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XiO

Training Guide







Revision History
Revision Date Changes
XiO_TUT_434_C.pdf June 2008 Physics Lesson Updates

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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
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CMS is a registered trademark of CMS, Inc.

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Copyright 2008 by CMS, Inc. All rights reserved.
Performance characteristics given in this manual are for reference only and are not intended as guaranteed specifications.
Document ID: XiO_TUT_434_C.pdf
Part Number: 98911













ii

Manufacturer Japan
CMS, Inc.
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

Europe
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





























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

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iv

XiO

Training Course Outline
For RTT/CMD
Monday 8:30 am 4:30 pm
Welcome to CMS
Section 1 - Things You Should Know Before You Begin
- Include Reference Library
Section 2 - Help Resources
Section 4 - Patient File Maintenance
Section 5 - Teletherapy- Part 1
Tuesday 8:30 am 4:30 pm Review/ Q and A
Section 6 -Teletherapy- Part 2
Section 3- Settings
Section 7 - 2D Breast
Section 8 -3D Lung
Wednesday 8:30 am 4:30 pm


Review/ Q and A
Section9- Preferences
Section 10- 3D Four Field Prostate
Section 17- Digitally Reconstructed Radiograph (DRR)
Section 11- Electron Beam Plan
Section 12- Arc Rotation
Thursday 8:30 am 4:30 pm Review/ Q and A
- Explanation of Irregular Field Interface
Section 13 - Irregular Field
Section 14- Time/MU Program
- Focal (Focal Training CD)
- Brachytherapy Source File Maintenance
Section 15- Brachytherapy GYN
Section 16- Prostate Brachytherapy
Friday 8:30 am Noon Review/ Q and A
- Brachytherapy (contd)
Section 22- Miscellaneous Tasks
- Algorithms (Reference Library- Online Help )
- IMRT overview
- TCP/NTCP (per request)
- RTOG Interface (per request)
Completion of XiO Training Checklist
Completion of Evaluation
Completion of Expense Reports
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vi

XiO

Training Course Outline
For Medical Physicists
Monday 8:30 am 4:30 pm Welcome to CMS
Section 1- Things you Should Know Before Planning
Begins
Section 2- Help Resources
Section 3- Settings
Section 4- Patient File Maintenance interactive lecture
Section 5- Teletherapy-Part 1
Section 6- Teletherapy- Part 2
Section 8-3Dlung time permitting
Tuesday 8:30 am 4:30 pm Review/ Q and A
Beam Data Requirements/Data Acquisition
Source File Maintenance/Physics Data
Creating Beams/Data Transfer
Clarkson Algorithm Modeling
(Beam Modeling Guide)
Wednesday 8:30 am 4:30 pm


Review/ Q and A
XiO Physics Algorithms
Convolution/Superposition Algorithm Modeling
Wedge Modeling
Pencil Beam Algorithm Modeling
(Beam Modeling Guide)
Thursday 8:30 am 4:30 pm Review/ Q and A
Section 17- Digitally Reconstructed Radiographs (DRR)
And the Virtual Patient
Monitor Units Calculation
Section 27 XiO IMRT Overview. QA Tools
Friday 8:30 am Noon Review/ Q and A
Completion of XiO Training Checklist
Completion of XiO Training Course Evaluation
Completion of Expense Reports
Section 28 Introduction to Linux/Unix
Additional Physics Topics time permitting
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XiO Training Guide

Table of Contents

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


Section 2. Help Resources
General Information................................................................................................. 2-1
XiO Main Help Window.......................................................................................... 2-2
Sample Dialog Box Help.......................................................................... 2-3
Contents Tab ............................................................................................ 2-4
Index Tab ............................................................................................ 2-5
Search ............................................................................................ 2-6
Finding "How To" Procedures for a Specific Task .................................. 2-8
Print a Screen in XiO Help....................................................................... 2-9
Print a Page or Frame in XiO Help........................................................... 2-10
Additional Help Resources ...................................................................................... 2-11
Phone Support........................................................................................... 2-22
Beam Modeling ........................................................................................ 2-12
Online User Access .................................................................................. 2-13

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Section 3. Settings
Overview.................................................................................................................. 3-1
Practice Exercise...................................................................................................... 3-2
Task 1. Selecting a Clinic...................................................................................... 3-2
Installation ............................................................................................................... 3-3
Task 1. User Authorization ................................................................................... 3-3
Task 2. Hospital/Clinic.......................................................................................... 3-4
Task 3. Date Format .............................................................................................. 3-5
Task 4. Language .................................................................................................. 3-6
Task 5. GCD Model .............................................................................................. 3-7
Task 6. Transfer Data to FOCAL PC.................................................................... 3-8
Workstation.............................................................................................................. 3-9
Task 1. Backup Utility........................................................................................... 3-9
Task 2. Printers...................................................................................................... 3-10
Data Locations for PDF and Postscript Print............................................ 3-11
Task 3. CT Interfaces ............................................................................................ 3-12
Task 4. MRI Interfaces.......................................................................................... 3-13
Task 5. SC Interfaces............................................................................................. 3-14
Task 6. PET Interfaces .......................................................................................... 3-15
Task 7. Nuclear Medicine Interfaces..................................................................... 3-16
Task 8. Ultrasound Interfaces................................................................................ 3-17
Task 9. DICOM Settings ....................................................................................... 3-18
Clinic 3-19
Task 1. Data Compression..................................................................................... 3-19
Task 2. User Interfaces Preferences ...................................................................... 3-20
Task 3. Scanner/LMS Definition........................................................................... 3-21
Patient Data.............................................................................................................. 3-28
Task 1. General Anatomical Site........................................................................... 3-28
Task 2. Specific Anatomical Sites......................................................................... 3-31
Task 3. CT to Rel Elec Dens Files ........................................................................ 3-35
Task 4. Prostate Template ..................................................................................... 3-38
Sample Template ..................................................................................................... 3-41
Plan Defaults............................................................................................................ 3-42
Task 1. Brachytherapy Drawing............................................................................ 3-42
Task 2. Calculation Defaults ................................................................................. 3-43
Sub-task 1. Teletherapy ......................................................................... 3-43
Weight Point field edge warning distance. ......................... 3-45
Sub-task 2. Brachytherapy General Parameters.................................. 3-48
Task 3. DRR Calculation Defaults.......................................................................... 3-50
Initial Image Display ................................................................................ 3-52
Final Image (Display)............................................................................... 3-53
Film Image 3-53
DICOM 3.0 Image.................................................................................... 3-53
Task 4. Proton Beam Defaults ................................................................................ 3-54
Task 5. Proton Defaults ......................................................................................... 3-55
Subtask 1. General Proton Parameters ................................................. 3-55
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Section 3. Settings (cont.)
Subtask 2. Milling Tool Size ................................................................ 3-57
Task 6. TCP/NTCP Parameters............................................................................. 3-58
Task 7. Teletherapy ............................................................................................... 3-59
Output 3-60
Task 1. DRR Print ................................................................................................. 3-60
Task 2. Intensity Maps .......................................................................................... 3-61
Task 3. Intensity Map Output Devices .................................................................. 3-62
Task 4 Tele Source Data ...................................................................................... 3-64
Sub-task 1. Treatment Parameters ......................................................... 3-64
Task 5. Standalone Time/MU ............................................................................... 3-66
Task 6. Display Printer Defaults ........................................................................... 3-67
Sub-task 1. Brachy Isocurve / Isosurface Colors ................................... 3-67
Sub-task 2. Print Colors ......................................................................... 3-69
Sub-task 3. Beam Colors (Proton Only) ................................................ 3-71
Sub-task 4. Thickness (Proton Only) ..................................................... 3-72
Task 7. DRR Printing Size .................................................................................... 3-73
Task 8. .decimal Order Defaults............................................................................ 3-74
Task 9. Block Cutter Export.................................................................................. 3-76
Technical Considerations......................................................................................... 3-77

Section 3A. Setting Presentation

Section 4. Patient File Maintenance
Practice Exercise...................................................................................................... 4-1
Task 1. Access XiO - PFM.................................................................................... 4-1
Task 2. Create a New Patient ................................................................................ 4-3
Method 1. Enter Demographic Information......................................... 4-3
Method 2. Use DICOM Header information........................................ 4-4
Task 3. Start Image Transfer ................................................................................. 4-5
Task 4. Finish Image Transfer............................................................................... 4-7
Task 5. Contouring................................................................................................ 4-9
Sub-task 1. Add a Group of Contour Names & Enter a Contour Name4-9
Sub-task 2. Create the Patient Contour Using Auto-by-Threshold
(Multiple Slices) ................................................................. 4-11
Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice) . 4-14
Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice) . 4-15
Sub-task 4. Create Contours Using Auto-by-Threshold (Range) .......... 4-16
Sub-task 5. Create/Edit Contours using the Paintbrush......................... 4-17
Sub-task 6. Create Contours Using Autosegmentation.......................... 4-18
Sub-task 7. Edit Existing Contour ......................................................... 4-20
Replace Contour Segment................................................... 4-20
Stretch Sym/Asym.............................................................. 4-21
Move ................................................................................... 4-21
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Section 4. Patient File Maintenance (cont.)
Copy Superior/Inferior........................................................ 4-22
Copy/Paste to Another Slice (keyboard shortcuts) ............. 4-22
Delete a Single Contour ...................................................... 4-22
Delete ALL Contours for an Entire Structure..................... 4-23
Stop Editing ........................................................................ 4-23
Sub-task 8. Create Contours from Predefined Shapes
Using the Keyboard ............................................................ 4-24
Sub-task 9. Draw Contours using the Mouse......................................... 4-25
Sub-task 10. Interpolate ........................................................................... 4-26
Sub-task 11. Free-form Exercise Outline the Seminal Vesicles using any
method ................................................................................ 4-27
Sub-task 12. 3-D Auto-Margin - Uniform............................................... 4-28
Sub-task 13. 3D Auto-Margin with Exclusion ....................................... 4-30
Sub-task 14. 3-D Auto-Margin Variable .............................................. 4-31
Sub-task 15. 3-D Auto-Margin Negative.............................................. 4-32
Sub-task 16. 2-D Automargin.................................................................. 4-33
Sub-task 17. Edit Contour Information.................................................... 4-33
Sub-task 17. Create Interest Points Using the Mouse.............................. 4-34
Sub-task 18. Create a Marker Using the Mouse and Scales feature ........ 4-34
Sub-task 19. Obtain Shift Calculations Setup Reference Definition .... 4-36
Task 6. Turning On and Off Display of Contours and Plan Objects..................... 4-39
Toggle the Display of Contours................................................................ 4-39
Toggle the Display of Plan Objects .......................................................... 4-40
Task 7. Window Format Options .......................................................................... 4-41
Task 8. (Optional) Image Fusion in PFM.............................................................. 4-43
Subtask 1. Create a Secondary Studyset............................................... 4-43
Subtask 2. Open the Patient for Fusion ................................................ 4-43
Subtask 3. Fusion Tools and AutoRegistration .................................... 4-44
Subtask 4. Open Fused Studysets in PFM............................................ 4-45

Section 5. Teletherapy Part 1
Overview.................................................................................................................. 5-1
Practice Exercise...................................................................................................... 5-2
Task 1A. Open the Patient in Teletherapy (from PFM) ........................................... 5-2
Task 1B. Open the Patient in Teletherapy (from the Main XiO screen).................. 5-4
Task 2. Graphical Display Options ....................................................................... 5-6
Activate a Window................................................................................... 5-6
Scale ............................................................................................ 5-6
Window/Level .......................................................................................... 5-7
Movie ............................................................................................ 5-9
Pan ............................................................................................ 5-9
Rotate ............................................................................................ 5-9
Translate ............................................................................................ 5-10
Maximize/Restore..................................................................................... 5-10
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Section 5. Teletherapy Part 1 (cont.)

Task 3. Add and Edit a Beam................................................................................ 5-11
Task 4. Create an Auto Port .................................................................................. 5-22
Task 5. Mirror a Beam.......................................................................................... 5-24
Task 6. Copy a Beam............................................................................................ 5-26
Task 7. Change the Active Beam in the ABV (Active Beams-eye View) Window5-29
Task 8. Display Isodoses ....................................................................................... 5-30
Task 9. (Optional) Evaluate Point Doses Using the Reference Dose Cursor........ 5-33
Task 10. Normalization of Dose Display ................................................................ 5-34
Absolute Dose Normalization................................................................... 5-34
Global Maximum, Selected Point and Selected Dose Normalization ...... 5-34
Task 11. Beam Weighting and Rescaling................................................................ 5-36
Task 12. Dose Volume Histogram.......................................................................... 5-39
Display a Quick DVH............................................................................... 5-39
Using the Comprehensive DVH Tools ..................................................... 5-41
Re-display a Histogram............................................................................ 5-47
Task 13. Save the Plan ............................................................................................ 5-48
Task 14. Create a Template..................................................................................... 5-49
Task 15. Display and/or Print Outputs and Reports ................................................ 5-50

Section 6. Teletherapy Part 2
Task 1. Additional Beam Functionality................................................................. 6-1
Subtask 1. Delete beam(s) .................................................................... 6-1
Delete the Active Beam...................................................... 6-1
Delete a Group of Beams.................................................... 6-1
Subtask 2. Renumber Beams................................................................ 6-1
Subtask 3. Toggle Beam Display (include shortcut) ............................ 6-2
Toggle Selected Beams On or Off ...................................... 6-2
Subtask 4. Move Isocentric Group ....................................................... 6-3
Task 2. Additional Port Functionality ................................................................... 6-5
Subtask 1. Draw a Port Using the Mouse............................................. 6-5
Subtask 2. Draw a Port Using the Tablet.............................................. 6-6
Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC)..... 6-6
Subtask 4. Create and Edit a Port using the Keyboard......................... 6-9
Subtask 5. (MLC Only) Edit MLC Leaves........................................... 6-9
Subtask 6. MLCs and Blocks ............................................................... 6-11
Subtask 7. (MLC Only) MLC Display Feature .................................... 6-12
Subtask 8. Rotate Collimator Independent of Port ............................... 6-13
Subtask 9. Automatically Update the MLC or Aperture as the
Gantry is Rotated ................................................................ 6-14
Subtask 10. Auto Conform the Port for the Active Beam...................... 6-15
Subtask 11. Auto Conform Ports or Collimator Jaws to a
Specific Margin for One or Multiple Beams ...................... 6-16
Subtask 12. Conform Collimator for the Active Beam........................... 6-17
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Section 6. Teletherapy Part 2 (cont.)
Subtask 13. Conform Collimator Jaws for all Beams at Once ................ 6-18
Subtask 14. How To Save and Use Public Ports ..................................... 6-18
Subtask 15. Port Properties...................................................................... 6-19
MLC.................................................................................... 6-19
Aperture/Block.................................................................... 6-20
Subtask 16. Delete Port Options............................................................. 6-21
Delete Entire Ports .............................................................. 6-21
Delete a Port Shape............................................................. 6-21
Subtask 17. Convert Aperture/MLC........................................................ 6-22
Task 3. Items That Influence Dose Calculation...................................................... 6-23
Subtask 1. Calculation Setting.............................................................. 6-23
Subtask 2. Dose Status ......................................................................... 6-26
Task 4. Setup Reference Definition (CT Sim)........................................................ 6-27
Determine and Mark the Scan Reference Point........................................ 6-27
Report Relative Shifts............................................................................... 6-29
Report Absolute Readings ........................................................................ 6-31
Task 5. Optional Display Settings .......................................................................... 6-32
Subtask 1. Window Format .................................................................. 6-32
Select/Save a Predefined Window Format.......................... 6-32
Create your own Window Format....................................... 6-33
Create an SPV Plane perpendicular to the
Central Axis (SPV CAX).................................................... 6-34
Create an Oblique Plane (Not necessarily
perpendicular to the plane of any beam)............................. 6-35
Subtask 2. Enhance Contours ............................................................... 6-37
Subtask 3. Scales .................................................................................. 6-38
Toggle Scales On and Off................................................... 6-38
Change the Scales Tic-mark Spacing ................................. 6-38
Move the Scales in a Single Window................................. 6-38
Move the Scales in all SPV Windows at Once ................... 6-38
Subtask 4. View Plans on Primary, Secondary, or
Electron Density Image Data.............................................. 6-39
Subtask 5. View Image Planes in MPV................................................ 6-40
Subtask 6. Plan Objects ........................................................................ 6-41
Turn On or Off One Plan Object At a Time ....................... 6-41
Turn On or Off Multiple Plan Objects................................ 6-42
Subtask 7. Beam Objects...................................................................... 6-43
MLC Shadow............................................................................................ 6-44
Turn On or Off One Beam Object At a Time ..................... 6-44
Turn On or Off Multiple Beam Objects.............................. 6-44
Subtask 8. Adding, Editing and Deleting Interest Points and Markers 6-45
Add an Interest Point or Marker ......................................... 6-45
Edit an Interest Point or Marker.......................................... 6-46
Delete an Interest Point or Marker...................................... 6-47
Subtask 9. Measure Tools..................................................................... 6-48
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Section 6. Teletherapy Part 2 (cont.)
Using the Ruler Measure Tool ............................................ 6-48
Using the Point to Point Measure Tool............................... 6-49
Subtask 10. Plane Icon ........................................................................... 6-50
Subtask 11. Contour Editing................................................................... 6-50
Subtask 12. Create Subcontour............................................................... 6-51
Task 6. Multiple Plan Review................................................................................. 6-52
Open the Patient and Select Plans for Review.......................................... 6-52
Display Dose to a Single Point ................................................................. 6-56
DVH ............................................................................................ 6-56
Save an Addition Plan .............................................................................. 6-57
Plan Comment/ Approval ......................................................................... 6-57
Task 7. Additional Beam Modifiers ...................................................................... 6-58
Subtask 1. Open a Permanent Plan....................................................... 6-58
Subtask 2. Bolus ................................................................................... 6-58
Draw Bolus SPV................................................................. 6-58
Draw Bolus BEV................................................................ 6-61
Edit Bolus ........................................................................... 6-63
Assign Bolus ....................................................................... 6-64
Delete Bolus........................................................................ 6-65
Sub-task 3. Wedges................................................................................ 6-66
Add Wedge ......................................................................... 6-66
Delete Wedge...................................................................... 6-67
Sub-task 4. Compensating Filters .......................................................... 6-68
Add Compensating Filter.................................................... 6-68
Delete Compensating Filter ................................................ 6-69
Send Compensating Filter Data to a
Milling Machine (Huestis and Par Scientific)..................... 6-70
Task 8. Delete Options in XiO................................................................................ 6-73

Section 7. 2-D Breast Tangents
Practice Exercise...................................................................................................... 7-1
Task 1. Access XiO ................................................................................................ 7-2
Task 2. Enter Patient Demographic Data and Define the Studyset ....................... 7-3
Task 3. Digitize Contours...................................................................................... 7-6
Sub-Task 1. Set up the Contouring Parameters and Orient the Axes...... 7-6
Sub-Task 2. Digitize Contours................................................................ 7-8
Sub-Task 3. Digitize Interest Points and Markers................................... 7-10
Sub-Task 4. Digitize Contours on Final Cross Section........................... 7-10
Sub-Task 5. Name the Interest Points and Markers ................................ 7-11
Task 4. Create a New Plan...................................................................................... 7-12
Sub-Task 1. Enter Plan Information........................................................ 7-12
Sub-Task 2. Create an Active Beams-Eye View (ABV) Window.......... 7-13
Sub-Task 3. Create a New Beam............................................................ 7-14
Sub-Task 4. Add a Wedge ...................................................................... 7-15
Sub-Task 5. Mirror the Beam.................................................................. 7-15
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Section 7. 2-D Breast Tangents (cont.)
Sub-Task 6. Normalize and View Isodose.............................................. 7-16
Task 5. Save the Plan ............................................................................................ 7-19
Task 6. Print a Single Plane View......................................................................... 7-20

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


Section 9. Preferences
General Preferences ................................................................................................. 9-1
Patient File Maintenance Preference Settings.......................................................... 9-1
General .................................................................................................................. 9-1
Color .................................................................................................................. 9-6
W/L Presets.............................................................................................................. 9-9
Teletherapy Preference Settings .............................................................................. 9-10
General .................................................................................................................. 9-10
New Plan Object Displays........................................................................ 9-13
Color .................................................................................................................. 9-16
DICOM .................................................................................................................. 9-17
DICOM .................................................................................................................. 9-18
DRR Output ............................................................................................................. 9-18
Print .................................................................................................................. 9-20
Window/Level ......................................................................................................... 9-22
Beam Display........................................................................................................... 9-23
Beam .................................................................................................................. 9-26
Port .................................................................................................................. 9-28
Histogram................................................................................................................. 9-32
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Section 9. Preferences (cont.)
Sampling Resolution................................................................................. 9-32
Dose Bin Width ........................................................................................ 9-32
IMRT .................................................................................................................. 9-34
IMRT Graphs............................................................................................ 9-34
Initial Optimization................................................................................... 9-35
Beam Weight Optimization...................................................................... 9-36
Segmentation Method............................................................................... 9-36
Ideal Map Extension................................................................................. 9-37
Discrete Intensity Levels .......................................................................... 9-37
Split Field Parameters............................................................................... 9-37
Minimum Segment Size ........................................................................... 9-39
Compensating Filter Smoothing............................................................... 9-39
Intensity Map........................................................................................................... 9-40
Display Print ............................................................................................ 9-40
Output Map To ......................................................................................... 9-41
ASCII Output............................................................................................ 9-41
Define Default Filename Format .............................................................. 9-41
Define Default Filename Format .............................................................. 9-42
Default Filename Formats ........................................................................ 9-43
Plan Output .............................................................................................................. 9-44
Brachytherapy.......................................................................................................... 9-47
Brachytherapy Histogram Print Preferences............................................................ 9-47

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

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

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

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

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

Section 15. Gynecological Brachytherapy Implant
Practice Exercise...................................................................................................... 15-1
Task 1. Create a Source Type................................................................................ 15-1
Sub-task 1. Enter General Parameters ................................................... 15-2
Sub-task 2. Enter the Physical Geometry for the
Sievert Integral Data ........................................................... 15-3
Sub-task 3. Enter the Attenuation Information for the
Sievert Integral Data15-3
Sub-task 4. Enter the Dose Rate Parameters and Create the
Dose Rate Table15-4
Task 2. Create a Source Template .......................................................................... 15-7
Task 3. Create a Source Inventory.......................................................................... 15-8
Task 4. Create Tandem Catheter Template............................................................. 15-9
Task 5. Create a New Patient .................................................................................. 15-10
Task 6. Create a New Treatment Plan .................................................................... 15-11
Task 7. Digitize Ovoid Source................................................................................ 15-12
Task 8. Define Tandem Sources ............................................................................. 15-14
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Section 15. Gynecological Brachytherapy Implant (cont.)
Task 9. Digitize the Tandem................................................................................. 15-15
Task 10. Digitize Interest Points for Dose Calculations.......................................... 15-16
Task 11. Digitize Markers for Automatically Calculating Points A and B............ 15-17
Task 12. Position Markers for Defining Points A and B......................................... 15-19
Task 13. Create a Best-fit Oblique Plane and Sagittal
and Transverse Views of the Implant ....................................................... 15-20
Task 14. Calculate Dose.......................................................................................... 15-22
Task 15. (Optional) Edit/Delete Sources and Catheters ......................................... 15-23
Sub-task 1. Edit a Group of Sources...................................................... 15-23
Sub-task 2. Edit One Source .................................................................. 15-24
Sub-task 3. Delete a Group of Sources .................................................. 15-24
Sub-task 4. Delete One Source .............................................................. 15-25
Sub-task 5. Edit the Sources in a Group of Catheters............................ 15-25
Sub-task 6. Edit Sources in One Catheter.............................................. 15-26
Sub-task 7. Delete a Group of Catheters................................................ 15-26
Sub-task 8. Delete One Catheter............................................................ 15-27
Task 16. Plot Brachytherapy Plan ........................................................................... 15-28

Section 16. Prostate Brachytherapy
Prostate Brachytherapy Preplan A
Practice Exercise....................................................................................... 16-1
Task 1. Create a Source Type................................................................................ 16-2
Sub-task 1. Enter General Parameters ................................................... 16-2
Sub-task 2. Enter the Radial Dose Function information
for the TG43 Data ............................................................... 16-3
Sub-task 3. Enter the Anisotropy Function information
for the TG43 Data ............................................................... 16-5
Sub-task 4. Enter the Dose Rate Function information
for the TG43 Data ............................................................... 16-7
Sub-task 5. Enter the Dose Rate Parameters and Create Dose
Rate and Seed Equivalent Tables........................................ 16-7
Task 2. Create a Source Template......................................................................... 16-9
Task 3. Create a Preplanning Prostate Template................................................... 16-10
Task 4. Enter Patient Data..................................................................................... 16-11
Task 5. Enter Data about Cross Sections............................................................... 16-12
Task 5. Enter Data about Cross Sections............................................................... 16-13
Task 6. Start the Creation of New Treatment Pre-Plan......................................... 16-14
Task 7. Modify Graphics....................................................................................... 16-15
Task 8. Define Pre-Planning Parameters............................................................... 16-15
Task 9. Edit Existing Sources................................................................................ 16-16
Task 10. Enter Calculation Parameters ................................................................... 16-17
Task 11. Assign Dose Prescription.......................................................................... 16-18
Task 12. Print the Pre-plan Report .......................................................................... 16-19
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Section 16. Prostate Brachytherapy (cont.)
Prostate Seed Implant Postplan B
Practice Exercise...................................................................................................... 16-20
Task 1. Create a Prostate Post Plan ....................................................................... 16-21
Task 2. Find Seeds Using Automated Source Localization .................................. 16-22
Task 3. Review Seed Positions.............................................................................. 16-23
Task 4. Calculate Dose and Evaluate the Implant ................................................. 16-24
Task 5. Plot Plan.................................................................................................... 16-25

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

Section 17A. Digitally Reconstruction Radiographs

Section 17B. Virtual Patient

Section 18. Composite Planning
Practice Exercise...................................................................................................... 18-1
Prerequisites............................................................................................................. 18-1
Conditions................................................................................................................ 18-1
Learning Objectives................................................................................................. 18-1
Task 1. Start a New 3-D Treatment Plan............................................................... 18-3
Task 2. Examine Contoured Structures ................................................................. 18-5
Task 3. Create a Simple Four-Field Box Plan
to a PTV Volume (Prostate + Seminal Vesicles + Margin + Port Margin)18-7
Task 4. Ceate Four Boost Fields, Boosting
to a Smaller Volume (GTV + Port Margin).............................................. 18-10
Task 5. Define Prescriptions for the Two Beam Groups....................................... 18-12
Task 6. View the Dose Display for the Composite Plan ....................................... 18-18
Task 7. View the DVH Results for the Composite Plan ....................................... 18-20
Task 8. Review and Understand the Individual
Beam Weights for the Composite Plan..................................................... 18-22

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Section 19. IMRT Head and Neck
Practice Exercise...................................................................................................... 19-1
Task 1. Open Patient for IMRT............................................................................. 19-2
Task 2. Prepare Contours for IMRT...................................................................... 19-3
Task 3. Dose Calculation Settings......................................................................... 19-6
Task 4. Place Beams and Conform Jaws or Ports ................................................. 19-7
Task 5. IMRT Parameters and Prescription Table ................................................ 19-10
Treatment Goal ......................................................................................... 19-11
Task 6. Start IMRT Optimization Page................................................................. 19-13
Task 7. Optimized DVH and Isodoses .................................................................. 19-14
Task 8. Prescription Adjustment ........................................................................... 19-16
Task 9. Review/Edit Ideal Intensity Maps (optional)............................................ 19-18
Task 10. Generation and Review of MLC Segments .............................................. 19-19
Task 11. Using DVH, Isodoses and Intensity Maps to Evaluate IMRT Plans ........ 19-22
Task 12. Save the IMRT Plan ................................................................................. 19-24
Task 13. Compare Plans with Different Minimum Transmission Multiplers ......... 19-25
Task 14. Quality Assurance of the IMRT Plan........................................................ 19-26
Sub-task 1. Visualize, Sample, and Output Intensity Maps for QA ...... 19-26
Sub-task 2. Largest Leaf Extent Verification ........................................ 19-27
Sub-task 3. Create a QA Plan on a Phantom and Export Doses to a File19-28
Sub-task 4. Create a Single Beam QA File on a Phantom..................... 19-32
Example Prescription............................................................................................... 19-33


Section 20. Plan Evaluation Tools
Practice Exercise...................................................................................................... 20-1
Task 1. Set up an open-field breast tangent plan with arbitrary weight point ....... 20-8
Task 2. Use the Dose Profile Tool......................................................................... 20-12
Task 3. Delete Wedges to the Beams and Save the Open Plan............................. 20-14
Task 4. Add Compensators and Save the Compensated Plan ............................... 20-16
Task 5. Change the Patient Compensator "High Point" for
the Latter Beam to Reduce the Hot Spot Dose
and Save the 2
nd
Compensated Beam....................................................... 20-18
Task 6. View Dose Profile Output in Text Format................................................ 20-20
Linux Users ............................................................................................ 20-20
Non-Linux Users ...................................................................................... 20-20
For Linux and Non-Linux Users............................................................... 20-20
Task 7. For the 2
nd
Compensated Plan, Produce
QA Output Files for Each Compensator................................................... 20-22

Section 21. Monitor Units: Algorithm Dependencies
Practice Exercise...................................................................................................... 21-1
Why Do Monitor Units Depend on the Dose Calculation Algorithm?.................... 21-1
How Do I Use XiO to Calculate Monitor Units?..................................................... 21-1
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Section 21. Monitor Units: Algorithm Dependencies (cont.)
Conditions................................................................................................................ 21-1
Learning Objectives................................................................................................. 21-2
Task 1. Set up Multiple Beams Using Different Calculation Algorithms............. 21-3
Task 2. Verify Depths, Use Group Move, and Change Beam Parameters............ 21-8
Task 3. Draw Customized Internal Structures....................................................... 21-11
Task 4. Understand the Differences in Monitor
Units between Algorithms, and between Phantom Geometries................ 21-19
Monitor Unit Calculations - Photons ....................................................................... 21A1
Monitor Unit Calculations - Electrons..................................................................... 21B1


Section 21A. Monitor Units Calculations - Photons

Section 21B. Monitor Units Calculations - Electrons

Section 22. Miscellaneous Tasks
Practice Exercise...................................................................................................... 22-1
Task 1. Utilities Accessed through XiO Help ....................................................... 22-2
Trouble Shooting ...................................................................................... 22-2
View Log File ..................................................................... 22-2
View XiO System Information ........................................... 22-3
System Administration........................................................ 22-3
Configure Modem............................................................... 22-3
Install Phantom................................................................... 22-3
Restore Data........................................................................ 22-3
IMFast Machine ID......................................................... 22-3
Manage User Accounts ....................................................... 22-4
Task 2. Export/Archive Patient ............................................................................. 22-5
Task 3. Retrieve Archived Patient......................................................................... 22-6
Task 4. Running Multiple XiO Sessions on Linux................................................ 22-7
Task 5. Screen Captures - UNIX........................................................................... 22-8
Screen Capture for UNIX......................................................................... 22-9
Setting Keyboard Shortcut Preferences .................................................... 22-11
Task 6. Capturing a Screen Shot in LINUX.......................................................... 22-12

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Section 23. Dynamic Conformal
Practice Exercise...................................................................................................... 23-1
Task 1. Copy An Existing Machine in Source File Maintenance to Create a Dynamic
Conformal Machine.................................................................................. 23-2
Task 2. Setup and Validate New Dynamic Conformal Machine .......................... 23-3
Task 3. Setup Beam Preferences ........................................................................... 23-5
Task 4. Create a New Treatment Plan................................................................... 23-6
Task 5. Create a New Beam Using a Dynamic Conformal Setup........................ 23-7
Task 6. Set Treatment Margins and Generate Dynamic Conformal Beams........ 23-9
Task 7. Calculate Dose and Balance the Beam Weights....................................... 23-12
Task 8. Review the Isodose Lines ......................................................................... 23-14
Task 9. Review the Source Data ........................................................................... 23-15
Task 10. Review MLC Leaf Positions .................................................................... 23-16
Task 11. Review Dynamic Conformal Prescription................................................ 23-17
Task 12. An Alternative Beam Setup...................................................................... 23-18

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

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

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Section 25. Spot Scanning Proton Beam (cont.)
Appendix.................................................................................................................. 25-14
IMRT Prescription ................................................................................................... 25-14
Structure .................................................................................................................. 25-14
Type ............................................................................................ 25-15
Rank ............................................................................................ 25-15
Objective, Dose (cGy/Gy) and Volume (%)............................................. 25-16
Weight ............................................................................................ 25-19
Power ............................................................................................ 25-20
Status ............................................................................................ 25-21
Prescription DVH Graph Options............................................................. 25-22

Section 26. Are You Ready for IMRT

Section 27. XiO IMRT Overview

Section 28. Introduction to LINUX/UNIX

Section 29. Introduction to Convolution and Superposition

Section 30. Beam Modeling General Data

Section 31. 3D Photon Algorithms


Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins
Welcome
Congratulations on your purchase of the XiO system!
In an effort to insure your understanding of how to apply the functions of the
XiO system to the treatment plans in your clinic, various task steps have been
incorporated into practice exercises in this guide. The ultimate goal of this
training guide is to demonstrate all of the functions of the system in the exercises
presented.
The training begins with comprehensive coverage of Patient File Maintenance
and Teletherapy. Teletherapy is separated into two parts. The first part is
functional in nature, as new features are introduced while creating a typical
prostate plan. The second part of Teletherapy is feature-based and introduces
features that are not discussed in Part 1. Both parts provide step-by-step
instructions on how to use each feature.
The practice exercises are presented in a logical sequence. Each practice
exercise builds on the exercises completed. The practice exercises also illustrate
where toolbar buttons and drop-down menu options are located, as well as what
is going on behind the scenes when selecting options and entering information.
This training guide does not teach Radiation Treatment Planning (RTP). It
teaches you how to use the XiO software.
This guide includes a table of contents to assist you in locating the steps to
complete a specific task. To view a glossary of terms for the XiO system, refer
to the XiO Online Help glossary. For assistance in performing procedures not
discussed in the practice exercises of this guide, refer to the XiO Online Help, or
contact CMS Customer Support.
Intended Audience
The intended audience for the XiO Training Guide consists of clinicians who are
new to XiO and want to learn how to use the system to create treatment plans, as
it is also helpful to clinicians familiar with XiO who want to refresh their
knowledge.
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The 30-Minute Plan and Its Advanced Features
CMS has reached its goal of providing state-of-the-art technology for developing
complete 3-D treatment plans, including contouring in less than 30 minutes.
The 30-minute plan is made possible using the following advanced features:
x Autocontouring
x 3-D Auto Margin
x Templates
x Inverse Planning
Advanced Tools Contribute to Increased Accuracy
Advanced evaluation tools provide increased accuracy, including the following:
x Dose Volume Histograms (DVH)
x Digitally Reconstructed Radiographs (DRR)
x Tumor Control Probability (TCP) and Normal Tissue Complication
Probability (NTCP) calculations (to interpret how dose is distributed in a
tumor or anatomical structure.)
Objectives of the XiO Training Guide
The XiO Training Guide practice exercises are structured to assist you in the
following areas:
x Create plans quickly and efficiently
x Make the 30-minute plan routinely possible in the clinic
x Create accurate treatment plans
The XiO Training Guide is an easy reference tool that you can use when creating
treatment plans at your clinic. Listed below are some of the types of information
you will find in this guide:
x Comprehensive coverage of Patient File Maintenance
x Comprehensive coverage of Teletherapy
x Interactive treatment plans used to teach XiO (practice exercises)
x "How To" Procedures
x Pointers to XiO Online Help topics
x References that point to topics discussed in the XiO Reference Library

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Other XiO References
XiO Users Guide - A high level overview of the product for all XiO users that is
shipped with every XiO system.
XiO Getting Started Guide - A workbook provided to students prior to
attending an XiO training class to familiarize them with XiO operations in order
to receive maximum benefit from the course.
XiO Online Help and Reference Library (within the Online Help) - Online
help and documentation are provided with all systems.
Beam Modeling Guide Describes the procedures you use to create beam
models, transfer measured data into XiO, and evaluate computational models for
all algorithms.
CMS Corporate Web Site Our site provides current information available at
your request. The Customer Support area of the CMS Corporate web site
requires an assigned ID and password to enter.
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How to Use This Guide
The XiO Training Guide is organized into groups of tasks for specific types of
treatment plans. It allows you to easily look up related procedures when creating
similar types of plans.

The interactive treatment plan exercises in this guide provide "hands on"
experience with the XiO system whether you are using the plans during
practice exercises while participating in a CMS in-house training session, or in a
training session at your clinic.
CMS has set up a Training Clinic environment on the XiO system so that you can
practice each of the steps for most of the tasks illustrated in this training guide.
When creating a valid treatment plan for your clinic, Do Not use the data shown
in the practice exercises of this guide, or the data shown the Training Clinic
of your XiO system.
Radiation Treatment Planning in XiO
You perform five sequential processes when creating new plans or updating
existing plans. The drop-down menus and icons shown on each XiO window
provide you easy access to the various functions.
Listed below are the five sequential processes you perform when creating a new,
or updating an existing treatment plan. In addition, we have identified the areas
of the system where you perform each of the processes.
1. Selecting a New or Existing Patient (Performed in Patient File
Maintenance)
You can perform the following tasks on the first window that appears after
selecting the Patient File Maintenance option on the XiO Main Window.
x Open an existing patient and create a new studyset
x Open an existing patient and create a new non-image based studyset
for an existing patient
x Create a new patient and studyset

Once you have completed the fields in any one of the above-mentioned
functional activities, XiO begins importing the images for image-based
studysets and opens the contouring window. For non-image based
studysets, you can begin contouring.
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Radiation Treatment Planning in XiO (cont.)
2. Drawing New or Editing Existing Contours (Performed in Patient File
Maintenance)
Contouring in XiO varies depending on the type of treatment plan to which
you are applying the contours. You can create the contours using any of the
following tools:
Tablet When you use the tablet, you must use the tablet keypad controls
to enter points and trace contours.
Mouse You can use the mouse to draw contours selecting any one of the
following XiO tools:

Manual tracing (continuous mode or point mode)
x Auto-by-threshold
x AutoSegmentation
x Auto margin (2-D or 3-D)
x Interpolation


3. Creating or Updating a Plan (Performed in Teletherapy)
x 3D Auto-margin Combine Structures
x Beams (new, edit, mirror, wedge, compensating filter, DRR, bolus,
conform, isocentric group)
x Biology (TCP/NTCP parameters)
x Calculation region
x CAX SPV
x Display volumes
x Dose calculation
x Dose volume histogram
x DRR (add defaults)
x Wedges
x Edit relative electron density
x Interest points and markers (adding or deleting)
x Isocurve
x Printing and Plotting
x Set preferences
x Generate reports
x Rescaling beam weights
x Setup reference definition
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Radiation Treatment Planning in XiO (cont.)
x Studyset comments
x Time/MU
x Treatment Aids
x Treatment templates
x Weight

4. Reviewing the Plan (Performed in Teletherapy)
x Isodose Lines
x Dose Profile
x DVH
x Reports
x Interest point dose
x Source data
x Structure volume
5. Saving the Plan (Performed in Teletherapy)




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XiO Windows
The XiO Main window is the first window you see after you access the XiO
system. It is from this window you gain access to all of the functional areas of
the system.

Clinic
Selection
Drop Down
XiO Main Window













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PFM Window





Window Level Drop-down
Structure and Group
Contour Name Selector
Supportin
g Toolbar
Teletherapy
Tool Bar
W/L Slider Bars
3D
Navigationa
l
Thumbnail
Time/Date and Mouse
Mode
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XiO Teletherapy Window Layout





Window/Level Presets
Drop-down Menus
Active Beam
Teletherapy
Supporting
W/L Slider
Bars


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XiO Teletherapy Window Layout (cont.)



You can divide
the XiO graphics
area into 1, 2, 4, 6,
9, or 12 sub-
windows. There are
two 6-window
options, symmetric
or as displayed
here.
Transvers
BEV
Sagittal
Coronal
DVH MPV-3D
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Using the Computer Keyboard
Computer keyboards are used to enter and edit text and numerical data in XiO.
Keyboards might vary slightly in layout, but all the keyboards used to enter and
edit information in XiO use the same groups of keys. These include:

x Typewriter keys
x Function keys
x Cursor-movement keys
x Keypad keys
Several XiO functions can be activated using alternate keyboard combinations
instead of the mouse.
Computer Keyboard Keys
Use the computer keyboard to enter alphanumeric entries in XiO, for example,
your patients name or studyset description.

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

The Caps Lock key is a toggle-key that, when pressed (and the CAPS LOCK
light in the upper right corner of the keyboard is lit), locks the keyboard so that
uppercase letters are entered without pressing the Shift key. This key has no
effect on the number and punctuation keys.

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

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

The Shift key has two uses:

1. Combined with the computer keyboard keys to enter uppercase letters and
punctuation marks.
2. Combined with the function keys to activate global functions.

Use the Delete key to erase the character following the cursor.
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Using the Computer Keyboard (cont.)
Function Key Shortcuts
The following function key shortcuts apply to Brachytherapy, Irregular Field,
and Source File Maintenance only. For keyboard shortcuts in other modules,
refer to the toolbars described earlier in this section.
x SF1 opens the HELP function
x SF2 begins the RESTART function
x SF3 opens the EDITPLAN function
x SF4 begins the DISPDOSE function
x SF6 opens the SAVE PLAN function
x SF7 initiates the PLOT function
x SF8 initiates the APPROVAL function
x SF9 is the EXIT function
x SF10 does not have an assigned function
x SF11 does not have an assigned function
x SF12 does not have an assigned function
Keyboard Bindings
The following keyboard bindings apply to Patient File Maintenance and
Teletherapy only.
1. One (1) through zero (0) changes the active beam number to beam 1
through 10.
2. Shift F1 through F6 functions the same as selecting Major icons.
3. F1 through F12 functions the same as selecting the Minor icons.
4. Press C while the mouse is in the graphics area to open the Enhance
Contour dialog box.
5. Press B while the mouse is in the graphics area is a shortcut to Beam/Edit
Beam.
6. Pressing P while the mouse is in the graphics area is a short cut to toggle
the patient skin on and off.
7. Press W while the mouse is in the graphics area to open the Window
Format dialog box.
8. Press H while the mouse is in the graphics area to open online help.
9. Press T to turn all beams on or all beams off.
10. Press ~ (tilde) to make all beams inactive.
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Using the Computer Keyboard (cont.)
Cursor-Movement Keys
Use the Arrow Keys to move the cursor or highlight bar. The cursor or highlight
bar moves in the direction of the arrows. Arrow Keys are also called cursor keys
or cursor-movement keys.

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

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

Keypad Keys
The keypad is located at the far right side of your computer keyboard. It is
designed for rapid entry of numerical data.

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

The Num Lock toggle key enables and disables the numeric keypad. When this
key is pressed (and the NUM LOCK light in the right corner of your keyboard is
lit), the keypad functions like a numeric keypad.


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Using the Computer Keyboard (cont.)
Keyboard Shortcuts
Patient File Maintenance Teletherapy

Action Keyboard
Shortcut
Action Keyboard
Shortcut
File Alt + F Accept Enter
Edit Alt + E Acknowledge Ctrl + A
View Alt + V Answer-Help Ctrl + L
Insert Alt + I CANCEL Ctrl + C
Plan Alt + P Done Ctrl + D
Reports Alt + R Help
Local Functions
Ctrl +H or Shift F1
F#, where F# is the
appropriate function key
Graphics Alt + G Next-Field Down Arrow
Help Alt + H Page-Down Ctrl + W
Page-Up Ctrl + U
Prev-Field Up Arrow
Prev-Page Ctrl + R
Print Ctrl + P
Quit Ctrl + Q
Table-Down Ctrl + Down Arrow
Table Enter Keypad Enter
Table-Left Ctrl + Left Arrow
Table-Right Ctrl + Right Arrow
Table-Up Ctrl + Up Arrow

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Using the Computer Keyboard
Keyboard Shortcuts (cont.)
The following keyboard shortcuts apply to Brachytherapy, Irregular Field, and
Source File Maintenance. The first two also apply to Patient File Maintenance and
Teletherapy. All other function key shortcuts are described under the Toolbar heading
described earlier in this section. Using these shortcut key combinations, you can
perform many of the actions more quickly than with the mouse.
Action Keyboard Shortcut

CANCEL Ctrl + C
DONE/OK Ctrl + D
Local Functions F#, where F# is the appropriate function key
Global Functions Shift + F#, where F# is the appropriate function key
Help Shift + F1

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



LINUX

WARNING


Do not press Control+Alt+any other key. The LINUX
operating system uses the Ctrl +Alt+other keys for many other
operating system functions.

XiO 1-15

Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins
Using the Computer Keyboard
Keyboard Shortcuts (cont.)
UNIX

x Do not use the keyboard combination ALT + CONTROL + SHIFT + F1. If you
use this combination, the program exits from the XiO system and returns to the
UNIX window manager.

x Do not alter any UNIX files. Specifically, do not program and use X resource
files from your home directory. If you have any X resource files in your home
directory, they will overwrite XiO X resource files. If you overwrite or alter the
XiO X resource files, your XiO software may suffer irreparable damage, lose or
corrupt data, and/or calculate dose incorrectly.

WARNING

You should never exit XiO using a system break command
(example: Shift + Control + Break, Alt +F3, and Alt + Shift + 1).
A system break command causes the program to immediately
terminate XiO and return to the operating system. This is an
improper shutdown of the XiO system, which may cause data files
to become corrupt. This may cause incorrect dose calculations(s)
to occur, which can cause an incorrect dosage to be administered to
the patient.
1-16
Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins
Using the Mouse
The mouse used in XiO is a three-button mouse or a two-button mouse with a
scroll wheel that can be used as a middle-mouse button when clicked.
x Use the left mouse button to select or drag items on the screen.
x Use the right mouse to display drop-down lists in active fields or
windows.
x Use the middle mouse button or click the scroll wheel in active fields to
view pop-up help information boxes.
Special Cases:

x (3-button or scroll wheel mouse) To movie through images, right mouse
click in any single plane view window and select the movie option with a
left mouse click. Use the left and middle mouse buttons to move
superior and inferior through the images.
x (Scroll wheel mouse- Patient File Maintenance) You can use the scroll
at all times to movie through images.
x (Scroll wheel mouse- Teletherapy) There is a preference that you can set
in Teletherapy so that it is always used to movie, or you can set it so that
it functions as the option selected on a right mouse click. For example, if
you select Scale, the scroll wheel will function to scale the image in the
selected window (see the Preferences section of this training guide for
more information).
System Messages
There are three system message types that display when using XiO.
1. Warnings (designated by a yellow box). These warnings can display
during the following situations:
When there is a potential to incorrectly enter patient, source or
treatment data
When it is possible to enter incorrect data that could cause problems
later
This is what happens after XiO displays the warning:
- The program automatically regenerates data stored for the patient,
plan, or source.
- The program replaces existing data with new data.
XiO 1-17

Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins

System Messages (cont.)
2. Non-Fatal Errors (designated by a green box)
These errors display when data is entered that does not meet the
requirements for that parameter.
This is what happens after the warning displays:
- The software is unable to complete the selected option, function, or
task.
3. Fatal Errors (designated by a red box)
These errors display when there is a software or hardware malfunction.
This is what happens after the warning displays:
- The XiO session is terminated. Write down or print out the entire
error message, then contact customer support.



1-18
Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins

Where Can Help be Found?
Help can be found in many places including within the XiO and Focal
applications, in the Reference Library, or by contacting CMS customer support.
x XiO Help
- Help by Location
- Search
- Index
- Glossary
x Focal Help
- Search
- Index
- Procedures
- Glossary
x Reference Library
- Whats New
- XiO Getting Started Guide
- Featured Discussions
- Technical References
- Algorithm Discussions
- Utilities
x CMS Customer Support
- Software
- Hardware
- Physics

x New Features Training CD
- User Guides
- Training Guides



XiO 1-19

Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins

XiO Conventions

The following list describes some of the most common conventions that are used
throughout the XiO treatment planning system.
x Descriptions are always optional.
x Any ID (patient ID, machine ID, etc.) must consist of alphanumeric
characters only.
x XiO differentiates between capital and lowercase letters. For example,
AP and ap are two different names.
x If you do not place a value in a required field, the field turns red and you
are not able to proceed.
x Middle mouse click in any field to automatically display a menu of
options.




1-20
Things You Should Know before Planning Begins
XiO Training Guide

Things You Should Know before Planning Begins

XiO Coordinate System

XiO uses the following coordinate system.

x X right to left
x Y superior to inferior
x Z anterior to posterior



XiO 1-21

Things You Should Know before Planning Begins
XiO Training Guide

1-22
Things You Should Know before Planning Begins
Unix/Linux Logins

Listed below are the logins and passwords for the XiO systems in the training
classroom.
Login: test Password: cms
Login: root Password: focus1


Help Resources
XiO Training Guide
Help Resources

General Information
You can access the XiO Help from the menu of any XiO window. The type of
help that displays is determined by where you are located in the system when
help is requested. For example, if you are working in a dialog box and you open
Help, XiO displays help for the dialog box in which you are working. If you are
not working in a dialog box, XiO displays the main Help topic window. The
topics are shown in the left frame of this window and are presented in the order
in which XiO is used in a clinical environment.
Documents formerly located on a Reference Library CD can now be accessed in
the Online Help. Click the Reference Library link for additional reference
resources. Topics discussed in the Reference Library area include the following:

x New Features Discussion
x User Guides
x Technical References
x Algorithm Discussions
x Utilities
To assist you in using the XiO Help, there are three tabs for locating specific
information.

x Contents (including the following examples)
- How to procedures
- Definitions
- Examples
- Demonstrations
- Tutorials
x Index
x Glossary
XiO 2-1

Help Resources
XiO Training Guide

Help Resources
XiO Main Help Window

XiO Reference
Library
2-2

Help Resources
XiO Training Guide
Help Resources
XiO Main Help Window (cont.)
Sample Dialog Box Help
When you select XiO Help while working in a dialog box, the help window that
displays is relevant to the dialog box in which you are working. In this example,
Dose Normalization Help Page is illustrated. The help topic describes each
field on the dialog box. Should you elect to view other topics, click any of the
titles on the left panel of this window.


XiO 2-3

Help Resources
XiO Training Guide

Help Resources
XiO Main Help Window (cont.)
Contents Tab
Click a designated Topic book (example, IMRT). XiO Help "opens" this book
and lists the topic titles that relate to IMRT.
Click on a topic title to display the help information associated with the topic
selected.



2-4

Help Resources
XiO Training Guide
Help Resources
XiO Main Help Window (cont.)
Index Tab
The Index tab allows you to scroll to a topic by entering the first letter of a word,
the first few letters of a word, or an entire word. The index scrolls to the index
items that start with the letters you entered.
Click the Index tab. XiO Help displays an alpha table from where you can
make a selection.
Scroll down to the topic you wish to view and click on a topic. In this example,
under the Active keyword, choose the How do I edit a beams weight option.
XiO Help displays the associated information for the topic chosen in the right
panel of the window.


XiO 2-5

Help Resources
XiO Training Guide

Help Resources
XiO Main Help Window (cont.)
Search
1. Click the Search XiO Help option on the Contents tab. XiO Help displays
the Search Help Topics panel allowing you to enter a word or a phrase for a
search.


2. Enter a word or a phrase. Example, How do I edit a beam?
3. Click the Search button. XiO Help displays a Search Results window with
link(s) to the requested information.
2-6

Help Resources
XiO Training Guide
Help Resources
XiO Main Help Window
Search (cont.)


4. Click the How do I edit a beam? link. XiO Help displays the corresponding
window.
XiO 2-7


Help Resources
XiO Training Guide

Help Resources
XiO Main Help Window (cont.)
Finding "How To" Procedures for a Specific Task
When you open any one of the books under the Contents tabs in the left-panel of
the XiO Online Help window, the system displays a list of sub-topic books,
various sub-topics, and the "How To" procedures for the tasks related to the book
you opened.
This exercise walks you through the basic steps of accessing a set of "How To"
procedures for a specific topic.
1. Select the Compensators topic on the left panel of the Help window.
XiO Help displays two sub-topic books.
2. Click on the Filters book. XiO displays a list of all the topics related to
Filters including the various "How To" procedures.
3. Click on the How Do I (step-by-step procedures) book. XiO displays
an additional list of all the "How Do I" procedures related to Filters.

4. Repeat this process for each Contents book where you want to locate
specific "How Do I" procedures.

-
2-8

Help Resources
XiO Training Guide
Help Resources
XiO Main Help Window (cont.)
Print a Screen in XiO Help
1. Click your mouse pointer on the frame you want to print. Where you place
your mouse pointer determines the frame that prints.
2. Click the File drop-down menu and select the Print option.

OR

Click the Print icon on your browser toolbar.


3. Follow the instructions on your browsers print window.


XiO 2-9

Help Resources
XiO Training Guide

Help Resources
XiO Main Help Window (cont.)
Print a Page or Frame in XiO Help
4. Should you elect to print a specific frame in a new window, click your mouse
pointer on the frame, click your right mouse button and select the This
Frame and Show Only This Frame options. The frame redisplays without
the help topics displaying to the left of the window.


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

OR

Click the Print icon.

2-10

Help Resources
XiO Training Guide
Help Resources

Additional Help Resources
Phone Support
If you have questions that the published and online resources do not answer,
please contact the CMS Customer Support team for assistance.
North America, Central America, and South America
Hours: 7:30 am to 6:30 am Central Time (US), Monday through Friday
Phone: 1 (800) 878-4CMS (4267)

Europe and Africa
Hours: 08:00 to 17:00 Middle European Time, Monday through Friday
Phone: +49-761-88188-0
Asia, Australia, China, and New Zealand
Hours: 8:00am to 5:00pm Shanghai Time, Monday through Friday
Phone: +86-215058-1041
Japan
Hours: 8:00am to 5:00pm Toyko Time, Monday through Friday
Phone: +81-3-3556-5391


XiO 2-11

Help Resources
XiO Training Guide

Help Resources
Additional Help Resources (cont.)
Beam Modeling
A Beam Modeling Guide is sent out with each XiO Release. This guide is
available on CD-ROM and can be accessed online via the CMS web site.
The Beam Modeling Guide covers the following topics:
x Introduction
x Getting Started
x Data Collection
x Physics Data
x Create New Machine
x Treatment Aids
x Non-Scan Data
x Data Transfer
x Display/Output
x Clarkson
x FFT Conv/Super
x Pencil
x Beam
x Delete Data
x Validation
x Focus XiO
x IMRT
x Libraries
- List of Documents, Tables,
Worksheets
x RTPS QA


2-12

Help Resources
XiO Training Guide
Help Resources
Additional Help Resources (cont.)
Online User Access
1. Go to the CMS web page www.cms-stl.com.
2. Click the Support drop-down menu an select the User Access option.
3. Enter your CCR in the User Name field.
4. Enter your password (either focus or focus 1) unless your site has
requested it to be changed.
5. Click OK to display the User Access window. On this window, you
have access to the following information:
x CMS Beam Modeling Guide
x Frequently Asked Questions (FAQs)
x Errata Reports
x Summary of Changes
x Training Guides
x Hours of Operation
x Other Publications
x Demos
x Presentations


XiO 2-13









Settings
XiO Training Guide

Settings
Overview
The Settings drop-down menu shown on the main XiO window is where you set
general preferences for your XiO system. In addition, you can set textual and
numeric field values, the color and appearance of graphic objects on the window
and on the plots, and enable/disable other features.
The preferences set in Settings apply to all the treatment plans you create in a
specific clinic or in a group of clinics. The changes to the preferences you make
apply only to patients started or created after the change. All preferences remain
the same until you again access them from the Settings area of the system and
change the preferences for future use. You can access the Settings options at any
time to make changes, except during a back-up utility process.
Settings is also used to set up the XiO security system to prevent unauthorized
access to patient, source, and Settings data. Access to each option listed in the
Settings menu is determined by the authorization status entered for each user
through the User Authorization option. If you cannot select one of the options
listed in the Settings drop-down menu, it may be because you have not been
granted access to the option. Contact your system administrator for more
information about gaining access to the option.
XiO 3-1
Settings
XiO Training Guide

Settings
Practice Exercise
In this exercise, you will complete the procedures for each of the options (tasks)
listed on the Settings drop-down menu located on the XiO Main Menu window.
Task 1. Selecting a Clinic
There are instances when a clinician supports more than one clinic. If this
scenario applies to you, before performing any Settings activities, be sure to
select the correct clinic for the Settings preferences or default values you are
about to establish.
1. Click the drop-down arrow in the Clinic field on the XiO main window
and select XiO Training data. XiO loads the data options for this clinic.


The tasks in this lesson are presented in the same order as they appear on the
drop-down menu. After completing the training exercise, you can perform the
tasks in any order you choose.
3-2

Settings
XiO Training Guide

Settings
Installation
Task 1. User Authorization
This function allows you to set a users level of access to functions in XiO. To
access this function, you must have administrator rights.
1. Click the Settings drop-down menu and select the Installation and User
Authorization options. XiO displays the System User Access Preferences
dialog box.


2. Next to each Login Name in the Admin, Physics, Treatment Planner, and
Plan Approval fields, respond "Yes" or "No." If yes is selected in Plan
Approval, you are required to enter an additional login and password to be
used for plan approval.
3. Click OK. XiO sets the security-level access in accordance to your
responses in step 2.
4. Click CANCEL to close the dialog box.
XiO 3-3
Settings
XiO Training Guide

Settings
Installation (cont.)
Task 2. Hospital/Clinic
This option allows you to add a clinic and set date formats.
1. Click the Settings drop-down menu and select the Installation and
Hospital/Clinic options. XiO displays the Define Hospitals/Clinics dialog
box.


2. Enter the Hospital/Clinic Name for each hospital/clinic that you support.
You can define up to nine (9) names on this page. Each name can contain
up to 24 characters and must be unique. If you need to enter more names,
click the More button.
3. To delete a clinic, enter blank spaces.
4. Click your middle mouse button and select a Disk Name on which the
data for the hospital or clinic will physically reside.
NOTE: If your hospital/clinic names were previously defined, the
defaults are the disk names entered with these hospital/clinics.
You cannot change these defined disk names unless you first
delete; then, re-enter the hospital/clinic name.
5. Click OK. XiO adds the system defaults.
3-4

Settings
XiO Training Guide

Settings
Installation (cont.)
Task 3. Date Format

1. Click the Settings drop-down menu and select Installation and Date
Format options. XiO displays the Default Date Format dialog box.


2. Click your middle mouse button in the format field and select a Date
Format.
3. Click the drop-down arrow in the Separator field and select a separator
character you wish to appear between the month, day, and year parts of the
date.
4. Edit the month abbreviations for your XiO system. The month names
must be exactly three characters long and begin with a capital letter.
5. Click OK. XiO sets the date formats entered.
XiO 3-5
Settings
XiO Training Guide

Settings
Installation (cont.)
Task 4. Language
The Language option is used to select a desired language in which you wish to
have prompts presented in on the windows. At this time, English is the only
option.
1. Click the Settings drop-down menu and select Installation and Language
options. XiO displays the Default Language dialog box.


2. Click your middle mouse button and select the language in which to
display the prompts.
3. Click OK. XiO saves your language selection.
3-6

Settings
XiO Training Guide

Settings
Installation (cont.)
Task 5. GCD Model
The Graphics Control Device (spaceball) controls the graphics in the windows.
You can use the spaceball in Irregular Field and Brachytherapy. The GCD
Model option is used to set the sensitivity of the graphic control device.
1. Click the Settings drop-down menu and select Installation and GCD
Model options. XiO displays the GCD Model dialog box.

2. Click the drop-down arrow in the GCD Model Number field and select the
GCD Model label that best describes the model number of your GCD.
The model number of your GCD can be found on the bottom of your
GCD.
3. Enter the Rotational Sensitivity of the GCD. This value may be any
number from 1 to 10000, where 1 is most sensitive, and 10000 is least
sensitive, in steps of 1. This value has no units.
4. Click OK. XiO adds your entries.
XiO 3-7
Settings
XiO Training Guide

Settings
Installation (cont.)
Task 6. Transfer Data to FOCAL PC
To initiate this task, you will need the IP address of the PC to where you want to
transfer data.
1. Click the Settings drop-down menu and select the Installation and
Transfer Data to Focal PC options. XiO displays the Focal Data
Transfer Defaults dialog box.

2. Enter a Server ID Name.
3. Enter the IP Address to where you want to transfer the XiO data.
4. Click the Add IP Address button. XiO adds the address to the list of IP
addresses located in XiO.
5. To add additional IP addresses, complete steps 2 through 4.
6. Click CANCEL to close the dialog box.
3-8

Settings
XiO Training Guide

Settings
Workstation
Task 1. Backup Utility
XiO allows weekly or daily automatic backups. CMS recommends that you back
up your data on a regular basis. In order to do a successful backup, you must
adhere to the following conditions:
x The XiO computer, printer, and tape drive must be on for the backup to
start.
x Files cannot be in use during a backup. Should any files be in use, the
backup will stop at files that are in use and wait for them to be free
before continuing.
x Do not have two computers backing up the same clinics at the same time.
x No one can be running XiO on any workstation during the backup
process.
x The main workstation must be logged into the UNIX or Linux system for
the backup to work properly.
1. Click the Settings drop-down menu and select the Workstation and
Backup Utility options. XiO displays the System Archive dialog box.

2. Click your middle mouse button in the Backup Option: field and select
Disable or Automatic. When you select Automatic, XiO displays a
System Archive dialog box.
3. Click the drop-down arrow in the Frequency: field and select the
frequency (daily or weekly). This field displays only if Backup Option: is
set to "automatic."
XiO 3-9
Settings
XiO Training Guide

Settings
Workstation
Task 1. Backup Utility (cont.)
4. Enter the Start Time in HH:MM 24-hour military format that you want
the backups performed. This field displays only if Backup option: is set to
"automatic."
5. Click your middle mouse button in the Start Day: field and select a day of
the week you want to perform the backups. This field displays only if
Backup Option: is set to "automatic" and Schedule: is set to "weekly."
6. Click the XiO Demo-only data button if you do not want the changes to
affect the demo data only. This field defaults to "Yes."
7. Click the OK button. XiO updates the backup utility with your updates
and closes the dialog box.
Task 2: Printers
This setting allows you to setup default printers/plotters for outputs per user.
You also have printing options that include printing to printers/plotters, printing
to a file or printing to PDF. Printing to multiple destinations is available on
Linux only.
1. Click the Settings drop-down menu and select Workstation, then
Printers to open the Printers dialog box.

NOTE: The printers that are already setup in your clinic will display by
default. If you would like to add additional printers, please
contact Systems Support.
3-10

Settings
XiO Training Guide

Settings

Workstation
Task 2: Printers (cont.)
2. Next to each available printer, select a Model from the drop-down list.
3. Select Yes or No to each printing type if you want that printer to be
available for that type of print request.
4. Select the default Output Device from the drop-down menu. The options
are Printer/Plotter, Postscript File, or PDF File. Whenever you print, this
will be the type of output that is printed.
NOTE: If you want to change the output device to where you are
printing, you must return to this page and change the output
device to the desired type.
5. Identify the Printer that will be used for each type of print request by
clicking your right mouse button in the Printer, Plotter and Screen Capture
Printer fields, and selecting a printer from the list.
NOTE: If you select Postscript File or PDF File as the default Output
Device, these printer options will be ignored.
6. Click OK to accept these defaults, or Cancel to reject them and close the
dialog box.
Data Locations for PDF and Postscript Print
The data location for the PDF Print File is:
/FOCUS/tmp/network/pdf_output/<patient ID>.
The data location for the Postscript Print can be one of the following locations.
If you saved the plan then printed the Postscript File, the location is as follows:
/FOCUS/rtp<#>/<clinic #>/patient/<patient ID>/plan/<plan ID>hard_copy.
If you printed before you saved the plan, the print request will be attached to the
current temporary plan number: /FOCUS/rtp<#>/clinic<#>/temp/<temp
plan#>/hard_copy.


XiO 3-11
Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 3. CT Interfaces
1. Click the Settings drop-down menu and select the Workstation and CT
Interfaces options. XiO displays the Add/Delete CT Interfaces dialog
box.

2. Respond "On" or "Off " in the Mfr/Model field. To toggle the availability
setting (either "On" or "Off"), simply click the appropriate choice in this
column.
3. Click OK. XiO saves your changes and closes the dialog box.
3-12

Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 4. MRI Interfaces

1. Click the Settings drop-down menu and select the Workstation and MRI
Interfaces options. XiO displays the Add/Delete MRI Interfaces dialog
box.

2. Respond "On" or "Off " in the Mfr/Model field. To toggle the availability
setting (either "On" or "Off"), simply click the appropriate choice in this
column.
3. Click OK. XiO updates your changes and closes the dialog box.

XiO 3-13
Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 5. SC Interfaces

1. Click the Settings drop-down menu and select the Workstation and SC
Interfaces options. XiO displays the Add/Delete Secondary Capture
Interfaces dialog box.

2. Click the DICOM3SC button to enable the SC Interfaces to an "On"
position. To toggle the availability setting to "Off," click the DICOM3SC
button again. This field defaults to "Off."
3. Click OK. XiO updates your changes and closes the dialog box.

3-14

Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 6. PET Interfaces

1. Click the Settings drop-down menu and select the Workstation and PET
Interfaces options. XiO displays the Add/Delete PET Interfaces dialog
box.

2. Click the DICOM3PT button to enable the PET interface to an "On"
position. To toggle the availability setting to "Off," click the DICOM3PT
button again. This field defaults to "Off."
3. Click OK. XiO updates your interface setting and closes the dialog box.
XiO 3-15
Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 7. Nuclear Medicine Interfaces
1. Click the Settings drop-down menu and select the Workstation and
Add/Delete Nuclear Medicine Interfaces options. XiO Displays the
Add/Delete Nuclear Medicine Interfaces dialog box.

2. Click the DICOM3PT button to enable the PET interface to an "On"
position. To toggle the availability setting to "Off," click the DICOM3PT
button again. This field defaults to "Off."
3. Click OK. XiO updates your interface setting and closes the dialog box.
3-16

Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 8. Ultrasound Interfaces
1. Click the Settings drop-down menu and select the Workstation and
Ultrasound Interfaces options. XiO displays the Add/Delete Ultrasound
Interfaces dialog box.






2. Click the DICOM3US button to turn the importing of images capability to
an "On" position. The default of this option is "Off."
3. Click OK.
XiO 3-17
Settings
XiO Training Guide

Settings
Workstation (cont.)
Task 9. DICOM Settings
This dialog box allows you to specify workstation-specific parameters for
DICOM communication between XiO and other computers. For more
information regarding these settings, search the XiO Online Help for DICOM
Settings.
1. Click the Settings drop-down menu and select the Workstation and
DICOM Settings options. XiO displays the DICOM Settings dialog box.
2. Enter up to 5 Remote DICOM hosts Storage Class Provider Information.
(Obtain this information from the remote systems vendor.)
3. Enter the local Application Entity Title.
4. Click OK.

3-18

Settings
XiO Training Guide

Settings

Clinic
Task 1. Data Compression
1. Click the Settings drop-down menu and select the Clinic and Data
Compression options. XiO displays the Clinic Data Compression dialog
box.
2. Click the Data Compression button to an "On" position to store all data
created in the clinic in the compressed format.

OR

Click to an "Off" position to store all new data created in the clinic in the
uncompressed format.
NOTE: Compressing data may increase the amount of available storage
space on your XiO system.
3. Click the drop-down arrow in the Set Clinic Data to Selected Compression
Status?: field, and select Yes to update the clinics existing data to the
selected compression status.

OR

Click NO to keep the clinics data in its current compression status.
4. Click OK.

XiO 3-19
Settings
XiO Training Guide

Settings

Clinic (cont.)
Task 2. User Interfaces Preferences
This function allows you to set mouse movement characteristics for the global
function buttons in Irregular Field and Brachy functions.
1. Click the Settings drop-down menu and select the Clinic and User
Interface Preferences options. XiO displays the User Interface
Preferences dialog box.

2. In the Height and Depth of Buttons category, enter the integer for each
field. Refer to the XiO Online Help for definitions of each.
3. In the Automatic Movement of the Mouse Pointer category, select the
desired response "on" or "off" for each field. Go to the XiO Online Help
for definitions of each field.
4. In the Tool Tip Display category, select "on" to turn the tool on, or "off"
to turn the tool off. This field defaults to "off."
5. Click OK. XiO adds your User Preferences to the system.
3-20

Settings
XiO Training Guide

Settings

Clinic (cont.)
Task 3. Scanner/LMS Definition
Use this option to enter and edit CT scanner and laser marking system
information. This information is required if you want to use the XiO Setup
Reference Definition feature to determine shifts from reference locations to the
isocenter. It is also required if you want to see the scouts you send from the CT
in Patient File Maintenance.
1. Click the Settings drop-down menu and select the Clinic and
Scanner/LMS Definitions options. XiO displays the Scanner/LMS
Defaults dialog box.

2. Enter a new Scanner ID, or click your middle mouse button and select a
scanner ID from the list. All the attributes and settings you declare for
the scanner will be stored with this scanner ID. There is no default. This
field cannot be blank.
3. Enter the Description of the scanner. This can be any descriptive text, up
to 19 characters. If you have more than one scanner in your clinic, we
recommend that you enter a description. (Default: Optional; can be
blank.)
XiO 3-21
Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
4. Click the Use as the default scanner button. Valid responses depend on
the current scanner default. XiO requires that you always have a default
scanner assigned.
NOTES: If your clinic has multiple scanners defined in XiO, you can
redefine the default scanner at any time as long as you
always have one default scanner identified.

If no other scanners are defined for this clinic, XiO defaults
to "Yes" and the field cannot be changed.

If a default scanner already exists, this field is set to "No"
automatically. You can edit this field to "Yes" if you want to
change the default scanner to be the one you are currently
defining.
5. Click OK. XiO displays the Scout Image Viewing Data window.

6. Enter the Scanner source to center of scan ring distance (cm). This
value should be available through your CT vendor; also, DICOM 3.0 data
for some scanners contains this information.
3-22

Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
7. Enter the Source to scout image projection distance (cm). XiO models
scout images as if they are projected to a flat plane; this provides a good
approximation even in cases where these images are not projected to a flat
plane. Scanning a well-designed phantom should allow you to calculate
this value directly using geometrical considerations.

8. To get started quickly, enter a number close to (usually a bit larger) than
the source-to-center of the scan-ring value. You can tailor this number
until your contours appear to be projected correctly on the scouts in XiO.
9. Click the drop-down arrow and select a position (left or right) for lateral
scouts. This value (left/right) will be the location of the source as viewed
from the end of the CT couch facing the CT gantry. This value is needed
to map divergence correctly in graphics.
NOTE: If this field is left blank, XiO displays the scout image with no
amendments.
XiO 3-23
Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
10. Click the drop-down arrow and make a selection (above or below) to enter
the source position when scanning "AP" scouts. This value
(above/below) is the location of the source relative to the CT couch. You
need this value to map divergence correctly in graphics. XiO will call
these AP scouts. Keep in mind that some scanners move their source
below the couch, thus producing a PA scout.
11. Click OK. XiO displays the Scout Image Viewing Orientation dialog box.


3-24

Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
12. Click your middle mouse button and select the orientation that describes
how scout images should appear for each orientation. The following
examples should assist you with your decisions.


Lateral Scout Viewing Orientations
AP/PA Scout Viewing Orientations









XiO 3-25
Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
13. Click OK. XiO displays the Scanner/LMS Capabilities Data dialog box.

14. Click the drop-down arrow and select how the shifts will be performed (by
moving the couch or moving the lasers).
15. Enter the Calibration distance from center of scan ring to origin of
LMS (cm). This is the longitudinal distance from the center of the scan
ring to the origin of your LMS. This response particularly pertains to
externally mounted lasers.
NOTE: This assumes your LMS origin is aligned to the center of your
scan ring, offset by this constant amount.
16. Click the drop-down arrow and select the Units used for LMS readouts.
17. Click the drop-down arrow and select the Units used for couch position
readouts.
18. Click the drop-down arrow and select the LMS type for this scanner.
3-26

Settings
XiO Training Guide

Settings

Clinic
Task 3. Scanner/LMS Definition (cont.)
19. Click OK. XiO displays the LMS/Couch Limits Data dialog box.

20. Enter the LMS/Couch Leftmost reading (cm). Take this reading facing
the CT Gantry looking from the foot of the couch.
21. Enter the LMS/Couch Rightmost reading (cm). Take this reading facing
the CT Gantry looking from the foot of the couch.
22. Enter the Couch height movement limits Readout in highest pos. (cm).
23. Enter the Couch height movement limits Readout in lowest pos. (cm).
24. Click the drop-down arrow in the Do couch position readings increase or
decrease as the couch moves towards the gantry: field and select
Increases or Decreases.
25. Click OK. XiO returns you to the initial Scanner/LMS Defaults dialog
box.
26. Click CANCEL to close the dialog box.
XiO 3-27
Settings
XiO Training Guide

Settings

Patient Data
Task 1. General Anatomical Site
The General anatomical site is where you define the patient, tumor, and target
volume defaults.
1. Click the Settings drop-down menu and select the Patient Data and
General Anatomical Sites options. XiO displays the General Anatomical
Structure Descriptions dialog box.

2. The Pat field defaults to patient. Patient is an automatic field that has to
be defined in XiO. This classification structure has to exist.
3-28

Settings
XiO Training Guide

Settings

Patient Data
Task 1. General Anatomical Site (cont.)
3. Enter the default Rel Elec Dens (relative electron density, relative to
water) to be used for each anatomical structure description. The
acceptable range is 0.00 to 15.00, inclusive, in steps of 0.01. Blank is a
valid answer.
WARNING

x You must verify that the entered relative electron
density data is correct. If you do not, you may
be using incorrect data that may cause an
incorrect dose calculation to occur, causing an
incorrect dosage to be administered to the
patient.
x Do not assign a high relative electron density to
an individual contour for use as a block.
Contours used in this manner (i.e., for
unintended purposes) may cause an incorrect
dose calculation to occur, which may cause an
incorrect dosage to be administered to the
patient.

4. Click your middle mouse button and select the default Video Display
Color for the anatomical structure. The default value is the assigned
display color for the structure.
5. Click your middle mouse button and select the Video Display Rnd
(rendering) for the anatomical structure. The default is W or Wireframe.
Go to XiO Online Help for supporting information.
NOTE: If you assign an internal anatomical structure name Patient,
XiO will not allow you to place beams for this patient. You
must return to Patient File Maintenance and give the patient
contour a patient classification structure name. XiO ignores
any internal structure located outside of the patient contour.
6. Click your middle mouse button and select Yes or No to the Video
Display Color Fill. This option fills the selected structure with the
associated rendering on transverse, sagittal, and coronal images.
7. Click the OK button. XiO displays the General Anatomical Structure
Printer Output Preferences dialog box.
XiO 3-29
Settings
XiO Training Guide

Settings
Patient Data
Task 1. General Anatomical Site (cont.)

8. Enter the Line Type Number that will draw each associated item. Line
type options are listed in XiO Help.
9. Click your middle mouse button and select the desired Fill-Type that will
fill the object. Blank defaults to No Fill. Go to the XiO Online Help for
supporting information.
10. If you specified a fill type of HAT or CHAT, the fill angle choice
determines the angle of the hatched or crosshatched lines.
NOTE: The fill angle is 45 degrees unless you specify otherwise. If
this field is left blank, the fill type is none.
The angle, from 0 degrees to 180 degrees in steps of 1 degree, is reference
counter-clockwise from the positive direction of the X-axis where +X=0
degrees, and X=180 degrees.
11. Click the OK button. XiO adds the anatomical site. These values now
determine the structures name and the display for the selected clinic.

3-30

Settings
XiO Training Guide

Settings
Patient Data (cont.)
Task 2. Specific Anatomical Sites
The Specific anatomical site is where you define and edit a pre-defined
anatomical site default under the class internal structures.
1. Click the Settings drop-down menu and select the Patient Data and
Specific Anatomical Sites options. XiO displays the Enter/Edit Specific
Anatomical Site dialog box.

2. Click your middle mouse button and select the specific anatomical site
you want to edit, or Enter the name of a new site to add it (i.e., the group
name of the contours).
3 Click OK. XiO displays the Enter/Edit Specific Anatomical Structures
Names dialog box.
XiO 3-31
Settings
XiO Training Guide

Settings
Patient Data
Task 2. Specific Anatomical Sites (cont.)

3. Enter a new Anatomical Structure Name or edit an existing name.
3-32

Settings
XiO Training Guide

Settings
Patient Data
Task 2. Specific Anatomical Sites (cont.)
4. Enter or edit the default Rel Elec Dens (relative electron density, relative
to water) to be used for each structure. The acceptable range is 0.00 to
15.00, inclusive, in steps of 0.01. The precision is 0.01. The system
defaults to 1.00.
WARNINGS

You must verify that the entered relative
electron density data is correct. If you do not,
you may be using incorrect data that may cause
an incorrect dose calculation to occur, causing
an incorrect dosage to be administered to the
patient.
Do not assign a high relative electron density
to an individual contour for use as a block.
Contours used in this manner (i.e., for
untended purposes) may cause an incorrect
dose calculation to occur, which may cause an
incorrect dosage to be administered to the
patient.

5. Click the drop-down arrow in the Color field and select the desired color
for the anatomical structure.
6. Click the drop-down arrow in the Rnd field and select the desired
rendering for the anatomical structure. The default is "W" (Wireframe) if
there is no current rendering style already set.
7. Click your middle mouse button and select Yes or No to the Video
Display Color Fill. This option fills the selected structure with the
associated rendering on transverse, sagittal, and coronal images.
8. Click the OK button. XiO displays the Specific Anatomical Structure
Printer Output Preferences dialog box.
XiO 3-33
Settings
XiO Training Guide

Settings
Patient Data
Task 2. Specific Anatomical Sites (cont.)

9. Click OK again. XiO processes your anatomical structure specific entries.
The values now determine the structures name and their display for the
selected clinic.
3-34

Settings
XiO Training Guide

Settings
Patient Data (cont.)
Task 3. CT to Rel Elec Dens Files
Before performing this task, you must know the Manufacture/Model ID used for
CT image import.
1. Click the Settings drop-down menu and select the Patient Data and CT
to Rel Elec Dens. Files options. XiO displays the Enter/Edit CT to
Relative Electron Density File dialog box.

2. Click your middle mouse button in the Mfr/Model ID field and make a
selection from the list.
3. Enter a File ID to name the CT to ED file.

OR

Click your middle mouse button in the File ID field and make a selection
from the list.
4. Click OK. XiO displays the CT Number Assignment dialog box.
XiO 3-35
Settings
XiO Training Guide

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

5. Enter the CT Numbers for which relative electron densities will be
assigned.
6. Click OK. XiO displays the CT to Rel Elect Dens File Data Entry dialog
box in addition to the CT to ED Number to Relative Electron Density
Mapping chart.
7. Enter the Relative Electron Density Numbers that correspond with the
entered CT numbers.


3-36

Settings
XiO Training Guide

Settings
Patient Data
Task 3. CT to Rel Elec Dens Files (cont.)
WARNINGS

You must verify that the correct CT-to-relative
electron density file is specified for the selected
CT interface. If you do not, you may use incorrect
data that may cause an incorrect dosage to be
administered to the patient.
You must verify that the entered relative electron
density data is correct. If you do not, you may use
incorrect data that may cause an incorrect dose
calculation to occur, causing an incorrect dosage
to be administered to the patient.


8. Click OK. XiO returns you to the Enter/Edit CT to Relative Electron
Density File dialog box.
9. Click Cancel.
XiO 3-37
Settings
XiO Training Guide

Settings
Patient Data (cont.)
Task 4. Prostate Template
Use this option to create a prostate template for prostate seed preplanning.
1. Click the Settings drop-down menu and select the Patient Data and
Prostate Template options. XiO displays the Default Prostate Template
dialog box.

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


3-38

Settings
XiO Training Guide

Settings
Patient Data
Task 4. Prostate Template (cont.)
4. Enter the Row Spacing of the template. The acceptable range is 0.1 to 1.0
cm in steps of 0.01.
5. Enter the Number of Columns. The acceptable range is 2 to 100 in steps
of 1.
6. Enter the Number of Rows. The acceptable range is 2 to 100 in steps of
1.
7. Click OK. XiO displays the Prostate Template Column Labels dialog
box.

8. Enter the Column Label identifier. Column labels 1 through 13 run from
the left to the right of the template. This identifier is used during
placement of needles during treatment.
9. Click OK. XiO displays the Prostate Template Row Labels dialog box.


XiO 3-39
Settings
XiO Training Guide

Settings
Patient Data
Task 4. Prostate Template (cont.)
10. Enter the Row Labels. Row labels run from the bottom to the top of the
template.

11. Click OK. XiO returns you to the Default Prostate Template dialog
window.
12. Click CANCEL to close the dialog box.
3-40

Settings
XiO Training Guide

Settings
Patient Data (cont.)
Sample Template




XiO 3-41
Settings
XiO Training Guide

Settings
Plan Defaults
Task 1. Brachytherapy Drawing
Use this option to define the default guide radius and sample spacing for
contouring and port (MLC, block, or aperture) drawing.
1. Click the Settings drop-down menu and select Plan Defaults and
Brachytherapy Drawing options. XiO displays the Drawing Defaults
window.

2. In the Contour Entry Mouse sample spacing field, enter the value for the
distance between mouse sample points.
3. In the Contour Entry Mouse guide radius field, enter the value for the
radius of the guide circle.
4. Click OK. XiO saves these drawing default values for the selected clinic.

3-42

Settings
XiO Training Guide

Settings
Plan Defaults (cont.)
Task 2. Calculation Defaults
Use this option to set default grid spacing, default algorithms, AND
normalization options as well as other miscellaneous defaults.
Sub-task 1. Teletherapy
1. Click the Settings drop-down menu and select the Plan Defaults,
Calculation, and Teletherapy options. XiO displays the Teletherapy
Calculation dialog box.

2. Enter Yes or No for Heterogeneity Correction to be applied to all patients
by default.
3. Enter Yes or No for Pixel by Pixel Calculation to be used as the default
heterogeneity correction method.
4. Enter the width, height, and depth (cm) for the calculation region grid
spacing.
5. Click your middle mouse button and select a default algorithm for
photons.
XiO 3-43
Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults
Sub-task 1. Teletherapy (cont.)
6. Click your middle mouse button and select a default algorithm for proton
(if applicable).
7. Click the drop-down arrow in the Beam Weight Mode: field and select a
Beam weighting mode.
NOTE: Absolute Dose/MU mode allows you to enter daily, total or
relative doses for planning. Each beams weight point is its
dose prescription point; therefore, it is possible to create
composite plans when this mode is selected. In Absolute
Dose/MU mode you can weight beams to weight points or
enter monitor unit values to obtain weight. You also have
more flexibility and options for normalization. IMRT
functionality is only available when Absolute Dose/MU mode
is selected.

Relative dose mode is more limiting. None of the options
listed above for Absolute Dose/MU mode are available in
relative dose mode. There can also be some confusion when
determining the blocked, wedged and bolused normalization
when Relative Dose mode is selected. In Settings, you have
the option of setting the normalization for blocks, wedges, and
bolus. If the normalization is set to open for these beam
modifiers, the beam modifiers will not be recognized in the
dose calculation. For example, if a block is placed on a field
and it blocks the weight point, there will be no block factor
incorporated when the dose to the weight point is determined.
Therefore, the monitor units will not be accurate.
8. Click the drop-down arrow and select a Wedge Normalization.
NOTE: If you select the "Both" option for either the Wedge or Bolus
Normalization method, you must then select a default method
between the two methods.
9. Click the drop-down arrow and select a Bolus Normalization method(s).
3-44

Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults
Sub-task 1. Teletherapy (cont.)
10. Click the drop-down arrow and select a Port/MLC Normalization.
NOTES: Steps 7 through 9 only apply if you are using Relative Dose
mode.

If you select the "Both" option, you must then select a default
between the two options.
11. Click the drop-down arrow and select the Dose Units in cGy or Gy.
Weight Point field edge warning distance.
XiO warns you if the weight point location exceeds these checks.
12. Enter the Smallest collimator opening to check (cm).
13. Enter the Distance from the field edge (cm).
XiO 3-45
Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults
Sub-task 1. Teletherapy (cont.)
14. If you are performing either IMRT or using compensators, click the
Intensity Modulated QA Parameters button. XiO displays the Intensity
Modulation QA Parameters dialog box.

15. Enter the default QA Measurement SSD (source to skin).
16. Enter the default QA measurement for depth (how deep you will take the
measurement in the phantom).
17. Click your middle mouse button and select a default Phantom material.
18. Enter the Phantom rel. electron density number. The acceptable range is
0.8 to 1.2 in steps of 0.1.
3-46

Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults
Sub-task 1. Teletherapy (cont.)
19. Set the Calculate QA output. "Yes" automatically calculates the QA
output for every compensator-based or IMRT beam. "No" sets the default
to no, but allows you to manually turn the answer to "Yes" for each beam
individually.
WARNING A "Yes" response increases the calculation time. XiO
calculates the patient beam and the beam on the QA
phantom

20. Click OK. XiO sets your default intensity modulated and QA parameters
to the values for the selected clinic, returns you to the Teletherapy
Calculations Default dialog box, and saves your changes.
21. Click OK to close the dialog box.
XiO 3-47
Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults (cont.)
Sub-task 2. Brachytherapy General Parameters
1. Click the Settings drop-down menu and select the Plan Defaults,
Calculation Defaults, Brachytherapy, and General Parameters options.
XiO displays the Brachytherapy Calculation Defaults dialog box.

2. Select an Entry Device (keyboard or tablet).
3. Click the drop-down arrow and select a Reconstruction Algorithm.
Refer to the XiO Online Help for detailed field definitions.
4. Set the film magnification parameters. The acceptable range is 1.00 to
5.00 in steps of 0.01 for each field.
3-48

Settings
XiO Training Guide

Settings
Plan Defaults
Task 2. Calculation Defaults
Subtask 2. Brachytherapy General Parameters (cont.)
5. Click the drop-down arrow and select an Error Detection Type.
NOTE: The entry you select in this field determines if both the
physical length threshold and coordinate threshold fields
appear on the dialog box.

The physical length values are 0.00 to 10000.00 in steps of
0.01.

The coordinate threshold values are 0.00 to 100.00 in steps of
0.01.
6. Click the drop-down arrow and select a Calculation Volume Method.
7. If you select explicitly defined, enter the Height, Width, and Depth
default values.
8. Select Dose Units.
9. Click OK. XiO sets your general default parameters and closes the dialog
box for the selected clinic.
XiO 3-49
Settings
XiO Training Guide

Settings
Plan Defaults
Task 3. DRR Calculation Defaults
1. Click the Settings drop-down menu and select the Plan Defaults and
DRR Calculation Defaults options. XiO displays the DRR Calculation
Defaults dialog box.

2. Enter the Low and High (minimum and maximum) ED (electron density)
values for the filter defaults.

Wide Range is 0.0 to 20.0 (ED).
Bone Range is 1.5 to 20.0 (ED)
Tissue Range is 0.0 to 1.5 (ED).
Comb Range is 0.0 to 20.0 (ED).
Range Range is 0.0 to 20.0 (ED).

Refer to the XiO Online Help for additional field information.
3-50

Settings
XiO Training Guide

Settings
Plan Defaults
Task 3. DRR Calculation Defaults (cont.)
3. Enter "Yes" in the Film Printer field if the DRRs are to be sent to a film
printer/DICOM compatible printer. Enter "No" if they are not.
4. Click the drop-down arrow and select the Bit Format.
16 = 16-bit format (default)
8-BE = 8-bit big endian format
8-LE = 8-bit little endian format
5. Enter the Host Name.
NOTE: If you entered "Yes" in the film printer field, you must enter the
network host name in this field. The name entered must match
the host name assigned by the system administrator and be
listed in the etc/hosts file.
6. Enter the Port number.
NOTE: If you entered "Yes" in the film printer field, you must enter the
port number of the printer in the Port field. The name entered
must match the port number that the printer is using for input.
7. Enter the Application Name.
NOTE: If you entered "Yes" in the film printer field, you must enter
DICOM 3.0 application name of the printer in this field.
8. Enter "Yes" in the DICOM 3.0 Device field if the DRRs are to be sent to
another compatible device. For example, if DRRs are sent to a record and
verify system or other computer that is DICOM 3 compatible. Enter "No"
if they are not.
9. Click the drop-down arrow and select a Bit Format.

16 = 16-bit format (default)
8-BE = 8-bit big endian format
8-LE = 8-bit little endian format
NOTE: Big endian and little endian refer to the way the data is
processed.
XiO 3-51
Settings
XiO Training Guide

Settings
Plan Defaults
Task 3. DRR Calculation Defaults (cont.)
10. Enter the Host Name.
NOTE: If you entered "Yes" in the film printer field, you must enter the
network host name in this field. The name entered must match
the host name assigned by the system administrator and listed
in the etc/hosts file.
11. Enter the Port number.
NOTE: If you entered "Yes" in the film printer field, you must enter the
port number for the printer in the Port field. The number
entered must match the port number that the printer is using for
input.
12. Enter the Application Name.
NOTE: If you entered "Yes" in the film printer field, you must enter the
DICOM 3.0 application name of the printer in this field.
13. Enter the Max. Output Cols. The acceptable range is 256 to 1280 in
steps of 1. This value specifies the maximum resolution to be output to
the Film printer and DICOM 3.0 device.
Initial Image Display
14. Enter the Cols number specifying the number of columns. The acceptable
range is 32 to 1024 in steps of 1.
15. Click the drop-down arrow in the Interp field and select "Yes" to convert
the DRR image to an image with larger pixels that uses bilinear
interpolation to yield a smoother image. Select "No" to maintain the
original CT values.
16. Click the drop-down arrow in the Sharp field and select "Yes" to use an
algorithm to sharpen the image, or "No" to not sharpen the image.
3-52

Settings
XiO Training Guide

Settings
Plan Defaults
Task 3. DRR Calculation Defaults (cont.)
Final Image (Display)
17. Click the drop-down arrow in the Res field and select Editable or Auto to
determine whether the number of columns used by the system.
Editable allows you to specify the number of columns used and displays
the Cols field.
Auto determines the number of columns to be used that provide
approximate optimal sampling.
18. Click the drop-down arrow in the Sharp field and select "Yes" to use an
algorithm to sharpen the image, or "No" to not sharpen the image.
Film Image
19. Enter the Cols value specifying the resolution to be used to calculate and
build the DRR. The range is 32 to 1024 in increments of 1. If unchanged,
the resolution is 512.
20. Click the drop-down arrow in the Sharp field and select "Yes" to use an
algorithm to sharpen the image, or "No" to not sharpen the image.
21. Enter the TFD (cm) default target to film distance. The values can range
from 0.00 to 3000.00 in increments of 0.01 cm. If unchanged, this
distance is 100.0 cm.
DICOM 3.0 Image
22. Enter the Cols value specifying the number of columns used to control the
resolution.
23. Click the drop-down arrow in the Sharp field and select "Yes" to use an
algorithm to sharpen the image, or "No" to not sharpen the image.
24. Click OK. XiO saves the changes and closes the dialog box.

XiO 3-53
Settings
XiO Training Guide

Settings
Plan Defaults (cont.)
Task 4. Proton Beam Defaults
1. Click the Settings drop-down menu and select the Plan Defaults and
Proton Beam Defaults options. XiO displays the Proton Beam Default
dialog box.
2. Enter the Isocenter (cm) Min/Max, X/Y/Z coordinates to set the
minimum and maximum isocenter coordinates for proton beams.
3. Enter the Air Gap (cm) to set the default air gap intersection between the
skin and the downstream-most treatment aid (aperture, range compensator,
or compensating block. This field default value is blank.
4. Enter the Maximum beam weight for a proton beam in cGy or Gy. The
range is between 0 to 9999.0 cGy in increments of 1.0, or between 0 and
99.99 Gy in increments of 0.01 Gy.
NOTE: If you do not specify this value, XiO defaults the weight to 9999.0
cGy.
5. Enter the Default beam weight for a proton beam. The range can be
between 0 to the maximum beam weight (set in Step 4) in increments of
1.0 cGy or 0.01 Gy.
NOTE: If you do not specify this value, XiO defaults the weight to
blank.
6. Click OK.

3-54

Settings
XiO Training Guide

Settings
Plan Defaults (cont.)
Task 5. Proton Defaults
Subtask 1. General Proton Parameters
The parameters in this section are proton machine dependent. XiO supports four
different types of proton machines. You may or may not see the following
options depending on the type of machine you have licensed.
1. Click the Settings drop-down menu and select the Plan Defaults, Proton
Defaults, and General Proton Parameters options. XiO displays the
General Proton Parameters dialog box.
2. Click your middle mouse button in the Material: field and select a
Material default choice for range compensators.
3. Enter the Smearing distance (cm) to specify the default area surrounding
the ray that is included in the thickness determination. Valid values are
from 0.000 cm to 1.000 cm in steps of 0.001 cm.
NOTE: XiO identifies all the grid points within the smearing distance
and determines the range compensator thickness needed to place
90 percent of the Bragg peak dose at each point. XiO selects the
optional thickness for the range compensator.
4. Enter the Calculation grid spacing (cm) to specify the default minimum
distance between calculation points. The range of values is 0.05 cm to
5.00 cm, in increments of 0.01 cm.
NOTE: This designates that the range compensator calculation grid is a
rectilinear grid (centers form squares).
5. Enter the Calculation margin (cm) representing the default margin
around the aperture that defines the raw range compensator grid extents.
The range of values is 0.05 cm to 5.00 cm, in increments of 0.01 cm.
6. Enter the Fabrication margin (cm) representing the margin around the
aperture over which the range compensator thickness will be written to the
fabrication file. The range of values is 0.0 to 5.0 in increments of 0.1.
NOTE: Only points written within the fabrication margin are written to
the fabrication file. The range compensator fabrication grid is a
"packed grid" (staggered centers).
XiO 3-55
Settings
XiO Training Guide

Settings
Plan Defaults
Task 5. Proton Defaults
Subtask 1. General Proton Parameters (cont.)
7. Modulation type is a non-modifiable field that is permanently set to
"fixed."
8. Enter the Radius Weight. The range of values is 0.01 to 100.00 in steps
of 0.01. The default radius weight is 50.00.
9. Enter the Smearing Weight. The range of values is 0.01 to 100.00 in
steps of 0.01. The default smearing weight is 10.00.
10. Enter the Depth Weight. The range of values is 0.01 to 100.00 in steps of
0.01. The default depth weight is 20.00.
11. Set the Aperture Thickness (cm) of the proton apertures. The range of
values is 0.0 cm to 40.0 cm, in increments of 0.01 cm.
12. Click the drop-down arrow and select the Penumbra Calculation. Your
choices are "multiplicative," or "additive."
13. Set the Density (%) default percentage by which the electron density
values, due to CT uncertainties, could be too high or too low for a given
scan. The range of values is 0.0% to 20.0% in steps of 0.1%. The default
is 3.5%.
14. Enter the Threshold (cm). The range of values is 0.0 to 1.00 in
increments of 0.01 cm. The default is 0.15 cm.
15. Enter the Edge (cm). The range of values is 0.000 to 1.000 in increments
of 0.001 cm. The default is 0.300 cm.
16. Enter the Intensity (%). The range of values is 0.0 to 20.0 in increments
of 0.1. The default is 0.1 cm.
17. Enter the default Range (cm) depth due to cyclotron energy fluctuations.
The range of values is 0.00 cm to 2.000 cm, in steps of 0.01 cm.
18. Click OK.

3-56

Settings
XiO Training Guide

Settings
Plan Defaults
Task 5. Proton Defaults (cont.)
Subtask 2. Milling Tool Size
1. Click the Settings drop-down menu and select the Plan Defaults, Proton
Defaults, and Milling Tool Size options. XiO displays the Proton Milling
Tool Size Defaults dialog box.
2. Enter the Valid Milling Tool Diameters mm (up to 16 drill bits) that you
will use for aperture and treatment aids.
3. In the Default Milling Tool Diameters (millimeters) Aperture field, enter
one of the valid milling tool tip diameters defined in Step 2.
NOTE: This will be the default milling tool tip used for apertures.
4. In the Range Compensator field, enter one of the valid milling tool tip
diameters defined in Step 2.
NOTE: This will be the default milling tool tip used for range
compensators.
5. Click OK.

XiO 3-57
Settings
XiO Training Guide

Settings
Plan Defaults (cont.)
Task 6. TCP/NTCP Parameters
Tumor Control Probability (TCP) and Normal Tissue Complication Probability
(NTCP) are two models used in radiation therapy to biologically interpret Dose
Volume Histograms (DVH). The TCP/NTCP functions in XiO provide tools to
interpret how dose is distributed in a tumor or other substructure.
1. Click the Settings drop-down menu and select the Plan Defaults and
TCP / NTCP Parameters options. XiO displays the TCP / NTCP
Defaults dialog box.

2. Enter the TCP Alpha Mean (1/Gy) number. Blank is an acceptable
answer.
3. Enter the TCP Alpha Std. Dev. (1/Gy) number. Blank is an acceptable
answer.
4. Enter the TCP Tumor Cell Density (million/cc) number. Blank is an
acceptable answer.
5. Enter the NTCP Anatomical Structure Name.
3-58

Settings
XiO Training Guide

Settings
Plan Defaults
Task 6. TCP/NTCP Parameters (cont.)
6. Enter the NTCP TD50 (Gy) identifier for each anatomical structure name.
7. Enter the n number for each anatomical structure name. Blank is
acceptable.
8. Enter the m number for each anatomical structure name. Blank is
acceptable.
9. Click OK. XiO adds your TCP /NTCP Parameters and closes the dialog
box.
Task 7. Teletherapy
When you select this option.
1. Click the Settings drop-down menu and select the Plan Defaults and
Teletherapy options. XiO displays the Teletherapy Parameters Page
dialog box.
XiO allows you to set a preference as to whether or not you want the
ability to re-save plans that have already been electronically approved.
You can only view and edit this setting if you have plan approval
privileges.

2. Select Yes or No.
3. Click OK.

XiO 3-59
Settings
XiO Training Guide

Settings
Output
Task 1. DRR Print
1. Click the Settings drop-down menu and select the Output and DRR
Print options. XiO displays a "Yellow" warning message.
2. Click OK on the warning message box after reading. XiO displays the
DRR Plot Output Preferences dialog box.

3. Click your middle mouse button and respond "yes" or "no" to each of the
Print options.
4. Click OK. The DRRs you print now include the selected information for
the clinic.
3-60

Settings
XiO Training Guide

Settings
Output (cont.)
Task 2. Intensity Maps
1. Click the Settings drop-down menu and select the Output and Intensity
Maps options. XiO displays the Intensity Maps Text Setup Dialog Box

2. Click the drop-down arrow in any of the fields and select Yes to include
text when you print an intensity map. The default value is Yes.

OR

No to not include text when you print an intensity map.
3. Click OK.

XiO 3-61
Settings
XiO Training Guide

Settings

Output (cont.)
Task 3. Intensity Map Output Devices
The output device needs to be defined here before you can use it to output
intensity maps or relative fluence maps in Teletherapy
1. Click the Settings drop-down menu and select the Output and Intensity
Map Output Devices option. XiO displays the Intensity Map Output
Devices dialog box.

2. Click the drop-down arrow in the Film Printer: field and select Yes to
enter information for a Film Printer.

OR

Click No to not allow you to enter information for the film printer. No is
the default value.
NOTE: The film printer needs to be connected to XiO via an Ethernet
network.
3. Click the drop-down arrow in the Bit Format: field and Select the method
that your printer uses to process the data. Available choices are 16, 8-BE,
or 8-LE bit format. The default value is 16.
3-62

Settings
XiO Training Guide

Settings

Output
Task 3. Intensity Map Devices (cont.)
4. Enter a Host Name of 14 characters used to identify the host.
NOTE: The host name is the network host name for the printer. This
name should match the host name assigned by the network
administrator and listed in the /etc/hosts file.
5. Enter the Port number the printer is using for input. The acceptable range
is 0 to 9999. The default value is 104, the DICOM 3.0 standard port
number.
6. Enter the DICOM 3.0 Application Name of the printer. The default
application name is MERGE_PRINT. The name may include up to 16
characters.
7. Click the drop-down arrow in the DICOM 3.0 Device: field and select Yes
to enter information for a DICOM 3.0 compliant device.

OR

Click No to not allow you to enter information. No is the default value.
8. Click the drop-down arrow in the Bit Format field and select the method
that your device uses to process the data. Available choices are: 16, 8-BE,
or 8-LE bit format. The default value is 16.
9. Enter a Host Name of 14 characters used to identify the host. The host
name is the network host name for the device. This name should match
the host name assigned by the network administrator and listed in the
/etc/hosts file.
10. Enter the Port Number the device is using for input. The acceptable range
is 0 to 9999. The default value is 104, the DICOM 3.0 standard port
number.
11. Enter the DICOM 3.0 Application Name of the device. The default
application name is MERGECOM_SCP. The name may include up to 16
characters.
12. Enter the Minimum number of Output Columns used to determine the
intensity map resolution. As the number of columns increases, the quality
becomes higher. The acceptable range is between 256 and 1280. The
default value is 1280.
13. Click OK. XiO sets up the network location for the intensity map outputs.
XiO 3-63
Settings
XiO Training Guide

Settings
Output (cont.)
Task 4. Tele Source Data
Sub-task 1. Treatment Parameters
1. Click the Settings drop-down menu and select the Output, Tele Source
Data, and Treatment Parameters options. XiO displays the
Customizable Tele Source Data Treatment Parameters window.


2. Customize the source data index by clicking the drop down arrow in the
On/Off fields and selecting on for the items you want to display.
3. Re-order the items displayed on the source data index by manually
placing them in numerical order.
3-64

Settings
XiO Training Guide

Settings
Output
Task 4. Tele Source Data
Sub-task 1. Treatment Parameters (cont.)
4. Click the Report Preview button to preview the customized source data
index.
5. Click OK when finished.
6. XiO allows you to print the customized source data index when you have
a patient open in Teletherapy by selecting the File drop-down menu and
selecting the Print and Plan Data options.
OR
Print by selecting the Reports drop-down menu and selecting the Source
Data option.

OR

Click the Source Data and Print buttons.
7. You can also print the full source data index in Teletherapy (including all
of the items) by clicking the File drop-down menu and selecting the Print
and Full Source Data options.
XiO 3-65
Settings
XiO Training Guide

Settings
Output (cont.)
Task 5. Standalone Time/MU
1. Click the Settings drop-down menu and select Output and Standalone
Time/MU. XiO displays the Standalone Time/MU Output dialog box.

2. Click the drop-down arrow and respond "Yes" or "No" to each of the
display fields shown on this window.
3. Click OK. XiO logs your responses for future use.
3-66

Settings
XiO Training Guide

Settings
Output (cont.)
Task 6. Display Printer Defaults
The Display Printer Defaults option allows you to select color preferences for the
following display and print options:
x Isocurve / Isosurface Colors in Teletherapy
x Isocurve / Isosurface Colors in Brachytherapy
x Print Colors
x Beam Color (Protons Only)
x Thickness Color (Protons Only)
Sub-task 1. Brachy Isocurve / Isosurface Colors
1. Click the Settings drop-down menu and select the Output, Display
Printer Defaults, and Brachy Isocurve/Isosurface Colors options.
Regardless of the option you choose (i.e. Brachy or Tele), the information
that displays on the dialog box is the same.



NOTE: If the Isovalue defaults have not yet been defined, the columns
on this page appear as blank. You can enter one in order to
continue, or you can edit existing isovalues.
XiO 3-67
Settings
XiO Training Guide

Settings
Output
Task 6. Display Printer Defaults
Sub-task 1. Brachy Isocurve / Isosurface Colors (cont.)
2. To change a display color, click your middle mouse button. XiO displays
a list of color choices from where you can select a new color for each
Isovalue.
NOTE: This color is a display color. Your display and plot number
colors are different.
3. Select the desired Rnd (rendering) for each isosurface value.
4. Click the drop-down arrow in the Line Type field and select the line types
(one at a time) for each isocurve/isosurface color. Go to the XiO Online
Help to view the various line types.
5. To display dose in MPV, select "Yes" or "No." Selecting "Yes" increases
the time it takes the system to display isodose lines on SPVs. (This in
only used in Brachytherapy.)
6. Click the OK button. XiO adds these isocurve/isosuface display and print
defaults for the selected clinic.
3-68

Settings
XiO Training Guide

Settings
Output
Task 6. Display Printer Defaults (cont.)
Sub-task 2. Print Colors
The Print Colors option allows you to define the color you want to use for
graphic objects.
1. Click the Settings drop-down menu on the main XiO window and select
the Output, Display Printer Defaults, and Print Colors options. XiO
displays the Printer Defaults dialog box.

2. Enter the Color you want to use for each graphic object.
NOTE: If the printer parameters have been previously defined, XiO
displays them on this window. These parameters are modifiable.
XiO 3-69
Settings
XiO Training Guide

Settings
Output
Task 6. Display Printer Defaults
Sub-task 2. Print Colors (cont.)
3. To change the Line Type defaults, click the drop-down menu that
corresponds with the line type you want to change (one at a time), and
make a selection for each.
4. Click the drop-down menu that corresponds with the Fill Type you want
to change and make a selection. To view the Fill Type Defaults and
Renderings, go to the XiO Online Help.
NOTE: If the field is left blank, no pattern will fill the object.
5. Fill Angle is only available when a Fill Type is specified. This choice
determines the angle of the hatched or crosshatched lines. Go to the XiO
Online Help for supporting information.
6. Click the OK button. XiO displays a second plotter defaults dialog box.
NOTE: Because Printer Defaults encompasses two dialog boxes, the OK
button in the first window only opens the second window and
does not save the data.
7. Click the OK button again. XiO saves your Print Color preference
defaults for the selected clinic.
3-70

Settings
XiO Training Guide

Settings
Output
Task 6. Display Printer Defaults
Sub-task 3. Beam Colors (Proton Only)
Use the Pen Color Defaults to define the colors associated with proton beams.
1. Click the Settings drop-down menu on the main XiO window and select
the Output, Display Printer Defaults, and Beam Colors options. XiO
displays the Beam Color Defaults dialog box.

2. Click your middle mouse button in the Color field and select the desired
color you wish to associate with each beam.
3. Click the OK button. XiO saves the Beam Color preference defaults for
the selected clinic.
XiO 3-71
Settings
XiO Training Guide

Settings
Output
Task 6. Display Printer Defaults (cont.)
Sub-task 4. Thickness (Proton Only)
1. Click the Settings drop-down menu and select the Output, Display
Printer Defaults, and Thickness options. XiO displays the Printer
Isocurve Line Thickness Default dialog box.
2. Enter the thickness for each line to be displayed.
3. Select the color assigned to each thickness.
NOTE: Duplication is permitted.
4. Click OK.

3-72

Settings
XiO Training Guide

Settings
Output
Task 7. DRR Printing Size
Before printing a Digitally Reconstructed Radiograph (DRR), you must designate
the paper size (length, width) and designate the printer to where you want the
output printed. The following exercise assists you with these tasks.
1. Click the Settings drop-down menu and select the Output and DRR
Printing Size options. XiO displays the DRR Size Defaults dialog box.

2. Click the drop-down arrow in the Output device field and select the
desired device.
3. Click the drop-down arrow in the Paper size field and select the desired
Paper size.
4. Enter the Default Length. Acceptable values range from 0.01 cm to
80.00 cm in increments of 0.01 cm.
5. Enter the Default Width. Acceptable values range from 0.01 cm to 80.00
cm in increments of 0.01 cm.
6. Click the Add defaults button. XiO displays a Defaults Added message.
You can select another paper size and set the default length and width for
DRRs printed for that size paper.
7. Click OK. XiO closes the dialog box.

XiO 3-73
Settings
XiO Training Guide

Settings
Output
Task 8. . decimal Order Defaults
The .decimal Order dialog box is where you enter your clinics decimal shipping
priorities for mailing.
1. Click the Settings drop-down menu and select the Output and .decimal
Order Defaults options. XiO displays the .decimal Order Defaults dialog
box.



2. Click the drop-down arrow in the Processing field and select the desired
processing priority for your institution. Go to the XiO Online Help for
supporting information.
3. Enter your clinics Name and Shipping Address to where you want your
.decimal compensator shipped.
3-74

Settings
XiO Training Guide

Settings
Output
Task 8. . decimal Order Defaults (cont.)
4. Enter your clinics Name and Billing Address to where you want billing
statements for the .decimal compensators mailed.
5. Enter the Name, Phone Number (including area code) and Email
address of the contact person for your clinic.
6. Click the OK button. The values now appear as defaults when you order a
.decimal compensating filter during planning for the selected clinic.
XiO 3-75
Settings
XiO Training Guide

Settings
Output (cont.)
Task 9. Block Cutter Export
Use this option to set up defaults for export to a block cutting system by network
or floppy disk.

1. Click the Settings drop-down menu and select the Output and Block
Cutter Export options. XiO displays the Customized Port Export
Defaults dialog box.


2. Click the drop-down arrow in the Transfer method field and make a
selection (network or floppy).
3. Enter the Margin around collimator (cm) distance. The acceptable
range is 0.00 cm to 5.00 cm in steps of 0.01. If you leave this field blank,
XiO requires you to generate the outside outline yourself.
4. Click the drop-down arrow in the Foam block size field and make a
selection.
5. Enter the polystyrene Foam block thickness to be used by the block
cutter. The acceptable range is 0.00 cm to 20.00 cm in steps of 0.01 cm.
6. Click OK. XiO saves the entered default parameters and closes the dialog
box.

3-76

Settings
XiO Training Guide

Settings

Technical Considerations
Section 3. Settings of the XiO Training Guide is also used as a reference during
the classroom training lecture to support the slides shown in this section.


XiO 3-77




Settings
XiO Training Guide
3A-1
Settings
Settings
What a Physicist Should Know
Calculation Defaults
CT-to-ED Conversion Files
DRR Calculation Defaults
DRR Printing Defaults
Prostate Template
Scanner/LMS Definition
TCP/NTCP Defaults
Settings
XiO Training Guide
3A-2
Calculation Defaults
Calculation Grid Spacing
0.4 cm for speed
0.3 cm for speed and accuracy
0.2 cm for lMRT
Default External Beam Algorithm
Convolution, Superposition, Fast Superposition, or
Clarkson
Beam Weighting Mode
You want Absolute Dose/MU mode!
Dose Units
cGy or Gy
Calculation Defaults
Criteria for Warning for Weight Point Near Field Edge
Set the distance from the field edge (collimator, MLC, block); if the
weight point comes closer to the field edge than this distance, you
will be alerted
Set the minimum field size to check
lMRT QA Output Parameters
Set parameters for the virtual film
Measurement SSD (source to phantom)
Measurement depth
Phantom material and electron density
Default all intensity-modulated beams to have a QA file
calculated? (Yes/No)
Settings
XiO Training Guide
3A-3
CT-to-ED Conversion Files
Mapping CT numbers to electron density should be
linear from air to slightly denser than water (e.g.
muscle), then continue linear but with a lesser
slope beyond muscle as you get into tissues that
contain more higher-Z atoms (e.g. bone).
Be sure to measure a CT-to-ED file for each CT
scanner you will be using.
Mapping CT numbers to electron density should be
linear from air to slightly denser than water (e.g.
muscle), then continue linear but with a lesser
slope beyond muscle as you get into tissues that
contain more higher-Z atoms (e.g. bone).
Be sure to measure a CT-to-ED file for each CT
scanner you will be using.
DRR Calculation Defaults
User-defined range filters
A pre-defined Sim Film and Port Film filter will exist
automatically, not editable
You can define other filters if you wish (bone, tissue, etc.)
Film printers or DlCOM output devices
Host name, Port number, application name
Number of rays for initial, final, and output images
Suggestion: 128 columns for initial image, lnterpolation yes
Suggestion: 1000 columns for final image, or auto
Suggestion: 1000 columns for output images (film and DlCOM)
Settings
XiO Training Guide
3A-4
DRR Printing Defaults
Set up a default printing size for each output size
For laser printers, you will want to define sizes for each paper size
you might be using
You can set a width and a length, but it usually works better to let
the width be the driving number and use a length equal to the width
See the Physics Tutorial on DRRs for more information
Prostate Template
Define Prostate Templates for Brachytherapy Seeds
Row and column spacing
Number of rows and columns
Labels for each row
Labels for each column
Settings
XiO Training Guide
3A-5
Scanner/LMS Definition
Necessary for viewing scout images in PFM
Necessary for getting directional laser shifts and/or absolute
laser marking settings for CT simulation
Complete customization of any CT scanner
TCP/NTCP Defaults
Tumor Control Probability
Tumor sensitivity default (a from linear quadratic model)
a standard deviation default
Tumor cell density default
Normal Tissue Complication Probability
Per structure name (i.e. organ dependent)
TD50 default (uniform dose that creates complication 50% of the time)
n default (parameter that describes the serial or parallel sub-unit
response of the specific tissue)
m default (parameter that dictates the slope of the NTCP sigmoidal
curve)

Patient File Maintenance
XiO Training Guide

Patient File Maintenance


Before you begin this exercise, create an anatomical site. Click the Settings
drop-down menu and select the Patient Data and Specific Anatomical Sites
named Prostate. Enter the structure names bladder, rectum and femoral
heads. Refer to Settings section in this training guide for assistance in creating
this anatomical site.
Practice Exercise
Patient File Maintenance (PFM) is the location in XiO where you can perform
the following tasks:
x Enter and edit patient demographic information
x Import patient image data
x Draw, edit and delete structure contours
x Create 3D auto-margin contours
Task 1. Access XiO - PFM
The following steps illustrate how to access the XiO system and then PFM from
an operational XiO workstation.
1. Enter the word test in the Login ID field of the login window.
2. Enter the word cms in the Password field.
3. Click OK. XiO displays the main system window.


XiO 4-1
Patient File Maintenance
XiO Training Guide

Patient File Maintenance
Task 1. Access XiO PFM (cont.)
4. Verify the current clinic displays XiO Training Data. CMS created this
demo clinic so that you can practice each of the steps for each of the tasks
illustrated in this training guide. DO NOT use the data shown in the
practice exercises when creating a valid treatment plan for your clinic.
5. Click the Patient File Maintenance option.

OR

Click the Run drop-down menu and select the Patient File Maintenance
option. XiO displays the main window in Patient File Maintenance from
where you select options to import patient data.


4-2

Patient File Maintenance
XiO Training Guide

Patient File Maintenance
Task 2. Create a New Patient
There are two methods to creating a new patient in XiO. The first allows you to
enter the demographics information for the patient and begin the transfer process.
The second method uses the DICOM header and reads in the demographic
information for the patient automatically. You can edit this information after
transfer from the Edit drop-down menu. The only demographic data that is
transferred using the DICOM method is the patient ID and patient name. The
patient sex displays as unknown. If the ID has any non alpha-numeric characters
or spaces, XiO removes them by default.
Method 1: Enter Demographic Information
1. Click the File drop-down menu and select the New and Patient options.
XiO displays the New Patient dialog box.

2. Enter the Patient ID MRProstate.
3. Enter MR 3D Prostate in the Patient Name field.
4. Click the drop-down arrow in the Sex: field and select Male.
NOTE: The Date of birth, Telephone, and Address fields are optional.
5. Click the drop-down arrow in the Create field and select Imagebased
Studyset. There are three different data types.
(1) Imagebased Studyset is used to import image data.
(2) Nonimaged Studyset is used to create a studyset that does not contain
images. For example, you would select this option when you plan to
digitize patient contours into XiO.
XiO 4-3
Patient File Maintenance
XiO Training Guide

Patient File Maintenance
Task 2. Create a New Patient
Method 1: Enter Demographic Information (cont.)
(3) No Studyset is used when contours are not required, i.e.
brachytherapy.
6. Click OK. XiO displays the Start Image Transfer dialog box.
Method 2: Use DICOM Header information
1. Click the File drop-down menu and select the New and DICOM Patient
options. XiO displays the Start Image Transfer page.

4-4

Patient File Maintenance
XiO Training Guide

Patient File Maintenance

Task 3. Start Image Transfer
It is from this window that you bring data into XiO along with pertinent
information.

1. If you have more than one media type to choose from, click your middle
mouse button in the Image type field and select the Computed
Tomography option. Image Type refers to the type of data being
transferred (i.e. CT, MR, PET). If only one media is licensed, XiO
automatically fills in this field.
2. If you have more than one Image Media type to choose from, click your
middle mouse in the Image Media: field and select the Network option.
The available options for image transport are Network, Optical Disk, and
Dat Tape. If only one interface is licensed, XiO automatically populates
this field.
3. The Mfr/Model ID field defaults to DICOM3. This is the manufacturer
and model of the scanner/file format associated with the images being
transferred. DICOM is a standard file format by which many new scanners
comply, and therefore is also a valid answer. If only one model is
available, XiO automatically fills in this field.
4. The Host/Device field defaults to merge. This is the location where the
transferring device is attached to the system (i.e. file location, dat drive,
CD).
XiO 4-5
Patient File Maintenance
XiO Training Guide

Patient File Maintenance

Task 3. Start Image Transfer (cont.)
5. Click your middle mouse button in the Source PID: field and select the
ASTRO224 option. The Source PID is a directory of available patient
exams for import. The total range of image numbers from the selected
exam will default; however, you can edit this range to import as many or
few of the images from the selected exam.
NOTE: If the preference is turned on, you may encounter a yellow
screen warning you that the Source patient ID does not match
the ID entered in XiO. This warning is intended to prevent you
from transferring in images of one patient to the ID of another
patient.
6. Enter 3DProstate in the Studyset ID: field. The studyset is the entire set of
image data used for planning. The Studyset Description is an optional
field. You can use this field to describe the studyset you are creating.
7. DemoScanner1 defaults in the Scanner ID: field. Scanner ID refers to the
scanner from where the images were pulled. Scanners are defined in
Settings. It is necessary that you identify a scanner in order to correctly
display scout images and calculate shift information. Blank is an
acceptable answer if you do not want to assign a scanner to this patient.
(See the Settings lesson in this training guide for more information.)
8. (Optional) Click your middle mouse button in the CT to ED Conversion
File: field and select rocsboard. The conversion file is used to convert CT
numbers to electron densities. This is necessary for DRR calculations as
well as heterogeneity corrections.
9. In the Exam data to remain for future transfer: field, select All. The All
option means that the raw CT images remain in the Source PID directory
after they are transferred into PFM. Use the All option when you would
like the option of importing the same images over and over again into XiO.
However, if frequently select the All option, the image directory can
become full and reduce system performance.

Clinically, it is recommended to select None so that XiO removes all
images from the image directory upon the image transfer.

If you are importing plans from a source other than Focal, select the Non-
transferred option so that the plan files are not deleted after the images are
imported.

10. Click OK. XiO transfers the image data and displays the Finish Image
Transfer dialog box.
4-6

Patient File Maintenance
XiO Training Guide

Patient File Maintenance

Task 4. Finish Image Transfer
Use this page to check the transferred images for correctness of image order,
orientation (head to foot, right to left, flipped), position, and correct scale factor.



1. Edit the Coronal Reference Distance (cm): field, if needed. Use the
Coronal Image to evaluate Head to Foot direction. If the Coronal image
does not provide a meaningful display, reconstruct a new coronal cross
section at a different location by entering a different Coronal Reference
Distance (cm).
2. In the Transverse images viewed from foot: field, enter Yes. If you have
difficulty selecting the correct answer, perform the following test:
(1) On a transverse slice, draw an imaginary line from the patients right
side to the patients anterior, then left side, and finally stopping at the
patients posterior.
(2) If the line was drawn in the clockwise direction, the images are viewed
from the foot, select Yes.
(3) If the line was drawn in the counterclockwise direction, the images are
viewed from the head, select No.
XiO 4-7
Patient File Maintenance
XiO Training Guide

Patient File Maintenance

Task 4. Finish Image Transfer (cont.)
3. In the Reference distances increase towards head: field, select Yes. If the
direction arrow on the coronal image points toward the superior of the
patient, select Yes. If the arrow points to the inferior of the patient, select
No.
4. (Optional) The Superior and Inferior Couch Readings fields should match
the displayed Superior and Inferior Reference Distances. However, on
occasion, the DICOM fields that XiO reads in for the couch positions
(Reference Distances) are not representative of the actual readings on the
machine. If this is the case, you can re-synch the reference distances with
the actual couch readings. This is only necessary if you intend to report
shifts (Setup Reference Definition or Mark Anatomical Reference) in
Absolute Coordinates rather than Relative to the Scan Reference Point.
Without doing so, shifts reported in Absolute Coordinates will not be
correct.
5. (Optional) Use the Position offset to set a selected plane (y-coordinate) to
zero (for example, set the y-coordinate to the fiducial marker plane if not
done at the time of simulation).
(1) Enter the position-offset value to be used by the transferred images,

OR
(2) Click your right mouse button on the coronal image and select Position
Offset to set the y-coordinate graphically.
(3) Hold down your left mouse button and move superiorly or inferiorly.
The Position Offset automatically updates to the selected slice.
6. In the Patient Position: field, select supine. You can choose from supine,
prone, or rolled (patient was placed into a rolled position using a sponge or
pillow or other means). Should you choose rolled, XiO displays the Roll
Angle field making it a required field.
7. (Optional) You can add Position Comments (i.e. pillow, sponge support, tilt
board, bite block, face mask).
8. Click OK. XiO orients the cross sections according to the entries and
imports the images to the contouring module.


4-8

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XiO Training Guide

Patient File Maintenance

Task 5. Contouring
Sub-task 1. Add a Group of Contour Names & Enter a Contour
Name
If an anatomical site name has been created, XiO automatically displays an Add
Anatomical Site dialog box.
1. Click the Prostate anatomical site to highlight it. The Predefined Sites are
grouped lists of possible structure names. Selecting these predefined sites
eliminates the need for entering structure names as you contour them.
These structure name groups are created in Settings, Patient Data,
Specific Anatomical Sites.
2. Click OK.
3. Click the Edit drop-down menu and select the Contour Names and Type
in Contour Name options. XiO displays the Edit Contour Info dialog box.
4. Enter rt. femur in the Name field.

5. Enter 1.0 in Relative Density field.
6. Click the drop-down arrow in the Force CT Dens: field and select No.
NOTE: Select Yes to override pixel-by-pixel heterogeneity
corrections for this structure. Refer to the Teletherapy lesson
of this training guide for more information regarding the
heterogeneity correction options.
7. Click the drop-down arrows to edit the remaining fields. Color, Rendering,
and Color Fill affect how the contour is displayed on the screen. Line
Type, Fill Type, and Fill Angle affect the contour display when printed.
See XiO Help for more detailed information.
8. Click OK.
9. Repeat steps 4-7 for the lt. femur.
XiO 4-9
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XiO Training Guide

Patient File Maintenance

Task 5. Contouring
Sub-task 1. Add a Group of Contour Names & Enter a Contour Name
(cont.)
10. Click Cancel to close the dialog box.

OR

Continue adding additional structure names.
NOTE: Click the Edit drop-down menu and select the Contour
Names option to find additional contour names.

Contour Index displays an index of existing contour names.

Add Predefined Site is used to add additional grouped lists of
structure names.

Edit Contour Info is used to change the name, relative
density, rendering, color, color fill, and print options on this
dialog box.

Rename Contour is used to rename an entire structure by
selecting a new contour name.

Type in Contour Names is used to add custom anatomy
names.



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Patient File Maintenance

Task 5. Contouring
Sub-task 2. Create the Patient Contour Using Auto-by-Threshold
(Multiple Slices)
Use this function to automatically create contours along an edge of high contrast
in an image. Adjust the Window/Level settings to obtain high contrast around
the desired structure.
You can either Place Auto Points on all Selected Cross Sections for Auto-by-
Threshold by clicking the multi slice mode button, or Place Auto Points on
a Single Cross Section for Auto-by-Threshold by clicking the single slice mode
button. In XiO, Multi-slice mode is the default.
Adjusting the Window/Level settings may improve the performance of Auto-by-
Threshold. Structures like bone, lungs, and patient exterior are good candidates
for this contouring method because the structures are well delineated.

1. Click the Create Contours Using Auto-by-Threshold button.
2. Click the drop-down arrow in the (Save) W/L field and select Autoskin.
The autoskin window and level values were chosen to provide optimum
contrast in most CT images for contouring the patient skin using Auto-by-
Threshold.
3. Click the drop-down arrow in the Group field and select General.
4. Click the drop-down arrow in the Contour: field and select Patient. The
correct Group and Contour Name should always be chosen before
contouring begins.
5. Place the mouse pointer anywhere within the Cross Section Thumbnail
View.
6. Click your right mouse button and select the Select All option. XiO
highlights all cross sections with a yellow border.
7. Click your right-mouse button anywhere within the Single Plane View and
select the Place Point option. This action enables you to place auto points
to be used to identify where the drawing of contours will begin.
XiO 4-11
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XiO Training Guide

Patient File Maintenance

Task 5. Contouring
Sub-task 2. Create the Patient Contour Using Auto-by-Threshold
(Multiple Slices) [cont.]
8. Move the mouse pointer above the anterior surface of the patient and
click your left mouse button to place a set of auto points. With multiple-
slice mode and a range of all slices selected, XiO automatically places a
point in the same position on all slices.
9. Click your right-mouse button anywhere within the Single Plane View and
select the Generate Cont option.

OR

Click your middle-mouse button within the Single Plane View. XiO
automatically creates contours, after which the patient skin will appear
shaded in the Cross Section Thumbnail View, as a wire frame in the 3D
View, and as an outline in the Single Plane View. This action also displays
the Accept Auto-by-Threshold dialog box.

10. Scroll through the images to review the contours. Click the Accept the
new contours button to keep the contours you just created

OR
If an undesirable contour is found, edit the Point position using one of the
following methods:
(1) Move all points (multi slice button highlighted) by placing the
cursor near any point. When the point turns red, drag it to a new
position by holding down your left mouse. XiO updates all points to
the new location.
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Patient File Maintenance

Task 5. Contouring
Sub-task 2. Create the Patient Contour Using Auto-by-Threshold
(Multiple Slices) [cont.]
OR
(2) Move a single point (single slice button highlighted) by placing
the cursor near the point. When the point turns red, drag it to a new
position by holding down your left mouse. Only the selected point is
affected by the move.
11. After you edit the point, regenerate the contours.
NOTE: Should you elect to make manual edits to the auto-by-
threshold contours, you can do so in edit mode after the auto-
by-threshold contours are accepted
12. Click the Accept the new contours button when the contour outline is
satisfactory.

Here are steps you can use to optionally apply
the Area Of Interest Tool when using auto-by-
threshold. The Area of Interest tool can help you
exclude the table or part of the patient when
contouring using auto-by-threshold.
1. After you select all your slices to be
contoured, but before you place your point,
right mouse click and select Place AOI.
2. Hold down your left mouse button and drag
to create a box around your contours.
3. Movie through each slice, or look at the 3D
view to determine if all the slices are
encompassed appropriately by the AOI box.
4. Redraw the AOI box, if necessary.
5. Place the point inside the box, but above the
patient surface (if contouring the patient).
6. Generate the contours and verify that you
get the expected results.

XiO 4-13
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XiO Training Guide

Patient File Maintenance

Task 5. Contouring (cont.)
Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice)
This method is desirable when customizing the point location for each cross
section that is needed.
1. Click the Create Contours Using Auto-by-Threshold button on the
Contouring toolbar.
2. Click the drop-down arrow in the (Save) W/L button field and select
Autobone. The autobone window and level values were chosen to provide
optimum contrast in most CT images for contouring the bones using Auto-
by-Threshold.
3. Click the drop-down arrow in the Group: field and select User Defined.
4. Click the drop-down arrow in the Contour: field and select Rt. Femur.
5. Click the Place Auto-Point on a Single Cross Section for Auto-by-
Threshold button. This mode allows you to place points on only one
cross section, compared to the Place Multi Slice mode, which allows you to
place points on multiple cross sections.
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Patient File Maintenance

Task 5. Contouring
Sub-task 3. Create Contours Using Auto-by-Threshold (Single Slice)
6. Use the scroll bar on the thumbnails to find an image that displays the Rt.
Femur. Click your left mouse button on that thumbnail slice to update the
image in the Single Plane View.
OR
Click your right mouse button anywhere within the Single Plane View and
select the Movie option. Click your right or left mouse button to movie
through slices until you locate Rt. Femur. On some systems, you can also
use the scroll wheel on the mouse to movie through the images
OR

Use the Up or Down arrow keys or Page Up/ Page Down keys on your
computer keyboard to movie to a cross section with Rt. Femur.
7. Click your right-mouse button anywhere within the Single Plane View and
select the Place Point option. This enables you to place auto-points to be
used to identify where the drawing of contours will begin.
8. Move your mouse pointer slightly anterior to rt. Femur; then, click your
left mouse button to place an auto-point.
9. Click your middle mouse button to generate the contour. XiO displays
the Accept Auto by Threshold dialog box. You can generate and accept
each contour one by one, or movie to place single points on each slice,
generate them, and accept them all at once.
10. Repeat steps 6 through 9 for each rt. femur cross-section.

XiO 4-15
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XiO Training Guide

Patient File Maintenance

Task 5. Contouring
Sub-task 4. Create Contours Using Auto-by-Threshold (Range)
You can use this method to quickly create Auto-by-Threshold contours on a
selected range of slices.
1. Click the Create Contours Using Auto-by-Threshold button on the
Contouring toolbar.
2. Click the drop-down arrow in the (Save W/L): field and select Autobone.
3. Click the drop-down arrow in the Group: field and select User Defined.
4. Click the drop-down arrow in the Contour: field and select Lt. Femur.
5. Click the Place Auto-Points on all Select Cross Sections for Auto-by-
threshold button.
6. Select desired slices by clicking your middle mouse button on each
thumbnail cross section.

OR

Click your middle mouse button on the first desired contour; then, shift-
middle click the last contour on the thumbnails for the desired range. XiO
places yellow boxes around the selected cross sections in the thumbnails,
signifying that contours will be created for each of the selected slices.
7. Click your right-mouse button anywhere within the Single Plane View and
select the Place Point option.
8. Move your mouse pointer slightly anterior to the Lt. Femur; then, click
your left mouse button to place an auto-point.
9. Click your middle mouse button to generate the contour on all of the
selected slices at once. XiO displays the Accept Auto by Threshold button
dialog box.
10. Click the Accept the New Contours button, or edit a point(s) as needed.

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Patient File Maintenance

Task 5. Contouring
Sub-task 5. Create/Edit Contours using the Paintbrush
Use the paintbrush tool to create new contours or edit existing contours. Edit the
size of the paintbrush using the guide radius.
1. Click the Paint the contours Using the Mouse button.
2. Set the W/L to Soft Tissue from the list to the right of the (Save) W/L
button.
3. Click the drop-down arrow in the Group: field and select General.
4. Click the drop-down arrow in the Contour: field and select GTV.
5. In Single Plane View, movie to a cross section containing prostate.
6. Adjust the Guide Radius of the paintbrush tool displayed as a circle around
your mouse pointer. The guide radius determines the size of your
paintbrush. The guide radius size ranges from 0.01 to 10 cm. Use very
small radii carefully since you can create very small contours that are
difficult to edit.

Here are steps to edit the radius of the
circle guide.

1. Press the greater than key (>) to
increase the guide radius.
2. Press the less than key (< ) to
decrease the guide radius.
3. Press the G key on your computer
keyboard to turn the guide radius off
and on.
XiO displays the Guide Radius size at the
bottom of the XiO screen.


XiO 4-17
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Patient File Maintenance

Task 5. Contouring
Sub-task 5. Create/Edit Contours using the Paintbrush (cont.)
7. Hold down the left mouse button and drag on the transverse image to
paint the prostate contour. Paint the prostate contour on each slice where
the prostate is displayed.
8. Edit contours using the paintbrush by holding down the Shift key on the
keyboard while holding down the left mouse button and dragging the
paintbrush tool over the painted area to erase.
NOTE: You can edit any contour using the paintbrush tool regardless
of which tool was used to create the contour.
Sub-task 6. Create Contours Using Autosegmentation
Use Autosegmentation to automatically generate contours based on gray level
texture properties and gradients. You draw a sample contour (only a portion of
the desired whole) inside the perimeter of a structure. XiO then expands the
sample to encompass the entire structure.

Autosegmentation is most useful when used to contour areas that lack large
density differences.

Window Level (W/L) changes will not improve Autosegmentation performance.
Structures like liver, kidneys, spleen, and bladder are good candidates for this
contouring method.
1. Click the Create Contours Using Autosegmentation button on the
Patient File Maintenance toolbar.
2. Set theW/L to Soft Tissue from the list to the right of the (Save) W/L
button. This action improves the appearance of on screen images, but will
not affect the autosegmentation process. Autosegmentation uses CT
numbers to create contours with like-densities in a given sample.
3. Click the drop-down arrow in the Group: field and select Prostate.
4. Click the drop-down arrow in the Contour: field and select Bladder.
5. In Single Plane View, movie to a cross section containing bladder.
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Patient File Maintenance

Task 5. Contouring
Sub-task 6. Create Contours Using Autosegmentation (cont.)
6. Inside the bladder structure, provide a density sample by creating a
polygon of any shape or size using the left-mouse button and dragging.
Once you close the polygon, autosegmentation reshapes the sample to
encompass all surrounding tissue with like-densities.
7. Select another slice and repeat the process. Continue throughout the
bladder structure.
NOTE: You can use some of the other contouring tools, such as
contouring every other slice and using interpolation to
complete the contouring, or selecting a range from the
thumbnails to have the autosegmentation apply to multiple
slices.

XiO 4-19
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XiO Training Guide

Patient File Maintenance
Task 5. Contouring
Sub-task 7. Edit Existing Contour
Use this tool or the paintbrush tool when making changes to existing contours.
You initiate this process by selecting the Edit Existing Contour button on
the Patient File Maintenance toolbar, and identifying the contour to be edited by
placing your mouse cursor near the contour outline. When XiO changes the
arrow icon to the edit icon , click your left mouse button. XiO then displays a
purple box around the contour signifying the contour is in edit mode and can be
changed. Once in edit mode, the following functions represent the various
methods available for making changes.
NOTE: The Edit Contour option is always available on the right mouse drop-
down menu. When you are in Edit Contour mode, the Draw Contour
option is available on the right mouse drop-down menu.
Replace Contour Segment

This function allows you to replace a portion of the contour by manually
redrawing.
1. Click the Edit Existing Contours button on the Patient File
Maintenance toolbar.
2. Move your mouse cursor near the bladder contour until the edit symbol
appears on the window; then, click your left mouse button. XiO displays
the bladder contour with a purple box around it.
3. Move your cursor near the portion of the contour to be edited until the +
sign appears on the window.
4. Hold down your left mouse button and redraw the contour, extending
outside the edit box, if necessary. The newly drawn contour segment
replaces the original contour segment.
NOTE: The drawing must begin and end on the existing contour
outline.
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Patient File Maintenance
Task 5. Contouring
Sub-task 7. Edit Existing Contour (cont.)
Stretch Sym/Asym

This function allows you to stretch the contour.
1. With the bladder contour still in edit mode, place your mouse cursor near a
purple square located on the purple edit mode box. Look for the cursor to
change to one of the following icons.
NOTE: Symmetric stretch is the default.
2. Hold down your left mouse button and stretch or shrink the contour.
NOTE: You can stretch the contour in the width dimension or in the
height dimension, depending on the location. Width and
height may be stretched simultaneously if you choose a corner
square.
3. Click the Asym button.
4. Stretch the contour in Asym mode.
Move

This function allows you to move the contour.
1. With the bladder contour still in edit mode, place the cursor anywhere
inside the contour until the four-way pointer displays on the window.
2. Hold down your left mouse button and move the contour.

XiO 4-21
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Patient File Maintenance
Task 5. Contouring
Sub-task 7. Edit Existing Contour
Move Points (cont.)

This function allows you to move 1, 3, or 5 points of the contour outline.
1. With the bladder contour still in edit mode, place the cursor anywhere
inside the contour and click your left mouse button once. XiO toggles the
edit mode box to points.
2. Select the button representing 5 points.
3. Place your mouse cursor near a point until it turns red (active). You may
want to scale the image to make it larger so the points are easier to
visualize.
4. Hold down your the left mouse button and drag the points.
Copy Superior/Inferior

When a contour is in edit mode, the right arrow on the keyboard copies superior,
and the left arrow on the keyboard copies inferior.
Copy/Paste to Another Slice (keyboard shortcuts)
Ctrl/C copies a contour.
Ctrl/V pastes a contour.
The selected contour must be in edit mode to use these tools.
Delete a Single Contour
In edit mode, you can delete a single contour by selecting the Delete button on
the keyboard.
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Patient File Maintenance
Task 5. Contouring
Sub-task 7. Edit Existing Contour (cont.)
Delete ALL Contours for an Entire Structure

In edit mode, you can delete all contours with the same contour name by
selecting the Shift and Delete keys on your computer keyboard.
Stop Editing
When the contour editing is complete, click anywhere outside the purple edit box
to unselect the contour.

OR
Choose another contouring tool.
XiO 4-23
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Patient File Maintenance

Task 5. Contouring
Sub-task 8. Create Contours from Predefined Shapes Using the
Keyboard
Use this function when you want to create contours from simple shapes, such as
circles and rectangles, using your computer keyboard.
1. Use the scroll wheel or left/middle mouse buttons to movie to cross section
157.91 (cm).
2. Click the drop-down arrow by the Contour: field and select Rectum.
3. Click the Create Contours from Predefined Shapes Using the Keyboard
button. XiO displays the Keyboard Entry of Simple Shapes dialog
box.


4. Under the Polygon Definition heading, enter 360 in the Number of Sides:
field. The number of sides defines the shape (i.e. Triangle 3 sides, Circle
360 sides). Entering 100 sides creates a well-defined circle and uses
fewer points.
5. Enter 0.5 cm in the Center A (cm): field. This defines the left/right location
of the contour.
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Patient File Maintenance
Task 5. Contouring
Sub-task 8. Create Contours from Predefined Shapes Using the
Keyboard (cont.)
6. Enter 4.3 cm in the Center B (cm): field. This defines the
anterior/posterior location of the contour.
NOTE: If you do not know the exact location of the structure center,
enter 0 (zero) for A and B; then, in edit mode, select and move
the structure so it is centered on the structure of interest.
7. Enter 1.5 cm in the Size (cm): field. This value is used to define the
contour shape size.
8. Enter 0 in the Angle (deg): field. Use this value if a rotation is needed.
9. Click the Add Polygon Contour button. XiO creates a circular contour for
the rectum at the specified location. The contour is now manually editable.
10. Click Cancel to close the window.
Sub-task 9. Draw Contours using the Mouse
Use this function to manually trace contours.
1. Click the Page Up key on your computer keyboard to move superior.
2. Click the Draw Contours Using the Mouse button.
3. Hold down your left mouse button in the SPV window and drag to trace
the rectum. Points are automatically placed at a user-specified spacing.
Minimum Point Sample Spacing can be edited by selecting the Edit drop-
down menu and selecting the Preferences and General options.
OR
Trace the rectum by clicking your left mouse button multiple times to place
points manually around the structure.
4. If necessary, use the guide radius as a visual cue when you want to draw a
contour at a specific distance around a structure. See the Paintbrush section
for more information regarding controlling the size of the guide radius.
XiO 4-25
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Patient File Maintenance
Task 5. Contouring (cont.)
Sub-task 10. Interpolate
Use Interpolation to automatically create contours between two or more existing
contours on other slices. This function is ideal for outlining structures with little
change in size and shape throughout the studyset, such as the spinal cord or
rectum.
In this activity, you will create a contour on approximately every third cross
section; then, use the Interpolation feature to create contours on the slices in
between the other contoured slices.
1. Click the View drop-down menu and select the Window Format and Four
Window options XiO changes from the large single cross section window
to a four successive cross sections display.
2. Hold down your left mouse button and outline the rectum on one of the
four windows.
3. Click the Page Up key on your computer keyboard to move superior. XiO
updates all displayed slices.
4. Hold down your left mouse button and outline the rectum on one of the
four windows.
5. Continue this process using the Page Up/Page Down keys to move
throughout the rectum. Be sure to outline the superior most and inferior
most portion of the rectum.
6. Click the Interpolate between Contours button. XiO fills the skipped
slices with the interpolated rectum contours.
7. Review the contours and make edits if needed.
8. Click the View drop-down menu and select the Window Format and Four
Window options. XiO toggles the Four Window format back to the Single
Window format.
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Patient File Maintenance
Task 5. Contouring (cont.)
Sub-task 11. Free-form Exercise Outline the Seminal Vesicles
using any method

XiO 4-27
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XiO Training Guide

Patient File Maintenance

Task 5. Contouring
Sub-task 12. 3-D Auto-Margin - Uniform
Use the 3-D Auto-Margin to automatically generate new contours that are a
specified margin (positive or negative) from a selected contour(s).
1. Click the Create a Contour Using 3-D Auto-margin button. XiO
displays the 3-D Auto-Margin dialog box.

2. Enter Target in the New Structure Name field. This represents the name of
the 3-D Auto-Margin contour.
3. Leave the Class field defaulted to Int indicating an Internal structure.
Other valid selections for this field are TV1-TV5 and Tumr.
4. Click the drop-down arrow in the Color field and select Cyan.
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Task 5. Contouring
Sub-task 12. 3-D Auto-Margin Uniform (cont.)
5. Click the drop-down arrow in the Rendering field and select T50 (50%
transparent). Other valid selections are W (wire), S (solid), T25 (25%
transparent), and T75 (75% transparent).
6. Leave the Rel. Electron Density field default set to 1.0. You can edit this
field, if needed.
7. Click the drop-down arrow in the Variable Margin: field and select No.
This signifies that you want to create a uniform margin. Uniform 3D Auto-
Margin contours retain the shape of the initial contours and are scaled so
that each point is located no closer than the specified distance from the
initial contours.
8. Click your middle mouse button in the Structure field and select Prostate.
This is the first structure identified for 3-D Auto-Margin.
9. Enter 1 cm in the Margin field. You have the option of creating a positive
or negative margin by entering a positive or negative value.
10. Leave the Include/Exclude field to default to Include. A structure is
included by a specified value in the Auto-Margin contour if the Include
option is chosen. A structure is subtracted by a specified value from the
Auto-Margin contour if the Exclude option is chosen.
11. Click your middle mouse button in the next available Structure field and
select Sem Ves. This is the second structure to be included in the 3-D
Auto-Margin.
12. Enter 1 cm in the Margin field.
13. Leave the Include/Exclude field to default to Include.
14. Click the drop-down arrow in the Clip at Patient Surface: field and select
No. If you select Yes, XiO forces the new contour to follow the patient
contour if it comes in contact with it instead of continuing outside the
patient.
XiO 4-29
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Patient File Maintenance

Task 5. Contouring
Sub-task 12. 3D Auto-Margin Uniform (cont.)
15. Leave the Clip Inside By (cm) field defaulted to 0 cm. This value can be
edited to clip the 3D automargin contour inside the patient contour by the
specified amount. This feature could be used when you have to contour
superficial structures, but do not want to include tissue in the buildup
region.
16. Click the Create 3D automargin button. XiO creates the Auto-Margin
according to the specified values.
17. Use the scroll wheel to review the contours.
18. Click the Clear 3D automargin button. XiO discards the recently
generated margin.
19. DO NOT click the Cancel button. You will use the above settings in the
next task.
Sub-task 13: 3D Auto-Margin with Exclusion
The structures and margins created in Sub-task 11 should still be displayed.
1. Click your middle mouse button in the next available Structure field and
select Rectum.
2. Enter 0 cm in the Margin (cm): field.
3. Click the drop-down arrow in the Include/Exclude field and select Exclude.
4. Click the Create 3D automargin button and review the contours. XiO
excludes the Rectum (by 0 cm) from the 3-D Auto-Margin structure.
5. Click the Clear 3D automargin button.
6. Enter 0.5 cm in the Rectum Margin (cm): field.
7. Click the Create 3D automargin button and review the contours. The 3-D
Auto-Margin reduces the margin near the Rectum to 0.5 cm.
8. Click the Clear 3D automargin button.
9. DO NOT click the Cancel button. You will use the above settings in the
next task.
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Task 5. Contouring
Sub-task 14: 3-D Auto-Margin Variable
Variable 3-D Automargin contour shapes are based on the shape of the initial
contours, but may have different margins in different directions from the initial
contour (i.e. ant, post, rt., lt., sup, and inf).
The structures and margins created in Sub-task 12 should still be displayed.
1. Click the drop-down arrow in the Variable Margin: field and select Yes.
XiO changes the content of the dialog box to represent the variable fields.


2. Press the space bar in the Structure field to clear the name "Rectum" from
the field.
3. Enter 0.2 cm in the Posterior (cm): field for both Prostate and Sem Ves.
XiO 4-31
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Patient File Maintenance

Task 5. Contouring
Sub-task 14: 3-D Auto-Margin Variable (cont.)
4. Click the Create 3D automargin button and review the contours. The 3-D
Auto-Margin is 1 cm in size everywhere but posteriorly, where it is only
0.2 cm.
5. Click the Accept 3D automargin button to accept the contour.
6. Click Cancel to close the dialog box.

Sub-task 15. 3-D Auto-Margin Negative
Negative margins can be used to create contours inside other contoured
structures, such as bladder or rectal walls.
1. Click the Create a Contour with 3-D Auto-margin button.
2. Enter the New Structure Name rectalwall.
3. Change the Color to green.
4. Leave the default for Variable Margin to no. You can only create negative
uniform margins.
5. Click your middle mouse button in the Structure field and select Rectum.
6. Enter a 0.2 cm margin and leave the default to Include.
7. Click the Create 3-D Auto-Margin button and review the contours. The
new contour is drawn 0.2 cm inside the structure rectum.
8 Click Accept 3D Auto-margin.
9. Click Cancel to close the dialog box.
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Task 5. Contouring
Sub-task 16. 2-D Automargin
Use the 2-D Automargin function to automatically generate a new contour on a
single slice to create a specified margin around a selected contour on one slice.
A contour is selected when you place it in edit mode (the edit box encompasses
the structure), after which you can create a 2-D automargin contour by clicking
the Creating a 2-D Automargin button. The new contour retains the shape of
the initial contour and is scaled so that each point is located no closer than the
specified distance from the initial contour. The new contour also retains the
same contour name. Click the Edit the Distance between the Initial Contour
and the Derivative Contour button to change the value of the 2-D Auto-Margin.
Sub-task 17. Edit Contour Information
In PFM, you can edit contour information for contours in your General and
Specific Anatomical Sites groups.
1. Click the Edit drop-down menu and select Contour Names then Edit
Contour Info. XiO displays the Edit Contour Info dialog box.

2. Click your middle mouse button in the field next to Anatomical Site to
select the group of contours you want to edit.
3. Edit contours names and attributes. These edits will only apply to the
structures displayed on the current patient.
4. Click OK when finished.
NOTE: To set the contour information for Anatomical Sites globally for
all patients, you must edit the contour information in Settings-
Patient Data-General Anatomical Sites or Specific
Anatomical Sites.
XiO 4-33
Patient File Maintenance
XiO Training Guide

Patient File Maintenance
Task 5. Contouring
Sub-task 17. Create Interest Points Using the Mouse
1. Click the Create Interest Points and Markers Using the Mouse
button on the Patient File Maintenance toolbar.
2. Click your left mouse button to place an interest point in the rectum to
add an Interest Point.
OR

Place your mouse pointer in the desired location and press the (i) key on
your computer keyboard to add interest point.
NOTE: You can edit the letter that represents this hot key function by
clicking the Edit drop-down menu and selecting the
Preferences and General options.
3. Click the Edit drop-down menu and select the Interest Points option. XiO
displays the Edit Interest Point Definitions dialog box.


4. Enter Rectum in the Description field.
5. Click the OK button to close the dialog box.
Sub-task 18. Create a Marker Using the Mouse and Scales feature
1. Locate and display the cross section containing three fiducial markers on
the patient surface.
2. Click the View drop-down menu and select the Scales and Display options.
XiO toggles the scales to an "On" status in the Single Plane View.
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Patient File Maintenance
Task 5. Contouring
Sub-task 18. Create a Marker Using the Mouse and Scales Feature
(cont.)
3. Click your right mouse button in the Single Plane View and select the
Move Scales option.
4. Hold down your left mouse button and move the scales to intersect with
the fiducial markers.


5. With the mouse pointer located on the scales center, press the "m" key on
your computer keyboard to place a Marker Point.

OR

You can also place the point by clicking the Create Interest Points and
Markers Using the Mouse button. If you elect to use this method, hold
down the shift key on your computer keyboard and click your left mouse
button to place marker.

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Patient File Maintenance
Task 5. Contouring
Sub-task 18. Create a Marker Using the Mouse and Scales Feature
(cont.)
6. Click the Edit drop-down menu and select the Markers option. XiO
displays the Edit Marker Definition dialog box.

7. Enter Scan Ref Pt in the Description field.
8. Click the OK button to close the dialog box.
Sub-task 19. Obtain Shift Calculations Setup Reference Definition
You can set a scan reference point (such as, fiducial markers or the CT scan 0,0,0
coordinate) to be used to calculate shift information relative to another point. A
relative point is defined as a setup reference point, which is typically the center
of a structure, an interest point, or a beam isocenter. You can print the shift
information, or use it to drive the lasers from the scan reference point to the setup
reference point.
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Patient File Maintenance
Task 5. Contouring
Sub-task 19. Obtain Shift Calculations Setup Reference Definition
(cont.)
1. Click the Tools drop-down menu and select the Setup Reference
Definition option. XiO displays the Setup Reference dialog box.

2. Leave the Report Points field defaulted to Relative to Scan Reference
Point. If you select Relative to Scan Reference Point, XiO displays the
shifts based on the chosen scan reference point. If you select Absolute,
XiO displays the shifts in the actual scanner coordinates.
3. Click your middle mouse button in the Scan Reference, Interest Point or
Marker: field and select the Scan Ref Pt marker. This is the point used as
the origin when XiO calculates the shifts.
4. Click your middle mouse button in the Setup Reference Center of Structure:
field and select the Target option. XiO calculates the spatial coordinates
from the scan reference to this point.
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Patient File Maintenance
Task 5. Contouring
Sub-task 19. Obtain Shift Calculations Setup Reference Definition
(cont.)
5. Click the drop-down arrow in the Gammex LMS Automove: field and
select No to ignore the auto-move option. Selecting Yes enables the lasers
to move automatically when you click the Reposition Lasers button. XiO
sends instructions to the Gammex computer. You are responsible for
loading the file to move the lasers.
6. Click OK. XiO displays the Setup Reference Definition page, which
includes shift information.

NOTE: You can print and place this page in the patients chart.

7. Click the Quit button.

NOTE: The Mark Anatomical Reference (from the Tools drop down
menu) option is only available if the Setup Reference
Definition has been utilized. This feature pulls in the setup
reference point defined in Setup Reference Definition and
calculates shifts relative to another anatomical reference. The
Mark Anatomical Reference dialog box is much like the Setup
Reference Definition dialog box.
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Patient File Maintenance
Task 6. Turning On and Off Display of Contours and Plan
Objects
In PFM, you have the option of turning the display of contours and other plan
objects on or off. You can also change the Color, Rendering, and Color Fill of
contours.
Toggle the Display of Contours
1. Click the View drop-down menu and select the Enhance Contour option.
OR
Press the C key on the keyboard.
XiO opens the Enhance Contour dialog box.

2. Click each individual contour name to toggle it on or off.

OR

Click the All Structures On or All Structures Off button to toggle them
all.
3. Click the drop-down arrow next to the Color of a structure to see a list of
colors and select a new color.
4. Click the drop-down arrow next to the Rendering of a structure to see a list
of possible renderings. W = Wireframe, S = Solid and T25-T75 =
Transparent Rendering options. These rendering will be displayed in the 3D
view and on Transverse, Sagittal and Coronal images when Color Fill is
selected.
XiO 4-39
Patient File Maintenance
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Patient File Maintenance
Task 6. Turning On and Off Display of Contours and Plan
Objects
Toggle the Display of Contours (cont.)
5. Click the drop-down arrow next to Color Fill and select Yes if you would
like to display the structure filled with color on the transverse, sagittal, and
coronal images. Select No if you would like to display the structure as
wireframe on those views.
6. Click OK when finished.
Toggle the Display of Plan Objects
1. Click the View drop-down menu, select the Plan Objects option.
2. Place a checkmark in the box next to an individual plan object to turn
the display On.

OR

Remove the checkmark to turn the display Off.
NOTE: Plan Objects are described in more detail in the Teletherapy-
Part 2 section of the training guide.
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Patient File Maintenance
XiO Training Guide

Patient File Maintenance
Task 7: Window Format Options
You have the ability to customize the window format that displays in PFM. The
default view includes a main contouring window, a MPV window in the upper
right corner of the graphics area, and thumbnail slices displayed along the right
side of the graphics area.
1. Click the View drop-down menu and select the Window Format option.
2. Place a checkmark next to the option you want to display.
Below is a list of the display options and their individual characteristics.
Scout If you have transferred at least one scout view into XiO
from CT, this option will be available. XiO places the
scout view in the upper left corner of the graphics area.
Click your right mouse button in the Scout window to
view all the graphics options that are available. When you
movie through transverse images, a pointer displays on the
scout view that indicates the currently displayed slice
location.
MPV This view typically is on by default and displays in the
upper right corner of the graphics area. Right mouse click
in the MPV window to view all the graphics options that
are available.
Previous Select this option if you would like to display a window
where XiO displays the previously contoured transverse
image. XiO places the previous window in the lower right
corner of the graphics area. As you movie through
transverse images in the main window, the image in the
previous window will movie too, but trail by one slice,
therefore, displaying the previous slice. Click your right
mouse button in the previous window to view all the
graphics options that are available.
Four Window This option divides the main screen into four windows and
displays four consecutive images in each window. Click
your right mouse button in any of the four windows to
view all the graphics options that are available. If you use
page up/down or the up/down arrow keys to movie, XiO
updates the windows with the next four consecutive
images.
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Patient File Maintenance
Task 7: Window Format Options (cont.)
TSC View This option displays a four-window format featuring a
Transverse, Sagittal, Coronal and a 3D plane reconstructed
view. As contours are drawn on the transverse image,
those contours are displayed in the sagittal and coronal
views. Click your right mouse button in any of the four
windows to view all the graphics options that are available.
Select the Plane Icon option; then, click in any SPV view
to update the other two SPV views and the MPV view to
display the new plane(s).
Thumbnail This option toggles the thumbnail images on and off.
Thumbnails are used for navigational purposes and display
auto threshold contours before you accept them. This view
typically is on by default and displays along the right side
of the graphics area.


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Patient File Maintenance
Task 8: (Optional) Image Fusion in PFM
Not all users have Image Fusion, as it is a separate purchasable feature within
PFM.
Image Fusion is an automated tool used to fuse image sets, such as CT and MRI
images, so that contouring can be performed on either one in PFM. Before
fusion can be performed, you must import a secondary set of images under the
same patient ID as the primary studyset. For training purposes, you will access
an existing patient that has two studysets to fuse (Subtask 2); however, the steps
to create a secondary studyset can be found in the following subtask.
Subtask 1: Create a Secondary Studyset
1. Select Patient File Maintenance on the XiO Main window. XiO opens
PFM.
2. Click the File drop-down menu and select the Open option. XiO displays
the Open Patient/Studyset dialog box.
3. Click your middle mouse button in the Patient ID field and select a Patient
ID.
4. Click OK without selecting a Studyset ID.
5. Click the File drop-down menu and select the New and Studyset (image)
options.
6. Follow the same instructions from the PFM lesson to transfer in the
secondary studyset.
Subtask 2: Open the Patient for Fusion
1. Click the File drop-down menu and select the Open Patient for Fusion
option. XiO displays the Open Patient and Run Fusion dialog box.
2. Click your middle mouse button in the Patient ID field and select a Patient
ID.
3. Click OK. XiO opens the Fusion module and displays an Open Study
dialog box.
4. In the window labeled Primaries, expand the patient folder by clicking on
the plus sign + next to the folder.
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Patient File Maintenance
Task 8: (Optional) Image Fusion in PFM
Subtask 2: Open the Patient for Fusion (cont.)
5. Click the name Studyset: CT so that it is highlighted in blue. XiO places
all new and existing secondary studysets in the New and Existing
Secondaries windows to the right of the Primaries window.
NOTE: If the images have previously been fused, the secondary
studyset appears in the Existing Secondaries window. If the
images have never been fused, the secondary studyset appears
in the New Secondaries window.
6. Click the secondary studyset name MRI/MRI in the New or Existing
Secondaries window. XiO displays the Primary and Secondary Image
Background removal options.
NOTE: Before fusing the images, XiO may need to remove
background data. There are two methods that can be used and
the third does not remove the background. Typically, the
Shape /Intensity Model works best.
Shape Intensity Model: Use the patient shape and intensity
to remove the background outside the patient.
RE Segmentation: Use relative entropy to remove the
background outside the patient.
Keep Patient Exterior: This option does not remove the
background
7. Use the default Shape/Intensity Model and click OK. XiO loads the
primary and secondary studysets.
Subtask 3: Fusion Tools and AutoRegistration
1. You can manually translate secondary studysets by holding down your
left mouse button inside the circle on any image and translating.
2. You can manually rotate secondary studysets by holding down the left
mouse button anywhere outside the circle on any image and rotating.
3. You can adjust the Window and Level of the primary or the secondary
using the slider bars.
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Patient File Maintenance
Task 8: (Optional) Image Fusion in PFM
Subtask 3: Fusion Tools and AutoRegistration (cont.)
4. You can change the Colormap of the secondary studyset to any of seven
(7) options, from the Secondary slider bar.
5. You can fade from the primary to the secondary using the Fader bar.
6. There are zooming and measuring tools on the tool bar.
7. Slightly translate and rotate the image manually in any view; then, click
the AutoRegister button. XiO automatically fuses the images.
8. XiO displays the AutoRegistration Status in the second window on the top.
9. When you are finished, click the File drop-down menu and select the Save
Registration option.
10. Click the File drop-down menu and select the Exit option to close. XiO
closes the Fusion module and displays the Open Patient/Studyset dialog
box.
Subtask 4: Open Fused Studysets in PFM
1. Click your middle mouse button in the Studyset ID box and select the
primary studyset. (This should always be the planning CT). XiO expands
the Open Patient/Studyset dialog box to prompt for a Secondary Studyset
ID.
2. Click your middle mouse button and select the Secondary Studyset ID.
3. Click OK. XiO loads the fused images into PFM.
4. Toggle the display between fused Primary data (1) and Secondary data (2)
using the 1 and 2 buttons.
NOTE: The MRI studyset represents a smaller area than the CT, so
there will not be an MRI image for every CT image. Movie
towards the prostate to see the MRI images for this patient.
5. Use the window level tools or presets to adjust the window and levels if
needed for each studyset.
6. You can contour on either studyset or both. You can also begin the
contouring on one studyset, and end on another.
XiO 4-45







Teletherapy- Part 1
XiO Training Guide

Teletherapy

Overview
The Teletherapy lesson has been separated into two parts. Part 1 is functional in nature
where you create a plan for the prostate patient you contoured in Patient File
Maintenance. (If you skipped the PFM section, you may create a new plan using an
existing contoured prostate patient.) As you plan, new functions and features are
introduced at the most appropriate point in the process. This section is organized such
that you could use the process as a template for planning in your own clinic. However,
XiO is limitless in the number of ways you could accomplish these tasks.
Part 2 introduces additional Teletherapy features and functionality, but in more of a
feature-by-feature approach.

XiO 5-1

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1
Practice Exercise
Explanations, references and alternative steps (when applicable) for each field are
provided as you navigate through this lesson. First, you will open a patient in
Teletherapy, learning how to adjust the major graphical display options, and creating
and mirroring beams with ports so that you end up with a simple four-field prostate plan
giving a total dose prescription of 4500 cGy using 180 cGy per day. Next, you will
continue reviewing isodoses, normalizing, and evaluating the plan. This completes the
planning process. Then, you will review the various functions available in XiO.
If you are continuing from Patient File Maintenance (PFM), begin with Task 1A.
If you have exited PFM and would like to open the patient directly in Teletherapy, begin
with Task 1B.
Task 1A. Open the Patient in Teletherapy (from PFM)
Follow these steps if you have completed contouring the prostate patient in Patient File
Maintenance and are ready to continue with planning.
1. Click the Beam icon. XiO displays the New Teletherapy Plan dialog box.


2. The Patient ID automatically defaults.
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Teletherapy Part 1

Task 1A. Open the Patient in Teletherapy (from PFM) [cont.]
3. (Optional) Enter a description for this plan, such as "prostate."
4. Select the Beam Weighting Mode Absolute Dose/MU. The options are Absolute
Dose/MU or Relative Dose.
5. The Treatment Date defaults to todays date; however, this date is editable.
6. The Studyset ID defaults.
7. Create as 2D plan defaults to No. You will only be able to edit this option if you
have ten (10) slices or fewer.
8. Enter Head as the option for Head/Feet toward gantry. This option determines
how you will plan the patient regardless of how the patient was scanned. For
example, if the patient was scanned with the head towards the gantry and you
want to treat the patient with the feet towards the gantry, in PFM transfer in the
patient as scanned; then, at this prompt, enter Feet. The patient displays as feet
towards the gantry for planning purposes.
9. Select the Graphics Area Setup 6TSCMxA. These are predefined preset window
arrangements; however, you can create your own user-defined presets. This
option creates a screen with six windows containing a Transverse, a Sagittal, a
Coronal and Multi-Plane View (3D), a blank window and an Active Beams-Eye
View.
10. The alternative to selecting a Graphics Area Setup is to select a Template.
Templates are user-created default plans that can be applied to any patient. Items
that are saved with templates include, but are not limited to, the following: beam
arrangements, graphics area setups, prescriptions, wedges, heterogeneity settings,
grid spacing, ports, IMRT segments, etc. See section 13 in this training guide for
more information regarding templates.
11. Click OK. XiO opens the patient in the Teletherapy workspace.
XiO 5-3

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 1B. Open the Patient in Teletherapy (from the Main XiO
screen)
Follow these steps if you have exited Patient File Maintenance and would like to open
and plan a completely contoured prostate patient.
1. Click the Teletherapy option on the XiO main screen, or select Teletherapy from
the Run drop-down menu. XiO displays the Teletherapy workspace.
2. Click the File drop-down menu and select the New Teletherapy Plan option.
XiO displays the New Teletherapy Plan dialog box.

3. Click your middle mouse button in the Patient ID box and select the patient ID
MRProstate.
NOTE: You can sort the patient list by Patient ID, Patient Name, or
Creation Date by selecting one of these options in the Patient List
Sorted By: list before you select a patient ID.
4. (Optional) Enter a description for this plan, such as "prostate."
5. Select the Beam Weighting Mode Absolute Dose/MU. The options are Absolute
Dose/MU or Relative Dose. If you plan to create composite plans or IMRT plans,
you must use Absolute Dose/MU. Absolute Dose/MU mode allows more
flexibility when normalizing and prescribing than Relative Dose Mode.
5-4
Teletherapy- Part 1
XiO Training Guide

Teletherapy Part 1

Task 1B. Open the Patient in Teletherapy (from the Main XiO
screen) [cont.]
6. Todays date defaults as the treatment date; however, this date is editable.
7. Select the Studyset ID 3DProstate.
8. Create as 2D plan defaults to No. You will only be able to edit this option if you
have 10 slices or fewer.
9. Enter Head as the option for Head/Feet toward gantry. This option determines
how you will plan the patient regardless of how the patient was scanned. For
example, if the patient was scanned with the head towards the gantry and you
want to treat the patient with the feet towards the gantry, in PFM, transfer in the
patient as scanned; then, at this prompt, enter Feet. The patient displays as feet
towards the gantry for planning purposes.
10. Select the Graphics Area Setup 6TSCMxA. These are predefined preset window
arrangements; however, you can create your own user-defined presets. This
option creates a screen with six windows containing a Transverse, Sagittal,
Coronal, and Multi-plane view (3D), a blank window, and an Active Beams-Eye
View.
11. The alternative to selecting a Graphics Area Setup is to select a Template.
Templates are user-created default plans that that can be applied to any patient.
Items that are saved with templates include, but are not limited to, the following:
beam arrangements, graphics area setups, prescriptions, wedges, heterogeneity
settings, grid spacing, ports, IMRT segments, etc.
12. Click OK. XiO opens the patient in the Teletherapy workspace.

XiO 5-5

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 2. Graphical Display Options
Before you begin planning, you may want to make a few small changes to the images
displayed on your screen. This task discusses a few of the graphics manipulation tools
that are always available during planning.
Activate a Window
Activate a window by left-or-right mouse clicking in any window that is not blank. A
red box displays around the perimeter of the selected window.
Scale
Scale is used to increase or decrease the size of the item displayed in that window.
1. Right mouse click in any selected window then click your left mouse button and
select the Scale option.
2. Hold down the left mouse button in the selected window and drag from left to
right to increase or decrease the size of the image in that window.
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Teletherapy Part 1

Task 2. Graphical Display Options (cont.)
Window/Level
Adjust the window and level of the CT image data in an SPV window. You can use the
Window/Level option found on a right mouse click, use the W/L slider bars on the right
side of the screen, or use the saved preset window/level options. A default is set so that
the window/level affects all the windows together. If you would like the window/level
to affect only one window, click the icon W/L currently affects multiple windows
above the window/level slider bars so that it changes to this icon W/L currently
affects active window.

1. Click your right mouse button and select the Window/ Level option.
2. Hold down the left mouse button in the selected SPV window and drag from left to
right to adjust the level or up and down to adjust the window.
OR
Hold down the left mouse button on the window or level slider bar and drag up or
down to change the window and level.
OR
Select a saved preset window/level option from the drop down list in the upper
right corner of the XiO toolbar.
XiO 5-7

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 2. Graphical Display Options
Window/Level (cont.)
3. In this lesson, select the window/level preset Soft Tissue.

Here are steps you can use to save your own
window/level presets.
(1) Set the window and level you want to
save.
(2) Click the (Save) W/L button.
(3) Enter a New Preset Name in the pop-up
window.
(4) Click OK to add the preset, or Cancel if
you do not want to save the preset.

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Teletherapy Part 1

Task 2. Graphical Display Options (cont.)
Movie
In any SPV window, you will have a Movie option that allows you to movie through
your transverse, sagittal or coronal images. In a transverse image window, you can
movie through actual CT slices or reconstructed CT slices. In the sagittal or coronal
window, you can only movie through reconstructed slices. The slice spacing is user-
definable. Click the Edit drop-down menu and select the Preferences and General
options.
1. Click your right mouse button in any SPV window and select the Movie option.
2. Click your left mouse button to movie towards the foot.
3. Click you middle mouse button to movie towards the head.
4. If you have a Linux operating system and scroll-wheel mouse, you can use the
scroll wheel to movie the images from head to foot.
Pan
You can use pan to move the graphic image around in any window.
1. Click your right mouse button in any window and select the Pan option.
2. Hold down the left mouse button and drag the graphic image around the window.
3. Click your middle mouse button to reset the graphic image back to its original
location.
Rotate
This option is only available in an MPV window. Select this option to rotate the 3D
image.
1. Click your right mouse button in the MPV window and select the Rotate option.
2. Hold down the left mouse button and drag the image around the window.
3. Click your middle mouse button to reset the graphic image back to its original
position.
XiO 5-9

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 2. Graphical Display Options (cont.)
Translate
This option is only available in an MPV window. Select this option to translate the axis
of rotation off the center of the patient.
1. Click your right mouse button in the MPV window and select the Translate
option.
2. Hold down the left mouse and move the image around the screen.
3. The next time you rotate, you will notice that the image is translated off its
original axis of rotation.
4. Click your middle mouse button to reset the graphic image back to its original
position.
Maximize/Restore
1. Use these options to zoom and restore any one window to full screen and back.
2. Click your right mouse button in any window and select the Maximize option.
XiO zooms that window to full screen.
3. Click your right mouse and select Restore. XiO returns to the original window
format.
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Teletherapy Part 1

Task 3. Add and Edit a Beam
This task demonstrates how to add a new beam, edit the beam parameters, and
manipulate the beam using the mouse.
1. There are three ways to add a new beam.
(1) Click the New Beam button on the toolbar.
(2) Press the F5 button on the keyboard.
(3) Click the Beam drop-down menu and select the New Beam option.

XiO displays the New Beam dialog box.

2. The beam number defaults to 1; however, you can enter a different beam number.
3. Enter the beam Description AP. Descriptions are always optional; however, it is
customary to label each beam.
4. Click your middle mouse button in the Machine ID box and select the Machine ID
Varian18x with a left mouse click.
5. Use the default Setup SAD. The options are SAD, SSD and Rotational.
6. If necessary, change the Collimator Jaw setting from Symmetric to Asymmetric.
You will only have asymmetric as an option if your linear accelerator has the
asymmetric jaw capability, and the machine data entered in XiO is validated for
asymmetric jaws.
XiO 5-11

Teletherapy- Part 1
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Teletherapy Part 1

Task 3. Add and Edit a Beam (cont.)
7. Use the default Center of PTV1 for the Beam Isocenter Placement. Your options
consist of the center of any structure that you contoured, the studyset center, any
interest point or marker that you added or the isocenter of any beam that you
added.
8. Click OK to continue. XiO displays the Photon Beam dialog box.

9. You have already determined the Description, Machine ID, Setup and Collimator
Jaw settings; however, at this point, they are editable.
10. XiO displays the Treatment Distance and Source to Skin Distance, but they are not
editable since the Setup is SAD. The SSD is measured from the isocenter to the
patient surface contour. When the gantry is rotated, XiO updates the SSD.
NOTE: When you select SSD for the Setup, the Treatment Distance is
editable. When you select Rotational, XiO displays the start and stop
SSDs and the Treatment Distance, but they are not editable.
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Teletherapy Part 1

Task 3. Add and Edit a Beam (cont.)
11. Use the default Field Size values. For asymmetric jaws, you can manually edit
the field size by entering values for LW (left width), RW (right width), UL (upper
length) and LL (lower length). For symmetric jaws, you can manually edit the
field size by entering values for Width and Length. You can also edit the
collimator jaws using the mouse.

Here are steps you can use to edit the width and length
of the collimator jaws using the mouse.
(1) In any ABV (active beams-eye view) or BEV
(beams-eye view) window, click your right
mouse button and select Width Jaws when in
symmetric mode. In asymmetric mode, select
LW/RW Jaws.
(2) Place your pointer on a width edge of the
collimator. Hold down the left mouse and drag
to the right or left to open or close the collimator
jaw. If you have asymmetric jaws selected, only
the selected width edge will move. If you have
symmetric jaws selected, both the width jaws
will move.
(3) Notice that the collimator width automatically
updates on the Photon Beam dialog box. If you
do not have the Photon beam dialog box
displayed, you can still edit the collimator jaws as
long as the Beam Button is highlighted. XiO
displays the updated jaw settings in the bottom
left corner of the screen.
(4) To edit the length with the mouse when in
symmetric mode, click your right mouse button in
the ABV window and select. Length Jaws. In
asymmetric mode, select UL/LL Jaws.
(5) Follow the same instructions outlined in Steps 2
and 3, only drag the mouse up or down to open or
close the collimator jaws and the length updates
on the Photon beam dialog box.
XiO 5-13

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 3. Add and Edit a Beam (cont.)
12. Use the default Gantry Angle of zero for the AP beam. You can manually edit
the gantry angle by entering a value or by using the mouse.

Here are steps you can use to rotate the gantry
using the mouse.
(1) In the transverse image window, click your
right mouse button and select Gantry
Angle.
(2) Place your pointer where the beam
intersects the patient surface; hold down
your left mouse button and drag (rotate) the
beam to a new gantry angle.
(3) Notice that the SSD updates on the Photon
Beam dialog box. If you do not have the
Photon beam dialog box displayed, you can
still rotate the gantry as long as the Beam
Button is highlighted. XiO displays the
updated gantry angle in the bottom left
corner of the screen.

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Task 3. Add and Edit a Beam (cont.)
13. Use the default Collimator Angle of zero for the AP beam. You can manually
edit the collimator angle by entering a value, or by using the mouse.
Here are steps you can use to edit the collimator angle
using the mouse.
(1) In any ABV (active beams-eye view) or BEV
(beams-eye view) window, click your right
mouse button and select the Collimator Angle
option.
(2) Place your pointer on any edge of the collimator;
hold down your left mouse button and drag to
rotate the collimator.
(3) Notice that the collimator angle automatically
updates on the Photon Beam dialog box. If you
do not have the Photon beam dialog box
displayed, you can still edit the collimator angle
as long as the Beam button is highlighted. XiO
displays the updated collimator angle in the
bottom left corner of the screen.

14. Use the default Couch Angle of zero (0) for the AP beam. You can manually edit
the couch angle by entering values.
15. The Isocenter for this plan has already been selected (Center of PTV1); however,
you can edit it here if necessary. Click your middle mouse button in the Default
to: box and select a different isocenter from the pop-up window list. Click the
Quit button on the pop-up window if you do not want to select a new isocenter.
You may also edit the X, Y, and Z coordinates by entering new values or using the
mouse to select an isocenter location.
NOTE: When you mirror or copy a beam, XiO copies the isocenter from the
original beam; however, each beam can have its own isocenter.
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Task 3. Add and Edit a Beam (cont.)

Here are steps you can use to edit or define the
isocenter location using the mouse.
(1) Click your right mouse button in any SPV (single
plane view), ABV, or BEV window and select
Isocenter Move.
(2) Click your left mouse button in any of these
windows where you would like the isocenter to be
located. XiO automatically places the beams
isocenter in that location and updates all the
windows.

16. Use the default Weight Defined At: of Arb. Point (arbitrary point) and Default to:
beam 1 isocenter. When arbitrary point is selected, you must select the actual
point you want as your weight point by clicking your middle mouse button in the
Default to: box and selecting an option from the pop-up window, or by using the
mouse to place the weight point.
NOTES: (1). When you select arbitrary point for the weight point, you have
the option of displaying the coordinate location of this point in
beam coordinates or in patient coordinates by clicking the
button next to Location to toggle. When you choose in patient
coordinates, you cannot move the weight point with the mouse
on an ABV or BEV.
(2). When symmetric jaws are set as the default collimator, the
other three options besides arbitrary point are:

Isocenter where XiO places the weight point at isocenter

Ref. Depth where XiO places the weight point at Dmax or
reference depth in the center of the field

Def. Depth where XiO places the weight point at a depth
that you define in the center of the field. When you select this
option, XiO displays a new box labeled Depth of Weight where
you can enter a value for the defined depth.

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Task 3. Add and Edit a Beam (cont.)
(3). When asymmetric jaws are set as the default collimator, the
other three options besides arbitrary point are:
Iso.Depth Fld.Ctr. where XiO places the weight point at
isocenter depth in the center of the asymmetric field.

Ref.Depth Fld.Ctr. where XiO places the weight point at
the Dmax or reference depth for that machine, and at the center
of the asymmetric field.

Def.Depth Fld.Ctr. where XiO places the weight point at a
depth that you define and at the center of the asymmetric field.
When you select this option, XiO displays a new box labeled
Depth of Weight where you can enter in a value for the defined
depth.
(4). When you mirror or copy a beam, XiO copies the weight point
from the original beam; however, each beam can have its own
weight point.


Here are steps you can use to edit or define the weight
point location using the mouse.
(1) In any SPV, ABV or BEV window, click your
right mouse button and select Weight Point
Loc.

NOTE: You will not be able to change the
weight point location in an ABV or BEV
if the Location button is toggled to in
patient coordinates.
(2) Click your left mouse button in any of these
windows where you would like the weight point
to be located. XiO automatically places the
weight point in that location and updates all the
windows. (If you do not see the weight point in
the ABV or BEV window, it could be behind or
in the center of a structure that is rendered as
solid. If you render each structure as transparent
or wireframe, you will be able to see the weight
point in an ABV or BEV window.)
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Task 3. Add and Edit a Beam (cont.)

17. For this lesson, enter a Weight (cGy) of 1125 and Number of Fractions of 25.
You will plan to create a four-field prostate plan to a total dose of 4500 cGy using
180 cGy per day. XiO allows you to enter any combination of weight and number
of fractions that you want.
For example, you can plan a daily dose treatment by entering the daily dose per
beam and one fraction, or you can plan total dose by entering the total dose per
beam and entering the total number of fractions, or enter a relative dose per beam
(for example, use a weight of 25 for each of four beams to add up to 100) and
rescale to actual doses when the plan is complete.
18. If you plan to use bolus on a beam every other day, you must have at least two
fractions defined for each beam. You should also enter the weight for at least two
fractions.
19. Use the default value of 1.00 for the Composite Tray Factor. This value
represents the block tray factor multiplied by the compensating filter tray factor
(when there is one). You will enter a block tray factor later when you create a
block.
20. Use the Calculation Algorithm: Convolution. You can select other options for
algorithm, like Clarkson, Superposition and Fast Superposition by clicking your
middle mouse button in the Calculation Algorithm box and selecting another
algorithm from the pop-up window list. Click the Quit button on the pop-up
window if you would like to close the window without selecting a different
algorithm.
21. Use the default value of Weight Fan to determine the SSD to use for machine
table lookups when the CAX is outside the patient. The option entered in this
field only applies when the central axis is outside the patient. The other options
are Field Center and User-Defined. If you choose User-Defined, XiO adds
another box where you can enter the user-defined Distance.
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Task 3. Add and Edit a Beam (cont.)
22. Use the default value of 4.0 for Minimum TERMA Extents. XiO only uses this
value if you are planning with the Convolution or Superposition algorithm. XiO
adds at least four fanlines beyond the collimator edge to the smaller of the
minimum TERMA extents or the calculation volume. This ensures that scatter
and penumbra are properly modeled when using these algorithms.
23. Click OK to close the Photon Beam dialog box.
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Task 3. Add and Edit a Beam (cont.)
24. If you would like to make edits to any values on the Photon Beam page after you
have closed it, select the beam you would like to make edits to in the Active Beam
box in the upper right corner of the screen; then, select one of the following three
methods to open the photon beam page.
(1) Click the Edit Beam button.
OR
(2) Click the Beam drop-down menu and select the Edit Beam option.

OR
(3) Press the B button on the keyboard.

XiO displays the Photon Beam dialog box.

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Task 3. Add and Edit a Beam (cont.)
25. Click the Display BEV/DRR button to turn on the Digitally Reconstructed
Radiograph (DRR). See the section on Digitally Reconstructed Radiographs in
this training guide for more information on DRR manipulation.
26. Use the window and level tools discussed in Task 2 to adjust the window and level
of the DRR image.

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Task 4. Create an Auto Port
In XiO, a port is defined as an open area through which the beam travels to treat the
patient. A port could consist of MLCs, blocks, apertures, or a combination of MLCs
and blocks or apertures and blocks. Auto ports are ports that can be generated by
selecting a structure to encompass using a specific margin. You can create Auto Ports
while in the Beam or Port mode.
1. There are many ways you can create an auto port. The most common methods are
as follows:
(1) Click the Auto Port button when in Beam or Port mode.
(2) Click the Port drop-down menu and select the Auto and Active Beam
options.
XiO displays the Auto Port dialog box.

2. Click your middle mouse button in the Auto Margin To: field and select PTV1.
This is the structure you want to place an auto port around.
3. Enter 1.5 cm for With Margin. This is the margin XiO uses around the structure
to create the port.
4. Click the Calculate MLC button. XiO automatically generates the MLC.
NOTE: For this training lesson, MLCs are chosen to create a port. If you do
not want to use MLCs, you may choose Aperture and ignore all
MLC related comments.
5. Click OK. XiO closes the Auto Port dialog box.
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Task 4. Create an Auto Port (cont.)
6. Click the Port drop-down menu and select the Conform Collimator, Active
Beams, or Multiple Beams option. This action opens or closes the collimator
jaws for one or all beams so that the aperture fits inside. If asymmetric jaws are
used, the jaws conform asymmetrically. If symmetric jaws are used, the jaws
conform symmetrically.

NOTE: You also have the capability to default the jaws to conform to a set
step increment, like the nearest half-centimeter when you click the
Edit drop-down menu and select the Preferences and Port options.

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Task 5. Mirror a Beam
This task demonstrates how to oppose a beam using the Mirror Beam option. If you
have a port on the original beam, the opposed beam is created with a mirrored port.
1. There are three ways you can mirror a beam.

Click the Mirror Beam button.

OR

Press F8 on the keyboard.

OR

Click the Beam drop-down menu and select the Mirror Beam To option. XiO
mirrors the beam to the selected beam number. Click OK. XiO opens the Photon
Beam dialog box for the new beam. If you have a port on the beam, XiO will also
mirror the port.

2. Enter PA for the beam Description and leave all other values to their defaults.
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Task 5. Mirror a Beam (cont.)
NOTE: XiO remembers beam parameters such as isocenter location, weight
point location, weight and number of fractions so that when you
mirror or copy a beam, the same information is applied to the new
beam; however, XiO allows you the flexibility to change those point
locations or values for each individual beam.
3. Use the window and level tools discussed in Task 2 to adjust the window and level
of the DRR image.
4. Click OK. XiO closes the Photon beam dialog box.

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Task 6. Copy a Beam
This task demonstrates how to copy a beam to create a new beam. In this task you will
copy a beam; then, rotate it to a lateral position. When you copy and rotate the beam,
the MLC port, which was created as an auto port, will automatically update to the
specified margin around the target. When you copy a beam that has a port, be aware
that there is a properties setting to determine if the port will update when you rotate the
gantry, or if the port will remain static as copied. To review, click the Port drop-down
menu and select the Port/Properties and Auto-Generated Blocking Updates with
Beam Movement options. In this task, you will also mirror the copied beam to create
beam 4.
1. There are three ways you can copy a beam.

Click the Copy Beam button.

OR

Press F7 on the keyboard.

OR

Click the Beam drop-down menu and select the Copy Beam To option. XiO
copies the beam to the selected beam number. Click OK. XiO opens the Photon
Beam dialog box for the new beam.
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Task 6. Copy a Beam (cont.)

2. Enter RT LAT for the beam Description.
3. Enter 270 degrees for the Gantry Angle or use the instructions from Task 3 to
rotate the gantry with the mouse to 270 degrees. XiO updates the beam display.
NOTE: If you have an Auto Port on this beam, it will automatically update
as the gantry rotates, when the port property "Auto-Generated
Blocking Updates with Beam Movement" is set to Yes.
4. Click OK. XiO closes the Photon Beam dialog box.
5. To display a DRR, click the Display BEV/DRR button. XiO displays the DRR in
the ABV window.
6. Use the window and level tools discussed in Task 2 to adjust the window and level
of the DRR image.
7. To mirror this beam, click the Mirror Beam To button. XiO mirrors the beam
to the selected beam number.
8. Click OK. XiO displays the Photon Beam dialog box for beam 4.
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Task 6. Copy a Beam (cont.)
9. Enter LT LAT for the beam Description. Leave all other fields to their default
values.
10. Click OK. XiO closes the Photon Beam dialog box.
11. To display a DRR for beam 4, click the Display BEV/DRR button. XiO displays
the DRR in the ABV window.
12. Use the window and level tools discussed in Task 2 to adjust the window and level
of the DRR image.

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Task 7. Change the Active Beam in the ABV (Active Beams-eye
View) Window
This task demonstrates how to change the active beam displayed in the ABV window.
If you would like to review each beam in the ABV window, select a beam from the
drop-down menu in the Active Beam box located in the upper right corner of the
screen.
OR
You can quickly select beams by pressing the number (1, 2, 3, etc) of the beam on the
keyboard. Just make sure the mouse pointer is located anywhere in the graphics
window area when you select the beam number on the keyboard.
Technically, you have completed all the tasks necessary to create a simple prostate plan.
You will know that the plan is calculated when you see the Dose Valid confirmation in
the bottom right corner of the screen.

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Task 8. Display Isodoses
This task demonstrates the various options you have to display isodose values. This
includes how to display isodose values in an MPV (3D) and BEV window.
1. Click the Dose drop down menu and select the Isodose Lines option.
OR
Click the I key on your computer keyboard.
OR
Click the Dose button (Shift + F4); then, click the Isodose Lines button (F9).
XiO displays the Isodose Lines dialog box.

2. Enter the following isodose line values: 4500, 4275, 4050, and 2250. Isodose lines
display on all SPVs. Colors and renderings are automatically assigned, but can be
edited. (See XiO Help for more information on rendering options.)
3. To display the isodose values in an MPV window, click the Dose in MPV
button (F10).
OR
Click the Dose drop-down menu and select the Dose in MPV option.
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Task 8. Display Isodoses (cont.)
4. To display the isodose values in a BEV window, click the Dose drop-down menu
and select the Dose in BEV option.

NOTE: When you make edits to the plan, ports, etc, the original dose display
remains on the BEV until the dose is recalculated.
5. If you would like your isodose lines to be thicker, change the option for Thick
Lines to yes.
6. Turn isodose values on/off by clicking the on/off button next to the selected
isodose line.
OR
Turn all isodose values on or off by clicking the All Isovalues On or All Isovalues
Off button.
7. If you would like to display the isodose values in a colorwash or isofill, select the
appropriate option next to Dose Display Mode. (See XiO Help for more
information on the various dose display modes).
8. If you would like to clear all the isodose values on the list, click the Clear
Isovalues button.
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Task 8. Display Isodoses (cont.)
9. If you have created lists of preset isodose values, you can select them from the
Load Isodose Line Preset box.

OR

You can save the currently displayed set of Isovalues as an Isodose Line Preset
that can be used in the future by clicking the Save Isovalues button and entering a
unique name for the list.
10. Click OK on the Isodose Lines dialog when finished entering isodose values.
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Task 9. (Optional) Evaluate Point Doses Using the Reference Dose
Cursor
Once a plan has calculated, XiO allows you to evaluate your plan using a dose cursor.
1. Click your right mouse button in any SPV window and select the Reference
Point Loc option.
2. Hold down your left mouse button and drag.

OR

Click your left mouse button in any SPV to update the point dose and point
coordinates located (in yellow) in the upper right corner of each SPV window.

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Task 10. Normalization of Dose Display
In XiO, there are two distinct ways to display dose; absolute dose and percent dose. No
matter how you normalize the dose display on the screen, none of the options affect the
weighting or monitor unit calculation.
Absolute Dose Normalization
Absolute is the default normalization option. If you do nothing, doses display as
absolute doses. The current normalization option is always displayed in the upper left
corner of each image window.
Global Maximum, Selected Point and Selected Dose Normalization
These represent three different ways to display doses as a percentage. Follow the steps
below to learn about these display options and how to apply them.
NOTE: If dose in MPV and /or BEV are turned on, you may notice a lag when
clearing and entering new isodoses. Turn off the display in these windows
to avoid this lag.
1. Click the Dose drop-down menu and select the Normalization button.
OR
Click the Set Normalization Mode button (F7). XiO displays the Dose
Normalization dialog box.

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Task 10. Normalization of Dose Display
Global Maximum, Selected Point and Selected Dose Normalization (cont.)
2. Click the Global Maximum option. XiO updates the dose display such that the
Global Max (hottest point dose) of the entire plan is equal to 100%. Check the
upper-left corner of any image window to verify that the normalization has
changed to gmax. The isodose lines should also update to reflect the percentages
displayed in the SPV window.
3. Normalizing to a Selected Point is a two-step process. First, you must select the
point to which you would like to normalize. Click your middle mouse button next
to Default To: under the Reference Point Position heading and select a point
(usually, this is isocenter).

OR
Click your right mouse button in any SPV and select the Reference Point Loc.
Hold down the left mouse button and drag or click the left mouse button in any
SPV to select the point location where you would like to normalize.
4. Click the Selected Point option. XiO updates the dose display such that the
selected point is now equal to 100%. Check the upper left corner of any image
window to verify that the normalization has changed to Pnt. The isodose lines
should also update to reflect the percentages displayed in the SPV window.
5. Normalizing to a Selected Dose is a two-step process. First, you must select the
dose value to which you would like to normalize. Typically, this is total dose or
total of all the beam doses, but you can enter any value you desire. Enter 4500 in
the field next to the Selected Dose button.
6. Click the Selected Dose button. XiO updates the dose display such that the
selected dose is now equal to 100%. Check the upper-left corner of any image
window to verify that the normalization has changed to Dose. The isodose lines
should also update to reflect the percentages displayed in the SPV window.
7. Click Cancel when you have finished normalization.

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Task 11. Beam Weighting and Rescaling
After the plan is complete, you may want to review your beam weights, or possibly
rescale them. If you have a composite plan and want to display the dose for one plan at
a time, you can turn on or off ALL or selected beams from the Beam Weights page.
1. Click the Dose drop down menu and select the Weight option.
OR
Click the Beam Weight button (F12). XiO displays the Beam Weight dialog
box.

2. Turn all beams and doses on or off by clicking the All Doses On/Off button.
3. Click the Update Display to Reflect Changes button, if needed.
4. Turn on or off individual beam doses by clicking the on/off button under Stat for
each beam.
5. Click the Update Beams to Reflect Changes button, if needed.
6. Weight, Monitor Unit and Fraction values are all editable by entering a new value.
When you edit one value, XiO updates all other affected values to reflect changes.
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Task 11. Beam Weighting and Rescaling (cont.)
7. Click OK to Close the Beam Weights dialog box.
OR
Follow the steps below to rescale to a selected point or selected isodose line.

Here are steps you can use to Rescale the Prescribed
Dose to a selected point.
(1) Click the Rescale (Prescribe) Beam Weights
button.
(2) Next to Prescribe To, select Point.
(3) Under the Prescription Point heading, select the
default point or type in X, Y, Z coordinates.
(4) Enter the new Prescribed Dose you want to
deliver to that point.
(5) Click OK. XiO returns you to the Beam Weights
page.
Isodoses, Beam, Weights, and Monitor Units
automatically update.
NOTE: If you used Selected Dose as your
normalization option, you may want to
update the dose to reflect the rescale.


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Task 11. Beam Weighting and Rescaling (cont.)

Here are steps you can use to Rescale the Prescribed
Dose to a selected isodose line.
(1) Click the Rescale (Prescribe) Beam Weights
button.
(2) Next to Prescribe To:, select Isodose Line.
(3) Enter the Isodose Value (cGy) to which the
rescaled dose will be prescribed.
(4) Enter the new Prescribed Dose you want to
deliver to that isodose line.
(5) Click OK. XiO returns you to the Beam Weights
page.
(6) Isodoses, Beam, Weights, and Monitor Units
automatically update.
NOTE: If you used Selected Dose as your
normalization option, you may want to
update the dose to reflect the rescale.
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Task 12. Dose Volume Histogram
After a plan has been calculated, you can evaluate it using a dose volume histogram.
This section reviews the quick method to display and manipulate the DVH and the more
comprehensive tools that can be used to evaluate a DVH.
Display a Quick DVH
1. Click the Histogram button. XiO displays the Histogram dialog box.

NOTE: If you do not have an empty window for the DVH to display, XiO
first displays a Select Window dialog box. Enter a window number
and click OK.
From this dialog box, you can turn on or off and change the color for as many
DVH curves as you desire.
You can change the axis labels and /or choose to display the curves as cumulative
or differential. See XiO Help for more information on DVH types.
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Task 12. Dose Volume Histogram
Display a Quick DVH (cont.)
2. Click OK when you are finished adding structures to your DVH.


Here are steps you can follow to manipulate the DVH
curves using the mouse.
(1) Click your right mouse button in the DVH
window and select the Histogram Cursors
option.
(2) Hold down the left mouse button and drag to the
right. You will see a red dose cursor move
across the screen. XiO displays the dose
represented by the red cursor in the lower left
corner of the DVH window. The Cursor
Volume for the selected structure changes as you
move the cursor. This represents the volume of
the structure that is receiving the dose
represented by the cursor.
(3) Hold down your middle mouse button and drag
to the right. XiO displays a yellow dose cursor
moving across the screen, and displays the dose
represented by the yellow cursor in the lower-
right corner of the DVH window. This is an
optional dose cursor that could be used in a case
where you want to know the volume of a
structure between a range of doses. The Cursor
Volume Difference for the selected structure
changes as you move the cursor. This represents
the volume of the structure that is receiving the
range of doses represented by both cursors.
NOTE: If the Inclusion of a structure is not
100%, the volume reported my not
be what you would expect.
Inclusion is the percentage of the
volume of a particular structure that
falls within the Dose Calculation
Region. The cursor volume or
cursor volume difference is only
based on the percent of the volume
that is included in the Dose
Calculation Region.
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Task 12. Dose Volume Histogram
Display a Quick DVH (cont.)

(4) Click your right mouse button and select the
Movie option.
(5) Click your left or middle mouse button to toggle
through each structures set of information.
(6) To return to the structure list to make more edits,
click your right mouse button and select the
Histogram Edit option. XiO displays the
Histogram dialog box.
Using the Comprehensive DVH Tools
1. Click the Dose drop-down menu and select the Histogram and New/Edit options.
XiO displays the Full Histogram dialog box.

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Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)
2. Here you can edit the Sampling Resolution and Dose Binning Parameters.
These parameters deal with the spacing between calculation points and the
resolution of the DVH graph. See XiO Help for more information.
3. If you would like the histogram report to be printed when you print the histogram
graph, select Yes next to Include Histogram Report with Print.
4. Select a window where you would like the DVH graph to be displayed next to
Display DVH in Window #.
5. Click OK. XiO displays the Histogram Report dialog box.

NOTE: The comprehensive DVH tools allow only seven structures to be
displayed while in use. If you already have a DVH displayed in the
window you selected, and it has more than seven structures, XiO
opens the quick Histogram dialog box instead of the Histogram
Report dialog box. If this happens, turn off as many structures as
needed until you have seven or fewer, then repeat steps 1-5.
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Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)
6. Enter a Name for the histogram.
7. Under Anatomical Structures, click on the number next to the name of the
structure you want to add to the graph. XiO displays the name of the structure just
below the Anatomical Structures list.
8. Click Accept next to that structure to add it to the graph.

Follow these instructions to create a structure
combination.
(1) Click the number next to the first structure you
would like to add. XiO displays the name of the
structure just below the Anatomical Structures
list.
(2) Click the With (+) button.
(3) Click the number next to the second structure
you would like to add. XiO now displays the
structure names in the following format
"structure 1 + structure 2."
(4) Click Accept. XiO adds the structure
combination to the DVH graph.
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Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)

Follow these instructions to subtract one structure
volume from another.
(1) Click the number next to the structure from
which you would like to subtract another
structures volume. XiO displays the name of the
structure just below the Anatomical Structures
list.
(2) Click the Without (-) button.
(3) Click the number next to the structure you want
to subtract from the first. XiO now displays the
structure names in the following format
"structure 1 - structure 2."
(4) Click Accept. XiO subtracts the second
structures volume from the first and displays the
new volume on the DVH graph.


5-44
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XiO Training Guide

Teletherapy Part 1

Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)

Follow these instructions to create a structure that is
the intersection of two structures.
(1) Click the number next to the first structure. XiO
displays the name of the structure just below the
Anatomical Structures list.
(2) Click the Inside (*) button.
(3) Click the number next to the second structure.
XiO now displays the structure names in the
following format "structure 1 * structure 2."
(4) Click Accept. XiO displays the intersection of
the two structures as a new structure on the DVH
graph.
NOTES: (1) The Undo button will always
undo the last step, or remove
the last structure added before
you accept.
(2) You can combine multiple
(more than 2) structures using
any combination of With,
Without, or Inside.

9. Change the Axis Labels if desired. See the XiO Help for more information.
XiO 5-45

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)
10. Change the upper limit of the Scale for the DVH graph. See the XiO Help for
more information.
11. Enter values for the Left and/or Right Dose Cursor. XiO displays dose cursor
values in the same color as the dose cursor in the bottom right and left corners of
the DVH window.
12. Change the Color of the left and right dose cursors, if desired.
13. Under the Structure Combination heading, click the structure or structure
combination for which you would like to see the displayed information on the
DVH graph.
14. Under Type, you can select to display a cumulative DVH, differential DVH, or
Both. You can also choose to hide or delete a structure or combination from the
graph. See XiO help for more information.
5-46
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XiO Training Guide

Teletherapy Part 1

Task 12. Dose Volume Histogram
Using the Comprehensive DVH Tools (cont.)
15. Change the color of a structure line by selecting it under the Color heading.
NOTE: When you select Histogram from the Dose drop-down menu, only
seven (7) structures are allowed on the graph. If there are more than
seven already displayed because you originally created the histogram
using the Histogram button, delete structures from the quick list until
there are seven or less; then, you can go into Histogram from the
Dose drop-down menu.
Re-display a Histogram
If you create a histogram, then change something about the plan that forces a re-
calculation, XiO removes the DVH structures from the graph. Once the calculation is
complete, click the Redisplay Histogram Data button, or from the Dose drop-
down menu select the Histogram and Redisplay Data options. XiO recalculates and
re-displays the structures on the DVH graph.


XiO 5-47

Teletherapy- Part 1
XiO Training Guide
Teletherapy Part 1

Task 13. Save the Plan
At any time during the planning process, you can save the treatment plan as a permanent
plan; however, XiO has a feature where it saves the plan as you go along as a numbered
temporary plan. If you exit from Teletherapy, either accidentally or on purpose, you
can always recall the temporary plan. It is recommended that you save all your plans as
permanent plans.

1. Click the File drop-down menu and select the Save Plan or Save as Plan option.
XiO displays the Save Permanent Plan dialog box.

2. Enter a unique plan ID and an optional description.
NOTE: When re-saving a plan with edits, the plan ID must be edited to save
it as a new plan. The description is an optional field. Simply
changing description only will not save the plan as new.
3. Click OK when finished.
5-48
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XiO Training Guide

Teletherapy Part 1

Task 14. Create a Template
In XiO, you can save commonly used beam arrangements, beam information, ports, and
prescriptions as templates to add to new patients with similar treatment plans.
1. Click the File drop-down menu and select the Save as Template option. XiO
opens the Save Template dialog box.

2. Click your middle mouse button in the File field and enter a File ID and an
optional Description.
3. Click OK when finished.
Here is how you would apply the template to a new
patient
(1) In Teletherapy, create a New Teletherapy Plan.
(2) Enter the Patient ID and Studyset ID for the
new patient.
(3) Instead of selecting a Graphics Area Setup, click
your middle mouse button and select a saved
Template from the Template field.
(4) If the template was saved from a segmented
IMRT plan and you want the segments to be
applied to the new patient, answer Yes in this
field.
(5) If the template was saved from a Dynamic
Conformal Arc plan and you want the
segmented Arcs to be applied to the new patient,
answer Yes in this field.
(6) Click OK. XiO opens the patient and displays
the Isocenter Location dialog box.
(7) Click your middle mouse button and select an
Isocenter.
(8) Click OK. XiO applies the template.

XiO 5-49

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XiO Training Guide
Teletherapy Part 1

Task 15. Display and/or Print Outputs and Reports
Once you have completed the planning process, you will want to display and/or print
the plan data. In XiO, you have the capability of printing individual images, ports,
DRRs and reports, or printing multiple images, ports, and DRRs and reports with the
click of a button.
To display individual reports on the screen and print them, click the Reports drop-down
menu and select a report. At the bottom of the report window, you can select Page-Up,
Page-Down, Quit or Print.
These are the print options that you can select when you click the File drop-down menu
and select the Print option.
x Plan Data prints the Isodose Treatment Plan report, the Teletherapy Sources
report and the Interest Point Doses report.
x Single Plane View prints any selected transverse, sagittal or coronal Image.
(Only active if the SPV to be printed is in the active window.)
x Beams Eye View prints any selected Beams Eye View image. (Only active if
the BEV to be printed is in the active window.)
x DRR opens the Print DRR dialog box where you can select parameters for
printing the DRR for a selected beam.
x Port opens the Print Port dialog box where you can select parameters for
printing selected ports at a specified distance. (Only active if you have apertures
or blocks defined.)
x Multileaf Collimator opens the Print MLC dialog box where you can select
parameters for printing selected MLC ports at a specified distance. (This option
is only active if you have MLC fields defined.)
x Compensating Filter allows you to print out your 1D or Ellis Compensating
filter information.
x Intensity Map opens the Print Intensity Map dialog box where you can select
intensity map parameters and output devices.


5-50
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XiO Training Guide

Teletherapy Part 1

Task 15. Displaying and/or Print Outputs and Reports (cont.)
x Plan Output prints all the images and reports defined under the drop-down
menu Edit/Preferences/Plan Output. See the Preferences sections for more
information on setting plan output defaults.
x Full Source Data allows you to customize the Teletherapy Sources report to
include or exclude data items that you choose, XiO also provides an option to
print the full Teletherapy Sources report that includes all the data items.
XiO 5-51

Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

This segment of Teletherapy is designed to follow Part 1 of this section. The best way
to proceed is to use the same plan from Part 1; however, you should be able to open
any plan and proceed.
Task 1. Additional Beam Functionality
This task defines a few additional beam functions that were not used when creating the
prostate plan in Teletherapy Part 1. These functions can be used anytime during the
planning process.
Subtask 1. Delete beam(s)
In XiO Teletherapy, you have the option of deleting the active beam or deleting a
group of beams.
Delete the Active Beam
1. Click the Beam button. XiO displays the supporting beam buttons.
2. Make the beam you want to delete the active beam (displayed in red).
3. Click the Delete Beam button or press the F9 key on the keyboard. XiO
deletes the active beam.
Delete a Group of Beams
1. Click the Beam drop-down menu and select the Delete Beam(s) option.
2. Click on each beam you want XiO to delete. Selected beams display in blue.
3. Click OK. XiO deletes the selected beams.
Subtask 2. Renumber Beams
XiO makes it easy to renumber your beams.
1. Click the Beam drop-down menu and select the Renumber Beams option. XiO
displays the Renumber Beams dialog box.
2. Reassign new numbers to each beam.
3. Click OK. XiO automatically renumbers the displayed beams.
XiO 6-1
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XiO Training Guide

Teletherapy - Part 2
Task 1. Additional Beam Functionality (cont.)
Subtask 3. Toggle Beam Display (include shortcut)
Occasionally, you may want to turn all the beams on or off, or display only specific
beams. XiO offers multiple options to perform this task.
To toggle All Beams On or Off:
(1) Press the shortcut key T to toggle beams on or off.
NOTES: XiO will not turn off the active beams. Make sure your mouse
pointer is located anywhere in the graphics window area when you
press the key.

OR

(2) Click the View drop-down menu and selecting the Beam Objects and Show
Beams options. If the box has a checkmark, XiO displays the beams; if the
box does not have the checkmark, XiO turns the beams off.
Toggle Selected Beams On or Off
1. Click the View drop-down menu and select the Show/Hide Selected Beams
option. XiO displays the Show/Hide Specific Inactive Beams dialog box.
2. Click the beam number to toggle selected beam on or off.
3. Click OK when finished.
6-2
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XiO Training Guide
Teletherapy - Part 2
Task 1. Additional Beam Functionality (cont.)
Subtask 4. Move Isocentric Group
Follow these steps to move a group of beams that share the same isocenter to a new
location.
1. Click the Beam drop-down menu and select the Move Isocentric Group option.
XiO opens the Move Isocentric Group dialog box.

2. If you have beams representing more than one isocenter, you must first select the
Group Number. XiO groups each set of beams that share the same isocenter.
XiO 6-3
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XiO Training Guide

Teletherapy - Part 2

Task 1. Additional Beam Functionality
Subtask 4. Move Isocentric Group (cont.)
3. Next, you have the option to move the group using one of four methods:
(1) Move the group to a predefined interest point location. (Click your middle
mouse button to select.)
(2) Move the group to a predefined marker location. (Click your middle mouse
button to select.)
(3) Move the group to another groups isocenter location. (Click your middle
mouse button to select.)
(4) Move the group to a specific coordinate locations. (Enter the coordinate
values.)
4. Click OK when finished.


6-4
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 2. Additional Port Functionality
This task defines additional port functions that were not covered when creating the
prostate plan in Teletherapy Part 1. These functions can be used at any time during
the planning process.
Subtask 1. Draw a Port Using the Mouse
1. Click the Port button (Shift+F3). XiO displays the port drawing and editing
tools along the secondary toolbar.

2. On the Port supporting toolbar, click the Define Shape as Aperture , Define
Shape as Block , or Define Shape as MLC button.
3. Click the Draw Port with Mouse button.

OR

Click the Port drop-down menu and select the Mouse option.
XiO 6-5
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XiO Training Guide

Teletherapy - Part 2

Task 2. Additional Port Functionality (cont.)
4. In a BEV window, click your left mouse button and hold while moving the
mouse to draw the aperture, block, or MLC.

OR

Click your left mouse button to place points and draw the port. XiO
automatically closes the port when you reach the position where you started the
contour.
Subtask 2. Draw a Port Using the Tablet
1. Click the Port button on the main toolbar.
2. On the Port supporting toolbar, click the Define Shape as Aperture , Define
Shape as Block , or Define Shape as MLC button.
3. Click the Trace Port with Tablet button.

OR

Click the Port drop-down menu and select the Tablet option.
4. Enter the Scale Factor, Auto Sample Spacing Values, and orient the tablet.
5. Trace the Port according to the digitizing instructions on the Port Tablet dialog
box.
Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC)
Use these steps to edit any aperture, block or MLC.
1. Click the Port button (Shift+F3). XiO displays the port drawing and editing
tools along the secondary toolbar.
2. If a port already exists, XiO automatically places you in edit mode for the
specific type of port. (This means that the Edit Port button and one of the
following buttons are automatically selected: Define Shape as Aperture ,
Block , or MLC .)
6-6
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 2. Additional Port Functionality
Subtask 3. Edit a Port using the Mouse (Aperture, Block or MLC) [cont.]
3. In an ABV or BEV window, click your right mouse button and select the Edit
Contour option.
4. Place your mouse on the edge of the port shape and click your left mouse button
when your cursor changes to the following . XiO places a yellow edit box
around the port shape.

5. Port shape editing is the same as contour editing. Place your mouse on the edge
of the port shape. When the icon changes to the following , hold down your
left mouse button and drag, or use a series of mouse clicks to create the new
shape. You must finish the edit by clicking on the edge of the contour shape.
XiO automatically displays a circle guide around the mouse pointer with a user
editable radius. You can use the guide to draw a port around a structure with a
specific margin.
Here are steps to edit the radius of the circle
guide.

1. Press the greater than key (>) to increase
the guide radius.
2. Press the less than key (< ) to decrease
the guide radius.
3. Press the G key on your computer
keyboard to turn the guide radius off and
on. XiO displays the Guide Radius size
at the bottom of the XiO screen.
XiO 6-7
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 4. Create and Edit a Port using the Keyboard
You may want to use the keyboard to create regular shaped ports. You may also want
to edit these ports, or in the case of MLCs, you may want to edit individual MLC leaf
coordinates.
The Keyboard option can be selected from the Port drop-down menu. If there is no
port on the active beam, XiO assumes you would like to create a port. If a port exists,
XiO allows you to edit the existing port, add a block to it, or convert the port to a
different type (example, aperture to MLC) for editing.
When you select the Keyboard option, you have the option of creating or editing an
Aperture, Block or MLC.
NOTE: You can only create or edit a port that has 30 or fewer points. If you
created an autoport on a beam, it will most likely contain more than 30
points. Therefore, it will not be editable via the keyboard.
6-8
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 5. (MLC Only) Edit MLC Leaves
Use these steps to edit individual MLC leaves or groups of closed leaves.
1. Click the Port button.

OR

Click the Shift and F3 keys on your computer keyboard.

XiO displays the port drawing and editing tools along the secondary toolbar.
2. If a port already exists, XiO automatically places you in edit mode for the
specific type of port. (This means that the Edit Port button and one of the
following, Define Shape as Aperture , Block or MLC buttons are
automatically selected.)

3. In an ABV or BEV window, right mouse click and select Edit Leaf from the pop
up window.

4. Place your mouse pointer on the leaf you would like to edit, hold down your left
mouse and drag to the right or left. XiO highlights the selected leaf and updates
its position on the screen.
XiO 6-9
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality
Subtask 5. (MLC Only) Edit MLC Leaves (cont.)
NOTES: If you have the port property MLC Updates with Leaf Edits set to
Yes, XiO updates the port contour as you move leaves.

If you have the port property MLC Updates with Leaf Edits set to
No, the port contour does not update as you move leaves. This
allows you to use the shape as a reference for moving additional
leaves. However, this can be a problem in the following scenario.
If you decide to use the Edit Contour tool after editing leaves, when
the contour updates, the leaves will move back to their original
position.
5. Move an entire group of closed leaves by placing your mouse pointer on any
closed leaf that does not abut the treatment field. XiO moves the entire group of
closed leaves.
NOTE: The closed leaves above the treatment field move independent of
the closed leaves below the treatment field.
6-10
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 2. Additional Port Functionality (cont.)
Subtask 6. MLCs and Blocks
XiO allows you to add blocks to MLC fields. For example, you can use MLCs for the
original field; then for the boost, you can add a cord block. You can create blocks
using the drawing tool when you select Define Shape as Block, by using the keyboard,
or by using auto-port to create a shape around a structure of interest.

XiO 6-11
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 7. (MLC Only) MLC Display Feature
Occasionally, the MLC leaf display obscures the image or DRR in the BEV or ABV
window. Here are steps to turn the display on and off. This function is available in all
modes whenever a BEV or ABV with an MLC is displayed.
1. Click your right mouse button in the BEV or ABV window.
2. Select MLC LEAF. This option toggles the MLC leaves on and off. When the
leaves are off, XiO displays only an MLC field outline.




6-12
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XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 8. Rotate Collimator Independent of Port
In XiO, you can rotate the collimator without rotating the port when the Port Property,
Blocking Rotates With Collimator is set to No.
1. Click the Port drop-down menu and select the Port Properties option. XiO
opens the Port Properties dialog box.

2. Set the option Blocking Rotates with Collimator to No. (See the Preferences
section of this training guide for more information on setting the preference for
this feature.)
3. Click OK.
4. Rotate the collimator to the new collimator angle using any method you choose.
The port does not rotate with the collimator.
XiO 6-13
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 9. Automatically Update the MLC or Aperture as the Gantry is
Rotated
In XiO, when you rotate the gantry, un-edited ports created using Auto Port
automatically update.
1. Click the Port drop-down menu and select the Port Properties option. XiO
opens the Port Properties dialog box.
2. Set the option Auto-Generated Blocking Updates with Beam Movement to Yes.
(See the Preferences section of this training guide for more information on
setting the preferences for this feature.)

3. Click OK.
4. Rotate the gantry using any method you choose. The port automatically updates
according to the structure and margin selected for the auto port.
6-14
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 10. Auto Conform the Port for the Active Beam

In XiO, you can automatically create an aperture, block, or MLC field for the active
beam.


1. Click the Port drop-down menu and select the Auto and Active Beam options.
XiO displays the Auto Port dialog box.

2. Click your middle mouse button in the field next to Auto Margin To and select a
structure from the list that you would to create an auto port around.
3. Enter the Margin you want to place around the structure in the With Margin
field.
4. To create an aperture, click the Calculate Aperture button.
OR
To create a block, click the Calculate Block button.
OR
To create an MLC, click the Calculate MLC button.
5. Click OK when finished.

XiO 6-15
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 11. Auto Conform Ports or Collimator Jaws to a Specific
Margin for One or Multiple Beams
In XiO, you can automatically create apertures, blocks, or MLC fields for multiple
beams simultaneously.

1. Click the Port drop-down menu and select the Auto and Multiple Beams
options. XiO displays the Photon Conform Beams dialog box.

2. Select the beams that you would like to conform by clicking on them (they are
selected when highlighted in blue).
3. Click your middle mouse in the Structure field and select a structure to create a
margin around.
6-16
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality
Subtask 11. Auto Conform Ports or Collimator Jaws to a Specific Margin
for One or Multiple Beams (cont.)
4. Enter the Margin you want to place around the structure in the Margin field.
5. Click your middle mouse in the Collimator Type field and select Aperture,
MLC, or Jaws Only.
6. If you select Jaws Only, click OK to finish.
7. If you select Aperture, select Yes in the Conform Jaws field to conform the jaws
as well to the step increment specified in Port Preferences.
8. Enter an appropriate Tray Factor, HVL, Thickness and Material.
9. Click OK to finish.
10. If you select MLC, select yes in the Conform Jaws field to conform the jaws as
well to the step increment specified in Port Preferences.
11. Enter an appropriate Leaf Insertion and Closed Leaf Position.
12. Click OK to finish.

Subtask 12. Conform Collimator for the Active Beam
Use this task to conform the collimator for the active beam to the step increment
specified in Port Preferences.
1. Click the Port drop-down menu and select the Conform Collimator and Active
Beam options.
OR
When in Port Mode, click the Conform Collimator Jaws to Port button. XiO
automatically conforms the collimator for the active beam.
XiO 6-17
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 13. Conform Collimator Jaws for all Beams at Once
Use this task to conform all collimators to the step increment specified in Port
Preferences.
1. Click the Port drop-down menu and select the Conform Collimator and
Multiple Beams options. XiO automatically conforms the collimators for all
beams.
Subtask 14. How To Save and Use Public Ports
Occasionally, you may want to create public ports that can be used from patient to
patient. Public ports can only be created from Apertures and/or Blocks. The
following steps demonstrate how to save and use public ports.
1. Create an Aperture and/or Block that you would like to use as a Public Port.
2. Click the Port drop-down menu and select the Copy to Public Port option. XiO
opens the Copy Port to Public Port ID dialog box.

3. Enter a unique ID and optional Description for this port.
4. Click OK. XiO saves the port as a Public Port.
5. Close the patient.
6. Open a new patient and create a new beam.
7. Click the Port drop-down menu and select the Use Public Port option. XiO
displays the Port ID dialog box.
8. Click your middle mouse button in the Port ID field and select the Port ID that
you saved.
9. Click OK. XiO places the Public Port on the new beam.
6-18
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XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 15. Port Properties
Some of the Port Properties have already been discussed in other tasks. This task
covers the remaining Port Properties. The Port Properties dialog box is different when
you are using MLC ports than when you are using apertures and blocks. Both topics
are discussed as follows:

MLC
x Blocking Rotates with Collimator See Task 2, Subtask 8.
x The Leaf Insertion determines what percent of the leaf intrudes into the port
shape. See XiO Help for more detailed information.
x Closed Leaf Position (Varian Only) Here you can enter a new location for
the closed leaf position. However, ALL USERS can edit the closed leaf
position with the mouse. See steps on Task 2, Subtask 5.
XiO 6-19
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XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality
Subtask 15. Port Properties (cont.)
Aperture/Block
x You can enter the Port Tray Factor for each beam from the Port Properties
dialog box. The Port Tray Factor entered here only applies to the active beam.
You can set a default tray factor value in Source File Maintenance specifically
for each machine.

x Rotate Collimator Independent of Port See Task 2, Subtask 8.
x Auto Generated Blocking Updates With Beam Movement See Task 2,
Subtask 9.
x Under port Type, you can change an aperture to a block or a block to an
aperture.
x The Material, Thickness and HVL are required values for each aperture or
block. You can create default values in Source File Maintenance.

6-20
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XiO Training Guide
Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 16. Delete Port Options
In XiO, you can delete an entire port or just part of one. For example, if you have a
port that consists of an aperture and a block, you can choose to only delete the block or
only the aperture. See the steps below for more information on deleting ports.
Delete Entire Ports
1. Click the Port drop-down menu and select the Delete and Port options. XiO
removes the entire port from the active beam.
OR
When the Port button is active, click the Delete Port button. XiO
deletes the port from the active beam.
Delete a Port Shape
1. Click the Port drop-down menu and select the Delete and Shape options. XiO
displays the Select Aperture or Block, or MLC dialog box.

2. Enter the number that corresponds to the block or aperture you would like to
delete. (Numbers are displayed in the BEV or ABV window.)
3. Click OK. XiO removes the selected block or aperture.

XiO 6-21
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XiO Training Guide

Teletherapy - Part 2
Task 2. Additional Port Functionality (cont.)
Subtask 17. Convert Aperture/MLC
In XiO, you can easily convert any port from one type to another. For example, you
can convert an aperture to an MLC. Use the following steps to convert an existing
port.
1. Click the Port drop-down menu and select the Convert Aperture/MLC option.
XiO displays the Convert Aperture, Block, or MLC dialog box.

2. Select from the three conversion options; then, click Cancel to close the dialog
box.

6-22
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XiO Training Guide
Teletherapy - Part 2
Task 3. Items That Influence Dose Calculation
XiO allows you to set preferences for your dose calculation settings. These settings
will be applied for each patient; however, you can change these settings at any time
during the planning process using the following steps.
Subtask 1. Calculation Setting
1. Click the Dose drop-down menu and select the Calculation and Settings
options. XiO displays the Dose Calculation Settings dialog box.

2. Turn the heterogeneity correction off or on by selecting Yes or No.
XiO 6-23
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XiO Training Guide

Teletherapy - Part 2
Task 3. Items That Influence Dose Calculation
Subtask 1. Calculation Setting (cont.)
3. If the heterogeneity correction is set to Yes, select if it will be Pixel-by-Pixel
correction (Yes), or bulk heterogeneity correction (No).

Here is a list of heterogeneity options that can be
used in XiO.
Pixel-by-Pixel heterogeneity XiO assigns each
CT pixel an electron density based on the CT to ED
file selected for this patient. This method provides
the most accurate method in XiO to emulate
heterogeneity correction.
Bulk heterogeneity You assign density to specific
structures. All structures that are unassigned are
given a density of 1.
Pixel-by-Pixel and Bulk These two types of
heterogeneity corrections can be used in combination.
Consider the following example. You want to use
pixel-by-pixel heterogeneity; however, there is
contrast in the bladder that will not be there for
treatment. In this case, you could contour the bladder,
assign it a density, and check the force density option.
This creates a pixel-by-pixel corrected patient, except
in the area of the bladder, where the density will be
forced to a user defined value.
No Heterogeneity If you do not turn on
heterogeneity correction, XiO assumes the patient is
of unit density.

4. Select Yes or No if you want the ability to generate DRRs as Enhanced DRRs.
Enhanced DRRs have a higher resolution than regular DRRs in that each
grayscale pixel of the regular DRR is divided into four and each of those four
new pixels are assigned new grayscale values. If you are printing DRRs to a film
printer, you may want to consider using Enhanced DRRs to produce better
images.
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Teletherapy - Part 2
Task 3. Items That Influence Dose Calculation
Subtask 1. Calculation Setting (cont.)
5. The calculation region dimensions and calculation region center deal with the
size and center of the calculation region. You can change the size of the
calculation region and move the center by entering a new width, height and
depth, or X, Y, and Z coordinates. You can also use the mouse to change the
size and move the center.

Here are steps to resize the Calculation Region and
Move the Center with the Mouse.
1. Click your right mouse button in any SPV
window (transverse, sagittal, or coronal) and
select the Calc Size option.
2. Hold down your left mouse button and drag any
corner of the red calculation region box to resize.
The calculation region dimensions automatically
update.
3. Click your right mouse button in any SPV
window and select the Calc Translate option.
4. Hold down your left mouse button and drag the
red box to the new location. XiO automatically
updates the calculation region center coordinate
values.

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Teletherapy - Part 2
Task 3. Items That Influence Dose Calculation
Subtask 1. Calculation Setting (cont.)
6. The Number of Calculation Points and Distance Between Calculation Points
options are mutually exclusive. Toggle the Parameters to Specify option to no.
of pts. if you would like to edit the number of points instead of the grid spacing.
Grid spacing determines the number of calculation points within the calculation
region that XiO uses when calculating the plan. Grid spacing provides an evenly
spaced grid of calc points in all three dimensions. The number of calculation
points allows you to create your own (uneven) grid spacing by entering a unique
number of calculation points for XiO to calculate in each dimension. Grid
Spacing is most commonly used.
7. Click OK when finished.

Subtask 2. Dose Status
XiO displays the Dose Status dialog box to indicate which beam is being calculated
during the calculation cycle. If you are in dose mode, the Dose button is
highlighted. XiO automatically displays dose status until the dose is valid. However,
if you are in any other mode and XiO is calculating, you can click the Dose drop-down
menu and select the Dose Status option. XiO displays the Dose Status dialog box.

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Teletherapy - Part 2

Task 4. Setup Reference Definition (CT Sim)
The Setup Reference Definition and Mark Anatomical Reference tools allow you to
determine and display relative or absolute shifts from one point to another. Both work
the same way. In general, only Setup Reference specifies shifts from the scan
reference to the setup reference, and Mark Anatomical Reference specifies shifts from
the setup reference to another anatomical location (which could be used when the
isocenter is moved a second time for a boost plan).
You must define a scanner in Settings-Clinic-Scanner/ LMS Definition before you can
use these tools. You must also have created a Setup Reference before you can use
Mark Anatomical Reference (see the Settings section of this training guide for more
information).
The steps for using Setup Reference Definition are described here, but could generally
be applied to Mark Anatomical Reference.
Determine and Mark the Scan Reference Point
There are many methods you could use to determine the scan reference point position.
This is one example.
1. Click the View drop-down menu and select the Scales option; then, place a
checkmark in the Display box. XiO displays scales in each SPV and BEV
window.

2. Click your right mouse button in the transverse image and select the Maximize
option. XiO displays the transverse image in full screen.
3. Click your right mouse button and select the Movie option. XiO places you in
Movie mode.
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Teletherapy - Part 2

Task 4. Setup Reference Definition (CT Sim)
Determine and Mark the Scan Reference Point (cont.)
4. Movie the images using your left and middle mouse buttons or the scroll wheel
until you display a slice that has fiducial markers placed on the skin surface. (For
the patient used in this task, it is slice T: -158.51.)
5. Click your right mouse button and select the Move Scales option.
6. Hold down your left mouse button and drag the scales on the transverse image
until the scales line up with the ap and lateral fiducial markers.
7. Click the Contour drop-down option and select the Markers (or Interest
Points), then New options. XiO displays the Add Marker (or Interest Point)
dialog box.

8. Enter the description Scan Ref.
9. Click your left mouse button at the intersection of the scales to place the marker
(or interest point).
10. Click OK to accept, then, click Cancel to close the dialog box.
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Task 4. Setup Reference Definition (CT Sim) [cont.]
Report Relative Shifts
1. Click the Tools drop-down menu and select the Setup Reference Definition
option. XiO displays the Setup Reference dialog box.

2. Click the drop-down arrow next to the Report Points field and select Relative to
Scan Reference Point.
3. Under the Scan Reference heading, middle mouse click in the Interest Point or
Marker field and select Scan Ref.
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Task 4. Setup Reference Definition (CT Sim)
Report Relative Shifts (cont.)
4. Under the Setup Reference heading, middle mouse in the Center of Structure
field and select the center of the target structure.
NOTE: Your other options to shift to include an interest
point or marker that has been placed or a beam
isocenter if one has been defined.
NOTE to Gammex Users: If you plan to send your shifts to Gammex for
automatic movement of the lasers, select Yes next to
the Gammex LMS Automove ? field; then, click
the Reposition Lasers to Setup Reference button.
5. Click OK. XiO displays the Setup Reference Definition Index and the relative
shifts at the bottom of the index along with the direction in which to shift.
(patients left, anterior, etc.).
6. (Optional) Click Print to print the displayed index.
7. Click Quit to close the index.
6-30
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Teletherapy - Part 2

Task 4. Setup Reference Definition (CT Sim) [cont.]
Report Absolute Readings
1. Click the Tools drop-down menu option and select the Setup Reference
Definition option. XiO displays the Setup Reference dialog box.

2. Click the drop-down arrow next to the Report Points field and select Absolute
Readings.
3. Under the Setup Reference heading, click your middle mouse button in the
Center of Structure field and select the center of the target structure.
NOTE: Your other options to shift to include an interest
point or marker that has been placed or a beam
isocenter if one has been defined.
NOTE to Gammex Users: If you plan to send your shifts to Gammex for
automatic movement of the lasers, select Yes next to
the Gammex LMS Automove? field, then click the
Reposition Lasers to Setup Reference button.
4. Click OK. XiO displays the Setup Reference Definition Index and the absolute
couch/laser readings for the setup reference point at the bottom of the index.
5. (Optional) Click Print to print the displayed index.
6. Click Quit to close the index.

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Task 5. Optional Display Settings
XiO has many optional display settings. Some have already been covered in
Teletherapy Section 1, the rest are covered in this section. These optional settings can
be changed or used at any time during the planning process.
Subtask 1. Window Format
Typically, you will select a window format (Graphics Area Setup) when you first
begin a new treatment plan in XiO; however, it is possible to change that format as you
are planning or during plan review.
1. Press the shortcut key W on your computer keyboard, or from the View drop-
down menu select the Window Format option. XiO displays the Window
Format dialog box.

Select/Save a Predefined Window Format
1. Click your middle mouse button in the Load Graphic Area Setup: field and select
a new window format. When you first receive your system, XiO lists a set of
default graphics area setups.
2. If you would like to save the displayed window format, click the Save Graphics
Area Setup button and enter a unique name for the format.

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Task 5. Optional Display Settings
Subtask 1. Window Format (cont.)
Create your own Window Format
1. Select a number of windows in the Window format field. Options are one, two
horizontal, two vertical, four, six, six symmetric, nine and twelve.
2. While you have the Window format dialog box open, click your right mouse
button in any window you would like to delete and select the Delete Window
option. XiO automatically removes the contents of that window.
3. Setup each window with the appropriate view, orientation, ref distance, beam
number and center of structure. Not all views require an orientation, ref, beam
number, and center of structure. (See XiO Help for more information on how to
fill out the window information appropriately.)
4. Select a Sync ID for each window. This is used primarily for plan review so you
can synchronize mouse movements between plans. For example, if you have the
transverse image of three plans displayed side-by-side and they all have the same
Sync ID, when you perform any mouse movements, such as movie or scale, all
three transverse images will movie or scale together.
5. Click the Update Graphics Display to display any changes or additions.
6. You can easily exchange the content of the selected windows by clicking your
right mouse in any window and selecting the Exchange Window option.
7. Click your left mouse button in each of the two windows where you would like
to exchange content. XiO automatically exchanges the windows contents.
8. Click Cancel to exit Window Format.
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Task 5. Optional Display Settings
Subtask 1. Window Format (cont.)
Create an SPV Plane perpendicular to the Central Axis (SPV CAX)
1. In any empty window on the Window Format page, select the View SPV option.
2. Select the Orientation CAX.
3. Click the window number located to the left of the View option. XiO displays
the CAX Oblique Window.

4. Enter the Beam Number for the beam you want to create the perpendicular
plane.
5. Enter the Distance of the plane from the source (Typically this is 100).
6. Enter a Stack Label. XiO uses this label to name the image in the window.
7. (Optional) Enter a Distance Between Planes. If you want to movie through a
stack of reconstructed images in this plane, this value determines the spacing of
the reconstructed images.
8. (Optional) Enter a Number of Planes Per Side. If you want to movie through a
stack of reconstructed images in this plane, this value determines the number of
planes you want XiO to reconstruct on each side of the CAX plane.
9. Click OK. XiO displays the reconstructed plane(s) in the selected window. If
you created a stack, use the Movie option to movie through the reconstructed
slices.
10. Click Cancel to Close the Window format dialog box.
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Task 5. Optional Display Settings
Subtask 1. Window Format (cont.)
Create an Oblique Plane (Not necessarily perpendicular to the plane of any
beam)
To best use this feature, you should have a transverse SPV, sagittal SPV, and MPV
displayed. Try to keep the arrow on the plane pointing generally towards the anterior
or the superior of the patient, and the arrow perpendicular to the plane pointing
generally towards the foot or the left side of the patient to avoid reconstructing a plane
that is upside down or backwards.
1. In an empty window on the Window Format page, select the View SPV.
2. Select the Orientation Obl.
3. Click the window number located to the left of the View option. XiO displays
the Define an Oblique Stack of Planes dialog box.

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Task 5. Optional Display Settings
Subtask 1. Window Format
Create an Oblique Plane (Not necessarily perpendicular to the plane of any
beam) [cont.]
4. There are two modes available, creation of an orthogonal or non-orthogonal
plane. If you choose orthogonal, you will only be required to place two points in
the same plane using the mouse. If you choose non-orthogonal, you can enter
three points on two different planes using the mouse, enter the coordinate values,
or select three points that already exist to snap the plane to.
NOTE: Since creating an orthogonal plane is described in the first two steps
to creating a non-orthogonal plane, the non-orthogonal option will
be described here.
5. Click your left mouse on the transverse image to place the first point. XiO
displays a yellow plane on all the images except a BEV. If necessary, you can
hold down your left mouse button and drag the plane to a new location.
6. Click your middle mouse on the transverse image to place the second point.
Hold down your middle mouse button and drag to rotate the plane around the
superior/inferior axis.
7. Click your right mouse button on a sagittal image to place the third point. Hold
down the right mouse button and drag to rotate the plane around the
anterior/posterior axis. As you rotate, look at the MPV image to determine the
location of the plane.
8. Enter a stack label. XiO uses this label to name the image in the window.
9. (Optional) Enter a distance between planes. If you want to movie through a
stack of reconstructed images in this plane, this value determines the spacing of
the reconstructed images.
10. (Optional) Enter a number of planes per side. If you want to movie through a
stack of reconstructed images in this plane, this value determines the number of
planes you want XiO to reconstruct on each side of the CAX plane.
11. Click OK. XiO displays the reconstructed plane(s) in the selected window. If
you created a stack, use the Movie option to movie through the reconstructed
slices.
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Teletherapy - Part 2
Task 5. Optional Display Settings (cont.)
Subtask 2. Enhance Contours
The Enhance Contour dialog box enables you to turn selected structures on and off and
change their attributes.
1. Press the shortcut key C on the keyboard.

OR

Click the View drop-down menu and select the Enhance Contour option. XiO
displays the Enhance Contour dialog box.

2. Click on the structure name to toggle the selected structure on or off.
3. Click the All Structures Off or All Structures On buttons to toggle them all off
or on.
4. Click your middle mouse button in the Color field to select a new color.
5. Click your middle mouse button in the Rendering field and select a new
rendering for the associated structure. (See XiO help for more information on
the rendering options.)
6. Click your middle mouse button in the Color Fill field to select Yes or No to
displaying the selected rendering as a color fill on the transverse, sagittal, and
coronal images.
7. Click OK when finished.
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Teletherapy - Part 2
Task 5. Optional Display Settings (cont.)
Subtask 3. Scales
XiO allows you to display scales in each SPV, ABV, or BEV window. The tic-mark
spacing is user-defined and the scales can be moved around the window. You can use
scales to locate the scan reference center based on fiducial markers placed on the skin.
Toggle Scales On and Off
When you click the View drop-down menu and select the Scales option and place a
checkmark in the box next to Display, XiO displays the scales in each SPV, ABV and
BEV window.
Change the Scales Tic-mark Spacing
1. Click the View drop-down menu and select the Scales and Spacing options. XiO
opens the Scales Spacing dialog box.

2. Enter the spacing in centimeters.
3. Click OK when finished. XiO applies the new spacing to the scales.
Move the Scales in a Single Window
1. Click your mouse button in any SPV, ABV or BEV window and select the Move
Scales option.
2. Hold down your left mouse button and drag the scales to a new location.
Move the Scales in all SPV Windows at Once
1. Click your right mouse button in any SPV window and select the Move Scales
All option.
2. Hold down your left mouse and drag the scales to a new location. XiO moves
the scales in all the SPV windows in patient coordinates.

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Task 5. Optional Display Settings (cont.)
Subtask 4. View Plans on Primary, Secondary, or Electron Density Image
Data
If you have fused a primary and secondary set of images (for example, a CT and an
MRI), XiO allows you to display the plan and isodoses on the primary or the
secondary studyset. If you have elected to use bulk density override for any structure,
it may be useful to view the plan on the electron density image data. This view
displays the images using the actual densities prescribed.
To toggle the view from primary to secondary to electron density, click the View drop-
down menu and select the Image Data option; then, place a checkmark next to the
image dataset you want to view. XiO replaces the primary dataset images with the
selected dataset images.
Primary Secondary Electron

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Teletherapy - Part 2
Task 5. Optional Display Settings (cont.)
Subtask 5. View Image Planes in MPV
XiO allows you to view transverse, sagittal, and coronal image planes on the MPV
image. Only those planes that display in an SPV window will display in the MPV
window. For example, if you have two SPV windows that contain a transverse and a
sagittal image, only those two planes will display in the MPV window. Graphical
changes you make to the images in the SPV, such as movie and window/level will also
apply to the corresponding plane in the MPV window.
Click the View drop-down menu and select the Image in MPV option; then, select to
display it as a solid plane or select a level of transparency. XiO displays the planes in
the MPV.

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Task 5. Optional Display Settings (cont.)
Subtask 6. Plan Objects
XiO allows you to select the plan objects that you want to display during planning.
These can be toggled on and off one-by-one, or you can select multiple objects to edit
at one time.
Plan Objects include the following:
Interest Points Points that carry dose
Markers Points that do not carry dose
Calculation Volume/Area Calculation Region box
Patient Orientation Icon Figure that displays in the lower-left corner of each
window
Patient Spheres Spheres that represent the anterior, superior, and left side
of the patient (These spheres correspond in color with the
spheres on the patient orientation icon.)
Bilinear Interpolation Smoothing algorithm that is applied to CT image to
reduce pixilation
Bolus When applied it is viewed as a slab
CT Origin Crosshair that defines the CT 0, 0, 0 position
(See XiO Help for more detailed information regarding Plan Objects)
Turn On or Off One Plan Object At a Time
Click the View drop-down menu and select the Plan Objects option; then, place a
checkmark next to the object you would like XiO to display. Remove the checkmark
from the objects that you do not want XiO to display.
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Teletherapy - Part 2
Task 5. Optional Display Settings
Subtask 6. Plan Objects (cont.)
Turn On or Off Multiple Plan Objects
1. Click the View drop-down menu and select the Plan Objects and Multiple
Objects options. XiO displays the View Plan Objects dialog box.

2. Click on each Plan Object to toggle it off or on.
3. Click CANCEL when finished.
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Task 5. Optional Display Settings (cont.)
Subtask 7. Beam Objects
XiO allows you to select the beam objects that you want XiO to display during
planning. These can be toggled on and off one-by-one, or you can select multiple
objects to edit at one time.
Beam Objects include the following:
Complex/Simple Display Simple displays only the portion of the beam that
intersects the image you are viewing in an SPV.
Complex displays the entire beam and portions of the
beams that do not intersect the selected cross-section
display as dashed lines in an SPV.
Moveable Plane When you select this option, XiO displays the Moveable
Plane From and Moveable Plane Distance options on the
Photon beam page. These options allow you to display a
plane perpendicular to the beam at any designated
distance on an SPV and an MPV. Use this option to
display a plane through the weight point on a tangent, or
to display the cone distance for an electron beam to see
if the cone will collide with the patient.
Corner Divergent Lines In the MPV, this option toggles the display of the
divergent lines.
Crosshairs In the BEV and MPV, this option toggles the display of
the crosshairs.
Isocentric Plane In the SPV windows, this option toggles the display of
the lines representing the isocentric planes.
Aperture/Block
Coverage Lines This option toggles the display of the lines that represent
the divergent block.
Aperture /Block Shadow This option toggles the display of the shadow of the
divergent block.
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Teletherapy - Part 2
Task 5. Optional Display Settings
Subtask 7. Beam Objects (cont.)
MLC Coverage Lines This option toggles the display of the lines that represent
the divergent MLC blocking.
MLC Shadow This option toggles the display of the shadow of the
divergent MLC blocking.
Segmented MLC
Maximum Extents This option toggles the display of the maximum extent
of MLC leaves for IMRT plans.
Compensating Filter If you have a CF on your plan, this option toggles the
display of the CF.
Show Beams This option toggles the beams on or off. (See Task 1,
Subtask 3 for more information.)
Weight Point This option toggles the display of the weight point(s).
Turn On or Off One Beam Object At a Time
Click the View drop-down menu and select the Beam Objects option; then, place a
checkmark next to the object you would like XiO to display. Remove the checkmark
from the objects that you do not want XiO to display.
Turn On or Off Multiple Beam Objects
1. Click the View drop-down menu and select the Beam Objects and Multiple
Objects options. XiO displays the View Beam Objects dialog box.

2. Click on each beam object to toggle it off or on.
3. Click Cancel when finished.
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Task 5. Optional Display Settings (cont.)
Subtask 8. Adding, Editing and Deleting Interest Points and Markers
Interest points and markers may be added edited and deleted in PFM or in Teletherapy.
This subtask discusses the latter. The difference between interest points and markers
are that interest points carry and report dose, markers do not.
Add an Interest Point or Marker
1. Click the Contour drop-down menu and select the Interest Points or Markers,
then New options. XiO displays the Add Interest Point or Add Marker dialog
box.

2. Enter an optional description.
3. Enter the coordinates for the point or marker.
OR
Click your middle mouse button and select the Center of a Structure option to
place the point.
OR
Place the point with your mouse (left click) on any transverse, sagittal or coronal
image. XiO automatically updates the coordinate values.
4. Click OK. XiO allows you to add more interest points or markers.
5. Click CANCEL when you have finished entering points.
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Teletherapy - Part 2
Task 5. Optional Display Settings
Subtask 8. Adding, Editing and Deleting Interest Points and Markers
(cont.)
Edit an Interest Point or Marker
1. Click the Contour drop-down menu and select the Interest Points or Markers,
then Edit options. XiO displays the Reposition Interest Point or Reposition
Marker dialog box.

2. Click your middle mouse button and select the Point number you want to edit.
3. Click OK. XiO displays the position information for the selected point.
4. Edit the coordinates for the point or marker.
OR
Click your middle mouse button and select the center of a structure to move the
point.
OR
Move the point using your mouse (left click) on any transverse, sagittal, or
coronal image. XiO automatically updates the coordinate values.
5. Click OK. XiO allows you to edit more interest points or markers.
6. Click CANCEL when you have finished editing points.
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Task 5. Optional Display Settings
Subtask 8. Adding, Editing and Deleting Interest Points and Markers
(cont.)
Delete an Interest Point or Marker
1. Click the Contour drop-down menu and select the Interest Points or Markers,
and Delete options. XiO displays the Remove Interest Point or Remove Marker
dialog box.

2. Click your middle mouse button and select the Point number you want to delete.
3. Click OK. XiO deletes the selected point and allows you to delete more points.
4. Click CANCEL when you are finished deleting points.

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Task 5. Optional Display Settings (cont.)
Subtask 9. Measure Tools
There are two types of measurement tools available in XiO. One is a ruler-type tool;
the other measures the distance between two points that are placed in any SPV
window. The second tool also provides the radiological distance if heterogeneity
correction is applied and XiO displays the CT and ED values (if a CT-to-ED file is
applied) for each placed point.
Using the Ruler Measure Tool
1. Click your right mouse button in any SPV and select the Measure option.
2. Hold down your left mouse button and drag across the area to be measured. XiO
displays a ruler as the mouse is moved across the window.

3. You may create as many rulers as you want; however, the measurement value
will only display on the last ruler you draw.
4. Click your middle mouse button to delete the rulers.
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Task 5. Optional Display Settings
Subtask 9. Measure Tools (cont.)
Using the Point to Point Measure Tool
1. Click the Tools drop-down menu and select the Measure option. XiO opens the
Measure dialog box.

2. Click your left mouse button on the location of the first point in any SPV
window.
OR
Enter the coordinates of the first point under the heading Point Location 1.
3. Click your middle mouse button on the location of the second point in the same
SPV window.
OR
Enter the coordinates of the second point under the heading Point Location 2.
4. After the placement of the second point, XiO displays the Physical and
Radiological Distances between the two placed points. XiO also displays the CT
and ED values for each point below their respective coordinates.
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Task 5. Optional Display Settings
Subtask 9. Measure Tools
Using the Point to Point Measure Tool (cont.)
5. You can move the point locations by clicking your left and middle mouse buttons
again to refresh the distances.
6. Click Cancel when finished with this tool.
Subtask 10. Plane Icon
You can use the Plane Icon tool to select a new transverse, sagittal, or coronal plane to
view in any SPV. You must have at least two of the three types of SPV planes
displayed to use this tool.
1. Click your right mouse button in any SPV and select the Plane Icon option. The
plane icon (a white line) appears in one or more of the other plane types
windows. For example, if you select the Plane Icon option from the transverse
SPV window, the plane icon itself displays in the sagittal and/or coronal SPV
windows as a white line representing the currently displayed transverse plane.

2. Hold down your left mouse button and drag the white line to a new location. XiO
automatically updates the selected plane in its respective window.
Subtask 11. Contour Editing
If, for any reason you would like to make edits to your contours or create automargins
during planning in Teletherapy, you can click the Contour button, or from the
Contour drop-down menu, select the Contour Editing option. XiO transitions you to
an abbreviated version on PFM. Some PFM functionality may not be available. If
there is a PFM feature you would like to use that is not available through the shortcut
(abbreviated version), you can close the patient in Teletherapy and open the patient in
the full-featured version of PFM.
You can now close the patient you have been using during this exercise. In the next
few tasks, you will be using different patients.
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Task 5. Optional Display Settings (cont.)
Subtask 12. Create Subcontour
In Teletherapy, you are allowed to create a subcontour that is the remainder of an
existing contour, minus the intersecting beam (including beam modifiers). You can
access this tool by clicking the Contour drop-down menu and selecting Create
Subcontour. Although this tool was created for proton plans, there may be an
application in photon and electron planning as well. For more information on using
this tool, see the Broad Beam Proton section of this training guide.
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Teletherapy - Part 2

Task 6. Multiple Plan Review
You can use Multiple Plan Review to review up to three plans at a time
simultaneously. You can also review added plans or subtracted plans. It is
recommended that you save a window format specifically for plan review to avoid
setting one up each time.
In this task, you will open a patient that has multiple saved plans, select the plans for
review, and create a window format to be used for multiple plan review. All plans
must be saved and calculated with the exception of the current plan to be available on
the list of plans to review.
Open the Patient and Select Plans for Review
1. Click the Teletherapy button on the Main XiO screen. XiO opens Teletherapy.
2. Click the File drop-down option and select the Open Permanent Plan option.
XiO displays the Open Permanent Plan dialog box.

NOTE: You must have saved permanent plans in order to view them in
Plan Review.
3. Click your middle mouse button in the Patient ID field and select
FusionProstate.
4. Click your middle mouse button in the Plan ID field and select 4fieldProstate.
5. Click OK. XiO displays the selected plan.
6-52
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 6. Multiple Plan Review
Open the Patient and Select Plans for Review (cont.)
6. Click the Tools drop down menu and select the Plan Review option. XiO
displays the Plan Review Maintenance dialog box.

NOTE: Plan 1 is the currently displayed plan and is already selected.
7. Click your middle mouse button in the Second Plan ID field and select
6FieldRTOG0126.
8. For plan 3 there are four options. You can select a third plan to review (when
available), subtract plan two from plan one, subtract plan one from plan two or
add plan one and two (for composite). For this task, select Plan 1-Plan 2.
9. Select the Graphics Area Setup 9MultiPlan. If you do not want to use
9MultiPlan, you can edit it or create a new one and save your own Multiple Plan
Graphics Area Setup.
10. Click OK. XiO closes the Plan Review Maintenance dialog box and displays the
three plans side-by-side.
XiO 6-53
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 6. Multiple Plan Review (cont.)
Change Isodose Display
1. Click the Dose drop-down option and select the Isodose Lines option. XiO
displays the Isodose Lines dialog box.


NOTE: If you have a subtraction or addition plan, the Isodose Lines dialog
box displays two isodose lists; one for the original plan, and another
for the subtraction or addition plan when in Multiple Plan Review.
Appropriate values will default for the subtraction or addition plan,
but can be edited.
2. Select Colorwash or Isofill as the Dose Display Mode. XiO displays the
isodoses as colorwashes.
6-54
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 6. Multiple Plan Review
Change Isodose Display (cont.)
3. Edit the isodose values.

OR

Click OK to close the isodose lines dialog box.
XiO 6-55
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 6. Multiple Plan Review (cont.)
Display Dose to a Single Point
1. Click your right mouse button in any SPV window and select the Reference
Point Loc option.
2. Hold down your left mouse button in any SPV window and move the mouse
pointer around the window. As you move, the reference dose (displayed in the
upper right corner of each window) is updated to reflect the dose at the same
point in all plans when in Multiple Plan Review.
DVH
When you display a DVH in Multiple Plan Review, XiO displays the DVH for all the
selected plans on the same graph. A solid line on the DVH graph represents the
original plan; a dashed line represents the second plan, and a dotted line represents the
third plan. XiO does not display an addition or subtraction DVH on the graph with the
other plans.

For more information on creating a dose volume histogram, see the Teletherapy- Part 1
section of this training guide.
6-56
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 6. Multiple Plan Review (cont.)
Save an Addition Plan
If you have an additional plan displayed in Multiple Plan Review, you can save that
plan by clicking the File drop-down menu and selecting the Save Addition Plan
option.
Plan Comment/ Approval
When using Plan Comment/Approval in Multiple Plan Review you have the ability to
write comments, or approve any of the plans displayed by clicking the Tools drop-
down menu and selecting the Plan Comment/Approval option and selecting the plan.
XiO 6-57
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 7. Additional Beam Modifiers
This task demonstrates how to add, edit, assign and delete bolus, how to add and
remove wedges, and how to add and remove compensating filters in XiO.
Subtask 1. Open a Permanent Plan
1. Select Teletherapy from the Main XiO Screen. XiO opens Teletherapy.
2. Click the File drop-down menu and select the Open Permanent Plan option.
XiO displays the Open Permanent Plan dialog box.
3. Click your middle mouse button in the Patient ID field and select Breast 1.
4. Click your middle mouse button in the Plan ID field and select onebeam.
5. Click OK. XiO loads and displays the selected patient.
Subtask 2. Bolus
In XiO, bolus is drawn and treated as a slab bolus. It can be drawn on a non-
reconstructed transverse SPV or a BEV.
Draw Bolus SPV
1. Click the Beam drop-down menu and select the Bolus and New options. XiO
displays the Edit Bolus Definition Data dialog box.

2. (Optional) Enter a description for this bolus.
6-58
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 7. Additional Beam Modifiers
Subtask 1. Open a Permanent Plan
Draw Bolus SPV (cont.)
3. Enter a bolus thickness of 1 cm.
4. (Optional) Change the Bolus Relative Electron Density.
5. Click your right mouse in the transverse image window and select Movie.
6. Movie to the most superior slice where you want to place bolus.
7. Click your right mouse button in the transverse image window and select the
Edit Bolus option.
XiO 6-59
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus
Draw Bolus SPV (cont.)
8. Hold down your left mouse button in the transverse image window and drag the
mouse from right to left or left to right along the patients surface to draw the
slab of bolus on the superior slice.
NOTE: If the bolus does not appear as you are drawing it, you may have a
reconstructed transverse slice displayed. You can verify that you
have a real slice or change to a real slice by clicking the View drop-
down menu and selecting the Window Format option. Click your
middle mouse under the Ref (cm) heading next to the SPV
transverse window. XiO displays real numbers on this list. Verify
that the Ref value is a real slice number. If not, select a real slice
from the list.
9. Click your right mouse button in the transverse image window and select the
Movie option.
10. Movie to the most inferior slice where you want to place bolus.
11. Click your right mouse button in the transverse image window and select the
Edit Bolus option.
12. Hold down your left mouse button in the transverse image window and drag the
mouse from right to left or left to right along the patients surface to draw the
slab of bolus on the inferior slice.
13. Click OK on the Edit Bolus Definition Data dialog box. XiO closes the box and
interpolates the bolus to all slices in between.
NOTE: If you would like to create a bolus with various thicknesses (step
bolus), you can either create multiple boluses (each with a different
thickness), abut them on the patient surface, or you can overlap
them and only the largest bolus thickness will take effect.
6-60
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus
Draw Bolus BEV
Before you begin, it will be helpful to display the patient contour as wireframe. When
you draw the bolus on a BEV, you will draw a slab just as you did on the SPV, but you
will draw on the most superior and inferior wireframe contours displayed in the BEV.
1. Click the Beam drop-down menu and select the Bolus and New options. XiO
displays the Edit Bolus Definition Data dialog box.

2. (Optional) Enter a description for this bolus.
3. Enter a bolus thickness of 1 cm.
4. (Optional) Change the Bolus Relative Electron Density.
5. Click your right mouse button in the BEV and select Edit Bolus.
NOTE: Move your mouse pointer over the patient surface. As you do this,
the individual wireframe contours of the patient are highlighted in
white when the mouse pointer is pointing to them.
XiO 6-61
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus
Draw Bolus BEV (cont.)
6. Place your mouse pointer on the most superior slice (highlighted in white) where
you would like to place bolus. Hold down your left mouse button and drag from
right to left or left to right along the wireframe contour to draw the superior
border of the bolus.
7. Place your mouse pointer on the most inferior slice (highlighted in white) where
you would like to place bolus. Hold down your left mouse button and drag in the
same direction you did on the superior slice to draw the inferior border of the
bolus.
8. Click OK on the Edit Bolus dialog box. XiO interpolates and displays the slab
bolus.
6-62
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus (cont.)
Edit Bolus
This section describes how to edit bolus on a slice-by-slice basis using the bolus
displayed in the transverse image window.
1. Click the Beam drop-down menu option and select the Bolus and Edit options;
then, select the number of the bolus you want to edit. XiO displays the Edit
Bolus Definition Data dialog box.
2. Click your right mouse button in the transverse image window and select the
Movie option. Movie to the slice where you would like to edit the bolus.
3. Click your right mouse button in the transverse image window and select the
Edit Bolus option.
Place your mouse pointer at either end of the bolus; hold down your left mouse
button and drag the bolus edge to the right or left around the patient surface.
Perform this step on as many slices as necessary.
4. Click OK when finished.
XiO 6-63
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus (cont.)
Assign Bolus
After you create bolus, you have the opportunity to assign the bolus to one or all of the
beams. If you do not assign bolus to any beams, XiO will not account for the bolus in
the calculation.
If you created the beams using total dose and more than one fraction, you have the
ability to fractionate bolus; therefore, you only need to create one beam for each
tangent and designate that the beam be bolused a specified number of days and
unbolused a specified number of days.
1. Click the Beam drop-down option and select the Bolus and Assign options. XiO
displays the Assign Bolus to Beam dialog box.

2. For each beam number, assign bolus by clicking the yes/no toggle button under
each bolus number.
3. If necessary, enter a ratio of bolused to unbolused fractions. If you entered total
doses on the photon beam page and you want bolus applied every day, you can
leave the unbolused/bolused ratio at 0:1.
4. Click OK when finished.
6-64
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Subtask 2. Bolus (cont.)
Delete Bolus
1. Click the Beam drop-down option and select the Bolus and Delete options. XiO
displays the Remove Bolus dialog box.

2. Click the number of the bolus you want to delete. XiO places an asterisk (*) next
to the bolus number(s) selected for deletion.
3. Click OK. XiO removes the selected bolus.
XiO 6-65
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 7. Additional Beam Modifiers (cont.)
Sub-task 3. Wedges
Add Wedge
1. In Beam mode, make the beam to which you want to add a wedge the active
beam.
2. Click the Wedge button.

OR
Press F12 on your computer keyboard. XiO displays the Wedge dialog box.
OR
Click the Beam drop-down option and select the Wedge option. (XiO may
prompt you for a beam number if no beams are active.) XiO displays the Wedge
dialog box.

3. Click your middle mouse button in the Wedge ID field and select a wedge (if
you have multiple wedge options).
4. Enter the Wedge Orientation (if required).
5. (Optional) Enter the Wedge Angle for EDW, Virtual Wedge or Motorized
Wedge.
6. Click OK. XiO displays the wedge on the selected beam.
6-66
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2
Task 7. Additional Beam Modifiers
Sub-task 3. Wedges (cont.)
Delete Wedge
1. In Beam mode, make the beam to which you want to add a wedge the active
beam.
2. Click the Wedge button.

OR

Press F12 on the your computer keyboard. XiO displays the Wedge dialog box.
OR
Click the Beam drop-down option and select the Wedge option. (XiO may
prompt you for a beam number if no beams are active.) XiO displays the Wedge
dialog box.

3. Click the Remove Wedge button. XiO removes the wedge from the active beam
and closes the Wedge dialog box.
XiO 6-67
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Sub-task 4. Compensating Filters
There are several types of compensating filters supported in XiO. Some require that
you enter different information than others. XiO can print Ellis and 1D compensator
information from the File-Print menu options. You can review Decimal, Huestis, and
Par Scientific compensators on screen from the Tools-Review Compensating Filter
menu options and order or export to a milling machine.
Filter information must be setup and validated for the machine you want to use prior to
creating one on a patient. If you want to try using a Huestis or Par Scientific
compensating filter, the material you should select in the training data is cfIronGran.
Add Compensating Filter
1. In Beam mode, make the beam to which you want to add a compensator the
active beam; then, click the Compensating Filter button. XiO displays the
Compensating Filter dialog box.
OR
Click the Beam drop-down option and select the Compensating Filter option.
(You may be prompted for a beam number if no beams are active.) XiO displays
the Compensating Filter dialog box.

2. Select a filter if you have multiple types validated. If only one filter type is
validated, XiO displays this type and it is not editable.
NOTE: All of the fields displayed in this dialog box contain default values
if they were set up in Source File Maintenance.
6-68
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Sub-task 4. Compensating Filters
Add Compensating Filter (cont.)
3. Edit any of the fields, if necessary. See the XiO Online Help for more
information regarding the contents of these fields.
4. Click OK. XiO displays the compensator on the patient as a yellow line
perpendicular to the beam in the SPV window. It also displays the compensator
in an MPV window as a plane perpendicular to the beam.
Delete Compensating Filter
1. In Beam mode, make the beam to which you want to add a compensator the
active beam; then, click the Compensating Filter button. XiO displays the
Compensating Filter dialog box.
OR
Click the Beam drop-down option and select the Compensating Filter option.
(You may be prompted for a beam number is no beams are active.) XiO displays
the Compensating Filter dialog box.
2. Click the Remove Compensator button. XiO removes the compensator and
closes the dialog box.
XiO 6-69
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Sub-task 4. Compensating Filters (cont.)
Send Compensating Filter Data to a Milling Machine (Huestis and Par
Scientific)
1. Click the Tools drop-down menu and select the Review Compensating Filter
option. XiO opens the Review Compensating Filter dialog box.
2. Click the Send to Milling Machine button. XiO opens the Send to Milling
Machine dialog box.

3. If the format is Par Scientific, enter the Version Number you are using in your
clinic.
6-70
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 7. Additional Beam Modifiers
Sub-task 4. Compensating Filters
Send Compensating Filter Data to a Milling Machine (Huestis and Par Scientific)
[cont.]

4. Enter the Distance Exported beyond the Field Edge.
NOTE: As a caution, you will want to be aware of how the Distance Exported
beyond Field Edge (cm) is related to the boundary of the beam matrix.
During the dose calculation, XiO computes compensating
transmission factors for not only the open field, but also up to the
boundary of the beam matrix. For FFT Convolution/Superposition,
the boundary of the beam matrix is the sum of the field extended by
the TERMA extent as defined on the Beam dialog box. For Clarkson,
the beam extent is equal to the maximum fan line ratio generated for
the computational OCR data tables in Source File Maintenance
(SFM). If the Distance Exported beyond Field Edge (cm) is set to a
value smaller than the TERMA extent, or the OCR ratio, when the
transmission factors are converted to filter material, it will be possible
to cut some regions off which were calculated as part of the beam
extent. Therefore, the actual dose distribution outside of the field will
not be identical to the doses computed in XiO. A Distance Exported
beyond Field Edge of zero (0) will have the largest discrepancy
between the calculated dose and the actual delivered dose.
XiO 6-71
Teletherapy - Part 2
XiO Training Guide

Teletherapy - Part 2
Task 7. Additional Beam Modifiers
Sub-task 4. Compensating Filters
Send Compensating Filter Data to a Milling Machine (Huestis and Par
Scientific) [cont.]
When using FFT Convolution or Superposition, material thicknesses
are only calculated out to the TERMA extents. If the Distance Exported
beyond Field Edge (cm) field is set to a value larger than the TERMA
extents, the compensating file, when exported, will pad the border with
zeros (diagram 1).
Compensator Exported
as Calculated







Outside the TERMA
extents, no filter is
calculated. This will
be padded with 0

TERMA extent
outside the jaws,
exported as calculated
.

Diagram 1: Schematic of exported compensator thickness values.
WARNING

Due to the above issues, CMS recommends that
the Distance Exported beyond Field Edge (cm) be
set to the same value as TERMA on the Beam
dialog box. CMS also recommends a value of 4
cm for the TERMA extent. Users should be
aware that for XiO 4.2.2 with PDA 10141, the
Distance Exported beyond Field Edge (cm) is not
being saved with the plan. Therefore, every time
the plan is opened, this field reverts to the default
of blank.

5. Select a Transfer Method.
6. Enter a File Name for the Milling Machine.
6-72
Teletherapy - Part 2
XiO Training Guide
Teletherapy - Part 2

Task 8. Delete Options in XiO
Additional delete functionality is available in XiO for cleaning up your systems and
deleting unwanted plans, information, and templates. You can find the following
delete options in Teletherapy and in Patient File Maintenance under the File drop-
down option. Unless you have first created a backup of your data that you can restore,
deleting any of these items is permanent.
Patient Delete a patient from the XiO system.
Studyset (PFM Only) Delete a studyset from a patient file.
Isodose Plan Delete a selected plan from a patient file.
IFPD Plan Delete an irregular field point dose plan from a patient file.
Temporary Plan Delete one or multiple temporary plans from a patient file.
DICOM Import Deletes DICOM imported plans from the merge directory.
Public Port Delete a public port from XiO.
Plan Template Delete plan templates from XiO.
Graphics Presets Delete Graphics Window Preset lists from XiO.
Isodose Lines Presets Delete Isodose Lines Presets from XiO.
Plan Output Delete Plan Output templates from XiO.
XiO 6-73
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Practice Exercise
This 2-D Breast Tangents plan is the first treatment plan that you interactively
follow in the XiO Dosimetry training course. If you have an operational XiO
workstation at your clinic, you may also follow this exercise on your own.
Patient contours to use for digitizing can be found in the back of this section.
The design of this plan illustrates the basic actions required to digitize contours
and create a simple 2-D plan.
This plan is similar to the plan using pre-drawn contours that you may have
completed in the XiO Getting Started Guide prior to coming to class.
Consequently, this should be a relatively straightforward plan for you to
complete.

Refer to the Online Help glossary for definitions of terms where you need further
clarification.
Once you complete this exercise, you should understand the following concepts
and be able to execute the various tasks without additional supervision:
x Access XiO
x Enter patient demographic data and define the studyset
x Digitize contours
x Create a new plan
x Save the plan
x Print a Single Plane View

XiO 7-1
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 1. Access XiO
The following steps illustrate how to access the XiO system from an operational
XiO workstation.
1. On the login window, type test in the Login ID field and cms in the
Password field.
2. Click the OK button. XiO displays the main system window for HP/UX.

OR

Click the XiO icon on your computer desktop for Linux systems.



3. Verify the current clinic displays: XiO Training Data. CMS set up the
demo clinic so that you can practice each of the steps for each of the tasks
illustrated in the training guide. Do Not use the data shown in the practice
exercises when creating a valid treatment plan for your clinic.
7-2
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 2. Enter Patient Demographic Data and Define the
Studyset
The following steps illustrate how to enter the patient demographic information
and create the studyset.
1. On the XiO main window, click the Patient File Maintenance option.
XiO opens Patient File Maintenance (PFM) where you can select options
from the drop-down menus.
2. Click the File drop-down menu and select the New and Patient options.
XiO displays the New Patient dialog box.



3. Enter 12345 in the Patient ID field.
4. Enter Breast Tangents in the Patient name: field.
5. Click the drop-down arrow in the Sex: field and select Female.
6. Click the drop-down arrow in the Create: field and select Nonimaged
Studyset.
XiO 7-3
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 2. Enter Patient Demographic Data and Define the
Studyset (cont.)
7. Click OK. XiO displays the New Non-image Based Studyset Definition
dialog box.

8. Enter Tangents in the Studyset ID field.
NOTE: UNIX and LINUX are case sensitive and do not allow spaces in
the ID names. Entries must also be alphanumeric.
9. (Optional) Enter 2-D Training in the Studyset Description: field.
9. The Patient Position can be left as the default, Supine.
10. (Optional) Enter Position Comments (sponge under knee, head to the
right, etc).
NOTE: If you are planning a prostate preplan and will be digitizing
ultrasound prostate images, you have to select a template to use.
In that case, select Yes for prostate preplanning and enter a
Prostate Template ID.
7-4
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 2. Enter Patient Demographic Data and Define the
Studyset (cont.)
11. Under the heading Cross Section Reference Distance Positions, enter the
following (3) cross section reference distance positions: -5.0 cm, 0.0 cm,
and +5.0 cm. These are the three cross sections you will be contouring.
OR
If the slices you plan to create contours on are evenly spaced in the From,
To, and Step boxes, enter the most inferior slice, the most superior slice,
and the step increment between them. The number of slices you will create
contours on will default in the Cross Section Reference Distance Positions
boxes.
NOTE: The (3) cross sections to be digitized can be found in the
training guide at the end of this exercise. Each cross section
is labeled with a corresponding reference distance position.
12. Click OK.
XiO 7-5
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 3. Digitize Contours
The following steps illustrate how to set up the contouring parameters, orient the
axes, and digitize contours into XiO.
Sub-Task 1. Set up the Contouring Parameters and Orient the Axes
1. On the Patient File Maintenance Toolbar, select the option Trace Contours
Using the Tablet button. XiO displays the Orient the Tablet dialog
box.
2. Enter the following values:

Scale Factor: 0.62.
Auto Sample Spacing: 0
NOTE: Values entered in the Auto Sample Spacing field will be used to
determine sample spacing when you digitize contours. Use zero
(0) when you want to digitize each point yourself. If you enter
any other value 0.0 - 5.0, you will not digitize each point. You
only have to drag the mouse around the contour. XiO will drop
points in the increment you entered. You may enter several
values, separated by commas, and change the value you will use
at any time during contouring. As a general rule, for larger
contours, such as for patient skin, use larger spacing. For
smaller contours, such as the spinal cord, use a smaller spacing.
To learn more, see the XiO Online Help.
3. Turn on the digitizer tablet. There are two buttons on the left side of the
tablet. One is for power the other for the backlight. (Turning on the
backlight is optional.)
4. Locate the cross section labeled +5.0 cm and place it on the digitizer tablet.
This is the most superior cross section. Orient the cross section on the
tablet using the following steps. Create a 3-point orientation by digitizing
the axis, the + axis, then the origin.
(1) To create the axis point, click the {enter point} button on the
transducer keypad with the transducer positioned on the
crosshair to the left of the origin.
NOTE: The tablet makes a beeping sound as you enter each
point.
7-6
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 3. Digitize Contours
Sub-Task 1. Set up the Contouring Parameters and Orient the Axes
(cont.)
(2) To create the + axis point, click the {enter point} button on the
transducer keypad with the transducer positioned on the
crosshair to the right of the origin.
(3) To create the origin point, click the {enter point} button on the
transducer keypad with the transducer positioned on the origin of
the crosshair. After you orient the contour on the tablet, XiO
displays the Tablet Contour Information window.
(4) Before contouring begins, verify that the reference distance listed on
the Tablet Contour Information dialog box is +5.0 cm. If not, you
may need to press button {8} Switch to Previous Cross Section, or
{9} Switch to Next Cross Section on the transducer keypad to move
to that cross section reference distance.
XiO 7-7
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 3. Digitize Contours
Sub-Task 2. Digitize Contours
Digitize all structures, interest points, and markers one cross section at a time;
however, you can always go back to any cross section and digitize new contours
or points.
You do not have to digitize the cross sections in any particular order; verify that
the cross section you are digitizing corresponds with the reference distance
displayed on the screen.
You also do not have to digitize the contours in any particular order; verify that
the contour name displayed in the upper right corner of the screen is the name of
the contour you are digitizing.
A view of the transducer buttons and a list of the tablet keypad controls are
shown at the end of this section.
Begin by digitizing the Patient contour. The group name "General" and contour
name "Patient" should be displayed in the upper right corner of the screen. If
these names are not displayed, press {5} on the transducer keypad to toggle to
Group name, and/or {6} to toggle the Contour name.
1. Trace the Patient Contour as follows:

(1) Place the transducer on the line of the patient contour. Press the {start}
button on the transducer.
(2) Place the contour outline by pressing the {enter point} button at each
position you place the transducer around the patient contour.
NOTES: If you chose a different auto sample spacing other than
zero, you do not need to press the enter point button to
add points. Points are dropped automatically as you
slide the transducer around the patient contour.

Press {0} on the digitizer controller to start over.

(3) Press the {end} button on the transducer when you want to close the
contour.
(4) Next, digitize the breast tissue (target). Use the Contour name PTV1.
7-8
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 3. Digitize Contours
Sub-Task 2. Digitize Contours (cont.)
2. Trace the Target Contour as follows:
(1) Select PTV1 from the Contour name list by pressing {6} two times.
(2) Place the transducer on the line of the target contour. Press the {start}
button on the transducer.
(3) Trace the contour outline by pressing the {enter point} button at each
position you place the transducer around the target contour.
(4) Press the {end} button on the transducer when you want to close the
contour.
(5) After the contours have been entered on cross section +5.0 cm, replace
that cross section on the tablet with the 0.0 cm cross section. This is
the central axis cross section.
NOTE: If you place the cross section in the same position on the
digitizer tablet, there is no need to reorient the tablet
between cross sections; however, if you do not place the
next cross sections in the same position on the tablet, press
{1} Reorient Axis each time you place a new cross section
on the tablet. This allows you to reorient the new cross
section.
3. Prepare to digitize contours on cross section 0.0 cm as follows:
(1) Press {8} Previous Cross Section or {9} Next Cross Section on the
transducer keypad to change the display to the 0.0 cm cross section.
XiO displays the label 0.0 cm at the bottom of the contouring window
and at the top of the Tablet Contour Information window.
(2) Press {6} Next Contour Name to toggle the Contour name back to
Patient.
(3) Digitize the patient contour as described in previous steps.
(4) Toggle the Contour name to PTV1.
(5) Digitize the target contour as described in previous steps.

XiO 7-9
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 3. Digitize Contours (cont.)
Sub-Task 3. Digitize Interest Points and Markers
Use the transducer to digitize the interest point and markers on the cross section
0.0 cm. To distinguish the two, dose is reported for interest points; however,
dose is not reported for markers. In this task, place an interest point at isocenter
and markers at the medial and lateral field borders.

1. Position the transducer over point 1. (This point appears as a + sign in the
center of the target contour.)
2. Press button {3} Interest Point on the transducer keypad to digitize the
interest point.
3. Position the transducer over point 2.
4. Press button {2} Marker Point on the transducer keypad to digitize the
medial border marker.
5. Position the transducer over point 3.
6. Press button {2} Marker Point on the transducer keypad to digitize the
lateral border marker.
Sub-Task 4. Digitize Contours on Final Cross Section
1. Replace the cross section on the digitizer tablet with the cross section
labeled -5.0 cm. This is the most inferior cross section.
2. Repeat steps found in sub-task 2 to digitize the patient and target contours
on cross section -5.0 cm.
NOTE: Do not forget to change to a new cross section -5.0 cm and
change the contour name to represent each contour before it is
digitized.
3. When you have completely finished all tablet digitizing, press button {4}
End Tablet Entry.
7-10
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 3. Digitize Contours
Sub-Task 5. Name the Interest Points and Markers
1. Click your right mouse button in the main window and select the Movie
option.
2. Click the left or middle mouse button (or use the scroll wheel) to movie to
slice 0.0 cm.
3. Click the Edit drop-down menu and select the Interest Points option. XiO
displays the Edit Interest Point Definition dialog box.
4. Enter the name Isocenter for the Interest Point displayed.
5. Click OK. XiO closes the dialog box.
6. Click the Edit drop-down menu and select the Markers option. XiO
displays the Edit Marker Definition dialog box.
7. Enter the names Medial and Lateral for the Marker points displayed.
8. Click OK. XiO closes the dialog box.
XiO 7-11
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 4. Create a New Plan
Once all the contouring is complete, you can create a new beam plan. This task
illustrates how to create a new plan in XiO. The total dose prescription for this
breast tangents plan is 5040 over 28 fractions. You will plan using total dose;
then, normalize 5040 to the 100% isodose line for dose display.
Sub-Task 1. Enter Plan Information
1. Click the Beam button on the main toolbar. XiO opens Teletherapy and
displays the New Teletherapy Plan dialog box.




2. (Optional) Enter Tangents in the Description field.
3. The Beam Weighting Mode field defaults to Absolute dose/MU.
4. The Treatment Date defaults to the current date.
5. Click the drop-down arrow in the Head/Feet Toward Gantry: field and
select Head. (Head is the default.)
6. Click OK. XiO closes the dialog box and displays the patient in a four
window format.
7-12
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 4. Create a New Plan (cont.)
Sub-Task 2. Create an Active Beams-Eye View (ABV) Window
1. Click the View drop-down menu and select Window Format.

OR

Press W on your computer keyboard. XiO displays the Window Format
dialog box.

2. Click the drop-down arrow in window number 4 under View and select
ABV. This designates window 4 as an active beams eye view window.
3. Click the Update Graphics Display button.
4. Click CANCEL.

NOTE: Window 4 remains blank until a beam is added.
XiO 7-13
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents
Task 4. Create a New Plan (cont.)
Sub-Task 3. Create a New Beam
1. Create a new beam using one of the following methods:

Click the New Beam button on the sub-mode toolbar.

OR

Click the Beam drop-down menu and select the New Beam option.

OR

Press F5 on the keyboard.
2. Enter the beam description Medial Tangent.
3. Click your middle mouse button in the Machine ID: field and select
Vari06x.
4. Verify the Setup is SAD and set the collimator jaws to Asymmetric.
5. Click your middle mouse button in the Beam Isocenter Placement box and
select the interest point labeled Isocenter as the default.
6. Click OK. XiO displays the Photon Beam dialog box.
7. Enter the following parameters at the field size defined at field:

LW: 6.0
RW: 5.5
UL: 10.0
LL: 10.0

8. Enter a gantry angle of 65 deg.

OR

Click your right mouse button right mouse in the 0.0 cm crosssection
window and select the Gantry Angle option. Hold down and move the left
mouse button in this window to rotate the gantry manually until the medial
and lateral markers are superimposed in the ABV window.
7-14
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents
Task 4. Create a New Plan
Sub-Task 3. Create a New Beam (cont.)
9. Enter 2520 cGy for weight, and 28 for number of fractions.
10. Leave all other parameters at their default values.
11. Click OK. XiO closes the photon beam dialog box.
Sub-Task 4. Add a Wedge

1. Click the Wedge button on the sub-mode toolbar.

OR

Click the Beam drop-down menu and select the Wedge option. XiO
displays the wedge dialog box.
2. Click your middle mouse button in the Wedge ID: field and select W15.
3. Select Left for the Toe Orientation.
4. Click OK. XiO closes the wedge dialog box and displays the wedge on the
medial tangent in the correct orientation.
Sub-Task 5. Mirror the Beam
This task illustrates how to create an opposed beam. All the parameters set for
the medial tangent will be applied to the lateral tangent, including the wedge.
You only need to adjust the gantry angle to match the inner border.
1. Click the Mirror Beam button on the sub-mode toolbar.

OR

Click the Beam drop-down menu an select the Mirror Beam option. XiO
displays the Mirror Beam dialog box.
OR
XiO 7-15
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XiO Training Guide

2-D Breast Tangents

Task 4. Create a New Plan
Sub-Task 5. Mirror the Beam (cont.)
Press F8 on the keyboard.
2. Enter the beam description Lateral Tangent.
3. Edit the gantry angle to be 239 deg.

OR

Click your right mouse button in the 0.0 cm cross section window and
select the Gantry Angle option. Hold down and move the left mouse in
that window to rotate the gantry manually until the medial and lateral inner
borders are superimposed.
4. Click OK to close the photon beam dialog box.
Sub-Task 6. Normalize and View Isodose
Once the beam information has been entered, the dose calculation begins
automatically (unless you have set the preference to not automatically start the
dose calculation). After the dose calculation is complete, you can setup the
normalization and enter isodoses for plan review.
1. Click the Dose button on the main Teletherapy toolbar. XiO activates
the Dose supporting toolbar buttons.
7-16
2-D Breast Tangents
XiO Training Guide
2-D Breast Tangents

Task 4. Create a New Plan
Sub-Task 6. Normalize and View Isodose (cont.)
2. Click the Set Normalization Mode button on the sub-mode toolbar.
XiO displays the Dose Normalization dialog box.

3. Enter 5040 in the Selected Dose (cGy) field.
4. Click the Selected Dose button to normalize the dose to 100%.
5. Click Cancel to exit the dose normalization dialog box.
6. Click the Isodose Lines button on the sub-mode toolbar. XiO opens
the Isodose Lines dialog box.
7. Enter the following isodose lines 110, 105, 100, 98. Review the coverage
of the isodose lines on all three cross sections.
8. Click OK to close the isodose lines dialog box.
9. Click the Beam Weight button on the sub-mode toolbar. XiO displays
the Beam Weight dialog box allowing you to type in beam weights and
click on Update Display to Reflect Changes. You may edit the beam
weights if necessary.
NOTE: The Rescale (prescribe) beam weight option allows you to rescale
beam weights to a point or isodose line. This topic is discussed
later in the training guide.
XiO 7-17
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2-D Breast Tangents

Task 4. Create a New Plan
Sub-Task 6. Normalize and View Isodose (cont.)
10. Click OK to close the beam weights dialog box.
11. Click the Source Data button on the sub-mode toolbar. XiO displays
the source data index for this plan. Review the information on this index
for accuracy. You can print this index by selecting the Print option at the
bottom of the index.
12. Click Quit to close the index.
7-18
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XiO Training Guide
2-D Breast Tangents

Task 5. Save the Plan
1. Click the Save button on the sub-mode toolbar.

OR

Click the File drop-down menu and select the Save Plan option. XiO
opens the save permanent plan dialog box.
2. Enter Tangents for the Plan ID.
3. (Optional) Enter a Plan Description.
4. Click OK to save the permanent plan.
XiO 7-19
2-D Breast Tangents
XiO Training Guide

2-D Breast Tangents

Task 6. Print a Single Plane View
This task illustrates how to select and print a single plane view (SPV) window.
In this exercise, include the printed report data in the printout.
1. Click your left mouse button in the 0.0 cm window (Subwindow 2). XiO
displays a red box around that window. This action activates the 0.0 cm
cross section so it can be printed.
2. Click the File drop-down menu and select the Print and Single Plane View
options. XiO displays the Print Single Plane View dialog box.
NOTE: Notice that Subwindow 2 is designated as the window to be
printed.
3. Any scale factor in the range of 0.1 to 3.0 may be entered; however, the
scale factor that defaults is the largest image that will fit on one 11x17
page. Use the default for this exercise.
4. Answer yes to include Source Data, Dose Labels, and Printed Data.
Leave all other options to their default values.
NOTE: If you do not include the Printed Data, XiO prints only the
SPV image with no supporting reports.
5. Click OK to begin the print job.
6. Review the printed data to familiarize yourself with the information that
XiO provides.
7. Once you finish the plan, click the File drop-down menu and select the Exit
option. XiO returns you to the XiO main screen.
7-20
2-D Breast Tangents
XiO Training Guide



Tablet Keypad Control Options

{Start} : Start Contour

{Enter Point} : Enter Contour Point

{End} : Close Contour

{0} : Restart Tracing

{1} : Reorient Axis

{2} : Marker Point

{3} : Interest Point

{4} : End Tablet Entry

{5} : Next Group Name

{6} : Next Contour Name

{8} : Previous Cross Section

{9} : Next Cross Section

{+} : Use Next Sample Spacing

{-} : Delete Last Contour Point



Indicator Light
The Green light is lit
when transducer and
tablet are
communicating.
+
+ 0 -
2 3
Start
1
5 6
End
4
9
Enter
Point
8 7
XiO 7-21





2D Breast Tangents Plan-Superior Cross Section
T = +5.0 cm
Scale Factor = 0.62
NOTE: This factor may vary depending on the printer;
verify before using this factor.





2D Breast Tangents Plan- Cax Cross Section
T = 0.0 cm
Scale Factor = 0.62
NOTE: This factor may vary depending on the printer;
verify before using this factor.







2D Breast Tangents Plan- Inferior Cross Section
T = -5.0 cm
Scale Factor = 0.62
NOTE: This factor may vary depending on the printer;
verify before using this factor.





















































3-D Lung
XiO Training Guide

3-D Lung
Practice Exercise
This practice exercise builds on the knowledge you gained by completing the
Patient File Maintenance and Teletherapy lessons. Completing this exercise
should help to reinforce what you have already learned and also illustrate how
easy it is to create 3-D plans in XiO.
Besides being a 3-D plan, this is also a composite plan. To create a composite
plan in XiO, you place all the beams on one plan, then turn off and on the beams
you would like to calculate. Turn them all on to review the composite plan, turn
off the boost beams to review the original plan or turn off the original beams to
review the boost plan.
NOTE: You are required to transfer CT data in this exercise. This patient is
only available if you are in a CMS Training Class. However, you
could follow these steps for almost any patient and complete a 3-D
plan.

Once you complete this exercise, in addition to the skills learned in the previous
lessons, you should understand the following concepts and be able to execute the
various tasks without additional supervision.
x Create a new patient and transfer in data
x Use Auto Margin to expand a structure
x Add an interest point in Teletherapy
x Set the 3-D calculation matrix
x Create a new beam
x Add a treatment aid (port)
x Mirror a beam
x Edit a port
x Save a plan
x Normalize the dose display and review isodoses
x Add boost fields for a composite plan
x Review the boost plan
x Review the composite plan
x Create a dose volume histogram


XiO 8-1

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XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data
This task demonstrates how to enter the patient demographics and transfer CT
data from the Source directory (where CT sends the raw data) into Patient File
Maintenance.
1. Select Patient File Maintenance from the XiO main screen. XiO displays
the Patient File Maintenance main screen.
2. Click the File drop-down menu and select the New and Patient options.
XiO displays the New Patient dialog box. This is where you enter the
patient demographic data.
3. Enter the name ChestPatient in the Patient ID: field.
4. Enter Sara P. Rose in the Patient Name field.
5. Click the drop-down arrow in the Sex field and select Female.
6. Click OK. XiO displays the Start Image Transfer dialog box.

8-2
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XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data (cont.)
7. Click your middle mouse button in the Source PID: field and select 147-11-
10 from the list. Note that all the available images are selected for transfer.
8. Enter 3Dlung in the Studyset ID field.
9. Click your middle mouse button in the CT to ED Conversion: field and
select rocsboard from the list.
10. Click OK. XiO transfers the CT data.
11. Once the CT data transfer is complete, XiO displays the Finish Image
Transfer dialog box.

Enter the following information:
(1) Click the drop-down arrow in the Transverse images views from foot
field and select Yes.

XiO 8-3

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XiO Training Guide

3-D Lung

Task 1. Create a New Patient and Transfer CT Data (cont.)
(2) Click the drop-down arrow in the Reference distances increase towards
head field and select Yes.
NOTE: View the graphic area to ensure that the green arrow is
pointing superiorly on the coronal image.
(3) Click the drop-down arrow in the Patient Position field: and select
Supine as the patient position.
12. Click OK. XiO re-orients the cross sections (that is, if the settings were
changed from the defaults), and displays the Add Anatomical Site dialog
box.

13. Click the Chest button to add the predefined anatomy site. The button turns
blue.
14. Click OK.
8-4
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XiO Training Guide

3-D Lung

Task 2. Create Contours
Contour the following structures.
x Patient (external)
x Right lung
x Left lung
x Spinal cord
x Tumor (GTV)
You may choose from any of the contouring methods outlined in the Patient File
Maintenance section of this training guide. Refer to those procedures as needed.



XiO 8-5

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XiO Training Guide

3-D Lung

Task 3. Use Auto Margin to Expand the Target Volume
Use the 3-D Auto Margin tool if you would like to combine structures to create a
new structure or create positive, negative, or variable margins on structures.
Refer to the Patient File Maintenance section of this training guide for more
information on creating 3-D auto margins.
1. Click the Create a Contour Using 3-D Auto Margin button on the
sub-mode toolbar. XiO displays the 3-D Auto-Margin dialog box.

2. At the New Structure Name: field enter PTV.
3. Click the drop-down arrow in the Class: field and select Int.
4. Click your middle mouse button in the Color: field and select a Color.
5. Click the drop-down arrow in the Rendering: field and select a Rendering.
6. Click your middle mouse button at the Structure field and select GTV.
8-6
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XiO Training Guide

3-D Lung

Task 3. Use Auto Margin to Expand the Target Volume (cont.)
7. In the Margin field that corresponds with the "GTV" structure, enter 1.5
(cm).
8. Click the drop-down arrow in the associated Include/Exclude column and
select Include.

9. Click the Create 3-D auto-margin button.
10. Click the Accept 3D auto-margin button.
11. Click CANCEL to close the dialog box.
XiO 8-7

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XiO Training Guide

3-D Lung

Task 4. Enter Basic Teletherapy Information
Click the Beam button to transition from Patient File Maintenance to
Teletherapy. At any time, you can return to Patient File Maintenance by clicking
the Contour button.
1. Click the Beam button on the toolbar. XiO opens the Teletherapy
function and displays the New Teletherapy Plan dialog box.


2. Click the drop-down arrow in the Graphics Area Setup: field and select the
predefined graphics area setup 4TSCA.
3. Click OK.
8-8
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XiO Training Guide

3-D Lung

Task 5. Add an Interest Point
In Patient File Maintenance or Teletherapy, you can place interest points or
markers. This task explains how to create interest points in Teletherapy. For
more information on placing interest points or markers in PFM, refer to the
Patient File Maintenance section in this training guide.
1. Click the Contour drop-down menu and select the Interest Points and
New options. XiO displays the Add Interest Point dialog box.

2. At the Description prompt, enter GTV.
3. Click your middle mouse button in the Center of Structure: field and select
GTV from the list.
4. Click OK. XiO adds the interest point and clears the fields on the dialog
box so you can add additional interest points.
5. Click CANCEL to close the dialog box.


XiO 8-9

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XiO Training Guide

3-D Lung

Task 6. Dose Calculation Settings
Dose calculation settings include heterogeneity correction, calculation region
size, and calculation grid spacing. XiO supports bulk, pixel by pixel, and a
combination of the two for heterogeneity correction. XiO automatically sets the
calculation region to encompass the entire patient; however, you can edit the box
here. Grid spacing determines the numbers of points calculated in the region.
Common grid spacing for conventional photon beam planning is 3-5 mm grid
spacing.
1. Click the Dose drop-down menu and select Calculation and Settings
options. XiO displays the Dose Calculation Settings dialog box.


2. Click the drop-down arrow in the Heterogeneity Correction field and make
a selection. Yes means the system considers the heterogeneity correction
during dose calculation. No means the system does not consider the
heterogeneity correction.
3. Click the drop-down arrow in the Pixel-by-Pixel Calculation field and make
a selection. Yes means the system uses CT pixel converted electron
densities in the heterogeneity correction. No means the system does not
use CT pixel converted electron densities in the heterogeneity correction;
instead, it uses the bulk densities assigned in PFM.
8-10
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XiO Training Guide

3-D Lung

Task 6. Dose Calculation Settings (cont.)
4. Enter the following Distance between Calculation Points:

Along Width 0.4
Along Height 0.4
Along Depth 0.4
5. Click OK. XiO updates your changes and closes the dialog box.
XiO 8-11

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XiO Training Guide

3-D Lung

Task 7. Add New Beam
This task demonstrates how to add a new beam to a patient and enter all the
appropriate beam information.
1. Click the New Beam button on the Beam supporting toolbar.

OR

Click the Beam drop-down menu and select the New Beam option. XiO
displays the New Beam dialog box.

2. (Optional) Enter a description of the current treatment beam, such as AP.
3. Click your middle mouse button in the Machine ID field and select the
Vari06x to be used in the treatment.
NOTE: This machine ID must be defined and validated in Source
File Maintenance prior to selecting it here.
4. Click your middle mouse button in the Beam Isocenter Placement field and
select the Center of GTV for your treatment plan. Your selection
determines where the beam isocenter is located.

8-12
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XiO Training Guide

3-D Lung

Task 7. Add New Beam (cont.)
5. Click OK. XiO displays the Photon Beam dialog box.



6. Enter this data for the following fields:

Width (cm): 10
Length (cm): 10
Gantry Angle (deg): 0
Collimator Angle (deg): 0
Couch Angle (deg): 0
Weight Defined At: Isocenter
Weight (cGy): 2000
Number of Fractions: 20
7. Click OK. XiO creates and displays the new photon beam.




XiO 8-13

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XiO Training Guide

3-D Lung
Task 8. Adding an Aperture
After you place your first beam, the Auto Port button becomes available. You
can access this button by clicking either the Beam or Port buttons located on the
main toolbar. For illustrative purposes, this exercise discusses how to create an
aperture using the Port button. For more information on creating apertures,
blocks and MLC ports, refer to the Teletherapy sections of this training guide.
1. Click the Port button on the main toolbar.
2. Click the AutoPort button on the supporting toolbar. XiO displays the
Auto Port dialog box.

3. Click your middle mouse button and select the PTV for the Auto Margin
To: field.
4. Enter "1" for the With Margin units.
5. Click the Calculate Aperture button.
6. Click OK. XiO displays the newly created aperture.
7. Click the Conform Collimator Jaws to Aperture button. XiO
conforms the jaws to the port, either symmetrically or asymmetrically,
depending on the jaw setting selected.

8-14
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XiO Training Guide

3-D Lung

Task 9. Mirror Beam
Use the Mirror Beam option to copy a beam parallel opposed to the original
beam. If you have a port on your beam, it will also mirror the port.
1. Click the Beam drop-down menu and select the Mirror Beam To
option. XiO displays the Mirror Beam dialog box.

2. Click OK. XiO displays the Photon Beam dialog box for beam 2.
3. (Optional) Enter a beam description, such as PA.
4. Click OK to close the Photon Beam dialog box.

XiO 8-15

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XiO Training Guide

3-D Lung

Task 10. (Optional) Edit a Port
The Port editing tools function the same as the editing tools in Contouring.
Follow these instructions if you want to manually make edits to your port.
1. Click the Port button.
2. Click the Define Shape as Aperture button.
3. Click the Edit Port button on the Port supporting toolbar.
4. Verify the active beam is beam 2. Click your right mouse button in the
Active Beams-Eye View (ABV) window.
5. Select the option Edit Contour.
6. Click your left mouse button on the aperture shape edge. A yellow edit box
displays around the port.
7. Edit the aperture using the same tools that you use to edit a contour, such as
stretching, dragging, replacing, etc. Review the contour editing tools in the
Patient File Maintenance section of this guide, if necessary.
8-16
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XiO Training Guide

3-D Lung
Task 11. Save the Plan
It is important to save your plan as a permanent plan when you are finished. If
you do not save your plan, XiO automatically saves it as a temporary plan.
However, temporary plans can be altered at any time and your original plan data
may be lost.
1. Click the Save button on the supporting toolbar. XiO displays the Save
Permanent Plan dialog box.

2. Enter a Plan ID.
3. (Optional) Enter a description.
4. Click OK. XiO saves the plan and closes the dialog box.
XiO 8-17

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XiO Training Guide

3-D Lung

Task 12. Normalize the Dose Display and Review Isodoses
1. Click the Dose toolbar button.
2. Click the Set Normalization Mode button.
3. To normalize to a Selected Dose of 4000, enter 4000 in the field next to the
Selected Dose option.
4. Click the Selected Dose button. XiO normalizes to the selected dose.
5. Click Cancel to close the Set Normalization dialog box.
6. Click the Isodose Lines icon.
7. Change Thick Lines to Yes.
8. Enter the following isodose values 100, 98, 95, 80.
9. Click OK when finished.


8-18
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3-D Lung

Task 13. Add Boost Fields for a Composite Plan
This exercise demonstrates how to add oblique boost fields to an existing plan to
create a composite plan.
NOTE: If the port property for auto-generated blocking updates with beam
movement is set to yes, blocking will update automatically.
1. Click the Beam button on the main toolbar. XiO displays the Beam
supporting toolbar.
2. Select Beam 1 in the Active Beam drop-down list.
3. Click the Copy Beam button. XiO displays the Photon Beam dialog box
for beam number 3.
4. Enter the following information:

Description: RAO
Gantry Angle: 330
Weight: 1000
No. Fractions: 10
5. Click OK. XiO closes the dialog box.
6. Click the Mirror Beam button. XiO mirrors the beam and port and
displays the Photon Beam dialog box for beam 4.
7. Enter the Description LPO.
8. Click OK. XiO closes the dialog box.



XiO 8-19

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3-D Lung

Task 14. (Optional) Review the Boost Plan
Follow these instructions to review and print information for one plan at a time
when you have created a composite plan. This example demonstrates how to
review the boost plan alone.
1. Click the Dose button on the Teletherapy main toolbar.
2. Click the Beam Weight button on the Dose supporting toolbar. XiO
displays the Beam Weight dialog box.

3. In the Stat (Status) field, click the on/off button to an Off status for beams 1
and 2.
4. Click the Update Display to Reflect Changes button.
5. Click OK.
6. Click the Set Normalization Mode button.
7. Enter 2000 in the Selected Dose field. XiO updates the isodose lines to
reflect the boost dose alone.
8. Click Cancel to close the dialog box.
9. Review the isodose lines for the boost.
8-20
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XiO Training Guide

3-D Lung

Task 15. Review the Composite Plan
Follow these steps to review the composite plan. Since the weight point is the
same for all beams in the original and boost plans, you can review your isodoses
in percent (all doses add together). If doses are prescribed to multiple weight
points, you will need to view your isodoses in Absolute doses (all doses do not
add together). This example shows how to convert to Absolute dose.
1. Click the Beam Weight button on the Dose supporting toolbar. XiO
displays the Beam Weight dialog box.
2. Click the All Doses On/Off button. Note that all beams should now be in
an On mode.
3. Click the Update Display to Reflect Changes button.
4. Click OK.
5. Click the Absolute/Standard Dose Normalization button on the
supporting toolbar. XiO automatically changes the normalization to
absolute and updates the isodose values.
6. Click Cancel to close the Normalization dialog box.




XiO 8-21

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3-D Lung

Task 16. Create a DVH
This task demonstrates how to create and use a Dose Volume Histogram to
review your plan.
1. Click the Histogram button on the Dose supporting toolbar.
NOTE: If you do not have an available window in which to place the
histogram, XiO prompts you to select a window to place the
histogram.
2. Click your middle mouse button in the Histogram Window Number field
and select a window.
3. Click OK. XiO displays the Histogram dialog box.


4. Click on the anatomy structures you want to add to the DVH graph.
5. Click OK.
6. Review the DVH using any of the tools discussed in the Teletherapy
section of this training guide.


8-22
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3-D Lung

Task 17. Save the Revised Plan as a New Plan
Follow these steps to save the composite plan as a separate plan.
1. Click the File drop-down menu and select the Save as Plan option. XiO
displays the Save Permanent Plan dialog box.
2. Enter the new Plan ID: Composite.
3. Click OK. XiO saves the plan with the new ID and closes the dialog box.
XiO 8-23

Preferences
XiO Training Guide

Preferences

General Preferences
These preferences are located on the Edit drop-down menu when XiO displays
the splash screen.

These preferences are related to the Printer Settings found under Settings >
Workstation > Printers. See the Settings section of the training guide for more
detailed information.
This preference page allows you to easily edit the default output device, printer,
plotter, and screen capture printer.
Scenario: Your default output device is PDF, but you want to print your plan to
paper first. Minimize the working plan to display the XiO splash screen. Click
the Edit drop down menu and select the Preferences option. Change the default
output device to Printer/Plotter. Maximize your working plan and print the plan
to paper.

Patient File Maintenance Preference Settings
The following Patient File Maintenance Preference Settings are user-specific.
Any logged in user can set individually desired preferences.
General
The Patient File Maintenance (PFM) General Preference Settings allow you to
customize the settings for all PFM activities and use these default settings for all
future contouring. Any contours created after the new preference settings are
made will reflect the defaults of the new preference settings.
Any settings made to contours prior to setting the new preferences are not
affected by your recently made changes.
XiO 9-1
Preferences
XiO Training Guide

Preferences

Patient File Maintenance Preference Settings
General (cont.)
1. Click the Edit drop-down menu and select the Preferences and General
options. XiO displays the General Preferences dialog box for Patient File
Maintenance.


2. Enter the Minimum Point Sample Spacing (cm) representing the least
distance you want to move the mouse in Draw Mode before a sample point
is placed. Make this value large to reduce the number of sample points.
Make this value small to increase the number of sample points.
3. Enter the 2-D Automargin Default Value (cm) to which you want the 2-D
Auto-Margin to default to. You can change the margin from the default
when in the Edit Mode.
4. Enter the Quick Interest Point Placement Character shortcut key you
want to use to place interest points in PFM. For example, if you want to be
able to press I to place an interest point, enter the letter "i."
5. Enter the Quick Marker Point Placement Character shortcut key you
want to use to place markers in PFM. For example, if you want to be able
to press M to place a marker, enter the letter "m."
9-2
Preferences
XiO Training Guide

Preferences

Patient File Maintenance
General (cont.)
6. Click the drop-down arrow in the Init Display Scout: field and select Yes if
you want XiO to display the scout image view every time you open a
studyset.
OR

Select No if you do not want XiO to display the scout view every time you
open a studyset. The scout image view displays scout images if they are
included in the studyset.
7. Click the drop-down arrow in the Init Display MPV: field and select Yes if
you want XiO to display the multi-plane image view every time you open a
studyset.

OR

Select No if you do not want XiO to display the multi-plane image view
each time you open a studyset. The multi-plane image view displays all the
contours in a studyset without image data.
8. Click the drop-down arrow in the Init Display Previous: field and select
Yes if you want XiO to display the previous image view every time you
open a studyset.

OR

Select No if you do not want XiO to display the previous image view every
time you open a studyset. The previous image view displays the last cross
section displayed in the single-plane image view.
XiO 9-3
Preferences
XiO Training Guide

Preferences

Patient File Maintenance
General (cont.)
9. Click the drop-down arrow in the Init Display Thumbnail: field and select
Yes if you want XiO to display the thumbnail image view every time you
open a studyset.

OR

Select No if you do not want XiO to display the thumbnail image view
every time you open a studyset. The thumbnail image view displays every
cross section in the studyset, in order.
10. Click the drop-down arrow in the Display Name Warning: field and select
Yes if you want XiO to warn you every time the patient name listed in the
image data does not match the patient name entered in Patient File
Maintenance.

OR

Select No if you do not want XiO to warn you. The default value is Yes; if
you enter No, you must reset this value every time you install a new version
of XiO.
11. Click the drop-down arrow in the Display Save Box On Close: field and
select Yes if you want XiO to prompt you to save your work when you
close a patient or studyset, or when exiting from Patient File Maintenance
with a patient open.

OR

Select No if you do not want XiO to prompt you to save your work.
9-4
Preferences
XiO Training Guide

Preferences

Patient File Maintenance
General (cont.)
12. Click the drop-down arrow in the Default Bilinear Interp. on: field and
select Yes if you want to use bilinear interpolation to display scaled images.

OR

Select No if you want to use pixel replication to display scaled images.
Pixel replication displays large studysets or images faster, but are not as
high a quality as bilinear interpolation.
13. Enter the Default Patient List Sorted By value you want XiO to display
by default for sorting patient list contents for the Patient ID field on the
Open Patient/Studyset dialog box: "Patient ID," "Name," or "Creation
Date."
14. Enter the Default New patient action value you want XiO to display by
default for the Create field on the New Patient dialog box: "Imagebased
Studyset," "Nonimaged Studyset," or "No Studyset."
15. Click the drop-down arrow in the Default exam data to remain for future
transfer: field and select All if you want all data to remain on the network
after transferring images to XiO.

OR

Select Non-transferred if you want only data that was not transferred to
remain on the network after transferring images to XiO.

OR

Select None if you want none of the image sets to remain on the network
after transferring images to XiO.
16. Click the drop-down arrow in the Default Delete Patient Data After Archive
field and select Yes if you want the archived patient data to be deleted
automatically.
OR
Select No if you do not want archived patient data to be deleted
automatically.
17. Click OK. XiO closes the Patient File Maintenance General Preferences
dialog box and uses the default settings every time you open Patient File
Maintenance.
XiO 9-5
Preferences
XiO Training Guide

Preferences

Patient File Maintenance (cont.)
Color
1. Click the Edit drop-down menu and select the Preferences and Color
options. XiO displays the Color Preferences dialog box for Patient File
Maintenance.


2. Click the drop-down arrow in the Setup Reference Color: field and select a
color.
3. Click the drop-down arrow in the Setup Reference Projection Color: field
and select a color. When the setup reference point is between cross
sections, XiO Patient File Maintenance displays the projection of that point
on the nearest transverse cross section. This projected point is called the
setup reference point projection.
4. Click the drop-down arrow in the Active object color: field and select the
color you would like to use when displaying active objects. An active
object is any selected interest point, marker, or contour.

9-6
Preferences
XiO Training Guide

Preferences

Patient File Maintenance
Color (cont.)
5. Click the drop-down arrow in the Measure Color: field and select the color
you would like to use when displaying the measure mode tick marks.
6. Click the drop-down arrow in the Auto by threshold Point Color: field and
select the color you would like to use when displaying the auto by
threshold auto-point.
7. Click the drop-down arrow in the Auto by threshold unaccepted contour
Color: field and select the color you would like to use when displaying
contours created using Auto-by-Threshold that you have not yet accepted
using the Accept Auto by Threshold dialog box.
8. Click the drop-down arrow in the Interest point Color: field and select the
color you would like to use when displaying interest points.
9. Click the drop-down arrow in the Marker Color: field and select the color
you would like to use when displaying markers.
10. Click the drop-down arrow in the Small Edit Square Color: field and select
the color you would like to use when displaying small edit square.
Defining points selection can be accessed by double-clicking an unselected
contour, or by clicking anywhere within a selected contour.
11. Click the drop-down arrow in the Select Square Color: field and select the
color you would like to use when displaying a selected square. Contour
selections can be accessed by clicking an unselected contour, or by double-
clicking anywhere within a defining-points-selected contour.
12. Click the drop-down arrow in the Draw Start/End Square Color: field and
select the color you would like to use when displaying the Draw Start/End
Square Color that marks the beginning of a contour in Draw mode.
13. Click the drop-down arrow in the Non Interactive Color: field and select the
color you would like to use when displaying the non interactive color
during image transfer. These are the colors of pre-defined contours
transferred into XiO.
14. Click the drop-down arrow in the Pt. Non Interactive Color: field and select
the color you would like to use when displaying the Pt. Non Interactive
Color during image transfer. These are the colors of pre-defined interest
points and markers transferred into XiO.
XiO 9-7
Preferences
XiO Training Guide

Preferences

Patient File Maintenance
Color (cont.)
15. Click the drop-down arrow in the Position Line Color: field and select the
color you would like XiO Patient File Maintenance to use when displaying
position lines on the coronal reconstruction during image transfer.
16. Click the drop-down arrow in the Position Line Origin Color: field and
select the color you would like to use when displaying the position line
representing the origin of the studyset in the coronal reconstruction during
image transfer.
17. Click the drop-down arrow in the Direction line Color: field and select the
color you would like to use when displaying the direction line in the
coronal reconstruction during image transfer.
18. Click OK. XiO sets the color preferences to be used in Patient File
Maintenance.









9-8
Preferences
XiO Training Guide

Preferences

Patient File Maintenance (cont.)
W/L Presets
1. Click the Edit drop-down menu and select the Preferences and W/L
Presets options. XiO displays the Window Level Preferences dialog.

2. Enter or modify the Label for the window/level preset you want to create
or edit.
NOTE: The order in which window/level presets appear in this list
determines the order they are presented in the list to the right
of the (Save) W/L button in the PFM User Interface.
3. Enter or modify the Window value for the corresponding window/level
preset.
4. Enter or modify the Level value for the corresponding window/level preset.
5. Click OK. XiO adds any new presets or edits made to the window level
preset list in Patient File Maintenance.
XiO 9-9
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
The following Teletherapy Preference Settings are user-specific. Any logged in
user can set individually desired preferences.
General
1. Click the Edit drop-down menu and select the Preferences and General
options. XiO opens the General Preferences dialog box.

2. Click the drop-down arrow in the Generate Enhanced DRRs: field and
select Yes to generate enhanced DRRs from the Print DRR option on the
File menu.

OR

Select No to obtain standard resolution DRRs from the Print DRR option
on the File menu.
NOTE: Enhanced DRRs are better quality radiograph images because
they are generated at a higher resolution than ordinary DRRs.

9-10
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
General (cont.)
3. Click the drop-down arrow in the Automatically Start Dose Calculation:
field and select Yes to cause dose calculations to be performed
automatically. XiO automatically recalculates the dose whenever you add
or delete a beam or modify the parameters of an existing beam.

OR

Select No to cause the dose calculation to wait until you initiate it. When
you are ready to recalculate the plan, click the Dose drop-down menu and
select the Calculation and start options.
NOTE: Select Yes when planning using IMRT.

XiO 9-11
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
General (cont.)
4. Click the drop-down arrow in the Always Prompt When Saving a
Permanent Plan: field and select Yes. XiO displays the Save Plan dialog
box when you select any of the Save options from the File menu, and when
you click the Save button on the toolbar.

OR

Select No. If the open plan has a valid Plan ID, XiO automatically saves
the plan with the current Plan ID. XiO does not display a dialog box when
you select the File drop-down menu and select the Save Plan option.
NOTE: If the plan does not have a defined Plan ID, XiO displays the
Save Plan dialog box so you can enter the required Plan ID,
regardless of the setting for this preference.
5. Click the drop-down arrow in the Always Use Scroll Wheel for Movie:
field and select Yes. Whenever you use the scroll wheel on the mouse it
will be used to scroll through CT images.
OR
Select No. Whenever you use the scroll wheel on the mouse it will take the
functionality of the option selected with a right mouse click, if applicable.
For example, if you selected the Scale option, the scroll wheel will be used
to scale the image in the window.
6. Enter the CT Sample Radius (cm) value to be used for the sample
selection for CTs. The default value is 1.0 cm. When creating a CT to ED
file, it is necessary to sample the CT to ED phantom. This tool allows you
to sample a user-defined area. XiO averages the CT values for that area.
7. Click your middle mouse button in the Defaults Graphics Area Setup filed
click and select the Default Graphics Area Setup. XiO displays this
default when you start a New Teletherapy Plan.
9-12
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
General (cont.)
New Plan Object Displays
8. Click your middle mouse button in the Default Isocurve Setup field and
select the Default Isocurve Setup. XiO displays these isocurve values by
default on the Isodose Lines dialog box.
9. Click the drop-down arrow in the Interest Points: field and select On. XiO
displays the interest points.
NOTE: You can use interest points to obtain dose calculations at
specific points in or around a cross section. XiO represents
interest points as either two- or three-dimensional plus signs,
depending on the treatment-planning mode used.
10. Click the drop-down arrow in the Markers: field and select On. XiO
displays markers.
NOTE: Markers do not carry dose. XiO represents markers as either
two- or three-dimensional plus signs, depending on the
treatment-planning mode used.
11. Click the drop-down arrow in the Calculation Volume/Area Icon: field and
select On. XiO displays the calculation region icon.
NOTE: The calculation region (volume or area) is defined as that
region in the patient anatomy for which the dose is calculated.
All points located inside (including on the edge) of this region
are used during dose display; all points outside of this region
are not used during dose display.
XiO 9-13
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
General
New Plan Object Displays (cont.)
12. Click the drop-down arrow in the Patient Orientation Icon: field and select
On. XiO displays the patient orientation icon.
NOTE: The patient orientation icon shows the relationship between
individual sub-window orientations and the entire patient body
shape. The patient orientation icon is composed of a patient icon
combined with three orientation spheres. The patient icon is
made of three wire contours showing a profile of the entire body
viewed from the transverse, sagittal, and coronal sides.
Orientation spheres are three small spheres that represent the
patients head (green), left (yellow), and anterior (blue) on the
patient icon.
13. Click the drop-down arrow in the Patient Spheres: field and select On. XiO
displays the patient spheres.
NOTE: The patient spheres show the relationship between individual
sub-window orientations and the entire patient body shape.
Orientation spheres are three spheres that represent the patients
head (green), left (yellow), and anterior (blue).
14. Click the drop-down arrow in the Bilinear Interpolation: field and select
On. The new plan automatically uses bilinear interpolation.

OR

Select Off. The new plan automatically uses pixel replication.
NOTE: Bilinear interpolation utilizes the pixels surrounding pixels to
produce a linear combination of those pixels. The linear
combination is produced in both dimensions simultaneously.
Therefore, the bilinear method produces a higher quality
representation of the original image at the chosen scale than
pixel replication. The disadvantage of the bilinear method is that
the image is not produced as quickly. Pixel replication scales
images by replicating a pixel to create more pixels with the same
intensity. For example, one pixel will become four (2 X 2) if the
scale is doubled.
9-14
Preferences
XiO Training Guide

Preferences

Teletherapy Preference Settings
General
New Plan Object Displays (cont.)
15. Click the drop-down arrow in the Bolus: field and select On. XiO displays
the bolus.
NOTE: Bolus is represented as a closed contour of a specified
thickness that follows the curvature of the patient skin contour
in a user-defined color in all BEV, MPV, and non-
reconstructed SPV displays.
16. Click the drop-down arrow in the CT Origin field and select On if you
would like the CT origin (0,0,0 of the scanner) to display as a point on your
image views by default.
OR
Select Off if you do not want the CT origin to display by default.
17. Click the drop-down arrow in the Thick Isodose Lines: field and select On.
XiO displays thick isodose lines.

OR

Select Off. XiO displays thin isodose lines.
18. Enter the Reconstructed Movie Step Size (cm) for the movie option when
you are moving through reconstructed cross sections. The acceptable values
are from 0.1 cm to 5.0 cm in steps of 0.1 cm. The default value is 1.0 cm.
19. Click OK. XiO closes the Teletherapy General Preferences dialog box and
uses the default settings for new plans.

XiO 9-15
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Color
1. Click the Edit drop-down menu and select the Preferences and Color
options. XiO displays the Color Preferences dialog box.


2. Click the drop-down arrow in the Active Object field and select a color.
The default preferred color is red. XiO uses this color when displaying
active objects, which includes beams, interest points, and markers.
NOTE: Be sure to select the active object color setting first, since the
active object color cannot be used for any other objects.
3. Select the preferred colors for the remaining objects.
4. Click OK. XiO sets the color preferences to be used in Teletherapy.
9-16
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
DICOM
1. Click the Edit drop-down menu and select the Preferences and DICOM
options. XiO displays the DICOM Preferences dialog box.


2. Click the drop-down arrow in the CT Images field and select Yes if you
would like CT Images to export by default in a DICOM export.
3. Click the drop-down arrow in the RT Structure Set: field and select Yes if
you would like the structure sets to be exported by default in a DICOM
export.
4. Click the drop-down arrow in the RT Plan field and select Yes if you
would like plan information to export by default in a DICOM export.
5. (Protons Only) Click the drop-down arrow in the RT Ion Plan field and
select Yes if you would like proton plan information to export by default
in a DICOM export.
6. Click the drop-down arrow in the RT Dose field and select Yes if you
would like the dose information to export by default in a DICOM export.
7. Click the drop-down arrow in the Export To: field and select the location
to where you will export DICOM information.
XiO 9-17
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
DICOM
8. Click the drop-down arrow next to the field Export Only Approved Plans
and select Yes or No if you would like to send only plans that have been
approved within XiO.
9. Click OK.
DRR Output
1. Click the Edit drop-down menu and select the Preferences and DRR Output
options. XiO displays the DRR Output dialog box.

2. Click the drop-down arrow next to the Orientation field and select a default
orientation. BEV is the most common option. The others are rarely used
unless you have a dedicated alignment-imaging device in the treatment
room. Orientations other than BEV must be set up for each machine in
Source File Maintenance.
3. Click the drop-down arrow next to the Paper Size field and select a default
paper size.
4. Click the drop-down arrow next to Spooler and select Plotter or Laser as
the type of destination printer.
5. If you are printing to Backlit paper, the image must be reversed. In this
case, click the drop-down arrow next to Mirror Image (Backlit) and select
Yes so that the mirror image is printed by default.
9-18
Preferences
XiO Training Guide

Preferences

Teletherapy
DRR Output (cont.)
6. If you would like the displayed DRR to be printed by default, click the
drop-down menu next to Print Displayed DRR and select Yes. If you select
No, you can designate the width, length, offset and distance manually.
7. Toggle the Anatomy Outlines button On or Off depending on if you would
like the anatomy outlines to be displayed by default.
8. Click OK to update the DRR Output preferences.
XiO 9-19
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Print
1. Click the Edit drop-down menu and select the Preferences and Print
options. XiO displays the Print Preferences dialog box.


2. Click the drop-down arrow in the Print Source Data: field and select Yes.
XiO displays the source data on the printed image itself. This data
includes: beam number, machine ID, coll, setup, Tx dist, SSD, W(L/R), L
(U/L), gantry, coll, arc, couch, wedge, ID/angle, port ID, TX aids, algor,
wt, wt at D, TAR/TPR/PDD, eff D and eff TAR/TPR/PDD.
NOTE: If you select Yes for Print Source Data, XiO requires
additional printing time but does not reduce the size of the
print.
3. Click the drop-down arrow in the Print Dose Label: field and select Yes.
XiO prints the isocurve dose labels.
4. Click the drop-down arrow in the Print Image Data: field and select Yes.
XiO prints a pixel (grayscale) representation of the cross section. The pixel
image is clipped to the patient skin. The window and level settings for the
image are represented.
NOTE: XiO only supports this setting for printers that support
PostScript printing.
9-20
Preferences
XiO Training Guide

Preferences

Teletherapy
Print (cont.)
5. Click the drop-down arrow in the Print Plan Summary field and select Yes.
XiO prints the Plan Summary report that includes the isodose treatment
plan data, source data, calculation information, and interest point dose data.
6. Click the drop-down arrow in the Force Life-Sized to One Page: field and
select Yes. XiO generates a life-size plot of the image on one sheet of
paper. XiO scales the resulting plot from the center of the image, then clips
it from the sides until it fits on one sheet of paper.
7. Click the drop-down arrow in the Allow Postscript N-up: field and select
Yes. XiO prints multiple images on one sheet of paper.
NOTES: Lexmark Optra 45 and 1200 are currently the only compatible
printers that support this functionality.

Important: Your plotter must be configured for N-up printing,
and this field must be set to Yes if you want to print multiple
images on one sheet of paper. Refer to the documentation
shipped with your printer for information on setting your
printer up for N-up printing.

Important: N-up printing cannot be performed on a network
printer.
8. Enter the default distance in (cm) you would like XiO to use when
printing BEVs, Ports, or MLCs.
9. Select the default value for the Isodose Line Type on the plotted plan. See
XiO Help for more information regarding the Isodose Line Type options.
10. Click OK. XiO updates the print preferences for Teletherapy.
XiO 9-21
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Window/Level
1. Click the Edit drop-down menu and select the Preferences and
Window/Level options. XiO displays the Edit Window/Level Presets
dialog box.


2. Enter or modify the Label for the Window/Level Preset you want to create
or edit.
NOTE: The order in which Window/Level Presets appear in this list
determines the order they are presented in the list to the right of
the (Save) W/L button in the PFM User Interface.
3. Enter or modify the Window value for the corresponding Window/Level
Preset.
4. Enter or modify the Level value for the corresponding Window/Level
Preset.
5. Click OK. XiO adds any new presets or edits made to the window level
preset list in Teletherapy.
9-22
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Beam Display
1. Click the Edit drop-down menu and select the Preferences and Beam
Display options. XiO displays the Beam Display Preferences dialog box.


2. Click the drop-down arrow in the Complex Display field and select On to
display all parts of the beams. The complex beam display is useful if you
want to determine the beams orientation, particularly when the beam
intersects a cross section at an odd angle.

OR

Select Off to display the beams in a simplified form. The simple beam
display consists of only the portion of the beam that intersects the displayed
cross section. Use the simple beam display when you want to simplify the
graphics area display.
3. Click the drop-down arrow in the Moveable Plane field and select On to
display the movable plane as a rectangular radiation field (defined by the
collimator) perpendicular to the central axis and passing through a user-
defined position along the central axis.
XiO 9-23
Preferences
XiO Training Guide

Preferences

Teletherapy
Beam Display (cont.)
4. Click the drop-down arrow in the Corner Divergent Lines field and select
On to display the four corner divergent lines as they pass through the
movable/isocentric planes of the beams. Corner divergent lines appear as
four divergent line segments representing the corners of the beam pyramid.
The lines start on the surface plane and end at the depth at which the
machine data ends.
NOTE: XiO does not support corner divergent lines display for
proton beams.
5. Click the drop-down arrow in the Cross Hairs field and select On to display
the crosshairs on the surface and isocentric planes. Crosshairs appear as
two line segments, parallel to the beam width and length axes, each
connecting opposing edges of a rectangle defined by the collimator and
intersecting each other at the central axis.
6. Click the drop-down arrow in the Isocentric Plane field and select On to
display an isocentric plane as a rectangular radiation field (defined by the
collimator) perpendicular to the central axis and passing through the
isocenter.
7. Click the drop-down arrow in the Port Coverage Lines field and select On
to display the port coverage lines as dashed lines that pass through the area
blocked by the port.
NOTE: This display option is independent of the port shadow option.
8. Click the drop-down arrow in the Port Shadow field and select On to
display the port shadow as a semitransparent representation of the area
blocked by the port. XiO displays the port shadow in the port color.
NOTE: This display option is independent of the port coverage lines
option.
9. Click the drop-down arrow in the Aperture Limit Circle (only for active
proton beams) field and select On to display the aperture limit circle as a
line representing the projection at isocenter for the current snout.
NOTE: XiO supports the aperture limit circle display only for active
proton beams.
9-24
Preferences
XiO Training Guide

Preferences

Teletherapy
Beam Display (cont.)
10. Click the drop-down arrow in the MLC Coverage Lines field and select
On to display the MLC coverage lines as dashed lines that outline the area
blocked by the MLC.
NOTE: This display option is independent of the MLC shadow
option.
11. Click the drop-down arrow in the MLC Shadow field and select On to
display the MLC shadow as a semitransparent representation of the area
blocked by the MLC. XiO displays the MLC shadow in the MLC color.
NOTE: This display option is independent of the MLC coverage lines
option.
12. Click the drop-down arrow in the Segmented MLC Maximum Extents
field and select On to display the maximum extents of the MLC leaves on
the BEV.
13. Click the drop-down arrow in the Compensating Filter field and select On
to display the compensating filter as a semitransparent planar representation
of the collimator area covered by the compensating filter in the
compensating filter color.
14. Click the drop-down arrow in the Show Beams field and select Off. XiO
turns off all beams.
15. Click the drop-down arrow in the Weight Point field and select On to
display the weight points. Weight points are represented by either a two-
or three-dimensional plus sign. Depending on the treatment planning mode
used; the weight point color is the same as the beam color.
16. Click OK. XiO updates the beam display preferences for Teletherapy.




XiO 9-25
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Beam

1. Click the Edit drop-down menu and select the Preferences and Beam
options. XiO displays the Beam Preferences dialog box.
Use this dialog box to specify your preferred beam settings for planning.
Dynamic conformal beam settings are available only if you have a dynamic
conformal license and have defined this type of beam for the current
machine.
The values specified on this page are the default values for new plans.

2. Under the Beam Setup heading, select the default values for the Field Size,
beam Weight and Number of Fractions.
3. Under the Dynamic Conformal heading, enter the Minimum Arc Extent
for New Beams. The range is 0 to 180 in steps of 1.
4. Under the Dynamic Conformal heading, enter the Minimum Segment
Area (cm^2): value. The range is from 1.0cm to 25 in increments of 1.0.
9-26
Preferences
XiO Training Guide

Preferences

Teletherapy
Beam (cont.)
5. Enter the Minimum Leaf Gap (cm): value. The range is from 0.0 cm to
10.0 cm in increments of 0.1 cm. The default leaf gap is 0.1 cm.
6. Click the drop-down arrow in the Compensating Filter Type field and select
a default compensating filter type.
7. Enter the Review Angle (deg): value. The value is between 1 and 360 in
increments of 1; the default review angle is 10. For example, if the
review angle is 5, the BEV display on the screen will shift by 5 every
time you middle-click or scroll the mouse button.
NOTE: This value specifies the number of degrees that will increment
between successive views of the dynamic conformal beams-
eye-view. This setting allows you to set a custom angle
increment in degrees.
8. Click OK. XiO updates the beam preferences for Teletherapy.

XiO 9-27
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Port
1. Click the Edit drop-down menu and select the Preferences and Port
options. XiO displays the Port Preferences dialog box.


2. Enter the Conform Collimator to Step (cm) value. Determine the step size
that rounds up to the collimator step precision value. XiO uses the step size
when conforming the collimator to make the field size an even multiple of
the value entered.
3. Click the drop-down arrow in the Move Collimator Width Jaws as MLC
Leaves are Edited field and select Yes. XiO conforms the collimator width
jaws to the MLC shape as you edit the leaves.

OR

Select No. XiO does not move the collimator jaws.
4. Click the drop-down arrow in the Auto-Generated Blocking Updates with
Beam Movement field and select Yes. XiO automatically updates auto-
blocking whenever a beam is rotated.
OR
Select No if you do not want XiO to change the blocking when the beam is
rotated.
9-28
Preferences
XiO Training Guide

Preferences

Teletherapy
Port (cont.)
5. Enter the minimum spacing between points that defines the block or
aperture in the Auto Port Resolution (cm) field. Smaller numbers give more
accurate results. Acceptable values range from 0.02 cm to 0.10 cm in steps
of 0.01 cm.
6. Click the drop-down arrow in the Guide Radius field and select Yes. XiO
places a circle around the mouse point when drawing ports. Use the guide
radius as a visual cue when you want to draw a port at a specific distance
around a structure or target.
7. Enter the default value in the Guide Radius Size (cm) field for the radius
for the guide radius circle. This value can range from 0.01 cm to 5.00 cm,
in steps of 0.01 cm.
8. Click the drop-down arrow in the Always Re-orient Tablet: field and select
Yes. XiO opens the Tablet Orientation dialog box when you start to draw a
port with the tablet.

OR

Select No. XiO allows you to continue drawing ports without tablet
reorientation, as long as you are continuously working on the same patient.
WARNING

If you do not orient all films on the tablet with the same
axis and orientation, the data entered will be incorrect,
resulting in incorrect patient treatment.

9. Enter the default value in the Tablet Scale Factor: field for the
magnification factor of the film. The scale factor is the ratio of the length
on the film to the length at the reference distance. Acceptable values range
from 0.001 to 10.000 in steps of 0.001. For supporting information, refer to
the graphical explanation and examples in the "What are the Ways I can
Make a Port?" procedures described in the XiO Help.
XiO 9-29
Preferences
XiO Training Guide

Preferences

Teletherapy
Port (cont.)
10. Click the drop-down arrow in the Default Port Type field and select a type.
If you select Block, XiO automatically defines the first shape you make as a
block. XiO displays the shape drawn as a physical block where photons
cannot pass.

OR

If you select Aperture, XiO automatically defines the first shape you make
as an aperture, all subsequent shapes are blocks. XiO displays the shape
drawn as an opening where photons may pass.

OR

If you select MLC, XiO automatically defines the first shape you make as
an MLC. XiO always displays MLCs as openings where photons may pass.
11. Enter the value for the Mouse Minimum Sample Spacing (cm) representing
the minimum distance between mouse sample points.
NOTE: XiO does not automatically make the sample spacing equal to
this value. XiO uses this value to prevent the calculation of
identical or closely spaced points during dose calculation and
prevent the accompanying increased calculation time. This
value can range from 0 cm to 5.00 cm, in steps of 0.01 cm.
12. Click the drop-down arrow in the Blocking Rotates with Collimator: field
and select Yes as the preferred setting for photon and electron beams. Yes
means that the blocks and/or aperture move with the beam when you
change the collimator angle. If you change the collimator angle, the port
coordinates change as the beam coordinates change.

OR
Enter No so that the blocks and/or aperture stay with the anatomy; they do
not move with the beam when you change the collimator angle.
9-30
Preferences
XiO Training Guide

Preferences

Teletherapy
Port (cont.)
13. Click the drop-down arrow in the MLC Contour Updates with Leaf Edits
field and select Yes.
14. Enter a default value for Leaf Insertion (%). XiO uses this value by
default when MLC ports are created.
15. Enter a default value for Closed Leaf Position. XiO uses this value by
default when MLC ports are created.
16. Click OK. XiO updates the port preferences for Teletherapy.
XiO 9-31
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Histogram
1. Click the Edit drop-down menu and select the Preferences and Histogram
options. XiO displays the Histogram Preferences dialog box.

Sampling Resolution
2. Enter the default spacing value in the Structure Combinations field for the
distance between the sample points used to calculate volume and binned
doses for structure combinations. Acceptable values range from 0.1 cm to
1.0 cm in steps of 0.1 cm. The preset default value is 0.1 cm.
3. Enter the default spacing value in the Unspecified Tissue (cGy): field for
the distance between the sample points used to calculate volume and dose
for unspecified tissue. The acceptable values range from 0.1 cm to 1.0 cm
in steps of 0.1 cm. The preset default value is 0.2 cm.
Dose Bin Width
4. Enter the default value in the Structure Combinations (cGy): field
representing the width of the bins in which the sample points are to be
grouped for structure combinations. If your clinic uses cGy, the value can
range from 1 cGy to 10,000 cGy in steps of 1 cGy. The preset default is 10
cGy. If your clinic uses Gy, the value can range from 0.01 Gy to 100.00
Gy in steps of 0.01 Gy. The preset default is 0.10 Gy.
9-32
Preferences
XiO Training Guide

Preferences

Teletherapy
Histogram (cont.)
5. Enter the default width value in the Unspecified Tissue (cGy): field
representing the bins in which the sample points are to be grouped for
unspecified tissue. If your clinic uses cGy, the value can range from 1 cGy
to 10,000 cGy in steps of 1 cGy. The preset default is 10 cGy. If your
clinic uses Gy, the value can range from 0.01 Gy to 100.00 Gy in steps of
0.01 Gy. The preset default is 0.10 Gy.
6. Select Yes or No to designate whether or not you would like to include the
Histogram Report when you print the Dose Volume Histogram.

Yes means XiO automatically prints the Histogram Report when you use
the right-mouse menu option to print a histogram.

OR

No means XiO prints only the histogram when you use the right-mouse
Print menu option.
NOTE: The Histogram Report lists statistical and descriptive
information for the displayed histogram.
7. Click OK. XiO updates the histogram preferences for Teletherapy.
XiO 9-33
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
IMRT
1. Click the Edit drop-down menu and select the Preferences and IMRT
options. XiO displays the IMRT Preferences dialog box.

IMRT Graphs
2. Click the drop-down arrow in the Grid field and select On or Off as the
default value for displaying the grid.
3. Click the drop-down arrow in the Legend field and select On or Off as the
default for displaying the legend.
9-34
Preferences
XiO Training Guide

Preferences
Teletherapy
IMRT (cont.)
4. Select the default number of Iterations between DVH Updates during
IMRT optimization.
5. Click the drop-down arrow in the Modulator field and select the preferred
setting for your IMRT modulator. Your choices are MLC or
Compensating Filter.
6. Click the drop-down arrow in the Compensating Filter Type: field and
select the compensating filter type. Your choices are Huestis, Par
Scientific or decimal.
NOTE: You must define Filters in Source File Maintenance (SFM)
before you can use them in Teletherapy.
7. Enter a value in the MLC Step Increment X(cm): field. Acceptable values
range between 0.3 and 2.0 in steps of 0.1 cm. The step increment is the
width of the ideal fluence elements used during optimization. The leaf step
increment and the leaf width (defined by XiO MLC configuration file),
determine the resolution of the MLC intensity map.
8. Enter a value for the compensating filter resolution in the Resolution
X(cm): and Y(cm): field. Acceptable values range from 0.3 cm to 2.0 cm,
in steps of 0.1 cm. These represent the width and length of the ideal
fluence elements used during optimization.
Initial Optimization
The optimization stops when either the difference between successive score
functions is less than the convergence criteria, or the maximum number of
iterations has been reached.
9. Enter a value in the Convergence Criterion (%): field. Acceptable values
range from 0.0001% to 100 %, in steps of 0.0001%. Tip: Use a starting
convergence criterion of 0.1000%.
10. Enter a value in the Maximum Iterations: field. Acceptable values range
between 0 and 300, in steps of 1.
11. Enter a value in the Scatter Extent (cm): field representing the distance that
is measured from the edge (not from the center) of the beamlet. Acceptable
values range from 0.0 cm and 3.0 cm, in steps of 0.1 cm.
XiO 9-35
Preferences
XiO Training Guide

Preferences
Teletherapy
IMRT
Initial Optimization (cont.)
12. Enter a value in the Optimization Margin (cm): field representing the area
to which the optimization is restricted around the target (which includes
some margin for penumbra). Acceptable values range from 0.0 cm and the
value of Scatter Extent, in steps of 0.1 cm.
Beam Weight Optimization
The optimization stops when either the difference between successive score
functions is less than the convergence criteria, or the maximum number of
iterations has been reached.
13. Enter a value in the Convergence Criterion (%): field. Acceptable values
range from 0.0001% to 100 %, in steps of 0.0001%.
14. Enter a value in the Maximum Iterations: field. Acceptable values range
between 0 and 300, in steps of 1.
Segmentation Method
15. Click the drop-down arrow in the Segmentation Method: field and select a
leaf segmentation algorithm. For MLC-based IMRT, the selection is
Sliding Wnd (Sliding Window).
If your clinic uses ImFast, you can select the preferred leaf segmentation
from the following choices:
x Sliding Wnd (Sliding Window)
x ExpIntMap (Export Intensity Maps)
x Platform (Platform Optimal ImFAST - only for the internal version
of Siemens ImFAST )
x PltFluence (Platform Optimal ImFAST with Fluence Correction -
only for the internal version of Siemens ImFAST )
x Standard (Standard Optimal ImFAST- only for the internal version
of Siemens ImFAST )

9-36
Preferences
XiO Training Guide

Preferences
Teletherapy
IMRT
Segmentation Method (cont.)
x StdFluence (Standard Optimal ImFAST with Fluence Correction -
only for the internal version of Siemens ImFAST )
Ideal Map Extension
Ideal map extension is used in IMRT when the MLC field must be extended
beyond the patients surface for flash or movement. This is most often used for
IMRT breast tangents.
16. Enter a value in the Distance to Extend (cm): field to extend the edge of the
ideal intensity map. Acceptable values range from 0.0 cm to 3.0 cm, in
steps of 0.1 cm.

XiO extends the edge of the intensity map along the direction of the leaf
travel and outward from the patient.
17. Enter a value in the Average Distance (cm): field as the preferred distance
from the edge of the skin back into the patient, to use for the intensity in the
extended region. Acceptable values range from 0.0 cm to 2.0 cm, in
multiples of the step increment used for the optimization.

XiO averages these intensities and assigns the average to the extended
portion of the intensity map.
Discrete Intensity Levels
18. Enter a value in the Discrete Intensity Levels: field. Acceptable values
range from 2 to 20, in steps of 1.
Split Field Parameters
Enter the preferred settings to use on beams that need to be split after
optimization. Some users may have IMRT fields that need to be split due to the
field width limitation of their Linacs MLCs.
19. Enter a value in the Minimum Field Width (cm) field representing the
smallest allowable width for the beams resulting from the beam splitting
(also called child beams). Acceptable values range from 0.5 cm to 10.0 cm,
in steps of 0.5 cm.
XiO 9-37
Preferences
XiO Training Guide

Preferences

Teletherapy
IMRT
Varian Split Field Parameters (cont.)
20. Enter a value in the Overlap Extent (cm) representing the preferred setting
for the extent, in the MLC leaf travel direction, that the child beams will
overlap. Acceptable values range from 0.0 cm to two-thirds of the value
defined for Minimum Field Width, in steps of 0.5 cm.
21. Enter a value in the Split Extent (cm) field representing the width direction,
over which the intensity of the original (parent) beam will be distributed to
the child beam intensity maps. Valid entries lie in the range of 0.0 cm to
the value defined for Overlap Extent in steps of 0.5 cm.
NOTES: If the Split Extent is set equal to the Overlap Extent, XiO
distributes the intensities in the entire overlap region between
the resulting child beams.

If the Split Extent is less than the Overlap Extent, XiO
determines (for each leaf pair) where the lowest dose region
of contiguous width equal to the Split Extent lies, and
distributes the intensities of this region among the child
beams.
22. Click the drop-down arrow in the Delete Parent Beams field and select the
action you would like XiO to take after the beam splitting has been
accomplished. Yes means XiO deletes the parent beams when the final
dose calculation is launched after segmentation.

OR
No means XiO turns the parent beams off and does not delete the parent
beams when the final dose calculation is launched.
9-38
Preferences
XiO Training Guide

Preferences

Teletherapy
IMRT (cont.)
Minimum Segment Size
23. Enter a value in the Minimum Segment Size (cm): field. Acceptable values
range from 0.0 cm and 3.0 cm, in steps of 0.1 cm.
Compensating Filter Smoothing
24. Click the drop-down arrow in the Compensating Filter Intensity Map
Smoothing Distance (pixels): field and select a value for the preferred
number of pixels. Acceptable values are 3, 5, 7, or 9 pixels. The default
value is 3.
25. Click OK. XiO updates the IMRT preferences for Teletherapy.
XiO 9-39
Preferences
XiO Training Guide

Preferences

Teletherapy (cont.)
Intensity Map
Intensity maps are two-dimensional planes of data perpendicular to the central
axis and projected to isocenter. Set the intensity map preferences here.
1. Click the Edit drop-down menu and select the Preferences and Intensity
Map options. XiO displays the Intensity Map Preferences dialog box.

Display Print
2. Click the drop-down arrow in the Highest Intensity field and select the
preferred color for displaying intensity maps.

Black means the highest intensity is shown in black. Intensities less than
the highest are shown in decreasing shades of gray. This is the default.

White means the highest intensity is shown in white. Intensities less than
the highest are shown in increasing shades of gray.
3. Click the drop-down arrow in the Anatomy Outlines field and select On
(meaning the preferred settings for the anatomy outlines is on and included
in the output).

OR

Select Off (meaning the preferred settings for anatomy outlines is off and
are not included in the output).
9-40
Preferences
XiO Training Guide

Preferences

Teletherapy
Intensity Map (cont.)
Output Map To
4. Click the drop-down arrow in the Output Map To: field and select the
preferred output device.
NOTE: If you only have one device set up, XiO displays it as the
default.
5. Click the drop-down arrow in the Paper Size: field and make a selection.
The choices available depend on your output device.

A/A4 (ANSI, size A: 8.5 x 11 inches)
B/A3 (ANSI, size B: 11 x 17 inches)
8x10 in (for film printers)
14x17 in (for film printers)
Large A (user-defined size)
Large B (user-defined size)
The default is A/A4.
6. (This field only appears for PostScript Output.) Click the drop-down arrow
in the Spooler: field and select an output device (Laser Printer or Plotter)
on which the intensity maps are to be printed. Plotter is the default.
ASCII Output
7. Enter a value in the Resolution (cm): field representing the preferred
resolution for the 2-D intensity map scale, in the X and Y directions. The
resolution is the same in both directions. Acceptable values range from 0-
1. cm to 1.0 cm, in steps of 0.1 cm. The default value is 0.1 cm.
Define Default Filename Format
Use the following fields to define the format for the file names used when XiO
outputs intensity maps in ASCII. This format becomes the default filename; you
can change it, if necessary, when you output the intensity map.
8. Enter the first part (prefix) of the filename in the Prefix: field. Up to three
alphanumeric characters. The default is blank.
XiO 9-41
Preferences
XiO Training Guide

Preferences

Teletherapy
Intensity Map (cont.)
Define Default Filename Format
9. Enter the Maximum Patient ID Characters (alphanumeric). Acceptable
values range from none (blank) to up to 14 alphanumeric characters. The
default maximum is no characters (blank).
10. Click the drop-down arrow in the Include Beam Number field and select
Yes to include the beam number in the filename.

OR

Select No to not include in the file name. The default is No.
11. Enter the Maximum Beam Description Characters. The acceptable
values range from none to 24-characters. The default maximum is no
characters (blank).
12. Enter a suffix in the Ideal Map Suffix: field for ideal map filenames. You
can enter up to three-alphanumeric characters. The default is blank.
13. Enter a suffix in the Segmented MLC Map Suffix: field for the MLC
intensity map filenames. You can enter up to three alphanumeric
characters. The default is blank.
14. Enter a suffix in the Compensating Filter Map Suffix: field for
compensating filter map filenames. You can enter up to three alphanumeric
characters. The default is blank.
15. Enter a suffix in the Relative Fluence Map Suffix: field for relative fluence
map filenames. You can enter up to three alphanumeric characters. The
default is blank.
16. Click the drop-down arrow in the Generate Unique Filename: field and
select Yes to add a unique number to the filename.

OR

Select No.

9-42
Preferences
XiO Training Guide

Preferences

Teletherapy
Intensity Map (cont.)
Default Filename Formats
XiO displays sample filenames based on your entries.
Ideal Map
Segmented MLC Map
Compensating Filter Map
Relative Fluence Map

17. Click OK. XiO updates the intensity map preferences for Teletherapy.
XiO 9-43
Preferences
XiO Training Guide

Preferences

Teletherapy
Plan Output
Create templates and set a default template for printing multiple outputs at once.
1. Click the Edit drop-down menu and select the Preferences and Plan
Output options. XiO displays the Plan Output Preferences dialog box.

2. Enter a Plan Output Template ID.
9-44
Preferences
XiO Training Guide

Preferences

Teletherapy
Plan Output (cont.)
3. Click the Default button next to the template ID if you would like this to be
the default template.
4. Enter an optional Description for this template.
5. Under the Reports heading, select each report that you would like to print
using this Template. See XiO Help for more information on the types of
reports listed.
6. Under the Graphics Displays SPVs heading, select one or all of the
following options:
All Displayed prints all SPV images that are displayed on the screen when
this print option is selected.
All Transverse That Cut Through prints all transverse slices that cut
through the selected structure. You must also select a structure name from
the answer-help list.
T/S/C Passing Through prints the transverse, sagittal and coronal images
that pass through the reference point, the normalization point or the first
beams isocenter.
NOTE: You must be normalized to a point to print the T/S/C images
that pass through the Normalization Point.

XiO 9-45
Preferences
XiO Training Guide

Preferences

Teletherapy
Plan Output (cont.)
1. Under the graphics display BEVs heading, select one of the following
options:
All prints the beams eye views for all the beams in the selected plan.
All On (dose) prints only the beams eye views for the beams that are turned
to an on position on the beam weights page.
All Displayed prints all the beams eye views that are displayed on the screen
for the selected plan.
None will not print any beams eye view images for this plan.
2. Under the Beam Treatment Aids heading, select the treatment aid
information that you would like to print using this template.
3. For each treatment aid you must select to print them All, only the treatment
aids that are turned to an on position on the beam weights page (All On), or
None.
4. For each treatment plan, you must also select a Paper Size (when available)
and a Distance at which you want to print.
5. Click OK when you are finished creating your template.
6. Repeat this process to create as many templates as you need.
9-46
Preferences
XiO Training Guide

Preferences

Brachytherapy
Brachytherapy Histogram Print Preferences
When planning in brachytherapy and the F6 Histogram function is available, you
can set the Brachytherapy Histogram Preference.


1. Select Yes in the in the Include Histogram Report with Print: field if you
would like to include the image of the histogram when you print the
histogram report.
2. Click Done.



XiO 9-47
3-D Four Field Prostate
XiO Training Guide

3-D Four Field Prostate


After completing the PFM and Teletherapy lessons and the first two interactive
treatment plans in this series, you should be familiar with most of the procedures
required to create 3-D treatment plans. Therefore, this plan and the remaining
plans discussed in the training guide will have been previously created and have
the contours already drawn.
Preliminary Instructions:
1. Use the following patient and studyset information and create a standard 3-D
four-field prostate plan. As a part of your plan, remember to use volume
calculation with heterogeneity correction and pixel-by-pixel calculation.
Change the grid spacing to 0.4.
Patient ID: FusionProstate
Studyset: CT
Graphics area setup: 6TSCMxA

2. Turn on the following structures:
x Patient
x GTV (color red; rendering solid)
x Rt and Lt Femur (color white; rendering T75)
x Rectum (color brown; rendering T50)
x Bladder (color yellow; rendering T50)
Task 1. Vary the Margin Around a Structure Using 3-D Auto
Margin
Use Automargin to vary the margin around the structure using the variable
automargin tool.
1. Select Yes for Variable Automargin.
2. Use a 1 cm margin everywhere, except the posterior margin, where you will
use a 0.5 cm margin.
3. Label this structure PTV (your name).
Task 2. Create the Plan
1. Set the isocenter in the center of the PTV.
XiO 10-1

3-D Four Field Prostate
XiO Training Guide

10-2

3-D Four Field Prostate

Task 2. Create the Plan (cont.)
2. Create a four-field prostate plan using the following parameters:

Machine: Vari18x
Prescription: 6000 in 30 fractions (1500 per beam)
Plan in: Absolute dose
3. Place blocks around the PTV with a 0.5 cm margin.
Task 3. Save the Plan as a Template
1. Click the File drop-down menu and select the Save as Template option.
XiO displays the Save Template dialog box.
2. Enter a File Name for the template.
3. (optional) Enter a Description.
4. Click OK. XiO saves the plan as a template.
Task 4. Save the Plan
5. Click the File drop-down menu and select the Save as Plan option to save as
a permanent plan. XiO displays the Save Permanent Plan dialog box.
6. Enter a New plan ID.

OR

Click you middle-mouse button in the Plan ID field and select an ID.
7. Click OK. XiO saves the plan and closes the dialog box.





Electron Beam
XiO Training Guide

Electron Beam

Practice Exercise
This exercise demonstrates how to place an electron beam, edit the gantry, edit
the collimator and beam entry point using the mouse or keyboard, create an
electron block, and create and assign bolus. Since the electron beam is an SSD
beam, you will define the beam entry point on the surface instead of the
isocenter. Rotating the collimator and gantry with the mouse is similar to
rotating photon beams.
Task 1. Start the Plan
1. Click the Teletherapy option on the XiO main window.
2. Click the File drop-down menu and select the New Teletherapy Plan
option.

3. Click your middle mouse button in the Patient ID: field and select Breast2.
4. Click your middle mouse button in the Studyset field and select the studyset
named 1.
5. Click the drop-down arrow in the Graphics Area Setup field: and select
6TSCMxA.
6. Click OK. XiO opens the Breast2 patient in the selected six-window
format.
7. Click the View drop-down menu and select the Enhance Contour option.
XiO 11-1
Electron Beam
XiO Training Guide
Electron Beam

Task 1. Start the Plan (cont.)


8. Turn off all structures and turn on only the structures Clips and EXT.
9. Click OK. XiO displays two clips contoured in blue. They are very small
and can be found in the lymph node area superior to the right breast. View
the transverse slices from -94.50 through -97.51.
10. Click the View drop-down menu and select the Window Format option.
For the transverse image in window number 1, change the Ref (cm) to
96.01; then, click Update Graphics Display button.
11. Click Cancel to close the Window Format dialog box. This will be your
central axis slice. There are no clips contoured on this slice; but it is a slice
centered between the two clips.
11-2
Electron Beam
XiO Training Guide

Electron Beam

Task 2. Add the Electron Beam

1. Click the New Beam button on the Beam supporting toolbar to add the
electron beam.


2. (Optional) Enter Electron Boost in the description field.
3. Enter Vari16e in the Machine ID field.
4. Leave center of PTV1 as the default in the Initial Beam Placement Default
To: field.
5. Click OK. XiO opens the Electron Beam dialog box.

XiO 11-3
Electron Beam
XiO Training Guide
Electron Beam

Task 3. Manipulate the Electron Beam Using the Mouse or
Keyboard.
1. Click your middle mouse button in the Cone ID: field and select 6x6.
2. Enter 300 in the Gantry angle field.
3. Hold down your left mouse button on the Electron Beam dialog box and
Move it so that it does not overlap the Transverse or ABV windows.

OR
If you have a Linux machine, double click on the title bar to hide the
dialog box.
4. Click your right mouse button in the transverse window and select the
Beam Entry Point option.
5. Hold down the left mouse and drag the mouse around the right side of the
patient until the clips are centered in the field on the BEV.
NOTE: If the beam does not move with the mouse, XiO may display a
reconstructed transverse slice. You can verify that you have a
real slice or change to a real slice in View-Window Format.
Click your middle mouse under the Ref (cm) heading next to
the SPV transverse window. XiO displays real numbers on
this list. Verify that the Ref value is a real slice number. If
not, select a real slice from the list.
6. You can set the beam entry point with the keyboard using the Movement
Around Plane option on the Electron Beam Dialog box. Enter in positive
increments to move clockwise, and enter in negative increments to move
counter-clockwise.
7. If the cone is close enough to the patient that a collision may occur, XiO
displays a green message and does not allow the dose to calculate. To
correct this problem, select a different gantry or collimator angle, change
the beams entry position, or enter an extended SSD.
8. Click OK to close the Electron Beam Dialog Box.

11-4
Electron Beam
XiO Training Guide

Electron Beam
Task 4. Add an Electron Port

1. Click the Auto Port button. XiO opens the Auto Port dialog box.
NOTE: If you have not defined your port properties in Source File
Maintenance, XiO requires you to enter the values before XiO
displays the auto port dialog box.

2. Click your middle mouse button in the Auto Margin To: field and select
Clips.
3. Enter 2 cm in the With Margin (cm): field.
4. Click Calculate Aperture to create the port.
5. Click OK to close the Auto Port dialog box and start the dose calculation.


XiO 11-5
Electron Beam
XiO Training Guide
Electron Beam
Task 5. (Optional) Create and Assign Bolus
This task demonstrates how to create bolus and how to assign the bolus to
electron beams. You will use an interpolation technique to easily create the
bolus.
1. Click the Beam drop-down menu select the Bolus and New options. XiO
displays the Edit Bolus Definition Data dialog box.
2. (Optional) Enter a bolus Description.
3. Enter a bolus thickness of 1.0 cm.
4. Leave the default value of 1.0 for the Relative Electron Density. DO NOT
close the Edit Bolus Definition Data dialog box.
5. In the Transverse SPV window, movie to a slice that is superior to the port
such as T = -91.81.
6. Click your right mouse button in the SPV field and select Edit Bolus.
7. Hold down your left mouse button and drag the mouse around the
transverse image so that bolus displays over the right side of the patient.

OR

Click your left mouse button at the start and end of the bolus to create it on
the slice.
NOTE: If the bolus does not appear as you are drawing it, XiO may
display a reconstructed transverse slice. You can verify that
you have a real slice or change to a real slice in View-
Window Format. Click your middle mouse under the Ref
(cm) heading next to the SPV transverse window. XiO
displays real numbers on this list. Verify that the Ref value is
a real slice number. If not, select a real slice from the list.
8. Movie to the most inferior slice where you want to place bolus, such as T=
-99.90.
9. Hold down your left mouse button and drag the mouse around the
transverse image so that bolus displays over the right side of the patient.

OR

Click your left mouse button at the start and end of the bolus to create it on
the slice.

11-6
Electron Beam
XiO Training Guide

Electron Beam
Task 5. (Optional) Create and Assign Bolus (cont.)
10. Click OK on the Edit Bolus Definition Data dialog box. XiO interpolates
the bolus between the superior and inferior bolus contours that were
created.
11. Review the Transverse and ABV images to verify the coverage of the
bolus. Bolus appears as a yellow wireframe mesh on the patient surface.
12. Assign the bolus to the beam. Click the Beam drop down menu and select
the Bolus and Assign options. XiO displays the Assign Bolus to Beam
dialog box.
13. If you would like to assign this bolus to beam 1, toggle the No to Yes.
However, in this exercise, it is not necessary to assign bolus since the clips
are not superficial.
NOTE: You cannot fractionate bolus for electron beams since it is an
SSD beam and the calculation dose depth changes when bolus
is added. To mock beam fractionation using electrons, you can
create one beam with bolus and another without. Then,
fractionate the dose to each.
14. Click OK to close the Assign Bolus to Beam dialog box.


XiO 11-7
Electron Beam
XiO Training Guide
Electron Beam
Task 6. Normalize and Review the Final Dose.

1. Click the Dose button to access the isodose tools.
2. Click the Set Normalization Mode button. XiO opens the Dose
Normalization dialog box.

3. Next to the Selected Dose Normalization Mode, enter 1000 cGy.
4. Click Selected Dose. XiO normalizes 1000 cGy to the 100% isodose line.
5. Click Cancel to close the Dose Normalization dialog box.
6. Click your right mouse button in the transverse image window and select
Maximize. XiO expands the transverse image window to full screen.
7. Click your right mouse button again and select the Movie option. Scroll to
a slice where you see a clip contour. Example, slice -97.21.
11-8
Electron Beam
XiO Training Guide

Electron Beam
Task 6. Normalize and Review the Final Dose (cont.)
8. Click the Isodose Lines button. XiO opens the Isodose Lines dialog
box.

9. Enter the following isodose lines 105, 100, 95, 90 and 70.
10. Click OK to close the Isodose Lines dialog box.
11. Movie through the slices to review the coverage of the isodoses.
12. Click your right mouse button and select the Restore option to restore the
transverse image.
13. Click your right mouse button in the MPV window and select Maximize to
maximize the MPV image to review the dose distribution in the 3D view.
14. Click the Dose in MPV button to display the isodose lines.
15. Once you have finished reviewing the 3D isodoses, select the Restore
option to restore the MPV window.
16. Click the drop-down menu and select the Exit option when you are
finished.
XiO 11-9
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan

Practice Exercise

This lesson demonstrates how to create a plan using rotational arc beams. You
can use either symmetric or asymmetric collimator jaws in arc planning. In this
exercise, you will be creating an Arc rotation plan on a prostate patient. The
prescription goal is 6820 cGy in 38 treatments using two lateral arcs.
Task 1. Start the Plan
1. Click the Teletherapy option on the XiO Main window.
2. Click the File drop-down menu and select the New Teletherapy Plan
option.
3. Click your middle mouse button in the Patient ID field and select
FusionProstate.
4. Click your middle mouse button in the Studyset field and select CT.
5. Click the drop-down arrow in the Graphics Area Setup field and select
6TSCMxA.

6. Click OK. XiO opens the FusionProstate patient in the selected six-
window format.

XiO 12-1
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan

Task 1. Start the Plan (cont.)
7. Click the View drop-down menu select the Enhance Contour option. XiO
displays the Enhance Contours dialog box.
8. Turn off all structures; turn on only the structures PTV2 and Patient.
9. Click OK.

12-2
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan
Task 2. Add the Rotational Arc Beams

1. Click the New Beam button. XiO displays the New Beam dialog box.



2. (Optional) Enter Right Lateral Arc in the description field.
3. Enter Vari18x in the Machine ID field.
4. Click the drop-down arrow in the Setup: field and select Rotational.
5. Click the drop-down arrow in the Collimator jaw: field and select
Asymmetric.
6. Click your middle mouse button in the Default to: field and select the Beam
Isocenter center of PTV2.
7. Click OK. XiO opens the Photon Beam dialog box.
XiO 12-3
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan
Task 2. Add the Rotational Arc Beams (cont.)




8. Enter LW= 4.5 RW = 4.0 UL= 5.5 LL= 5.5 in the Field Size Defined At:
fields.
9. Enter 225 in the Gantry Angle field.
10. Enter the degrees of 90 in 10 deg increments in the Rotation Arc field.
The increment is the degree interval at which the system calculates dose.
11. Enter 3420 in the Weight: field and 38 in the Number of Fractions: field.
12. Leave all other fields as their default values and click OK.
13. Click the Mirror Beam button to create the opposing beam. XiO
displays the Photon Beam dialog box.
14. (Optional) Enter the description as Left Lateral Arc.
15. All other values can be left to their default settings. Click OK to close.
12-4
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan
Task 3. Normalize and Review the Final Plan

1. Click the Dose button on the main toolbar. The status indicator displays
the percent done for each beam as it calculates. Once the calculation is
complete, proceed to the next step.
2. Click the Set Normalization Mode button. XiO opens the Dose
Normalization dialog box.


3. Click your middle mouse button in the Reference Point Position field and
select center of PTV2 as the default normalization point.
4. Click the Selected Point button. XiO normalizes the point to 100%.
5. Click Cancel to close the Dose Normalization dialog box.
XiO 12-5
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan
Task 3. Normalize and Review the Final Plan (cont.)
6. Click the Isodose Lines button. XiO displays the Isodose Lines dialog
box.

7. Enter the following isodose lines 102, 100, 98, 95 and 70.
8. Click OK to close the Isodose Lines dialog box.
9. Click your right mouse button in the transverse image window and select
Maximize. XiO maximizes the transverse image to full screen. Note the
coverage of the 98% isodose line.
10. Click your right mouse button in the window again and select the Movie
option. Scroll through the transverse slices to review the isodose line
coverage.
11. Click your right mouse button in the transverse image window to Restore
the transverse image.
12. Click the Beam Weight button. XiO displays the Beam Weight dialog
box.
13. Click the Rescale (Prescribe) Beam Weights button. XiO displays the
Rescale Weights dialog box.
12-6
Arc Rotation Plan
XiO Training Guide

Arc Rotation Plan
Task 3. Normalize and Review the Final Plan (cont.)



14. Click the drop-down arrow in the Prescribe to: field and select Isodose
Line. XiO displays the Rescale Weights dialog box.
15. Enter 98% in the Isocurve Value: field and 6840 in the Prescribed Dose
(cGy): field. XiO redisplays the Beam Weight dialog box.
16. Click OK to rescale the doses.
17. Click OK to close the Beam Weight dialog box.
18 Click your right mouse button in the transverse image window and select
Movie. Movie through the transverse slices and review the coverage of the
98% isodose line.
19 Click your right mouse button in the MPV window and select Maximize to
maximize the MPV window.
20 Click the Isodose Lines button. XiO displays the Isodose Lines dialog
box.
21 Turn off all isodose lines except the 98% line and change the rendering to
Solid.
22. Click OK to close the Isodose Lines dialog box.
XiO 12-7
Arc Rotation Plan
XiO Training Guide

12-8
Arc Rotation Plan
Task 3. Normalize and Review the Final Plan (cont.)
23. Click the Dose in MPV button. You can now see that the 98% isodose
curve covers the PTV2 structure.
24. Click your right mouse button in the MPV window and select Restore to
restore the MPV window.
25. Click the File drop-down menu and select the Exit option when you are
finished with the patient.




Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field Single Field Irregular Field
Single Field Irregular Field Plan A.
This exercise walks you through the steps to create an irregular field plan with a
treatment aid. The port that you will digitize can be found at the end of this
section.
In this plan, you will complete the following tasks:

x Enter setup information
x Enter beam parameters
x Enter a block
x Define surface points
x Enter point depths
x Calculate dose
Enter Setup Information
1. Select the Irregular Field option on the XiO Main window.
2. Click the New Treatment Plan button.
3. Enter MrIrreg in the Patient ID field.
4. Click DONE.

XiO 13-1
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A. (cont.)
5. Enter the patient demographic data of your choice. Patient Name and
Sex are required fields.
Enter Beam Information
1. Click your middle mouse button in the Irregular Field Calculation Type
field and select Single Beam Vertical Depths. This option assumes all
calculation point depths are vertical depths from the surface to the point.
The other options are Single Beam Diverging Depth, where all calculation
point depths off the CAX are assumed to be diverging depths and Opposed
Beam Vertical Depths, where you are going to enter a patient thickness and
calculate both entrance and exit dose to a point.

2. Click your middle mouse button in the Setup Type field and select SSD.
3. Click DONE.
4. Click your middle mouse button in the Machine ID field and select
Vari06x.
5. Click you middle mouse button in the Collimator Jaw field and select
symmetric.

13-2
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field Single Field Irregular Field
Single Field Irregular Field Plan A.
Enter Beam Information (cont.)
6. Click Done. XiO displays the Source dialog box.

7. At the Gap Reference Distance field, leave the value at 100 cm. This is the
distance from which all other calculation point depths will be referenced.
8. All other values can be left to their defaults.
9. Click DONE. XiO displays the Customized Port dialog box.
XiO 13-3
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A. (cont.)
Enter a Block
1. Enter the Customized Port ID AP.
2. Click Done. XiO displays the customized port entry modes.
3. Click the Tablet button as the entry mode.
4. Click the Enter Additional Polygon button.
5. Enter a Scale Factor of 0.99.
6. Enter a sample spacing of your own choice. This is the spacing between
points when digitizing the port. The smaller the spacing, the smoother the
contour, and vice versa. 0.5 cm is useful in most cases.
7. Click DONE.
8. Digitize a point along the X axis.
9. Digitize a point along the +X axis.
10. Digitize the origin point.
11. Press the Start button on the digitizer transducer. Drag the transducer
around the contour. Points will be dropped at the previously selected
sample spacing.
12. When the contour is completed, push the End button on the digitizer
controller two times; once to end the contour, and a second time to finish
using the tablet.
13. Click the CANCEL button two times. XiO displays the port definition
dialog box.
14. At the Polygon Number Representing Cutout field, enter 1. Enter 1 when
you want to define the contour as an aperture (you have drawn the
opening). Leave the field blank when you want to define the contour as a
block (you have drawn the actual block).
15. Click DONE. XiO displays the port description dialog box.
13-4
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A.
Enter a Block (cont.)
16. Enter .97 for the customized port tray factor.
17. (Optional) Enter a port Description.
18. Enter 5 HVLS, Cerrobend and a thickness of 7.5. This is applicable for
the Clarkson algorithm. These values will default if they have been set up
in Source File Maintenance.
19. Click DONE.
20. Click CANCEL.
21. Select the Conform Coll. To Cutout option.
22. Click CANCEL. If you have the automatic block cutter, you would select
Export to Block Cutter option here instead of CANCEL. XiO displays
the Surface Point Entry text page.
XiO 13-5
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A. (cont.)
Define Surface Points
1. Select Tablet.
2. Enter 0.99 for the scale factor.
3. Click DONE. XiO displays the Orient Axis dialog box.
4. Reorient the tablet as previously done.
5. Enter the points 1-3 as indicated on the printout (film).
6. Press End on the digitizer transducer.
7. Label point 1 as Sup Mediastinum.
8. Change the SSD to 102. Note the vertical gap distance is automatically
adjusted, based on the reference distance (100).
9. Click DONE.
10. Label point 2 as CAX.
11. Leave the SSD as is.
12. Click DONE.
13. Label point 3 as Inf. Mediastinum.
14. Change the SSD to 98.
15. Click DONE.
16. Click CANCEL two times; once to exit point entry, and a second time to
display the Depth dialog box.
13-6
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A. (cont.)
Enter Point Depths
1. At the Enter/Edit Calculation depths, review the information for point 1.
2. Click DONE.
3. Enter 5 cm in the first blank line in the first of five columns. You can use
the From, To, and Step options easily to create a series of depths from a
specified point; however, in this lesson, you will only enter one depth for
each point.
4. Click DONE.
5. Review information for point 2.
6. Click DONE.
7. Enter 10 cm.
8. Click DONE.
9. Review information for point 3 and click DONE.
10. Enter 6 cm.
11. Click DONE. You are now finished with point depth entry.
XiO 13-7
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Single Field Irregular Field Plan A. (cont.)
Calculate Dose
1. Click the global function SF4 DISPDOSE button.
2. Click the Prescribe to a point button.
3. Click your middle mouse button in the Point Number field to display a list
of points and select point 2.
4. Click your middle mouse in the Depth field and select a depth of 10 cm
5. Enter 100 cGy for the dose.
6. Enter 1 for the number of fractions.
7. Click DONE. XiO displays the Irregular Field Output options list. The
first three options listed allow you to review the information on screen.
The final option listed prints the information.
8. Select Dose and Time/MU Results. XiO displays the results page.
9. Click Quit to close the results page.
10. Click SF9 EXIT to exit the program.


13-8
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field Single Field Irregular Field
Parallel Opposed Irregular Field Plan B.
The following tasks will be covered in this segment of the exercise:
x Enter setup information
x Enter beam parameters for opposing beams
x Enter blocks
x Define surface points
x Enter point depths
x Calculate dose

Task 1. Enter Setup Information
1. Select the Irregular Field option on the XiO main window.
2. Click the New Treatment Plan button.
3. Enter 4569 in the Patient ID field.
4. Click DONE.

5. Enter Mickey Mantle in the Patient Name field.
6. Click the drop-down arrow in the Sex field and select Male.
XiO 13-9
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B.
Task 1. Enter Setup Information (cont.)
7. Enter the Current Date in the Treatment Date field in MMM DD YYYY
format. Alternate formats can be set up in Site Customization.
8. Click your middle mouse button in the Irregular Field Calculation field and
select Opposed Beam Vertical Depths.
9. Click your middle mouse button in the Setup Type field and select SSD.
10. Enter 20 cm in the CAX patient thickness field.
11. Click DONE. XiO positions you for the next task.

13-10
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 2. Enter Beam Parameters
1. Enter AP Mantle in the Description field for Beam number 1.
2. Click your middle mouse button in the Machine ID field and select
Vari06x.
3. Click your middle mouse button in the Collimator Jaw field and select
symmetric.
4. Click DONE. XiO displays the main text page in local function F1 Source.
Information is provided about Beam 1.
NOTE: In this example, the treatment SSD is 100 and gap reference
distance is also 100 SSD. The gap reference distance is the
SSD that XiO uses to reference the off-axis points. Generally,
this SSD will be the same SSD as the treatment plan distance
at CAX.


XiO 13-11
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B.
Task 2. Enter Beam Parameters (cont.)
5. Enter 39 in the Field Width field.
6. Enter 28 in the Field Length field.
7. Click DONE. XiO displays the main text page in local function F1 Source
with information provided for Beam 2.
8. Enter PA Mantle in the description field for Beam 2.
NOTE: The changes made for Beam 1 have also been assigned to
Beam 2.
9. Click DONE. You are now positioned for Task 3.


13-12
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 3. Enter Blocks
1. Select AP Mantle (beam 1).
2. Enter AP in the Customized Port ID field.
3. Click DONE. XiO displays the tablet entry modes.
4. Click the Tablet button.
5. Click the Enter Additional Polygon button.

6. Enter 0.55 in the Scale Factor field.
7. Enter 0.5 in the Sample Spacing field. You can define multiple spacings.
If you want to change this sample spacing, you can do so during the
digitizing process.
8. Click DONE. XiO displays the orient axis dialog box.

XiO 13-13
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B.
Task 3. Enter Blocks (cont.)
9. Follow the instructions in the Text Area to orient the field axis on the
digitizer. After the axis orientation is complete, a prompt is displayed to
start the block contour entry.
10. Follow the instructions in the Text Area to enter the open field (not each
block individually).
11. After you have entered the field, click End twice to close the contour and
end polygon entry.
12. Click CANCEL. This displays the port enter edit modes.
13. Click CANCEL. XiO displays the port definition dialog box.
14. Enter 1 in the Polygon number representing cutout field.
15. Click DONE.
16. Enter 0.97 for the customized port tray factor
17. Click DONE.
18. Click CANCEL two times. Once to return to the customized ports main
menu, and a second time to display Enter/Edit Customized Port for Beam
Number: dialog box.
19. Select PA Mantle (beam 2).
20. Click the drop-down arrow in the Customized Port ID field and select AP.
The AP port that was previously digitized is now placed on Beam 2.
21. Click DONE.
22. Click Mirror. XiO mirrors the AP customized port so that it is the proper
orientation for the PA field (beam 2).
23. Click CANCEL two times. Both beams now have customized blocks
defined.
24. Verify that Beam 1 is selected. If not, toggle the Beam Number to 1 by
clicking on the beam number. This positions you to begin Task 4.
13-14
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 4. Define First Surface Point
1. Click the Tablet button.
2. Enter scale factor 0.55.
3. Click DONE. XiO displays the tablet orientation dialog box.
4. Orient the tablet according to the instructions on the window.
5. Digitize points 1-6 using the Enter Point button on the digitizer transducer.
Press End once on the transducer when finished entering all the points.
6. Enter the description CAX for Point Number: 1.
7. Select 100.00 cm in the Entrance Curve Correction/Surface Point SSD
field. The default is 100.00 cm.
8. Select 0.0 cm in the Entrance Curve Correction/Vertical Gap Distance
field. The default is 0.0.
9. Select 20 cm in the Thickness field. The default is 20.0 cm.
NOTE: This is the thickness designated at the start of the plan.
10. Select 100 at the Opposed Curve Correction/Default SSD field. The default
is 100.
11. Select 0.0 at the Opposed Curve correction/Vertical Gap Distance field.
The default is 0.0.
12. Click DONE. XiO positions you for the next task.

XiO 13-15
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 5. Define Additional Surface Points
1. Repeat Steps 6 through 12 in Task 4 for the additional surface points using
the following values:

For Point 2 Upper Mediastinum, use the following values:
SSD = 101
Thickness = 19.0
For Point 3 Right Neck, use the following values:
SSD = 99
Thickness = 12.0
For Point 4 Right Supraclavicular, use the following values:
SSD = 103
Thickness = 15.0
For Point 5 Right Axilla, use the following values:
SSD = 103
Thickness = 16.0
For Point 6 Lower Mediastinum, use the following values:
SSD = 99
Thickness = 21.0
2. Click CANCEL two times. The depths for each point can now be entered.


13-16
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 6. Enter Point Depths
1. Enter 1 in the Enter/Edit Calculation Depths field. The default should be 1.
2. Click DONE.
3. Enter 1.5 and 10 cm in the Enter Calculation Depths field.
4. Click DONE. XiO prompts you for the depth of each point.
5. Enter the following depths for each point:

Upper Mediastinum From 1.5 cm to 9.5 cm in Steps of 4 cm.
Right Neck 6 cm
Right Supraclavicular 2 cm
Right Axilla 8 cm
Lower Mediastinum: Use Copy Depth from Point Number and select
point number 2.
6. Click DONE when finished with the point depth entry.

XiO 13-17
Single Field Irregular Field
XiO Training Guide

Single Field Irregular Field
Parallel Opposed Irregular Field Plan B. (cont.)
Task 7. Calculate Dose
1. Click the global function SF4 Dispdose button.
2. Select Prescribe to Point.
NOTE: There is also an option available to enter Time/MU.

If the patient has already been treated to this field, you could
enter the MU with which the patient was treated. XiO
calculates the dose given to the patient at prescription point
and at all designated off axis points.
3. Verify that the value in the Point Data Viewed from Beam field is Beam 1.
If not, toggle so that Beam 1 is displayed.
4. Select 1 in the Point Number field. Point 1 is the CAX point.
5. Select 10 in the Depth field. 10 cm is the midplane depth at CAX.
6. Enter 75 in the Prescribe Dose for Beam 1 (cGy) field.
7. Enter 75 in the Prescribe Dose for Beam 2 (cGy) field.
8. Enter 1 in the Number of Fractions field.
NOTE: The total dose is displayed in yellow after the number of
fractions is entered.
9. Click DONE.
10. Click the Dose and Time/MU results button. XiO displays dose at each
point to the depth in the graphics area.
11. Click QUIT in the graphics area.
You may want to go through this plan again, exploring Irregular Field output
options. If you want to save a plan as a permanent plan, use the global function
SF6 SAVEPLAN.

13-18




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Single Beam Irregular Field Block
Scale Factor = 0.99
Note: This factor may vary depending on the
printer; verify before using this factor.








Time/MU
XiO Training Guide

Time/MU

Practice Exercise
Time/MU is a simple dose calculation program that runs on XiO or any PC
networked to it. This program can be used to do a point dose calculation.
NOTE: You can access Time/MU on the Internet by accessing the XiO
IP/xio_help.htm. The following is an example of what the address
would look like when entered into the Address field of your Internet
web page: http://172.16.11.20/xio_help.htm
1. From any XiO window, click the Help drop-down menu and select XiO
Help.
2. Under the contents list on the left, select Utilities and the Utilities Table of
Contents.

3. Under the Treatment Planning Heading on the right, select Calculate a
Time/MU. XiO opens the Time/MU module.
4. Enter a User ID. This field is optional; but if entered, it appears at the
bottom of the final calculation window next to Data Entry.
NOTE: You must click in each box to enter data. Press the Tab
button on your computer keyboard to move from field to field.
5. Click Continue. XiO displays the next window.
XiO 14-1
Time/MU
XiO Training Guide

Time/MU


6. Enter the Patient ID, Patient Name, Physician, Beam Description and
Anatomical Site. All fields are optional.


7. Click the drop-down menu in the Machine ID: field and select a Machine
ID.
8. Click the drop-down arrow in the Setup: field and select a Setup.
9. Click Continue. XiO displays the next window.
14-2
Time/MU
XiO Training Guide

Time/MU




10. Enter a Treatment Distance.
11. Select the Field Size defined at.
12. Enter the Open fld. and Blocked fld. sizes.
13. Select a Wedge ID.
14. Enter the calculation Point depth cm.
15. Click Continue. XiO displays the next window.
XiO 14-3
Time/MU
XiO Training Guide

Time/MU




16. Edit the Blocked Equivalent Square, if necessary.
17. Enter a Tray Factor.
18. Enter any Miscellaneous Correction Factors such as a compensating filter
factor.
19. Select Point Dose or Time/MU; then, enter the value.
20. (Optional) Enter any Comments.
14-4
Time/MU
XiO Training Guide

Time/MU

21. If this is the only beam you are calculating, click Continue. XiO displays
the Printable Calculation window.


22. If you have another beam to calculate, click the box next to Enter another
beam. XiO returns you to the initial window (at step 6) where you can
begin entering a new beam description. Repeat steps 7-20.

XiO 14-5
Time/MU
XiO Training Guide

Time/MU


23. (Optional) You can print the final calculation window from the Print
option on the toolbar at the top of the help window.
24. (Optional) Other buttons that appear at the top of the window during data
entry are:
Help (which provides help on each entry window)
Restart (which takes you back to the Patient ID entry window)
Exit (which takes you back to the User ID window).
25. (Optional) Buttons displayed at the bottom of the window include:
Reset Defaults (which reset any drop-down menu selections
example, Machine ID)
Back (which takes you back to the last entry window)
Continue (which takes you forward to the window)
14-6
Time/MU
XiO Training Guide

Time/MU

If you would like to display entrance and exit dose, you must enter a dmax dose
for each machine in SFM that you plan to use in the Time/MU program. These
steps must be performed before you create a Time/MU calculation.
1. Select Source File Maintenance on the main XiO screen.
2. Select Teletherapy; then, select a machine.
3. Click Done.
4. Click the Stand Alone Time/MU Data button.
5. Enter the Dmax for the machine.
6. Click Done.
7. Cancel out of Source File Maintenance.
XiO 14-7
Gynecological Brachytherapy Implant
XiO Training Guide

Gynecological Brachytherapy Implant
Practice Exercise
This plan is designed to illustrate how to create a gynecological brachytherapy
plan using XiO. The following tasks are covered in this exercise:
x Create a source type
x Create a source template
x Create a source inventory
x Create additional sources
x Create catheter template
x Create a new patient
x Start creation of a new treatment plan
x Digitize ovoid source
x Define tandem sources
x Digitize the tandem
x Digitize interest points for dose calculations
x Digitize markers for automatically calculating points A and B
x Position markers for defining points A and B
x Create a best-fit oblique plane and sagittal and transverse view of the implant
x Calculate dose
x (Optional) Edit/Delete sources and catheters
x Plot brachytherapy plan
Task 1. Create a Source Type
This task walks you through creating a brachytherapy source type. By creating a
source type, you are simply entering the physical characteristics of a particular
kind of source, such as Cesium or Iridium, etc. These physical characteristics do
not often change and only need to be entered once, or edited when the vendor
notifies you of some change.
WARNING

All suggested parameters used in this training lesson are to be
used for training purposes only; when you are creating source
types in your clinic; verify the necessary parameters with the
source vendor before validating.

XiO 15-1
Gynecological Brachytherapy Implant
XiO Training Guide
Gynecological Brachytherapy Implant
Task 1. Create a Source Type (cont.)
Sub-task 1. Enter General Parameters
1. Select Source File Maintenance.
2. Select Brachytherapy.
3. Select Source Type Editor.
4. Enter the Source Type ID CS137training.
5. Click Done.
6. Enter CS137 as the Isotope.
7. Select Years for the Half Life Units.
8. Enter 30 (years) for the Half Life.
9. Select Linear for the source Geometry. If you choose linear here, you can
choose later to use it as a linear or a seed source. If you choose seed here,
XiO limits you to the source being a seed only source.
10. Enter mgRaeq for the Units of Strength.
11. Enter 2.0 (cm) for the Physical Length.
12. Enter 1 for the number of subsources.
13. Once you have entered the number of subsources, XiO requires you to enter
the position of the tip and end of the source and the relative strength. Enter
the following parameters:
Subsource Tip: 0.325 (cm).
Subsource End: 1.675 (cm).
Relative Strength: 1.0.
14. Click Done when finished entering all values.
15. On the main entry page for this source, you can now verify that the general
parameters have been entered. Under the heading "Complete," you should
see the word "yes." There is no validation required for the general
parameters.
15-2
Gynecological Brachytherapy Implant
XiO Training Guide

Gynecological Brachytherapy Implant
Task 1. Create a Source Type (cont.)
Sub-task 2. Enter the Physical Geometry for the Sievert Integral
Data
1. Select Physical Geometry under the Integral Data heading.
2. Enter 0.27 (cm) for the Physical Diameter.
3. Enter 0.05 (cm) for the Wall Thickness.
4. Enter 0.325 (cm) for the Tip Cap Thickness.
5. Enter 0.325 (cm) for the End Cap Thickness.
6. Click Done when you are finished entering the Physical Geometry values.
XiO returns you to the main entry page for this source.
7. You can now verify that the Physical Geometry information has been
entered. Under the heading "Complete," you should see the word "yes."
Sub-task 3. Enter the Attenuation Information for the Sievert
Integral Data

1. Select Source Interior under the Attenuation Information heading.
2. Enter 1 for the Number of Coefficients.
3. Once this information is entered, you are required to provide the Thickness
and the Coefficient. Use the following parameters:
Thickness 10 (cm)
Coefficient 0.046 (1/cm).
4. Click Done when finished entering the Source Interior Data.
5. Select Source Shell under the Attenuation Information heading.
6. Enter 1 for the Number of Coefficients.
7. Once this information is entered, you are required to provide the Thickness
and the Coefficient. Use the following parameters:
Thickness: 10 (cm)
Coefficient: 0.37 (1/cm)
XiO 15-3
Gynecological Brachytherapy Implant
XiO Training Guide
Gynecological Brachytherapy Implant
Task 1. Create a Source Type
Sub-task 3. Enter the Attenuation Information for the Sievert
Integral Data (cont.)
8. Click Done when finished entering the Source Shell Data.
9. Select Tissue under the Attenuation Information heading.
10. Enter the Meisberger Coefficients for tissue attenuation. Use the following
values:
Mantissa Exponent Units
A: 1.0091 0
B: -9.015 -3 1/cm
C: -3.459 -4 1/cm^2
D: -2.817 -5 1/cm^3

11. Enter 10 (cm) for the Meisberger Range and 0.0 (1/cm) for the Tissue
Attenuation Coefficient.
12. Click Done when you are finished entering these values.
13. Select Conversion Constant under the Attenuation Information heading.
14. Enter 8.2135 for the Mantissa and 0 for the Exponent.
15. Click Done when you are finished.
16. You can now verify that the Attenuation Information has been entered.
Under the heading "Complete," you should see the word "yes" for all four
sections of the attenuation data. There is no validation required for these
sections.
Sub-task 4. Enter the Dose Rate Parameters and Create the Dose
Rate Table
1. Select Dose Rate Parameters close to the bottom of the main entry screen.
2. Enter 0.15 (cm) for the Minimum Radius.
3. Enter 2.0 (cm) for the Midpoint Radius.
15-4
Gynecological Brachytherapy Implant
XiO Training Guide

Gynecological Brachytherapy Implant
Task 1. Create a Source Type
Sub-task 4. Enter the Dose Rate Parameters and Create the Dose
Rate Table (cont.)
4. Enter 10 (cm) for the Maximum Radius.
5. Enter 150 for the Number of Radii from Minimum to Midpoint.
6. Enter 150 for the Number of Radii above Midpoint to Maximum.
7. Enter 101 for the Number of Angles.
8. If you would like to create this source to be used as a seed source or a linear
source, select yes for the option to Calc seed equivalent dose rate. For this
task, choose no. Typically, Cesium sources are calculated and planned as
linear sources only.
9. Click Done when you are finished entering the Dose Rate Parameters.
10. To generate the Dose Rate Table, click the Cancel button to go back one
page.
11. Select the option Generate Dose Rate Table.
12. Read the warning message; then, click Acknowledge.
13. Click Done to generate the Sievert Integral Dose Rate Table. XiO displays
a yellow message once the table is successfully calculated. Read the
message; then, click Acknowledge.
14. Next, you must Validate the Dose Rate Table. Select Validate from the
menu options. XiO displays a warning message. Read and Acknowledge
the message.
15. Review the table using the Page-Up/Page-Down button.
16. Click the Quit button when finished reviewing.
17. Select Validate to validate the table.
18. XiO displays a warning message and again asks you if you would like to
Validate the table? Answer yes (the default); then, click Done.
XiO 15-5
Gynecological Brachytherapy Implant
XiO Training Guide
Gynecological Brachytherapy Implant
Task 1. Create a Source Type
Sub-task 4. Enter the Dose Rate Parameters and Create the Dose
Rate Table (cont.)
19. Select Enter/Edit.
20. You can now verify that the Dose Rate Table has been created and
Validated. Under the headings "Complete" and "Validated," you should
see the word "yes" for this table. There is no validation required for Dose
Rate Parameters.
21. Once you are finished, click Cancel three times to go back to the
Brachytherapy Source and Catheter Editor page.

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Gynecological Brachytherapy Implant
Task 2. Create a Source Template
The Source Template Editor in Source File Maintenance is where you create an
inventory of source templates (library of source templates in the clinic). For
example, if you have ten physical sources of 10 mgRaeq each, only one template
would need to be created for each activity.
1. Click the Source Template Editor option. XiO displays the Source File
Maintenance Brachytherapy ID Text Page.
2. Enter CS137CMS20 in the Source Template ID field.
3. Click DONE.
4. Select CS137training in the Source Type ID field.
5. Enter the Calibration Strength. In this example, enter 20.
6. Enter the Calibration Date. In this example, enter todays date, and
Time: 8:00. Use the following date format: MMM DD YYYY.
7. Click your middle mouse button in the Lock Status field and select Locked.
NOTE: The "Locked" status is typically used for sources in your
permanent inventory that have long half-lives and the calibration
date needs to remain static.
8. Click DONE.
XiO 15-7
Gynecological Brachytherapy Implant
XiO Training Guide
Gynecological Brachytherapy Implant
Task 3. Create a Source Inventory
Use the procedures in this task to create an entire source inventory.

1. Click the Copy/Duplicate button. XiO displays the Source File
Maintenance Brachytherapy Copy Page.
2. Enter CS137CMS15 at the Source Template ID prompt.
3. Click DONE. XiO displays a system message in a yellow box.
4. Read and Acknowledge the message. XiO displays the Source File
Maintenance Brachy Editor Menu Text Page.
5. Click the Enter/Edit button. XiO displays the Source Template Edit Text
Page.
6. Enter 15 at the Calibration Strength (mgRaeq)field.
NOTE: This is the only value that is to be changed for this source.
7. Click DONE.
8. Repeat Steps 1 through 7, but substitute CS137CMS10 in the Source
Template ID field and 10 in the Calibration Strength (mgRaeq) field.
9. Click the CANCEL button two times. XiO displays the Source File
Maintenance Brachy Text Page.
10. Click the Source Templates Index button. XiO displays a list of sources.
NOTE: The current strength is a product of calibration strength and
decay factor. This shows strength due to decay from the
calibration date and time that you have previously entered.
11. Verify that the source templates are included in the index.
12. Click the QUIT button. You are now positioned to perform the next task.

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Gynecological Brachytherapy Implant
Task 4. Create Tandem Catheter Template
A catheter template is a generic catheter or ribbon that contains unstructured
sources. The catheter or ribbon is digitized via simulation films with the implant
instruments in place, allowing you to edit sources or spacers.

1. Click the Catheter Template Editor button. XiO displays the Source File
Maintenance Brachy ID Text Page.
2. Enter cstandem1 in the Catheter Template ID field.
3. Click DONE. XiO displays the Catheter Template Parameters Text Page.
4. Click your middle mouse button in the Load Method field and select
Unstructured. Refer to the XiO Help for definitions of the various
options.
5. Click DONE. XiO displays the Catheter Template Edit Text Page.
6. Select Geometry.
7. Click your middle mouse button in the Sampling Method field and select
the Continuous Tracking option. Refer to the XiO Help for definitions of
the various options.
8. DO NOT make an entry in the Total Length field; leave it blank.
NOTE: By leaving this field blank, the total length of the template can
vary.
9. Click DONE. XiO displays the Catheter Template Edit Text Page.
10. Click the Source Loading button. XiO displays the Catheter Template
Unstructured Text Page.
11. Click the Insert Gap button seven (7) times. XiO displays the fields for
seven gap positions for which content can be entered.
12. Click DONE. XiO displays the Catheter Template Edit Text Page.
13. Click the CANCEL button five times to return to the Main XiO Menu.


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XiO Training Guide
Gynecological Brachytherapy Implant
Task 5. Create a New Patient
Use the steps described in this task to enter the demographic information of a
new brachytherapy patient.

1. Click the Patient File Maintenance (PFM) option on the XiO Main
window. XiO launches the PFM module.
2. Click the File drop-down menu and select the New and Patient options.
XiO displays the New Patient dialog box, where you enter the patients
demographic data.
3. Enter BrachyTutorial in the Patient ID field.
4. Enter the patients name. In this exercise, use Brachy Tutorial.
5. Enter Female in the Sex field.
6. Click the drop-down arrow in the Create field and select the No Studyset
option from the list.
7. Click OK.
8. Click the File drop-down menu and select the Exit option. XiO returns you
to the main XiO window.

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Gynecological Brachytherapy Implant
Task 6. Create a New Treatment Plan
In this task, you will create a new brachytherapy treatment plan.
1. Select the Brachytherapy option on the XiO main window.
2. Click the New Treatment Plan button. XiO displays the Patient ID text
page.
3. Click your middle mouse button in the Patient ID field and select
BrachyTutorial.
4. Click DONE. XiO displays the Treatment Subplan Type Menu.
5. Click your middle mouse button in the Planning Mode field and select
Treatment.
6. Click DONE.
7. Do not enter a value in the Studyset ID field. Leave this field blank.
8. Click DONE.
9. Click your middle mouse button in the Anatomy View Towards field and
select the head option.
10. Click DONE. XiO displays the F2 Source Text Page. This positions you
to work on the next task.

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XiO Training Guide
Gynecological Brachytherapy Implant
Task 7. Digitize Ovoid Source
In this exercise, you will reconstruct the ovoid sources as single sources. You
will also reconstruct the tandem sources using a tandem catheter.

1. Click the Tablet Entry button.
2. Click your middle mouse button in the Algorithm field and select Ortho
(Geo). Refer to the XiO Help for definitions of the various options.
3. Enter 135 in the AP film SFD (cm) field.
4. Enter 135 in the LAT film SFD (cm) field.
5. Click DONE. XiO displays a system message reminding you how to orient
the films on the tablet.
6. Click the Acknowledge button. XiO displays the Brachytherapy Orient
Tablet text page.
7. Place the drawing labeled FIGURE AP_GYN on the left side of the
tablet, and the drawing labeled FIGURE LAT_GYN on the right side of
the tablet.
NOTE: The two drawings are replications of two orthogonal simulator
films, AP and Lateral.
8. Click the Enter Point button on the transducer with the cross hairs on the
AP film axis.
NOTE: Instructions for using the transducer are also provided in the
Text Area.
9. Click the Enter Point button on the transducer with the cross hairs on the
AP film + axis.
10. Click the Enter Point button on the transducer with the cross hairs on the
AP film origin axis.
11. Click the Enter Point button on the transducer with the cross hairs on the
LAT film - axis.
12. Click the Enter Point button on the transducer with the cross hairs on the
LAT film + axis.
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Gynecological Brachytherapy Implant
Task 7. Digitize Ovoid Source (cont.)
13. Click the Enter Point button on the transducer with the cross hairs on the
LAT film origin axis.
NOTE: When all six points in Steps 8 through 13 have been digitized,
XiO displays the Tablet Sources Add text page.
14. Click your middle mouse button in the Source Template ID column and
select CS137CMS15 source.
NOTE: If you need to edit the calibration strength, you can do so now
if the source is not locked in Source File Maintenance.
15. Click the Enter Point button on the transducer with the cross hair on the
TIP1 marker. The marker is located on the tip of the first ovoid source on
the AP film.
16. Click the Enter Point button on the transducer with the cross hair on the
END1 marker. The marker is located on the end of the first ovoid source
on the AP film.
17. Click the Enter point button on the transducer with the cross hair on the
TIP1 marker. The marker is located on the tip of the first ovoid source on
the LAT film.
18. Click the Enter point button on the transducer with the cross hair on the
END1 marker. The marker is located on the end of the first ovoid source
on the LAT film.
19. Click the Enter Point button on the transducer with the cross hair on the
TIP2 marker. The marker is located on the tip of the second ovoid source
on the AP film.
20. Click the Enter Point button on the transducer with the cross hair on the
END2 marker. The marker is located on the end of the second ovoid
source on the AP film.
21. Click the Enter Point button on the transducer with the cross hair on the
TIP2 marker. The marker is located on the tip of the second ovoid source
on the LATfilm.
22. Click the Enter Point button on the transducer with the cross hair on the
END2 marker. The marker is located on the end of the second ovoid
source on the LAT film.
XiO 15-13
Gynecological Brachytherapy Implant
XiO Training Guide
Gynecological Brachytherapy Implant
Task 8. Define Tandem Sources
A catheter in XiO is a container with one end closed. You can define a catheter
in XiO using several methods. In this procedure, you will use the unstructured
method to allow flexibility in placing sources.
1. Select local function F3 Catheters. XiO displays the Brachytherapy
Catheter text page.
2. Click the Tablet Entry button. XiO displays the Brachytherapy Tablet
Parameters Text Page.
3. Click DONE. XiO displays the Catheter Tablet Add Text Page.
4. In the Catheter Template field, select the cstandem defined in Source File
Maintenance. XiO displays the Catheter Edit Text Page.
5. Select Source Loading. XiO displays the Brachytherapy Catheter
Unstructured Text Page.
6. Click your middle mouse button and select CS137CMS15 for the first
position. The sources are loaded from the tip (closed end) of the tandem to
the end (open end).
7. Enter a gap of 0.25 cm in the second position in the Len Column,
8. Select CS137CMS10 for the third position.
9. Repeat steps 7 and 8 for the fourth and fifth positions.
10. Click DONE. XiO displays the Catheter Edit Text Page.
11. Click CANCEL. XiO displays the Catheter Tablet Add Text Page.
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Gynecological Brachytherapy Implant
Task 9. Digitize the Tandem
In this exercise, you will digitize the tandem on the AP and LAT films for use in
planning. By digitizing the catheter, you are creating a virtual tube in which to
place sources. It is important that you begin digitizing the catheter at the same
point on both films; for example the tip of the catheter or the tip of the first
source. XiO uses these point coordinates as the starting point to place sources
inside the catheter. If you begin digitizing at the tip, you will want to create a
spacer in you catheter loading (in XiO) equal to the distance from the tip of the
catheter to the tip of the first source.

1. To digitize the AP tandem catheter, click the Enter Point button on the
digitizer controller at discrete points along the tandem. Start at the tip of
the first source and proceed down the catheter.
2. Use more points in curved sections and fewer points in straight sections,
starting at the top (closed end) and working your way toward the open end.
3. Click the {9} button on the transducer. This ends the digitization of the
tandem catheter on the AP film.
4. To digitize the LAT tandem catheter, click the Enter Point button on the
transducer at discrete points along the tandem. Once again, start at the tip
of the first source and proceed down the catheter.
5. Use more points in curved sections and fewer points in straight sections,
starting at the top (closed end), and working your way toward the open end.
6. Click the {9} button on the transducer. This ends the digitization of the
tandem catheter on the LAT film.

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XiO Training Guide
Gynecological Brachytherapy Implant
Task 10. Digitize Interest Points for Dose Calculations
In this exercise, you will digitize points of interest into the computer for dose
analysis to critical organs.
1. Click the F4 Points local function button. XiO displays the Brachytherapy
Points Menu Text Page.
2. Click the Tablet button under Interest Point Localization Methods. XiO
displays the Brachytherapy Tablet Parameters Text Page.
3. Click DONE. XiO displays the Brachytherapy Tablet Add Points Text
Page.
NOTE: You do not have to re-orient the films unless they have moved
since digitizing the sources and tandem catheter.
4. Enter the word Bladder in the Description field; then, click the Enter key
on your computer keyboard.
5. Click the Enter Point button on the transducer with the cross hair on the
point labeled BLADDER on the AP film (FIGURE AP_GYN).
6. Click the Enter Point button on the transducer with the cross hair on the
point labeled BLADDER on the LAT film (FIGURE LAT_GYN).
7. Enter the word Rectum in the Description field; then, click the Enter key
on your computer keyboard.
8. Click the Enter Point button on the transducer with the cross hair on the
point labeled RECTUM on the AP film (FIGURE AP_GYN).
9. Click the Enter Point button on the transducer with the cross hair on the
point labeled RECTUM on the LAT film (FIGURE LAT_GYN).
10. Click CANCEL. XiO displays the Brachytherapy Points Menu Text page.

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Task 11. Digitize Markers for Automatically Calculating
Points A and B
Use these procedures to digitize markers for automatically calculating Points A
and B and for defining the best-fit oblique plane.
1. Under the Marker Localization Methods heading, select Tablet.
2. Click DONE. XiO displays the Brachytherapy Tablet Add Points Text
Page.
3. Enter External OS in the Description field; then, click the Enter key on
your computer keyboard.
4. Click the Enter Point button on the transducer with the cross hair on the
point labeled External OS on the AP film (FIGURE AP_GYN).
5. Click the Enter Point button on the transducer with the cross hair on the
point labeled External OS on the LAT film (FIGURE LAT_GYN).
6. Enter Midline in the Description field; then, click the Enter key on your
computer keyboard.
7. Click the Enter Point button on the transducer with the cross hair on the
point labeled Midline on the AP film (FIGURE AP_GYN).
8. Click the Enter Point button on the transducer with the cross hair on the
point labeled Midline on the LAT film (FIGURE LAT_GYN).
9. Enter Ovoid1 in the Description field; then, click the Enter key on your
computer keyboard.
10. Click the Enter Point button on the transducer with the cross hair on the
point labeled Ovoid1 on the AP film (FIGURE AP_GYN).
11. Click the Enter Point button on the transducer with the cross hair on the
point labeled Ovoid1 on the LAT film (FIGURE LAT_GYN).
12. Enter Ovoid2 in the Description field; then, click the Enter key on your
computer keyboard.
13. Click the Enter Point button on the transducer with the cross hair on the
point labeled Ovoid2 on the AP film (FIGURE AP_GYN).
14. Click the Enter Point button on the transducer with the cross hair on the
point labeled Ovoid2 on the LAT film (FIGURE LAT_GYN).
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XiO Training Guide
Gynecological Brachytherapy Implant
Task 11. Digitize Markers for Automatically Calculating
Points A and B (cont.)
15. Enter Tandem in the Description field.
16. Click the Enter key on your computer keyboard.
17. Click the Enter Point button on the transducer with the cross hair on the
point labeled Tandem on the AP film (FIGURE AP_GYN).
18. Click the Enter Point button on the transducer with the cross hair on the
point labeled Tandem on the LAT film (FIGURE LAT_GYN).
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Task 12. Position Markers for Defining Points A and B
XiO automatically places points A and B for you. In this task, you will select the
correct markers and catheter.
1. Click the F8 Calc Param button. XiO displays the Calculation Parameters
Text Page.
2. Under Dose Specification, click the Point A and B option.
3. Select Arc Length in the Tandem Tracing Method field. Refer to the XiO
Help for definitions of the various options.
4. Select the External OS marker in the External OS field. One (1) is the Marker
No. 1.
5. Select the Midline Marker in the Midline field. Two (2) is Marker No. 2.
6. Select Catheter in the Tandem type field. Points A right/left and B
right/left are automatically positioned and added to the treatment plan as
interest points for later dose calculations.
7. Click DONE. XiO displays the Calculation Parameters Menu.
8. Under the Ref. Fram Translation column, select Auto Center All. This
centers the implant relative to the CAX of the films and the implant in the
Graphics Area.
9. Under the Calculation Parameters column, select Calculation Mode.
10. Under the Calculation Mode column, select Volume.
11. In the Parameters to specify field, select grid spacing.
12. Enter 0.1 in the Distance between calculation points field. The default is
0.1.
13. Enter 4 in the Calculation Volume Margin (cm) field.
14. Select Auto Fit Volume Size and Center. This centers the calculation
volume about the extents of the sources and tandem.
15. Click DONE. XiO displays the Calculation Parameters Menu.
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Task 13. Create a Best-fit Oblique Plane and Sagittal and
Transverse Views of the Implant
In this task, you will create a best plane through the implant and setup transverse
and sagittal views for better visualization of the implant.
1. Click the F10 Graphics button. XiO displays the Graphics menu. The
default display for XiO Brachytherapy is four subwindows. In this
procedure, you will keep four subwindows, but change the views.
2. Press the spacebar with the cursor in the View fields in each subwindow.
3. Click the Update Graphics Display button. This clears each of the
existing subwindows.
4. Enter the following information in sub-window 1:

View: SPV
Orient: Obl
5. Enter the following information in sub-window 2:

View: MPV
Orient: Blank
6. Click the Update Graphics Display button. XiO defines the oblique plane
in Subwindow 1.
7. In the first Pt. ID field under Central Plane Specification Points, enter the
marker with the description Ovoid1.
8. In the second Pt. ID field under Central Plane Specification Points, select
the marker with the description Ovoid2.
9. In the third Pt. ID field under Central Plane Specification Points, enter the
marker with the description Tandem. The oblique plane now intersects
both avoid sources and the tandem.
10. At the Stack Label field, enter Coronal.
11. Select Apply.
12. Click DONE. XiO displays the Graphics Menu.
13. Select Object On/Off. XiO allows you to change some display
parameters.
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Task 13. Create a Best-fit Oblique Plane and Sagittal and
Transverse Views of the Implant (cont.)
14. Turn On the Patient Orientation icon. XiO displays the patient icon on
each of the subwindows.
15. Change the View Mode to Complex. XiO changes the mode from simple
to complex.
16. Click CANCEL.
17. Enter the following information for subwindow 3:

View: SPV
Orient: SAG
Ref (cm): 0.0
18. Enter the following information for subwindow 4:

View: SPV
Orient: Tran
Ref (cm): 0.0
19. Select Update Graphics Display. XiO displays the new transverse plane
in subwindow 4.
20. Movie through any transverse, sagittal or oblique image to display a
different plane.
21. Scale each subwindow to gain the best view.

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Task 14. Calculate Dose
In this task, you will display dose and set up the dose prescription.
1. Click the global function SF4 DISPDOSE button. XiO calculates and
displays the doses.
2. Select Modify List. XiO displays the Isodose List Text Page. This page
allows you to enter appropriate dose rate isodose lines.
3. In the first four fields, enter 65, 40, 30, and 20. Should you choose to do
so, you can also change colors and/or rendering.
NOTE: You also have the ability to select a predefined isodose list if
you have created one for brachytherapy doses. See the
Preferences section of this training guide for more information
about creating predefined isodose lists.
4. Click DONE.
5. Click the local function F3 PointIndx button. XiO displays the Point
Index Menu Text Page.
6. Click the Interest Point Dose button. XiO displays the doses to the
interest points.
7. Click Quit.
8. Click the local function F4 DosePrescr button. XiO displays the
Brachytherapy Non-Uniform Dose Prescription Text Page.
9. Enter the following information:

Prescribed to: Isodose Line
Line (cGy/hr): 60
10. At the Prescribed Dose field, enter 3000. XiO calculates treatment duration
in days, hours, and minutes.
11. Click DONE.
12. Click QUIT.
13. Review the dose information; then, click the Quit button when finished.
14. Click the Dose Display Using button. XiO toggles between displaying
dose rate and dose. Edit isodose lines as necessary.
15-22
Gynecological Brachytherapy Implant
XiO Training Guide

Gynecological Brachytherapy Implant
Task 15. (Optional) Edit/Delete Sources and Catheters
If you would like to edit or delete sources after the plan has been calculated, here
are some optional steps to edit or delete groups of sources, individual sources, or
catheters.

1. Click the SF3 Editplan button.
2. To edit or delete sources, click the F2 Sources button.
3. To edit or delete catheters, click the F3 Catheters button..
Sub-task 1. Edit a Group of Sources
Use these steps to edit a group of sources. Sources lock status must be Unlocked
to edit them as a group. See the section Create a Source Template for more
information on lock status.

1. These steps demonstrate how to edit the Calibration Date, Calibration
Strength or Dwell Time for a group of sources.
2. To edit a group of sources, click the F2 Source button; then, click Source
Index to see the list of sources that are available to edit.
3. Click Quit to close the index.
4. To edit Calibration Dates, Calibrations Strengths and Dwell Time Weights
for a group of sources, click Group Edit.
5. Enter the range of sources you would like to edit, example, 1-2; then, select
one of the three group edit options: Calibration Dates, Calibrations,
Strengths, or Dwell Time Weights.
6. Enter the new information; then, click Done.
7. Enter the range of sources again and select another group edit option or
Click the SF4 Dispdose button to begin calculating.
XiO 15-23
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XiO Training Guide
Gynecological Brachytherapy Implant
Task 15. (Optional) Edit/Delete Sources and Catheters (cont.)
Sub-task 2. Edit One Source
These steps demonstrate how to edit all characteristics of an individual source.
1. To edit one source, click the Keyboard Entry button.
2. Under Mode, select Edit/Delete Sources.
3. Click your middle mouse button in the Source Number field and select the
source you want to edit. XiO displays the source Characteristics
4. Make the necessary edits; then, the click Apply Edits button.
5. Select a different Source Number if you would like to edit an additional
source.

OR

Click the SF4 Dispdose button to begin calculating.
Sub-task 3. Delete a Group of Sources
Use these steps to delete a group of sources. Sources lock status must be
Unlocked to delete them as a group. See the section Create a Source Template
for more information on lock status.
These steps demonstrate how to delete a selected group of sources.
1. To delete a group of sources, click the Source Index to see the list of
sources that are available to delete.
2. Click Quit to close the index.
3. Click Group Delete.
4. Enter the range of sources you would like to delete, example, 1-2.
5. Click Done.
6. If you are sure you want to delete the selected sources, answer Yes to the
question "Are You Sure?"
7. Click Done.
8. Add new sources.
OR

Click the SF4 Dispdose button to begin calculating with the selected
sources deleted.
15-24
Gynecological Brachytherapy Implant
XiO Training Guide

Gynecological Brachytherapy Implant
Task 15. (Optional) Edit/Delete Sources and Catheters (cont.)
Sub-task 4. Delete One Source
These steps demonstrate how to delete an individual source.
1. To delete one source, click the Keyboard Entry button.
2. Under Mode, select Edit/Delete Sources.
3. Click your middle mouse button in the Source Number field and select the
source you want to delete.
4. Click the Delete Source button to delete that individual source.
5. Select another source to delete.
OR

Click the SF4 Dispdose button to begin calculating with the selected source
deleted.
Sub-task 5. Edit the Sources in a Group of Catheters
These steps demonstrate how to edit the source loading for a group of catheters.

1. To edit sources in a group of catheters, click the Catheter Index to see the
list of catheters that are available to edit.
2. Click Quit to close the index.
3. Click Group Edit.
4. Enter the range of catheters you would like to edit, example, 1-2.
5. Click Done. XiO displays the Edit Catheter page.
6. Make the necessary edits; then, click Done.
7. Click the SF4 Dispdose button to begin calculating.

XiO 15-25
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XiO Training Guide
Gynecological Brachytherapy Implant
Task 15. (Optional) Edit/Delete Sources and Catheters (cont.)
Sub-task 6. Edit Sources in One Catheter
These steps demonstrate how to edit source in an individual catheter.
1. To edit one source, click the Keyboard Entry button.
2. Under Mode, select Edit/Delete Catheter.
3. Middle Mouse in the Catheter Number field and select, with a left mouse
click, the catheter you want to edit.
4. Edit Catheter Coordinates if necessary and click Apply Edits

OR

Click Edit Catheter Characteristics to edit General Parameters,
Geometry or Source Loading.
5. Click Done after edits have been made.
6. Click the SF4 Dispdose button to begin calculating.
Sub-task 7. Delete a Group of Catheters
These steps demonstrate how to delete a group of catheters.
1. To delete a group of catheters, click the Catheter Index to see the list of
catheters that are available to delete.
2. Click the Quit button to close the index.
3. Click Group Delete.
4. Enter the range of sources you would like to delete, example, 1-2.
5. Click Done.
6. If you are sure you want to delete the selected catheters, answer Yes to the
question "Are You Sure?"
7. Click Done.
8. Add new catheters.

OR

Click the SF4 Dispdose button to begin calculating with the selected
catheters deleted.
15-26
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XiO Training Guide

Gynecological Brachytherapy Implant
Task 15. (Optional) Edit/Delete Sources and Catheters (cont.)
Sub-task 8. Delete One Catheter
These steps demonstrate how to delete an individual catheter.
1. To delete one catheter, click the Keyboard Entry button.
2. Under Mode, select Edit/Delete Catheter.
3. Click your middle mouse button in the Catheter Number field and select the
catheter you want to delete.
4. Click the Delete Catheter button to delete that individual catheter.
5. Select another catheter to delete.
OR
Click the SF4 Dispdose button to begin calculating with the selected
catheter deleted.

XiO 15-27
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XiO Training Guide
Gynecological Brachytherapy Implant
Task 16. Plot Brachytherapy Plan
In this task, you will plot a brachytherapy plan.
1. Click the global function SF7 Plot.
2. Select Single-window format.
3. Click DONE. XiO plots the active SPV.

15-28
















Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A
Practice Exercise
This plan illustrates how to use the XiO Brachytherapy preplanning feature.
Once you have completed this lesson, you will be familiar with the procedures to
complete the following tasks:
x Create a source type
x Create a source template
x Create a preplanning prostate template
x Enter patient data
x Enter data about cross sections
x Start the creation of new treatment pre-plan
x Modify graphics
x Define preplanning parameters
x Edit sources
x Enter calculation parameters
x Assign dose prescription
x Print the pre-plan report

XiO 16-1
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
This task walks you through creating a brachytherapy source type. By creating a
source type, you are simply entering the physical characteristics of a particular
kind of source, such as Iodine, Palladium, Iridium, etc. These physical
characteristics do not often change and only need to be entered once, or edited
when the vendor notifies you of some change.
WARNING

All suggested parameters used in this training lesson are to be
used for training purposes only. When you are creating source
types in your clinic, verify the necessary parameters with the
source vendor before validating.
Sub-task 1. Enter General Parameters
1. Select Source File Maintenance on the XiO Main Menu window.
2. Select Brachytherapy.
3. Select Source Type Editor.
4. Enter the Source Type ID I125training.
5. Click DONE.
6. Enter I125 as the Isotope.
7. Select Days for the Half Life Units.
8. Enter 59.4 for the Half Life.
9. Select Linear for the seed-source Geometry. If you choose linear here, you
can choose later to use it as a linear or a seed source. If you choose seed
here, you will be limited to the source being a seed-only source.
10. Enter U (air-KERMA) for the Units of Strength.
11. Enter 0.45 (cm) for the Physical Length.
12. Enter 1 for the number of subsources.
16-2
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
Sub-task 1. Enter General Parameters (cont.)
Once you have entered the number of subsources, XiO requires you to enter the
subsource tip, subsource end, and relative strength. See XiO Help for more
information.
13. Subsource Tip: 0.075 (cm).
14. Subsource End: 0.375 (cm).
15. Relative Strength: 1.0.
16. Click Done when finished entering all values.
17. On the main entry page for this source, you can now verify that the General
Parameters have been entered. Under the heading "Complete," you should
see the word "yes." There is no validation required for the General
Parameters.
Sub-task 2. Enter the Radial Dose Function information for the
TG43 Data
1. Select Radial Dose Function under the TG43 Data heading.
2. Enter 0.5 (cm) for the Minimum Radius.
3. Enter 7.0 (cm) for the Maximum Radius.
4. Enter 14 for the Number of Radii.
5. There are three methods to generate the Radial Dose Table. In this
example, use the Direct Entry of New Table. Refer to the XiO Help for
more information about the other methods.
XiO 16-3
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
Sub-task 2. Enter the Radial Dose Function information for the
TG43 Data (cont.)
6. For each Radius (cm), enter the following values:
Radius Value
0.5 1.04
1.0 1.0
1.5 0.926
2.0 0.832
2.5 0.731
3.0 0.632
3.5 0.541
4.0 0.463
4.5 0.397
5.0 0.344
5.5 0.300
6.0 0.264
6.5 0.233
7.0 0.204

Once the values have been entered, you are able to see a graphical representation
of the Radial Dose Table. This graph can be edited manually by placing the
mouse cursor over the nodes on the graph, holding down your left mouse button,
and dragging the node. The value updates in the table.
7. When you have completed the entry of values for the Radial Dose Table,
click Done.
8. You now have three options.
(1) You can edit the Radial Dose Function.
(2) Edit the Radial Dose Table
(3) Display/Validate the Radial Dose Table.

For this task, select Display/Validate the Radial Dose Table.
9. When you select this option, the table displays once again for you to review
and verify. Click Quit to close the display box.
10. Select Validate to validate the table.
16-4
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
Sub-task 2. Enter the Radial Dose Function information for the
TG43 Data (cont.)
11. XiO displays warning and again asks if you would like to Validate the
table? Answer yes (default); then, click Done.
12. Click Cancel to go back to the main entry page for this source.
13. You can now verify that the Radial Dose Function information has been
entered and Validated. Under the headings "Complete" and "Validated,"
you should see the word "yes."
Sub-task 3. Enter the Anisotropy Function information for the
TG43 Data
1. Select Anisotropy Function under the TG43 Data heading.
2. Enter 1.0 (cm) for the Minimum Radius.
3. Enter 7.0 (cm) for the Maximum Radius.
4. Enter 7 for the Number of Radii.
5. 0 (deg) defaults as the Minimum Angle.
6. Enter 90 (deg) for the Maximum Angle.
7. Enter 10 for the Number of Angles.
8. To create the Anisotropy Table, use the Direct Entry of a New Table
method.
9. Enter the following values in the Anisotropy Factor table:
Radius
Angle 1.0 2.0 3.0 4.0 5.0 6.0 7.0
0 .350 .439 .452 .521 .573 .581 .603
10 .423 .549 .529 .582 .600 .621 .660
20 .628 .690 .612 .688 .681 .718 .758
30 .826 .816 .754 .798 .793 .803 .829
40 .953 .903 .888 .842 .888 .826 .861
50 1.00 .954 .795 .866 .903 .891 .922
60 1.03 1.00 .877 .935 .922 .912 .932
70 1.04 1.06 1.07 .969 .915 .953 .978
80 1.02 1.04 1.07 .998 .985 .962 .972
90 1.00 1.00 1.00 1.00 1.00 1.00 1.00
XiO 16-5
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
Sub-task 3. Enter the Anisotropy Function information for the
TG43 Data (cont.)
Once the values have been entered, you are able to see a graphical representation
of the Anisotropy Table. You can edit this graph manually by placing your
mouse cursor over the nodes on the graph, holding down the left mouse button,
and dragging the node. The value updates in the table.
1. When you complete the entry of values for the Anisotropy Table, click
Done.
2. You now have three options:
(1) You can Edit the Anisotropy Function.
(2) Edit the Anisotropy Table.
(3) Display/Validate the Anisotropy Table.

For this task, select Display/Validate the Anisotropy Table.
3. When you select this option, XiO displays the table again so that you can
review and verify. Use the Page-Up/Page-Down options to review the
entire table, and/or Click Quit to close the display box.
4. Select Validate to validate the table. XiO again displays a warning
message asking you if you would like to validate the table?
5. Answer yes (default); then, click Done.
6. Click Cancel to go back to the main entry page for this source.
7. Verify that the Anisotropy Function information has been entered and
validated. Under the headings "Complete" and "Validated," you should see
the word "yes."
16-6
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type (cont.)
Sub-task 4. Enter the Dose Rate Function information for the TG43
Data
1. Select Dose Rate Function under the TG43 Data heading.
2. Enter the dose rate constant ((cGy/hr)/U) Mantissa as 8.8 and the exponent
as 1.
3. Enter 0.0 (1/cm) for the Attenuation coefficient to extend radial dose table.
4. Click Done when you have completed entering the Dose Rate Function
information. XiO returns you to the main entry page for this source.
5. You can now verify that the Dose Rate Function information has been
entered. Under the heading "Complete," you should see the word "yes."
There is no validation required for the Dose Rate Function.
Sub-task 5. Enter the Dose Rate Parameters and Create Dose Rate
and Seed Equivalent Tables
1. Select Dose Rate Parameters close to the bottom of the main entry screen.
2. Enter 0.16 (cm) for the Minimum Radius.
3. Enter 0.5 (cm) for the Midpoint Radius.
4. Enter 10 (cm) for the Maximum Radius.
5. Enter 150 for the Number of Radii from Minimum to Midpoint.
6. Enter 150 for the Number of Radii above Midpoint to Maximum.
7. Enter 101 for the Number of Angles.
8. If you would like to create this source to be used as a seed source or a linear
source, select yes for the option to Calc seed equivalent dose rate. For this
task, choose yes.
9. Click Done when you are finished entering the Dose Rate Parameters.
XiO 16-7
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 1. Create a Source Type
Sub-task 5. Enter the Dose Rate Parameters and Create Dose Rate
and Seed Equivalent Tables (cont.)
10. To generate the Dose Rate Table, click Cancel to go back one page.
11. Select the option Generate Dose Rate Table.
12. Read and Acknowledge the warning message.
13. Click Done to generate the TG43 Dose Rate Table. XiO displays a yellow
message once the table is successfully calculated. Read and Acknowledge
this message.
14. Next, you must Validate the Dose Rate Table. Select Validate from the
menu options. XiO displays a warning message. Read and Acknowledge
this message.
15. Review the table using the Page-Up/Page-Down button. Click Quit when
you are finished reviewing. If you have created a seed table (as you did in
this task), you must click Quit twice to close both tables.
16. Select Validate to validate the table. XiO displays a warning message and
asks you if you would like to Validate the table. Answer yes (default);
then, click Done.
17. Select Enter/Edit.
18. You can now verify that the Dose Rate Table and Seed Equivalent Table
has been created and Validated. Under the headings "Complete" and
"Validated," you should see the word "yes" for these two tables. There is
no validation required for Dose Rate Parameters.
19. Once you are finished, click Cancel three (3) times to go back to the
Brachytherapy Source and Catheter Editor page.
16-8
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A


Task 2. Create a Source Template
This task walks you through creating a source template. Once a source type has
been created, templates can be created for each activity or planning geometry
(linear/seed).
1. Select Source Template Editor.
2. Enter in the Source Template ID, I125CMS.
3. Click Done.
4. Select the Source Type ID, I125training
5. Enter 1.0 (U) for the calibration strength, and enter todays date and 8:00
for the calibration date and time. Note the date format is as follows: Dec 31
2003.
6. Seed sources are generally left as unlocked sources. Leaving a source
unlocked allows you the flexibility to edit the source strength while you are
in the planning process or when you know the actual ordered source
strength. The locked status is usually used for sources that you have in
your inventory that have long half-lives, and the calibration date needs to
remain static. In this task, set the source to be Unlocked.
7. You also have the choice of linear or seed planning geometry.
NOTE: Linear Planning incorporates anisotropy factors where Seed
Planning will not.
In this task, choose Seed for the Planning Geometry.
8. Click Done when you are finished entering Source Template information.
9. If you would like to edit, duplicate, or delete this template, optional
functions are now available; otherwise, click Cancel several times to go
back to the main XiO screen.


XiO 16-9
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 3. Create a Preplanning Prostate Template
Before you plan a prostate for the first time, you must create a template. Once
you create the template, it can be used repeatedly.
1. Click the Settings drop-down menu and select the Patient Data and
Prostate Template options. XiO displays the Prostate Template ID dialog
box.
2. Enter john1 in the Prostate Template ID: field.
3. Click OK.
4. Enter the following values:

Column Spacing (cm): 0.5
Row Spacing (cm): 0.5
Number of Columns: 13
Number of Rows: 12
5. Click OK. XiO displays the Prostate Template Column Labels dialog box.
6. Enter the letters A through M in boxes 1 through 13 for column labels.
These labels run left to right on the template.
7. Click OK. XiO displays the Prostate Template Row Labels Text Page.
8. Enter the numbers 0 through 11 in boxes 1 through 12 for row labels.
These labels run from bottom to top on the template.
9. Click OK. XiO displays the Prostate Template ID Text Page. This
completes the process to create a prostate template.
10. Click CANCEL. XiO displays the main system window.
16-10
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 4. Enter Patient Data
In this task, enter the demographic information of a new prostate brachytherapy
plan.
1. Select the Patient File Maintenance option on the XiO main window.
XiO launches the Patient File Maintenance module.
2. Click the File drop-down menu and select the New and Patient options.
XiO displays the New Patient dialog box allowing you to enter the patients
demographic data.
3. Enter the following values:
Patient ID: John
Patient Name: John
Sex: Male

4. From the Create list, select Nonimaged Studyset.
5. Click OK. XiO opens the New Non-Image Based Studyset Definition
dialog box.
6. Enter prostemp in the Studyset ID: field.
7. Enter pre-plan in the Studyset Description: field.
8. Select Yes in the prostate preplanning field.
9. Click your middle mouse button in the Prostate Template ID field and
select john1 from the list of templates. You created the john1 template in
Task 1 of this lesson.
10. Enter 0.0 to -3.5 in the Cross section reference distance positions (cm)
field, and put 0.5 in the Step (cm) field.
11. Click OK.
XiO 16-11
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 5. Enter Data about Cross Sections
This task illustrates where to enter contour names and digitize those contours into
XiO.
1. Click the Edit drop-down menu and select the Contour Names and Type
in Contour Names options. XiO opens the Edit Contour Definition dialog
box. This is where you add contour names to a patient that are not
contained in the predefined anatomy list. Contours added here are added to
the user-defined list.
2. Enter the following values:
Name: Prostate
Relative Density: 1.0
3. Click OK. XiO saves your entry and redisplays the Edit Contour Definition
dialog box.
4. Enter the following values:
Name: Urethra
Relative Density: 1.0
5. Click OK.
6. Click CANCEL.
7. On the Contouring toolbar, click the Trace Contours Using the Tablet
(F6) button. XiO opens the Orient the Tablet dialog box.

16-12
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 5. Enter Data about Cross Sections
8. Verify that the reference distance for the starting contour is 3.5. You may
need to press {8} to switch to previous cross section, or {9} to switch to
next cross section on the tablet keypad to move to cross section reference
distance 0.5.

9. Read and acknowledge the yellow warning message.
10. Orient the tablet according to the instructions on the dialog box.
11. After the axis is oriented, right-click in the Single Plane View and click
Scale in the shortcut menu.
12. Drag toward the right-hand side of the XiO screen to scale up, (increasing
the viewing magnification).
13. Change to the user-defined group from the Group list by pressing {5} one
or more times on the tablet keypad.
14. Change to the Prostate contour name form the Contour list by pressing {6}
one or more times on the tablet keypad.
15. Click the Start Contour button.
16. Enter Points on the prostate contour by pressing the Enter Point button on
the digitizer keypad; then, press the End button to close.
XiO 16-13
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 5. Enter Data about Cross Sections (cont.)
17. Press {6} on the digitizer keypad to change to the urethra.
18. Enter the urethra contour using the same process used to create the prostate
contour. XiO prompts you for the next slice to enter.
19. Press {9} switch to Next Cross Section on the tablet keypad to move to
cross section reference distance 3.0.
20. Press 1 on the tablet keypad to reorient the tablet axes.
21. Orient the film axes on the tablet by following the instructions on the
Orient the Tablet dialog box.
22. Repeat this process for the remaining reference distances.
23. When finished contouring all cross sections, press {4} End Tablet Entry
on the tablet keypad.
24. Click the File drop-down menu and select the Exit option.
25. If XiO displays the "Do you wish to save the patient data?" message, click
the Yes button.
Task 6. Start the Creation of New Treatment Pre-Plan
1. Select the Brachytherapy option on the XiO main window. XiO launches
the Brachytherapy module.
2. Select New Treatment Plan.
3. At Patient ID: field, select john.
4. Click DONE.
5. At the Planning mode: field, select planning. Refer to the XiO Help for
information on the various options.
6. Select DONE.
7. Click your middle mouse button at the Studyset ID: field and select
prostemp.
8. Click DONE two (2) times.
16-14
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 7. Modify Graphics
In this task, use the auto distribution function to automatically place seed sources
in even rows on alternating slices. This provides a good start to the preplan.
Sources can be added, edited, or deleted at any time.
1. Click on local function F10 Graphics.
2. Select Enhance contour.
3. Change contour for prostate to red and T50.
4. Change contour for urethra to yellow and T25.
5. Click DONE.
6. Select Object On/Off.
7. Turn the patient orientation icon to an On position.
8. Click CANCEL twice.
Task 8. Define Pre-Planning Parameters
1. At the Add/delete prompt, select autodistribution. When defining sources
in autodistribution, the first pass places sources on every other slice and in
every other column and row. The second pass places sources on slices,
rows, and columns skipped on the first pass.
2. At the source template ID prompt, select I125CMS.
3. At the Source strength prompts, enter 1.0.
4. At the Inclusion contour prompt, select prostate. This indicates where
sources should be placed.
5. At the Exclusion contour prompt, select urethra. This indicates where
sources should not be placed.
6. At the Cross section prompt, select 3.5. This is the most superior cross
section
7. At the Cross section interval prompt, enter 2. This designates every other
cross section.
XiO 16-15
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 8. Define Pre-Planning Parameters (cont.)
8. At the Starting Row prompt, enter 0.
9. At the Row interval prompt, enter 2. This designates every other row.
10. At the Starting column prompt, enter A.
11. At the Column interval prompt, enter 2. This designates every other
column.
12. Click Autodistribute.
13. Repeat the above steps with the following changes:
Starting cross sections: -3.0 (This is the second most superior cross section)
Cross section interval: 2.0
Starting row: 1
Row interval: 2
Starting column: B
Column interval: 2
14. Select Autodistribute. Note that you can rotate the MPV to review the
distribution of sources.
15. Click CANCEL.
16. If preferred, change to a nine-window format to see all the slices.
Task 9. Edit Existing Sources
1. At the Add/delete prompt, select sources.
2. Remove the sources/needles near the urethra by holding down the shift key
and clicking the middle mouse button on the cross section and source to be
removed. You can add a source by holding down the shift key clicking
your left mouse button on a cross section at a specific needle location.
3. Click CANCEL.
16-16
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 10. Enter Calculation Parameters
In this exercise, you will create a useable calculation grid for this implant.
1. Click on local function F8 Calc Parameters.
2. Select Calculation Mode.
3. At the Calc volume margin (cm) prompt, enter 2.0.
4. Select Auto fit volume size and center. XiO automatically creates a 2.0
(cm) margin in all three dimensions around the sources.
5. At the Parameters to specify prompt, change to Grid Spacing and then
change the distance between calculation points to 0.20 along width,
height, and depth.
6. Click DONE.
XiO 16-17
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 11. Assign Dose Prescription
In this exercise, you will calculate dose and evaluate the implant plan.
1. Click on global function SF4 DISPDOSE. XiO displays the local F1
Isocurve function.
2. Click Set Treatment Duration.
3. Click DONE. XiO recalculates the dose then displays a pop-up window
showing the source parameters
4. Review the parameters; then, click Quit to close.
5. Select Modify List to enter and view isodose lines in dose rate.
NOTE: You also have the ability to select a predefined isodose list if
you have created one for brachytherapy doses. See the
Preferences section of this training guide for more information
about creating predefined isodose lists.
6. Enter doses; then, click DONE.
7. Click the Dose Display Using button to toggle the view to Dose instead of
dose rate.
8. Select Modify list.
9. Enter 16,000 cGy to identify hotspots.
10. Add or remove sources as needed by clicking the SF3 Edit Plan button,
then the F6 Preplan button. (This process was covered earlier in this plan.)
16-18
Prostate Brachytherapy
XiO Training Guide
Prostate Brachytherapy Preplan A

Task 12. Print the Pre-plan Report
1. Click on global function SF7 Plot.
2. Print the pre-plan report. The report identifies sources per needle and
distance you need to pull needle back from the base of template. It also
tells you the slice number and needle position.

XiO 16-19
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Postplan B
Practice Exercise
This plan is designed to illustrate how to create a prostate seed implant post plan
using XiO. The patient with a prostate seed implant and I-125 seed sources has
already been entered for you.
Once you have completed this exercise, you will be able to execute the following
tasks:
x Create a prostate post plan
x Find seeds
x Review seed positions
x Calculate doses
x Plot plan

16-20
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Plan B

Task 1. Create a Prostate Post Plan
1. Select the Brachytherapy option on the XiO main window. XiO displays
the Treatment Subplan Description Page.
2. Select the New Treatment Plan option. XiO displays the Patient ID Text
Page.
3. Click your middle mouse button in the Patient ID field and select
ProstImplant.
4. Click DONE.
5. Click your middle mouse button in the Planning mode field and select
Planning.
6. Click DONE.
7. Click your middle mouse button in the Studyset ID field and select
postplan. This patient was scanned using 3 mm slices and implanted with
132 iodine 125 seeds.
8. Click DONE.
9. Click your middle mouse button in the Anatomy view towards field and
select head. Head is the default.
10. Click DONE. XiO displays the F2 Source Text Page.

XiO 16-21
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Plan B

Task 2. Find Seeds Using Automated Source Localization
The XiO Brachytherapy function has an automated source localization feature.
This task walks you through the steps to automatically locate seeds on a post-
plan CT.
1. Select the Automatic Entry option. XiO displays the Automatic Seed
Source Localization Text Page that allows you to use the Automated Source
Localization feature (algorithm).
2. Click your middle mouse button in the Source Template field and select
I125CMS. XiO recalls the source template. You can edit the calibration
data if needed.

This algorithm can only use sources designated as seed sources in the
planning geometry and will only list seed (not linear) sources in the index
for this field.
3. Click your middle mouse button in the Confine Search To field and select
Patient. This parameter confines the search volume for the algorithm.

Typically, the patient skin is sufficient and can be accepted as the default.
NOTE: Unusual patient conditions, such as titanium hip implants and
urethral contrast, can cause the algorithm to find false
positives outside of the intended treatment volume.
4. Enter 132 at the Actual number of seeds prompt. The algorithm uses this
parameter as a guide in finding the seeds in the patient studyset. It is not
guaranteed that the algorithm will return this number of seeds, but it will
generally be close. The number entered here should be independently
verified (usually by a radiograph) to account for any stray seeds in the
patient.
5. Click DONE. XiO starts the search process. Within a few seconds, XiO
begins adding seed sources to the plan and displaying them in the graphics
display. After the algorithm finishes searching, XiO displays the total
number of sources found.
16-22
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Plan B
Task 3. Review Seed Positions
Use this task to review seeds found using the automated tool. Make edits as
needed.
1. Click the F10 Graphics button. XiO displays the Graphics Menu.
2. Select Object on/off. XiO displays the Object On/Off text page.
3. Click the View mode to toggle from simple to complex. Simple view
displays seeds that fall directly on a given cross section. Complex view
displays these seeds and all other seeds in the range of one slice inferior and
one slice superior to the currently viewed slice.
4. Click Cancel twice to return to the Add/Delete Sources Edit window.
5. Click the Scale button to scale the image in the SPV window to gain the
best view.
6. Click the Movie button to review each cross section and verify the results
of the algorithm.
NOTES: Seeds that are on the current slice are represented by a green
circle.

Seeds that are superior to the current slice are represented by a
green circle with a plus + sign in the center.

Seeds that are inferior to the current slice are represented by a
green circle with a minus sign in the center.
XiO 16-23
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Plan B

Task 4. Calculate Dose and Evaluate the Implant
1. Click the SF4 DISPDOSE button. XiO calculates doses of the sources and
displays the Isocurve Menu.
2. Select the Set Treatment Duration option. XiO displays the
Brachytherapy Non-Uniform Dose Prescription text page.
3. Click your middle mouse button in the Implant type prompt and select
permanent.
4. Click DONE. XiO recalculates the total dose and displays the Source
Index.
5. Click QUIT. XiO displays the Isocurve Menu.
6. Click your left mouse button in the Display Dose Using: field and toggle to
dose. Click on the prompt to toggle between dose rate and dose.
7. Select Modify List under Isovalues. XiO displays the Isocurve List text
page.
8. Enter the isodose values. You can also change colors and rendering as
needed.
16-24
Prostate Brachytherapy
XiO Training Guide
Prostate Seed Implant Plan B
Task 5. Plot Plan
1. Click the SF7 PLOT button.
2. Select the Single window format.
3. Click DONE. XiO plots the window.

XiO 16-25



















DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs

Practice Exercise
A Digitally Reconstructed Radiograph (DRR) is an image computed from CT
data that simulates a traditional radiograph.
Radiographs generated by a treatment simulator are used routinely in radiation
therapy to provide volumetric gray scale beams eye view (BEV) information
about the location and densities of anatomical structures for a specific
beam/patient setup. When doing CT simulation, DRRs are used to replace
conventional simulation films. Small CT slice spacing, on the order of 1-3 mm,
produces the highest quality DRR images.
Simulation films (DRRs) are used to perform the following tasks:
x Visualize the target to verify the isocenter location or tumor position.
x Visualize the position and volumetric properties of target volumes and
normal structures to determine the appropriate beam arrangements and
field shaping.
x Visualize subtle details and high-contrast tissues characteristic of certain
types of cancerous or normal tissue, which can be discerned by
experienced physicians and physicists.
x Identify organ motion and verify positional stability of anatomical
structures.
x Compare with mega-voltage port films to verify patient setup.
To perform this exercise, you will need the following information:
x One image-based XiO patient
x One valid external photon or electron machine
x One output plotting device (laser printer will work)
Once you complete this exercise, you should understand the following concepts
and be able to execute the following tasks:
x Set up DRR defaults in Settings
x Verify CT to ED conversion for tissues
x Create DRR windows in XiO
x Use different image filters (sim, film, port film, etc.)
x Generate high-resolution DRRs
x Plot a DRR
x Plot a "life-size" DRR to life-size (magnified to source-to-film distance)
XiO 17-1
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs

Task 1. Set up DRR Defaults in Settings
1. Click the Settings drop-down menu and select the Plan Defaults and DRR
Calculation Defaults options. XiO Displays the DRR Calculation Defaults
dialog box.


2. Enter the Bone filter to correspond to a range of electron density values
from 1.10 to 2.00.
3. Under the Initial Image (Display) heading in the Cols: field, enter the initial
image number of columns to be 128.
NOTE: You want the initial DRR image to display very quickly
during planning so that you set the number of columns (i.e.,
the number of horizontal pixels) to be low, but sufficient for a
discernable image. The interpolation fills in the missing
pixels and decreases calculation time.
4. Click the drop-down arrow in the Interp: field and click Yes to enter the
Interpolation and sharpness for the initial image.
17-2
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 1. Set up DRR Defaults in Settings (cont.)
5. Under the Final Image (Display) heading in the Res: field, click the drop-
down arrow and set the final image number of the columns to be Auto.
NOTE: Auto allows the system to determine the number of columns
to be used, resulting in optimum sampling.
6. Under the DICOM Image heading in the Cols: field, set the columns to be
512, which sets the resolution used to construct the DRR.
NOTE: The higher the resolution, the higher the quality; however, the
time it takes to construct the DRR goes up as well. The
maximum resolution is 1024.
7. Click OK.
8. Click the Settings drop-down menu and select the Output and DRR
Printing Size options. XiO displays the DRR Size Defaults dialog box.

9. Click the drop-down arrow in the Output Device field and select
postscript.
10. Click the drop-down arrow in the Paper size field and select a paper size.
11. Enter a Default length of 10.00 cm.
12. Enter a Default width of 10.00 cm.
13. Click the Add Defaults button.
14. Click OK. Acknowledge the warning message.
NOTE: Later in this exercise when you generate the life size DRRs
(Task 7), you will adjust the lengths and widths.
XiO 17-3
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs

Task 2. Verify CT to ED Conversion
When you do a treatment plan, it is helpful to sample CT and electron density
values from the patient to verify that you have defined/chosen the correct CT-to-
ED conversion. This task illustrates an easy method of doing this. An incorrect
CT to ED file could lead to poor quality DRR images.
1. Select the Teletherapy option on the XiO main window. XiO launches the
teletherapy module.
2. Click the File drop-down menu and select the New Teletherapy Plan
option. XiO displays the New Teletherapy Plan dialog box.
3. Click your middle mouse button in the Patient ID field and select a Patient
that contains a studyset with at least 50 axial CT slices.
4. Click OK. XiO loads the CT images.
5. Click the Edit drop-down menu and select the Assigned Electron Density
option. XiO displays the Edit Assigned Electron Density dialog box.


6. Click your middle mouse button in the CT Number to Relative Electron
Density Conversion File ID field: and select a CT to ED conversion file if
one has not been assigned.
7. Click OK.
17-4
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs

Task 2. Verify CT to ED Conversion for Tissues (cont.)
8. Click the Dose drop-down menu and select the Calculation and Settings
options. XiO displays the Dose Calculation Settings dialog box.

9. Click the drop-down arrow in the Heterogeneity field and select Yes.
10. Click the drop-down arrow in the Generate Enhanced DRRs: field and
select Yes.
NOTE: Enhanced DRRs are higher resolution DRRs used for film and
life-size printing.
11. In the Distance between Calculation Points fields, use the following
parameters for grid spacing.

Along Width (cm): 0.30
Along Height (cm): 0.30
Along Depth (cm): 0.30
12. Click OK.
XiO 17-5
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 2. Verify CT to ED Conversion for Tissues (cont.)
13. Click the View drop-down menu and select the Window Format option.
XiO displays the Window Format dialog box.

OR

Press the W key on your keyboard.

14. Click the drop-down arrow in the Window Format field and select the H
Two format.
15. Click the drop-down arrow in the View field for window one (1) and select
SPV (single plane view).
16. Select Tran for Orient.
17. Click your middle mouse button in Ref. (cm) field and select the reference
distance you want to display.
18. Leave window two (2) blank.
19. Click the Update Graphics Display button.
20. Click the CANCEL button.
21. Click your right mouse button in the SPV window to make it active. XiO
displays a red border on the window.
22. Click your right mouse button and select Movie from the mouse menu.
23. Use the scroll wheel, or click the left or middle mouse buttons to view the
CT slices. Find one that contains fat, muscle, and bone.
24. Click the Tools button located on the main toolbar.
17-6
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 2. Verify CT to ED Conversion for Tissues (cont.)
25. Click the Image Sampling button located on the supporting toolbar.
XiO displays the electron density and CT number on the status bar as
(Ele.Dens./Img:).
26. Place your mouse pointer on the image but outside the patient volume (in
the air.); then, click your left mouse button.
NOTE: Outside the patient, electron density is set to 0.00. The
electron density value here should be equal to or near 0.00.
27. Place your mouse pointer on the image over the muscle tissue; then, click
your left mouse button.
NOTE: Muscle tissue is denser than water. The electron density value
here should be anywhere from 1.00 to 1.10. If not, you may
have chosen an inappropriate CT-to-ED file.
28. Place your mouse pointer on the image over the dense bone tissue; then,
click your left mouse button.
NOTE: Dense bone can have electron densities ranging from 1.7 to
1.9 relative to water. The CT numbers for bone are higher
relative to water than the electron densities because CT
images are formed from diagnostic x-ray energies. The
photoelectric effect at diagnostic energies leads to the high CT
numbers for bone.
29. Verify that the CT-to-ED file chosen is appropriate for your selected
patient. If the electron density numbers sampled do not correspond to your
expectations, select a different CT-to-ED file.
XiO 17-7
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 3. Create DRR Windows in XiO
In this activity, you will learn how to define a beams eye view (BEV) window
and generate a DRR. To get started, you will set up an AP and PA beam on a
patient, using a valid photon beam and placing the beam isocenter in the middle
of the patient volume.
1. Click the Beam button on the Teletherapy main toolbar.
2. Click the New Beam button on the Beam supporting toolbar. XiO
displays the New Beam dialog box.


3. Enter a description in the description field.
4. Click your middle mouse button in the Machine ID field and choose a valid
photon machine.
5. Click OK. XiO displays the Photon Beam dialog box.
6. Define Beam 1.
7. Click OK.

17-8
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 3. Create DRR Windows in XiO (cont.)
8. Click the Copy Beam button on the Beam Supporting toolbar. XiO
displays the Photon Beam dialog box for beam 2.

9. Click OK.
10. Click the W key on your computer keyboard. XiO displays the Window
Format dialog box.
11. Change window 1 to a BEV for Beam 2.
12. Change window 2 to an SPV view that cuts across the beam volume. Refer
to Task 2, Steps 15 through 17 in this exercise.
13. Click the Update Graphics Display button.
14. Click CANCEL.
XiO 17-9
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 3. Create DRR Windows in XiO (cont.)
15. Click the Beam drop-down menu and select the DRR option. XiO displays
the DRR Setup dialog box.


16. Toggle the DRR button to an On position. (Leave the enhanced DRR
button in an Off position.)
17. Click OK. XiO closes the dialog box and generates a DRR, first quickly as
an initial coarse image, then a few seconds later at a final high resolution.

17-10
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 3. Create DRR Windows in XiO (cont.)
18. Click the View drop-down menu and select the Enhance Contour option.
XiO displays the Enhance Contour dialog box.

OR

Click the C key on your keyboard.
19. Click the All Structures Off button. This removes the contours from the
graphics display so you can clearly see the DRRs.
20. Click OK.
21. Click your right mouse button in window 1 and select the window/level
option.
22. Holding your left mouse button down, swipe the cursor left/right and
up/down to adjust the level (brightness) and window (contrast) of the DRR
for beam 2.
23. In the Active Beam field, change the active beam to Beam 1.
24. Repeat steps 11, 12 and 13 to turn the DRR on for Beam 1.
25. Click your right mouse button in window 2 (SPV) to make it active.
XiO 17-11
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 3. Create DRR Windows in XiO (cont.)
26. Click it again and select the Gantry Angle option. This activates the
mouse control of the gantry rotation.
27. Hold down your left mouse button to rotate the gantry. Note how the
DRR automatically updates when any relevant beam parameter is changed.
28. Click the Edit Beam button on the Beam supporting toolbar.
29. In the Couch Angle field, change the couch angle slightly. Again, the
DRR image updates automatically.
30. Click OK.
31. Click your right mouse button on window 1 to make it active.
32. Click it again and select the Collimator Width option to activate the
mouse control of the collimator size.
33. Hold down your left mouse button to increase and decrease the
collimator width. The DRR should not have to update because the DRR
image remains the same.
34. Click the Edit Beam button on the Beam supporting toolbar.
35. Return the beam parameters to their original nominal values.
36. Click OK.

17-12
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 4. Use Different Image Filters (Sim, Film, Port Film, etc.)
This task familiarizes you with the steps needed to use different DRR image
filters.
1. Click the Beam drop-down menu and select the DRR option. XiO displays
the DRR Setup dialog box.

In window 1, you have a DRR for beam 1. The DRR filter defaults to Sim
Film. The image mimics a diagnostic x-ray. The Sim Film filter shows the
soft tissue but enhances high-density objects (such as bone) in order to
mimic the photoelectric effect of diagnostic x-rays.
NOTE: After each filter change, you may have to update the W/L
settings to give an optimal image.
2. Click your middle mouse button in the Filter field and select Bone. The
image should recalculate and the resulting image should subtract out all
anatomy except for those having density between 1.10 and 2.00, as
previously defined in Settings.
3. Click your middle mouse button in the Filter field and select Port Film.
The port film filter is primarily a Compton-driven image, but you have
slightly enhanced bone in order to aid in delineating bony landmarks.
4. Click your middle mouse button the Filter field and change the filter type to
Range.
XiO 17-13
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 4. Use Different Image Filters (Sim, Film, Port Film, etc.) (cont.)
5. In the Min: and Max: fields, select various ranges of CT numbers to
isolate in the DRR image.
6. Click your middle mouse button in the Filter field and select Sim Film.
7. Click OK. XiO closes the DRR Setup dialog box.

17-14
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 5. Generate High-Resolution DRRs
This task illustrates how to use the Enhanced DRR feature to generate higher
quality DRRs. The Enhanced DRR option works by keeping the integrity of the
original CT resolution as opposed to the standard DRR which averages the CT
pixels. This option is most often used to increase the quality of the DRR image
when the DRR is printed to film. `
1. In window 2, display a BEV for Beam 2. This should look identical to the
BEV for Beam 1.
2. Click the Beam drop-down menu and select the DRR option. XiO displays
the DRR Setup dialog box.


3. Enter 2 in the Beam Number field.
4. Click the Enhanced DRR button to On.
5. Using the Window and Level slider bars, adjust the DRR window/level of
the beam 2 DRR to mimic that of the beam 1 DRR.
6. When the DRR calculation is complete, scale up window 1 and window 2
in order to study the image resolution.
NOTE: You should notice a less pixilated image in window 2. This is
an enhanced DRR. Enhanced DRRs are useful when printing
or plotting to life-size film magnification. Because these
images are greatly magnified, the higher resolution is
important.
XiO 17-15
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 6. Plot a DRR
1. Click the Edit Beam button on the Beam supporting toolbar. XiO
displays the Photon Beam dialog box.
2. In order to facilitate knowing which plots are yours, set your Active Beam
to beam 2 on the edit page, and enter your name in the Description field.
3. Click OK.
4. Click the File drop-down menu and select the Print and DRR options.
XiO displays the Print DRR dialog box.


5. Click your middle mouse button in the Beam Number field and select 2.
6. Click the drop-down arrow in the Output DRR to: field and select the
postscript output device.
7. Click the drop-down arrow in the Print Displayed DRR field and select No.
NOTE: When the Print Displayed DRR field is set to No, a new
Enhanced DRR is automatically calculated and sent to the
output device.
17-16
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 6. Plot a DRR (cont.)
8. Click OK.
9. Retrieve your DRR from the printer.
10. Click the File drop-down menu and select the Print and DRR options. XiO
displays the Print DRR dialog box.
11. Click the drop-down arrow in the Output DRR To: field and select the
postscript output device.
12. Select 1 in the Beam Number field.
13. Click the drop-down arrow in the Spooler field and select the
printer/plotter output device.
14. Click the drop-down arrow in the Print Displayed DRR field and select Yes.
15. Click OK. XiO spools your print request to the printer immediately
because the DRR image on the screen is used, and no recalculation is
necessary.
16. Compare the two plots for differences in quality.
XiO 17-17
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 7. Plot a DRR to Life-Size (magnified to source-to-film
distance)
In this task, you will set up width and length defaults to generate life-size DRR
plots for different printing devices and plot life-size DRRs.
1. Click the Beam drop-down menu and select the DRR option. XiO displays
the DRR Setup dialog box.
2. Enter 2 in the Beam Number: field. XiO displays the DRR Setup dialog
box.


3. Select the Width and Length fields each to be 20.00 cm. The DRR will
calculate on a square field.
NOTE: Width and length fields are defined at the isocenter. In the
Defined at Distance (cm): field, you can enter the distance
from the source to the film(SFD). This number is then
divided by the source to axis distance (SAD) to magnify the
image on the plot.
4. Click OK.
5. Click the File drop-down menu and select the Print and DRR options.
XiO displays the Print DRR dialog box.
17-18
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 7. Plot a DRR to Life-Size (magnified to source-to-film
distance) [cont.]
6. Enter 2 in the Beam Number field.
7. Click the drop-down arrow in the Print Displayed DRR? field and select
Yes.
8. Click OK.
9. Retrieve your plot and measure the width and length of the entire DRR
printed area using the black edges as the end points.
10. Measure the 1 cm graticules on the plot and verify that they are projected
to the source-to-film distance. For example, if the isocenter is at 100 cm
and the source-to-film distance is at 140 cm, each graticule should measure
1.4 cm.
11. Again, click the Beam drop-down menu and select the DRR option. XiO
displays the DRR Setup dialog box.
12. Change the displayed DRR Width and Length to the measured values.
See Step 9. The DRR will recalculate.
XiO 17-19
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Task 7. Plot a DRR to Life-Size (magnified to source-to-film
distance) [cont.]
13. Click the File drop-down menu and select the Print and DRR options.
XiO displays the Print DRR dialog box.

14. Click the drop-down arrow in the Print displayed DRR field and select Yes.
15. Click OK.
16. Measure the 1 cm graticules on the plot and verify that they are projected to
the source-to-film distance.
Use this method to customize the life-size width/length values for different
output devices. This method works because XiO scales DRR images up or down
to fit into the printable area, so you must enter the exact area in order to print life-
size to source-to-film distance. It is recommended that you return to Settings
DRR Printing Size and enter the measured values from Step 6 as a default for this
paper size. You must complete this procedure once for each paper size you use
in your clinic.
17-20
DRR and Virtual Patient
XiO Training Guide
Digitally Reconstructed Radiographs
Technical Considerations
The Digitally Reconstructed Radiographs (DRR) Technical Considerations
located on the Reference Library in XiO Help were used as a reference during a
training classroom discussion to support the slides shown in this section.

XiO 17-21

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