Brilliance CT: Therapy Top Kit Installation Instructions

TM
Brilliance CT
Therapy Top Kit Installation
Instructions
4535 673 48411

Revision C
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© 2011 Koninklijke Philips Electronics N.V. All Rights Reserved.

CSIP Level 1
BrillianceTM CT Therapy Top Kit Installation Instructions Rev C
Philips Healthcare
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Safety Information
To the User of This Manual
The user of this manual is directed to read and carefully review the instructions, warnings and cautions contained herein prior to beginning installation
or service activities. While you may have previously installed or serviced equipment similar to that described in this manual, changes in design,
manufacture or procedure may have occurred which significantly affect the present installation or service.
!
WARNING In addition to the warnings listed above, make sure to follow all safety guidelines as
described in the Safety Manual. Failure to do so can result in severe personal injury.
Installation and Environment
Except for installations requiring certification by the manufacturer per federal standards, see that a radiation protection survey is made by a qualified
expert in accordance with NCRP 102, section 7, as revised or replaced in the future. Perform a survey after every change in equipment, workload, or
operating conditions which might significantly increase the probability of persons receiving more than the maximum permissible dose equivalent.
Diagnostic Imaging Systems - Mechanical-electrical Warning

All of the moveable assemblies and parts of this equipment should be operated with care and routinely inspected in accordance with the
manufacturer’s recommendations contained in the equipment manuals.
Only properly trained and qualified personnel should be permitted access to any internal parts. Live electrical terminals are deadly; be sure line
disconnects are opened and other appropriate precautions are taken before opening access doors, removing enclosure panels, or attaching
accessories.
Do not under any circumstances, remove the flexible high tension cables from the x-ray tube housing or high tension generator and/or the access
covers from the generator until the main and auxiliary power supplies have been disconnected. Failure to comply with the above may result in serious
or fatal bodily injuries to the operator or those in the area.
Prior to any service and maintenance activities inside components:
Switch off the system at the main power supply (using the on-site On-Off switch), and the internal/external uninterruptible power supply (UPS).
Make sure that no other person can switch on power or switch off the security measures, when installation, maintenance or service work on the
system is performed.
Always use an ESD protection wrist strap when servicing any component in the system.
4535 673 48411 © 2011 Koninlijke Philips Electronics N.V All Rights Reserved CSIP Level 1 iv
Electrical-grounding Instructions
The equipment must be grounded to an earth ground by a separate conductor. The neutral side of the line is not to be considered the earth ground.
On equipment provided with a line cord, the equipment must be connected to properly grounded, three-pin receptacle. Do not use a three-to-two pin
adapter.
Diagnostic Imaging Systems - Radiation Warning

X-ray and Gamma-rays are dangerous to both operator and others in the vicinity unless established safe exposure procedures are strictly observed.
The useful and scattered beams can produce serious or fatal bodily injuries to any persons in the surrounding area if used by an unskilled operator.
Adequate precautions must always be taken to avoid exposure to the useful beam, as well as to leakage radiation from within the source housing or
to scattered radiation resulting from the passage of radiation through matter.
Those authorized to operate, participate in or supervise the operation of the equipment must be thoroughly familiar and comply completely with the
current established safe exposure factors and procedures described in publications, such as: Subchapter J of Title 21 of the Code of Federal
Regulations, "Diagnostic X-ray Systems and Their Major Components", and the national council on radiation protection (NCRP) no. 102, "Medical X-
ray And Gamma-ray Protection For Energies Up To 10 Mev-equipment Design and Use", as revised or replaced in the future.
Those responsible for planning of x-ray and gamma-ray equipment installations must be thoroughly familiar and comply completely with NCRP no.
49, "Structural Shielding Design and Evaluation For Medical Of X-rays and Gamma-rays of Energies Up to 10 Mev", as revised and replaced in the
future. Failure to observe these warnings may cause serious or fatal bodily injuries to the operator or those in the area.
4535 673 48411 © 2011 Koninlijke Philips Electronics N.V All Rights Reserved CSIP Level 1 v
Revision History
Revision History
ECO # Revision Date Comments

-1 July 12, 2005 Preliminary review issue.
-2 July 22, 2005 Comments incorporated, sent for additional review.
-3 July 28, 2005 Final review copy.
Comments incorporated and proprietary notice updated, sent for
-4 August 15, 2005
second final review.
A November 17, 2005 Release at revision A.
Update to measurement data in table 1-3, added tools to table 1-2,
B March 13, 2006 added additional figures and screen captures, updated with field
comments.
Complete revision of document with screen captures and new
C February 22, 2011
photos. Added verification section.
This document was prepared by CT/NM Service Innovation.

For any additions, corrections, or suggestions, contact your next level of support.
4535 673 48411 © 2011 Koninlijke Philips Electronics N.V All Rights Reserved CSIP Level 1 vi
Brilliance CT Therapy Top Kit Installation Instructions
Brilliance CT Therapy Top Kit Installation Instructions
Introduction
The Brilliance CT Therapy Top is a carbon fiber couch top that may be installed on any Philips Brilliance CT scanner
patient support. This therapy top provides radiation oncologists with a patient positioning system that is identical to the
Clinac family of linear accelerators, ensuring identical patient setup between CT scanning and treatment.
There are three major sections to installing the therapy top:
• Aligning the patient support and positioning the therapy top
• Taking deflection measurements
• Verification
This document will provide detail on each section.
NOTE The approximate time required for this installation is 2 - 4 hours. If the therapy top is being installed on an
existing couch, it might take much longer, depending on the cleanup that would be required on the base.
Prerequisites
Philips Brilliance CT Scanner with patient support.
Patient support must have the bayonet style mount for head rests. If not, order the patient support carbon top upgrade
kit, p/n 4535 671 15431.
Materials and Tools Required

Brilliance Therapy Top, p/n 4535 670 91962
Therapy Top Kit, p/n 4535 673 43661 (see Table 1 for kit contents)
See Table 2 for tools required.
4535 673 48411 © 2011 Koninlijke Philips Electronics N.V All Rights Reserved CSIP Level 1 1
.
Table 1: Contents of Therapy Top Kit, p/n 4535 673 43661
Part Number Description Qty.

4535 670 91962 Therapy Top, Brilliance 1
4535 673 48561 Tape, Neoprene, .06 in. x 1.00 in., w/PSA 16 ft.
4535 673 43771 Phantom, Therapy Top Calibration 1
4535 670 81411 Hanger, AcQSim Therapy Top 1
4535 673 48411 Instructions, Therapy Top Kit Installation (this document) 1
4535 673 06161 Assy, Therapy Top Phantom Support 1
Table 2: Tools Required
Part Number Description Qty.

Standard FSE Toolkit 1
4598 001 26231 Self-Leveling Laser (Acculine Pro Laser Level model 40-6525 or equivalent) 1
Electric Drill, Reversible 1
Drill Bit, 1/8 in. diameter 1
Hammer, small ballpeen 1
Center punch, 3/16 in. dia. 1
Bubble level 1
4598 001 26221 Weights, 180 pounds (82 kg) AR
Tape measure or yardstick, minimum 36 in. length 1
Combination square or stainless ruler 6 - 12 in. 1
4598 001 26261 Digital level 1

Steps for first time installation of Brilliance CT Therapy Top:
Aligning the Patient Support and Positioning the Therapy Top
1. Before attempting to install the Therapy Top, the patient support must be checked for levelness and that the
horizontal travel is orthogonal to the scan plane.
2. Remove the patient support covers. Refer to the Brilliance CT Patient Support Repair / Replacement Manual.
3. Place a bubble level on the front and rear edges of the patient support base, and on the right and left side rails.
Level front to rear (longitudinal) and left to right (transverse). See Figure 1 and Figure 2. Verify patient support is
level.
Figure 1: Verifying Patient Support Levelness (Front / Rear)
Figure 2: Verifying Patient Support Levelness (Left / Right)
4. If patient support is not level, loosen the five patient support mounting bolts and install the proper shims under the
patient support base to bring patient support to level. Tighten the mounting bolts once levelness is verified.
5. Place the therapy top on top of the patient support. Loosen the five #10 mounting screws securing the adjustable
end plate at the foot end and three #10 mounting screws securing the adjustable wedge at the head end of the
therapy top to allow for adjustment. See Figure 3 for location of mounting screws.
Adjustment
Mounting screws at Foot End Mounting screws at Head End
Figure 3: Mounting screws at Foot End and Head End of Therapy Top
6. Back out the thumbscrews on the foot end of the therapy top to allow it to rest on the top edge of the patient support
carbon top. There should be a gap between the inside of the Adjustment End Plate and the couch carbon top. The
head end of the therapy top has a “male” wedge feature to consistently locate the recess in the center of the front
edge of the carbon top (see Figure 4). Insert wedge of therapy top into recess in patient support carbon top.
Figure 4: Wedge fitted into carbon top (Head End)
7. Ensure the therapy top is laying flat on the carbon top. At the foot end of the therapy top, engage the two fluted
thumbscrews into the recessed holes in the carbon top (see Figure 5).
Fluted
Thumbscrew Recessed Hole
Fluted
Thumbscrew
Figure 5: Adjustment end plate with thumbscrews
8. Place bubble level on therapy top in both X and Y positions to verify levelness. (see Figure 6) If therapy top is not
level, use neoprene tape as needed to shim therapy top.
Bubble Level in Y Position Bubble Level in X Position
Figure 6: Using Bubble Level on Therapy Top
NOTE Three different varieties (.015 in., .030 in., and .060 in. thickness) of neoprene shim tape are available to
achieve alignment in the Y direction. The shim tape may be carefully placed along the .060 neoprene strips
where the therapy top rests on the patient support. Refer to Figure 7 for shim tape placement.
Figure 7: Shim Tape Placement (Therapy Top shown inverted)
NOTE To compensate for the deflection of the couch top, it may be necessary to shim the patient support. The
suggested shim thickness is 0.070 inches in the front and 0.035 inches in the center. These values are based
on experimentation. In some cases, there may be a need to add or remove shims to achieve the required
deflection. Make sure that final vertical couch travel is plumb.
9. Place the Therapy Top Calibration Phantom (p/n 4535 673 43771) onto the head end (H5/H4) of the therapy top.
Secure in place using the two lockbars supplied with the phantom. See Figure 8.
Figure 8: Therapy Top Calibration Phantom Installed

10. Use the gantry display panel to move the top all the way into the bore. Reset the gantry display to zero.
11. Move the top out until the cross hairs of the phantom align with the gantry (rotor) lasers. This is the scan plane for
the head position (SP-H).
12. Retract the top 500 mm. This is the marking plane for head position (MP-H).
13. Place the phantom on the F1/F2 position of the therapy top.
14. Move the top so the cross hairs align with the gantry (rotor) lasers. This is the scan plane for the prostrate (SP-P).
15. Retract the top 500 mm backwards. This is the marking plane for the prostrate position (MP-P).
16. Record these values in the table below:
Table 3:
SP-H
MP-H
SP-P
MP-P
17. Use the following protocol setup:
Setup a surview 180 and an abdominal axial body (see Figure 9).
Figure 9: Sureview 180 Selection
18. Make corrections: (see Figure 10):
Resolution: high Set thickness to 0.75 mm
Collimation: 16 x 0.75 Increment: contiguous
Length: 36.0 . (the rest of the scan parameters are default).
Figure 10: Additional Protocol Setup

19. Adjust the scanable range to include the entire range of the phantom (see Figure 11).
Figure 11: Scanable Range Adjustment

20. Press the “auto scan”.
21. Scan the phantom and verify that you can observe the cross marks on the phantom. See Figure 12. Repeat scan
at the prostate position.
Figure 12: Calibration Phantom Scan

NOTE Cross marks are visible in single image.
NOTE The therapy top may need to be repositioned and scanned several times until this is achieved.
22. Remove the therapy top calibration phantom from the therapy top.
23. Secure the Adjustment Wedge to the therapy top head end by tightening the three #10 machine screws. Be careful
not to strip the threads by over tightening.
24. Adjust the foot end of the therapy top left and right until it is exactly centered in the scan plane on the carbon top.
Use the calibration phantom at the prostate location of the therapy top to verify the therapy top tracks orthogonal to
the scan plane.
Taking Deflection Measurements

25. Position the patient support at maximum height.
26. Place a 175 - 180 pounds (80 - 82 kg) load centered about the center of gravity (CG) located 34 in. (86.3 cm) from
front end of therapy top. (see Figure 13)
27. Tape a blank piece of paper centered on the wall behind the gantry opening.
28. Place the laser 6 in. (15.2 cm) from the front end (head position) of therapy top. (see Figure 13)
Figure 13: Laser at Head Position with Weights at CG Position
29. Turn the laser on.

30. Verify a laser line is displayed on the paper. (see Figure 14)
Figure 14: Laser Line Displayed on Paper

NOTE The laser line will have some thickness. To avoid confusion, consistently mark the top of the laser line for
all measurements.
31. Refer to Table 3 on page 12. Move to the patient support to MP-H position. This is the marking plane. Make a
mark on the paper at the top edge of the laser line.
32. Move the patient support 500 mm to SP-H position. This is the scan plane. Make a mark on the paper at the top
edge of the laser line.
33. Measure the deflection between the marking plane and scan plane markings. Verify less than 2 mm deflection.
34. Move laser behind the weights to the prostate position (37 in. (93.9 cm) from front end). (see Figure 15)
Figure 15: Laser at Prostate Position Behind Weights

35. Refer to Table 3 on page 12. Move the patient support to MP-P position. This is the marking plane. Make a mark
on the paper at the top edge of the laser line.
36. Move the patient support 500 mm to SP-P position. This is the scan plane. Make a mark on the paper at the top
edge of the laser line.
37. Measure the deflection between the marking plane and iso-center markings. Verify less than 2 mm deflection.
NOTE If further alignment is needed, use neoprene tape as required to shim therapy top.
NOTE If the deflection criteria is not met, remove the weights from the therapy top. Loosen the base mounting
bolts and add shims between the floor and the couch base as required. Repeat Step 25 through Step 37.
38. Remove the laser from the therapy top, leaving the weights in place.
Verification
NOTE The following steps are verification steps that have to be performed after the lap lasers or any third party
lasers are installed.
39. Perform the following steps to verify the deflection measurements.
40. The head and prostate positions can be simulated by placing the phantom in the H5 / H4 and
F1 / F2 notches respectively. The Head position is shown in Figure 16.
Figure 16: Head Position
41. Make sure to keep the head and prostate areas clear for installation of the phantom (see Figure 17).
Figure 17: Weights Centered about the CG.

42. Refer to Table 3 on page 12. Position the couch with the head location in the marking plane (MP-H).
43. Check that the top travels in a level fashion as it is moved from full out to the scan plane (SP-H).
44. Extend tabletop to position the prostate at the scan plane (SP-P).
45. Check levelness of the top with digital level (levelness must be within 0.5 degrees over stated travel range). If not
level, perform Step a thru Step g to correct.
a. Remove all weight.
b. Remove carbon top handle covers.
c. Loosen, do not remove, 16 hex-head screws connecting table top to the four j-brackets. Refer to Figure 18.
Figure 18: J-Bracket Screws Location (Left-hand side shown, right-hand side similar)
d. Tilt carbon top up or down as required (the intent is to preload the carbon top so that when the weight is re-
applied, the top will be level).
e. Use supports between subframe and carbon top until top is secure.
f. Tighten 16 fasteners to 11 lb-ft (132 lb-in / 14.9 Nm) torque.
g. Repeat Step 41 thru Step 45 above.
46. If additional adjustment is necessary, add shims between the carbon top and therapy top. Refer to Figure 7 on
page 10.
NOTE Ensure therapy top is level along scan length. Add shim where needed to correct irregularities of top.
Check with laser assembly and combination square or ruler as required.
NOTE The LAP lasers are usually placed 500 mm from the gantry isocenter. This actual distance has to be
verified at each site. The marking plane for head and prostrate locations has to be changed for the
following verification test section only.
47. Install the phantom at head location (H4/H5) and align with external third party marking plane lasers (MP-H).
48. Write down the X and Y values from the laser as XL-head and YL-head.
49. Move the top 500 mm (or the external laser distance from the isocenter) forward to scan position.
50. Perform an axial scan with the parameters defined in Step 18. DO NOT do a surview scan.
51. Verify if all the crosshairs are visible. Ideally the crosshairs should be visible on the center (8th or 9th slide). But
they could be off by a slide or two depending on how the laser is aligned to the phantom in the marking plane.
52. Mark the center point on the center phantom as shown in . Write down the center values from the scan as X1-head
and Y1-head. Refer to Figure 19.
Figure 19:
53. Install the phantom at the prostate location (F1/F2) and align with the external third party marking lasers, marking
the centerpoint of the phantom (MP_P).
54. Write down the X and Y values from the laser as XL-prostate and YL-prostate.
55. Repeat Step 49 through Step 51.
56. Mark the centerpoint and write down the center values from the scan as X1-prostate and Y1-prostate.
57. Calculate the delta values for head and prostate position according to the tables below.
Table 4: Head Location
Laser Scanner Delta

XL-head X1-head XL-head - X1-head
YL-head Y1-head YL-head - Y1-head
Table 5: Prostate Location
Laser Scanner Delta

XL-prostate X1-prostate XL-prostate - X1-prostate
YL-prostate Y1-prostate YL-prostate - Y1-prostate
58. Verify that the difference in values from head and prostate location X and Y coordinates are within 1.0 mm and
2.0 mm respectively.
59. Carefully drill and pin the steel plate to the foot end of the therapy top using the two pilot holes in the plate. Drill into
the therapy top with a 1/8 in. diameter bit. Insert the provided 1/8 in. diameter dowel pins using Loctite #401 to
retain the pins (see Figure 20).
Figure 20: Drill and pin the End Plate at Foot End
60. Secure the steel plate at the head end of the therapy top by tightening the three #10 screws. Be careful not to strip
the threads by over tightening.
61. Carefully drill and pin the steel plate at the head end of the therapy top using the two pilot holes to pin the Wedge to
the therapy top (see Figure 21).
Pilot Holes
Figure 21: Drill and pin the Wedge at Head End
62. Locate and install two (2) Alignment Labels (4535 673 20581) on the couch carbon top foot end near the handles
for easy location of the therapy top by the technician during clinical usage. Place labels on each side of the carbon
top so that when facing the top surface of the therapy top, you can see all of the arrows but not the line (see
Figure 22).
Figure 22: Alignment label placement

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! Attention symbol Radiation warning symbol

Laser warning symbol Biohazard warning symbol

Magnetism warning symbol Projectile warning symbol

Electrical warning symbol Do not touch

Crush warning symbol

Diagnostic Imaging Systems - Mechanical-electrical Warning

Prior to any service and maintenance activities inside components:

Diagnostic Imaging Systems - Radiation Warning

ECO # Revision Date Comments

This document was prepared by CT/NM Service Innovation.

Brilliance CT Therapy Top Kit Installation Instructions

Materials and Tools Required

Part Number Description Qty.

Table 2: Tools Required

Part Number Description Qty.

Therapy Top Kit Installation

Aligning the Patient Support and Positioning the Therapy Top

Figure 1: Verifying Patient Support Levelness (Front / Rear)

Figure 2: Verifying Patient Support Levelness (Left / Right)

Mounting screws at Foot End Mounting screws at Head End

Figure 4: Wedge fitted into carbon top (Head End)

Figure 5: Adjustment end plate with thumbscrews

Bubble Level in Y Position Bubble Level in X Position

Figure 6: Using Bubble Level on Therapy Top

Figure 7: Shim Tape Placement (Therapy Top shown inverted)

Figure 8: Therapy Top Calibration Phantom Installed

17. Use the following protocol setup:

Figure 9: Sureview 180 Selection

18. Make corrections: (see Figure 10):

Resolution: high Set thickness to 0.75 mm

Collimation: 16 x 0.75 Increment: contiguous

Length: 36.0 . (the rest of the scan parameters are default).

Figure 10: Additional Protocol Setup

Figure 11: Scanable Range Adjustment

Figure 12: Calibration Phantom Scan

Taking Deflection Measurements

Figure 13: Laser at Head Position with Weights at CG Position

29. Turn the laser on.

Figure 14: Laser Line Displayed on Paper

Figure 15: Laser at Prostate Position Behind Weights

Figure 16: Head Position

Figure 17: Weights Centered about the CG.

Table 4: Head Location

Laser Scanner Delta

Table 5: Prostate Location

Laser Scanner Delta

Figure 21: Drill and pin the Wedge at Head End

Figure 22: Alignment label placement

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