September 29, 2020
Tips and Tricks: ARIA/Eclipse v15+ Best Features

Generally speaking, the term upgrade as it applies to software products has a unique ability to stir up mixed emotions in radiation oncology departments, and for good reason. On one hand, upgrades can be challenging to implement. Some require days of training and can involve everyone from physicians to front office staff. But software can be complex, and as software designers ourselves, we can appreciate how errors find a way to sneak into new versions.

On the other hand, updates can solve known, lingering issues and patch bugs, removing the need for workarounds. And of course, upgrades often include new features and improvements that impact user experience in a positive way: optimizing productivity, providing new key information, or designing new ways to attack familiar problems. Ultimately, the goal is to keep innovating and providing useful tools that provide value to the clinicians and patients we serve.

As former clinicians with decades of combined experience, we at Radformation are users of Varian’s ARIA and Eclipse, and are well-versed in the detailed workflows of both programs. With version 15 becoming more widely adopted, we wanted to make a list of the features that made our clinical lives easier. Here are the tips and tricks from version 15 that we think are worth sharing:

Tighten the Gap in Algorithm Performance with Unique DLG/Transmission Values

It’s often the case that departments need to fine tune their models using the dosimetric leaf gap (DLG) or leaf transmission parameters to maximize agreement with dose measurements. Prior to v15, having unique DLG parameters for algorithms of the same energy on a particular linac wasn’t a possibility. But this need isn’t uncommon—it could be that a department has a standard model and a small field model of the same energy, for example. Prior to v15, this was RT admin global setting. In v15, creating a model with a unique DLG can be done by simply adding a DLG to the MLC in Beam Configuration, which overrides the global setting for that algorithm.

-Tyler Blackwell, Physicist

Changing Isodose Levels on the Fly

This one is practical for those that prefer isodose lines to dose color wash. Instead of accessing the Relative Dose Isolevel Editor from the Tools dropdown, it’s extremely easy to change isodose levels on the fly by simply holding CTRL and double-clicking on any of the isodose values and replacing it with a different value. The rest of the lines scale with your entry for quick and easy isodose changes.

There are other dose display modifications that give users more control in the 2D display window. For example, you can also toggle between relative and absolute isodose by clicking on the [%], and you can remove all isodose lines by CTRL + clicking on the check marks.

-Elisabeth Van Wie, Physicist

Plan Optimization: No More OAR Overlap or Beam Transmission

As a dosimetrist, I did a lot of VMAT planning in the clinic, so the most impactful changes in version 15 were the upgrades in Eclipse. The IMRT/VMAT optimizer includes Target Autocrop, a new feature that automatically crops organs at risk (OARs) from targets during optimization, eliminating the need to create separate cropped contours just for optimization.

Source: Varian TPS New Features Workbook v15.5
I also liked the ability to avoid pushing dose to the target through OARs. The optimizer can now avoid that transmission dose in an attempt to reduce critical structure doses, which comes in handy for tricky clinical situations like planning prostates with bilateral artificial hips or sites near a pacemaker. The ability to auto-feather between multiple isocenters during optimization was also really useful for smoothing out junction dose gradients, too.

-Brad Rauschenbach, Dosimetrist

More Control with Scripting

From the scripting perspective, the v15 API opens up the possibility to write changes back to ARIA, which allows us to do so much more to streamline planning and plan reporting. For example, using document services, we’ve modified ClearCheck to allow one-click direct reporting to ARIA Documents, which eliminates the hassle of saving to a storage drive for later import. In the latest version of EZFluence, the fields and plan can drop directly into Eclipse instead of requiring manual import for those with Eclipse v15+, and we can call the leaf sequencer and calculation modules through the Eclipse API to run those calculations efficiently.

-Kurt Sysock, Physicist

ChartQA and DICOM Import Improvements

Before joining Radformation to work on a tool for automated weekly physics review, the clinic I worked for used ChartQA for our weekly physics checks, because it has most of the information you need to verify over the course of treatment. Since we linked our RT prescription to the plan in Eclipse, we wanted to verify the accuracy of that prescription entry as well, but prior to v15, that wasn’t an option. With the latest version, input from the RT Prescription tab is available, including all dose levels, within ChartQA for easy verification of primary and secondary reference points.

The DICOM importer functions differently in the new version as well. You can now choose an “automatic” contour resolution for import so that contours are created at both high and low resolution on import. It’s nice from an automation standpoint since we did the bulk of our contouring outside Eclipse and we import a lot of structure sets. It saved a lot of time for dosimetry, since they didn’t have to remember to manually convert structures for SRS or SBRT.

-Jennifer Seger-Paisley, Physicist

Going Incognito with Patient Anonymization

On the topic of the DICOM importer, one thing that has made physicist’s lives easier is the built-in patient anonymizer. With the new tool, clinicians have control to customize what pieces of the patient’s exported chart need to be kept private. This feature makes data sharing easier for clinical trials or for sending data to other clinics if you don’t have a third-party anonymizer. To enable the anonymizer, head to the Import/Export module and click on Export Options. The Anonymization tab has a number of customization options to make it work for any department.

-Alan Nelson, Physicist

Without a doubt, new versions bring change. It’s clear that Varian packed a number of useful features into v15, making a positive impact on how clinicians approach patient care. Hopefully there is something here that you weren’t aware of that you can incorporate in the clinic. Are there any great features from Eclipse/ARIA v15 that we missed? What are your favorites?

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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