XiO_TUT_434_C_1

XiO

Training Guide

Revision History

Revision Date Changes

XiO_TUT_434_C.pdf June 2008 Physics Lesson Updates

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Copyright © 2008 by CMS, Inc. All rights reserved.

Performance characteristics given in this manual are for reference only and are not intended as guaranteed specifications.

Document ID: XiO_TUT_434_C.pdf

Part Number: 98911

ii

Manufacturer Japan

CMS, Inc.

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Phone: 1-314-993-0003

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M Devices Group

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CMS Worldwide Corp.

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XiO Training Course Outline

For RTT/CMD Monday 8:30 am – 4:30 pm

Welcome to CMS

Section 1 - Things You Should Know Before You Begin

- Include Reference Library

Section 2 - Help Resources

Section 4 - Patient File Maintenance

Section 5 - Teletherapy- Part 1

Tuesday 8:30 am – 4:30 pm Review/ Q and A

Section 6 -Teletherapy- Part 2

Section 3- Settings

Section 7 - 2D Breast

Section 8 -3D Lung

Wednesday 8:30 am – 4:30 pm

Review/ Q and A

Section9- Preferences

Section 10- 3D Four Field Prostate

Section 17- Digitally Reconstructed Radiograph (DRR)

Section 11- Electron Beam Plan

Section 12- Arc Rotation

Thursday 8:30 am – 4:30 pm Review/ Q and A

- Explanation of Irregular Field Interface

Section 13 - Irregular Field

Section 14- Time/MU Program

- Focal (Focal Training CD)

- Brachytherapy Source File Maintenance

Section 15- Brachytherapy – GYN

Section 16- Prostate Brachytherapy

Friday 8:30 am – Noon Review/ Q and A

- Brachytherapy (cont’d)

Section 22- Miscellaneous Tasks

- Algorithms (Reference Library- Online Help )

- IMRT overview

- TCP/NTCP (per request)

- RTOG Interface (per request)

Completion of XiO Training Checklist

Completion of Evaluation

Completion of Expense Reports

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XiO Training Course Outline

For Medical Physicists

Monday 8:30 am – 4:30 pm Welcome to CMS

Section 1- Things you Should Know Before Planning

Begins

Section 2- Help Resources

Section 3- Settings

Section 4- Patient File Maintenance interactive lecture

Section 5- Teletherapy-Part 1

Section 6- Teletherapy- Part 2

Section 8-3Dlung –time permitting

Tuesday 8:30 am – 4:30 pm Review/ Q and A

Beam Data Requirements/Data Acquisition

Source File Maintenance/Physics Data

Creating Beams/Data Transfer

Clarkson Algorithm Modeling

(Beam Modeling Guide)

Wednesday 8:30 am – 4:30 pm

Review/ Q and A

XiO Physics Algorithms

Convolution/Superposition Algorithm Modeling

Wedge Modeling

Pencil Beam Algorithm Modeling

(Beam Modeling Guide)

Thursday 8:30 am – 4:30 pm Review/ Q and A

Section 17- Digitally Reconstructed Radiographs (DRR)

And the Virtual Patient

Monitor Units Calculation

Section 27 – XiO IMRT Overview. QA Tools

Friday 8:30 am – Noon Review/ Q and A

Completion of XiO Training Checklist

Completion of XiO Training Course Evaluation

Completion of Expense Reports

Section 28 – Introduction to Linux/Unix

Additional Physics Topics – time permitting

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Section 1. Things You Should Know before Planning Begins

Welcome .................................................................................................................. 1-1 Intended Audience ................................................................................................... 1-1 The 30-Minute Plan and Its Advanced Features...................................................... 1-2 Advanced Tools Contribute to Increased Accuracy ................................................ 1-2 Objectives of the XiO Training Guide..................................................................... 1-2 Other XiO References.............................................................................................. 1-3 How to Use This Guide ........................................................................................... 1-4 Radiation Treatment Planning in XiO ..................................................................... 1-4 XiO Windows .......................................................................................................... 1-7 PFM Window........................................................................................................... 1-8 XiO Teletherapy Window Layout ........................................................................... 1-9 Using the Computer Keyboard ................................................................................ 1-11 Computer Keyboard Keys ....................................................................................... 1-11 Function Key Shortcuts ........................................................................................... 1-12 Keyboard Bindings .................................................................................................. 1-12 Cursor-Movement Keys........................................................................................... 1-13 Keypad Keys............................................................................................................ 1-13 Keyboard Shortcuts.................................................................................................. 1-14 Using the Mouse ...................................................................................................... 1-17 System Messages ..................................................................................................... 1-17 Where Can Help be Found?..................................................................................... 1-19 XiO Conventions ..................................................................................................... 1-20 XiO Coordinate System ........................................................................................... 1-21 Unix/Linux Logins................................................................................................... 1-22

Section 2. Help Resources

General Information................................................................................................. 2-1 XiO Main Help Window.......................................................................................... 2-2

Sample Dialog Box Help .......................................................................... 2-3 Contents Tab ............................................................................................ 2-4 Index Tab ............................................................................................ 2-5 Search ............................................................................................ 2-6 Finding "How To" Procedures for a Specific Task .................................. 2-8 Print a Screen in XiO Help ....................................................................... 2-9 Print a Page or Frame in XiO Help........................................................... 2-10

Additional Help Resources ...................................................................................... 2-11 Phone Support........................................................................................... 2-22 Beam Modeling ........................................................................................ 2-12 Online User Access .................................................................................. 2-13

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Section 3. Settings

Overview.................................................................................................................. 3-1 Practice Exercise...................................................................................................... 3-2 Task 1. Selecting a Clinic...................................................................................... 3-2 Installation ............................................................................................................... 3-3 Task 1. User Authorization ................................................................................... 3-3 Task 2. Hospital/Clinic.......................................................................................... 3-4 Task 3. Date Format .............................................................................................. 3-5 Task 4. Language .................................................................................................. 3-6 Task 5. GCD Model .............................................................................................. 3-7 Task 6. Transfer Data to FOCAL PC .................................................................... 3-8 Workstation.............................................................................................................. 3-9 Task 1. Backup Utility........................................................................................... 3-9 Task 2. Printers...................................................................................................... 3-10

Data Locations for PDF and Postscript Print............................................ 3-11 Task 3. CT Interfaces ............................................................................................ 3-12 Task 4. MRI Interfaces.......................................................................................... 3-13 Task 5. SC Interfaces............................................................................................. 3-14 Task 6. PET Interfaces .......................................................................................... 3-15 Task 7. Nuclear Medicine Interfaces..................................................................... 3-16 Task 8. Ultrasound Interfaces................................................................................ 3-17 Task 9. DICOM Settings ....................................................................................... 3-18 Clinic 3-19 Task 1. Data Compression..................................................................................... 3-19 Task 2. User Interfaces Preferences ...................................................................... 3-20 Task 3. Scanner/LMS Definition........................................................................... 3-21 Patient Data.............................................................................................................. 3-28 Task 1. General Anatomical Site........................................................................... 3-28 Task 2. Specific Anatomical Sites......................................................................... 3-31 Task 3. CT to Rel Elec Dens Files ........................................................................ 3-35 Task 4. Prostate Template ..................................................................................... 3-38 Sample Template ..................................................................................................... 3-41 Plan Defaults............................................................................................................ 3-42 Task 1. Brachytherapy Drawing............................................................................ 3-42 Task 2. Calculation Defaults ................................................................................. 3-43

Sub-task 1. Teletherapy ......................................................................... 3-43 Weight Point field edge warning distance. ......................... 3-45

Sub-task 2. Brachytherapy – General Parameters.................................. 3-48 Task 3. DRR Calculation Defaults.......................................................................... 3-50

Initial Image Display ................................................................................ 3-52 Final Image (Display) ............................................................................... 3-53 Film Image 3-53 DICOM 3.0 Image.................................................................................... 3-53

Task 4. Proton Beam Defaults ................................................................................ 3-54 Task 5. Proton Defaults ......................................................................................... 3-55

Subtask 1. General Proton Parameters ................................................. 3-55

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Section 3. Settings (cont.)

Subtask 2. Milling Tool Size ................................................................ 3-57 Task 6. TCP/NTCP Parameters............................................................................. 3-58 Task 7. Teletherapy ............................................................................................... 3-59 Output 3-60 Task 1. DRR Print ................................................................................................. 3-60 Task 2. Intensity Maps .......................................................................................... 3-61 Task 3. Intensity Map Output Devices .................................................................. 3-62 Task 4 Tele Source Data ...................................................................................... 3-64

Sub-task 1. Treatment Parameters ......................................................... 3-64 Task 5. Standalone Time/MU ............................................................................... 3-66 Task 6. Display Printer Defaults ........................................................................... 3-67

Sub-task 1. Brachy Isocurve / Isosurface Colors ................................... 3-67 Sub-task 2. Print Colors ......................................................................... 3-69 Sub-task 3. Beam Colors (Proton Only) ................................................ 3-71 Sub-task 4. Thickness (Proton Only) ..................................................... 3-72

Task 7. DRR Printing Size .................................................................................... 3-73 Task 8. .decimal Order Defaults............................................................................ 3-74 Task 9. Block Cutter Export.................................................................................. 3-76 Technical Considerations......................................................................................... 3-77

Section 3A. Setting Presentation

Section 4. Patient File Maintenance

Practice Exercise...................................................................................................... 4-1 Task 1. Access XiO - PFM.................................................................................... 4-1 Task 2. Create a New Patient ................................................................................ 4-3

Method 1. Enter Demographic Information ......................................... 4-3 Method 2. Use DICOM Header information........................................ 4-4

Task 3. Start Image Transfer ................................................................................. 4-5 Task 4. Finish Image Transfer............................................................................... 4-7 Task 5. Contouring ................................................................................................ 4-9

Sub-task 1. Add a Group of Contour Names & Enter a Contour Name4-9 Sub-task 2. Create the Patient Contour Using Auto-by-Threshold

(Multiple Slices) ................................................................. 4-11 Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice) . 4-14 Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice) . 4-15 Sub-task 4. Create Contours Using Auto-by-Threshold (Range) .......... 4-16 Sub-task 5. Create/Edit Contours using the Paintbrush ......................... 4-17 Sub-task 6. Create Contours Using Autosegmentation.......................... 4-18 Sub-task 7. Edit Existing Contour ......................................................... 4-20

Replace Contour Segment................................................... 4-20 Stretch Sym/Asym .............................................................. 4-21 Move ................................................................................... 4-21

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Section 4. Patient File Maintenance (cont.) Copy Superior/Inferior........................................................ 4-22 Copy/Paste to Another Slice (keyboard shortcuts) ............. 4-22 Delete a Single Contour ...................................................... 4-22 Delete ALL Contours for an Entire Structure..................... 4-23 Stop Editing ........................................................................ 4-23

Sub-task 8. Create Contours from Predefined Shapes

Using the Keyboard ............................................................ 4-24 Sub-task 9. Draw Contours using the Mouse......................................... 4-25 Sub-task 10. Interpolate ........................................................................... 4-26 Sub-task 11. Free-form Exercise – Outline the Seminal Vesicles using any

method ................................................................................ 4-27 Sub-task 12. 3-D Auto-Margin - Uniform ............................................... 4-28 Sub-task 13. 3D Auto-Margin with Exclusion ....................................... 4-30 Sub-task 14. 3-D Auto-Margin – Variable .............................................. 4-31 Sub-task 15. 3-D Auto-Margin – Negative.............................................. 4-32 Sub-task 16. 2-D Automargin.................................................................. 4-33 Sub-task 17. Edit Contour Information.................................................... 4-33 Sub-task 17. Create Interest Points Using the Mouse.............................. 4-34 Sub-task 18. Create a Marker Using the Mouse and Scales feature ........ 4-34 Sub-task 19. Obtain Shift Calculations – Setup Reference Definition .... 4-36

Task 6. Turning On and Off Display of Contours and Plan Objects..................... 4-39 Toggle the Display of Contours................................................................ 4-39 Toggle the Display of Plan Objects .......................................................... 4-40

Task 7. Window Format Options .......................................................................... 4-41 Task 8. (Optional) Image Fusion in PFM.............................................................. 4-43

Subtask 1. Create a Secondary Studyset............................................... 4-43 Subtask 2. Open the Patient for Fusion ................................................ 4-43 Subtask 3. Fusion Tools and AutoRegistration .................................... 4-44 Subtask 4. Open Fused Studysets in PFM............................................ 4-45

Section 5. Teletherapy Part 1

Overview.................................................................................................................. 5-1 Practice Exercise...................................................................................................... 5-2 Task 1A. Open the Patient in Teletherapy (from PFM) ........................................... 5-2 Task 1B. Open the Patient in Teletherapy (from the Main XiO screen).................. 5-4 Task 2. Graphical Display Options ....................................................................... 5-6

Activate a Window ................................................................................... 5-6 Scale ............................................................................................ 5-6 Window/Level .......................................................................................... 5-7 Movie ............................................................................................ 5-9 Pan ............................................................................................ 5-9 Rotate ............................................................................................ 5-9 Translate ............................................................................................ 5-10 Maximize/Restore..................................................................................... 5-10

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Section 5. Teletherapy Part 1 (cont.)

Task 3. Add and Edit a Beam................................................................................ 5-11 Task 4. Create an Auto Port .................................................................................. 5-22 Task 5. Mirror a Beam .......................................................................................... 5-24 Task 6. Copy a Beam ............................................................................................ 5-26 Task 7. Change the Active Beam in the ABV (Active Beams-eye View) Window5-29 Task 8. Display Isodoses ....................................................................................... 5-30 Task 9. (Optional) Evaluate Point Doses Using the Reference Dose Cursor........ 5-33 Task 10. Normalization of Dose Display ................................................................ 5-34

Absolute Dose Normalization................................................................... 5-34 Global Maximum, Selected Point and Selected Dose Normalization ...... 5-34

Task 11. Beam Weighting and Rescaling................................................................ 5-36 Task 12. Dose Volume Histogram .......................................................................... 5-39

Display a Quick DVH............................................................................... 5-39 Using the Comprehensive DVH Tools ..................................................... 5-41 Re-display a Histogram ............................................................................ 5-47

Task 13. Save the Plan ............................................................................................ 5-48 Task 14. Create a Template ..................................................................................... 5-49 Task 15. Display and/or Print Outputs and Reports ................................................ 5-50

Section 6. Teletherapy Part 2

Task 1. Additional Beam Functionality................................................................. 6-1 Subtask 1. Delete beam(s) .................................................................... 6-1

Delete the Active Beam ...................................................... 6-1 Delete a Group of Beams.................................................... 6-1

Subtask 2. Renumber Beams ................................................................ 6-1 Subtask 3. Toggle Beam Display (include shortcut) ............................ 6-2

Toggle Selected Beams On or Off ...................................... 6-2 Subtask 4. Move Isocentric Group ....................................................... 6-3

Task 2. Additional Port Functionality ................................................................... 6-5 Subtask 1. Draw a Port Using the Mouse............................................. 6-5 Subtask 2. Draw a Port Using the Tablet.............................................. 6-6 Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC)..... 6-6 Subtask 4. Create and Edit a Port using the Keyboard ......................... 6-9 Subtask 5. (MLC Only) Edit MLC Leaves........................................... 6-9 Subtask 6. MLCs and Blocks ............................................................... 6-11 Subtask 7. (MLC Only) MLC Display Feature .................................... 6-12 Subtask 8. Rotate Collimator Independent of Port ............................... 6-13 Subtask 9. Automatically Update the MLC or Aperture as the

Gantry is Rotated ................................................................ 6-14 Subtask 10. Auto Conform the Port for the Active Beam ...................... 6-15 Subtask 11. Auto Conform Ports or Collimator Jaws to a

Specific Margin for One or Multiple Beams ...................... 6-16 Subtask 12. Conform Collimator for the Active Beam ........................... 6-17

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Section 6. Teletherapy Part 2 (cont.) Subtask 13. Conform Collimator Jaws for all Beams at Once ................ 6-18 Subtask 14. How To Save and Use Public Ports ..................................... 6-18 Subtask 15. Port Properties...................................................................... 6-19

MLC.................................................................................... 6-19 Aperture/Block.................................................................... 6-20

Subtask 16. Delete Port Options............................................................. 6-21 Delete Entire Ports .............................................................. 6-21 Delete a Port Shape............................................................. 6-21

Subtask 17. Convert Aperture/MLC........................................................ 6-22 Task 3. Items That Influence Dose Calculation...................................................... 6-23

Subtask 1. Calculation Setting.............................................................. 6-23 Subtask 2. Dose Status ......................................................................... 6-26

Task 4. Setup Reference Definition (CT Sim)........................................................ 6-27 Determine and Mark the Scan Reference Point........................................ 6-27 Report Relative Shifts............................................................................... 6-29 Report Absolute Readings ........................................................................ 6-31

Task 5. Optional Display Settings .......................................................................... 6-32 Subtask 1. Window Format .................................................................. 6-32

Select/Save a Predefined Window Format.......................... 6-32 Create your own Window Format....................................... 6-33 Create an SPV Plane perpendicular to the

Central Axis (SPV CAX).................................................... 6-34 Create an Oblique Plane (Not necessarily

perpendicular to the plane of any beam)............................. 6-35 Subtask 2. Enhance Contours ............................................................... 6-37 Subtask 3. Scales .................................................................................. 6-38

Toggle Scales On and Off................................................... 6-38 Change the Scales Tic-mark Spacing ................................. 6-38 Move the Scales in a Single Window ................................. 6-38 Move the Scales in all SPV Windows at Once ................... 6-38

Subtask 4. View Plans on Primary, Secondary, or

Electron Density Image Data .............................................. 6-39 Subtask 5. View Image Planes in MPV................................................ 6-40 Subtask 6. Plan Objects ........................................................................ 6-41

Turn On or Off One Plan Object At a Time ....................... 6-41 Turn On or Off Multiple Plan Objects ................................ 6-42

Subtask 7. Beam Objects ...................................................................... 6-43 MLC Shadow............................................................................................ 6-44

Turn On or Off One Beam Object At a Time ..................... 6-44 Turn On or Off Multiple Beam Objects.............................. 6-44

Subtask 8. Adding, Editing and Deleting Interest Points and Markers 6-45 Add an Interest Point or Marker ......................................... 6-45 Edit an Interest Point or Marker.......................................... 6-46 Delete an Interest Point or Marker...................................... 6-47

Subtask 9. Measure Tools..................................................................... 6-48

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Section 6. Teletherapy Part 2 (cont.) Using the Ruler Measure Tool ............................................ 6-48 Using the Point to Point Measure Tool............................... 6-49

Subtask 10. Plane Icon ........................................................................... 6-50 Subtask 11. Contour Editing................................................................... 6-50 Subtask 12. Create Subcontour............................................................... 6-51

Task 6. Multiple Plan Review................................................................................. 6-52 Open the Patient and Select Plans for Review.......................................... 6-52 Display Dose to a Single Point ................................................................. 6-56 DVH ............................................................................................ 6-56 Save an Addition Plan .............................................................................. 6-57 Plan Comment/ Approval ......................................................................... 6-57

Task 7. Additional Beam Modifiers ...................................................................... 6-58 Subtask 1. Open a Permanent Plan....................................................... 6-58 Subtask 2. Bolus ................................................................................... 6-58

Draw Bolus SPV................................................................. 6-58 Draw Bolus BEV ................................................................ 6-61 Edit Bolus ........................................................................... 6-63 Assign Bolus ....................................................................... 6-64 Delete Bolus........................................................................ 6-65

Sub-task 3. Wedges................................................................................ 6-66 Add Wedge ......................................................................... 6-66 Delete Wedge...................................................................... 6-67

Sub-task 4. Compensating Filters .......................................................... 6-68 Add Compensating Filter.................................................... 6-68 Delete Compensating Filter ................................................ 6-69 Send Compensating Filter Data to a

Milling Machine (Huestis and Par Scientific)..................... 6-70 Task 8. Delete Options in XiO................................................................................ 6-73

Section 7. 2-D Breast Tangents

Practice Exercise...................................................................................................... 7-1 Task 1. Access XiO ................................................................................................ 7-2 Task 2. Enter Patient Demographic Data and Define the Studyset ....................... 7-3 Task 3. Digitize Contours...................................................................................... 7-6

Sub-Task 1. Set up the Contouring Parameters and Orient the Axes...... 7-6 Sub-Task 2. Digitize Contours ................................................................ 7-8 Sub-Task 3. Digitize Interest Points and Markers................................... 7-10 Sub-Task 4. Digitize Contours on Final Cross Section........................... 7-10 Sub-Task 5. Name the Interest Points and Markers ................................ 7-11

Task 4. Create a New Plan...................................................................................... 7-12 Sub-Task 1. Enter Plan Information........................................................ 7-12 Sub-Task 2. Create an Active Beams-Eye View (ABV) Window.......... 7-13 Sub-Task 3. Create a New Beam ............................................................ 7-14 Sub-Task 4. Add a Wedge ...................................................................... 7-15 Sub-Task 5. Mirror the Beam.................................................................. 7-15

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Section 7. 2-D Breast Tangents (cont.) Sub-Task 6. Normalize and View Isodose .............................................. 7-16

Task 5. Save the Plan ............................................................................................ 7-19 Task 6. Print a Single Plane View......................................................................... 7-20

Section 8. 3-D Lung

Practice Exercise...................................................................................................... 8-1 Task 1. Create a New Patient and Transfer CT Data............................................. 8-2 Task 2. Create Contours ........................................................................................ 8-5 Task 3. Use Auto Margin to Expand the Target Volume...................................... 8-6 Task 4. Enter Basic Teletherapy Information........................................................ 8-8 Task 5. Add an Interest Point ................................................................................ 8-9 Task 6. Dose Calculation Settings......................................................................... 8-10 Task 7. Add New Beam ........................................................................................ 8-12 Task 8. Adding an Aperture .................................................................................. 8-14 Task 9. Mirror Beam ............................................................................................. 8-15 Task 10. (Optional) Edit a Port ............................................................................... 8-16 Task 11. Save the Plan ............................................................................................ 8-17 Task 12. Normalize the Dose Display and Review Isodoses .................................. 8-18 Task 13. Add Boost Fields for a Composite Plan ................................................... 8-19 Task 14. (Optional) Review the Boost Plan ............................................................ 8-20 Task 15. Review the Composite Plan...................................................................... 8-21 Task 16. Create a DVH ........................................................................................... 8-22 Task 17. Save the Revised Plan as a New Plan ....................................................... 8-23

Section 9. Preferences

General Preferences ................................................................................................. 9-1 Patient File Maintenance Preference Settings.......................................................... 9-1 General .................................................................................................................. 9-1 Color .................................................................................................................. 9-6 W/L Presets.............................................................................................................. 9-9 Teletherapy Preference Settings .............................................................................. 9-10 General .................................................................................................................. 9-10

New Plan Object Displays ........................................................................ 9-13 Color .................................................................................................................. 9-16 DICOM .................................................................................................................. 9-17 DICOM .................................................................................................................. 9-18 DRR Output ............................................................................................................. 9-18 Print .................................................................................................................. 9-20 Window/Level ......................................................................................................... 9-22 Beam Display........................................................................................................... 9-23 Beam .................................................................................................................. 9-26 Port .................................................................................................................. 9-28 Histogram................................................................................................................. 9-32

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Section 9. Preferences (cont.) Sampling Resolution................................................................................. 9-32 Dose Bin Width ........................................................................................ 9-32

IMRT .................................................................................................................. 9-34 IMRT Graphs............................................................................................ 9-34

Initial Optimization................................................................................... 9-35 Beam Weight Optimization ...................................................................... 9-36 Segmentation Method............................................................................... 9-36 Ideal Map Extension................................................................................. 9-37 Discrete Intensity Levels .......................................................................... 9-37 Split Field Parameters............................................................................... 9-37 Minimum Segment Size ........................................................................... 9-39 Compensating Filter Smoothing ............................................................... 9-39

Intensity Map ........................................................................................................... 9-40 Display Print ............................................................................................ 9-40 Output Map To ......................................................................................... 9-41 ASCII Output............................................................................................ 9-41 Define Default Filename Format .............................................................. 9-41 Define Default Filename Format .............................................................. 9-42 Default Filename Formats ........................................................................ 9-43

Plan Output .............................................................................................................. 9-44 Brachytherapy.......................................................................................................... 9-47 Brachytherapy Histogram Print Preferences............................................................ 9-47

Section 10. 3-D Four Field Prostate

Preliminary Instructions:.......................................................................................... 10-1 Task 1. Vary the Margin Around a Structure Using 3-D Auto Margin................. 10-1 Task 2. Create the Plan.......................................................................................... 10-1 Task 3. Save the Plan as a Template ..................................................................... 10-2 Task 4. Save the Plan ............................................................................................ 10-2

Section 11. Electron Beam

Practice Exercise...................................................................................................... 11-1 Task 1. Start the Plan............................................................................................. 11-1 Task 2. Add the Electron Beam............................................................................. 11-3 Task 3. Manipulate the Electron Beam Using the Mouse or Keyboard. ............... 11-4 Task 4. Add an Electron Port ................................................................................ 11-5 Task 5. (Optional) Create and Assign Bolus ......................................................... 11-6 Task 6. Normalize and Review the Final Dose. .................................................... 11-8

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Section 12. Arc Rotation Plan

Practice Exercise...................................................................................................... 12-1 Task 1. Start the Plan............................................................................................. 12-1 Task 2. Add the Rotational Arc Beams ................................................................. 12-3 Task 3. Normalize and Review the Final Plan ...................................................... 12-5

Section 13. Single Field Irregular Field

Single Field Irregular Field — Plan A. .................................................................... 13-1 Task 1. Enter Setup Information ........................................................................... 13-1 Task 2. Enter Beam Information ........................................................................... 13-2 Task 3. Enter a Block ............................................................................................ 13-4 Task 4. Define Surface Points ............................................................................... 13-6 Task 5. Enter Point Depths.................................................................................... 13-7 Task 6. Calculate Dose.......................................................................................... 13-8 Parallel Opposed Irregular Field — Plan B. ............................................................ 13-9 Task 1. Enter Setup Information ........................................................................... 13-9 Task 2. Enter Beam Parameters............................................................................. 13-11 Task 3. Enter Blocks ............................................................................................. 13-13 Task 4. Define First Surface Point ........................................................................ 13-15 Task 5. Define Additional Surface Points ............................................................. 13-16 Task 6. Enter Point Depths.................................................................................... 13-17 Task 7. Calculate Dose.......................................................................................... 13-18

Section 14. Time/MU Practice Exercise...................................................................................................... 14-1

Section 15. Gynecological Brachytherapy Implant

Practice Exercise...................................................................................................... 15-1 Task 1. Create a Source Type................................................................................ 15-1

Sub-task 1. Enter General Parameters ................................................... 15-2 Sub-task 2. Enter the Physical Geometry for the

Sievert Integral Data ........................................................... 15-3 Sub-task 3. Enter the Attenuation Information for the

Sievert Integral Data15-3 Sub-task 4. Enter the Dose Rate Parameters and Create the

Dose Rate Table15-4 Task 2. Create a Source Template .......................................................................... 15-7 Task 3. Create a Source Inventory.......................................................................... 15-8 Task 4. Create Tandem Catheter Template............................................................. 15-9 Task 5. Create a New Patient.................................................................................. 15-10 Task 6. Create a New Treatment Plan .................................................................... 15-11 Task 7. Digitize Ovoid Source................................................................................ 15-12 Task 8. Define Tandem Sources ............................................................................. 15-14

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Section 15. Gynecological Brachytherapy Implant (cont.) Task 9. Digitize the Tandem ................................................................................. 15-15 Task 10. Digitize Interest Points for Dose Calculations.......................................... 15-16 Task 11. Digitize Markers for Automatically Calculating Points A and B............ 15-17 Task 12. Position Markers for Defining Points A and B......................................... 15-19 Task 13. Create a Best-fit Oblique Plane and Sagittal

and Transverse Views of the Implant ....................................................... 15-20 Task 14. Calculate Dose.......................................................................................... 15-22 Task 15. (Optional) Edit/Delete Sources and Catheters ......................................... 15-23

Sub-task 1. Edit a Group of Sources...................................................... 15-23 Sub-task 2. Edit One Source .................................................................. 15-24 Sub-task 3. Delete a Group of Sources .................................................. 15-24 Sub-task 4. Delete One Source .............................................................. 15-25 Sub-task 5. Edit the Sources in a Group of Catheters............................ 15-25 Sub-task 6. Edit Sources in One Catheter .............................................. 15-26 Sub-task 7. Delete a Group of Catheters................................................ 15-26 Sub-task 8. Delete One Catheter............................................................ 15-27

Task 16. Plot Brachytherapy Plan ........................................................................... 15-28

Section 16. Prostate Brachytherapy Prostate Brachytherapy Preplan A

Practice Exercise....................................................................................... 16-1 Task 1. Create a Source Type................................................................................ 16-2

Sub-task 1. Enter General Parameters ................................................... 16-2 Sub-task 2. Enter the Radial Dose Function information

for the TG43 Data ............................................................... 16-3 Sub-task 3. Enter the Anisotropy Function information

for the TG43 Data ............................................................... 16-5 Sub-task 4. Enter the Dose Rate Function information

for the TG43 Data ............................................................... 16-7 Sub-task 5. Enter the Dose Rate Parameters and Create Dose

Rate and Seed Equivalent Tables........................................ 16-7 Task 2. Create a Source Template......................................................................... 16-9 Task 3. Create a Preplanning Prostate Template................................................... 16-10 Task 4. Enter Patient Data ..................................................................................... 16-11 Task 5. Enter Data about Cross Sections............................................................... 16-12 Task 5. Enter Data about Cross Sections............................................................... 16-13 Task 6. Start the Creation of New Treatment Pre-Plan ......................................... 16-14 Task 7. Modify Graphics....................................................................................... 16-15 Task 8. Define Pre-Planning Parameters............................................................... 16-15 Task 9. Edit Existing Sources................................................................................ 16-16 Task 10. Enter Calculation Parameters ................................................................... 16-17 Task 11. Assign Dose Prescription.......................................................................... 16-18 Task 12. Print the Pre-plan Report .......................................................................... 16-19

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Section 16. Prostate Brachytherapy (cont.) Prostate Seed Implant Postplan B

Practice Exercise...................................................................................................... 16-20 Task 1. Create a Prostate Post Plan ....................................................................... 16-21 Task 2. Find Seeds Using Automated Source Localization .................................. 16-22 Task 3. Review Seed Positions.............................................................................. 16-23 Task 4. Calculate Dose and Evaluate the Implant ................................................. 16-24 Task 5. Plot Plan.................................................................................................... 16-25

Section 17. Digitally Reconstructed Radiographs

Practice Exercise...................................................................................................... 17-1 Task 1. Set up DRR Defaults in Settings .............................................................. 17-2 Task 2. Verify CT to ED Conversion.................................................................... 17-4 Task 3. Create DRR Windows in XiO .................................................................. 17-8 Task 4. Use Different Image Filters (Sim, Film, Port Film, etc.).......................... 17-13 Task 5. Generate High-Resolution DRRs ............................................................. 17-15 Task 6. Plot a DRR................................................................................................ 17-16 Task 7. Plot a DRR to Life-Size (magnified to source-to-film distance) .............. 17-18 Technical Considerations......................................................................................... 17-21

Section 17A. Digitally Reconstruction Radiographs

Section 17B. Virtual Patient

Section 18. Composite Planning

Practice Exercise...................................................................................................... 18-1 Prerequisites............................................................................................................. 18-1 Conditions................................................................................................................ 18-1 Learning Objectives ................................................................................................. 18-1 Task 1. Start a New 3-D Treatment Plan............................................................... 18-3 Task 2. Examine Contoured Structures ................................................................. 18-5 Task 3. Create a Simple Four-Field Box Plan

to a PTV Volume (Prostate + Seminal Vesicles + Margin + Port Margin)18-7 Task 4. Ceate Four Boost Fields, Boosting

to a Smaller Volume (GTV + Port Margin).............................................. 18-10 Task 5. Define Prescriptions for the Two Beam Groups....................................... 18-12 Task 6. View the Dose Display for the Composite Plan ....................................... 18-18 Task 7. View the DVH Results for the Composite Plan ....................................... 18-20 Task 8. Review and Understand the Individual

Beam Weights for the Composite Plan..................................................... 18-22

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Section 19. IMRT Head and Neck Practice Exercise...................................................................................................... 19-1

Task 1. Open Patient for IMRT............................................................................. 19-2

Task 2. Prepare Contours for IMRT...................................................................... 19-3

Task 3. Dose Calculation Settings......................................................................... 19-6

Task 4. Place Beams and Conform Jaws or Ports ................................................. 19-7

Task 5. IMRT Parameters and Prescription Table ................................................ 19-10

Treatment Goal ......................................................................................... 19-11

Task 6. Start IMRT Optimization Page................................................................. 19-13

Task 7. Optimized DVH and Isodoses .................................................................. 19-14

Task 8. Prescription Adjustment ........................................................................... 19-16

Task 9. Review/Edit Ideal Intensity Maps (optional)............................................ 19-18

Task 10. Generation and Review of MLC Segments .............................................. 19-19

Task 11. Using DVH, Isodoses and Intensity Maps to Evaluate IMRT Plans ........ 19-22

Task 12. Save the IMRT Plan ................................................................................. 19-24

Task 13. Compare Plans with Different Minimum Transmission Multiplers ......... 19-25

Task 14. Quality Assurance of the IMRT Plan........................................................ 19-26

Sub-task 1. Visualize, Sample, and Output Intensity Maps for QA ...... 19-26

Sub-task 2. Largest Leaf Extent Verification ........................................ 19-27

Sub-task 3. Create a QA Plan on a Phantom and Export Doses to a File19-28

Sub-task 4. Create a Single Beam QA File on a Phantom..................... 19-32

Example Prescription............................................................................................... 19-33

Section 20. Plan Evaluation Tools

Practice Exercise...................................................................................................... 20-1 Task 1. Set up an open-field breast tangent plan with arbitrary weight point ....... 20-8 Task 2. Use the Dose Profile Tool......................................................................... 20-12 Task 3. Delete Wedges to the Beams and Save the Open Plan ............................. 20-14 Task 4. Add Compensators and Save the Compensated Plan ............................... 20-16 Task 5. Change the Patient Compensator "High Point" for

the Latter Beam to Reduce the Hot Spot Dose

and Save the 2nd Compensated Beam ....................................................... 20-18 Task 6. View Dose Profile Output in Text Format................................................ 20-20

Linux Users ............................................................................................ 20-20 Non-Linux Users ...................................................................................... 20-20 For Linux and Non-Linux Users............................................................... 20-20

Task 7. For the 2nd Compensated Plan, Produce

QA Output Files for Each Compensator................................................... 20-22

Section 21. Monitor Units: Algorithm Dependencies

Practice Exercise...................................................................................................... 21-1 Why Do Monitor Units Depend on the Dose Calculation Algorithm?.................... 21-1 How Do I Use XiO to Calculate Monitor Units?..................................................... 21-1

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Section 21. Monitor Units: Algorithm Dependencies (cont.)

Conditions................................................................................................................ 21-1 Learning Objectives ................................................................................................. 21-2 Task 1. Set up Multiple Beams Using Different Calculation Algorithms............. 21-3 Task 2. Verify Depths, Use Group Move, and Change Beam Parameters ............ 21-8 Task 3. Draw Customized Internal Structures....................................................... 21-11 Task 4. Understand the Differences in Monitor

Units between Algorithms, and between Phantom Geometries................ 21-19 Monitor Unit Calculations - Photons ....................................................................... 21A1 Monitor Unit Calculations - Electrons..................................................................... 21B1

Section 21A. Monitor Units Calculations - Photons

Section 21B. Monitor Units Calculations - Electrons

Section 22. Miscellaneous Tasks Practice Exercise...................................................................................................... 22-1 Task 1. Utilities Accessed through XiO Help ....................................................... 22-2

Trouble Shooting ...................................................................................... 22-2 View Log File ..................................................................... 22-2 View XiO System Information ........................................... 22-3 System Administration........................................................ 22-3 Configure Modem............................................................... 22-3 Install Phantom ................................................................... 22-3 Restore Data........................................................................ 22-3 IMFast™ Machine ID......................................................... 22-3 Manage User Accounts ....................................................... 22-4

Task 2. Export/Archive Patient ............................................................................. 22-5 Task 3. Retrieve Archived Patient......................................................................... 22-6 Task 4. Running Multiple XiO Sessions on Linux................................................ 22-7 Task 5. Screen Captures - UNIX........................................................................... 22-8

Screen Capture for UNIX ......................................................................... 22-9 Setting Keyboard Shortcut Preferences .................................................... 22-11

Task 6. Capturing a Screen Shot in LINUX.......................................................... 22-12

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Section 23. Dynamic Conformal Practice Exercise...................................................................................................... 23-1 Task 1. Copy An Existing Machine in Source File Maintenance to Create a Dynamic

Conformal Machine.................................................................................. 23-2 Task 2. Setup and Validate New Dynamic Conformal Machine .......................... 23-3 Task 3. Setup Beam Preferences ........................................................................... 23-5 Task 4. Create a New Treatment Plan ................................................................... 23-6 Task 5. Create a New Beam Using a Dynamic Conformal Setup........................ 23-7 Task 6. Set Treatment Margins and Generate Dynamic Conformal Beams........ 23-9 Task 7. Calculate Dose and Balance the Beam Weights....................................... 23-12 Task 8. Review the Isodose Lines ......................................................................... 23-14 Task 9. Review the Source Data ........................................................................... 23-15 Task 10. Review MLC Leaf Positions .................................................................... 23-16

Task 11. Review Dynamic Conformal Prescription................................................ 23-17 Task 12. An Alternative Beam Setup ...................................................................... 23-18

Section 24. Broad Beam Proton

Practice Exercise...................................................................................................... 24-1 Task 1. Create a Beam........................................................................................... 24-1 Task 2. Create an Aperture.................................................................................... 24-3 Task 3. Create a Range Compensator.................................................................... 24-4 Task 4. Delete a Range Compensator (optional)................................................... 24-8 Task 5. Edit the Range Compensator Prescription (optional) ............................... 24-9 Task 6. Modify the Range Compensator (optional) .............................................. 24-10 Task 7. Create a Subcontour (optional) ................................................................. 24-11 Task 8. Calculate and Review the Isodoses........................................................... 24-13 Task 9. Set the Range Compensator Isothickness Levels ..................................... 24-14 Task 10. Fabricate the Range Compensator ............................................................ 24-15 Task 11. Fabricate the Port...................................................................................... 24-16

Section 25. Spot Scanning Proton Beam

Lecture .................................................................................................................. 25-1 Task 1. Create a Transition Volume for PTV1...................................................... 25-2 Task 2. Start a New Proton Plan............................................................................ 25-4 Task 3. Set the Dose Calculation Grid Spacing .................................................... 25-5 Task 4. Create a Proton Beam ............................................................................... 25-5 Task 5. Create a Subcontour (Optional) ................................................................ 25-6 Task 5. Enter Scan Volume Parameters ................................................................ 25-6 Task 6. Add a Second Beam ................................................................................. 25-8 Task 7. Enter Scan Volume Parameters for second beam..................................... 25-9 Task 8. Create Subcontours (optional) .................................................................. 25-9 Task 9. Verify Parameters and Enter Prescription ................................................ 25-10 Task 10. Optimize the Plan and Calculate the Dose................................................ 25-11 (Optional) Task 11. Edit the Intensity Map per Layer ............................................ 25-13

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Section 25. Spot Scanning Proton Beam (cont.) Appendix.................................................................................................................. 25-14 IMRT Prescription ................................................................................................... 25-14 Structure .................................................................................................................. 25-14

Type ............................................................................................ 25-15 Rank ............................................................................................ 25-15 Objective, Dose (cGy/Gy) and Volume (%)............................................. 25-16 Weight ............................................................................................ 25-19 Power ............................................................................................ 25-20 Status ............................................................................................ 25-21 Prescription DVH Graph Options............................................................. 25-22

Section 26. Are You Ready for IMRT

Section 27. XiO IMRT Overview

Section 28. Introduction to LINUX/UNIX

Section 29. Introduction to Convolution and Superposition

Section 30. Beam Modeling General Data

Section 31. 3D Photon Algorithms

Things You Should Know before Planning Begins

XiO Training Guide


Welcome

Congratulations on your purchase of the XiO system!

In an effort to insure your understanding of how to apply the functions of the

XiO system to the treatment plans in your clinic, various task steps have been

incorporated into practice exercises in this guide. The ultimate goal of this

training guide is to demonstrate all of the functions of the system in the exercises

presented.

The training begins with comprehensive coverage of Patient File Maintenance

and Teletherapy. Teletherapy is separated into two parts. The first part is

functional in nature, as new features are introduced while creating a typical

prostate plan. The second part of Teletherapy is feature-based and introduces

features that are not discussed in Part 1. Both parts provide step-by-step

instructions on how to use each feature.

The practice exercises are presented in a logical sequence. Each practice

exercise builds on the exercises completed. The practice exercises also illustrate

where toolbar buttons and drop-down menu options are located, as well as what

is going on behind the scenes when selecting options and entering information.

This training guide does not teach Radiation Treatment Planning (RTP). It

teaches you how to use the XiO software.

This guide includes a table of contents to assist you in locating the steps to

complete a specific task. To view a glossary of terms for the XiO system, refer

to the XiO Online Help glossary. For assistance in performing procedures not

discussed in the practice exercises of this guide, refer to the XiO Online Help, or

contact CMS Customer Support.

Intended Audience

The intended audience for the XiO Training Guide consists of clinicians who are

new to XiO and want to learn how to use the system to create treatment plans, as

it is also helpful to clinicians familiar with XiO who want to refresh their

knowledge.

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XiO Training Guide


The 30-Minute Plan and Its Advanced Features

CMS has reached its goal of providing state-of-the-art technology for developing

complete 3-D treatment plans, including contouring in less than 30 minutes.

The 30-minute plan is made possible using the following advanced features:

!" Autocontouring

!" 3-D Auto Margin

!" Templates

!" Inverse Planning

Advanced Tools Contribute to Increased Accuracy

Advanced evaluation tools provide increased accuracy, including the following:

!" Dose Volume Histograms (DVH)

!" Digitally Reconstructed Radiographs (DRR)

!" Tumor Control Probability (TCP) and Normal Tissue Complication

Probability (NTCP) calculations (to interpret how dose is distributed in a

tumor or anatomical structure.)

Objectives of the XiO Training Guide

The XiO Training Guide practice exercises are structured to assist you in the

following areas:

! Create plans quickly and efficiently

! Make the 30-minute plan routinely possible in the clinic

! Create accurate treatment plans

The XiO Training Guide is an easy reference tool that you can use when creating

treatment plans at your clinic. Listed below are some of the types of information

you will find in this guide:

! Comprehensive coverage of Patient File Maintenance

! Comprehensive coverage of Teletherapy

! Interactive treatment plans used to teach XiO (practice exercises)

! "How To" Procedures

! Pointers to XiO Online Help topics

! References that point to topics discussed in the XiO Reference Library

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XiO Training Guide


Other XiO References

XiO Users Guide - A high level overview of the product for all XiO users that is

shipped with every XiO system.

XiO Getting Started Guide - A workbook provided to students prior to

attending an XiO training class to familiarize them with XiO operations in order

to receive maximum benefit from the course.

XiO Online Help and Reference Library (within the Online Help) - Online

help and documentation are provided with all systems.

Beam Modeling Guide – Describes the procedures you use to create beam

models, transfer measured data into XiO, and evaluate computational models for

all algorithms.

CMS Corporate Web Site – Our site provides current information available at

your request. The Customer Support area of the CMS Corporate web site

requires an assigned ID and password to enter.

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XiO Training Guide


How to Use This Guide

The XiO Training Guide is organized into groups of tasks for specific types of

treatment plans. It allows you to easily look up related procedures when creating

similar types of plans.

The interactive treatment plan exercises in this guide provide "hands on"

experience with the XiO system — whether you are using the plans during

practice exercises while participating in a CMS in-house training session, or in a

training session at your clinic.

CMS has set up a Training Clinic environment on the XiO system so that you can

practice each of the steps for most of the tasks illustrated in this training guide.

When creating a valid treatment plan for your clinic, Do Not use the data shown

in the practice exercises of this guide, or the data shown the Training Clinic

of your XiO system.

Radiation Treatment Planning in XiO

You perform five sequential processes when creating new plans or updating

existing plans. The drop-down menus and icons shown on each XiO window

provide you easy access to the various functions.

Listed below are the five sequential processes you perform when creating a new,

or updating an existing treatment plan. In addition, we have identified the areas

of the system where you perform each of the processes.

1. Selecting a New or Existing Patient (Performed in Patient File

Maintenance)

You can perform the following tasks on the first window that appears after

selecting the Patient File Maintenance option on the XiO Main Window.

! Open an existing patient and create a new studyset

! Open an existing patient and create a new non-image based studyset

for an existing patient

! Create a new patient and studyset

Once you have completed the fields in any one of the above-mentioned

functional activities, XiO begins importing the images for image-based

studysets and opens the contouring window. For non-image based

studysets, you can begin contouring.

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XiO Training Guide


Radiation Treatment Planning in XiO (cont.)

2. Drawing New or Editing Existing Contours (Performed in Patient File

Maintenance)

Contouring in XiO varies depending on the type of treatment plan to which

you are applying the contours. You can create the contours using any of the

following tools:

Tablet When you use the tablet, you must use the tablet keypad controls

to enter points and trace contours.

Mouse You can use the mouse to draw contours selecting any one of the

following XiO tools:

Manual tracing (continuous mode or point mode)

! Auto-by-threshold

! AutoSegmentation

! Auto margin (2-D or 3-D)

! Interpolation

3. Creating or Updating a Plan (Performed in Teletherapy)

! 3D Auto-margin Combine Structures

! Beams (new, edit, mirror, wedge, compensating filter, DRR, bolus,

conform, isocentric group)

! Biology (TCP/NTCP parameters)

! Calculation region

! CAX SPV

! Display volumes

! Dose calculation

! Dose volume histogram

! DRR (add defaults)

! Wedges

! Edit relative electron density

! Interest points and markers (adding or deleting)

! Isocurve

! Printing and Plotting

! Set preferences

! Generate reports

! Rescaling beam weights

! Setup reference definition

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XiO Training Guide


Radiation Treatment Planning in XiO (cont.)

! Studyset comments

! Time/MU

! Treatment Aids

! Treatment templates

! Weight

4. Reviewing the Plan (Performed in Teletherapy)

! Isodose Lines

! Dose Profile

! DVH

! Reports

! Interest point dose

! Source data

! Structure volume

5. Saving the Plan (Performed in Teletherapy)

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XiO Training Guide


XiO Windows

The XiO Main window is the first window you see after you access the XiO

system. It is from this window you gain access to all of the functional areas of

the system.

Clinic

Selection Drop Down

XiO Main Window

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XiO Training Guide


PFM Window

Window Level Drop-down Structure and Group

Contour Name Selector

Supportin

g Toolbar

Teletherapy

Tool Bar

W/L Slider Bars

3D

Navigationa

l

Thumbnail

Time/Date and Mouse

Mode

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XiO Training Guide


XiO Teletherapy Window Layout

Window/Level Presets

Drop-down Menus Active Beam

Teletherapy

Supporting

W/L Slider

Bars

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XiO Training Guide


XiO Teletherapy Window Layout (cont.)

You can divide

the XiO graphicsarea into 1, 2, 4, 6,

9, or 12 sub-

windows. There are

two 6-window

options, symmetric

or as displayed

here.

TransversBEV

Sagittal

Coronal

DVHMPV-3D

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XiO Training Guide


Using the Computer Keyboard

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.

Computer Keyboard Keys

Use the computer keyboard to enter alphanumeric entries in XiO, for example,

your patient’s name or studyset description.

Use the Backspace key to delete the character to the left of the cursor.

The Caps Lock key is a toggle-key that, when pressed (and the CAPS LOCK

light in the upper right corner of the keyboard is lit), locks the keyboard so that

uppercase letters are entered without pressing the Shift key. This key has no

effect on the number and punctuation keys.

Use the Ctrl (Control) key in combination with other keys to generate

commands.

Use Enter or Return to enter an answer in a field and to move to the next field.

The Shift key has two uses:

1. Combined with the computer keyboard keys to enter uppercase letters and

punctuation marks.

2. Combined with the function keys to activate global functions.

Use the Delete key to erase the character following the cursor.

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XiO Training Guide


Using the Computer Keyboard (cont.)

Function Key Shortcuts

The following function key shortcuts apply to Brachytherapy, Irregular Field,

and Source File Maintenance only. For keyboard shortcuts in other modules,

refer to the toolbars described earlier in this section.

! SF1 opens the HELP function

! SF2 begins the RESTART function

! SF3 opens the EDITPLAN function

! SF4 begins the DISPDOSE function

! SF6 opens the SAVE PLAN function

! SF7 initiates the PLOT function

! SF8 initiates the APPROVAL function

! SF9 is the EXIT function

! SF10 does not have an assigned function



Keyboard Bindings

The following keyboard bindings apply to Patient File Maintenance and

Teletherapy only.

1. One (1) through zero (0) changes the active beam number to beam 1

through 10.

2. Shift F1 through F6 functions the same as selecting Major icons.

3. F1 through F12 functions the same as selecting the Minor icons.

4. Press C while the mouse is in the graphics area to open the Enhance

Contour dialog box.

5. Press B while the mouse is in the graphics area is a shortcut to Beam/Edit

Beam.

6. Pressing P while the mouse is in the graphics area is a short cut to toggle

the patient skin on and off.

7. Press W while the mouse is in the graphics area to open the Window

Format dialog box.

8. Press H while the mouse is in the graphics area to open online help.

9. Press T to turn all beams on or all beams off.

10. Press ~ (tilde) to make all beams inactive.

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Cursor-Movement Keys

Use the Arrow Keys to move the cursor or highlight bar. The cursor or highlight

bar moves in the direction of the arrows. Arrow Keys are also called cursor keys

or cursor-movement keys.

Use the Page Down key to display the next page of a multi-page index or

Answer-Help display.

Press the Page Up key to display the previous page of a multi-page index or

Answer-Help display.

Keypad Keys

The keypad is located at the far right side of your computer keyboard. It is

designed for rapid entry of numerical data.

Use the Enter key to enter tabular data in the XiO Table Entry function.

The Num Lock toggle key enables and disables the numeric keypad. When this

key is pressed (and the NUM LOCK light in the right corner of your keyboard is

lit), the keypad functions like a numeric keypad.

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XiO Training Guide



Keyboard Shortcuts

Patient File Maintenance Teletherapy

Action Keyboard

Shortcut

Action Keyboard

Shortcut

File Alt + F Accept Enter

Edit Alt + E Acknowledge Ctrl + A

View Alt + V Answer-Help Ctrl + L

Insert Alt + I CANCEL Ctrl + C

Plan Alt + P Done Ctrl + D

Reports Alt + R Help

Local Functions

Ctrl +H or Shift F1

F#, where F# is the

appropriate function key

Graphics Alt + G Next-Field Down Arrow

Help Alt + H Page-Down Ctrl + W

Page-Up Ctrl + U

Prev-Field Up Arrow

Prev-Page Ctrl + R

Print Ctrl + P

Quit Ctrl + Q

Table-Down Ctrl + Down Arrow

Table Enter Keypad Enter

Table-Left Ctrl + Left Arrow

Table-Right Ctrl + Right Arrow

Table-Up Ctrl + Up Arrow

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XiO Training Guide



Keyboard Shortcuts (cont.)

The following keyboard shortcuts apply to Brachytherapy, Irregular Field, and

Source File Maintenance. The first two also apply to Patient File Maintenance and

Teletherapy. All other function key shortcuts are described under the Toolbar heading

described earlier in this section. Using these shortcut key combinations, you can

perform many of the actions more quickly than with the mouse.

Action Keyboard Shortcut

CANCEL Ctrl + C

DONE/OK Ctrl + D

Local Functions F#, where F# is the appropriate function key

Global Functions Shift + F#, where F# is the appropriate function key

Help Shift + F1

If you decide to use keyboard shortcuts, you must be careful not to use the following

combinations:

LINUX

WARNING

Do not press Control+Alt+any other key. The LINUX

operating system uses the Ctrl +Alt+other keys for many other

operating system functions.

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XiO Training Guide



Keyboard Shortcuts (cont.)

UNIX

! Do not use the keyboard combination ALT + CONTROL + SHIFT + F1. If you

use this combination, the program exits from the XiO system and returns to the

UNIX window manager.

! Do not alter any UNIX files. Specifically, do not program and use X resource

files from your home directory. If you have any X resource files in your home

directory, they will overwrite XiO X resource files. If you overwrite or alter the

XiO X resource files, your XiO software may suffer irreparable damage, lose or

corrupt data, and/or calculate dose incorrectly.

WARNING

You should never exit XiO using a system break command

(example: Shift + Control + Break, Alt +F3, and Alt + Shift + 1).

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, which may cause data files

to become corrupt. This may cause incorrect dose calculations(s)

to occur, which can cause an incorrect dosage to be administered to

the patient.

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XiO Training Guide


Using the 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 middle-mouse button when clicked.

! Use the left mouse button to select or drag items on the screen.

! Use the right mouse to display drop-down lists in active fields or

windows.

! Use the middle mouse button or click the scroll wheel in active fields to

view pop-up help information boxes.

Special Cases:

! (3-button or scroll wheel mouse) To movie through images, right mouse

click in any single plane view window and select the movie option with a

left mouse click. Use the left and middle mouse buttons to move

superior and inferior through the images.

! (Scroll wheel mouse- Patient File Maintenance) You can use the scroll

at all times to movie through images.

! (Scroll wheel mouse- Teletherapy) There is a preference that you can set

in Teletherapy so that it is always used to movie, or you can set it so that

it functions as the option selected on a right mouse click. For example, if

you select Scale, the scroll wheel will function to scale the image in the

selected window (see the Preferences section of this training guide for

more information).

System Messages

There are three system message types that display when using XiO.

1. Warnings (designated by a yellow box). These warnings can display

during the following situations:

• When there is a potential to incorrectly enter patient, source or

treatment data

• When it is possible to enter incorrect data that could cause problems

later

This is what happens after XiO displays the warning:

- The program automatically regenerates data stored for the patient,

plan, or source.

- The program replaces existing data with new data.

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XiO Training Guide


System Messages (cont.)

2. Non-Fatal Errors (designated by a green box)

• These errors display when data is entered that does not meet the

requirements for that parameter.

This is what happens after the warning displays:

- The software is unable to complete the selected option, function, or

task.

3. Fatal Errors (designated by a red box)

• These errors display when there is a software or hardware malfunction.

This is what happens after the warning displays:

- The XiO session is terminated. Write down or print out the entire

error message, then contact customer support.

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XiO Training Guide


Where Can Help be Found?

Help can be found in many places including within the XiO and Focal

applications, in the Reference Library, or by contacting CMS customer support.

! XiO Help

- Help by Location

- Search

- Index

- Glossary

! Focal Help

- Search

- Index

- Procedures

- Glossary

! Reference Library

- What’s New

- XiO Getting Started Guide

- Featured Discussions

- Technical References

- Algorithm Discussions

- Utilities

! CMS Customer Support

- Software

- Hardware

- Physics

! New Features Training CD

- User Guides

- Training Guides

XiO" 1-19


XiO Training Guide


XiO Conventions

The following list describes some of the most common conventions that are used

throughout the XiO treatment planning system.

! Descriptions are always optional.

! Any ID (patient ID, machine ID, etc.) must consist of alphanumeric

characters only.

! XiO differentiates between capital and lowercase letters. For example,

AP and ap are two different names.

! If you do not place a value in a required field, the field turns red and you

are not able to proceed.

! Middle mouse click in any field to automatically display a menu of

options.

1-20


XiO Training Guide


XiO Coordinate System

XiO uses the following coordinate system.

! X right to left

! Y superior to inferior

! Z anterior to posterior

XiO" 1-21


XiO Training Guide

1-22


Unix/Linux Logins

Listed below are the logins and passwords for the XiO systems in the training

classroom.

Login: test Password: cms

Login: root Password: focus1

Help Resources

XiO Training Guide

Help Resources

General Information

You can access the XiO Help from the menu of any XiO window. The type of

help that displays is determined by where you are located in the system when

help is requested. For example, if you are working in a dialog box and you open

Help, XiO displays help for the dialog box in which you are working. If you are

not working in a dialog box, XiO displays the main Help topic window. The

topics are shown in the left frame of this window and are presented in the order

in which XiO is used in a clinical environment.

Documents formerly located on a Reference Library CD can now be accessed in

the Online Help. Click the Reference Library link for additional reference

resources. Topics discussed in the Reference Library area include the following:

! New Features Discussion

! User Guides

! Technical References

! Algorithm Discussions

! Utilities

To assist you in using the XiO Help, there are three tabs for locating specific

information.

! Contents (including the following examples)

- How to procedures

- Definitions

- Examples

- Demonstrations

- Tutorials

! Index

! Glossary

XiO" 2-1

Help Resources

XiO Training Guide

Help Resources

XiO Main Help Window

XiO Reference

Library

2-2

Help Resources

XiO Training Guide

Help Resources

XiO Main Help Window (cont.)

Sample Dialog Box Help

When you select XiO Help while working in a dialog box, the help window that

displays is relevant to the dialog box in which you are working. In this example,

Dose Normalization Help Page is illustrated. The help topic describes each

field on the dialog box. Should you elect to view other topics, click any of the

titles on the left panel of this window.

XiO" 2-3

Help Resources

XiO Training Guide

Help Resources


Contents Tab

Click a designated Topic book (example, IMRT). XiO Help "opens" this book

and lists the topic titles that relate to IMRT.

Click on a topic title to display the help information associated with the topic

selected.

2-4

Help Resources

XiO Training Guide

Help Resources


Index Tab

The Index tab allows you to scroll to a topic by entering the first letter of a word,

the first few letters of a word, or an entire word. The index scrolls to the index

items that start with the letters you entered.

Click the Index tab. XiO Help displays an alpha table from where you can

make a selection.

Scroll down to the topic you wish to view and click on a topic. In this example,

under the Active keyword, choose the How do I edit a beam’s weight option.

XiO Help displays the associated information for the topic chosen in the right

panel of the window.

XiO" 2-5

Help Resources

XiO Training Guide

Help Resources


Search

1. Click the Search XiO Help option on the Contents tab. XiO Help displays

the Search Help Topics panel allowing you to enter a word or a phrase for a

search.

2. Enter a word or a phrase. Example, How do I edit a beam?

3. Click the Search button. XiO Help displays a Search Results window with

link(s) to the requested information.

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Help Resources

XiO Training Guide

Help Resources

XiO Main Help Window

Search (cont.)

4. Click the How do I edit a beam? link. XiO Help displays the corresponding

window.

XiO" 2-7

Help Resources

XiO Training Guide

Help Resources


Finding "How To" Procedures for a Specific Task

When you open any one of the books under the Contents tabs in the left-panel of

the XiO Online Help window, the system displays a list of sub-topic books,

various sub-topics, and the "How To" procedures for the tasks related to the book

you opened.

This exercise walks you through the basic steps of accessing a set of "How To"

procedures for a specific topic.

1. Select the Compensators topic on the left panel of the Help window.

XiO Help displays two sub-topic books.

2. Click on the Filters book. XiO displays a list of all the topics related to

Filters including the various "How To" procedures.

3. Click on the How Do I …(step-by-step procedures) book. XiO displays

an additional list of all the "How Do I" procedures related to Filters.

4. Repeat this process for each Contents book where you want to locate

specific "How Do I" procedures.

-

2-8

Help Resources

XiO Training Guide

Help Resources


Print a Screen in XiO Help

1. Click your mouse pointer on the frame you want to print. Where you place

your mouse pointer determines the frame that prints.

2. Click the File drop-down menu and select the Print option.

OR

Click the Print icon on your browser toolbar.

3. Follow the instructions on your browser’s print window.

XiO 2-9

Help Resources

XiO Training Guide

Help Resources


Print a Page or Frame in XiO Help

4. Should you elect to print a specific frame in a new window, click your mouse

pointer on the frame, click your right mouse button and select the This

Frame and Show Only This Frame options. The frame redisplays without

the help topics displaying to the left of the window.

5. Click the drop-down arrow and select the Print option.

OR

Click the Print icon.

2-10

Help Resources

XiO Training Guide

Help Resources

Additional Help Resources

Phone Support

If you have questions that the published and online resources do not answer,

please contact the CMS Customer Support team for assistance.

North America, Central America, and South America

Hours: 7:30 am to 6:30 am Central Time (US), Monday through Friday

Phone: 1 (800) 878-4CMS (4267)

Europe and Africa

Hours: 08:00 to 17:00 Middle European Time, Monday through Friday

Phone: +49-761-88188-0

Asia, Australia, China, and New Zealand

Hours: 8:00am to 5:00pm Shanghai Time, Monday through Friday

Phone: +86-215058-1041

Japan

Hours: 8:00am to 5:00pm Toyko Time, Monday through Friday

Phone: +81-3-3556-5391

XiO 2-11

Help Resources

XiO Training Guide

Help Resources

Additional Help Resources (cont.)

Beam Modeling

A Beam Modeling Guide is sent out with each XiO Release. This guide is

available on CD-ROM and can be accessed online via the CMS web site.

The Beam Modeling Guide covers the following topics:

!" Introduction

!" Getting Started

!" Data Collection

!" Physics Data

!" Create New Machine

!" Treatment Aids

!" Non-Scan Data

!" Data Transfer

!" Display/Output

!" Clarkson

!" FFT Conv/Super

!" Pencil

!" Beam

!" Delete Data

!" Validation

!" Focus XiO

!" IMRT

!" Libraries

- List of Documents, Tables,

Worksheets

!" RTPS QA

2-12

Help Resources

XiO Training Guide

Help Resources

Additional Help Resources (cont.)

Online User Access

1. Go to the CMS web page www.cms-stl.com.

2. Click the Support drop-down menu an select the User Access option.

3. Enter your CCR in the User Name field.

4. Enter your password (either focus or focus 1) unless your site has

requested it to be changed.

5. Click OK to display the User Access window. On this window, you

have access to the following information:

!" CMS Beam Modeling Guide

!" Frequently Asked Questions (FAQs)

!" Errata Reports

!" Summary of Changes

!" Training Guides

!" Hours of Operation

!" Other Publications

!" Demos

!" Presentations

XiO 2-13

Settings

XiO Training Guide

Settings

Overview

The Settings drop-down menu shown on the main XiO window is where you set

general preferences for your XiO system. In addition, you can set textual and

numeric field values, the color and appearance of graphic objects on the window

and on the plots, and enable/disable other features.

The preferences set in Settings apply to all the treatment plans you create in a

specific clinic or in a group of clinics. The changes to the preferences you make

apply only to patients started or created after the change. All preferences remain

the same until you again access them from the Settings area of the system and

change the preferences for future use. You can access the Settings options at any

time to make changes, except during a back-up utility process.

Settings is also used to set up the XiO security system to prevent unauthorized

access to patient, source, and Settings data. Access to each option listed in the

Settings menu is determined by the authorization status entered for each user

through the User Authorization option. If you cannot select one of the options

listed in the Settings drop-down menu, it may be because you have not been

granted access to the option. Contact your system administrator for more

information about gaining access to the option.

XiO 3-1

Settings

XiO Training Guide

Settings

Practice Exercise

In this exercise, you will complete the procedures for each of the options (tasks)

listed on the Settings drop-down menu located on the XiO Main Menu window.

Task 1. Selecting a Clinic

There are instances when a clinician supports more than one clinic. If this

scenario applies to you, before performing any Settings activities, be sure to

select the correct clinic for the Settings preferences or default values you are

about to establish.

1. Click the drop-down arrow in the Clinic field on the XiO main window

and select XiO Training data. XiO loads the data options for this clinic.

The tasks in this lesson are presented in the same order as they appear on the

drop-down menu. After completing the training exercise, you can perform the

tasks in any order you choose.

3-2

Settings

XiO Training Guide

Settings

Installation

Task 1. User Authorization

This function allows you to set a user’s level of access to functions in XiO. To

access this function, you must have administrator rights.

1. Click the Settings drop-down menu and select the Installation and User

Authorization options. XiO displays the System User Access Preferences

dialog box.

2. Next to each Login Name in the Admin, Physics, Treatment Planner, and

Plan Approval fields, respond "Yes" or "No." If yes is selected in Plan

Approval, you are required to enter an additional login and password to be

used for plan approval.

3. Click OK. XiO sets the security-level access in accordance to your

responses in step 2.

4. Click CANCEL to close the dialog box.

XiO 3-3

Settings

XiO Training Guide

Settings

Installation (cont.)

Task 2. Hospital/Clinic

This option allows you to add a clinic and set date formats.

1. Click the Settings drop-down menu and select the Installation and

Hospital/Clinic options. XiO displays the Define Hospitals/Clinics dialog

box.

2. Enter the Hospital/Clinic Name for each hospital/clinic that you support.

You can define up to nine (9) names on this page. Each name can contain

up to 24 characters and must be unique. If you need to enter more names,

click the More button.

3. To delete a clinic, enter blank spaces.

4. Click your middle mouse button and select a Disk Name on which the

data for the hospital or clinic will physically reside.

NOTE: If your hospital/clinic names were previously defined, the

defaults are the disk names entered with these hospital/clinics.

You cannot change these defined disk names unless you first

delete; then, re-enter the hospital/clinic name.

5. Click OK. XiO adds the system defaults.

3-4

Settings

XiO Training Guide

Settings


Task 3. Date Format

1. Click the Settings drop-down menu and select Installation and Date

Format options. XiO displays the Default Date Format dialog box.

2. Click your middle mouse button in the format field and select a Date

Format.

3. Click the drop-down arrow in the Separator field and select a separator

character you wish to appear between the month, day, and year parts of the

date.

4. Edit the month abbreviations for your XiO system. The month names

must be exactly three characters long and begin with a capital letter.

5. Click OK. XiO sets the date formats entered.

XiO 3-5

Settings

XiO Training Guide

Settings


Task 4. Language

The Language option is used to select a desired language in which you wish to

have prompts presented in on the windows. At this time, English is the only

option.

1. Click the Settings drop-down menu and select Installation and Language

options. XiO displays the Default Language dialog box.

2. Click your middle mouse button and select the language in which to

display the prompts.

3. Click OK. XiO saves your language selection.

3-6

Settings

XiO Training Guide

Settings


Task 5. GCD Model

The Graphics Control Device (spaceball) controls the graphics in the windows.

You can use the spaceball in Irregular Field and Brachytherapy. The GCD

Model option is used to set the sensitivity of the graphic control device.

1. Click the Settings drop-down menu and select Installation and GCD

Model options. XiO displays the GCD Model dialog box.

2. Click the drop-down arrow in the GCD Model Number field and select the

GCD Model label that best describes the model number of your GCD.

The model number of your GCD can be found on the bottom of your

GCD.

3. Enter the Rotational Sensitivity of the GCD. This value may be any

number from 1 to 10000, where 1 is most sensitive, and 10000 is least

sensitive, in steps of 1. This value has no units.

4. Click OK. XiO adds your entries.

XiO 3-7

Settings

XiO Training Guide

Settings


Task 6. Transfer Data to FOCAL PC

To initiate this task, you will need the IP address of the PC to where you want to

transfer data.

1. Click the Settings drop-down menu and select the Installation and

Transfer Data to Focal PC options. XiO displays the Focal Data

Transfer Defaults dialog box.

2. Enter a Server ID Name.

3. Enter the IP Address to where you want to transfer the XiO data.

4. Click the Add IP Address button. XiO adds the address to the list of IP

addresses located in XiO.

5. To add additional IP addresses, complete steps 2 through 4.


3-8

Settings

XiO Training Guide

Settings

Workstation

Task 1. Backup Utility

XiO allows weekly or daily automatic backups. CMS recommends that you back

up your data on a regular basis. In order to do a successful backup, you must

adhere to the following conditions:

!" The XiO computer, printer, and tape drive must be on for the backup to

start.

!" Files cannot be in use during a backup. Should any files be in use, the

backup will stop at files that are in use and wait for them to be free

before continuing.

!" Do not have two computers backing up the same clinics at the same time.

!" No one can be running XiO on any workstation during the backup

process.

!" The main workstation must be logged into the UNIX or Linux system for

the backup to work properly.

1. Click the Settings drop-down menu and select the Workstation and

Backup Utility options. XiO displays the System Archive dialog box.

2. Click your middle mouse button in the Backup Option: field and select

Disable or Automatic. When you select Automatic, XiO displays a

System Archive dialog box.

3. Click the drop-down arrow in the Frequency: field and select the

frequency (daily or weekly). This field displays only if Backup Option: is

set to "automatic."

XiO 3-9

Settings

XiO Training Guide

Settings

Workstation

Task 1. Backup Utility (cont.)

4. Enter the Start Time in HH:MM 24-hour military format that you want

the backups performed. This field displays only if Backup option: is set to

"automatic."

5. Click your middle mouse button in the Start Day: field and select a day of

the week you want to perform the backups. This field displays only if

Backup Option: is set to "automatic" and Schedule: is set to "weekly."

6. Click the XiO Demo-only data button if you do not want the changes to

affect the demo data only. This field defaults to "Yes."

7. Click the OK button. XiO updates the backup utility with your updates

and closes the dialog box.

Task 2: Printers

This setting allows you to setup default printers/plotters for outputs per user.

You also have printing options that include printing to printers/plotters, printing

to a file or printing to PDF. Printing to multiple destinations is available on

Linux only.

1. Click the Settings drop-down menu and select Workstation, then

Printers to open the Printers dialog box.

NOTE: The printers that are already setup in your clinic will display by

default. If you would like to add additional printers, please

contact Systems Support.

3-10

Settings

XiO Training Guide

Settings

Workstation

Task 2: Printers (cont.)

2. Next to each available printer, select a Model from the drop-down list.

3. Select Yes or No to each printing type if you want that printer to be

available for that type of print request.

4. Select the default Output Device from the drop-down menu. The options

are Printer/Plotter, Postscript File, or PDF File. Whenever you print, this

will be the type of output that is printed.

NOTE: If you want to change the output device to where you are

printing, you must return to this page and change the output

device to the desired type.

5. Identify the Printer that will be used for each type of print request by

clicking your right mouse button in the Printer, Plotter and Screen Capture

Printer fields, and selecting a printer from the list.

NOTE: If you select Postscript File or PDF File as the default Output

Device, these printer options will be ignored.

6. Click OK to accept these defaults, or Cancel to reject them and close the

dialog box.

Data Locations for PDF and Postscript Print

The data location for the PDF Print File is:

/FOCUS/tmp/network/pdf_output/<patient ID>.

The data location for the Postscript Print can be one of the following locations.

If you saved the plan then printed the Postscript File, the location is as follows:

/FOCUS/rtp<#>/<clinic #>/patient/<patient ID>/plan/<plan ID>hard_copy.

If you printed before you saved the plan, the print request will be attached to the

current temporary plan number: /FOCUS/rtp<#>/clinic<#>/temp/<temp

plan#>/hard_copy.

XiO 3-11

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 3. CT Interfaces

1. Click the Settings drop-down menu and select the Workstation and CT

Interfaces options. XiO displays the Add/Delete CT Interfaces dialog

box.

2. Respond "On" or "Off " in the Mfr/Model field. To toggle the availability

setting (either "On" or "Off"), simply click the appropriate choice in this

column.

3. Click OK. XiO saves your changes and closes the dialog box.

3-12

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 4. MRI Interfaces

1. Click the Settings drop-down menu and select the Workstation and MRI

Interfaces options. XiO displays the Add/Delete MRI Interfaces dialog

box.

2. Respond "On" or "Off " in the Mfr/Model field. To toggle the availability

setting (either "On" or "Off"), simply click the appropriate choice in this

column.

3. Click OK. XiO updates your changes and closes the dialog box.

XiO 3-13

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 5. SC Interfaces

1. Click the Settings drop-down menu and select the Workstation and SC

Interfaces options. XiO displays the Add/Delete Secondary Capture

Interfaces dialog box.

2. Click the DICOM3SC button to enable the SC Interfaces to an "On"

position. To toggle the availability setting to "Off," click the DICOM3SC

button again. This field defaults to "Off."


3-14

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 6. PET Interfaces

1. Click the Settings drop-down menu and select the Workstation and PET

Interfaces options. XiO displays the Add/Delete PET Interfaces dialog

box.

2. Click the DICOM3PT button to enable the PET interface to an "On"

position. To toggle the availability setting to "Off," click the DICOM3PT


3. Click OK. XiO updates your interface setting and closes the dialog box.

XiO 3-15

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 7. Nuclear Medicine Interfaces


Add/Delete Nuclear Medicine Interfaces options. XiO Displays the

Add/Delete Nuclear Medicine Interfaces dialog box.

2. Click the DICOM3PT button to enable the PET interface to an "On"

position. To toggle the availability setting to "Off," click the DICOM3PT


3. Click OK. XiO updates your interface setting and closes the dialog box.

3-16

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 8. Ultrasound Interfaces


Ultrasound Interfaces options. XiO displays the Add/Delete Ultrasound

Interfaces dialog box.

2. Click the DICOM3US button to turn the importing of images capability to

an "On" position. The default of this option is "Off."

3. Click OK.

XiO 3-17

Settings

XiO Training Guide

Settings

Workstation (cont.)

Task 9. DICOM Settings

This dialog box allows you to specify workstation-specific parameters for

DICOM communication between XiO and other computers. For more

information regarding these settings, search the XiO Online Help for DICOM

Settings.


DICOM Settings options. XiO displays the DICOM Settings dialog box.

2. Enter up to 5 Remote DICOM hosts Storage Class Provider Information.

(Obtain this information from the remote system’s vendor.)

3. Enter the local Application Entity Title.

4. Click OK.

3-18

Settings

XiO Training Guide

Settings

Clinic

Task 1. Data Compression

1. Click the Settings drop-down menu and select the Clinic and Data

Compression options. XiO displays the Clinic Data Compression dialog

box.

2. Click the Data Compression button to an "On" position to store all data

created in the clinic in the compressed format.

OR

Click to an "Off" position to store all new data created in the clinic in the

uncompressed format.

NOTE: Compressing data may increase the amount of available storage

space on your XiO system.

3. Click the drop-down arrow in the Set Clinic Data to Selected Compression

Status?: field, and select Yes to update the clinic’s existing data to the

selected compression status.

OR

Click NO to keep the clinic’s data in its current compression status.

4. Click OK.

XiO 3-19

Settings

XiO Training Guide

Settings

Clinic (cont.)

Task 2. User Interfaces Preferences

This function allows you to set mouse movement characteristics for the global

function buttons in Irregular Field and Brachy functions.

1. Click the Settings drop-down menu and select the Clinic and User

Interface Preferences options. XiO displays the User Interface

Preferences dialog box.

2. In the Height and Depth of Buttons category, enter the integer for each

field. Refer to the XiO Online Help for definitions of each.

3. In the Automatic Movement of the Mouse Pointer category, select the

desired response "on" or "off" for each field. Go to the XiO Online Help

for definitions of each field.

4. In the Tool Tip Display category, select "on" to turn the tool on, or "off"

to turn the tool off. This field defaults to "off."

5. Click OK. XiO adds your User Preferences to the system.

3-20

Settings

XiO Training Guide

Settings

Clinic (cont.)

Task 3. Scanner/LMS Definition

Use this option to enter and edit CT scanner and laser marking system

information. This information is required if you want to use the XiO Setup

Reference Definition feature to determine shifts from reference locations to the

isocenter. It is also required if you want to see the scouts you send from the CT

in Patient File Maintenance.

1. Click the Settings drop-down menu and select the Clinic and

Scanner/LMS Definitions options. XiO displays the Scanner/LMS

Defaults dialog box.

2. Enter a new Scanner ID, or click your middle mouse button and select a

scanner ID from the list. All the attributes and settings you declare for

the scanner will be stored with this scanner ID. There is no default. This

field cannot be blank.

3. Enter the Description of the scanner. This can be any descriptive text, up

to 19 characters. If you have more than one scanner in your clinic, we

recommend that you enter a description. (Default: Optional; can be

blank.)

XiO 3-21

Settings

XiO Training Guide

Settings

Clinic

Task 3. Scanner/LMS Definition (cont.)

4. Click the Use as the default scanner button. Valid responses depend on

the current scanner default. XiO requires that you always have a default

scanner assigned.

NOTES: If your clinic has multiple scanners defined in XiO, you can

redefine the default scanner at any time as long as you

always have one default scanner identified.

If no other scanners are defined for this clinic, XiO defaults

to "Yes" and the field cannot be changed.

If a default scanner already exists, this field is set to "No"

automatically. You can edit this field to "Yes" if you want to

change the default scanner to be the one you are currently

defining.

5. Click OK. XiO displays the Scout Image Viewing Data window.

6. Enter the Scanner source to center of scan ring distance (cm). This

value should be available through your CT vendor; also, DICOM 3.0 data

for some scanners contains this information.

3-22

Settings

XiO Training Guide

Settings

Clinic


7. Enter the Source to scout image projection distance (cm). XiO models

scout images as if they are projected to a flat plane; this provides a good

approximation even in cases where these images are not projected to a flat

plane. Scanning a well-designed phantom should allow you to calculate

this value directly using geometrical considerations.

8. To get started quickly, enter a number close to (usually a bit larger) than

the source-to-center of the scan-ring value. You can tailor this number

until your contours appear to be projected correctly on the scouts in XiO.

9. Click the drop-down arrow and select a position (left or right) for lateral

scouts. This value (left/right) will be the location of the source as viewed

from the end of the CT couch facing the CT gantry. This value is needed

to map divergence correctly in graphics.

NOTE: If this field is left blank, XiO displays the scout image with no

amendments.

XiO 3-23

Settings

XiO Training Guide

Settings

Clinic


10. Click the drop-down arrow and make a selection (above or below) to enter

the source position when scanning "AP" scouts. This value

(above/below) is the location of the source relative to the CT couch. You

need this value to map divergence correctly in graphics. XiO will call

these AP scouts. Keep in mind that some scanners move their source

below the couch, thus producing a PA scout.

11. Click OK. XiO displays the Scout Image Viewing Orientation dialog box.

3-24

Settings

XiO Training Guide

Settings

Clinic


12. Click your middle mouse button and select the orientation that describes

how scout images should appear for each orientation. The following

examples should assist you with your decisions.

Lateral Scout Viewing Orientations

AP/PA Scout Viewing Orientations

XiO 3-25

Settings

XiO Training Guide

Settings

Clinic


13. Click OK. XiO displays the Scanner/LMS Capabilities Data dialog box.

14. Click the drop-down arrow and select how the shifts will be performed (by

moving the couch or moving the lasers).

15. Enter the Calibration distance from center of scan ring to origin of

LMS (cm). This is the longitudinal distance from the center of the scan

ring to the origin of your LMS. This response particularly pertains to

externally mounted lasers.

NOTE: This assumes your LMS origin is aligned to the center of your

scan ring, offset by this constant amount.

16. Click the drop-down arrow and select the Units used for LMS readouts.

17. Click the drop-down arrow and select the Units used for couch position

readouts.

18. Click the drop-down arrow and select the LMS type for this scanner.

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Settings

XiO Training Guide

Settings

Clinic


19. Click OK. XiO displays the LMS/Couch Limits Data dialog box.

20. Enter the LMS/Couch Leftmost reading (cm). Take this reading facing

the CT Gantry looking from the foot of the couch.

21. Enter the LMS/Couch Rightmost reading (cm). Take this reading facing

the CT Gantry looking from the foot of the couch.

22. Enter the Couch height movement limits Readout in highest pos. (cm).

23. Enter the Couch height movement limits Readout in lowest pos. (cm).

24. Click the drop-down arrow in the Do couch position readings increase or

decrease as the couch moves towards the gantry: field and select

Increases or Decreases.

25. Click OK. XiO returns you to the initial Scanner/LMS Defaults dialog

box.


XiO 3-27

Settings

XiO Training Guide

Settings

Patient Data

Task 1. General Anatomical Site

The General anatomical site is where you define the patient, tumor, and target

volume defaults.

1. Click the Settings drop-down menu and select the Patient Data and

General Anatomical Sites options. XiO displays the General Anatomical

Structure Descriptions dialog box.

2. The Pat field defaults to patient. Patient is an automatic field that has to

be defined in XiO. This classification structure has to exist.

3-28

Settings

XiO Training Guide

Settings

Patient Data

Task 1. General Anatomical Site (cont.)

3. Enter the default Rel Elec Dens (relative electron density, relative to

water) to be used for each anatomical structure description. The

acceptable range is 0.00 to 15.00, inclusive, in steps of 0.01. Blank is a

valid answer.

WARNING

!" You must verify that the entered relative electron

density data is correct. If you do not, you may

be using incorrect data that may cause an

incorrect dose calculation to occur, causing an

incorrect dosage to be administered to the

patient.

!" Do not assign a high relative electron density to

an individual contour for use as a block.

Contours used in this manner (i.e., for

unintended purposes) may cause an incorrect

dose calculation to occur, which may cause an


patient.

4. Click your middle mouse button and select the default Video Display

Color for the anatomical structure. The default value is the assigned

display color for the structure.

5. Click your middle mouse button and select the Video Display Rnd

(rendering) for the anatomical structure. The default is W or Wireframe.

Go to XiO Online Help for supporting information.

NOTE: If you assign an internal anatomical structure name “Patient,”

XiO will not allow you to place beams for this patient. You

must return to Patient File Maintenance and give the patient

contour a patient classification structure name. XiO ignores

any internal structure located outside of the patient contour.

6. Click your middle mouse button and select Yes or No to the Video

Display Color Fill. This option fills the selected structure with the

associated rendering on transverse, sagittal, and coronal images.

7. Click the OK button. XiO displays the General Anatomical Structure

Printer Output Preferences dialog box.

XiO 3-29

Settings

XiO Training Guide

Settings

Patient Data

Task 1. General Anatomical Site (cont.)

8. Enter the Line Type Number that will draw each associated item. Line

type options are listed in XiO Help.

9. Click your middle mouse button and select the desired Fill-Type that will

fill the object. Blank defaults to No Fill. Go to the XiO Online Help for

supporting information.

10. If you specified a fill type of HAT or CHAT, the fill angle choice

determines the angle of the hatched or crosshatched lines.

NOTE: The fill angle is 45 degrees unless you specify otherwise. If

this field is left blank, the fill type is none.

The angle, from 0 degrees to 180 degrees in steps of 1 degree, is reference

counter-clockwise from the positive direction of the X-axis where +X=0

degrees, and –X=180 degrees.

11. Click the OK button. XiO adds the anatomical site. These values now

determine the structure’s name and the display for the selected clinic.

3-30

Settings

XiO Training Guide

Settings

Patient Data (cont.)

Task 2. Specific Anatomical Sites

The Specific anatomical site is where you define and edit a pre-defined

anatomical site default under the class internal structures.


Specific Anatomical Sites options. XiO displays the Enter/Edit Specific

Anatomical Site dialog box.

2. Click your middle mouse button and select the specific anatomical site

you want to edit, or Enter the name of a new site to add it (i.e., the group

name of the contours).

3 Click OK. XiO displays the Enter/Edit Specific Anatomical Structures

Names dialog box.

XiO 3-31

Settings

XiO Training Guide

Settings

Patient Data

Task 2. Specific Anatomical Sites (cont.)

3. Enter a new Anatomical Structure Name or edit an existing name.

3-32

Settings

XiO Training Guide

Settings

Patient Data


4. Enter or edit the default Rel Elec Dens (relative electron density, relative

to water) to be used for each structure. The acceptable range is 0.00 to

15.00, inclusive, in steps of 0.01. The precision is 0.01. The system

defaults to 1.00.

WARNINGS

You must verify that the entered relative

electron density data is correct. If you do not,

you may be using incorrect data that may cause

an incorrect dose calculation to occur, causing

an incorrect dosage to be administered to the

patient.

Do not assign a high relative electron density

to an individual contour for use as a block.

Contours used in this manner (i.e., for

untended purposes) may cause an incorrect

dose calculation to occur, which may cause an


patient.

5. Click the drop-down arrow in the Color field and select the desired color

for the anatomical structure.

6. Click the drop-down arrow in the Rnd field and select the desired

rendering for the anatomical structure. The default is "W" (Wireframe) if

there is no current rendering style already set.

7. Click your middle mouse button and select Yes or No to the Video

Display Color Fill. This option fills the selected structure with the

associated rendering on transverse, sagittal, and coronal images.

8. Click the OK button. XiO displays the Specific Anatomical Structure

Printer Output Preferences dialog box.

XiO 3-33

Settings

XiO Training Guide

Settings

Patient Data


9. Click OK again. XiO processes your anatomical structure specific entries.

The values now determine the structure’s name and their display for the

selected clinic.

3-34

Settings

XiO Training Guide

Settings


Task 3. CT to Rel Elec Dens Files

Before performing this task, you must know the Manufacture/Model ID used for

CT image import.

1. Click the Settings drop-down menu and select the Patient Data and CT

to Rel Elec Dens. Files options. XiO displays the Enter/Edit CT to

Relative Electron Density File dialog box.

2. Click your middle mouse button in the Mfr/Model ID field and make a

selection from the list.

3. Enter a File ID to name the CT to ED file.

OR

Click your middle mouse button in the File ID field and make a selection

from the list.

4. Click OK. XiO displays the CT Number Assignment dialog box.

XiO 3-35

Settings

XiO Training Guide

Settings

Patient Data

Task 3. CT to Rel Elec Dens Files (cont.)

5. Enter the CT Numbers for which relative electron densities will be

assigned.

6. Click OK. XiO displays the CT to Rel Elect Dens File Data Entry dialog

box in addition to the CT to ED Number to Relative Electron Density

Mapping chart.

7. Enter the Relative Electron Density Numbers that correspond with the

entered CT numbers.

3-36

Settings

XiO Training Guide

Settings

Patient Data

Task 3. CT to Rel Elec Dens Files (cont.)

WARNINGS

You must verify that the correct CT-to-relative

electron density file is specified for the selected

CT interface. If you do not, you may use incorrect

data that may cause an incorrect dosage to be

administered to the patient.

You must verify that the entered relative electron

density data is correct. If you do not, you may use

incorrect data that may cause an incorrect dose

calculation to occur, causing an incorrect dosage

to be administered to the patient.

8. Click OK. XiO returns you to the Enter/Edit CT to Relative Electron

Density File dialog box.

9. Click Cancel.

XiO 3-37

Settings

XiO Training Guide

Settings


Task 4. Prostate Template

Use this option to create a prostate template for prostate seed preplanning.


Prostate Template options. XiO displays the Default Prostate Template

dialog box.

2. Enter the Prostate Template ID.

3. Click OK. XiO displays the Prostate Template Definition dialog box.

3-38

Settings

XiO Training Guide

Settings

Patient Data

Task 4. Prostate Template (cont.)

4. Enter the Row Spacing of the template. The acceptable range is 0.1 to 1.0

cm in steps of 0.01.

5. Enter the Number of Columns. The acceptable range is 2 to 100 in steps

of 1.

6. Enter the Number of Rows. The acceptable range is 2 to 100 in steps of

1.

7. Click OK. XiO displays the Prostate Template Column Labels dialog

box.

8. Enter the Column Label identifier. Column labels 1 through 13 run from

the left to the right of the template. This identifier is used during

placement of needles during treatment.

9. Click OK. XiO displays the Prostate Template Row Labels dialog box.

XiO 3-39

Settings

XiO Training Guide

Settings

Patient Data

Task 4. Prostate Template (cont.)

10. Enter the Row Labels. Row labels run from the bottom to the top of the

template.

11. Click OK. XiO returns you to the Default Prostate Template dialog

window.


3-40

Settings

XiO Training Guide

Settings


Sample Template

XiO 3-41

Settings

XiO Training Guide

Settings

Plan Defaults

Task 1. Brachytherapy Drawing

Use this option to define the default guide radius and sample spacing for

contouring and port (MLC, block, or aperture) drawing.

1. Click the Settings drop-down menu and select Plan Defaults and

Brachytherapy Drawing options. XiO displays the Drawing Defaults

window.

2. In the Contour Entry Mouse sample spacing field, enter the value for the

distance between mouse sample points.

3. In the Contour Entry Mouse guide radius field, enter the value for the

radius of the guide circle.

4. Click OK. XiO saves these drawing default values for the selected clinic.

3-42

Settings

XiO Training Guide

Settings

Plan Defaults (cont.)

Task 2. Calculation Defaults

Use this option to set default grid spacing, default algorithms, AND

normalization options as well as other miscellaneous defaults.

Sub-task 1. Teletherapy

1. Click the Settings drop-down menu and select the Plan Defaults,

Calculation, and Teletherapy options. XiO displays the Teletherapy

Calculation dialog box.

2. Enter Yes or No for Heterogeneity Correction to be applied to all patients

by default.

3. Enter Yes or No for Pixel by Pixel Calculation to be used as the default

heterogeneity correction method.

4. Enter the width, height, and depth (cm) for the calculation region grid

spacing.

5. Click your middle mouse button and select a default algorithm for

photons.

XiO 3-43

Settings

XiO Training Guide

Settings

Plan Defaults


Sub-task 1. Teletherapy (cont.)

6. Click your middle mouse button and select a default algorithm for proton

(if applicable).

7. Click the drop-down arrow in the Beam Weight Mode: field and select a

Beam weighting mode.

NOTE: Absolute Dose/MU mode allows you to enter daily, total or

relative doses for planning. Each beam’s weight point is its

dose prescription point; therefore, it is possible to create

composite plans when this mode is selected. In Absolute

Dose/MU mode you can weight beams to weight points or

enter monitor unit values to obtain weight. You also have

more flexibility and options for normalization. IMRT

functionality is only available when Absolute Dose/MU mode

is selected.

Relative dose mode is more limiting. None of the options

listed above for Absolute Dose/MU mode are available in

relative dose mode. There can also be some confusion when

determining the blocked, wedged and bolused normalization

when Relative Dose mode is selected. In Settings, you have

the option of setting the normalization for blocks, wedges, and

bolus. If the normalization is set to open for these beam

modifiers, the beam modifiers will not be recognized in the

dose calculation. For example, if a block is placed on a field

and it blocks the weight point, there will be no block factor

incorporated when the dose to the weight point is determined.

Therefore, the monitor units will not be accurate.

8. Click the drop-down arrow and select a Wedge Normalization.

NOTE: If you select the "Both" option for either the Wedge or Bolus

Normalization method, you must then select a default method

between the two methods.

9. Click the drop-down arrow and select a Bolus Normalization method(s).

3-44

Settings

XiO Training Guide

Settings

Plan Defaults



10. Click the drop-down arrow and select a Port/MLC Normalization.

NOTES: Steps 7 through 9 only apply if you are using Relative Dose

mode.

If you select the "Both" option, you must then select a default

between the two options.

11. Click the drop-down arrow and select the Dose Units in cGy or Gy.

Weight Point field edge warning distance.

XiO warns you if the weight point location exceeds these checks.

12. Enter the Smallest collimator opening to check (cm).

13. Enter the Distance from the field edge (cm).

XiO 3-45

Settings

XiO Training Guide

Settings

Plan Defaults



14. If you are performing either IMRT or using compensators, click the

Intensity Modulated QA Parameters button. XiO displays the Intensity

Modulation QA Parameters dialog box.

15. Enter the default QA Measurement SSD (source to skin).

16. Enter the default QA measurement for depth (how deep you will take the

measurement in the phantom).

17. Click your middle mouse button and select a default Phantom material.

18. Enter the Phantom rel. electron density number. The acceptable range is

0.8 to 1.2 in steps of 0.1.

3-46

Settings

XiO Training Guide

Settings

Plan Defaults



19. Set the Calculate QA output. "Yes" automatically calculates the QA

output for every compensator-based or IMRT beam. "No" sets the default

to no, but allows you to manually turn the answer to "Yes" for each beam

individually.

WARNING A "Yes" response increases the calculation time. XiO

calculates the patient beam and the beam on the QA

phantom

20. Click OK. XiO sets your default intensity modulated and QA parameters

to the values for the selected clinic, returns you to the Teletherapy

Calculations Default dialog box, and saves your changes.

21. Click OK to close the dialog box.

XiO 3-47

Settings

XiO Training Guide

Settings

Plan Defaults

Task 2. Calculation Defaults (cont.)

Sub-task 2. Brachytherapy – General Parameters

1. Click the Settings drop-down menu and select the Plan Defaults,

Calculation Defaults, Brachytherapy, and General Parameters options.

XiO displays the Brachytherapy Calculation Defaults dialog box.

2. Select an Entry Device (keyboard or tablet).

3. Click the drop-down arrow and select a Reconstruction Algorithm.

Refer to the XiO Online Help for detailed field definitions.

4. Set the film magnification parameters. The acceptable range is 1.00 to

5.00 in steps of 0.01 for each field.

3-48

Settings

XiO Training Guide

Settings

Plan Defaults


Subtask 2. Brachytherapy – General Parameters (cont.)

5. Click the drop-down arrow and select an Error Detection Type.

NOTE: The entry you select in this field determines if both the

physical length threshold and coordinate threshold fields

appear on the dialog box.

The physical length values are 0.00 to 10000.00 in steps of

0.01.

The coordinate threshold values are 0.00 to 100.00 in steps of

0.01.

6. Click the drop-down arrow and select a Calculation Volume Method.

7. If you select explicitly defined, enter the Height, Width, and Depth

default values.

8. Select Dose Units.

9. Click OK. XiO sets your general default parameters and closes the dialog

box for the selected clinic.

XiO 3-49

Settings

XiO Training Guide

Settings

Plan Defaults

Task 3. DRR Calculation Defaults

1. Click the Settings drop-down menu and select the Plan Defaults and

DRR Calculation Defaults options. XiO displays the DRR Calculation


2. Enter the Low and High (minimum and maximum) ED (electron density)

values for the filter defaults.

Wide Range is 0.0 to 20.0 (ED).

Bone Range is 1.5 to 20.0 (ED)

Tissue Range is 0.0 to 1.5 (ED).

Comb Range is 0.0 to 20.0 (ED).

Range Range is 0.0 to 20.0 (ED).

Refer to the XiO Online Help for additional field information.

3-50

Settings

XiO Training Guide

Settings

Plan Defaults

Task 3. DRR Calculation Defaults (cont.)

3. Enter "Yes" in the Film Printer field if the DRRs are to be sent to a film

printer/DICOM compatible printer. Enter "No" if they are not.

4. Click the drop-down arrow and select the Bit Format.

16 = 16-bit format (default)

8-BE = 8-bit big endian format

8-LE = 8-bit little endian format

5. Enter the Host Name.

NOTE: If you entered "Yes" in the film printer field, you must enter the

network host name in this field. The name entered must match

the host name assigned by the system administrator and be

listed in the etc/hosts file.

6. Enter the Port number.


port number of the printer in the Port field. The name entered

must match the port number that the printer is using for input.

7. Enter the Application Name.

NOTE: If you entered "Yes" in the film printer field, you must enter

DICOM 3.0 application name of the printer in this field.

8. Enter "Yes" in the DICOM 3.0 Device field if the DRRs are to be sent to

another compatible device. For example, if DRRs are sent to a record and

verify system or other computer that is DICOM 3 compatible. Enter "No"

if they are not.

9. Click the drop-down arrow and select a Bit Format.

16 = 16-bit format (default)

8-BE = 8-bit big endian format

8-LE = 8-bit little endian format

NOTE: Big endian and little endian refer to the way the data is

processed.

XiO 3-51

Settings

XiO Training Guide

Settings

Plan Defaults


10. Enter the Host Name.


network host name in this field. The name entered must match

the host name assigned by the system administrator and listed

in the etc/hosts file.

11. Enter the Port number.


port number for the printer in the Port field. The number

entered must match the port number that the printer is using for

input.

12. Enter the Application Name.


DICOM 3.0 application name of the printer in this field.

13. Enter the Max. Output Cols. The acceptable range is 256 to 1280 in

steps of 1. This value specifies the maximum resolution to be output to

the Film printer and DICOM 3.0 device.

Initial Image Display

14. Enter the Cols number specifying the number of columns. The acceptable

range is 32 to 1024 in steps of 1.

15. Click the drop-down arrow in the Interp field and select "Yes" to convert

the DRR image to an image with larger pixels that uses bilinear

interpolation to yield a smoother image. Select "No" to maintain the

original CT values.

16. Click the drop-down arrow in the Sharp field and select "Yes" to use an

algorithm to sharpen the image, or "No" to not sharpen the image.

3-52

Settings

XiO Training Guide

Settings

Plan Defaults


Final Image (Display)

17. Click the drop-down arrow in the Res field and select Editable or Auto to

determine whether the number of columns used by the system.

Editable allows you to specify the number of columns used and displays

the Cols field.

Auto determines the number of columns to be used that provide

approximate optimal sampling.



Film Image

19. Enter the Cols value specifying the resolution to be used to calculate and

build the DRR. The range is 32 to 1024 in increments of 1. If unchanged,

the resolution is 512.



21. Enter the TFD (cm) default target to film distance. The values can range

from 0.00 to 3000.00 in increments of 0.01 cm. If unchanged, this

distance is 100.0 cm.

DICOM 3.0 Image

22. Enter the Cols value specifying the number of columns used to control the

resolution.



24. Click OK. XiO saves the changes and closes the dialog box.

XiO 3-53

Settings

XiO Training Guide

Settings


Task 4. Proton Beam Defaults


Proton Beam Defaults options. XiO displays the Proton Beam Default

dialog box.

2. Enter the Isocenter (cm) Min/Max, X/Y/Z coordinates to set the

minimum and maximum isocenter coordinates for proton beams.

3. Enter the Air Gap (cm) to set the default air gap intersection between the

skin and the downstream-most treatment aid (aperture, range compensator,

or compensating block. This field default value is blank.

4. Enter the Maximum beam weight for a proton beam in cGy or Gy. The

range is between 0 to 9999.0 cGy in increments of 1.0, or between 0 and

99.99 Gy in increments of 0.01 Gy.

NOTE: If you do not specify this value, XiO defaults the weight to 9999.0

cGy.

5. Enter the Default beam weight for a proton beam. The range can be

between 0 to the maximum beam weight (set in Step 4) in increments of

1.0 cGy or 0.01 Gy.

NOTE: If you do not specify this value, XiO defaults the weight to

blank.

6. Click OK.

3-54

Settings

XiO Training Guide

Settings


Task 5. Proton Defaults

Subtask 1. General Proton Parameters

The parameters in this section are proton machine dependent. XiO supports four

different types of proton machines. You may or may not see the following

options depending on the type of machine you have licensed.

1. Click the Settings drop-down menu and select the Plan Defaults, Proton

Defaults, and General Proton Parameters options. XiO displays the

General Proton Parameters dialog box.

2. Click your middle mouse button in the Material: field and select a

Material default choice for range compensators.

3. Enter the Smearing distance (cm) to specify the default area surrounding

the ray that is included in the thickness determination. Valid values are

from 0.000 cm to 1.000 cm in steps of 0.001 cm.

NOTE: XiO identifies all the grid points within the smearing distance

and determines the range compensator thickness needed to place

90 percent of the Bragg peak dose at each point. XiO selects the

optional thickness for the range compensator.

4. Enter the Calculation grid spacing (cm) to specify the default minimum

distance between calculation points. The range of values is 0.05 cm to

5.00 cm, in increments of 0.01 cm.

NOTE: This designates that the range compensator calculation grid is a

rectilinear grid (centers form squares).

5. Enter the Calculation margin (cm) representing the default margin

around the aperture that defines the raw range compensator grid extents.

The range of values is 0.05 cm to 5.00 cm, in increments of 0.01 cm.

6. Enter the Fabrication margin (cm) representing the margin around the

aperture over which the range compensator thickness will be written to the

fabrication file. The range of values is 0.0 to 5.0 in increments of 0.1.

NOTE: Only points written within the fabrication margin are written to

the fabrication file. The range compensator fabrication grid is a

"packed grid" (staggered centers).

XiO 3-55

Settings

XiO Training Guide

Settings

Plan Defaults

Task 5. Proton Defaults

Subtask 1. General Proton Parameters (cont.)

7. Modulation type is a non-modifiable field that is permanently set to

"fixed."

8. Enter the Radius Weight. The range of values is 0.01 to 100.00 in steps

of 0.01. The default radius weight is 50.00.

9. Enter the Smearing Weight. The range of values is 0.01 to 100.00 in

steps of 0.01. The default smearing weight is 10.00.

10. Enter the Depth Weight. The range of values is 0.01 to 100.00 in steps of

0.01. The default depth weight is 20.00.

11. Set the Aperture Thickness (cm) of the proton apertures. The range of

values is 0.0 cm to 40.0 cm, in increments of 0.01 cm.

12. Click the drop-down arrow and select the Penumbra Calculation. Your

choices are "multiplicative," or "additive."

13. Set the Density (%) default percentage by which the electron density

values, due to CT uncertainties, could be too high or too low for a given

scan. The range of values is 0.0% to 20.0% in steps of 0.1%. The default

is 3.5%.

14. Enter the Threshold (cm). The range of values is 0.0 to 1.00 in

increments of 0.01 cm. The default is 0.15 cm.

15. Enter the Edge (cm). The range of values is 0.000 to 1.000 in increments

of 0.001 cm. The default is 0.300 cm.

16. Enter the Intensity (%). The range of values is 0.0 to 20.0 in increments

of 0.1. The default is 0.1 cm.

17. Enter the default Range (cm) depth due to cyclotron energy fluctuations.

The range of values is 0.00 cm to 2.000 cm, in steps of 0.01 cm.

18. Click OK.

3-56

Settings

XiO Training Guide

Settings

Plan Defaults

Task 5. Proton Defaults (cont.)

Subtask 2. Milling Tool Size

1. Click the Settings drop-down menu and select the Plan Defaults, Proton

Defaults, and Milling Tool Size options. XiO displays the Proton Milling

Tool Size Defaults dialog box.

2. Enter the Valid Milling Tool Diameters mm (up to 16 drill bits) that you

will use for aperture and treatment aids.

3. In the Default Milling Tool Diameters (millimeters) Aperture field, enter

one of the valid milling tool tip diameters defined in Step 2.

NOTE: This will be the default milling tool tip used for apertures.

4. In the Range Compensator field, enter one of the valid milling tool tip

diameters defined in Step 2.

NOTE: This will be the default milling tool tip used for range

compensators.

5. Click OK.

XiO 3-57

Settings

XiO Training Guide

Settings


Task 6. TCP/NTCP Parameters

Tumor Control Probability (TCP) and Normal Tissue Complication Probability

(NTCP) are two models used in radiation therapy to biologically interpret Dose

Volume Histograms (DVH). The TCP/NTCP functions in XiO provide tools to

interpret how dose is distributed in a tumor or other substructure.


TCP / NTCP Parameters options. XiO displays the TCP / NTCP


2. Enter the TCP Alpha Mean (1/Gy) number. Blank is an acceptable

answer.

3. Enter the TCP Alpha Std. Dev. (1/Gy) number. Blank is an acceptable

answer.

4. Enter the TCP Tumor Cell Density (million/cc) number. Blank is an

acceptable answer.

5. Enter the NTCP Anatomical Structure Name.

3-58

Settings

XiO Training Guide

Settings

Plan Defaults

Task 6. TCP/NTCP Parameters (cont.)

6. Enter the NTCP TD50 (Gy) identifier for each anatomical structure name.

7. Enter the n number for each anatomical structure name. Blank is

acceptable.

8. Enter the m number for each anatomical structure name. Blank is

acceptable.

9. Click OK. XiO adds your TCP /NTCP Parameters and closes the dialog

box.

Task 7. Teletherapy

When you select this option.


Teletherapy options. XiO displays the Teletherapy Parameters Page

dialog box.

XiO allows you to set a preference as to whether or not you want the

ability to re-save plans that have already been electronically approved.

You can only view and edit this setting if you have plan approval

privileges.

2. Select Yes or No.

3. Click OK.

XiO 3-59

Settings

XiO Training Guide

Settings

Output

Task 1. DRR Print

1. Click the Settings drop-down menu and select the Output and DRR

Print options. XiO displays a "Yellow" warning message.

2. Click OK on the warning message box after reading. XiO displays the

DRR Plot Output Preferences dialog box.

3. Click your middle mouse button and respond "yes" or "no" to each of the

Print options.

4. Click OK. The DRRs you print now include the selected information for

the clinic.

3-60

Settings

XiO Training Guide

Settings

Output (cont.)

Task 2. Intensity Maps

1. Click the Settings drop-down menu and select the Output and Intensity

Maps options. XiO displays the Intensity Maps Text Setup Dialog Box

2. Click the drop-down arrow in any of the fields and select Yes to include

text when you print an intensity map. The default value is Yes.

OR

No to not include text when you print an intensity map.

3. Click OK.

XiO 3-61

Settings

XiO Training Guide

Settings

Output (cont.)

Task 3. Intensity Map Output Devices

The output device needs to be defined here before you can use it to output

intensity maps or relative fluence maps in Teletherapy

1. Click the Settings drop-down menu and select the Output and Intensity

Map Output Devices option. XiO displays the Intensity Map Output

Devices dialog box.

2. Click the drop-down arrow in the Film Printer: field and select Yes to

enter information for a Film Printer.

OR

Click No to not allow you to enter information for the film printer. No is

the default value.

NOTE: The film printer needs to be connected to XiO via an Ethernet

network.

3. Click the drop-down arrow in the Bit Format: field and Select the method

that your printer uses to process the data. Available choices are 16, 8-BE,

or 8-LE bit format. The default value is 16.

3-62

Settings

XiO Training Guide

Settings

Output

Task 3. Intensity Map Devices (cont.)

4. Enter a Host Name of 14 characters used to identify the host.

NOTE: The host name is the network host name for the printer. This

name should match the host name assigned by the network

administrator and listed in the /etc/hosts file.

5. Enter the Port number the printer is using for input. The acceptable range

is 0 to 9999. The default value is 104, the DICOM 3.0 standard port

number.

6. Enter the DICOM 3.0 Application Name of the printer. The default

application name is MERGE_PRINT. The name may include up to 16

characters.

7. Click the drop-down arrow in the DICOM 3.0 Device: field and select Yes

to enter information for a DICOM 3.0 compliant device.

OR

Click No to not allow you to enter information. No is the default value.

8. Click the drop-down arrow in the Bit Format field and select the method

that your device uses to process the data. Available choices are: 16, 8-BE,

or 8-LE bit format. The default value is 16.

9. Enter a Host Name of 14 characters used to identify the host. The host

name is the network host name for the device. This name should match

the host name assigned by the network administrator and listed in the

/etc/hosts file.

10. Enter the Port Number the device is using for input. The acceptable range

is 0 to 9999. The default value is 104, the DICOM 3.0 standard port

number.

11. Enter the DICOM 3.0 Application Name of the device. The default

application name is MERGECOM_SCP. The name may include up to 16

characters.

12. Enter the Minimum number of Output Columns used to determine the

intensity map resolution. As the number of columns increases, the quality

becomes higher. The acceptable range is between 256 and 1280. The

default value is 1280.

13. Click OK. XiO sets up the network location for the intensity map outputs.

XiO 3-63

Settings

XiO Training Guide

Settings

Output (cont.)

Task 4. Tele Source Data

Sub-task 1. Treatment Parameters

1. Click the Settings drop-down menu and select the Output, Tele Source

Data, and Treatment Parameters options. XiO displays the

Customizable Tele Source Data Treatment Parameters window.

2. Customize the source data index by clicking the drop down arrow in the

On/Off fields and selecting on for the items you want to display.

3. Re-order the items displayed on the source data index by manually

placing them in numerical order.

3-64

Settings

XiO Training Guide

Settings

Output

Task 4. Tele Source Data

Sub-task 1. Treatment Parameters (cont.)

4. Click the Report Preview button to preview the customized source data

index.

5. Click OK when finished.

6. XiO allows you to print the customized source data index when you have

a patient open in Teletherapy by selecting the File drop-down menu and

selecting the Print and Plan Data options.

OR

Print by selecting the Reports drop-down menu and selecting the Source

Data option.

OR

Click the Source Data and Print buttons.

7. You can also print the full source data index in Teletherapy (including all

of the items) by clicking the File drop-down menu and selecting the Print

and Full Source Data options.

XiO 3-65

Settings

XiO Training Guide

Settings

Output (cont.)

Task 5. Standalone Time/MU

1. Click the Settings drop-down menu and select Output and Standalone

Time/MU. XiO displays the Standalone Time/MU Output dialog box.

2. Click the drop-down arrow and respond "Yes" or "No" to each of the

display fields shown on this window.

3. Click OK. XiO logs your responses for future use.

3-66

Settings

XiO Training Guide

Settings

Output (cont.)

Task 6. Display Printer Defaults

The Display Printer Defaults option allows you to select color preferences for the

following display and print options:

!" Isocurve / Isosurface Colors in Teletherapy

!" Isocurve / Isosurface Colors in Brachytherapy

!" Print Colors

!" Beam Color (Protons Only)

!" Thickness Color (Protons Only)

Sub-task 1. Brachy Isocurve / Isosurface Colors

1. Click the Settings drop-down menu and select the Output, Display

Printer Defaults, and Brachy Isocurve/Isosurface Colors options.

Regardless of the option you choose (i.e. Brachy or Tele), the information

that displays on the dialog box is the same.

NOTE: If the Isovalue defaults have not yet been defined, the columns

on this page appear as blank. You can enter one in order to

continue, or you can edit existing isovalues.

XiO 3-67

Settings

XiO Training Guide

Settings

Output


Sub-task 1. Brachy Isocurve / Isosurface Colors (cont.)

2. To change a display color, click your middle mouse button. XiO displays

a list of color choices from where you can select a new color for each

Isovalue.

NOTE: This color is a display color. Your display and plot number

colors are different.

3. Select the desired Rnd (rendering) for each isosurface value.

4. Click the drop-down arrow in the Line Type field and select the line types

(one at a time) for each isocurve/isosurface color. Go to the XiO Online

Help to view the various line types.

5. To display dose in MPV, select "Yes" or "No." Selecting "Yes" increases

the time it takes the system to display isodose lines on SPVs. (This in

only used in Brachytherapy.)

6. Click the OK button. XiO adds these isocurve/isosuface display and print

defaults for the selected clinic.

3-68

Settings

XiO Training Guide

Settings

Output

Task 6. Display Printer Defaults (cont.)

Sub-task 2. Print Colors

The Print Colors option allows you to define the color you want to use for

graphic objects.

1. Click the Settings drop-down menu on the main XiO window and select

the Output, Display Printer Defaults, and Print Colors options. XiO

displays the Printer Defaults dialog box.

2. Enter the Color you want to use for each graphic object.

NOTE: If the printer parameters have been previously defined, XiO

displays them on this window. These parameters are modifiable.

XiO 3-69

Settings

XiO Training Guide

Settings

Output


Sub-task 2. Print Colors (cont.)

3. To change the Line Type defaults, click the drop-down menu that

corresponds with the line type you want to change (one at a time), and

make a selection for each.

4. Click the drop-down menu that corresponds with the Fill Type you want

to change and make a selection. To view the Fill Type Defaults and

Renderings, go to the XiO Online Help.

NOTE: If the field is left blank, no pattern will fill the object.

5. Fill Angle is only available when a Fill Type is specified. This choice

determines the angle of the hatched or crosshatched lines. Go to the XiO

Online Help for supporting information.

6. Click the OK button. XiO displays a second plotter defaults dialog box.

NOTE: Because Printer Defaults encompasses two dialog boxes, the OK

button in the first window only opens the second window and

does not save the data.

7. Click the OK button again. XiO saves your Print Color preference

defaults for the selected clinic.

3-70

Settings

XiO Training Guide

Settings

Output


Sub-task 3. Beam Colors (Proton Only)

Use the Pen Color Defaults to define the colors associated with proton beams.

1. Click the Settings drop-down menu on the main XiO window and select

the Output, Display Printer Defaults, and Beam Colors options. XiO

displays the Beam Color Defaults dialog box.

2. Click your middle mouse button in the Color field and select the desired

color you wish to associate with each beam.

3. Click the OK button. XiO saves the Beam Color preference defaults for

the selected clinic.

XiO 3-71

Settings

XiO Training Guide

Settings

Output

Task 6. Display Printer Defaults (cont.)

Sub-task 4. Thickness (Proton Only)

1. Click the Settings drop-down menu and select the Output, Display

Printer Defaults, and Thickness options. XiO displays the Printer

Isocurve Line Thickness Default dialog box.

2. Enter the thickness for each line to be displayed.

3. Select the color assigned to each thickness.

NOTE: Duplication is permitted.

4. Click OK.

3-72

Settings

XiO Training Guide

Settings

Output

Task 7. DRR Printing Size

Before printing a Digitally Reconstructed Radiograph (DRR), you must designate

the paper size (length, width) and designate the printer to where you want the

output printed. The following exercise assists you with these tasks.


Printing Size options. XiO displays the DRR Size Defaults dialog box.

2. Click the drop-down arrow in the Output device field and select the

desired device.

3. Click the drop-down arrow in the Paper size field and select the desired

Paper size.

4. Enter the Default Length. Acceptable values range from 0.01 cm to

80.00 cm in increments of 0.01 cm.

5. Enter the Default Width. Acceptable values range from 0.01 cm to 80.00

cm in increments of 0.01 cm.

6. Click the Add defaults button. XiO displays a Defaults Added message.

You can select another paper size and set the default length and width for

DRRs printed for that size paper.

7. Click OK. XiO closes the dialog box.

XiO 3-73

Settings

XiO Training Guide

Settings

Output

Task 8. . decimal Order Defaults

The .decimal Order dialog box is where you enter your clinic’s decimal shipping

priorities for mailing.

1. Click the Settings drop-down menu and select the Output and .decimal

Order Defaults options. XiO displays the .decimal Order Defaults dialog

box.

2. Click the drop-down arrow in the Processing field and select the desired

processing priority for your institution. Go to the XiO Online Help for

supporting information.

3. Enter your clinic’s Name and Shipping Address to where you want your

.decimal compensator shipped.

3-74

Settings

XiO Training Guide

Settings

Output

Task 8. . decimal Order Defaults (cont.)

4. Enter your clinic’s Name and Billing Address to where you want billing

statements for the .decimal compensators mailed.

5. Enter the Name, Phone Number (including area code) and Email

address of the contact person for your clinic.

6. Click the OK button. The values now appear as defaults when you order a

.decimal compensating filter during planning for the selected clinic.

XiO 3-75

Settings

XiO Training Guide

Settings

Output (cont.)

Task 9. Block Cutter Export

Use this option to set up defaults for export to a block cutting system by network

or floppy disk.

1. Click the Settings drop-down menu and select the Output and Block

Cutter Export options. XiO displays the Customized Port Export


2. Click the drop-down arrow in the Transfer method field and make a

selection (network or floppy).

3. Enter the Margin around collimator (cm) distance. The acceptable

range is 0.00 cm to 5.00 cm in steps of 0.01. If you leave this field blank,

XiO requires you to generate the outside outline yourself.

4. Click the drop-down arrow in the Foam block size field and make a

selection.

5. Enter the polystyrene Foam block thickness to be used by the block

cutter. The acceptable range is 0.00 cm to 20.00 cm in steps of 0.01 cm.

6. Click OK. XiO saves the entered default parameters and closes the dialog

box.

3-76

Settings

XiO Training Guide

Settings

Technical Considerations

Section 3. Settings of the XiO Training Guide is also used as a reference during

the classroom training lecture to support the slides shown in this section.

XiO 3-77

Settings

XiO Training Guide

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XiO Training Guide

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XiO Training Guide

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linear from air to slightly denser than water (e.g.

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contain more higher-Z atoms (e.g. bone).

• Be sure to measure a CT-to-ED file for each CT

scanner you will be using.

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linear from air to slightly denser than water (e.g.

muscle), then continue linear but with a lesser

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scanner you will be using.

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XiO Training Guide

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XiO Training Guide

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Patient File Maintenance

XiO Training Guide


Before you begin this exercise, create an anatomical site. Click the Settings

drop-down menu and select the Patient Data and Specific Anatomical Sites

named Prostate. Enter the structure names bladder, rectum and femoral

heads. Refer to Settings section in this training guide for assistance in creating

this anatomical site.

Practice Exercise

Patient File Maintenance (PFM) is the location in XiO where you can perform

the following tasks:

! Enter and edit patient demographic information

! Import patient image data

! Draw, edit and delete structure contours

! Create 3D auto-margin contours

Task 1. Access XiO - PFM

The following steps illustrate how to access the XiO system and then PFM from

an operational XiO workstation.

1. Enter the word test in the Login ID field of the login window.

2. Enter the word cms in the Password field.

3. Click OK. XiO displays the main system window.

XiO" 4-1


XiO Training Guide


Task 1. Access XiO – PFM (cont.)

4. Verify the current clinic displays XiO Training Data. CMS created this

demo clinic so that you can practice each of the steps for each of the tasks

illustrated in this training guide. DO NOT use the data shown in the

practice exercises when creating a valid treatment plan for your clinic.

5. Click the Patient File Maintenance option.

OR

Click the Run drop-down menu and select the Patient File Maintenance

option. XiO displays the main window in Patient File Maintenance from

where you select options to import patient data.

4-2


XiO Training Guide


Task 2. Create a New Patient

There are two methods to creating a new patient in XiO. The first allows you to

enter the demographics information for the patient and begin the transfer process.

The second method uses the DICOM header and reads in the demographic

information for the patient automatically. You can edit this information after

transfer from the Edit drop-down menu. The only demographic data that is

transferred using the DICOM method is the patient ID and patient name. The

patient sex displays as unknown. If the ID has any non alpha-numeric characters

or spaces, XiO removes them by default.

Method 1: Enter Demographic Information

1. Click the File drop-down menu and select the New and Patient options.

XiO displays the New Patient dialog box.

2. Enter the Patient ID MRProstate.

3. Enter MR 3D Prostate in the Patient Name field.

4. Click the drop-down arrow in the Sex: field and select Male.

NOTE: The Date of birth, Telephone, and Address fields are optional.

5. Click the drop-down arrow in the Create field and select Imagebased

Studyset. There are three different data types.

(1) Imagebased Studyset is used to import image data.

(2) Nonimaged Studyset is used to create a studyset that does not contain

images. For example, you would select this option when you plan to

digitize patient contours into XiO.

XiO" 4-3


XiO Training Guide



Method 1: Enter Demographic Information (cont.)

(3) No Studyset is used when contours are not required, i.e.

brachytherapy.

6. Click OK. XiO displays the Start Image Transfer dialog box.

Method 2: Use DICOM Header information

1. Click the File drop-down menu and select the New and DICOM Patient

options. XiO displays the Start Image Transfer page.

4-4


XiO Training Guide


Task 3. Start Image Transfer

It is from this window that you bring data into XiO along with pertinent

information.

1. If you have more than one media type to choose from, click your middle

mouse button in the Image type field and select the Computed

Tomography option. Image Type refers to the type of data being

transferred (i.e. CT, MR, PET). If only one media is licensed, XiO

automatically fills in this field.

2. If you have more than one Image Media type to choose from, click your

middle mouse in the Image Media: field and select the Network option.

The available options for image transport are Network, Optical Disk, and

Dat Tape. If only one interface is licensed, XiO automatically populates

this field.

3. The Mfr/Model ID field defaults to DICOM3. This is the manufacturer

and model of the scanner/file format associated with the images being

transferred. DICOM is a standard file format by which many new scanners

comply, and therefore is also a valid answer. If only one model is

available, XiO automatically fills in this field.

4. The Host/Device field defaults to merge. This is the location where the

transferring device is attached to the system (i.e. file location, dat drive,

CD…).

XiO" 4-5


XiO Training Guide


Task 3. Start Image Transfer (cont.)

5. Click your middle mouse button in the Source PID: field and select the

ASTRO224 option. The Source PID is a directory of available patient

exams for import. The total range of image numbers from the selected

exam will default; however, you can edit this range to import as many or

few of the images from the selected exam.

NOTE: If the preference is turned on, you may encounter a yellow

screen warning you that the Source patient ID does not match

the ID entered in XiO. This warning is intended to prevent you

from transferring in images of one patient to the ID of another

patient.

6. Enter 3DProstate in the Studyset ID: field. The studyset is the entire set of

image data used for planning. The Studyset Description is an optional

field. You can use this field to describe the studyset you are creating.

7. DemoScanner1 defaults in the Scanner ID: field. Scanner ID refers to the

scanner from where the images were pulled. Scanners are defined in

Settings. It is necessary that you identify a scanner in order to correctly

display scout images and calculate shift information. Blank is an

acceptable answer if you do not want to assign a scanner to this patient.

(See the Settings lesson in this training guide for more information.)

8. (Optional) Click your middle mouse button in the CT to ED Conversion

File: field and select rocsboard. The conversion file is used to convert CT

numbers to electron densities. This is necessary for DRR calculations as

well as heterogeneity corrections.

9. In the Exam data to remain for future transfer: field, select All. The All

option means that the raw CT images remain in the Source PID directory

after they are transferred into PFM. Use the All option when you would

like the option of importing the same images over and over again into XiO.

However, if frequently select the All option, the image directory can

become full and reduce system performance.

Clinically, it is recommended to select None so that XiO removes all

images from the image directory upon the image transfer.

If you are importing plans from a source other than Focal, select the Non-

transferred option so that the plan files are not deleted after the images are

imported.

10. Click OK. XiO transfers the image data and displays the Finish Image

Transfer dialog box.

4-6


XiO Training Guide


Task 4. Finish Image Transfer

Use this page to check the transferred images for correctness of image order,

orientation (head to foot, right to left, flipped), position, and correct scale factor.

1. Edit the Coronal Reference Distance (cm): field, if needed. Use the

Coronal Image to evaluate Head to Foot direction. If the Coronal image

does not provide a meaningful display, reconstruct a new coronal cross

section at a different location by entering a different Coronal Reference

Distance (cm).

2. In the Transverse images viewed from foot: field, enter Yes. If you have

difficulty selecting the correct answer, perform the following test:

(1) On a transverse slice, draw an imaginary line from the patient’s right

side to the patient’s anterior, then left side, and finally stopping at the

patient’s posterior.

(2) If the line was drawn in the clockwise direction, the images are viewed

from the foot, select Yes.

(3) If the line was drawn in the counterclockwise direction, the images are

viewed from the head, select No.

XiO" 4-7


XiO Training Guide


Task 4. Finish Image Transfer (cont.)

3. In the Reference distances increase towards head: field, select Yes. If the

direction arrow on the coronal image points toward the superior of the

patient, select Yes. If the arrow points to the inferior of the patient, select

No.

4. (Optional) The Superior and Inferior Couch Readings fields should match

the displayed Superior and Inferior Reference Distances. However, on

occasion, the DICOM fields that XiO reads in for the couch positions

(Reference Distances) are not representative of the actual readings on the

machine. If this is the case, you can re-synch the reference distances with

the actual couch readings. This is only necessary if you intend to report

shifts (Setup Reference Definition or Mark Anatomical Reference) in

Absolute Coordinates rather than Relative to the Scan Reference Point.

Without doing so, shifts reported in Absolute Coordinates will not be

correct.

5. (Optional) Use the Position offset to set a selected plane (y-coordinate) to

zero (for example, set the y-coordinate to the fiducial marker plane if not

done at the time of simulation).

(1) Enter the position-offset value to be used by the transferred images,

OR

(2) Click your right mouse button on the coronal image and select Position

Offset to set the y-coordinate graphically.

(3) Hold down your left mouse button and move superiorly or inferiorly.

The Position Offset automatically updates to the selected slice.

6. In the Patient Position: field, select supine. You can choose from supine,

prone, or rolled (patient was placed into a rolled position using a sponge or

pillow or other means). Should you choose rolled, XiO displays the Roll

Angle field making it a required field.

7. (Optional) You can add Position Comments (i.e. pillow, sponge support, tilt

board, bite block, face mask).

8. Click OK. XiO orients the cross sections according to the entries and

imports the images to the contouring module.

4-8


XiO Training Guide


Task 5. Contouring

Sub-task 1. Add a Group of Contour Names & Enter a Contour Name

If an anatomical site name has been created, XiO automatically displays an Add

Anatomical Site dialog box.

1. Click the Prostate anatomical site to highlight it. The Predefined Sites are

grouped lists of possible structure names. Selecting these predefined sites

eliminates the need for entering structure names as you contour them.

These structure name groups are created in Settings, Patient Data,

Specific Anatomical Sites.

2. Click OK.

3. Click the Edit drop-down menu and select the Contour Names and Type

in Contour Name options. XiO displays the Edit Contour Info dialog box.

4. Enter rt. femur in the Name field.

5. Enter 1.0 in Relative Density field.

6. Click the drop-down arrow in the Force CT Dens: field and select No.

NOTE: Select Yes to override pixel-by-pixel heterogeneity

corrections for this structure. Refer to the Teletherapy lesson

of this training guide for more information regarding the

heterogeneity correction options.

7. Click the drop-down arrows to edit the remaining fields. Color, Rendering,

and Color Fill affect how the contour is displayed on the screen. Line

Type, Fill Type, and Fill Angle affect the contour display when printed.

See XiO Help for more detailed information.

8. Click OK.

9. Repeat steps 4-7 for the lt. femur.

XiO" 4-9


XiO Training Guide


Task 5. Contouring

Sub-task 1. Add a Group of Contour Names & Enter a Contour Name (cont.)

10. Click Cancel to close the dialog box.

OR

Continue adding additional structure names.

NOTE: Click the Edit drop-down menu and select the Contour

Names option to find additional contour names.

Contour Index displays an index of existing contour names.

Add Predefined Site is used to add additional grouped lists of

structure names.

Edit Contour Info is used to change the name, relative

density, rendering, color, color fill, and print options on this

dialog box.

Rename Contour is used to rename an entire structure by

selecting a new contour name.

Type in Contour Names is used to add custom anatomy

names.

4-10


XiO Training Guide


Task 5. Contouring

Sub-task 2. Create the Patient Contour Using Auto-by-Threshold (Multiple Slices)

Use this function to automatically create contours along an edge of high contrast

in an image. Adjust the Window/Level settings to obtain high contrast around

the desired structure.

You can either Place Auto Points on all Selected Cross Sections for Auto-by-

Threshold by clicking the multi slice mode button, or Place Auto Points on

a Single Cross Section for Auto-by-Threshold by clicking the single slice mode

button. In XiO, Multi-slice mode is the default.

Adjusting the Window/Level settings may improve the performance of Auto-by-

Threshold. Structures like bone, lungs, and patient exterior are good candidates

for this contouring method because the structures are well delineated.

1. Click the Create Contours Using Auto-by-Threshold button.

2. Click the drop-down arrow in the (Save) W/L field and select Autoskin.

The autoskin window and level values were chosen to provide optimum

contrast in most CT images for contouring the patient skin using Auto-by-

Threshold.

3. Click the drop-down arrow in the Group field and select General.

4. Click the drop-down arrow in the Contour: field and select Patient. The

correct Group and Contour Name should always be chosen before

contouring begins.

5. Place the mouse pointer anywhere within the Cross Section Thumbnail

View.

6. Click your right mouse button and select the Select All option. XiO

highlights all cross sections with a yellow border.

7. Click your right-mouse button anywhere within the Single Plane View and

select the Place Point option. This action enables you to place auto points

to be used to identify where the drawing of contours will begin.

XiO" 4-11


XiO Training Guide


Task 5. Contouring

Sub-task 2. Create the Patient Contour Using Auto-by-Threshold (Multiple Slices) [cont.]

8. Move the mouse pointer above the anterior surface of the patient and

click your left mouse button to place a set of auto points. With multiple-

slice mode and a range of all slices selected, XiO automatically places a

point in the same position on all slices.


select the Generate Cont option.

OR

Click your middle-mouse button within the Single Plane View. XiO

automatically creates contours, after which the patient skin will appear

shaded in the Cross Section Thumbnail View, as a wire frame in the 3D

View, and as an outline in the Single Plane View. This action also displays

the Accept Auto-by-Threshold dialog box.

10. Scroll through the images to review the contours. Click the Accept the

new contours button to keep the contours you just created

OR

If an undesirable contour is found, edit the Point position using one of the

following methods:

(1) Move all points (multi slice button highlighted) by placing the

cursor near any point. When the point turns red, drag it to a new

position by holding down your left mouse. XiO updates all points to

the new location.

4-12


XiO Training Guide


Task 5. Contouring

Sub-task 2. Create the Patient Contour Using Auto-by-Threshold (Multiple Slices) [cont.]

OR

(2) Move a single point (single slice button highlighted) by placing

the cursor near the point. When the point turns red, drag it to a new

position by holding down your left mouse. Only the selected point is

affected by the move.

11. After you edit the point, regenerate the contours.

NOTE: Should you elect to make manual edits to the auto-by-

threshold contours, you can do so in edit mode after the auto-

by-threshold contours are accepted

12. Click the Accept the new contours button when the contour outline is

satisfactory.

Here are steps you can use to optionally apply

the Area Of Interest Tool when using auto-by-

threshold. The Area of Interest tool can help you

exclude the table or part of the patient when

contouring using auto-by-threshold.

1. After you select all your slices to be

contoured, but before you place your point,

right mouse click and select Place AOI.

2. Hold down your left mouse button and drag

to create a box around your contours.

3. Movie through each slice, or look at the 3D

view to determine if all the slices are

encompassed appropriately by the AOI box.

4. Redraw the AOI box, if necessary.

5. Place the point inside the box, but above the

patient surface (if contouring the patient).

6. Generate the contours and verify that you

get the expected results.

XiO" 4-13


XiO Training Guide


Task 5. Contouring (cont.)

Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice)

This method is desirable when customizing the point location for each cross

section that is needed.

1. Click the Create Contours Using Auto-by-Threshold button on the

Contouring toolbar.

2. Click the drop-down arrow in the (Save) W/L button field and select

Autobone. The autobone window and level values were chosen to provide

optimum contrast in most CT images for contouring the bones using Auto-

by-Threshold.

3. Click the drop-down arrow in the Group: field and select User Defined.

4. Click the drop-down arrow in the Contour: field and select Rt. Femur.

5. Click the Place Auto-Point on a Single Cross Section for Auto-by-

Threshold button. This mode allows you to place points on only one

cross section, compared to the Place Multi Slice mode, which allows you to

place points on multiple cross sections.

4-14


XiO Training Guide


Task 5. Contouring

Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice)

6. Use the scroll bar on the thumbnails to find an image that displays the Rt.

Femur. Click your left mouse button on that thumbnail slice to update the

image in the Single Plane View.

OR

Click your right mouse button anywhere within the Single Plane View and

select the Movie option. Click your right or left mouse button to movie

through slices until you locate Rt. Femur. On some systems, you can also

use the scroll wheel on the mouse to movie through the images

OR

Use the Up or Down arrow keys or Page Up/ Page Down keys on your

computer keyboard to movie to a cross section with Rt. Femur.


select the Place Point option. This enables you to place auto-points to be

used to identify where the drawing of contours will begin.

8. Move your mouse pointer slightly anterior to rt. Femur; then, click your

left mouse button to place an auto-point.

9. Click your middle mouse button to generate the contour. XiO displays

the Accept Auto by Threshold dialog box. You can generate and accept

each contour one by one, or movie to place single points on each slice,

generate them, and accept them all at once.

10. Repeat steps 6 through 9 for each rt. femur cross-section.

XiO" 4-15


XiO Training Guide


Task 5. Contouring

Sub-task 4. Create Contours Using Auto-by-Threshold (Range)

You can use this method to quickly create Auto-by-Threshold contours on a

selected range of slices.

1. Click the Create Contours Using Auto-by-Threshold button on the

Contouring toolbar.

2. Click the drop-down arrow in the (Save W/L): field and select Autobone.

3. Click the drop-down arrow in the Group: field and select User Defined.

4. Click the drop-down arrow in the Contour: field and select Lt. Femur.

5. Click the Place Auto-Points on all Select Cross Sections for Auto-by-

threshold button.

6. Select desired slices by clicking your middle mouse button on each

thumbnail cross section.

OR

Click your middle mouse button on the first desired contour; then, shift-

middle click the last contour on the thumbnails for the desired range. XiO

places yellow boxes around the selected cross sections in the thumbnails,

signifying that contours will be created for each of the selected slices.


select the Place Point option.

8. Move your mouse pointer slightly anterior to the Lt. Femur; then, click

your left mouse button to place an auto-point.

9. Click your middle mouse button to generate the contour on all of the

selected slices at once. XiO displays the Accept Auto by Threshold button

dialog box.

10. Click the Accept the New Contours button, or edit a point(s) as needed.

4-16


XiO Training Guide


Task 5. Contouring

Sub-task 5. Create/Edit Contours using the Paintbrush

Use the paintbrush tool to create new contours or edit existing contours. Edit the

size of the paintbrush using the guide radius.

1. Click the Paint the contours Using the Mouse button.

2. Set the W/L to Soft Tissue from the list to the right of the (Save) W/L

button.

3. Click the drop-down arrow in the Group: field and select General.

4. Click the drop-down arrow in the Contour: field and select GTV.

5. In Single Plane View, movie to a cross section containing prostate.

6. Adjust the Guide Radius of the paintbrush tool displayed as a circle around

your mouse pointer. The guide radius determines the size of your

paintbrush. The guide radius size ranges from 0.01 to 10 cm. Use very

small radii carefully since you can create very small contours that are

difficult to edit.

Here are steps to edit the radius of the

circle guide.

1. Press the greater than key (>) to

increase the guide radius.

2. Press the less than key (< ) to

decrease the guide radius.

3. Press the G key on your computer

keyboard to turn the guide radius off

and on.

XiO displays the Guide Radius size at the

bottom of the XiO screen.

XiO 4-17


XiO Training Guide


Task 5. Contouring

Sub-task 5. Create/Edit Contours using the Paintbrush (cont.)

7. Hold down the left mouse button and drag on the transverse image to

“paint” the prostate contour. Paint the prostate contour on each slice where

the prostate is displayed.

8. Edit contours using the paintbrush by holding down the Shift key on the

keyboard while holding down the left mouse button and dragging the

paintbrush tool over the painted area to erase.

NOTE: You can edit any contour using the paintbrush tool regardless

of which tool was used to create the contour.

Sub-task 6. Create Contours Using Autosegmentation

Use Autosegmentation to automatically generate contours based on gray level

texture properties and gradients. You draw a sample contour (only a portion of

the desired whole) inside the perimeter of a structure. XiO then expands the

sample to encompass the entire structure.

Autosegmentation is most useful when used to contour areas that lack large

density differences.

Window Level (W/L) changes will not improve Autosegmentation performance.

Structures like liver, kidneys, spleen, and bladder are good candidates for this

contouring method.

1. Click the Create Contours Using Autosegmentation button on the

Patient File Maintenance toolbar.

2. Set theW/L to Soft Tissue from the list to the right of the (Save) W/L

button. This action improves the appearance of on screen images, but will

not affect the autosegmentation process. Autosegmentation uses CT

numbers to create contours with like-densities in a given sample.

3. Click the drop-down arrow in the Group: field and select Prostate.

4. Click the drop-down arrow in the Contour: field and select Bladder.

5. In Single Plane View, movie to a cross section containing bladder.

4-18


XiO Training Guide


Task 5. Contouring

Sub-task 6. Create Contours Using Autosegmentation (cont.)

6. Inside the bladder structure, provide a density sample by creating a

polygon of any shape or size using the left-mouse button and dragging.

Once you close the polygon, autosegmentation reshapes the sample to

encompass all surrounding tissue with like-densities.

7. Select another slice and repeat the process. Continue throughout the

bladder structure.

NOTE: You can use some of the other contouring tools, such as

contouring every other slice and using interpolation to

complete the contouring, or selecting a range from the

thumbnails to have the autosegmentation apply to multiple

slices.

XiO 4-19


XiO Training Guide


Task 5. Contouring

Sub-task 7. Edit Existing Contour

Use this tool or the paintbrush tool when making changes to existing contours.

You initiate this process by selecting the Edit Existing Contour button on

the Patient File Maintenance toolbar, and identifying the contour to be edited by

placing your mouse cursor near the contour outline. When XiO changes the

arrow icon to the edit icon , click your left mouse button. XiO then displays a

purple box around the contour signifying the contour is in edit mode and can be

changed. Once in edit mode, the following functions represent the various

methods available for making changes.

NOTE: The Edit Contour option is always available on the right mouse drop-

down menu. When you are in Edit Contour mode, the Draw Contour

option is available on the right mouse drop-down menu.

Replace Contour Segment

This function allows you to replace a portion of the contour by manually

redrawing.

1. Click the Edit Existing Contours button on the Patient File

Maintenance toolbar.

2. Move your mouse cursor near the bladder contour until the edit symbol

appears on the window; then, click your left mouse button. XiO displays

the bladder contour with a purple box around it.

3. Move your cursor near the portion of the contour to be edited until the +

sign appears on the window.

4. Hold down your left mouse button and redraw the contour, extending

outside the edit box, if necessary. The newly drawn contour segment

replaces the original contour segment.

NOTE: The drawing must begin and end on the existing contour

outline.

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XiO Training Guide


Task 5. Contouring

Sub-task 7. Edit Existing Contour (cont.)

Stretch Sym/Asym

This function allows you to stretch the contour.

1. With the bladder contour still in edit mode, place your mouse cursor near a

purple square located on the purple edit mode box. Look for the cursor to

change to one of the following icons.

NOTE: Symmetric stretch is the default.

2. Hold down your left mouse button and stretch or shrink the contour.

NOTE: You can stretch the contour in the width dimension or in the

height dimension, depending on the location. Width and

height may be stretched simultaneously if you choose a corner

square.

3. Click the Asym button.

4. Stretch the contour in Asym mode.

Move

This function allows you to move the contour.

1. With the bladder contour still in edit mode, place the cursor anywhere

inside the contour until the four-way pointer displays on the window.

2. Hold down your left mouse button and move the contour.

XiO 4-21


XiO Training Guide


Task 5. Contouring

Sub-task 7. Edit Existing Contour

Move Points (cont.)

This function allows you to move 1, 3, or 5 points of the contour outline.

1. With the bladder contour still in edit mode, place the cursor anywhere

inside the contour and click your left mouse button once. XiO toggles the

edit mode box to points.

2. Select the button representing 5 points.

3. Place your mouse cursor near a point until it turns red (active). You may

want to scale the image to make it larger so the points are easier to

visualize.

4. Hold down your the left mouse button and drag the points.

Copy Superior/Inferior

When a contour is in edit mode, the right arrow on the keyboard copies superior,

and the left arrow on the keyboard copies inferior.

Copy/Paste to Another Slice (keyboard shortcuts)

! Ctrl/C copies a contour.

! Ctrl/V pastes a contour.

The selected contour must be in edit mode to use these tools.

Delete a Single Contour

In edit mode, you can delete a single contour by selecting the Delete button on

the keyboard.

4-22


XiO Training Guide


Task 5. Contouring

Sub-task 7. Edit Existing Contour (cont.)

Delete ALL Contours for an Entire Structure

In edit mode, you can delete all contours with the same contour name by

selecting the Shift and Delete keys on your computer keyboard.

Stop Editing

When the contour editing is complete, click anywhere outside the purple edit box

to unselect the contour.

OR

Choose another contouring tool.

XiO 4-23


XiO Training Guide


Task 5. Contouring

Sub-task 8. Create Contours from Predefined Shapes Using the Keyboard

Use this function when you want to create contours from simple shapes, such as

circles and rectangles, using your computer keyboard.

1. Use the scroll wheel or left/middle mouse buttons to movie to cross section

–157.91 (cm).

2. Click the drop-down arrow by the Contour: field and select Rectum.

3. Click the Create Contours from Predefined Shapes Using the Keyboard

button. XiO displays the Keyboard Entry of Simple Shapes dialog

box.

4. Under the Polygon Definition heading, enter 360 in the Number of Sides:

field. The number of sides defines the shape (i.e. Triangle – 3 sides, Circle

– 360 sides…). Entering 100 sides creates a well-defined circle and uses

fewer points.

5. Enter 0.5 cm in the Center A (cm): field. This defines the left/right location

of the contour.

4-24


XiO Training Guide


Task 5. Contouring

Sub-task 8. Create Contours from Predefined Shapes Using the Keyboard (cont.)

6. Enter –4.3 cm in the Center B (cm): field. This defines the

anterior/posterior location of the contour.

NOTE: If you do not know the exact location of the structure center,

enter 0 (zero) for A and B; then, in edit mode, select and move

the structure so it is centered on the structure of interest.

7. Enter 1.5 cm in the Size (cm): field. This value is used to define the

contour shape size.

8. Enter 0 in the Angle (deg): field. Use this value if a rotation is needed.

9. Click the Add Polygon Contour button. XiO creates a circular contour for

the rectum at the specified location. The contour is now manually editable.

10. Click Cancel to close the window.

Sub-task 9. Draw Contours using the Mouse

Use this function to manually trace contours.

1. Click the Page Up key on your computer keyboard to move superior.

2. Click the Draw Contours Using the Mouse button.

3. Hold down your left mouse button in the SPV window and drag to trace

the rectum. Points are automatically placed at a user-specified spacing.

Minimum Point Sample Spacing can be edited by selecting the Edit drop-

down menu and selecting the Preferences and General options.

OR

Trace the rectum by clicking your left mouse button multiple times to place

points manually around the structure.

4. If necessary, use the guide radius as a visual cue when you want to draw a

contour at a specific distance around a structure. See the Paintbrush section

for more information regarding controlling the size of the guide radius.

XiO 4-25


XiO Training Guide



Sub-task 10. Interpolate

Use Interpolation to automatically create contours between two or more existing

contours on other slices. This function is ideal for outlining structures with little

change in size and shape throughout the studyset, such as the spinal cord or

rectum.

In this activity, you will create a contour on approximately every third cross

section; then, use the Interpolation feature to create contours on the slices in

between the other contoured slices.

1. Click the View drop-down menu and select the Window Format and Four

Window options XiO changes from the large single cross section window

to a four successive cross sections display.

2. Hold down your left mouse button and outline the rectum on one of the

four windows.

3. Click the Page Up key on your computer keyboard to move superior. XiO

updates all displayed slices.

4. Hold down your left mouse button and outline the rectum on one of the

four windows.

5. Continue this process using the Page Up/Page Down keys to move

throughout the rectum. Be sure to outline the superior most and inferior

most portion of the rectum.

6. Click the Interpolate between Contours button. XiO fills the skipped

slices with the interpolated rectum contours.

7. Review the contours and make edits if needed.

8. Click the View drop-down menu and select the Window Format and Four

Window options. XiO toggles the Four Window format back to the Single

Window format.

4-26


XiO Training Guide



Sub-task 11. Free-form Exercise – Outline the Seminal Vesicles using any method

XiO 4-27


XiO Training Guide


Task 5. Contouring

Sub-task 12. 3-D Auto-Margin - Uniform

Use the 3-D Auto-Margin to automatically generate new contours that are a

specified margin (positive or negative) from a selected contour(s).

1. Click the Create a Contour Using 3-D Auto-margin button. XiO

displays the 3-D Auto-Margin dialog box.

2. Enter Target in the New Structure Name field. This represents the name of

the 3-D Auto-Margin contour.

3. Leave the Class field defaulted to Int indicating an Internal structure.

Other valid selections for this field are TV1-TV5 and Tumr.

4. Click the drop-down arrow in the Color field and select Cyan.

4-28


XiO Training Guide


Task 5. Contouring

Sub-task 12. 3-D Auto-Margin – Uniform (cont.)

5. Click the drop-down arrow in the Rendering field and select T50 (50%

transparent). Other valid selections are W (wire), S (solid), T25 (25%

transparent), and T75 (75% transparent).

6. Leave the Rel. Electron Density field default set to 1.0. You can edit this

field, if needed.

7. Click the drop-down arrow in the Variable Margin: field and select No.

This signifies that you want to create a uniform margin. Uniform 3D Auto-

Margin contours retain the shape of the initial contours and are scaled so

that each point is located no closer than the specified distance from the

initial contours.

8. Click your middle mouse button in the Structure field and select Prostate.

This is the first structure identified for 3-D Auto-Margin.

9. Enter 1 cm in the Margin field. You have the option of creating a positive

or negative margin by entering a positive or negative value.

10. Leave the Include/Exclude field to default to Include. A structure is

included by a specified value in the Auto-Margin contour if the Include

option is chosen. A structure is subtracted by a specified value from the

Auto-Margin contour if the Exclude option is chosen.

11. Click your middle mouse button in the next available Structure field and

select Sem Ves. This is the second structure to be included in the 3-D

Auto-Margin.

12. Enter 1 cm in the Margin field.

13. Leave the Include/Exclude field to default to Include.

14. Click the drop-down arrow in the Clip at Patient Surface: field and select

No. If you select Yes, XiO forces the new contour to follow the patient

contour if it comes in contact with it instead of continuing outside the

patient.

XiO 4-29


XiO Training Guide


Task 5. Contouring

Sub-task 12. 3D Auto-Margin – Uniform (cont.)

15. Leave the Clip Inside By (cm) field defaulted to 0 cm. This value can be

edited to clip the 3D automargin contour inside the patient contour by the

specified amount. This feature could be used when you have to contour

superficial structures, but do not want to include tissue in the buildup

region.

16. Click the Create 3D automargin button. XiO creates the Auto-Margin

according to the specified values.

17. Use the scroll wheel to review the contours.

18. Click the Clear 3D automargin button. XiO discards the recently

generated margin.

19. DO NOT click the Cancel button. You will use the above settings in the

next task.

Sub-task 13: 3D Auto-Margin with Exclusion

The structures and margins created in Sub-task 11 should still be displayed.

1. Click your middle mouse button in the next available Structure field and

select Rectum.

2. Enter 0 cm in the Margin (cm): field.

3. Click the drop-down arrow in the Include/Exclude field and select Exclude.

4. Click the Create 3D automargin button and review the contours. XiO

excludes the Rectum (by 0 cm) from the 3-D Auto-Margin structure.

5. Click the Clear 3D automargin button.

6. Enter 0.5 cm in the Rectum Margin (cm): field.

7. Click the Create 3D automargin button and review the contours. The 3-D

Auto-Margin reduces the margin near the Rectum to 0.5 cm.

8. Click the Clear 3D automargin button.

9. DO NOT click the Cancel button. You will use the above settings in the

next task.

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XiO Training Guide


Task 5. Contouring

Sub-task 14: 3-D Auto-Margin – Variable

Variable 3-D Automargin contour shapes are based on the shape of the initial

contours, but may have different margins in different directions from the initial

contour (i.e. ant, post, rt., lt., sup, and inf).

The structures and margins created in Sub-task 12 should still be displayed.

1. Click the drop-down arrow in the Variable Margin: field and select Yes.

XiO changes the content of the dialog box to represent the variable fields.

2. Press the space bar in the Structure field to clear the name "Rectum" from

the field.

3. Enter 0.2 cm in the Posterior (cm): field for both Prostate and Sem Ves.

XiO 4-31


XiO Training Guide


Task 5. Contouring

Sub-task 14: 3-D Auto-Margin – Variable (cont.)

4. Click the Create 3D automargin button and review the contours. The 3-D

Auto-Margin is 1 cm in size everywhere but posteriorly, where it is only

0.2 cm.

5. Click the Accept 3D automargin button to accept the contour.


Sub-task 15. 3-D Auto-Margin – Negative

Negative margins can be used to create contours inside other contoured

structures, such as bladder or rectal walls.

1. Click the Create a Contour with 3-D Auto-margin button.

2. Enter the New Structure Name rectalwall.

3. Change the Color to green.

4. Leave the default for Variable Margin to no. You can only create negative

uniform margins.

5. Click your middle mouse button in the Structure field and select Rectum.

6. Enter a –0.2 cm margin and leave the default to Include.

7. Click the Create 3-D Auto-Margin button and review the contours. The

new contour is drawn 0.2 cm inside the structure rectum.

8 Click Accept 3D Auto-margin.


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XiO Training Guide


Task 5. Contouring

Sub-task 16. 2-D Automargin

Use the 2-D Automargin function to automatically generate a new contour on a

single slice to create a specified margin around a selected contour on one slice.

A contour is selected when you place it in edit mode (the edit box encompasses

the structure), after which you can create a 2-D automargin contour by clicking

the Creating a 2-D Automargin button. The new contour retains the shape of

the initial contour and is scaled so that each point is located no closer than the

specified distance from the initial contour. The new contour also retains the

same contour name. Click the Edit the Distance between the Initial Contour

and the Derivative Contour button to change the value of the 2-D Auto-Margin.

Sub-task 17. Edit Contour Information

In PFM, you can edit contour information for contours in your General and

Specific Anatomical Sites groups.

1. Click the Edit drop-down menu and select Contour Names then Edit

Contour Info. XiO displays the Edit Contour Info dialog box.

2. Click your middle mouse button in the field next to Anatomical Site to

select the group of contours you want to edit.

3. Edit contours names and attributes. These edits will only apply to the

structures displayed on the current patient.


NOTE: To set the contour information for Anatomical Sites globally for

all patients, you must edit the contour information in Settings-

Patient Data-General Anatomical Sites or Specific

Anatomical Sites.

XiO 4-33


XiO Training Guide


Task 5. Contouring

Sub-task 17. Create Interest Points Using the Mouse

1. Click the Create Interest Points and Markers Using the Mouse

button on the Patient File Maintenance toolbar.

2. Click your left mouse button to place an interest point in the rectum to

add an Interest Point.

OR

Place your mouse pointer in the desired location and press the (i) key on

your computer keyboard to add interest point.

NOTE: You can edit the letter that represents this hot key function by

clicking the Edit drop-down menu and selecting the

Preferences and General options.

3. Click the Edit drop-down menu and select the Interest Points option. XiO

displays the Edit Interest Point Definitions dialog box.

4. Enter Rectum in the Description field.

5. Click the OK button to close the dialog box.

Sub-task 18. Create a Marker Using the Mouse and Scales feature

1. Locate and display the cross section containing three fiducial markers on

the patient surface.

2. Click the View drop-down menu and select the Scales and Display options.

XiO toggles the scales to an "On" status in the Single Plane View.

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XiO Training Guide


Task 5. Contouring

Sub-task 18. Create a Marker Using the Mouse and Scales Feature (cont.)

3. Click your right mouse button in the Single Plane View and select the

Move Scales option.

4. Hold down your left mouse button and move the scales to intersect with

the fiducial markers.

5. With the mouse pointer located on the scales center, press the "m" key on

your computer keyboard to place a Marker Point.

OR

You can also place the point by clicking the Create Interest Points and

Markers Using the Mouse button. If you elect to use this method, hold

down the shift key on your computer keyboard and click your left mouse

button to place marker.

XiO 4-35


XiO Training Guide


Task 5. Contouring

Sub-task 18. Create a Marker Using the Mouse and Scales Feature (cont.)

6. Click the Edit drop-down menu and select the Markers option. XiO

displays the Edit Marker Definition dialog box.

7. Enter Scan Ref Pt in the Description field.

8. Click the OK button to close the dialog box.

Sub-task 19. Obtain Shift Calculations – Setup Reference Definition

You can set a scan reference point (such as, fiducial markers or the CT scan 0,0,0

coordinate) to be used to calculate shift information relative to another point. A

relative point is defined as a setup reference point, which is typically the center

of a structure, an interest point, or a beam isocenter. You can print the shift

information, or use it to drive the lasers from the scan reference point to the setup

reference point.

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XiO Training Guide


Task 5. Contouring

Sub-task 19. Obtain Shift Calculations – Setup Reference Definition (cont.)

1. Click the Tools drop-down menu and select the Setup Reference

Definition option. XiO displays the Setup Reference dialog box.

2. Leave the Report Points field defaulted to Relative to Scan Reference

Point. If you select Relative to Scan Reference Point, XiO displays the

shifts based on the chosen scan reference point. If you select Absolute,

XiO displays the shifts in the actual scanner coordinates.

3. Click your middle mouse button in the Scan Reference, Interest Point or

Marker: field and select the Scan Ref Pt marker. This is the point used as

the origin when XiO calculates the shifts.

4. Click your middle mouse button in the Setup Reference Center of Structure:

field and select the Target option. XiO calculates the spatial coordinates

from the scan reference to this point.

XiO 4-37


XiO Training Guide


Task 5. Contouring

Sub-task 19. Obtain Shift Calculations – Setup Reference Definition (cont.)

5. Click the drop-down arrow in the Gammex LMS Automove: field and

select No to ignore the auto-move option. Selecting Yes enables the lasers

to move automatically when you click the Reposition Lasers button. XiO

sends instructions to the Gammex computer. You are responsible for

loading the file to move the lasers.

6. Click OK. XiO displays the Setup Reference Definition page, which

includes shift information.

NOTE: You can print and place this page in the patient’s chart.

7. Click the Quit button.

NOTE: The Mark Anatomical Reference (from the Tools drop down

menu) option is only available if the Setup Reference

Definition has been utilized. This feature pulls in the setup

reference point defined in Setup Reference Definition and

calculates shifts relative to another anatomical reference. The

Mark Anatomical Reference dialog box is much like the Setup

Reference Definition dialog box.

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Task 6. Turning On and Off Display of Contours and Plan Objects

In PFM, you have the option of turning the display of contours and other plan

objects on or off. You can also change the Color, Rendering, and Color Fill of

contours.

Toggle the Display of Contours

1. Click the View drop-down menu and select the Enhance Contour option.

OR

Press the “C” key on the keyboard.

XiO opens the Enhance Contour dialog box.

2. Click each individual contour name to toggle it on or off.

OR

Click the All Structures On or All Structures Off button to toggle them

all.

3. Click the drop-down arrow next to the Color of a structure to see a list of

colors and select a new color.

4. Click the drop-down arrow next to the Rendering of a structure to see a list

of possible renderings. W = Wireframe, S = Solid and T25-T75 =

Transparent Rendering options. These rendering will be displayed in the 3D

view and on Transverse, Sagittal and Coronal images when Color Fill is

selected.

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Task 6. Turning On and Off Display of Contours and Plan Objects

Toggle the Display of Contours (cont.)

5. Click the drop-down arrow next to Color Fill and select Yes if you would

like to display the structure filled with color on the transverse, sagittal, and

coronal images. Select No if you would like to display the structure as

wireframe on those views.


Toggle the Display of Plan Objects

1. Click the View drop-down menu, select the Plan Objects option.

2. Place a checkmark in the box next to an individual plan object to turn

the display On.

OR

Remove the checkmark to turn the display Off.

NOTE: Plan Objects are described in more detail in the Teletherapy-

Part 2 section of the training guide.

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XiO Training Guide


Task 7: Window Format Options

You have the ability to customize the window format that displays in PFM. The

default view includes a main contouring window, a MPV window in the upper

right corner of the graphics area, and thumbnail slices displayed along the right

side of the graphics area.

1. Click the View drop-down menu and select the Window Format option.

2. Place a checkmark next to the option you want to display.

Below is a list of the display options and their individual characteristics.

Scout If you have transferred at least one scout view into XiO

from CT, this option will be available. XiO places the

scout view in the upper left corner of the graphics area.

Click your right mouse button in the Scout window to

view all the graphics options that are available. When you

movie through transverse images, a pointer displays on the

scout view that indicates the currently displayed slice

location.

MPV This view typically is on by default and displays in the

upper right corner of the graphics area. Right mouse click

in the MPV window to view all the graphics options that

are available.

Previous Select this option if you would like to display a window

where XiO displays the previously contoured transverse

image. XiO places the previous window in the lower right

corner of the graphics area. As you movie through

transverse images in the main window, the image in the

previous window will movie too, but trail by one slice,

therefore, displaying the previous slice. Click your right

mouse button in the previous window to view all the

graphics options that are available.

Four Window This option divides the main screen into four windows and

displays four consecutive images in each window. Click

your right mouse button in any of the four windows to

view all the graphics options that are available. If you use

page up/down or the up/down arrow keys to movie, XiO

updates the windows with the next four consecutive

images.

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Task 7: Window Format Options (cont.)

TSC View This option displays a four-window format featuring a

Transverse, Sagittal, Coronal and a 3D plane reconstructed

view. As contours are drawn on the transverse image,

those contours are displayed in the sagittal and coronal

views. Click your right mouse button in any of the four

windows to view all the graphics options that are available.

Select the Plane Icon option; then, click in any SPV view

to update the other two SPV views and the MPV view to

display the new plane(s).

Thumbnail This option toggles the thumbnail images on and off.

Thumbnails are used for navigational purposes and display

auto threshold contours before you accept them. This view

typically is on by default and displays along the right side

of the graphics area.

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Task 8: (Optional) Image Fusion in PFM

Not all users have Image Fusion, as it is a separate purchasable feature within

PFM.

Image Fusion is an automated tool used to fuse image sets, such as CT and MRI

images, so that contouring can be performed on either one in PFM. Before

fusion can be performed, you must import a secondary set of images under the

same patient ID as the primary studyset. For training purposes, you will access

an existing patient that has two studysets to fuse (Subtask 2); however, the steps

to create a secondary studyset can be found in the following subtask.

Subtask 1: Create a Secondary Studyset

1. Select Patient File Maintenance on the XiO Main window. XiO opens

PFM.

2. Click the File drop-down menu and select the Open option. XiO displays

the Open Patient/Studyset dialog box.

3. Click your middle mouse button in the Patient ID field and select a Patient

ID.

4. Click OK without selecting a Studyset ID.

5. Click the File drop-down menu and select the New and Studyset (image)

options.

6. Follow the same instructions from the PFM lesson to transfer in the

secondary studyset.

Subtask 2: Open the Patient for Fusion

1. Click the File drop-down menu and select the Open Patient for Fusion

option. XiO displays the Open Patient and Run Fusion dialog box.


ID.

3. Click OK. XiO opens the Fusion module and displays an Open Study

dialog box.

4. In the window labeled Primaries, expand the patient folder by clicking on

the plus sign + next to the folder.

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Subtask 2: Open the Patient for Fusion (cont.)

5. Click the name Studyset: CT so that it is highlighted in blue. XiO places

all new and existing secondary studysets in the New and Existing

Secondaries windows to the right of the Primaries window.

NOTE: If the images have previously been fused, the secondary

studyset appears in the Existing Secondaries window. If the

images have never been fused, the secondary studyset appears

in the New Secondaries window.

6. Click the secondary studyset name MRI/MRI in the New or Existing

Secondaries window. XiO displays the Primary and Secondary Image

Background removal options.

NOTE: Before fusing the images, XiO may need to remove

background data. There are two methods that can be used and

the third does not remove the background. Typically, the

Shape /Intensity Model works best.

Shape Intensity Model: Use the patient shape and intensity

to remove the background outside the patient.

RE Segmentation: Use relative entropy to remove the

background outside the patient.

Keep Patient Exterior: This option does not remove the

background

7. Use the default Shape/Intensity Model and click OK. XiO loads the

primary and secondary studysets.

Subtask 3: Fusion Tools and AutoRegistration

1. You can manually translate secondary studysets by holding down your

left mouse button inside the circle on any image and translating.

2. You can manually rotate secondary studysets by holding down the left

mouse button anywhere outside the circle on any image and rotating.

3. You can adjust the Window and Level of the primary or the secondary

using the slider bars.

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Subtask 3: Fusion Tools and AutoRegistration (cont.)

4. You can change the Colormap of the secondary studyset to any of seven

(7) options, from the Secondary slider bar.

5. You can fade from the primary to the secondary using the Fader bar.

6. There are zooming and measuring tools on the tool bar.

7. Slightly translate and rotate the image manually in any view; then, click

the AutoRegister button. XiO automatically fuses the images.

8. XiO displays the AutoRegistration Status in the second window on the top.

9. When you are finished, click the File drop-down menu and select the Save

Registration option.

10. Click the File drop-down menu and select the Exit option to close. XiO

closes the Fusion module and displays the Open Patient/Studyset dialog

box.

Subtask 4: Open Fused Studysets in PFM

1. Click your middle mouse button in the Studyset ID box and select the

primary studyset. (This should always be the planning CT). XiO expands

the Open Patient/Studyset dialog box to prompt for a Secondary Studyset

ID.

2. Click your middle mouse button and select the Secondary Studyset ID.

3. Click OK. XiO loads the fused images into PFM.

4. Toggle the display between fused Primary data (1 ) and Secondary data (2 )

using the 1º and 2º buttons.

NOTE: The MRI studyset represents a smaller area than the CT, so

there will not be an MRI image for every CT image. Movie

towards the prostate to see the MRI images for this patient.

5. Use the window level tools or presets to adjust the window and levels if

needed for each studyset.

6. You can contour on either studyset or both. You can also begin the

contouring on one studyset, and end on another.

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XiO Training Guide

Teletherapy

Overview

The Teletherapy lesson has been separated into two parts. Part 1 is functional in nature

where you create a plan for the prostate patient you contoured in Patient File

Maintenance. (If you skipped the PFM section, you may create a new plan using an

existing contoured prostate patient.) As you plan, new functions and features are

introduced at the most appropriate point in the process. This section is organized such

that you could use the process as a template for planning in your own clinic. However,

XiO is limitless in the number of ways you could accomplish these tasks.

Part 2 introduces additional Teletherapy features and functionality, but in more of a

feature-by-feature approach.

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Teletherapy – Part 1

Practice Exercise

Explanations, references and alternative steps (when applicable) for each field are

provided as you navigate through this lesson. First, you will open a patient in

Teletherapy, learning how to adjust the major graphical display options, and creating

and mirroring beams with ports so that you end up with a simple four-field prostate plan

giving a total dose prescription of 4500 cGy using 180 cGy per day. Next, you will

continue reviewing isodoses, normalizing, and evaluating the plan. This completes the

planning process. Then, you will review the various functions available in XiO.

If you are continuing from Patient File Maintenance (PFM), begin with Task 1A.

If you have exited PFM and would like to open the patient directly in Teletherapy, begin

with Task 1B.

Task 1A. Open the Patient in Teletherapy (from PFM)

Follow these steps if you have completed contouring the prostate patient in Patient File

Maintenance and are ready to continue with planning.

1. Click the Beam icon. XiO displays the New Teletherapy Plan dialog box.

2. The Patient ID automatically defaults.

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Task 1A. Open the Patient in Teletherapy (from PFM) [cont.]

3. (Optional) Enter a description for this plan, such as "prostate."

4. Select the Beam Weighting Mode Absolute Dose/MU. The options are Absolute

Dose/MU or Relative Dose.

5. The Treatment Date defaults to today’s date; however, this date is editable.

6. The Studyset ID defaults.

7. Create as 2D plan defaults to No. You will only be able to edit this option if you

have ten (10) slices or fewer.

8. Enter Head as the option for Head/Feet toward gantry. This option determines

how you will plan the patient regardless of how the patient was scanned. For

example, if the patient was scanned with the head towards the gantry and you

want to treat the patient with the feet towards the gantry, in PFM transfer in the

patient as scanned; then, at this prompt, enter Feet. The patient displays as feet

towards the gantry for planning purposes.

9. Select the Graphics Area Setup 6TSCMxA. These are predefined preset window

arrangements; however, you can create your own user-defined presets. This

option creates a screen with six windows containing a Transverse, a Sagittal, a

Coronal and Multi-Plane View (3D), a blank window and an Active Beam’s-Eye

View.

10. The alternative to selecting a Graphics Area Setup is to select a Template.

Templates are user-created default plans that can be applied to any patient. Items

that are saved with templates include, but are not limited to, the following: beam

arrangements, graphics area setups, prescriptions, wedges, heterogeneity settings,

grid spacing, ports, IMRT segments, etc. See section 13 in this training guide for

more information regarding templates.

11. Click OK. XiO opens the patient in the Teletherapy workspace.

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Task 1B. Open the Patient in Teletherapy (from the Main XiO screen)

Follow these steps if you have exited Patient File Maintenance and would like to open

and plan a completely contoured prostate patient.

1. Click the Teletherapy option on the XiO main screen, or select Teletherapy from

the Run drop-down menu. XiO displays the Teletherapy workspace.

2. Click the File drop-down menu and select the New Teletherapy Plan option.

XiO displays the New Teletherapy Plan dialog box.

3. Click your middle mouse button in the Patient ID box and select the patient ID

MRProstate.

NOTE: You can sort the patient list by Patient ID, Patient Name, or

Creation Date by selecting one of these options in the Patient List

Sorted By: list before you select a patient ID.

4. (Optional) Enter a description for this plan, such as "prostate."

5. Select the Beam Weighting Mode Absolute Dose/MU. The options are Absolute

Dose/MU or Relative Dose. If you plan to create composite plans or IMRT plans,

you must use Absolute Dose/MU. Absolute Dose/MU mode allows more

flexibility when normalizing and prescribing than Relative Dose Mode.

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Task 1B. Open the Patient in Teletherapy (from the Main XiO screen) [cont.]

6. Today’s date defaults as the treatment date; however, this date is editable.

7. Select the Studyset ID 3DProstate.

8. Create as 2D plan defaults to No. You will only be able to edit this option if you

have 10 slices or fewer.

9. Enter Head as the option for Head/Feet toward gantry. This option determines

how you will plan the patient regardless of how the patient was scanned. For

example, if the patient was scanned with the head towards the gantry and you

want to treat the patient with the feet towards the gantry, in PFM, transfer in the

patient as scanned; then, at this prompt, enter Feet. The patient displays as feet

towards the gantry for planning purposes.

10. Select the Graphics Area Setup 6TSCMxA. These are predefined preset window

arrangements; however, you can create your own user-defined presets. This

option creates a screen with six windows containing a Transverse, Sagittal,

Coronal, and Multi-plane view (3D), a blank window, and an Active Beam’s-Eye

View.

11. The alternative to selecting a Graphics Area Setup is to select a Template.

Templates are user-created default plans that that can be applied to any patient.

Items that are saved with templates include, but are not limited to, the following:

beam arrangements, graphics area setups, prescriptions, wedges, heterogeneity

settings, grid spacing, ports, IMRT segments, etc.

12. Click OK. XiO opens the patient in the Teletherapy workspace.

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Task 2. Graphical Display Options

Before you begin planning, you may want to make a few small changes to the images

displayed on your screen. This task discusses a few of the graphics manipulation tools

that are always available during planning.

Activate a Window

Activate a window by left-or-right mouse clicking in any window that is not blank. A

red box displays around the perimeter of the selected window.

Scale

Scale is used to increase or decrease the size of the item displayed in that window.

1. Right mouse click in any selected window then click your left mouse button and

select the Scale option.

2. Hold down the left mouse button in the selected window and drag from left to

right to increase or decrease the size of the image in that window.

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XiO Training Guide


Task 2. Graphical Display Options (cont.)

Window/Level

Adjust the window and level of the CT image data in an SPV window. You can use the

Window/Level option found on a right mouse click, use the W/L slider bars on the right

side of the screen, or use the saved preset window/level options. A default is set so that

the window/level affects all the windows together. If you would like the window/level

to affect only one window, click the icon W/L currently affects multiple windows

above the window/level slider bars so that it changes to this icon W/L currently

affects active window.

1. Click your right mouse button and select the Window/ Level option.

2. Hold down the left mouse button in the selected SPV window and drag from left to

right to adjust the level or up and down to adjust the window.

OR

Hold down the left mouse button on the window or level slider bar and drag up or

down to change the window and level.

OR

Select a saved preset window/level option from the drop down list in the upper

right corner of the XiO toolbar.

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Task 2. Graphical Display Options

Window/Level (cont.)

3. In this lesson, select the window/level preset Soft Tissue.

Here are steps you can use to save your own

window/level presets.

(1) Set the window and level you want to

save.

(2) Click the (Save) W/L button.

(3) Enter a New Preset Name in the pop-up

window.

(4) Click OK to add the preset, or Cancel if

you do not want to save the preset.

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Movie

In any SPV window, you will have a Movie option that allows you to movie through

your transverse, sagittal or coronal images. In a transverse image window, you can

movie through actual CT slices or reconstructed CT slices. In the sagittal or coronal

window, you can only movie through reconstructed slices. The slice spacing is user-

definable. Click the Edit drop-down menu and select the Preferences and General

options.

1. Click your right mouse button in any SPV window and select the Movie option.

2. Click your left mouse button to movie towards the foot.

3. Click you middle mouse button to movie towards the head.

4. If you have a Linux operating system and scroll-wheel mouse, you can use the

scroll wheel to movie the images from head to foot.

Pan

You can use pan to move the graphic image around in any window.

1. Click your right mouse button in any window and select the Pan option.

2. Hold down the left mouse button and drag the graphic image around the window.

3. Click your middle mouse button to reset the graphic image back to its original

location.

Rotate

This option is only available in an MPV window. Select this option to rotate the 3D

image.

1. Click your right mouse button in the MPV window and select the Rotate option.

2. Hold down the left mouse button and drag the image around the window.


position.

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Translate

This option is only available in an MPV window. Select this option to translate the axis

of rotation off the center of the patient.

1. Click your right mouse button in the MPV window and select the Translate

option.

2. Hold down the left mouse and move the image around the screen.

3. The next time you rotate, you will notice that the image is translated off its

original axis of rotation.


position.

Maximize/Restore

1. Use these options to zoom and restore any one window to full screen and back.

2. Click your right mouse button in any window and select the Maximize option.

XiO zooms that window to full screen.

3. Click your right mouse and select Restore. XiO returns to the original window

format.

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Task 3. Add and Edit a Beam

This task demonstrates how to add a new beam, edit the beam parameters, and

manipulate the beam using the mouse.

1. There are three ways to add a new beam.

(1) Click the New Beam button on the toolbar.

(2) Press the F5 button on the keyboard.

(3) Click the Beam drop-down menu and select the New Beam option.

XiO displays the New Beam dialog box.

2. The beam number defaults to 1; however, you can enter a different beam number.

3. Enter the beam Description AP. Descriptions are always optional; however, it is

customary to label each beam.

4. Click your middle mouse button in the Machine ID box and select the Machine ID

Varian18x with a left mouse click.

5. Use the default Setup SAD. The options are SAD, SSD and Rotational.

6. If necessary, change the Collimator Jaw setting from Symmetric to Asymmetric.

You will only have asymmetric as an option if your linear accelerator has the

asymmetric jaw capability, and the machine data entered in XiO is validated for

asymmetric jaws.

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Task 3. Add and Edit a Beam (cont.)

7. Use the default Center of PTV1 for the Beam Isocenter Placement. Your options

consist of the center of any structure that you contoured, the studyset center, any

interest point or marker that you added or the isocenter of any beam that you

added.

8. Click OK to continue. XiO displays the Photon Beam dialog box.

9. You have already determined the Description, Machine ID, Setup and Collimator

Jaw settings; however, at this point, they are editable.

10. XiO displays the Treatment Distance and Source to Skin Distance, but they are not

editable since the Setup is SAD. The SSD is measured from the isocenter to the

patient surface contour. When the gantry is rotated, XiO updates the SSD.

NOTE: When you select SSD for the Setup, the Treatment Distance is

editable. When you select Rotational, XiO displays the start and stop

SSDs and the Treatment Distance, but they are not editable.

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11. Use the default Field Size values. For asymmetric jaws, you can manually edit

the field size by entering values for LW (left width), RW (right width), UL (upper

length) and LL (lower length). For symmetric jaws, you can manually edit the

field size by entering values for Width and Length. You can also edit the

collimator jaws using the mouse.

Here are steps you can use to edit the width and length

of the collimator jaws using the mouse.

(1) In any ABV (active beam’s-eye view) or BEV

(beams-eye view) window, click your right

mouse button and select Width Jaws when in

symmetric mode. In asymmetric mode, select

LW/RW Jaws.

(2) Place your pointer on a width edge of the

collimator. Hold down the left mouse and drag

to the right or left to open or close the collimator

jaw. If you have asymmetric jaws selected, only

the selected width edge will move. If you have

symmetric jaws selected, both the width jaws

will move.

(3) Notice that the collimator width automatically

updates on the Photon Beam dialog box. If you

do not have the Photon beam dialog box

displayed, you can still edit the collimator jaws as

long as the Beam Button is highlighted. XiO

displays the updated jaw settings in the bottom

left corner of the screen.

(4) To edit the length with the mouse when in

symmetric mode, click your right mouse button in

the ABV window and select. Length Jaws. In

asymmetric mode, select UL/LL Jaws.

(5) Follow the same instructions outlined in Steps 2

and 3, only drag the mouse up or down to open or

close the collimator jaws and the length updates

on the Photon beam dialog box.

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12. Use the default Gantry Angle of zero for the AP beam. You can manually edit

the gantry angle by entering a value or by using the mouse.

Here are steps you can use to rotate the gantry

using the mouse.

(1) In the transverse image window, click your

right mouse button and select Gantry

Angle.

(2) Place your pointer where the beam

intersects the patient surface; hold down

your left mouse button and drag (rotate) the

beam to a new gantry angle.

(3) Notice that the SSD updates on the Photon

Beam dialog box. If you do not have the

Photon beam dialog box displayed, you can

still rotate the gantry as long as the Beam

Button is highlighted. XiO displays the

updated gantry angle in the bottom left

corner of the screen.

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13. Use the default Collimator Angle of zero for the AP beam. You can manually

edit the collimator angle by entering a value, or by using the mouse.

Here are steps you can use to edit the collimator angle

using the mouse.

(1) In any ABV (active beams-eye view) or BEV

(beam’s-eye view) window, click your right

mouse button and select the Collimator Angle

option.

(2) Place your pointer on any edge of the collimator;

hold down your left mouse button and drag to

rotate the collimator.

(3) Notice that the collimator angle automatically

updates on the Photon Beam dialog box. If you

do not have the Photon beam dialog box

displayed, you can still edit the collimator angle

as long as the Beam button is highlighted. XiO

displays the updated collimator angle in the

bottom left corner of the screen.

14. Use the default Couch Angle of zero (0) for the AP beam. You can manually edit

the couch angle by entering values.

15. The Isocenter for this plan has already been selected (Center of PTV1); however,

you can edit it here if necessary. Click your middle mouse button in the Default

to: box and select a different isocenter from the pop-up window list. Click the

Quit button on the pop-up window if you do not want to select a new isocenter.

You may also edit the X, Y, and Z coordinates by entering new values or using the

mouse to select an isocenter location.

NOTE: When you mirror or copy a beam, XiO copies the isocenter from the

original beam; however, each beam can have its own isocenter.

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Here are steps you can use to edit or define the

isocenter location using the mouse.

(1) Click your right mouse button in any SPV (single

plane view), ABV, or BEV window and select

Isocenter Move.

(2) Click your left mouse button in any of these

windows where you would like the isocenter to be

located. XiO automatically places the beams

isocenter in that location and updates all the

windows.

16. Use the default Weight Defined At: of Arb. Point (arbitrary point) and Default to:

beam 1 isocenter. When arbitrary point is selected, you must select the actual

point you want as your weight point by clicking your middle mouse button in the

Default to: box and selecting an option from the pop-up window, or by using the

mouse to place the weight point.

NOTES: (1). When you select arbitrary point for the weight point, you have

the option of displaying the coordinate location of this point in

beam coordinates or in patient coordinates by clicking the

button next to Location to toggle. When you choose in patient

coordinates, you cannot move the weight point with the mouse

on an ABV or BEV.

(2). When symmetric jaws are set as the default collimator, the

other three options besides arbitrary point are:

Isocenter — where XiO places the weight point at isocenter

Ref. Depth — where XiO places the weight point at Dmax or

reference depth in the center of the field

Def. Depth — where XiO places the weight point at a depth

that you define in the center of the field. When you select this

option, XiO displays a new box labeled Depth of Weight where

you can enter a value for the defined depth.

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(3). When asymmetric jaws are set as the default collimator, the

other three options besides arbitrary point are:

Iso.Depth Fld.Ctr. — where XiO places the weight point at

isocenter depth in the center of the asymmetric field.

Ref.Depth Fld.Ctr. — where XiO places the weight point at

the Dmax or reference depth for that machine, and at the center

of the asymmetric field.

Def.Depth Fld.Ctr. — where XiO places the weight point at a

depth that you define and at the center of the asymmetric field.

When you select this option, XiO displays a new box labeled

Depth of Weight where you can enter in a value for the defined

depth.

(4). When you mirror or copy a beam, XiO copies the weight point

from the original beam; however, each beam can have its own

weight point.

Here are steps you can use to edit or define the weight

point location using the mouse.

(1) In any SPV, ABV or BEV window, click your

right mouse button and select Weight Point

Loc.

NOTE: You will not be able to change the

weight point location in an ABV or BEV

if the Location button is toggled to in

patient coordinates.

(2) Click your left mouse button in any of these

windows where you would like the weight point

to be located. XiO automatically places the

weight point in that location and updates all the

windows. (If you do not see the weight point in

the ABV or BEV window, it could be behind or

in the center of a structure that is rendered as

solid. If you render each structure as transparent

or wireframe, you will be able to see the weight

point in an ABV or BEV window.)

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17. For this lesson, enter a Weight (cGy) of 1125 and Number of Fractions of 25.

You will plan to create a four-field prostate plan to a total dose of 4500 cGy using

180 cGy per day. XiO allows you to enter any combination of weight and number

of fractions that you want.

For example, you can plan a daily dose treatment by entering the daily dose per

beam and one fraction, or you can plan total dose by entering the total dose per

beam and entering the total number of fractions, or enter a relative dose per beam

(for example, use a weight of 25 for each of four beams to add up to 100) and

rescale to actual doses when the plan is complete.

18. If you plan to use bolus on a beam every other day, you must have at least two

fractions defined for each beam. You should also enter the weight for at least two

fractions.

19. Use the default value of 1.00 for the Composite Tray Factor. This value

represents the block tray factor multiplied by the compensating filter tray factor

(when there is one). You will enter a block tray factor later when you create a

block.

20. Use the Calculation Algorithm: Convolution. You can select other options for

algorithm, like Clarkson, Superposition and Fast Superposition by clicking your

middle mouse button in the Calculation Algorithm box and selecting another

algorithm from the pop-up window list. Click the Quit button on the pop-up

window if you would like to close the window without selecting a different

algorithm.

21. Use the default value of Weight Fan to determine the SSD to use for machine

table lookups when the CAX is outside the patient. The option entered in this

field only applies when the central axis is outside the patient. The other options

are Field Center and User-Defined. If you choose User-Defined, XiO adds

another box where you can enter the user-defined Distance.

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22. Use the default value of 4.0 for Minimum TERMA Extents. XiO only uses this

value if you are planning with the Convolution or Superposition algorithm. XiO

adds at least four fanlines beyond the collimator edge to the smaller of the

minimum TERMA extents or the calculation volume. This ensures that scatter

and penumbra are properly modeled when using these algorithms.

23. Click OK to close the Photon Beam dialog box.

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24. If you would like to make edits to any values on the Photon Beam page after you

have closed it, select the beam you would like to make edits to in the Active Beam

box in the upper right corner of the screen; then, select one of the following three

methods to open the photon beam page.

(1) Click the Edit Beam button.

OR

(2) Click the Beam drop-down menu and select the Edit Beam option.

OR

(3) Press the B button on the keyboard.

XiO displays the Photon Beam dialog box.

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25. Click the Display BEV/DRR button to turn on the Digitally Reconstructed

Radiograph (DRR). See the section on Digitally Reconstructed Radiographs in

this training guide for more information on DRR manipulation.

26. Use the window and level tools discussed in Task 2 to adjust the window and level

of the DRR image.

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Task 4. Create an Auto Port

In XiO, a port is defined as an open area through which the beam travels to treat the

patient. A port could consist of MLCs, blocks, apertures, or a combination of MLCs

and blocks or apertures and blocks. Auto ports are ports that can be generated by

selecting a structure to encompass using a specific margin. You can create Auto Ports

while in the Beam or Port mode.

1. There are many ways you can create an auto port. The most common methods are

as follows:

(1) Click the Auto Port button when in Beam or Port mode.

(2) Click the Port drop-down menu and select the Auto and Active Beam

options.

XiO displays the Auto Port dialog box.

2. Click your middle mouse button in the Auto Margin To: field and select PTV1.

This is the structure you want to place an auto port around.

3. Enter 1.5 cm for With Margin. This is the margin XiO uses around the structure

to create the port.

4. Click the Calculate MLC button. XiO automatically generates the MLC.

NOTE: For this training lesson, MLCs are chosen to create a port. If you do

not want to use MLCs, you may choose Aperture and ignore all

MLC related comments.

5. Click OK. XiO closes the Auto Port dialog box.

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Task 4. Create an Auto Port (cont.)

6. Click the Port drop-down menu and select the Conform Collimator, Active

Beams, or Multiple Beams option. This action opens or closes the collimator

jaws for one or all beams so that the aperture fits inside. If asymmetric jaws are

used, the jaws conform asymmetrically. If symmetric jaws are used, the jaws

conform symmetrically.

NOTE: You also have the capability to default the jaws to conform to a set

step increment, like the nearest half-centimeter when you click the

Edit drop-down menu and select the Preferences and Port options.

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Task 5. Mirror a Beam

This task demonstrates how to oppose a beam using the Mirror Beam option. If you

have a port on the original beam, the opposed beam is created with a mirrored port.

1. There are three ways you can mirror a beam.

Click the Mirror Beam button.

OR

Press F8 on the keyboard.

OR

Click the Beam drop-down menu and select the Mirror Beam To … option. XiO

mirrors the beam to the selected beam number. Click OK. XiO opens the Photon

Beam dialog box for the new beam. If you have a port on the beam, XiO will also

mirror the port.

2. Enter PA for the beam Description and leave all other values to their defaults.

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Task 5. Mirror a Beam (cont.)

NOTE: XiO remembers beam parameters such as isocenter location, weight

point location, weight and number of fractions so that when you

mirror or copy a beam, the same information is applied to the new

beam; however, XiO allows you the flexibility to change those point

locations or values for each individual beam.


of the DRR image.

4. Click OK. XiO closes the Photon beam dialog box.

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Task 6. Copy a Beam

This task demonstrates how to copy a beam to create a new beam. In this task you will

copy a beam; then, rotate it to a lateral position. When you copy and rotate the beam,

the MLC port, which was created as an auto port, will automatically update to the

specified margin around the target. When you copy a beam that has a port, be aware

that there is a properties setting to determine if the port will update when you rotate the

gantry, or if the port will remain static as copied. To review, click the Port drop-down

menu and select the Port/Properties and Auto-Generated Blocking Updates with

Beam Movement options. In this task, you will also mirror the copied beam to create

beam 4.

1. There are three ways you can copy a beam.

Click the Copy Beam button.

OR


OR

Click the Beam drop-down menu and select the Copy Beam To… option. XiO

copies the beam to the selected beam number. Click OK. XiO opens the Photon

Beam dialog box for the new beam.

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Task 6. Copy a Beam (cont.)

2. Enter RT LAT for the beam Description.

3. Enter 270 degrees for the Gantry Angle or use the instructions from Task 3 to

rotate the gantry with the mouse to 270 degrees. XiO updates the beam display.

NOTE: If you have an Auto Port on this beam, it will automatically update

as the gantry rotates, when the port property "Auto-Generated

Blocking Updates with Beam Movement" is set to Yes.

4. Click OK. XiO closes the Photon Beam dialog box.

5. To display a DRR, click the Display BEV/DRR button. XiO displays the DRR in

the ABV window.


of the DRR image.

7. To mirror this beam, click the Mirror Beam To… button. XiO mirrors the beam

to the selected beam number.

8. Click OK. XiO displays the Photon Beam dialog box for beam 4.

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Task 6. Copy a Beam (cont.)

9. Enter LT LAT for the beam Description. Leave all other fields to their default

values.

10. Click OK. XiO closes the Photon Beam dialog box.

11. To display a DRR for beam 4, click the Display BEV/DRR button. XiO displays

the DRR in the ABV window.


of the DRR image.

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Task 7. Change the Active Beam in the ABV (Active Beams-eye View) Window

This task demonstrates how to change the active beam displayed in the ABV window.

If you would like to review each beam in the ABV window, select a beam from the

drop-down menu in the Active Beam box located in the upper right corner of the

screen.

OR

You can quickly select beams by pressing the number (1, 2, 3, etc…) of the beam on the

keyboard. Just make sure the mouse pointer is located anywhere in the graphics

window area when you select the beam number on the keyboard.

Technically, you have completed all the tasks necessary to create a simple prostate plan.

You will know that the plan is calculated when you see the Dose Valid confirmation in

the bottom right corner of the screen.

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Task 8. Display Isodoses

This task demonstrates the various options you have to display isodose values. This

includes how to display isodose values in an MPV (3D) and BEV window.

1. Click the Dose drop down menu and select the Isodose Lines option.

OR

Click the I key on your computer keyboard.

OR

Click the Dose button (Shift + F4); then, click the Isodose Lines button (F9).

XiO displays the Isodose Lines dialog box.

2. Enter the following isodose line values: 4500, 4275, 4050, and 2250. Isodose lines

display on all SPVs. Colors and renderings are automatically assigned, but can be

edited. (See XiO Help for more information on rendering options.)

3. To display the isodose values in an MPV window, click the Dose in MPV

button (F10).

OR

Click the Dose drop-down menu and select the Dose in MPV option.

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Task 8. Display Isodoses (cont.)

4. To display the isodose values in a BEV window, click the Dose drop-down menu

and select the Dose in BEV option.

NOTE: When you make edits to the plan, ports, etc, the original dose display

remains on the BEV until the dose is recalculated.

5. If you would like your isodose lines to be thicker, change the option for Thick

Lines to yes.

6. Turn isodose values on/off by clicking the on/off button next to the selected

isodose line.

OR

Turn all isodose values on or off by clicking the All Isovalues On or All Isovalues

Off button.

7. If you would like to display the isodose values in a colorwash or isofill, select the

appropriate option next to Dose Display Mode. (See XiO Help for more

information on the various dose display modes).

8. If you would like to clear all the isodose values on the list, click the Clear

Isovalues button.

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Task 8. Display Isodoses (cont.)

9. If you have created lists of preset isodose values, you can select them from the

Load Isodose Line Preset box.

OR

You can save the currently displayed set of Isovalues as an Isodose Line Preset

that can be used in the future by clicking the Save Isovalues button and entering a

unique name for the list.

10. Click OK on the Isodose Lines dialog when finished entering isodose values.

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Task 9. (Optional) Evaluate Point Doses Using the Reference Dose Cursor

Once a plan has calculated, XiO allows you to evaluate your plan using a dose cursor.

1. Click your right mouse button in any SPV window and select the Reference

Point Loc option.

2. Hold down your left mouse button and drag.

OR

Click your left mouse button in any SPV to update the point dose and point

coordinates located (in yellow) in the upper right corner of each SPV window.

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Task 10. Normalization of Dose Display

In XiO, there are two distinct ways to display dose; absolute dose and percent dose. No

matter how you normalize the dose display on the screen, none of the options affect the

weighting or monitor unit calculation.

Absolute Dose Normalization

Absolute is the default normalization option. If you do nothing, doses display as

absolute doses. The current normalization option is always displayed in the upper left

corner of each image window.

Global Maximum, Selected Point and Selected Dose Normalization

These represent three different ways to display doses as a percentage. Follow the steps

below to learn about these display options and how to apply them.

NOTE: If dose in MPV and /or BEV are turned on, you may notice a lag when

clearing and entering new isodoses. Turn off the display in these windows

to avoid this lag.

1. Click the Dose drop-down menu and select the Normalization button.

OR

Click the Set Normalization Mode button (F7). XiO displays the Dose

Normalization dialog box.

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Task 10. Normalization of Dose Display

Global Maximum, Selected Point and Selected Dose Normalization (cont.)

2. Click the Global Maximum option. XiO updates the dose display such that the

Global Max (hottest point dose) of the entire plan is equal to 100%. Check the

upper-left corner of any image window to verify that the normalization has

changed to gmax. The isodose lines should also update to reflect the percentages

displayed in the SPV window.

3. Normalizing to a Selected Point is a two-step process. First, you must select the

point to which you would like to normalize. Click your middle mouse button next

to Default To: under the Reference Point Position heading and select a point

(usually, this is isocenter).

OR

Click your right mouse button in any SPV and select the Reference Point Loc.

Hold down the left mouse button and drag or click the left mouse button in any

SPV to select the point location where you would like to normalize.

4. Click the Selected Point option. XiO updates the dose display such that the

selected point is now equal to 100%. Check the upper left corner of any image

window to verify that the normalization has changed to Pnt. The isodose lines

should also update to reflect the percentages displayed in the SPV window.

5. Normalizing to a Selected Dose is a two-step process. First, you must select the

dose value to which you would like to normalize. Typically, this is total dose or

total of all the beam doses, but you can enter any value you desire. Enter 4500 in

the field next to the Selected Dose button.

6. Click the Selected Dose button. XiO updates the dose display such that the

selected dose is now equal to 100%. Check the upper-left corner of any image

window to verify that the normalization has changed to Dose. The isodose lines

should also update to reflect the percentages displayed in the SPV window.

7. Click Cancel when you have finished normalization.

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Task 11. Beam Weighting and Rescaling

After the plan is complete, you may want to review your beam weights, or possibly

rescale them. If you have a composite plan and want to display the dose for one plan at

a time, you can turn on or off ALL or selected beams from the Beam Weights page.

1. Click the Dose drop down menu and select the Weight option.

OR

Click the Beam Weight button (F12). XiO displays the Beam Weight dialog

box.

2. Turn all beams and doses on or off by clicking the All Doses On/Off button.

3. Click the Update Display to Reflect Changes button, if needed.

4. Turn on or off individual beam doses by clicking the on/off button under Stat for

each beam.

5. Click the Update Beams to Reflect Changes button, if needed.

6. Weight, Monitor Unit and Fraction values are all editable by entering a new value.

When you edit one value, XiO updates all other affected values to reflect changes.

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Task 11. Beam Weighting and Rescaling (cont.)

7. Click OK to Close the Beam Weights dialog box.

OR

Follow the steps below to rescale to a selected point or selected isodose line.

Here are steps you can use to Rescale the Prescribed

Dose to a selected point.

(1) Click the Rescale (Prescribe) Beam Weights

button.

(2) Next to Prescribe To, select Point.

(3) Under the Prescription Point heading, select the

default point or type in X, Y, Z coordinates.

(4) Enter the new Prescribed Dose you want to

deliver to that point.

(5) Click OK. XiO returns you to the Beam Weights

page.

Isodoses, Beam, Weights, and Monitor Units

automatically update.

NOTE: If you used Selected Dose as your

normalization option, you may want to

update the dose to reflect the rescale.

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Task 11. Beam Weighting and Rescaling (cont.)

Here are steps you can use to Rescale the Prescribed

Dose to a selected isodose line.

(1) Click the Rescale (Prescribe) Beam Weights

button.

(2) Next to Prescribe To:, select Isodose Line.

(3) Enter the Isodose Value (cGy) to which the

rescaled dose will be prescribed.

(4) Enter the new Prescribed Dose you want to

deliver to that isodose line.

(5) Click OK. XiO returns you to the Beam Weights

page.

(6) Isodoses, Beam, Weights, and Monitor Units


NOTE: If you used Selected Dose as your

normalization option, you may want to

update the dose to reflect the rescale.

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Task 12. Dose Volume Histogram

After a plan has been calculated, you can evaluate it using a dose volume histogram.

This section reviews the quick method to display and manipulate the DVH and the more

comprehensive tools that can be used to evaluate a DVH.

Display a Quick DVH

1. Click the Histogram button. XiO displays the Histogram dialog box.

NOTE: If you do not have an empty window for the DVH to display, XiO

first displays a Select Window dialog box. Enter a window number

and click OK.

From this dialog box, you can turn on or off and change the color for as many

DVH curves as you desire.

You can change the axis labels and /or choose to display the curves as cumulative

or differential. See XiO Help for more information on DVH types.

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Display a Quick DVH (cont.)

2. Click OK when you are finished adding structures to your DVH.

Here are steps you can follow to manipulate the DVH

curves using the mouse.

(1) Click your right mouse button in the DVH

window and select the Histogram Cursors

option.

(2) Hold down the left mouse button and drag to the

right. You will see a red dose cursor move

across the screen. XiO displays the dose

represented by the red cursor in the lower left

corner of the DVH window. The Cursor

Volume for the selected structure changes as you

move the cursor. This represents the volume of

the structure that is receiving the dose

represented by the cursor.

(3) Hold down your middle mouse button and drag

to the right. XiO displays a yellow dose cursor

moving across the screen, and displays the dose

represented by the yellow cursor in the lower-

right corner of the DVH window. This is an

optional dose cursor that could be used in a case

where you want to know the volume of a

structure between a range of doses. The Cursor

Volume Difference for the selected structure

changes as you move the cursor. This represents

the volume of the structure that is receiving the

range of doses represented by both cursors.

NOTE: If the Inclusion of a structure is not

100%, the volume reported my not

be what you would expect.

Inclusion is the percentage of the

volume of a particular structure that

falls within the Dose Calculation

Region. The cursor volume or

cursor volume difference is only

based on the percent of the volume

that is included in the Dose

Calculation Region.

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Display a Quick DVH (cont.)

(4) Click your right mouse button and select the

Movie option.

(5) Click your left or middle mouse button to toggle

through each structure’s set of information.

(6) To return to the structure list to make more edits,

click your right mouse button and select the

Histogram Edit option. XiO displays the

Histogram dialog box.

Using the Comprehensive DVH Tools

1. Click the Dose drop-down menu and select the Histogram and New/Edit options.

XiO displays the Full Histogram dialog box.

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Using the Comprehensive DVH Tools (cont.)

2. Here you can edit the Sampling Resolution and Dose Binning Parameters.

These parameters deal with the spacing between calculation points and the

resolution of the DVH graph. See XiO Help for more information.

3. If you would like the histogram report to be printed when you print the histogram

graph, select Yes next to Include Histogram Report with Print.

4. Select a window where you would like the DVH graph to be displayed next to

Display DVH in Window #.

5. Click OK. XiO displays the Histogram Report dialog box.

NOTE: The comprehensive DVH tools allow only seven structures to be

displayed while in use. If you already have a DVH displayed in the

window you selected, and it has more than seven structures, XiO

opens the quick Histogram dialog box instead of the Histogram

Report dialog box. If this happens, turn off as many structures as

needed until you have seven or fewer, then repeat steps 1-5.

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6. Enter a Name for the histogram.

7. Under Anatomical Structures, click on the number next to the name of the

structure you want to add to the graph. XiO displays the name of the structure just

below the Anatomical Structures list.

8. Click Accept next to that structure to add it to the graph.

Follow these instructions to create a structure

combination.

(1) Click the number next to the first structure you

would like to add. XiO displays the name of the

structure just below the Anatomical Structures

list.

(2) Click the With (+) button.

(3) Click the number next to the second structure

you would like to add. XiO now displays the

structure names in the following format

"structure 1 + structure 2."

(4) Click Accept. XiO adds the structure

combination to the DVH graph.

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Follow these instructions to subtract one structure

volume from another.

(1) Click the number next to the structure from

which you would like to subtract another

structures volume. XiO displays the name of the

structure just below the Anatomical Structures

list.

(2) Click the Without (-) button.

(3) Click the number next to the structure you want

to subtract from the first. XiO now displays the

structure names in the following format

"structure 1 - structure 2."

(4) Click Accept. XiO subtracts the second

structures volume from the first and displays the

new volume on the DVH graph.

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Follow these instructions to create a structure that is

the intersection of two structures.

(1) Click the number next to the first structure. XiO

displays the name of the structure just below the

Anatomical Structures list.

(2) Click the Inside (*) button.

(3) Click the number next to the second structure.

XiO now displays the structure names in the

following format "structure 1 * structure 2."

(4) Click Accept. XiO displays the intersection of

the two structures as a new structure on the DVH

graph.

NOTES: (1) The Undo button will always

undo the last step, or remove

the last structure added before

you accept.

(2) You can combine multiple

(more than 2) structures using

any combination of With,

Without, or Inside.

9. Change the Axis Labels if desired. See the XiO Help for more information.

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10. Change the upper limit of the Scale for the DVH graph. See the XiO Help for

more information.

11. Enter values for the Left and/or Right Dose Cursor. XiO displays dose cursor

values in the same color as the dose cursor in the bottom right and left corners of

the DVH window.

12. Change the Color of the left and right dose cursors, if desired.

13. Under the Structure Combination heading, click the structure or structure

combination for which you would like to see the displayed information on the

DVH graph.

14. Under Type, you can select to display a cumulative DVH, differential DVH, or

Both. You can also choose to hide or delete a structure or combination from the

graph. See XiO help for more information.

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15. Change the color of a structure line by selecting it under the Color heading.

NOTE: When you select Histogram from the Dose drop-down menu, only

seven (7) structures are allowed on the graph. If there are more than

seven already displayed because you originally created the histogram

using the Histogram button, delete structures from the quick list until

there are seven or less; then, you can go into Histogram from the

Dose drop-down menu.

Re-display a Histogram

If you create a histogram, then change something about the plan that forces a re-

calculation, XiO removes the DVH structures from the graph. Once the calculation is

complete, click the Redisplay Histogram Data button, or from the Dose drop-

down menu select the Histogram and Redisplay Data options. XiO recalculates and

re-displays the structures on the DVH graph.

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Task 13. Save the Plan

At any time during the planning process, you can save the treatment plan as a permanent

plan; however, XiO has a feature where it saves the plan as you go along as a numbered

temporary plan. If you exit from Teletherapy, either accidentally or on purpose, you

can always recall the temporary plan. It is recommended that you save all your plans as

permanent plans.

1. Click the File drop-down menu and select the Save Plan or Save as Plan option.

XiO displays the Save Permanent Plan dialog box.

2. Enter a unique plan ID and an optional description.

NOTE: When re-saving a plan with edits, the plan ID must be edited to save

it as a new plan. The description is an optional field. Simply

changing description only will not save the plan as new.


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Task 14. Create a Template

In XiO, you can save commonly used beam arrangements, beam information, ports, and

prescriptions as templates to add to new patients with similar treatment plans.

1. Click the File drop-down menu and select the Save as Template option. XiO

opens the Save Template dialog box.

2. Click your middle mouse button in the File field and enter a File ID and an

optional Description.


Here is how you would apply the template to a new

patient

(1) In Teletherapy, create a New Teletherapy Plan.

(2) Enter the Patient ID and Studyset ID for the

new patient.

(3) Instead of selecting a Graphics Area Setup, click

your middle mouse button and select a saved

Template from the Template field.

(4) If the template was saved from a segmented

IMRT plan and you want the segments to be

applied to the new patient, answer Yes in this

field.

(5) If the template was saved from a Dynamic

Conformal Arc plan and you want the

segmented Arcs to be applied to the new patient,

answer Yes in this field.

(6) Click OK. XiO opens the patient and displays

the Isocenter Location dialog box.

(7) Click your middle mouse button and select an

Isocenter.

(8) Click OK. XiO applies the template.

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Task 15. Display and/or Print Outputs and Reports

Once you have completed the planning process, you will want to display and/or print

the plan data. In XiO, you have the capability of printing individual images, ports,

DRRs and reports, or printing multiple images, ports, and DRRs and reports with the

click of a button.

To display individual reports on the screen and print them, click the Reports drop-down

menu and select a report. At the bottom of the report window, you can select Page-Up,

Page-Down, Quit or Print.

These are the print options that you can select when you click the File drop-down menu

and select the Print option.

!" Plan Data prints the Isodose Treatment Plan report, the Teletherapy Sources

report and the Interest Point Doses report.

!" Single Plane View prints any selected transverse, sagittal or coronal Image.

(Only active if the SPV to be printed is in the active window.)

!" Beam’s Eye View prints any selected Beam’s Eye View image. (Only active if

the BEV to be printed is in the active window.)

!" DRR opens the Print DRR dialog box where you can select parameters for

printing the DRR for a selected beam.

!" Port opens the Print Port dialog box where you can select parameters for

printing selected ports at a specified distance. (Only active if you have apertures

or blocks defined.)

!" Multileaf Collimator opens the Print MLC dialog box where you can select

parameters for printing selected MLC ports at a specified distance. (This option

is only active if you have MLC fields defined.)

!" Compensating Filter allows you to print out your 1D or Ellis Compensating

filter information.

!" Intensity Map opens the Print Intensity Map dialog box where you can select

intensity map parameters and output devices.

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Task 15. Displaying and/or Print Outputs and Reports (cont.)

!" Plan Output prints all the images and reports defined under the drop-down

menu Edit/Preferences/Plan Output. See the Preferences sections for more

information on setting plan output defaults.

!" Full Source Data allows you to customize the Teletherapy Sources report to

include or exclude data items that you choose, XiO also provides an option to

print the full Teletherapy Sources report that includes all the data items.

XiO 5-51

Teletherapy - Part 2

XiO Training Guide


This segment of Teletherapy is designed to follow Part 1 of this section. The best way

to proceed is to use the same plan from Part 1; however, you should be able to open

any plan and proceed.

Task 1. Additional Beam Functionality

This task defines a few additional beam functions that were not used when creating the

prostate plan in Teletherapy – Part 1. These functions can be used anytime during the

planning process.

Subtask 1. Delete beam(s)

In XiO Teletherapy, you have the option of deleting the active beam or deleting a

group of beams.

Delete the Active Beam

1. Click the Beam button. XiO displays the supporting beam buttons.

2. Make the beam you want to delete the active beam (displayed in red).

3. Click the Delete Beam button or press the F9 key on the keyboard. XiO

deletes the active beam.

Delete a Group of Beams

1. Click the Beam drop-down menu and select the Delete Beam(s) option.

2. Click on each beam you want XiO to delete. Selected beams display in blue.

3. Click OK. XiO deletes the selected beams.

Subtask 2. Renumber Beams

XiO makes it easy to renumber your beams.

1. Click the Beam drop-down menu and select the Renumber Beams option. XiO

displays the Renumber Beams dialog box.

2. Reassign new numbers to each beam.

3. Click OK. XiO automatically renumbers the displayed beams.

XiO 6-1


XiO Training Guide


Task 1. Additional Beam Functionality (cont.)

Subtask 3. Toggle Beam Display (include shortcut)

Occasionally, you may want to turn all the beams on or off, or display only specific

beams. XiO offers multiple options to perform this task.

To toggle All Beams On or Off:

(1) Press the shortcut key T to toggle beams on or off.

NOTES: XiO will not turn off the active beams. Make sure your mouse

pointer is located anywhere in the graphics window area when you

press the key.

OR

(2) Click the View drop-down menu and selecting the Beam Objects and Show

Beams options. If the box has a checkmark, XiO displays the beams; if the

box does not have the checkmark, XiO turns the beams off.

Toggle Selected Beams On or Off

1. Click the View drop-down menu and select the Show/Hide Selected Beams

option. XiO displays the Show/Hide Specific Inactive Beams dialog box.

2. Click the beam number to toggle selected beam on or off.


6-2


XiO Training Guide


Task 1. Additional Beam Functionality (cont.)

Subtask 4. Move Isocentric Group

Follow these steps to move a group of beams that share the same isocenter to a new

location.

1. Click the Beam drop-down menu and select the Move Isocentric Group option.

XiO opens the Move Isocentric Group dialog box.

2. If you have beams representing more than one isocenter, you must first select the

Group Number. XiO groups each set of beams that share the same isocenter.

XiO 6-3


XiO Training Guide


Task 1. Additional Beam Functionality

Subtask 4. Move Isocentric Group (cont.)

3. Next, you have the option to move the group using one of four methods:

(1) Move the group to a predefined interest point location. (Click your middle

mouse button to select.)

(2) Move the group to a predefined marker location. (Click your middle mouse

button to select.)

(3) Move the group to another group’s isocenter location. (Click your middle

mouse button to select.)

(4) Move the group to a specific coordinate locations. (Enter the coordinate

values.)


6-4


XiO Training Guide


Task 2. Additional Port Functionality

This task defines additional port functions that were not covered when creating the

prostate plan in Teletherapy – Part 1. These functions can be used at any time during

the planning process.

Subtask 1. Draw a Port Using the Mouse

1. Click the Port button (Shift+F3). XiO displays the port drawing and editing

tools along the secondary toolbar.

2. On the Port supporting toolbar, click the Define Shape as Aperture , Define

Shape as Block , or Define Shape as MLC button.

3. Click the Draw Port with Mouse button.

OR

Click the Port drop-down menu and select the Mouse option.

XiO 6-5


XiO Training Guide


Task 2. Additional Port Functionality (cont.)

4. In a BEV window, click your left mouse button and hold while moving the

mouse to draw the aperture, block, or MLC.

OR

Click your left mouse button to place points and draw the port. XiO

automatically closes the port when you reach the position where you started the

contour.

Subtask 2. Draw a Port Using the Tablet

1. Click the Port button on the main toolbar.

2. On the Port supporting toolbar, click the Define Shape as Aperture , Define

Shape as Block , or Define Shape as MLC button.

3. Click the Trace Port with Tablet button.

OR

Click the Port drop-down menu and select the Tablet option.

4. Enter the Scale Factor, Auto Sample Spacing Values, and orient the tablet.

5. Trace the Port according to the digitizing instructions on the Port Tablet dialog

box.

Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC)

Use these steps to edit any aperture, block or MLC.

1. Click the Port button (Shift+F3). XiO displays the port drawing and editing

tools along the secondary toolbar.

2. If a port already exists, XiO automatically places you in edit mode for the

specific type of port. (This means that the Edit Port button and one of the

following buttons are automatically selected: Define Shape as Aperture ,

Block , or MLC .)

6-6


XiO Training Guide



Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC) [cont.]

3. In an ABV or BEV window, click your right mouse button and select the Edit

Contour option.

4. Place your mouse on the edge of the port shape and click your left mouse button

when your cursor changes to the following . XiO places a yellow edit box

around the port shape.

5. Port shape editing is the same as contour editing. Place your mouse on the edge

of the port shape. When the icon changes to the following , hold down your

left mouse button and drag, or use a series of mouse clicks to create the new

shape. You must finish the edit by clicking on the edge of the contour shape.

XiO automatically displays a circle guide around the mouse pointer with a user

editable radius. You can use the guide to draw a port around a structure with a

specific margin.

Here are steps to edit the radius of the circle

guide.

1. Press the greater than key (>) to increase

the guide radius.

2. Press the less than key (< ) to decrease

the guide radius.

3. Press the G key on your computer

keyboard to turn the guide radius off and

on. XiO displays the Guide Radius size

at the bottom of the XiO screen.

XiO 6-7


XiO Training Guide



Subtask 4. Create and Edit a Port using the Keyboard

You may want to use the keyboard to create regular shaped ports. You may also want

to edit these ports, or in the case of MLCs, you may want to edit individual MLC leaf

coordinates.

The Keyboard option can be selected from the Port drop-down menu. If there is no

port on the active beam, XiO assumes you would like to create a port. If a port exists,

XiO allows you to edit the existing port, add a block to it, or convert the port to a

different type (example, aperture to MLC) for editing.

When you select the Keyboard option, you have the option of creating or editing an

Aperture, Block or MLC.

NOTE: You can only create or edit a port that has 30 or fewer points. If you

created an autoport on a beam, it will most likely contain more than 30

points. Therefore, it will not be editable via the keyboard.

6-8


XiO Training Guide



Subtask 5. (MLC Only) Edit MLC Leaves

Use these steps to edit individual MLC leaves or groups of closed leaves.

1. Click the Port button.

OR

Click the Shift and F3 keys on your computer keyboard.

XiO displays the port drawing and editing tools along the secondary toolbar.

2. If a port already exists, XiO automatically places you in edit mode for the

specific type of port. (This means that the Edit Port button and one of the

following, Define Shape as Aperture , Block or MLC buttons are

automatically selected.)

3. In an ABV or BEV window, right mouse click and select Edit Leaf from the pop

up window.

4. Place your mouse pointer on the leaf you would like to edit, hold down your left

mouse and drag to the right or left. XiO highlights the selected leaf and updates

its position on the screen.

XiO 6-9


XiO Training Guide



Subtask 5. (MLC Only) Edit MLC Leaves (cont.)

NOTES: If you have the port property “MLC Updates with Leaf Edits” set to

Yes, XiO updates the port contour as you move leaves.

If you have the port property “MLC Updates with Leaf Edits” set to

No, the port contour does not update as you move leaves. This

allows you to use the shape as a reference for moving additional

leaves. However, this can be a problem in the following scenario.

If you decide to use the Edit Contour tool after editing leaves, when

the contour updates, the leaves will move back to their original

position.

5. Move an entire group of closed leaves by placing your mouse pointer on any

closed leaf that does not abut the treatment field. XiO moves the entire group of

closed leaves.

NOTE: The closed leaves above the treatment field move independent of

the closed leaves below the treatment field.

6-10


XiO Training Guide



Subtask 6. MLCs and Blocks

XiO allows you to add blocks to MLC fields. For example, you can use MLCs for the

original field; then for the boost, you can add a cord block. You can create blocks

using the drawing tool when you select Define Shape as Block, by using the keyboard,

or by using auto-port to create a shape around a structure of interest.

XiO 6-11


XiO Training Guide



Subtask 7. (MLC Only) MLC Display Feature

Occasionally, the MLC leaf display obscures the image or DRR in the BEV or ABV

window. Here are steps to turn the display on and off. This function is available in all

modes whenever a BEV or ABV with an MLC is displayed.

1. Click your right mouse button in the BEV or ABV window.

2. Select MLC LEAF. This option toggles the MLC leaves on and off. When the

leaves are off, XiO displays only an MLC field outline.

6-12


XiO Training Guide



Subtask 8. Rotate Collimator Independent of Port

In XiO, you can rotate the collimator without rotating the port when the Port Property,

Blocking Rotates With Collimator is set to No.

1. Click the Port drop-down menu and select the Port Properties option. XiO

opens the Port Properties dialog box.

2. Set the option Blocking Rotates with Collimator to No. (See the Preferences

section of this training guide for more information on setting the preference for

this feature.)

3. Click OK.

4. Rotate the collimator to the new collimator angle using any method you choose.

The port does not rotate with the collimator.

XiO 6-13


XiO Training Guide



Subtask 9. Automatically Update the MLC or Aperture as the Gantry is Rotated

In XiO, when you rotate the gantry, un-edited ports created using Auto Port


1. Click the Port drop-down menu and select the Port Properties option. XiO

opens the Port Properties dialog box.

2. Set the option Auto-Generated Blocking Updates with Beam Movement to Yes.

(See the Preferences section of this training guide for more information on

setting the preferences for this feature.)

3. Click OK.

4. Rotate the gantry using any method you choose. The port automatically updates

according to the structure and margin selected for the auto port.

6-14


XiO Training Guide



Subtask 10. Auto Conform the Port for the Active Beam

In XiO, you can automatically create an aperture, block, or MLC field for the active

beam.

1. Click the Port drop-down menu and select the Auto and Active Beam options.

XiO displays the Auto Port dialog box.

2. Click your middle mouse button in the field next to Auto Margin To and select a

structure from the list that you would to create an auto port around.

3. Enter the Margin you want to place around the structure in the With Margin

field.

4. To create an aperture, click the Calculate Aperture button.

OR

To create a block, click the Calculate Block button.

OR

To create an MLC, click the Calculate MLC button.


XiO 6-15


XiO Training Guide



Subtask 11. Auto Conform Ports or Collimator Jaws to a Specific Margin for One or Multiple Beams

In XiO, you can automatically create apertures, blocks, or MLC fields for multiple

beams simultaneously.

1. Click the Port drop-down menu and select the Auto and Multiple Beams

options. XiO displays the Photon Conform Beams dialog box.

2. Select the beams that you would like to conform by clicking on them (they are

selected when highlighted in blue).

3. Click your middle mouse in the Structure field and select a structure to create a

margin around.

6-16


XiO Training Guide



Subtask 11. Auto Conform Ports or Collimator Jaws to a Specific Margin for One or Multiple Beams (cont.)

4. Enter the Margin you want to place around the structure in the Margin field.

5. Click your middle mouse in the Collimator Type field and select Aperture,

MLC, or Jaws Only.

6. If you select Jaws Only, click OK to finish.

7. If you select Aperture, select Yes in the Conform Jaws field to conform the jaws

as well to the step increment specified in Port Preferences.

8. Enter an appropriate Tray Factor, HVL, Thickness and Material.

9. Click OK to finish.

10. If you select MLC, select yes in the Conform Jaws field to conform the jaws as

well to the step increment specified in Port Preferences.

11. Enter an appropriate Leaf Insertion and Closed Leaf Position.

12. Click OK to finish.

Subtask 12. Conform Collimator for the Active Beam

Use this task to conform the collimator for the active beam to the step increment

specified in Port Preferences.

1. Click the Port drop-down menu and select the Conform Collimator and Active

Beam options.

OR

When in Port Mode, click the Conform Collimator Jaws to Port button. XiO

automatically conforms the collimator for the active beam.

XiO 6-17


XiO Training Guide



Subtask 13. Conform Collimator Jaws for all Beams at Once

Use this task to conform all collimators to the step increment specified in Port

Preferences.

1. Click the Port drop-down menu and select the Conform Collimator and

Multiple Beams options. XiO automatically conforms the collimators for all

beams.

Subtask 14. How To Save and Use Public Ports

Occasionally, you may want to create public ports that can be used from patient to

patient. Public ports can only be created from Apertures and/or Blocks. The

following steps demonstrate how to save and use public ports.

1. Create an Aperture and/or Block that you would like to use as a Public Port.

2. Click the Port drop-down menu and select the Copy to Public Port option. XiO

opens the Copy Port to Public Port ID dialog box.

3. Enter a unique ID and optional Description for this port.

4. Click OK. XiO saves the port as a Public Port.

5. Close the patient.

6. Open a new patient and create a new beam.

7. Click the Port drop-down menu and select the Use Public Port option. XiO

displays the Port ID dialog box.

8. Click your middle mouse button in the Port ID field and select the Port ID that

you saved.

9. Click OK. XiO places the Public Port on the new beam.

6-18


XiO Training Guide



Subtask 15. Port Properties

Some of the Port Properties have already been discussed in other tasks. This task

covers the remaining Port Properties. The Port Properties dialog box is different when

you are using MLC ports than when you are using apertures and blocks. Both topics

are discussed as follows:

MLC

!" Blocking Rotates with Collimator — See Task 2, Subtask 8.

!" The Leaf Insertion determines what percent of the leaf intrudes into the port

shape. See XiO Help for more detailed information.

!" Closed Leaf Position (Varian Only) — Here you can enter a new location for

the closed leaf position. However, ALL USERS can edit the closed leaf

position with the mouse. See steps on Task 2, Subtask 5.

XiO 6-19


XiO Training Guide



Subtask 15. Port Properties (cont.)

Aperture/Block

!" You can enter the Port Tray Factor for each beam from the Port Properties

dialog box. The Port Tray Factor entered here only applies to the active beam.

You can set a default tray factor value in Source File Maintenance specifically

for each machine.

!" Rotate Collimator Independent of Port — See Task 2, Subtask 8.

!" Auto Generated Blocking Updates With Beam Movement — See Task 2,

Subtask 9.

!" Under port Type, you can change an aperture to a block or a block to an

aperture.

!" The Material, Thickness and HVL are required values for each aperture or

block. You can create default values in Source File Maintenance.

6-20


XiO Training Guide



Subtask 16. Delete Port Options

In XiO, you can delete an entire port or just part of one. For example, if you have a

port that consists of an aperture and a block, you can choose to only delete the block or

only the aperture. See the steps below for more information on deleting ports.

Delete Entire Ports

1. Click the Port drop-down menu and select the Delete and Port options. XiO

removes the entire port from the active beam.

OR

When the Port button is active, click the Delete Port button. XiO

deletes the port from the active beam.

Delete a Port Shape

1. Click the Port drop-down menu and select the Delete and Shape options. XiO

displays the Select Aperture or Block, or MLC dialog box.

2. Enter the number that corresponds to the block or aperture you would like to

delete. (Numbers are displayed in the BEV or ABV window.)

3. Click OK. XiO removes the selected block or aperture.

XiO 6-21


XiO Training Guide



Subtask 17. Convert Aperture/MLC

In XiO, you can easily convert any port from one type to another. For example, you

can convert an aperture to an MLC. Use the following steps to convert an existing

port.

1. Click the Port drop-down menu and select the Convert Aperture/MLC option.

XiO displays the Convert Aperture, Block, or MLC dialog box.

2. Select from the three conversion options; then, click Cancel to close the dialog

box.

6-22


XiO Training Guide


Task 3. Items That Influence Dose Calculation

XiO allows you to set preferences for your dose calculation settings. These settings

will be applied for each patient; however, you can change these settings at any time

during the planning process using the following steps.

Subtask 1. Calculation Setting

1. Click the Dose drop-down menu and select the Calculation and Settings

options. XiO displays the Dose Calculation Settings dialog box.

2. Turn the heterogeneity correction off or on by selecting Yes or No.

XiO 6-23


XiO Training Guide



Subtask 1. Calculation Setting (cont.)

3. If the heterogeneity correction is set to Yes, select if it will be Pixel-by-Pixel

correction (Yes), or bulk heterogeneity correction (No).

Here is a list of heterogeneity options that can be

used in XiO.

Pixel-by-Pixel heterogeneity — XiO assigns each

CT pixel an electron density based on the CT to ED

file selected for this patient. This method provides

the most accurate method in XiO to emulate

heterogeneity correction.

Bulk heterogeneity — You assign density to specific

structures. All structures that are unassigned are

given a density of 1.

Pixel-by-Pixel and Bulk — These two types of

heterogeneity corrections can be used in combination.

Consider the following example. You want to use

pixel-by-pixel heterogeneity; however, there is

contrast in the bladder that will not be there for

treatment. In this case, you could contour the bladder,

assign it a density, and check the force density option.

This creates a pixel-by-pixel corrected patient, except

in the area of the bladder, where the density will be

forced to a user defined value.

No Heterogeneity — If you do not turn on

heterogeneity correction, XiO assumes the patient is

of unit density.

4. Select Yes or No if you want the ability to generate DRRs as Enhanced DRRs.

Enhanced DRRs have a higher resolution than regular DRRs in that each

grayscale pixel of the regular DRR is divided into four and each of those four

new pixels are assigned new grayscale values. If you are printing DRRs to a film

printer, you may want to consider using Enhanced DRRs to produce better

images.

6-24


XiO Training Guide




5. The calculation region dimensions and calculation region center deal with the

size and center of the calculation region. You can change the size of the

calculation region and move the center by entering a new width, height and

depth, or X, Y, and Z coordinates. You can also use the mouse to change the

size and move the center.

Here are steps to resize the Calculation Region and

Move the Center with the Mouse.

1. Click your right mouse button in any SPV

window (transverse, sagittal, or coronal) and

select the Calc Size option.

2. Hold down your left mouse button and drag any

corner of the red calculation region box to resize.

The calculation region dimensions automatically

update.

3. Click your right mouse button in any SPV

window and select the Calc Translate option.

4. Hold down your left mouse button and drag the

red box to the new location. XiO automatically

updates the calculation region center coordinate

values.

XiO 6-25


XiO Training Guide




6. The Number of Calculation Points and Distance Between Calculation Points

options are mutually exclusive. Toggle the Parameters to Specify option to no.

of pts. if you would like to edit the number of points instead of the grid spacing.

Grid spacing determines the number of calculation points within the calculation

region that XiO uses when calculating the plan. Grid spacing provides an evenly

spaced grid of calc points in all three dimensions. The number of calculation

points allows you to create your own (uneven) grid spacing by entering a unique

number of calculation points for XiO to calculate in each dimension. Grid

Spacing is most commonly used.


Subtask 2. Dose Status

XiO displays the Dose Status dialog box to indicate which beam is being calculated

during the calculation cycle. If you are in dose mode, the Dose button is

highlighted. XiO automatically displays dose status until the dose is valid. However,

if you are in any other mode and XiO is calculating, you can click the Dose drop-down

menu and select the Dose Status option. XiO displays the Dose Status dialog box.

6-26


XiO Training Guide


Task 4. Setup Reference Definition (CT Sim)

The Setup Reference Definition and Mark Anatomical Reference tools allow you to

determine and display relative or absolute shifts from one point to another. Both work

the same way. In general, only Setup Reference specifies shifts from the scan

reference to the setup reference, and Mark Anatomical Reference specifies shifts from

the setup reference to another anatomical location (which could be used when the

isocenter is moved a second time for a boost plan).

You must define a scanner in Settings-Clinic-Scanner/ LMS Definition before you can

use these tools. You must also have created a Setup Reference before you can use

Mark Anatomical Reference (see the Settings section of this training guide for more

information).

The steps for using Setup Reference Definition are described here, but could generally

be applied to Mark Anatomical Reference.

Determine and Mark the Scan Reference Point

There are many methods you could use to determine the scan reference point position.

This is one example.

1. Click the View drop-down menu and select the Scales option; then, place a

checkmark in the Display box. XiO displays scales in each SPV and BEV

window.

2. Click your right mouse button in the transverse image and select the Maximize

option. XiO displays the transverse image in full screen.

3. Click your right mouse button and select the Movie option. XiO places you in

Movie mode.

XiO 6-27


XiO Training Guide



Determine and Mark the Scan Reference Point (cont.)

4. Movie the images using your left and middle mouse buttons or the scroll wheel

until you display a slice that has fiducial markers placed on the skin surface. (For

the patient used in this task, it is slice T: -158.51.)

5. Click your right mouse button and select the Move Scales option.

6. Hold down your left mouse button and drag the scales on the transverse image

until the scales line up with the ap and lateral fiducial markers.

7. Click the Contour drop-down option and select the Markers (or Interest

Points), then New options. XiO displays the Add Marker (or Interest Point)

dialog box.

8. Enter the description Scan Ref.

9. Click your left mouse button at the intersection of the scales to place the marker

(or interest point).

10. Click OK to accept, then, click Cancel to close the dialog box.

6-28


XiO Training Guide


Task 4. Setup Reference Definition (CT Sim) [cont.]

Report Relative Shifts

1. Click the Tools drop-down menu and select the Setup Reference Definition

option. XiO displays the Setup Reference dialog box.

2. Click the drop-down arrow next to the Report Points field and select Relative to

Scan Reference Point.

3. Under the Scan Reference heading, middle mouse click in the Interest Point or

Marker field and select Scan Ref.

XiO 6-29


XiO Training Guide



Report Relative Shifts (cont.)

4. Under the Setup Reference heading, middle mouse in the Center of Structure

field and select the center of the target structure.

NOTE: Your other options to shift to include an interest

point or marker that has been placed or a beam

isocenter if one has been defined.

NOTE to Gammex Users: If you plan to send your shifts to Gammex for

automatic movement of the lasers, select Yes next to

the Gammex LMS Automove ? field; then, click

the Reposition Lasers to Setup Reference button.

5. Click OK. XiO displays the Setup Reference Definition Index and the relative

shifts at the bottom of the index along with the direction in which to shift.

(patient’s left, anterior, etc.).

6. (Optional) Click Print to print the displayed index.

7. Click Quit to close the index.

6-30


XiO Training Guide


Task 4. Setup Reference Definition (CT Sim) [cont.]

Report Absolute Readings

1. Click the Tools drop-down menu option and select the Setup Reference

Definition option. XiO displays the Setup Reference dialog box.

2. Click the drop-down arrow next to the Report Points field and select Absolute

Readings.

3. Under the Setup Reference heading, click your middle mouse button in the

Center of Structure field and select the center of the target structure.

NOTE: Your other options to shift to include an interest

point or marker that has been placed or a beam

isocenter if one has been defined.

NOTE to Gammex Users: If you plan to send your shifts to Gammex for

automatic movement of the lasers, select Yes next to

the Gammex LMS Automove? field, then click the

Reposition Lasers to Setup Reference button.

4. Click OK. XiO displays the Setup Reference Definition Index and the absolute

couch/laser readings for the setup reference point at the bottom of the index.

5. (Optional) Click Print to print the displayed index.


XiO 6-31


XiO Training Guide


Task 5. Optional Display Settings

XiO has many optional display settings. Some have already been covered in

Teletherapy Section 1, the rest are covered in this section. These optional settings can

be changed or used at any time during the planning process.

Subtask 1. Window Format

Typically, you will select a window format (Graphics Area Setup) when you first

begin a new treatment plan in XiO; however, it is possible to change that format as you

are planning or during plan review.

1. Press the shortcut key W on your computer keyboard, or from the View drop-

down menu select the Window Format option. XiO displays the Window

Format dialog box.

Select/Save a Predefined Window Format

1. Click your middle mouse button in the Load Graphic Area Setup: field and select

a new window format. When you first receive your system, XiO lists a set of

default graphics area setups.

2. If you would like to save the displayed window format, click the Save Graphics

Area Setup button and enter a unique name for the format.

6-32


XiO Training Guide



Subtask 1. Window Format (cont.)

Create your own Window Format

1. Select a number of windows in the Window format field. Options are one, two

horizontal, two vertical, four, six, six symmetric, nine and twelve.

2. While you have the Window format dialog box open, click your right mouse

button in any window you would like to delete and select the Delete Window

option. XiO automatically removes the contents of that window.

3. Setup each window with the appropriate view, orientation, ref distance, beam

number and center of structure. Not all views require an orientation, ref, beam

number, and center of structure. (See XiO Help for more information on how to

fill out the window information appropriately.)

4. Select a Sync ID for each window. This is used primarily for plan review so you

can synchronize mouse movements between plans. For example, if you have the

transverse image of three plans displayed side-by-side and they all have the same

Sync ID, when you perform any mouse movements, such as movie or scale, all

three transverse images will movie or scale together.

5. Click the Update Graphics Display to display any changes or additions.

6. You can easily exchange the content of the selected windows by clicking your

right mouse in any window and selecting the Exchange Window option.

7. Click your left mouse button in each of the two windows where you would like

to exchange content. XiO automatically exchanges the windows contents.

8. Click Cancel to exit Window Format.

XiO 6-33


XiO Training Guide




Create an SPV Plane perpendicular to the Central Axis (SPV CAX)

1. In any empty window on the Window Format page, select the View SPV option.

2. Select the Orientation CAX.

3. Click the window number located to the left of the View option. XiO displays

the CAX Oblique Window.

4. Enter the Beam Number for the beam you want to create the perpendicular

plane.

5. Enter the Distance of the plane from the source (Typically this is 100).

6. Enter a Stack Label. XiO uses this label to name the image in the window.

7. (Optional) Enter a Distance Between Planes. If you want to movie through a

stack of reconstructed images in this plane, this value determines the spacing of

the reconstructed images.

8. (Optional) Enter a Number of Planes Per Side. If you want to movie through a

stack of reconstructed images in this plane, this value determines the number of

planes you want XiO to reconstruct on each side of the CAX plane.

9. Click OK. XiO displays the reconstructed plane(s) in the selected window. If

you created a stack, use the Movie option to movie through the reconstructed

slices.

10. Click Cancel to Close the Window format dialog box.

6-34


XiO Training Guide




Create an Oblique Plane (Not necessarily perpendicular to the plane of any beam)

To best use this feature, you should have a transverse SPV, sagittal SPV, and MPV

displayed. Try to keep the arrow on the plane pointing generally towards the anterior

or the superior of the patient, and the arrow perpendicular to the plane pointing

generally towards the foot or the left side of the patient to avoid reconstructing a plane

that is upside down or backwards.

1. In an empty window on the Window Format page, select the View SPV.

2. Select the Orientation Obl.

3. Click the window number located to the left of the View option. XiO displays

the Define an Oblique Stack of Planes dialog box.

XiO 6-35


XiO Training Guide



Subtask 1. Window Format

Create an Oblique Plane (Not necessarily perpendicular to the plane of any beam) [cont.]

4. There are two modes available, creation of an orthogonal or non-orthogonal

plane. If you choose orthogonal, you will only be required to place two points in

the same plane using the mouse. If you choose non-orthogonal, you can enter

three points on two different planes using the mouse, enter the coordinate values,

or select three points that already exist to snap the plane to.

NOTE: Since creating an orthogonal plane is described in the first two steps

to creating a non-orthogonal plane, the non-orthogonal option will

be described here.

5. Click your left mouse on the transverse image to place the first point. XiO

displays a yellow plane on all the images except a BEV. If necessary, you can

hold down your left mouse button and drag the plane to a new location.

6. Click your middle mouse on the transverse image to place the second point.

Hold down your middle mouse button and drag to rotate the plane around the

superior/inferior axis.

7. Click your right mouse button on a sagittal image to place the third point. Hold

down the right mouse button and drag to rotate the plane around the

anterior/posterior axis. As you rotate, look at the MPV image to determine the

location of the plane.

8. Enter a stack label. XiO uses this label to name the image in the window.

9. (Optional) Enter a distance between planes. If you want to movie through a

stack of reconstructed images in this plane, this value determines the spacing of

the reconstructed images.

10. (Optional) Enter a number of planes per side. If you want to movie through a

stack of reconstructed images in this plane, this value determines the number of

planes you want XiO to reconstruct on each side of the CAX plane.

11. Click OK. XiO displays the reconstructed plane(s) in the selected window. If

you created a stack, use the Movie option to movie through the reconstructed

slices.

6-36


XiO Training Guide


Task 5. Optional Display Settings (cont.)

Subtask 2. Enhance Contours

The Enhance Contour dialog box enables you to turn selected structures on and off and

change their attributes.

1. Press the shortcut key C on the keyboard.

OR

Click the View drop-down menu and select the Enhance Contour option. XiO

displays the Enhance Contour dialog box.

2. Click on the structure name to toggle the selected structure on or off.

3. Click the All Structures Off or All Structures On buttons to toggle them all off

or on.

4. Click your middle mouse button in the Color field to select a new color.

5. Click your middle mouse button in the Rendering field and select a new

rendering for the associated structure. (See XiO help for more information on

the rendering options.)

6. Click your middle mouse button in the Color Fill field to select Yes or No to

displaying the selected rendering as a color fill on the transverse, sagittal, and

coronal images.


XiO 6-37


XiO Training Guide



Subtask 3. Scales

XiO allows you to display scales in each SPV, ABV, or BEV window. The tic-mark

spacing is user-defined and the scales can be moved around the window. You can use

scales to locate the scan reference center based on fiducial markers placed on the skin.

Toggle Scales On and Off

When you click the View drop-down menu and select the Scales option and place a

checkmark in the box next to Display, XiO displays the scales in each SPV, ABV and

BEV window.

Change the Scales Tic-mark Spacing

1. Click the View drop-down menu and select the Scales and Spacing options. XiO

opens the Scales Spacing dialog box.

2. Enter the spacing in centimeters.

3. Click OK when finished. XiO applies the new spacing to the scales.

Move the Scales in a Single Window

1. Click your mouse button in any SPV, ABV or BEV window and select the Move

Scales option.

2. Hold down your left mouse button and drag the scales to a new location.

Move the Scales in all SPV Windows at Once

1. Click your right mouse button in any SPV window and select the Move Scales

All option.

2. Hold down your left mouse and drag the scales to a new location. XiO moves

the scales in all the SPV windows in patient coordinates.

6-38


XiO Training Guide



Subtask 4. View Plans on Primary, Secondary, or Electron Density Image Data

If you have fused a primary and secondary set of images (for example, a CT and an

MRI), XiO allows you to display the plan and isodoses on the primary or the

secondary studyset. If you have elected to use bulk density override for any structure,

it may be useful to view the plan on the electron density image data. This view

displays the images using the actual densities prescribed.

To toggle the view from primary to secondary to electron density, click the View drop-

down menu and select the Image Data option; then, place a checkmark next to the

image dataset you want to view. XiO replaces the primary dataset images with the

selected dataset images.

Primary Secondary Electron

XiO 6-39


XiO Training Guide



Subtask 5. View Image Planes in MPV

XiO allows you to view transverse, sagittal, and coronal image planes on the MPV

image. Only those planes that display in an SPV window will display in the MPV

window. For example, if you have two SPV windows that contain a transverse and a

sagittal image, only those two planes will display in the MPV window. Graphical

changes you make to the images in the SPV, such as movie and window/level will also

apply to the corresponding plane in the MPV window.

Click the View drop-down menu and select the Image in MPV option; then, select to

display it as a solid plane or select a level of transparency. XiO displays the planes in

the MPV.

6-40


XiO Training Guide



Subtask 6. Plan Objects

XiO allows you to select the plan objects that you want to display during planning.

These can be toggled on and off one-by-one, or you can select multiple objects to edit

at one time.

Plan Objects include the following:

Interest Points Points that carry dose

Markers Points that do not carry dose

Calculation Volume/Area Calculation Region box

Patient Orientation Icon Figure that displays in the lower-left corner of each

window

Patient Spheres Spheres that represent the anterior, superior, and left side

of the patient (These spheres correspond in color with the

spheres on the patient orientation icon.)

Bilinear Interpolation Smoothing algorithm that is applied to CT image to

reduce pixilation

Bolus When applied it is viewed as a slab

CT Origin Crosshair that defines the CT 0, 0, 0 position

(See XiO Help for more detailed information regarding Plan Objects)

Turn On or Off One Plan Object At a Time

Click the View drop-down menu and select the Plan Objects option; then, place a

checkmark next to the object you would like XiO to display. Remove the checkmark

from the objects that you do not want XiO to display.

XiO 6-41


XiO Training Guide



Subtask 6. Plan Objects (cont.)

Turn On or Off Multiple Plan Objects

1. Click the View drop-down menu and select the Plan Objects and Multiple

Objects options. XiO displays the View Plan Objects dialog box.

2. Click on each Plan Object to toggle it off or on.

3. Click CANCEL when finished.

6-42


XiO Training Guide



Subtask 7. Beam Objects

XiO allows you to select the beam objects that you want XiO to display during

planning. These can be toggled on and off one-by-one, or you can select multiple

objects to edit at one time.

Beam Objects include the following:

Complex/Simple Display Simple displays only the portion of the beam that

intersects the image you are viewing in an SPV.

Complex displays the entire beam and portions of the

beams that do not intersect the selected cross-section

display as dashed lines in an SPV.

Moveable Plane When you select this option, XiO displays the Moveable

Plane From and Moveable Plane Distance options on the

Photon beam page. These options allow you to display a

plane perpendicular to the beam at any designated

distance on an SPV and an MPV. Use this option to

display a plane through the weight point on a tangent, or

to display the cone distance for an electron beam to see

if the cone will collide with the patient.

Corner Divergent Lines In the MPV, this option toggles the display of the

divergent lines.

Crosshairs In the BEV and MPV, this option toggles the display of

the crosshairs.

Isocentric Plane In the SPV windows, this option toggles the display of

the lines representing the isocentric planes.

Aperture/Block

Coverage Lines This option toggles the display of the lines that represent

the divergent block.

Aperture /Block Shadow This option toggles the display of the shadow of the

divergent block.

XiO 6-43


XiO Training Guide



Subtask 7. Beam Objects (cont.)

MLC Coverage Lines This option toggles the display of the lines that represent

the divergent MLC blocking.

MLC Shadow This option toggles the display of the shadow of the

divergent MLC blocking.

Segmented MLC

Maximum Extents This option toggles the display of the maximum extent

of MLC leaves for IMRT plans.

Compensating Filter If you have a CF on your plan, this option toggles the

display of the CF.

Show Beams This option toggles the beams on or off. (See Task 1,

Subtask 3 for more information.)

Weight Point This option toggles the display of the weight point(s).

Turn On or Off One Beam Object At a Time

Click the View drop-down menu and select the Beam Objects option; then, place a

checkmark next to the object you would like XiO to display. Remove the checkmark

from the objects that you do not want XiO to display.

Turn On or Off Multiple Beam Objects

1. Click the View drop-down menu and select the Beam Objects and Multiple

Objects options. XiO displays the View Beam Objects dialog box.

2. Click on each beam object to toggle it off or on.

3. Click Cancel when finished.

6-44


XiO Training Guide



Subtask 8. Adding, Editing and Deleting Interest Points and Markers

Interest points and markers may be added edited and deleted in PFM or in Teletherapy.

This subtask discusses the latter. The difference between interest points and markers

are that interest points carry and report dose, markers do not.

Add an Interest Point or Marker

1. Click the Contour drop-down menu and select the Interest Points or Markers,

then New options. XiO displays the Add Interest Point or Add Marker dialog

box.

2. Enter an optional description.

3. Enter the coordinates for the point or marker.

OR

Click your middle mouse button and select the Center of a Structure option to

place the point.

OR

Place the point with your mouse (left click) on any transverse, sagittal or coronal

image. XiO automatically updates the coordinate values.

4. Click OK. XiO allows you to add more interest points or markers.

5. Click CANCEL when you have finished entering points.

XiO 6-45


XiO Training Guide



Subtask 8. Adding, Editing and Deleting Interest Points and Markers (cont.)

Edit an Interest Point or Marker


then Edit options. XiO displays the Reposition Interest Point or Reposition

Marker dialog box.

2. Click your middle mouse button and select the Point number you want to edit.

3. Click OK. XiO displays the position information for the selected point.

4. Edit the coordinates for the point or marker.

OR

Click your middle mouse button and select the center of a structure to move the

point.

OR

Move the point using your mouse (left click) on any transverse, sagittal, or

coronal image. XiO automatically updates the coordinate values.

5. Click OK. XiO allows you to edit more interest points or markers.

6. Click CANCEL when you have finished editing points.

6-46


XiO Training Guide



Subtask 8. Adding, Editing and Deleting Interest Points and Markers (cont.)

Delete an Interest Point or Marker


and Delete options. XiO displays the Remove Interest Point or Remove Marker

dialog box.

2. Click your middle mouse button and select the Point number you want to delete.

3. Click OK. XiO deletes the selected point and allows you to delete more points.

4. Click CANCEL when you are finished deleting points.

XiO 6-47


XiO Training Guide



Subtask 9. Measure Tools

There are two types of measurement tools available in XiO. One is a ruler-type tool;

the other measures the distance between two points that are placed in any SPV

window. The second tool also provides the radiological distance if heterogeneity

correction is applied and XiO displays the CT and ED values (if a CT-to-ED file is

applied) for each placed point.

Using the Ruler Measure Tool

1. Click your right mouse button in any SPV and select the Measure option.

2. Hold down your left mouse button and drag across the area to be measured. XiO

displays a ruler as the mouse is moved across the window.

3. You may create as many rulers as you want; however, the measurement value

will only display on the last ruler you draw.

4. Click your middle mouse button to delete the rulers.

6-48


XiO Training Guide



Subtask 9. Measure Tools (cont.)

Using the Point to Point Measure Tool

1. Click the Tools drop-down menu and select the Measure option. XiO opens the

Measure dialog box.

2. Click your left mouse button on the location of the first point in any SPV

window.

OR

Enter the coordinates of the first point under the heading Point Location 1.

3. Click your middle mouse button on the location of the second point in the same

SPV window.

OR

Enter the coordinates of the second point under the heading Point Location 2.

4. After the placement of the second point, XiO displays the Physical and

Radiological Distances between the two placed points. XiO also displays the CT

and ED values for each point below their respective coordinates.

XiO 6-49


XiO Training Guide



Subtask 9. Measure Tools

Using the Point to Point Measure Tool (cont.)

5. You can move the point locations by clicking your left and middle mouse buttons

again to refresh the distances.

6. Click Cancel when finished with this tool.

Subtask 10. Plane Icon

You can use the Plane Icon tool to select a new transverse, sagittal, or coronal plane to

view in any SPV. You must have at least two of the three types of SPV planes

displayed to use this tool.

1. Click your right mouse button in any SPV and select the Plane Icon option. The

plane icon (a white line) appears in one or more of the other plane types

windows. For example, if you select the Plane Icon option from the transverse

SPV window, the plane icon itself displays in the sagittal and/or coronal SPV

windows as a white line representing the currently displayed transverse plane.

2. Hold down your left mouse button and drag the white line to a new location. XiO

automatically updates the selected plane in its respective window.

Subtask 11. Contour Editing

If, for any reason you would like to make edits to your contours or create automargins

during planning in Teletherapy, you can click the Contour button, or from the

Contour drop-down menu, select the Contour Editing option. XiO transitions you to

an abbreviated version on PFM. Some PFM functionality may not be available. If

there is a PFM feature you would like to use that is not available through the shortcut

(abbreviated version), you can close the patient in Teletherapy and open the patient in

the full-featured version of PFM.

You can now close the patient you have been using during this exercise. In the next

few tasks, you will be using different patients.

6-50


XiO Training Guide



Subtask 12. Create Subcontour

In Teletherapy, you are allowed to create a subcontour that is the remainder of an

existing contour, minus the intersecting beam (including beam modifiers). You can

access this tool by clicking the Contour drop-down menu and selecting Create

Subcontour. Although this tool was created for proton plans, there may be an

application in photon and electron planning as well. For more information on using

this tool, see the Broad Beam Proton section of this training guide.

XiO 6-51


XiO Training Guide


Task 6. Multiple Plan Review

You can use Multiple Plan Review to review up to three plans at a time

simultaneously. You can also review added plans or subtracted plans. It is

recommended that you save a window format specifically for plan review to avoid

setting one up each time.

In this task, you will open a patient that has multiple saved plans, select the plans for

review, and create a window format to be used for multiple plan review. All plans

must be saved and calculated with the exception of the current plan to be available on

the list of plans to review.

Open the Patient and Select Plans for Review

1. Click the Teletherapy button on the Main XiO screen. XiO opens Teletherapy.

2. Click the File drop-down option and select the Open Permanent Plan option.

XiO displays the Open Permanent Plan dialog box.

NOTE: You must have saved permanent plans in order to view them in

Plan Review.

3. Click your middle mouse button in the Patient ID field and select

FusionProstate.

4. Click your middle mouse button in the Plan ID field and select 4fieldProstate.

5. Click OK. XiO displays the selected plan.

6-52


XiO Training Guide



Open the Patient and Select Plans for Review (cont.)

6. Click the Tools drop down menu and select the Plan Review option. XiO

displays the Plan Review Maintenance dialog box.

NOTE: Plan 1 is the currently displayed plan and is already selected.

7. Click your middle mouse button in the Second Plan ID field and select

6FieldRTOG0126.

8. For plan 3 there are four options. You can select a third plan to review (when

available), subtract plan two from plan one, subtract plan one from plan two or

add plan one and two (for composite). For this task, select Plan 1-Plan 2.

9. Select the Graphics Area Setup 9MultiPlan. If you do not want to use

9MultiPlan, you can edit it or create a new one and save your own Multiple Plan

Graphics Area Setup.

10. Click OK. XiO closes the Plan Review Maintenance dialog box and displays the

three plans side-by-side.

XiO 6-53


XiO Training Guide


Task 6. Multiple Plan Review (cont.)

Change Isodose Display

1. Click the Dose drop-down option and select the Isodose Lines option. XiO

displays the Isodose Lines dialog box.

NOTE: If you have a subtraction or addition plan, the Isodose Lines dialog

box displays two isodose lists; one for the original plan, and another

for the subtraction or addition plan when in Multiple Plan Review.

Appropriate values will default for the subtraction or addition plan,

but can be edited.

2. Select Colorwash or Isofill as the Dose Display Mode. XiO displays the

isodoses as colorwashes.

6-54


XiO Training Guide



Change Isodose Display (cont.)

3. Edit the isodose values.

OR

Click OK to close the isodose lines dialog box.

XiO 6-55


XiO Training Guide



Display Dose to a Single Point

1. Click your right mouse button in any SPV window and select the Reference

Point Loc option.

2. Hold down your left mouse button in any SPV window and move the mouse

pointer around the window. As you move, the reference dose (displayed in the

upper right corner of each window) is updated to reflect the dose at the same

point in all plans when in Multiple Plan Review.

DVH

When you display a DVH in Multiple Plan Review, XiO displays the DVH for all the

selected plans on the same graph. A solid line on the DVH graph represents the

original plan; a dashed line represents the second plan, and a dotted line represents the

third plan. XiO does not display an addition or subtraction DVH on the graph with the

other plans.

For more information on creating a dose volume histogram, see the Teletherapy- Part 1

section of this training guide.

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XiO Training Guide



Save an Addition Plan

If you have an additional plan displayed in Multiple Plan Review, you can save that

plan by clicking the File drop-down menu and selecting the Save Addition Plan

option.

Plan Comment/ Approval

When using Plan Comment/Approval in Multiple Plan Review you have the ability to

write comments, or approve any of the plans displayed by clicking the Tools drop-

down menu and selecting the Plan Comment/Approval option and selecting the plan.

XiO 6-57


XiO Training Guide


Task 7. Additional Beam Modifiers

This task demonstrates how to add, edit, assign and delete bolus, how to add and

remove wedges, and how to add and remove compensating filters in XiO.

Subtask 1. Open a Permanent Plan

1. Select Teletherapy from the Main XiO Screen. XiO opens Teletherapy.

2. Click the File drop-down menu and select the Open Permanent Plan option.

XiO displays the Open Permanent Plan dialog box.

3. Click your middle mouse button in the Patient ID field and select Breast 1.

4. Click your middle mouse button in the Plan ID field and select onebeam.

5. Click OK. XiO loads and displays the selected patient.

Subtask 2. Bolus

In XiO, bolus is drawn and treated as a slab bolus. It can be drawn on a non-

reconstructed transverse SPV or a BEV.

Draw Bolus SPV

1. Click the Beam drop-down menu and select the Bolus and New options. XiO

displays the Edit Bolus Definition Data dialog box.

2. (Optional) Enter a description for this bolus.

6-58


XiO Training Guide



Subtask 1. Open a Permanent Plan

Draw Bolus SPV (cont.)

3. Enter a bolus thickness of 1 cm.

4. (Optional) Change the Bolus Relative Electron Density.

5. Click your right mouse in the transverse image window and select Movie.

6. Movie to the most superior slice where you want to place bolus.

7. Click your right mouse button in the transverse image window and select the

Edit Bolus option.

XiO 6-59


XiO Training Guide



Subtask 2. Bolus

Draw Bolus SPV (cont.)

8. Hold down your left mouse button in the transverse image window and drag the

mouse from right to left or left to right along the patient’s surface to draw the

slab of bolus on the superior slice.

NOTE: If the bolus does not appear as you are drawing it, you may have a

reconstructed transverse slice displayed. You can verify that you

have a real slice or change to a real slice by clicking the View drop-

down menu and selecting the Window Format option. Click your

middle mouse under the Ref (cm) heading next to the SPV

transverse window. XiO displays real numbers on this list. Verify

that the Ref value is a real slice number. If not, select a real slice

from the list.


Movie option.

10. Movie to the most inferior slice where you want to place bolus.


Edit Bolus option.

12. Hold down your left mouse button in the transverse image window and drag the

mouse from right to left or left to right along the patient’s surface to draw the

slab of bolus on the inferior slice.

13. Click OK on the Edit Bolus Definition Data dialog box. XiO closes the box and

interpolates the bolus to all slices in between.

NOTE: If you would like to create a bolus with various thicknesses (step

bolus), you can either create multiple boluses (each with a different

thickness), abut them on the patient surface, or you can overlap

them and only the largest bolus thickness will take effect.

6-60


XiO Training Guide



Subtask 2. Bolus

Draw Bolus BEV

Before you begin, it will be helpful to display the patient contour as wireframe. When

you draw the bolus on a BEV, you will draw a slab just as you did on the SPV, but you

will draw on the most superior and inferior wireframe contours displayed in the BEV.

1. Click the Beam drop-down menu and select the Bolus and New options. XiO


2. (Optional) Enter a description for this bolus.

3. Enter a bolus thickness of 1 cm.

4. (Optional) Change the Bolus Relative Electron Density.

5. Click your right mouse button in the BEV and select Edit Bolus.

NOTE: Move your mouse pointer over the patient surface. As you do this,

the individual wireframe contours of the patient are highlighted in

white when the mouse pointer is pointing to them.

XiO 6-61


XiO Training Guide



Subtask 2. Bolus

Draw Bolus BEV (cont.)

6. Place your mouse pointer on the most superior slice (highlighted in white) where

you would like to place bolus. Hold down your left mouse button and drag from

right to left or left to right along the wireframe contour to draw the superior

border of the bolus.

7. Place your mouse pointer on the most inferior slice (highlighted in white) where

you would like to place bolus. Hold down your left mouse button and drag in the

same direction you did on the superior slice to draw the inferior border of the

bolus.

8. Click OK on the Edit Bolus dialog box. XiO interpolates and displays the slab

bolus.

6-62


XiO Training Guide



Subtask 2. Bolus (cont.)

Edit Bolus

This section describes how to edit bolus on a slice-by-slice basis using the bolus

displayed in the transverse image window.

1. Click the Beam drop-down menu option and select the Bolus and Edit options;

then, select the number of the bolus you want to edit. XiO displays the Edit

Bolus Definition Data dialog box.


Movie option. Movie to the slice where you would like to edit the bolus.


Edit Bolus option.

Place your mouse pointer at either end of the bolus; hold down your left mouse

button and drag the bolus edge to the right or left around the patient surface.

Perform this step on as many slices as necessary.


XiO 6-63


XiO Training Guide




Assign Bolus

After you create bolus, you have the opportunity to assign the bolus to one or all of the

beams. If you do not assign bolus to any beams, XiO will not account for the bolus in

the calculation.

If you created the beams using total dose and more than one fraction, you have the

ability to fractionate bolus; therefore, you only need to create one beam for each

tangent and designate that the beam be bolused a specified number of days and

unbolused a specified number of days.

1. Click the Beam drop-down option and select the Bolus and Assign options. XiO

displays the Assign Bolus to Beam dialog box.

2. For each beam number, assign bolus by clicking the yes/no toggle button under

each bolus number.

3. If necessary, enter a ratio of bolused to unbolused fractions. If you entered total

doses on the photon beam page and you want bolus applied every day, you can

leave the unbolused/bolused ratio at 0:1.


6-64


XiO Training Guide




Delete Bolus

1. Click the Beam drop-down option and select the Bolus and Delete options. XiO

displays the Remove Bolus dialog box.

2. Click the number of the bolus you want to delete. XiO places an asterisk (*) next

to the bolus number(s) selected for deletion.

3. Click OK. XiO removes the selected bolus.

XiO 6-65


XiO Training Guide


Task 7. Additional Beam Modifiers (cont.)

Sub-task 3. Wedges

Add Wedge

1. In Beam mode, make the beam to which you want to add a wedge the active

beam.

2. Click the Wedge button.

OR

Press F12 on your computer keyboard. XiO displays the Wedge dialog box.

OR

Click the Beam drop-down option and select the Wedge option. (XiO may

prompt you for a beam number if no beams are active.) XiO displays the Wedge

dialog box.

3. Click your middle mouse button in the Wedge ID field and select a wedge (if

you have multiple wedge options).

4. Enter the Wedge Orientation (if required).

5. (Optional) Enter the Wedge Angle for EDW, Virtual Wedge or Motorized

Wedge.

6. Click OK. XiO displays the wedge on the selected beam.

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XiO Training Guide



Sub-task 3. Wedges (cont.)

Delete Wedge

1. In Beam mode, make the beam to which you want to add a wedge the active

beam.

2. Click the Wedge button.

OR

Press F12 on the your computer keyboard. XiO displays the Wedge dialog box.

OR

Click the Beam drop-down option and select the Wedge option. (XiO may

prompt you for a beam number if no beams are active.) XiO displays the Wedge

dialog box.

3. Click the Remove Wedge button. XiO removes the wedge from the active beam

and closes the Wedge dialog box.

XiO 6-67


XiO Training Guide



Sub-task 4. Compensating Filters

There are several types of compensating filters supported in XiO. Some require that

you enter different information than others. XiO can print Ellis and 1D compensator

information from the File-Print menu options. You can review Decimal, Huestis, and

Par Scientific compensators on screen from the Tools-Review Compensating Filter

menu options and order or export to a milling machine.

Filter information must be setup and validated for the machine you want to use prior to

creating one on a patient. If you want to try using a Huestis or Par Scientific

compensating filter, the material you should select in the training data is cfIronGran.

Add Compensating Filter

1. In Beam mode, make the beam to which you want to add a compensator the

active beam; then, click the Compensating Filter button. XiO displays the

Compensating Filter dialog box.

OR

Click the Beam drop-down option and select the Compensating Filter option.

(You may be prompted for a beam number if no beams are active.) XiO displays

the Compensating Filter dialog box.

2. Select a filter if you have multiple types validated. If only one filter type is

validated, XiO displays this type and it is not editable.

NOTE: All of the fields displayed in this dialog box contain default values

if they were set up in Source File Maintenance.

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XiO Training Guide




Add Compensating Filter (cont.)

3. Edit any of the fields, if necessary. See the XiO Online Help for more

information regarding the contents of these fields.

4. Click OK. XiO displays the compensator on the patient as a yellow line

perpendicular to the beam in the SPV window. It also displays the compensator

in an MPV window as a plane perpendicular to the beam.

Delete Compensating Filter

1. In Beam mode, make the beam to which you want to add a compensator the

active beam; then, click the Compensating Filter button. XiO displays the

Compensating Filter dialog box.

OR

Click the Beam drop-down option and select the Compensating Filter option.

(You may be prompted for a beam number is no beams are active.) XiO displays

the Compensating Filter dialog box.

2. Click the Remove Compensator button. XiO removes the compensator and

closes the dialog box.

XiO 6-69


XiO Training Guide



Sub-task 4. Compensating Filters (cont.)

Send Compensating Filter Data to a Milling Machine (Huestis and Par Scientific)

1. Click the Tools drop-down menu and select the Review Compensating Filter

option. XiO opens the Review Compensating Filter dialog box.

2. Click the Send to Milling Machine button. XiO opens the Send to Milling

Machine dialog box.

3. If the format is Par Scientific, enter the Version Number you are using in your

clinic.

6-70


XiO Training Guide




Send Compensating Filter Data to a Milling Machine (Huestis and Par Scientific) [cont.]

4. Enter the Distance Exported beyond the Field Edge.

NOTE: As a caution, you will want to be aware of how the Distance Exported

beyond Field Edge (cm) is related to the boundary of the beam matrix.

During the dose calculation, XiO computes compensating

transmission factors for not only the open field, but also up to the

boundary of the beam matrix. For FFT Convolution/Superposition,

the boundary of the beam matrix is the sum of the field extended by

the TERMA extent as defined on the Beam dialog box. For Clarkson,

the beam extent is equal to the maximum fan line ratio generated for

the computational OCR data tables in Source File Maintenance

(SFM). If the Distance Exported beyond Field Edge (cm) is set to a

value smaller than the TERMA extent, or the OCR ratio, when the

transmission factors are converted to filter material, it will be possible

to cut some regions off which were calculated as part of the beam

extent. Therefore, the actual dose distribution outside of the field will

not be identical to the doses computed in XiO. A Distance Exported

beyond Field Edge of zero (0) will have the largest discrepancy

between the calculated dose and the actual delivered dose.

XiO 6-71


XiO Training Guide




Send Compensating Filter Data to a Milling Machine (Huestis and Par Scientific) [cont.]

When using FFT Convolution or Superposition, material thicknesses

are only calculated out to the TERMA extents. If the Distance Exported

beyond Field Edge (cm) field is set to a value larger than the TERMA

extents, the compensating file, when exported, will pad the border with

zeros (diagram 1).

Compensator Exported

as Calculated

Outside the TERMA

extents, no filter is

calculated. This will

be padded with 0

TERMA extent

outside the jaws,

exported as calculated

.

Diagram 1: Schematic of exported compensator thickness values.

WARNING

Due to the above issues, CMS recommends that

the Distance Exported beyond Field Edge (cm) be

set to the same value as TERMA on the Beam

dialog box. CMS also recommends a value of 4

cm for the TERMA extent. Users should be

aware that for XiO 4.2.2 with PDA 10141, the

Distance Exported beyond Field Edge (cm) is not

being saved with the plan. Therefore, every time

the plan is opened, this field reverts to the default

of blank.

5. Select a Transfer Method.

6. Enter a File Name for the Milling Machine.

6-72


XiO Training Guide


Task 8. Delete Options in XiO

Additional delete functionality is available in XiO for cleaning up your systems and

deleting unwanted plans, information, and templates. You can find the following

delete options in Teletherapy and in Patient File Maintenance under the File drop-

down option. Unless you have first created a backup of your data that you can restore,

deleting any of these items is permanent.

Patient Delete a patient from the XiO system.

Studyset (PFM Only) Delete a studyset from a patient file.

Isodose Plan Delete a selected plan from a patient file.

IFPD Plan Delete an irregular field point dose plan from a patient file.

Temporary Plan Delete one or multiple temporary plans from a patient file.

DICOM Import Deletes DICOM imported plans from the merge directory.

Public Port Delete a public port from XiO.

Plan Template Delete plan templates from XiO.

Graphics Presets Delete Graphics Window Preset lists from XiO.

Isodose Lines Presets Delete Isodose Lines Presets from XiO.

Plan Output Delete Plan Output templates from XiO.

XiO 6-73

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Practice Exercise

This 2-D Breast Tangents plan is the first treatment plan that you interactively

follow in the XiO Dosimetry training course. If you have an operational XiO

workstation at your clinic, you may also follow this exercise on your own.

Patient contours to use for digitizing can be found in the back of this section.

The design of this plan illustrates the basic actions required to digitize contours

and create a simple 2-D plan.

This plan is similar to the plan using pre-drawn contours that you may have

completed in the XiO Getting Started Guide prior to coming to class.

Consequently, this should be a relatively straightforward plan for you to

complete.

Refer to the Online Help glossary for definitions of terms where you need further

clarification.

Once you complete this exercise, you should understand the following concepts

and be able to execute the various tasks without additional supervision:

! Access XiO

! Enter patient demographic data and define the studyset

! Digitize contours

! Create a new plan

! Save the plan

! Print a Single Plane View

XiO" 7-1

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 1. Access XiO

The following steps illustrate how to access the XiO system from an operational

XiO workstation.

1. On the login window, type test in the Login ID field and cms in the

Password field.

2. Click the OK button. XiO displays the main system window for HP/UX.

OR

Click the XiO icon on your computer desktop for Linux systems.

3. Verify the current clinic displays: XiO Training Data. CMS set up the

demo clinic so that you can practice each of the steps for each of the tasks

illustrated in the training guide. Do Not use the data shown in the practice

exercises when creating a valid treatment plan for your clinic.

7-2

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 2. Enter Patient Demographic Data and Define the Studyset

The following steps illustrate how to enter the patient demographic information

and create the studyset.

1. On the XiO main window, click the Patient File Maintenance option.

XiO opens Patient File Maintenance (PFM) where you can select options

from the drop-down menus.


XiO displays the New Patient dialog box.

3. Enter 12345 in the Patient ID field.

4. Enter Breast Tangents in the Patient name: field.

5. Click the drop-down arrow in the Sex: field and select Female.

6. Click the drop-down arrow in the Create: field and select Nonimaged

Studyset.

XiO" 7-3

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 2. Enter Patient Demographic Data and Define the Studyset (cont.)

7. Click OK. XiO displays the New Non-image Based Studyset Definition

dialog box.

8. Enter Tangents in the Studyset ID field.

NOTE: UNIX and LINUX are case sensitive and do not allow spaces in

the ID names. Entries must also be alphanumeric.

9. (Optional) Enter 2-D Training in the Studyset Description: field.

9. The Patient Position can be left as the default, Supine.

10. (Optional) Enter Position Comments (sponge under knee, head to the

right, etc).

NOTE: If you are planning a prostate preplan and will be digitizing

ultrasound prostate images, you have to select a template to use.

In that case, select Yes for prostate preplanning and enter a

Prostate Template ID.

7-4

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 2. Enter Patient Demographic Data and Define the Studyset (cont.)

11. Under the heading Cross Section Reference Distance Positions, enter the

following (3) cross section reference distance positions: -5.0 cm, 0.0 cm,

and +5.0 cm. These are the three cross sections you will be contouring.

OR

If the slices you plan to create contours on are evenly spaced in the From,

To, and Step boxes, enter the most inferior slice, the most superior slice,

and the step increment between them. The number of slices you will create

contours on will default in the Cross Section Reference Distance Positions

boxes.

NOTE: The (3) cross sections to be digitized can be found in the

training guide at the end of this exercise. Each cross section

is labeled with a corresponding reference distance position.

12. Click OK.

XiO" 7-5

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 3. Digitize Contours

The following steps illustrate how to set up the contouring parameters, orient the

axes, and digitize contours into XiO.

Sub-Task 1. Set up the Contouring Parameters and Orient the Axes

1. On the Patient File Maintenance Toolbar, select the option Trace Contours

Using the Tablet button. XiO displays the Orient the Tablet dialog

box.

2. Enter the following values:

Scale Factor: 0.62.

Auto Sample Spacing: 0

NOTE: Values entered in the Auto Sample Spacing field will be used to

determine sample spacing when you digitize contours. Use zero

(0) when you want to digitize each point yourself. If you enter

any other value 0.0 - 5.0, you will not digitize each point. You

only have to drag the mouse around the contour. XiO will drop

points in the increment you entered. You may enter several

values, separated by commas, and change the value you will use

at any time during contouring. As a general rule, for larger

contours, such as for patient skin, use larger spacing. For

smaller contours, such as the spinal cord, use a smaller spacing.

To learn more, see the XiO Online Help.

3. Turn on the digitizer tablet. There are two buttons on the left side of the

tablet. One is for power the other for the backlight. (Turning on the

backlight is optional.)

4. Locate the cross section labeled +5.0 cm and place it on the digitizer tablet.

This is the most superior cross section. Orient the cross section on the

tablet using the following steps. Create a 3-point orientation by digitizing

the – axis, the + axis, then the origin.

(1) To create the – axis point, click the {enter point} button on the

transducer keypad with the transducer positioned on the

crosshair to the left of the origin.

NOTE: The tablet makes a beeping sound as you enter each

point.

7-6

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 1. Set up the Contouring Parameters and Orient the Axes (cont.)

(2) To create the + axis point, click the {enter point} button on the

transducer keypad with the transducer positioned on the

crosshair to the right of the origin.

(3) To create the origin point, click the {enter point} button on the

transducer keypad with the transducer positioned on the origin of

the crosshair. After you orient the contour on the tablet, XiO

displays the Tablet Contour Information window.

(4) Before contouring begins, verify that the reference distance listed on

the Tablet Contour Information dialog box is +5.0 cm. If not, you

may need to press button {8} Switch to Previous Cross Section, or

{9} Switch to Next Cross Section on the transducer keypad to move

to that cross section reference distance.

XiO" 7-7

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 2. Digitize Contours

Digitize all structures, interest points, and markers one cross section at a time;

however, you can always go back to any cross section and digitize new contours

or points.

You do not have to digitize the cross sections in any particular order; verify that

the cross section you are digitizing corresponds with the reference distance

displayed on the screen.

You also do not have to digitize the contours in any particular order; verify that

the contour name displayed in the upper right corner of the screen is the name of

the contour you are digitizing.

A view of the transducer buttons and a list of the tablet keypad controls are

shown at the end of this section.

Begin by digitizing the Patient contour. The group name "General" and contour

name "Patient" should be displayed in the upper right corner of the screen. If

these names are not displayed, press {5} on the transducer keypad to toggle to

Group name, and/or {6} to toggle the Contour name.

1. Trace the Patient Contour as follows:

(1) Place the transducer on the line of the patient contour. Press the {start}

button on the transducer.

(2) Place the contour outline by pressing the {enter point} button at each

position you place the transducer around the patient contour.

NOTES: If you chose a different auto sample spacing other than

zero, you do not need to press the enter point button to

add points. Points are dropped automatically as you

slide the transducer around the patient contour.

Press {0} on the digitizer controller to start over.

(3) Press the {end} button on the transducer when you want to close the

contour.

(4) Next, digitize the breast tissue (target). Use the Contour name PTV1.

7-8

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 2. Digitize Contours (cont.)

2. Trace the Target Contour as follows:

(1) Select PTV1 from the Contour name list by pressing {6} two times.

(2) Place the transducer on the line of the target contour. Press the {start}

button on the transducer.

(3) Trace the contour outline by pressing the {enter point} button at each

position you place the transducer around the target contour.

(4) Press the {end} button on the transducer when you want to close the

contour.

(5) After the contours have been entered on cross section +5.0 cm, replace

that cross section on the tablet with the 0.0 cm cross section. This is

the central axis cross section.

NOTE: If you place the cross section in the same position on the

digitizer tablet, there is no need to reorient the tablet

between cross sections; however, if you do not place the

next cross sections in the same position on the tablet, press

{1} Reorient Axis each time you place a new cross section

on the tablet. This allows you to reorient the new cross

section.

3. Prepare to digitize contours on cross section 0.0 cm as follows:

(1) Press {8} Previous Cross Section or {9} Next Cross Section on the

transducer keypad to change the display to the 0.0 cm cross section.

XiO displays the label 0.0 cm at the bottom of the contouring window

and at the top of the Tablet Contour Information window.

(2) Press {6} Next Contour Name to toggle the Contour name back to

Patient.

(3) Digitize the patient contour as described in previous steps.

(4) Toggle the Contour name to PTV1.

(5) Digitize the target contour as described in previous steps.

XiO" 7-9

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 3. Digitize Contours (cont.)

Sub-Task 3. Digitize Interest Points and Markers

Use the transducer to digitize the interest point and markers on the cross section

0.0 cm. To distinguish the two, dose is reported for interest points; however,

dose is not reported for markers. In this task, place an interest point at isocenter

and markers at the medial and lateral field borders.

1. Position the transducer over point 1. (This point appears as a + sign in the

center of the target contour.)

2. Press button {3} Interest Point on the transducer keypad to digitize the

interest point.

3. Position the transducer over point 2.

4. Press button {2} Marker Point on the transducer keypad to digitize the

medial border marker.

5. Position the transducer over point 3.

6. Press button {2} Marker Point on the transducer keypad to digitize the

lateral border marker.

Sub-Task 4. Digitize Contours on Final Cross Section

1. Replace the cross section on the digitizer tablet with the cross section

labeled -5.0 cm. This is the most inferior cross section.

2. Repeat steps found in sub-task 2 to digitize the patient and target contours

on cross section -5.0 cm.

NOTE: Do not forget to change to a new cross section -5.0 cm and

change the contour name to represent each contour before it is

digitized.

3. When you have completely finished all tablet digitizing, press button {4}

End Tablet Entry.

7-10

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 5. Name the Interest Points and Markers

1. Click your right mouse button in the main window and select the Movie

option.

2. Click the left or middle mouse button (or use the scroll wheel) to movie to

slice 0.0 cm.

3. Click the Edit drop-down menu and select the Interest Points option. XiO

displays the Edit Interest Point Definition dialog box.

4. Enter the name Isocenter for the Interest Point displayed.


6. Click the Edit drop-down menu and select the Markers option. XiO

displays the Edit Marker Definition dialog box.

7. Enter the names Medial and Lateral for the Marker points displayed.


XiO" 7-11

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 4. Create a New Plan

Once all the contouring is complete, you can create a new beam plan. This task

illustrates how to create a new plan in XiO. The total dose prescription for this

breast tangents plan is 5040 over 28 fractions. You will plan using total dose;

then, normalize 5040 to the 100% isodose line for dose display.

Sub-Task 1. Enter Plan Information

1. Click the Beam button on the main toolbar. XiO opens Teletherapy and

displays the New Teletherapy Plan dialog box.

2. (Optional) Enter Tangents in the Description field.

3. The Beam Weighting Mode field defaults to Absolute dose/MU.

4. The Treatment Date defaults to the current date.

5. Click the drop-down arrow in the Head/Feet Toward Gantry: field and

select Head. (Head is the default.)

6. Click OK. XiO closes the dialog box and displays the patient in a four

window format.

7-12

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 4. Create a New Plan (cont.)

Sub-Task 2. Create an Active Beams-Eye View (ABV) Window

1. Click the View drop-down menu and select Window Format.

OR

Press W on your computer keyboard. XiO displays the Window Format

dialog box.

2. Click the drop-down arrow in window number 4 under View and select

ABV. This designates window 4 as an active beams eye view window.

3. Click the Update Graphics Display button.

4. Click CANCEL.

NOTE: Window 4 remains blank until a beam is added.

XiO" 7-13

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 4. Create a New Plan (cont.)

Sub-Task 3. Create a New Beam

1. Create a new beam using one of the following methods:

Click the New Beam button on the sub-mode toolbar.

OR

Click the Beam drop-down menu and select the New Beam option.

OR


2. Enter the beam description Medial Tangent.

3. Click your middle mouse button in the Machine ID: field and select

Vari06x.

4. Verify the Setup is SAD and set the collimator jaws to Asymmetric.

5. Click your middle mouse button in the Beam Isocenter Placement box and

select the interest point labeled Isocenter as the default.

6. Click OK. XiO displays the Photon Beam dialog box.

7. Enter the following parameters at the field size defined at field:

LW: 6.0

RW: 5.5

UL: 10.0

LL: 10.0

8. Enter a gantry angle of 65 deg.

OR

Click your right mouse button right mouse in the 0.0 cm crosssection

window and select the Gantry Angle option. Hold down and move the left

mouse button in this window to rotate the gantry manually until the medial

and lateral markers are superimposed in the ABV window.

7-14

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 3. Create a New Beam (cont.)

9. Enter 2520 cGy for weight, and 28 for number of fractions.

10. Leave all other parameters at their default values.

11. Click OK. XiO closes the photon beam dialog box.

Sub-Task 4. Add a Wedge

1. Click the Wedge button on the sub-mode toolbar.

OR

Click the Beam drop-down menu and select the Wedge option. XiO

displays the wedge dialog box.

2. Click your middle mouse button in the Wedge ID: field and select W15.

3. Select Left for the Toe Orientation.

4. Click OK. XiO closes the wedge dialog box and displays the wedge on the

medial tangent in the correct orientation.

Sub-Task 5. Mirror the Beam

This task illustrates how to create an opposed beam. All the parameters set for

the medial tangent will be applied to the lateral tangent, including the wedge.

You only need to adjust the gantry angle to match the inner border.

1. Click the Mirror Beam button on the sub-mode toolbar.

OR

Click the Beam drop-down menu an select the Mirror Beam option. XiO

displays the Mirror Beam dialog box.

OR

XiO" 7-15

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 5. Mirror the Beam (cont.)


2. Enter the beam description Lateral Tangent.

3. Edit the gantry angle to be 239 deg.

OR

Click your right mouse button in the 0.0 cm cross section window and

select the Gantry Angle option. Hold down and move the left mouse in

that window to rotate the gantry manually until the medial and lateral inner

borders are superimposed.

4. Click OK to close the photon beam dialog box.

Sub-Task 6. Normalize and View Isodose

Once the beam information has been entered, the dose calculation begins

automatically (unless you have set the preference to not automatically start the

dose calculation). After the dose calculation is complete, you can setup the

normalization and enter isodoses for plan review.

1. Click the Dose button on the main Teletherapy toolbar. XiO activates

the Dose supporting toolbar buttons.

7-16

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 6. Normalize and View Isodose (cont.)

2. Click the Set Normalization Mode button on the sub-mode toolbar.

XiO displays the Dose Normalization dialog box.

3. Enter 5040 in the Selected Dose (cGy) field.

4. Click the Selected Dose button to normalize the dose to 100%.

5. Click Cancel to exit the dose normalization dialog box.

6. Click the Isodose Lines button on the sub-mode toolbar. XiO opens

the Isodose Lines dialog box.

7. Enter the following isodose lines 110, 105, 100, 98. Review the coverage

of the isodose lines on all three cross sections.

8. Click OK to close the isodose lines dialog box.

9. Click the Beam Weight button on the sub-mode toolbar. XiO displays

the Beam Weight dialog box allowing you to type in beam weights and

click on Update Display to Reflect Changes. You may edit the beam

weights if necessary.

NOTE: The Rescale (prescribe) beam weight option allows you to rescale

beam weights to a point or isodose line. This topic is discussed

later in the training guide.

XiO" 7-17

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


Sub-Task 6. Normalize and View Isodose (cont.)

10. Click OK to close the beam weights dialog box.

11. Click the Source Data button on the sub-mode toolbar. XiO displays

the source data index for this plan. Review the information on this index

for accuracy. You can print this index by selecting the Print option at the

bottom of the index.


7-18

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents


1. Click the Save button on the sub-mode toolbar.

OR

Click the File drop-down menu and select the Save Plan option. XiO

opens the save permanent plan dialog box.

2. Enter Tangents for the Plan ID.

3. (Optional) Enter a Plan Description.

4. Click OK to save the permanent plan.

XiO" 7-19

2-D Breast Tangents

XiO Training Guide

2-D Breast Tangents

Task 6. Print a Single Plane View

This task illustrates how to select and print a single plane view (SPV) window.

In this exercise, include the printed report data in the printout.

1. Click your left mouse button in the 0.0 cm window (Subwindow 2). XiO

displays a red box around that window. This action activates the 0.0 cm

cross section so it can be printed.

2. Click the File drop-down menu and select the Print and Single Plane View

options. XiO displays the Print Single Plane View dialog box.

NOTE: Notice that Subwindow 2 is designated as the window to be

printed.

3. Any scale factor in the range of 0.1 to 3.0 may be entered; however, the

scale factor that defaults is the largest image that will fit on one 11x17

page. Use the default for this exercise.

4. Answer yes to include Source Data, Dose Labels, and Printed Data.

Leave all other options to their default values.

NOTE: If you do not include the Printed Data, XiO prints only the

SPV image with no supporting reports.

5. Click OK to begin the print job.

6. Review the printed data to familiarize yourself with the information that

XiO provides.

7. Once you finish the plan, click the File drop-down menu and select the Exit

option. XiO returns you to the XiO main screen.

7-20

2-D Breast Tangents

XiO Training Guide

Tablet Keypad Control Options

{Start} : Start Contour

{Enter Point} : Enter Contour Point

{End} : Close Contour

{0} : Restart Tracing

{1} : Reorient Axis

{2} : Marker Point

{3} : Interest Point

{4} : End Tablet Entry

{5} : Next Group Name

{6} : Next Contour Name

{8} : Previous Cross Section

{9} : Next Cross Section

{+} : Use Next Sample Spacing

{-} : Delete Last Contour Point

Indicator Light –

The Green light is lit

when transducer and

tablet are

communicating.

+

+ 0 -

2 3 Start 1

5 6 End 4

9 Enter

Point 87

XiO" 7-21

2D Breast Tangents Plan-Superior Cross Section

T = +5.0 cm

Scale Factor = 0.62

NOTE: This factor may vary depending on the printer;

verify before using this factor.

2D Breast Tangents Plan- Cax Cross Section

T = 0.0 cm

Scale Factor = 0.62



2D Breast Tangents Plan- Inferior Cross Section

T = -5.0 cm

Scale Factor = 0.62



3-D Lung

XiO Training Guide

3-D Lung

Practice Exercise

This practice exercise builds on the knowledge you gained by completing the

Patient File Maintenance and Teletherapy lessons. Completing this exercise

should help to reinforce what you have already learned and also illustrate how

easy it is to create 3-D plans in XiO.

Besides being a 3-D plan, this is also a composite plan. To create a composite

plan in XiO, you place all the beams on one plan, then turn off and on the beams

you would like to calculate. Turn them all on to review the composite plan, turn

off the boost beams to review the original plan or turn off the original beams to

review the boost plan.

NOTE: You are required to transfer CT data in this exercise. This patient is

only available if you are in a CMS Training Class. However, you

could follow these steps for almost any patient and complete a 3-D

plan.

Once you complete this exercise, in addition to the skills learned in the previous

lessons, you should understand the following concepts and be able to execute the

various tasks without additional supervision.

! Create a new patient and transfer in data

! Use Auto Margin to expand a structure

! Add an interest point in Teletherapy

! Set the 3-D calculation matrix

! Create a new beam

! Add a treatment aid (port)

! Mirror a beam

! Edit a port

! Save a plan

! Normalize the dose display and review isodoses

! Add boost fields for a composite plan

! Review the boost plan

! Review the composite plan

! Create a dose volume histogram

XiO" 8-1

3-D Lung

XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data

This task demonstrates how to enter the patient demographics and transfer CT

data from the Source directory (where CT sends the raw data) into Patient File

Maintenance.

1. Select Patient File Maintenance from the XiO main screen. XiO displays

the Patient File Maintenance main screen.


XiO displays the New Patient dialog box. This is where you enter the

patient demographic data.

3. Enter the name ChestPatient in the Patient ID: field.

4. Enter Sara P. Rose in the Patient Name field.

5. Click the drop-down arrow in the Sex field and select Female.

6. Click OK. XiO displays the Start Image Transfer dialog box.

8-2

3-D Lung

XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data (cont.)

7. Click your middle mouse button in the Source PID: field and select 147-11-

10 from the list. Note that all the available images are selected for transfer.

8. Enter 3Dlung in the Studyset ID field.

9. Click your middle mouse button in the CT to ED Conversion: field and

select rocsboard from the list.

10. Click OK. XiO transfers the CT data.

11. Once the CT data transfer is complete, XiO displays the Finish Image

Transfer dialog box.

Enter the following information:

(1) Click the drop-down arrow in the Transverse images views from foot

field and select Yes.

XiO" 8-3

3-D Lung

XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data (cont.)

(2) Click the drop-down arrow in the Reference distances increase towards

head field and select Yes.

NOTE: View the graphic area to ensure that the green arrow is

pointing superiorly on the coronal image.

(3) Click the drop-down arrow in the Patient Position field: and select

Supine as the patient position.

12. Click OK. XiO re-orients the cross sections (that is, if the settings were

changed from the defaults), and displays the Add Anatomical Site dialog

box.

13. Click the Chest button to add the predefined anatomy site. The button turns

blue.

14. Click OK.

8-4

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XiO Training Guide

3-D Lung

Task 2. Create Contours

Contour the following structures.

! Patient (external)

! Right lung

! Left lung

! Spinal cord

! Tumor (GTV)

You may choose from any of the contouring methods outlined in the Patient File

Maintenance section of this training guide. Refer to those procedures as needed.

XiO" 8-5

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Task 3. Use Auto Margin to Expand the Target Volume

Use the 3-D Auto Margin tool if you would like to combine structures to create a

new structure or create positive, negative, or variable margins on structures.

Refer to the Patient File Maintenance section of this training guide for more

information on creating 3-D auto margins.

1. Click the Create a Contour Using 3-D Auto Margin button on the

sub-mode toolbar. XiO displays the 3-D Auto-Margin dialog box.

2. At the New Structure Name: field enter PTV.

3. Click the drop-down arrow in the Class: field and select Int.

4. Click your middle mouse button in the Color: field and select a Color.

5. Click the drop-down arrow in the Rendering: field and select a Rendering.

6. Click your middle mouse button at the Structure field and select GTV.

8-6

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3-D Lung

Task 3. Use Auto Margin to Expand the Target Volume (cont.)

7. In the Margin field that corresponds with the "GTV" structure, enter 1.5

(cm).

8. Click the drop-down arrow in the associated Include/Exclude column and

select Include.

9. Click the Create 3-D auto-margin button.

10. Click the Accept 3D auto-margin button.


XiO" 8-7

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3-D Lung

Task 4. Enter Basic Teletherapy Information

Click the Beam button to transition from Patient File Maintenance to

Teletherapy. At any time, you can return to Patient File Maintenance by clicking

the Contour button.

1. Click the Beam button on the toolbar. XiO opens the Teletherapy

function and displays the New Teletherapy Plan dialog box.

2. Click the drop-down arrow in the Graphics Area Setup: field and select the

predefined graphics area setup 4TSCA.

3. Click OK.

8-8

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XiO Training Guide

3-D Lung

Task 5. Add an Interest Point

In Patient File Maintenance or Teletherapy, you can place interest points or

markers. This task explains how to create interest points in Teletherapy. For

more information on placing interest points or markers in PFM, refer to the

Patient File Maintenance section in this training guide.

1. Click the Contour drop-down menu and select the Interest Points and

New options. XiO displays the Add Interest Point dialog box.

2. At the Description prompt, enter GTV.

3. Click your middle mouse button in the Center of Structure: field and select

GTV from the list.

4. Click OK. XiO adds the interest point and clears the fields on the dialog

box so you can add additional interest points.


XiO 8-9

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3-D Lung

Task 6. Dose Calculation Settings

Dose calculation settings include heterogeneity correction, calculation region

size, and calculation grid spacing. XiO supports bulk, pixel by pixel, and a

combination of the two for heterogeneity correction. XiO automatically sets the

calculation region to encompass the entire patient; however, you can edit the box

here. Grid spacing determines the numbers of points calculated in the region.

Common grid spacing for conventional photon beam planning is 3-5 mm grid

spacing.

1. Click the Dose drop-down menu and select Calculation and Settings


2. Click the drop-down arrow in the Heterogeneity Correction field and make

a selection. Yes means the system considers the heterogeneity correction

during dose calculation. No means the system does not consider the

heterogeneity correction.

3. Click the drop-down arrow in the Pixel-by-Pixel Calculation field and make

a selection. Yes means the system uses CT pixel converted electron

densities in the heterogeneity correction. No means the system does not

use CT pixel converted electron densities in the heterogeneity correction;

instead, it uses the bulk densities assigned in PFM.

8-10

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XiO Training Guide

3-D Lung

Task 6. Dose Calculation Settings (cont.)

4. Enter the following Distance between Calculation Points:

Along Width 0.4

Along Height 0.4

Along Depth 0.4


XiO 8-11

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Task 7. Add New Beam

This task demonstrates how to add a new beam to a patient and enter all the

appropriate beam information.

1. Click the New Beam button on the Beam supporting toolbar.

OR

Click the Beam drop-down menu and select the New Beam option. XiO

displays the New Beam dialog box.

2. (Optional) Enter a description of the current treatment beam, such as AP.

3. Click your middle mouse button in the Machine ID field and select the

Vari06x to be used in the treatment.

NOTE: This machine ID must be defined and validated in Source

File Maintenance prior to selecting it here.

4. Click your middle mouse button in the Beam Isocenter Placement field and

select the Center of GTV for your treatment plan. Your selection

determines where the beam isocenter is located.

8-12

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3-D Lung

Task 7. Add New Beam (cont.)


6. Enter this data for the following fields:

Width (cm): 10

Length (cm): 10

Gantry Angle (deg): 0

Collimator Angle (deg): 0

Couch Angle (deg): 0

Weight Defined At: Isocenter

Weight (cGy): 2000

Number of Fractions: 20

7. Click OK. XiO creates and displays the new photon beam.

XiO 8-13

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3-D Lung

Task 8. Adding an Aperture

After you place your first beam, the Auto Port button becomes available. You

can access this button by clicking either the Beam or Port buttons located on the

main toolbar. For illustrative purposes, this exercise discusses how to create an

aperture using the Port button. For more information on creating apertures,

blocks and MLC ports, refer to the Teletherapy sections of this training guide.

1. Click the Port button on the main toolbar.

2. Click the AutoPort button on the supporting toolbar. XiO displays the

Auto Port dialog box.

3. Click your middle mouse button and select the PTV for the Auto Margin

To: field.

4. Enter "1" for the With Margin units.

5. Click the Calculate Aperture button.

6. Click OK. XiO displays the newly created aperture.

7. Click the Conform Collimator Jaws to Aperture button. XiO

conforms the jaws to the port, either symmetrically or asymmetrically,

depending on the jaw setting selected.

8-14

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XiO Training Guide

3-D Lung

Task 9. Mirror Beam

Use the Mirror Beam option to copy a beam parallel opposed to the original

beam. If you have a port on your beam, it will also mirror the port.

1. Click the Beam drop-down menu and select the Mirror Beam To…

option. XiO displays the Mirror Beam dialog box.

2. Click OK. XiO displays the Photon Beam dialog box for beam 2.

3. (Optional) Enter a beam description, such as PA.

4. Click OK to close the Photon Beam dialog box.

XiO 8-15

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XiO Training Guide

3-D Lung

Task 10. (Optional) Edit a Port

The Port editing tools function the same as the editing tools in Contouring.

Follow these instructions if you want to manually make edits to your port.

1. Click the Port button.

2. Click the Define Shape as Aperture button.

3. Click the Edit Port button on the Port supporting toolbar.

4. Verify the active beam is beam 2. Click your right mouse button in the

Active Beams-Eye View (ABV) window.

5. Select the option Edit Contour.

6. Click your left mouse button on the aperture shape edge. A yellow edit box

displays around the port.

7. Edit the aperture using the same tools that you use to edit a contour, such as

stretching, dragging, replacing, etc. Review the contour editing tools in the

Patient File Maintenance section of this guide, if necessary.

8-16

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It is important to save your plan as a permanent plan when you are finished. If

you do not save your plan, XiO automatically saves it as a temporary plan.

However, temporary plans can be altered at any time and your original plan data

may be lost.

1. Click the Save button on the supporting toolbar. XiO displays the Save

Permanent Plan dialog box.

2. Enter a Plan ID.

3. (Optional) Enter a description.

4. Click OK. XiO saves the plan and closes the dialog box.

XiO 8-17

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XiO Training Guide

3-D Lung

Task 12. Normalize the Dose Display and Review Isodoses

1. Click the Dose toolbar button.

2. Click the Set Normalization Mode button.

3. To normalize to a Selected Dose of 4000, enter 4000 in the field next to the

Selected Dose option.

4. Click the Selected Dose button. XiO normalizes to the selected dose.

5. Click Cancel to close the Set Normalization dialog box.

6. Click the Isodose Lines icon.

7. Change Thick Lines to Yes.

8. Enter the following isodose values 100, 98, 95, 80.


8-18

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3-D Lung

Task 13. Add Boost Fields for a Composite Plan

This exercise demonstrates how to add oblique boost fields to an existing plan to

create a composite plan.

NOTE: If the port property for auto-generated blocking updates with beam

movement is set to yes, blocking will update automatically.

1. Click the Beam button on the main toolbar. XiO displays the Beam

supporting toolbar.

2. Select Beam 1 in the Active Beam drop-down list.

3. Click the Copy Beam button. XiO displays the Photon Beam dialog box

for beam number 3.

4. Enter the following information:

Description: RAO

Gantry Angle: 330

Weight: 1000

No. Fractions: 10


6. Click the Mirror Beam button. XiO mirrors the beam and port and

displays the Photon Beam dialog box for beam 4.

7. Enter the Description LPO.


XiO 8-19

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3-D Lung

Task 14. (Optional) Review the Boost Plan

Follow these instructions to review and print information for one plan at a time

when you have created a composite plan. This example demonstrates how to

review the boost plan alone.

1. Click the Dose button on the Teletherapy main toolbar.

2. Click the Beam Weight button on the Dose supporting toolbar. XiO

displays the Beam Weight dialog box.

3. In the Stat (Status) field, click the on/off button to an Off status for beams 1

and 2.

4. Click the Update Display to Reflect Changes button.

5. Click OK.

6. Click the Set Normalization Mode button.

7. Enter 2000 in the Selected Dose field. XiO updates the isodose lines to

reflect the boost dose alone.


9. Review the isodose lines for the boost.

8-20

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3-D Lung

Task 15. Review the Composite Plan

Follow these steps to review the composite plan. Since the weight point is the

same for all beams in the original and boost plans, you can review your isodoses

in percent (all doses add together). If doses are prescribed to multiple weight

points, you will need to view your isodoses in Absolute doses (all doses do not

add together). This example shows how to convert to Absolute dose.

1. Click the Beam Weight button on the Dose supporting toolbar. XiO

displays the Beam Weight dialog box.

2. Click the All Doses On/Off button. Note that all beams should now be in

an On mode.

3. Click the Update Display to Reflect Changes button.

4. Click OK.

5. Click the Absolute/Standard Dose Normalization button on the

supporting toolbar. XiO automatically changes the normalization to

absolute and updates the isodose values.

6. Click Cancel to close the Normalization dialog box.

XiO 8-21

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XiO Training Guide

3-D Lung

Task 16. Create a DVH

This task demonstrates how to create and use a Dose Volume Histogram to

review your plan.

1. Click the Histogram button on the Dose supporting toolbar.

NOTE: If you do not have an available window in which to place the

histogram, XiO prompts you to select a window to place the

histogram.

2. Click your middle mouse button in the Histogram Window Number field

and select a window.

3. Click OK. XiO displays the Histogram dialog box.

4. Click on the anatomy structures you want to add to the DVH graph.

5. Click OK.

6. Review the DVH using any of the tools discussed in the Teletherapy

section of this training guide.

8-22

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3-D Lung

Task 17. Save the Revised Plan as a New Plan

Follow these steps to save the composite plan as a separate plan.

1. Click the File drop-down menu and select the Save as Plan option. XiO

displays the Save Permanent Plan dialog box.

2. Enter the new Plan ID: Composite.

3. Click OK. XiO saves the plan with the new ID and closes the dialog box.

XiO 8-23

Preferences

XiO Training Guide

Preferences

General Preferences

These preferences are located on the Edit drop-down menu when XiO displays

the splash screen.

These preferences are related to the Printer Settings found under Settings >

Workstation > Printers. See the Settings section of the training guide for more

detailed information.

This preference page allows you to easily edit the default output device, printer,

plotter, and screen capture printer.

Scenario: Your default output device is PDF, but you want to print your plan to

paper first. Minimize the working plan to display the XiO splash screen. Click

the Edit drop down menu and select the Preferences option. Change the default

output device to Printer/Plotter. Maximize your working plan and print the plan

to paper.

Patient File Maintenance Preference Settings

The following Patient File Maintenance Preference Settings are user-specific.

Any logged in user can set individually desired preferences.

General

The Patient File Maintenance (PFM) General Preference Settings allow you to

customize the settings for all PFM activities and use these default settings for all

future contouring. Any contours created after the new preference settings are

made will reflect the defaults of the new preference settings.

Any settings made to contours prior to setting the new preferences are not

affected by your recently made changes.

XiO 9-1

Preferences

XiO Training Guide

Preferences

Patient File Maintenance Preference Settings

General (cont.)

1. Click the Edit drop-down menu and select the Preferences and General

options. XiO displays the General Preferences dialog box for Patient File

Maintenance.

2. Enter the Minimum Point Sample Spacing (cm) representing the least

distance you want to move the mouse in Draw Mode before a sample point

is placed. Make this value large to reduce the number of sample points.

Make this value small to increase the number of sample points.

3. Enter the 2-D Automargin Default Value (cm) to which you want the 2-D

Auto-Margin to default to. You can change the margin from the default

when in the Edit Mode.

4. Enter the Quick Interest Point Placement Character shortcut key you

want to use to place interest points in PFM. For example, if you want to be

able to press I to place an interest point, enter the letter "i."

5. Enter the Quick Marker Point Placement Character shortcut key you

want to use to place markers in PFM. For example, if you want to be able

to press M to place a marker, enter the letter "m."

9-2

Preferences

XiO Training Guide

Preferences


General (cont.)

6. Click the drop-down arrow in the Init Display Scout: field and select Yes if

you want XiO to display the scout image view every time you open a

studyset.

OR

Select No if you do not want XiO to display the scout view every time you

open a studyset. The scout image view displays scout images if they are

included in the studyset.

7. Click the drop-down arrow in the Init Display MPV: field and select Yes if

you want XiO to display the multi-plane image view every time you open a

studyset.

OR

Select No if you do not want XiO to display the multi-plane image view

each time you open a studyset. The multi-plane image view displays all the

contours in a studyset without image data.

8. Click the drop-down arrow in the Init Display Previous: field and select

Yes if you want XiO to display the previous image view every time you

open a studyset.

OR

Select No if you do not want XiO to display the previous image view every

time you open a studyset. The previous image view displays the last cross

section displayed in the single-plane image view.

XiO 9-3

Preferences

XiO Training Guide

Preferences


General (cont.)

9. Click the drop-down arrow in the Init Display Thumbnail: field and select

Yes if you want XiO to display the thumbnail image view every time you

open a studyset.

OR

Select No if you do not want XiO to display the thumbnail image view

every time you open a studyset. The thumbnail image view displays every

cross section in the studyset, in order.

10. Click the drop-down arrow in the Display Name Warning: field and select

Yes if you want XiO to warn you every time the patient name listed in the

image data does not match the patient name entered in Patient File

Maintenance.

OR

Select No if you do not want XiO to warn you. The default value is Yes; if

you enter No, you must reset this value every time you install a new version

of XiO.

11. Click the drop-down arrow in the Display Save Box On Close: field and

select Yes if you want XiO to prompt you to save your work when you

close a patient or studyset, or when exiting from Patient File Maintenance

with a patient open.

OR

Select No if you do not want XiO to prompt you to save your work.

9-4

Preferences

XiO Training Guide

Preferences


General (cont.)

12. Click the drop-down arrow in the Default Bilinear Interp. on: field and

select Yes if you want to use bilinear interpolation to display scaled images.

OR

Select No if you want to use pixel replication to display scaled images.

Pixel replication displays large studysets or images faster, but are not as

high a quality as bilinear interpolation.

13. Enter the Default Patient List Sorted By value you want XiO to display

by default for sorting patient list contents for the Patient ID field on the

Open Patient/Studyset dialog box: "Patient ID," "Name," or "Creation

Date."

14. Enter the Default New patient action value you want XiO to display by

default for the Create field on the New Patient dialog box: "Imagebased

Studyset," "Nonimaged Studyset," or "No Studyset."

15. Click the drop-down arrow in the Default exam data to remain for future

transfer: field and select All if you want all data to remain on the network

after transferring images to XiO.

OR

Select Non-transferred if you want only data that was not transferred to

remain on the network after transferring images to XiO.

OR

Select None if you want none of the image sets to remain on the network

after transferring images to XiO.

16. Click the drop-down arrow in the Default Delete Patient Data After Archive

field and select Yes if you want the archived patient data to be deleted

automatically.

OR

Select No if you do not want archived patient data to be deleted

automatically.

17. Click OK. XiO closes the Patient File Maintenance General Preferences

dialog box and uses the default settings every time you open Patient File

Maintenance.

XiO 9-5

Preferences

XiO Training Guide

Preferences

Patient File Maintenance (cont.)

Color

1. Click the Edit drop-down menu and select the Preferences and Color

options. XiO displays the Color Preferences dialog box for Patient File

Maintenance.

2. Click the drop-down arrow in the Setup Reference Color: field and select a

color.

3. Click the drop-down arrow in the Setup Reference Projection Color: field

and select a color. When the setup reference point is between cross

sections, XiO Patient File Maintenance displays the projection of that point

on the nearest transverse cross section. This projected point is called the

setup reference point projection.

4. Click the drop-down arrow in the Active object color: field and select the

color you would like to use when displaying active objects. An active

object is any selected interest point, marker, or contour.

9-6

Preferences

XiO Training Guide

Preferences


Color (cont.)

5. Click the drop-down arrow in the Measure Color: field and select the color

you would like to use when displaying the measure mode tick marks.

6. Click the drop-down arrow in the Auto by threshold Point Color: field and

select the color you would like to use when displaying the auto by

threshold auto-point.

7. Click the drop-down arrow in the Auto by threshold unaccepted contour

Color: field and select the color you would like to use when displaying

contours created using Auto-by-Threshold that you have not yet accepted

using the Accept Auto by Threshold dialog box.

8. Click the drop-down arrow in the Interest point Color: field and select the

color you would like to use when displaying interest points.

9. Click the drop-down arrow in the Marker Color: field and select the color

you would like to use when displaying markers.

10. Click the drop-down arrow in the Small Edit Square Color: field and select

the color you would like to use when displaying small edit square.

Defining points selection can be accessed by double-clicking an unselected

contour, or by clicking anywhere within a selected contour.

11. Click the drop-down arrow in the Select Square Color: field and select the

color you would like to use when displaying a selected square. Contour

selections can be accessed by clicking an unselected contour, or by double-

clicking anywhere within a defining-points-selected contour.

12. Click the drop-down arrow in the Draw Start/End Square Color: field and

select the color you would like to use when displaying the Draw Start/End

Square Color that marks the beginning of a contour in Draw mode.

13. Click the drop-down arrow in the Non Interactive Color: field and select the

color you would like to use when displaying the non interactive color

during image transfer. These are the colors of pre-defined contours

transferred into XiO.

14. Click the drop-down arrow in the Pt. Non Interactive Color: field and select

the color you would like to use when displaying the Pt. Non Interactive

Color during image transfer. These are the colors of pre-defined interest

points and markers transferred into XiO.

XiO 9-7

Preferences

XiO Training Guide

Preferences


Color (cont.)

15. Click the drop-down arrow in the Position Line Color: field and select the

color you would like XiO Patient File Maintenance to use when displaying

position lines on the coronal reconstruction during image transfer.

16. Click the drop-down arrow in the Position Line Origin Color: field and

select the color you would like to use when displaying the position line

representing the origin of the studyset in the coronal reconstruction during

image transfer.

17. Click the drop-down arrow in the Direction line Color: field and select the

color you would like to use when displaying the direction line in the

coronal reconstruction during image transfer.

18. Click OK. XiO sets the color preferences to be used in Patient File

Maintenance.

9-8

Preferences

XiO Training Guide

Preferences

Patient File Maintenance (cont.)

W/L Presets

1. Click the Edit drop-down menu and select the Preferences and W/L

Presets options. XiO displays the Window Level Preferences dialog.

2. Enter or modify the Label for the window/level preset you want to create

or edit.

NOTE: The order in which window/level presets appear in this list

determines the order they are presented in the list to the right

of the (Save) W/L button in the PFM User Interface.

3. Enter or modify the Window value for the corresponding window/level

preset.

4. Enter or modify the Level value for the corresponding window/level preset.

5. Click OK. XiO adds any new presets or edits made to the window level

preset list in Patient File Maintenance.

XiO 9-9

Preferences

XiO Training Guide

Preferences

Teletherapy Preference Settings

The following Teletherapy Preference Settings are user-specific. Any logged in

user can set individually desired preferences.

General

1. Click the Edit drop-down menu and select the Preferences and General

options. XiO opens the General Preferences dialog box.

2. Click the drop-down arrow in the Generate Enhanced DRRs: field and

select Yes to generate enhanced DRRs from the Print DRR option on the

File menu.

OR

Select No to obtain standard resolution DRRs from the Print DRR option

on the File menu.

NOTE: Enhanced DRRs are better quality radiograph images because

they are generated at a higher resolution than ordinary DRRs.

9-10

Preferences

XiO Training Guide

Preferences


General (cont.)

3. Click the drop-down arrow in the Automatically Start Dose Calculation:

field and select Yes to cause dose calculations to be performed

automatically. XiO automatically recalculates the dose whenever you add

or delete a beam or modify the parameters of an existing beam.

OR

Select No to cause the dose calculation to wait until you initiate it. When

you are ready to recalculate the plan, click the Dose drop-down menu and

select the Calculation and start options.

NOTE: Select Yes when planning using IMRT.

XiO 9-11

Preferences

XiO Training Guide

Preferences


General (cont.)

4. Click the drop-down arrow in the Always Prompt When Saving a

Permanent Plan: field and select Yes. XiO displays the Save Plan dialog

box when you select any of the Save options from the File menu, and when

you click the Save button on the toolbar.

OR

Select No. If the open plan has a valid Plan ID, XiO automatically saves

the plan with the current Plan ID. XiO does not display a dialog box when

you select the File drop-down menu and select the Save Plan option.

NOTE: If the plan does not have a defined Plan ID, XiO displays the

Save Plan dialog box so you can enter the required Plan ID,

regardless of the setting for this preference.

5. Click the drop-down arrow in the Always Use Scroll Wheel for Movie:

field and select Yes. Whenever you use the scroll wheel on the mouse it

will be used to scroll through CT images.

OR

Select No. Whenever you use the scroll wheel on the mouse it will take the

functionality of the option selected with a right mouse click, if applicable.

For example, if you selected the Scale option, the scroll wheel will be used

to scale the image in the window.

6. Enter the CT Sample Radius (cm) value to be used for the sample

selection for CTs. The default value is 1.0 cm. When creating a CT to ED

file, it is necessary to sample the CT to ED phantom. This tool allows you

to sample a user-defined area. XiO averages the CT values for that area.

7. Click your middle mouse button in the Defaults Graphics Area Setup filed

click and select the Default Graphics Area Setup. XiO displays this

default when you start a New Teletherapy Plan.

9-12

Preferences

XiO Training Guide

Preferences


General (cont.)

New Plan Object Displays

8. Click your middle mouse button in the Default Isocurve Setup field and

select the Default Isocurve Setup. XiO displays these isocurve values by

default on the Isodose Lines dialog box.

9. Click the drop-down arrow in the Interest Points: field and select On. XiO

displays the interest points.

NOTE: You can use interest points to obtain dose calculations at

specific points in or around a cross section. XiO represents

interest points as either two- or three-dimensional plus signs,

depending on the treatment-planning mode used.

10. Click the drop-down arrow in the Markers: field and select On. XiO

displays markers.

NOTE: Markers do not carry dose. XiO represents markers as either

two- or three-dimensional plus signs, depending on the

treatment-planning mode used.

11. Click the drop-down arrow in the Calculation Volume/Area Icon: field and

select On. XiO displays the calculation region icon.

NOTE: The calculation region (volume or area) is defined as that

region in the patient anatomy for which the dose is calculated.

All points located inside (including on the edge) of this region

are used during dose display; all points outside of this region

are not used during dose display.

XiO 9-13

Preferences

XiO Training Guide

Preferences


General

New Plan Object Displays (cont.)

12. Click the drop-down arrow in the Patient Orientation Icon: field and select

On. XiO displays the patient orientation icon.

NOTE: The patient orientation icon shows the relationship between

individual sub-window orientations and the entire patient body

shape. The patient orientation icon is composed of a patient icon

combined with three orientation spheres. The patient icon is

made of three wire contours showing a profile of the entire body

viewed from the transverse, sagittal, and coronal sides.

Orientation spheres are three small spheres that represent the

patient’s head (green), left (yellow), and anterior (blue) on the

patient icon.

13. Click the drop-down arrow in the Patient Spheres: field and select On. XiO

displays the patient spheres.

NOTE: The patient spheres show the relationship between individual

sub-window orientations and the entire patient body shape.

Orientation spheres are three spheres that represent the patient’s

head (green), left (yellow), and anterior (blue).

14. Click the drop-down arrow in the Bilinear Interpolation: field and select

On. The new plan automatically uses bilinear interpolation.

OR

Select Off. The new plan automatically uses pixel replication.

NOTE: Bilinear interpolation utilizes the pixel’s surrounding pixels to

produce a linear combination of those pixels. The linear

combination is produced in both dimensions simultaneously.

Therefore, the bilinear method produces a higher quality

representation of the original image at the chosen scale than

pixel replication. The disadvantage of the bilinear method is that

the image is not produced as quickly. Pixel replication scales

images by replicating a pixel to create more pixels with the same

intensity. For example, one pixel will become four (2 X 2) if the

scale is doubled.

9-14

Preferences

XiO Training Guide

Preferences


General

New Plan Object Displays (cont.)

15. Click the drop-down arrow in the Bolus: field and select On. XiO displays

the bolus.

NOTE: Bolus is represented as a closed contour of a specified

thickness that follows the curvature of the patient skin contour

in a user-defined color in all BEV, MPV, and non-

reconstructed SPV displays.

16. Click the drop-down arrow in the CT Origin field and select On if you

would like the CT origin (0,0,0 of the scanner) to display as a point on your

image views by default.

OR

Select Off if you do not want the CT origin to display by default.

17. Click the drop-down arrow in the Thick Isodose Lines: field and select On.

XiO displays thick isodose lines.

OR

Select Off. XiO displays thin isodose lines.

18. Enter the Reconstructed Movie Step Size (cm) for the movie option when

you are moving through reconstructed cross sections. The acceptable values

are from 0.1 cm to 5.0 cm in steps of 0.1 cm. The default value is 1.0 cm.

19. Click OK. XiO closes the Teletherapy General Preferences dialog box and

uses the default settings for new plans.

XiO 9-15

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Color

1. Click the Edit drop-down menu and select the Preferences and Color

options. XiO displays the Color Preferences dialog box.

2. Click the drop-down arrow in the Active Object field and select a color.

The default preferred color is red. XiO uses this color when displaying

active objects, which includes beams, interest points, and markers.

NOTE: Be sure to select the active object color setting first, since the

active object color cannot be used for any other objects.

3. Select the preferred colors for the remaining objects.

4. Click OK. XiO sets the color preferences to be used in Teletherapy.

9-16

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

DICOM

1. Click the Edit drop-down menu and select the Preferences and DICOM

options. XiO displays the DICOM Preferences dialog box.

2. Click the drop-down arrow in the CT Images field and select Yes if you

would like CT Images to export by default in a DICOM export.

3. Click the drop-down arrow in the RT Structure Set: field and select Yes if

you would like the structure sets to be exported by default in a DICOM

export.

4. Click the drop-down arrow in the RT Plan field and select Yes if you

would like plan information to export by default in a DICOM export.

5. (Protons Only) Click the drop-down arrow in the RT Ion Plan field and

select Yes if you would like proton plan information to export by default

in a DICOM export.

6. Click the drop-down arrow in the RT Dose field and select Yes if you

would like the dose information to export by default in a DICOM export.

7. Click the drop-down arrow in the Export To: field and select the location

to where you will export DICOM information.

XiO 9-17

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

DICOM

8. Click the drop-down arrow next to the field Export Only Approved Plans

and select Yes or No if you would like to send only plans that have been

approved within XiO.

9. Click OK.

DRR Output

1. Click the Edit drop-down menu and select the Preferences and DRR Output

options. XiO displays the DRR Output dialog box.

2. Click the drop-down arrow next to the Orientation field and select a default

orientation. BEV is the most common option. The others are rarely used

unless you have a dedicated alignment-imaging device in the treatment

room. Orientations other than BEV must be set up for each machine in

Source File Maintenance.

3. Click the drop-down arrow next to the Paper Size field and select a default

paper size.

4. Click the drop-down arrow next to Spooler and select Plotter or Laser as

the type of destination printer.

5. If you are printing to Backlit paper, the image must be reversed. In this

case, click the drop-down arrow next to Mirror Image (Backlit) and select

Yes so that the mirror image is printed by default.

9-18

Preferences

XiO Training Guide

Preferences

Teletherapy

DRR Output (cont.)

6. If you would like the displayed DRR to be printed by default, click the

drop-down menu next to Print Displayed DRR and select Yes. If you select

No, you can designate the width, length, offset and distance manually.

7. Toggle the Anatomy Outlines button On or Off depending on if you would

like the anatomy outlines to be displayed by default.

8. Click OK to update the DRR Output preferences.

XiO 9-19

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Print

1. Click the Edit drop-down menu and select the Preferences and Print

options. XiO displays the Print Preferences dialog box.

2. Click the drop-down arrow in the Print Source Data: field and select Yes.

XiO displays the source data on the printed image itself. This data

includes: beam number, machine ID, coll, setup, Tx dist, SSD, W(L/R), L

(U/L), gantry, coll, arc, couch, wedge, ID/angle, port ID, TX aids, algor,

wt, wt at D, TAR/TPR/PDD, eff D and eff TAR/TPR/PDD.

NOTE: If you select Yes for Print Source Data, XiO requires

additional printing time but does not reduce the size of the

print.

3. Click the drop-down arrow in the Print Dose Label: field and select Yes.

XiO prints the isocurve dose labels.

4. Click the drop-down arrow in the Print Image Data: field and select Yes.

XiO prints a pixel (grayscale) representation of the cross section. The pixel

image is clipped to the patient skin. The window and level settings for the

image are represented.

NOTE: XiO only supports this setting for printers that support

PostScript printing.

9-20

Preferences

XiO Training Guide

Preferences

Teletherapy

Print (cont.)

5. Click the drop-down arrow in the Print Plan Summary field and select Yes.

XiO prints the Plan Summary report that includes the isodose treatment

plan data, source data, calculation information, and interest point dose data.

6. Click the drop-down arrow in the Force Life-Sized to One Page: field and

select Yes. XiO generates a life-size plot of the image on one sheet of

paper. XiO scales the resulting plot from the center of the image, then clips

it from the sides until it fits on one sheet of paper.

7. Click the drop-down arrow in the Allow Postscript N-up: field and select

Yes. XiO prints multiple images on one sheet of paper.

NOTES: Lexmark Optra 45 and 1200 are currently the only compatible

printers that support this functionality.

Important: Your plotter must be configured for N-up printing,

and this field must be set to Yes if you want to print multiple

images on one sheet of paper. Refer to the documentation

shipped with your printer for information on setting your

printer up for N-up printing.

Important: N-up printing cannot be performed on a network

printer.

8. Enter the default distance in (cm) you would like XiO to use when

printing BEVs, Ports, or MLCs.

9. Select the default value for the Isodose Line Type on the plotted plan. See

XiO Help for more information regarding the Isodose Line Type options.

10. Click OK. XiO updates the print preferences for Teletherapy.

XiO 9-21

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Window/Level

1. Click the Edit drop-down menu and select the Preferences and

Window/Level options. XiO displays the Edit Window/Level Presets

dialog box.

2. Enter or modify the Label for the Window/Level Preset you want to create

or edit.

NOTE: The order in which Window/Level Presets appear in this list

determines the order they are presented in the list to the right of

the (Save) W/L button in the PFM User Interface.

3. Enter or modify the Window value for the corresponding Window/Level

Preset.

4. Enter or modify the Level value for the corresponding Window/Level

Preset.

5. Click OK. XiO adds any new presets or edits made to the window level

preset list in Teletherapy.

9-22

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Beam Display

1. Click the Edit drop-down menu and select the Preferences and Beam

Display options. XiO displays the Beam Display Preferences dialog box.

2. Click the drop-down arrow in the Complex Display field and select On to

display all parts of the beams. The complex beam display is useful if you

want to determine the beam’s orientation, particularly when the beam

intersects a cross section at an odd angle.

OR

Select Off to display the beams in a simplified form. The simple beam

display consists of only the portion of the beam that intersects the displayed

cross section. Use the simple beam display when you want to simplify the

graphics area display.

3. Click the drop-down arrow in the Moveable Plane field and select On to

display the movable plane as a rectangular radiation field (defined by the

collimator) perpendicular to the central axis and passing through a user-

defined position along the central axis.

XiO 9-23

Preferences

XiO Training Guide

Preferences

Teletherapy

Beam Display (cont.)

4. Click the drop-down arrow in the Corner Divergent Lines field and select

On to display the four corner divergent lines as they pass through the

movable/isocentric planes of the beams. Corner divergent lines appear as

four divergent line segments representing the corners of the beam pyramid.

The lines start on the surface plane and end at the depth at which the

machine data ends.

NOTE: XiO does not support corner divergent lines display for

proton beams.

5. Click the drop-down arrow in the Cross Hairs field and select On to display

the crosshairs on the surface and isocentric planes. Crosshairs appear as

two line segments, parallel to the beam width and length axes, each

connecting opposing edges of a rectangle defined by the collimator and

intersecting each other at the central axis.

6. Click the drop-down arrow in the Isocentric Plane field and select On to

display an isocentric plane as a rectangular radiation field (defined by the

collimator) perpendicular to the central axis and passing through the

isocenter.

7. Click the drop-down arrow in the Port Coverage Lines field and select On

to display the port coverage lines as dashed lines that pass through the area

blocked by the port.

NOTE: This display option is independent of the port shadow option.

8. Click the drop-down arrow in the Port Shadow field and select On to

display the port shadow as a semitransparent representation of the area

blocked by the port. XiO displays the port shadow in the port color.

NOTE: This display option is independent of the port coverage lines

option.

9. Click the drop-down arrow in the Aperture Limit Circle (only for active

proton beams) field and select On to display the aperture limit circle as a

line representing the projection at isocenter for the current snout.

NOTE: XiO supports the aperture limit circle display only for active

proton beams.

9-24

Preferences

XiO Training Guide

Preferences

Teletherapy

Beam Display (cont.)

10. Click the drop-down arrow in the MLC Coverage Lines field and select

On to display the MLC coverage lines as dashed lines that outline the area

blocked by the MLC.

NOTE: This display option is independent of the MLC shadow

option.

11. Click the drop-down arrow in the MLC Shadow field and select On to

display the MLC shadow as a semitransparent representation of the area

blocked by the MLC. XiO displays the MLC shadow in the MLC color.

NOTE: This display option is independent of the MLC coverage lines

option.

12. Click the drop-down arrow in the Segmented MLC Maximum Extents

field and select On to display the maximum extents of the MLC leaves on

the BEV.

13. Click the drop-down arrow in the Compensating Filter field and select On

to display the compensating filter as a semitransparent planar representation

of the collimator area covered by the compensating filter in the

compensating filter color.

14. Click the drop-down arrow in the Show Beams field and select Off. XiO

turns off all beams.

15. Click the drop-down arrow in the Weight Point field and select On to

display the weight points. Weight points are represented by either a two-

or three-dimensional plus sign. Depending on the treatment planning mode

used; the weight point color is the same as the beam color.

16. Click OK. XiO updates the beam display preferences for Teletherapy.

XiO 9-25

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Beam

1. Click the Edit drop-down menu and select the Preferences and Beam

options. XiO displays the Beam Preferences dialog box.

Use this dialog box to specify your preferred beam settings for planning.

Dynamic conformal beam settings are available only if you have a dynamic

conformal license and have defined this type of beam for the current

machine.

The values specified on this page are the default values for new plans.

2. Under the Beam Setup heading, select the default values for the Field Size,

beam Weight and Number of Fractions.

3. Under the Dynamic Conformal heading, enter the Minimum Arc Extent

for New Beams. The range is 0 to 180 in steps of 1.

4. Under the Dynamic Conformal heading, enter the Minimum Segment

Area (cm^2): value. The range is from 1.0cm to 25 in increments of 1.0.

9-26

Preferences

XiO Training Guide

Preferences

Teletherapy

Beam (cont.)

5. Enter the Minimum Leaf Gap (cm): value. The range is from 0.0 cm to

10.0 cm in increments of 0.1 cm. The default leaf gap is 0.1 cm.

6. Click the drop-down arrow in the Compensating Filter Type field and select

a default compensating filter type.

7. Enter the Review Angle (deg): value. The value is between 1° and 360° in

increments of 1°; the default review angle is 10°. For example, if the

review angle is 5°, the BEV display on the screen will shift by 5° every

time you middle-click or scroll the mouse button.

NOTE: This value specifies the number of degrees that will increment

between successive views of the dynamic conformal beam’s-

eye-view. This setting allows you to set a custom angle

increment in degrees.

8. Click OK. XiO updates the beam preferences for Teletherapy.

XiO 9-27

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Port

1. Click the Edit drop-down menu and select the Preferences and Port

options. XiO displays the Port Preferences dialog box.

2. Enter the Conform Collimator to Step (cm) value. Determine the step size

that rounds up to the collimator step precision value. XiO uses the step size

when conforming the collimator to make the field size an even multiple of

the value entered.

3. Click the drop-down arrow in the Move Collimator Width Jaws as MLC

Leaves are Edited field and select Yes. XiO conforms the collimator width

jaws to the MLC shape as you edit the leaves.

OR

Select No. XiO does not move the collimator jaws.

4. Click the drop-down arrow in the Auto-Generated Blocking Updates with

Beam Movement field and select Yes. XiO automatically updates auto-

blocking whenever a beam is rotated.

OR

Select No if you do not want XiO to change the blocking when the beam is

rotated.

9-28

Preferences

XiO Training Guide

Preferences

Teletherapy

Port (cont.)

5. Enter the minimum spacing between points that defines the block or

aperture in the Auto Port Resolution (cm) field. Smaller numbers give more

accurate results. Acceptable values range from 0.02 cm to 0.10 cm in steps

of 0.01 cm.

6. Click the drop-down arrow in the Guide Radius field and select Yes. XiO

places a circle around the mouse point when drawing ports. Use the guide

radius as a visual cue when you want to draw a port at a specific distance

around a structure or target.

7. Enter the default value in the Guide Radius Size (cm) field for the radius

for the guide radius circle. This value can range from 0.01 cm to 5.00 cm,

in steps of 0.01 cm.

8. Click the drop-down arrow in the Always Re-orient Tablet: field and select

Yes. XiO opens the Tablet Orientation dialog box when you start to draw a

port with the tablet.

OR

Select No. XiO allows you to continue drawing ports without tablet

reorientation, as long as you are continuously working on the same patient.

WARNING

If you do not orient all films on the tablet with the same

axis and orientation, the data entered will be incorrect,

resulting in incorrect patient treatment.

9. Enter the default value in the Tablet Scale Factor: field for the

magnification factor of the film. The scale factor is the ratio of the length

on the film to the length at the reference distance. Acceptable values range

from 0.001 to 10.000 in steps of 0.001. For supporting information, refer to

the graphical explanation and examples in the "What are the Ways I can

Make a Port?" procedures described in the XiO Help.

XiO 9-29

Preferences

XiO Training Guide

Preferences

Teletherapy

Port (cont.)

10. Click the drop-down arrow in the Default Port Type field and select a type.

If you select Block, XiO automatically defines the first shape you make as a

block. XiO displays the shape drawn as a physical block where photons

cannot pass.

OR

If you select Aperture, XiO automatically defines the first shape you make

as an aperture, all subsequent shapes are blocks. XiO displays the shape

drawn as an opening where photons may pass.

OR

If you select MLC, XiO automatically defines the first shape you make as

an MLC. XiO always displays MLCs as openings where photons may pass.

11. Enter the value for the Mouse Minimum Sample Spacing (cm) representing

the minimum distance between mouse sample points.

NOTE: XiO does not automatically make the sample spacing equal to

this value. XiO uses this value to prevent the calculation of

identical or closely spaced points during dose calculation and

prevent the accompanying increased calculation time. This

value can range from 0 cm to 5.00 cm, in steps of 0.01 cm.

12. Click the drop-down arrow in the Blocking Rotates with Collimator: field

and select Yes as the preferred setting for photon and electron beams. Yes

means that the blocks and/or aperture move with the beam when you

change the collimator angle. If you change the collimator angle, the port

coordinates change as the beam coordinates change.

OR

Enter No so that the blocks and/or aperture stay with the anatomy; they do

not move with the beam when you change the collimator angle.

9-30

Preferences

XiO Training Guide

Preferences

Teletherapy

Port (cont.)

13. Click the drop-down arrow in the MLC Contour Updates with Leaf Edits

field and select Yes.

14. Enter a default value for Leaf Insertion (%). XiO uses this value by

default when MLC ports are created.

15. Enter a default value for Closed Leaf Position. XiO uses this value by

default when MLC ports are created.

16. Click OK. XiO updates the port preferences for Teletherapy.

XiO 9-31

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Histogram

1. Click the Edit drop-down menu and select the Preferences and Histogram

options. XiO displays the Histogram Preferences dialog box.

Sampling Resolution

2. Enter the default spacing value in the Structure Combinations field for the

distance between the sample points used to calculate volume and binned

doses for structure combinations. Acceptable values range from 0.1 cm to

1.0 cm in steps of 0.1 cm. The preset default value is 0.1 cm.

3. Enter the default spacing value in the Unspecified Tissue (cGy): field for

the distance between the sample points used to calculate volume and dose

for unspecified tissue. The acceptable values range from 0.1 cm to 1.0 cm

in steps of 0.1 cm. The preset default value is 0.2 cm.

Dose Bin Width

4. Enter the default value in the Structure Combinations (cGy): field

representing the width of the bins in which the sample points are to be

grouped for structure combinations. If your clinic uses cGy, the value can

range from 1 cGy to 10,000 cGy in steps of 1 cGy. The preset default is 10

cGy. If your clinic uses Gy, the value can range from 0.01 Gy to 100.00

Gy in steps of 0.01 Gy. The preset default is 0.10 Gy.

9-32

Preferences

XiO Training Guide

Preferences

Teletherapy

Histogram (cont.)

5. Enter the default width value in the Unspecified Tissue (cGy): field

representing the bins in which the sample points are to be grouped for

unspecified tissue. If your clinic uses cGy, the value can range from 1 cGy

to 10,000 cGy in steps of 1 cGy. The preset default is 10 cGy. If your

clinic uses Gy, the value can range from 0.01 Gy to 100.00 Gy in steps of

0.01 Gy. The preset default is 0.10 Gy.

6. Select Yes or No to designate whether or not you would like to include the

Histogram Report when you print the Dose Volume Histogram.

Yes means XiO automatically prints the Histogram Report when you use

the right-mouse menu option to print a histogram.

OR

No means XiO prints only the histogram when you use the right-mouse

Print menu option.

NOTE: The Histogram Report lists statistical and descriptive

information for the displayed histogram.

7. Click OK. XiO updates the histogram preferences for Teletherapy.

XiO 9-33

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

IMRT

1. Click the Edit drop-down menu and select the Preferences and IMRT

options. XiO displays the IMRT Preferences dialog box.

IMRT Graphs

2. Click the drop-down arrow in the Grid field and select On or Off as the

default value for displaying the grid.

3. Click the drop-down arrow in the Legend field and select On or Off as the

default for displaying the legend.

9-34

Preferences

XiO Training Guide

Preferences

Teletherapy

IMRT (cont.)

4. Select the default number of Iterations between DVH Updates during

IMRT optimization.

5. Click the drop-down arrow in the Modulator field and select the preferred

setting for your IMRT modulator. Your choices are MLC or

Compensating Filter.

6. Click the drop-down arrow in the Compensating Filter Type: field and

select the compensating filter type. Your choices are Huestis, Par

Scientific or decimal.

NOTE: You must define Filters in Source File Maintenance (SFM)

before you can use them in Teletherapy.

7. Enter a value in the MLC Step Increment X(cm): field. Acceptable values

range between 0.3 and 2.0 in steps of 0.1 cm. The step increment is the

width of the ideal fluence elements used during optimization. The leaf step

increment and the leaf width (defined by XiO MLC configuration file),

determine the resolution of the MLC intensity map.

8. Enter a value for the compensating filter resolution in the Resolution

X(cm): and Y(cm): field. Acceptable values range from 0.3 cm to 2.0 cm,

in steps of 0.1 cm. These represent the width and length of the ideal

fluence elements used during optimization.

Initial Optimization

The optimization stops when either the difference between successive score

functions is less than the convergence criteria, or the maximum number of

iterations has been reached.

9. Enter a value in the Convergence Criterion (%): field. Acceptable values

range from 0.0001% to 100 %, in steps of 0.0001%. Tip: Use a starting

convergence criterion of 0.1000%.

10. Enter a value in the Maximum Iterations: field. Acceptable values range

between 0 and 300, in steps of 1.

11. Enter a value in the Scatter Extent (cm): field representing the distance that

is measured from the edge (not from the center) of the beamlet. Acceptable

values range from 0.0 cm and 3.0 cm, in steps of 0.1 cm.

XiO 9-35

Preferences

XiO Training Guide

Preferences

Teletherapy

IMRT

Initial Optimization (cont.)

12. Enter a value in the Optimization Margin (cm): field representing the area

to which the optimization is restricted around the target (which includes

some margin for penumbra). Acceptable values range from 0.0 cm and the

value of Scatter Extent, in steps of 0.1 cm.

Beam Weight Optimization

The optimization stops when either the difference between successive score

functions is less than the convergence criteria, or the maximum number of

iterations has been reached.

13. Enter a value in the Convergence Criterion (%): field. Acceptable values

range from 0.0001% to 100 %, in steps of 0.0001%.

14. Enter a value in the Maximum Iterations: field. Acceptable values range

between 0 and 300, in steps of 1.

Segmentation Method

15. Click the drop-down arrow in the Segmentation Method: field and select a

leaf segmentation algorithm. For MLC-based IMRT, the selection is

Sliding Wnd (Sliding Window).

If your clinic uses ImFast, you can select the preferred leaf segmentation

from the following choices:

!" Sliding Wnd (Sliding Window)

!" ExpIntMap (Export Intensity Maps)

!" Platform (Platform Optimal ImFAST - only for the internal version

of Siemens’ ImFAST™ )

!" PltFluence (Platform Optimal ImFAST with Fluence Correction -

only for the internal version of Siemens’ ImFAST™ )

!" Standard (Standard Optimal ImFAST- only for the internal version

of Siemens’ ImFAST™ )

9-36

Preferences

XiO Training Guide

Preferences

Teletherapy

IMRT

Segmentation Method (cont.)

!" StdFluence (Standard Optimal ImFAST with Fluence Correction -

only for the internal version of Siemens’ ImFAST™ )

Ideal Map Extension

Ideal map extension is used in IMRT when the MLC field must be extended

beyond the patient’s surface for flash or movement. This is most often used for

IMRT breast tangents.

16. Enter a value in the Distance to Extend (cm): field to extend the edge of the

ideal intensity map. Acceptable values range from 0.0 cm to 3.0 cm, in

steps of 0.1 cm.

XiO extends the edge of the intensity map along the direction of the leaf

travel and outward from the patient.

17. Enter a value in the Average Distance (cm): field as the preferred distance

from the edge of the skin back into the patient, to use for the intensity in the

extended region. Acceptable values range from 0.0 cm to 2.0 cm, in

multiples of the step increment used for the optimization.

XiO averages these intensities and assigns the average to the extended

portion of the intensity map.

Discrete Intensity Levels

18. Enter a value in the Discrete Intensity Levels: field. Acceptable values

range from 2 to 20, in steps of 1.

Split Field Parameters

Enter the preferred settings to use on beams that need to be split after

optimization. Some users may have IMRT fields that need to be split due to the

field width limitation of their Linac’s MLCs.

19. Enter a value in the Minimum Field Width (cm) field representing the

smallest allowable width for the beams resulting from the beam splitting

(also called child beams). Acceptable values range from 0.5 cm to 10.0 cm,

in steps of 0.5 cm.

XiO 9-37

Preferences

XiO Training Guide

Preferences

Teletherapy

IMRT

Varian Split Field Parameters (cont.)

20. Enter a value in the Overlap Extent (cm) representing the preferred setting

for the extent, in the MLC leaf travel direction, that the child beams will

overlap. Acceptable values range from 0.0 cm to two-thirds of the value

defined for Minimum Field Width, in steps of 0.5 cm.

21. Enter a value in the Split Extent (cm) field representing the width direction,

over which the intensity of the original (parent) beam will be distributed to

the child beam intensity maps. Valid entries lie in the range of 0.0 cm to

the value defined for Overlap Extent in steps of 0.5 cm.

NOTES: If the Split Extent is set equal to the Overlap Extent, XiO

distributes the intensities in the entire overlap region between

the resulting child beams.

If the Split Extent is less than the Overlap Extent, XiO

determines (for each leaf pair) where the lowest dose region

of contiguous width equal to the Split Extent lies, and

distributes the intensities of this region among the child

beams.

22. Click the drop-down arrow in the Delete Parent Beams field and select the

action you would like XiO to take after the beam splitting has been

accomplished. Yes means XiO deletes the parent beams when the final

dose calculation is launched after segmentation.

OR

No means XiO turns the parent beams off and does not delete the parent

beams when the final dose calculation is launched.

9-38

Preferences

XiO Training Guide

Preferences

Teletherapy

IMRT (cont.)

Minimum Segment Size

23. Enter a value in the Minimum Segment Size (cm): field. Acceptable values

range from 0.0 cm and 3.0 cm, in steps of 0.1 cm.

Compensating Filter Smoothing

24. Click the drop-down arrow in the Compensating Filter Intensity Map

Smoothing Distance (pixels): field and select a value for the preferred

number of pixels. Acceptable values are 3, 5, 7, or 9 pixels. The default

value is 3.

25. Click OK. XiO updates the IMRT preferences for Teletherapy.

XiO 9-39

Preferences

XiO Training Guide

Preferences

Teletherapy (cont.)

Intensity Map

Intensity maps are two-dimensional planes of data perpendicular to the central

axis and projected to isocenter. Set the intensity map preferences here.

1. Click the Edit drop-down menu and select the Preferences and Intensity

Map options. XiO displays the Intensity Map Preferences dialog box.

Display Print

2. Click the drop-down arrow in the Highest Intensity field and select the

preferred color for displaying intensity maps.

Black means the highest intensity is shown in black. Intensities less than

the highest are shown in decreasing shades of gray. This is the default.

White means the highest intensity is shown in white. Intensities less than

the highest are shown in increasing shades of gray.

3. Click the drop-down arrow in the Anatomy Outlines field and select On

(meaning the preferred settings for the anatomy outlines is on and included

in the output).

OR

Select Off (meaning the preferred settings for anatomy outlines is off and

are not included in the output).

9-40

Preferences

XiO Training Guide

Preferences

Teletherapy

Intensity Map (cont.)

Output Map To

4. Click the drop-down arrow in the Output Map To: field and select the

preferred output device.

NOTE: If you only have one device set up, XiO displays it as the

default.

5. Click the drop-down arrow in the Paper Size: field and make a selection.

The choices available depend on your output device.

A/A4 (ANSI, size A: 8.5 x 11 inches)

B/A3 (ANSI, size B: 11 x 17 inches)

8x10 in (for film printers)

14x17 in (for film printers)

Large A (user-defined size)

Large B (user-defined size)

The default is A/A4.

6. (This field only appears for PostScript Output.) Click the drop-down arrow

in the Spooler: field and select an output device (Laser Printer or Plotter)

on which the intensity maps are to be printed. Plotter is the default.

ASCII Output

7. Enter a value in the Resolution (cm): field representing the preferred

resolution for the 2-D intensity map scale, in the X and Y directions. The

resolution is the same in both directions. Acceptable values range from 0-

1. cm to 1.0 cm, in steps of 0.1 cm. The default value is 0.1 cm.

Define Default Filename Format

Use the following fields to define the format for the file names used when XiO

outputs intensity maps in ASCII. This format becomes the default filename; you

can change it, if necessary, when you output the intensity map.

8. Enter the first part (prefix) of the filename in the Prefix: field. Up to three

alphanumeric characters. The default is blank.

XiO 9-41

Preferences

XiO Training Guide

Preferences

Teletherapy


Define Default Filename Format

9. Enter the Maximum Patient ID Characters (alphanumeric). Acceptable

values range from none (blank) to up to 14 alphanumeric characters. The

default maximum is no characters (blank).

10. Click the drop-down arrow in the Include Beam Number field and select

Yes to include the beam number in the filename.

OR

Select No to not include in the file name. The default is No.

11. Enter the Maximum Beam Description Characters. The acceptable

values range from none to 24-characters. The default maximum is no

characters (blank).

12. Enter a suffix in the Ideal Map Suffix: field for ideal map filenames. You

can enter up to three-alphanumeric characters. The default is blank.

13. Enter a suffix in the Segmented MLC Map Suffix: field for the MLC

intensity map filenames. You can enter up to three alphanumeric

characters. The default is blank.

14. Enter a suffix in the Compensating Filter Map Suffix: field for

compensating filter map filenames. You can enter up to three alphanumeric

characters. The default is blank.

15. Enter a suffix in the Relative Fluence Map Suffix: field for relative fluence

map filenames. You can enter up to three alphanumeric characters. The

default is blank.

16. Click the drop-down arrow in the Generate Unique Filename: field and

select Yes to add a unique number to the filename.

OR

Select No.

9-42

Preferences

XiO Training Guide

Preferences

Teletherapy


Default Filename Formats

XiO displays sample filenames based on your entries.

Ideal Map

Segmented MLC Map

Compensating Filter Map

Relative Fluence Map

17. Click OK. XiO updates the intensity map preferences for Teletherapy.

XiO 9-43

Preferences

XiO Training Guide

Preferences

Teletherapy

Plan Output

Create templates and set a default template for printing multiple outputs at once.

1. Click the Edit drop-down menu and select the Preferences and Plan

Output options. XiO displays the Plan Output Preferences dialog box.

2. Enter a Plan Output Template ID.

9-44

Preferences

XiO Training Guide

Preferences

Teletherapy

Plan Output (cont.)

3. Click the Default button next to the template ID if you would like this to be

the default template.

4. Enter an optional Description for this template.

5. Under the Reports heading, select each report that you would like to print

using this Template. See XiO Help for more information on the types of

reports listed.

6. Under the Graphics Displays SPV’s heading, select one or all of the

following options:

All Displayed prints all SPV images that are displayed on the screen when

this print option is selected.

All Transverse That Cut Through prints all transverse slices that cut

through the selected structure. You must also select a structure name from

the answer-help list.

T/S/C Passing Through prints the transverse, sagittal and coronal images

that pass through the reference point, the normalization point or the first

beam’s isocenter.

NOTE: You must be normalized to a point to print the T/S/C images

that pass through the Normalization Point.

XiO 9-45

Preferences

XiO Training Guide

Preferences

Teletherapy

Plan Output (cont.)

1. Under the graphics display BEVs heading, select one of the following

options:

All prints the beams eye views for all the beams in the selected plan.

All On (dose) prints only the beams eye views for the beams that are turned

to an on position on the beam weights page.

All Displayed prints all the beams eye views that are displayed on the screen

for the selected plan.

None will not print any beams eye view images for this plan.

2. Under the Beam Treatment Aids heading, select the treatment aid

information that you would like to print using this template.

3. For each treatment aid you must select to print them All, only the treatment

aids that are turned to an on position on the beam weights page (All On), or

None.

4. For each treatment plan, you must also select a Paper Size (when available)

and a Distance at which you want to print.

5. Click OK when you are finished creating your template.

6. Repeat this process to create as many templates as you need.

9-46

Preferences

XiO Training Guide

Preferences

Brachytherapy

Brachytherapy Histogram Print Preferences

When planning in brachytherapy and the F6 Histogram function is available, you

can set the Brachytherapy Histogram Preference.

1. Select Yes in the in the Include Histogram Report with Print: field if you

would like to include the image of the histogram when you print the

histogram report.

2. Click Done.

XiO 9-47

3-D Four Field Prostate

XiO Training Guide


After completing the PFM and Teletherapy lessons and the first two interactive

treatment plans in this series, you should be familiar with most of the procedures

required to create 3-D treatment plans. Therefore, this plan and the remaining

plans discussed in the training guide will have been previously created and have

the contours already drawn.

Preliminary Instructions:

1. Use the following patient and studyset information and create a standard 3-D

four-field prostate plan. As a part of your plan, remember to use volume

calculation with heterogeneity correction and pixel-by-pixel calculation.

Change the grid spacing to 0.4.

Patient ID: FusionProstate

Studyset: CT

Graphics area setup: 6TSCMxA

2. Turn on the following structures:

! Patient

! GTV (color – red; rendering – solid)

! Rt and Lt Femur (color – white; rendering – T75)

! Rectum (color – brown; rendering – T50)

! Bladder (color – yellow; rendering – T50)

Task 1. Vary the Margin Around a Structure Using 3-D Auto Margin

Use Automargin to vary the margin around the structure using the variable

automargin tool.

1. Select Yes for Variable Automargin.

2. Use a 1 cm margin everywhere, except the posterior margin, where you will

use a 0.5 cm margin.

3. Label this structure PTV (your name).

Task 2. Create the Plan

1. Set the isocenter in the center of the PTV.

XiO" 10-1


XiO Training Guide

10-2


Task 2. Create the Plan (cont.)

2. Create a four-field prostate plan using the following parameters:

Machine: Vari18x

Prescription: 6000 in 30 fractions (1500 per beam)

Plan in: Absolute dose

3. Place blocks around the PTV with a 0.5 cm margin.

Task 3. Save the Plan as a Template

1. Click the File drop-down menu and select the Save as Template option.

XiO displays the Save Template dialog box.

2. Enter a File Name for the template.

3. (optional) Enter a Description.

4. Click OK. XiO saves the plan as a template.


5. Click the File drop-down menu and select the Save as Plan option to save as

a permanent plan. XiO displays the Save Permanent Plan dialog box.

6. Enter a New plan ID.

OR

Click you middle-mouse button in the Plan ID field and select an ID.

7. Click OK. XiO saves the plan and closes the dialog box.

Electron Beam

XiO Training Guide

Electron Beam

Practice Exercise

This exercise demonstrates how to place an electron beam, edit the gantry, edit

the collimator and beam entry point using the mouse or keyboard, create an

electron block, and create and assign bolus. Since the electron beam is an SSD

beam, you will define the beam entry point on the surface instead of the

isocenter. Rotating the collimator and gantry with the mouse is similar to

rotating photon beams.

Task 1. Start the Plan

1. Click the Teletherapy option on the XiO main window.

2. Click the File drop-down menu and select the New Teletherapy Plan

option.

3. Click your middle mouse button in the Patient ID: field and select Breast2.

4. Click your middle mouse button in the Studyset field and select the studyset

named 1.

5. Click the drop-down arrow in the Graphics Area Setup field: and select

6TSCMxA.

6. Click OK. XiO opens the Breast2 patient in the selected six-window

format.


XiO 11-1

Electron Beam

XiO Training Guide

Electron Beam

Task 1. Start the Plan (cont.)

8. Turn off all structures and turn on only the structures Clips and EXT.

9. Click OK. XiO displays two clips contoured in blue. They are very small

and can be found in the lymph node area superior to the right breast. View

the transverse slices from -94.50 through -97.51.


For the transverse image in window number 1, change the Ref (cm) to

–96.01; then, click Update Graphics Display button.

11. Click Cancel to close the Window Format dialog box. This will be your

central axis slice. There are no clips contoured on this slice; but it is a slice

centered between the two clips.

11-2

Electron Beam

XiO Training Guide

Electron Beam

Task 2. Add the Electron Beam

1. Click the New Beam button on the Beam supporting toolbar to add the

electron beam.

2. (Optional) Enter Electron Boost in the description field.

3. Enter Vari16e in the Machine ID field.

4. Leave center of PTV1 as the default in the Initial Beam Placement Default

To: field.

5. Click OK. XiO opens the Electron Beam dialog box.

XiO 11-3

Electron Beam

XiO Training Guide

Electron Beam

Task 3. Manipulate the Electron Beam Using the Mouse or Keyboard.

1. Click your middle mouse button in the Cone ID: field and select 6x6.

2. Enter 300 in the Gantry angle field.

3. Hold down your left mouse button on the Electron Beam dialog box and

Move it so that it does not overlap the Transverse or ABV windows.

OR

If you have a Linux machine, double click on the title bar to hide the

dialog box.

4. Click your right mouse button in the transverse window and select the

Beam Entry Point option.

5. Hold down the left mouse and drag the mouse around the right side of the

patient until the clips are centered in the field on the BEV.

NOTE: If the beam does not move with the mouse, XiO may display a

reconstructed transverse slice. You can verify that you have a

real slice or change to a real slice in View-Window Format.

Click your middle mouse under the Ref (cm) heading next to

the SPV transverse window. XiO displays real numbers on

this list. Verify that the Ref value is a real slice number. If

not, select a real slice from the list.

6. You can set the beam entry point with the keyboard using the Movement

Around Plane option on the Electron Beam Dialog box. Enter in positive

increments to move clockwise, and enter in negative increments to move

counter-clockwise.

7. If the cone is close enough to the patient that a collision may occur, XiO

displays a green message and does not allow the dose to calculate. To

correct this problem, select a different gantry or collimator angle, change

the beam’s entry position, or enter an extended SSD.

8. Click OK to close the Electron Beam Dialog Box.

11-4

Electron Beam

XiO Training Guide

Electron Beam

Task 4. Add an Electron Port

1. Click the Auto Port button. XiO opens the Auto Port dialog box.

NOTE: If you have not defined your port properties in Source File

Maintenance, XiO requires you to enter the values before XiO

displays the auto port dialog box.

2. Click your middle mouse button in the Auto Margin To: field and select

Clips.

3. Enter 2 cm in the With Margin (cm): field.

4. Click Calculate Aperture to create the port.

5. Click OK to close the Auto Port dialog box and start the dose calculation.

XiO 11-5

Electron Beam

XiO Training Guide

Electron Beam

Task 5. (Optional) Create and Assign Bolus

This task demonstrates how to create bolus and how to assign the bolus to

electron beams. You will use an interpolation technique to easily create the

bolus.

1. Click the Beam drop-down menu select the Bolus and New options. XiO


2. (Optional) Enter a bolus Description.

3. Enter a bolus thickness of 1.0 cm.

4. Leave the default value of 1.0 for the Relative Electron Density. DO NOT

close the Edit Bolus Definition Data dialog box.

5. In the Transverse SPV window, movie to a slice that is superior to the port

such as T = -91.81.

6. Click your right mouse button in the SPV field and select Edit Bolus.

7. Hold down your left mouse button and drag the mouse around the

transverse image so that bolus displays over the right side of the patient.

OR

Click your left mouse button at the start and end of the bolus to create it on

the slice.

NOTE: If the bolus does not appear as you are drawing it, XiO may

display a reconstructed transverse slice. You can verify that

you have a real slice or change to a real slice in View-

Window Format. Click your middle mouse under the Ref

(cm) heading next to the SPV transverse window. XiO

displays real numbers on this list. Verify that the Ref value is

a real slice number. If not, select a real slice from the list.

8. Movie to the most inferior slice where you want to place bolus, such as T=

-99.90.

9. Hold down your left mouse button and drag the mouse around the

transverse image so that bolus displays over the right side of the patient.

OR

Click your left mouse button at the start and end of the bolus to create it on

the slice.

11-6

Electron Beam

XiO Training Guide

Electron Beam

Task 5. (Optional) Create and Assign Bolus (cont.)

10. Click OK on the Edit Bolus Definition Data dialog box. XiO interpolates

the bolus between the superior and inferior bolus contours that were

created.

11. Review the Transverse and ABV images to verify the coverage of the

bolus. Bolus appears as a yellow wireframe mesh on the patient surface.

12. Assign the bolus to the beam. Click the Beam drop down menu and select

the Bolus and Assign options. XiO displays the Assign Bolus to Beam

dialog box.

13. If you would like to assign this bolus to beam 1, toggle the No to Yes.

However, in this exercise, it is not necessary to assign bolus since the clips

are not superficial.

NOTE: You cannot fractionate bolus for electron beams since it is an

SSD beam and the calculation dose depth changes when bolus

is added. To mock beam fractionation using electrons, you can

create one beam with bolus and another without. Then,

fractionate the dose to each.

14. Click OK to close the Assign Bolus to Beam dialog box.

XiO 11-7

Electron Beam

XiO Training Guide

Electron Beam

Task 6. Normalize and Review the Final Dose.

1. Click the Dose button to access the isodose tools.

2. Click the Set Normalization Mode button. XiO opens the Dose


3. Next to the Selected Dose Normalization Mode, enter 1000 cGy.

4. Click Selected Dose. XiO normalizes 1000 cGy to the 100% isodose line.

5. Click Cancel to close the Dose Normalization dialog box.

6. Click your right mouse button in the transverse image window and select

Maximize. XiO expands the transverse image window to full screen.

7. Click your right mouse button again and select the Movie option. Scroll to

a slice where you see a clip contour. Example, slice -97.21.

11-8

Electron Beam

XiO Training Guide

Electron Beam

Task 6. Normalize and Review the Final Dose (cont.)

8. Click the Isodose Lines button. XiO opens the Isodose Lines dialog

box.

9. Enter the following isodose lines 105, 100, 95, 90 and 70.

10. Click OK to close the Isodose Lines dialog box.

11. Movie through the slices to review the coverage of the isodoses.

12. Click your right mouse button and select the Restore option to restore the

transverse image.

13. Click your right mouse button in the MPV window and select Maximize to

maximize the MPV image to review the dose distribution in the 3D view.

14. Click the Dose in MPV button to display the isodose lines.

15. Once you have finished reviewing the 3D isodoses, select the Restore

option to restore the MPV window.

16. Click the drop-down menu and select the Exit option when you are

finished.

XiO 11-9

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Practice Exercise

This lesson demonstrates how to create a plan using rotational arc beams. You

can use either symmetric or asymmetric collimator jaws in arc planning. In this

exercise, you will be creating an Arc rotation plan on a prostate patient. The

prescription goal is 6820 cGy in 38 treatments using two lateral arcs.

Task 1. Start the Plan

1. Click the Teletherapy option on the XiO Main window.


option.


FusionProstate.

4. Click your middle mouse button in the Studyset field and select CT.

5. Click the drop-down arrow in the Graphics Area Setup field and select

6TSCMxA.

6. Click OK. XiO opens the FusionProstate patient in the selected six-

window format.

XiO 12-1

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Task 1. Start the Plan (cont.)

7. Click the View drop-down menu select the Enhance Contour option. XiO

displays the Enhance Contours dialog box.

8. Turn off all structures; turn on only the structures PTV2 and Patient.

9. Click OK.

12-2

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Task 2. Add the Rotational Arc Beams

1. Click the New Beam button. XiO displays the New Beam dialog box.

2. (Optional) Enter Right Lateral Arc in the description field.

3. Enter Vari18x in the Machine ID field.

4. Click the drop-down arrow in the Setup: field and select Rotational.

5. Click the drop-down arrow in the Collimator jaw: field and select

Asymmetric.

6. Click your middle mouse button in the Default to: field and select the Beam

Isocenter center of PTV2.

7. Click OK. XiO opens the Photon Beam dialog box.

XiO 12-3

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Task 2. Add the Rotational Arc Beams (cont.)

8. Enter LW= 4.5 RW = 4.0 UL= 5.5 LL= 5.5 in the Field Size Defined At:

fields.

9. Enter 225 in the Gantry Angle field.

10. Enter the degrees of 90 in 10 deg increments in the Rotation Arc field.

The increment is the degree interval at which the system calculates dose.

11. Enter 3420 in the Weight: field and 38 in the Number of Fractions: field.

12. Leave all other fields as their default values and click OK.

13. Click the Mirror Beam button to create the opposing beam. XiO

displays the Photon Beam dialog box.

14. (Optional) Enter the description as Left Lateral Arc.

15. All other values can be left to their default settings. Click OK to close.

12-4

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Task 3. Normalize and Review the Final Plan

1. Click the Dose button on the main toolbar. The status indicator displays

the percent done for each beam as it calculates. Once the calculation is

complete, proceed to the next step.

2. Click the Set Normalization Mode button. XiO opens the Dose


3. Click your middle mouse button in the Reference Point Position field and

select center of PTV2 as the default normalization point.

4. Click the Selected Point button. XiO normalizes the point to 100%.

5. Click Cancel to close the Dose Normalization dialog box.

XiO 12-5

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan

Task 3. Normalize and Review the Final Plan (cont.)

6. Click the Isodose Lines button. XiO displays the Isodose Lines dialog

box.

7. Enter the following isodose lines 102, 100, 98, 95 and 70.


9. Click your right mouse button in the transverse image window and select

Maximize. XiO maximizes the transverse image to full screen. Note the

coverage of the 98% isodose line.

10. Click your right mouse button in the window again and select the Movie

option. Scroll through the transverse slices to review the isodose line

coverage.

11. Click your right mouse button in the transverse image window to Restore

the transverse image.

12. Click the Beam Weight button. XiO displays the Beam Weight dialog

box.

13. Click the Rescale (Prescribe) Beam Weights button. XiO displays the

Rescale Weights dialog box.

12-6

Arc Rotation Plan

XiO Training Guide

Arc Rotation Plan


14. Click the drop-down arrow in the Prescribe to: field and select Isodose

Line. XiO displays the Rescale Weights dialog box.

15. Enter 98% in the Isocurve Value: field and 6840 in the Prescribed Dose

(cGy): field. XiO redisplays the Beam Weight dialog box.

16. Click OK to rescale the doses.

17. Click OK to close the Beam Weight dialog box.

18 Click your right mouse button in the transverse image window and select

Movie. Movie through the transverse slices and review the coverage of the

98% isodose line.

19 Click your right mouse button in the MPV window and select Maximize to

maximize the MPV window.

20 Click the Isodose Lines button. XiO displays the Isodose Lines dialog

box.

21 Turn off all isodose lines except the 98% line and change the rendering to

Solid.


XiO 12-7

Arc Rotation Plan

XiO Training Guide

12-8

Arc Rotation Plan


23. Click the Dose in MPV button. You can now see that the 98% isodose

curve covers the PTV2 structure.

24. Click your right mouse button in the MPV window and select Restore to

restore the MPV window.

25. Click the File drop-down menu and select the Exit option when you are

finished with the patient.

Single Field Irregular Field

XiO Training Guide

Single Field Irregular Field Single Field Irregular Field

Single Field Irregular Field — Plan A.

This exercise walks you through the steps to create an irregular field plan with a

treatment aid. The port that you will digitize can be found at the end of this

section.

In this plan, you will complete the following tasks:

! Enter setup information

! Enter beam parameters

! Enter a block

! Define surface points

! Enter point depths

! Calculate dose

Enter Setup Information

1. Select the Irregular Field option on the XiO Main window.

2. Click the New Treatment Plan button.

3. Enter MrIrreg in the Patient ID field.

4. Click DONE.

XiO" 13-1


XiO Training Guide


Single Field Irregular Field — Plan A. (cont.)

5. Enter the patient demographic data of your choice. Patient Name and

Sex are required fields.

Enter Beam Information

1. Click your middle mouse button in the Irregular Field Calculation Type

field and select Single Beam Vertical Depths. This option assumes all

calculation point depths are vertical depths from the surface to the point.

The other options are Single Beam Diverging Depth, where all calculation

point depths off the CAX are assumed to be diverging depths and Opposed

Beam Vertical Depths, where you are going to enter a patient thickness and

calculate both entrance and exit dose to a point.

2. Click your middle mouse button in the Setup Type field and select SSD.

3. Click DONE.

4. Click your middle mouse button in the Machine ID field and select

Vari06x.

5. Click you middle mouse button in the Collimator Jaw field and select

symmetric.

13-2


XiO Training Guide



Enter Beam Information (cont.)

6. Click Done. XiO displays the Source dialog box.

7. At the Gap Reference Distance field, leave the value at 100 cm. This is the

distance from which all other calculation point depths will be referenced.

8. All other values can be left to their defaults.

9. Click DONE. XiO displays the Customized Port dialog box.

XiO" 13-3


XiO Training Guide



Enter a Block

1. Enter the Customized Port ID AP.

2. Click Done. XiO displays the customized port entry modes.

3. Click the Tablet button as the entry mode.

4. Click the Enter Additional Polygon button.

5. Enter a Scale Factor of 0.99.

6. Enter a sample spacing of your own choice. This is the spacing between

points when digitizing the port. The smaller the spacing, the smoother the

contour, and vice versa. 0.5 cm is useful in most cases.

7. Click DONE.

8. Digitize a point along the –X axis.

9. Digitize a point along the +X axis.

10. Digitize the origin point.

11. Press the Start button on the digitizer transducer. Drag the transducer

around the contour. Points will be dropped at the previously selected

sample spacing.

12. When the contour is completed, push the End button on the digitizer

controller two times; once to end the contour, and a second time to finish

using the tablet.

13. Click the CANCEL button two times. XiO displays the port definition

dialog box.

14. At the Polygon Number Representing Cutout field, enter 1. Enter 1 when

you want to define the contour as an aperture (you have drawn the

opening). Leave the field blank when you want to define the contour as a

block (you have drawn the actual block).

15. Click DONE. XiO displays the port description dialog box.

13-4


XiO Training Guide



Enter a Block (cont.)

16. Enter .97 for the customized port tray factor.

17. (Optional) Enter a port Description.

18. Enter 5 HVLS, Cerrobend and a thickness of 7.5. This is applicable for

the Clarkson algorithm. These values will default if they have been set up

in Source File Maintenance.

19. Click DONE.

20. Click CANCEL.

21. Select the Conform Coll. To Cutout option.

22. Click CANCEL. If you have the automatic block cutter, you would select

Export to Block Cutter option here instead of CANCEL. XiO displays

the Surface Point Entry text page.

XiO" 13-5


XiO Training Guide



Define Surface Points

1. Select Tablet.

2. Enter 0.99 for the scale factor.

3. Click DONE. XiO displays the Orient Axis dialog box.

4. Reorient the tablet as previously done.

5. Enter the points 1-3 as indicated on the printout (film).

6. Press End on the digitizer transducer.

7. Label point 1 as Sup Mediastinum.

8. Change the SSD to 102. Note the vertical gap distance is automatically

adjusted, based on the reference distance (100).

9. Click DONE.

10. Label point 2 as CAX.

11. Leave the SSD as is.

12. Click DONE.

13. Label point 3 as Inf. Mediastinum.

14. Change the SSD to 98.

15. Click DONE.

16. Click CANCEL two times; once to exit point entry, and a second time to

display the Depth dialog box.

13-6


XiO Training Guide



Enter Point Depths

1. At the Enter/Edit Calculation depths, review the information for point 1.

2. Click DONE.

3. Enter 5 cm in the first blank line in the first of five columns. You can use

the From, To, and Step options easily to create a series of depths from a

specified point; however, in this lesson, you will only enter one depth for

each point.

4. Click DONE.

5. Review information for point 2.

6. Click DONE.

7. Enter 10 cm.

8. Click DONE.

9. Review information for point 3 and click DONE.

10. Enter 6 cm.

11. Click DONE. You are now finished with point depth entry.

XiO" 13-7


XiO Training Guide



Calculate Dose

1. Click the global function SF4 DISPDOSE button.

2. Click the Prescribe to a point button.

3. Click your middle mouse button in the Point Number field to display a list

of points and select point 2.

4. Click your middle mouse in the Depth field and select a depth of 10 cm

5. Enter 100 cGy for the dose.

6. Enter 1 for the number of fractions.

7. Click DONE. XiO displays the Irregular Field Output options list. The

first three options listed allow you to review the information on screen.

The final option listed prints the information.

8. Select Dose and Time/MU Results. XiO displays the results page.

9. Click Quit to close the results page.

10. Click SF9 EXIT to exit the program.

13-8


XiO Training Guide


Parallel Opposed Irregular Field — Plan B.

The following tasks will be covered in this segment of the exercise:

! Enter setup information

! Enter beam parameters for opposing beams

! Enter blocks

! Define surface points

! Enter point depths

! Calculate dose

Task 1. Enter Setup Information

1. Select the Irregular Field option on the XiO main window.

2. Click the New Treatment Plan button.

3. Enter 4569 in the Patient ID field.

4. Click DONE.

5. Enter Mickey Mantle in the Patient Name field.

6. Click the drop-down arrow in the Sex field and select Male.

XiO" 13-9


XiO Training Guide



Task 1. Enter Setup Information (cont.)

7. Enter the Current Date in the Treatment Date field in MMM DD YYYY

format. Alternate formats can be set up in Site Customization.

8. Click your middle mouse button in the Irregular Field Calculation field and

select Opposed Beam Vertical Depths.

9. Click your middle mouse button in the Setup Type field and select SSD.

10. Enter 20 cm in the CAX patient thickness field.

11. Click DONE. XiO positions you for the next task.

13-10


XiO Training Guide


Parallel Opposed Irregular Field — Plan B. (cont.)

Task 2. Enter Beam Parameters

1. Enter AP Mantle in the Description field for Beam number 1.

2. Click your middle mouse button in the Machine ID field and select

Vari06x.

3. Click your middle mouse button in the Collimator Jaw field and select

symmetric.

4. Click DONE. XiO displays the main text page in local function F1 Source.

Information is provided about Beam 1.

NOTE: In this example, the treatment SSD is 100 and gap reference

distance is also 100 SSD. The gap reference distance is the

SSD that XiO uses to reference the off-axis points. Generally,

this SSD will be the same SSD as the treatment plan distance

at CAX.

XiO" 13-11


XiO Training Guide



Task 2. Enter Beam Parameters (cont.)

5. Enter 39 in the Field Width field.

6. Enter 28 in the Field Length field.

7. Click DONE. XiO displays the main text page in local function F1 Source

with information provided for Beam 2.

8. Enter PA Mantle in the description field for Beam 2.

NOTE: The changes made for Beam 1 have also been assigned to

Beam 2.

9. Click DONE. You are now positioned for Task 3.

13-12


XiO Training Guide



Task 3. Enter Blocks

1. Select AP Mantle (beam 1).

2. Enter AP in the Customized Port ID field.

3. Click DONE. XiO displays the tablet entry modes.

4. Click the Tablet button.

5. Click the Enter Additional Polygon button.

6. Enter 0.55 in the Scale Factor field.

7. Enter 0.5 in the Sample Spacing field. You can define multiple spacings.

If you want to change this sample spacing, you can do so during the

digitizing process.

8. Click DONE. XiO displays the orient axis dialog box.

XiO" 13-13


XiO Training Guide



Task 3. Enter Blocks (cont.)

9. Follow the instructions in the Text Area to orient the field axis on the

digitizer. After the axis orientation is complete, a prompt is displayed to

start the block contour entry.

10. Follow the instructions in the Text Area to enter the open field (not each

block individually).

11. After you have entered the field, click End twice to close the contour and

end polygon entry.

12. Click CANCEL. This displays the port enter edit modes.

13. Click CANCEL. XiO displays the port definition dialog box.

14. Enter 1 in the Polygon number representing cutout field.

15. Click DONE.

16. Enter 0.97 for the customized port tray factor

17. Click DONE.

18. Click CANCEL two times. Once to return to the customized ports main

menu, and a second time to display Enter/Edit Customized Port for Beam

Number: dialog box.

19. Select PA Mantle (beam 2).

20. Click the drop-down arrow in the Customized Port ID field and select AP.

The AP port that was previously digitized is now placed on Beam 2.

21. Click DONE.

22. Click Mirror. XiO mirrors the AP customized port so that it is the proper

orientation for the PA field (beam 2).

23. Click CANCEL two times. Both beams now have customized blocks

defined.

24. Verify that Beam 1 is selected. If not, toggle the Beam Number to 1 by

clicking on the beam number. This positions you to begin Task 4.

13-14


XiO Training Guide



Task 4. Define First Surface Point

1. Click the Tablet button.

2. Enter scale factor 0.55.

3. Click DONE. XiO displays the tablet orientation dialog box.

4. Orient the tablet according to the instructions on the window.

5. Digitize points 1-6 using the Enter Point button on the digitizer transducer.

Press End once on the transducer when finished entering all the points.

6. Enter the description CAX for Point Number: 1.

7. Select 100.00 cm in the Entrance Curve Correction/Surface Point SSD

field. The default is 100.00 cm.

8. Select 0.0 cm in the Entrance Curve Correction/Vertical Gap Distance

field. The default is 0.0.

9. Select 20 cm in the Thickness field. The default is 20.0 cm.

NOTE: This is the thickness designated at the start of the plan.

10. Select 100 at the Opposed Curve Correction/Default SSD field. The default

is 100.

11. Select 0.0 at the Opposed Curve correction/Vertical Gap Distance field.

The default is 0.0.

12. Click DONE. XiO positions you for the next task.

XiO" 13-15


XiO Training Guide



Task 5. Define Additional Surface Points

1. Repeat Steps 6 through 12 in Task 4 for the additional surface points using

the following values:

For Point 2 Upper Mediastinum, use the following values:

SSD = 101

Thickness = 19.0

For Point 3 Right Neck, use the following values:

SSD = 99

Thickness = 12.0

For Point 4 Right Supraclavicular, use the following values:

SSD = 103

Thickness = 15.0

For Point 5 Right Axilla, use the following values:

SSD = 103

Thickness = 16.0

For Point 6 Lower Mediastinum, use the following values:

SSD = 99

Thickness = 21.0

2. Click CANCEL two times. The depths for each point can now be entered.

13-16


XiO Training Guide



Task 6. Enter Point Depths

1. Enter 1 in the Enter/Edit Calculation Depths field. The default should be 1.

2. Click DONE.

3. Enter 1.5 and 10 cm in the Enter Calculation Depths field.

4. Click DONE. XiO prompts you for the depth of each point.

5. Enter the following depths for each point:

Upper Mediastinum — From 1.5 cm to 9.5 cm in Steps of 4 cm.

Right Neck — 6 cm

Right Supraclavicular — 2 cm

Right Axilla — 8 cm

Lower Mediastinum: Use Copy Depth from Point Number and select

point number 2.

6. Click DONE when finished with the point depth entry.

XiO" 13-17


XiO Training Guide



Task 7. Calculate Dose

1. Click the global function SF4 Dispdose button.

2. Select Prescribe to Point.

NOTE: There is also an option available to enter Time/MU.

If the patient has already been treated to this field, you could

enter the MU with which the patient was treated. XiO

calculates the dose given to the patient at prescription point

and at all designated off axis points.

3. Verify that the value in the Point Data Viewed from Beam field is Beam 1.

If not, toggle so that Beam 1 is displayed.

4. Select 1 in the Point Number field. Point 1 is the CAX point.

5. Select 10 in the Depth field. 10 cm is the midplane depth at CAX.

6. Enter 75 in the Prescribe Dose for Beam 1 (cGy) field.

7. Enter 75 in the Prescribe Dose for Beam 2 (cGy) field.

8. Enter 1 in the Number of Fractions field.

NOTE: The total dose is displayed in yellow after the number of

fractions is entered.

9. Click DONE.

10. Click the Dose and Time/MU results button. XiO displays dose at each

point to the depth in the graphics area.

11. Click QUIT in the graphics area.

You may want to go through this plan again, exploring Irregular Field output

options. If you want to save a plan as a permanent plan, use the global function

SF6 SAVEPLAN.

13-18

Par

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ield

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5

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r m

ay v

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Single Beam Irregular Field – Block

Scale Factor = 0.99

Note: This factor may vary depending on the

printer; verify before using this factor.

Time/MU

XiO Training Guide

Time/MU

Practice Exercise

Time/MU is a simple dose calculation program that runs on XiO or any PC

networked to it. This program can be used to do a point dose calculation.

NOTE: You can access Time/MU on the Internet by accessing the XiO

IP/xio_help.htm. The following is an example of what the address

would look like when entered into the Address field of your Internet

web page: http://172.16.11.20/xio_help.htm

1. From any XiO window, click the Help drop-down menu and select XiO

Help.

2. Under the contents list on the left, select Utilities and the Utilities Table of

Contents.

3. Under the Treatment Planning Heading on the right, select Calculate a

Time/MU. XiO opens the Time/MU module.

4. Enter a User ID. This field is optional; but if entered, it appears at the

bottom of the final calculation window next to Data Entry.

NOTE: You must click in each box to enter data. Press the Tab

button on your computer keyboard to move from field to field.

5. Click Continue. XiO displays the next window.

XiO 14-1

Time/MU

XiO Training Guide

Time/MU

6. Enter the Patient ID, Patient Name, Physician, Beam Description and

Anatomical Site. All fields are optional.

7. Click the drop-down menu in the Machine ID: field and select a Machine

ID.

8. Click the drop-down arrow in the Setup: field and select a Setup.


14-2

Time/MU

XiO Training Guide

Time/MU

10. Enter a Treatment Distance.

11. Select the Field Size defined at.

12. Enter the Open fld. and Blocked fld. sizes.

13. Select a Wedge ID.

14. Enter the calculation Point depth cm.


XiO 14-3

Time/MU

XiO Training Guide

Time/MU

16. Edit the Blocked Equivalent Square, if necessary.

17. Enter a Tray Factor.

18. Enter any Miscellaneous Correction Factors such as a compensating filter

factor.

19. Select Point Dose or Time/MU; then, enter the value.

20. (Optional) Enter any Comments.

14-4

Time/MU

XiO Training Guide

Time/MU

21. If this is the only beam you are calculating, click Continue. XiO displays

the Printable Calculation window.

22. If you have another beam to calculate, click the box next to Enter another

beam. XiO returns you to the initial window (at step 6) where you can

begin entering a new beam description. Repeat steps 7-20.

XiO 14-5

Time/MU

XiO Training Guide

Time/MU

23. (Optional) You can print the final calculation window from the Print

option on the toolbar at the top of the help window.

24. (Optional) Other buttons that appear at the top of the window during data

entry are:

Help (which provides help on each entry window)

Restart (which takes you back to the Patient ID entry window)

Exit (which takes you back to the User ID window).

25. (Optional) Buttons displayed at the bottom of the window include:

Reset Defaults (which reset any drop-down menu selections

example, Machine ID)

Back (which takes you back to the last entry window)

Continue (which takes you forward to the window)

14-6

Time/MU

XiO Training Guide

Time/MU

If you would like to display entrance and exit dose, you must enter a dmax dose

for each machine in SFM that you plan to use in the Time/MU program. These

steps must be performed before you create a Time/MU calculation.

1. Select Source File Maintenance on the main XiO screen.

2. Select Teletherapy; then, select a machine.

3. Click Done.

4. Click the Stand Alone Time/MU Data button.

5. Enter the Dmax for the machine.

6. Click Done.

7. Cancel out of Source File Maintenance.

XiO 14-7

Gynecological Brachytherapy Implant

XiO Training Guide


Practice Exercise

This plan is designed to illustrate how to create a gynecological brachytherapy

plan using XiO. The following tasks are covered in this exercise:

! Create a source type

! Create a source template

! Create a source inventory

! Create additional sources

! Create catheter template

! Create a new patient

! Start creation of a new treatment plan

! Digitize ovoid source

! Define tandem sources

! Digitize the tandem

! Digitize interest points for dose calculations

! Digitize markers for automatically calculating points A and B

! Position markers for defining points A and B

! Create a best-fit oblique plane and sagittal and transverse view of the implant

! Calculate dose

! (Optional) Edit/Delete sources and catheters

! Plot brachytherapy plan

Task 1. Create a Source Type

This task walks you through creating a brachytherapy source type. By creating a

source type, you are simply entering the physical characteristics of a particular

kind of source, such as Cesium or Iridium, etc. These physical characteristics do

not often change and only need to be entered once, or edited when the vendor

notifies you of some change.

WARNING

All suggested parameters used in this training lesson are to be

used for training purposes only; when you are creating source

types in your clinic; verify the necessary parameters with the

source vendor before validating.

XiO" 15-1


XiO Training Guide


Task 1. Create a Source Type (cont.)

Sub-task 1. Enter General Parameters

1. Select Source File Maintenance.

2. Select Brachytherapy.

3. Select Source Type Editor.

4. Enter the Source Type ID CS137training.

5. Click Done.

6. Enter CS137 as the Isotope.

7. Select Years for the Half Life Units.

8. Enter 30 (years) for the Half Life.

9. Select Linear for the source Geometry. If you choose linear here, you can

choose later to use it as a linear or a seed source. If you choose seed here,

XiO limits you to the source being a seed only source.

10. Enter mgRaeq for the Units of Strength.

11. Enter 2.0 (cm) for the Physical Length.

12. Enter 1 for the number of subsources.

13. Once you have entered the number of subsources, XiO requires you to enter

the position of the tip and end of the source and the relative strength. Enter

the following parameters:

Subsource Tip: 0.325 (cm).

Subsource End: 1.675 (cm).

Relative Strength: 1.0.

14. Click Done when finished entering all values.

15. On the main entry page for this source, you can now verify that the general

parameters have been entered. Under the heading "Complete," you should

see the word "yes." There is no validation required for the general

parameters.

15-2


XiO Training Guide



Sub-task 2. Enter the Physical Geometry for the Sievert Integral Data

1. Select Physical Geometry under the Integral Data heading.

2. Enter 0.27 (cm) for the Physical Diameter.

3. Enter 0.05 (cm) for the Wall Thickness.

4. Enter 0.325 (cm) for the Tip Cap Thickness.

5. Enter 0.325 (cm) for the End Cap Thickness.

6. Click Done when you are finished entering the Physical Geometry values.

XiO returns you to the main entry page for this source.

7. You can now verify that the Physical Geometry information has been

entered. Under the heading "Complete," you should see the word "yes."

Sub-task 3. Enter the Attenuation Information for the Sievert Integral Data

1. Select Source Interior under the Attenuation Information heading.

2. Enter 1 for the Number of Coefficients.

3. Once this information is entered, you are required to provide the Thickness

and the Coefficient. Use the following parameters:

Thickness 10 (cm)

Coefficient 0.046 (1/cm).

4. Click Done when finished entering the Source Interior Data.

5. Select Source Shell under the Attenuation Information heading.

6. Enter 1 for the Number of Coefficients.

7. Once this information is entered, you are required to provide the Thickness

and the Coefficient. Use the following parameters:

Thickness: 10 (cm)

Coefficient: 0.37 (1/cm)

XiO" 15-3


XiO Training Guide



Sub-task 3. Enter the Attenuation Information for the Sievert Integral Data (cont.)

8. Click Done when finished entering the Source Shell Data.

9. Select Tissue under the Attenuation Information heading.

10. Enter the Meisberger Coefficients for tissue attenuation. Use the following

values:

Mantissa Exponent Units

A: 1.0091 0

B: -9.015 -3 1/cm

C: -3.459 -4 1/cm^2

D: -2.817 -5 1/cm^3

11. Enter 10 (cm) for the Meisberger Range and 0.0 (1/cm) for the Tissue

Attenuation Coefficient.

12. Click Done when you are finished entering these values.

13. Select Conversion Constant under the Attenuation Information heading.

14. Enter 8.2135 for the Mantissa and 0 for the Exponent.

15. Click Done when you are finished.

16. You can now verify that the Attenuation Information has been entered.

Under the heading "Complete," you should see the word "yes" for all four

sections of the attenuation data. There is no validation required for these

sections.

Sub-task 4. Enter the Dose Rate Parameters and Create the Dose Rate Table

1. Select Dose Rate Parameters close to the bottom of the main entry screen.

2. Enter 0.15 (cm) for the Minimum Radius.

3. Enter 2.0 (cm) for the Midpoint Radius.

15-4


XiO Training Guide



Sub-task 4. Enter the Dose Rate Parameters and Create the Dose Rate Table (cont.)

4. Enter 10 (cm) for the Maximum Radius.

5. Enter 150 for the Number of Radii from Minimum to Midpoint.

6. Enter 150 for the Number of Radii above Midpoint to Maximum.

7. Enter 101 for the Number of Angles.

8. If you would like to create this source to be used as a seed source or a linear

source, select yes for the option to Calc seed equivalent dose rate. For this

task, choose no. Typically, Cesium sources are calculated and planned as

linear sources only.

9. Click Done when you are finished entering the Dose Rate Parameters.

10. To generate the Dose Rate Table, click the Cancel button to go back one

page.

11. Select the option Generate Dose Rate Table.

12. Read the warning message; then, click Acknowledge.

13. Click Done to generate the Sievert Integral Dose Rate Table. XiO displays

a yellow message once the table is successfully calculated. Read the

message; then, click Acknowledge.

14. Next, you must Validate the Dose Rate Table. Select Validate from the

menu options. XiO displays a warning message. Read and Acknowledge

the message.

15. Review the table using the Page-Up/Page-Down button.

16. Click the Quit button when finished reviewing.

17. Select Validate to validate the table.

18. XiO displays a warning message and again asks you if you would like to

Validate the table? Answer yes (the default); then, click Done.

XiO" 15-5


XiO Training Guide



Sub-task 4. Enter the Dose Rate Parameters and Create the Dose Rate Table (cont.)

19. Select Enter/Edit.

20. You can now verify that the Dose Rate Table has been created and

Validated. Under the headings "Complete" and "Validated," you should

see the word "yes" for this table. There is no validation required for Dose

Rate Parameters.

21. Once you are finished, click Cancel three times to go back to the

Brachytherapy Source and Catheter Editor page.

15-6


XiO Training Guide


Task 2. Create a Source Template

The Source Template Editor in Source File Maintenance is where you create an

inventory of source templates (library of source templates in the clinic). For

example, if you have ten physical sources of 10 mgRaeq each, only one template

would need to be created for each activity.

1. Click the Source Template Editor option. XiO displays the Source File

Maintenance Brachytherapy ID Text Page.

2. Enter CS137CMS20 in the Source Template ID field.

3. Click DONE.

4. Select CS137training in the Source Type ID field.

5. Enter the Calibration Strength. In this example, enter 20.

6. Enter the Calibration Date. In this example, enter today’s date, and

Time: 8:00. Use the following date format: MMM DD YYYY.

7. Click your middle mouse button in the Lock Status field and select Locked.

NOTE: The "Locked" status is typically used for sources in your

permanent inventory that have long half-lives and the calibration

date needs to remain static.

8. Click DONE.

XiO" 15-7


XiO Training Guide


Task 3. Create a Source Inventory

Use the procedures in this task to create an entire source inventory.

1. Click the Copy/Duplicate button. XiO displays the Source File

Maintenance Brachytherapy Copy Page.

2. Enter CS137CMS15 at the Source Template ID prompt.

3. Click DONE. XiO displays a system message in a yellow box.

4. Read and Acknowledge the message. XiO displays the Source File

Maintenance Brachy Editor Menu Text Page.

5. Click the Enter/Edit button. XiO displays the Source Template Edit Text

Page.

6. Enter 15 at the Calibration Strength (mgRaeq)field.

NOTE: This is the only value that is to be changed for this source.

7. Click DONE.

8. Repeat Steps 1 through 7, but substitute CS137CMS10 in the Source

Template ID field and 10 in the Calibration Strength (mgRaeq) field.

9. Click the CANCEL button two times. XiO displays the Source File

Maintenance Brachy Text Page.

10. Click the Source Templates Index button. XiO displays a list of sources.

NOTE: The current strength is a product of calibration strength and

decay factor. This shows strength due to decay from the

calibration date and time that you have previously entered.

11. Verify that the source templates are included in the index.

12. Click the QUIT button. You are now positioned to perform the next task.

15-8


XiO Training Guide


Task 4. Create Tandem Catheter Template

A catheter template is a generic catheter or ribbon that contains unstructured

sources. The catheter or ribbon is digitized via simulation films with the implant

instruments in place, allowing you to edit sources or spacers.

1. Click the Catheter Template Editor button. XiO displays the Source File

Maintenance Brachy ID Text Page.

2. Enter cstandem1 in the Catheter Template ID field.

3. Click DONE. XiO displays the Catheter Template Parameters Text Page.

4. Click your middle mouse button in the Load Method field and select

Unstructured. Refer to the XiO Help for definitions of the various

options.

5. Click DONE. XiO displays the Catheter Template Edit Text Page.

6. Select Geometry.

7. Click your middle mouse button in the Sampling Method field and select

the Continuous Tracking option. Refer to the XiO Help for definitions of

the various options.

8. DO NOT make an entry in the Total Length field; leave it blank.

NOTE: By leaving this field blank, the total length of the template can

vary.


10. Click the Source Loading button. XiO displays the Catheter Template

Unstructured Text Page.

11. Click the Insert Gap button seven (7) times. XiO displays the fields for

seven gap positions for which content can be entered.


13. Click the CANCEL button five times to return to the Main XiO Menu.

XiO" 15-9


XiO Training Guide



Use the steps described in this task to enter the demographic information of a

new brachytherapy patient.

1. Click the Patient File Maintenance (PFM) option on the XiO Main

window. XiO launches the PFM module.


XiO displays the New Patient dialog box, where you enter the patient’s

demographic data.

3. Enter BrachyTutorial in the Patient ID field.

4. Enter the patient’s name. In this exercise, use Brachy Tutorial.

5. Enter Female in the Sex field.

6. Click the drop-down arrow in the Create field and select the No Studyset

option from the list.

7. Click OK.

8. Click the File drop-down menu and select the Exit option. XiO returns you

to the main XiO window.

15-10


XiO Training Guide


Task 6. Create a New Treatment Plan

In this task, you will create a new brachytherapy treatment plan.

1. Select the Brachytherapy option on the XiO main window.

2. Click the New Treatment Plan button. XiO displays the Patient ID text

page.


BrachyTutorial.

4. Click DONE. XiO displays the Treatment Subplan Type Menu.

5. Click your middle mouse button in the Planning Mode field and select

Treatment.

6. Click DONE.

7. Do not enter a value in the Studyset ID field. Leave this field blank.

8. Click DONE.

9. Click your middle mouse button in the Anatomy View Towards field and

select the head option.

10. Click DONE. XiO displays the F2 Source Text Page. This positions you

to work on the next task.

XiO" 15-11


XiO Training Guide


Task 7. Digitize Ovoid Source

In this exercise, you will reconstruct the ovoid sources as single sources. You

will also reconstruct the tandem sources using a tandem catheter.

1. Click the Tablet Entry button.

2. Click your middle mouse button in the Algorithm field and select Ortho

(Geo). Refer to the XiO Help for definitions of the various options.

3. Enter 135 in the AP film SFD (cm) field.

4. Enter 135 in the LAT film SFD (cm) field.

5. Click DONE. XiO displays a system message reminding you how to orient

the films on the tablet.

6. Click the Acknowledge button. XiO displays the Brachytherapy Orient

Tablet text page.

7. Place the drawing labeled FIGURE AP_GYN on the left side of the

tablet, and the drawing labeled FIGURE LAT_GYN on the right side of

the tablet.

NOTE: The two drawings are replications of two orthogonal simulator

films, AP and Lateral.

8. Click the Enter Point button on the transducer with the cross hairs on the

AP film – axis.

NOTE: Instructions for using the transducer are also provided in the

Text Area.


AP film + axis.


AP film origin axis.


LAT film - axis.


LAT film + axis.

15-12


XiO Training Guide


Task 7. Digitize Ovoid Source (cont.)


LAT film origin axis.

NOTE: When all six points in Steps 8 through 13 have been digitized,

XiO displays the Tablet Sources Add text page.

14. Click your middle mouse button in the Source Template ID column and

select CS137CMS15 source.

NOTE: If you need to edit the calibration strength, you can do so now

if the source is not locked in Source File Maintenance.

15. Click the Enter Point button on the transducer with the cross hair on the

TIP1 marker. The marker is located on the tip of the first ovoid source on

the AP film.


END1 marker. The marker is located on the end of the first ovoid source

on the AP film.

17. Click the Enter point button on the transducer with the cross hair on the

TIP1 marker. The marker is located on the tip of the first ovoid source on

the LAT film.

18. Click the Enter point button on the transducer with the cross hair on the

END1 marker. The marker is located on the end of the first ovoid source

on the LAT film.


TIP2 marker. The marker is located on the tip of the second ovoid source

on the AP film.


END2 marker. The marker is located on the end of the second ovoid

source on the AP film.


TIP2 marker. The marker is located on the tip of the second ovoid source

on the LATfilm.


END2 marker. The marker is located on the end of the second ovoid

source on the LAT film.

XiO" 15-13


XiO Training Guide


Task 8. Define Tandem Sources

A catheter in XiO is a container with one end closed. You can define a catheter

in XiO using several methods. In this procedure, you will use the unstructured

method to allow flexibility in placing sources.

1. Select local function F3 Catheters. XiO displays the Brachytherapy

Catheter text page.

2. Click the Tablet Entry button. XiO displays the Brachytherapy Tablet

Parameters Text Page.

3. Click DONE. XiO displays the Catheter Tablet Add Text Page.

4. In the Catheter Template field, select the cstandem defined in Source File

Maintenance. XiO displays the Catheter Edit Text Page.

5. Select Source Loading. XiO displays the Brachytherapy Catheter

Unstructured Text Page.

6. Click your middle mouse button and select CS137CMS15 for the first

position. The sources are loaded from the tip (closed end) of the tandem to

the end (open end).

7. Enter a gap of 0.25 cm in the second position in the Len Column,

8. Select CS137CMS10 for the third position.

9. Repeat steps 7 and 8 for the fourth and fifth positions.

10. Click DONE. XiO displays the Catheter Edit Text Page.

11. Click CANCEL. XiO displays the Catheter Tablet Add Text Page.

15-14


XiO Training Guide


Task 9. Digitize the Tandem

In this exercise, you will digitize the tandem on the AP and LAT films for use in

planning. By digitizing the catheter, you are creating a virtual tube in which to

place sources. It is important that you begin digitizing the catheter at the same

point on both films; for example the tip of the catheter or the tip of the first

source. XiO uses these point coordinates as the starting point to place sources

inside the catheter. If you begin digitizing at the tip, you will want to create a

spacer in you catheter loading (in XiO) equal to the distance from the tip of the

catheter to the tip of the first source.

1. To digitize the AP tandem catheter, click the Enter Point button on the

digitizer controller at discrete points along the tandem. Start at the tip of

the first source and proceed down the catheter.

2. Use more points in curved sections and fewer points in straight sections,

starting at the top (closed end) and working your way toward the open end.

3. Click the {9} button on the transducer. This ends the digitization of the

tandem catheter on the AP film.

4. To digitize the LAT tandem catheter, click the Enter Point button on the

transducer at discrete points along the tandem. Once again, start at the tip

of the first source and proceed down the catheter.

5. Use more points in curved sections and fewer points in straight sections,

starting at the top (closed end), and working your way toward the open end.

6. Click the {9} button on the transducer. This ends the digitization of the

tandem catheter on the LAT film.

XiO" 15-15


XiO Training Guide


Task 10. Digitize Interest Points for Dose Calculations

In this exercise, you will digitize points of interest into the computer for dose

analysis to critical organs.

1. Click the F4 Points local function button. XiO displays the Brachytherapy

Points Menu Text Page.

2. Click the Tablet button under Interest Point Localization Methods. XiO

displays the Brachytherapy Tablet Parameters Text Page.

3. Click DONE. XiO displays the Brachytherapy Tablet Add Points Text

Page.

NOTE: You do not have to re-orient the films unless they have moved

since digitizing the sources and tandem catheter.

4. Enter the word Bladder in the Description field; then, click the Enter key

on your computer keyboard.


point labeled BLADDER on the AP film (FIGURE AP_GYN).


point labeled BLADDER on the LAT film (FIGURE LAT_GYN).

7. Enter the word Rectum in the Description field; then, click the Enter key

on your computer keyboard.


point labeled RECTUM on the AP film (FIGURE AP_GYN).


point labeled RECTUM on the LAT film (FIGURE LAT_GYN).

10. Click CANCEL. XiO displays the Brachytherapy Points Menu Text page.

15-16


XiO Training Guide


Task 11. Digitize Markers for Automatically Calculating Points A and B

Use these procedures to digitize markers for automatically calculating Points A

and B and for defining the best-fit oblique plane.

1. Under the Marker Localization Methods heading, select Tablet.

2. Click DONE. XiO displays the Brachytherapy Tablet Add Points Text

Page.

3. Enter External OS in the Description field; then, click the Enter key on

your computer keyboard.


point labeled External OS on the AP film (FIGURE AP_GYN).


point labeled External OS on the LAT film (FIGURE LAT_GYN).

6. Enter Midline in the Description field; then, click the Enter key on your

computer keyboard.


point labeled Midline on the AP film (FIGURE AP_GYN).


point labeled Midline on the LAT film (FIGURE LAT_GYN).

9. Enter Ovoid1 in the Description field; then, click the Enter key on your

computer keyboard.


point labeled Ovoid1 on the AP film (FIGURE AP_GYN).


point labeled Ovoid1 on the LAT film (FIGURE LAT_GYN).

12. Enter Ovoid2 in the Description field; then, click the Enter key on your

computer keyboard.


point labeled Ovoid2 on the AP film (FIGURE AP_GYN).


point labeled Ovoid2 on the LAT film (FIGURE LAT_GYN).

XiO" 15-17


XiO Training Guide


Task 11. Digitize Markers for Automatically Calculating Points A and B (cont.)

15. Enter Tandem in the Description field.

16. Click the Enter key on your computer keyboard.


point labeled Tandem on the AP film (FIGURE AP_GYN).


point labeled Tandem on the LAT film (FIGURE LAT_GYN).

15-18


XiO Training Guide


Task 12. Position Markers for Defining Points A and B

XiO automatically places points A and B for you. In this task, you will select the

correct markers and catheter.

1. Click the F8 Calc Param button. XiO displays the Calculation Parameters

Text Page.

2. Under Dose Specification, click the Point A and B option.

3. Select Arc Length in the Tandem Tracing Method field. Refer to the XiO

Help for definitions of the various options.

4. Select the External OS marker in the External OS field. One (1) is the Marker

No. 1.

5. Select the Midline Marker in the Midline field. Two (2) is Marker No. 2.

6. Select Catheter in the Tandem type field. Points A right/left and B

right/left are automatically positioned and added to the treatment plan as

interest points for later dose calculations.

7. Click DONE. XiO displays the Calculation Parameters Menu.

8. Under the Ref. Fram Translation column, select Auto Center All. This

centers the implant relative to the CAX of the films and the implant in the

Graphics Area.

9. Under the Calculation Parameters column, select Calculation Mode.

10. Under the Calculation Mode column, select Volume.

11. In the Parameters to specify field, select grid spacing.

12. Enter 0.1 in the Distance between calculation points field. The default is

0.1.

13. Enter 4 in the Calculation Volume Margin (cm) field.

14. Select Auto Fit Volume Size and Center. This centers the calculation

volume about the extents of the sources and tandem.

15. Click DONE. XiO displays the Calculation Parameters Menu.

XiO" 15-19


XiO Training Guide


Task 13. Create a Best-fit Oblique Plane and Sagittal and Transverse Views of the Implant

In this task, you will create a best plane through the implant and setup transverse

and sagittal views for better visualization of the implant.

1. Click the F10 Graphics button. XiO displays the Graphics menu. The

default display for XiO Brachytherapy is four subwindows. In this

procedure, you will keep four subwindows, but change the views.

2. Press the spacebar with the cursor in the View fields in each subwindow.

3. Click the Update Graphics Display button. This clears each of the

existing subwindows.

4. Enter the following information in sub-window 1:

View: SPV

Orient: Obl

5. Enter the following information in sub-window 2:

View: MPV

Orient: Blank

6. Click the Update Graphics Display button. XiO defines the oblique plane

in Subwindow 1.

7. In the first Pt. ID field under Central Plane Specification Points, enter the

marker with the description Ovoid1.

8. In the second Pt. ID field under Central Plane Specification Points, select

the marker with the description Ovoid2.

9. In the third Pt. ID field under Central Plane Specification Points, enter the

marker with the description Tandem. The oblique plane now intersects

both avoid sources and the tandem.

10. At the Stack Label field, enter Coronal.

11. Select Apply.

12. Click DONE. XiO displays the Graphics Menu.

13. Select Object On/Off. XiO allows you to change some display

parameters.

15-20


XiO Training Guide


Task 13. Create a Best-fit Oblique Plane and Sagittal and Transverse Views of the Implant (cont.)

14. Turn On the Patient Orientation icon. XiO displays the patient icon on

each of the subwindows.

15. Change the View Mode to Complex. XiO changes the mode from simple

to complex.

16. Click CANCEL.

17. Enter the following information for subwindow 3:

View: SPV

Orient: SAG

Ref (cm): 0.0

18. Enter the following information for subwindow 4:

View: SPV

Orient: Tran

Ref (cm): 0.0

19. Select Update Graphics Display. XiO displays the new transverse plane

in subwindow 4.

20. Movie through any transverse, sagittal or oblique image to display a

different plane.

21. Scale each subwindow to gain the best view.

XiO" 15-21


XiO Training Guide


Task 14. Calculate Dose

In this task, you will display dose and set up the dose prescription.

1. Click the global function SF4 DISPDOSE button. XiO calculates and

displays the doses.

2. Select Modify List. XiO displays the Isodose List Text Page. This page

allows you to enter appropriate dose rate isodose lines.

3. In the first four fields, enter 65, 40, 30, and 20. Should you choose to do

so, you can also change colors and/or rendering.

NOTE: You also have the ability to select a predefined isodose list if

you have created one for brachytherapy doses. See the

Preferences section of this training guide for more information

about creating predefined isodose lists.

4. Click DONE.

5. Click the local function F3 PointIndx button. XiO displays the Point

Index Menu Text Page.

6. Click the Interest Point Dose button. XiO displays the doses to the

interest points.

7. Click Quit.

8. Click the local function F4 DosePrescr button. XiO displays the

Brachytherapy Non-Uniform Dose Prescription Text Page.

9. Enter the following information:

Prescribed to: Isodose Line

Line (cGy/hr): 60

10. At the Prescribed Dose field, enter 3000. XiO calculates treatment duration

in days, hours, and minutes.

11. Click DONE.

12. Click QUIT.

13. Review the dose information; then, click the Quit button when finished.

14. Click the Dose Display Using button. XiO toggles between displaying

dose rate and dose. Edit isodose lines as necessary.

15-22


XiO Training Guide


Task 15. (Optional) Edit/Delete Sources and Catheters

If you would like to edit or delete sources after the plan has been calculated, here

are some optional steps to edit or delete groups of sources, individual sources, or

catheters.

1. Click the SF3 Editplan button.

2. To edit or delete sources, click the F2 Sources button.

3. To edit or delete catheters, click the F3 Catheters button..

Sub-task 1. Edit a Group of Sources

Use these steps to edit a group of sources. Sources lock status must be Unlocked

to edit them as a group. See the section Create a Source Template for more

information on lock status.

1. These steps demonstrate how to edit the Calibration Date, Calibration

Strength or Dwell Time for a group of sources.

2. To edit a group of sources, click the F2 Source button; then, click Source

Index to see the list of sources that are available to edit.


4. To edit Calibration Dates, Calibrations Strengths and Dwell Time Weights

for a group of sources, click Group Edit.

5. Enter the range of sources you would like to edit, example, 1-2; then, select

one of the three group edit options: Calibration Dates, Calibrations,

Strengths, or Dwell Time Weights.

6. Enter the new information; then, click Done.

7. Enter the range of sources again and select another group edit option or

Click the SF4 Dispdose button to begin calculating.

XiO" 15-23


XiO Training Guide


Task 15. (Optional) Edit/Delete Sources and Catheters (cont.)

Sub-task 2. Edit One Source

These steps demonstrate how to edit all characteristics of an individual source.

1. To edit one source, click the Keyboard Entry button.

2. Under Mode, select Edit/Delete Sources.

3. Click your middle mouse button in the Source Number field and select the

source you want to edit. XiO displays the source Characteristics

4. Make the necessary edits; then, the click Apply Edits button.

5. Select a different Source Number if you would like to edit an additional

source.

OR

Click the SF4 Dispdose button to begin calculating.

Sub-task 3. Delete a Group of Sources

Use these steps to delete a group of sources. Sources lock status must be

Unlocked to delete them as a group. See the section Create a Source Template

for more information on lock status.

These steps demonstrate how to delete a selected group of sources.

1. To delete a group of sources, click the Source Index to see the list of

sources that are available to delete.


3. Click Group Delete.

4. Enter the range of sources you would like to delete, example, 1-2.

5. Click Done.

6. If you are sure you want to delete the selected sources, answer Yes to the

question "Are You Sure?"

7. Click Done.

8. Add new sources.

OR

Click the SF4 Dispdose button to begin calculating with the selected

sources deleted.

15-24


XiO Training Guide



Sub-task 4. Delete One Source

These steps demonstrate how to delete an individual source.

1. To delete one source, click the Keyboard Entry button.

2. Under Mode, select Edit/Delete Sources.

3. Click your middle mouse button in the Source Number field and select the

source you want to delete.

4. Click the Delete Source button to delete that individual source.

5. Select another source to delete.

OR

Click the SF4 Dispdose button to begin calculating with the selected source

deleted.

Sub-task 5. Edit the Sources in a Group of Catheters

These steps demonstrate how to edit the source loading for a group of catheters.

1. To edit sources in a group of catheters, click the Catheter Index to see the

list of catheters that are available to edit.


3. Click Group Edit.

4. Enter the range of catheters you would like to edit, example, 1-2.

5. Click Done. XiO displays the Edit Catheter page.

6. Make the necessary edits; then, click Done.

7. Click the SF4 Dispdose button to begin calculating.

XiO" 15-25


XiO Training Guide



Sub-task 6. Edit Sources in One Catheter

These steps demonstrate how to edit source in an individual catheter.

1. To edit one source, click the Keyboard Entry button.

2. Under Mode, select Edit/Delete Catheter.

3. Middle Mouse in the Catheter Number field and select, with a left mouse

click, the catheter you want to edit.

4. Edit Catheter Coordinates if necessary and click Apply Edits

OR

Click Edit Catheter Characteristics to edit General Parameters,

Geometry or Source Loading.

5. Click Done after edits have been made.

6. Click the SF4 Dispdose button to begin calculating.

Sub-task 7. Delete a Group of Catheters

These steps demonstrate how to delete a group of catheters.

1. To delete a group of catheters, click the Catheter Index to see the list of

catheters that are available to delete.

2. Click the Quit button to close the index.

3. Click Group Delete.

4. Enter the range of sources you would like to delete, example, 1-2.

5. Click Done.

6. If you are sure you want to delete the selected catheters, answer Yes to the

question "Are You Sure?"

7. Click Done.

8. Add new catheters.

OR


catheters deleted.

15-26


XiO Training Guide



Sub-task 8. Delete One Catheter

These steps demonstrate how to delete an individual catheter.

1. To delete one catheter, click the Keyboard Entry button.

2. Under Mode, select Edit/Delete Catheter.

3. Click your middle mouse button in the Catheter Number field and select the

catheter you want to delete.

4. Click the Delete Catheter button to delete that individual catheter.

5. Select another catheter to delete.

OR


catheter deleted.

XiO" 15-27


XiO Training Guide


Task 16. Plot Brachytherapy Plan

In this task, you will plot a brachytherapy plan.

1. Click the global function SF7 Plot.

2. Select Single-window format.

3. Click DONE. XiO plots the active SPV.

15-28

Prostate Brachytherapy

XiO Training Guide

Prostate Brachytherapy Preplan A

Practice Exercise

This plan illustrates how to use the XiO Brachytherapy preplanning feature.

Once you have completed this lesson, you will be familiar with the procedures to

complete the following tasks:

! Create a source type

! Create a source template

! Create a preplanning prostate template

! Enter patient data

! Enter data about cross sections

! Start the creation of new treatment pre-plan

! Modify graphics

! Define preplanning parameters

! Edit sources

! Enter calculation parameters

! Assign dose prescription

! Print the pre-plan report

XiO" 16-1


XiO Training Guide



This task walks you through creating a brachytherapy source type. By creating a

source type, you are simply entering the physical characteristics of a particular

kind of source, such as Iodine, Palladium, Iridium, etc. These physical

characteristics do not often change and only need to be entered once, or edited

when the vendor notifies you of some change.

WARNING

All suggested parameters used in this training lesson are to be

used for training purposes only. When you are creating source

types in your clinic, verify the necessary parameters with the

source vendor before validating.

Sub-task 1. Enter General Parameters

1. Select Source File Maintenance on the XiO Main Menu window.

2. Select Brachytherapy.

3. Select Source Type Editor.

4. Enter the Source Type ID I125training.

5. Click DONE.

6. Enter I125 as the Isotope.

7. Select Days for the Half Life Units.

8. Enter 59.4 for the Half Life.

9. Select Linear for the seed-source Geometry. If you choose linear here, you

can choose later to use it as a linear or a seed source. If you choose seed

here, you will be limited to the source being a seed-only source.

10. Enter U (air-KERMA) for the Units of Strength.

11. Enter 0.45 (cm) for the Physical Length.

12. Enter 1 for the number of subsources.

16-2


XiO Training Guide



Sub-task 1. Enter General Parameters (cont.)

Once you have entered the number of subsources, XiO requires you to enter the

subsource tip, subsource end, and relative strength. See XiO Help for more

information.

13. Subsource Tip: 0.075 (cm).

14. Subsource End: 0.375 (cm).

15. Relative Strength: 1.0.

16. Click Done when finished entering all values.

17. On the main entry page for this source, you can now verify that the General

Parameters have been entered. Under the heading "Complete," you should

see the word "yes." There is no validation required for the General

Parameters.

Sub-task 2. Enter the Radial Dose Function information for the TG43 Data

1. Select Radial Dose Function under the TG43 Data heading.


3. Enter 7.0 (cm) for the Maximum Radius.

4. Enter 14 for the Number of Radii.

5. There are three methods to generate the Radial Dose Table. In this

example, use the Direct Entry of New Table. Refer to the XiO Help for

more information about the other methods.

XiO" 16-3


XiO Training Guide



Sub-task 2. Enter the Radial Dose Function information for the TG43 Data (cont.)

6. For each Radius (cm), enter the following values:

Radius Value

0.5 1.04

1.0 1.0

1.5 0.926

2.0 0.832

2.5 0.731

3.0 0.632

3.5 0.541

4.0 0.463

4.5 0.397

5.0 0.344

5.5 0.300

6.0 0.264

6.5 0.233

7.0 0.204

Once the values have been entered, you are able to see a graphical representation

of the Radial Dose Table. This graph can be edited manually by placing the

mouse cursor over the nodes on the graph, holding down your left mouse button,

and dragging the node. The value updates in the table.

7. When you have completed the entry of values for the Radial Dose Table,

click Done.

8. You now have three options.

(1) You can edit the Radial Dose Function.

(2) Edit the Radial Dose Table

(3) Display/Validate the Radial Dose Table.

For this task, select Display/Validate the Radial Dose Table.

9. When you select this option, the table displays once again for you to review

and verify. Click Quit to close the display box.

10. Select Validate to validate the table.

16-4


XiO Training Guide



Sub-task 2. Enter the Radial Dose Function information for the TG43 Data (cont.)

11. XiO displays warning and again asks if you would like to Validate the

table? Answer yes (default); then, click Done.

12. Click Cancel to go back to the main entry page for this source.

13. You can now verify that the Radial Dose Function information has been

entered and Validated. Under the headings "Complete" and "Validated,"

you should see the word "yes."

Sub-task 3. Enter the Anisotropy Function information for the TG43 Data

1. Select Anisotropy Function under the TG43 Data heading.


3. Enter 7.0 (cm) for the Maximum Radius.

4. Enter 7 for the Number of Radii.

5. 0 (deg) defaults as the Minimum Angle.

6. Enter 90 (deg) for the Maximum Angle.


8. To create the Anisotropy Table, use the Direct Entry of a New Table

method.

9. Enter the following values in the Anisotropy Factor table:

Radius Angle 1.0 2.0 3.0 4.0 5.0 6.0 7.0

0 .350 .439 .452 .521 .573 .581 .603

10 .423 .549 .529 .582 .600 .621 .660

20 .628 .690 .612 .688 .681 .718 .758

30 .826 .816 .754 .798 .793 .803 .829

40 .953 .903 .888 .842 .888 .826 .861

50 1.00 .954 .795 .866 .903 .891 .922

60 1.03 1.00 .877 .935 .922 .912 .932

70 1.04 1.06 1.07 .969 .915 .953 .978

80 1.02 1.04 1.07 .998 .985 .962 .972

90 1.00 1.00 1.00 1.00 1.00 1.00 1.00

XiO" 16-5


XiO Training Guide



Sub-task 3. Enter the Anisotropy Function information for the TG43 Data (cont.)

Once the values have been entered, you are able to see a graphical representation

of the Anisotropy Table. You can edit this graph manually by placing your

mouse cursor over the nodes on the graph, holding down the left mouse button,

and dragging the node. The value updates in the table.

1. When you complete the entry of values for the Anisotropy Table, click

Done.

2. You now have three options:

(1) You can Edit the Anisotropy Function.

(2) Edit the Anisotropy Table.

(3) Display/Validate the Anisotropy Table.

For this task, select Display/Validate the Anisotropy Table.

3. When you select this option, XiO displays the table again so that you can

review and verify. Use the Page-Up/Page-Down options to review the

entire table, and/or Click Quit to close the display box.

4. Select Validate to validate the table. XiO again displays a warning

message asking you if you would like to validate the table?

5. Answer yes (default); then, click Done.

6. Click Cancel to go back to the main entry page for this source.

7. Verify that the Anisotropy Function information has been entered and

validated. Under the headings "Complete" and "Validated," you should see

the word "yes."

16-6


XiO Training Guide



Sub-task 4. Enter the Dose Rate Function information for the TG43 Data

1. Select Dose Rate Function under the TG43 Data heading.

2. Enter the dose rate constant ((cGy/hr)/U) Mantissa as 8.8 and the exponent

as –1.

3. Enter 0.0 (1/cm) for the Attenuation coefficient to extend radial dose table.

4. Click Done when you have completed entering the Dose Rate Function

information. XiO returns you to the main entry page for this source.

5. You can now verify that the Dose Rate Function information has been

entered. Under the heading "Complete," you should see the word "yes."

There is no validation required for the Dose Rate Function.

Sub-task 5. Enter the Dose Rate Parameters and Create Dose Rate and Seed Equivalent Tables

1. Select Dose Rate Parameters close to the bottom of the main entry screen.


3. Enter 0.5 (cm) for the Midpoint Radius.

4. Enter 10 (cm) for the Maximum Radius.

5. Enter 150 for the Number of Radii from Minimum to Midpoint.

6. Enter 150 for the Number of Radii above Midpoint to Maximum.


8. If you would like to create this source to be used as a seed source or a linear

source, select yes for the option to Calc seed equivalent dose rate. For this

task, choose yes.

9. Click Done when you are finished entering the Dose Rate Parameters.

XiO" 16-7


XiO Training Guide



Sub-task 5. Enter the Dose Rate Parameters and Create Dose Rate and Seed Equivalent Tables (cont.)

10. To generate the Dose Rate Table, click Cancel to go back one page.

11. Select the option Generate Dose Rate Table.

12. Read and Acknowledge the warning message.

13. Click Done to generate the TG43 Dose Rate Table. XiO displays a yellow

message once the table is successfully calculated. Read and Acknowledge

this message.

14. Next, you must Validate the Dose Rate Table. Select Validate from the

menu options. XiO displays a warning message. Read and Acknowledge

this message.

15. Review the table using the Page-Up/Page-Down button. Click Quit when

you are finished reviewing. If you have created a seed table (as you did in

this task), you must click Quit twice to close both tables.

16. Select Validate to validate the table. XiO displays a warning message and

asks you if you would like to Validate the table. Answer yes (default);

then, click Done.

17. Select Enter/Edit.

18. You can now verify that the Dose Rate Table and Seed Equivalent Table

has been created and Validated. Under the headings "Complete" and

"Validated," you should see the word "yes" for these two tables. There is

no validation required for Dose Rate Parameters.

19. Once you are finished, click Cancel three (3) times to go back to the

Brachytherapy Source and Catheter Editor page.

16-8


XiO Training Guide


Task 2. Create a Source Template

This task walks you through creating a source template. Once a source type has

been created, templates can be created for each activity or planning geometry

(linear/seed).

1. Select Source Template Editor.

2. Enter in the Source Template ID, I125CMS.

3. Click Done.

4. Select the Source Type ID, I125training

5. Enter 1.0 (U) for the calibration strength, and enter today’s date and 8:00

for the calibration date and time. Note the date format is as follows: Dec 31

2003.

6. Seed sources are generally left as unlocked sources. Leaving a source

unlocked allows you the flexibility to edit the source strength while you are

in the planning process or when you know the actual ordered source

strength. The locked status is usually used for sources that you have in

your inventory that have long half-lives, and the calibration date needs to

remain static. In this task, set the source to be Unlocked.

7. You also have the choice of linear or seed planning geometry.

NOTE: Linear Planning incorporates anisotropy factors where Seed

Planning will not.

In this task, choose Seed for the Planning Geometry.

8. Click Done when you are finished entering Source Template information.

9. If you would like to edit, duplicate, or delete this template, optional

functions are now available; otherwise, click Cancel several times to go

back to the main XiO screen.

XiO" 16-9


XiO Training Guide


Task 3. Create a Preplanning Prostate Template

Before you plan a prostate for the first time, you must create a template. Once

you create the template, it can be used repeatedly.


Prostate Template options. XiO displays the Prostate Template ID dialog

box.

2. Enter john1 in the Prostate Template ID: field.

3. Click OK.


Column Spacing (cm): 0.5

Row Spacing (cm): 0.5

Number of Columns: 13

Number of Rows: 12

5. Click OK. XiO displays the Prostate Template Column Labels dialog box.

6. Enter the letters A through M in boxes 1 through 13 for column labels.

These labels run left to right on the template.

7. Click OK. XiO displays the Prostate Template Row Labels Text Page.

8. Enter the numbers 0 through 11 in boxes 1 through 12 for row labels.

These labels run from bottom to top on the template.

9. Click OK. XiO displays the Prostate Template ID Text Page. This

completes the process to create a prostate template.

10. Click CANCEL. XiO displays the main system window.

16-10


XiO Training Guide


Task 4. Enter Patient Data

In this task, enter the demographic information of a new prostate brachytherapy

plan.

1. Select the Patient File Maintenance option on the XiO main window.

XiO launches the Patient File Maintenance module.


XiO displays the New Patient dialog box allowing you to enter the patient’s

demographic data.


Patient ID: John

Patient Name: John

Sex: Male

4. From the Create list, select Nonimaged Studyset.

5. Click OK. XiO opens the New Non-Image Based Studyset Definition

dialog box.

6. Enter prostemp in the Studyset ID: field.

7. Enter pre-plan in the Studyset Description: field.

8. Select Yes in the prostate preplanning field.

9. Click your middle mouse button in the Prostate Template ID field and

select john1 from the list of templates. You created the john1 template in

Task 1 of this lesson.

10. Enter 0.0 to -3.5 in the Cross section reference distance positions (cm)

field, and put 0.5 in the Step (cm) field.

11. Click OK.

XiO 16-11


XiO Training Guide


Task 5. Enter Data about Cross Sections

This task illustrates where to enter contour names and digitize those contours into

XiO.

1. Click the Edit drop-down menu and select the Contour Names and Type

in Contour Names options. XiO opens the Edit Contour Definition dialog

box. This is where you add contour names to a patient that are not

contained in the predefined anatomy list. Contours added here are added to

the user-defined list.


Name: Prostate

Relative Density: 1.0

3. Click OK. XiO saves your entry and redisplays the Edit Contour Definition

dialog box.


Name: Urethra

Relative Density: 1.0

5. Click OK.

6. Click CANCEL.

7. On the Contouring toolbar, click the Trace Contours Using the Tablet

(F6) button. XiO opens the Orient the Tablet dialog box.

16-12


XiO Training Guide


Task 5. Enter Data about Cross Sections

8. Verify that the reference distance for the starting contour is –3.5. You may

need to press {8} to switch to previous cross section, or {9} to switch to

next cross section on the tablet keypad to move to cross section reference

distance 0.5.

9. Read and acknowledge the yellow warning message.

10. Orient the tablet according to the instructions on the dialog box.

11. After the axis is oriented, right-click in the Single Plane View and click

Scale in the shortcut menu.

12. Drag toward the right-hand side of the XiO screen to scale up, (increasing

the viewing magnification).

13. Change to the user-defined group from the Group list by pressing {5} one

or more times on the tablet keypad.

14. Change to the Prostate contour name form the Contour list by pressing {6}

one or more times on the tablet keypad.

15. Click the Start Contour button.

16. Enter Points on the prostate contour by pressing the Enter Point button on

the digitizer keypad; then, press the End button to close.

XiO 16-13


XiO Training Guide


Task 5. Enter Data about Cross Sections (cont.)

17. Press {6} on the digitizer keypad to change to the urethra.

18. Enter the urethra contour using the same process used to create the prostate

contour. XiO prompts you for the next slice to enter.

19. Press {9} switch to Next Cross Section on the tablet keypad to move to

cross section reference distance –3.0.

20. Press 1 on the tablet keypad to reorient the tablet axes.

21. Orient the film axes on the tablet by following the instructions on the

Orient the Tablet dialog box.

22. Repeat this process for the remaining reference distances.

23. When finished contouring all cross sections, press {4} End Tablet Entry

on the tablet keypad.

24. Click the File drop-down menu and select the Exit option.

25. If XiO displays the "Do you wish to save the patient data?" message, click

the Yes button.

Task 6. Start the Creation of New Treatment Pre-Plan

1. Select the Brachytherapy option on the XiO main window. XiO launches

the Brachytherapy module.

2. Select New Treatment Plan.

3. At Patient ID: field, select john.

4. Click DONE.

5. At the Planning mode: field, select planning. Refer to the XiO Help for

information on the various options.

6. Select DONE.

7. Click your middle mouse button at the Studyset ID: field and select

prostemp.

8. Click DONE two (2) times.

16-14


XiO Training Guide


Task 7. Modify Graphics

In this task, use the auto distribution function to automatically place seed sources

in even rows on alternating slices. This provides a good start to the preplan.

Sources can be added, edited, or deleted at any time.

1. Click on local function F10 Graphics.

2. Select Enhance contour.

3. Change contour for prostate to red and T50.

4. Change contour for urethra to yellow and T25.

5. Click DONE.

6. Select Object On/Off.

7. Turn the patient orientation icon to an On position.

8. Click CANCEL twice.

Task 8. Define Pre-Planning Parameters

1. At the Add/delete prompt, select autodistribution. When defining sources

in autodistribution, the first pass places sources on every other slice and in

every other column and row. The second pass places sources on slices,

rows, and columns skipped on the first pass.

2. At the source template ID prompt, select I125CMS.

3. At the Source strength prompts, enter 1.0.

4. At the Inclusion contour prompt, select prostate. This indicates where

sources should be placed.

5. At the Exclusion contour prompt, select urethra. This indicates where

sources should not be placed.

6. At the Cross section prompt, select –3.5. This is the most superior cross

section

7. At the Cross section interval prompt, enter 2. This designates every other

cross section.

XiO 16-15


XiO Training Guide


Task 8. Define Pre-Planning Parameters (cont.)

8. At the Starting Row prompt, enter 0.

9. At the Row interval prompt, enter 2. This designates every other row.

10. At the Starting column prompt, enter A.

11. At the Column interval prompt, enter 2. This designates every other

column.

12. Click Autodistribute.

13. Repeat the above steps with the following changes:

Starting cross sections: -3.0 (This is the second most superior cross section)

Cross section interval: 2.0

Starting row: 1

Row interval: 2

Starting column: B

Column interval: 2

14. Select Autodistribute. Note that you can rotate the MPV to review the

distribution of sources.

15. Click CANCEL.

16. If preferred, change to a nine-window format to see all the slices.

Task 9. Edit Existing Sources

1. At the Add/delete prompt, select sources.

2. Remove the sources/needles near the urethra by holding down the shift key

and clicking the middle mouse button on the cross section and source to be

removed. You can add a source by holding down the shift key clicking

your left mouse button on a cross section at a specific needle location.

3. Click CANCEL.

16-16


XiO Training Guide


Task 10. Enter Calculation Parameters

In this exercise, you will create a useable calculation grid for this implant.

1. Click on local function F8 Calc Parameters.

2. Select Calculation Mode.

3. At the Calc volume margin (cm) prompt, enter 2.0.

4. Select Auto fit volume size and center. XiO automatically creates a 2.0

(cm) margin in all three dimensions around the sources.

5. At the Parameters to specify prompt, change to Grid Spacing and then

change the distance between calculation points to 0.20 along width,

height, and depth.

6. Click DONE.

XiO 16-17


XiO Training Guide


Task 11. Assign Dose Prescription

In this exercise, you will calculate dose and evaluate the implant plan.

1. Click on global function SF4 DISPDOSE. XiO displays the local F1

Isocurve function.

2. Click Set Treatment Duration.

3. Click DONE. XiO recalculates the dose then displays a pop-up window

showing the source parameters

4. Review the parameters; then, click Quit to close.

5. Select Modify List to enter and view isodose lines in dose rate.

NOTE: You also have the ability to select a predefined isodose list if

you have created one for brachytherapy doses. See the

Preferences section of this training guide for more information

about creating predefined isodose lists.

6. Enter doses; then, click DONE.

7. Click the Dose Display Using button to toggle the view to Dose instead of

dose rate.

8. Select Modify list.

9. Enter 16,000 cGy to identify hotspots.

10. Add or remove sources as needed by clicking the SF3 Edit Plan button,

then the F6 Preplan button. (This process was covered earlier in this plan.)

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XiO Training Guide


Task 12. Print the Pre-plan Report

1. Click on global function SF7 Plot.

2. Print the pre-plan report. The report identifies sources per needle and

distance you need to pull needle back from the base of template. It also

tells you the slice number and needle position.

XiO 16-19


XiO Training Guide

Prostate Seed Implant Postplan B

Practice Exercise

This plan is designed to illustrate how to create a prostate seed implant post plan

using XiO. The patient with a prostate seed implant and I-125 seed sources has

already been entered for you.

Once you have completed this exercise, you will be able to execute the following

tasks:

!" Create a prostate post plan

!" Find seeds

!" Review seed positions

!" Calculate doses

!" Plot plan

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XiO Training Guide

Prostate Seed Implant Plan B

Task 1. Create a Prostate Post Plan

1. Select the Brachytherapy option on the XiO main window. XiO displays

the Treatment Subplan Description Page.

2. Select the New Treatment Plan option. XiO displays the Patient ID Text

Page.


ProstImplant.

4. Click DONE.

5. Click your middle mouse button in the Planning mode field and select

Planning.

6. Click DONE.

7. Click your middle mouse button in the Studyset ID field and select

postplan. This patient was scanned using 3 mm slices and implanted with

132 iodine 125 seeds.

8. Click DONE.

9. Click your middle mouse button in the Anatomy view towards field and

select head. Head is the default.

10. Click DONE. XiO displays the F2 Source Text Page.

XiO 16-21


XiO Training Guide


Task 2. Find Seeds Using Automated Source Localization

The XiO Brachytherapy function has an automated source localization feature.

This task walks you through the steps to automatically locate seeds on a post-

plan CT.

1. Select the Automatic Entry option. XiO displays the Automatic Seed

Source Localization Text Page that allows you to use the Automated Source

Localization feature (algorithm).

2. Click your middle mouse button in the Source Template field and select

I125CMS. XiO recalls the source template. You can edit the calibration

data if needed.

This algorithm can only use sources designated as seed sources in the

planning geometry and will only list seed (not linear) sources in the index

for this field.

3. Click your middle mouse button in the Confine Search To field and select

Patient. This parameter confines the search volume for the algorithm.

Typically, the patient skin is sufficient and can be accepted as the default.

NOTE: Unusual patient conditions, such as titanium hip implants and

urethral contrast, can cause the algorithm to find false

positives outside of the intended treatment volume.

4. Enter 132 at the Actual number of seeds prompt. The algorithm uses this

parameter as a guide in finding the seeds in the patient studyset. It is not

guaranteed that the algorithm will return this number of seeds, but it will

generally be close. The number entered here should be independently

verified (usually by a radiograph) to account for any stray seeds in the

patient.

5. Click DONE. XiO starts the search process. Within a few seconds, XiO

begins adding seed sources to the plan and displaying them in the graphics

display. After the algorithm finishes searching, XiO displays the total

number of sources found.

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XiO Training Guide


Task 3. Review Seed Positions

Use this task to review seeds found using the automated tool. Make edits as

needed.

1. Click the F10 Graphics button. XiO displays the Graphics Menu.

2. Select Object on/off. XiO displays the Object On/Off text page.

3. Click the View mode to toggle from simple to complex. Simple view

displays seeds that fall directly on a given cross section. Complex view

displays these seeds and all other seeds in the range of one slice inferior and

one slice superior to the currently viewed slice.

4. Click Cancel twice to return to the Add/Delete Sources Edit window.

5. Click the Scale button to scale the image in the SPV window to gain the

best view.

6. Click the Movie button to review each cross section and verify the results

of the algorithm.

NOTES: Seeds that are on the current slice are represented by a green

circle.

Seeds that are superior to the current slice are represented by a

green circle with a plus + sign in the center.

Seeds that are inferior to the current slice are represented by a

green circle with a minus – sign in the center.

XiO 16-23


XiO Training Guide


Task 4. Calculate Dose and Evaluate the Implant

1. Click the SF4 DISPDOSE button. XiO calculates doses of the sources and

displays the Isocurve Menu.

2. Select the Set Treatment Duration option. XiO displays the

Brachytherapy Non-Uniform Dose Prescription text page.

3. Click your middle mouse button in the Implant type prompt and select

permanent.

4. Click DONE. XiO recalculates the total dose and displays the Source

Index.

5. Click QUIT. XiO displays the Isocurve Menu.

6. Click your left mouse button in the Display Dose Using: field and toggle to

dose. Click on the prompt to toggle between dose rate and dose.

7. Select Modify List under Isovalues. XiO displays the Isocurve List text

page.

8. Enter the isodose values. You can also change colors and rendering as

needed.

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XiO Training Guide


Task 5. Plot Plan

1. Click the SF7 PLOT button.

2. Select the Single window format.

3. Click DONE. XiO plots the window.

XiO 16-25

DRR and Virtual Patient

XiO Training Guide

Digitally Reconstructed Radiographs

Practice Exercise

A Digitally Reconstructed Radiograph (DRR) is an image computed from CT

data that simulates a traditional radiograph.

Radiographs generated by a treatment simulator are used routinely in radiation

therapy to provide volumetric gray scale beam’s eye view (BEV) information

about the location and densities of anatomical structures for a specific

beam/patient setup. When doing CT simulation, DRRs are used to replace

conventional simulation films. Small CT slice spacing, on the order of 1-3 mm,

produces the highest quality DRR images.

Simulation films (DRRs) are used to perform the following tasks:

! Visualize the target to verify the isocenter location or tumor position.

! Visualize the position and volumetric properties of target volumes and

normal structures to determine the appropriate beam arrangements and

field shaping.

! Visualize subtle details and high-contrast tissues characteristic of certain

types of cancerous or normal tissue, which can be discerned by

experienced physicians and physicists.

! Identify organ motion and verify positional stability of anatomical

structures.

! Compare with mega-voltage port films to verify patient setup.

To perform this exercise, you will need the following information:

! One image-based XiO patient

! One valid external photon or electron machine

! One output plotting device (laser printer will work)

Once you complete this exercise, you should understand the following concepts

and be able to execute the following tasks:

! Set up DRR defaults in Settings

! Verify CT to ED conversion for tissues

! Create DRR windows in XiO

! Use different image filters (sim, film, port film, etc.)

! Generate high-resolution DRRs

! Plot a DRR

! Plot a "life-size" DRR to life-size (magnified to source-to-film distance)

XiO" 17-1


XiO Training Guide


Task 1. Set up DRR Defaults in Settings

1. Click the Settings drop-down menu and select the Plan Defaults and DRR

Calculation Defaults options. XiO Displays the DRR Calculation Defaults

dialog box.

2. Enter the Bone filter to correspond to a range of electron density values

from 1.10 to 2.00.

3. Under the Initial Image (Display) heading in the Cols: field, enter the initial

image number of columns to be 128.

NOTE: You want the initial DRR image to display very quickly

during planning so that you set the number of columns (i.e.,

the number of horizontal pixels) to be low, but sufficient for a

discernable image. The interpolation fills in the missing

pixels and decreases calculation time.

4. Click the drop-down arrow in the Interp: field and click Yes to enter the

Interpolation and sharpness for the initial image.

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XiO Training Guide


Task 1. Set up DRR Defaults in Settings (cont.)

5. Under the Final Image (Display) heading in the Res: field, click the drop-

down arrow and set the final image number of the columns to be Auto.

NOTE: Auto allows the system to determine the number of columns

to be used, resulting in optimum sampling.

6. Under the DICOM Image heading in the Cols: field, set the columns to be

512, which sets the resolution used to construct the DRR.

NOTE: The higher the resolution, the higher the quality; however, the

time it takes to construct the DRR goes up as well. The

maximum resolution is 1024.

7. Click OK.


Printing Size options. XiO displays the DRR Size Defaults dialog box.

9. Click the drop-down arrow in the Output Device field and select

postscript.

10. Click the drop-down arrow in the Paper size field and select a paper size.

11. Enter a Default length of 10.00 cm.

12. Enter a Default width of 10.00 cm.

13. Click the Add Defaults button.

14. Click OK. Acknowledge the warning message.

NOTE: Later in this exercise when you generate the life size DRRs

(Task 7), you will adjust the lengths and widths.

XiO" 17-3


XiO Training Guide


Task 2. Verify CT to ED Conversion

When you do a treatment plan, it is helpful to sample CT and electron density

values from the patient to verify that you have defined/chosen the correct CT-to-

ED conversion. This task illustrates an easy method of doing this. An incorrect

CT to ED file could lead to poor quality DRR images.

1. Select the Teletherapy option on the XiO main window. XiO launches the

teletherapy module.


option. XiO displays the New Teletherapy Plan dialog box.


that contains a studyset with at least 50 axial CT slices.

4. Click OK. XiO loads the CT images.

5. Click the Edit drop-down menu and select the Assigned Electron Density

option. XiO displays the Edit Assigned Electron Density dialog box.

6. Click your middle mouse button in the CT Number to Relative Electron

Density Conversion File ID field: and select a CT to ED conversion file if

one has not been assigned.

7. Click OK.

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XiO Training Guide


Task 2. Verify CT to ED Conversion for Tissues (cont.)

8. Click the Dose drop-down menu and select the Calculation and Settings


9. Click the drop-down arrow in the Heterogeneity field and select Yes.

10. Click the drop-down arrow in the Generate Enhanced DRRs: field and

select Yes.

NOTE: Enhanced DRRs are higher resolution DRRs used for film and

life-size printing.

11. In the Distance between Calculation Points fields, use the following

parameters for grid spacing.

Along Width (cm): 0.30

Along Height (cm): 0.30

Along Depth (cm): 0.30

12. Click OK.

XiO" 17-5


XiO Training Guide




XiO displays the Window Format dialog box.

OR

Press the W key on your keyboard.

14. Click the drop-down arrow in the Window Format field and select the H

Two format.

15. Click the drop-down arrow in the View field for window one (1) and select

SPV (single plane view).

16. Select Tran for Orient.

17. Click your middle mouse button in Ref. (cm) field and select the reference

distance you want to display.

18. Leave window two (2) blank.


20. Click the CANCEL button.

21. Click your right mouse button in the SPV window to make it active. XiO

displays a red border on the window.

22. Click your right mouse button and select Movie from the mouse menu.

23. Use the scroll wheel, or click the left or middle mouse buttons to view the

CT slices. Find one that contains fat, muscle, and bone.

24. Click the Tools button located on the main toolbar.

17-6


XiO Training Guide



25. Click the Image Sampling button located on the supporting toolbar.

XiO displays the electron density and CT number on the status bar as

(Ele.Dens./Img:).

26. Place your mouse pointer on the image but outside the patient volume (in

the air.); then, click your left mouse button.

NOTE: Outside the patient, electron density is set to 0.00. The

electron density value here should be equal to or near 0.00.

27. Place your mouse pointer on the image over the muscle tissue; then, click

your left mouse button.

NOTE: Muscle tissue is denser than water. The electron density value

here should be anywhere from 1.00 to 1.10. If not, you may

have chosen an inappropriate CT-to-ED file.

28. Place your mouse pointer on the image over the dense bone tissue; then,

click your left mouse button.

NOTE: Dense bone can have electron densities ranging from 1.7 to

1.9 relative to water. The CT numbers for bone are higher

relative to water than the electron densities because CT

images are formed from diagnostic x-ray energies. The

photoelectric effect at diagnostic energies leads to the high CT

numbers for bone.

29. Verify that the CT-to-ED file chosen is appropriate for your selected

patient. If the electron density numbers sampled do not correspond to your

expectations, select a different CT-to-ED file.

XiO" 17-7


XiO Training Guide


Task 3. Create DRR Windows in XiO

In this activity, you will learn how to define a beam’s eye view (BEV) window

and generate a DRR. To get started, you will set up an AP and PA beam on a

patient, using a valid photon beam and placing the beam isocenter in the middle

of the patient volume.

1. Click the Beam button on the Teletherapy main toolbar.

2. Click the New Beam button on the Beam supporting toolbar. XiO

displays the New Beam dialog box.

3. Enter a description in the description field.

4. Click your middle mouse button in the Machine ID field and choose a valid

photon machine.


6. Define Beam 1.

7. Click OK.

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XiO Training Guide


Task 3. Create DRR Windows in XiO (cont.)

8. Click the Copy Beam button on the Beam Supporting toolbar. XiO

displays the Photon Beam dialog box for beam 2.

9. Click OK.

10. Click the W key on your computer keyboard. XiO displays the Window

Format dialog box.

11. Change window 1 to a BEV for Beam 2.

12. Change window 2 to an SPV view that cuts across the beam volume. Refer

to Task 2, Steps 15 through 17 in this exercise.


14. Click CANCEL.

XiO" 17-9


XiO Training Guide



15. Click the Beam drop-down menu and select the DRR option. XiO displays

the DRR Setup dialog box.

16. Toggle the DRR button to an On position. (Leave the enhanced DRR

button in an Off position.)

17. Click OK. XiO closes the dialog box and generates a DRR, first quickly as

an initial coarse image, then a few seconds later at a final high resolution.

17-10


XiO Training Guide




XiO displays the Enhance Contour dialog box.

OR

Click the C key on your keyboard.

19. Click the All Structures Off button. This removes the contours from the

graphics display so you can clearly see the DRRs.

20. Click OK.

21. Click your right mouse button in window 1 and select the window/level

option.

22. Holding your left mouse button down, swipe the cursor left/right and

up/down to adjust the level (brightness) and window (contrast) of the DRR

for beam 2.

23. In the Active Beam field, change the active beam to Beam 1.

24. Repeat steps 11, 12 and 13 to turn the DRR on for Beam 1.

25. Click your right mouse button in window 2 (SPV) to make it active.

XiO" 17-11


XiO Training Guide



26. Click it again and select the Gantry Angle option. This activates the

mouse control of the gantry rotation.

27. Hold down your left mouse button to rotate the gantry. Note how the

DRR automatically updates when any relevant beam parameter is changed.

28. Click the Edit Beam button on the Beam supporting toolbar.

29. In the Couch Angle field, change the couch angle slightly. Again, the

DRR image updates automatically.

30. Click OK.

31. Click your right mouse button on window 1 to make it active.

32. Click it again and select the Collimator Width option to activate the

mouse control of the collimator size.

33. Hold down your left mouse button to increase and decrease the

collimator width. The DRR should not have to update because the DRR

image remains the same.

34. Click the Edit Beam button on the Beam supporting toolbar.

35. Return the beam parameters to their original nominal values.

36. Click OK.

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XiO Training Guide


Task 4. Use Different Image Filters (Sim, Film, Port Film, etc.)

This task familiarizes you with the steps needed to use different DRR image

filters.



In window 1, you have a DRR for beam 1. The DRR filter defaults to Sim

Film. The image mimics a diagnostic x-ray. The Sim Film filter shows the

soft tissue but enhances high-density objects (such as bone) in order to

mimic the photoelectric effect of diagnostic x-rays.

NOTE: After each filter change, you may have to update the W/L

settings to give an optimal image.

2. Click your middle mouse button in the Filter field and select Bone. The

image should recalculate and the resulting image should subtract out all

anatomy except for those having density between 1.10 and 2.00, as

previously defined in Settings.

3. Click your middle mouse button in the Filter field and select Port Film.

The port film filter is primarily a Compton-driven image, but you have

slightly enhanced bone in order to aid in delineating bony landmarks.

4. Click your middle mouse button the Filter field and change the filter type to

Range.

XiO" 17-13


XiO Training Guide


Task 4. Use Different Image Filters (Sim, Film, Port Film, etc.) (cont.)

5. In the Min: and Max: fields, select various ranges of CT numbers to

isolate in the DRR image.

6. Click your middle mouse button in the Filter field and select Sim Film.

7. Click OK. XiO closes the DRR Setup dialog box.

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XiO Training Guide


Task 5. Generate High-Resolution DRRs

This task illustrates how to use the Enhanced DRR feature to generate higher

quality DRRs. The Enhanced DRR option works by keeping the integrity of the

original CT resolution as opposed to the standard DRR which averages the CT

pixels. This option is most often used to increase the quality of the DRR image

when the DRR is printed to film. `

1. In window 2, display a BEV for Beam 2. This should look identical to the

BEV for Beam 1.



3. Enter 2 in the Beam Number field.

4. Click the Enhanced DRR button to On.

5. Using the Window and Level slider bars, adjust the DRR window/level of

the beam 2 DRR to mimic that of the beam 1 DRR.

6. When the DRR calculation is complete, scale up window 1 and window 2

in order to study the image resolution.

NOTE: You should notice a less pixilated image in window 2. This is

an enhanced DRR. Enhanced DRRs are useful when printing

or plotting to life-size film magnification. Because these

images are greatly magnified, the higher resolution is

important.

XiO" 17-15


XiO Training Guide


Task 6. Plot a DRR

1. Click the Edit Beam button on the Beam supporting toolbar. XiO

displays the Photon Beam dialog box.

2. In order to facilitate knowing which plots are yours, set your Active Beam

to beam 2 on the edit page, and enter your name in the Description field.

3. Click OK.

4. Click the File drop-down menu and select the Print and DRR options.

XiO displays the Print DRR dialog box.

5. Click your middle mouse button in the Beam Number field and select 2.

6. Click the drop-down arrow in the Output DRR to: field and select the

postscript output device.

7. Click the drop-down arrow in the Print Displayed DRR field and select No.

NOTE: When the Print Displayed DRR field is set to No, a new

Enhanced DRR is automatically calculated and sent to the

output device.

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XiO Training Guide


Task 6. Plot a DRR (cont.)

8. Click OK.

9. Retrieve your DRR from the printer.

10. Click the File drop-down menu and select the Print and DRR options. XiO

displays the Print DRR dialog box.

11. Click the drop-down arrow in the Output DRR To: field and select the

postscript output device.

12. Select 1 in the Beam Number field.

13. Click the drop-down arrow in the Spooler field and select the

printer/plotter output device.

14. Click the drop-down arrow in the Print Displayed DRR field and select Yes.

15. Click OK. XiO spools your print request to the printer immediately

because the DRR image on the screen is used, and no recalculation is

necessary.

16. Compare the two plots for differences in quality.

XiO" 17-17


XiO Training Guide


Task 7. Plot a DRR to Life-Size (magnified to source-to-film distance)

In this task, you will set up width and length defaults to generate life-size DRR

plots for different printing devices and plot life-size DRRs.



2. Enter 2 in the Beam Number: field. XiO displays the DRR Setup dialog

box.

3. Select the Width and Length fields each to be 20.00 cm. The DRR will

calculate on a square field.

NOTE: Width and length fields are defined at the isocenter. In the

Defined at Distance (cm): field, you can enter the distance

from the source to the film(SFD). This number is then

divided by the source to axis distance (SAD) to magnify the

image on the plot.

4. Click OK.



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XiO Training Guide


Task 7. Plot a DRR to Life-Size (magnified to source-to-film distance) [cont.]

6. Enter 2 in the Beam Number field.

7. Click the drop-down arrow in the Print Displayed DRR? field and select

Yes.

8. Click OK.

9. Retrieve your plot and measure the width and length of the entire DRR

printed area using the black edges as the end points.

10. Measure the 1 cm graticules on the plot and verify that they are projected

to the source-to-film distance. For example, if the isocenter is at 100 cm

and the source-to-film distance is at 140 cm, each graticule should measure

1.4 cm.

11. Again, click the Beam drop-down menu and select the DRR option. XiO

displays the DRR Setup dialog box.

12. Change the displayed DRR Width and Length to the measured values.

See Step 9. The DRR will recalculate.

XiO" 17-19


XiO Training Guide


Task 7. Plot a DRR to Life-Size (magnified to source-to-film distance) [cont.]



14. Click the drop-down arrow in the Print displayed DRR field and select Yes.

15. Click OK.

16. Measure the 1 cm graticules on the plot and verify that they are projected to

the source-to-film distance.

Use this method to customize the life-size width/length values for different

output devices. This method works because XiO scales DRR images up or down

to fit into the printable area, so you must enter the exact area in order to print life-

size to source-to-film distance. It is recommended that you return to Settings

DRR Printing Size and enter the measured values from Step 6 as a default for this

paper size. You must complete this procedure once for each paper size you use

in your clinic.

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XiO Training Guide


Technical Considerations

The Digitally Reconstructed Radiographs (DRR) Technical Considerations

located on the Reference Library in XiO Help were used as a reference during a

training classroom discussion to support the slides shown in this section.

XiO" 17-21

XiO_TUT_434_C_1

Documents

Transcript of XiO_TUT_434_C_1