Xio 434

XiO
User Guide
Contact Information, Revision History, Trademarks XiO User Guide
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Document Name: XiO_URG_434_ENG_A.pdf Part Number: 98910
Manufacturer CMS, Inc. 1145 Corporate Lake Drive Suite 100 St. Louis, Missouri 63132 USA http://www.cmsrtp.com Phone: 1-314-993-0003 Toll Free: 1-800-878-4267 FAX: 1-314-993-0075 Email: sales-na@cmsrtp.com Customer Support: North, Central and South America Phone: 1-800-878-4CMS (4267) Email: support@cmsrtp.com European Union CMS GmbH Heinrich-von-Stephan Str. 5 b 79100 Freiburg Germany Phone: +49-761-88188-0 Toll Free: +800-4000-5000 (regionally limited) FAX: +49-761-88188-11 Free FAX: +800-4000-5001 (regionally limited) Email: sales-europe@cmsrtp.com Customer Support: Europe, Middle East and Africa Phone: +49-761-88188-0 Email: support-europe@cmsrtp.com European Union Authorized Representative Paul Shane Bennetts M Devices Group Marlborough House, Riding Street Southport PR8 1EW UK Phone: (0) 1704 544 944 Revision History Revision XiO_URG_430_ENG_A.pdf XiO_URG_430_ENG_B.pdf XiO_URG_434_ENG_A.pdf Date 07/18/2005 06/30/2006 03/07/2007
Japan CMS, Japan, K.K. Nagatacho Bldg. 2-4-3, Nagata-cho, Chiyoda-ku, Tokyo 100-0014 Japan Phone: 81-3-3580-7100 FAX: 81-3-3580-7120 Email: sales-japan@cmsrtp.com Customer Support: Japan Phone: +81-3-3556-5391 Email: callcenter-japan@cmsrtp.com
Asia CMS Worldwide Corp. 25th Floor, Suntime International Mansion #450 Fushan Road Pudong, Shanghai 200122 P.R. China Phone: +86-215058-1041 FAX: +86-215058-1045 Email: PacRim@cmsrtp.com Customer Support: China Phone: +86-215058-1041 Email: support-china@cmsrtp.com Customer Support: Asia, Australia and New Zealand CMS Worldwide Corp Suite 15 International Business Centre Australian Technology Park Eveleigh, Sydney NSW 1430 Australia Phone: 61-2-9209-4507 FAX: 61-2-9209-4154 Email: support-australia@cmsrtp.com
Changes New document Update screen shots for new logo; contact information Update for release 4.34
Trademarks All terms mentioned in this manual that are known trademarks, registered trademarks, or service marks have been appropriately labeled as such. Other products, services, or terms that are referred to in this manual may be trademarks, registered trademarks, or service marks of their respective owners. CMS makes no claim to these trademarks. Use of a term in this manual should not be regarded as affecting the validity of any trademark, registered trademark, or service mark. CMS is a registered trademark of CMS, Inc. XiO is a registered trademark of CMS, Inc. Adobe, Acrobat, and the Acrobat logo are trademarks of Adobe Systems Incorporated, which may be registered in certain jurisdictions. Hewlett-Packard is a trademark of Hewlett-Packard Corporation. Netscape and Netscape Navigator are registered trademarks of Netscape Communications Corporation in the United States and other countries. Netscape's logos and Netscape product and service names are also trademarks of Netscape Communications Corporation, which may be registered in other countries. UNIX is a registered trademark in the United States and other countries, licensed exclusively through X/Open Company Ltd. Red Hat and all Red Hat-based trademarks and logos are trademarks or registered trademarks of Red Hat, Inc. in the United States and other countries.
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Microsoft, Windows, and Windows NT are registered trademarks of Microsoft Corporation in the United States and other countries. Copyright 2007 by CMS, Inc. All rights reserved. Performance characteristics given in this manual are for reference only and are not intended as guaranteed specifications.
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Document Name: XiO_URG_434_ENG_A.pdf Part Number: 98910
Table of Contents
Introduction to XiO ........................................... 1
Overview .................................................................................1
Intended Users of the XiO RTP System .....................................................1 Intended Use of the XiO RTP System .......................................................1 Training on the XiO RTP System .............................................................2 Using the XiO RTP System ....................................................................2 Program License Agreement .................................................................2
The Basics of a Treatment Plan .....................................................3

Plan Types ......................................................................................3 Patient Data ....................................................................................3 Entering Patient Anatomy Data..............................................................4 Anatomy Data Classifications ................................................................7 Patient Anatomy File Identification ........................................................8 Plan Modes .................................................................................... 11 Interest Points and Markers ................................................................ 11 Calculation Region........................................................................... 12
Radiation Source Information...................................................... 14

Teletherapy Source Parameters ........................................................... 14 Source Physics Data ......................................................................... 15 Wedge and Compensator Information .................................................... 15
Brachytherapy Source Information ............................................... 17 Dose Calculation Algorithms ....................................................... 17
XiO Basics...................................................... 19
Starting XiO ............................................................................ 19 Logging into XiO ...................................................................... 19
Linux ........................................................................................... 19 UNIX ............................................................................................ 19 XiO Modules ................................................................................... 20
Create Login Usernames and Passwords......................................... 22

XiO User Utility............................................................................... 22
User Definable Setup, Customization, and Preferences ..................... 25

Create Clinics................................................................................. 25 Window Size .................................................................................. 25 DICOM RT Plan Import....................................................................... 25 DICOM Export Setup and Configuration................................................... 25 RTP Link ....................................................................................... 26
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Table of Contents XiO User Guide
Customizing the Linux Desktop ............................................................ 26 Settings........................................................................................ 27 PFM and Teletherapy Preferences ........................................................ 27 Brachytherapy Source Types, Source Templates, and Catheter Types.............. 27 RTOG Protocol Submission Software...................................................... 28 VIDAR Film Scanner.......................................................................... 28 Screen Capture Utility (UNIX).............................................................. 28
Navigation.............................................................................. 28 Limits and Color Definitions........................................................ 30

General Limitations ......................................................................... 30 IDs, Names, and Descriptions .............................................................. 31 Brachytherapy................................................................................ 31 Irregular Field Point Dose Calculation.................................................... 31 System Color Definitions.................................................................... 32
Getting Help ........................................................................... 33

Auto-Help/Answer-Help .................................................................... 34
Exiting XiO ............................................................................. 35
Patient File Maintenance ...................................37

XiO PFM Interface .................................................................... 37 PFM Functionality .................................................................... 40
The Mode Buttons............................................................................ 41 The Submode Buttons ....................................................................... 41
Teletherapy ...................................................43
XiO Teletherapy Interface .......................................................... 43 Teletherapy Functionality.......................................................... 45
The Main Toolbar ............................................................................ 45 Contour Supporting Toolbar................................................................ 46 Beam Supporting Toolbar................................................................... 47 Port Supporting Toolbar .................................................................... 47 Dose Supporting Toolbar.................................................................... 48 Tools Supporting Toolbar ................................................................... 50 IMRT Supporting Toolbar ................................................................... 50
Teletherapy Features ............................................................... 51

Window Format .............................................................................. 51 Making a Beam Active....................................................................... 54 Bolus ........................................................................................... 54 Add/Edit a Contour.......................................................................... 54 Dose............................................................................................ 55 Histogram ..................................................................................... 56
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Multiple Plan Review ........................................................................ 57 Saving Plans................................................................................... 57 Plan Approval................................................................................. 57
Next Step............................................................................... 57
Index ........................................................... 59
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Introduction to XiO
Overview
Welcome to XiO! You join thousands of clinicians worldwide who use XiO to develop treatment plans for cancer patients. As you work with XiO, you will appreciate the remarkable capability you now have to create extremely accurate treatment plans in a minimum amount of time. In this guide, you will read about the underlying concepts that help you understand the softwares features. XiO is a combination of two-dimensional, three-dimensional, and IMRT radiation treatment planning systems, representing over five hundred man years of cumulative research and development by Computerized Medical Systems (CMS) scientific staff and academic partners. While many XiO features are discussed in this guide, some are licensed individually and it is possible that some topics discussed are not available to you. Review your sales contract to verify the hardware and software features that were installed at your site and activated by the CMS technician.
Intended Users of the XiO RTP System

The XiO radiation treatment planning (RTP) system is intended to be used by qualified individuals. An intended user should be either a Certified Medical Physicist, a Certified Medical Dosimetrist (CMD), or a Registered Radiation Therapy Technologist (RTT), all under the direction of the Radiation Oncologist (MD). They should be knowledgeable in radiation treatment planning conventions, should be certified by their respective national accrediting agency, and should hold all appropriate state and federal licenses.
Intended Use of the XiO RTP System

The XiO RTP System is used to create treatment plans for any cancer patient for whom external beam radiation therapy or brachytherapy has been prescribed. The system will calculate and display, both on-screen and in hard-copy, either two- or three-dimensional radiation dose distributions within a patient for a given treatment plan set-up. The XiO online documentation contains detailed information on how the system is intended to be used. The XiO Training Guide contains examples that explain how the system is intended to be used. You are responsible for ensuring that you use the system in this manner.
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Introduction to XiO XiO User Guide
The examples and figures used throughout the XiO online documentation and XiO Training Guide demonstrate specific aspects of the XiO RTP system. These figures and examples do not necessarily reflect what is used in a clinical setting and, as such, should not be used as examples for treatment planning.
Training on the XiO RTP System

CMS, Inc., provides extensive training when the system is installed at the site and has Customer Support Specialists available to answer questions and handle problems encountered during day-to-day operation. The XiO Training Guide was designed to supplement CMS training by explaining how to use the system to set up a treatment plan. The XiO online documentation contains detailed explanations on how the system works. These manuals are not intended to replace CMS training. You are responsible for ensuring that all people using XiO to generate treatment plans have been trained to use the system prior to using a patients treatment plan in a treatment course. If you do not, the plans may not be correct, and an incorrect dose may be administered to the patient.
Using the XiO RTP System

Before using the XiO RTP system in clinical applications, you should determine the suitability and accuracy of the software for its intended use. Only after thoroughly testing and accepting the results from the system should you release the software for use in your clinic or hospital. Remember, treatment plans derived from the use of this equipment are dependent on data entry made by those professionals trained to use the system. As such, treatment plans derived from this equipment should not be substituted for human judgment. You should verify all treatment plans and patient and source data before using them in a treatment course.
Program License Agreement

All terms, provisions, and conditions stated in the Program License Agreement for XiO apply. CMS, Inc., must have a signed program license agreement from you on file before you can use the software or contents of the XiO documentation. A copy of your signed agreement can be obtained by contacting your Customer Support Specialist.
The Basics of a Treatment Plan

A treatment plan is fundamental when you plan a treatment course for a cancer patient. It is a collection of data files from which the radiation dose data is calculated. A treatment plan specifies how radiation sources are applied to a patient and incorporates these items: Information about the patient Information about the radiation sources used (the teletherapy beams or the brachytherapy source groups) Information that describes how the radiation is to be applied to the patient
Plan Types
XiO differentiates between plans that have been created and saved (called permanent plans) and plans that have not yet been saved (called temporary plans). When you start a new treatment plan, that plan is temporary until you actually save it in the XiO database. When you use or edit a plan that is already permanent, XiO provides a copy instead of letting you work directly with the permanent plan; this copy is also a temporary plan. If you edit the temporary plan and then save it, XiO replaces the original permanent plan with the modified version.
Patient Data
XiO maintains demographic and anatomical data for each patient for whom treatment planning is performed. All patient data is stored under a unique, user-defined patient ID. Demographic Data Patient demographic data about each patient is collected and stored for use in demographic studies and tumor registry. Typical demographic data includes patient name, address, telephone number, birth date, and gender. Anatomy Data Patient anatomical data identifies the disease sites. XiO categorizes information about patient anatomy in terms of anatomical sites and anatomical structure names. These are defined on a clinic-by-clinic basis and are applied to all patients stored on the system.
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Patient anatomy data is physical information about a patient. Patient anatomy data includes: Anatomical structure contours Tissue density of anatomical structures
Entering Patient Anatomy Data

Patient anatomy data can be entered into XiO in two forms: pixel images and contours. Pixel Images Pixel images are images of patient anatomical structures formed using tissue density information stored in units called pixels. Specifically, a CT combined with the appropriate electron density conversion file determines the tissue density of a pixel-size area of patient tissue. MRI may also be used, but the pixel information does not determine the tissue density. Using unique shades of color to represent each pixels numeric value, XiO constructs a patient anatomy image. Five or more pixel images in the same orientation comprise a three-dimensional patient volume. Although a pixel image contains the tissue density of many anatomical structures, it does not differentiate the structures. You must outline each structure before XiO can use the pixel image data.
Figure 1: Pixel image
Figure 2: Contours
Contours In XiO, a single CT image is referred to as a cross section. Contours are connected line segments that outline the individual anatomical structures within a cross section. Individual structures include such things as the patient outline, the tumor, individual target regions, and individual organs (such as the lungs, the heart, or the spinal cord). You create the contours in the Patient File Maintenance module of XiO using: A tablet (digitizer), which is used to trace drawings from graph paper, a radiograph, or a hardcopy CT image. A mouse, which is used to either trace a structures contour directly from the screen or to select an area of the image for automatic contouring (that is, the automatic generation of individual contours in a cross section). XiO provides four methods of automatic contouring: Auto-by-Threshold XiO draws a contour around the edge of a sharply delineated structure by detecting the abrupt change in color. AutoSegmentation XiO draws a contour after analyzing subtle changes in gray level and intensity taken from a userdefined segment of the image. Auto Margin XiO draws a second contour around a structure. XiO also offers three-dimensional variable auto margin and the ability to draw one contour around a structure combination. Interpolation XiO generates contours on cross sections that lie between the beginning and ending contours that you specify.
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Figure 3: Contour with an automatically generated margin.
Contours can be imported along with digital image data in the DICOM 3.0 image format. Although a contour image contains the contours of many anatomical structures, it does not contain the tissue density of each structure. You must enter the tissue density of each structure or use a pixel-by-pixel calculation instead of assigning a value to a structure before XiO can use the contour data. XiO prompts you for this information.
Figure 4: Pixel image with contours traced on it.
Figure 5: Zoom in on the image to see each of the tiny squares, or pixels, that make up the image.
Five or more cross sections in the same orientation comprise a threedimensional patient volume. It is important to remember that at least one contour in a cross section outline must be the patients external outline (the skin).
Anatomy Data Classifications

Studysets Studysets are sets of cross sections intended for use with a specific treatment plan. Studysets can be broken down into image-based and nonimage-based studysets. Because isodose treatment plans require at least one transverse patient cross section, any studyset to be used in an isodose treatment plan must contain one. Each studyset is referenced by a studyset ID. Predefined Anatomy Site An anatomical site is a description of a particular area of the body (for example, head and neck, lung, or prostate). In general, these sites correspond to the anatomy surrounding a specific region of the body. These sites are user-definable and vary from clinic to clinic.
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Anatomical information can be obtained from pixel images or contours. XiO reconstructs pixel images (such as CT images) from numeric values captured by the scanner or other imaging machine. Each anatomical site contains corresponding internal structures (contours) identified by anatomical structure names. For example, the anatomical site lung might contain anatomical structures named right lung, left lung, heart, and spinal cord. These structure names are also user-definable. Each anatomical structure name has one of three classification types assigned to it: General Includes the structure names automatically included in each anatomical site. General structures are further divided into the following categories: Patient The patients external outline (the skin); this structure is always required. All other structure definitions are optional. Tumor (Tum) The tumor to be treated. Target Volumes 1 through 5 (TV1, TV2, TV3, TV4, and TV5) The area defined as the tumor plus a user-defined margin to account for microscopic extensions of the tumor that cannot be precisely seen and to allow for a margin of error in defining the tumor.
Specific Includes structure names inside of the patient contour other than the tumor and target volumes. User-defined Includes all user-defined structure names for individual sites.
If you dont add a predefined site, you only have general and specific contour names.
Patient Anatomy File Identification

An anatomy file is identified by its orientation, location, and anatomy data mode. Orientation The orientation of a cross section is determined by its position relative to the patient coordinate system axes. A cross section can be orthogonal (perpendicular to one of the three axes) or semi-orthogonal (at some angle other than 90 to the axes).
Orthogonal planes are classified as being transverse, sagittal, or coronal. Cross sections or image planes that are perpendicular to the patient Yp axis are called transverse. Cross sections or image planes that are perpendicular to the patient Xp axis are called sagittal. Cross sections or image planes that are perpendicular to the patient Zp axis are called coronal.
Figure 6: Patient orientation
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Location The location of each cross section within a patient is also determined by its reference distance. The reference distance of a cross section specifies the coordinate where the plane containing the cross section intersects the patient axis to which it is perpendicular.
Figure 7: Reference distance
Anatomy Data Mode The anatomy data mode describes whether contours or pixels are defined and, for pixel data, what parameter the pixel values denote. The possible anatomy data modes (and their standard abbreviations) are: Wireframe contours (WC) Computed tomography (CT) Electron density converted from CT pixels (EP) Electron density converted from assigned contour density (EC)
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Plan Modes
A treatment plan can be two-dimensional or three-dimensional (2-D or 3D), based on the nature of the studyset. The plan mode affects how the plan appears on the screen, how the plan is set up, and how the dose is calculated. If the plan has a studyset with fewer than five transverse cross sections, the planning mode is set to 2-D. In this mode, only individual cross sections are displayed on the screen. Representations of beams and treatment aids are displayed in two dimensions. If the plan uses five to 30 transverse cross sections, you can set up the treatment plan as 2-D or 3-D. If you have more than 30 cross sections, you can display individual cross sections or a patient volume constructed from several cross sections in 3-D.
Intensity Modulated Radiation Therapy When creating a 3-D treatment plan, you also have the option of Intensity Modulated Radiation Therapy (IMRT). In IMRT, rather than manipulating beam parameters to achieve a suitable dose distribution, you reverse the process by defining the clinical goals first and then allowing the optimization algorithm to find the best configuration of beam intensities.
Interest Points and Markers

Optional interest points and markers can be defined on each cross section. Interest points are used to obtain dose calculations at specific points in a cross section. Markers are used to mark specific points in anatomical structures. Dose is not calculated at markers. Interest points and markers are defined in two places within XiO: In the actual studyset, while entering cross sections. These points are available in any treatment plan containing this cross section. While you are setting up the treatment plan. These points are available only for this treatment plan. Interest points and markers are affected by the treatment planning mode: Interest points and markers in three-dimensional planning mode can be defined, moved, or added to anywhere in the patient including between cross sections. Interest points and markers in two-dimensional planning mode must be located on individual cross sections in the
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orientation in which the point was originally defined. In other words, a point originally defined on a transverse cross section can be relocated only to relevant transverse cross sections and cannot be located between cross sections. In XiO, interest points and markers are displayed using the same symbol (+), but in different colors.
Calculation Region
The calculation region is that region in the patient anatomy for which the radiation dose will be calculated. Only points inside (including on the edge) of this region are used during dose calculation. The type of calculation region used in the treatment plan is called the calculation mode. The calculation area and region are specified by their x, y, and z coordinates. The possible modes include: Volume Available only for three-dimensional plans, a calculation volume consists of user-definable, equally spaced calculation points along each dimension of the volume. You may specify the volumes size, its center position, and the number of points in each dimension or grid spacing to place calculation points. The system calculates the radiation dose for each point in the matrix, along with any interest points you have specified. Selected Planes Available when two- or three-dimensional treatment plans are used, this method calculates dose for an area on user-selected cross sections. This area is divided into a series of equally spaced calculation points along the two dimensions of the area. You may specify the orientations and reference distances for each cross section, the dimensions along two of the axes that apply to the plane, two center coordinates of the calculation area, and the number of points in each dimension or grid spacing to place calculation points. The system calculates the radiation dose for each point in the matrix, along with any interest points you have specified. Interest Points Only This mode is available when interest points are defined in the treatment plan. Each calculation point is defined by its coordinates in the patient coordinate system. The system calculates the dose only at the specified interest points.
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Figure 8: 3-D calculation region
Figure 9: 2-D calculation region
Tissue Density Heterogeneities Tissue density heterogeneities are tied to the calculation region and may be either included or excluded in dose calculation. When the heterogeneities are not considered in the dose calculation, the entire volume inside the patient surface is calculated as homogeneous water. The relative electron densities of the anatomical structures and tumors will be ignored. Use heterogeneity corrections to account for innate variability in the anatomy, density, and geometry of individual patients. When the heterogeneities are considered in the dose calculation, two different methods of deriving the tissue densities (relative electron densities) inside the patient exist. These are: For non-image-based and image-based cross sections, the method uses user-assigned relative electron densities, which assume that the entire region inside each user-defined contour is homogeneous with one relative electron density. For image-based cross sections, the pixel values used to generate the image are used to determine density values within a contour.
Even when heterogeneity corrections are turned off, XiO converts the patient data to an electron density matrix. When calculating with a homogeneous patient, the electron densities of the pixels inside the patient wire contour are set to 1.0 and outside are set to 0.0.
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Radiation Source Information

Before you use XiO for the first time, your medical physicist gathers a great deal of information from your equipment and enters it into XiO. Most of this information consists of measurements obtained from the linear accelerator and acceptance tests of the many XiO programs. This process of integrating XiO into your clinic is called commissioning or machine commissioning and is an important responsibility of the medical physicist. XiO must be commissioned before you can use it on a daily basis for treatment planning. The information in this book does not cover machine commissioning nor does it explain how to create and store the files containing data about the radiation sources. But it does explain what this data is and how it is used in preparing your treatment plans. A machine ID identifies each teletherapy source. Use this user-defined ID to recall the entered source data used in the treatment plan.
Teletherapy Source Parameters

Source parameters are all of the treatment beam constraints that specify how radiation sources are applied to the patient in the treatment plan. In teletherapy plans, these determine how individual beams are positioned on the patient. This data is supplied by the machine manufacturer or is determined from clinical measurements. The system uses this data to determine the limits for treatment setups. XiO requires these parameters for each energy of the machine: The modality (photon, electron, or proton) Energy Machine reference distance (source-to-isocenter distance, where the field size readout on the machine is defined) Machine setup (source-to-axis distance, source-to-skin distance, rotational arc, or symmetric or asymmetric beam) Collimator settings and angle (including asymmetric jaw parameters or multileaf collimators) Gantry settings, angles, and degrees of rotation Couch settings and angle Isocenter/beam entry point location Placement of treatment aids (wedges, ports, and compensating filters) Beam weighting settings
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Normalization method and settings Source-to-skin distance (which varies for each treatment plan)
Source Physics Data

Source physics data consists of the following tables or parameters used to calculate the radiation dose. From the following list of data tables, photon machines maintain internal tables for BSF, PSCF, TAR, TPR, OCR (aligned and diagonal), PDD, dose outputs, and irregular field data. Electron machines maintain tables for PDD and cone parameter data. Not all tables listed exist for all machines. The data required by radiation dose calculation varies with the calculation algorithms. These parameters determine the range of values, which can be used when positioning individual beams in a treatment plan. Source physics data consists of a subset of the following tables or parameters used to calculate dose: Backscatter factors (BSF) Phantom scatter correction factors (PSCF) Tissue-air ratios (TAR) Tissue-phantom ratios (TPR) Aligned and diagonal off-center ratios (OCR/OCD) Percent depth doses (PDD) Dose outputs Cone parameters Irregular field parameters Penumbra modeling parameters Machine energy spectra Collimator, MLC transmission parameters Machine non-scanned data (geometry and other information)
Wedge and Compensator Information

Wedge data consists of the wedge type and all parameters required for the wedge correction and attenuation. The wedge types available with XiO are: Physical wedge Motorized wedge A wedge angle synthesized from a wedge that is in place for a specified fraction of the treatment and then removed for the remaining portion. Enhanced dynamic wedge A software simulated wedge for Varian linear accelerators.
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Virtual wedge A software simulated wedge for Siemens linear accelerators.
Compensating filter (or compensator) data consists of the compensating filter type and all parameters required for the addition of a compensating filter to a treatment plan. A compensating filter attenuates the radiation beam before the radiation reaches the patient. The purpose is to provide an even dose distribution to the patient at the required depth in the presence of patient irregularities (surface shape or internal densities). The compensating filters available with XiO are: 1D 1D compensators provide one-dimensional compensation. One-dimensional filters are constructed by stacking thin sheets of attenuating material of different lengths in stepwise fashion, only over the area requiring compensation. You can send 1D compensating filter data to a plotter. Ellis Ellis compensators provide two-dimensional compensation. Ellis filters are attached to a mounting tray and constructed with aluminum or brass blocks that correspond to the irregular surface or internal inhomogeneities. You can send Ellis compensating filter data to a plotter. Milling machines XiO supports Huestis and Par Scientific milling machines. Milling machines are linked to the planning system in order to automate the construction of compensators, which can be constructed with a variety of materials of different mass densities. These include wax, plastic, aluminum, brass, and a gypsum/steel mixture. You can send the data for Huestis and Par Scientific filters to the milling machines. .decimal These compensating filters are built using data files you send to .decimal via email. The .decimal compensating filter is made using special CADCAM software on a computer networked to a computerized milling machine. The standard .decimal compensator is machined from aluminum, however brass may also be used. The .decimal compensator is shipped with a quality assurance report.
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Brachytherapy Source Information

Three types of brachytherapy source information are stored in source files: Source types A source type is a set of data that defines certain parameters about a source, such as the geometry of a source and which method is used to create a dose rate table for the source. Source templates A source template is based on the data found in a source type, but adds information about the calibration date, calibrated strength, and other specifics to make the template clinically useful. Catheter templates A catheter template is a set of data about one or more physical catheters. Information like the geometric properties of the catheter and its source loading are maintained here.
Dose Calculation Algorithms

A dose calculation algorithm is a set of principles, models, and formulas used to calculate the dose throughout the calculation area, volume, or set of interest points. Algorithms available are: Clarkson Fast Fourier Transform (FFT) Convolution Superposition Fast Superposition Electron 3-D Pencil Beam Proton Broad Beam and Pencil Beam
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XiO Basics
Starting XiO
1. Connect the XiO system to the proper power outlets. 2. Turn on power to all of the devices attached to the workstation. 3. Turn on the power to the workstation. A login prompt appears.
Logging into XiO

Linux
1. At the login prompt, type your user name and press Enter. 2. At the password prompt, type your password and press Enter. If you have added the XiO icon to the desktop, click the XiO icon. XiO opens automatically. If you have not added the XiO icon to the desktop, do the following: a. Close the Start Here window. b. Open a terminal window. To do so, right-click on the desktop. Select New Terminal on the menu. c. In the terminal window, type xio and press Enter. The system displays the main XiO window.
UNIX
1. At the login prompt, type your user name and press Enter. 2. At the password prompt, type your password and press Enter. The XiO software starts and displays the main window. A dedicated XiO user has access only to the XiO application. When a dedicated XiO user logs on to the workstation, XiO immediately starts up. When they exit from XiO, they are automatically logged off of the workstation. A nondedicated user (root user) has access to all of the applications and utilities stored on the workstation. When a nondedicated user logs on to the workstation, the UNIX system prompt is displayed. They must then
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XiO Basics XiO User Guide
enter an additional command to run XiO. When they exit from XiO, they return to the UNIX system prompt.
Figure 10: XiO main window
XiO Modules
M o du l e Patient File Maintenance D e sc rip t ion The Patient File Maintenance (PFM) module is used to maintain all patient data, including: o o Patient demographic data Anatomy data, including anatomical structure contours and tissue density of anatomical structures
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M o du l e Teletherapy
D e sc rip t ion The Teletherapy planning module is used to develop and evaluate treatment plans, including the production of the dose matrix and generation of isodose surfaces or isodose curves. Several features are available only when special licenses for them have been purchased. If you see a Help topic for a feature that you do not have at your clinic, check with your system administrator to see if your XiO system is licensed for that feature.
Irregular Field
The Irregular Field Point Dose Calculation module allows dose calculations to be performed for specific points in a patient. Plans are created, saved, recalled, and modified in Irregular Field Point Dose Calculation in a way similar to the Teletherapy planning module, but with the following differences: o Patient surface topology and density variation information are represented differently. They are represented in Teletherapy planning by entering CT scan data or digitizing wire contours to which you assign densities. The Irregular Field Point Dose Calculation module assumes a 1.0 homogeneous density. The Clarkson algorithm, used to perform dose calculations, is implemented differently in that the user must provide the point depths and distance to surface since CT data and contours are not used.
Brachytherapy
The Brachytherapy planning module is used to develop and evaluate treatment plans utilizing brachytherapy, including the localization of seed sources, production of the dose matrix, and generation of isodose surfaces or isodose curves. The Brachytherapy planning module is organized into a large set of global and local functions.
Source File Maintenance
The Source File Maintenance (SFM) module is used to enter and maintain data that defines the characteristics of radioactive sources. The data is used to set up treatment plans and to calculate dose. Data for each source, such as a teletherapy machine, is saved under a directory identified by a unique source ID. For teletherapy machines, this ID is also called the machine ID.
Data Export
The Data Export module is used to create data files for use on record and verify systems.
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M o du l e RTOG Submission
D e sc rip t ion The RTOG Submission module is used to submit data to the RTOG 3D Quality Assurance (QA) Center. The Transfer Data to Focal PC module is used to send data to a Focal system. The Film Digitizer System module is used to connect to the VIDAR Film Digitizer. This enables you to: o o o o Scan films from an x-ray, CT, or MRI scan Extract individual images from the scanned film Manipulate the images for the best possible quality Export the images to the DICOM 3.0 Secondary Capture format
Transfer Data to Focal PC Film Digitizer
The individual images can then be imported into XiO, where they can be used to create contours and treatment plans.
Create Login Usernames and Passwords

When your XiO system was installed, a default username and password were created. You may choose to use only this one username and password, or you can set up unique usernames and passwords for each planner and set up privileges based on each individuals usage.
XiO User Utility

Run the XiO user utility on a workstation when you want to add a dedicated user, remove a user, or change a users password. If a user has an account on more than one workstation on your network, you must run this utility on each workstation. Before running this utility, verify that: You are not running NIS, shadow passwords, or any other automatic configuration utility. No one is modifying the password file.
Add a user through XiO: 1. Open the XiO Online Help. 2. On the Contents tab, click the Utilities book. 3. Click the Utilities Table of Contents topic.
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4. Click the Manage User Accounts link. 5. When prompted, enter the root password. Continue with the UNIX/Linux system prompt in step 3 below. Add a user through a UNIX/Linux system prompt: 1. Log in as the root user. 2. Enter the following, pressing Enter at the end of each line:
cd / /FOCUS/bin/xio_user
3. Enter the number for the Add an XiO User option and press Enter. This option sets up the login ID to be a dedicated XiO user. When you select this option, the following is displayed:
Add an XiO User ---------------Enter a valid XiO login ID: ID must be unique, 8 characters or less, and may contain the characters, A-Z, a-z, or the numbers 0-9 only. Enter a blank line to return to the previous menu.
NOTE:
Linux does not allow uppercase A-Z characters.
4. Enter an ID and press Enter. When you enter a valid ID, the following is displayed:
Enter user identification: User identification should include the name of the user and any other demographics desired but may not contain a :.
5. Enter a description for the ID to identify the user and press Enter. 6. Enter a password and press Enter. 7. Enter the password again to confirm and press Enter. After entering a valid password, the following is displayed:
User [login id] was successfully added. Press ENTER to continue.
8. Press Enter. 9. Enter the number for the Exit option and press Enter to return to the User Utility menu.
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User Authorization To set up user access privileges, follow the steps below. 1. Open XiO. 2. On the main window, go to the Settings menu and select Installation followed by User Authorization. The System User Access Preferences dialog box displays. 3. Complete the fields according to the definitions below for each user.
Field Login Name Definition Enter an eight-character user name that has been previously defined in UNIX/Linux. Login names may consist of numbers or letters only. Enter Yes to grant administrator privileges. Enter No to deny administrator privileges. This privilege allows other users to access all areas in Settings. Enter Yes to grant physicist privileges. Enter No to deny physicist privileges. This privilege allows access to the following areas of XiO: o o Source File Maintenance Settings (only Anatomical Sites, Calculation Defaults, CT/MRI Interface Defaults, and Display/Plotter Defaults)
Admin
Physicist
Treatment Planner
Enter Yes to grant treatment planner privileges. Enter No to deny treatment planner privileges. This privilege allows access to the following areas of XiO: o o o o Teletherapy Irregular Field Patient File Maintenance Settings (only Anatomical Sites and CT/MRI Interface Defaults)
Plan Approval
Enter Yes to grant plan approval privileges. Enter No to deny plan approval privileges, but allow the user to enter comments for plan review. This privilege allows access to the following areas of XiO: o o o SF8 APPROVAL (Irregular Field) Patient File Maintenance Teletherapy
4. Click OK when finished.
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User Definable Setup, Customization, and Preferences

After your new XiO system is installed and before you begin planning, you may need to setup specific features and/or customize your planning system using the Settings menu on the XiO main window. This section will help you get your clinics up and running by providing the location of specific documentation that covers the listed topics. If you have further questions regarding these topics or have trouble finding the information, you may contact CMS Customer Support and they will help you get set up.
Create Clinics
XiO requires that you create at least one clinic in which all your patient data will be stored. If you plan for multiple hospitals/clinics, this provides an easy way to subdivide your patients into various virtual clinics. For more information, see the XiO Online Help.
Window Sizes
The Window Size drop-down box on the main window displays only for Linux systems. It displays the current window size for Teletherapy and PFM. The default is the highest resolution available that fits within the current screen resolution. Any Teletherapy or PFM window launched after you change the size will open with the new setting.
DICOM RT Plan Import

If you intend to import images, structure sets, and plan data from another vendor that has DICOM export capability, you will need to customize and map XiO identifiers with the system that is sending plan information to XiO. Setup is only required if you meet the following criteria: You have purchased this feature. XiO installation is complete. A DICOM network has been established and tested between XiO and the system (i.e., other vendors CT simulation workstation, other vendors TPS) that will be sending the DICOM plan information.
For more information, see the DICOM RT Plan Import topic under Features Discussion in the reference library in the online help. The XiO DICOM Conformance Statement can also be found on the CMS web site.
DICOM Export Setup and Configuration

If you intend to export images, structure sets, dose, and plan data to a receiving system, you will need to map XiO identifiers with a receiving
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systems identifiers. Setup is only required if you meet the following criteria: You have purchased this feature. XiO installation is complete. A DICOM network has been established and tested between XiO and the system (i.e., R&V, MU check program, etc.) that will be receiving the DICOM plan information.
For more information, see the DICOM Export Setup and Configuration topic under Features Discussion in the reference library in the online help. The XiO DICOM Conformance Statement can also be found on the CMS web site.
RTP Link
If you intend to export plan data to a receiving system, you will need to map XiO identifiers with a receiving systems identifiers. Setup is only required if you meet the following criteria: Your receiving system does not support DICOM export or your receiving system does support DICOM, but you have not purchased DICOM Export. XiO installation is complete. RTP Link has been configured to transfer information via floppy or network.
For more information, see the XiO RTP Link Conformance Statement in the XiO Online Help and the XiO RTP Link and MLC Export document in the reference library.
Customizing the Linux Desktop

You can customize the following options for your Linux operating system: Add the XiO icon to the desktop. Set the window focus. Set the screensaver. Set the taskbar to autohide. Set print screen and screen capture shortcuts.
For more information, see the XiO Upgrade Instructions.
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Settings
Use the Settings menu to customize your treatment planning system with predefined information and defaults. The following items are of particular importance: Create CT to ED file for heterogeneity correction Define scanner/LMS for CT simulation (XiO will report shifts) Anatomical site (setting up predefined contour names makes contouring faster and easier) Backup Utility (set up this utility to perform regular data backups) Scale DRRs so they print to the proper magnification
For more information: Access the XiO Online Help. See the Settings section in the XiO Training Guide. See the Digitally Reconstruction Radiograph section in the XiO Training Guide. See the Scanner/LMS Definitions section in the XiO Training Guide.
PFM and Teletherapy Preferences

You can customize your planning clinic with PFM and Teletherapy preferences. You must be in PFM or Teletherapy to set these preferences. Preferences will apply to the next patient you plan or the next plan you make. For more information, see the Preferences section in the XiO Training Guide. You can also read the online help topics for PFM and Teletherapy preferences.
Brachytherapy Source Types, Source Templates, and Catheter Types

If you would like step-by-step instructions for setting up these parameters, follow the instructions in: The Gynecological Brachytherapy Implant section in the XiO Training Guide Dose Calculation: Brachytherapy under Algorithm Discussions in the XiO Reference Library
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RTOG Protocol Submission Software

If you intend to send protocol patients to the ITC QA Center via the network or tape, you will need to load and customize the RTOG Protocol Submission Software. The RTOG Submission Software is free and included in your software packet. However, you must have RTOG turned on in your XiO license. For more information, see the XiO Upgrade Instructions and the RTOG Protocol Submission Software User Guide located on the CMS website.
VIDAR Film Scanner

If you intend to scan CT images into XiO using a VIDAR Film Scanner, you will need to configure the film scanner in order to scan films into XiO. The VIDAR Film Scanning Software is included in your software packet. Loading the software is only required if you have purchased a VIDAR Film Scanner. For more information, see the XiO Upgrade Instructions and the Film Digitizer System Users Guide in the reference library.
Screen Capture Utility (UNIX)

If you would like to set up the screen capture utility in UNIX, follow the instructions in the XiO Upgrade Instructions.
Navigation
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 third button when clicked. Use the left mouse button to select or drag items on the screen. Use the right mouse button to display drop-down lists in active fields or windows. Use the middle mouse button or click the scroll wheel to view popup help information boxes in active fields. You can also movie through images. Right mouse click in any single plane view window and select Movie with a left mouse click. Use the left and middle mouse buttons to move superior and inferior or use the scroll wheel to movie through the images. Use the mouse to move over the fields to highlight the required fields.
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Figure 11: A red box indicates a required field.
Using the 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. For more information, see the XiO Online Help. Dialog Box The following screen buttons control the movement from page to page. Select OK when you have completed all of the fields in a dialog box. CANCEL is sometimes used to discard the work done on the current page. PREV PAGE is available when a list of fields is too long to be displayed on one page. Select PREV PAGE to move back one text page at a time.
Figure 12: OK and CANCEL
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Limits and Color Definitions

The following is a list of the system limitations and definitions within XiO. Many of these items are covered in more detail throughout the help.
General Limitations
I tem Number of stored permanent plans L imi t The number of plans that can be stored on your system depends on the space available on your hard drive. The number of plans that can be stored on your system depends on the space available on your hard drive. 999
Number of stored temporary plans generated in Teletherapy Number of stored temporary plans generated in Irregular Field Point Dose Calculation Number of cross sections allowed per studyset Number of structures allowed per studyset Number of contours allowed on a single cross section Number of structures per anatomical site Number of bifurcated structures per cross section Number of interest points allowed per studyset Number of markers allowed per studyset Number of beams allowed per plan Number of boluses per plan Number of clinics per workstation Number of anatomical sites per clinic Number of contours defined per anatomical structure per cross section
240 487 100 80 80 999 999 99 5 99 Unlimited 4
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IDs, Names, and Descriptions

I tem Anatomical site Anatomical structure name Clinic name Patient name IDs L imi t 14 characters (a-z, A-Z, 0-9) 14 characters (a-z, A-Z, 0-9, punctuation, and spaces) 24 characters (a-z, A-Z, 0-9, punctuation, and spaces) 24 characters (a-z, A-Z, 0-9, punctuation, and spaces) IDs have a limit of 14 characters unless otherwise noted. IDs are case-sensitive; this means that capital letters and lowercase letters are different. Descriptions have a limit of 24 characters unless otherwise noted. This includes a-z, A-Z, 0-9, punctuation, and spaces.
Descriptions
Brachytherapy
I tem Number of catheter templates allowed Number of source templates allowed Number of sources per plan Number of catheters per plan Number of interest points allowed per plan Number of markers allowed per plan L imi t 20 20 999 999 999 999
Irregular Field Point Dose Calculation

I tem Number of beams Number of surface points per plan Number of depths per surface point Number of points/depths per plan L imi t 1 or 2 (SSD or SAD) 50 50 50
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System Color Definitions

Objects
Beam (active) Beam (inactive) Bolus Calculation volume Compensating filter Customized port Multileaf collimator (MLC) Scale icon Wedge Unique user-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences User-defined in preferences
Points
Arbitrary weight point (active) Arbitrary weight point (inactive) Interest point Global maximum point Group point Local maximum point Marker Measure points CT origin Prescription point Reference point Setup reference icon Red Green User-defined in preferences Red User-defined in preferences Pink User-defined in preferences User-defined in preferences Light magenta User-defined in preferences User-defined in preferences Yellow
Irregular Field
Surface point incomplete Surface point with no depths Surface point with depths White Purple Yellow
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Getting Help
Access to the XiO Online Help is from the main menu bar of any window. The type of help that displays is determined by where you are in the system when help is requested. Example, if you are not working in a dialog box, XiO displays the Help default window. The topics shown on the left-most panel of this window are presented in the order in which XiO is used in a clinic environment.
Figure 13: Welcome to XiO help topic
The XiO Online Help is highly dynamic. It contains topics about all the dialog boxes, step-by-step procedures, and background information. The online help includes a Contents tab that identifies the help topics by their titles and lets you open any of them. On the Contents tab, select the Search XiO Help topic to perform a full-text search for topics that contain specific words. The Index tab is an alphabetical list of all the subjects covered in the online help. The Glossary tab allows you to look up definitions for specific words.
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Auto-Help/Answer-Help
XiO also offers Auto-Help and Answer-Help windows when completing dialog boxes. Click the middle mouse button in the field. Depending on the type of field, either an Auto-Help window displays with an explanation (such as the number range to enter or date format to use) or an Answer-Help window displays a list from which you can select an item to complete the field.
Figure 14: An Auto-Help pop-up window
Figure 15: An Answer-Help pop-up window
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Exiting XiO
When finished, exit each module according to the table below to ensure files are properly closed.
Modu le Patient File Maintenance Teletherapy Irregular Field Brachytherapy Source File Maintenance Data Export RTOG Submission Select and then
Never exit XiO using a system break command. A system break command causes the program to immediately terminate XiO and return to the operating system. This is an improper shutdown of the XiO system. Turning off the XiO system improperly will result in the loss or corruption of files. CMS recommends that you do not turn off the power to the XiO workstation at the end of each working day. Doing so may corrupt important system files. There may be times when it is necessary to turn off the system. Contact CMS Customer Support for information about how to turn off the system.
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Patient File Maintenance
XiO PFM Interface

The Patient File Maintenance (PFM) user interface includes the title bar, menus, toolbars, graphics area, control list boxes, window/level slide controls, and the status bar used in the Patient File Maintenance functions.
Figure 16: Patient File Maintenance window
Title Bar The title bar displays the release number, patient name, patient ID, and studyset ID.
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Patient File Maintenance XiO User Guide
Main Menu The main menu has the File, Edit, View, Insert, Tools, Reports, and Help menus. Each of these menus has drop-down options.
Status Bar The status bar displays the date, time, mouse status, and other information depending on the active function. Main Toolbar The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. All buttons on this toolbar, except the Beam button, are inactive in PFM and grayed out. Supporting Toolbar Modes The secondary toolbar modes are Draw, Paint Brush, Tablet, Keyboard, Edit, AutoSegmentation, Auto-by-Threshold, and Point. Each mode has a button. When you click a mode button, the system displays the mode's associated submode buttons. Supporting Toolbar Submodes The submode buttons include Save, Zoom In, and Zoom Out. Additional buttons display depending on the toolbar mode. Group and Contour Control List Boxes Select the anatomical site from the Group drop-down list; select the structure name from the Contour drop-down list. Window Level Presets Select and save a predefined window and level value and grayscale/color scale in any transverse single plane view. You can also change the color of the color scale for the Auto-by-Threshold tool. Window Controls Toggle the icons to: o o o Go between Transverse Mode and Scout Mode. Apply grayscale or color scale values. Change the color for the Auto Threshold color scale.
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Window/Level Slide Controls Use the window and level slider bars or enter values in the W and L fields to adjust the contrast of the image display.
Graphics Area The graphics area contains the studyset and graphic objects used to set up the treatment plan.
Cross Section Thumbnails Thumbnails display a small image of each cross section. A red outline shows the image currently selected and displayed in the graphics area. You can: o o Click the middle mouse button to select multiple cross sections. Press Shift and click the middle mouse button to select a range of cross sections. A yellow outline shows all the cross sections currently selected. Click the right mouse button to select all or unselect all the cross sections.
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Reference Distance and Scale Factor The reference distance shows the distance from the origin of the studyset of the cross section you are viewing in the graphics area single plane view. The scale factor shows the current magnification of the single plane view. Dialog Box Contains the prompts and answer fields you will complete as you set up the treatment plan.
Multiple Plane View (MPV) Displays all the contours in a studyset without image data.
PFM Functionality
The PFM toolbars include the main toolbar and secondary toolbar. The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. All buttons on this toolbar, except the Beam button, are inactive in PFM and grayed out. The secondary toolbar modes are Draw, Paint Brush, Tablet, Keyboard, Edit, AutoSegmentation, Auto-by-Threshold, and Point. Each mode has a button. When you click a mode button, the system displays the modes associated submode buttons. Position the mouse over a toolbar button to view a tool tip. The tool tip describes the button and its keyboard shortcut. NOTE: When a button icon is grayed-out, it is not available. Different planning tasks have requirements you must meet before these buttons are available, some of which are licensing requirements.
For more information, see the online help for the planning task in question.
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The Mode Buttons

I c on Mode Draw Paint Brush Tablet Keyboard Edit AutoSegmentation Auto-by-Threshold Point S h o rt cu t F5 F6 F7 F8 F9 F10 F11 F12 D e sc rip t ion Draw contours with the mouse. Paint the contours with the mouse. Trace contours on the digitizing tablet. Create contours from predefined shapes with the keyboard. Edit or delete existing contours. Create contours automatically with AutoSegmentation. Create contours automatically with Auto-by-Threshold. Enter, edit, or delete interest points and markers with the mouse.
The Submode Buttons

(There are no keyboard shortcuts for the submode buttons.)
Icon Submode Primary Dataset Descript ion View a primary dataset that is fused to the secondary dataset. A primary studyset is made of CT-based images, which serve as a baseline around which you manipulate a secondary studyset in order to create a registration. View secondary dataset that is fused to the primary dataset. A secondary dataset is made of either CT-based, MR-based images, or PET images, which you manipulate in order to create a registration. Replace a section of the selected contour. Move a single contour defining point. Move three contour defining points. Move five contour defining points. Resize or stretch a contour symmetrically. The opposite edge stays in place. Resize or stretch a contour asymmetrically. The opposite edge stays in place. Automatically create contours on cross sections that lie between two or more cross sections on which you have already created contours. Create a contour with 3-D Auto Margin.
Secondary Dataset
Replace Segment Single Point Edit Triple Point Edit Quintuple Point Edit Symmetric Resize Asymmetric Resize Interpolate
3-D Auto Margin
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Icon
Submode 2-D Auto Margin 2-D Auto Distance Place Single AutoPoint Place Multiple AutoPoints
Descript ion Create a contour with 2-D Auto Margin. Edit the distance between the initial contour and the new contour. Place auto-points on a single cross section for Auto-by-Threshold. Place auto-points on multiple cross sections for Auto-by-Threshold.
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Teletherapy
XiO Teletherapy Interface

The Teletherapy user interface includes the title bar, menus, toolbars, graphics area, control list boxes, window/level slide controls, and the status bar.
Figure 17: Teletherapy user interface
Title Bar The title bar displays the release number, patient name, patient ID, and plan type.
Main Menu The main menu has the File, Edit, View, Contour, Beam, Port, Dose, Tools, Optimize, Reports, and Help menus. Each of these menus has drop-down options.
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Teletherapy XiO User Guide
Status Bar The status bar displays the date, time, mouse status, and other information depending on the active function. Main Toolbar The main toolbar includes Contour, Beam, Port, Dose, Tools, and IMRT buttons. The active button displays with a blue background. Supporting Toolbar Submodes The submode buttons include Save, Zoom In, and Zoom Out. The active main toolbar button determines the types of additional supporting buttons that display. Active Beam The Active Beam box allows you to select an active beam. Once a beam is selected, it becomes the active beam. Window Level Presets Select and save window and level settings and grayscale/color scale in any transverse single plane view. Window Controls Toggle the icons to: o Apply the window/level adjustment to an active window or all displayed windows. Display images in grayscale or as outlined contours. Set the mouse movie of an oblique stack of images to show images in grayscale or as outlined contours.
o o
Window/Level Slide Controls Use the window and level sliders or enter values in the W and L fields to adjust the contrast of the image display.
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Graphics Area The graphics area is the area of the screen with a graphical display of information about the patient, source, or treatment plan. Each window in the graphics area has a view format associated with it. The view format determines how the physical space in the subwindow is used to display the treatment plan information.
Teletherapy Functionality
The Teletherapy toolbars include the main toolbar and a supporting toolbar for each main toolbar button. When you click a main toolbar button, the system changes the button background to blue and displays its associated supporting toolbar. Each supporting toolbar includes the Zoom In, Zoom Out, and Save buttons. Position the mouse over a toolbar button to view a tool tip. The tool tip describes the button and its keyboard shortcut. NOTE: When a button icon is grayed-out, it is not available. Different planning tasks have requirements you must meet before these buttons are available, some of which are licensing requirements.
For more information, see the online help for the planning task in question.
The Main Toolbar

I c on Fun cti on Contour Beam Sh ort cut Shift+F1 Shift+F2 D e sc rip t ion Use the Contour toolbar to draw, trace, or edit contours with the XiO drawing and editing tools. Use the Beam toolbar to manipulated beams and add treatment aids. Use the Auto Port and Auto MLC buttons to quickly shape the beam. Use the Port toolbar to draw, trace, or edit ports with the XiO drawing and editing tools. Use the Dose toolbar to choose normalization and weight, and view isodose lines and histograms. Use the Tools toolbar to access general planning tools during the planning or virtual simulation process. Use the IMRT toolbar to access the setup, prescription, and dose review tools necessary for IMRT planning.
Port Dose Tools
Shift+F3 Shift+F4 Shift+F5
IMRT
Shift+F6
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Contour Supporting Toolbar

NOTE: Clicking the Contour button removes many of the teletherapy options. To resume planning with these options, click the Beam button on the main toolbar.
Fun cti on Draw Paint Brush Tablet Keyboard Edit AutoSegmentation Auto-by-Threshold Point Interpolate Sh o rt cut F5 F6 F7 F8 F9 F10 F11 F12 None D e sc rip t ion Draw contours with the mouse. Paint the contours with the mouse. Trace contours on the digitizing tablet. Create contours from predefined shapes using the keyboard. Edit or delete existing contours. Create contours automatically. Create contours automatically. Create, edit, or delete interest points and markers with the mouse. Automatically create contours on cross sections that lie between two or more cross sections on which you have already created contours. Replace a section of the selected contour. Move a single contour defining point. Move three contour defining points. Move five contour defining points. Resize or stretch a contour symmetrically. The center of the contour stays in place. Resize or stretch a contour asymmetrically. The opposite edge stays in place. Create a contour using 3-D Auto Margin. Create a contour using 2-D Auto Margin. Edit the distance between the initial contour and the new contour. Place auto-points on a single crosssection using Auto-by-Threshold. Place auto-points on all cross sections using Auto-by-Threshold.
I c on
Replace Stretch1 Stretch3 Stretch5 Symmetric
None None None None None
Asymmetric
None
3-D Auto Margin 2-D Auto Margin 2-D Auto Distance Single Auto-byThreshold Mode Multiple Auto-byThreshold Mode
None None None None None
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Beam Supporting Toolbar

I c on Fun cti on New Edit Copy Mirror Delete Auto Port Wedge Comp Filter DRR/BEV Sh o rt cut F5 F6 F7 F8 F9 F11 F12 None None None None Display Intensity Maps/BEV None None D e sc rip t ion Create a new beam. Edit the active beam. Copy the active beam. Create a mirror copy of the active beam. Delete the active beam. Automatically add a port to the active beam. Add or edit a wedge for the active beam. Add or edit a compensating filter for the active beam. Display a BEV or DRR for the active beam. Display a relative fluence map or a BEV. Display an ideal intensity map or a BEV. Display a segmented MLC intensity map or a BEV. Display a compensating filter intensity map or a BEV.
Port Supporting Toolbar

I c on Fun cti on Auto Mouse Tablet Edit Aperture Block MLC Port Properties Delete Port Replace Sh o rt cut F5 F6 F7 F8 F10 F11 F12 None None None D e sc rip t ion Automatically add a port/MLC to the active beam. Draw a port/MLC with the mouse. Trace a port/MLC on the digitizing tablet. Edit the active port/MLC. Define the active shape as an aperture. Define the active shape as a block. Define the active shape as an MLC. Enter or change parameters defining the port shapes. Delete aperture, blocks, or MLC. Replace a section of the selected port/MLC shape.
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I c on
Fun cti on Stretch1 Stretch3 Stretch5 Symmetric Asymmetric
Sh o rt cut None None None None None
D e sc rip t ion Move a single port/MLC shape-defining point. Move three port/MLC shape-defining points. Move five port/MLC shape-defining points. Resize or stretch a port/MLC shape symmetrically. The center stays in place. Resize or stretch a port/MLC shape symmetrically. The opposite edge stays in place. Adjust the collimator jaws to the defined shape plus the collimator step size. Display a BEV or DRR for the active beam. Display a relative fluence map or a BEV. Display an ideal intensity map or a BEV. Display a segmented MLC intensity map or a BEV. Display a compensating filter intensity map or a BEV.
Conform Collimator Jaws to Aperture DRR/BEV
None
None None None
Display Intensity Maps/BEV
None None
Dose Supporting Toolbar

Icon Fun cti on Absolute or Standard Normalization Sh ort cut F5 Descript ion Set the normalization mode to absolute dose, if the beam-weighting mode is absolute dose/MU. Set the normalization mode to standard, if the beam-weighting mode is relative. Global Normalization Set Normalization Mode Isodose Lines Dose in MPV Beam Weight F6 F7 F9 F10 F11 Set the normalization mode to global maximum. Set or change the normalization mode. Display isodose lines or surfaces. Display, or remove from display, the dose values in the MPV. Edit a beams weight value, edit a beam's MU value, turn doses on or off, and define the weight point.
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Icon
Fun cti on Time/MU
Sh ort cut F12
Descript ion Change the treatment date, if the beamweighting mode is absolute dose/MU. Calculate the amount of time or number of monitor units required, if the beamweighting mode is relative.
Source Data
None
Display the Teletherapy Sources Index that contains statistical and descriptive information for each beam. Make a DVH, which is a plot of volume versus dose. Re-make the histograms with the recalculated dose values. Calculate TCP or NTCP. Display a dose profile. Display a relative fluence map or a BEV. Display an ideal intensity map or a BEV. Display a segmented MLC intensity map or a BEV. Display a compensating filter intensity map or a BEV.
Histogram Redisplay Histogram Data TCP/NTCP Dose Profile
None None None None None None
Display Intensity Maps/BEV
None None
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Tools Supporting Toolbar

Icon Fun cti on CT Sampling Sh ort cut F5 Descript ion Sample points. For a CT-based patient, the system reports CT values and relative electron density at the sampled points. For a non-CT based patient, the system reports electron density at the sampled points. Setup Reference Definition Mark Anatomical Reference Review Compensator F6 F7 F8 Position the setup reference definition for a laser marking system. Mark anatomical positions for a laser marking system. View a Par Scientific, Huestis, or .decimal compensating filter in 3-D. Order a .decimal compensator; send milling or QA information. None None Display Intensity Maps/BEV None None Display a relative fluence map or a BEV. Display an ideal intensity map or a BEV. Display a segmented MLC intensity map or a BEV. Display a compensating filter intensity map or a BEV.
IMRT Supporting Toolbar

Icon Fun cti on IMRT Parameters IMRT Prescription Start Optimization Generate Treatment Aids Histogram Redisplay Histogram Data Isodose Lines Dose in MPV Sh ort cut F5 F6 F7 F8 F9 F10 F11 F10 Descript ion Select beams to optimize. Select targets and contoured structures and enter dose goals. Use an optimization algorithm to optimize a plan. Generate segmented MLC or .decimal compensator to deliver modulated dose. Make a DVH, which is a plot of volume versus dose. Re-make the histograms with the recalculated dose values. Display isodose lines or surfaces. Display, or remove from display, the dose values in the MPV.
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Icon
Fun cti on IMRT Index IMRT Prescription Index Source Data
Sh ort cut None None None
Descript ion Display the parameter summary for the IMRT plan. Display the prescription summary for the IMRT plan. Display the Teletherapy Sources Index that contains statistical and descriptive information for each beam. Display a relative fluence map or a BEV. Display an ideal intensity map or a BEV. Display a segmented MLC intensity map or a BEV. Display a compensating filter intensity map or a BEV.
None None Display Intensity Maps/BEV None None
Teletherapy Features
This section contains highlights of some of the features within the Teletherapy module. Refer to the XiO Training Guide or online help for more information on how to perform these functions.
Window Format
The graphics area is divided into smaller areas called subwindows. You can select the number of subwindows, the view type, and their contents. The window format choices depend on the current format and the subwindows contents. The available view types are: SPV Single Plane View MPV Multiple Plane View BEV Beams Eye View ABV Active Beams Eye View
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Window Display Formats The graphics area supports these formats: One (one subwindow)
H Two (two subwindows horizontal)
V Two (two subwindows vertical)
Four (four subwindows)
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Six (six subwindows)
Sym Six (six equal subwindows)
Nine (nine subwindows)
Twelve (12 subwindows)
Save a Window Format The layout of the graphics area can be saved and recalled. In the Window Format dialog box, you can select a predefined graphics area setup or start from scratch and make adjustments to the layout. Once you have the graphics area set up to your liking, save the layout. The setup can then be selected later when creating a new Teletherapy or QA plan. When the setup is no longer needed, it can be deleted. Synchronize Subwindows You can synchronize the plans so that the same planes and reference distances are visible concurrently in the graphics area. Group the subwindows to synchronize certain functions, such as scaling, panning, or zooming in and out.
XiO
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Making a Beam Active

When you select a beam from the Active Beam box in the upper righthand side of the Teletherapy window, the beam becomes the active beam. From this point, any treatment aids you add or any edits you make are for the active beam.
Figure 18: Active beam
Bolus
Bolus is a material that conforms to the patient surface. Its most common use is to raise the dose to the skin for treatment of surgical scars, skin lesions, or carcinomas that have invaded the skin. You can define the description, bolus thickness, relative electron density, orientation, and cross section reference distance of the bolus.
Add/Edit a Contour
Contouring is available to you from the Teletherapy toolbar. This is a quick access method to add or modify a contour in Teletherapy. Once you have made your additions or edits, XiO allows you to continue planning by clicking the Beam button on the toolbar. To gain access to all contouring functions you have to exit Teletherapy and enter PFM.
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Enhance Contours You can change the way the system displays patient anatomy structures in the graphics area with the Enhance Contour function. You can determine the color and rendering of the structures. When editing contours, turn off any structures that are not needed. Only structures that are displayed are available for editing. The graphics area automatically updates to reflect any changes.
Dose
The Dose menu in XiO is where you: Enter calculation settings. Evaluate or change dose (normalization) for your plan. Display the isodose lines and surfaces. Edit beam weight values. Calculate Tumor Control Probability (TCP) or Normal Tissue Complication Probability (NTCP). Determine treatment time and monitor units. Display or print a histogram. Determine the dose status. Save dose profile or dose plane.
Calculation Settings Use this function to define the dose calculation region in an open treatment plan. You define the calculation region dimensions, center, and distance calculation points to measure radiation dose calculation. Choose Calculation Mode Refer to the Calculation Region topic described on page 12 of this guide for more information on choosing a calculation mode. Calculate Dose XiO automatically performs the dose calculation whenever any part of the beam definition changes. If you want to control the dose calculation yourself, use the General Preferences dialog box under the Edit dropdown menu.
XiO
55
Dose Status When you select the Dose Status option, XiO provides the following status messages: Beam number in progress... The system displays the beam numbers for the beams with dose calculating. Beam number completed... The system displays the beam numbers for beams with completed dose calculation. The system also displays the dose status on the Status Bar.
Histogram
A dose volume histogram (DVH) is a histogram used to generate plots of volume versus dose. DVHs summarize dose distribution information throughout normal tissue and tumors. DVHs are useful in: Enhancing the dose information provided by isocurves and isosurface Showing the uniformity of dose in a structure Identifying hot spots outside the target volume, which could potentially cause damage to normal tissue
Figure 19: A dose volume histogram
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Multiple Plan Review

XiO lets you open up to three plans (primary, secondary, and tertiary) for the same patient and view the beam arrangements and dose distributions simultaneously. These are important factors in evaluating the alternative plans developed for the patient. You can also instruct XiO to graphically compare the plans. Instead of opening a third plan, you can create a subtraction or addition plan.
Saving Plans
You can save the following types of plans (if you have multiple plans selected for review, only the primary plan is saved): A temporary patient treatment plan: the system changes it from a temporary plan to a permanent plan. A revised permanent treatment plan. The current state of a treatment plan in Optimize (IMRT or conventional inverse planning).
You can also save templates and addition plans.
Plan Approval
You can add comments to a plan and, if you have the authority, approve a plan. Note that your system administrator sets the plan approval authority for each user. The name of the approver is displayed and is stored with the approval comments as the electronic signature of the approver. The approvers most recent comments are stamped with the date and time. If you dont have the authority to approve plans, you can enter planners comments. You can toggle between the planners comments and the approvers comments.
Next Step
To learn more about XiO, read the XiO Training Guide, XiO Online Help, and the XiO Reference Library.
XiO
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58
Index
. .decimal compensating filter......... 16 1 1D compensators........................... 16 A ABV .............................................. 51 Active beam ............................ 44, 54 eye view ......................... See ABV Anatomical structure....................... 4 Anatomical structures ..................... 5 Anatomy data .............................. 3, 4 classifications.............................. 7 mode.......................................... 10 Anatomy site general......................................... 8 predefined ................................... 7 specific ........................................ 8 user-defined................................. 8 Answer-help.................................. 34 Auto margin .................................... 5 Auto-by-threshold ........................... 5 Auto-help ...................................... 34 Autosegmentation ........................... 5 B Beam active ......................................... 54 entry point ................................. 14 parameters ................................. 14 weighting................................... 14 Beam supporting toolbar............... 47 Beams eye view .................See BEV BEV............................................... 51 Bolus ............................................. 54 Brachytherapy ................... 21, 27, 31 source information .................... 17 C Calculation algorithms ................................. 17 mode.................................... 12, 55 pixel-by-pixel.............................. 6 region .................................. 12, 55 settings ...................................... 55 Catheter templates ................................... 17 types .......................................... 27 Clinic............................................. 25 Collimator settings ........................ 14 Color definitions ........................... 32 irregular field ............................ 32 objects ....................................... 32 points......................................... 32 Color definitions ........................... 30 Commissioning ............................. 14 Compensating filter................. 14, 16 Computed tomography.................. 10 Contour control ............................. 38 Contour supporting toolbar ........... 46 Contours.......................................... 5 add............................................. 54 auto margin ................................. 5 auto-by-threshold ........................ 5 autosegmentation ........................ 5 edit............................................. 54 enhance ..................................... 55 import.......................................... 6 interpolation ................................ 5 Coronal............................................ 9 Couch settings............................... 14 Cross section ............................. 5, 39 Customization ............................... 25 site ............................................. 27 D Data demographic................................ 3 entering ....................................... 4 patient.......................................... 3 source physics ........................... 15 Data export.................................... 21 Demographic data ........................... 3 Descriptions .................................. 31 59
XiO
Index XiO User Guide
DICOM 3.0 ............................... 6, 22 DICOM export .............................. 26 DICOM RT plan import................ 25 Digitizer .................................... 5, 28 film............................................ 22 Dose .............................................. 55 calculate .................................... 55 calculation algorithms............... 17 parameters ................................. 15 status ......................................... 56 Dose supporting toolbar................ 48 DVH.............................................. 56 E Electron density converted from assigned contour density ................................... 10 converted from CT pixels ......... 10 relative....................................... 13 Ellis compensators ........................ 16 Enhanced dynamic wedge............. 15 Exiting........................................... 35 F Film digitizer................................. 22 Focal.............................................. 22 G Gantry settings .............................. 14 General limitations........................ 30 Graphics area .............. 39, 45, 51, 53 Group list box ............................... 38 H Heterogeneity................................ 13 Histogram...................................... 56 Huestis........................................... 16 I IDs................................................. 31 Image-based studyset ................ 7, 13 IMRT....................................... 11, 57 IMRT supporting toolbar .............. 50 Intensity Modulated Radiation Therapy .........................See IMRT Interest points.......................... 11, 12 Interpolation.................................... 5
Irregular field .......................... 21, 32 Irregular field point dose calculation ................................................... 31 Isocenter........................................ 14 K Keyboard using.......................................... 29 L Limits ............................................ 30 brachytherapy............................ 31 general....................................... 30 IDs, names, description............. 31 irregular field point dose calculation ............................. 31 Linux desktop ...................................... 26 logging in .................................. 19 screen capture............................ 26 Login ....................................... 19, 22 M Machine commissioning ............... 14 Main menu patient file maintenance ............ 38 teletherapy................................. 43 Main toolbar.................................. 45 patient file maintenance ............ 38 teletherapy................................. 44 Markers ......................................... 11 Milling machines .......................... 16 Mode buttons ................................ 41 Modules......................................... 20 Motorized wedge .......................... 15 Mouse using...................................... 5, 28 MPV.................................. 40, 48, 51 Multiple plane view ........... See MPV N Names ........................................... 31 Navigation dialog box.................................. 29 keyboard.................................... 29 mouse ........................................ 28 Non-image-based studyset ........ 7, 13
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Normalization ......................... 15, 55 NTCP ...................................... 49, 55 O Objects .......................................... 32 Online help.................................... 33 answer-help ............................... 34 auto-help ................................... 34 Orientation ...................................... 8 P Par Scientific................................. 16 Passwords...................................... 22 Patient anatomy file identification......................... 8 location...................................... 10 orientation ................................... 8 Patient data...................................... 3 Patient file maintenance functionality .............................. 40 mode buttons............................. 41 preferences ................................ 27 submode buttons ....................... 41 user interface............................. 37 Permanent plans .............................. 3 PFM...... See Patient file maintenance Physical wedge.............................. 15 Pixel images .................................... 4 Pixel-by-pixel calculation ............... 6 Plan approval............................... 24, 57 basics........................................... 3 comments .................................. 57 modes ........................................ 11 review........................................ 57 save ........................................... 57 types ............................................ 3 Points............................................. 32 Port supporting toolbar ................. 47 Preferences.................................... 25 patient file maintenance ............ 27 teletherapy................................. 27 Program license agreement ............. 2 R Radiation source information........ 14 Reference distance ............ 10, 14, 40
Relative electron densities ............ 13 RTOG protocol submission software ... 28 simulation.................................. 22 RTP link ........................................ 26 S Sagittal ............................................ 9 Save plan............................................ 57 window format .......................... 53 Scale factor.................................... 40 Screen capture utility .................... 28 Single plane view................ See SPV Source templates ............................. 17, 27 types .................................... 17, 27 Source file maintenance................ 21 Source information brachytherapy............................ 17 radiation .................................... 14 Source physics data....................... 15 SPV ............................................... 51 Status bar patient file maintenance ............ 38 teletherapy................................. 44 Studysets ......................................... 7 Submode buttons........................... 41 T Tablet .............................................. 5 TCP ......................................... 49, 55 Teletherapy features...................................... 51 functionality .............................. 45 preferences ................................ 27 source parameters...................... 14 toolbar ....................................... 45 user interface............................. 43 Templates...................................... 57 catheter...................................... 17 source .................................. 17, 27 Temporary plans ............................. 3 Three-dimensional plan ................ 11 Thumbnails ................................... 39 Tissue density.............................. 4, 6 heterogeneities .......................... 13 61
XiO
Title bar patient file maintenance ............ 37 teletherapy................................. 43 Tool tip.................................... 40, 45 Toolbar beam supporting........................ 47 contour supporting .................... 46 dose supporting ......................... 48 IMRT supporting ...................... 50 main........................................... 45 port supporting .......................... 47 submodes............................. 38, 44 supporting modes ...................... 38 tools supporting......................... 50 Tools supporting toolbar ............... 50 Transverse ....................................... 9 Treatment plan .....................See Plan Two-dimensional plan .................. 11 Types catheter...................................... 27 source ........................................ 27 U UNIX logging in .................................. 19 screen capture............................ 28 User add............................................. 22 authorization ............................. 24 dedicated ................................... 19 definable setup .......................... 25 nondedicated ............................. 19 utility ......................................... 22 Usernames..................................... 22
V VIDAR film scanner ..................... 28 View types .................................... 51 Virtual wedge................................ 16 W Wedge ..................................... 14, 15 Window level presets......................... 38, 44 slide controls ....................... 39, 44 Window format ............................. 51 display ....................................... 52 save ........................................... 53 synchronize ............................... 53 Window size.................................. 25 Wireframe contours ...................... 10 X XiO add a user .................................. 22 create clinics.............................. 25 exiting ....................................... 35 intended use ................................ 1 intended users.............................. 1 logging in .................................. 19 modules ..................................... 20 navigation.................................. 28 online help................................. 33 overview...................................... 1 program license agreement ......... 2 starting....................................... 19 training ........................................ 2 user utility ................................. 22 window size .............................. 25
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Xio 434

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Contact Information, Revision History, Trademarks XiO User Guide

Document Name: XiO_URG_434_ENG_A.pdf Part Number: 98910

Contact Information, Revision History, Trademarks XiO User Guide

Contact Information, Revision History, Trademarks XiO User Guide

Document Name: XiO_URG_434_ENG_A.pdf Part Number: 98910

The Basics of a Treatment Plan .....................................................3

Radiation Source Information...................................................... 14

Brachytherapy Source Information ............................................... 17 Dose Calculation Algorithms ....................................................... 17

Create Login Usernames and Passwords......................................... 22

User Definable Setup, Customization, and Preferences ..................... 25

Table of Contents XiO User Guide

Navigation.............................................................................. 28 Limits and Color Definitions........................................................ 30

Getting Help ........................................................................... 33

Exiting XiO ............................................................................. 35

Patient File Maintenance ...................................37

Teletherapy Features ............................................................... 51

Table of Contents XiO User Guide

Multiple Plan Review ........................................................................ 57 Saving Plans................................................................................... 57 Plan Approval................................................................................. 57

Table of Contents XiO User Guide

Intended Users of the XiO RTP System

Intended Use of the XiO RTP System

Introduction to XiO XiO User Guide

Training on the XiO RTP System

Using the XiO RTP System

Program License Agreement

Introduction to XiO XiO User Guide

The Basics of a Treatment Plan

Introduction to XiO XiO User Guide

Entering Patient Anatomy Data

Figure 1: Pixel image

Introduction to XiO XiO User Guide

Introduction to XiO XiO User Guide

Figure 3: Contour with an automatically generated margin.

Figure 4: Pixel image with contours traced on it.

Introduction to XiO XiO User Guide

Anatomy Data Classifications

Introduction to XiO XiO User Guide

Patient Anatomy File Identification

Introduction to XiO XiO User Guide

Figure 6: Patient orientation

Introduction to XiO XiO User Guide

Figure 7: Reference distance

Introduction to XiO XiO User Guide

Interest Points and Markers

Introduction to XiO XiO User Guide

Introduction to XiO XiO User Guide

Figure 8: 3-D calculation region

Figure 9: 2-D calculation region

Introduction to XiO XiO User Guide

Radiation Source Information

Teletherapy Source Parameters

Introduction to XiO XiO User Guide

Source Physics Data

Wedge and Compensator Information

Introduction to XiO XiO User Guide

Virtual wedge A software simulated wedge for Siemens linear accelerators.

Introduction to XiO XiO User Guide

Brachytherapy Source Information

Dose Calculation Algorithms

Introduction to XiO XiO User Guide

Logging into XiO