1 Introduction
1.1 Welcome to the CyberKnife® version 10.6 and InCiseTM 2 MLC eLearning for installation, servicing, and
maintenance. My name is Peter Stafford and I will be guiding you through today’s learning. Let’s take a
moment to highlight various tools in this learning platform. Click on the question mark in the upper right to get
information about navigating the training, toggling the on‐screen closed caption (CC) text and understanding %
completion. On the bottom of this platform, please see volume controls, play button, and replay button. Use
these if you wish to see or hear a slide over again. To begin this training, please click the Continue button.
1.2 Christian has received an email notification that he will be upgrading his CyberKnife® System to version 10.6
and installing the new InCiseTM 2 MLC at his site. Brian is a colleague of Christian from another region. He
recently performed these upgrades and has some valuable notes to pass along.
1.3 Please take a moment to read the learning objectives associated with this eLearning course. When you are
finished click on the right arrow button to continue.
1.4 Now we will cover the version‐specific information about the 10.6 software release. CyberKnife® version 10.6 is
merely a vehicle for the release of the InCiseTM 2 Multileaf collimator, also known as MLC, and as such, includes
all features and enhancements released in version 10.5. These include Synchrony® 2 with image burst and
Optimal Path Traversal 2, or OPT2. For more information about these options, please refer to the eLearning for
version 10.5. For a list of anomalies fixed and known anomalies contained in version 10.6, please see the
document CK V10.6: Known Anamolies Fixed in the Resources drop down menu, in the top right of this
window. Please note that this particular list is for internal Accuray employees only. Additionally, CyberKnife
version 10.5.X is the last version that will support the InCise 1 MLC; as such this collimator will not work with
version 10.6 software, and beyond.
The video on the following screen shows generically how the CyberKnife works, however, the secondary
collimator housing shows the MLC. Notice at the end of the video, the MLC leaves move to collimate the MV
beam shape. Please click on the right arrow button to view the video.
1.5 When delivering high doses of radiation to tumors that are adjacent to critical organs, precision matters. The
CyberKnife® Robotic Radiosurgery System by Accuray provides extremely precise treatments using its wide
range of non‐coplanar beams and dynamic motion compensation. Many tumors move during the course of
treatment. Conventional LINACs are only able to compensate for motion through expanding dose margins,
beam‐gating or operator intervention. The CyberKnife System features automated image guidance for
alignment, tracking, and real‐time beam adjustment during the treatment. Without compromise the
CyberKnife System targets the tumor with sub‐millimeter precision and avoids critical organs, even when the
tumor moves. The CyberKnife System combines its extreme precision with the flexibility to shape beams using
circular or Multileaf collimators to rapidly treat tumors anywhere in the body.
2 MENU
2.1 The main menu is the dashboard through which you will navigate through the remainder of this course. You
will notice that there are several sections that are currently marked as unavailable. They will become available
after you complete the InCise 2 MLC Hardware section. To begin exploring the mechanics of the InCise 2 MLC,
please click on INCISE 2 MLC HARDWARE to begin.
3 InCise 2 MLC: Technical Specifications
3.1 The InCiseTM 2 MLC is a unique secondary collimator for the CyberKnife® M6TM version 10.6 and beyond. The
MLC is the only rectangular shaped collimator used by the CyberKnife. This allows for the creation of patient
specific, non‐symmetric beam shapes using two banks of 26 individually motored and controlled leaves.
3.2 InCise 2 Hardware Menu:
The hardware lesson is separated into two parts: the MLC mechanics, and the secondary feedback unit. Let’s
start with the MLC hardware. Please click on this button to continue.
3.16 The next screen will introduce the interconnect diagram for the InCiseTM 2 MLC. It offers a great visualization of
the different components within this secondary collimator and how they interact with each other. You will
notice on the schematic and interconnect diagram title, the InCise 2 MLC is also referred to as the MLC26. This
name is derived from its design of having 26 leaves on each bank, as opposed to the Incise 1 MLC (hMLC),
which has 41. It is important that you do not use the MLC26 and hMLC internal engineering names, when
referring to these collimators (in the field and at client sites). It is the official policy of Accuray that the MLC,
regardless of whether it is the Incise 1 or Incise 2, merely be referred to as InCise MLC to steer the public away
from emphasis on competing MLCs, whenever possible. Only use the differentiation of InCise 1 versus InCise 2
when these are being talked about in comparison or to differentiate them within a conversation. Also, the
InCise 2 Multileaf collimator will be referred to simply as MLC for the remainder of the presentation.
3.17 The two sides of the MLC, which represent the two different banks of tungsten leaves used in conjunction to
make a radiation shape, are labeled A and B, or X1 and X2.
Let’s focus on the left side of this diagram which shows how the MLC communicates upstream to the
CyberKnife. There are two hardware components on the tool plate of the MLC that accomplish two different
sets of communication. The PTCU connector block, labeled “PTCU_TOOL_MODULE,” carries various non‐
specific MLC housing signals, like the safe‐to‐release magnet sensor or the presence of the pinhole collimator,
upstream to the PTCU. This connector is also responsible for sending the output interlock signal downstream,
which represents any and all CyberKnife® initiated upstream interlocks that prevents the MLC from
functioning. When the MLC is not functioning, it is important to know whether this inhibition is originating
upstream of the MLC, or within the MLC when troubleshooting.
The MLC connector block, labeled “MLC_TOOL_MODULE,” provides power to the MLC and is the conduit
through which commands are given for MLC function. This module also returns all MLC specific signals
including (but not limited to): motor encoder position, secondary feedback camera image, and through‐beam
sensor activation. Don’t worry, we will cover all of these components more in‐depth as we work our way
through this course. This connector block is specific to the InCise 2 MLC and is part of the hardware upgrade
procedures covered later.
One last thing to take notice of on the left side of this diagram is the MLC Ethernet switch. This is a new
component installed on the base of the robot, also called the ‘Spider Switch’, which will be covered in the
Installation section.
3 InCise 2 MLC: Technical Specifications (continued)
3.17
(cont’d)
The last portion to focus on is highlighted now and consists of the MLC26 motherboard, driver boards for each
bank of leaves, regulator boards, the identification board, and through‐beam sensors. The motherboard is the
main MLC interconnect board for both power and commands and is located on the side of the housing
farthest from the Robot. The Mother Board Regulator Board and the ID Board reside to the left of the
motherboard on this diagram. The regulator board is responsible for providing constant voltage regulation
across the motherboard. The ID board is a pinned resistor providing a unique output specific to each MLC that
is read by the CyberKnife® System and is known as the MLC Serial Number. Let’s examine the driver boards
now. Each driver board is attached to the motherboard via a 200‐pin right angle connector, providing
command signals including torque, velocity, and position to the motors and receives various signals back. The
other connection between the motherboard and each driver board would be the 24 volt power supply cable.
The voltage regulation for these boards comes from the Driver Board regulator board and functions through
Driver Board B through a connection from DB A to DB B. Each leaf in the MLC has a unique motor with a tail
that is attached to the corresponding driver board.
The last component to discuss in this section will be the OMRON through‐beam sensors. These sensors
provide a fixed reference point used in the primary motor encoder calibration as well as initialization
processes; and will be discussed in more detail during the Calibration section. Each bank of leaves for the MLC,
A and B, have a front and rear through‐beam sensor. These sensors can sometimes need re‐tuning; review
Section 3.7 of the WI document Replace the MLC Through Beam Sensor (1033739), found in the Resources
tab. Click on the right arrow button to continue.
3.18 Now that we have explored some of the MLC components, let’s take a closer look at the hardware specifics.
What this drawing does not show is each one of the 26 motor tails for banks A and B that originate on the end
of the motor and attach to their respective driver board. Downstream of the motor, we see the leaf drive train
composed of the lead screw and insert/nut. Each leaf is moved individually when the driver board gives the
motor a command for position, torque, and velocity technique. The motor is mechanically coupled to the lead
screw, so as the motor turns, so does the lead screw. The leaf is also mechanically coupled to the lead screw
via the nut which allows back‐and‐forth movement over the lead screw as the motor turns, which in turn
moves the leaf.
Notice the connector blocks, safe‐to‐release magnet, and through‐beam sensors, including their fixed
reference points, the fiber‐optic sensors. You can see how each side of the MLC, or bank, has two fiber‐optic
sensors, front and rear. This will be discussed further in the Calibration section. The safe‐to‐release magnet is
now being highlighted. Please note this magnet is adjustable and may need to be extended, if not activated
when in wall (can be verified through SCS GUI devices tab, PTCU sub‐tab). This problem will likely not present
itself until after the Xchange® calibration is completed. Take a moment to scroll over each of the components
located on this and the following drawings, for identification and additional pictures. When finished, click on
the right arrow button to continue.
3.19 We can now see the opposite side of the MLC, with the motherboard removed. The driver boards and some of
the radiation shielding have also been removed to give us a better view of the frame and the green bearing
block. The bearing block is the track through which each leaf is guided. This track has sprung and fixed
bearings that enable each leaf to move very precisely to its commanded position. The bearing block and track
create as frictionless of an environment as possible while also minimizing concentric forces from the length of
the lead screw that could affect leaf position accuracy. Please note the presence of the fiber‐optic sensor
receiver. This receiver is pinned to the frame exactly perpendicular to the fiber‐optic sensor transmitter
shown on the previous MLC view. You will also notice both the MLC and PTCU connector blocks visible from
the top angle. Take a moment to explore this drawing. Hover your mouse over each orange button to identify
each component. Click on the right arrow button to continue.
3 InCise 2 MLC: Technical Specifications (continued)
3.20 Adding the motherboard and driver boards back on we see what they look like from the same side view. From
this view, we can see the motherboard, ID board, regulator boards, and the 200‐pin connector junction
between the motherboard and driver board. Here is a closer look at the ID board, which was hard to see in
this drawing. This chip can program up to 65,535 different serial numbers. After programming in
Manufacturing, the jumper is cut, making it read‐only. Hover your mouse over each orange button and click
on the right arrow button to continue.
3.21 From a different view, we can see how the motherboard is integrated into the MLC frame. The motherboard
communicates upstream directly with the UCC, via the Spider Switch and then the network switch. The
motherboard integrates many pieces of information from the control system, provides power to different
MLC components, and is the main distribution point for signals within the unit.
This view also allows a closer look at the OMRON controllers, which are responsible for reading whether the
fiber‐optic sensors are either blocked or not blocked by a leaf. Also notice the many connectors located on the
driver board, as each corresponds to a unique motor tail connection. Click on the right arrow button to
continue.
3.22 Now let’s examine the driver board layout. This diagram shows the driver board motor map for the InCiseTM 2
MLC. When replacing motors or troubleshooting, you will be following the blue board layout. These driver
boards are swappable between banks A and B, but please ensure all bank specific settings are correctly
configured prior to installation as per service work instructions. Click on the right arrow button to continue.
3.23 After covering the non‐camera components of the MLC, we now transition to the leaf position breakdown.
This graphic illustrates the fixed absolute positions of the through‐beam sensors for each bank, along with the
mechanical and software driven limits. Click on the right arrow button to continue.
3.24 We now know where the MLC limits are, and these limits are pivotal to understanding the initialization
process of the MLC. MLC initialization happens prior to any treatment, when the MLC is picked up, or when
initiated by certain failures/errors (re‐initialization). Click through each of the numbered buttons on the left to
walk though the MLC initialization pathway, and, when completed, click on the right arrow button to
continue.
3.25 We have completed the non‐camera MLC specific hardware portion of this course, and now will look at the
signal pathway for the UCC when setting a MLC shape, from Service Mode. In this scenario, the UCC, via
Service Mode, requests the leaves to move to a desired position, in order to create a specific shape (involving
both banks). The signal originates from the UCC, travels through the network switch, Spider Switch, and MLC
Connector block and then on to the motherboard. The motherboard then directs each leaf bank to drive via
their respective driver board. The driver boards provide the motors with a torque, velocity, and position
control request (and gains created from calibration, if they are requested to be loaded). The UCC gets primary
feedback regarding encoder count, effort (proportional to current) per leaf, total power used by the MLC to
make the requested shape, aperture positions per leaf, velocity per leaf, and temperature. Click on the right
arrow button to continue.
3.26 You have completed the first InCiseTM 2 MLC specific hardware section.
3.3 A new unit incorporated into the InCiseTM 2 MLC, the secondary feedback unit, is known as the SFB. This major
improvement incorporated in the InCise 2 MLC, provides an independent secondary leaf position check
against the primary motor encoder, by using a camera to look at the top of the leaves across the field. As the
camera is only able to see the tops of the leaves, they are manufactured with properties that allow the
camera to distinguish them from one another in the field of view. SFB provides increased MLC robustness to
ensure beam shape is redundantly checked for patient safety.
3 InCise 2 MLC: Technical Specifications (continued)
3.4 Re‐examining the interconnect diagram let’s highlight the SFB components within the MLC: the camera,
camera controller board, and illuminator (LED) board. Just like all activities within the MLC, SFB components
are ultimately controlled by the motherboard.
The camera, which is responsible for providing live images to leaf location, is controlled by the camera control
board. This board is located in the MLC on the opposite side of the motherboard.
The final component of the SFB unit within the MLC is the LED or illuminator board. This board, which is
directly connected to the motherboard, functions to provide the SFB camera field with constant light. This
helps to standardize the images taken by the SFB camera for consistency and to keep integrity of SFB
calibration from patient‐to‐patient. Although this diagram shows the ability to configure two LED boards, only
1 is present on the MLC. Click on the right arrow button to continue.
3.5 The engineering drawing will allow us to see where the SFB components are attached to the MLC. Here, we
can see all aspects of SFB in the MLC: the illuminator board, camera, and camera controller board. Hover your
mouse over each component for identification and click the right arrow button to continue.
3.6 The camera control board, or CCB, is a small embedded Linux computer that is connected to the CyberKnife®
LocalAreaNetwrok through the motherboard. This has 3 connections: ethernet connection downstream to the
camera, ethernet connection upstream to the motherboard, and power input from the motherboard. We will
discuss post‐service activities for each of these replacements in later sections. The camera control board also
has shown some sensitivity to radiation exposure and will be replaced on a quarterly basis. Click on the right
arrow button to continue.
3.7 The SFB camera is a commercial grade security camera manufactured by Axis, and was chosen due to its
ability to easily be swapped out for replacement and its resolution of 0.1 mm = 1 pixel. It is crucial that the
manual adjustment of the camera focus is not changed in the field! As we will talk about during the
Installation lesson, the camera is partially calibrated in manufacturing and any adjustment to the focus set
screw will invalidate this factory calibration. Each camera is identified by its unique serial number that can be
found on the camera itself. The camera mounts directly to the MLC frame, and due to its radiation exposure,
customers can expect yellowing of the camera picture over time, due to yellowing of the camera lens. This has
been shown internally not to impact the ability for the SFB unit to appropriately check and control leaf
position; however, it is something that will be proactively changed during annual PMs. Click on the right arrow
button to continue.
3.8 The LED board is a FRU item consisting of 22 high‐brightness white light‐emitting diodes setup in 4 parallel
rows. It is not expected that this component will need replacement, although it might be possible in some
scenarios. Click on the right arrow button to continue.
3.9 Along with the SFB components located within the MLC, this upgrade also boasts a new rack mounted PC in
the equipment room, called the SFBPC. This PC is responsible for processing, analyzing, and directing images
taken by the camera for its check in treatment. Here is where the SFBPC fits into the computer rack along with
a picture of what this PC looks like. The SFBPC is the same hardware as the TLSPC, with not as many
computing enhancements added. Click on the right arrow button to continue.
3.10 The SFBPC can be hooked anywhere into the 192.168.185 network, via any of the ports shown in the red box,
which is now highlighted. As always, the CyberKnife® IT Guide can be referenced for any additional networking
questions. Click on the right arrow button to continue.
3 InCise 2 MLC: Technical Specifications (continued)
3.11 Within the SFBPC is a program called MlcCamView, located on the Desktop and is used for seeing the camera
field of view. Click on each of the numbered buttons on the left of the screen to walk though the image
capture and modification process.
1. MlcCamView will be used almost exclusively in Service Mode (and some treatment UI‐side functions via
Remote Desktop). MlcCamView will be used to see the raw and reduced images the camera takes of
the leaf‐top field of view, in tabular format. The SFB camera is meant to detect two things: separation
of each individual leaf from one another per bank, and where each leaf resides in the field (think X and
Y).
2. The first image is the uncorrected raw image that the camera plainly sees. You’ll notice that the leaves
are shown at an angle as the camera is mounted off –center when looking down on the top of the
leaves.
3. Once the raw image is captured, it is then modified through the distortion and perspective action which
modifies and transforms the image, to correct for both camera offset angle and ambient light. After
this step is completed, the image will look as if the camera is mounted in coincidence with the MV
beam.
4. For the final stage of image processing, the SFB calibration is applied to detect the two X and Y
attributes of the leaves we just mentioned. Once the calibration is overlaid, the secondary check can be
accomplished against the primary encoder position to sign off on beam shape. Click on the right arrow
button to continue.
3.12 The secondary feedback camera processing workflow shows how the picture is taken, transformed, and
modified until a result is recorded along with the time it takes the SFBPC to accomplish this. Click on the right
arrow button to continue.
3.13 Let’s see how the SFB process is incorporated by referring back to the interconnect diagram. When the
primary, or motor encoder pathway is executed during a clinical MLC aperture move, the SFB pathway is then
triggered (represented in pink). An image is taken and moves upstream, first through the CCB, then
motherboard, and finally to the UCC through the MLC connector block, Spider Switch, network switch, and
SFBPC (which takes care of the image processing techniques described previously). The UCC then determines
if the primary (encoder) and secondary (camera) agree with the leaf location, and if so, signoff so the aperture
size is completed and beam is allowed to commence. Please click on the right arrow button to continue.
3.14 This SFB image check workflow is now shown from the treatment user interface side with its incorporated
script names. One thing to note is that if the secondary check fails the first time, the MLC is re‐initialized, and
the secondary check is requested again. If the second check fails, the operator has to make a decision as to
whether treatment should continue or be aborted. This means that a treatment operator can commence
treatment with a failing secondary feedback check!
3.15 You have completed all parts of the InCiseTM 2 Hardware training and are 40% finished, please click the right
arrow button to continue with the remaining sections, which have now been unlocked.
4 InCise 1 MLC vs. InCise 2 MLC
4.1 The InCiseTM 2 MLC, which is tied to the V10.6 software release, is an improvement on the InCiseTM 1 MLC (tied to
V10.5 software). Although the software between the two versions provides the same features, the MLC of the
InCise 2 has been improved upon both in mechanics and design. Please click on each of the schematics to
compare interconnect and component differences. Click on the right arrow button to continue.
4.2 Please read about the specifics improvements made to the InCiseTM 2 MLC here. Be sure to click on both green
buttons to see all of the changes! Click on the right arrow button to continue.
4.3 Although the InCiseTM 2 MLC represents improvements made to this secondary collimator, Accuray is still very
dedicated to the potential future sale and current use of the InCiseTM 1 MLC. This is a subject that is likely to
come up while you are on‐site and it is important you have the correct information at your disposal to
comment on this. If a subject comes up that you are either uncomfortable answering or don’t know the answer
to, escalate concerns to the customer site’s Accuray account representative within the sales team. These
individuals have been specifically trained to deal with these delicate topics. Please see the Resources section
for “External Talking Points” documentation when dealing with InCise 1 versus InCise 2 questions and click on
the right arrow button to return to the Main Menu.
6 CK V10.6 / InCise 2 MLC: Installation
6.1 This lesson will now detail the pre‐10.5 V10.X system to V10.6 + InCiseTM 2 MLC pathway as version 10.6
includes all of the hardware changes encompassed in version 10.5. The installation pathway you will be shown
follows the workflow of service documentation, however, depending on the reality of the install (parts not
present, software discs not working, among others things), the order may not follow this exactly and is
therefore recommended with the assumption that this won’t necessarily follow what the documentation
states. Due to the scope of this install, be sure to take inventory of parts on‐site against kit contents (can be
found in Agile) to ensure any pieces not present can be accounted for and sent. To start, remove the Xchange®
,manipulator base, A3 top cover (if performing LED laser upgrade), and all manipulator tool head covers
(including metal cover). Please walk through the Installation menu from start‐to‐finish to see this order and
referenced documentation and parts.
1. In order for the CyberKnife® System to handle the addition of the InCiseTM 2 MLC, and specifically the SFB
camera, new robot base components are going to be added that include a new 24 volt power supply,
new network switch call the spider switch shown here in blue, and new LED power supply (if one is not
already on the robot). Take special care to secure and harness cables and wires when you are finished
with this section to ensure the robot can move without effecting function. It is a good idea to drive the
A1 joint of the manipulator to span the treatment range for use to ensure that cables and wires for
these components to stay secured.
The power filter upgrade has 3 parts: the power filter, tungsten shield, and new longer screws that are
required because of the tungsten shield. This is an item that will be replaced during quarterly PM’s so
make sure you keep the part number handy!
The MLC connector block and cable that runs upstream of it are replaced with this upgrade. These
screws are fitted with loc‐tite and may require some effort to remove. Use the new screws that come
with the upgrade connector block to replace.
The matrix physics kit foam insert will have to be replaced as there are new QA tools associated with the
InCise 2 MLC.
There is a new Xchange® puck, an improvement over the previous design, which provides the MLC some
relief by the beveled edge shown in this picture.
Because of the Spider Switch addition, the ways in which the robot gets its incoming network
connection requires modification. Incoming ethernet no longer comes directly into the CAS box; rather
to the Spider Switch first, and then it is split and directed to individual components. As such, the CAS box
has some modifications to be able to allow for this.
2. If performing the LED upgrade, remember to re‐baseline the laser alignment check calibration for each
housing, when completed. Make sure all electrical components on the robot arm have had sufficient
time to bleed down prior to handling. Verify with live‐dead‐live procedures.
3. Take special care when un‐wrapping the MLC from its packaging and placing in the Xchange® table.
Remember that this collimator requires two people, lifting ONLY with the housing handle, to place in the
Xchange table. If you have not replaced the Xchange puck, DO NOT PLACE THE MLC ON THE TABLE.
6 CK V10.6 / InCise 2 MLC: Installation (continued)
6.1
(cont’d)
4. When it comes time to install the SFBPC into the computer rack, take time to fit the castors and track
properly so that the computer looks visually appealing in the rack and is mounted flush with the other
computers. In order to be accessible from the KVM (does not matter for Remote Desktop), the port will
have to be added at the KVM. Access by pressing CTRL + ALT + DELETE on the KVM. Follow the
instructions on KVM menu to add port 07 and name the port SFB.
The remainder of the slides will detail each subsystem’s specific hardware and software upgrades,
please follow the work instructions very carefully for each to ensure proper upgrade.
Subsystem specific notes: After all hardware and software changes have been made, replace all of the
covers on the robot, and begin calibrations starting with Xchange calibration. Make sure you are
present in the vault to ensure proper seating of the MLC, on the head of the robot, for the first time.
Always know your surroundings when in the vault with the robot moving and where the closest E‐stop
button is located. Please click on the right arrow button to continue.
6.2 Aside from the MLC calibration (discussed in the next section) there are other various system calibrations and
wrap‐up activities that need to happen to conclude the installation upgrade. The leakage check can be
performed at any time after the MLC is on the head, and the system is able to be beamed on from the
MLCPHYAPP. Given the 24 exposure window for the films, plan the upgrade schedule to include running this
test at a time that won’t extend the installation schedule (i.e. shoot films over lunch).
For path calibration, especially if the LED laser upgrade was performed, spend time to make sure the iso‐post
sensitivity is within the acceptable range. This can be viewed manually via the teach pendant, AS WELL AS
what is recorded in pcal.log after calibration has started. Keep in mind that any intensity average for a node
that is 0.999 is oversaturated and any node under 0.2 will cause path calibration to fail. It is good practice to
start path calibration while tailing pcal.log for the first 20‐30 nodes to ensure that most (if not all) of the
nodes are less than the 0.999 value.
Do you recall that the laser alignment calibration is a DVC checked action and needs to have data for each
collimator housing? Prior to this being performed and base‐lined for the MLC, in order to start up the system
from EQP, you would have to disable security.
Fun Fact: For ATP, it is acceptable to use garden fence results obtained from MLC calibration for completion.
New to V10.6 is a Post‐Upgrade Checkout that can be filled out whenever the sections become
relevant/testable. In addition to this, depending on region, additional, more comprehensive quality/regulatory
testing may be required to demonstrate safety/efficacy. This should have been communicated through
sales/project management prior to your arrival on‐site for installation; however, additional protocols can be
created by engineering upon request.
You have now completed the upgrade installation section. Click on the right arrow button to return to the
Main Menu.
5 InCise 2 MLC: Calibrations
5.1 Calibration of the InCiseTM 2 MLC is a multi‐faceted, iterative process that involves different user interfaces,
interpretation of results, and film analysis. It is imperative that you follow established service procedures for
workflow, order, film software, and file‐naming conventions to keep data consistent and trend able.
5.2 If you hover your mouse over the different calibration premise buttons, Installation and Post‐Installation, you
will see that not every step is performed for post‐installation calibration scenarios. If you scroll your mouse
over each calibration procedure, you will also see through what software interface and GUI this will be
accomplished. Finally, during MLC movement, you can remote desktop to the secondary feedback PC, open up
the MlcCamView application, and see the leaves moving in real‐time. For efficiency, it is a good idea to add a
Remote Desktop icon to the UCC service desktop, much like the other computers on the CyberKnife. The
LINUX command to insert into this shortcut is <rdesktop sfb –u cks –p cksvc@accuray.com –g 1600×900>
(modify the resolution to your preference).
To see the individual workflow sections, click on the numbered buttons on the left.
1. The initial checks section of the calibration involves you locating and verifying various hardware,
software, firmware revisions, IP addresses, and the MLCID. Although not specified in the service
instructions, it is a good idea to remove the metal covers of the MLC to retrieve the serial number from
the camera prior to proceeding with calibration; this will make the workflow more efficient and will be
needed later on in the calibration process. While the covers are off, give the MLC a good visual
inspection to make sure connections and components are secured. Prior to proceeding with calibration,
put back the metal covers; this is important for consistency in the SFB calibration.
2. See the two SCS GUI tasks, baseline beam distances and quick test with no robot motion, located here.
Please click on the report to see it zoomed in.
3. The last task performed in the SCS GUI for this calibration pathway is called the quick test with no robot
motion. This script runs through a litany of mechanical movement tests that measure various timing
and functional success for completion of various shapes and stresses. This is a script that is a good tool
to use for trending of MLC mechanics over time.
5 InCise 2 MLC: Calibrations (continued)
5.2
(cont’d)
4. The MLC GUI, script name </accuray/tools/scs/mlc26tool>, can be accessed from the SCS dropdown
on the CyberKnife Service menu and performs many different calibration and mechanical movement
script tasks along with user‐friendly html report viewing. You’ll also notice many different radio
buttons on the left side of the GUI, in either a red or green state, depending on whether they have
been met or are passing/failing.
The full installation calibration procedure, once you have completed the SCSi tasks, will move from the
top of the MLC GUI to the bottom and will therefore start with the repeatability test. This test
represents the official calibration of the primary mean of determining individual leaf position, the
motor encoder. This script runs 30 cycles of the “baseline beam distances” script; this script performs a
two‐point motor encoder calibration by driving each leaf to break the plane of the front and rear
through‐beam sensor and records the measured encoder distance 30 times. When this encoder
distance is compared to the known distance of where each sensor resides, any leaf position can then be
extrapolated into the field with accuracy and precision.
This test generates the
</accuray/tools/scs/test_results/Repeatability_Test\Repeatability_Test_Date‐Time.html> report.
Let’s take a look at what this report looks like…you should see two tables which represent each bank of
leaves (remember A=X1 and B=X2). Also, in the header for the test, you will see the overall PASS/FAIL
result to quickly see whether or not you can accept these results or start troubleshooting a failure. Each
of the 26 leaves for each bank should have its own row in the table and determined whether it is a pass
or fail. If it is a fail, the row will be highlighted in red. The “avg” column represents the n=30 motor
encoder measured distance between the rear and front through beam sensor for its own bank. It
should be noted that any trend noticed in this column across the bank in either the positive or negative
direction should be considered normal and will be corrected for by the slope correction output in the
garden fence calibration. The items “min err”, “max err”, and “std” represent the difference between
the average and the lowest recorded measured encoder value. The max represents the same, except
for the highest value. Std represents the standard deviation of the n=30 sample. The specification that
each leaf needs to meet for a pass is min threshold > ‐10, max threshold < 10, std deviation < 5.
After you determine this test to be acceptable, it is necessary to confirm this within the MLCGUI by
clicking Accept. The MLCGUI performed calibrations are hierarchical in that anything downstream of
that calibration activity is invalidated once performed. Once the repeatability test is accepted; garden
fence and SFB calibration radio buttons turn red meaning they are invalidated and need to be re‐
performed/verified. Alternatively, if just the garden fence test was performed and corrections made,
then only the SFB calibration would need to be performed as it is the only thing downstream in this
workflow. The repeatability test is completed by initializing the MLC; this will make the ‘Verified’ radio
button turn green.
5 InCise 2 MLC: Calibrations (continued)
5.2
(cont’d)
5. The garden fence calibration is a film‐based test whose output verifies individual leaf accuracy to that
of its entire bank. This is an iterative test, in that after it is run once, if the film yields results that are
outside specification, corrections need to be made, and another film run (much like delta man). This
process is performed until acceptable results are obtained and accomplished by exposing 5 “fence
posts” on a small piece of film, and then determines how crisp and well proportioned each of the fence
posts are, down to the individual leaf. Each MLC is shipped with all manufacturing data that was
collected during testing, manufacturing‐specific calibrations, one of which was garden fence. It is a
good idea to look at the garden fence bank A and B offsets that generated acceptable results to
compare with offsets you actually determine, and will be a good reference as they should be very
similar.
The garden fence film analysis uses a program called RITg142, which is included in the upgrade
package. This software program has been validated by Accuray to analyze the garden fence results
through the Bayouth MLC algorithm. It should be noted that although this software is only validated for
use on Accuray MLC garden fence tests, the customer receives a full license of this powerful program
that has many other functions that could be used elsewhere in their film work, something to make note
of during conversations with client.
During the RIT film analysis, an optical density to dose conversion needs to take place, meaning a
calibration curve needs to be generated. This calibration curve is specific to each batch, or lot of film.
Make sure you find out whether the site has one already established for any film work they may
already be doing; if not, this will need to be completed prior to running your first garden fence.
Instructions to complete this calibration curve are located in the garden fence work instruction.
After each film, you will enter corrections for offset and slope for each bank in the MLCGUI. For these
changes to be active, you will need to click Apply prior to running another film. When you are satisfied
with the results and are ready to move on to secondary feedback calibration, you will click Finalize
Offsets, which completes the garden fence activities.
Make sure you secure the CyberKnife® System prior to performing garden fence as you need to log in to
physics mode to complete the film exposure!
The Garden Fence Test utilizes the Light Weight Film Holder (LWFH) to consistently place the film at
433.5 SAD for a leveled exposure. The LWFH attaches directly to the accessory mount on the MLC.
Please see the video embedded in the Quick Reference Guide located in the Resources section for how
to setup the film and accessory mount.
5 InCise 2 MLC: Calibrations (continued)
5.2
(cont’d)
6. The secondary feedback camera’s focus, angle, and orientation are calibrated as part of manufacturing.
As such, this is the only datafile that is shipped with the MLC. Make sure this disc is present and that
there is a file on the disc that is labeled with the serial number that matches what you have previously
recorded from the actual camera lens.
The secondary feedback unit is calibrated on‐site in three parts. The first step involves uploading the
manufacturing‐generated camera‐specific calibration file. It should be noted that the MLC may need to
be initialized prior to starting the SFB cal. The second, called “Perspective Calibration,” calibrates the
process that rotates, transforms, and corrects for light/distortion for the camera image. The third,
called “Import/Calibrate,” is the primary (encoder) to secondary (camera picture) that creates the
detection model for (1) distinguishing each leaf from one another and (2) where each leaf is in the
radiation field.
From a datafile level, after the secondary feedback is completed, the CyberKnife® System will consider
the MLC calibrated and will show this at the EQP screen. However, there are still additional actions that
need to be performed to verify function and establish baselines for certain characteristics.
Make sure to secure the system after SFB completion as additional physics related tasks will be
performed next!
7. MLC Leaves Drive Test is accessed by the MLC physics app, located on the treatment side of the
software.
8. The MLC Leaves Drive Test is meant to simulate the mechanical rigors the MLC encounters during a
clinical treatment. Afterwards, an additional Garden Fence Test needs to be run. If you recall, the
garden fence output lets us know how accurate leaf positions are at an individual and bank level. This
garden fence, known as the Confirmatory Garden Fence Test, needs to be run immediately after the
completion of the MLC Leaves Drive Test WITHOUT re‐initializing, to ensure that leaf position accuracy
of the unit is still intact after treatment, without the zero‐ing of encoder counts at the home position
that happens during initialization. If this confirmatory garden fence fails to meet bank offset
specifications, contact Accuray Technical Support for a remediation pathway. It is likely that the MLC
Leaves Drive Test/Confirmatory Garden Fence Test will be repeated to confirm results; however, other
actions may be taken as well.
9. The Picket Fence Test is run after a successful completion of the Confirmatory Garden Fence Test. Like
the Garden Fence Test, the LWFH is used to position film at a leveled 433.5 SAD to expose 10 fence
posts, with no spacing in between posts. The purpose of this test is to be a unit‐specific qualitative
measure of the leaf position drift over time. This is accomplished by running the Picket Fence at the
time of installation, in order to act as a baseline after a successful calibration pathway, up to this point.
To clarify, if you have made it this far into the installation pathway, the picket fence film will be
accepted as the baseline however it presents itself. It is scanned and saved, but no further analysis is
done. Then, when Picket Fence film tests are run after this baseline, it can be qualitatively compared to
the baseline to establish a trend for any exposure drifts or other artifacts over time.
The calibration of the InCiseTM 2 MLC completes with the Apertures script, which can be run from the
MLC GUI in Service Mode. Spend time understanding this workflow and the specific order from start to
finish, and once you are comfortable with the information, click the right arrow button to continue.
5 InCise 2 MLC: Calibrations (continued)
5.3 Please drag and drop these calibration activities into the correct, installation workflow order, and click Submit
when you are finished to see how you did!
5.4 Remember that this calibration workflow will not always be followed entirely from start to finish. Technical
Support or Engineering may request some tests to be completed to support unit performance trending, such
as the Quick Test with no Robot motion. Click the right arrow button to continue.
5.5 The InCiseTM 2 MLC uses a new coupler, front‐pointer adapter, and pinhole collimator. Ensure you have access
to the Matrix Physics Kit on‐site in order to configure the new accessory tools. Please note the birdcage is also
required to be attached to the MLC via the coupler as well. Please click on the right arrow button to continue.
5.6 It is important to understand which post‐tests are associated with the FRU parts identified for the InCise 2
MLC. These details are outlined in the InCise 2 MLC: FRU Matrix document, provided from the Resources link
at the top.
7 Conclusion
7.1 The introduction of the CyberKnife® version 10.6 also introduced the world to the InCiseTM 2 MLC. Key
functional and operational characteristics of this MLC were discussed in this eLearning course, along with
important similarities and differences to that of the InCiseTM 1 MLC. The primary and secondary
communication pathway loops are critical for the successful operation, both during clinical operation and
during installation and subsequent calibrations. Last but certainly not least, there are important items to
consider prior to, during and after the installation of both the version 10.6 software and InCise 2 MLC
hardware, as outlined in the upgrade service procedures and work instructions.
7.2 Congratulations! You’ve completed all of the required items for the CyberKnife® version 10.6 and InCiseTM 2
MLC eLearning course. We hope you feel more prepared for installing, servicing, and supporting this exciting
new hardware component and corresponding software release, at your site.
