate from 

patient demographics and from the Diagnoses and 

Interventions window. 

Displays a window listing the patient’s medication 

administration record. 

Captures the codes listed in the selected list. 

Displays the Code Capture dialog box for the selected code, 

from which you can change any information about an 

individual code. 

Deletes the selected code from the list of selected codes. 

Cancels capture of the selected codes. 

Expands the code listing so you can see all the columns at 

one time. The Auto and Super Bills tabs are removed when 

the list of selected codes is maximized. This button is only 

available if the list of selected codes is not maximized. 

Restores the Multi-Code Capture dialog box to its original 

configuration. This button is only available if the list of 

selected codes is maximized. 

adds the selected codes to the selected list of 

codes captured for the specified date or date range. 

Selecting a Diagnosis 

Diagnoses associated with a patient normally display in the Diagnoses group. The 

diagnoses displayed in the Diagnoses group are associated with any charge codes you 


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Notes capture for your patient. Since your patient only has one diagnosis, in this exercise, you 

will simply view the diagnosis listing. 

1. Click . 

Displays the Diagnoses and Problem List dialog box, which contains a listing of 

all diagnoses for your patient. To select a single diagnosis, click the diagnosis, then 

click . To select multiple diagnoses, press CTRL, click up to four 

diagnoses, release CTRL, then click . 

2. Click . 

Closes the Diagnoses and Problem List dialog box, then returns to the Multi- 

Code Capture dialog box. 

Capturing Multiple Codes 

You can select multiple codes from any of the sub-tabs, such as Simulations, that 

display in the Super Bills tab. In this exercise, you will select multiple codes for the 

simulation appointment you created earlier. 

The charge code corresponding to the activity you selected when 

you created the appointment slip, Simulation:C, has already 

been selected for capture. 

1. From the Multi-Code Capture dialog box’s Simulation sub-tab, double-click 

Special Dosimetry. 

Adds the code to the list of selected codes, which is to the right of the Simulation 

tab. 

2. Double-click VacLoc. 

Adds VacLoc to the list of selected codes. Your entry should look similar to the 

one shown in Figure 107.


Notes 

Figure 107: Multi-Code Capture with Three Codes Selected 

Note that, in the Simulation tab, each selected code is highlighted in gray. Charge 

code group titles are highlighted in blue. 

3. Click . 

Displays the pre-configured charges applying to a therapist. 

4. From the Therapist tab, select Special Tx Procedure, then press 

SPACEBAR. 

Highlights the selected code in green. 

5. Select Clinical Tx Plan: C, then press SPACEBAR. 

Highlights the second selected code in green. 

6. Click . 

Adds the codes you just selected to the selected list. 

7. Click . 

Captures the codes listed on the right for billing, as shown in Figure 108. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 108: Multi-Code Capture with Codes Captured 

Notice that all selected codes are highlighted in gray in the selected codes list, 

indicating they have been captured for billing, and that the three codes you just 

selected each have a ‘Y’ next to them in the Therapist tab, indicating that the codes 

were captured. Notice that you do not see checkmarks for two of the captured 

codes because you captured them from the Simulation tab. If you clicked the 

Simulation tab, those two charge codes would each display with a checkmark.



Closes the Multi-Code Capture dialog box, then returns to the Location Schedule 

window, shown in Figure 109. 

Figure 109: Location Schedule with Captured Appointment 

Notice the Status column displays a C, indicating that the charge codes for the 

appointment have been captured. 


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Notes 

Printing a Simulation Report 

You can print the simulation settings for any field to have a verified hardcopy of your 

setup. In this exercise, you will print a simulation report. 

1. From the Diagnoses and Interventions window, right-click anywhere or press F4. 

Displays the Diagnoses and Interventions Options menu. 

2. Move your mouse pointer over Reports…. 

Displays the Reports submenu, shown in Figure 110. 

3. Click Simulation …. 

Figure 110: Reports Submenu 

Displays the Simulation Fields Report dialog box, shown in Figure 111. 

Figure 111: Simulation Fields Report Dialog Box 

4. Select the Tagged radio button. 

Specifies that only tagged simulation fields display in the report. If you select the 

default, All, all simulation fields associated with the current patient display in the 

report. 

5. Click . 

Displays the Simulation Fields window, shown in Figure 112.


Notes 

Figure 112: Simulation Fields Window 

6. Click each of the first two simulation fields in the far left column, or, for each 

simulation field, select the simulation field, then press SPACEBAR. 

Displays a » next to each tagged entry. 

7. Click . 

Selects the simulation fields you tagged, closes the Simulation Fields window, then 

displays the Print dialog box, shown in Figure 113. 

8. Click . 

Figure 113: Print Dialog Box 

Closes the Print dialog box, then displays the report on your monitor as shown in 

Figure 114. 


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Notes 

What’s Next 

Figure 114: Simulation Field Report 

In this lesson, you learned how to schedule a simulation appointment, create 

simulation fields with or without a radiation prescription, as well as how to enter 

geometric parameters manually or capture the values with SIM-SET. In addition, you 

also learned how create a simulation field by copying a simulation field, how to 

capture charges for a simulation, and how to print simulation reports. Use the Quick 

Version as a concise, step-by-step guide when you must quickly apply any of the skills 

you’ve learned in this lesson or if you simply want to reinforce what you have learned. 

In the next lesson, you will learn how to create treatment fields, as well as import, 

view, and edit MLC parameters. You will learn how to work with field setup 

information, capture parameters from the linear accelerator, and create treatment 

fields by copying simulation fields or other treatment fields. Finally, you will learn how 

to copy, edit, or approve treatment fields, view fields or field delta views, and track 

field doses.


Notes 


Scheduling a Simulation Appointment 

1. Click Schedule | Location…, then select the simulator you are currently 

using from the Location field if it is not already selected. 

2. From the Location Schedule window, click . 

3. From the Appointment Slip dialog box, click next to the Activity field. 

4. From the Select Procedure/Lab dialog box, in the Group column, select the 

Simulation group. 

5. In the Code/Description column, double-click the simulation appointment type. 

6. From the Appointment Slip dialog box, type the date the simulation takes place in 

the Date field. 

7. Type the time the simulation takes place in the Time field. 

8. Click next to the Staff field, then double-click the staff member who will 

perform the simulation. 

9. Type a brief note, if needed, in the Comment field. 

10. Click . 

11. From the Conflict Checking message box, click . 

Opening a Patient’s Chart from the Schedule 

1. From the Location Schedule window, select an appointment. 

2. Right-click or press F4, then click Open Patient Chart Only…. 

Creating a Simulation Field When a Prescription Exists 

1. From the Diagnoses and Interventions window, select the radiation prescription 

you want to associate with the new simulation field. 


3. From the Simulation Field dialog box, type an identifier/ID for the simulation 

field in the first Sim Field text box. 

4. Type a name for the simulation field, up to 20 characters, in the second Sim Field 

text box. 

5. Click next to the Machine field, then double-click the treatment machine. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 6. From the Measurements section, type the Source to Skin Distance in the SSD field. 

7. Type the Source to Film Distance in the SFD field. 

8. Type the Source to Axis Distance in the SAD field. 

9. Click , then enter the setup note. 

10. Click . 

Creating a Simulation Field When a Prescription Does Not Exist 



2. From the Diagnoses and Interventions Option menu, click Add Simulation 

without Rad Rx…. 

3. From the Simulation Field dialog box, type the simulation field ID in the first Sim 

Field text box. 

4. Type the name of the simulation field in the second Sim Field text box. 

5. Click next to the Machine field, then double-click the treatment machine. 

6. Enter all appropriate parameters, such as the gantry angle. 

7. Click , then enter the setup note. 

8. Click . 

Entering Geometric Settings/Parameters Manually 

1. From the Diagnoses and Interventions window, double-click a simulation field. 

2. From the Simulation Field dialog box, type the gantry angle for the simulation in 

the Gantry field. 

3. Set the other geometric parameters, such as the X and Y jaws. 

4. Set the geometric parameters for the couch. 

5. Click .


Notes 

Capturing Geometric Settings/Parameters 

1. From the Diagnoses and Interventions window, double-click the simulation field. 

2. From the Simulation Field dialog box, right-click anywhere in the dialog box or 

press F4. 

3. From the Simulation Field Options menu, click Capture Settings. 

4. From the Simulation Field dialog box, click . 

Copying a Simulation Field 

1. From the Diagnoses and Interventions window, select the simulation you want to 

copy, then click . 

2. From the Confirm Field Copy message box, click . 

3. From the Simulation Field dialog box, type the ID for the new simulation field in 

the first Sim Field text box. 

4. Click the second Sim Field, text box, highlight the field, then type the name of the 

new simulation field. 

5. Edit the measurements and geometric parameters as needed. 

6. Click . 

Adding a Site Simulation 

1. In the Diagnoses and Interventions window, select the radiation prescription. 

2. Click in the Add group, then click Site to open the Site Simulation 

dialog box. 

3. Click adjacent to the Patient Orientation field, then click the patient orientation, 

such as Head In, Supine. 

4. In the Accessories group, click adjacent to the Pt Support field, then click the 

method of patient support. 

5. Click the positioning device(s) from the Positioning Device 1 – 4 fields. 

6. Add a patient note or view simulation images, if necessary. 

7. Click to save the site simulation. 


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Notes 

Selecting a Diagnosis from Multi-Code Capture 

1. From the Multi-Code Capture dialog box, click . 

2. From the Diagnoses and Problem List dialog box, select the diagnosis you want, 

then click . 

3. Click . 

Capturing Multiple Charge Codes from Multi-Code Capture 

1. Click Schedule | Location…, then select the simulator from the Location 

field. 

2. From the Location Schedule window, select the simulation appointment you 

created in an earlier exercise, then right-click or press F4. 

3. From the Schedule Options menu, click Capture Only.... 

4. From the Multi-Code Capture dialog box, click the appropriate sub-tab in the 

Super Bills tab. 

5. From the appropriate Super Bills sub-tab of the Multi-Capture Code dialog box, 

double-click the code(s) you want to capture or select the code, then press 

SPACEBAR. 

6. Click . 

7. Click another sub-tab, then repeat steps 5 and 6 as needed. 

8. Click . 

9. Click . 

Printing a Simulation Report 



2. From the Diagnoses and Interventions Options menu, move your mouse pointer 

over Reports…. 

3. From the Reports submenu, click Simulation Fields…. 

4. From the Simulation Fields Report dialog box, determine whether All or only 

Tagged simulation fields should display in the report. 

5. Click . 

6. If you selected Tagged, from the Simulation Fields dialog box, select the 

simulation fields you want to display in the report from the Simulation Fields 

window.



8. From the Print dialog box, click . 


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Notes


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Notes 

Lesson 5: Creating 

Treatment Fields 

Objectives 


• Manually create treatment fields and add geometric parameters, accessory 

information, portal image information, and field setup information 

• Create treatment fields by copying simulation fields or other treatment fields 

• Capture parameters from the linear accelerator 

• Copy, edit, or approve treatment fields 

• View historical treatment fields or field delta views 

• Track basic field doses to prescriptions 

• Import, view, and edit MLC parameters 

When you are required to create a new treatment field, MOSAIQ provides the 

tools to do the job quickly and efficiently. In this lesson, you will create a treatment 

field manually, enter field MU/dose specifications, manually enter geometric 

settings, enter treatment field notes, and apply tolerance tables. You will also create a 

treatment field by copying a simulation or treatment field, capture geometric 

settings electronically, and approve treatment fields.

Lesson 5: Creating Treatment Fields 


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Notes 

To view the Diagnoses and Interventions window, you must have 

Clinical | General | View rights. 

To create, change, or copy a treatment field or to import, export, 

or edit an MLC Plan or shape, as well as capture geometric 

settings from the linear accelerator, you must have Clinical | Field 

Defs | Modify rights. 

To add or modify dose coefficient/MU information from the Portal 

Image section of the Treatment Field Definitions dialog box, you 

must have Clinical | Field Defs | Modify and Clinical | Coefficients | 

Modify rights. 

To approve a treatment field, you must have Clinical | Field Defs | 

Approve rights. 

To do basic dose tracking, you must have Clinical | Dosimetry Gen 

| Modify rights, Clinical | Coefficients | View and Clinical | Action 

Points | View rights. 

To view the Historical Treatment dialog box from the Treatment 

Chart window, you must have Clinical | General | View and Clinical 

| Coefficients | View rights. 

To view the Field Delta dialog box or view an MLC shape from the 

Treatment Field Definition dialog box, you must have Clinical | Field 

Defs | View rights. 

To create a primary dose tracking site, you must have Clinical | 

Dosimetry Gen | Modify and Clinical | Coefficients | Modify Rights.


Notes 

Manually Creating Treatment Fields 

In many cases, you will create treatment fields by copying simulation fields or other 

treatment fields. However, there may be times when you will want to create a 

treatment field “from scratch” – for example, if the patient’s treatment does not 

come over from your treatment planning system via DICOM. This could happen if 

the patient was not planned, or if you are not transferring plans from a treatment 

planning system into MOSAIQ. In the following exercises, you will manually create a 

treatment field, as well as manually enter geometric and other information. 

Manually Creating a Treatment Field 

In this exercise, you will manually create a treatment field for a patient. 

1. From the Diagnoses and Interventions window, select the LUNG radiation 

prescription you created in an earlier lesson. 

2. Click . 

Displays the Treatment Field Definition dialog box, shown in Figure 106. 

Beam settings not 

available to a 

Simulation Field 

Accessories settings not 

available to a Simulation 

Field 

Geometric 

settings 

Couch settings 

Field setup note or 

field graphic 

Portal Image settings not available 

to a Simulation Field 

Figure 115: Treatment Field Definition Dialog Box 


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Notes Notice that at the top of dialog box, in the center, the Dose field displays ?????. 

This means that the radiation prescription associated with the treatment field does 

not have a corresponding dose tracking site. 

3. Click in the first Field text box, then type 01. 

Specifies the Treatment Field ID, which identifies the treatment field. 

4. Click in the second Field text box, then type LT AP LUNG. 

Specifies a more detailed description of the treatment field. 

5. Click next to the Machine field, then double-click Clinac MLC (80) (or the 

linear accelerator you are using). 

Specifies the linear accelerator used to treat the patient. Notice that once you select 

the linear accelerator, you can also select the BEV radio button to view the 

Beam’s Eye View, which displays the dimensions of the treatment field. Before 

this, you could only view any notes entered in the Field Setup Note field. 

6. Click next to the Tolerance field, then select 5 Lung. 

Specifies the tolerance table for the treatment field. This establishes the degree of 

tolerance within which the treatment unit parameters must remain when setting up 

the patient to treat. Your entries should look similar to the ones shown in Figure 

116. 

Figure 116: Partially Finished Treatment Field Definition 

7. Click in the Dose field, then type 90.


Notes Specifies the dose for this treatment field. The radiation prescription calls for 180 

cGy for each treatment and there are (or will be) two treatment fields for this 

prescription, so the dose must be between 1 and 179 cGy. Notice that once you 

enter a dose, the yellow highlighting no longer displays. 

8. In the Beam section, click next to the Type field, then select Fixed or any other 

field type. 

Specifies whether the beam is fixed, dynamic (variable), or arcing. 

9. Click next to the Modality field, then select Xrays. 

Specifies the method of treatment, then displays the Beam Configurations dialog 

box, shown in Figure 117. 

Figure 117: Beam Configurations Dialog Box 

10. Select 6 in the Energy column, select 400 in the Doserate column, then click 

. 

Specifies the energy to use when treating the field and the doserate for the 

treatment field, closes the Beam Configuration dialog box, then returns to the 

Treatment Field dialog box. 

11. Click in the MU field, then type 100. 

Specifies the monitor units for the field. 

The Wedge MU field is only significant for centers with Elekta or 

GE linear accelerators. If you have a Varian or Siemens linear 

accelerator, never use the Wedge MU field. 

If you have an Elekta or GE linear accelerator, the instructor will 

explain its usage in MOSAIQ. 

12. Click in the Time field, then type .50. 

Specifies the treatment delivery time, in fractions of a minute, such as 0.50 for 30 

seconds. Your entries should look similar to the ones shown in Figure 118. 


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Notes 

Figure 118: Treatment Field Definition with Beam Information 

You are now ready to manually enter the geometric parameters. 

Manually Creating Geometric Settings 

Most of the time, you will transfer treatment field geometric settings from the 

treatment planning system that you use. Sometimes, however, you may have to enter 

the geometric settings manually. In this exercise, you will manually enter geometric 

settings such as the beam, gantry, collimator, and couch for your new treatment field. 

In this exercise, both the gantry and collimator angles are 0, so 

skip the Gantry Angle and Collimator Angle fields. 

1. From the Treatment Field Definition dialog box, click in the Field Size X field, 

then type 12. 

Specifies the size of the X jaws, width and length. 

2. Click in the Field Size Y, then type 15. 

Specifies the size of the Y jaws. For this exercise, the X and Y jaws are the same 

size, so you will skip the two Asy checkboxes. The Asy checkboxes indicate that 

the jaw sizes are asymmetrical. If you clicked one or both of the checkboxes, the 

jaw size fields for that jaw become active. You then enter the individual jaw 

values. Note the MLC checkbox in the Gantry/Collimator section. You will learn 

about this checkbox and MLC later. 

3. From the Couch section, click in the Longitudinal field, then type 100.


Notes Specifies the longitudinal couch angle, which cannot be zero for Varian linear 

accelerators. Your entries should look similar to the ones shown in Figure 119. 

Figure 119: Treatment Field with Geometric Settings 

You are now ready to manually add the accessory information. 

You can add longitudinal value of 100 to the RTP Import Defaults 

section of your machine characterization. 

Manually Creating Accessory Information 

You can specify parameters for accessories such as wedges, compensators, and 

blocks. In this exercise, you will manually enter/create information on accessories. 

1. From the Treatment Field Definition dialog box of the treatment field for which 

you just manually entered geometric settings, click next to the Wedge field, then 

select NONE or leave the field blank. 

Specifies that the treatment field does not use a wedge. For this exercise, you will 

skip the Compensator field, which specifies the type of compensator required for 

treatment. 

2. Click in the Block field, then type Cerro. 

Specifies the type of block required for treatment. For this exercise, you will also 

skip the Bolus field, which specifies the type of bolus required for treatment. 

Your entries should look similar to the ones shown in Figure 120. 


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Notes 

Figure 120: Treatment Field with Accessory Settings 

You are now ready to manually add the portal image information. 

Manually Creating Portal Image Information 

You can specify MU and other parameters specifically for portal images. In this 

exercise, you will enter portal image information. 

1. From the Portal Image section of the Treatment Field Definition dialog box for 

the treatment field you created earlier, click in the Planned MU field, then type 2. 

Specifies the planned portal image acquisition MU. 

2. Click in the Open MU field, then type 2. 

Specifies the open field portal image MU. For this exercise, you will skip the Dose 

Coeff fields for open and planned portal images 

You only need to enter a dose coefficient if your facility includes 

portal images when calculating the total dose. 

3. Click in the Delta field, then type 8. 

Specifies the change in field size for open portal images. Also, for this exercise, 

skip the EPID, and SID fields. When checked, the EPID checkbox specifies that 

an EPID (Electronic Portal Imaging Device) will be used to acquire the portal 

image as opposed to film. The SID field specifies the Source-Image-Distance for


Notes the portal image in centimeters (cm). Your entries should look similar to the ones 


Figure 121: Treatment Field with Portal Image Settings 

You are now ready to add the field setup information. 


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Notes Adding Field Setup Information 

You can use the Field Setup pane of the Treatment Field Definition dialog box to 

add information therapists need to know when setting the patient up for treatment, 

such as patient position or accessories not listed in the Accessories section, such as 

angle cushions or breast boards. In this exercise, you will add field setup information 

to the treatment field you created earlier in this lesson. 

1. From the Treatment Field Definition dialog box for the treatment field you 

created earlier, click . 

Displays the Field Setup portion of the Treatment Field Definition dialog box, 


Prescription information Note entered in Radiation 

Field header information 

Prescription dialog box. Not 

editable from here. 

Imported photos 

and diagrams 

Field setup note. Simulation or 

treatment field notes display here. 

Patient Orientation information entered in Site 

Setup dialog box. Not editable from here. . 

Figure 122: Field Setup – Treatment Field Definition Dialog Box 

2. Click in the Field Setup text field, then type SUPINE, ANGLE CUSHION 

UNDER KNEES. 

Specifies any conditions, such as patient position that the therapist should be 

aware of when treating the patient.



Saves the treatment field information, closes the Treatment Field Definition dialog 

box, then returns to the Diagnoses and Interventions window, shown in 

Figure 123. 

Figure 123: Diagnoses and Interventions with New Treatment Field Definition 

Adding Site Setup Information 

You can use the Site Setup dialog box to enter patient positioning data into a 

treatment site. Patient positioning (orientation) is necessary to communicate 

shifts/offsets in patient coordinates and translate isocenter changes from patient 

coordinates to machine coordinates for couch calculations. This form is created by 

your treatment planning system with the Patient Orientation and the Structure Set 

section pre-populated. 

1. In the Diagnoses and Interventions window, click the Lung Boost radiation 

prescription. 

Specifies the treatment site to associate with the site setup information. 


Displays the Site Setup dialog box, shown in Figure 124. 


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Notes 

Figure 124: Site Setup Dialog Box 

2. Click adjacent to the Patient Orientation field, then click Head In, Supine. 

Specifies the patient orientation. 

4. In the Couch Movement Threshold / Maximum group, click adjacent to the Couch 

Threshold, then click the couch threshold for movement value. 

Specifies the couch threshold for movement value. This is used specifically for 

Elekta Automated Table Movement (ATM) and only if you registered the ATM. 

5. Click adjacent to the Couch Maximum, then click the couch maximum 

movement value. 

Specifies the couch maximum movement value. 

6. In the Setup Correction group, under Prescribed Offset (cm): 

click and select Superior. In the adjacent text box, type the magnitude of the 

prescribed offset in cm. 

click and select Right. In the adjacent text box, type the magnitude of the 

prescribed offset in cm. 

click and select Posterior. In the adjacent text box, type the magnitude of 

the prescribed offset in cm. 

The Prescribed Relative Offset (cm) shows the setup correction from simulation 

as defined in the treatment plan.


Notes The Localization Offset (cm) shows the offset direction and magnitude of systematic 

deviations from surface references determined by setup verification processes. 

This is a view-only dialog box and you cannot make any changes. 

The Total Offset (cm) shows the combined direction and magnitude (in cm) of 

planning and systematic changes. This is a view-only dialog box and you cannot 

make any changes. 

When you select Completed check-box, the Localization Offset and the Prescribed 

Offset are set to inactive and the total correction will be zero. The total offset is 

reset to zero whenever the patient is re-marked with new surface references. 

The Structure Set group shows any available structure set associated with the 

Prescription Site. This is only used with XVi or OBI. For these two machines, the 

Site Setup form must be approved for treatment delivery. Refer to the RTP 

Import section in the Dosimetrist/Physics Training Guide. 

7. Click . 

Saves the offset site setup changes, then closes the Site Setup dialog box. The new 

site setup information appears as a part of the radiation prescription of the 

Diagnoses and Interventions window, shown in Figure 125. 

Figure 125: Diagnoses and Interventions with New Site Setup Information 


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Notes 

Creating a Treatment Field by Copying a 

Simulation Field 

To save time and effort, you can create new treatment fields by directly copying 

simulation fields. In this exercise, you will create a new treatment field by copying a 

simulation field. 

1. From the Diagnoses and Interventions window, select the 03 LAO LUNG 

simulation field. 

2. Click . 

Displays the Confirm Field Copy message box, shown in Figure 126. 

3. Click . 

Figure 126: Confirm Field Copy Message Box 

Displays the Machine Characterization warning message box, shown in 

Figure 127. 

Figure 127: Machine Characterization Warning Message Box 

4. Click . 

Displays the Treatment Field Definition dialog box, shown in Figure 128.


Notes 

Figure 128: Treatment Field Copied from Simulation Field 

When you copy a simulation field to create a new treatment field, only the field 

number and name, the linear accelerator, and the geometric settings copy over. 

5. Click in the Dose field, then type 90. 

Specifies the dose for the treatment field. 

6. Click next to the Tolerance field, then select 5 Lung. 

Specifies the tolerance table for the treatment field. 

7. Click next to the Type field, then select Fixed. 

Specifies the type of beam. 

8. Click next to the Modality field, then select Xrays. 

Specifies the treatment modality, then displays the Beam Configuration dialog 

box. 

9. Select 15 in the Energy column, select 400 in the Doserate column, then click 

. 

Specifies the energy to use when treating the field and the doserate for the 

treatment field, closes the Beam Configuration dialog box, then returns to the 

Treatment Field dialog box. 

If your linear accelerator does not support an Energy of 15, select 

18 instead. 


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Notes 

10. Click in the MU field, then type 120. 

Specifies the monitor units for the field. Skip the Wedge MU field. 

11. Click in the Time field, then type .50. 

Specifies the treatment delivery time, in fractions of a minute. Your entries should 

look similar to the ones shown in Figure 129. 

Figure 129: Finished Treatment Field from Copied Simulation Field 

12. Click . 

Adds the treatment field, closes the Treatment Field Definition dialog box, then 

returns to the Diagnoses and Interventions window. Your entries should look 

similar to the ones shown in Figure 130.


Notes 

Figure 130: Diagnoses and Interventions with Copied Treatment Field 

Creating a Treatment Field by Copying an 

Existing Treatment Field 

You can create a treatment field by copying another treatment field in much the same 

way that you created a treatment field by copying a simulation field. However, since 

you have already entered all the beam and accessory parameters for the first treatment 

field, you can copy that treatment field, then edit only those parameters you want 

changed for the second treatment field. When you copy a treatment field, not only do 

you copy the geometric settings, but also its MLC shape. In this exercise, you will 

create a new treatment field by copying an existing treatment field. 

1. In the Diagnoses and Interventions window, select the 01 LT AP Lung 

treatment field, then click . 

Displays the Confirm Field Copy message box. 

2. Click . 

Closes the Confirm Field Copy message box, then displays the Treatment Field 

Definition dialog box, shown in Figure 131. 


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Notes 

Figure 131: Treatment Field from Copied Treatment Field 

3. Click in the first Field text box, then type 02. 

Specifies that this is the second treatment field. 

4. Click in the second Field text box, highlight the existing text, then type LT PA 

LUNG. 

Specifies that this is the posterior treatment field. 

5. Right-click anywhere in the Treatment Field Definition dialog box or press F4. 

Displays the Options menu for the Treatment Field Definition dialog box, shown 

in Figure 132.


Notes 

6. Click Flip. 

Figure 132: Treatment Field Definition Options Menu 

Displays the Flip confirmation message box, shown in Figure 133. 

7. Click . 

Figure 133: Flip Confirmation Message Box 

Specifies that the geometric settings, such the gantry, should be inverted. Displays 

the Question message box, shown in Figure 134. 

8. Click . 

Figure 134: Question Message Box 

Inverts the geometric settings. Your entries should look similar to the ones shown 

in Figure 135. 


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Notes 

Figure 135: Treatment Field with “Flipped” Geometric Settings 

9. Click . 

Saves your changes to the field definition, then displays the new field in the 

Diagnoses and Interventions window, as shown in Figure 136. 

Figure 136: Diagnoses and Interventions with Third Treatment Field


Notes You are now ready to capture parameters from the linear accelerator. 

Capturing Parameters from the Machine 

As with simulation fields, you can automatically capture geometric settings from your 

linear accelerator. In this exercise, you will capture treatment field settings 

electronically. 

1. Set your linear accelerator to the following parameters: 

Type Fixed 

Mode X-rays 

Energy 6 

MU 141 

Time Accept default 

Wedge 45 degree 

Gantry 270 

Collimator Angle 165 

Field X 6 

Field Y 6 


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Notes 2. From the Diagnoses and Interventions window, double-click 03 LAO LUNG. 

Displays the Treatment Field Definition dialog box for the selected treatment 

field, shown in Figure 137. 

Figure 137: Treatment Field Before Parameter Capture 

3. Right-click anywhere in the dialog box or press F4. 

Displays the Treatment Field Definition Options menu. 

4. Click Capture Settings. 

Displays the Capture All Parameters message box, shown in Figure 138. 

5. Click . 

Figure 138: Capture All Parameters Message Box 

Highlights the Energy, MU, and Wedge fields in red because they differ from the 

linear accelerator settings, then displays the Console Rx Warning message box, 

shown in Figure 139.


Notes 

Figure 139: Treatment Field Definition with Highlighted Fields 

6. Click . 

Closes the Console Rx Warning message box, then displays the MU Information 

message box, shown in Figure 140. 

7. Click . 

Figure 140: MU Information Message Box 

Closes the MU Information message box, captures the settings from the linear 

accelerator, then automatically replaces the field parameters with the linear 

accelerator parameters, as shown in Figure 141. 


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Notes 

Figure 141: Treatment Field with Captured Geometric Parameters 

Notice that the MU field did not change. 

8. Click . 

If your System Administrator checked the Disable Capture Console 

checkbox in the File | System Utilities | Department Setup… | 

Clinical (RO) tab, MOSAIQ only captures the settings for the 

Gantry/Collimator and Couch sections. 

Cancels the changes, closes the Treatment Field Definition dialog box, then 

returns to the Diagnoses and Interventions window. 

Capturing Settings is also available from the Treatment Delivery 

window. Select 03 LAO LUNG and right-click and select Change 

Field. Right- click again and select Capture Settings.


Notes 

Editing a Treatment Field 

You may need to edit a treatment field definition if, for example, some element of 

the linear accelerator’s characterization changes or if there is a change to the patient 

treatment plan. In this exercise, you will edit a treatment field. 

1. From the Diagnoses and Interventions window, double-click 03 LAO LUNG. 

Displays the Treatment Field Definition for the selected treatment field. 

2. In the Portal Image section, click in the Planned MU field, then type 2. 

Specifies the MU for the planned portal image. 

3. Tab to the Open MU field, then type 3. 

Specifies the MU for the open portal image. 

4. Click the next to the Wedge field, then select NONE. 

Specifies that no wedge is used with this treatment field. Your entries should look 

similar to the ones shown in Figure 142. 

5. Click . 

Figure 142: Treatment Field with Changes 

Displays the Field Setup pane of the Treatment Field Definition dialog box. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 6. Click in the Field Setup text field, then type SUPINE, WING BOARD, ANGLE 

CUSHION UNDER KNEES. 

Specifies information about setting up the treatment field and the patient’s 

position. Your entry should look similar to the one shown in Figure 143. 

7. Click . 

Figure 143: Treatment Field – Field Setup with Change 

Saves the changes, closes the Treatment Field Definition dialog box, then returns 

to the Diagnoses and Interventions window. 

8. Add a second treatment field to the LUNG Boost prescription, 04 RPO 

LUNG, by copying the 03 LAO LUNG treatment field, then “flipping” the 

geometric parameters. 

Adds the second boost treatment field to the LUNG Boost prescription.


Notes 

Approving a Treatment Field 

Once you have finished creating and editing a treatment field, you should approve the 

treatment field prior to treating the patient. In fact, depending on how you have 

configured MOSAIQ, you may not be able to treat the patient using an unapproved 

field. Keep in mind, however, that once you have approved a field, you cannot delete 

it, though you can make changes to the field. If you make a change to an approved 

field, the status of the field automatically changes to Unapproved. In this exercise, you 

will approve a treatment field. 

1. From the Diagnoses and Interventions window, double-click 03 LAO Lung. 

Displays the Treatment Field Definition dialog box for the selected field. 


Displays the Treatment Field Definition Options menu, shown in Figure 144. 

3. Click Approve…. 

Figure 144: Treatment Field Definition Options Menu 

Displays the Approve Treatment Field Definition dialog box, shown in 

Figure 145. 

Figure 145: Approve Treatment Field Definition Dialog Box 

4. Click in the Password field, type impac (or your password), then click 

. 


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Notes Approves the treatment field, closes the Approve Treatment Field Definition 

dialog box, then returns to the Treatment Field Definition dialog box. Notice that 

the Approved field in the header now displays your initials and a date, as shown 


5. Click . 

Figure 146: Approved Treatment Field 

Saves the changes, closes the Treatment Field Definition dialog box, then returns 

to the Diagnoses and Interventions window. Notice that an A, the date of 

approval and your initials display in the Status column as shown in Figure 147.


Notes 

Figure 147: Diagnoses and Interventions with Approved Treatment Field 


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Notes 

Viewing the Field Delta and Historic Views 

The Field Delta dialog box enables you to view recent changes to a treatment field. 

The Historic Treatment View dialog box enables you to view information on a 

recorded treatment. In the following exercises, you will view the delta for a treatment 

field, as well as view a historical treatment field. 

Viewing the Field Delta View 

In this exercise, you will view a treatment field delta view, or history of changes. 

1. From the Diagnoses and Interventions window, double-click a treatment field. 

Displays the Treatment Field Definition dialog box for the selected field. 

2. Make changes to at least two parameters or geometric settings, such as Gantry 

Angle or MU, for the treatment field. 

4. Click 

to save your changes. 


Displays the Treatment Field Definition Options menu. 

5. Click Field Delta. 

Displays the Field Delta View dialog box, shown in Figure 148.


Notes 

Figure 148: Field Delta View for the Selected Treatment Field 

Notice that each change you made to the field is highlighted in yellow. You can 

revert to a previous version of the field by clicking . You cannot use 

the Rollback option if the most recent version of the field was approved or 

treated. You cannot change fields in the Field Delta View dialog box. 

You can also view the Field Delta View from the Treatment Chart 

window. 


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Closes the Field Delta View, then returns to the Treatment Field Definition dialog 

box. 

7. Click . 

Cancels the changes, closes the Treatment Field Definition dialog box, then 

returns to the Diagnoses and Interventions window. 

Viewing an Historical Treatment Field 

After you have recorded a treatment, you can view the details of the recorded 

treatment from the Historic Treatment dialog box. In this exercise, you will view a 

historical treatment field. 

1. Open the chart for Conner, Rosanne (or the patient you treated in Lesson 2). 

Closes the current patient chart, then opens the selected patient chart. 


Displays the Treatment Chart window for the selected patient. Already treated 

sessions display in black text. If the patient had a Treatment Calendar set up for 

them, you would also see current untreated sessions in green text and future 

untreated sessions in blue text. 

3. Click + next to the session you treated in Lesson 2. 

Displays the fields you treated in Lesson 2. 

4. Double-click a treated field. 

Displays the Historic Treatment dialog box for the selected field, shown in 

Figure 149. 

Figure 149: Historic Treatment Dialog Box



Closes the Historic Treatment dialog box, then returns to the Treatment Chart 

window. 

6. Click . 

Closes the Treatment Chart window. 

Adding Dose Tracking to Radiation Prescriptions 

Tracking doses to a site is important. You not only want to track doses from the 

current prescription site, but also doses from other past or current prescription sites. 

Dosimetry Setup enables you to create the dose tracking sites, both secondary and 

primary, so you can make sure patients are not receiving more dose than they should. 

In the following exercises, you will perform basic dose tracking. 

Creating the Primary Dose Tracking Site 

In this exercise, you will create the primary dose tracking sites. 

1. Select your lesson patient, then click eChart | Diagnoses and 

Interventions…. 

Displays the Diagnoses and Interventions window. 

2. Click . 

Displays the Dosimetry Setup Information window, shown in Figure 150. 

Figure 150: Dosimetry Setup Information Window 

The Dosimetry Setup Information dialog box usually displays once, when the 

primary dose tracking site and dose tracking coefficients are created. If you have a 

treatment field without a radiation prescription, this dialog box displays each time 


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Notes you try to display the Dosimetry Setup window. It also displays when you delete 

fields, substantially change fields, or move fields between radiation prescriptions.



Creates the dose tracking sites, then displays the Dosimetry Setup window, shown 


Figure 151: Dosimetry Setup Window 

Setting up secondary dose sites and managing dose coefficients is 

the beyond the scope of this training guide and is discussed in the 

Dosimetrist/Physicist Training Guide. 

Creating a Dose Action Point 

When you use eCHART to track dose to patients under treatment, you can use the 

Dose Action Points feature to automatically warn you when a specified dose is 

approaching at a specified site. In this exercise, you will create a Dose Action Point 

for one of your prescriptions. 

1. From the Dosimetry Setup window, click . 

You can also create a Dose Action Point from the Diagnoses and 

Interventions window by right-clicking or pressing F4, then clicking 

Dose Action Points…. 

Displays the Dose Action Points window, shown in Figure 152. 


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Notes 

Figure 152: Dose Action Points Window 

The Dose Action Points window lists all past and current Dose Action Points 

created for the patient. Depending on the View selected, you can view all Dose 

Action Points, only acknowledged Dose Action Points, or only unacknowledged 

Dose Action Points. 

2. Click . 

Displays the Dose Action Point dialog box, shown in Figure 153. 

Figure 153: Dose Action Point Dialog Box 

The Dose Action Point dialog box enables you to add a new Dose Action Point 

or change an existing one. The only two required fields are Dose Site and 

Comment. While it is not a required field, you should also enter the Action Dose 

or the dose at which the action entered in the Comment field should be 

performed. 

3. Click next to the Dose Site field, then select LUNG. 

Specifies the dose site to which the Dose Action Point belongs.


Notes 4. Click in the Action Dose field, then type 180. 

Specifies the dose at which the Dose Action Point is triggered. The default Lead 

Dose, which you can only edit from Department Setup displays the dose quantity 

that is subtracted from the Action Dose to change its status to Active. Active 

Dose Action Points trigger notification at treatment delivery that a Dose Action 

Point is approaching. To use another Lead Dose uncheck the Use Default box, 

then enter another value. 

5. In the Dose Action Point Type section, select the Mandatory radio button. 

Specifies the type of Dose Action Point, and the action you must take to continue 

treatment. Standard triggers an alert, but you do not need to acknowledge the 

Dose Action Point to continue treatment. Mandatory requires that you 

acknowledge the Dose Action Point when the Action Dose is reached before you 

can continue treatment. Dose Limit requires you to acknowledge the Dose Action 

Point each time you treat the patient after you reach the Action Dose. 

6. Click in the Comment field, then type MAKE SURE YOU DISCUSS WITH 

PHYSICIAN AFTER TREATMENT. 

Specifies the action that the therapist should perform when the Dose Action Point 

is triggered. Your entries should look similar to the one shown in 

Figure 154. 

7. Click . 

Figure 154: Finished Dose Action Point 

Adds the new Dose Action Point, closes the Dose Action Point dialog box, then 

returns to the Dose Action Points window. Your entry should look similar to the 

one shown in Figure 155. 


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Notes 

Figure 155: Dose Action Points Window with New Dose Action Point 

Working with MLC Parameters 

The MLC Fit feature provides you with the ability to create, view, and edit geometric 

information that is ultimately used to generate treatment field shapes. To do so, MLC 

Fit enables you to digitize treatment field shapes, derive Multi-leaf Collimator (MLC) 

leaf plans from these digitized shapes, and modify those shapes within MOSAIQ. In 

the following exercises, you will import an MLC plan, edit an MLC plan, and view an 

MLC plan. If you have not purchased MLC Fit, you can only view MLC parameters, 

as illustrated in the second exercise. 

Importing an MLC Plan 

In this exercise, you will import an MLC plan. 

1. Click File | Import/Export | MLC Import.... 

Displays the Specify File Type and Import Directory dialog box, shown in 

Figure 156. 

Figure 156: Specify File Type and Import Directory Dialog Box


Notes 


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Notes 2. In the MLC Type section, select the Varian/BrainLab radio button if it is 

not already selected. 

Specifies which type of MLC file you are importing. Note that the radio button 

you select determines which of the three checkboxes below it are active. 

For this exercise, click , then browse to the directory where your file(s) are 

located, which will display in the Import Directory field. 

3 Verify the information in the Import Files no older than days field. 

Specifies the maximum “age” of the files. For example, if the Import files no 

older than days field is set to 7, MLC only imports files that are a week or less 

old. If you use the default (0 or 999), all MLC files are imported. 

4. Check the Only Import files having extension of MLC, Dnn, or Ann checkbox. 

Specifies that the MLC must have an extension of .mlc, .dnn, or .ann or the 

import feature will not recognize them. For this exercise, skip the Map MLC File 

IDs to checkbox/field, which enables you to map the imported MLC files to a 

specific field ID. 

5. Click . 

The MLC File Import dialog box displays, shown in Figure 157. 

Figure 157: MLC File Import Dialog Box


Notes 6. Select the Patient ID of your lesson patient listed in the leftmost column. 

Displays the patient’s name and ID in the display fields. Notice that a new column 

displays next to the Original and New displays columns: the Import column. 

7. From the list on the right, select the field ID to which to import the MLC file. 

Displays a checkmark next to the geometric parameter(s) that will be imported 

from the MLC plan as shown in Figure 158. 

Figure 158: MLC File Import with Field ID Selected 

The Field ID displays in the rightmost set of columns and is the treatment field 

into which you will import the MLC. Below the header, the name of the patient, 

geometric settings (Gantry, etc.) display. Notice that three fields display in red and 

a checkmark displays in the Import column checkbox next to each setting. This 

means that the current treatment field has a different value for those geometric 

settings. These settings will be imported, and the imported geometric settings will 

overwrite the current geometric settings in the treatment field. If you do not want 

to import the MLC geometric settings, uncheck the Import column checkbox. 

Notice also that is now active. 


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Imports the MLC file with the specified parameters. A message box may display 

indicating that a definition for that field already exists. Click to 

continue. Your entry should look similar to the one shown in Figure 159. 

Figure 159: MLC File Import with MLC File Imported 

Notice that Imported displays in the right-hand Status column and the current date 

displays in the File Date column next to it. 

9. Click . 

Closes the MLC File Import dialog box.


Notes Viewing MLC Parameters (No MLC Fit) 

If your facility does not have MLC Fit, you cannot edit or create shapes. You can, 

however, view MLC parameters created elsewhere. In this exercise, you will view 

MLC parameters for a treatment field. 

1. From the Diagnoses and Interventions window, double-click 04 RPO LUNG 

(or another treatment field with an MLC shape). 

Displays the Treatment Field Definition dialog box. 

2. Click . 

Displays the Beam’s Eye View dialog box, shown in Figure 160. 

Figure 160: Beam’s Eye View Dialog Box 

Notice that there are no buttons that enable you to change the MLC shape. You 

can change the position of the leaves and jaws, but not the MLC shape itself. 


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Notes Editing MLC Parameters (MLC Fit) 

If you have an MLC plan for a treatment field, whether you created it in MOSAIQ 

or you imported it from an MLC workstation, you may need to make changes to it. 

Keep in mind that you can only edit MLC shapes if you have MLC Fit as a part of 

MOSAIQ. In this exercise, you will edit an MLC shape. 

You cannot modify IMRT treatment fields using MLC Fit. 

1. From the Diagnoses and Interventions window, double-click the same field you 

used in the previous exercise. 

Displays the Treatment Field Definition dialog box. 

2. Click . 

Displays the Beam’s Eye View dialog box. Notice that additional buttons are 

now available, such as , , and . These buttons 

enable you to change the shape of the MLC so that the leaves are better 

positioned. For example, automatically finds the best fit for the leaves 

around the MLC shape. 


Displays the Beam’s Eye View Options menu, shown in Figure 161. 

4. Click Unlock Shape. 

Figure 161: Beam’s Eye View Options Menu 

Unlocks the shape, as shown in Figure 162.


Notes 

Figure 162: Beam’s Eye View with Unlocked Shape 

Note that if you bring up the Beam’s Eye View Options menu again, all items on 

the Options menu except Unlock Shape are deactivated, and there is a checkmark 

next to Unlock Shape. 

5. Click the MLC shape. 

Displays the MLC shape points, as shown in Figure 163. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 163: Beam’s Eye View with MLC Shape Points Visible 

6. Change the MLC shape by clicking and moving the MLC shape points. 

7. When finished, right-click anywhere in the dialog box or press F4, then click 

Unlock Shape. 

Relocks the MLC shape, as shown in Figure 164.


Notes 

Figure 164: Beam’s Eye View with Changes to the MLC Shape 

Notice that while the shape has changed, the leaves still follow the old shape. 

8. In the Fit Method section select Intrusive, then click . 

Automatically changes the leaf positions, as shown in Figure 165. 


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LTG19002A / 1.0/ 11-May-2009 

Notes 

Figure 165: Beam’s Eye View with AutoFit to the New MLC Shape 

Notice that the angle of the collimator has changed so that more of the shape is 

covered. Also note that the leaves intrude into the MLC shape. This occurred 

because you clicked Intrusive as the Fit Method. 

9. In the Fit Method section, select Non-Intrusive. 

Changes the position of the leaves so that they do not intrude into the MLC 

shape, as shown in Figure 166.


Notes 

10. Click . 

Figure 166: Beam’s Eye View with Non-Intrusive Fit 

Saves the changes, closes the Beam’s Eye View dialog box, then returns to the 

Treatment Field Definition dialog box. 

11. Click , then click . 

Cancels all changes, closes the Treatment Field Definition dialog box, then returns 

to the Diagnoses and Interventions window. 

What’s Next 

In this lesson, you learned how to manually create a treatment field, then manually 

enter the geometric, accessory, and portal image parameters. You learned how to add 

field setup information for a treatment field, create treatment fields by copying 

simulation fields or other treatment fields, and capturing geometric settings from the 

linear accelerator. You also learned how edit and approve treatment fields, as well as 

view a historic treatment field and a treatment field delta view. Lastly, you learned the 

basics of dose tracking, creating a Dose Action Point, and importing, viewing, and 

editing MLC shapes. Use the Quick Version as a concise, step-by-step guide when 

you must quickly apply any of the skills you’ve learned in this lesson or if you simply 

want to reinforce what you have learned. In the next lesson, you will learn how to 

import patient photos and field setup images, associate field setup photos with 


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Notes treatment fields and/or radiation prescription sites, crop imported images, move and 

delete images from the patient’s chart, and print patient photos.


Notes 


Manually Creating a Treatment Field 

1. From the Diagnoses and Interventions window, click the radiation prescription 

for which you want to create a treatment field. 

2. Click . 

3. From the Treatment Field dialog box, type the number of the treatment field in 

the first Field text box. 

4. Type the name of the treatment field in the second Field text box. 

5. Click next to the Machine field, then double-click the linear accelerator used to 

treat the patient with the field. 

6. Click next to the Tolerance field, then select the tolerance table for the 

anatomical area to treat. 

7. Type the dose in Dose field. 

8. Click next to the Type field, then select the type of beam. 

9. Click next to the Modality field, then select the method of treatment. 

10. From the Beam Configuration dialog box, select the mV in the Energy column, 

select the doserate in the Doserate column, then click . 

11. From the Treatment Field Definition dialog box, type the monitor units in the 

MU field. 

12. Type the treatment delivery time in the Time field. 

Manually Creating Geometric Settings 

1. From the Gantry/Collimator section of the Treatment Field Definition dialog box, 

type the gantry angle in the Gantry Angle field. 

2. Type the collimator angle in the Collimator Angle field. 

3. Type the width and length of the X jaws in the Field Size X field. 

4. Type the width and length of the Y jaws in the Field Size Y field. 

5. If the X jaws are asymmetrical, check the Asy checkbox next to the X jaw fields, 

then type the width/length of each X jaw in the Jaw X1 and Jaw X2 fields. 

6. If the Y jaws are asymmetrical, check the Asy checkbox next to the Y jaw fields, 

then type the width/length of each Y jaw in the Jaw Y1 and Jaw Y2 fields. 

7. Type the couch settings in the Couch section, such as the Angle field. 


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Notes Manually Creating Accessory Information 

1. From the Wedge section of the Treatment Field Definition dialog box, click 

next to the Wedge field, then select the wedge to be used in treatment. 

2. Type the name of the compensator required for treatment in the Compensator field. 

3. Type the block required for treatment in the Block field. 

4. Type the bolus required for treatment in the Bolus field. 

Manually Creating Portal Image Information 

1. From the Portal Image section of the Treatment Field Definition dialog box, type 

the planned portal image monitor units in the Planned MU field. 

2. Type the open field portal image monitor units in the Open MU field. 

3. Type the incremental number of centimeters the collimator field size open from 

the treatment field size for an open field portal image exposure in the Delta field. 

Adding Field Setup Information 

1. From the Treatment Field Definition dialog box, click . 

2. From the Field Setup pane of the Treatment Field Definition dialog box, type the 

field setup information in the Field Setup text field. 

3. Click . 

Creating a Treatment Field by Copying a Simulation Field 

1. From the Diagnoses and Interventions window, select the simulation field you 

want to use to create a treatment field, then click . 


3. From the Treatment Field Definition dialog box, type the treatment field number 

in the first Field text box, then type the name of the new treatment in the second 

Field text box. 

4. From the Treatment Field Definition dialog box, type the dose for the treatment 

field in the Dose field. 

5. Click next to the Tolerance field, then select the tolerance table for the 

anatomical area to be treated. 

6. Click next to the Type field, then select the type of beam. 

7. Click next to the Modality field, then select the method of treatment.


Notes 8. From the Beam Configuration dialog box, select the mV in the Energy column, 

select the doserate in the Doserate column, then click . 

9. Type the monitor units for the treatment field in the MU field. 

10. Type the treatment delivery time in the Time field. 

11. Add any Accessories information, such as Wedge or Bolus, as well as Portal Image 

information. 

12. Click . 

Creating a Treatment Field by Copying an Existing Treatment 

Field 

1. In the Diagnoses and Interventions window, select the treatment field you want 

to copy to create a treatment field. 

2. Click . 

3. From the Flip Confirmation message box, click. . 


5. From the Machine Characterization message box, click . 

6. From the Treatment Field Definition dialog box, type the treatment field number 

in the first Field text box. 

7. Type the name of the new treatment in the second Field text box. 

8. Edit the geometric, couch, accessory, and other setup information. 

9. Click . 

Capturing Parameters from the Machine 

1. Set the linear accelerator to the parameters you want to capture. 

2. From the Diagnoses and Interventions window, double-click the treatment field 

for which you want to capture parameters. 

3. From the Treatment Field Definition dialog box, right-click anywhere in the 

dialog box or press F4. 

4. From the Options menu, click Capture Settings. 

5. From the Capture All Parameters message box, click . 

6. If the Console Rx Warning message box displays, click . 


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Notes 7. If the MU in the treatment field differs from the linear accelerator’s MU, click 

when the MU Information message box displays. 

8. Click . 

Editing a Treatment Field 


you want to edit. 

2. From the Treatment Field Definition dialog box, make the changes to the 

treatment field. 

3. Click . 

Approving a Treatment Field 


you want to approve. 



3. From the Options menu, click Approve…. 

4. From the Approve Treatment Field Definition dialog box, type your password in 

the Password field, then click . 

5. From the Treatment Field Definition dialog box, click . 

Viewing the Field Delta View 


whose field delta you want to view. 



3. From the Options menu, click Field Delta. 

4. From Field Delta View dialog box, click . 

Viewing an Historical Treatment Field 

1. Select the patient whose treated field you want to view. 

2. Click . 

3. From the Treatment Chart window, click + next to a previously-treated session.


Notes 4. Double-click one of the treated fields. 

5. From the Historic Treatment dialog box, click . 

Creating the Primary Dose Tracking Site 



2. From the Options menu, click Dosimetry. 

3. From the Dosimetry Setup Information, click . 

Creating a Dose Action Point 

1. From the Dosimetry Setup window, click . 

2. From the Dose Action Points window, click . 

3. From the Dose Action Point dialog box, click next to the Dose Site field, then 

select the dose site for which you are creating the Dose Action Point. 

4. Type the dose at which you want the Dose Action Point triggered in the Action 

Dose field. 

5. In the Dose Action Point Type section, select the desired type of Dose Action Point. 

6. Type the action to perform when the Dose Action Point is triggered in the 

Comment field. 

7. Click . 

Importing an MLC Plan 

1. Click File | Import/Export | MLC Import.... 

2. From the Specify File Type and Import Directory dialog box, select the radio 

button for the type of MLC import to perform. 

3. Confirm the full path of the directory from which you are importing the MLC 

files in the Import Directory field. 

4. Verify the information in the Import Files no older than days field. 

5. Check the Only Import files having extension of MLC, Dnn, or Ann checkbox. 

6. Click . 

7. From the MLC File Import dialog box, click the Patient ID of the patient for 

whom you are importing the MLC files from the leftmost column. 

8. From the list on the right, click the field ID to which to import the MLC file. 

9. Click . 


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Viewing MLC Parameters (No MLC Fit) 

1. From the Diagnoses and Interventions window, double-click a treatment field 

with an MLC shape. 

2. From the Treatment Field Definition dialog box, click 

. 

Editing MLC Parameters (MLC Fit) 

1. From the Diagnoses and Interventions window, double-click a treatment field 

with an MLC shape. 

2. From the Treatment Field Definition dialog box, click 

. 

3. Right-click anywhere in the dialog box or press F4, then click Unlock Shape. 

4. Click the MLC shape anywhere in the shape itself to display the MLC shape 

points. 

5. Change the MLC shape by selecting and moving the MLC shape points. 

6. When finished, right-click anywhere in the dialog box or press F4, then click 

Unlock Shape. 

7. Select the Fit Method, then click .


Notes 


LTG19002A /1.0/ 11-May-2009

Course Evaluation: Radiation Therapist 

Now that you have completed the Radiation Therapist Training Module II, please answer the following by placing a 

checkmark in the appropriate box. Mark the tasks that were covered in class on the left, then indicate your “comfort” 

level with each task that was covered in class. Each task is followed by a lesson reference. If you answer “Cannot do” 

for any of the tasks, you can refer to the appropriate lesson in the Training Guide to review the course information. 

Check tasks 

covered 

Can you do the following tasks? 

Can do 

Can do 

with 

help 

Cannot 

do 

 

Display the eChart menu and eCHART Navigator window 

(Lesson 1) 

Display the Diagnoses and Interventions window (Lesson 1) 

Display the Treatment Chart/Calendar window (Lesson 1) 

 

Display the Dose Site Summary and Dose Action Points 

window (Lesson 1) 

Create and modify a wave appointment (Lesson 2) 

 

Manually treat and record a patient from the Schedule 

(Lesson 2) 

Charge a patient for a treatment (Lesson 2) 

Print a Location schedule (Lesson 2) 

Quick admit a new patient (Lesson 3) 

Enter and affirm a new diagnosis (Lesson 3) 

Enter a basic course/Care Plan (Lesson 3) 

Enter a basic radiation prescription (Lesson 3) 

Add a second radiation prescription (Lesson 3) 

Create and schedule a simulation appointment (Lesson 4) 

Create a simulation field (Lesson 4) 

Copy a simulation field (Lesson 4) 

Capture simulation charge codes (Lesson 4) 

Print a simulation report (Lesson 4) 

Create a treatment field manually (Lesson 5) 

 

Create a treatment field by copying a simulation field 

(Lesson 5) 

 

Create a treatment field by copying a treatment field 

(Lesson 5) 

Capture parameters from the machine (Lesson 5) 

Copyright 2010, IMPAC Medical Systems 189

Check tasks 

covered 

Can you do the following tasks? 

Can do 

Can do 

with 

help 

Cannot 

do 

Edit a treatment field (Lesson 5) 

Approve a treatment field (Lesson 5) 

View the Field Delta and Historic views (Lesson 5) 

Add dose tracking to a radiation prescription (Lesson 5) 

Import, view, and edit MLC plans (Lesson 5) 

Name: Date: 

Facility: 

190 Copyright 2010, IMPAC Medical Systems

100 Mathilda Place, 5 th Floor, Sunnyvale, CA 94086

Therapist Training Module I - UCSF Radiation Oncology

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