XiO
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User Guide
Contact Infor mati on, R Revision evision Hist Hist ory, Trademarks XiO User Guide
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Document Name: Xi O_UR O_URG_434_ENG _434_ENG_A.p _A.pdf df
Contact Inf ormat ion, Revision Revision Histor Histor y, Trademarks XiO User Guide
Manufacturer CMS, Inc. 1145 Corporate Lake Drive Suite 100 St. Louis, Missouri 63132 USA http://www.cmsrtp.com Phone: 1-314-993-0003 1-314-993-0003 Toll Free: 1-800-878-4267 1-800-878-4267 FAX: 1-314-993-0075 1-314-993-0075 Email:
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Japan CMS, Japan, K.K. Nagatacho Bldg. 2-4-3, Nagata-cho, Chiyoda-ku, Tokyo 100-0014 Japan Phone: 81-3-3580-7100 81-3-3580-7100 FAX: 81-3-3580-7120 81-3-3580-7120 Email:
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European Union CMS GmbH Heinrich-von-Stephan Heinrich-von-Stephan Str. 5 b 79100 Freiburg Germany Phone: +49-761-88188-0 +49-761-88188-0 Toll Free: +800-4000-5000 +800-4000-5000 (regionally limited) FAX: +49-761-88188-11 +49-761-88188-11 Free FAX: +800-4000-5001 +800-4000-5001 (regionally limited) Email:
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Asia CMS Worldwide Corp. 25th Floor, Suntime International Mansion #450 Fushan Road Pudong, Shanghai 200122 P.R. China Phone: +86-215058-1041 +86-215058-1041 FAX: +86-215058-1045 +86-215058-1045 Email:
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[email protected] Customer Support: Support: Asia, Australia and New Zealand CMS Worldwide Corp Suite 15 International Business Centre Australian Technology Park Eveleigh, Sydney NSW 1430 Australia Phone: 61-2-9209-4507 61-2-9209-4507 FAX: 61-2-9209-4154 61-2-9209-4154 Email:
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European Union Authorized Representative Paul Shane Bennetts M Devices Group Marlborough House, Riding Street Southport PR8 1EW UK Phone: (0) 1704 544 944 Revision History Revision XiO_URG_430_ENG_A.pdf XiO_URG_430_ENG_A.pdf XiO_URG_430_ENG_B.pdf XiO_URG_430_ENG_B.pdf XiO_URG_434_ENG_A.pdf XiO_URG_434_ENG_A.pdf
Date 07/18/2005 06/30/2006 03/07/2007
Changes New document Update screen shots for new logo; contact information Update for release 4.34
Trademarks All terms mentioned in this manual that are known trademarks, registered trademarks, or service marks have been appropriately labeled as such. Other products, services, or terms that are referred to in this manual may be trademarks, registered trademarks, or service marks of their respective owners. CMS makes no claim to these trademarks. Use of a term in this manual should not be regarded as affecting the validity of any trademark, registered trademark, or service mark.
CMS® is a registered trademark of CMS, Inc. XiO® is a registered trademark of CMS, Inc. Adobe™, Acrobat™, and the Acrobat logo are trademarks of Adobe Systems Incorporated, which may be registered in certain jurisdictions. jurisdictions. Hewlett-Packard™ is a trademark of Hewlett-Packard Corporation. Netscape® and Netscape Navigator® are registered trademarks of Netscape Communications Corporation Corporation in the United States and other countries. Netscape's logos and Netscape product and service names are also trademarks of Netscape Communications Corporation, Corporation, which may be registered in other countries. UNIX® is a registered trademark in the United States and other countries, licensed exclusively through X/Open Company Ltd. Red Hat and all Red Hat-based trademarks and logos are trademarks or registered trademarks of Red Hat, Inc. in the United States and other countries.
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XiO
Contact Infor mati on, R Revision evision Hist Hist ory, Trademarks XiO User Guide Microsoft®, Windows®, Windows®, and Windows NT® are registered trademarks of Microsoft Corporation in the United States and other countries. Copyright © 2007 by CMS, Inc. All rights reserved. Performance characteristics given in this manual are for reference only and are not intended as guaranteed specifications.
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Ta b l e o f Co n t e n t s Intr od oduc uctt ion to XiO XiO .. . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. .. . 1 Overview verview .. ............................... ............................................... ................................ ................................ ................ 1 Int ended Users Users of t he XiO XiO RTP RTP Syst yst em . . ................................................... 1 Int ended Us Use of t he XiO XiO RTP RTP Syst yst em . . ..................................................... 1 Training Trai ning on t he XiO XiO RTP RTP Syst yst em . . ........................................................... 2 Usi Usi ng the t he Xi Xi O RTP System yst em . . .................................................................. 2 Program License License Ag Agreement reement . . ............................................................... 2
The Bas Basics ics of a Tr Tr eatment Plan .. ................................ ................................................ ................... ... 3 Plan Types Types .. .................................................................................... 3 Patient Da Dat a .. .................................................................................. 3 Enteri nt ering ng Pati Pati ent Anatomy Data Data.. . ............................................................ 4 Anatomy Data Data Clas Class sif icat ions . . .............................................................. 7 Patient Anat nat om omy y File File Iden Identt if icat icat ion .. ...................................................... 8 Plan Modes... ................................................................................. 11 Interes Int erestt Points oint s and Markers . . . ............................................................. 11 Calculation Region... ........................................................................ 12
Radiati adiati on Source Source Infor ma matt ion .. . ................................ ................................................ ................... ... 14 Teletherapy Telet herapy Source Parame Paramett ers . . . ........................................................ 14 Source Phys Physics ics Dat Data a . . . ...................................................................... 15 Wedg edge e and Compen Compens sator Informat ion . . . ................................................. 15
Brachyther apy apy Source Source Infor Infor ma matt ion .. . ............................................ 17 Dose ose Calcula Calculatt ion Algorit Algorit hms .. . .............................. .............................................. ...................... ...... 17
XiO Basics... . . . . . . . . . . . .... . . . . . . . . . . . .. . . . . . . . . . . . . . .. .. . . . . . . . . . . . . 19 St art ing XiO XiO .. . ............................... .............................................. ............................... ........................... ........... 19 Logg Log ging into XiO XiO .. . ................................ ................................................ ................................ ................... ... 19 Linux inux .. . ........................................................................................ 19 UNIX............................................................................................ UNIX... ......................................................................................... 19 XiO Modules... ................................................................................ 20
Cr eat eate e Login User User names and and Pass Passwor ds. .. ...................................... 22 XiO Us User Ut Ut il it y. .. ............................................................................ 22
User Defi nab nable le Setup, Cust ust omizat omizat ion, and Pref Pref erences .. . .................. 25 Create Clinics... .............................................................................. Window Size .. . ............................................................................... DICO ICOM RT Pl Pl an Import Impor t . . . .................................................................... DICO ICOM Export Setup et up and Conf Configurat igurat ion. . . ................................................
25 25 25 25
RTP Link . . . .................................................................................... 26 ®
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Table of Contents XiO User Guide
Cust ust omizing the Linux Des Deskt kt op. op . . . ......................................................... 26 Sett ings.. ings.... ..................................................................................... PFM and Telet Telet herapy Pref Pref erences . . . ..................................................... Brachyt herapy Source Source Types, Types, Source Templat Templ ates es,, and C Cat athet heter er Types.. . ........... RTOG TOG Prot Prot ocol Submission ubmission Soft of t ware. ware . . . ................................................... VIDAR Film Scanner... ....................................................................... Screen Capture Capture Ut il it y (UNIX (UNIX). ). . . ...........................................................
27 27 27 28 28 28
Navigation................... Navigation... ................................ ................................ ................................ ........................... ........... 28 Limit s and Color Color Defi nit ions.. ions.. . .............................. .............................................. ....................... ....... 30 Genera enerall Limit ations ations .. . ...................................................................... IDs, Names, and Descriptions... ........................................................... Brachytherapy................................................................................ Brachytherapy... ............................................................................. Irreg Irr egular ular Field Point Point Dose ose Calculat Calculat ion. . . .................................................
30 31 31 31
Syst yst em C Color olor Defi nit ions. ions. . . ................................................................. 32
Gett ing Help ... ................................ ................................................ ................................ ........................ ........ 33 Auto-Help/ uto-Help/ Answer-H nswer-Help elp .. . ................................................................. 34
Exiting XiO... .............................. .............................................. ................................ ............................ ............ 35
Pat ient File Ma Maint ena enance nce .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 .3 7 XiO PFM PFM Inter face .. . .............................. .............................................. ................................ ................... ... 37 PFM Functi Functi ona onalili t y .. . ............................... .............................................. ............................... ................... ... 40 The Mode Mode But Buttt ons. ons. . . ......................................................................... 41 The Submode But Buttt ons.. ons. . . .................................................................... 41
T e l et e t h er e r ap ap y . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. .. . . . . . . . . 43 XiO Telether apy apy Interf ace ace .. . ................................ ................................................ ....................... ....... 43 Teletherapy Teletherapy Functi Functi ona onalit lit y ... ............................... ............................................... ........................ ........ 45 The The M Main ain Toolba Toolbarr .. . ......................................................................... Contour Support upport ing Toolbar Toolbar . . . ............................................................. Beam Supporting Toolbar... ................................................................ Port Supp upport orting ing Toolba Toolbarr .. . ................................................................. Dose ose Support ing Toolbar. . . ................................................................. Tools Tools Supporting upport ing Toolbar Toolbar . . . ................................................................ IMR IMRT Support upport ing Toolbar Toolbar . . . ................................................................
45 46 47 47 48 50 50
Teletherapy Teletherapy Fea Featur tur es ... ................................ ................................................ ............................ ............ 51 Window indow Format ormat .. . ........................................................................... 51 Making a Beam Active... .................................................................... 54 Bolus... ........................................................................................ 54 Add/ Edit a Con Contt our our .. . ....................................................................... 54 Dose... ......................................................................................... 55 Hist ist ogram ogram .. . .................................................................................. 56
Table of Contents XiO User Guide
Mult iple Plan Review Review .. . ..................................................................... 57 Saving Plans... ................................................................................ 57 Plan Approval Approval.. . . .............................................................................. 57
Next St ep.. . .............................. ............................................. ............................... ............................... ............... 57
In d e x . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. .. . . . 59
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Table of Contents XiO User Guide
I nt n t r o du d u c t i o n t o Xi O
Overview Welcome to XiO! You join thousands of clinicians worldwide who use XiO to develop treatment plans for cancer patients. As you work with XiO, you will appreciate the remarkable capability you now have to create extremely accurate treatment plans in a minimum amount amount of time. In this guide, you will read about the underlying concepts that help you understand the software’s features. XiO is a combination of two-dimensional, three-dimensional, three-dimensional, and IMRT radiation treatment planning systems, representing over five hundred “man years” of cumulative research and development by Computerized Medical Systems’ (CMS) scientific staff and academic partners. While many XiO features are discussed in this guide, some are licensed individually and it is possible that some topics discussed are not available to you. Review your sales contract to verify the hardware and software features that were installed at your site and activated by the CMS technician.
Intended Users of the XiO RTP System The XiO radiation treatment planning (RTP) system is intended to be used by qualified individuals. An intended user should be either a Certified Medical Physicist, a Certified Medical Dosimetrist (CMD), or a Registered Radiation Therapy Technologist (RTT), all under the direction of the Radiation Oncologist (MD). They should be knowledgeable in radiation treatment planning conventions, should be certified by their respective national accrediting agency, and should hold all appropriate state and federal licenses.
Intended Use of the XiO RTP System The XiO RTP System is used to create treatment plans for any cancer patient for whom external beam radiation therapy or brachytherapy has been prescribed. The system will calculate and display, both on-screen and in hard-copy, either two- or three-dimensional three-dimensional radiation dose distributions distributions within a patient for a given treatment plan set-up. The XiO online documentation contains detailed information on how the system is intended to be used. The XiO Training Guide contains examples that explain how the system is intended to be used. You are responsible for ensuring that you use the system in this manner. ®
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Introduction to XiO XiO User Guide
The examples and figures used throughout the XiO online documentation and XiO Training Guide demonstrate specific aspects of the XiO RTP system. These figures and examples do not necessarily reflect what is used in a clinical setting and, as such, should not be used as examples for treatment planning.
Training on the XiO RTP System CMS, Inc., provides extensive training when the system is installed at the site and has Customer Support Specialists available to answer questions and handle problems encountered during day-to-day operation. The XiO Training Guide was designed to supplement CMS training by explaining how to use the system to set up a treatment plan. The XiO online documentation contains detailed explanations on how the system works. These manuals are not intended to replace CMS training. You are responsible for ensuring that all people using XiO to generate treatment plans have been trained to use the system prior to using a patient’s treatment plan in a treatment course. If you do not, the plans may not be correct, and an incorrect dose may be administered to the patient.
Usii ng t he XiO RTP Us RTP Syst Syst em Before using the XiO RTP system in clinical applications, you should determine the suitability and accuracy of the software for its intended use. Only after thoroughly testing and accepting the results from the system should you release the software for use in your clinic or hospital. Remember, treatment plans derived from the use of this equipment are dependent on data entry made by those professionals trained to use the system. As such, treatment plans derived from this equipment should not be substituted for human judgment. You should verify all treatment plans and patient and source data before using them in a treatment course.
Pr og ogrr am Licen se Agr Agr eement All terms, provisions, and conditions stated in the Program License Agreement for XiO apply. CMS, Inc., must have a signed program license agreement from you on file before you can use the software or contents of the XiO documentation. A copy of your signed agreement can be obtained by contacting your Customer Support Specialist.
Introduction to XiO XiO User Guide
The Bas Basii cs of a Treat ment Pl an A treatment plan is fundamental when you plan a treatment course for a cancer patient. It is a collection of data files from which the radiation dose data is calculated. A treatment plan specifies how radiation sources are applied to a patient and incorporates these items: •
Information about the patient
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Information about the radiation sources used (the teletherapy beams or the brachytherapy source groups)
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Information that describes how the radiation is to be applied to the patient
Plan Types XiO differentiates between plans that have been created and saved (called “permanent plans”) and plans that have not yet been saved (called “temporary plans”). When you start a new treatment plan, that plan is temporary until you actually save it in the XiO database. When you use or edit a plan that is already permanent, XiO provides a copy instead of letting you work directly with the permanent plan; this copy is also a temporary plan. If you edit the temporary plan and then save it, XiO replaces the original permanent plan with the modified version.
Patient Data XiO maintains demographic and anatomical data for each patient for whom treatment planning is performed. All patient data is stored under a unique, user-defined patient ID.
Demographi c Dat Data a Patient demographic data about each patient is collected and stored for use in demographic studies and tumor registry. Typical demographic data includes patient name, address, telephone number, birth date, and gender.
Anat natomy omy Dat Data a Patient anatomical data identifies the disease sites. XiO categorizes information about patient anatomy anatomy in terms of anatomical sites and anatomical structure names. These are defined on a clinic-by-clinic basis and are applied to all patients stored on the system.
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Introduction to XiO XiO User Guide
Patient anatomy data is physical information about a patient. Patient anatomy data includes: •
Anatomical structure contours
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Tissue density of anatomical structures
Entering Patient Anatomy Data Patient anatomy data can be entered into XiO in two forms: pixel images and contours.
Pixel Images Pixel images are images of patient anatomical structures formed using tissue density information stored in units called pixels. Specifically, a CT combined with the appropriate electron density conversion file determines the tissue density of a pixel-size area of patient tissue. MRI may also be used, but the pixel information does not determine the tissue density. Using unique shades of color to represent each pixel’s numeric value, XiO constructs a patient anatomy image. Five or more pixel images in the same orientation comprise a three-dimensional patient volume. Although a pixel image contains the tissue density of many anatomical structures, it does not differentiate the structures. You must outline each structure before XiO can use the pixel image data.
Figure 1: Pixel image
Introduction to XiO XiO User Guide
Figure 2: Contours
Contours In XiO, a single CT image is referred to as a cross section. Contours are connected line segments that outline the individual anatomical structures within a cross section. Individual structures include such things as the patient outline, the tumor, individual target r egions, and individual organs (such as the lungs, the heart, or the spinal cord). You create the contours in the Patient File Maintenance module of XiO using:
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A tablet (digitizer), which is used to trace drawings from graph paper, a radiograph, or a hardcopy CT image.
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A mouse, which is used to either trace a structure’s contour directly from the screen or to select an area of the image for automatic contouring (that is, the automatic generation of individual contours in a cross section). XiO provides four methods of automatic contouring: °
Auto-by-Threshold − XiO draws a contour around the edge of a sharply delineated structure by detecting the abrupt change in color.
°
AutoSegmentation − XiO draws a contour after analyzing subtle changes in gray level and intensity taken from a userdefined segment of the image.
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Auto Margin − XiO draws a second contour around a structure. XiO also offers three-dimensional variable auto margin and the ability to draw one contour around a structure combination.
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Interpolation − XiO generates contours on cross sections that lie between the beginning and ending contours that you specify.
Introduction to XiO XiO User Guide
Figure 3: Contour with an automatically generated margin.
Contours can be imported along with digital image data in the DICOM 3.0 image format. Although a contour image contains the contours of many anatomical structures, it does not contain the tissue density of each structure. You must enter the tissue density of each structure or use a pixel-by-pixel calculation instead of assigning a value to a structure before XiO can use the contour data. XiO prompts you for this information.
Figure 4: Pixel image with contours traced on it.
Introduction to XiO XiO User Guide
Figure 5: Zoom in on the image to see each of the tiny squares, or pixels, that make up the image.
Five or more cross sections in the same orientation comprise a threedimensional patient volume. volume. It is important to remember that at least one contour in a cross section outline must be the patient’s external outline (the skin).
Anatomy Data Classifications St udys udyset et s Studysets are sets of cross sections intended for use with a specific treatment plan. Studysets can be broken down into image-based and nonimage-based studysets. Because isodose treatment plans require at least one transverse patient cross section, any studyset to be used in an isodose treatment plan must contain one. Each studyset is referenced by a studyset ID.
Predefined Anatomy Site An anatomical site is a description of a particular area of the body (for example, “head and neck,” “lung,” or “prostate”). In general, these sites correspond to the anatomy surrounding a specific region of the body. These sites are user-definable and vary from clinic to clinic.
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Introduction to XiO XiO User Guide
Anatomical information can be obtained from pixel images or contours. XiO reconstructs pixel images (such as CT images) from numeric values captured by the scanner or other imaging machine. Each anatomical site contains corresponding internal structures (contours) identified by anatomical structure names. For example, the anatomical site “lung” might contain anatomical structures named “right lung,” “left lung,” “heart,” and “spinal cord.” These structure names are also user-definable. Each anatomical structure name has one of three classification types assigned to it: •
General − Includes the structure names automatically included in each anatomical site. General structures are further divided into the following categories: °
Patient − The patient’s external outline (the skin); this structure is always required. All other structure definitions are optional.
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Tumor (Tum) − The tumor to be treated.
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Target Volumes 1 through 5 (TV1, TV2, TV3, TV4, and TV5) − The area defined as the tumor plus a user-defined margin to account for microscopic extensions of the tumor that cannot be precisely seen and to allow for a margin of error in defining the tumor.
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Specific – Includes structure names inside of the patient contour other than the tumor and target volumes.
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User-defined − Includes all user-defined structure names for individual sites.
If you don’t add a predefined site, you only have general and specific contour names.
Patient Anatomy File Identification An anatomy file is identified by its orientation, location, and anatomy data mode.
Orientation The orientation of a cross section is determined by its position relative to the patient coordinate system axes. A cross section can be orthogonal (perpendicular to one of the three axes) or semi-orthogonal (at some angle other than 90 to the axes).
Introduction to XiO XiO User Guide
Orthogonal planes are classified as being transverse, sagittal, or coronal. •
Cross sections or image planes that are perpendicular to the patient Yp axis are called transverse.
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Cross sections or image planes that are perpendicular to the patient Xp axis are called sagittal.
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Cross sections or image planes that are perpendicular to the patient Zp axis are called coronal.
Figure 6: Patient orientation
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Introduction to XiO XiO User Guide
Location The location of each cross section within a patient is also determined by its reference distance. The reference distance of a cross section specifies the coordinate where the plane containing the cross section intersects the patient axis to which it is perpendicular.
Figure 7: Reference distance
Anatt omy Dat Ana Dat a Mode Mode The anatomy data mode describes whether contours or pixels are defined and, for pixel data, what parameter the pixel values denote. The possible anatomy data modes (and their standard abbreviations) are: •
Wireframe contours (WC)
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Computed tomography (CT)
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Electron density converted from CT pixels (EP)
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Electron density converted from assigned contour density (EC)
Introduction to XiO XiO User Guide
Pl an Modes A treatment plan can be two-dimensional two-dimensional or three-dimensional (2-D or 3D), based on the nature of the studyset. The plan mode affects how the plan appears on the screen, how the plan is set up, and how the dose is calculated. •
If the plan has a studyset with fewer than five transverse cross sections, the planning mode is set to 2-D. In this mode, only individual cross sections are displayed on the screen. Representations of beams and treatment aids are displayed in two dimensions.
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If the plan uses five to 30 transverse cross sections, you can set up the treatment plan as 2-D or 3-D.
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If you have more than 30 cross sections, you can display individual cross sections or a patient volume constructed from several cross sections in 3-D.
Intensity Modulated Radiation Therapy When creating a 3-D treatment plan, you also have the option of Intensity Modulated Radiation Therapy (IMRT). In IMRT, rather than manipulating beam parameters to achieve a suitable dose distribution, you “reverse” the process by defining the clinical goals first and then allowing the optimization algorithm to find the best configuration of beam intensities.
Interest Points and Markers Optional interest points and markers can be defined on each cross section. Interest points are used to obtain dose calculations at specific points in a cross section. Markers are used to mark specific points in anatomical structures. Dose is not calculated at markers. Interest points and markers are defined in two places within XiO:
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In the actual studyset, while entering cross sections. These points are available in any treatment plan containing this cross section.
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While you are setting up the treatment plan. These points are available only for this treatment plan.
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Interest points and markers are affected by the treatment planning mode: °
Interest points and markers in three-dimensional planning mode can be defined, moved, or added to anywhere in the patient including between cross sections.
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Interest points and markers in two-dimensional planning mode must be located on individual cross sections in the
Introduction to XiO XiO User Guide
orientation in which the point was originally defined. In other words, a point originally defined on a transverse cross section can be relocated only to relevant transverse cross sections and cannot be located between cross sections. In XiO, interest points and markers are displayed using the same symbol (+), but in different colors.
Calculation Region The calculation region is that region in the patient anatomy for which the radiation dose will be calculated. Only points inside (including on the edge) of this region are used during dose calculation. The type of calculation region used in the treatment plan is called the calculation mode. The calculation area and region are specified by their x, y, and z coordinates. The possible modes include: •
Volume − Available only for three-dimensional plans, a calculation volume consists of user-definable, equally spaced calculation points along each dimension of the volume. You may specify the volume’s size, its center position, and the number of points in each dimension or grid spacing to place calculation points. The system calculates the radiation dose for each point in the matrix, along with any interest points you have specified.
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Selected Planes − Available when two- or three-dimensional treatment plans are used, this method calculates dose for an area on user-selected cross sections. This area is divided into a series of equally spaced calculation points along the two dimensions of the area. You may specify the orientations and reference distances for each cross section, the dimensions along two of the axes that apply to the plane, two center coordinates of the calculation area, and the number of points in each dimension or grid spacing to place calculation points. The system calculates the radiation dose for each point in the matrix, along with any interest points you have specified.
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Interest Points Only − This mode is available when interest points are defined in the treatment plan. Each calculation point is defined by its coordinates in the patient coordinate system. The system calculates the dose only at the specified interest points.
Introduction to XiO XiO User Guide
Figure 8: 3-D calculation region
Figure 9: 2-D calculation region
Tiss Tis sue Dens Densit it y Heter og ogeneit eneit ies Tissue density heterogeneities are tied to the calculation region and may be either included or excluded in dose calculation. When the heterogeneities are not considered in the dose calculation, the entire volume inside the patient surface is calculated as homogeneous water. The relative electron densities of the anatomical structures and tumors will be ignored. Use heterogeneity corrections to account for innate variability in the anatomy, density, and geometry of individual patients. When the heterogeneities are considered in the dose calculation, two different methods of deriving the tissue densities (relative electron densities) inside the patient exist. These are: •
For non-image-based and image-based cross sections, the method uses user-assigned relative electron densities, which assume that the entire region inside each user-defined contour is homogeneous with one relative electron density.
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For image-based cross sections, the pixel values used to generate the image are used to determine density values within a contour.
Even when heterogeneity corrections are turned off, XiO converts the patient data to an electron density matrix. When calculating with a homogeneous patient, patient, the electron densities of the pixels inside the patient wire contour are set to 1.0 and outside are set to 0.0.
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Introduction to XiO XiO User Guide
Rad adii at ion Sour ce Inf ormat ion Before you use XiO for the first time, your medical physicist gathers a great deal of information from your equipment and enters it into XiO. Most of this information consists of measurements obtained from the linear accelerator and acceptance tests of the many XiO programs. This process of integrating XiO into your clinic is called commissioning or machine commissioning and is an important responsibility of the medical physicist. XiO must be commissioned before you can use it on a daily basis for treatment planning. The information in this book does not cover machine commissioning commissioning nor does it explain how to create and store the files containing data about the radiation sources. But it does explain what this data is and how it is used in preparing your treatment plans. A machine ID identifies each teletherapy source. Use this user-defined ID to recall the entered source data used in the treatment plan.
Telet her apy Sour Sour ce Paramet Paramet ers Source parameters are all of the treatment beam constraints that specify how radiation sources are applied to the patient in the treatment plan. In teletherapy plans, these determine how individual beams are positioned on the patient. This data is supplied by the machine manufacturer or is determined from clinical measurements. The system uses this data to determine the limits for treatment setups. XiO requires these parameters for each e nergy of the machine: •
The modality (photon, electron, or proton)
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Energy
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Machine reference distance (source-to-isocenter (source-to-isocenter distance, where the field size readout on the machine is defined)
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Machine setup (source-to-axis distance, source-to-skin distance, rotational arc, or symmetric or asymmetric beam)
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Collimator settings and angle (including asymmetric jaw parameters or multileaf collimators)
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Gantry settings, angles, and degrees of rotation
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Couch settings and angle
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Isocenter/beam entry point location
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Placement of treatment aids (wedges, ports, and compensating filters)
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Beam weighting settings
Introduction to XiO XiO User Guide •
Normalization method and settings
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Source-to-skin distance (which varies for each treatment plan)
Sour ce Physics Dat Dat a Source physics data consists of the following tables or parameters used to calculate the radiation dose. From the following list of data tables, photon machines maintain internal tables for BSF, PSCF, TAR, TPR, OCR (aligned and diagonal), PDD, dose outputs, and irregular field data. Electron machines maintain tables for PDD and cone parameter data. Not all tables listed exist for all machines. The data required by radiation dose calculation varies with the calculation algorithms. These parameters determine the range of values, which can be used when positioning individual beams in a treatment plan. Source physics data consists of a subset of the following tables or parameters used to calculate dose: •
Backscatter factors (BSF)
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Phantom scatter correction factors (PSCF)
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Tissue-air ratios (TAR)
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Tissue-phantom ratios (TPR)
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Aligned and diagonal off-center ratios (OCR/OCD)
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Percent depth doses (PDD)
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Dose outputs
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Cone parameters
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Irregular field parameters
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Penumbra modeling parameters
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Machine energy spectra
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Collimator, MLC transmission parameters
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Machine non-scanned data (geometry and other information)
Wedg edge e and Compens Compensator ator Infor mati on Wedge data consists of the wedge type and all parameters required for the wedge correction and attenuation. The wedge types available with XiO are:
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Physical wedge
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Motorized wedge − A wedge angle synthesized from a wedge that is in place for a specified fraction of the treatment and then removed for the remaining portion.
•
Enhanced dynamic wedge − A software simulated wedge for Varian linear accelerators.
Introduction to XiO XiO User Guide •
Virtual wedge − A software simulated wedge for Siemens linear accelerators.
Compensating filter (or compensator) data consists of the compensating filter type and all parameters required for the addition of a compensating filter to a treatment plan. A compensating filter attenuates the radiation beam before the radiation reaches the patient. The purpose is to provide an even dose distribution to the patient at the required depth in the presence of patient irregularities (surface shape or internal densities). The compensating filters available with XiO are: •
1D − 1D compensators provide one-dimensional compensation. One-dimensional One-dimensional filters are constructed by stacking thin sheets of attenuating material of different lengths in stepwise fashion, only over the area requiring compensation. You can send 1D compensating filter data to a plotter.
•
Ellis − Ellis compensators provide two-dimensional compensation. Ellis filters are attached to a mounting tray and constructed with aluminum or brass blocks that correspond to the irregular surface or internal inhomogeneities. You can send Ellis compensating filter data to a plotter.
•
Milling machines − XiO supports Huestis and Par Scientific milling machines. Milling machines are linked to the planning system in order to automate the construction of compensators, which can be constructed with a variety of materials of different mass densities. These include wax, plastic, aluminum, brass, and a gypsum/steel mixture. mixture. You can send the data for Huestis and Par P ar Scientific filters to the milling machines.
•
.decimal − These compensating filters are built using data files you send to .decimal via email. The .decimal compensating filter is made using special CADCAM software on a computer networked to a computerized milling machine. The standard .decimal compensator is machined from aluminum, however brass may also be used. The .decimal compensator is shipped with a quality assurance report.
Introduction to XiO XiO User Guide
Br achyt her apy Sour Sour ce Inf Inf ormat ion Three types of brachytherapy source information are stored in source files: •
Source types − A source type is a set of data that defines certain parameters about a source, such as the geometry of a source and which method is used to create a dose rate table for the source.
•
Source templates − A source template is based on the data found in a source type, but adds information about the calibration date, calibrated strength, and other specifics to make the template clinically useful.
•
Catheter templates − A catheter template is a set of data about one or more physical catheters. Information like the geometric properties of the catheter and its source loading are maintained here.
Dose Calculation Algorithms A dose calculation algorithm is a set of principles, models, and formulas used to calculate the dose throughout the calculation area, volume, or set of interest points. Algorithms available are:
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Clarkson
•
Fast Fourier Transform (FFT) Convolution
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Superposition
•
Fast Superposition
•
Electron 3-D Pencil Beam
•
Proton Broad Beam and Pencil Beam
Introduction to XiO XiO User Guide
XiO Basics
Starting XiO 1. Connect the XiO XiO system to the proper power power outlets. outlets. 2. Turn on power to all of the devices attached to the workstation. workstation. 3. Turn on the power to the workstation. A login login prompt prompt appears.
Logg Log gi ng int o Xi Xi O Linux 1. At the the login prompt, type your your user name and press Enter. 2. At the password prompt, type your password password and and press Enter. ♦
If you have added the XiO icon to the desktop, click the XiO icon. XiO opens automatically.
♦
If you have not added the XiO icon to the desktop, do the following:
a.
Close the Start Here window.
b. Open a terminal window. To do so, right-click right-click on the desktop. Select New Terminal on the menu. c.
In the terminal window, type xio and press Enter. The system displays the main XiO window.
UNIX 1. At the the login prompt, type your your user name and press Enter. 2. At the the password password prompt, prompt, type your password password and press Enter. The XiO software starts and displays the main window. A dedicated XiO user has access only to the XiO application. When a dedicated XiO user logs on to the workstation, XiO immediately immediately starts up. When they exit from XiO, they are automatically logged off of the workstation. A nondedicated user (root user) has access to all of the applications and utilities stored on the workstation. When a nondedicated user logs on to the workstation, the UNIX system prompt is displayed. They must then
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XiO Basics XiO User Guide
enter an additional command to run XiO. When they exit from XiO, they return to the UNIX system prompt.
Figure 10: XiO main window
XiO Modules Patient File Maintenance Maintenance
The Patient Patient File Maintenance (PFM) module is used to maintain all patient data, including: o
o
Patient demographic data Anatomy data, including anatomical structure contours and tissue density of anatomical structures
XiO Basics XiO User Guide
Teletherapy
The Teletherapy planning module is used to develop and evaluate treatment plans, including the production of the dose matrix and generation of isodose surfaces or isodose curves. Several features are available only when special licenses for them have have been purchased. If you see a Help topic for a f eature that you do not have at your clinic, check with your system administrator to see if your XiO system is licensed for that feature.
Irregular Field
The Irregular Field Point Dose Calculation module allows dose calculations to be performed for specific points in a patient. Plans are created, saved, recalled, and modified in Irregular Field Point Dose Calculation in a w ay similar to the Teletherapy planning module, but with the following differences: o
o
Brachytherapy
Patient surface topology and density variation information are represented differently. They are represented in Teletherapy planning by entering CT scan data or digitizing wire contours to which you assign densities. The Irregular Field Point Dose Calculation module assumes a 1.0 homogeneous density. The Clarkson algorithm, used to perform dose calculations, is implemented differently in that the user must provide the point depths and distance to surface since CT data and contours are not used.
The Brachytherapy planning module is used to develop and evaluate treatment plans utilizing brachytherapy, including the localization of seed sources, production of the dose matrix, and generation of isodose surfaces or isodose curves. The Brachytherapy planning module is organized into a large set of global and local functions.
Source File Maintenance
The Source File File Maintenance Maintenance (SFM) module is used to enter and maintain data that defines the characteristics of radioactive sources. The data is used to set up treatment plans and to calculate dose. Data for each source, such as a tele therapy machine, is saved under a directory identified by a unique source ID. For teletherapy machines, this ID is also called the machine ID.
Data Export
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The Data Export module is used to create data files for use on record and verify systems.
XiO Basics XiO User Guide
RTOG Submission
The RTOG Submission module is used to submit data to the RTOG 3D Quality Assurance (QA) Center.
Transfer Data to Focal PC
The Transfer Data to Focal PC module is used to send data to a Focal system.
Film Digitizer
The Film Digitizer System module is used to connect to the VIDAR Film Digitizer. This enables you to: o
o
o
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Scan films from an x-ray, CT, or MRI scan Extract individual images from the scanned film Manipulate the images for the best possible quality Export the images to the DICOM 3.0 Secondary Capture format
The individual images can then be imported into XiO, where they can be used to create contours and treatment plans.
Create Login Usernames and Passwords When your XiO system was installed, a default username and password were created. You may choose to use only this one username and password, or you can set up unique usernames and passwords for each planner and set up privileges based on each individual’s usage.
XiO User Utility Run the XiO user utility on a workstation when you want to add a dedicated user, remove a user, or change a user’s password. If a user has an account on more than one workstation on your network, you must run this utility on each workstation. Before running this utility, verify that: •
You are not running NIS, shadow passwords, or any other automatic configuration utility.
•
No one is modifying the password file.
Add a user through XiO: 1. Open the XiO Online Help. 2. On the Contents tab, click the Utilities book. 3. Click the Utilities Table of Contents topic.
XiO Basics XiO User Guide
4. Click the Manage User Accounts link. 5. When prompted, enter the root password. password. Continue Continue with the the UNIX/Linux system prompt in step 3 below. Add a user through a UNIX/Linux system prompt: prompt: 1. Log in as the root user. 2. Enter the following, pressing Enter at the end of each line: cd / /FOCUS/bin/xio_user
3. Enter the number for the Add an XiO User option and press Enter. This option sets up the login ID to be a dedicated XiO user. When you select this option, the following is displayed: Add an XiO User ---------------Enter a valid XiO login ID: ID must be unique, 8 characters or less, and may contain the characters, A-Z, a-z, or the numbers 0-9 only. Enter a blank line to return to the previous menu.
NOTE:
Linux does not allow uppercase A-Z characters.
4. Enter an ID and press Enter. When you enter a valid ID, the following is displayed: Enter user identification: User identification should include the name of the user and any other demographics desired but may not contain a ‘:’.
5. Enter a description for the ID to identify the user and press Enter. 6. Enter a password and press Enter. 7. Enter the password again to confirm confirm and press press Enter. After entering a valid password, the following is displayed: User [login id] was successfully added. Press ENTER to continue.
8. Press Enter. 9. Enter the number for the Exit option and press Enter to return to the User Utility menu.
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XiO Basics XiO User Guide
User Authorization To set up user access privileges, follow the steps below. 1. Open XiO. 2. On the main window, go to the Settings menu and select Installation followed by User Authorization . The System User Access Preferences dialog box displays. 3. Complete the the fields according to the definitions definitions below below for each user.
Login Name
Enter an eight-character user name that has been previously defined in UNIX/Linux. Login names may consist of numbers or letters only.
Admin
Enter to grant administrator privileges. Enter to deny administrator privileges. This privilege allows other users to access all areas in Settings.
Physicist
Enter to grant physicist privileges. Enter to deny physicist privileges. This privilege allows access to the following areas of XiO: o
o
Treatment Planner
Settings (only Anatomical Sites, Calculation Defaults, CT/MRI Interface Defaults, and Display/Plotter Defaults)
Enter to grant treatment planner privileges. Enter to deny treatment planner privileges. This privilege allows access to the following areas of XiO: o
Teletherapy
o
Irregular Field
o
Patient File Maintenance
o
Plan Approval
Source File Maintenance
Settings (only Anatomical Sites and CT/MRI Interface Defaults)
Enter to grant plan approval privileges. Enter to deny plan approval privileges, but allow the user to enter comments for plan review. This privile ge allows access to the following areas of XiO: o
SF8 APPROVAL (Irregular Field)
o
Patient File Maintenance
o
Teletherapy
4. Click OK when finished.
XiO Basics XiO User Guide
User Defi nab nable le Set up, Cust ust omizat i on, and Pr Pr ef erences After your new XiO system is installed and before you begin planning, you may need to setup specific features and/or customize your planning system using the Settings menu on the XiO main window. This section will help you get your clinics up and a nd running by providing the location of specific documentation that covers the listed topics. If you have further questions regarding these topics or have trouble finding the information, you may contact CMS Customer Support and they will help you get set up.
Create Clinics XiO requires that you create at least one clinic in which all your y our patient data will be stored. If you plan for multiple hospitals/clinics, this provides an easy way to subdivide your patients into various “virtual” clinics. For more information, see the XiO Online Help.
Window Sizes The Window Size drop-down box on the main window displays only for Linux systems. It displays the current window size for Teletherapy and PFM. The default is the highest resolution available that fits within the current screen resolution. Any Teletherapy or PFM window launched after you change the size will open with the new setting.
DICOM RT Plan Import If you intend to import images, structure sets, and plan data from another vendor that has DICOM export capability, you will need to customize and map XiO identifiers with the system that is sending plan information to XiO. Setup is only required if you meet the following criteria: •
You have purchased this feature.
•
XiO installation is complete.
•
A DICOM network has been established and tested between XiO and the system (i.e., other vendor’s CT simulation workstation, other vendor’s TPS) that will be sending the DICOM plan information.
For more information, see the DICOM RT Plan Import topic under Features Discussion in the reference library in the online help. The XiO DICOM Conformance Statement can also be found on the CMS web site.
DIC ICO OM Expor Expor t Set up and Conf Conf i gur at ion If you intend to export images, structure sets, dose, and plan data to a receiving system, you will need to map XiO identifiers with a receiving ®
XiO
XiO Basics XiO User Guide
system’s identifiers. Setup is only required if you meet the following criteria: •
You have purchased this feature.
•
XiO installation is complete.
•
A DICOM network has been established and tested between XiO and the system (i.e., R&V, MU check program, etc.) that will be receiving the DICOM plan information.
For more information, see the DICOM Export Setup and Configuration topic under Features Discussion in the reference library in the online help. The XiO DICOM Conformance Statement can also be found on the CMS web site.
RTP Link If you intend to export plan data to a receiving system, you will need to map XiO identifiers with a receiving system’s identifiers. Setup is only required if you meet the following criteria: •
Your receiving system does not support DICOM export or your receiving system does support DICOM, but you have not purchased DICOM Export.
•
XiO installation is complete.
•
RTP Link has been configured to transfer information via floppy or network.
For more information, see the XiO RTP Link Conformance Statement in the XiO Online Help and the XiO RTP Link and MLC Export document in the reference library.
Cus ustt omizi ng t he Linu x Deskt Deskt op You can customize the following options for your Linux operating system: •
Add the XiO icon to the desktop.
•
Set the window focus.
•
Set the screensaver.
•
Set the taskbar to autohide.
•
Set print screen and screen capture shortcuts.
Ins tructions. For more information, see the XiO Upgrade Instructions
XiO Basics XiO User Guide
Settings Use the Settings menu to customize your treatment planning system with predefined information and defaults. The following items are of particular importance: •
Create CT to ED file for heterogeneity correction
•
Define scanner/LMS for CT simulation (XiO will report shifts)
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Anatomical site (setting up predefined contour names makes contouring faster and easier)
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Backup Utility (set up this utility to perform regular data backups)
•
Scale DRRs so they print to the proper magnification
For more information: •
Access the XiO Online Help.
•
See the Settings section in the XiO Training Guide.
•
See the Digitally Reconstruction Radiograph section in the XiO Training Guide.
•
See the Scanner/LMS Definitions section in the XiO Training Guide.
PFM and Telet her apy Pr Pr efer ences You can customize your planning clinic with PFM and Teletherapy preferences. You must be in PFM or Teletherapy to set these preferences. Preferences will apply to the next patient you plan or the next plan you make. For more information, see the Preferences section in the XiO Training Guide. You can also read the online help topics for PFM and Teletherapy preferences.
Br achyth er apy Sour Sour ce Types, Types, Sour ce Templat es es,, and Cathet Cathet er Types If you would like step-by-step instructions for setting up these parameters, follow the instructions in:
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The Gynecological Brachytherapy Implant section in the XiO Training Guide
•
Dose Calculation: Brachytherapy under Algorithm Discussions in the XiO Reference Library
XiO Basics XiO User Guide
RTOG Protocol Submission Software If you intend to send protocol patients to the ITC QA Center via the network or tape, you will need to load and customize the RTOG Protocol Submission Software. The RTOG Submission Software is free and included in your software packet. However, you must have RTOG turned on in your XiO license. For more information, see the XiO Upgrade Instructions Ins tructions and the RTOG Protocol Submission – Software User Guide located on the CMS website.
VIDAR VID AR Fi l m Scann er If you intend to scan CT images into XiO using a VIDAR Film Scanner, you will need to configure the film scanner in order to scan films into XiO. The VIDAR Film Scanning Software is included in your software packet. Loading the software is only required if you have purchased a VIDAR Film Scanner. For more information, see the XiO Upgrade Instructions Ins tructions and the Film Digitizer System User’s Guide in the reference library.
Screen Captu r e Uti li t y (UNIX (UNIX)) If you would like to set up the screen capture utility in UNIX, follow the Instruction s. instructions in the XiO Upgrade Instructions
Navigation Usii ng t he Mouse Us Mouse The mouse used in XiO is a three-button mouse or a two-button mouse with a scroll wheel that can be used as a third button when clicked. •
Use the left mouse button to select or drag items on the screen.
•
Use the right mouse button to display drop-down lists in active fields or windows.
•
Use the middle mouse button or click the scroll wheel to view popup help information boxes in active fields. You can also movie through images. Right mouse click in any single plane view window and select Movie with a left mouse click. Use the left and middle mouse buttons to move superior and inferior or use the scroll wheel to movie through the images.
•
Use the mouse to move over the fields to highlight the required fields.
XiO Basics XiO User Guide
Figure 11: A red box indicates a required field.
Usii ng the Us t he Keyboar Keyboar d Computer keyboards are used to enter and edit text and numerical data in XiO. Keyboards might vary slightly in layout, but all the keyboards used to enter and edit information in XiO use the same groups of keys. These include: •
Typewriter keys
•
Function keys
•
Cursor-movement keys
•
Keypad keys
Several XiO functions can be activated using alternate keyboard combinations instead of the mouse. For more information, see the XiO Online Help.
Dialog Box The following screen buttons control the movement from page to page. •
Select OK when you have completed all of the fields in a dialog box.
•
CANCEL is sometimes used to discard the work done on the current page.
•
PREV PAGE is available when a list of fields is too long to be displayed on one page. Select PREV PAGE to move back one text page at a time.
Figure 12: OK and CANCEL
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XiO Basics XiO User Guide
Limits and Color Definitions The following is a list of the system limitations and definitions within XiO. Many of these items are covered in more detail throughout the help.
General Limitations Number of stored permanent plans
The number of plans that can be stored on your system depends on the space available on your hard drive.
Number of stored temporary plans generated in Teletherapy
The number of plans that can be stored on your system depends on the space available on your hard drive.
Number of stored temporary plans generated in Irregular Field Point Dose Calculation
999
Number of cross sections allowed per studyset
240
Number of structures allowed per studyset
487
Number of contours allowed on a single cross section
100
Number of structures per anatomical site
80
Number of bifurcated structures per cross section
80
Number of interest points allowed per studyset
999
Number of markers allowed per studyset
999
Number of beams allowed per plan
99
Number of boluses per plan
5
Number of clinics per workstation
99
Number of anatomical sites per clinic
Unlimited
Number of contours defined per anatomical structure per cross section
4
XiO Basics XiO User Guide
IDs, Names, and Descriptions Anatomical site
14 characters (a-z, A-Z, 0-9)
Anatomical structure name
14 characters (a-z, A-Z, 0-9, punctuation, and spaces)
Clinic name
24 characters (a-z, A-Z, 0-9, punctuation, and spaces)
Patient name
24 characters (a-z, A-Z, 0-9, punctuation, and spaces)
IDs
IDs have a limit of 14 characters unless otherwise noted. IDs are case-sensitive; this means that capital letters and lowercase letters are different.
Descriptions
Descriptions have a limit of 24 c haracters unless otherwise noted. This includes a-z, A-Z, 0-9, punctuation, and spaces.
Brachytherapy Number of catheter templates allowed
20
Number of source templates allowed
20
Number of sources per plan
999
Number of catheters per plan
999
Number of interest points allowed per plan
999
Number of markers allowed per plan
999
Irr eg egul ul ar Fiel d Point Point Dos ose e Calculat Calculat ion
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Number of beams
1 or 2 (SSD or SAD)
Number of surface points per plan
50
Number of depths per surface point
50
Number of points/depths per plan
50
XiO Basics XiO User Guide
System Color Definitions Obj ec ectt s Beam (active)
Unique user-defined in preferences
Beam (inactive)
User-defined in preferences
Bolus
User-defined in preferences
Calculation volume
User-defined in preferences
Compensating filter
User-defined in preferences
Customized port
User-defined in preferences
Multileaf collimator (MLC)
User-defined in preferences
Scale icon
User-defined in preferences
Wedge
User-defined in preferences
Points Arbitrary weight point (active)
Red
Arbitrary weight point (inactive)
Green
Interest point
User-defined in preferences
Global maximum point
Red
Group point
User-defined in preferences
Local maximum point
Pink
Marker
User-defined in preferences
Measure points
User-defined in preferences
CT origin
Light magenta
Prescription point
User-defined in preferences
Reference point
User-defined in preferences
Setup reference icon
Yellow
Irregular Field Surface point incomplete
White
Surface point with no depths
Purple
Surface point with depths
Yellow
XiO Basics XiO User Guide
Get t ing Help Help Access to the XiO Online Help is from the main menu bar of any window. The type of help that displays is determined by where you are in the system when help is requested. Example, if you are not working in a dialog box, XiO displays the Help default window. The topics shown on the left-most panel of this window are presented in the order in which XiO is used in a clinic environment.
Figure 13: Welcome to XiO help topic
The XiO Online Help is highly dynamic. It contains topics about all the dialog boxes, step-by-step procedures, and background information. The online help includes a Contents tab that identifies the help topics by their titles and lets you open any of them. On the Contents tab, select the Search XiO Help topic to perform a full-text search for f or topics that contain specific words. The Index tab is an alphabetical list of all the subjects covered in the online help. The Glossary tab allows you to look up definitions for specific words.
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XiO Basics XiO User Guide
Auto-Help/Answer-Help XiO also offers Auto-Help and Answer-Help windows when completing dialog boxes. Click the middle mouse button in the field. Depending on the type of field, either an Auto-Help window displays with an explanation (such as the number range to enter or date format to use) or an Answer-Help window displays a list from which you can select an item to complete the field.
Figure 14: An Auto-Help pop-up window
Figure 15: An Answer-Help pop-up window
XiO Basics XiO User Guide
Exi t in g XiO When finished, exit each module according to the table below to ensure files are properly closed.
Patient File Maintenance Teletherapy
and then
Irregular Field Brachytherapy Source File Maintenance Data Export RTOG Submission
Never exit XiO using a system break command. A system break command causes the program to immediately terminate XiO and return to the operating system. This is an improper shutdown of the XiO system. Turning off the XiO system improperly will result in the loss or corruption of files. CMS recommends that you do not turn off the power to the XiO workstation at the end of each working day. Doing so may corrupt important system files. There may be times when it is necessary to turn off the system. Contact CMS Customer Support for information about how to turn off the system.
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XiO Basics XiO User Guide
Pat i ent F i l e Maint Maint ena enance nce
Xi O PFM Int er f ace The Patient File Maintenance (PFM) user interface includes the title bar, menus, toolbars, graphics area, control list boxes, window/level slide controls, and the status bar used in the Patient File Maintenance functions.
Figure 16: Patient File Maintenance window
− The title bar displays the rele ase number, patient name, patient ID, and studyset ID.
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Pati ent File Fil e Maint Maint enance XiO User Guide
The main menu has the File, Edit, View, Insert, Tools, Reports, and Help menus. Each of these menus has drop-down options. −
− The status bar displays the date, time, mouse status, and other information depending on the active function.
The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. All buttons on this toolbar, except the Beam button, are inactive in PFM and grayed out. −
The secondary toolbar modes are Draw, Paint Brush, Tablet, Keyboard, Edit, AutoSegmentation, Auto-by-Threshold, and Point. Each mode has a button. When you click a mode button, the system displays the mode's associated submode buttons. −
− The submode buttons include Save, Zoom In, and Zoom Out. Additional buttons display depending on the toolbar mode. −
Select the anatomical site from the Group drop-down list; select the structure name from the Contour drop-down list. − Select and save a predefined window and level value and grayscale/color scale in any transverse single plane view. You can also change the color of the color scale for the Auto-by-Threshold tool. − o
o
o
Toggle the icons to:
Go between Transverse Mode and Scout Mode. Apply grayscale or color scale values. Change the color for the Auto Threshold color scale.
Patient at ient Fil e Maint Maint enance XiO User Guide
− Use the window and level slider bars or enter values in the W and L fields to adjust the contrast of the image display.
− The graphics area contains the studyset and graphic objects used to set up the treatment plan.
Thumbnails display a small image of each cr oss section. A red outline shows the image currently selected and displayed in the graphics area. You can: −
o
o
o
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Click the middle mouse button to select multiple cross sections. Press and click the middle mouse button to select a range of cross sections. A yellow outline shows all the cross sections currently selected. Click the right mouse button to select all or unselect all the cross sections.
Pati ent File Fil e Maint Maint enance XiO User Guide
and − The reference distance shows the distance from the origin of the studyset of the cross section you are viewing in the graphics area single plane view. The scale factor shows the current magnification of the single plane view. − Contains the prompts and answer fields you will complete as you set up the treatment plan.
− Displays all the contours in a studyset without image data.
PFM Functionality The PFM toolbars include the main toolbar and secondary toolbar. The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. All buttons on this toolbar, except the Beam button, are inactive in PFM and grayed out. The secondary toolbar modes are Draw, Paint Brush, Tablet, Keyboard, Edit, AutoSegmentation, Auto-by-Threshold, Auto-by-Threshold, and Point. Each mode has a button. When you click a mode button, the system displays the mode’s associated submode buttons. Position the mouse over a toolbar button to view a tool tip. The tool tip describes the button and its keyboard shortcut. NOTE:
When a button icon is grayed-out, it is not available. Different planning tasks have requirements you must meet before these buttons are available, some of which are licensing requirements.
For more information, see the online help for the planning task in question.
Patient at ient Fil e Maint Maint enance XiO User Guide
The Mode Mode But But t ons Draw
F5
Draw contours with the mouse.
Paint Brush
F6
Paint the contours with the mouse.
Tablet
F7
Trace contours on the digitizing tablet.
Keyboard
F8
Create contours from predefined shapes with the keyboard.
Edit
F9
Edit or delete existing contours.
AutoSegmentation
F10
Create contours automatically with AutoSegmentation.
Auto-by-Threshold
F11
Create contours automatically with Auto-by-Threshold.
Point
F12
Enter, edit, or delete interest points and markers with the mouse.
The Submode Buttons (There are no keyboard shortcuts for the submode buttons.)
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Primary Dataset
View a primary dataset that is fused to the secondary dataset. A primary studyset is made of CT-based images, which serve as a baseline around which you manipulate a secondary studyset in order to create a registration.
Secondary Dataset
View secondary dataset that is fused to the primary dataset. A secondary dataset is made of either CT-based, MR-based images, or PET images, which you manipulate in order to cre ate a registration.
Replace Segment
Replace a section of the selected contour.
Single Point Edit
Move a single contour defining point.
Triple Point Edit
Move three contour defining points.
Quintuple Point Edit
Move five contour defining points.
Symmetric Resize
Resize or stretch a contour symmetrically. The opposite edge stays in place.
Asymmetric Resize
Resize or stretch a contour asymmetrically. The opposite edge stays in place.
Interpolate
Automatically create contours on cross sections that lie between two or more cross sections on which you have already created contours.
3-D Auto Margin
Create a contour with 3-D Auto Margin.
Pati ent File Fil e Maint Maint enance XiO User Guide
2-D Auto Margin
Create a contour with 2-D Auto Margin.
2-D Auto Distance
Edit the distance between the initial contour and the new contour.
Place Single AutoPoint
Place auto-points on a single cross section for Auto-by-Threshold.
Place Multiple AutoPoints
Place auto-points on multiple cross sections for Auto-by-Threshold.
Teletherapy
XiO Teletherapy Interface The Teletherapy user interface includes the title bar, menus, toolbars, graphics area, control list boxes, window/level slide controls, and the status bar.
Figure 17: Teletherapy user interface
The title bar displays the rele ase number, patient name, patient ID, and plan type. −
− The main menu has the File, Edit, View, Contour, Beam, Port, Dose, Tools, Optimize, Reports, and Help menus. Each of these menus has drop-down options.
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Teletherapy XiO User Guide
− The status bar displays the date, time, mouse status, and other information depending on the active function.
The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. The active button displays with a blue background. −
− The submode buttons include Save, Zoom In, and Zoom Out. The active main toolbar button determines the types of additional supporting buttons that display.
The Active Beam box allows you to select an active be am. Once a beam is selected, it becomes the active beam. −
− Select and save window and level settings and grayscale/color scale in any transverse single plane view. −
Toggle the icons
to: o
o
o
Apply the window/level adjustment to an active window or all displayed windows. Display images in grayscale or as outlined contours. Set the mouse movie of an oblique stack of images to show images in grayscale or as outlined contours.
− Use the window and level sliders or enter values in the W and L fields to adjust the contrast of the image display.
Teletherapy XiO User Guide
The graphics area is the area of the screen with a graphical display of information about the patient, source, or treatment plan. Each window in the graphics area has a view format associated with it. The view format determines how the physical space in the subwindow is used to display the treatment plan information. −
Teletherapy Functionality The Teletherapy toolbars include the main toolbar and a supporting toolbar for each main toolbar button. When you click a main toolbar button, the system changes the button background to blue and displays its associated supporting toolbar. Each supporting toolbar includes the Zoom In, Zoom Out, and Save buttons. Position the mouse over a toolbar button to view a tool tip. The tool tip describes the button and its keyboard shortcut. NOTE:
When a button icon is grayed-out, it is not available. Different planning tasks have requirements you must meet before these buttons are available, some of which are licensing requirements.
For more information, see the online help for the planning task in question.
The Main Main Tool bar
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XiO
Contour
Shift+F1
Use the Contour toolbar to draw, trace, or edit contours with the XiO drawing and editing tools.
Beam
Shift+F2
Use the Beam toolbar to manipulated beams and add treatment aids. Use the Auto Port and Auto MLC buttons to quickly shape the beam.
Port
Shift+F3
Use the Port toolbar to draw, trace, or edit ports with the XiO drawing and editing tools.
Dose
Shift+F4
Use the Dose toolbar to choose normalization and weight, and view isodose lines and histograms.
Tools
Shift+F5
Use the Tools toolbar to access general planning tools during the planning or virtual simulation process.
IMRT
Shift+F6
Use the IMRT toolbar to access the setup, prescription, and dose review tools necessary for IMRT planning.
Teletherapy XiO User Guide
Cont our Suppor t i ng Toolbar Toolbar NOTE:
Clicking the Contour button removes many of the teletherapy options. To resume planning with these options, click the Beam button on the main toolbar.
Draw
F5
Draw contours with the mouse.
Paint Brush
F6
Paint the contours with the mouse.
Tablet
F7
Trace contours on the digitizing tablet.
Keyboard
F8
Create contours from predefined shapes using the keyboard.
Edit
F9
Edit or delete existing contours.
AutoSegmentation
F10
Create contours automatically.
Auto-by-Threshold
F11
Create contours automatically.
Point
F12
Create, edit, or delete interest points and markers with the mouse.
Interpolate
None
Automatically create contours on cross sections that lie between two or more cross sections on which you have already created contours.
Replace
None
Replace a section of the selected contour.
Stretch1
None
Move a single contour defining point.
Stretch3
None
Move three contour defining points.
Stretch5
None
Move five contour defining points.
Symmetric
None
Resize or stretch a contour symmetrically. The center of the contour stays in place.
Asymmetric
None
Resize or stretch a contour asymmetrically. The opposite edge stays in place.
3-D Auto Margin
None
Create a contour using 3-D Auto Margin.
2-D Auto Margin
None
Create a contour using 2-D Auto Margin.
2-D Auto Distance
None
Edit the distance between the initial contour and the new contour.
Single Auto-byThreshold Mode
None
Place auto-points on a single crosssection using Auto-by-Threshold.
Multiple Auto-byThreshold Mode
None
Place auto-points on all cross sections using Auto-by-Threshold.
Teletherapy XiO User Guide
Beam Supporting Toolbar New
F5
Create a new beam.
Edit
F6
Edit the active beam.
Copy
F7
Copy the active beam.
Mirror
F8
Create a mirror copy of the active beam.
Delete
F9
Delete the active beam.
Auto Port
F11
Automatically add a port to the active beam.
Wedge
F12
Add or edit a wedge for the active beam.
Comp Filter
None
Add or edit a compensating filter for the active beam.
DRR/BEV
None
Display a BEV or DRR for the active beam.
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map or a BEV.
None
Display a compensating filter intensity map or a BEV.
Auto
F5
Automatically add a port/MLC to the active beam.
Mouse
F6
Draw a port/MLC with the mouse.
Tablet
F7
Trace a port/MLC on the digitizing tablet.
Edit
F8
Edit the active port/MLC.
Aperture
F10
Define the active shape as an aperture.
Block
F11
Define the active shape as a block.
MLC
F12
Define the active shape as an MLC.
Port Properties
None
Enter or change parameters defining the port shapes.
Delete Port
None
Delete aperture, blocks, or MLC.
Replace
None
Replace a section of the selected port/MLC shape.
Display Intensity Maps/BEV
Port Suppor t in g Toolbar Toolbar
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XiO
Teletherapy XiO User Guide
Stretch1
None
Move a single port/MLC shape-defining point.
Stretch3
None
Move three port/MLC shape-defining points.
Stretch5
None
Move five port/MLC shape-defining points.
Symmetric
None
Resize or stretch a port/MLC shape symmetrically. The center stays in place.
Asymmetric
None
Resize or stretch a port/MLC shape symmetrically. The opposite edge stays in place.
None
Adjust the collimator jaws to the defined shape plus the collimator step size.
None
Display a BEV or DRR for the active beam.
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map or a BEV.
None
Display a compensating filter intensity map or a BEV.
Conform Collimator Jaws to Aperture DRR/BEV
Display Intensity Maps/BEV
Dos ose e Suppor Suppor t i ng Toolbar Absolute or Standard Normalization
F5
Set the normalization mode to absolute dose, if the beam-weighting mode is absolute dose/MU. Set the normalization mode to standard, if the beam-weighting mode is relative.
Global Normalization
F6
Set the normalization mode to global maximum.
Set Normalization Mode
F7
Set or change the normalization mode.
Isodose Lines
F9
Display isodose lines or surfaces.
Dose in MPV
F10
Display, or remove from display, the dose values in the MPV.
Beam Weight
F11
Edit a beam’s weight value, edit a beam's MU value, turn doses on or off, and define the weight point.
Teletherapy XiO User Guide
Time/MU
F12
Change the treatment date, if the beamweighting mode is absolute dose/MU. Calculate the amount of time or number of monitor units required, if the beamweighting mode is relative.
Source Data
None
Display the Teletherapy Sources Index that contains statistical and descriptive information for each beam.
Histogram
None
Make a DVH, which is a plot of volume versus dose.
Redisplay Histogram Data
None
Re-make the histograms with the recalculated dose values.
TCP/NTCP
None
Calculate TCP or NTCP.
Dose Profile
None
Display a dose profile.
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map or a BEV.
None
Display a compensating filter intensity map or a BEV.
Display Intensity Maps/BEV
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XiO
Teletherapy XiO User Guide
Tools Supporting Toolbar CT Sampling
F5
Sample points. For a CT-based patient, the system reports CT values and relative electron density at the sampled points. For a non-CT based patient, the system reports electron density at the sampled points.
Setup Reference Definition
F6
Position the setup reference definition for a laser marking system.
Mark Anatomical Reference
F7
Mark anatomical positions for a laser marking system.
Review Compensator
F8
View a Par Scientific, Huestis, or .decimal compensating filter in 3-D. Order a .decimal compensator; send milling or QA information.
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map or a BEV.
None
Display a compensating filter intensity map or a BEV.
IMRT Parameters
F5
Select beams to optimize.
IMRT Prescription
F6
Select targets and contoured structures and enter dose goals.
Start Optimization
F7
Use an optimization algorithm to optimize a plan.
Generate Treatment Aids
F8
Generate segmented MLC or .decimal compensator to deliver modulated dose.
Histogram
F9
Make a DVH, which is a plot of volume versus dose.
Redisplay Histogram Data
F10
Re-make the histograms with the recalculated dose values.
Isodose Lines
F11
Display isodose lines or surfaces.
Dose in MPV
F10
Display, or remove from display, the dose values in the MPV.
Display Intensity Maps/BEV
IMR IM RT Supp Supp or t i ng Tool Tool bar
Teletherapy XiO User Guide
IMRT Index
None
Display the parameter summary for the IMRT plan.
IMRT Prescription Index
None
Display the prescription summary for the IMRT plan.
Source Data
None
Display the Teletherapy Sources Index that contains statistical and descriptive information for each beam.
None
Display a relative fluence map or a BEV.
None
Display an ideal intensity map or a BEV.
None
Display a segmented MLC intensity map or a BEV.
None
Display a compensating filter intensity map or a BEV.
Display Intensity Maps/BEV
Telet Telet herapy Fea Featt ures This section contains highlights of some of the features within the Teletherapy module. Refer to the XiO Training Guide or online help for more information on how to perform these functions.
Window Fo Forr mat The graphics area is divided into smaller areas called subwindows. You can select the number of subwindows, the view type, and their contents. The window format choices depend on the current format and the subwindow’s contents. The available view types are:
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XiO
•
SPV – Single Plane View
•
MPV – Multiple Plane View
•
BEV – Beam’s Eye View
•
ABV – Active Beam’s Eye View
Teletherapy XiO User Guide
Window Di spl play ay Format Format s The graphics area supports these formats: •
One (one subwindow)
•
H Two (two subwindows horizontal)
•
V Two (two subwindows vertical)
•
Four (four subwindows)
Teletherapy XiO User Guide •
Six (six subwindows)
•
Sym Six (six equal subwindows)
•
Nine (nine subwindows)
•
Twelve (12 subwindows)
Save a Window Format The layout of the graphics area can be saved and recalled. In the Window Format dialog box, you can select a predefined graphics area setup or start from scratch and make adjustments to the layout. Once you have the graphics area set up to your liking, save the layout. The setup can then be selected later when creating a new Teletherapy or QA plan. When the setup is no longer needed, it can be deleted.
Synchronize Subwindows You can synchronize the plans so that the same planes and reference distances are visible concurrently in the graphics area. Group the subwindows to synchronize certain functions, such as scaling, panning, or zooming in and out.
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XiO
Teletherapy XiO User Guide
Maki ng a Beam Beam Act i ve When you select a beam from the Active Beam box in the upper righthand side of the Teletherapy window, the beam becomes the active beam. From this point, any treatment aids you add or any edits you make are for the active beam.
Figure 18: Active beam
Bolus Bolus is a material that conforms to the patient surface. Its most common use is to raise the dose to the skin for treatment of surgical scars, skin lesions, or carcinomas that have invaded the skin. You can define the description, bolus thickness, relative electron density, orientation, and cross section reference distance of the bolus.
Add/ Edit a Cont Cont our Contouring is available to you from the Teletherapy toolbar. This is a quick access method to add or modify a contour in Teletherapy. Once you have made your additions or edits, XiO allows you to continue planning by clicking the Beam button on the toolbar. To gain access to all contouring functions you have to exit Teletherapy and enter PFM.
Teletherapy XiO User Guide
Enhance Cont Cont our ours s You can change the way the system displays patient anatomy structures in the graphics area with the Enhance Contour function. You can determine the color and rendering of the structures. When editing contours, turn off any structures that are not needed. Only structures that are displayed are available for editing. The graphics area automatically updates to reflect any changes.
Dose The Dose menu in XiO is where you: •
Enter calculation settings.
•
Evaluate or change dose (normalization) for your plan.
•
Display the isodose lines and surfaces.
•
Edit beam weight values.
•
Calculate Tumor Control Probability (TCP) or Normal Tissue Complication Probability (NTCP).
•
Determine treatment time and monitor units.
•
Display or print a histogram.
•
Determine the dose status.
•
Save dose profile or dose plane.
Calculat ion Set ettt ings Use this function to define the dose calculation region in an open treatment plan. You define the calculation region dimensions, center, and distance calculation points to measure radiation dose calculation.
Choos hoose e Cal Cal cul culat at i on Mode Mode Refer to the Calculation Region topic described on page 12 of this guide for more information on choosing a calculation mode.
Calcu alcull at ate e Dose Dose XiO automatically performs the dose calculation whenever any part of the beam definition changes. If you want to control the dose calculation yourself, use the General Preferences dialog box under the Edit dropdown menu.
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XiO
Teletherapy XiO User Guide
Dos ose e St St at us When you select the Dose Status option, XiO provides the following status messages: “Beam number in progress... The system displays the beam numbers for the beams with dose calculating. Beam number completed... The system displays the beam numbers for beams with completed dose calculation.” The system also displays the dose status on the Status Bar.
Histogram A dose volume histogram (DVH) is a histogram used to generate plots of volume versus dose. DVHs summarize dose distribution information throughout normal tissue and tumors. DVHs are useful in: •
Enhancing the dose information provided by isocurves and isosurface
•
Showing the uniformity of dose in a structure
•
Identifying “hot spots” outside the target volume, which could potentially cause damage to normal tissue
Figure 19: A dose volume histogram
Teletherapy XiO User Guide
Mult ipl e Plan Plan Review Review XiO lets you open up to three plans (primary, secondary, and tertiary) for the same patient and view the beam arrangements and dose distributions simultaneously. simultaneously. These are important factors in evaluating the alternative plans developed for the patient. You can also instruct XiO to graphically compare the plans. Instead of opening a third plan, you can create a subtraction or addition plan.
Saving Plans You can save the following types of plans (if you have multiple plans selected for review, only the primary plan is saved): •
A temporary patient treatment plan: the system changes it from a temporary plan to a permanent plan.
•
A revised permanent treatment plan.
•
The current state of a treatment plan in Optimize (IMRT or conventional inverse planning).
You can also save templates and addition plans.
Plan Approval You can add comments to a plan and, if you have the authority, approve a plan. Note that your system administrator administrator sets the plan approval authority for each user. The name of the approver is displayed and is stored with the approval comments as the electronic signature of the approver. The approver’s most recent comments are stamped with the date and time. If you don’t have the authority to approve plans, you can enter planner’s comments. You can toggle between the planner’s comments and the approver’s comments.
Next St ep To learn more about XiO, read the XiO Training Guide, XiO Online Help, and the XiO Reference Library.
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XiO
Teletherapy XiO User Guide
Index .
.decimal compensating compensating filter......... filter...... ... 16 1
1D compensators........................... compensators........................... 16 A
ABV .............. .................... ............. .............. ............. ............ ...... 51 Active Active beam .............. .................... ............. ......... 44, 54 eye view ......................... See ABV Anatomical Anatomical structure....................... 4 Anatomi Anatomical cal structur structures es .............. ..................... ....... 5 Anatomy Anatomy data .............. ..................... ............. ......... ... 3, 4 classifications.... classifications.............................. .......................... 7 mode.......................................... 10 Anatomy site general........ general.............. ............. .............. ............. ............. ....... 8 predefin predefined ed .............. .................... ............. .............. ......... 7 specific specific...... ............. .............. .............. ............. ............. ....... 8 user-defined................................. user-defined................................. 8 Answer-h Answer-help......... elp................ .............. ............. ........... ..... 34 Auto margin margin .............. ..................... .............. ............. ........ .. 5 Auto-by-threshold... Auto-by-threshold........................... ........................ 5 Auto-hel Auto-help p ............. .................... .............. ............. ........... ..... 34 Autosegm Autosegmenta entation tion ............. .................... .............. ....... 5 B
Beam active active....... .............. .............. ............. ............. .............. ....... 54 entry entry point point .............. ..................... ............. ............ ...... 14 paramet parameters............ ers................... .............. .............. ....... 14 weighting................................... 14 Beam supporting supporting toolbar............... 47 Beam’s eye view................. See BEV BEV............................................... 51 Bolus Bolus .............. .................... ............. .............. ............. ........... ..... 54 Brachytherapy Brachytherapy................... ................... 21, 27, 31 source source informa information tion .............. .................... ...... 17 C
Calculation algorith algorithms ms .............. .................... ............. ............. ...... 17 ®
XiO
mode.................................... 12, 55 pixel-by-pixel........ pixel-by-pixel.............................. ...................... 6 region region .............. .................... ............. .............. ....... 12, 55 settings settings .............. ..................... .............. ............. .......... .... 55 Catheter templat templates es .............. ..................... .............. .............. ....... 17 types types ............. .................... .............. .............. .............. ......... 27 Clinic........................................... .. 25 Collimator Collimator settings........................ settings........ ................ 14 Color Color definiti definitions ons ............. .................... .............. ....... 32 irregula irregularr field field ............. .................... .............. ......... 32 objects objects .............. ..................... ............. ............. ............ ..... 32 points......... points................ .............. ............. ............. ............ ..... 32 Color Color definiti definitions ons ............. .................... .............. ....... 30 Commis Commission sioning ing .............. .................... ............. ......... .. 14 Compensating Compensating filter................. 14, 16 16 Computed Computed tomography.................. tomography.................. 10 Contour Contour control control ............. .................... .............. ......... .. 38 Contour supporting supporting toolbar........... toolbar. .......... 46 Contours........................................ .. 5 add............. add.................... .............. ............. ............. ............ ..... 54 auto margin margin .............. .................... ............. ............. ...... 5 auto-by auto-by-thr -thresho eshold ld .............. ..................... .......... ... 5 autosegm autosegmenta entation tion .............. ..................... .......... ... 5 edit............................................. 54 enhance enhance ............. .................... .............. ............. .......... .... 55 import.......... import................. .............. .............. ............. ........... ..... 6 interpol interpolatio ation n .............. ..................... ............. ........... ..... 5 Coronal............................................ 9 Couch settings........................... settings............................... .... 14 Cross Cross section section .............. .................... ............. ......... .. 5, 39 Custom Customizat ization ion ............. .................... .............. ........... .... 25 site................. site........................ .............. .............. .............. ....... 27 D
Data demographic................................ demographic................................ 3 entering entering ............. .................... .............. ............. ............ ...... 4 patient.......................................... 3 source source physics physics ............. .................... .............. ....... 15 Data export.................................... 21 Demograp Demographic hic data...... data ............. .............. .............. ....... 3 Descript Descriptions ions ............. .................... .............. .............. ....... 31
59
Index XiO User Guide
DICOM DICOM 3.0 ............. .................... .............. ........... .... 6, 22 DICOM DICOM export............. export................... ............. ........... .... 26 DICOM RT RT plan plan import................ import................ 25 Digitize Digitizerr .............. ..................... ............. ............. ......... .. 5, 28 film............... film..................... ............. .............. .............. ......... .. 22 Dose ............. .................... .............. ............. ............. ............. ...... 55 calculat calculatee ............. .................... .............. .............. ......... .. 55 calculation calculation algorithms algorithms ............... 17 paramete parameters rs....... .............. .............. .............. ............ ..... 15 status status ............. .................... .............. .............. ............. ........ 56 Dose supporting supporting toolbar................ 48 DVH.................. DVH........................ ............. .............. ............. ........ .. 56 E
Electron density converted from assigned contour density........... density.................. ............. ............. ........... .... 10 converte converted d from CT pixel pixelss ......... ......... 10 relative....................................... 13 Ellis Ellis compens compensator atorss .............. ..................... .......... ... 16 Enhanced Enhanced dynamic dynamic wedge............. wedge............. 15 Exiting........................................... 35 F
Film digitizer................................. 22 Focal.............................................. 22 G
Gantry Gantry settings settings .............. .................... ............. .......... ... 14 General limitations............... limitations........................ ......... 30 Graphics Graphics area area ............. ............... 39, 45, 51, 51, 53 Group Group list box .............. ..................... ............. .......... .... 38 H
Heterogeneity... Heterogeneity................................ ............................. 13 Histogram...................................... 56 Huestis........................................... 16 I
IDs.................... ............................. 31 Image-based Image-based studyset................ studyset.... ............ 7, 13 IMRT....................................... 11, 57 IMRT supporting supporting toolbar .............. 50 Intensity Modulated Radiation Therapy ......................... See IMRT Interest points.......................... 11, 12 Interpolation.... Interpolation.................................... ................................ 5
Irregula Irregularr field field .............. .................... ............ ...... 21, 32 Irregular field point dose calculation ................................................... 31 Isocenter Isocenter ........................................ 14 K
Keyboard using using ............. .................... .............. .............. ............. ........ .. 29 L
Limits Limits .............. ..................... .............. .............. ............. ......... ... 30 brachytherapy............................ brachytherapy............................ 31 general....................................... 30 IDs, names, description........... description............. .. 31 irregular field point dose calculat calculation............. ion................... ............. .......... ... 31 Linux desktop desktop .............. .................... ............. .............. ........... .... 26 logging logging in .............. ..................... .............. ............. ...... 19 screen capture............................ 26 Login Login....... .............. .............. ............. ............. ............ ..... 19, 22 M
Machine commissioning commissioning ............... 14 Main menu patient file maintenance maintenance ............ 38 teletherapy............... teletherapy................................. .................. 43 Main toolbar.................................. 45 patient file maintenance maintenance ............ 38 teletherapy............... teletherapy................................. .................. 44 Markers Markers ............. .................... .............. ............. ............. ......... 11 Milling Milling machine machiness .............. ..................... ............ ..... 16 Mode buttons buttons ............. .................... .............. ............ ..... 41 Modules......................................... 20 Motorize Motorized d wedge wedge .............. ..................... ............ ..... 15 Mouse using using ............. .................... .............. .............. ........... .... 5, 28 MPV................ MPV....................... .............. ........... .... 40, 48, 51 Multiple plane view ........... See MPV N
Names Names ............. .................... .............. ............. ............. .......... ... 31 Navigation dialog box.................................. 29 keyboard.................................... 29 mouse mouse .............. .................... ............. .............. ............. ...... 28 Non-image-based Non-image-based studyset........ studyset..... ... 7, 13
Index XiO User Guide
Normaliz Normalizatio ation n ............. .................... ............ ..... 15, 55 NTCP ............. .................... ............. ............. ............ ..... 49, 55 O
Objects Objects .............. .................... ............. .............. .............. ......... 32 Online help............................... help.................................... ..... 33 answer-h answer-help............ elp................... ............. ............ ...... 34 auto-hel auto-help p .............. .................... ............. .............. ......... 34 Orientat Orientation ion ............. .................... .............. .............. ........... .... 8 P
Par Scientific................................. 16 Passwords...................................... 22 Patient anatomy file identification.. identification......................... ....................... 8 location...................................... 10 orientat orientation ion .............. ..................... ............. ............. ......... 8 Patient data.............................. data...................................... ........ 3 Patient file maintenance function functionalit ality y ............. .................... .............. .......... ... 40 mode buttons............................. 41 preferen preferences ces .............. ..................... ............. ........... ..... 27 submode submode buttons .............. .................... ......... ... 41 user interface............................. 37 Permanen Permanentt plans plans .............. ..................... .............. ......... .. 3 PFM...... See Patient file maintenance maintenance Physical wedge.............................. 15 Pixel Pixel images............ images................... .............. .............. .......... ... 4 Pixel-by-pixel Pixel-by-pixel calculation calculation ............... 6 Plan approval............................... 24, 57 basics........ basics............... .............. ............. ............. .............. ......... 3 comments............. comments.................... ............. ............. ......... 57 modes modes ............. .................... .............. ............. ............. ....... 11 review........................................ 57 save .............. .................... ............. .............. ............. ......... ... 57 types types .............. ..................... ............. ............. .............. .......... ... 3 Points............................................. 32 Port supporti supporting ng toolbar toolbar .............. ................. ... 47 Preferences Preferences.................................... .................................... 25 patient patient file mainten maintenanc ancee ............ ............ 27 teletherapy........... teletherapy................................. ...................... 27 Program license agreement agreement ............. 2 R
Radiation source information........ information........ 14 Referenc Referencee distance distance ............ ............ 10, 14, 40 ®
XiO
Relative Relative electron electron densiti densities es ............ ............ 13 RTOG protoco protocoll submission submission softwar softwaree ... 28 simulation.................................. simulation.................................. 22 RTP link................. link........................ .............. ............. ......... ... 26 S
Sagittal Sagittal .............. .................... ............. .............. .............. .......... ... 9 Save plan............................................ 57 window window format format ............. .................... ............. ...... 53 Scale factor.................................... 40 Screen Screen capture utility utility ............. .................... ....... 28 Single plane plane view................ view ................ See SPV Source templat templates es .............. ..................... .............. ......... 17, 27 types types ............. .................... .............. .............. ......... .. 17, 27 Source file maintenance. maintenance................ ............... 21 Source information brachytherapy............................ brachytherapy............................ 17 radiatio radiation n .............. ..................... .............. ............. ........ .. 14 Source physics data....................... 15 SPV ............. .................... ............. ............. .............. ............. ........ 51 Status bar patient file maintenance maintenance ............ 38 teletherapy............. teletherapy................................. .................... 44 Studyset Studysetss .............. .................... ............. .............. .............. ....... 7 Submode Submode buttons........................... 41 T
Tablet Tablet ............. .................... .............. .............. ............. ............ ...... 5 TCP ............. .................... ............. ............. .............. ......... 49, 55 Teletherapy features....... features.............. .............. ............. ............. ........... .... 51 function functionalit ality y .............. ..................... .............. ......... .. 45 preferen preferences ces .............. .................... ............. ............ ..... 27 source parameters...................... parameters...................... 14 toolbar toolbar ............. .................... ............. ............. ............. ...... 45 user interface............................. 43 Templates Templates...................................... ...................................... 57 catheter....... catheter.............. .............. .............. ............. .......... .... 17 source source .............. .................... ............. .............. ....... 17, 27 Tempora Temporary ry plans plans .............. ..................... .............. ......... 3 Three-di Three-dimens mensiona ionall plan .............. ................ .. 11 Thumbn Thumbnails ails .............. ..................... .............. .............. ....... 39 Tissue density.............................. 4, 6 heterog heterogenei eneities ties .............. .................... ............ ...... 13
Index XiO User Guide
Title bar patient file maintenance maintenance ............ 37 teletherapy............. teletherapy................................. .................... 43 Tool tip...................... .............. 40, 45 Toolbar beam supporting........................ 47 contour contour support supporting ing .............. .................... ...... 46 dose supporti supporting ng ............. .................... ............ ..... 48 IMRT supporti supporting ng .............. .................... ........ .. 50 main........................................... 45 port supporti supporting ng....... ............. ............. ............. ...... 47 submodes............................. submodes............................. 38, 44 supporti supporting ng modes modes .............. .................... ........ .. 38 tools supporting......................... supporting......................... 50 Tools supporting supporting toolbar............... toolbar ............... 50 Transve Transverse............ rse.................. ............. .............. .............. ....... 9 Treatment Treatment plan ..................... See Plan Two-dim Two-dimensi ensional onal plan ............. .................. ..... 11 Types catheter....... catheter.............. .............. .............. ............. .......... .... 27 source source .............. .................... ............. .............. ............. ...... 27 U
UNIX logging logging in ............. .................... .............. .............. ....... 19 screen capture............................ 28 User add............. add.................... .............. ............. ............. ............ ..... 22 authoriz authorizatio ation n ............. .................... .............. ......... .. 24 dedicate dedicated d ............. .................... .............. .............. ......... 19 definab definable le setup setup ............. .................... ............. ...... 25 nondedic nondedicated ated ............. .................... .............. ......... .. 19 utility............ utility................... .............. .............. .............. ......... 22 Usernames......... Usernames..................................... ............................ 22
V
VIDAR film scanner................ scanner..................... ..... 28 View types .............. ..................... .............. ............. ........ .. 51 Virtual wedge............................... . 16 W
Wedge Wedge ............. .................... .............. ............. .......... .... 14, 15 Window level presets......................... 38, 44 slide slide controls controls....... .............. .............. ......... .. 39, 44 Window Window format format .............. .................... ............. ......... .. 51 display............ display................... .............. ............. ............. ....... 52 save ............. .................... ............. ............. .............. .......... ... 53 synchron synchronize ize ............. .................... .............. ........... .... 53 Window size.................................. 25 Wirefra Wireframe me contours contours ............. .................... ......... .. 10 X
XiO add a user .............. ..................... .............. ............. ...... 22 create clinics.............................. 25 exiting exiting .............. .................... ............. .............. ............ ..... 35 intende intended d use .............. .................... ............. ............ ..... 1 intended users.............................. 1 logging logging in .............. ..................... .............. ............. ...... 19 modules........... modules................. ............. .............. ............. ...... 20 navigation.................................. navigation.................................. 28 online help................................. 33 overview...................................... 1 program program license license agreement agreement ......... ......... 2 starting....................................... 19 training............ training................... .............. .............. .............. ....... 2 user utility ............. .................... .............. ............. ...... 22 window window size .............. .................... ............. .......... ... 25
