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Brainlab RT/RS Hardware User's Manual

Stereotactic hardware
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RT / RS
STEREOTACTIC
HARDWARE
Hardware User Guide
Revision 4.9
Copyright 2016, Brainlab AG Germany. All rights reserved.

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Summary of Contents for Brainlab RT/RS

  • Page 1 RT / RS STEREOTACTIC HARDWARE Hardware User Guide Revision 4.9 Copyright 2016, Brainlab AG Germany. All rights reserved.

  • Page 3: Table Of Contents

    ............................33 Overview..............................33 Attaching the Collimator Mount ........................34 Detaching the Collimator Mount .........................35 Collimator Mount Siemens with Coded Plug ....................36 Third-Party Labels on the Brainlab Collimator Mount .................40 Using Conical Collimators ..........................41 Third-Party Labels on Brainlab Collimators ....................46 IMMOBILIZATION HARDWARE ..................47 Stereotactic Headring ..........................47...
  • Page 4 Positioning the System for Treatment......................87 QUALITY ASSURANCE .......................89 Winston-Lutz Test ............................89 Testing with the Phantom Pointer for Brainlab Headring................90 Testing with the Phantom Pointer for a non-Brainlab Headring..............92 Film Exposure ............................94 CLEANING, DISINFECTION, AND STERILIZATION ........95 Reprocessing ............................95 Automatic Cleaning and Disinfection......................95 Neutral Steam Sterilization.........................97...
  • Page 5 TABLE OF CONTENTS Stereotactic Headring..........................100 Stereotactic Mask System........................102 Upper Jaw Support and Reference Plates ....................103 CT/X-Ray Localizer, CT/X-Ray Localizer for Leksell Headring ..............104 Stereotactic Target Positioner, Target Positioner for Leksell Headring............105 INDEX ..............................107 Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...
  • Page 6 TABLE OF CONTENTS Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 7: General Information

    Japan Fax: +81 3 3769 6901 Expected Service Life Brainlab provides a minimum of five years of service for system components. During this time period, spare parts as well as field service are offered. Feedback Despite careful review, this manual may contain errors.

  • Page 8: Legal Information

    Medical Intelligence Medizintechnik GmbH. • kVue™ and Quantum™ are trademarks of WFR-Aquaplast/Q-Fix Systems. CE Label • The CE label indicates that the Brainlab product complies with the essential re- quirements of European Council Directive 93/42/EEC, the Medical Device Di- rective (MDD).
  • Page 9 GENERAL INFORMATION Language Information All Brainlab user guides are originally drafted in English. Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 10: Symbols

    Symbols Symbols 1.2.1 Symbols Used in This Guide Warnings Warnings are indicated by triangular warning symbols. They contain safety-critical information regarding possible injury, death or other serious consequences associated with equipment misuse. Cautions Cautions are indicated by circular caution symbols. They contain safety-critical information regarding possible problems with the device.

  • Page 11: Hardware Symbols

    GENERAL INFORMATION 1.2.2 Hardware Symbols Symbols on Hardware Components Symbol Explanation Class I Type B equipment according to IEC 60601-1 Attention: Consult accompanying documents. MR Unsafe Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 12: Intended Use

    MR Compatibility All Brainlab devices and parts mentioned in this user guide are explicitly indicated as MR unsafe (according to ASTM F2503-05) and must not be used in any other imaging devices, except where specifically noted. This also applies to all non-metal devices and parts.

  • Page 13: Compatibility With Medical Devices

    GENERAL INFORMATION Compatibility with Medical Devices 1.4.1 Brainlab Medical Devices Background RT/RS Stereotactic Hardware is compatible with the following Brainlab medical devices: CT/X-Ray Localizer Localizer Types Compatible Devices Headring CT/X-Ray Localizer Stereotactic Mask System CT/X-Ray Localizer and CT/X-Ray Local- BrainSCAN, iPlan RT Dose, iPlan RT Image...
  • Page 14 Compatibility with Medical Devices Compatible Devices Upper Jaw Support for Mask System Couchmount Adapter Brainlab Headring (for Elekta Couch) Couchmount Compatible Devices Couchmount Adapter Brainlab Headring Couchmount Adapter Brainlab Headring (for Elekta Couch) Couchmount Adapter Radionics Headring Couchmount Adapter Leksell Headring...
  • Page 15 Collimator Mount Siemens with Coded Plug Other Brainlab Devices Only devices and spare parts specified by Brainlab may be used with these medical devices. Using unauthorized devices/spare parts may adversely affect the safety and/or the effectiveness of the medical devices and endanger the safety of the patient, user and/or environment.

  • Page 16: Non-Brainlab Medical Devices

    Compatibility with Medical Devices 1.4.2 Non-Brainlab Medical Devices CT/X-Ray Localizer Localizer Types Model Manufacturer BRW-HR and UCHR-AP Radionics (Integra Radionics, Inc.) CT/X-Ray Localizer Adapter for UCHR Headring Burlington, MA, USA CT/X-Ray Localizer for Lek- G-Frame Headring Elekta AB, Stockholm, Sweden...
  • Page 17 GENERAL INFORMATION Brainlab Couchmount Compatible Couch Tops Manufacturer Types Connexion Couch Top with Connexion Head & Neck Module (P10105-213) kVue IGRT Couch Top with kVue Univer- sal Tip Extension WFR-Aquaplast/Q-Fix Sys- tems, New Jersey, USA Quantum Couch Top with Quantum Uni-...
  • Page 18 Compatibility with Medical Devices Brainlab Couchmount Compatible Couch Tops Manufacturer Lite Types Quantum Couch Top with Quantum Uni- versal Tip Extension CIVCO Mastercouch Stereotactic Treat- CIVCO Medical Systems, ment Module (MC STERM), Revision Kalona, USA Feb. 2009 or later CIVCO medical solutions, CIVCO MTIL3015 Siemens TT-M Tab- letop Revision Nov.
  • Page 19 System Syngo RT Therapist 4.2 or high- Other Non-Brainlab Devices Non-Brainlab medical devices may only be used with these medical devices if specified by Brainlab. Using unauthorized medical devices may adversely affect the safety and/or effectiveness of these medical devices and endanger the safety of the patient, user and/or environment.

  • Page 20: Training & Documentation

    1.5.1 Training Brainlab Training In order to ensure safe and appropriate use of the system, Brainlab recommends that before using the system for the first time, all users should participate in an extensive training program held by a Brainlab representative.

  • Page 21: Documentation

    • Access is provided to these user guides at all times Available User Guides User Guide Description iPlan Dose Clinical User Guide Detailed instructions on using the relevant Brainlab treatment planning system BrainSCAN Software User Guide Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...
  • Page 22 Training & Documentation Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 23: Hardware Overview

    Brainlab Couchmount 2.1.1 Preparing and Handling Couchmounts Overview The Brainlab couchmounts enable you to immobilize and accurately position the patient’s head. They are mounted to the couch top. There are three basic models of couchmount: Couchmount Compatible with... Attachment Instructions •...
  • Page 24 The couchmount component warranty (for usage under normal operating conditions) is valid for one year. NOTE: Brainlab is not liable for damages resulting from misuse, incorrect installation, accidents, or connections to devices or accessories not approved by Brainlab Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...
  • Page 25 HARDWARE OVERVIEW Adjusting the Couchmount ① Figure 2 If you use the couchmount, follow these steps during adjustment: Steps Release each of the locks ① a quarter turn. Adjust the X, Y, and Z axes on the couchmount using the rotary knobs. See page 23 Refasten the locks.

  • Page 26: Siemens Zxt, Elekta/Philips Ram, And Varian Etr Couch Tops

    Brainlab Couchmount 2.1.2 Siemens ZXT, Elekta/Philips RAM, and Varian ETR Couch Tops Attaching the Couchmount ① Figure 3 Steps Ensure that no accessories obstruct placement of the side rail holder. Loosen the rail fixation levers ①. Slide the couchmount onto the couch’s side rails.

  • Page 27: Siemens Zxt Carbon Fiber Couch Top

    HARDWARE OVERVIEW 2.1.3 Siemens ZXT Carbon Fiber Couch Top Attaching the Couchmount ② ① ③ Figure 4 Steps Loosen the lower and upper fixation levers ① by approximately 2 mm. Twist the lower blocks ②completely outward. Lower the couchmount onto the couch’s side rails ③. The notches on the couchmount should fit directly over each side rail.

  • Page 28: Varian Exact And Siemens Tt-S Couch Tops

    The Couchmount for Siemens TT-S is also more compact and somewhat smaller. NOTE: The two fastening screws for the Couchmount Brainlab Imaging Couch Top / Varian Exact are only required if used with the Couch Adapter for Imaging Couch Top. Otherwise, they must be removed.
  • Page 29 HARDWARE OVERVIEW Attaching the Couchmount ④ ③ Figure 6 Steps Ensure that the status indicator (② on Figure 5) is red. Lower the back of the couchmount onto the hooks (③ on Figure 6) on the couch. Lower the bottom of the couchmount until it sits flushly against the couch. The locking bolt ④will automatically engage and secure the attachment.

  • Page 30: Couchmount Lite

    Brainlab Couchmount 2.1.5 Couchmount Lite Overview The couchmount lite can be used as an alternative to the normal couchmount. It does not allow positioning of the patient; this must be done via the couch mechanism. Figure 8 Mounting the Couchmount Lite The couchmount lite is mounted the same way as the couchmount (page 26 to 28).

  • Page 31: Couchmount Adapters

    HARDWARE OVERVIEW Couchmount Adapters 2.2.1 Couchmount Adapter Types Overview Brainlab provides special couchmount adapters for various stereotactic headrings. These adapters are attached via attachment holes to the couchmount. (See page 24) Couchmount Adapter Types ① ② ③ ⑤ ④ Figure 9 Component ①...

  • Page 32: Couchmount Adapters: Brainlab Headring Models

    (see Page 31) are available for use with the Elekta couch: • Couchmount Adapter Brainlab Headring for lesions on the lower head, between +30 mm and +110 mm in the cranial direction. This adapter extends further in the longitudinal direction to compensate for the limited movement of the couch.

  • Page 33: Collimator Mount

    HARDWARE OVERVIEW Collimator Mount 2.3.1 Overview Background The Collimator Mount, in conjunction with various conical collimators, supplements the internal Linac X-Y jaws to shape the beam with steep-dose gradients for stereotactic radiosurgery/ radiotherapy treatments. Components (Shown: Mount for Varian Linacs) ⑤...

  • Page 34: Attaching The Collimator Mount

    Collimator Mount 2.3.2 Attaching the Collimator Mount Background The collimator mount must only be used with the specific LINAC for which it was accepted. Never change the collimator mount while a person is beneath the collimator mount. After installing the collimator mount on the Linac, do not perform any Linac modifications that could alter the distance between the source and collimator mount.

  • Page 35: Detaching The Collimator Mount

    HARDWARE OVERVIEW 2.3.3 Detaching the Collimator Mount Background Never change the collimator mount while a person is beneath the collimator mount. Detaching the Collimator Mount (Siemens/Varian) Steps Position the gantry at 0°/180° (according to the IEC 61217 scale). Remove the conical collimator (see Page 43). Turn the Linac collimator so that the opening of the accessory tray slot points towards you.

  • Page 36: Collimator Mount Siemens With Coded Plug

    Collimator Mount 2.3.4 Collimator Mount Siemens with Coded Plug General Information The Collimator Mount Siemens with coded plug supports the Siemens accessory code ST5VAR. The linac X-Y jaw field is thereby restricted to a maximum of 5.3cm x 5.3cm. Components ②...
  • Page 37 HARDWARE OVERVIEW Coded Plug As shown in Figure 13, the coded plug has four resistors integrated that generate the Siemens code ST5VAR at the Linac console. Figure 13 The LINAC Console Software must be able to support “ST5VAR” that allows the jaws to be to set to a maximum field size of 5.3cm x 5.3cm.
  • Page 38 Collimator Mount Do not use the Collimator Mount if the Collimator Mount, or part of it, is damaged or warped. Make sure that the coded plug does not come into contact with moisture or fluids as the electronic parts might be destroyed or damaged. The Collimator Mount Siemens with Coded Plug is classified IPX0 according to IEC 60529.
  • Page 39 HARDWARE OVERVIEW If the coded plug had to be removed due to insufficient system requirements there is no automatic restriction of the primary jaw field. How to Detach the Collimator Mount Steps Position the gantry at 0°/180° (according to the IEC 61217 scale). Remove the conical collimator (see page 43).

  • Page 40: Third-Party Labels On The Brainlab Collimator Mount

    General Information Brainlab has authorized users and third-party linear accelerator manufacturers to attach labels to the Brainlab Collimator Mount. Brainlab warrants that the terms of Brainlab warranty of service, where applicable, will not be affected if the instructions below are followed.

  • Page 41: Using Conical Collimators

    HARDWARE OVERVIEW 2.3.6 Using Conical Collimators Background Never change the collimator while a person is beneath the collimator mount. Components ① ② ④ ③ Figure 15 Component ① Installation groove ② Security pin ③ Snap-in groove ④ Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...
  • Page 42 The engraved cipher ① on the collimator specifies the circular field size ø (mm) in the isocenter. ① Figure 16 How to Attach the Collimator Brainlab recommends positioning the gantry at 180° (according to the IEC 61217 scale). Steps Align the collimator with the collimator mount. The blue lines on both components should be aligned.
  • Page 43 HARDWARE OVERVIEW How to Remove the Collimator Brainlab recommends positioning the gantry at 180° (according to the IEC 61217 scale). To remove the collimator: Steps Unscrew the fixation ring. While firmly holding the collimator, press the security pin (④on Figure 15) towards its center to open the locking mechanism.
  • Page 44 The models and range of conical collimator apertures differ significantly. For Brainlab conical collimators, to avoid radiation outside the conical collimator or leakage at the edge of the field resulting from potential set-up inaccuracies (mechanical collimator alignment, jaw positioning, and other tolerances), Brainlab recommends using the jaw settings listed in the table below.
  • Page 45 Regardless of the jaw-shaped field size in use, Brainlab recommends using a suitable film test to verify and document the complete shielding outside the intended center beam through the conical collimator.

  • Page 46: Third-Party Labels On Brainlab Collimators

    General Information Brainlab has authorized users and third-party linear accelerator manufacturers to attach labels to the Brainlab Conical Collimators. Brainlab warrants that the terms of Brainlab warranty or service, where applicable, will not be affected if the instructions below are followed.

  • Page 47: Immobilization Hardware

    IMMOBILIZATION HARDWARE IMMOBILIZATION HARDWARE Stereotactic Headring 3.1.1 Overview Overview The Stereotactic Headring is an invasive stereotactic fixation system. It prevents the patient’s head from moving and minimizes errors during patient setup. Only one screw needs to be loosened to adjust the headring for the patient’s anatomy. The Stereotactic Headring is a hardware component that is used for invasive patient immobilization with highest positioning accuracy.

  • Page 48: Stereotactic Headring Components

    Stereotactic Headring 3.1.2 Stereotactic Headring Components Torque Wrench The torque wrench is provided to prevent the user from applying more than the desired torque to the fixation pins. It offers a reliable method for applying reproducible and measurable force to a patient’s head.
  • Page 49 The fixation pins must be tightened using a torque wrench adjusted to no more than 30 Ncm, otherwise the pins or posts may be damaged. If patients show indications of Creutzfeld-Jakob Disease (CJD) and are treated using Brainlab fixation pins, these fixation pins must be disposed of directly after surgery to prevent microbiological contamination. Headring The Brainlab headring is used for cranial fixation and consists of an aluminum alloy.
  • Page 50 Stereotactic Headring Component ① Holes for mounting localizer or Stereotactic Target Positioner (front of headring) ② Locks ③ Front piece ④ T-screws for attachment of couchmount adapter (back of headring) Headring Front Piece An aperture for the front piece ③ can be found on the anterior side of the headring. It consists of two parts: A straight piece and a curved piece.

  • Page 51: Attaching The Fixation Posts

    ①, guidance piece ④, post ⑤, and sliding nut ⑥. NOTE: Install the short fixation posts on the posterior side of the headring, and the long fixation posts on the anterior side. Otherwise, Brainlab cannot guarantee a secure fixation.

  • Page 52: Adjusting The Torque Wrench

    Stereotactic Headring 3.1.4 Adjusting the Torque Wrench Overview Adjust the torque wrench prior to tightening the fixation pins. The necessary torque will vary by patient. The locking mechanism prevents the user from applying more than the adjusted torque value to the fixation pins.
  • Page 53 IMMOBILIZATION HARDWARE How to Adjust the Torque Wrench Before mounting the Headring to the patient's head, adjust the torque wrench to the maximum torque applicable to the patient’s head by following steps 1 to 4. Steps Unlock the torque wrench, turning the black ring ① in the opposite direction to the en- graved arrow.

  • Page 54: Affixing The Stereotactic Headring To The Patient

    Stereotactic Headring 3.1.5 Affixing the Stereotactic Headring to the Patient Before You Begin Thoroughly review the patient’s records and image data to ensure that no parts of the skull cap have been removed during previous brain operations. The posts should be attached to the headring, but to avoid injuring the patient, no fixation pins should be inserted at this point.
  • Page 55 IMMOBILIZATION HARDWARE How to Affix the Stereotactic Headring ③ ① ② ④ Figure 26 Steps Position the headring onto the (sitting) patient using the velcro strap. Loosen the locking screws of the posts to enable adjustment. Remove the headring temporarily to prepare the pin sites. NOTE:The surgeon is responsible for maintaining appropriate care of the pin sites.
  • Page 56 Stereotactic Headring Never remove both front pieces simultaneously while the headring is attached to the patient’s calvarium. Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 57: Stereotactic Mask System

    IMMOBILIZATION HARDWARE Stereotactic Mask System 3.2.1 Mask System Components Overview The non-invasive Stereotactic Mask System enables precise and easily repeatable patient fixation for cranial stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS). The mask, constructed from thermo-transformable material, is individually molded for each patient and secured to the mask ring.
  • Page 58 Stereotactic Mask System Mask Set ③ ② ④ ① ⑤ Figure 28 Component ① Top and rear masks (interchangeable) ② Middle mask ③ Dental support strip ④ Loose pellets ⑤ Mesh Mask Set Accessories ⑤ ④ ③ ② ⑥ ① ⑦...
  • Page 59 IMMOBILIZATION HARDWARE Component ① Vertical posts, Low Frame ② Vertical posts ③ Blank clips ④ S clips ⑤ 0 - 4 mm clips ⑥ 1 - 4 mm spacers ⑦ T screws Set for Low Mask Fixation The Set for Low Mask Fixation is intended for inferior lesions. The vertical posts and headrest contained in this set replace the corresponding parts of the standard set and allow a lower fixation of the patient's head.

  • Page 60: Molding The Mask

    Stereotactic Mask System 3.2.2 Molding the Mask Before you Begin Steps Have patients remove all items from their heads (toupee, false teeth, hearing aid, ear- rings, etc.). Heat a water bath to 70° - 80°C (158° - 176°F). As the material can stick to porous surfaces after activation, covering the patient’s hair with plastic foil is recommended.
  • Page 61 IMMOBILIZATION HARDWARE Steps Before proceeding, test the temperature of the softened mask to ensure the patient's comfort. Lift the patient's head and snap the mask onto the upper side of the vertical posts. Lower the patient's head onto the headrest (Figure 31, left). Gently mold the material to the contour of the patient's head as the mask material hardens (Figure 31, right).
  • Page 62 Stereotactic Mask System How to Mold the Nose Bridge Figure 33 Steps Place the loose pellets onto the mesh sheet provided with the mask set (④ and ⑤ on Figure 28, respectively), then into the water bath. After the pellets have become transparent, remove them from the water bath. Roll them in your hand to create an oval form (Figure 33, upper left), then shape them with your fingers to create a t-shaped form (Figure 33, lower left).
  • Page 63 IMMOBILIZATION HARDWARE How to Mold the Top Mask Figure 34 Steps Remove the clips from the vertical posts. Place the top mask (④ on Figure 28) in the water bath until it becomes transparent. Remove the mask from the bath and place on a towel to dry. Before proceeding, test the temperature of the softened mask to ensure the patient's comfort.
  • Page 64 Stereotactic Mask System Hardening Process Figure 35 The duration of the hardening process largely depends on the conditions (temperature and humidity) under which the mask has been molded. • Always allow the material enough time to completely harden in order to avoid shrinkage of the mask.

  • Page 65: Removing And Reattaching The Mask

    Never open the screws that mount the vertical posts to the mask ring if the mask has already been placed on the patient and is secured with the clips. If the patient moves when fixed to the Brainlab mask system and applies force to the devices, the fixation is no longer accurate.
  • Page 66 Stereotactic Mask System Treating through 3.2 mm material (with no less than 6 MeV) can be done without significant irritation of skin. If the treatment is performed with static fields rather than convergent arcs, we recommend avoiding the double-layer areas of the mask with the beam path if skin irritation starts to occur.

  • Page 67: Upper Jaw Support

    IMMOBILIZATION HARDWARE Upper Jaw Support 3.3.1 Components Overview The Upper Jaw Support is an optional accessory of the Stereotactic Mask System. It is designed to reduce the longitudinal movement of the patient by referencing his upper jaw position. Key Components ④...
  • Page 68 Upper Jaw Support Component The Reference Plate Small should be used when the patient’s upper jaw is located ② directly below the hand screw for the fixation of the reference plate; it is marked with a ② on the top of the plate. The Reference Plate Long should be used with the Set for Lower Mask Fixation;...

  • Page 69: Attaching The Upper Jaw Support

    IMMOBILIZATION HARDWARE 3.3.2 Attaching the Upper Jaw Support Before You Begin Verify the positioning of the reference plate before molding the mask, as it must be directly adjacent to the patient’s upper jaw. Patients with false teeth/dentures should remove them before attaching or adjusting the reference plate.
  • Page 70 Upper Jaw Support Reference Plate Settings Figure 39 Take note of the scale setting of the reference plate following adjustment. Always read the settings on the side of the scale (see Figure 39). Because the plates can be mounted in both directions, it is necessary to record the side of the Upper Jaw Support (A or B) from which the scale has been read.

  • Page 71: Imaging

    IMAGING IMAGING Imaging with the Headring and Mask System 4.1.1 Localizer Design Overview A localizer is mounted to the headring or the mask system for imaging. The localizer’s 210 mm scanning range allows the entire head to be scanned and localized, which is especially important for inferior lesions.
  • Page 72 Imaging with the Headring and Mask System Component ③ Holding spigot ④ Holding screw PVC Localizer Rods Six PVC localizer rods ① are embedded into the acrylic glass of the localizer. In the axial CT images, they are visible as six index markers. These markers provide the geometric matrix for determining the exact position of any structure relative to the headring and mask system.

  • Page 73: Attaching The Localizer

    Attach the CT/X-Ray Localizer to the Brainlab (or the Radionics BRW) headring, or the Stereotactic Mask System. The three ball feet of the localizer should fit precisely into the locks of the Brainlab headring or mask system. The localizer cannot be incorrectly mounted due to the asymmetrical arrangement of the fixing mechanism.
  • Page 74 Verify that the images are not distorted if any form of digital imaging has been used. The CT/X-Ray Localizer for Leksell Headring and the CT/X-Ray Localizer may only be used with a Brainlab treatment planning system. Do not use the CT/X-Ray Localizer for Leksell Headring or the CT/X-Ray Localizer if it is any way warped or damaged, or any of the parts are loose.

  • Page 75: Angio Distortion Correction Module

    IMAGING 4.1.3 Angio Distortion Correction Module Overview The Angio Distortion Correction Module is a low density carbon fiber plate that can be attached to either the CT/X-Ray LocalizerorCT/X-Ray Localizer for Leksell Headring. A grid of 294 stainless steel spheres – each with a diameter of 2 mm – is embedded in its surface. ①...
  • Page 76 Safe Handling Never use the Angio Distortion Correction Module to lift the localizer. If you accidentally drop the Angio Distortion Correction Module, return it to Brainlab support for verification. Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 77: Positioning For Treatment

    The Stereotactic Target Positioner fits onto the Stereotactic Headring or Stereotactic Mask System. It enables alignment of the patient’s isocenter with the wall lasers. The Stereotactic Target Positioner may only be used with a Brainlab treatment planning system. Radionics Compatibility The Stereotactic Target Positioner can also be mounted to the Radionics BRW headring and the Radionics UCHR-AP adapter for the UCHR headring.
  • Page 78 Stereotactic Target Positioner Component Explanation Stereotactic Target ② Consists of an aluminum frame with room for four carrier plates. Positioner ③ Adhesive Tape Used to attach the overlays to the carrier plates. Target Positioner Shows the patient’s isocenter. Printed out and taped to the carrier ④...

  • Page 79: Attaching The Overlays And Carrier Plates

    Continue attaching carrier plates B, C and D (with overlays B, C, and D, respectively) to the corresponding sides of the target positioner. NOTE:Brainlab provides an alternate plate C if the mask protrudes into the normal plate C (anterior carrier plate) near the nose. This alternate plate C features a cutout to make room for the mask.

  • Page 80: Mounting The Stereotactic Target Positioner

    Stereotactic Target Positioner 5.1.3 Mounting the Stereotactic Target Positioner How to Mount the Target Positioner Figure 45 Steps Mount the Stereotactic Headring or Stereotactic Mask System to the couchmount adapter using the two t-screws provided. Bring the three ball feet of the target positioner in line with the corresponding holes in the headring or mask system (Figure 45, left).

  • Page 81: Positioning The System For Treatment

    POSITIONING FOR TREATMENT 5.1.4 Positioning the System for Treatment Before you Begin Position the patient so that the isocenter on the overlays is aligned with the Linac isocenter (projected by wall lasers). Sometimes the weight of the patient may cause the couch to tilt downwards. This can be compensated using the tilt adjustment screw on the couchmount (see Page 24).

  • Page 82: Using The Stereotactic Counterweight

    Stereotactic Target Positioner 5.1.5 Using the Stereotactic Counterweight General Information The Stereotactic Counterweightoffsets the weight deviation that occurs when the Brainlab Stereotactic Target Positioneris removed from the treatment table. This further improves patient positioning accuracy during stereotactic treatment. Stereotactic Counterweight...
  • Page 83 Hold the Stereotactic Counterweightwith one hand. Turn the fixation screw counter-clockwise until the screw loosens. Carefully remove the Stereotactic Counterweightand store in an appropriate location. The Stereotactic Counterweight must be removed before attaching the Brainlab Stereotactic Target Positioner. Service & Support A CW_Alignment_Tool is provided for service use only.

  • Page 84: Target Positioner For Leksell Headring

    The Target Positioner for Leksell Headring may only be used with the Leksell G-Frame headring. It enables alignment of the patient’s isocenter with the wall lasers. The Target Positioner for Leksell Headring may only be used with a Brainlab treatment planning system.

  • Page 85: Attaching The Overlays And Carrier Plates

    Target Positioner for Leksell Headring. NOTE:Brainlab provides an alternate plate C if the mask protrudes into the normal plate C (anterior carrier plate) near the nose. This alternate plate C features a cutout to make room for the mask.

  • Page 86: Mounting The Target Positioner For Leksell Headring

    Target Positioner for Leksell Headring 5.2.3 Mounting the Target Positioner for Leksell Headring How to Mount the Target Positioner Figure 49 Steps Bring the four alignment pins of the Target Positioner for Leksell Headring in line with the corresponding holes (Figure 49, left) of the Leksell G-Frame headring. Insert the alignment pins into the holes.

  • Page 87: Positioning The System For Treatment

    POSITIONING FOR TREATMENT 5.2.4 Positioning the System for Treatment Before you Begin Position the patient so that the isocenter on the overlays is aligned with the Linac isocenter (projected by wall lasers). Sometimes the weight of the patient may cause the couch to tilt downwards. This can be compensated using the tilt adjustment screw on the couchmount (see Page 24).
  • Page 88 Target Positioner for Leksell Headring Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 89: Quality Assurance

    The need for high geometric and dosimetric accuracy in stereotactic radiotherapy/radiosurgery requires a special quality assurance program. Brainlab recommends conducting a Winston-Lutz quality assurance test using the Phantom Pointer. The quality procedures described in this chapter must be performed prior to each patient treatment.

  • Page 90: Testing With The Phantom Pointer For Brainlab Headring

    Testing with the Phantom Pointer for Brainlab Headring Overview Brainlab recommends using a 7.5 mm collimator, as the tungsten sphere in the Phantom Pointer is 5 mm in diameter. The sphere generates a non-irradiated area on the film. This projection of the tungsten sphere must always be completely inside the exposed film area for every gantry and table position.
  • Page 91 QUALITY ASSURANCE Steps Position the film for each exposure in the film holder with the area to be irradiated in the circular field. Fasten the screw on the film holder to fix the film during each exposure in the clamp. Expose the film (see Page 94).

  • Page 92: Testing With The Phantom Pointer For A Non-Brainlab Headring

    Winston-Lutz Test 6.1.2 Testing with the Phantom Pointer for a non-Brainlab Headring Setup ② ④ ③ ⑤ ① Figure 51 Component ① Film holder ② Phantom Pointer tip ③ Pointer rod ④ Ball pointer tip ø 2.9 mm diameter ⑤...
  • Page 93 • Brainlab provides two different tungsten sphere tips of diameters 2.9 mm and 5 mm. Brainlab recommends using a 7.5 mm collimator and the 5 mm ball pointer tip.

  • Page 94: Film Exposure

    The pattern should approximate the above figure. The data collected during the commissioning of the Brainlab radiosurgery system should form the baseline to which future tests are compared.

  • Page 95: Cleaning, Disinfection, And Sterilization

    CLEANING, DISINFECTION, AND STERILIZATION CLEANING, DISINFECTION, AND STERILIZATION Reprocessing 7.1.1 Automatic Cleaning and Disinfection How to Clean and Disinfect Steps Transfer the instruments to the washer-disinfector. Use baskets for small instruments. Start the program. After the program has finished, let the instruments dry and then remove them. Cleaning Detergent Pay attention to the following points when selecting cleaning detergents: The detergent used for cleaning must be fundamentally approved for instru-...
  • Page 96 Reprocessing Thermo Disinfector Pay attention to the following points during thermo disinfection: The disinfector should have regulatory clearance in the jurisdiction in which it is being used. For example: • FDA clearance Disinfector • CE marking • Products listed by DGHM (German Society for Hygiene and Microbiology) and ÖGHMP (Austrian Society for Hygiene, Microbiology and Preventive Medicine) Only a cleaning and disinfection program that is recommended by the Robert...

  • Page 97: Neutral Steam Sterilization

    CLEANING, DISINFECTION, AND STERILIZATION 7.1.2 Neutral Steam Sterilization Applicable Technology Only use the following sterilization procedure, which has been validated in accordance with ISO 17665 and AAMI TIR 12-2004: • Prevac/fractionated vacuum procedure with at least three vacuum phases The use of other sterilization procedures may require longer sterilization times and must be validated.

  • Page 98: Low Temperature Plasma Sterilization (Ltp)

    Reprocessing 7.1.3 Low Temperature Plasma Sterilization (LTP) Abbreviation Throughout this guide, the term low temperature plasma sterilization will be abbreviated as LTP Sterilization. Applicable Technology • Only LTP sterilization and sterilizers that conform to the requirements of ISO 14937 should be used •...

  • Page 99: Stereotactic Hardware

    This information applies to all RT/RS Stereotactic Hardware. Instructions for specific hardware is provided in subsequent sections. Handling and Storage Store RT/RS Stereotactic Hardware in a clean and dry area, safe from infectious products, impacts, scratches, and falling objects. Maintenance RT/RS Stereotactic Hardware does not require particular maintenance.

  • Page 100: Stereotactic Headring

    Stereotactic Hardware 7.2.2 Stereotactic Headring Handling and Storage Store the headring at the same place as the other stereotactic equipment. Often, a transportable instrument cart is suitable for such purposes. Store the sterilized fixation pins in the sterilization tray. The Stereotactic Headring components are precise mechanical parts. Even minor damage to any of these parts may render the entire apparatus inoperable.
  • Page 101 The use of hot instruments could injure the patient or damage non-heat resistant instruments. If applied properly, Brainlab fixation pins can be used for up to two years or sterilized up to 150 times, whichever occurs first. Using the STERRAD® 100S sterilization system, up to 100 re-processing cycles are possible.

  • Page 102: Stereotactic Mask System

    The Stereotactic Mask Set is delivered non-sterile and is for single patient use only. Do not use warm water (temperature 30°C (86°F) or higher), cleaning solutions, solvents or ultrasonic cleaners to clean the Brainlab Mask Set. The device must not be sterilized under any circumstances. Sterilization will destroy the device.

  • Page 103: Upper Jaw Support And Reference Plates

    The user is fully responsible for any deviations from the recommended cleaning, disinfection, and sterilization processes. If the processes are altered, the desired effect may not be achieved. Brainlab excludes any liability in such cases. Following sterilization, wait until instruments are cooled down to room temperature before use.

  • Page 104: Ct/X-Ray Localizer, Ct/X-Ray Localizer For Leksell Headring

    The user is fully responsible for any deviations from the recommended cleaning, disinfection, and sterilization processes. If the processes are altered, the desired effect may not be achieved. Brainlab excludes any liability in such cases. Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 105: Stereotactic Target Positioner, Target Positioner For Leksell Headring

    CLEANING, DISINFECTION, AND STERILIZATION 7.2.6 Stereotactic Target Positioner, Target Positioner for Leksell Headring Maintenance and Storage The target positioner carrier plates are not scratch proof and must be handled with care. Do not store or use the target positioner carrier plates in humid places, under conditions of constant humidity, or above 80°C (176°F).
  • Page 106 Stereotactic Hardware Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...

  • Page 107: Index

    INDEX INDEX Angio Distortion Correction Module..........75 neutral steam sterilization............97 automatic cleaning and disinfection........... 95 reference plates Brainlab Headring for Elekta............32 sterilization................103 CE Label..................8 Set for Low Mask Fixation............59 cleaning detergent..............95 Siemens TT-S................28 collimator mount................. 33 Stereotactic Headring attaching................. 34 attaching posts...............
  • Page 108 INDEX validation parameters..............96 Varian ETR................. 26 warranty..................8 WEEE...................8 Winston-Lutz Test...............89 film exposure................94 Phantom Pointer for Brainlab Headring........90 Phantom Pointer for non-Brainlab Headring......92 Hardware User Guide Rev. 4.9 RT / RS Stereotactic Hardware...
  • Page 110 Art-No. 60912-97EN *60912-97EN*...

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