Mobius3D User Guide - Mobius Medical Systems,...

USER GUIDE

VERSION 1.4.2 REV 1.0

OCTOBER 2, 2014

MOBIUS MEDICAL SYSTEMS, LP

5012 Tamarisk St. Houston, TX 77401

Phone 888.263.8541 International phone +1 832.390.3555

Email [email protected]

Copyright 2012-2014 MOBIUS MEDICAL SYSTEMS, LP. All Rights Reserved.

This manual is the sole property of MOBIUS MEDICAL SYSTEMS, LP. No part may be reproduced or transmitted in

any form or by any means without the express written permission of MOBIUS MEDICAL SYSTEMS, LP. Additionally,

no part of electronic versions of this manual may be deleted, added to, changed or copied without the express

written consent of MOBIUS MEDICAL SYSTEMS, LP. MOBIUS MEDICAL SYSTEMS, LP assumes no liability for use of

this document if the content or format has been altered in any way.

Mobius3D User Guide v. 1.4.2 rev 1.0

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Intended Audience:

This manual is written for the intended users of Mobius3D software. It is advised to thoroughly read and

completely understand the manual prior to clinical use.

Keep this manual and any other documentation delivered with the software at a location that is easily accessible to

all pertinent employees and review them periodically.

Explanation of Warning, Caution and Important Message symbols:

Warning: Bodily harm or important loss of data possible.

Caution, Consult Accompanying Documents: Bodily harm or important loss of data possible.

Important Message: Important settings information. There is no risk of bodily harm.

Explanation of other symbols:

Manufacturer

SN Serial number

European Authorized Representative

General Warnings and Symbols

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General Device Warnings:

U.S.A law: CAUTION: Federal law restricts this device to use by or on the order of a licensed medical practitioner. RX ONLY

Only trained personnel should use this software. New personnel should receive training prior to unsupervised operation of the software. For more information, contact Mobius Medical Systems.

Injury to patients can result due to the misapplication of this product. Only trained medical personnel should use this device within the limitations of the intended use.

Mobius Medical Systems, LP has taken care to ensure the accuracy of this document. However, Mobius Medical Systems, LP assumes no liability for errors or omissions and reserves the right to make changes without further notice to any products herein to improve accuracy, function or design. Mobius Medical Systems, LP provides this guide without warranty of any kind, implied or expressed, including, but not limited to, the implied warranties of merchantability and fitness for a particular product. Mobius Medical Systems, LP may make improvements or changes in the product described in this manual at any time.


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TABLE OF CONTENTS 1. Introduction.......................................................................................................................................................... 9

1.1 Intended Use .................................................................................................................................................. 9 1.2 Typical Workflow ............................................................................................................................................ 9 1.3 Installation Requirements & Compatibility .................................................................................................... 10 1.4 Version Release Notes .................................................................................................................................. 11 1.5 Support Resources ........................................................................................................................................ 11

2. Getting Started ................................................................................................................................................... 12

2.1 Log in to Mobius3D ....................................................................................................................................... 12 2.2 Linear Accelerator Setup ............................................................................................................................... 12 2.3 TPS Exports ................................................................................................................................................... 13 2.4 Next Steps .................................................................................................................................................... 14

3. Using the Home Screen....................................................................................................................................... 15

3.1 Top Menu Bar ............................................................................................................................................... 15 3.2 Patient List .................................................................................................................................................... 16 3.3 Plan Summary Panel ..................................................................................................................................... 17

4. Viewing a Mobius3D Plan Check ......................................................................................................................... 19

4.1 Navigating the Plan Check Screen ................................................................................................................. 19 4.2 DVH Graph Section ....................................................................................................................................... 21 4.3 Target Coverage Section ............................................................................................................................... 22 4.4 DVH Limits Section ........................................................................................................................................ 23 4.5 3D Gamma Section ....................................................................................................................................... 24 4.6 Beam Information Section ............................................................................................................................ 27 4.7 ROI Overview Section ................................................................................................................................... 30 4.8 Notes and Approvals Section ........................................................................................................................ 31 4.9 Changing Local Plan Check Settings ............................................................................................................... 32 4.10 Saving a PDF Report .................................................................................................................................... 33

5. MobiusFX QA Checks .......................................................................................................................................... 34

5.1 MobiusFX Initial Configuration ...................................................................................................................... 34 5.2 QA Report Overview ..................................................................................................................................... 36 5.3 DVH Graph Section ....................................................................................................................................... 37 5.4 Target Coverage Section ............................................................................................................................... 37 5.5 DVH Limits Section ........................................................................................................................................ 38 5.6 3D Gamma Section ....................................................................................................................................... 38 5.7 RMS Values Section ...................................................................................................................................... 38 5.8 Beam Information Section ............................................................................................................................ 39 5.9 ROI Overview Section ................................................................................................................................... 40 5.10 Notes and Approvals ................................................................................................................................... 40

6. MobiusFX Treatment Summaries ........................................................................................................................ 41

7. Quick Calc Utility ................................................................................................................................................. 42

7.1 Performing a Photon Quick Calc .................................................................................................................... 42 7.2 Performing an Electron Quick Calc ................................................................................................................ 43 7.3 Asymmetric jaws, off-axis points, etc. ........................................................................................................... 44

8. Electron Calculations .......................................................................................................................................... 45

Table of Contents

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8.1 Electron Calculation Licensing and Configuration .......................................................................................... 45 8.2 Performing Electron calculations .................................................................................................................. 45

9. Brachytherapy Calculations ................................................................................................................................ 46

9.1 Calculation Overview .................................................................................................................................... 46 9.2 Viewing a Brachytherapy Plan Check ............................................................................................................ 47

10. Configuration Options....................................................................................................................................... 49

10.1 Configuration Screen .................................................................................................................................. 49 10.2 DICOM Files ................................................................................................................................................ 50 10.3 Delivery Files ............................................................................................................................................... 51 10.4 System Logs ................................................................................................................................................ 52 10.5 Resouce Usage ............................................................................................................................................ 52 10.6 Manage Machines....................................................................................................................................... 52 10.7 ROI Settings ................................................................................................................................................ 57 10.8 Plan Check Settings ..................................................................................................................................... 60 10.9 Manage Users ............................................................................................................................................. 62 10.10 Network Setup .......................................................................................................................................... 63 10.11 DICOM Device Setup ................................................................................................................................. 64 10.12 Manage Network Shares ........................................................................................................................... 65 10.13 Mail Setup................................................................................................................................................. 66 10.14 Clock Settings ............................................................................................................................................ 66 10.15 Update System Software ........................................................................................................................... 67 10.16 Reboot Mobius3D ..................................................................................................................................... 67 10.17 Wipe Data ................................................................................................................................................. 67 10.18 Shutdown Mobius3D ................................................................................................................................ 67

11. Commissioning ................................................................................................................................................. 68

11.1 Verify Beam Modeling Report ..................................................................................................................... 68 11.2 Water Phantom Calculations....................................................................................................................... 70 11.3 Simple Patient Calculations ......................................................................................................................... 70 11.4 DLG Adjustment .......................................................................................................................................... 70 11.5 Complex Patient Calculations ...................................................................................................................... 70 11.6 Analyze Your TPS Beam Model .................................................................................................................... 70 11.7 TomoTherapy Commissioning ..................................................................................................................... 71

12. Troubleshooting ............................................................................................................................................... 72

12.1 Compatibility Issues .................................................................................................................................... 72 12.2 Processing Errors ........................................................................................................................................ 73 12.3 Dose Discrepancies ..................................................................................................................................... 74 12.4 Point Dose Discrepancies ............................................................................................................................ 76 12.5 DVH and Mean Dose Discrepancies ............................................................................................................. 76 12.6 DVH Limit Alerts .......................................................................................................................................... 76 12.7 Gantry Clearance Alerts .............................................................................................................................. 76 12.8 Deliverability Alerts ..................................................................................................................................... 77 12.9 Incorrect Treatment Times.......................................................................................................................... 77 12.10 System Upgrade Issues ............................................................................................................................. 77 12.11 Sending Anonymized DICOM Data ............................................................................................................ 77

Appendix A. TPS Export to Mobius3D ..................................................................................................................... 78

A.1 Pinnacle DICOM Export................................................................................................................................. 78 A.2 Eclipse DICOM Export ................................................................................................................................... 79 A.3 TomoTherapy DICOM Export ........................................................................................................................ 80


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Appendix B. Safety and Regulatory Notices ............................................................................................................ 81

B.1 Injury Hazard ................................................................................................................................................ 81 B.2 FDA 21 CFR 820 ............................................................................................................................................ 81 B.3 CE Notice (European Union) ......................................................................................................................... 81 B.4 MOBIUS3D BEOOGD GEBRUIK ...................................................................................................................... 82 B.5 ISO 13485:2003 ............................................................................................................................................ 82

Appendix C. Raw Data Access ................................................................................................................................. 83

C.1 Accessing a Single Patient’s Data .................................................................................................................. 83 C.2 Accessing Many Patient’s Data with Scripting ............................................................................................... 84

Appendix D. Treatment Log Files ............................................................................................................................ 85

D.1 Varian DynaLog Files..................................................................................................................................... 85 D.2 Varian Trajectory Log Files ............................................................................................................................ 86 D.3 Elekta Log Files ............................................................................................................................................. 86

Appendix E. PeerSync for Log File Transfer ............................................................................................................. 88

E.1 Creating a PeerSync Job ................................................................................................................................ 88 E.2 Special Note for ARIA Users .......................................................................................................................... 92

Appendix F. TomoTherapy Calculations .................................................................................................................. 93

F.1 TomoTherapy Beam Model ........................................................................................................................... 93 F.2 Expected Dose Calculation Differences ......................................................................................................... 93

Appendix G. Technical Specifications ...................................................................................................................... 94

G.1 Delivered Goods Specifications..................................................................................................................... 94 G.2 Compatibility Specifications ......................................................................................................................... 94 G.3 Performance Specifications .......................................................................................................................... 97


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1. INTRODUCTION This chapter provides some basic information about your Mobius3D software.

1.1 INTENDED USE

Mobius3D software is used for quality assurance and treatment plan verification in radiation therapy. It calculates radiation

dose three-dimensionally in a representation of a patient or a phantom. The calculation is based on read-in treatment plans

that are initially calculated by a treatment planning system, and may additionally be based on external measurements of

radiation fields from other sources such as linac delivery log data.

Mobius3D is not a treatment planning system. It is only to be used by trained radiation oncology personnel as a quality assurance tool.

1.2 TYPICAL WORKFLOW

The following is an overview of how Mobius3D is typically used in a clinic to perform quality assurance on treatment plans.

Related sections from this user guide are included for reference.

1. After a plan has been developed in your Treatment Planning System (TPS), DICOM files are pushed from your

TPS across your clinic’s network to the Mobius3D software. (2.3 TPS Exports)

2. When Mobius3D receives all the required files, it automatically performs a rigorous plan check and can send you

an email notification with or without PDF report attachment. (10.13 Mail Setup)

3. You can access Mobius3D via a browser from any computer or tablet connected to your clinic’s network to find

patients’ plan checks. (3 Using the Home Screen)

4. Plan checks can be reviewed in detail in the Plan Check screen. (4 Viewing a Mobius3D Plan Check)

5. If necessary you can modify settings for the individual plan check and re-compute. (4.9 Changing Local Plan

Check Settings)

6. Once satisfied with the plan check, you can approve the plan. (4.8 Notes and Approvals Section)

7. You can save a plan check PDF report with notes, approvals, and plan check details. (4.10 Saving a PDF Report)

8. If you have the MobiusFX add-on module, you can import the treatment log data created by your linac during

delivery of a pre-treatment fraction of the plan, and perform IMRT QA of the delivered radiation field. (5

MobiusFX QA Checks)

Chapter 1. Introduction

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1.3 INSTALLATION REQUIREMENTS & COMPATIBILITY

The following are requirements for the installation of Mobius3D in your clinical environment and compatibility

specifications. More detailed compatibility issues are presented in the Troubleshooting chapter (12.1 Compatibility Issues).

For software technical specifications, see Appendix G: Technical Specifications.

1.3.1 SERVER REQUIREMENTS

The server on which Mobius3D software is installed must meet the following minimum hardware requirements:

Intel Core i7 CPU

32 GB RAM

2 Nvidia GPU(s) with 1GB + RAM

2, 2 TB hard drives in RAID 10 for local storage

750 W power supply, 100-240 V

1 Gigabit full duplex network card (RJ45 connector)

The initial Mobius3D software installation must be professionally performed by a Mobius Medical Systems representative on a server which meets the minimum hardware requirements and is reserved only for Mobius3D software use.

No Virtual Machines: Mobius3D is implemented using technologies that require hardware access not supported by virtual machine platforms. This prevents M3D from operating inside of a virtual machine.

The server should be connected to your clinic’s network by qualified IT personnel. Please refer to the accompanying Mobius Server IT Manual for network connection instructions.

Prior to connection of the server on your clinical network, please review the Instructions included with the server

1.3.2 BROWSER COMPATIBILITY

The Mobius3D interface can be accessed by any computer, tablet, or mobile device that is connected to your clinic’s

network using one of the following browsers:

Google Chrome (recommended)

Internet Explorer 6+ (IE 6, 7, 8 require the use of Google Chrome Frame plug-in)

Mozilla Firefox

Apple Safari 3+

Android 2+

Apple iOS 4+

1.3.3 LINAC COMPATIBILITY

Mobius3D is compatible with plans designed for Varian, Elekta, TomoTherapy, and Siemens machines


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1.3.4 TREATMENT PLANNING SYSTEM COMPATIBILITY

Mobius3D requires input from a treatment planning system that can transmit CT images, structures, RT-Dose, and RT-Plan

via DICOM-RT. Common planning systems with these capabilities are Pinnacle 9 (Philips Healthcare) and Eclipse 10 (Varian

Medical Systems).

1.3.5 TREATMENT PLAN TYPE COMPATIBILITY

Mobius3D verifies IMRT, VMAT, arc, conformal arc, dynamic / virtual wedge, physical wedge, and other MLC-shaped

treatment fields for photon plans. It performs single-point electron calculations. It does not yet support radiosurgery cones.

1.3.6 TREATMENT LOG FILE COMPATIBILITY

The MobiusFX add-on module is compatible with Varian DynaLogs,Trajectory Logs, and Elekta Mobius Logs.

1.3.7 BRACHYTHERAPY COMPATIBILITY

Mobius3D is compatible with all common LDR, PDR, and HDR sources. Plan information must be transmitted via DICOM (RT-

plan only).

1.4 VERSION RELEASE NOTES

Release notes for all versions of Mobius3D can be found at:

http://mobiusmed.com/support/

1.5 SUPPORT RESOURCES

In addition to this user manual, the following support resources are available

Email questions to [email protected]

Call for support at (888) 263-8541 or +1 (832) 390-3555

http://mobiusmed.com/support/

mailto:[email protected]

Chapter 2. Getting Started

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2. GETTING STARTED This chapter presents the first configuration steps to perform with Mobius3D. It is assumed that the server on which

Mobius3D software is installed has already been connected to your clinical network.

2.1 LOG IN TO MOBIUS3D

Follow the procedure below to log in to Mobius3D.

1. Open one of the supported web browsers listed in 1.3 Installation Requirements on a computer in your clinic’s

network. Navigate to http://mobius3d/ (or use the hostname your IT department has designated). You should see

the Mobius3D login page. You may wish to create a bookmark in the browser or add a shortcut link on your

computer’s desktop.

Note: If you are prompted to install the Google Chrome Frame plug-in on your browser, you will need to do so.

This does not require Administrative Rights, and will not change your browser’s performance on other websites.

2. Log in either with the default administrator user

credentials:

Username: admin

Password: admin

or with your credentials as provided to you by an

administrator.

Note: Administrators can add/edit users in the Mobius3D

Configuration and Maintenance Options.

3. After log in, the home screen should appear. You will see

the Mobius3D menu bar at top. If the software has not yet

been used, you will not yet see any plan check data listed.

2.2 LINEAR ACCELERATOR SETUP

2.2.1 CONFIRM LINACS

Each linear accelerator (linac) at your site is registered in Mobius3D via the license file provided by Mobius Medical

Systems, LP. Mobius3D arrives pre-loaded with your license file. You can confirm your linacs are properly registered this by

taking the following steps:

http://mobius3d/


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1. On the Mobius3D menu bar, click the configuration icon on the right side.

2. Click the Manage Machines button.

3. The Current Machines list should include of all of your linacs and show the measurement parameters you

provided. If not, contact Mobius3D support.

2.2.2 BEAM MODELS

Your software is pre-configured to use Mobius3D’s reference beam models which should provide accurate results for

comparison to your TPS. Eventually, you may wish to perform automodeling to customize your beam models, but it is not

recommended to do so at this point.

More information about Mobius3D’s reference and custom beam model options is included in:

Section 10.6 Manage Machines

Section 11 Commissioning

Mobius3D White Paper: Dose Calculation Algorithm (available at mobiusmed.com/mobius3d/dose-calculation/)

2.3 TPS EXPORTS

Prior to analyzing plans with Mobius3D, a new DICOM export node must be configured within your Treatment Planning

System. Refer to your TPS’s instructions. In general, the following information will be required by your TPS:

Mobius3D server IP address: Shown on the "DICOM Device Setup" page in the Configuration screen

AE Title: MOBIUS3D

Port: 104

Note: The AE Title can be customized in the Mobius3D Configuration Options (10.11 DICOM Device Setup)

After the DICOM export node has been configured, completed plans may be exported (i.e., pushed) from the TPS to the

Mobius3D software. The export should include the RT-Plan, the structures/ROIs, the CT image set used for planning, and

the RT-dose. See Appendix A TPS Export to Mobius3D for example export settings from Pinnacle and Eclipse systems.

You should also be familiar with the following concepts related to your TPS DICOM-RT exports before pushing plans for

clinical checks.

http://www.mobiusmed.com/mobius3d/dose-calculation/

Chapter 2. Getting Started

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2.3.1 DENSITY OVERRIDES

Your TPS may have an option to override the density values in its CT data for specific structures in a plan. For a valid

comparison between TPS and Mobius3D calculations, it is important that any density overrides are transmitted to

Mobius3D. Density overrides are automatically transmitted in the DICOM-RT structure set, and can be verified in the ROI

section of each plan check.

2.3.2 BOLUS

Plans with bolus will be transmitted to Mobius3D and calculated automatically. Mobius3D will use the bolus material to

attenuate the beam, but may not perform dose calculations within the bolus itself.

2.3.3 TREATMENT COUCH

Dose calculations in your TPS typically remove the CT couch from the CT scan. You should adjust the CT Couch Removal

options in Mobius3D to best match your TPS (10.8 Plan Check Settings). If your TPS adds the treatment couch to your dose

calculations, you should verify the couch structures and density overrides are transferred to Mobius3D.

2.4 NEXT STEPS

Mobius3D is now ready to functionally perform plan checks. At this point it is recommended to push some existing

treatment plans from your TPS to Mobius3D to use as examples.

Using your example plans, you can reference this user guide to familiarize yourself with Using the Home Screen (Chapter 3),

Viewing a Mobius3D Plan Check (Chapter 4), and Configuration Options (Chapter 10). It is then recommended to perform a

Commissioning process (Chapter 11). After commissioning, you will be fully prepared to use Mobius3D clinically.


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3. USING THE HOME SCREEN This chapter shows you how to navigate the Mobius3D home screen, where you can find the plans you have exported from

your TPS. To access the home screen, you must first log in to Mobius3D (see 2.1 Log in to Mobius3D).

3.1 TOP MENU BAR

The top menu bar is displayed on all screens of Mobius3D. It allows you to see basic info and quickly navigate to different

screens in Mobius3D. From left to right, the components of the top menu bar are:

Mobius3D icon and Patients links

Clicking either of these will always navigate you to (or refresh) the home screen

DICOM Activity menu

Hovering the cursor over this will show you a dropdown list of all recently processed or currently processing

DICOM files. Selecting one of the files in the list navigates you to an interface to browse DICOM objects (See 10.2

DICOM Files).

User Name label

This shows the username you are logged in as.

Preferences link

Clicking this navigates you to a page to edit your user information.

Log out link

Clicking this logs you out and navigates you to the login screen

Configuration Icon

Clicking this will navigate you to the Mobius3D Configuration Options (See 10 Configuration Options). This icon is

only displayed when an administrator is logged in.

Chapter 3. Using the Home Screen

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3.2 PATIENT LIST

Along the left half of the home screen is the Patient List. This is where you will find the plan checks you wish to review. A

patient’s plan data must be pushed from the TPS to Mobius3D before that patient will appear in the list.

You can filter the patient list using the

search box located at the top. You can also

sort the list by clicking on the column labels

for Patient and Received. Below the list, you

can control how many patients are shown

per page.

You can select a patient by clicking

anywhere on that patient’s row. When you

do so, you will see that patient’s plan

check(s) summarized in the Plan Summary

Panel on the right half of the home screen.

The fields in the patient list are as follows:

Patient

Displays the patient name and patient ID (names are anonymized in the example above but not on your software).

Received

Displays the date & time that the DICOM plan file was received by Mobius3D.

Result

Displays a message and corresponding icon indicating one of the following for the plan check:

o Pass – All elements of every plan loaded for the patient passed

o Warn – One or more of the plan check elements warned, but none alerted

o Alert – One or more of the plan check elements alerted

o Waiting – The plan check is currently in progress

o Timeout – The plan check stopped because it exceeded the allowed processing time

o Exception – The plan check generated a processing error

Number of Plans (no column label)

Displays the number of individual plans loaded for the patient on a blue button. The icons on the right side of the

button indicate what types of reports each patient has (Mobius3D Plan Check, MobiusFX QA Check, etc.).

Note: If the Number of Plans is more than 1, the Result in the Patient List is for the top-most check in the Plan Summary Panel.


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3.3 PLAN SUMMARY PANEL

The Plan Summary Panel is on the right half of

the home screen. It shows a summary box for

each of the loaded plans for the currently

selected patient. If there is more than one plan

loaded for the patient, a separate summary box

will be shown for each.

The elements of a plan summary box are:

Plan Info - Line 1

Contains the:

o Plan name specified in the DICOM RT-Plan (e.g. SBRT Lung)

o Beam energies used in the plan (e.g. 6MV)

o Type of delivery identified by Mobius3D (e.g. Static, SnS, Dynamic, or VMAT). This is based on analysis of

leaf and gantry motion in the plan.

o Reference dose that Mobius3D will use for Gamma calculations (e.g. 7.04 Gy)

o Whether Reference Dose is the maximum or prescribed dose from the plan.

Plan Info - Line 2

Contains the:

o Physician name specified in the DICOM-RT plan (e.g. Dr. J. Jones, “Anonymized” in figure)

o Machine name specified in the DICOM-RT plan

o Number of fractions specified in the DICOM RT-Plan

o Institution name specified in the DICOM-RT plan

DICOM Status section

Indicates if all necessary DICOM files have been received for a plan check to be performed. This section can be

expanded / collapsed by clicking the small triangle icon. Hovering the mouse over each icon will display the

DICOM file's UID number in a tooltip.

Plan Check Evaluation section

Indicates whether plan check components have been completed by Mobius3D and their pass/alert status. It also

indicates if any Mobius3D users have approved the plan. This section can also be expanded / collapsed.

Delete Plan Check icon

After a confirmation, clicking this will permanently delete Mobius3D’s plan check and the underlying DICOM RT-

Plan file from your Mobius3D software. The Structure Set, CT, and Dose DICOM files will be retained by the

software in case a replacement plan is pushed to Mobius3D that uses those same elements.

Chapter 3. Using the Home Screen

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View Plan Check Settings icon

Clicking this will navigate you to the Local Plan Check Settings.

Note: These settings are also accessible by clicking the same icon on the Plan Check screen itself. The process is

described in 4.9 Changing Local Plan Check Settings.

PDF Report icon

Clicking this opens a .PDF report of the detailed plan check results which you can save locally.

Note: This option is also accessible by clicking the same button on the Plan Check screen itself. The process is

described in 4.10 Saving a PDF Report.

Approve / Revoke Approval button

Clicking this adds your approval and navigates you to the Plan Check screen. If you have already approved the plan,

the button removes your approval.

Note: The plan can also be approved/revoked on the Plan Check screen itself. The process is described in 4.8

Notes and Approvals Section.

View Plan Check button

Clicking this navigates you to the Plan Check screen.


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4. VIEWING A MOBIUS3D PLAN CHECK The Plan Check screen is where you can interactively review the analysis that Mobius3D performs for a treatment plan.

Access the Plan Check screen by clicking the View Plan Check button for a plan on the home screen.

4.1 NAVIGATING THE PLAN CHECK SCREEN

The plan check screen has several sections of analysis:

DVH Graph

Target Coverage

DVH Limits

3D Gamma

Beam Information

ROI Overview

Notes and Approvals

Sections can be expanded/collapsed in the view area by clicking the small triangle icon next to the section heading. To

navigate to an individual section you can either scroll up/down, or click the button/icon link to that section on the vertical

sidebar.

Chapter 4. Viewing a Mobius3D Plan Check

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4.1.1 VERTICAL SIDEBAR

The vertical sidebar is always visible on the left side of the Plan Check screen. It allows you to directly navigate to a section

of interest.

Basic Information

The top area displays the Patient Name, Patient ID, and Plan Name from the

DICOM RT-plan file.

Plan Section Links

Clicking the DVH Graph, Target Coverage, DVH Limits, 3D Gamma, Beam

Information, ROI Overview, or Notes & Approvals links will navigate your scroll

position to the corresponding section of the plan check. The links are color coded

according to the following scheme:

o Green – All plan check elements in that section passed

o Yellow – At least one plan check element in that section generated a

warning, but no elements alerted

o Red – At least one plan check element in that section alerted

o Gray –Plan check elements have not been performed for this section

Approve Plan Check / Revoke Approval icon

Clicking the thumbs up adds your approval to the plan. If you have already

approved the plan, clicking the thumbs down icon removes your approval.

Open Plan Check Settings icon

Clicking this will navigate you to the Local Plan Check Settings.

Open PDF Report icon

Clicking this opens a PDF report of the detailed plan check results which you can save locally.

Delete Plan Check icon

After a confirmation, clicking this will permanently delete Mobius3D’s plan check and the underlying DICOM RT-

Plan file from Mobius3D. The Structure Set, CT, and Dose DICOM files will be retained in case a replacement plan is

pushed to Mobius3D that uses those same elements.

Back to Patient List Button

Clicking this navigates you back to the home screen.


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4.2 DVH GRAPH SECTION

The DVH Graph section lets you analyze DVH curves for all the structures imported from the plan.

Mobius3D generates a pair of DVHs curves for each structure. One curve is generated by the dose distribution calculated by

your TPS (solid lines). The other is generated by the dose calculated by Mobius3D (dashed lines). This lets you compare the

TPS and Mobius3D- computed DVHs in structures of interest.

Position your cursor in the graph area to see values along the DVHs. A box will appear showing you the relative volume % of

the structures for the dose level where your cursor is positioned.

You can turn on/off the display of any structure’s DVH by clicking its name in the legend on the right side. The initial view

will show DVH curves for all the structures whose name either matches to a Target ROI type or to an anatomical ROI type

with DVH limits.

Although DVH values are used for some of the pass/alert checks in subsequent sections, Mobius3D does not indicate any

pass/alert results in the DVH Graph section itself.

4.2.1 DVH CALCULATIONS

ROIs in a DICOM-RT structure set are defined as a series of 2D contours on individual CT slices that determines which CT

voxels are considered inside the ROI. Mobius3D performs DVH calculations by resampling the TPS dose and the Mobius3D

dose to the resolution of the plan's CT scan using trilinear interpolation. Resampled doses are combined with each ROI's

voxel information to allow histogram calculations.


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4.3 TARGET COVERAGE SECTION

The Target Coverage section compares the TPS-calculated dose to the Mobius3D (M3D) dose for any structures identified as

target ROIs (See 10.7 ROI Settings) using ROI “Targets” name settings. If a plan does not have any ROIs matching target

names, structures with high mean doses will be automatically selected as targets.

The Target Coverage table presents the following information:

TPS Name

The name of the structure from the plan which has been identified as a target ROI.

Mean Dose

The mean dose level within the volume of the structure. It is calculated from both the TPS and Mobius3D (M3D)

dose distributions.

% Coverage

The dose value corresponding to a specific % Relative Volume level from the structure’s DVH. This is calculated

from both the TPS and Mobius3D (M3D) DVHs. 90% is the default relative volume level, but this Percent Coverage

value can be modified in the settings if desired (See 10.8.4 Target Coverage).

% Diff

The percent difference between the TPS and Mobius3D dose level. This is presented for both the Mean Dose and

the % Coverage dose. The % Diff determines a pass/alert indication depending on whether the magnitude exceeds

the Mean Dose Difference value in the Plan Check Settings (See 10.8.4 Target Coverage).

Stray Voxels

Mobius3D expects target ROIs to be connected regions. Stray voxels may indicate a contouring mistake, which can

lead to inverse planning systems delivering dose in unexpected regions. The number of stray voxels is shown along

with the slice number(s) containing the stray voxel(s) and a pass/warn indication (See 10.8.4 Target Coverage).


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4.4 DVH LIMITS SECTION

The DVH Limits section shows you if the plan meets recommended guidelines for allowable dose (or allowable volume

receiving a dose) in anatomical structures. Pass/alert evaluations are made with respect to the DVH limits defined for

different types of anatomical ROIs. The evaluations are made independently using both the TPS and Mobius3D computed

DVHs. Alerts are only triggered by a failure to meet DVH limits, not by a difference between the TPS and Mobius3D

computed values.

Note: The default DVH limits are from RTOG guidelines for conventional fractionation and from AAPM TG-101 guidelines

for SRS/SBRT fractionation. Limits can be customized as desired (See 10.7.3 DVH Limits).

The DVH Limits table presents the following information:

Limit Set

Mobius3D allows different sets of DVH limits to be applied depending on the fractionation of the plan (e.g.

Conventional Fractionation, 1-Fraction SRS, etc.) The Limit Set being used can be modified in the DVH Limits

section of the local Plan Check Settings.

Tolerance Scaling

The critical dose levels associated with all DVH limits can be uniformly scaled up or down from the default levels

using the Tolerance Scaling value in the Plan Check Settings (See 10.8.5 DVH Limits). A value of 100% indicates no

scaling has been performed.

TPS Name

The name of the structure from the TPS.


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Limit Name

The name of the associated ROI type in Mobius3D which has pre-defined DVH limits. If you hover the mouse over

the icon beside the limit name, the pop-up will display the limit set being used for that particular ROI.

Volume

If the DVH objective is for a dose level, this will display either:

o RV % - the relative volume level for the DVH dose objective

o “Mean” – the DVH objective is for mean dose in the ROI

o “Max” – the DVH objective is for maximum dose in the ROI

If the DVH objective is for a total volume level, this will display either:

o < V cc – the maximum allowable volume

o > V cc – the minimum allowable volume to spare

Dose

If the DVH objective is for a dose level, this will display:

o < D gy – the maximum allowable dose

If the DVH objective is for a total volume level, this will display

o D gy – the dose level for the DVH volume objective

TPS

The computed dose (or volume) from the TPS dose distribution. This will determine a pass/alert.

M3D

The computed dose (or volume) from the Mobius3D dose distribution. This will determine a pass/alert.

Note

Clicking the Add Note icon navigates you into the Notes and Approvals section and begins a new note with

identifying text (e.g. DVH Limit **Heart** (User1):). You may choose to add more information to the note, such as

a reason that a DVH Limit alert is acceptable for that structure.

4.5 3D GAMMA SECTION

The 3D Gamma section shows the results of a full 3D gamma comparison between the TPS and Mobius3D dose distributions

over the entire dose calculation volume. Results are shown in a summarized table and in an interactive graphic with the

patient’s CT. Gamma values are displayed as negative numbers if Mobius3D's dose is lower than the TPS dose (cooler) for

that voxel.

4.5.1 3D GAMMA TABLE


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The elements of the 3D Gamma table are:

Passing Rate

The percentage of voxels in the entire dose volume with a gamma comparison value between -1.0 and 1.0. Voxels

with a low density (<0.2 g/cc) are not included, unless they are inside an ROI with the word "lung". A

pass/warn/alert indication is shown based on whether the Passing Rate is less than the Warning Failure Percent

(warn) or the Alert Failure Percent (alert) values in the Plan Check Settings (See 10.8.3 3D Gamma).

Criteria

The dose/distance criteria used in the gamma calculation

Reference Dose

The dose level used as the denominator for the gamma’s dose % difference calculation. By default, this is chosen

as the maximum dose.

Threshold Dose

If the dose level calculated by both the TPS and Mobius3D is below this level, then gamma is not considered for

this voxel.

TPS Voxels

Length in mm of each of the voxel edges in the TPS dose grid.

M3D Voxels

Length in mm of the voxel edges in the Mobius3D dose grid, independent of the TPS dose grid. The Mobius3D dose

grid resolution is solely dependent on the smallest effective field size within a given plan. From that value,

Mobius3D automatically selects the appropriate voxel size. The default dose grid resolution is 3 mm. Should a plan

contain a field with an effective size below 3.5 cm, the dose grid resolution drops to 2 mm. For effective field sizes

less than 2.5 cm, the dose grid resolution is changed to 1 mm. However, should the smaller dose resolution make it

impractical to perform the calculation due to memory limits, the dose grid will be adjusted accordingly.

4.5.2 3D GAMMA GRAPHIC

The 3D Gamma graphic displays isodose and gamma levels overlaid on the patient’s CT imagery. This may be a useful image

for understanding the nature of any dose discrepancies. The tabs across the top of the image allow you to select one of six

views. Each view shows one of two quantities (isodose or gamma) overlaying one of three CT image planes (transverse,

coronal, sagittal). A dashed blue line shows the TPS calculation region boundary.


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Note: The image depicts the densities used to calculate dose, including all density overrides (See 2.3.1 Density Overrides).

Gamma views show individual pixels colored based on gamma value according to the legend at bottom-right. Pixels with

gamma between -1 and 1 are not colored. Contours for targets and anatomical structures are also shown as solid lines on

the image.

Isodose views show TPS (solid) and Mobius3D (dashed) isodose contours overlaid on the CT data colored according to the

legend. Structure contours are not depicted in isodose views.

On the right and the bottom of the image are profile graphs for the vertical and horizontal dose profiles. If you move your

cursor over a profile graph, it displays the dose values where your cursor is located.

The gamma image slices are taken either through isocenter or the maximum dose point. This point is not user-adjustable.

Densities are calculated by applying a CT to density table with the following HU:g/cc ratios: -1000:0, 0:1, and 6000:4.8. The

CT to density table will be user-adjustable in a future release.

4.5.3 3D GAMMA CALCULATIONS

3D gamma values represent the per-point degree of agreement between two dose grids. They combine dose differences

and distance to agreement metrics. Mobius3D performs 3D gamma calculations by resampling the TPS and Mobius3D dose

grids to the resolution of the plan's CT scan using trilinear interpolation. A 3D search window is used to ensure gamma

values up to 200% of the passing criteria are accurately computed (i.e., values between 0 and 2). Values larger than 200%

are capped to 200%. Optimizations are made to limit the overestimation effects a discrete voxel grid causes on gamma

calculations in high-gradient regions. Mobius3D gamma calculations use positive gamma values to indicate that Mobius3D's

dose was hotter than the TPS dose and negative gamma values to indicate the inverse.


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4.6 BEAM INFORMATION SECTION

The Beam Information section shows parameters and calculations for the individual beams that compose the overall

treatment plan. The section includes both an information table and a graphic.

4.6.1 BEAM INFORMATION TABLE

The beam information table provides a great deal of information about the plan:


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Two pieces of information are shown at the top of the table before it is divided into separate beam components

Number of Fractions Planned

The number of fractions indicated from the plan

Treatment Machine Name

The linac for which the plan was designed

Below the basic information, the table is divided into separate columns for each component beam

Beam

Each beam's name from the treatment planning system.

Energy (MV)

Nominal energy planned for the beam.

TPS MU

Total monitor units planned for the beam. Mobius3D uses this MU for its calculation.

M3D MU

The MU needed to deliver the TPS Beam Dose using Mobius3D's calculation. Shown only for billing purposes. The

TPS must export a calculation point dose for each beam via DICOM. If this is not done, this row will show "--".

TPS Beam Dose (cGy)

Dose level in the reference TPS voxel for the beam (defined as the calculation point in the TPS).

M3D Beam Dose (cGy)

Dose level in the reference Mobius3D voxel for the beam.

Dose Difference

Percent difference between the TPS Beam Dose and the M3D Beam Dose.

Diode Dose (cGy)

(Optional) If activated in the Mobius3D license file, the M3D dose along the central axis at Dmax.

Segments

Number of delivery segments for the beam.

X1 / X2 Jaws (cm)

Positions of the X1 and X2 jaws respectively, defining the collimator opening for the beam.

Y1 / Y2 Jaws (cm)

Positions of the Y1 and Y2 jaws respectively, defining the collimator opening for the beam.

Wedge

Type (Dynamic, Physical, None) of wedge used for the beam and its DICOM Wedge ID.

MLCs

Multi-leaf collimator behavior for the beam

o Static – no leaf movement (i.e., non IMRT)


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o SnS (Step and Shoot) – leaf movement only when beam is off

o Dynamic – leaf movement while beam is on (no gantry rotation)

o VMAT – leaf movement while beam is on and gantry is rotating

Rotation

o Static – no gantry rotation

o Arc – gantry rotation, no leaf movement

o VMAT – gantry rotation, with leaf movement

Gantry

Planned angular position of the gantry at the beginning and end of the beam delivery (displayed in Varian or IEC

coordinates, depending on the machine's configuration).

Collimator

Planned angular position of the collimator for beam delivery (displayed in Varian or IEC coordinates, depending on

the machine's configuration).

Couch

Planned angular position of the couch for beam delivery (displayed in Varian or IEC coordinates, depending on the

machine's configuration).

Gantry Clearance (cm)

Mobius3D uses the patient CT data to determine the closest distance between the treatment head and the

patient/couch for the beam. A warning is displayed if this distance is <= 3 cm, and an alert is displayed if the

clearance is <=0 cm.

Deliverable

Mobius3D determines if the planned MLC shapes can be produced by the linac (checking items such as interleaf

digitation, maximum opening size, etc.). If not, an alert will be indicated for the beam.


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4.6.2 DELIVERY INFORMATION GRAPHIC

The delivery information graphic is a circular plot depicting the time required by the machine to deliver each

beam/segment in the plan. The delivery sequence starts at the top of the circle and proceeds clockwise.

The inner ring of the circle shows colored wedges representing each beam in the plan, with gray wedges representing the

time required in-between beams. The outer ring of the circle shows colored blocks representing the segments that

compose each beam, with gray blocks for the time required between segments. If you position your cursor over any section

in the entire circle, the section is identified, and the required time is displayed.

A box at the top-left of the plot indicates the Total Delivery Time, Beam On Time, and Total MU for the entire plan.

The delivery time is calculated by using the MU/min value and machine-specific rotation and linear speed values (such as

one gantry revolution per minute). For TomoTherapy plans, the time from the planning system is displayed.

4.7 ROI OVERVIEW SECTION

The ROI Overview section shows parameters and dose calculations for every structure defined in the plan, whether or not

they are deemed to be a target ROI or an anatomical ROI with DVH limits. There are no pass/alert evaluations in this

section, but analysis can be useful for understanding dose discrepancies.


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The elements of the ROI Overview table are:

TPS Name

The name of the structure in the TPS.

Volume

The volume of the structure, as calculated by Mobius3D.

3D Gamma (% / mm)

The percentage of voxels in the ROI which pass the gamma evaluation (gamma between -1.0 and 1.0). 3D gamma

is calculated for every voxel in the ROI (no Dose Threshold is applied).

Mean Dose

The mean dose level within the volume of the structure. It is calculated from both the TPS and Mobius3D (M3D)

dose distributions.

% Diff

The percent difference between the TPS and Mobius3D mean dose level. The formula for % Diff is (M3D dose - TPS

dose) / Reference dose * 100%.

Density Override

If None, this indicates if the default density has been used as calculated from CT data. Otherwise this shows the

density manually specified for the region in the TPS export.

4.8 NOTES AND APPROVALS SECTION

The Notes and Approvals section allows you to approve a plan for treatment, monitor other users’ approvals, and add

notes. The notes and approvals are recorded for the plan and shown on the first page of the plan’s PDF report.


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By clicking the Approve This Plan button at the bottom of the section (not shown), your approval is logged either in the

Dosimetrist, Physician, Physicist, or Unknown box, depending on your User Group (see 10.9 Manage Users). Pressing the

Approve Plan Check icon in the vertical sidebar performs the same function. You can remove your approval by clicking

the Revoke Approval button at the bottom of the section.

To approve the plan as a different user than the one currently logged in, click the Approve As button. A popup window

appears where you can select a different user, enter their password, and click a button to confirm.

To add notes for the plan check, click the Edit Notes button, type in your notes, and save them by clicking the Save Notes

button which appears.

Note: You can add formatting to notes (e.g. boldface, italics, etc.) using standard “Markdown” syntax. See

http://en.wikipedia.org/wiki/Markdown for Information on this syntax.

4.9 CHANGING LOCAL PLAN CHECK SETTINGS

If you want to adjust settings for only the current plan check and re-compute it, then you should click the Plan Check

Settings icon on the Vertical Sidebar.

Settings on this screen are analogous to global configuration options described in Chapter 10: Configuration Options except

that they apply only to the current plan. For descriptions, you can refer to the corresponding section of this user guide:

Dose Calculation - Checking the recalculate dose box forces Mobius3D to reload all DICOM data and recalculate dose.

This is primarily useful after upgrading a beam model or Mobius3D itself.

CT Couch Removal – 10.8.2 CT Couch Removal

3D Gamma –10.8.3 3D Gamma

http://en.wikipedia.org/wiki/Markdown


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Target Coverage –10.8.4 Target Coverage

DVH Limits –10.7.3 DVH Limits

ROI Identification – This section lists the ROIs found in the

plan and what ROI they matched. Automatic matching

rules can be changed in 10.7 ROI Settings. In addition, ROI

density overrides can be manually adjusted.

After you have made the desired changes, click the

Recompute Plan Check button at the bottom of the screen.

4.10 SAVING A PDF REPORT

To view/save a PDF report of the plan check, click the PDF Report button. This opens a new browser window which

displays the same basic information as the Plan Check screen in PDF format. It also includes a front page with overview

information for the plan including any notes you have added, and any approvals that have been recorded.

You can then choose to save the PDF file on your computer via your web browser options. This PDF file is typically stored as

part of the patient's electronic medical record in your record and verify system.

Chapter 5. MobiusFX QA Checks

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5. MOBIUSFX QA CHECKS The MobiusFX QA Check screen displays an interactive analysis of a delivered dose, calculated using measurements in

treatment logs. Access the QA Check screen by clicking the View QA Check button for a plan on the home screen. This

chapter assumes you are already familiar with 4 Viewing a Mobius3D Plan Check.

5.1 MOBIUSFX INITIAL CONFIGURATION

MobiusFX requires a valid MobiusFX license (purchased separately from Mobius3D). A Mobius3D Plan Check must be

completed before a MobiusFX QA Check can be generated. Treatment log files can be continuously monitored by setting up

10.12 Manage Network Shares for one or more linacs. They can also be manually uploaded (either as a single file or a ZIP

containing many files) in the 10.2 DICOM Files utility, or the 10.3 Delivery Files utility.

A MobiusFX QA Check will be automatically generated for the first fraction of a Mobius3D Plan Check's delivery. Subsequent

fractions will be displayed in 6 MobiusFX . MobiusFX settings cannot be changed on a per-plan basis; they can only be

adjusted in 10.1 Configuration Screen (Global Plan Settings).

5.1.1 TREATMENT LOG COMPATIBILITY

MobiusFX is currently compatible with Varian DynaLog,Trajectory Log, and Elekta Mobius log files. See Appendix D

Treatment Log Files for details on generating treatment log files.

5.1.2 MULTIPLE PLAN CHECKS AND MULTIPLE QA REPORTS

If a treatment plan is associated with multiple Mobius3D Plan Checks (perhaps due to a recalculation within Mobius3D, or

multiple transfers from the planning system), MobiusFX will use the most recently completed Plan Check.

By design, only one QA Check is generated per plan. To manually generate an updated QA Check, first re-compute a

Mobius3D Plan Check (see 4.9 Changing Local Plan Check Settings). MobiusFX will generate a new QA Report when it

detects treatment logs corresponding to the recomputed plan, either through its network drive monitoring or due to a

manual file upload.

5.1.3 REQUIREMENTS FOR MATCHING TREATMENT LOGS TO PLAN CHECKS

In order for MobiusFX to automatically produce a QA Check:

The treatment log files must be identified with the same patient ID as a completed Mobius3D Plan Check.

The first segment of every beam in the Plan Check must match the first segment of all delivered fields. If the

treatment plan is altered, a new Plan Check must be created.

Every field must be delivered with no interruptions. QA Checks will not be generated for partial deliveries.

Each beam must be delivered within an hour of the beam delivered prior.

The Mobius3D Plan Check must have only one fraction group (i.e., Prescription). If a plan has multiple fraction

groups or prescriptions and you would like a MobiusFX QA Check, please export each prescription separately.

The RTPlan must be present within Mobius3D within the previous 30 days (See 10.3 Delivery Files).


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When matching the imported log files to a specific Plan Check, MobiusFX applies the following patent pending logic:

All log files are first grouped according to Patient ID.

If one (or more) of the patient’s plans has been Approved in Mobius3D, all other Plan Checks for that Patient ID

that are not approved will be ignored when attempting to match the delivery logs to a plan.

For all plans available for matching (if approved or if all unapproved), MobiusFX will attempt to match the delivery

logs to the most recently calculated/retired plan first and then progress from there until a match is either found or

not found at all. Beam fingerprinting uses the following logic:

o MobiusFX checks the agreement between the first planned control point and the first delivered control

point data while allowing the following tolerances:

o Energy - must be equal to planned

o initial X Jaw extents - within 1.1 cm of planned (ignored for Elekta)

o initial Y Jaw extents - within 1.1 cm of planned

o initial Gantry Angle - within 4.1 degrees of planned

o initial Collimator Angle - within 4.1 degrees of planned

o And then MobiusFX performs additional fingerprinting of the MLC leaf positions within the field while

allowing a 1 cm tolerance.

Finally, delivery log file pairs (i.e., A and B bank) must be uploaded within 2 hours of each other.

Note that if you upload old delivery log files, MobiusFX will wait for a short period of time to ensure that all files have been

uploaded by the user before designating the earliest delivery log files as the QA Check log files.

5.1.4 TREATMENT LOG FILE CAPABILITIES

Treatment log files record precise measurements of linear accelerator deliveries. However, each system has the ability to

record slightly different parameters. The table below lists each log file's capability.

Measurement Varian

DynaLogs Varian

Trajectory Logs Elekta Logs

(Mobius Logs)

Sampling time 0.05 s 0.01 - 0.05 s ~0.3 s

Fractional MU Yes Yes Yes

Delivered MU No Yes Yes

MLC positions 0.01 mm 0.01 mm 0.1 mm

VMAT and dynamic deliveries

Yes Yes "Set" values not recorded,

"Delivered" values are

Jaw positions 0.1 cm 0.1 cm 0.1 cm

Gantry angle 0.1° 0.1° 0.1°

Collimator angle 0.1° 0.1° 0.1°

Couch angle No 0.1° 0.1°

Beam energy No Yes Yes

Wedge insertion No Yes Yes

Other inserts No Yes Yes

MobiusFX determines data transfer succeeded by comparing the Mobius3D TPS plan to the "Set" values in log files. It

determines RMS errors by comparing "Delivered" values to "Set" values. If "Set" values are not available, MobiusFX uses

prescribed values for RMS calculations and cannot perform automatic data transfer checks.


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Elekta logs typically return partial "Set" data. If MobiusFX finds any missing "Set" data, even one point in one hundred, it

replaces that component's "Set" values with the prescribed values. For Elekta machines, this means that typically data

transfer cannot be checked on MLC leaves. Thus, data transfer errors are displayed as RMS errors. Full data transfer checks

are typically performed on beam energy and set MUs.

Additionally, the sampling time in Elekta logs can lead to "Delivered" values that are up to ~0.3 s different from their

corresponding prescribed value. This typically results higher RMS values on Elekta machines compared to Varian machines.

This data timing issue does not result in significant changes to the 3D dose (Fontenot, Jonas D. "Feasibility of a remote,

automated daily delivery verification of volumetric-modulated arc therapy treatments using a commercial record and verify

system." Journal of Applied Clinical Medical Physics 13.2 (2012)).

5.1.5 TROUBLESHOOTING MOBIUSFX QA REPORT GENERATION

MobiusFX is designed to have no interface other than completed QA Checks and Delivery Reports. If you have network

shares set up to monitor new treatment log files, everything happens automatically. If a QA Report does not appear for a

patient, you should:

Verify all 5.1.3 Requirements for matching Treatment Logs to Plan Checks are met

Verify that treatment logs were generated by the delivery machine

View the 10.3 Delivery Files log to verify MobiusFX imported all treatment logs

5.2 QA REPORT OVERVIEW

MobiusFX QA Reports have many similarities to Mobius3D Plan Checks. QA Reports compare the delivered 3D dose

(calculated using Mobius3D's dose calculation algorithm and the positional measurements contained in treatment log files)

to the 3D TPS dose. Machine performance statistics are also reported.

5.2.1 EVALUATING DIFFERENCES IN QA REPORTS

Most sections include results from the intermediate Mobius3D Plan Check. These results can be used to help separate

calculation differences from differences caused by linac performance. If MobiusFX delivered doses closely match Mobius3D

doses, the linear accelerator delivered the prescribed treatment plan accurately. If the TPS doses do not match Mobius3D

or the delivered MobiusFX doses, there are likely both calculation differences and treatment delivery issues.


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5.3 DVH GRAPH SECTION

Thick solid DVH lines correspond to the TPS dose, dashed lines to Mobius3D dose, and thin solid lines to the delivered dose

(calculated by MobiusFX). The example above shows Mobius3D calculates more dose in most structures, and MobiusFX

matches Mobius3D lines well. This indicates that the linac performed well, and the differences in MobiusFX doses are not

due to delivery performance issues.

5.4 TARGET COVERAGE SECTION

The Mobius3D values are included for reference. All percent differences are calculated from the delivered MobiusFX doses.


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5.5 DVH LIMITS SECTION

The Mobius3D values are included for reference. All DVH objectives are evaluated for the delivered MobiusFX doses.

5.6 3D GAMMA SECTION

The MobiusFX delivered dose is compared to the TPS dose to generate the 3D gamma passing rate and images. All 3D

gamma and isodose images are displayed on CT slices identical to the Mobius3D Plan Check. However, profile plots include

TPS, Mobius3D, and MobiusFX delivered dose.

5.7 RMS VALUES SECTION

The RMS error for the position of each MLC leaf, jaw, collimator angle, and gantry angle is displayed in this interactive

section. RMS errors are only calculated for MLC leaves that move during treatment. The RMS error is calculated by

comparing the difference between the delivered positions and the set values, both read directly from the treatment log.


- 39 -

Thus, RMS errors represent the pure machine delivery performance of each component. RMS errors are only calculated for

the periods in which dose is being delivered to the patient.

By default, MobiusFX displays results for all fields combined. You can change the field displayed by selecting a different item

from the Beam dropdown box. This will update both the MLC RMS error graph and the RMS error table beneath it. Actual

MLC RMS values can be seen by hovering your mouse over individual leaves in the graph.

5.8 BEAM INFORMATION SECTION

The Beam Information table displays the delivered beam

parameters. Display and evaluation of results depends

specifically on the data available in the treatment log file,

meaning some rows may not have data to check.

The Data Transfer row displays whether the data for every

beam component was transferred to the linac successfully and

interpreted by the linac's delivery software correctly. This is

determined by comparing the prescribed values in the plan to

the set values in the treatment logs for all beam-on times.

Every component must match within 5 mm or 2° at every

point within the delivery to pass the Data Transfer check.

Note that it is possible for data to be transferred correctly but

interpreted incorrectly by the delivery software (i.e., the linac

incorrectly delivers a static MLC field due to a software issue).

Rows highlighted in green indicate that component has both

passed the data transfer check and met its RMS error

tolerances. Rows highlighted in red indicate an alert in one or

both of these checks.

The example shows the Beam Information from a Trajectory

Log-measured plan. Please note that some results are

unevaluated due to available data in the treatment logs. For

example, DynaLogs do not record absolute MU, meaning the

TPS MU is shown and the row is not highlighted for pass/alert evaluation. Similarly, they also do not record couch, jaw, and

gantry positions, so only the prescribed value from the TPS RT-plan is displayed and the row is not highlighted. The

following table can be used as a guide to show which values are evaluated.

Trajectory Logs DynaLogs Elekta Logs

Data Transfer Evaluated Values

(Green/ Red highlighted)

Energy, MU, Jaws, MLC, Gantry, Collimator

MLC Energy, MU


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5.9 ROI OVERVIEW SECTION

This section is unchanged from Mobius3D's Plan Checks, other than the addition of the Delivered MobiusFX dose column.

All percent differences are calculated by comparing the TPS dose to the Delivered MobiusFX dose.

5.10 NOTES AND APPROVALS

This section is unchanged from Mobius3D's Plan Checks.


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6. MOBIUSFX TREATMENT SUMMARIES This section is reserved for a future feature addition.

Chapter 7. Quick Calc Utility

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7. QUICK CALC UTILITY While Mobius3D Plan Checks contain a large amount of useful information, they require CT scans, 3D dose, and structures

to be transferred from an external TPS. The Mobius3D Quick Calc utility allows users to verify doses in an artificial water

phantom at a single point, by manually entering key parameters. This utility allows users to perform MU checks on patients

that do not have full 3D treatment plans.

The Mobius3D Quick Calc feature is intended as a secondary check and not a primary treatment planning system.

7.1 PERFORMING A PHOTON QUICK CALC

Users can access Quick Calcs by hovering the mouse pointer over the "Quick Calc" menu in the header, and then selecting

"Photon Quick Calc".

The following screen will appear:


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Patient name, Patient ID, and Beam Names can be entered. These fields are informational only and do not affect

the MU calculation.

Select the correct treatment machine in the "Machine Name" dropdown.

Jaw openings are entered as total opening size. For example, if a field has X1 = 6 cm and X2 = 6 cm, you would

enter 12 cm as the "X Opening".

SSD is the source to surface distance in cm.

Depth is the distance from the surface to the point of calculation.

Beam dose is the cGy the beam should deliver. (Maximum beam dose allowed is 1000 cGy)

If TPS MU is entered, the percent difference between the Mobius3D and TPS MUs will be displayed.

Blocked field sizes cannot be larger than open fields. Mobius3D will set MLC positions to create an opening that

matches the blocked field size. This allows the calculation to be adjusted for flash.

Note: The Photon Quick Calc utility does not support Tomotherapy calculations.

After these values are entered, click the "Compute Quick Calc" button. Mobius3D will internally perform a full collapsed

cone calculation using a geometric water phantom set to the SSD entered. After a few seconds, results will be displayed on

the screen. A PDF report is available for exporting by clicking the "View PDF" button that appears.

7.2 PERFORMING AN ELECTRON QUICK CALC

Users can access Quick Calcs by hovering the mouse pointer over the "Quick Calc" menu in the header, and then selecting

"Electron Quick Calc". The following screen will appear:

Chapter 7. Quick Calc Utility

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Patient name, Patient ID, and Beam Names can be entered. These fields are informational only and do not affect

the MU calculation.

Select the correct treatment machine, beam energy, and applicator using the dropdowns.

Mobius3D will use the cutout size both for its output factor calculation and its depth dose calculation. All cutouts

are modeled as rectangles. Users should find the smallest size rectangle (rotated at any angle) that encompasses

the patient's cutout to determine its equivalent rectangle. The calculation will be the same no matter which side is

entered as the length or width.

SSD is the source to surface distance in cm.

Depth % is the isodose line of electron treatment (i.e., 100% or 90%).

Beam dose is the cGy the beam should deliver. (Maximum beam dose allowed is 1000 cGy)

If TPS MU is entered, the percent difference between the Mobius3D and TPS MUs will be displayed.

After these values are entered, click the "Compute Quick Calc" button. Mobius3D will internally perform a full PBRA

calculation using a geometric water phantom set to the SSD entered. After a few seconds, results will be displayed on the

screen. A PDF report is available for exporting by clicking the "View PDF" button that appears.

7.3 ASYMMETRIC JAWS, OFF-AXIS POINTS, ETC.

Mobius3D's Quick Calc has fewer settings compared to other manual MU calculation software. This is intentional. The Quick Calc was designed to produce accurate answers and minimizing potential user errors. The calculation point is always along central axis, jaws are always symmetric, etc. If a plan needs these extra settings for an accurate dose calculation, it is recommended that a full plan be created in a TPS so a full Mobius3D Plan Check can be created.


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8. ELECTRON CALCULATIONS Mobius3D uses the pencil beam redefinition algorithm (PBRA) to perform electron calculations. PBRA calculations were

implemented with assistance from Dr. Ken Hogstrom's research group at Mary Bird Perkins Cancer Center. PBRA was

chosen due to its high accuracy, abundance of previous publications, and ease of commissioning.

For more information on PBRA dose calculations, refer to A. Shiu, K. Hogstrom, Pencil‐beam redefinition algorithm for

electron dose distributions, Med Phys, 18, 7-18 (1991) and R. Boyd, K. Hogstrom, G. Starkschall, Electron pencil beam

redefinition algorithm dose calculations in the presence of heterogeneities, Med Phys 28, 2096-2104 (2001).

8.1 ELECTRON CALCULATION LICENSING AND CONFIGURATION

All Mobius3D licenses include electron calculations, although a license file is needed to perform electron calculations.

Please contact Mobius support with a list of electron energies and R90 values to obtain a license.

Mobius3D is calibrated to calculate a dose of 1 cGy/MU at dmax for a 10x10 applicator at 100 cm SSD. If your clinic uses a

different calibration specification, you must customize the default output factors to match your settings. Learn more about

customizing output factors in 10.6.4 Electron Output factor customization.

Ep,0 and σ-θ-x data from a representative sample of machines were curve fit to R90 values in order to generate correct

inputs for PBRA calculations. This was repeated for a variety of energies for different linear accelerator manufacturers. Due

to this, users only need to specify their energies' R90 (depth of the distal 90% point on an electron PDD curve) values for

10x10 fields in order to commission Mobius3D's electron PBRA calculations.

Mobius3D includes reference data for electron output factors and off-axis ratios. Off-axis ratios for electron beams cannot

be modified at this time.

8.2 PERFORMING ELECTRON CALCULATIONS

Currently, Mobius3D only supports Electron Quick Calcs. Information about these can be found in 7.2 Performing an

Electron Quick Calc. The full PBRA electron calculation algorithm is used for Quick Calcs.

Chapter 9. Brachytherapy Calculations

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9. BRACHYTHERAPY CALCULATIONS Mobius3D supports LDR, MDR, and HDR brachytherapy calculations. This feature requires a separate license to be

purchased. Mobius3D automatically imports DICOM RT-Plan brachytherapy plans, performs AAPM TG-43 point dose

calculations at all reference points, and generates a report showing the compared doses. Users only need to transfer the

RT-Plan - Mobius3D does not use CT scans, structures, or 3D dose in its comparison.

9.1 CALCULATION OVERVIEW

Mobius3D performs a standard AAPM TG-43 calculation at all reference points. Mobius3D includes all TG-43 parameters for

its supported sources.

9.1.1 AAPM TG-43 CALCULATION PARAMETERS

TG-43 parameters were compiled from TG-43, TG-43 updates, TG-43 errata, and the High Energy Brachytherapy Source

Dosimetry (HEBD) Working Group report. TG-43 parameters are not user-adjustable.

Mobius3D performs a point source calculation. 2D aniostropy data for all sources are converted into point source

approximations (i.e., the dependence on is removed). This allows Mobius3D to perform calculations without knowing the

orientation of the sources, which is often not specified in DICOM RT-Plan input files.

9.1.2 DICOM DATA IMPORT

Mobius3D only accepts DICOM RT-Plan files as input. They can be transferred to Mobius3D in the same manner as any

other TPS output - via a DICOM push or by manual upload in the 10.2 DICOM Files configuration page. The isotope, source

manufacturer and model, air kerma strength, source coordinates, reference point coordinates, and reference doses are

imported.

Not all TPSes export reference doses. In this case, users will need to manually enter doses by 9.2.5 Changing Brachytherapy

Plan Check Settings for each plan.

9.1.3 SOURCE CATALOG

In a future version of Mobius3D, users will be able to specify which TG-43 data set to use for each imported source, as well

as keep a source catalog of calibrated sources.

9.1.4 SUPPORTED BRACHYTHERAPY SOURCES

Please see Appendix G.2.4 Brachytherapy Source Compatibility for information on currently supported brachytherapy

sources.


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9.2 VIEWING A BRACHYTHERAPY PLAN CHECK

The Plan Check screen is where you can interactively review the analysis that Mobius3D performs for a treatment plan.

Access the Plan Check screen by clicking the View Plan Check button for a plan on the home screen. 4.1 Navigating the Plan

Check Screen is the same for external beam and brachytherapy plans.

9.2.1 SOURCE OVERVIEW SECTION

This section identifies all source information read from the DICOM plan. Mobius3D uses this information to select the

proper TG-43 reference source data for its TG-43 calculation.

9.2.2 PLAN OVERVIEW SECTION

This section lists all dwell locations, their coordinates, and dwell times. For permanent implants, dwell times will be

displayed as >20 years. Some TPSes export 2 data rows for each dwell position, one having zero time. Mobius3D uses the X,

Y, Z coordinates and dwell times as inputs to its TG-43 calculation.

Chapter 9. Brachytherapy Calculations

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9.2.3 REFERENCE POINTS SECTION

Mobius3D calculates dose at all imported reference points, displaying single fraction results. Mobius3D's dose is compared

to TPS values to generate pass / warn / alerts. For an accurate comparison, export single fraction results from your planning

system. Reference points and dose comparison tolerances can be edited by 9.2.5 Changing Brachytherapy Plan Check

Settings.

9.2.4 NOTES AND APPROVALS SECTION

This section is identical to the 4.8 Notes and Approvals Section for external beam plans.

9.2.5 CHANGING BRACHYTHERAPY PLAN CHECK SETTINGS

If you want to adjust settings for only the current plan check and re-compute it, click the Plan Check Settings icon on

the Vertical Sidebar.Settings on this screen are analogous to global configuration options described in Chapter 10:

Configuration Options except that they apply only to the current plan. The "Dose Reference Points" section only appears in

the local plan check settings.

After you have made the desired changes, click the Recompute Plan Check button at the bottom of the screen.


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10. CONFIGURATION OPTIONS This chapter describes the Diagnostics, Configuration, and Maintenance Options for Mobius3D.

10.1 CONFIGURATION SCREEN

The Configuration screen is a categorized button menu used to access all the global configuration and maintenance options

for your Mobius3D software. System administrators can navigate to this screen from any window by clicking the

configuration icon on the top-right of the menu bar. Users that do not have administrative privileges will not see this

icon or be able to access these settings.

Note: The global settings for ROIs and Plan Checks are accessed through this menu. Some global settings can

be overridden for individual plan checks by using the Local Plan Check Settings icon within a plan check (See 4.9 Changing Local Plan Check Settings).

Chapter 10. Configuration Options

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10.2 DICOM FILES

The DICOM Files screen allows you to view the information tag labels and values from any

DICOM file which has been loaded into Mobius3D. It also allows you to upload additional

DICOM or treatment log files, as well as download an anonymized version of the DICOM data.

To upload a set of DICOM files or treatment log files to the software, you should first create a single ZIP file containing all

files you would import. Then click the "Choose File" button and select the ZIP file. You may now click the "Upload DICOM

File" button. It may take several minutes for the file to be transmitted, depending on network speed. After the file is

received, a banner will appear on the top of the page.

You can find any individual DICOM file by searching/selecting the following in order:

Patient

Patient Name and/or Patient ID.

Note that after a patient is selected you can download that patient’s anonymized DICOM data by clicking the blue

Download anonymized DICOM button.


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Modality

The type of DICOM file (RTPlan, RTDose, RTStruct, or CT)

Series UID

The Unique IDentifier (UID) string for the associated series of DICOM files

SOP Instance UID

The Service Object Pair (SOP) UID for the individual DICOM file from the selected series.

Once an individual DICOM file is selected, all of the tags from the selected DICOM file are shown below. The tag labels are

boxes with dark gray values. The values are to the right of the tag labels. Values which are arrays must be expanded to see

their data by clicking on the plus sign .

10.3 DELIVERY FILES

The Delivery Files screen allows you to upload delivery files directly to Mobius3D/MobiusFX, as

well as view the list of files that MobiusFX has scanned.

To upload a set of treatment log files to the software, you should first create a single ZIP file containing all files you would

import. Then click the "Choose File" button and select the ZIP file. You may now click the "Upload Delivery File" button. It

may take several minutes for the file to be transmitted, depending on network speed. After the file is received, a banner

will appear on the top of the page.


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The table of scanned treatment files shows what files MobiusFX has scanned. This list is especially useful to monitor which

files have automatically been imported through a network share. It will also show files that have been manually uploaded.

It is important to note that the RTPlan must have been uploaded to Mobius3D within the previous 30 days for the MobiusFX

plan check to run. If the plan check does not begin, try pushing the plan to Mobius3D again to begin the plan check. If

MobiusFX still does not detect an RTPlan after 24 hours, or the log files have stopped attempting to associate to a RTPlan,

the plan check will not run. If this occurs, you will need to re-import the plan and/or the treatment files, depending on

which object (RTPlan or treatment files) is still within Mobius3D.

10.4 SYSTEM LOGS

If you are having issues with Mobius3D, our tech support team may ask you to go to your

System Logs screen, download log files, and send them to us. Note that log files in the "NON-

HIPAA-Compliant (may contain PII data)" section may contain patient information.

While most of these logs are only useful to our support team, the "mms_webapp_access.log" file contains a complete list of

each user's actions. This log may be useful for IT departments that monitor employee access of patient records.

10.5 RESOUCE USAGE

If you are having issues with Mobius3D, our tech support team may ask you to go to your

Resource Usage screen and send screenshots to us. The graphs in this screen tell us how many

resources your server is using to perform dose calculations and routine operations.

10.6 MANAGE MACHINES

Your license file, provided by Mobius Medical Systems, is necessary to operate your

Mobius3D software. It contains custom information about your institution’s machines. This

screen shows you the linear accelerators for which you are licensed to use with Mobius3D,

as well as allowing you to customize beam models and view beam model reports.

10.6.1 UPLOAD LICENSE FILE

If you wish to add another linac, or update information for a current linac,

you should first request a new license file by contacting customer support.

After receiving the file, you should click Choose File to select it and then click

the Upload License File button to apply the update.


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10.6.2 CURRENT MACHINES

In Current Machines, every linac currently registered in Mobius3D is listed with its key information. At the right are the

calibration dose values you provided for the linac (dose for 100 MU, 10 cm depth, 10x10 cm field). Clicking on any one of

these values opens a beam model report for the selected energy.

Note: If there is an entry in the Matched Machines column, it indicates that the linac listed in the Machine Name, will

always use the same beam model as the Matched Machine.

10.6.3 BEAM MODEL REPORTS

Clicking the dose calibration values in the Current Machines table opens a beam model report PDF file for the selected

energy. This is a useful tool for comparing Mobius3D’s beam characteristics to measured data or to beam model

characteristics of your TPS. Using beam model reports is a recommended part of commissioning Mobius3D (See 11

Commissioning).

10.6.4 ELECTRON OUTPUT FACTOR CUSTOMIZATION

The right-hand side of the Current Machines table lists electron energies and their R90 values. Hovering your mouse over an

R90 value displays its output factor table.

Clicking on the R90 value displays a new page that allows users to download a CSV of the output factors (including cutout

factors), edit the CSV to match the clinically-measured values, and upload the edited CSV to Mobius3D. All output factors

are specified relative to a 10x10 open field at dmax at 100 cm SSD.

If your machine is calibrated differently, all output factors will need to be scaled by the difference between your calibration

and Mobius3D's calibration point. For example, if you calibrate to a 15x15 field at dmax at 100 cm SSD, you may need to

divide all output factors in the CSV by 1.01 (or your clinical difference between 15x15 and 10x10 OFs).


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After downloading the CSV file for each energy, users can use a program like Microsoft Excel to edit the output factors.

Mobius3D will produce an error if any Energy, Applicator, or Insert values are modified. A red banner will be displayed

describing the error. Mobius3D's output factors will remain unchanged.

If the import is successful, a green banner will appear and the output factor table will change accordingly.


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After successfully uploading a CSV file, users should verify Mobius3D's displayed output factors match their intended

values. Users should also perform a series of simple calculations to verify the updated air gap and cutout factors are being

applied correctly.

10.6.5 USING REFERENCE BEAM MODELS

Mobius3D contains an internal database of reference beam model parameters for every manufacturer/model of linac it

supports. Using the reference beam models should provide accurate results for comparison to your TPS calculated dose. If

you wish to use the reference beam models for your linac(s), no additional work is necessary.

Note: The calibration dose point you provided (dose for 100 MU, 10 cm depth, 10x10 cm field) does not affect the reference beam model parameters. The measurement is used only to compute a constant factor to uniformly scale dose computed by the model.

10.6.6 CUSTOMIZE MACHINE CONFIGURATION

Mobius3D comes with a full set of machine

configuration values. However, you may customize

certain parameters in this section. To customize

parameters, select the Machine and Energy, type

new values, and then click the "Change Machine

Configuration" button. Changes will take effect

immediately.

User-adjustable parameters are:

DLG correction from M3D's default

Mobius3D performs full rounded leaf end

calculations. It also applies a separate leaf

gap adjustment to MLC openings to adjust

for differences between real-world

dosimetry and the inherent model.

Mobius3D has a different inherent DLG

value for every MLC. Altering the default

DLG value (typically between -0.5 mm and

+0.5 mm) will result in different absolute

dose calculations for IMRT and VMAT plans. This should only be done if your clinic has measured multiple IMRT

and VMAT plans with a cylindrical ion chamber (not a 2D or 3D array device, which have complicated absolute

dose calibrations) and found the absolute dose M3D calculates to disagree with your measured values. Positive

DLGs result in higher doses, while negative DLGs result in less dose.

Dose rate

The dose rate is used only to calculate treatment times in Plan Checks.


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Max MU per field

This is used to calculate deliverability in Plan Checks (to ensure each beam's MU is below the maximum)

Distance between isocenter and gantry surface

Mobius3D calculates gantry clearance in Plan Checks by modeling the linac as a cylinder. This value is the distance

between isocenter and the face of the gantry. Higher values will result in less plans failing gantry clearance.

Gantry radius

This is the radius of the cylinder for gantry clearance calculations. Higher values will result in more plans failing

gantry clearance.

10.6.7 CUSTOMIZING BEAM MODELS

If you wish to customize your beam model parameters instead of using a reference beam model, you can use the

Mobius3D’s automodeling feature. This will require additional measurement data and potentially several hours of

Mobius3D computation time per beam.

Beam model customization is not recommended until you have begun a commissioning process. Customizing your beam PDD or OAR values is only recommended if your machine differs by more than 3% from the reference data. Beam model customization should only be performed by qualified personnel.

To perform beam model customization, you should select the Machine, Energy, and Wedge for the desired beam. Then you

should enter measurement data for all of the indicated sections and click the Queue Beam Model Customization button.


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Note: All physical wedge beams are modeled using built-in characteristics of physical wedges. Off-axis ratios cannot be customized for wedges. All Output Factors are relative to the 10x10 cm open field (not relative to the wedged 10x10 field). Dynamic and Virtual wedges use the open beam model and the manufacturer's STT table for profile and output calculations, and cannot be modified.

As a general guide, physical wedge output factors tend to be more machine-specific than open field output factors. Most

notably, for Varian 15 degree and 30 degree hard wedges, the wedge output factors may need to be adjusted to match

your specific wedge output factors. It is still recommended that you perform your calculations using the reference beam

model prior to adjusting these factors.

For more technical information on Mobius3D’s beam modeling principles, refer to the Dose Calculation White Paper

available at http://www.mobiusmed.com/mobius3d/dose-calculation/.

10.7 ROI SETTINGS

The ROI Settings screen allows you to:

Customize the ROI types you wish to analyze in Mobius3D

Set up ROI name matching conventions between names used in your TPS and

names used in Mobius3D

Set up the DVH limits you wish to apply to each ROI type

Note: The global DVH limits set here can be overridden for individual plan checks by using the Local Plan Check Settings

icon within a plan check.

ROI setting customization should only be performed by qualified personnel.

10.7.1 ROI LIST

The ROI List portion of the ROI Settings screen shows you all of the ROIs

that are defined for analysis in Mobius3D. Clicking on an ROI opens its

settings windows to the right.

The first section of the ROI list is for Special regions and includes Body and

Targets. You cannot add or delete any Special regions. The Body region is

used to define the patient boundary, outside of which Mobius3D will set

all density to zero (except for density overrides). This behavior can be

changed on the Plan Check Settings page (10.8 Plan Check Settings). The

Targets region allows you to include any individual ROIs from your plans

you want to analyze in the Target Coverage section of the Plan Check

screen.

The second section of the ROI list is for standard ROIs. You may add or

delete ROIs in this section. The initial list of ROIs used by Mobius3D is

based on the DVH objectives defined in RTOG protocols and by the AAPM

http://www.mobiusmed.com/mobius3d/dose-calculation/


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TG-101 Report.

The buttons below the ROI list are:

Back

Navigates you back to the main Configuration screen.

New ROI

Opens a popup dialog for you to enter the name of a new ROI to add to the standard ROIs.

Reset Everything

After a confirmation, this will reset all ROI settings to the defaults including removal of any custom ROIs you have

created.

Delete ROI (located under DVH Limits)

After a confirmation, this button deletes the currently selected ROI.

10.7.2 NAME SETTINGS

If you use any naming variations for structures in your TPS, you should use the Name Settings section to allow Mobius3D to

match its ROIs to the appropriate structures. Clicking an ROI in the ROI list opens its name settings to the right.

In the Names column, you should add any name you may use for the ROI in your TPS by entering them in the text box. You

can remove names by clicking the red X next to them. Names are not case sensitive.


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In the TPS Name Matching column, you should check the matching options you wish to apply to variations of the names:

Include names with left and right labels…

Check this to match ROIs which include any of the additional text strings (left, lt, l, right, rt, r)

Exclude names that contain special characters…

Check this to never match ROIs which include special characters (+, -, and .)

Exclude names that contain the word “ring”

Check this to never match ROIs containting “ring” or "extrude" in the name (unless it is explicitly part of a name).

Match the exact phrase….

Check this to require that a match uses a name as a discrete word, not as part of a longer word.

Name must start with the phrase…

Check this to require that the ROI name from the TPS must begin with the exact phrase of a listed name.

10.7.3 DVH LIMITS

The DVH Limits portion of the ROI Settings screen configures the checks which will be applied in the DVH Limits section of

the Plan Check screen. You can edit any existing limit in the list. You can also “Add a new limit” by clicking that text at the

bottom of the list, or remove a limit by clicking the red at the right. The columns are as follows:

Enabled

If this is checked, the DVH limit defined in this row will be applied to any newly loaded plans which use the

denoted Fractionation scheme.


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Type

Select if the limit being checked will apply to

o Max Dose

o Mean Dose

o Volume (%) Limit

o Volume (cc) Limit

o Volume to Spare (cc)

Volume

Enter the limiting volume quantity in cubic centimeters (cc) or % of ROI volume. This column is not relevant for

Max Dose or Mean Dose limits.

Dose (Gy)

Enter the limiting dose value in Gy.

Fractionation

Select the fractionation scheme with which the DVH limit is associated. Mobius3D applies the DVH limits

corresponding to number of fractions in the plan. Choices are:

o 1 Fraction SRS (used for plans with one fraction and a reference dose >3.5 Gy/fx)

o 3 Fraction SBRT (used for plans with two or three fractions and a reference dose >3.5 Gy/fx)

o 5 Fraction SBRT (used for plans with four or five fractions and a reference dose >3.5 Gy/fx)

o Conventional Fractionation (used for plans with more than five fractions, or any plan with a reference

dose <=3.5 Gy/fx)

Notes

Enter any desired notes for the limit. Mobius3D uses this column to reference the source of its default limits.

10.8 PLAN CHECK SETTINGS

The Plan Check Settings screen allows you to modify some of the general parameters and

threshold levels for the plan check.

Note: The global plan check settings on this screen can be overridden for individual plans

by clicking the Settings button for the plan and making the desired changes.

Plan check settings customization should only be performed by qualified personnel.

10.8.1 BRACHYTHERAPY

Dose Difference Alert Criteria

Mobius3D will generate an

alert if the Mobius3D dose

differs from the TPS dose by

more than this value.


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Dose Difference Warn Criteria

Mobius3D will generate a warning if the Mobius3D dose differs from the TPS dose by more than this value.

10.8.2 CT COUCH REMOVAL

The CT couch area is commonly removed from TPS dose calculations, as it usually does not correspond to the treatment

couch. Mobius3D provides several options to modify how the imported CT scans are truncated. Options are listed in

decreasing priority. For example, if all options are set to yes, and a Body contour is present in a plan, the other two options

will not be used.

Use Body Contour (if present)

Mobius3D’s dose and

density regions will be

contained within special

“Body” ROI (See ROI

Settings). This setting

typically matches the TPS

closely, but no independent

check of couch removal is performed.

Use CT Table Height (if present)

Mobius3D’s dose and density regions will be limited to the volume above the CT table if its height is included in the

CT scanner's DICOM output. This setting performs an independent check of couch removal. It will calculate dose in

immobilization and localization devices, even if they were manually excluded in the TPS dose calculation.

Note: A height can be manually specified in the local settings for an individual plan.

Use Dose Edge

All regions below the lowest non-zero dose point from the TPS dose grid will be ignored.

10.8.3 3D GAMMA

Settings in this section affect gamma calculations in the 3D Gamma and ROI Overview sections of plan checks.

Dose Difference Criteria

This value is the percent difference

criteria used for the gamma

calculation.

Distance Criteria

This value is the distance criteria

used for the gamma calculation.

Dose Threshold

Gamma is only calculated in voxels with either Mobius3D or TPS dose levels of at least this percent of the

reference dose. Any voxels with lower doses are ignored in passing rate calculations.


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Warning Percent

A warning will be indicated if the 3D gamma passing rate is less than or equal to this value, but greater than the

Alert Failure Percent.

Alert Percent

An alert will be indicated if the 3D gamma passing rate is less than or equal to this value.

10.8.4 TARGET COVERAGE

Settings in this section affect the calculations in the Target Coverage section of plan checks.

Mean Dose Difference

If the percent difference between the TPS

and Mobius3D dose is less than or equal to

this value, then a passing result will be

indicated. Otherwise an alert will be

indicated.

Percent Coverage

This value sets the relative volume level to be used from the DVH for the % Coverage check.

Stray Voxel Threshold

If a single contiguous region of voxels is both smaller than this volume and is less than 1% of the total ROI volume,

that region of voxels will be considered stray and an alert will be indicated. A setting of zero will disable this check.

10.8.5 DVH LIMITS

Settings in this section affect the calculations in the DVH Limits of plan checks.

Per-Fraction Boost Dose

If the maximum dose for a plan is less

than the value entered here, then

Conventional Fractionation DVH

Limits set will be applied even if the

number of fractions would otherwise imply SRS/SBRT fractionation limits.

Tolerance Scaling

This factor multiplies the dose levels of all DVH limits by the specified percent value. For example, an original DVH

limit of 50% <30.0 Gy becomes a limit of 50% <33.0 Gy if using a Tolerance Scaling of 110%.

10.9 MANAGE USERS

The Manage Users Screen allows you to manage information for the people who will use

Mobius3D.

The current list of users is shown in the list box on the left of the screen. New users can be


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added by clicking the Add User button below the list and entering their information in the Add New User box which pops

up.

Note: Users must have the Administrator box

checked to allow them to access Global

Configuration Options.

When a current user is selected in the list box,

their information is displayed and can be edited

on the right side of the screen. The Save

Changes button must be clicked to record any

changes. There are also buttons to Change

Password for the user or Remove User.

Removing a user will not affect any of the

previously computed plan data.

10.10 NETWORK SETUP

Network settings determine how the Mobius3D server is connected to your clinic’s network.

Typically these settings would only be edited by IT personnel.

Mobius3D can use DHCP (requires a DHCP server), or may be manually configured.


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10.11 DICOM DEVICE SETUP

The DICOM settings screen allows you to change the Application Entity Title (AE Title)

assigned to Mobius3D. This value is needed for setting up Mobius3D as a DICOM export

node in your TPS. The default value of “MOBIUS3D” is recommended but not required. This

value is typically never changed. Mobius3D uses TCP port 104.

The Receiver Status indicates whether the Mobius3D is currently ready to receive DICOM files from your TPS(s) (UP) or not

ready (DOWN).


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10.12 MANAGE NETWORK SHARES

Network shares can be added to Mobius3D to enable automatic functions. Each network

share can be assigned to one type of task. To add a network share, select if it is an NFS or

CIFS share, enter the hostname / IP address and path information, then select what you

would like to use the share for. Click the "Test Connection" button to verify Mobius3D can

read and write files to the share.

Network shares can do the following:

Search for delivery logs from a linac. Continuously monitors share for delivery logs for MobiusFX usage. MobiusFX

must be licensed for treatment logs to be converted to 3D patient dose.

Write user access audit logs. Mobius3D keeps a record of user activity for patient privacy compliance. Each night

at midnight this audit log can be copied to a network share.

Write PDF reports. Every time Mobius3D or MobiusFX automatically generates a PDF report, it will be copied to

the network share. This can save time when importing PDF reports to R+V systems.

Write unencrypted backups. Every night at midnight Mobius3D will make copies of its patient and system

configuration databases. Patient data will be unencrypted in these files. Please contact Mobius3D support to

restore data backups.

To add other network shares, click the "Add New Share" button. After all network shares are added, click the "Save" button.


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10.13 MAIL SETUP

The Mail Setup screen allows you to set up who will receive the automatic emails with plan

check PDF files that Mobius3D automatically sends. In the settings you can specify the

Sender E-Mail Address and the Default Recipient E-mail Addresses. You may either enter e-

mail addresses in format (e-mail address) or format (Name <e-mail address>).

Furthermore, you must specify the SMTP

Server IP address or DNS name, SMTP Port

number, SMTP User (if required), SMTP

Password (if required), and Connection

Security type. Consult your IT personnel if

these are not known.

You can use the Send Test E-Mail button

to check if you have configured e-mail

settings as desired, and you must click

Save Settings to apply changes.

10.14 CLOCK SETTINGS

On the Clock Settings screen, you should select your local time zone. Local times are used

in the timestamps for activities in Mobius3D. The Network Time Protocol (NTP) Host from

which time is synchronized nightly can be edited if desired.


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10.15 UPDATE SYSTEM SOFTWARE

This screen is used to update your Mobius3D software version. New versions are provided

via an update file. To apply the update, you should click the Choose File button and select

the file. Then click the Apply Update button.

Software upgrades should only be performed by qualified personnel.

10.16 REBOOT MOBIUS3D

Clicking this button will reboot your Mobius3D server after you confirm the action in a

popup window.

10.17 WIPE DATA

Clicking this button will permanently remove all plan checks, patient data, and activity logs

stored in Mobius3D after you confirm the action in a popup window. Executing this option

will not reset your configuration settings.

Before executing this option, you should ensure you have saved PDF reports of all the plan checks for which you wish to retain records.

10.18 SHUTDOWN MOBIUS3D

Clicking this button will shut down the Mobius3D server after you confirm the action in a

popup window.

Chapter 11. Commissioning

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11. COMMISSIONING Mobius3D is designed to perform accurate dose calculations using reference beam data with no configuration.

A basic commissioning procedure should be completed by qualified personnel to verify both your TPS dose calculation and Mobius3D are performing as expected prior to clinical use.

This procedure should require 1 day of effort and result in a better understanding of the dose calculation accuracy for your

TPS, Mobius3D, and MobiusFX.

11.1 VERIFY BEAM MODELING REPORT

The first step is to analyze Mobius3D's reference beam model and determine if it needs to be customized to your site. Click

the Manage Machines button on the Configuration page and view the "Customize Beam Model" section at the bottom of

this page. It lists reference measured values for PDD points, off axis ratios, and output factors. Verify that these values

match your measured values within 3%. We do not recommend customizing your beam models unless there are large

differences (>3%) between Mobius3D’s reference measurements and your measured data. While customizing your beam

model is easy and accurate, using reference beam models allows our support team to more easily replicate your results.

Optionally, you may view a beam model's full PDF report by clicking the cell for the machine and energy you wish to view

(see circle in figure below).

It is not important that the calculated data matches your clinical data within 1%, but it should mostly be within 3%. You will

notice that Mobius3D's calculated data likely has some areas that are 3%-5% different from the measured data. Mobius3D's

automodeling is designed to provide the best matches at medium depths for medium field sizes. Mobius3D uses only one

set of beam modeling parameters, so occasionally water phantom agreement is not perfect. However, this guarantees that

Mobius3D will achieve the same level of accuracy in patient plans.

Do not commission Mobius3D or MobiusFX by matching its output to your TPS. Mobius3D and MobiusFX should only be commissioned by comparison to high-quality measurements.


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11.1.1 BEAM MODEL PARAMETERS (OPTIONAL)

The beam modeling PDF reports have separate sections for every

wedged and non-wedged beam at the energy you selected. The

first page of each section shows the parameters that Mobius3D

uses in its beam modeling formulas.

This parameters page is presented for informational purposes, but is

not necessarily a useful part of commissioning. You cannot directly

change any of these parameters in Mobius3D. They are fixed for

reference models and determined only by the automodeling process

for custom beam models.

11.1.2 BEAM MODEL COMPARISONS (OPTIONAL)

The next section of the beam modeling reports shows Depth-

Dose (pictured) and Profile (not pictured) comparisons between

Mobius3D reference (measured) data and data computed by the

Mobius3D beam model. The top graph plots the data. The

bottom graph shows a 1D gamma computation and relative %

difference computation.

It is not possible to adjust the fit between reference (or measured)

and calculated. Mobius3D's automodeling process generates these

results. These full comparisons are provided so users can gain an

understanding of the calculation accuracy in various locations.

Chapter 11. Commissioning

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11.2 WATER PHANTOM CALCULATIONS

After verifying the beam model matches your clinical data, and becoming familiar with the level of accuracy you should

expect from future calculations, it is recommended that you check approximately 5 simple plans performed on a water

phantom. You should see similar results to the beam modeling report. Additionally, you will be able to check the absolute

output agreement of your TPS calculations. If a 10x10 field does not match well, please contact Mobius support, as the

machine's calibration value likely needs to be adjusted.

Sending a plan to Mobius3D that contains multiple beams at the same gantry angle will result in beam averaging for the

M3D MU value found in the Beam Information section of your Plan Check (i.e., single point calculation). This is a result of

Mobius3D combining all beams in a plan that have the same gantry angle when performing its calculations and assists in

reducing computation time. Thus, sending multiple beams at the same angle in one test plan will result in a combination

dose over the entire plan (i.e., all fields). If the M3D MU value is calculated using an average of multiple fields there will be

a icon next to the calculated value. Each field/plan should be sent to Mobius3D individually in order to obtain individual

results for the Mobius3D MU output value for a single field.

11.3 SIMPLE PATIENT CALCULATIONS

Next, check ~10 patient calculations with simple beam geometries, such as open fields, dynamic wedges, and physical

wedges. If 5% / 3 mm gamma passing rates are not >98%, you may need to adjust your TPS or Mobius3D beam model. If the

mean target doses are not within 3%, you may need to adjust your machine's calibration factor or its output factors.

11.4 DLG ADJUSTMENT

The DLG can be adjusted on a per-machine, per-energy level. For each energy, you should calculate approximately 5-10

IMRT and VMAT plans on a water phantom with an insert for a single, cylindrical ion chamber. We do not recommend using

diode or ion chamber arrays, as their calibrations are complex and they do not measure PTV dose as accurately as a

cylindrical ion chamber. Before transferring the plans to Mobius3D, make sure the air cavity in the ion chamber has a

density override to 1.0, otherwise Mobius3D will display a reduced dose to air. After measuring these plans, look at the

mean ion chamber to Mobius3D (and MobiusFX, if licensed) dose. If the mean dose differs by more than 2%, adjust the DLG

value for the machine, recalculate the plan, and repeat until the dose is within 2%.

11.5 COMPLEX PATIENT CALCULATIONS

Perform approximately 10 checks with IMRT and VMAT plans on very heterogeneous regions (lung, head and neck, etc.) to

verify that 5% / 3 mm gamma passing rates are >90%, areas of gamma failures are limited to in or near heterogeneous

regions, and mean target doses are within 5%. If any plan is outside of these ranges, review the Mobius3D beam model,

your TPS beam model, and contact Mobius3D support before using Mobius3D clinically.

11.6 ANALYZE YOUR TPS BEAM MODEL

Dose discrepancies result from dose calculation algorithm (i.e., collapsed cone, Monte Carlo, etc.) differences, and beam

modeling accuracy differences. Mobius3D is designed to use only automodeled parameters, ensuring consistent beam


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performance. It is recommended to review your TPS beam model for accuracy of modeled data, and accuracy of output

factors.

General tips:

Do not use multiple beam models that are field size dependent. While this technique can lead to excellent

agreement in water tank profiles, its interpolated field size beam parameters can cause problems in patient

calculations.

If possible, turn off electron contamination and verify depth dose calculations are accurate past dmax. If they are

not accurate, your TPS model may be relying too heavily on electron contamination.

The measured and calculated agreement in water tank geometries should be similar to Mobius3D's agreement:

>90% agreement at 2% / 2 mm for most fields, and 3% / 3 mm for lesser-used fields.

Verify your TPS calibration factor and output factors are correct.

If your machine is used for IMRT or VMAT calculations, verify there are profiles of MLC-collimated fields measured

using a diode or 0.01 cc ion chamber.

Verify output factors of small MLC fields with large jaw settings match your TPS calculations.

11.7 TOMOTHERAPY COMMISSIONING

Mobius3D performs 3D calculations of TomoTherapy plans. During your commissioning, if Mobius3D doses are consistently

inaccurate for the majority of your TomoTherapy plans, we recommend that you verify the absolute calibration values. All

TomoTherapy licenses are set in Mobius3D to the default TomoTherapy output calibration value that is expected to match

the full range of clinical TomoTherapy machines within 2%. We recommend measuring a series of IMRT plans with an ion

chamber, and then calculating dose for these plans with Mobius3D. As with any Mobius3D ion chamber calculation, ensure

the ROI density of the chamber cavity is overridden to 1.0 in your TPS so you are not calculating dose in air. Users should

verify that the average measured to Mobius3D calculated ratio is 0.98 - 1.02 (i.e., within 2%). If it is not, please contact our

support team and ask for a license which has a calibration value that better matches your machine's output.

If Mobius3D doses match well with your TomoTherapy plan doses for 40x5 cm field plans, but are inaccurate for smaller

field size plans, you may need to adjust the small field size output factor values for the TomoTherapy machine. To edit the

output factor value, i.e. for 1 cm field width, we recommend measuring multiple plans that include a 1 cm field size with an

ion chamber and calculating doses with Mobius3D. Again, ensure that the ROI density of the chamber cavity is overridden

to 1.0 within your TPS. You will then be able to obtain the ratio between the ion chamber measurements and the Mobius3D

calculated doses. Utilizing that data, you may adjust the output factors for your machine accordingly. For details on

TomoTherapy calculations, see Appendix F TomoTherapy Calculations.

Chapter 12. Troubleshooting

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12. TROUBLESHOOTING This chapter will describe some issues which may arise and possible troubleshooting actions.

12.1 COMPATIBILITY ISSUES

Following are the known Mobius3D compatibility issues for Mobius3D version 1.4.2 rev 1.0. Updates will be posted at

mobiusmed.com. If your clinic experiences compatibility errors, please contact Mobius3D support. We will likely ask for

anonymized DICOM data to help us test new features.

12.1.1 VARIABLE SLICE WIDTH CT DATA

CT scans with variable slice widths (for example, 2 mm near the PTV region and 5 mm on the periphery) are not currently

supported.

12.1.2 ADVANCED BOLUS PLANS

Bolus plans are supported, as long as each beam in any given fraction group (typically each prescription) has the same

bolus. For example, a breast plan with bolus for medial and tangent beams, but no bolus for the supraclavicular field, will be

supported as long there are separate fraction groups (i.e., prescriptions) for tangent and supraclavicular beams.

If your plan contains multiple boluses in the same fraction group, please contact Mobius3D support. As a workaround, you

may separate the beams into different fraction groups (i.e., assign beams with bolus to one prescription, and beams

without bolus to a different prescription).

12.1.3 STEREOTACTIC CONES

Cone collimated beams are not supported, although micro MLC plans are supported. Future support for cones is planned as

an add-on module.

12.1.4 VARIAN LOWER WEDGES

Varian machines with physical wedges in the upper tray slot are supported. Physical wedges designed for the lower tray are

not supported. No support is currently planned for this feature.

12.1.5 ELEKTA OMNIWEDGE

Mobius3D does not support Elekta Omniwedge deliveries. No support is currently planned for this feature.

12.1.6 AFTERMARKET WEDGES

Mobius3D does not support aftermarket (non-OEM) physical wedges. No support is currently planned for this feature.


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12.1.7 CYBERKNIFE MACHINES

Dose calculations of CyberKnife machines are not supported. Future releases may support displaying DVH objective data

without recalculating the plan, but no support is currently planned to calculate CyberKnife plans.

12.1.8 BRAINLAB VERO

Dose calculations of Vero machines are not supported. Future releases may support displaying DVH objective data without

recalculating the plan, but no support is currently planned to calculate Vero plans.

12.1.9 VIEWRAY

ViewRay calculations are not supported. Future releases may support displaying DVH objective data without recalculating

the plan, but no support is currently planned to calculate Viewray plans.

12.1.10 PROTON CALCULATIONS

Dose calculations of proton plans are not supported. Future releases may support displaying DVH objective data without

recalculating the plan, but no support is currently planned to calculate proton plans.

12.2 PROCESSING ERRORS

If a compatible plan is transferred to Mobius3D and a plan check is not generated, please check the following:

The entire DICOM-RT data set (Plan, Structure Set, CT, Dose) was sent, even if the TPS plan is a recalculation.

Note: If you recalculate a plan in your TPS and Mobius3D has a previous version, you typically do not need to resend the CT images. However, all other DICOM-RT objects are regenerated with different UIDs and must be sent together.

You are licensed to calculate dose for the specified treatment machine.

If your plan still does not process, please send the anonymized DICOM data to Mobius3D support.


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12.3 DOSE DISCREPANCIES

Mobius3D allows physicists to perform dose verifications in an entirely new manner. A million voxels, some near surfaces

and extreme heterogeneities, are recalculated and compared to output from an independent and complex treatment

planning system. Understanding differences, and whether they are clinically significant, is perhaps the biggest challenge in

transitioning from single point Clarkson verifications to 3D recalculations.

12.3.1 GENERAL TROUBLESHOOTING

The first step of troubleshooting dose discrepancies is to make sure all General Commissioning Guidelines have been

followed. This will help identify sources of error in your TPS, TPS beam model, or M3D beam model. If most plans have good

agreement, but there is an outlier, try the following steps:

Verify density overrides in your TPS are displayed correctly in Mobius3D's ROI Overview section.

Verify the patient images and ROI positions in Mobius3D's 3D Gamma graphic accurately reflect your TPS data.

Verify the TPS dose grid (the dashed blue line in Mobius3D's 3D Gamma graphic) is large enough to cover all

beams.

Decrease your TPS calculation voxel size to ~3 mm, change the TPS dose algorithm to the most rigorous available,

and transfer the updated plan to Mobius3D.

Compare Mobius3D's TPS DVH Graphs to your TPS to verify your TPS is correctly computing DVH values.

Review Mobius3D’s Beam Information table and look for beams with outlier dose differences. Make a copy of the

plan in your TPS, delete all but one beam, and perform a single beam comparison.

Make a copy of the plan, perform a 1.0 g/cc density override of the entire patient, recalculate, and send the

homogeneous plan to Mobuis3D for heterogeneity difference troubleshooting.

Verify your TPS beam model. Some TPS beam models give users nearly unlimited freedom, allowing them to make

multiple models customized to square field sizes (which may not interpolate well for real-world use), or change the

energy spectrum in a manner that leads to good agreement in water profiles but not heterogeneous plans, etc.

If there are still significant differences in dose calculations after these steps, please contact Mobius3D support. We will ask

you to send us an anonymized plan so we can use our internal tools to analyze advanced aspects of your beam model and

our calculation's performance.

12.3.2 TARGET COVERAGE DIFFERENCES

Target coverage differences are typically due to output factor differences or couch removal issues. If your Mobius3D beam

model used Automodeling, ensure the proper output factors were entered. Ensure that you are using CT Couch Removal

settings corresponding with how your TPS operates for the plan.

If the target is a lung tumor, the difference may be due to Mobius3D's re-buildup calculations compared to the TPS

calculations. If this is the case, you may also see several areas of gamma failure in the lung in Mobius3D’s 3D Gamma


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graphic. It is recommended that you perform TPS and Mobius3D calculations using 3 mm dose grids with the most rigorous

calculation algorithm available.

12.3.3 GAMMA FAILURES IN THE TREATMENT COUCH

If red streaks of gamma failures (meaning Mobius3D has calculated a higher dose)

appear in the couch, this typically indicates Mobius3D's couch removal process

does not match the TPS couch removal. You should try changing either the

settings in your TPS or Mobius3D and re-calculate. In the example image shown,

the CT table height option was selected, but the CT scanner did not provide a

table height in the DICOM data set. The couch was not removed, and dose was

calculated in the CT couch.

12.3.4 DIFFERENCES IN AIR AND BONE

Dose calculations at heterogeneities are likely to display the

largest difference. Mobius3D uses a rigorous collapsed cone

algorithm, and performs full-quality ray tracing through every

voxel of air. Some TPSs may not perform rigorous air

calculations. It is normal to observe dose differences that are

mostly confined to heterogeneous regions and not affect the

overall agreement. Differences in air are not clinically significant,

although differences in bone calculations may be. Contact

Mobius3D support if you see large differences in heterogeneous

plans that extend beyond buildup regions and affect overall plan

performance.


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12.3.5 BUILDUP REGION DISAGREEMENTS

Mobius3D may calculate more dose in buildup regions due to its rigorous use of 144 isotropic cones. Additionally,

Mobius3D’s automatic beam modeling ensures there is a correct amount of electron contamination. Large differences in

buildup regions are typically caused by these parameters not modeled or calculated well in the TPS beam model. You

should examine your TPS beam model and ensure that the electron contamination parameters are accurately defined (See

11.1 Verify Beam Modeling Report).

12.3.6 LARGE AREAS OF HIGH GAMMA FAILURES

Large regions of red gamma failures typically indicate that the TPS dose grid is smaller than the Mobius3D dose grid, or that

Mobius3D did not remove the same couch voxels as the TPS. You should ensure the TPS dose grid covers the entire dose

calculation region, and Mobius3D's couch removal options are working correctly for the plan.

12.4 POINT DOSE DISCREPANCIES

The point dose difference in the Beam Information table is for informational purposes only. While it is an accurate

calculation of dose at that point compared to your TPS dose at that point, our testing has found that it is normal to see

differences as high as 10-15% (although most differences should be <5%). This is likely due to the reference point being

near a high gradient region. While point dose differences can be useful in troubleshooting dose calculation differences, or

performing checks on simple fields, it is recommended to use 3D gamma and mean dose differences to perform plan check

evaluations.

12.5 DVH AND MEAN DOSE DISCREPANCIES

If the Mobius3D DVH graph or mean dose values do not match those calculations in your TPS, it is recommended to check a

series of basic plans with low dose gradients. If you cannot resolve the difference, please send the anonymized plan to

Mobius3D support and we can thoroughly verify our calculations for your plan.

12.6 DVH LIMIT ALERTS

If many of your treatment plans generate DVH objective alerts, you can increase the default Tolerance Scaling parameter. It

is typical for plans to be generated that conform very precisely to the objectives, or slightly exceed them. A Tolerance

Scaling value of 105% or 110% will allow for small exceedances and still alert staff of large discrepancies.

12.7 GANTRY CLEARANCE ALERTS

The gantry clearance calculation parameters are user-adjustable. It is recommended that users use Mobius3D's gantry

clearance alerts as a guide to help determine whether individual patient's clearances should be manually checked.


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12.8 DELIVERABILITY ALERTS

Mobius3D has several machine and MLC deliverability parameters built-in. If it produces a deliverability alert for a

deliverable plan, or does not alert while checking an undeliverable plan, please send the anonymized DICOM plan to

Mobius3D support.

12.9 INCORRECT TREATMENT TIMES

Mobius3D supports changing treatment time calculation parameters in the 10.6.6 Customize Machine Configuration

section. Updating these values to match your delivery machine will result in more accurate time calculations.

12.10 SYSTEM UPGRADE ISSUES

Mobius3D upgrades should complete automatically. If any issues are encountered, please contact Mobius3D support.

12.11 SENDING ANONYMIZED DICOM DATA

To send anonymized DICOM data to Mobius3D support:

1. Go to the Configuration Options screen by clicking the configuration icon

2. Select the DICOM Files icon

3. Select the Patient to send.

4. Click the Download Anonymized DICOM button and save the file locally.

5. Repeat steps 2 and 3 for all patients whose files you wish to send.

6. Go to http://files.mobiusmed.com/ to send the file(s) to Mobius Support.

http://files.mobiusmed.com/

Appendix A. TPS Export to Mobius3D

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APPENDIX A. TPS EXPORT TO MOBIUS3D The following are examples of the recommended configurations for Pinnacle and Eclipse systems.

A.1 PINNACLE DICOM EXPORT

For pushing DICOM files from Pinnacle, you should check the RT Plans, RT Structures, RT Dose, and DICOM Image

options, including all sub-options shown in the screenshot below.


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A.2 ECLIPSE DICOM EXPORT

For pushing DICOM plan files from Eclipse you should check the Include structure set, Include image slices of 3D

volume, Compatible to Varian Treatment Consoles 6.5-6.8, and Total Plan Dose with Absolute values options , as

shown in the screenshot below.

Appendix A. TPS Export to Mobius3D

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A.3 TOMOTHERAPY DICOM EXPORT

For pushing DICOM plan files from TomoPlan you should select the Tools | DICOM Export menu. Find the patient in

the list, and click the arrow on the left to expand the list. Click the arrow next to the approved plan. Control click

the Approved plan (RT-Plan), KVCT images (RT-Image), Optimized Dose After End of Planning (RT-Dose), and

Structures (RT-Struct) for the patient to be transferred. Select the Mobius3D export node, then click "Send Now".


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APPENDIX B. SAFETY AND REGULATORY

NOTICES

Review the manual and following information prior to operating the software.

B.1 INJURY HAZARD

If the software is used in a manner not specified by Mobius Medical Systems, LP, altered or modified, the

protection provided by the equipment may be void.

All repair or service should only be performed by qualified personnel. Please contact Mobius Medical Systems, LP

at 888-263-8541 or [email protected] for more information.

B.2 FDA 21 CFR 820

Mobius Medical Systems, LP products are designed and manufactured in accordance with this regulation.

B.3 CE NOTICE (EUROPEAN UNION)

Marking by the symbol indicates compliance of Mobius3D as a Class I Medical Device. The software

complies with:

MDD 93/42/EEC (Amended by 2007/47/EC)

IEC 62304:2006

Mobius Medical Systems, LP has appointed an Authorized Representative in the European Union, with the

following contact information:

Emergo Europe Molenstraat 15 2513 BH The Hague The Netherlands

A Declaration of Conformity (DoC) has been made and is on file. Please contact Mobius Medical Systems, LP at

+1(888)263-8541 or [email protected] for more information.



Appendix B. Safety and Regulatory Notices

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B.4 MOBIUS3D BEOOGD GEBRUIK

Mobius3D software wordt gebruikt voor kwaliteitsbewaking en behandelplan verificatie in de radiotherapie. Het

berekent stralingsdosis driedimensionale wijze een voorstelling van een patiënt of een fantoom. De berekening is

gebaseerd op read-in behandeling plannen die in eerste instantie worden berekend door een planning van de

behandeling systeem, en kan bovendien worden gebaseerd op externe metingen van straling velden van andere

bronnen, zoals lineaire versneller levering loggegevens.

Mobius3D is geen behandeling planningssysteem. Het is alleen door opgeleid straling kanker personeel om te worden gebruikt als een kwaliteitsborging tool.

B.5 ISO 13485:2003

Mobius Medical Systems, LP products are designed and manufactured in accordance with ISO 13485:2003.


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APPENDIX C. RAW DATA ACCESS Mobius3D was designed to make it easy for research organizations to extract all raw data and plan information

from its server. While programmatic access to the internal data structure is not officially supported, and the

internal data structure is not guaranteed to remain constant, this section describes the basic process needed to

access Mobius3D’s data.

Accessing user approval status is not currently available, but nearly every other piece of data is available.

Mobius3D makes extensive use of the JSON data format. JSON parsers can be downloaded for every popular

programming language, including MATLAB. Sample Python and MATLAB scripts can be downloaded from

Mobius3D's online support page.

C.1 ACCESSING A SINGLE PATIENT’S DATA

To see a list of the data files available for a Plan Check, append “/data” to the URL for the Plan Check page. This

will display a list of data files including Mobius3D’s 3D dose in DICOM format, the 3D TPS dose that has been

resampled to match M3D’s dose grid, JSON files containing DVH information, etc. No programming skills are

needed to access this page.

Example: You are currently viewing a patient’s Plan Check page. The URL of your browser shows you are at

“http://mobius3d/check/details/started_2013-01-01_1234”. To get access to data files, you would go to

“http://mobius3d/check/details/started_2013-01-01_1234/data”.

Appendix C. Raw Data Access

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C.2 ACCESSING MANY PATIENT’S DATA WITH SCRIPTING

Note: Scripting requires using URL tools that are capable of storing cookies. The default MATLAB “urlread”

function is not compatible with Mobius3D. Users can download a Python script from Mobius3D's online support

site that can download all relevant JSON files, which can then be processed by MATLAB.

C.2.1 GETTING A JSON LIST OF PATIENTS

A basic list can be accessed at http://mobius3d/_plan/list. The following parameters can be used to modify the

returned list:

sort: One of 'name' (default), 'date'

descending: If nonzero, sort in descending order (default false)

limit: Number of patients to return (default 10)

skip: Number of patients to skip before returning (default 0)

For example: http://mobius3d/_plan/list?sort=date&descending=1&limit=50 will return a list of the 50 most

recent plan checks.

C.2.2 RETRIEVING PLAN CHECK DETAILS

Now that you have a JSON list of patients, you can download information about one specific plan check by

constructing an URL for that patient. The HTML plan check page can be found at

“http://mobius3d/check/details/request_cid”. The corresponding JSON data is found at

“http://mobius3d/check/details/request_cid?format=json”. The JSON data of each plan check or QA plan object

contains nearly everything used to build HTML reports, plus a large amount of internal information.

If you need 3D dose or DVH data, you can download a JSON list of files at

“http://mobius3d/check/details/request_cid/data?format=json”. These files can be downloaded at

“http://mobius3d/check/attachment/request_cid/filename”.

For example, if a plan check’s request_cid is “started_2013-02-17_1234”, you can download JSON information for

this plan check at:

http://mobius3d/check/details/started_2013-02-17_1234?format=json

and a JSON formatted list of data files at:

http://mobius3d/check/details/started_2013-02-17_1234/data?format=json

http://mobius3d/_plan/list

http://mobius3d/_plan/list?sort=date&descending=1&limit=50

http://mobius3d/check/details/request_cid

http://mobius3d/check/details/request_cid?format=json



http://mobius3d/check/details/started_2013-02-17_1234?format=json

http://mobius3d/check/details/started_2013-02-17_1234/data?format=json


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APPENDIX D. TREATMENT LOG FILES

D.1 VARIAN DYNALOG FILES

DynaLog files are logs of the machine’s behavior during each delivery for Varian Clinac and Varian Trilogy

accelerators. Separate files are recorded for the A and B MLC banks, although these files share all information

other than MLC leaf positions. These files record the following information every 50 ms.

Beam on/off state

Beam hold on/off state

Fractional dose (not absolute MU)

Planned leaf positions

Delivered leaf positions

Jaw positions

Collimator rotation

Gantry rotation

Carriage positions

You can find a more detailed description of these files in Varian’s DynaLog File Viewer Reference Guide (P/N:

100013698-04). This guide and Varian’s DynaLog Viewer are available free of charge from Varian. Varian’s DynaLog

Viewer calculates machine performance information, but analyzes only one field at a time, does not have fluence

generation or gamma capabilities, cannot output to a database, and does not support tolerance settings.

Note: MobiusFX is compatible with Varian DynaLog Revision B files. These files can be automatically generated by

Windows-based (i.e., not DOS) MLC Workstations and 4DITCs.

D.1.1 GENERATING DYNALOG FILES

Perform the following steps to automatically generate DynaLog files for treatment deliveries.

1. On your MLC controller computer (or 4DITC), open My Computer, and go to C:\Program

Files\Varian\Oncology\MLC\Controller\Exec.

2. Open each startup.* file in a text editor and insert (or uncomment an existing line): “diagAutoDynalogs 1”

(or "diagAutoDynalogs 2, 1" for MLC Controller v7 or higher).

3. If there is a line with the text: "# diagUseRapidArcDynalogFormat", uncomment this line (remove the #

sign). This will cause VMAT deliveries to report fractional MU as column 1, rather than repeat the gantry

angle in column 1. This feature is only available in v7.4 or newer MLC controllers.

4. Save and close the file(s).

5. Reboot the MLC controller for the changes to take effect.

6. DynaLog files are automatically saved to the following folder after treatment:

C:\ProgramFiles\Varian\Oncology\MLC\Controller\Exec\dynalogs.

PeerSync can be installed to automatically copy log files to a network drive as they are generated. This allows you

to analyze the files in near real time with MobiusFX and provides easy access to the files from any computer on the

Appendix D. Treatment Log Files

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same network. Please see Appendix E PeerSync for Log File Transfer for details on using PeerSync to automatically

copy treatment log files.

Alternatively, you can manually copy DynaLog files to a computer with access to MobiusFX or save them to a

network drive (which may require IT installation). To simplify the copying steps, download a free version of Mobius

Copy at http://www.medphysfiles.com/. DynaLog files will not be automatically deleted, so each clinic that enables

automatic generation should routinely remove these files from the MLC Workstation or 4DITC. Mobius Copy

requires no installation and can be run directly on a Varian workstation when patients are not being treated.

D.2 VARIAN TRAJECTORY LOG FILES

Varian TrueBeams produce log files in a different format from Clinac and Trilogy accelerators called trajectory logs.

In addition to the information contained in DynaLog files, trajectory log files also contain:

couch positions

MU information

~10 ms data cycles.

TrueBeam consoles are typically pre-configured by Varian to be able to move the trajectory logs onto a network

directory where they can be accessed by MobiusFX. For help with trajectory log generation and file transfer, you

may wish to contact Varian support.

D.3 ELEKTA LOG FILES

MobiusFX will perform calculations using files generated by Mobius Log 1.31 and greater. Mobius Log is available

for download at mobiusmed.com/support. Mobius Log will record the Elekta iCom Vx stream into files. Mobius Log

can be run on any computer on your radiation oncology department's network. iCom-Vx is the Elekta network

communications protocol for monitoring of the accelerator by an external system. It is supported by Elekta

Desktop and Integrity treatment control systems.

D.3.1 CONFIGURING MOBIUS LOG

To generate Elekta log files for analysis within MobiusFX, follow these steps:

1. Install Mobius Log on a networked computer with access to the Elekta controller computer or the NSS (if installed outside the Elekta firewall). The computer must have Windows XP or newer. Do not install Mobius Log on the Sequencer computer. Note: The Elekta controller computer firewall should be configured by default to allow communication from port 1706. Please contact Elekta support for additional assistance. Note: Mobius Log can only be installed and run in a single instance. For clinics with multiple Elekta linacs, please install Mobius Log on multiple, different PCs.

2. Make sure all power saving settings are disabled to prevent the computer from hibernating, sleeping, etc.

http://www.medphysfiles.com/index.php?name=Downloads&file=details&id=103

http://www.mobiusmed.com/support/


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3. Launch Mobius Log.

4. Upon launching for the first time the Options screen will appear.

5. In the Host IP Address field, enter the IP address of the Elekta controller computer or the NSS IP (if configured outside the firewall). Next, select the number of MLC Leaves. Also, using the Change button, select the desired location for all log files to be saved (a network drive is recommended so that files can be analyzed from several computers). Select Save.

6. From the main Mobius Log screen, click Start Logging to begin generating log files. Mobius Log must be

running for log files to be generated; however it can be minimized and left running in the background.

7. Each field produces one .ebin and one .elog file. These files can be loaded and analyzed using Mobius FX. The .ebin file contains only machine performance data, and the .elog file contains a text summary of the treatment parameters

Appendix E. PeerSync for Log File Transfer

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APPENDIX E. PEERSYNC FOR LOG FILE

TRANSFER PeerSync, available from PeerSoftware, is often provided by Varian on treatment consoles for TrueBeam linacs and

customers who have Argus software. PeerSync can be configured to automatically move treatment log files from

behind the Varian firewall to a network location which is directly accessible to our software.

PeerSync is a third-party product known to be used on Varian consoles. However, it is not an integrated

component of our Quality Assurance software, nor is it required for operation of our software. It is only useful to

increase the level of automation of the QA processes. The choice to install the PeerSync utility on your Varian

system is solely at the discretion of the user.

Treatment consoles before the 4DITC are not behind any network firewall, and thus there is no need to utilize

PeerSync.

E.1 CREATING A PEERSYNC JOB

The following process details the steps to create a job within PeerSync for automatically moving log files to an

accessible location. This will allow MobiusFX to function in near real time.

1. Follow the software instructions for installing PeerSync on the MLC Workstation or 4DITC. Please note

that if you have Varian’s Argus software, PeerSync should already be installed.

a. While preparing for installation, select only PeerSync Profiler Interface and press next.


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b. If you have Varian’s ARIA record and verify, please see the end of this document for

important steps after installation is completed.

2. Select the profile Intermediate from the dropdown in the Left pane to see the Startup/Service in Global

settings. Then, select Add New Job. Note: If this is the first time using PeerSync, select Add New Job

first, then change profile to Intermediate

3. Highlight Folder Selection in the Left pane. Then rename the Job New Job Item 1 to DynaLog Files.

4. Select the Source Folder

C:\Program Files\Varian\Oncology\MLC\Controller\Exec\dynalogs The option Include sub-folders does

not need to be checked.

5. Select the Target Folder to be a location that is accessible to MobiusFX. This location is where the

DynaLog or Trajectory logs will be moved. You may wish to consult with your IT personnel to map a

network drive, in which case you could use the Normal mode.

6. Select File | Save to save the profile.

7. Next, select Automation from the Left pane. Then, in the bottom, Right pane check Scan Job once at

start and also check Use real-time monitoring.

8. Press Real-time Options…

9. Check Use standard real-time monitoring and select Source File/Folder Change, then press OK.


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10. Select File Options from the Left pane.

11. Select Standard, Add, Update. Make sure Replicate and Move deleted files… are not checked.

12. Select Open Files from the Left pane.


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13. Select Exclude open files (allow read access to source file during transfer).

14. Select Exceptions from the Left Pane.

15. Under Include Files, input *.dlg; (Optionally, if you have a TrueBeam, input *.bin; *.txt;) and for

Exclude Files, input ~;*.tmp;.

16. Optional: Select StartUp/Service from the Left pane and choose the desired startup method.

17. To Delete the file from the source location after it has been copied, follow these steps:


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a. Select Advanced from the dropdown in the Left pane.

b. Select Miscellaneous from the Left pane.

c. Select Move Files – Delete source file after successful copy to target

18. Select Run/View Current Profile from Left pane and select Launch Current Profile.

E.2 SPECIAL NOTE FOR ARIA USERS

The PeerSync Install Shield overwrites two DLLs in the \Windows\system32\ folder. The two DLLs, DartSnmp.dll

and DartSock.dll, are outdated and will result in an ARIA Syslog daemon failing to start! The steps below will

restore the DLLs to their original version.

Copy the following two files, overwriting the existing ones:

C:\Program Files\Varian\ProductLine\Syslogd\DartSnmp.dll to this location C:\WINDOWS\system32\

C:\Program Files\Varian\ProductLine\Syslogd\DartSock.dll to this location C:\WINDOWS\system32\

* Re-registration of the dlls is not necessary.

**Once you copy these two dlls, you should be able to start your Syslog daemon (and dependent daemons.


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APPENDIX F. TOMOTHERAPY

CALCULATIONS Mobius3D supports TomoTherapy calculations in the same manner as any other treatment plan. Users perform a

DICOM push of the RT-DOSE, RT-PLAN, RT-STRUCT, and CT scan to begin a plan check. Mobius3D supports

TomoHelical, TomoDirect, and TomoEDGE (variable jaw sizes) calculations.

MobiusFX is not supported for TomoTherapy machines.

For a discussion on commissioning a TomoTherapy machine, see 11.7 TomoTherapy Commissioning.

F.1 TOMOTHERAPY BEAM MODEL

A single beam model is used for all TomoTherapy machines. The TomoTherapy planning system allows some

customization of its parameters for older machines, mainly focusing on small differences in off-axis ratios. Output

factors for individual MLC leaves can be customized, but output factors can be customized in Mobius3D (see 11.7

TomoTherapy Commissioning). Mobius3D models 0.25% MLC leakage, whereas TomoTherapy does not project

MLC transmission (i.e., 0%). Mobius3D uses a source size of around 1 mm, and TomoTherapy uses a point source

model.

F.2 EXPECTED DOSE CALCULATION DIFFERENCES

Mobius3D's collapsed cone calculation and beam modeling are fundamentally different than TomoTherapy's TPS

calculations. Users should expect to see minor differences. Mobius3D typically calculates larger differences in

highly heterogeneous environments due to the collapsed cone differences between Mobius3D and TomoTherapy's

TPS. Mobius3D removes all dose outside the patient treatment volume (i.e., in air) so that users can focus on dose

differences inside the patient. Absolute dose agreement in mean target dose should typically match within 3%.

If you notice Mobius3D's surface dose is significantly lower than TomoTherapy's TPS, it may be caused by your CT

scanner's calibration. Mobius3D finds a body contour and sets all volume outside to zero density. TomoTherapy's

TPS uses the CT scanner's output, which can sometimes be incorrectly calibrated such that air is 0.01 - 0.03 g/cc.

This leads to TomoTherapy calculating higher dose in air and greater surface dose. After the CT scanner is

recalibrated, air should read <0.01 g/cc.

Appendix G. Technical Specifications

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APPENDIX G. TECHNICAL SPECIFICATIONS

G.1 DELIVERED GOODS SPECIFICATIONS

Delivered goods shall include:

Computer Server

Mobius3D software (professionally pre-installed on server)

Mobius3D User Guide (1 hardcopy)

The computer server may be one of two configurations (Standard or Upgraded). Please see Mobius Server Manual

for hardware minimum specifications for both.

G.2 COMPATIBILITY SPECIFICATIONS

G.2.1 BROWSER COMPATIBILITY

Google Chrome (recommended)

Internet Explorer 6+ (IE 6, 7, 8 require the use of Google Chrome Frame plug-in)

Mozilla Firefox

Apple Safari 3+

Android 2+

Apple iOS 4+


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G.2.2 LINAC COMPATIBILITY (FOR MOBIUS3D PLAN CHECKS – PHOTON/ELECTRON)

Vendor Supported Machine

Models Photon

Energy (MV)

Supported Physical

Wedge Angles

Virtual Wedge/Dynamic

Wedge

Electron Energy [MeV]

(as applicable)

Accuray TomoTherapy 6 N/A N/A N/A

Elekta

Synergy S 6, 10, 15 Universal

wedge Universal wedge

6, 7, 9, 10, 11, 12, 13, 15, 16,

18, 20 Synergy, SL, SLi, Infinity, Precise,

VersaHD

6, 10, 15, 18, - Universal

wedge Universal wedge

6FFF,10FFF N/A N/A

Siemens

Artiste 6, 18 15, 30, 45, 60 Yes

N/A Oncor, Primus

6, 15, 18, 23 15, 30, 45, 60 Yes

10 N/A Yes

6FFF N/A N/A

Varian

2100C/D, 21EX/23EX, 21iX/23iX, Trilogy,

TrueBeam/TrueBeam STx, Novalis Tx

4, 6, 10, 15, 16, 18, 23

15, 30, 45, 60

Yes

6, 9, 12, 15, 16, 18, 20

8, 20, 25 N/A Yes

6FFF, 10FFF, 6SRS

N/A N/A

6EX, 600C, Novalis 6 15, 30, 45, 60 Yes


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G.2.3 MLC COMPATIBILITY (FOR MOBIUS3D PLAN CHECKS – PHOTON)

Vendor MLC Model

Accuray TomoTherapy

Elekta

Agility 160

MLCI/MLCi2 801

BeamModulator 80

microMLC 112 (Apex)

Novalis NovalisM3 52

Siemens

Siemens 82

Siemens 160

3DMLC 58

Varian

Millennium 120

Millennium 80

Millennium 52

High Definition 120

1 MLCi2 is used to represent MLCi due to minimal modeling differences.

G.2.4 BRACHYTHERAPY SOURCE COMPATIBILITY

Isotope Supported Sources

I-125 Nucletron SelectSeed 130.002, Amersham OncoSeed 6711, Theragenics AgX100,

IsoAid Advantage I-125, Best I-125 Model 2301

Ir-192 Varian GammMedHDR Plus and VariSource VS2000

Nucletron mHDR-v1, mHDR-v2, and mPDR-v2

Pd-103 Theragenics Theraseed 200C

1 MLCi2 is used to represent MLCi due to minimal modeling differences.


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G.2.5 TREATMENT PLANNING SYSTEM COMPATIBILITY

Mobius3D requires input from a treatment planning system that can transmit CT images, structures, RT-Dose, and

RT-Plan via DICOM-RT . Common planning systems with these capabilities are Pinnacle 9 (Philips Healthcare) and

Eclipse 10 (Varian Medical Systems). Other systems which meet the DICOM-RT2 requirement are also compatible.

G.2.6 TREATMENT LOG FILE COMPATIBILITY

The MobiusFX add-on module is compatible with Varian DynaLogs, Varian Trajectory Logs (up to version 3.0), and

Elekta Mobius Logs.

G.3 PERFORMANCE SPECIFICATIONS3

G.3.1 PLAN CHECK SPEED4

• The Software shall complete a plan check evaluation for an IMRT plan (no arcs) in less than 15

minutes for a representative plan with 7 or fewer fields.

• With standard server configuration, the Software shall complete a plan check evaluation for a VMAT

plan (arc treatment) in less than 18 minutes per planned arc.

• With upgraded server configuration, the Software shall complete a plan check evaluation for a VMAT

plan (arc treatment) in less than 12 minutes per planned arc.

G.3.2 DOSE CALCULATION ACCURACY5

• A Mobius3D plan check shall calculate planned dose to a phantom with an accuracy of +/- 5% when

compared to ion chamber measurements.

2 DICOM standard NEMA PS 3 – 2011 3 Performance specifications assume software was installed professionally on manufacturer supplied server and system commissioning was performed by user per instructions in “Commissioning” chapter of the Mobius3D User Guide. 4 Complexity of treatment plans and patient anatomy directly influences calculation speed. The listed criteria are 50th Percentile benchmark values for a representative clinical sample of patients & plans. The criteria also assume only one plan is being actively processed by the software at a time. 5 The listed criteria are 95th Percentile benchmark values for accuracy based on a representative clinical sample of measurement points, patients, and treatment plans.


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• A MobiusFX delivery QA check shall calculate delivered dose to a phantom plan with an accuracy of

+/- 5% when compared to ion chamber measurements.

G.3.3 UPTIME6

The Mobius3D software shall perform such that it can be used without operational failure during at least 95% of

clinical operational hours.

6 An uptime-related issue exists in Mobius3D version 1.4.1 in which the software may hang and require a server reboot if the system is heavily loaded with incoming plans. The uptime specification assumes only one patient’s information is actively pushed to server at a time. This issue which will be fixed in the next released clinical version of the software.

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