April 2, 2020
The ClearCheck Experience Webinar: Questions and Answers
The ClearCheck Experience: Streamlining Plan Evaluation and Reporting webinar was truly an amazing event that yielded great feedback and questions, so thank you to everyone who was able to attend. We wanted to make a selection of questions easily accessible to everyone, even those unable to attend the webinar, as an ongoing reference. If you missed the webinar or wanted to revisit, you can watch it here. 
1. How do you enter the criteria for the couch collision detection? Is it inherent? Or are there output factors that you need to figure out? Have you found an accurate source documentation for the Varian specifications needed for the collision checks?
Default values for a TrueBeam machine are inherent in the ClearCheck software which can be used, but we recommend that the values be manually entered after being measured on the machine. You can enter the parameters of your machine in the administration section of ClearCheck. The software will automatically detect the body and any external contours on the couch, but the machine parameters must be entered by you. These machine parameters include electron/SRS cone dimensions, the gantry head diameter, and the gantry-to-isocenter distances.
2. Is the multi-view isodose axial view in the ClearCheck report a screenshot, or is it an inherent part of the script?
This item is auto-generated by ClearCheck using CT, structure, and dose information provided by the Eclipse API. The display of these items are unique to the view displayed in Eclipse at the time of script launch and can be customized with the ClearCheck report template for display consistency. If a screenshot of the Eclipse axial view is preferred, the use also has the option to add this using the ClearCheck Insert Screenshot button.
3. How do you do plan comparison with ClearCheck?
Start by selecting the arrows at the top of your screen, you can then choose your constraint template. From there the next step is to choose your two plans using the additional plan selection drop-down in the left side-bar. The created report can be used as documentation for insurance authorizers to compare plans, as needed. The comparison shows where there are any differences in the two plans and will display the plan name which best achieves the constraint in the right-most column.
4. How do you navigate to add a second check pdf?
An external PDF may be included into the ClearCheck report in two ways.

  1. The user may customize a report template by adding an expected PDF with Title to the Report Template in ClearCheck Administration. This will display as a new section within the ClearCheck template with a button allowing the user to insert a PDF from an external directory. The PDF will be merged into the ClearCheck report automatically
  2. A PDF may be added ad-hoc within the ClearCheck report window by clicking Insert > PDF button and choosing the appropriate file. The PDF will be appended automatically to the end of the ClearCheck report.
5. Can you add a screen capture of another program, like Mosaiq set-up notes, or internet explorer?
Yes, you are able to do this if you minimize the Eclipse window. However, if Eclipse is being accessed through a remote desktop or Citrix session, only screenshots within the planning workstation may be captured. As a work-around to this, screenshots using the Windows snipping tool may be saved as .jpeg or .png file to a network drive may be then imported into ClearCheck using the Insert > JPEG/PNG button.
6. How do you ensure that nothing changes between when the plan is printed and when physics checks it?
A good way to check this is to rerun the script in Eclipse and compare the plan document timestamps. Ensuring that the latest plan approval timestamp matches the printed by timestamp in the footer of the printer is the best way to confirm that no changes have been made. Screenshots, PDFs and Images inserted into the report before a change to the plan approval status of the plan will result in a warning message to the planner asking if they would like to keep or remove these inserted items. Additionally, You can also compare the plan document directly to the treatment plan, or by re-running the script at plan check to do a spot check of a few key dose metrics (eg. global plan max) and field properties (MU).

An alternative to this workflow would be to have the physics plan checker be the one to print the plan after plan check is completed. The ClearCheck report window can remain open while the plan check interacts with Eclipse/ARIA (ClearCheck MainWindow must be first closed).The plan checker may use this window to aid in their plan check and confirm that all necessary documentation is included correctly before printing everything to PDF in one click. This workflow has the added benefit of having the Physics reviewer username appear on the cover page with the Treatment Approval status (Eclipse API V15.1+ only) and assures that only documentation that is reviewed and ready for treatment may be printed.

7. How do you handle when patients are reCT’d and replanned as far as documentation?
ClearCheck can compare plan sums to initial plans and your chosen constraints. For example, you have a plan and after 20 fractions the patient is reCT’d and replanned. ClearCheck will allow you to add the dose that you had already delivered to the new dose you’re planning to deliver and compare it to tolerances. Alternatively, dose constraints within a template may be adjusted using the Scale Absolute Dose Constraints button in the Template Manager. This will allow for each phase to be evaluated uniquely against the appropriate fraction of the planned total dose.

ClearCheck has the ability to run dose constraints and display dose in the report window on a plan sum with two unique CT scans which have been fused. However, it is critical to note that this evaluation can only be performed based on the structures contoured within the primary structure set selected for that plan sum. The dose display and DVH in ClearCheck will therefore match that displayed in the Plan Evaluation window for these types of cases, but the user must be careful to confirm that no significant target or structure deformations have occurred between these two scans. The plan sum dose may be misleading if there are large changes between the two scans (eg full vs empty bladder for pelvis re-scans). The user is cautioned against using these kinds of plans sum unless the effect of the deformations between the two scans is fully evaluated.

8. Did you have to enter any physician specific templates? If so, did you run into any issues creating these and do you have any tips and tricks for organizing these in the software?
In general, there are a lot of templates to manage, let alone adding more. Templates can be listed however you choose, one option is head-to-tail. The physician ones just fall into whatever site they belong to then. For example, the regular right breasts will be listed, and then any physician specific ones. This can be changed in the admin settings, you can also set the templates up into folders. There could be for example physician specific folders, which could help with navigation.

It is possible to add Physician specific templates with the Constraints tab of the Administration tab, and it is up to each institution to decide how to organize. Each global template can be named uniquely by the site and MD or they can be organized into folders. The folders can either separate templates by disease sites, with each MDs template version separated by a unique name, or each physician could have a unique folder with all of their treatment site templates saved within. It is also possible to keep all templates within the default location and the Filter search may be used to quickly find individual templates.

9. In the prescription section, there is an option for “Eclipse Plan Total Dose 100%,” how does it work?
It automatically loads the total dose from the loaded Eclipse Plan Dose fractionation and sets that as the 100% prescription level for the template and for any constraints that reference a relative dose constraint (eg. D95% > 100% Rx), instead of it needing to be manually entered by the dosimetrist. This feature can be turned on and off if you prefer that your dosimetrist manually enter this value or if there are multiple dose prescription levels for Dose Painting, Simultaneous Integrated Boost plans.
10. There is a low dose coverage region extending in the center of your target, is there anyway ClearCheck can warn you of this?
We do not have a specific check for this though by adding a lower constraint to a GTV/CTV or on an Inner PTV evaluation structure (In Contouring, add new structure with 0.5-1.0cm inner margin from PTV), low dose in the center within the center of the target may be evaluated uniquely.

For cases where there are gaps in the target PTV, you would have need to look under structure checks because ClearCheck was warning of an incongruous PTV, which lead to the low dose region.

11. Is there a timestamp when ClearCheck is run?
ClearCheck does not have a place to directly see when the script has been run, but it is possible to see a change history log within the template manager window by clicking on the the Clock button in the upper right corner.
Thank you again to everyone that was able to join The ClearCheck Experience webinar. We hope these questions can continue to serve as an ongoing reference. We look forward to your feedback and questions during future events.

written by Tyler Blackwell

Tyler Blackwell is a board-certified medical physicist with extensive clinical experience in radiation therapy. He is active in several AAPM committees, has served as secretary-treasurer for the Northwest Chapter of AAPM, and is an ABR orals examiner. Tyler dabbles in real estate investing and loves preparing breakfast for his two kiddos.

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